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Pediatric Diabetes Type 2

Type 2 Diabetes In Children

Type 2 Diabetes In Children

For decades, type 2 diabetes was considered an adults-only condition. In fact, type 2 diabetes was once called adult-onset diabetes. But what was once a disease mainly faced by adults is becoming more common in children. Type 2 diabetes is a chronic condition that affects how the body metabolizes sugar (glucose). Over 5,000 people under the age of 20 were diagnosed with type 2 diabetes between 2008 and 2009. Until 10 years ago, type 2 diabetes accounted for less than 3% of all newly diagnosed diabetes cases in adolescents; it now comprises 45% of all such cases. It’s more common in those aged 10-19 and in non-Caucasian populations, including African Americans, Native Americans, Asian/Pacific Islanders, and Hispanics. Being overweight is closely tied to the development of type 2 diabetes. Overweight children have an increased likelihood of insulin resistance. As the body struggles to regulate insulin, high blood sugar leads to a number of potentially serious health problems. In the past 30 years, obesity in children has doubled and obesity in adolescents has quadrupled, according to the CDC. Genetics may also play a role. For instance, the risk of type 2 diabetes increases if one parent or both parents has the condition. Symptoms of type 2 diabetes are not always easy to spot. In most cases, the disease develops gradually, making the symptoms hard to detect. Many people do not feel any symptoms. In other cases, children may not show any obvious signs. If you believe your child has diabetes, keep an eye out for these signs: Excessive fatigue: If your child seems extraordinarily tired or sleepy, their body may not have enough sugar to properly fuel their normal body functions. Excessive thirst: Children who have excessive thirst may have high blood sugar levels. Frequent Continue reading >>

Type 2 Diabetes: What Is It?

Type 2 Diabetes: What Is It?

Diabetes is a disease that affects how the body uses glucose , the main type of sugar in the blood. Our bodies break down the foods we eat into glucose and other nutrients we need, which are then absorbed into the bloodstream from the gastrointestinal tract. The glucose level in the blood rises after a meal and triggers the pancreas to make the hormone insulin and release it into the bloodstream. But in people with diabetes, the body either can't make or can't respond to insulin properly. Insulin works like a key that opens the doors to cells and lets the glucose in. Without insulin, glucose can't get into the cells (the doors are "locked" and there is no key) and so it stays in the bloodstream. As a result, the level of sugar in the blood remains higher than normal. High blood sugar levels are a problem because they can cause a number of health problems. The two types of diabetes are type 1 and type 2. Both make blood sugar levels higher than normal but they do so in different ways. Type 1 diabetes happens when the immune system attacks and destroys the cells of the pancreas that produce insulin. Kids with type 1 diabetes need insulin to help keep their blood sugar levels in a normal range. Type 2 diabetes is different. A person with type 2 diabetes still produces insulin but the body doesn't respond to it normally. Glucose is less able to enter the cells and do its job of supplying energy (a problem called insulin resistance ). This raises the blood sugar level, so the pancreas works hard to make even more insulin. Eventually, this strain can make the pancreas unable to produce enough insulin to keep blood sugar levels normal. People with insulin resistance may or may not develop type 2 diabetes it all depends on whether the pancreas can make enough insulin to keep b Continue reading >>

Type 2 Diabetes Mellitus In Children And Adolescents

Type 2 Diabetes Mellitus In Children And Adolescents

Go to: INTRODUCTION Thirty years ago, type 2 diabetes mellitus has been thought to be a rare occurrence in children and adolescents. However, in the mid-1990s, investigators began to observe an increasing incidence of type 2 diabetes mellitus worldwide[1]. This is particularly the case in the United States[1,2] but has also been reported in other countries like Canada, Japan, Austria, United Kingdom and Germany[3-10]. In some regions in the United States, type 2 diabetes mellitus is as frequent as type 1 diabetes mellitus in adolescents [11]. This observation followed a striking increase both the prevalence and the degree of obesity in children and adolescents in many populations[12,13]. Overweight is at present the most common health problem facing children in both develop and developing countries[13]. While obesity is not increasing any more in the United States and some countries in Europe[14,15], the prevalence of type 2 diabetes mellitus has been increased threefold[15]. This has been attributed to the fact, that the prevalence of obesity is not increasing but the degree of obesity in affected children and adolescents[15]. Type 2 diabetes mellitus is a serious and costly disease. The chronic complications of diabetes mellitus include accelerated development of cardiovascular diseases, end-stage renal disease, loss of visual acuity, and limb amputations. All of these complications contribute to the excess morbidity and mortality in individuals with diabetes mellitus. Since the incidence and prevalence of type 2 diabetes mellitus in children are increasing and if this increase cannot be reversed, our society will face major challenges. That is, the burden of diabetes mellitus and its complications will affect many more individuals than currently anticipated, and the Continue reading >>

