Type II Diabetes Mellitus and Obesity in Youths
Type 2 diabetes (T2D), once considered an illness restricted to adults, is progressively affecting more and more adolescents as population rates of obesity increase. Estimates suggest that T2D represents 20–25% of new-onset cases in adolescents and that c
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Cosimo Giannini and Sonia Caprio
Abstract
Type 2 diabetes (T2D), once considered an illness restricted to adults, is progressively affecting more and more adolescents as population rates of obesity increase. Estimates suggest that T2D represents 20–25% of newonset cases in adolescents and that certain ethnic or racial groups are disproportionately affected. Its onset during adolescence represents a serious health burden as T2D shortens life expectancy and is associated with serious medical complications. Thus, effective treatments are urgently needed for youths who face the possibility of experiencing these complications at an earlier age than their adult counterpart. Therefore, the complete characterization of the pathophysiology of the disease represents a key element for assessing its risks and determining factors. Keywords
Type 2 diabetes • Childhood obesity • Pathophysiology of type 2 diabetes • Insulin resistance • Beta-cell function • Therapy for T2D • Therapy for childhood obesity
Introduction Diabetes mellitus is one of the leading chronic diseases of childhood affecting 1.82 out of every 1,000 young people in the United States [1]. Although until a few decades ago, type 1 diabetes
C. Giannini, M.D., Ph.D. • S. Caprio, M.D. (*) Department of Pediatrics, Yale-New Haven, Yale School of Medicine and the Yale Center for Clinical Investigation at Yale University, 330 Cedar Street, P.O. Box 208064, New Haven, CT 06520, USA e-mail: [email protected]
mellitus (T1D) accounted for almost all cases of diabetes in childhood, relevant changes in the prevalence of type 2 diabetes mellitus (T2D) have recently emerged in parallel with the worldwide “obesity epidemic” that has included both the developed and the developing nations [2–4]. Although obesity and in particular obesity with ectopic fat accumulation is a major risk factor, other important contributing factors such as genetic, gender, ethnic background, pubertal stage, and the “toxic environment” are also important triggers for T2D in youths. In this chapter, we review the most recent studies pertinent
S. Radovick and M.H. MacGillivray (eds.), Pediatric Endocrinology: A Practical Clinical Guide, Second Edition, Contemporary Endocrinology, DOI 10.1007/978-1-60761-395-4_29, © Springer Science+Business Media New York 2013
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to the epidemiology and pathophysiology of T2D in youths. In addition, practical approaches to diagnosis and treatment of T2D in obese youths are discussed, and final considerations on how to prevent this twin epidemic are offered.
Worldwide Epidemiology of T2D in Youths As outlined in the American Diabetes Association (ADA) position paper on T2D in children and adolescents [5], classification of diabetes type in youths is not straightforward. Individuals with clinically diagnosed T1D may lack evidence for diabetes-related autoimmunity, and individuals with a clinical diagnosis of T2D may have positive diabetes-related autoantibodies [6, 7]. Due to these challenging issues, the existing data on the prevalence of T2D may l
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