Pediatric Drugs

, Volume 4, Issue 4, pp 209–221

Increasing Incidence of Type 2 Diabetes in Children and Adolescents

Treatment Considerations
Leading Article


The emerging public health problem of type 2 diabetes in youth reflects increasing rates of childhood obesity. As in adults, type 2 diabetes in children is part of the insulin resistance syndrome that includes hypertension, dyslipidemia and other atherosclerosis risk factors, and hyperandrogenism seen as premature adrenarche and polycystic ovary syndrome. Studies in children document risk factors for type 2 diabetes and associated cardiovascular risk factors, including obesity, family history, diabetic gestation, and underweight or overweight for gestational age. Genetically determined insulin resistance, or limited β-cell reserve, has been demonstrated in high risk individuals. This genetic background, considered advantageous in a feast and famine existence (the thrifty genotype), is rendered detrimental with abundant food and physical inactivity, a lifestyle demonstrated to be typical of families of children with type 2 diabetes.

Case finding in high risk individuals who are asymptomatic may be an appropriate response to the public health challenge of type 2 diabetes in children, because risk factors for cardiovascular disease are already present at the time of diagnosis. Treatment is dictated by the degree of metabolic derangement and symptoms. The only data on the use of oral hypoglycemic agents in children has been with metformin. Prevention efforts will require community and government involvement to reduce obesity and increase physical activity in the child, as well as adult, population.


  1. 1.
    The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2001; 24: S5–20CrossRefGoogle Scholar
  2. 2.
    Rosenbloom AL, Kohrman A, Sperling M. Classification and diagnosis of diabetes mellitus in children and adolescents. J Pediatr 1981; 98: 320–3CrossRefGoogle Scholar
  3. 3.
    Winter WE, Nakamura M, House DV. Monogenic diabetes mellitus in youth: the MODY syndromes. Endocrinol Metab Clin North Am 1999; 28: 765–85PubMedCrossRefGoogle Scholar
  4. 4.
    Winter WE, Maclaren NK, Riley WJ, et al. Maturity onset diabetes of youth in black Americans. N Engl J Med 1987; 316: 285–91PubMedCrossRefGoogle Scholar
  5. 5.
    Rosenbloom AL. Type 2 diabetes in children. American Association for Clinical Chemistry. Diagn Endocrinol Immunol Metab 2000; 18(5): 143–53Google Scholar
  6. 6.
    Macaluso CJ, Bauer UE, Deeb LC, et al. Type 2 diabetes among Florida children, 1994 thourgh 1998. Public Health Reports. In pressGoogle Scholar
  7. 7.
    Pinhas-Hamiel O, Dolan LM, Zeitler PS. Diabetic ketoacidosis among obese African American adolescents with NIDDM. Diabetes Care 1997; 28: 484–6CrossRefGoogle Scholar
  8. 8.
    American Diabetes Association. Type 2 diabetes in children and adolescents: consensus conference report. Diabetes Care 2000; 23: 381–9CrossRefGoogle Scholar
  9. 9.
    Savage PJ, Bennett PH, Senter RG, et al. High prevalence of diabetes in young Pima Indians. Diabetes 1979; 28: 937–42PubMedCrossRefGoogle Scholar
  10. 10.
    Dabelea D, Hanson RL, Bennett PH, et al. Increasing prevalence of type 2 diabetes in American Indian children. Diabetologia 1998; 41: 904–10PubMedCrossRefGoogle Scholar
  11. 11.
    Dean HJ. NIDDM-Y in first nation children in Canada. Clin Pediatr (Phila) 1998; 39: 89–96CrossRefGoogle Scholar
  12. 12.
    Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiological review and a public health perspective. J Pediatr 2000; 136: 664–72PubMedCrossRefGoogle Scholar
  13. 13.
    Pinhas-Hamiel O, Dolan LM, Daniels SR, et al. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr 1996; 128: 608–15PubMedCrossRefGoogle Scholar
  14. 14.