Pediatric Type 2 Diabetes Mellitus

Pediatric Type 2 Diabetes Mellitus

Author: Alba E Morales Pozzo, MD; Chief Editor: Sasigarn A Bowden, MD more... Although type 2 diabetes is widely diagnosed in adults, its frequency has markedly increased in the pediatric age group since the end of the 20th century. Most pediatric patients with type 2 diabetes belong to minority communities. A simplified scheme for the etiology of type 2 diabetes mellitus is shown in the image below. Simplified scheme for the pathophysiology of type 2 diabetes mellitus. Distinguishing between type 1 and type 2 diabetes at diagnosis is important. Typical characteristics of type 2 diabetes include the following: Most common in overweight or obese patients from a minority group (Native Americans, blacks, and Pacific Islanders) Strong family history of type 2 diabetes: Familial lifestyle risk factors leading to obesity may be present, as may a family history of cardiovascular disease or metabolic syndrome Physical findings may include the following: Obesity (strongly associated with type 2 in children and adolescents) See Clinical Presentation for more detail. Testing for type 2 diabetes should be considered when a patient is overweight and has any 2 of the following [ 1 ] : Family history of type 2 diabetes in first-degree or second-degree relative Minority race or ethnicity (eg, American Indian, black, Hispanic, Asian or Pacific Islander) Signs of insulin resistance or conditions associated with insulin resistance (eg, acanthosis nigricans, hypertension dyslipidemia, PCOS) Recommendations for screening are as follows: Initial screening may begin at age 10 years or at onset of puberty if puberty occurs at a young age Screening should be performed every 2 years A fasting plasma glucose test is the preferred screening study; if clinical suspicion is high but fasting blood g Continue reading >>

Treatment Of Type 2 Diabetes In Youth

Treatment Of Type 2 Diabetes In Youth

Type 2 diabetes is becoming more common among youth, in parallel with the increasing prevalence of obesity in pediatrics. Despite this, therapeutic modalities remain extremely limited, with scanty data regarding appropriate treatment, desired glycemic targets, and management of associated comorbidities and complications. Management of type 2 diabetes in youth, both acute and long term, should occur in specialty tertiary care pediatric centers. Health care providers should address the pathophysiological components of insulin resistance and decline in β-cell function, aiming to preserve the latter while improving the former. Addressing comorbidities, namely hypertension and dyslipidemia, which are currently inadequately addressed, should be properly assessed and tracked. Further research is critical to establish treatment goals and develop effective diabetes management strategies that will not only enhance adherence to treatment recommendations, but also effectively manage comorbidities and prevent micro- and macrovascular complications. With the escalating rates of obesity, type 2 diabetes is increasing (1,2), not only in adults but also in youth. In the SEARCH for Diabetes in Youth study, it is estimated that the number of adolescents per year diagnosed with type 2 diabetes is ~3,700 and increasing (2,3). Despite this, there is a dearth of approved therapeutic options. The UK Prospective Diabetes Study showed that intensive glucose therapy for adults with newly diagnosed type 2 diabetes was associated with a decreased risk of microvascular complications and, among individuals who were >120% above their ideal body weight, with a decreased risk of myocardial infarction and death from any cause (4). In patients diagnosed with type 2 diabetes at a younger age, there may be Continue reading >>

