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  1. 1. DIAGNOSIS AND TREATMENT OF TYPE 2 DIABETES IN CHILDREN Sample-RHK
  2. 2. Outline of Discussion <ul><li>The importance of the problem </li></ul><ul><li>Diagnosis of type 2 diabetes in children </li></ul><ul><li>Special problems in children with T2DM </li></ul><ul><li>Management based on presentation </li></ul><ul><li>The metformin trial </li></ul><ul><li>Comorbid conditions </li></ul>
  3. 3. Pathogenesis of Type 2 Diabetes ELEVATED GLUCOSE PANCREAS 1. Increased Hepatic Glucose Production 2. Impaired Pancreatic Insulin Secretion 3. Peripheral Insulin Resistance MUSCLE LIVER   
  4. 4. Outline of Discussion <ul><li>The importance of the problem </li></ul><ul><li>Diagnosis of type 2 diabetes in children </li></ul><ul><li>Special problems in children with T2DM </li></ul><ul><li>Management based on presentation </li></ul><ul><li>The metformin trial </li></ul><ul><li>Comorbid conditions </li></ul>
  5. 5. Diabetes Trends in the United States <ul><li>Prevalence of diagnosed diabetes increased by 33% from 1990 to 1998 </li></ul><ul><ul><li>Age (y) % Increase </li></ul></ul><ul><ul><li>30–39 70 </li></ul></ul><ul><ul><li>40–49 40 </li></ul></ul><ul><ul><li>50–59 31 </li></ul></ul><ul><li>Highly correlated with prevalence of obesity (r = 0.64, P < 0.001) </li></ul>Mokdad et al. Diabetes Care . 2000;23:1278.
  6. 6. World 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)
  7. 7. Projected Obesity prevalence from 1960 to 2025 Source: Nature 404, 2000
  8. 8. Type 2 Diabetes in Children Epidemiology: Population-Based J Pediatr . May 2000.
  9. 9. Type 2 Diabetes in Children: Diagnosis by Year Patients
  10. 10. Prevalence of IFG in Nondiabetic US Adolescents (Aged 12–19 Yrs)
  11. 11. ADA Guidelines for Screening, Treatment of Children, Adolescents
  12. 12. ADA Guidelines for Screening, Treatment of Children, Adolescents (cont.)
  13. 13. C-Peptide Values at Diagnosis in T1DM and T2DM Unstimulated C-peptide values C-peptide (%ULN) N=38 N=42 P <0.001 140 120 100 80 60 40 20 0 T1DM T2DM
  14. 14. Outline of Discussion <ul><li>The importance of the problem </li></ul><ul><li>Diagnosis of type 2 diabetes in children </li></ul><ul><li>Special problems in children with T2DM </li></ul><ul><li>Management based on presentation </li></ul><ul><li>The metformin trial </li></ul><ul><li>Comorbid conditions </li></ul>
  15. 15. Special Issues In Children <ul><li>Risk of misdiagnosis </li></ul><ul><li>Need for initial use of insulin because of uncertainty or DKA </li></ul><ul><li>Lack of information regarding safety and efficacy of oral agents </li></ul>
  16. 16. Special Issues in Children With T2DM <ul><li>Risk of misdiagnosis </li></ul><ul><li>Need for initial use of insulin because of uncertainty or DKA </li></ul><ul><li>Lack of information regarding safety and efficacy of oral agents </li></ul>
  17. 17. Need for Initial Insulin Use in Children <ul><li>At least 10% of children with new-onset type 2 diabetes present with DKA </li></ul><ul><li>A multicenter therapeutic study found 20% of suspected type 2 adolescents were antibody-positive </li></ul><ul><li>Sometimes the diagnosis is just not initially clear and must await the return of immune markers and C-peptide </li></ul><ul><li>Some anxious parents want the blood glucose reduced quickly and don’t want to wait for the slower response to oral agents </li></ul>
  18. 19. Summary <ul><li>The approaches to glycemic therapy in type 2 diabetes in children do not differ from those in adults </li></ul><ul><li>Therapy by lifestyle change is difficult to implement and ineffective in children </li></ul><ul><li>A double-blind, placebo-controlled trial of metformin in children showed it to be safe and effective in this age group </li></ul>

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