    Knowles HC. Diabetes mellitus in childhood and adolescence. Med Clin North Am 1971; 55: 975–87PubMedGoogle Scholar
  15. 15.
    Pihoker C, Scott CR, Lensing SY, et al. Non-insulin dependent diabetes mellitus in African-American youths of Arkansas. Clin Pediatr (Phila) 1998; 37: 97–102CrossRefGoogle Scholar
  16. 16.
    Neufeld ND, Raffal LF, Landon C, et al. Early presentation of type 2 diabetes in Mexican-American youth. Diabetes Care 1998; 21: 80–6PubMedCrossRefGoogle Scholar
  17. 17.
    Kadiki OA, Reddy MR, Marzouk AA. Incidence of insulin-dependent diabetes (IDDM) and non-insulin-dependent diabetes (NIDDM) (0–34 years at onset) in Benghazi, Libya. Diabetes Res Clin Pract 1996; 32: 165–73PubMedCrossRefGoogle Scholar
  18. 18.
    Chan JCN, Cheung CK, Swaminathan R, et al. Obesity, albuminuria, and hypertension among Hong Kong Chinese with non-insulin-dependent diabetes mellitus (NIDDM). Postgrad Med J 1993; 69: 204–10PubMedCrossRefGoogle Scholar
  19. 19.
    Kitagawa T, Owada M, Urakami T, et al. Increased incidence of non-insulin dependent diabetes mellitus among Japanese school children correlates with an increased intake of animal protein and fat. Clin Pediatr (Phila) 1998; 37: 111–5CrossRefGoogle Scholar
  20. 20.
    Sayeed MA, Hussain MZ, Banu A, et al. Prevalence of diabetes in a suburban population of Bangladesh. Diabetes Res Clin Pract 1997; 34: 149–55PubMedCrossRefGoogle Scholar
  21. 21.
    Braun B, Zimmerman MB, Kretchmer N, et al. Risk factors for diabetes and cardiovascular disease in young Australian aborigines: a 5-year follow-up study. Diabetes Care 1996; 19: 472–9PubMedCrossRefGoogle Scholar
  22. 22.
    McGrath NM, Parker GN, Dawson P. Early presentation of type 2 diabetes mellitus in young New Zealand Maori. Diabetes Res Clin Pract 1999; 43: 205–9PubMedCrossRefGoogle Scholar
  23. 23.
    Ehtisham S, Barrett TG, Shawl NJ. Type 2 diabetes mellitus in UK children: an emerging problem. Diabet Med 2000; 17: 867–71PubMedCrossRefGoogle Scholar
  24. 24.
    Lev-Ran A. Thrifty genotype: how applicable is it to obesity and type 2 diabetes? Diabet Rev 1999; 7: 1–22Google Scholar
  25. 25.
    Lillioja S, Mott DM, Spraul M, et al. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus: prospective studies of Pima Indians. N Engl J Med 1993; 329: 1988–92PubMedCrossRefGoogle Scholar
  26. 26.
    Haffner SM, Stern MP, Dunn J, et al. Diminished insulin sensitivity and increased insulin response in non-obese, non-diabetic Mexican Americans. Metabolism 1990; 39: 842–7PubMedCrossRefGoogle Scholar
  27. 27.
    Haffner SM, Miettinen H, Stern MP. Insulin secretion and resistance in non-diabetic Mexican Americans and non-Hispanic whites with a parental history of diabetes. J Clin Endocrinol Metab 1996; 81: 1846–51PubMedCrossRefGoogle Scholar
  28. 28.
    Groop L, Forsblom C, Lehtovirta M, et al. Metabolic consequences of a family history of NIDDM (the Botnia Study): evidence for sex specific parental effects. Diabetes 1996; 45: 1585–93PubMedCrossRefGoogle Scholar
  29. 29.
