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.

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.

Differential Diagnoses

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Media Gallery

Simplified scheme for the pathophysiology of type 2 diabetes mellitus.

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Author

Alba E Morales Pozzo, MD Associate Professor, Department of Pediatrics, Division of Endocrinology and Diabetes, Kentucky Children's Hospital, University of Kentucky Healthcare

Alba E Morales Pozzo, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, American Telemedicine Association, Arkansas Foundation for Medical Care, Arkansas Medical Society, Endocrine Society, Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece; UNESCO Chair on Adolescent Health Care, University of Athens, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology

Disclosure: Nothing to disclose.

Chief Editor

Sasigarn A Bowden, MD, FAAP Professor of Pediatrics, Section of Pediatric Endocrinology, Metabolism and Diabetes, Department of Pediatrics, Ohio State University College of Medicine; Pediatric Endocrinologist, Division of Endocrinology, Nationwide Children’s Hospital; Affiliate Faculty/Principal Investigator, Center for Clinical Translational Research, Research Institute at Nationwide Children’s Hospital

Sasigarn A Bowden, MD, FAAP is a member of the following medical societies: American Society for Bone and Mineral Research, Central Ohio Pediatric Society, Endocrine Society, International Society for Pediatric and Adolescent Diabetes, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Arlan L Rosenbloom, MD Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida College of Medicine; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology

Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society, International Society for Pediatric and Adolescent Diabetes

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Jean-Claude DesMangles, MD,to the development and writing of the source article.