(18-12-10) Approach to the obese adolescent with new-onset diabetes.

Zeitler P.

The Children's Hospital, 13123 East 16th Avenue, Aurora, Colorado 80045. phil.
[email protected].
Abstract
The prevalence of both type 1 and type 2 diabetes among children and
adolescents has been steadily increasing over the last few decades. However, as
the general pediatric population becomes more obese and more ethnically
diverse, reliance on phenotypic characteristics for distinguishing between
these types of diabetes is becoming increasingly untenable. Yet, the
recognition of differences in treatment strategies, associated disorders, and
both short- and long-term diabetes and cardiovascular outcomes supports the
importance of diagnostic efforts to make a distinction between diabetes types.
An approach to determination of diabetes type is discussed, focused on the
presence or absence of autoimmunity and assessment of ?-cell function. At the
time of diagnosis, it is generally not possible to be certain of diabetes type,
and therefore, initial treatment decisions must be made based on aspects of the
presenting physiology, with adjustments in treatment approach made as the
individual's course proceeds and additional information becomes available. The
apparent overlap between type 1 and type 2 diabetes that occurs in obese
adolescents has resulted in some controversy regarding mixed forms of diabetes
that are ultimately semantic, but this does raise interesting questions about
the treatment of type 1 diabetes in the presence of an insulin-resistant
phenotype. Finally, the lack of information about the efficacy of treatment of
cardiovascular risk factors, such as dyslipidemia and hypertension, along with
the well-documented challenges in adherence to chronic illness treatment in
this population, creates substantial challenges.

Source: J Clin Endocrinol Metab. 2010 Dec;95(12):5163-70.

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