Type 2 diabetes mellitus in adolescents

Type 2 diabetes has traditionally been considered an adult disease, with increasing incidence in older age groups. However, a number of clinical and epidemiologic reports have suggested an increasing occurrence of type 2 diabetes over time among children and adolescents. Among Native Americans, the prevalence is approaching 5% in some age groups, and other minority populations are not far behind. Although the majority of children appear to have a form of diabetes that is very similar to type 2 diabetes in adults, at least two subtypes, maturity onset diabetes of the young (MODY) and 'atypical diabetes,' also appear to be occurring with increased frequency. A number of attributes may indicate a predisposition to type 2 diabetes in minority youths. Significant risk factors include ethnicity, family history, obesity, low (or high) birth weight, acanthosis nigricans, and a sedentary lifestyle. To date, there is no uniform agreement on the diagnostic criteria for type 2 diabetes in adolescents. However, the combination of obesity, a positive family history of type 2 diabetes, and the absence of antibodies to islet cell antigens is highly suggestive of type 2 diabetes. Genetic testing, which is already possible for many of the MODYs, may soon allow for the identification of individuals at very high risk. As the number of treatment options for type 2 diabetes expands, it remains important to temper enthusiasm for new agents with considerable caution, in light of the possibility that unanticipated side-effects may be more common in children. (C) 2000 Lippicott Williams and Wilkins, Inc.