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Page 48
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March 07-08, 2019 | London, UK
Journal of Diabetology | Volume 3
Annual Summit on
Diabetes, Obesity & Heart
Diabetes, Endocrinology and Metabolic Syndrome
International Conference on
Joint Event
&
Type 2 diabetes in children and adolescents - The next epidemic?
Hesham Fouad
International Clinic, Kuwait
The incidence of type 2 diabetesmellitus in youth (T2DM) has
increased worldwide and its incidence rates vary markedly
among different racial and ethnic groups. It has a major impact
on public health, costing billions of dollars and shortening life
expectancy as it has an earlier onset with a large opportunity
for complications. As a result, it is important to identify and
treat children and adolescents with this disorder. In the early
1990s, T2DM represented about 3% of pediatric diabetes in the
United States. By 2003, T2DM represented about 20 percent
of pediatric diabetes and nearly half of the cases of diabetes
among adolescents agedbetween15 and 19. The overall burden
of diabetes due to type 2 diabetes, in study, increased with age
groups from all races and ethnic groups, and among 15-19year
old, type 2 diabetes was more common than type 1 diabetes
among American Indian Alaskan Native youth. Asymptomatic
(about 40%), symptomatic e.g. polydipsia and polyuria without
ketonuria or acidosis (about 57-70%), diabetic ketoacidosis
(about 5-13%), hyperglycemic hyperosmolar state (uncommon
but serious). Obesity, positive family history, specific racial
and ethnic groups, female gender, genetic susceptibility
and conditions associated with insulin resistance. Prenatal
exposure, gestational diabetes and low birth weight are other
proposed risk factors. According to The American Diabetes
Association (ADA) testing of asymptomatic, children and
adolescents for T2DM after the onset of puberty or ≥10 years,
whichever occurs earlier, if they are overweight or obese, and
have T2DMmellitus in a first or second degree relative, member
of a high-risk racial/ethnic group, signs of insulin resistance or
conditions associated with insulin resistance (e.g. hypertension,
dyslipidemia, acanthosis nigricans, polycystic ovary syndrome
(PCOS) or small for gestational age birth weight), maternal
history of diabetes or gestational diabetes during the child’s
gestation and repeating the screening at a minimum of every
three years, or more frequently if BMI is increasing. Test for
diabetes in patients with typical presenting symptoms, such as
polydipsia, polyuria, blurred vision, or weight loss, should be
done regardless of risk factors. Hemoglobin A1C (A1C), fasting
plasma glucose (FPG), and an oral glucose tolerance test (OGTT)
are used. The diagnostic criteria, based upon the guidelines of
ADA, are the same as those used in adults. Unless unequivocal
symptomatic hyperglycemia is present, the diagnosis should be
confirmed by repeat testing on a different day. Considerable
overlap exists regarding both insulin resistance and pancreatic
autoantibodies. Thedifferentiation is basedupona combination
of the clinical presentation and history, supported by laboratory
studies. Similarly, T2DM is differentiated from maturity onset
diabetes of the yung (MODY). FPG or A1C is used to diagnose
the prediabetics, especially in patients with multiple risk factors
for T2DM because of its higher sensitivity. For prediabetes
annual rescreening for T2DM is recommended unless there is a
change in symptoms or signs (e.g. weight change or polydipsia/
polyuria) that need earlier retesting. Prediabetics should be
engaged in intensive lifestyle interventions. It has not been
established whether metformin should be used in adolescents
with prediabetes or with other evidence of insulin resistance.
Including hypertension, dyslipidemia, and nonalcoholic fatty
liver disease (NAFLD). Theymay be present before the diagnosis
of T2DM, like T2DMof adults, and are associated with excessive
weight. The data presented in this presentation were obtained
from published literature presented at scientific meetings,
clinical trials and review articles using the search term ‘type 2
diabetes mellitus’, ‘metabolic syndrome’, ‘obesity’, ‘children’,
and ‘adolescents’ in a MEDLINE search from 1995-2018.
Additionally, the bibliographies in the identified articles were
reviewed.
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