Diagnostic Considerations

Conditions to consider in the differential diagnosis of type 2 diabetes include the following:

Atypical diabetes mellitus (ADM)
Maturity-onset diabetes of the young (MODY)
Diabetes secondary to mutations in mitochondrial deoxyribonucleic acid (DNA)
Genetic defects of the beta cell
Genetic defects in insulin action
Diseases of the exocrine pancreas
Endocrinopathies
Drug- or chemical-induced diabetes

Differential Diagnoses

Workup

[Guideline] Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004 Jan. 27 Suppl 1:S5-S10. [QxMD MEDLINE Link].
American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care. 2000 Mar. 23(3):381-9. [QxMD MEDLINE Link].
Management of dyslipidemia in children and adolescents with diabetes. Diabetes Care. 2003 Jul. 26(7):2194-7. [QxMD MEDLINE Link].
Bennett WL, Maruthur NM, Singh S, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011 May 3. 154(9):602-13. [QxMD MEDLINE Link].
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 Jul. 27(7):1798-811. [QxMD MEDLINE Link].
Morales AE, Rosenbloom AL. Death caused by hyperglycemic hyperosmolar state at the onset of type 2 diabetes. J Pediatr. 2004 Feb. 144(2):270-3. [QxMD MEDLINE Link].
Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab. 2004 Jun. 89(6):2526-39. [QxMD MEDLINE Link].
Hillier TA, Pedula KL. Complications in young adults with early-onset type 2 diabetes: losing the relative protection of youth. Diabetes Care. 2003 Nov. 26(11):2999-3005. [QxMD MEDLINE Link].
Weyer C, Bogardus C, Mott DM, Pratley RE. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest. 1999 Sep. 104(6):787-94. [QxMD MEDLINE Link].
Matthews DR, Cull CA, Stratton IM, Holman RR, Turner RC. UKPDS 26: Sulphonylurea failure in non-insulin-dependent diabetic patients over six years. UK Prospective Diabetes Study (UKPDS) Group. Diabet Med. 1998 Apr. 15(4):297-303. [QxMD MEDLINE Link].
Gungor N, Arslanian S. Progressive beta cell failure in type 2 diabetes mellitus of youth. J Pediatr. 2004 May. 144(5):656-9. [QxMD MEDLINE Link].
Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. 1999 Feb. 22(2):345-54. [QxMD MEDLINE Link].
Wei JN, Sung FC, Li CY, et al. Low birth weight and high birth weight infants are both at an increased risk to have type 2 diabetes among schoolchildren in taiwan. Diabetes Care. 2003 Feb. 26(2):343-8. [QxMD MEDLINE Link].
Silverman BL, Metzger BE, Cho NH, Loeb CA. Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes Care. May 1995. 18(5):611-7. [QxMD MEDLINE Link].
Young TK, Martens PJ, Taback SP, et al. Type 2 diabetes mellitus in children: prenatal and early infancy risk factors among native canadians. Arch Pediatr Adolesc Med. 2002 Jul. 156(7):651-5. [QxMD MEDLINE Link].
Mayer-Davis EJ, Dabelea D, Lamichhane AP, D'Agostino RB Jr, Liese AD, Thomas J. Breast-feeding and type 2 diabetes in the youth of three ethnic groups: the SEARCh for diabetes in youth case-control study. Diabetes Care. 2008 Mar. 31(3):470-5. [QxMD MEDLINE Link].
Brauser D. More Proof Antipsychotics Boost Kids' Diabetes Risk. Medscape Medical News. Available at http://www.medscape.com/viewarticle/809942. Accessed: August 27, 2013.
Bobo WV, Cooper WO, Stein CM, Olfson M, Graham D, Daugherty J, et al. Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth. JAMA Psychiatry. 2013 Aug 21. [QxMD MEDLINE Link].
Type 2 diabetes in children and adolescents. American Diabetes Association. Pediatrics. 2000 Mar. 105(3 Pt 1):671-80. [QxMD MEDLINE Link].
Dabelea D, Bell RA, D'Agostino RB Jr, et al. Incidence of diabetes in youth in the United States. JAMA. 2007 Jun 27. 297(24):2716-24. [QxMD MEDLINE Link].
