Type 2 Diabetes Mellitus in Children and Adolescence: A Primer

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Type 2 diabetes mellitus traditionally has been considered a disorder of adults, rarely encountered in children. During the past 10 years, the disorder has been described with increasing frequency in the young, especially in adolescents. This increase has been so striking that it has been described as an epidemic. Although most races and ethnic origins have been affected, those adolescents affected are primarily Native American or North American aboriginal or have Mexican, African, or Asian genetic heritages. This review is intended to serve as a primer for those unfamiliar with this disease as it occurs in children. It briefly discusses the forms of diabetes currently being found in children and specifically reviews the clinical reports of type 2 diabetes, describing its epidemiology, clinical manifestations, diagnosis, and differential diagnosis. Approaches to therapy are discussed with attention to particular problems in this young population. Current recommendations for therapy are outlined and the recent report of a controlled trial of metformin in children is discussed, as is the authors' experience. The need to begin careful studies in children of glycemic management with oral antidiabetic drugs and to begin study of therapy of comorbid conditions is also addressed.The Endocrinologist 2000; 10: 389-396

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