    Martin BC, Warram JH, Krolewski AS, et al. Role of glucose and insulin resistance in development of type 2 diabetes mellitus: results of a 25-year follow-up study. Lancet 1992; 340: 925–9PubMedCrossRefGoogle Scholar
  30. 30.
    Pigon J, Giacca A, Ostenson C-G, et al. Normal hepatic insulin sensitivity in lean, mild non-insulin-dependent diabetic patients. J Clin Endocrinol Metab 1996; 81: 3702–8PubMedCrossRefGoogle Scholar
  31. 31.
    O’Rahilly S, Turner RC, Matthew D. Impaired pulsatile secretion of insulin in relatives of patients with non-insulin-dependent diabetes. N Engl J Med 1988; 318: 1225–30PubMedCrossRefGoogle Scholar
  32. 32.
    Phipps K, Barker DJP. Fetal growth and impaired glucose tolerance in men and women. Diabetologia 1993; 36: 225–8PubMedCrossRefGoogle Scholar
  33. 33.
    Philips DIW, Barker DJP, Hales CN, et al. Thinness at birth and insulin resistance in adult life. Diabetologia 1994; 37: 150–4CrossRefGoogle Scholar
  34. 34.
    Lithell HO, McKeigue PM, Gerglund L, et al. Relation at birth to non-insulin-dependent diabetes and insulin concentrations in men aged 50–60 years. BMJ 1996; 312: 406–10PubMedCrossRefGoogle Scholar
  35. 35.
    Curhan GC, Willett WC, Rimm EB, et al. Birth weight and adult hypertension, diabetes mellitus, and obesity in US men. Circulation 1996; 94: 3246–50PubMedCrossRefGoogle Scholar
  36. 36.
    Ravelli AC, van der Meulen JH, Michels RP, et al. Glucose tolerance in adults after prenatal exposure to famine. Lancet 1998; 351: 173–7PubMedCrossRefGoogle Scholar
  37. 37.
    Levitt NS, Lambert EV, Woods D, et al. Impaired glucose tolerance and elevated blood pressure in low birth weight, non-obese, young South African adults: early programming of cortisol axis. J Clin Endocrinol Metab 2000; 85: 4611–8PubMedCrossRefGoogle Scholar
  38. 38.
    Dabelea D, Pettitt DJ, Hanson RL, et al. Birthweight, type 2 diabetes, and insulin resistance in Pima Indian children and young adults. Diabetes Care 1999; 22: 944–50PubMedCrossRefGoogle Scholar
  39. 39.
    Bavdekar A, Yajnik CS, Fall CHD, et al. Insulin resistance syndrome in 8-year-old Indian children: small at birth, big at 8 years, or both? Diabetes 1999; 48: 2422–9PubMedCrossRefGoogle Scholar
  40. 40.
    Rosenbloom AL, Wheeler L, Bianchi R, et al. Age adjusted analysis of insulin responses during normal and abnormal oral glucose tolerance tests in children and adolescents. Diabetes 1975; 24: 820–8PubMedCrossRefGoogle Scholar
  41. 41.
    Caprio S, Tamborlane WV. Metabolic impact of obesity in childhood. Endocrinol Metab Clin North Am 1999; 28: 731–47PubMedCrossRefGoogle Scholar
  42. 42.
    Legro RS, Kunselman AR, Dodson WC, et al. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999; 84: 165–9PubMedCrossRefGoogle Scholar
  43. 43.
    Lewy V, Danadian K, Arslanian SA. Early metabolic abnormalities in adolescents with polycystic ovarian syndrome (PCOS) [abstract]. Pediatr Res 1999; 45: 93ACrossRefGoogle Scholar
  44. 44.
    Lewy V, Danadian K, Arslanian SA. Roles of insulin resistance & B-cell dysfunction in the pathogenesis of glucose intolerance in adolescents with polycystic ovary syndrome [abstract]. Diabetes 1999; 48: A292CrossRefGoogle Scholar
  45. 45.
