Type-2-diabetes in children and adolescents [Typ-2-diabetes mellitus bei kindern und jugendlichen]

Until recently, type-2-diabetes in pediatric patients was often used as a synonym for MODY-diabetes, a rare form with autosomal-dominant inheritance which often does not require insulin. In the new classification of diabetes, however, MODY is grouped as type 3, genetic defects of insulin secretion. Meanwhile, at least 5 phenotypically and genetically different forms of MODY are distinguished. During recent years, a rapid increase in classical type-2-diabetes, associated with insulin resistance, has been reported primarily from the United States. Risik factors are overweight, children from ethnic minorities (Indian, Hispanic, Afro-american), type-2-diabetes in parents/siblings as well as acanthosis nigricans or hyperandrogenism. β-cell-specific immune markers (e.g. β-cell-antibodies) are absent, insulin and C-peptide are elevated. However, the presence of ketone in the urine or ketoazidosis does not necessarily exclude type-2 diabetes in adolescents. herapeutic intervention should primarily aim at weight reduction, however, additional insulin or oral hypoglycemic agents like metformin are often necessary. However, so far, experience with oral agents in the pediatric age-range is limited. If possible, the choice of medication should not interfere with weight reduction in the patient. At present, the contribution of specific genetic factors interacting with increasing overweight and sedentary life stile is still unclear. Therefore no clear prediction is possible, whether the dramatic increase in type-2-diabetes in some populations in the US and the pacific area will occur with a similar magnitude in Europe as well.