Type Diabetes Mellitus in Youth The Complete Picture to Date

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Neslihan Gungor, MD, Tamara Hannon, MD, Ingrid Libman, MD, PhD, Fida Bacha, MD, Silva Arslanian, MD*

Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA

Type 2 diabetes mellitus (T2DM) historically was considered a disease of adults, with autoimmune type 1 diabetes mellitus (T1DM) accounting for almost all cases of pediatric diabetes. T2DM was recognized as a disease of the pediatric age group by the late 1970s. It has turned into a significant public health problem, with escalating numbers of new cases referred to as an "epidemic" by the American Diabetes Association (ADA) [1,2]. The problem is not limited to North America; it also has been reported in children from Europe [3-10], Asia [11-15], Africa [16], and Australia [17].

T2DM is a heterogeneous condition in which the clinical manifestation of hy-perglycemia is a reflection of the impaired balance between insulin sensitivity and insulin secretion [18,19]. Clinical experience and research in youth T2DM are in an early stage because of the relative novelty of the condition in pediatrics. This article discusses the amassed information in T2DM of youth to date with respect to the epidemiology, pathophysiology, risk factors, clinical presentation, screening, and management strategies.

This work was supported by the United States Public Health Service grant RO1 HD27503 (SA), K24 HD01357 (SA), the Pittsburgh Foundation (NG), M01-RR00084 General Clinical Research Center, the University of Pittsburgh Obesity and Nutrition Research Center (NG), the Thrasher Research Fund, the Cochrane-Weber Endowed Fund, the Bristol Myers Squibb Company, Eli Lilly and Company, and the Renziehausen Trust Fund.

* Corresponding author.

E-mail address: [email protected] (S. Arslanian).

0031-3955/05/$ - see front matter © 2005 Elsevier Inc. All rights reserved.

doi:10.1016/j.pcl.2005.07.009 pediatric.theclinics.com

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