Hands and feet

September 2009

Clinical

Children get type 2 diabetes too

Volume 38, No.9, September 2009 Pages 699-703

Jessica Phillips

Patrick J Phillips

Background

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.

Objective/s

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.

Discussion

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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Correspondence afp@racgp.org.au

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