Type 2 Diabetes In Children

Type 2 Diabetes In Children

Print Overview Type 2 diabetes in children is a chronic disease that affects the way your child's body processes sugar (glucose). It's important to manage your child's diabetes because its long-term consequences can be disabling or even life-threatening. Type 2 diabetes is more commonly associated with adults. In fact, it used to be called adult-onset diabetes. But type 2 diabetes in children is on the rise, fueled largely by the obesity epidemic. There's plenty you can do to help manage or prevent type 2 diabetes in children. Encourage your child to eat healthy foods, get plenty of physical activity and maintain a healthy weight. If diet and exercise aren't enough to control type 2 diabetes in children, oral medication or insulin treatment may be needed. Symptoms Type 2 diabetes in children may develop gradually. About 40 percent of children who have type 2 diabetes have no signs or symptoms and are diagnosed during routine physical exams. Other children might experience: Increased thirst and frequent urination. Excess sugar building up in your child's bloodstream pulls fluid from tissues. As a result your child might be thirsty — and drink and urinate more than usual. Weight loss. Without the energy that sugar supplies, muscle tissues and fat stores simply shrink. However, weight loss is less common in children with type 2 diabetes than in children with type 1 diabetes. Fatigue. Lack of sugar in your child's cells might make him or her tired and lethargic. Blurred vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. Your child might be unable to focus clearly. Slow-healing sores or frequent infections. Type 2 diabetes affects your child's ability to heal and resist infections. When to see a doctor See your child' Continue reading >>

Type 2 Diabetes And Insulin Resistance

Type 2 Diabetes And Insulin Resistance

The pediatric diabetes and endocrinology staff at American Family Children's Hospital in Madison, Wisconsin, provides comprehensive care for children with type 2 diabetes and insulin resistance. Topics: Video Health Facts for You Clinic Resources Internet Resources Continue reading >>

Type 2 Diabetes Mellitus In Children And Adolescents

Type 2 Diabetes Mellitus In Children And Adolescents

*Department of Pediatrics, University of Missouri Kansas City School of Medicine, Children's Mercy Hospital Kansas City, MO. Dr Dileepan was a pediatric endocrinology fellow at Children’s Mercy Hospital, Kansas City, MO, at the time this article was authored. †Department of Pediatrics, University of Missouri Kansas City School of Medicine, Children’s Mercy Hospital, Kansas City, MO. Drs Dileepan and Feldt have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device. Abbreviations: ADA: American Diabetes Association DM: diabetes mellitus FDA: Food and Drug Administration GAD: glutamic decarboxylase HbA1c: hemoglobin A1c OGTT: oral glucose tolerance test TODAY: Treatment Options for Type 2 Diabetes in Adolescents and Youth Educational Gaps The growing pandemic of childhood obesity has led to marked increases in the incidence and prevalence of type 2 diabetes mellitus (DM) and has further complicated the differentiation between type 2 and type 1 DM because more children with type 1 DM are overweight at time of diagnosis. In addition, numerous studies have demonstrated β-cell autoimmunity in children with type 2 DM. (1) Objectives After completing this article, readers should be able to: Differentiate between and understand the treatment of type 2 diabetes mellitus (DM) and type 1 DM by recognizing underlying pathophysiologic characteristics, clinical features, and laboratory markers. Recognize the difficulty in distinguishing between type 2 and type 1 DM because of the increasing prevalence of childhood obesity. Understand the increased prevalence of type 2 DM in children and adolescents, especially among certain racial/ethnic groups. Recognize risk fac Continue reading >>

Type 2 Diabetes In Youth: Epidemiology And Pathophysiology

Type 2 Diabetes In Youth: Epidemiology And Pathophysiology

The prevalence of type 2 diabetes is significantly increased in the pediatric population, which is affected by obesity worldwide. The progression from normal glucose tolerance (NGT) to type 2 diabetes involves intermediate stages of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), also known as prediabetes. The pathophysiology underlying the development of these glucose metabolic alterations is multifactorial; however an alteration in the balance between insulin sensitivity and insulin secretion represents the most important player in the development of type 2 diabetes. Obese children and adolescents affected by IGT and type 2 diabetes are characterized by severe insulin resistance, which is associated with an increased lipid accumulation in visceral compartments, liver and muscle tissues and by reduced sensitivity of β-cell of first and second-phase insulin secretion. The progression in obese children of insulin resistance to type 2 diabetes has been shown to be faster than in adults; in addition, type 2 diabetes is already associated with several metabolic and cardiovascular complications in this age group. In the present review, we summarize the most recent findings concerning the prevalence of type 2 diabetes in youth and in particular we explore the pathophysiology of type 2 diabetes and the natural history of this pathology in obese children and adolescents. Concurrent with the worldwide epidemic increase of childhood obesity, type 2 diabetes and the two prediabetic conditions, IFG and IGT, are becoming increasingly more common in obese children and adolescents (1,2). Until 10 years ago, type 2 diabetes accounted for less than 3% of all cases of new-onset diabetes in adolescents. At present 45% of cases are attributed to it (3,4). Type 2 diabe Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

