Type 2 diabetes mellitus in children and adolescents

Type 2 diabetes mellitus is emerging as a new clinical problem within pediatric practice.Recent reports indicate an increasing prevalence of type 2 diabetes mellitus in children and adolescents around the world in all ethnicities,even if the prevalence of obesity is not increasing any more.The majority of young people diagnosed with type 2 diabetes mellitus was found in specific ethnic subgroups such as African-American,Hispanic,Asian/Pacific Islanders and American Indians.Clinicians should be aware of the frequent mild or asymptomatic manifestation of type 2 diabetes mellitus in childhood.Therefore,a screening seems meaningful especially in high risk groups such as children and adolescents with obesity,relatives with type 2 diabetes mellitus,and clinical features of insulin resistance(hypertension,dyslipidemia,polycystic ovarian syndrome,or acanthosis nigricans).Treatment of choice is lifestyle intervention followed by pharmacological treatment(e.g.,metformin).New drugs such as dipeptidyl peptidase inhibitors or glucagon like peptide 1 mimetics are in the pipeline for treatment of youth with type2 diabetes mellitus.However,recent reports indicate a high dropout of the medical care system of adolescents with type 2 diabetes mellitus suggesting that management of children and adolescents with type2 diabetes mellitus requires some remodeling of current healthcare practices.

Risk factors for impaired glucose tolerance in obese children and adolescents

AIM:To investigate which obese children have an increased risk for impaired glucose tolerance(IGT),a risk factor for later diabetes.METHODS:We studied 169 European untreated obese children and adolescents with normal glucose tolerance at baseline.Waist circumference,fasting glucose,lipids,blood pressure,pubertal stage,2 h glucose in oral glucose tolerance test(oGTT),and HbA1c were deter mined at baseline and 1 year later.RESULTS:One year after baseline,19(11.2) children demonstrated IGT,4(2.4) children had impaired fas ting glucose,no(0) child suffered from diabetes,and 146(86) children still showed normal glucose tolerance.At baseline,the children with IGT and with normal glucose tolerance in a one-year follow-up did not differ significantly in respect of any analyzed parameter,apart from pubertal stage.The children developing IGT entered puberty significantly more frequently(37 vs 3,P < 0.001).One year after baseline,the childr en with IGT demonstrated significantly increased waist circumference,blood pressure values,insulin and triglyceride concentrations,and insulin resistance index HOMA.The children remaining in the normal glucose tolerance status 1 year after baseline did not demonstrate any significant changes.CONCLUSION:During the study period of 1 year,more than 10 of the obese children with normal glucose tolerance converted to IGT.Repeated screening with oGTT seems meaningful in obese children entering puberty or demonstrating increased insulin resistance,waist circumference,blood pressure,or triglyceride concen trations.

A Comparison of Polysomnographic Variables between Adolescents with Polycystic Ovarian Syndrome and Healthy Controls

The prevalence of obstructive sleep apnea syndrome (OSAS) is clearly increased in adults with polycystic ovarian syndrome (PCOS). The symptoms of PCOS usually begin around menarche. However, data concerning poly?somnographic variables in adolescents with PCOS are limited. As obesity is a well-known risk factor for OSAS, we aimed to analyze differences in polysomnographic variables between obese and extremely obese adolescents with PCOS and healthy, normal-weight, obese, and extremely obese controls. Methods: Sixteen obese and 17 extremely obese adolescents with PCOS, 18 normal-weight, 17 obese, and 13 extremely obese controls underwent polysomno?graphy to compare mean transcutaneous arterial oxygen saturation (Sat O2), apnea-index (AI), hypopnea- index (HI), apnea-hypopnea index (AHI), the absolute number of obstructive apneas (NOA), percentage sleep stages 3 and 4 of non REM-sleep (stages 3 & 4), percentage of REM-sleep (% REM), sleep-onset latency, and sleep efficiency. Results: We found no significant differences between the groups concerning AI, HI, AHI, NOA, and stages 3 & 4. Significant differ?ences between the groups were found regarding Sat O2, % REM, sleep-onset latency, and sleep efficiency. Conclusions: Concerning the respiratory variables, adolescents with PCOS do not seem to differ from healthy controls regardless of weight status, but there seem to be differences in sleep architecture.