    Banerjee S, Raghavan S, Wasserman EJ, et al. Hormonal findings in African-American and Caribbean Hispanic girls with premature adrenarche: implications for polycystic ovarian syndrome. Pediatrics 1998; 102: E36PubMedCrossRefGoogle Scholar
  46. 46.
    Vuguin P, Linder B, Rosenfeld RG, et al. The roles of insulin sensitivity, insulinlike growth factor I (IGF-I), and IGF-binding protein-1 and-3 in the hyperandrogenism of African American and Caribbean Hispanic girls with premature adrenarche. J Clin Endocrinol Metab 1999; 84: 2037–42PubMedCrossRefGoogle Scholar
  47. 47.
    Ibañez L, Potau N, Marcos MV, et al. Exaggerated adrenarche and hyperinsulinism in adolescent girls born small for gestational age. J Clin Endocrinol Metab 1999; 84: 4739–41PubMedCrossRefGoogle Scholar
  48. 48.
    Silverman BL, Metzger BE, Cho NH, et al. Impaired glucose tolerance in adolescent offspring of diabetic mothers: relationship to fetal hyperinsulinism. Diabetes Care 1995; 18: 611–7PubMedCrossRefGoogle Scholar
  49. 49.
    Pettitt DJ, Aleck KA, Baird HR, et al. Congenital susceptibility to NIDDM: role of intrauterine environment. Diabetes 1988; 37: 622–8PubMedCrossRefGoogle Scholar
  50. 50.
    Dabelea D, Knowler WC, Pettitt DJ. Effect of diabetes in pregnancy on offspring: follow-up research in the Pima Indians. J Matern Fetal Med 2000; 9: 83–8PubMedCrossRefGoogle Scholar
  51. 51.
    Svec F, Nastasi K, Hilton C, et al. Black-white contrasts and insulin levels during pubertal development: the Bogalusa Heart Study. Diabetes 1992; 41: 313–7PubMedCrossRefGoogle Scholar
  52. 52.
    Jiang X, Srinivasan SR, Radhakrishnamurthy B, et al. Racial (black-white) differences in insulin secretion and clearance in adolescents: the Bogalusa heart study. Pediatrics 1996; 97: 357–60PubMedGoogle Scholar
  53. 53.
    Arslanian S. Insulin secretion and sensitivity in healthy African-American vs American-white children. Clin Pediatr (Phila) 1998; 37: 81–8CrossRefGoogle Scholar
  54. 54.
    Danadian K, Lewy V, Janosky JJ, et al. Lipolysis in African-American children: is it a metabolic risk factor predisposing to obesity? J Clin Endocrinol Metab 2001; 86: 3022–6PubMedCrossRefGoogle Scholar
  55. 55.
    Danadian K, Balasekaran G, Lewy V, et al. Insulin sensitivity in African-American children with and without a family history of type 2 diabetes. Diabetes Care 1999; 22: 1325–9PubMedCrossRefGoogle Scholar
  56. 56.
    Ibañez L, Castell C, Tresserras R, et al. Increased prevalence of type 2 diabetes mellitus and impaired glucose tolerance in first-degree relatives of girls with a history of precocious pubarche. Clin Endocrinol (Oxf) 1999; 51: 395–401CrossRefGoogle Scholar
  57. 57.
    Pinhas-Hamiel O, Standiford D, Hamiel D, et al. The type 2 family: a setting for development and treatment of adolescent type 2 diabetes mellitus. Arch Pediatr Adolesc Med 1999; 153: 1063–7PubMedGoogle Scholar
  58. 58.
    Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology, the essentials. 2nd ed. Baltimore (MD): Williams and Wilkins, 1988Google Scholar
  59. 59.
    Sackett DL, Holland WW. Controversy in detection of disease. Lancet 1965; II: 357–9Google Scholar
  60. 60.
    Troiano RP, Flegal KM. Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics 1998; 101: 497–504PubMedGoogle Scholar
  61. 61.
