Pediatric Type 2 Diabetes Mellitus Clinical Presentation

Updated: Jun 18, 2019
  • Author: Alba E Morales Pozzo, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Presentation

History

At the time of diagnosis, determining whether a patient has type 1 or type 2 diabetes is important, because patients with type 1 diabetes are totally dependent on exogenous insulin administration for survival, whereas patients with type 2 diabetes do not necessarily require exogenous insulin to survive. [2]

Because of the increasing prevalence of obesity in the pediatric population, the percentage of immune-mediated diabetes in overweight or obese patients is increasing, rendering the distinction between type 1 and type 2 diabetes difficult at times. Blood glucose monitoring is required regardless of the type of diabetes, and treatment with insulin should be started when indicated. [2]

The onset of type 2 diabetes is usually slow and insidious; it most often occurs in overweight or obese patients from a minority group (Native Americans, blacks, and Pacific Islanders). Patients with type 2 diabetes often have signs of insulin resistance, such as hypertension, PCOS, [43] or acanthosis nigricans.

A strong family history of type 2 diabetes is usually reported among affected youth. The families of adolescents with type 2 diabetes often have lifestyle risk factors leading to obesity. [44] In addition, children with type 2 diabetes are more likely to report a family history of cardiovascular disease and/or metabolic syndrome.

Type 1 diabetes occurs in people of all races; its onset is typically acute and severe. Patients with type 1 diabetes are often lean and do not show manifestations of insulin resistance.

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Physical Examination

Obesity is strongly associated with type 2 diabetes in children and adolescents. Eighty-five percent of children with type 2 diabetes are either overweight or obese (defined as at or above the 85th percentile of the sex-specific body mass index [BMI] for age-based growth charts). [30]

Acanthosis nigricans, a marker of insulin resistance, is a velvety, hyperpigmented thickening of the skin; it is frequently seen on the nape of the neck and in intertriginous areas; it is found in as many as 90% of children with type 2 diabetes. [30]

PCOS is a reproductive disorder commonly seen in young women with acanthosis nigricans. It is characterized by hyperandrogenism and chronic anovulation. The role of insulin resistance in the etiology of PCOS has been extensively studied, and medications that decrease insulin resistance and/or hyperinsulinemia in women with this syndrome often attenuate the hyperandrogenism and metabolic abnormalities.

Hypertension may occur in children with type 2 diabetes. The risk of macrovascular and microvascular diabetic complications is positively associated with elevated systolic blood pressure.

Ophthalmologic examination should be performed at or shortly after diagnosis to detect incipient retinopathy.

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