Youth-onset type 2 diabetes

Youth-onset type 2 diabetes (T2D) is an emerging disorder in children, adolescents, and young adults with unique clinical challenges. The incidence of T2D in youth has increased dramatically over the last 20 years, though it remains rare, even in populations at the highest risk. T2D in youth resembles the pathophysiology in adults: Insulin resistance and non-autoimmune β-cell failure. However, youth-onset T2D has a number of unique aspects, including close association with the pubertal decrease in insulin sensitivity, a female sex preponderance, and reversibility in some individuals due the dynamic nature of the underlying insulin resistance. At the same time, another substantial portion of affected youth are characterized by more rapid β-cell failure, and failure of oral therapy, than in adults. Finally, there is evidence of early appearance and rapid accrual of microvascular complications and risk markers for macrovascular complications. This chapter will discuss the unique pathophysiology and clinical course of youth-onset prediabetes and T2D, the epidemiology of the disorder in the US and elsewhere, the spectrum of clinical presentation, the approach to determination of diabetes type given the relatively rarity of T2D in the pediatric population, and the initial and subsequent treatment of affected individuals. The chapter will also review appropriate monitoring and treatment of microvascular, macrovascular and other associated complications and comorbidities of youth-onset T2D.