Type 2 diabetes mellitus in children and adolescents

Table 1 Comparison between Caucasian and non-Caucasian children and adolescents with type 2 diabetes mellitus

	Caucasian	Non-Caucasian
Mean age at onset in years	14	12
Gender	Female > male	Female > male
Clinical manifestation	50% asymptomatic	33% asymptomatic
	4% ketoacidosis	5%-25% ketoacidosis
Obese	90%	90%
Acanthosis nigricans	50%	90%
1st - and 2nd - degree relatives with type 2 diabetes mellitus mellitus	83%	74%-100%

Table adapted from Reference [3].

Table 2 Clinical characteristics of type 1, type 2 and MODY diabetes mellitus

Clinical characteristic	Type 1 diabetes mellitus	Type 2 diabetes mellitus	MODY diabetes mellitus
Age when diagnosis is established	Preschool-adolescents	> 10 yr	MODY 2: youth
			MODY 3: adolescents
Obesity	Uncommon1	Common	Uncommon
Gender	Male = female	Female > male	Male = female
Relatives	5% Type 1 D.m.	75%-100% Type 2 D.m.	100% MODY
Population	Predominantly Caucasian	Predominantly Americans of African, Hispanic, Asian, and American Indian
b-cell autoantibodies	85%-98%	Uncommon2	Uncommon
Insulin, C-peptide	Low	high	Low
Ketoacidosis	Frequently	< 33%	Uncommon
Associated disorders	Autoimmune disorders (thyroid, adrenal, vitiligo), celiac disease	Acanthosis nigricans	MODY 5: urogenital malformation
		PCOS	MODY 8: exocrine pancreas insufficency
		Metabolic Syndrome

¹But prevalence of overweight children with type 1 diabetes mellitus is increasing parallel to the obesity epidemic;

²Children with type 2 diabetes mellitus and b-cell autoantibodies have been reported. MODY: Maturity onset of diabetes mellitus in youth.

Table 3 Criteria for testing of type 2 diabetes mellitus in children and adolescents

Overweight (BMI > 90 percentile) plus one of the following risk factors:

Family history of type 2 diabetes mellitus in first- or second-degree relative

Race/ethnicity (Asian, American Indian, Africa-Americans, Hispanics)

Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovarian syndrome)

Extreme obesity (BMI > 99.5 percentile)

Table adapted from Reference [7]. BMI: Body mass index.

Table 4 Treatment option of type 2 diabetes mellitus in children and adolescents [Federal Drug Administration (United States), European Medicine Evaluation Agency (European)]

Modality	Glycaemiareduction	Enhance insulin secretion	Insulin resistancelowering	FDA/EMEA approved for children	Notes
Diet and exercise	Yes	No	Yes	Yes	First-line approach
					Efficacy depends on successful ife-style change
Insulin	Yes	No	No	Yes	Weight gain discussed
					risk of hypoglycemia
Metformin	Yes	No	Yes	Yes	Good safety record
					minimal weight loss
Sulphonylureas	Yes	Yes	No	No	Good safety record in adults
					risk of hypoglycemia
Meglitinide analogues	Yes	Yes	No	No	Sparse data on their use
Thiazolidinediones	Yes	?	Yes	No	Weight gain
					lack of long-term data
Dipeptidyl peptidase inhibitors (DPP4)/ glucagon like peptide (GLP) 1 mimetics	Yes	No	No	No	Moderate weight loss
					Carcinoma of the pancreas discussed
					Lack of long-term data
Sodium-Glucose Cotransporter 2 Inhibitors	Yes	No	No	No	Minimal weight loss
					Urinary and genital tract infections
					Risk of hypoglycaemia
					Sparse data on their use
					Lack of long-term data
Acarbose	?	No	No	No	Side effects may be unacceptable
Orlistat	?	No	No	No	Side effects may be unacceptable
Surgical treatment of obesity	Yes	No	Yes	No	Some anecdotal evidence

?: Unknown; FDA: Federal Drug Administration; EMEA: European Medicine Evaluation Agency.