Feature Article

Type 2 diabetes in adolescents: a growing issue




The prevalence of type 2 diabetes in adolescents is increasing but the rate is still low and this type is much less common than type 1 diabetes. Confirming the presence and type of diabetes is important to ensure appropriate therapy is commenced to control glycaemia and prevent complications or the progression of any that are already present. Lifestyle modifications are the mainstay of treatment, and metformin and/or insulin are the main medication options.

Key Points

  • Type 2 diabetes is becoming more common in adolescents, but the overall prevalence is still low, and much below that of type 1 diabetes.
  • Type 2 diabetes onset generally coincides with mid to late puberty, during the peak of physiological pubertal insulin resistance.
  • Patients with type 2 diabetes are usually asymptomatic at presentation, being diagnosed incidentally or on screening after consideration of risk factors (family history of type 2 diabetes, obesity, signs of insulin resistance and high-risk race/ethnicity).
  • Diagnosis of type 2 diabetes is by glucose-based tests or glycated haemoglobin (HbA1c): fasting plasma glucose ≥7.0 mmol/L; 2 h plasma glucose after an oral glucose tolerance test ≥11.1 mmol/L; or HbA1c ≥48 mmol/mol (6.5%). Each test has its limitations. 

  • Treatment of type 2 diabetes is multidisciplinary. Lifestyle modification is the focus, with use of oral hypoglycaemics and insulin therapy depending on the degree of clinical decompensation.
  • Vigilance in follow-up health care is especially required in adolescents with diabetes as lifestyle and antihyperglycaemic medication interventions are often not very effective or durable in this patient population.

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