Urakami T, Kubota S, Nitadori Y, Harada K, Owada M, Kitagawa T. Annual incidence and clinical characteristics of type 2 diabetes in children as detected by urine glucose screening in the Tokyo metropolitan area. Diabetes Care. 2005 Aug. 28(8):1876-81. [QxMD MEDLINE Link].
Ehtisham S, Hattersley AT, Dunger DB, Barrett TG,. First UK survey of paediatric type 2 diabetes and MODY. Arch Dis Child. 2004 Jun. 89(6):526-9. [QxMD MEDLINE Link].
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 May. 32(3):165-73. [QxMD MEDLINE Link].
Chan JC, Cheung CK, Swaminathan R, Nicholls MG, Cockram CS. Obesity, albuminuria and hypertension among Hong Kong Chinese with non-insulin-dependent diabetes mellitus (NIDDM). Postgrad Med J. 1993 Mar. 69(809):204-10. [QxMD MEDLINE Link]. [Full Text].
Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Type 2 diabetes in Asian-Indian urban children. Diabetes Care. 2003 Apr. 26(4):1022-5. [QxMD MEDLINE Link].
Sayeed MA, Hussain MZ, Banu A, Rumi MA, Azad Khan AK. Prevalence of diabetes in a suburban population of Bangladesh. Diabetes Res Clin Pract. 1997 Jan. 34(3):149-55. [QxMD MEDLINE Link].
Braun B, Zimmermann MB, Kretchmer N, Spargo RM, Smith RM, Gracey M. Risk factors for diabetes and cardiovascular disease in young Australian aborigines. A 5-year follow-up study. Diabetes Care. 1996 May. 19(5):472-9. [QxMD MEDLINE Link].
McGrath NM, Parker GN, Dawson P. Early presentation of type 2 diabetes mellitus in young New Zealand Maori. Diabetes Res Clin Pract. 1999 Mar. 43(3):205-9. [QxMD MEDLINE Link].
Eppens MC, Craig ME, Jones TW, Silink M, Ong S, Ping YJ. Type 2 diabetes in youth from the Western Pacific region: glycaemic control, diabetes care and complications. Curr Med Res Opin. 2006 May. 22(5):1013-20. [QxMD MEDLINE Link].
Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr. May 2000. 136(5):664-72. [QxMD MEDLINE Link].
Grinstein G, Muzumdar R, Aponte L, et al. Presentation and 5-year follow-up of type 2 diabetes mellitus in African-American and Caribbean-Hispanic adolescents. Horm Res. 2003. 60(3):121-6. [QxMD MEDLINE Link].
Obesity and Type 2 Diabetes as Documented In Private Claims Data. A FAIR Health White Paper. FAIR Health, Inc.; January 2017. 1-16.
Phillips D. Diabetes, Obesity-Linked Disorders Double in Kids. Medscape Medical News. Available at http://www.medscape.com/viewarticle/874716#vp_1. January 20, 2017; Accessed: January 31, 2017.
Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014 May 7. 311(17):1778-86. [QxMD MEDLINE Link].
Pavkov ME, Bennett PH, Knowler WC, Krakoff J, Sievers ML, Nelson RG. Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians. JAMA. 2006 Jul 26. 296(4):421-6. [QxMD MEDLINE Link].
Yokoyama H, Okudaira M, Otani T, et al. Higher incidence of diabetic nephropathy in type 2 than in type 1 diabetes in early-onset diabetes in Japan. Kidney Int. 2000 Jul. 58(1):302-11. [QxMD MEDLINE Link].
Maahs DM, Snively BM, Bell RA, Dolan L, Hirsch I, Imperatore G. Higher prevalence of elevated albumin excretion in youth with type 2 than type 1 diabetes: the SEARCH for Diabetes in Youth study. Diabetes Care. 2007 Oct. 30(10):2593-8. [QxMD MEDLINE Link].
Dart AB, Sellers EA, Martens PJ, Rigatto C, Brownell MD, Dean HJ. High burden of kidney disease in youth-onset type 2 diabetes. Diabetes Care. 2012 Jun. 35 (6):1265-71. [QxMD MEDLINE Link].
Krakoff J, Lindsay RS, Looker HC, et al. Incidence of retinopathy and nephropathy in youth-onset compared with adult-onset type 2 diabetes. Diabetes Care. 2003 Jan. 26(1):76-81. [QxMD MEDLINE Link].
