Abstract
The global obesity epidemic has led to dramatic increases in the incidence and prevalence of type 2 diabetes mellitus (T2DM) among youth worldwide. In today’s clinical practice it has become increasingly difficult to distinguish type 1 diabetes mellitus (T1DM) from T2DM as many children with T1DM are overweight at diagnosis. Numerous recent publications note a significant proportion of physician-diagnosed T2DM youth with evidence of pancreatic autoimmunity, exemplifying the challenges in distinguishing between T1DM and T2DM. The clinical implications of the phenomenon of antibody positivity in phenotypic T2DM youth, also referred to as “type 1.5 diabetes” (T1.5 DM), “double diabetes,” “latent autoimmune diabetes in youth” (LADY), and “hybrid diabetes,” are unclear at present. Current and future work should determine if the presence of autoantibodies in phenotypic T2DM youth/children affects clinical course; this will facilitate the development of optimal treatment strategies.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Alberti G, Zimmet P, Shaw J, Bloomgarden Z, Kaufman F, Silink M. Type 2 diabetes in the young: the evolving epidemic: the international diabetes federation consensus workshop. Diabetes Care. 2004;27(7):1798–811.
Dabelea D, Hanson RL, Bennett PH, Roumain J, Knowler WC, Pettitt DJ. Increasing prevalence of Type II diabetes in American Indian children. Diabetologia. 1998;41(8):904–10.
Pinhas-Hamiel O, Zeitler P. The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr. 2005;146(5):693–700.
Dabelea D, Bell RA, D’Agostino Jr RB, Imperatore G, Johansen JM, Linder B, et al. Incidence of diabetes in youth in the United States. JAMA. 2007;297(24):2716–24.
Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care. 2000;23(3):381–9.
Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. 1999;22(2):345–54.
Kolb H, Mandrup-Poulsen T. The global diabetes epidemic as a consequence of lifestyle-induced low-grade inflammation. Diabetologia. 2010;53(1):10–20.
Copeland KC, Zeitler P, Geffner M, Guandalini C, Higgins J, Hirst K, et al. Characteristics of adolescents and youth with recent-onset type 2 diabetes: the TODAY cohort at baseline. J Clin Endocrinol Metab. 2011;96(1):159–67.
Cockram CS. The epidemiology of diabetes mellitus in the Asia-Pacific region. Hong Kong Med J. 2000;6(1):43–52.
Florez JC. Clinical review: the genetics of type 2 diabetes: a realistic appraisal in 2008. J Clin Endocrinol Metab. 2008;93(12):4633–42.
Smith RJ, Nathan DM, Arslanian SA, Groop L, Rizza RA, Rotter JI. Individualizing therapies in type 2 diabetes mellitus based on patient characteristics: what we know and what we need to know. J Clin Endocrinol Metab. 2010;95(4):1566–74.
Grant SF, Thorleifsson G, Reynisdottir I, Benediktsson R, Manolescu A, Sainz J, et al. Variant of transcription factor 7-like 2 (TCF7L2) gene confers risk of type 2 diabetes. Nat Genet. 2006;38(3):320–3.
Sladek R, Rocheleau G, Rung J, Dina C, Shen L, Serre D, et al. A genome-wide association study identifies novel risk loci for type 2 diabetes. Nature. 2007;445(7130):881–5.
Grant RW, Hivert M, Pandiscio JC, Florez JC, Nathan DM, Meigs JB. The clinical application of genetic testing in type 2 diabetes: a patient and physician survey. Diabetologia. 2009;52(11):2299–305.
McCarthy MI, Zeggini E. Genome-wide association studies in type 2 diabetes. Curr Diab Rep. 2009;9(2):164–71.
Voight BF, Scott LJ, Steinthorsdottir V, Morris AP, Dina C, Welch RP, et al. Twelve type 2 diabetes susceptibility loci identified through large-scale association analysis. Nat Genet. 2010;42(7):579–89.
