Type 2 diabetes mellitus in children

The prevalence of type 2 diabetes mellitus in children and adolescents has increased worldwide over the past three decades. This increase has coincided with the obesity epidemic, and minority groups are disproportionately affected. The American Diabetes Association recommends screening for type 2 diabetes beginning at 10 years of age or the onset of puberty in children who are overweight or obese and have two additional risk factors. Diagnostic criteria include a fasting blood glucose level of 126 mg per dL or greater, a two-hour plasma glucose level of 200 mg per dL or greater during an oral glucose tolerance test, an A1C level of 6.5% or more, or a random plasma glucose level of 200 mg per dL or greater plus symptoms of polyuria, polydipsia, or unintentional weight loss. Management should be focused on a multidisciplinary, family-centered approach. Nutrition and exercise counseling should be started at the time of diagnosis and as a part of ongoing management. Metformin is the first-line therapy in conjunction with lifestyle changes. Insulin therapy should be initiated if there are signs of ketosis or ketoacidosis, or if the patient has significant hyperglycemia (A1C greater than 9% or a random plasma glucose level of 250 mg per dL or greater).