    Reilly JJ, Dorosty AR. Epidemic of obesity in UK children. Lancet 1999; 354: 1874–5PubMedCrossRefGoogle Scholar
  62. 62.
    Cook VV, Hurley JS. Prevention of type 2 diabetes in childhood. Clin Pediatr (Phila) 1998; 37: 123–9CrossRefGoogle Scholar
  63. 63.
    Teufel NI, Ritenbaugh CK. Development of a primary prevention program: insight gained in the Zuni Diabetes Prevention Program. Clin Pediatr (Phila) 1998; 37: 131–41CrossRefGoogle Scholar
  64. 64.
    Macaulay AC, Paradis G, Potvin L, et al. The Kahnawake Schools Diabetes Prevention project: intervention, evaluation and baseline results of a diabetes primary prevention program with a native community in Canada. Prev Med 1997; 26: 779–90PubMedCrossRefGoogle Scholar
  65. 65.
    Perry CL, Stone EJ, Parcel GS, et al. School-based cardiovascular health promotion: the child and adolescent trial for cardiovascular health (CATCH). J Sch Health 1990; 60: 406–13PubMedCrossRefGoogle Scholar
  66. 66.
    Joe JR. Perceptions of diabetes by Indian adolescents. In: Joe JR, Young RS, editors. Diabetes as a disease of civilization: the impact of culture change on indigenous peoples. Berlin: Mouton de Gruyter, 1994: 329–356CrossRefGoogle Scholar
  67. 67.
    Silverstein JH, Rosenbloom AL. Treatment of type 2 diabetes in children and adolescents. J Pediatr Endocrinol Metab 2000; 13: 1403–9PubMedGoogle Scholar
  68. 68.
    DeFronzo RA, Goodman AM. Efficacy of metformin in patients with non-insulin dependent diabetes mellitus. The Multicenter Metformin Study group. N Engl J Med 1995; 333: 541–9PubMedCrossRefGoogle Scholar
  69. 69.
    Jones KL, Arslanian S, Peterokova VA, et al. Effect of metformin in pediatric patients with type 2 diabetes: a randomized controlled trial. Diabetes Care 2002; 25: 89–94PubMedCrossRefGoogle Scholar
  70. 70.
    Lebovitz HE. Insulin secretagogues, old and new. Diabet Rev 1999; 7: 139–52Google Scholar
  71. 71.
    Schwartz S, Raskin P, Fonseca V, et al. Effect of troglitazone in insulin-treated patients with type 2 diabetes. Troglitazone and Exogenous Insulin Study Group. N Engl J Med 1998; 338: 861–6PubMedCrossRefGoogle Scholar
  72. 72.
    Chiasson J, Josse R, Hunt J, et al. The efficacy of acarbose in the treatment of patients with non-insulin-dependent diabetes mellitus: a multicenter controlled clinical trial. Ann Intern Med 1994; 121: 928–35PubMedGoogle Scholar
  73. 73.
    UKPDS Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53CrossRefGoogle Scholar
  74. 74.
    UKPDS Group. Tight blood pressure control and risk of macrovascular and micro-vascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–13CrossRefGoogle Scholar
  75. 75.
    Yokoyama H, Okudaira M, Otani T, et al. High incidence of diabetic nephropathy in early-onset Japanese NIDDM patients; risk analysis. Diabetes Care 1998; 21: 1080–5PubMedCrossRefGoogle Scholar
  76. 76.
    Fagot-Campagna A, Knowler WC, Pettitt DJ. Type 2 diabetes in Pima Indian children: cardiovascular risk factors at diagnosis and 10 years later [abstract]. Diabetes 1998; Suppl. 1: A155Google Scholar
  77. 77.
    Law RE, Goetze S, Xi XP, et al. Expression and function of PPARγ in rat and human vascular smooth muscle cells. Circulation 2000; 101: 1311–8PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Children’s Medical Services CenterGainesvilleUSA

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