DESCRIPTION

The prevalence of youth-onset type 2 diabetes (T2D) continues to increase especially in youth from racial and ethnic minoritized groups. Youth risk developing devastating microvascular and macrovascular complications by early adulthood. Treatment options (pharmaceutical and other interventions) are continuing to expand.

EPIDEMIOLOGY

• Youth-onset T2D has increased over the past 3 decades in parallel to the increase in rates of obesity.
• Annual incidence increase from 2002 to 2015 was 4.8%, with a range of 0.8–7.7% based on race and ethnicity.
• In 2017, prevalence was estimated at 0.67 per 1,000; likely higher currently.

RISK FACTORS

• Body mass index (BMI) ≥85th percentile
• Adverse social determinants of health
• Adolescent age
• Offspring of mothers with gestational diabetes
• Family history of T2D
• Specific genetic variants
• History of the following:
  • Large for gestational age at birth
  • Intrauterine growth retardation
• Evidence of insulin resistance or metabolic dysregulation
  • Acanthosis nigricans
  • Hypertension, dyslipidemia, nonalcoholic fatty liver disease (NAFLD), polycystic ovarian syndrome (PCOS), or obstructive sleep apnea
• History of prediabetes, especially HgbA1c >6%

PATHOPHYSIOLOGY

• Severe insulin resistance
  • Tissues (muscle, hepatic, adipose) have a decreased response to insulin, mediated by abnormal insulin receptor phosphorylation.
• Initially, compensatory hyperinsulinemia develops to maintain euglycemia.
• Ultimately with β-cell dysfunction, inadequate amounts of insulin are secreted to meet demands from insulin resistance.
• This relative deficiency of insulin secretion leads to hyperglycemia and diabetes.
• Screening for T2D is recommended:
  • At ≥10 years of age or after onset of puberty, whichever is earlier, for youth living with overweight or obesity with 1 or more of the risk factors listed above.
  • With presentation of symptoms of hyperglycemia