TYPE
2 DIABETES MELLITUS EMERGING IN CHILDREN AND ADOLESCENTS - A NEW HEALTH
PROBLEM IN THE PEDIATRICS
Kaichi Kida
Ehime
University School of Medicine, Ehime 791-0295, Japan
Type 2 diabetes is a major type of diabetes
which is one of the biggest global health problems in adults today while it
is considered to be a minor or rare type of diabetes and not a serious
problem in children and adolescents. Rapid modernization of life style,
however, has been causing a steep increase of type 2 diabetes in children
and adolescents not only among particular high risk ethnic groups including
Native Canadians, Native Americans, African Americans, Latin Americans and
Japanese but also among many others including Caucasians. The incidence or
prevalence of type 2 diabetes in children and adolescents among high risk
ethnic groups is estimated to be 5-10 times higher than that that of type 1
diabetes in this age group.
Type 2 diabetes is caused by insulin
resistance and relative insufficiency of insulin secretion. Obesity is a
major risk factor for type 2 diabetes in children and adolescents as well
as in adults since it strongly associates with insulin resistance which is demonstrated
by an insulin resistance index(HOMA-R), minimal model with IVGTT and hyper-
or euglycemic clamp technique. Even healthy children of a high risk ethnic
group are shown to be more insulin resistant than those of a low risk
ethnic group. On the other hand, relative insufficiency of insulin
secretion plays a role in the development of childhood and adolescent type
2 diabetes in certain ethnic groups such as Japanese.
Chronic complications of retinopathy and
nephropathy develop in children and adolescents with type 2 diabetes as
fast as or even faster than in those with type 1 diabetes. A lack of
subjective symptoms in type 2 diabetes often leads to a poor compliance for
the treatment. It is thus anticipated that visual disorders and renal
failure from type 2 diabetes will be increased in the future. Early
detection of type 2 diabetes by screening and its primary prevention by
removing risk factors associated with life style in children and
adolescents are needed for a new health problem in the pediatrics.