Wheeler E, Barroso I. Genome-wide association studies and type 2 diabetes. Brief Funct Genomics. 2011;10(2):52–60.
Patterson CC, Dahlquist GG, Gyurus E, Green A, Soltesz G. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet. 2009;373(9680):2027–33.
Vehik K, Hamman RF, Lezotte D, Norris JM, Klingensmith G, Bloch C, et al. Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth. Diabetes Care. 2007;30(3):503–9.
Harjutsalo V, Sjoberg L, Tuomilehto J. Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Lancet. 2008;371(9626):1777–82.
Campbell-Stokes PL, Taylor BJ. Prospective incidence study of diabetes mellitus in New Zealand children aged 0 to 14 years. Diabetologia. 2005;48(4):643–8.
Knerr I, Wolf J, Reinehr T, Stachow R, Grabert M, Schober E, et al. The ‘accelerator hypothesis’: relationship between weight, height, body mass index and age at diagnosis in a large cohort of 9,248 German and Austrian children with type 1 diabetes mellitus. Diabetologia. 2005;48(12):2501–4.
Reinehr T, Holl RW, Roth CL, Wiesel T, Stachow R, Wabitsch M, et al. Insulin resistance in children and adolescents with type 1 diabetes mellitus: relation to obesity. Pediatr Diabetes. 2005;6(1):5–12.
Shenoy S, Waldron S, Cody D, Swift PG. Ethnic group differences in overweight and obese children with type 1 diabetes mellitus. Arch Dis Child. 2004;89(11):1076–7.
Saxena S, Ambler G, Cole TJ, Majeed A. Ethnic group differences in overweight and obese children and young people in England: cross sectional survey. Arch Dis Child. 2004;89(1):30–6.
Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C, et al. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes. 2010;11(1):4–11.
Libman IM, Pietropaolo M, Arslanian SA, LaPorte RE, Becker DJ. Changing prevalence of overweight children and adolescents at onset of insulin-treated diabetes. Diabetes Care. 2003;26(10):2871–5.
Wilkin TJ. Diabetes mellitus: Type 1 or type 2? The accelerator hypothesis. J Pediatr. 2002;141(3):449–50.
Wilkin TJ. The accelerator hypothesis: a review of the evidence for insulin resistance as the basis for type I as well as type II diabetes. Int J Obes (Lond). 2009;33(7):716–26.
Dabelea D, D’Agostino Jr RB, Mayer-Davis EJ, Pettitt DJ, Imperatore G, Dolan LM, et al. Testing the accelerator hypothesis: body size, beta-cell function, and age at onset of type 1 (autoimmune) diabetes. Diabetes Care. 2006;29(2):290–4.
Bingley PJ, Mahon JL, Gale EA. Insulin resistance and progression to type 1 diabetes in the European Nicotinamide Diabetes Intervention Trial (ENDIT). Diabetes Care. 2008;31(1):146–50.
Field SF, Howson JM, Smyth DJ, Walker NM, Dunger DB, Todd JA. Analysis of the type 2 diabetes gene, TCF7L2, in 13,795 type 1 diabetes cases and control subjects. Diabetologia. 2007;50(1):212–3.
Cambuli VM, Incani M, Cossu E, Congiu T, Scano F, Pilia S, et al. Prevalence of type 1 diabetes autoantibodies (GADA, IA2, and IAA) in overweight and obese children. Diabetes Care. 2010;33(4):820–2.
Hypponen E, Virtanen SM, Kenward MG, Knip M, Akerblom HK. Obesity, increased linear growth, and risk of type 1 diabetes in children. Diabetes Care. 2000;23(12):1755–60.
Cardwell CR, Stene LC, Joner G, Davis EA, Cinek O, Rosenbauer J, et al. Birthweight and the risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies using individual patient data. Diabetologia. 2010;53(4):641–51.
Hathout EH, Thomas W, El-Shahawy M, Nahab F, Mace JW. Diabetic autoimmune markers in children and adolescents with type 2 diabetes. Pediatrics. 2001;107(6):E102.
