Wednesday, November 14, 2018

Children and type 2 diabetes

Today being World Diabetes Day, which focuses on family this year and also Children’s Day, this is an opportune time to talk about type 2 diabetes in children.

Usually perceived to be a disease of adult-onset, type 2 diabetes (T2DM) is now becoming common in children because of the rising prevalence of childhood obesity.

Here are some salient points about type 2 diabetes in children:

·         At-risk groups include overweight or obese children and adolescents, those who have an affected close relative, or belong to a high-risk racial/ethnic group (e.g., Non-Hispanic Blacks, Native American, Hispanic, Pacific Islanders, and Asian Americans).
·         Most cases of childhood type 2 diabetes occur at the time of physiologic insulin resistance after the onset of puberty. Conditions that increase insulin resistance such as polycystic ovary disease (PCOD) are also associated with T2DM.
·         Symptoms of hyperglycemia, including polyuria, polydipsia, fatigue, and lethargy may help in the diagnosis. A minority of T2DM patients present with diabetic ketoacidosis (DKA).
·         Around 40% of children are asymptomatic and are diagnosed on lab investigation if risk factors are present or by urine examination during a routine physical examination.
·         In high-risk children, fasting blood glucose or A1c is recommended every three years beginning at 10 years of age or at the onset of puberty (whichever occurs first). At-risk children are those with a body mass index (BMI) ≥85th percentile and one or more additional risk factors (affected first- or second-degree relative, member of high-risk racial/ethnic group, or signs of insulin resistance).
·         Patients with impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or moderately raised A1c are at  risk for future development of diabetes. In adolescents with prediabetes, oral glucose tolerance test (OGTT) is recommended. In addition, such patients should undergo focused lifestyle intervention to support weight loss, and should be tested for type 2 diabetes at least once a year.
o   The diagnosis of diabetes is based upon presence of one of the following four; confirmatory testing is required in the absence of symptoms.
o   Fasting plasma glucose ≥126 mg/dL 
o   Symptoms of hyperglycemia and a plasma glucose ≥200 mg/dL 
o   Plasma glucose ≥200 mg/dL measured 2 hours after a glucose load in an OGTT
o   A1c ≥6.5%
·         Type 2 diabetes vis-à-vis type 1 diabetes: Clinical presentation and history may differentiate between the two conditions. The presence of obesity, signs and/or symptoms of insulin resistance (such as acanthosis nigricans, hypertension, dyslipidemia, and PCOS), a positive family history, and being a member of a high-risk racial/ethnic group are suggestive of type 2 diabetes in children.

(Source: Uptodate)

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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