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Type 2 Diabetes in Youth: Epidemiology and Pathophysiology

Ebe D’Adamo, +1 more
- 01 May 2011 - 
- Vol. 34, Iss: 2
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TLDR
The pathophysiology of type 2 diabetes and the natural history of this pathology in obese children and adolescents is explored, which is associated with an increased lipid accumulation in visceral compartments, liver and muscle tissues and by reduced sensitivity of I²-cell of first and second-phase insulin secretion.
Abstract
The prevalence of type 2 diabetes is significantly increased in the pediatric population, which is affected by obesity worldwide. The progression from normal glucose tolerance (NGT) to type 2 diabetes involves intermediate stages of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), also known as prediabetes. The pathophysiology underlying the development of these glucose metabolic alterations is multifactorial; however an alteration in the balance between insulin sensitivity and insulin secretion represents the most important player in the development of type 2 diabetes. Obese children and adolescents affected by IGT and type 2 diabetes are characterized by severe insulin resistance, which is associated with an increased lipid accumulation in visceral compartments, liver and muscle tissues and by reduced sensitivity of I²-cell of first and second-phase insulin secretion. The progression in obese children of insulin resistance to type 2 diabetes has been shown to be faster than in adults; in addition, type 2 diabetes is already associated with several metabolic and cardiovascular complications in this age group. In the present review, we summarize the most recent findings concerning the prevalence of type 2 diabetes in youth and in particular we explore the pathophysiology of type 2 diabetes and the natural history of this pathology in obese children and adolescents. Concurrent with the worldwide epidemic increase of childhood obesity, type 2 diabetes and the two prediabetic conditions, IFG and IGT, are becoming increasingly more common in obese children and adolescents (1,2). Until 10 years ago, type 2 diabetes accounted for less than 3% of all cases of new-onset diabetes in adolescents. At present 45% of cases are attributed to it (3,4). Type 2 diabetes occurs in youth more often during the second decade of life, coinciding with the physiological occurrence of pubertal insulin resistance (1). In addition, …

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Journal ArticleDOI

Type 2 diabetes in adolescents and young adults

TL;DR: Evidence is accumulating that young-onset type 2 diabetes has a more aggressive disease phenotype, leading to premature development of complications, with adverse effects on quality of life and unfavourable effects on long-term outcomes, raising the possibility of a future public health catastrophe.
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Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease

TL;DR: Paradigms in cardiovascular survival in patients with T2DM have contributed to patients surviving longer, allowing sufficient time to develop renal impairment, and this Review explores how the changing epidemiology of T2 DM has influenced the prevalence and incidence of associated CKD across different populations and clinical settings.
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Global trends in the incidence and prevalence of type 2 diabetes in children and adolescents : a systematic review and evaluation of methodological approaches

TL;DR: Worldwide incidence and prevalence of type 2 diabetes in children and adolescents vary substantially among countries, age categories and ethnic groups and this can be explained by variations in population characteristics and methodological dissimilarities between studies.
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Early onset type 2 diabetes: risk factors, clinical impact and management:

TL;DR: A review on the impact of early onset T2DM provides the latest insights into this emerging epidemic with a need for multidisciplinary care of complications and comorbidities, in addition to adequate educational and psychological support.
References
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Journal ArticleDOI

High Visceral and Low Abdominal Subcutaneous Fat Stores in the Obese Adolescent: A Determinant of an Adverse Metabolic Phenotype

TL;DR: Obese adolescents with a high proportion of visceral fat and relatively low abdominal subcutaneous fat have a phenotype reminiscent of partial lipodystrophy, yet they suffer from severe metabolic complications and are at a high risk of having the metabolic syndrome.
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Decreased insulin-stimulated ATP synthesis and phosphate transport in muscle of insulin-resistant offspring of type 2 diabetic parents.

TL;DR: It is demonstrated that insulin-stimulated rates of mitochondrial ATP synthesis are reduced in IR offspring of parents with type 2 diabetes, and these IR offspring also have impaired insulin- Stimulated phosphate transport in muscle, which may contribute to their defects in insulin- stimulated rates of ATP synthesis.
Journal ArticleDOI

Rising incidence of type 2 diabetes in children in the U.K.

TL;DR: In this article, the authors estimate the incidence of Type 2 diabetes in children under 17 years of age and its relationship to increasing childhood obesity in the United Kingdom and the Republic of Ireland (ROI).
Journal ArticleDOI

Impaired Glucose Tolerance and Reduced β-Cell Function in Overweight Latino Children with a Positive Family History for Type 2 Diabetes

TL;DR: IGT was present in 28% of children, and was similar across obesity groups, but higher in children exposed to gestational diabetes mellitus, and DI was significantly lower in IGT children by 16% (P < 0.02), but DI was inversely related to age.
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