Umpaichitra V, Banerji MA, Castells S. Autoantibodies in children with type 2 diabetes mellitus. J Pediatr Endocrinol Metab. 2002;15 Suppl 1:525–30.
Brooks-Worrell BM, Greenbaum CJ, Palmer JP, Pihoker C. Autoimmunity to islet proteins in children diagnosed with new-onset diabetes. J Clin Endocrinol Metab. 2004;89(5):2222–7.
•• Klingensmith GJ, Pyle L, Arslanian S, Copeland KC, Cuttler L, Kaufman F, et al. The presence of GAD and IA-2 antibodies in youth with a type 2 diabetes phenotype: results from the TODAY study. Diabetes Care. 2010;33(9):1970–5. This paper is important because the large sample size and ethnic/racial diversity of the TODAY study participants represents the largest and best-characterized sample of American youth with recent-onset T2DM and provides the most current data on the prevalence of autoimmunity in phenotypic T2DM youth in the United States.
Turner R, Stratton I, Horton V, Manley S, Zimmet P, Mackay IR, et al. UKPDS 25: autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes. UK Prospective Diabetes Study Group. Lancet. 1997;350(9087):1288–93.
Torn C, Landin-Olsson M, Lernmark A, Palmer JP, Arnqvist HJ, Blohme G, et al. Prognostic factors for the course of beta cell function in autoimmune diabetes. J Clin Endocrinol Metab. 2000;85(12):4619–23.
Gilliam LK, Brooks-Worrell BM, Palmer JP, Greenbaum CJ, Pihoker C. Autoimmunity and clinical course in children with type 1, type 2, and type 1.5 diabetes. J Autoimmun. 2005;25(3):244–50.
Zeitler P. Update on nonautoimmune diabetes in children. J Clin Endocrinol Metab. 2009;94(7):2215–20.
• Tfayli H, Bacha F, Gungor N, Arslanian S. Phenotypic type 2 diabetes in obese youth: insulin sensitivity and secretion in islet cell antibody-negative versus -positive patients. Diabetes. 2009;58(3):738–44. In this study, insulin clamp studies were undertaken to delineate metabolic differences in insulin sensitivity and secretion in diabetes autoantibody (DAA)–positive and DAA-negative obese youth with clinically designated T2DM. DAA-positive participants were found to have severe β-cell failure and insulin deficiency, whereas DAA-negative youth had severe insulin resistance and relative insulin deficiency.
Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ. Type 2 diabetes in children and adolescents. Pediatr Diabetes. 2009;10 Suppl 12:17–32.
• Pozzilli P, Guglielmi C, Caprio S, Buzzetti R. Obesity, autoimmunity, and double diabetes in youth. Diabetes Care. 2011;34(Suppl 2):S166–70.This recent review examines the epidemiologic evidence and pathophysiologic mechanisms relevant to the increasing incidence of T1DM and T2DM in youth. Diagnostic and classification challenges pertaining to antibody-positive youth with T2DM are discussed.
Donath MY, Storling J, Maedler K, Mandrup-Poulsen T. Inflammatory mediators and islet beta-cell failure: a link between type 1 and type 2 diabetes. J Mol Med (Berl). 2003;81(8):455–70.
Pickup JC. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care. 2004;27(3):813–23.
Kolb H, Mandrup-Poulsen T. An immune origin of type 2 diabetes? Diabetologia. 2005;48(6):1038–50.
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Conflicts of interest: A. Badaru: none; C. Pihoker: has received grant support from the Centers for Disease Control and Prevention/National Institute of Diabetes and Digestive and Kidney Diseases.
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Badaru, A., Pihoker, C. Type 2 Diabetes in Childhood: Clinical Characteristics and Role of β-Cell Autoimmunity. Curr Diab Rep 12, 75–81 (2012). https://doi.org/10.1007/s11892-011-0247-2
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DOI: https://doi.org/10.1007/s11892-011-0247-2