Zeitler P, Epstein L, Grey M, Hirst K, KaufmanF, Tamborlane W, et al. Treatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle intervention in adolescents with type 2 diabetes. Pediatric Diabetes. 2007. 8(2):74-87. [QxMD MEDLINE Link].
Tryggestad JB, Willi SM. Complications and comorbidities of T2DM in adolescents: findings from the TODAY clinical trial. J Diabetes Complications. 2015 Mar. 29(2):307-12. [QxMD MEDLINE Link].
Solis- Herrera C, Triplitt CL. Nephropathy in Youth and Young Adults with Type 2 Diabetes. Curr Diab Rep. 2014. 14:456-y. [QxMD MEDLINE Link].
Palmert MR, Gordon CM, Kartashov AI, et al. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab. 2002 Mar. 87(3):1017-23. [QxMD MEDLINE Link].
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 Oct. 153(10):1063-7. [QxMD MEDLINE Link].
Copeland KC, Silverstein J, Moore KR, Prazar GE, Raymer T, et al. Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents. Pediatrics. 2013 Feb. 131(2):364-82. [QxMD MEDLINE Link]. [Full Text].
Loimaala A, Groundstroem K, Rinne M, Nenonen A, Huhtala H, Parkkari J, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol. 2009 Apr 1. 103(7):972-7. [QxMD MEDLINE Link].
McGavock J, Sellers E, Dean H. Physical activity for the prevention and management of youth-onset type 2 diabetes mellitus: focus on cardiovascular complications. Diab Vasc Dis Res. 2007 Dec. 4(4):305-10. [QxMD MEDLINE Link].
Tamborlane WV, Barrientos-Pérez M, Fainberg U, Frimer-Larsen H, Hafez M, Hale PM, et al. Liraglutide in Children and Adolescents with Type 2 Diabetes. N Engl J Med. 2019 Apr 28. [QxMD MEDLINE Link].
Bydureon BCise (exenatide) [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP. July 2021. Available at [Full Text].
Kavey RE, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Aca... Circulation. 2006 Dec 12. 114(24):2710-38. [QxMD MEDLINE Link].
The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004 Aug. 114(2 Suppl 4th Report):555-76. [QxMD MEDLINE Link].
[Guideline] Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Feb. 42(2):517-84. [QxMD MEDLINE Link].
International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009 Jul. 32(7):1327-34. [QxMD MEDLINE Link]. [Full Text].
Kooy A, de Jager J, Lehert P, Bets D, Wulffelé MG, Donker AJ, et al. Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with type 2 diabetes mellitus. Arch Intern Med. 2009 Mar 23. 169(6):616-25. [QxMD MEDLINE Link].
Home PD, Pocock SJ, Beck-Nielsen H, Gomis R, Hanefeld M, Jones NP, et al. Rosiglitazone evaluated for cardiovascular outcomes--an interim analysis. N Engl J Med. 2007 Jul 5. 357(1):28-38. [QxMD MEDLINE Link].
McAfee AT, Koro C, Landon J, Ziyadeh N, Walker AM. Coronary heart disease outcomes in patients receiving antidiabetic agents. Pharmacoepidemiol Drug Saf. 2007 Jul. 16(7):711-25. [QxMD MEDLINE Link].
Home PD, Pocock SJ, Beck-Nielsen H, Curtis PS, Gomis R, Hanefeld M, et al. Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Lancet. 2009 Jun 20. 373(9681):2125-35. [QxMD MEDLINE Link].
Waknine Y. Diabetes rates rocket in US tweens and teens. Medscape Medical News. May 6, 2014. [Full Text].
US Food and Drug Administration. Early Communication About Safety of Lantus (insulin Glargine). [Full Text].
Bennett WL, Maruthur NM, Singh S, Segal JB, Wilson LM, Chatterjee R, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011 May 3. 154(9):602-13. [QxMD MEDLINE Link].

Media Gallery

Simplified scheme for the pathophysiology of type 2 diabetes mellitus.

of 1

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.