You’ve become the New York Times and the Wall Street Journal of medicine. A must-read every morning. ” Continue reading >>

Type 2 Trials - Pediatric Diabetes Research Center - Uc San Diego Department Of Pediatrics

Type 2 Trials - Pediatric Diabetes Research Center - Uc San Diego Department Of Pediatrics

Purpose: Determine if taking the study drug colesevelam/placebo will lower the type 2 diabetic's HBA1c over a 6 month period of time. Recruiting: Individuals ages 10 to 17 years with type 2 diabetes. Purpose: This national study involves collecting biological specimens and family medical history from participants with adolescent onset of type 2 diabetes to explore relationships between possible genetic causes of type 2 diabetes (T2D), as well as obesity, insulin resistance, and cardiovascular complications of insulin resistance. Recruiting: Individuals of any age who developed type 2 diabetes mellitus before 18 years of age. Purpose: Determine if type 2 diabetics taking exenatide/placebo will have a change in their HBA1c over a 28 week period of time. This is a twice daily injectable study drug. Recruiting: Individuals ages 10 to 17 years with type 2 diabetes mellitus. Purpose: Assess the safety of the addition of sitagliptin, and its effect on hemoglobin A1c in pediatric participants with type 2 diabetes mellitus and inadequate glycemic control. Recruiting: Individuals ages 10 to 17 years with type 2 diabetes mellitus who have not received treatment with an oral antihyperglycemic agent or insulin for the past 3 months. Continue reading >>

A Review Of The Treatment Of Type 2 Diabetes In Children

A Review Of The Treatment Of Type 2 Diabetes In Children

A Review of the Treatment of Type 2 Diabetes in Children 1University of Florida College of Pharmacy, Orlando, Florida 2University of Florida College of Pharmacy, Jacksonville, Florida 3University of Florida Health, Jacksonville, Florida Correspondence Erin St. Onge, PharmD, University of Florida College of Pharmacy, 6550 Sanger Road, Orlando, FL 32827; email: [email protected] Copyright 2015 Pediatric Pharmacy Advocacy Group This article has been cited by other articles in PMC. The incidence of type 2 diabetes and obesity in children and adolescents has risen at staggering rates. Studies have shown that treating type 2 diabetes with oral medications in children may be more difficult than treating in adults. Compounding this problem is the fact that most of the medications available for treating type 2 diabetes have not been studied in children. Recently, the American Diabetes Association and the Pediatric Endocrine Society have collaborated to create a guideline for the treatment of type 2 diabetes in children. Similar to the treatment of adults with type 2 diabetes, metformin remains the mainstay of therapy along with diet and exercise. Adjunctive therapy should be based on the limited clinical evidence available as well as on patient preference. In order to avoid detrimental microvascular and macrovascular complications, patients, clinicians, and family members should work together to ensure adequate treatment of type 2 diabetes in children. INDEX TERMS: adolescents, children, guidelines, treatment, type 2 diabetes The incidence of childhood obesity is increasing at a staggering rate, correlating with the incidence of type 2 diabetes mellitus (T2DM). Recently, the American Academy of Pediatrics (AAP) released a clinical practice guideline to aid providers in treatin Continue reading >>

