The Journal of the Arkansas Medical Society Issue 2 Vol 115 | Page 10

CASE STUDY
Youth-Onset Type 2 Diabetes
Heather Cantrell, APRN, MNSc,
CPNP-AC, CDE, BCADM
Arkansas Children’s Hospital Yu-Chi Wang, MD
Associate Professor of Pediatrics
University of Arkansas for Medical Sciences Jon Oden, MD
University of Arkansas for Medical Sciences
Associate Professor Pediatric Endocrinology,
Section Chief of Pediatric Endocrinology
Abstract
outh-onset Type 2 diabetes is in-
creasing at an alarming rate, in
part due to the obesity epidemic . For the overweight child, the American
Diabetes Association recommends screening
with any of the two following risk factors: family
history of Type 2 diabetes in a first or second
degree relative, race, or ethnicity with increased
risk (Native American, African American, La-
tino, Asian American, or Pacific Islander), signs
of insulin resistance or conditions associated
with insulin resistance (hypertension, dyslipid-
emia, acanthosis nigricans, polycystic ovarian
syndrome, small for gestation birthweight, or
maternal history of gestational diabetes during
the child’s pregnancy). It is important to note
that youth-onset Type 2 diabetes can exist in the
non-obese child. Screening should begin at the
age of 10 or at the onset of puberty (the earlier
of the two) and be carried out every three years
unless signs present sooner. However, docu-
mented cases have occurred at a much younger
age. Diabetes should be suspected and ruled out
in the primary care setting in children who have
any of the following complaints, regardless of
weight: increased thirst (polydipsia), increased
urination (polyuria), nocturia, enuresis, blurry vi-
sion, persistent headaches, unintentional weight
loss/failure to gain weight, recurrent yeast infec-
tions (diaper candidiasis, vaginal candidiasis or
thrush), or recurrent abscesses. The first step in diagnosis should include a
thorough history and physical assessment with
attention to the above signs and symptoms, fol-
lowed by an appropriate laboratory work up. The
initial analysis should include finger-stick glu-
cose for immediate evaluation (diagnosis must
be based on venous stick levels unless there
are overt symptoms), comprehensive metabolic
panel, Glycosylated Hemoglobin A1C, and uri-
nalysis to assess for ketones and glucose. Of
note, a random blood sugar level > 200 mg/dl in
an asymptomatic child should be repeated im-
mediately prior to the diagnosis of diabetes. If
these levels are suspicious for diabetic ketoaci-
dosis (DKA) or if the child appears sick, the child
should be sent to a local emergency room for
further management.
Y
Type 1 diabetes and youth-onset Type 2 diabetes
differ vastly in nature, and appropriate treatment
regimens are necessary to preserve beta cell
function and prevent complications. Guidelines
set forth by experts should be followed for screen-
ing, diagnosis, and treatment. Children found to
be at risk for, or have youth-onset Type 2 diabetes
should be managed by a pediatric diabetes care
provider. A multidisciplinary approach is neces-
sary to provide complete, appropriate education.
Manuscript
Youth-onset Type 2 diabetes is more com-
mon in the pediatric population as obesity rates
are on the rise. Due to the prevalence of obesity,
differentiating Type 1 diabetes from youth-onset
Type 2 diabetes is becoming increasingly difficult.
Treatment regimens differ vastly, so appropriate
recognition and management is crucial. Type 2
diabetes has been described as insulin resistance
and non-autoimmune beta cell dysfunction lead-
ing to hyperglycemia. In contrast, Type 1 diabetes
results from beta cell destruction, generally lead-
ing to absolute insulin deficiency.
Table 1
Diabetes Diagnostic Criteria Prediabetes (Increased Risk for Diabetes)
FPG=/> 126 mg/dl FPG =/> 100mg/dl-125mg/dl
2HR OGTT =/> 200 mg/dl 2HR OGTT 140 mg/dl-199 mg/dl
A1C =/> 6.5% A1C 5.7%-6.4%
Random glucose + Sx =/> 200 mg/dl
34 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
Diagnostic evaluation in the stable patient
can be performed in the following ways: fasting
plasma glucose (FPG), random venous glucose,
two-hour oral glucose tolerance test (2HR OGTT)
with 75g carbohydrate load and venous A1C lev-
els. Table 1 outlines diagnostic criteria for both
Type 1 and youth-onset Type 2 diabetes, as well
as ‘Prediabetes.’ Testing for prediabetes, or in-
creased risk to develop diabetes should be con-
sidered in patients meeting the criteria to screen
for youth-onset Type 2 diabetes.
Any child who is found to have youth-onset
Type 2 diabetes with a random glucose of 250
mg/dl or greater or an A1C of 9% or greater
should immediately be started on insulin under
the supervision of a specialist and care should
be transferred to a pediatric diabetes care pro-
vider. Children who will require multiple daily in-
jections should be admitted to a pediatric inpa-
tient setting to receive appropriate, pediatric fo-
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