Patrick J Phillips
In recent years there has been a worldwide increase in the number
of diagnoses of type 2 diabetes mellitus (T2DM) in children and
adolescents. This has become a major focus for the work of the
International Diabetes Federation. In Australia, most children and
adolescents with diabetes have type 1 diabetes. However, more
young Australians are developing T2DM.
This article presents the case of a girl, Aroha, 13 years of age and of
Polynesian descent, who presents with high random blood glucose
levels. It outlines the diagnosis, treatment and prognosis of T2DM in
children and adolescents.
Type 2 diabetes is the consequence of a complex interaction between
genes and the environment in a susceptible individual. Children
with T2DM are generally overweight, often with central adiposity.
Having one or more parents with T2DM gives offspring up to an 80%
chance of developing T2DM. At risk children and adolescents should
be screened for T2DM. It is important to check the glutamic acid
decarboxylase (GAD) antibody to exclude type 1 diabetes. Symptoms
and signs of the metabolic syndrome should be sought. Child and
adolescent patients with T2DM face the psychological burden
of living a lifetime with a chronic disease. Management is team
based and team members include the general practitioner, diabetes
educator, dietician and endocrinologist. Goals include achieving
and maintaining normoglycaemia, weight reduction and increased
physical activity. Lifestyle modification alone may control minor
hyperglycaemia and metformin can be added to control moderate
hyperglycaemia. In severe hypoglycaemia, insulin may be required
initially to achieve normoglycaemia and can be phased out and
metformin phased in later. Insulin is likely to be required again later in
the natural history of disease. Little is known about factors affecting
complication risk in children and adolescents with T2DM but they
essentially have a ‘double whammy’ of diabetes and the metabolic
syndrome and are likely to develop macrovascular complications
much earlier than adults who develop T2DM.
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