Management of Pediatric Type 2 Diabetes

Abstract

Type 2 Diabetes Mellitus (T2DM) can no longer be considered an adult chronic disease. The diagnosis of pediatric T2DM is based on the laboratory criteria of fasting plasma glucose ≥7.0 mmol/L; 2-hour plasma glucose on a 75 g oral glucose tolerance test (OGTT) ≥11.1 mmol/L; random plasma glucose ≥11.1 mmol/L; or A1c ≥6.5% per Diabetes Canada. It is important to note that these criteria are based on extrapolations from adult data, and have not been specifically validated in youth. The International Society for Pediatric and Adolescent Diabetes (ISPAD) adds that the diagnosis should not be made on these laboratory criteria alone, but should include symptoms of hyperglycemia and negative islet auto-antibodies.
 A Canadian national surveillance study of pediatric T2DM completed in 2010, has demonstrated a minimum incidence of youth-onset T2DM of 1.54 per 100,000 children per year with significant regional variation; the highest incidence was 12.45 per 100,000 children per year in Manitoba. Youth-onset T2DM disproportionately affected Canadian children from high-risk ethnic groups, with 44% of new diagnoses occurring in the Indigenous, Asian, African and Caribbean populations.
 Over the past twenty years, youth-onset diabetes has been rising. In the United States, according to the SEARCH for Diabetes in Youth Study, there has been an annual increase of 7.1% observed across all age, sex, race and ethnic groups. The COVID-19 pandemic has added further escalation in the incidence of youth-onset worsening disease severity at presentation. New cases in the United States rose by 77.3% in the initial year following the COVID-19 pandemic, vs in the two years pre-pandemic. Furthermore, 21% of youth presented with diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome vs previous estimates of 9% pre-pandemic. The SEARCH for Diabetes in Youth Group projects that the number of youths with T2DM will increase from 28,000 to 48,000 youth today, to 220,000 youth by 2060, with widening racial and ethnic disparities among youth with T2DM