Type-2-diabetes in children and adolescents

Until recently, type-2-diabetes in pediatric patients was often used as a s ynonym for MODY-diabetes, a rare form with autosomal-dominant inheritance w hich often does not require insulin. In the new classification of diabetes, however, MODY is grouped as type 3, genetic defects of insulin secretion. Meanwhile, at least 5 phenotypically and genetically different forms of MOD Y are distinguished. During recent years,a rapid increase in classical type -2-diabetes, associated with insulin resistance, has been reported primaril y from the United States. Risik factors are overweight, children from ethni c minorities (Indian, Hispanic, Afro-american), type-2-diabetes in parents/ siblings as well as acanthosis nigricans or hyperandrogenism. beta -cell-sp ecific immune markers (e.g. beta -cell-antibodies) are absent, insulin and C-peptide are elevated. However, the presence of ketone in the urine or ket oazidosis does not necessarily exclude type-2-diabetes in adolescents. Ther apeutic intervention should primarily aim at weight reduction, however, add itional insulin or oral hypoglycemic agents like metformin are often necess ary. However, so far, experience with oral agents in the pediatric age-rang e is limited. If possible, the choice of medication should not interfere wi th weight reduction in the patient. At present, the contribution of specifi c genetic factors interacting with increasing overweight and sedentary life stile is still unclear. Therefore no clear prediction is possible, whether the dramatic increase in type-2-diabetes in some populations in the US and the pacific area will occur with a similar magnitude in Europe as well.