Type 2 diabetes mellitus in UK children - an emerging problem

Aims Type 2 diabetes mellitus has never previously been described in UK chi ldren, although an increasing incidence in childhood is recognized in inter national studies. The prevalence of obesity in UK children is increasing an d is a recognized risk factor for the development of diabetes. The aim of t his study was to identify and characterize children with Type 2 diabetes in the West Midlands and Leicester. Methods Children were identified by contacting paediatricians responsible f or diabetes in five hospitals. Details were collected on demographics, mode of presentation, investigations and treatment on a standard proforma. Results Eight girls were identified with Type 2 diabetes, aged 9-16 years a nd who were of Pakistani, Indian or Arabic origin. They were all overweight (percentage weight for height 141-209%) and had a family history of diabet es in at least two generations. They presented insidiously with hyperglycae mia and glycosuria without ketosis and five were asymptomatic. Islet cell a ntibodies measured in seven patients were negative. Four had acanthosis nig ricans which is a cutaneous marker of insulin resistance and the other four had high plasma levels of insulin and/or C peptide. These patients are dis tinct from those with maturity-onset diabetes of the young (MODY). All were initially managed with dietary measures, seven have been treated with oral anti-diabetic agents of whom two have subsequently required insulin. Conclusions These are the first UK case reports of Type 2 diabetes in child ren. Paediatricians need to be aware of the risk of Type 2 diabetes develop ing in childhood in high-risk ethnic groups, particularly in association wi th obesity and a positive family history.