Obesity and type 2 diabetes in children and youth

Purpose of review Multiple aspects of the obesity and type 2 diabetes epidemics, how to distinguish type 2 from type 1 diabetes in youth, and how to manage type 2 diabetes are reviewed. Recent findings Sixteen percent of youth were overweight in the US in 1999–2000; in 2003–2004 this increased to 17.1%. This has resulted in a marked increase in the incidence of metabolic syndrome and type 2 diabetes in pediatric subjects. Risk factors that predispose to insulin resistance and limited β cell reserve include race/ethnicity, obesity, sedentary behavior, family history of type 2 diabetes, puberty, low birth weight and female gender. There appears to be a rapid progression from impaired glucose tolerance to type 2 diabetes in severely obese youth. Tests should be performed to differentiate type 1 from type 2 diabetes. Treatment algorithms are aimed to avoid poor long-term outcomes for youth with type 2 diabetes. Summary Clinically relevant information is given in this review to understand risk factors for type 2 diabetes, including how obesity causes insulin resistance, and to promote the appropriate work-up and management of type 2 diabetes in the pediatric population.