Pediatric Type 2 Diabetes

Pediatric Type 2 Diabetes

Type 2 diabetes, previously called adult-onset diabetes is the most common type of diabetes. With type 2 diabetes, the body does not use insulin correctly. Type 2 diabetes is a disease that has as its main symptom a high level of sugar (glucose) in the blood. It is the most common form of diabetes. Itis often called non-insulin-dependent diabetes, or adult-onset diabetes. With type 2 diabetes, the fat, liver and muscle cells dont work properly with insulin to use or to store the glucose that is in the diet. This is called insulin resistance. When the glucose cant get into the cells, it remains in the blood and builds up until there is too much. This is called hyperglycemia. It is common for people with type 2 diabetes to show no symptoms early in life. It can be years before symptoms show up. Unlike type 1 diabetes , research has shown that there are some ways to prevent type 2 diabetes, or at least delay its onset. Lifestyle changes, such as becoming more active and making sure your weight stays in a healthy range,help ward off type 2 diabetes. Blood glucose test - Ablood sugar test takes a sample of blood to see how much glucose is present. The test can be done after your child has not eaten anything for at least 8 hours (fasting) or at any time of the day (random). Glucose tolerance tests - This test mimics what happens in your childs body after he or sheeats. At the start, a baseline blood sample is taken. Your child will be given a drink containing a set amount of glucose (usually 75 grams). For the next three hours,another blood sample will be taken every 30 to 60 minutes Hemoglobin A1c (Hgb A1c) tests - These givean indication of the average blood sugar over the past three months. This type of test may be used in the diagnosis of type 2 diabetes. More often, it Continue reading >>

Management Of Pediatric And Adolescent Type 2 Diabetes

Management Of Pediatric And Adolescent Type 2 Diabetes

Management of Pediatric and Adolescent Type 2 Diabetes Department of Pediatrics, Division of Pediatric Endocrinology, McMaster Childrens Hospital, McMaster University, 1280 Main Street West, Room 3A-57, Hamilton, ON, Canada L8S 4K1 Received 13 July 2013; Accepted 20 August 2013 Copyright 2013 M. Constantine Samaan. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Type 2 diabetes (T2D) was an adult disease until recently, but the rising rates of obesity around the world have resulted in a younger age at presentation. Children who have T2D have several comorbidities and complications reminiscent of adult diabetes, but these are appearing in teens instead of midlife. In this review, we discuss the clinical presentation and management options for youth with T2D. We discuss the elements of lifestyle intervention programs and allude to pharmacotherapeutic options used in the treatment of T2D youth. We also discuss comorbidities and complications seen in T2D in children and adolescents. Type 2 diabetes (T2D) is increasing in youth, driven by the obesity epidemic that is affecting millions of children around the world [ 1 ]. T2D is a serious disorder with multiple complications that appear early in the course of the disease. Since T2D in young people has been only recognized over the past few years, knowledge of its natural history is lacking, and there are only few studies examining treatments beyond metformin and insulin. Even in case of the latter two medications, randomized controlled trials are very few, and knowledge is still accumulating in this field. One study whose results were published about the role Continue reading >>

Pediatric Diabetes, Type 1 And Type 2

Pediatric Diabetes, Type 1 And Type 2

Prevention & Risk Assessment What is prediabetes? Type 2 diabetes is commonly preceded by prediabetes. In prediabetes, blood glucose levels are higher than normal but not high enough to be defined as diabetes. However, many people with prediabetes develop type 2 diabetes within 10 years, states the National Institute of Diabetes and Digestive and Kidney Diseases. Prediabetes also increases the risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with prediabetes can delay or prevent type 2 diabetes. How does diabetes affect blood glucose? For glucose to be able to move into the cells of the body, the hormone insulin must be present. Insulin is produced in the pancreas, and, normally, is readily available to move glucose into the cells. However, in people who have diabetes, either the pancreas produces too little or no insulin, or certain cells in the body do not respond to the insulin that is produced. This causes a build up of glucose in the blood, which passes into the urine where it is eventually eliminated, leaving the body without its main source of fuel. What is maturity-onset diabetes in the young (MODY)? Although often misdiagnosed initially as the more common type 1 or type 2 diabetes, maturity-onset diabetes of the young (MODY) is a group of diseases characterized by inherited early-onset diabetes (usually in adolescence or early adulthood) from a single gene mutation. Severity of the diabetes symptoms associated with MODY vary depending on the type of MODY diagnosed. MODY 2 appears to be the mildest form of the disease, often only causing mild hyperglycemia and impaired glucose tolerance. MODY 1 and 3 may require treatment with insulin, much like type 1 diabetes. MODY accounts for about 1 to 5 percent of all cases o Continue reading >>

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