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DIAGNOSIS AND DIAGNOSIS AND TREATMENT OF TYPE 2 TREATMENT OF TYPE 2 DIABETES IN CHILDRENDIABETES IN CHILDREN
Sample-RHK
Outline of DiscussionOutline of Discussion
The importance of the problem Diagnosis of type 2 diabetes in children Special problems in children with T2DM Management based on presentation The metformin trial Comorbid conditions
ELEVATED GLUCOSE
PANCREAS
1. IncreasedHepatic GlucoseProduction
Pathogenesis of Type 2 Pathogenesis of Type 2 DiabetesDiabetes
2. Impaired Pancreatic Insulin Secretion
3. PeripheralInsulin Resistance
MUSCLE
LIVER
L
L
L
Outline of DiscussionOutline of Discussion
The importance of the problem Diagnosis of type 2 diabetes in children Special problems in children with T2DM Management based on presentation The metformin trial Comorbid conditions
Mokdad et al. Diabetes Care. 2000;23:1278.
Diabetes Trends in the United Diabetes Trends in the United StatesStates
Prevalence of diagnosed diabetes increased by 33% from 1990 to 1998
Age (y) % Increase30–39 7040–49 4050–59 31
Highly correlated with prevalence of obesity (r = 0.64, P < 0.001)
World wide trend of Type 2 Diabetes from 2000 to 2010World wide trend of Type 2 Diabetes from 2000 to 2010
Numbers of people with diabetes (in millions) for 2000 and 2010 (top and middle values, respectively), and the percentage increase.Source : Nature 414, 782 - 787 (2001)
Projected Obesity prevalence from 1960 to 2025Projected Obesity prevalence from 1960 to 2025
Source: Nature 404, 2000
J Pediatr. May 2000.
Type 2 Diabetes in ChildrenType 2 Diabetes in ChildrenEpidemiology: Population-BasedEpidemiology: Population-Based
Population Age (y) Sample Size Prevalence
per 1000 Navajo Indians 12–19 142 14.1
10–14 672 22.3 Pima Indians
15–19 530 50.9
4–19 717 11.1 Cree and Ojibway
10–19 – 0 for males 36 for
females US Caucasians, African Americans (AA), and Mexican Americans (MA)
12–19 2867 4.1
0
2
4
6
8
10
12
14
16
1990 1991 1992 1993 1994 1995 1996 1997 1998
Pat
ien
tsType 2 Diabetes in Children:Type 2 Diabetes in Children:
Diagnosis by YearDiagnosis by Year
Prevalence of IFG in Nondiabetic US Adolescents Prevalence of IFG in Nondiabetic US Adolescents (Aged 12–19 Yrs)(Aged 12–19 Yrs)
ADA Guidelines for Screening, ADA Guidelines for Screening, Treatment of Children, AdolescentsTreatment of Children, Adolescents
ADA Guidelines for Screening, ADA Guidelines for Screening, Treatment of Children, Adolescents (cont.)Treatment of Children, Adolescents (cont.)
C-Peptide Values at C-Peptide Values at Diagnosis in T1DM and T2DMDiagnosis in T1DM and T2DM
Unstimulated C-peptide values C
-pep
tid
e (%
UL
N)
N=38
N=42
P<0.001140
120
100
80
60
40
20
0
T1DM T2DM
Outline of DiscussionOutline of Discussion
The importance of the problem Diagnosis of type 2 diabetes in children Special problems in children with T2DM Management based on presentation The metformin trial Comorbid conditions
Special Issues In ChildrenSpecial Issues In Children
Risk of misdiagnosis Need for initial use of insulin because
of uncertainty or DKA Lack of information regarding safety
and efficacy of oral agents
Special Issues in Children Special Issues in Children With T2DMWith T2DM
Risk of misdiagnosis Need for initial use of insulin because
of uncertainty or DKA Lack of information regarding safety
and efficacy of oral agents
Need for Initial Insulin Use in Need for Initial Insulin Use in ChildrenChildren
At least 10% of children with new-onset type 2 diabetes present with DKA
A multicenter therapeutic study found 20% of suspected type 2 adolescents were antibody-positive
Sometimes the diagnosis is just not initially clear and must await the return of immune markers and C-peptide
Some anxious parents want the blood glucose reduced quickly and don’t want to wait for the slower response to oral agents
SummarySummary
The approaches to glycemic therapy in type 2 diabetes in children do not differ from those in adults
Therapy by lifestyle change is difficult to implement and ineffective in children
A double-blind, placebo-controlled trial of metformin in children showed it to be safe and effective in this age group