Type 2 Diabetes in Children and Adolescents

Initial treatment often focuses on changing lifestyle habits.

Type 2 diabetes has long been associated with adults. But in the last 20 years, the incidence of type 2 diabetes in children and adolescents has been rising worldwide. 

The children of certain ethnic groups are more susceptible: Africans, Middle Easterners, Asians, Hispanics and Aboriginals. In Canada, an estimated 44% of children diagnosed with type 2 diabetes are Aboriginal.

Symptoms

The symptoms are the same as for adults. Sometimes there are no symptoms at diagnosis.

Screening

Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Treatment of Diabetes in Canada recommends screening every two (2) years for children and adolescents in the following cases:

1. Presence of at least three (3) of the following risk factors for prepubescent children or at least two (2) of these risk factors after puberty:

  • Obesity: a BMI over the 95th percentile
  • Belonging to a high-risk population: Aboriginal, African, Asian, Arab, Hispanic or South Asian
  • Presence of type 2 diabetes in the immediate family (brother, sister, father, mother)
  • Presence of gestational diabetes in the mother during the child’s gestation
  • Signs of insulin resistance: ancanthosis nigricans , high blood pressure (hypertension), dyslipidemia, nonalcoholic fatty liver disease (NFLD), polycystic ovary syndrome (PCOS)

2. Abnormal fasting blood glucose (sugar) levels or glucose intolerance detected with a blood test

3. Taking atypical antipsychotic drugs

Measuring the level of glycated hemoglobin (A1C) alone is not recommended for diagnosing type 2 diabetes in children. It should be used in combination with fasting blood glucose test (FPG) and/or oral glucose tolerance test (OGTT). Otherwise, the diagnostic criteria are the same as for adults.

Treatment

When treating the diabetes, the child or adolescent should be supported by a team comprising various health care professionals.

Usually, the initial treatment focuses on changing lifestyle habits, because type 2 diabetes in children is primarily caused by being overweight. The entire family needs to get involved to achieve sustainable results.

If this change in lifestyle habits does not prove effective, then oral medication and sometimes insulin will be prescribed. It might sometimes be necessary to use insulin temporarily at the start of treatment if the child has symptoms of severe hyperglycemia at diagnosis. Sticking to the treatment is important to prevent early complications.

Prevention

Preventing type 2 diabetes is based on modifiable risk factors, primarily the prevention of obesity and the adoption of an active lifestyle and a healthy diet.

Research and writing: Diabetes Québec’s team of health professionals

© Diabetes Québec – September 2020

References:

Panagiotopoulos C, Hadjiyannakis S and Henderson M. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Type 2 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42 (Suppl 1): S247-S254.

Geoffroy L. and Gonthier M. (2012), “Le diabète de type 2,” Le diabète chez l’enfant and l’adolescent, (2e edition, pp. 61-66). Montréal: Éditions du CHU Ste-Justine.

Van Hulst A., Bonin S., Nakouzi P. et Henderson, M. (2018). Diabète de type 2 chez les jeunes: stratégies nutritionnelles pour la prévention et la prise en charge. Nutrition – Science en évolution, 16(1), 7-12.