Type 2 Diabetes in Youth

摘要

The incidence of type 2 diabetes in children and adolescents in the United Statesrose at an annual rate of 4.8% between 2002-2003 and 2014-2015. Type 2 diabetesprogresses more aggressively to complications than type 1 diabetes. For example,in one large epidemiological study, proliferative retinopathy affected 5.6% and9.1% of children with type 1 and type 2 diabetes, respectively. Screening beginsat age 10 or at onset of puberty, and is recommended among children with a BMI%≥85 with risk factors such as a family history and belonging to a high riskracial or ethnic or racial group. HbA1C% is preferred for screening as it doesnot require fasting. As distinguishing between type 1 and type 2 diabetes is notstraightforward, all children with new onset disease should undergo autoantibodytesting. Results of lifestyle interventions for control of type 2 diabetes havebeen disappointing, but are still recommended for their educational value andthe potential impact upon some participants. There is limited evidence for thebenefit of newer mediations. Liraglutide, a GLP-1 agonist, however, has beenshown to significantly reduce HbA1C% in one study and is now approved forchildren. Liraglutide should be considered as second line therapy.