Epidemiology (Lancet 2007;369:1823; Diabetes Care 2006;29:212; Pediatr Diabetes 2009:10(Suppl. 12):3)
• U/S prevalence ↑ing; most countries <10%, Japan 60–80%
• STOPP-T2D trial: ∼50% middle-school students w/ ↑BMI (≥85 percentile), 40%
w/fasting glucose ≥100 mg/dL, (only 0.4% >125 mg/dL, and 
w/ hyperinsulinism
w/fasting insulin ≥30 μU/mL) and thus prediabetes (Diabetes Care 2006;29:212)
Diagnostic Studies (Pediatrics 2003;112:e328)
• Characteristics: Polygenic, pubertal, rarely autoimmunity, acanthosis nigricans
• At dx, screen for proteinuria/microalbuminuria, dilated funduscopic exam by ophtho
• After metabolic stabilization (1–3 mo after dx): LFTs & fasting lipids
• Repeat all preceding annually. (AAP guidelines for at-risk groups) HgbA1c q3mo
Complications (Acute) (Lancet 2007;369:1823)
• Multi studies, 11–25% of pts p/w DKA, more w/ ketonuria (see section on DKA)
• Hyperglycemic hyperosmolar state (glucose >600 mg/dL, osmolality >330 mOsm/L, mild acidosis w/ bicarbonate >15 mmol/L and mild ketonuria ≤15 mg/dL) 2/2 nonadherence to Rx, meds, and stresses (infections, substance abuse, chronic disease)
• In one study at tertiary care facility, 3.7% of pts w/ T2DM had this presentation; case-mortality rates are high across studies, and range from 14% to 42%. Pts are more dehydrated than clinically apparent (J Pediatr 2011;158:9)
Complications (Chronic) (Lancet 2007;369:1823)
• Microalbuminuria and risk of AMI ↑ for pts w/ DM2 dx’d at younger ages
• HTN, dyslipidemia, retinopathy, nonalcoholic fatty liver dz, and neuropathy
• Poor glycemic control (by HgbA1c) & HTN predictive of subseq complications
• Complications may progress more rapidly in young DM2 than w/ DM1
Treatment
• Lifestyle Δ, diet mod, weight mgmt, exercise are effective but adherence is difficult
• Oral hypoglycemics; metformin (FDA approved). Dose can be titrated up slowly to avoid common side effects (headache, nausea)
• Insulin usually necessary with time