Sample

DIAGNOSIS AND DIAGNOSIS AND TREATMENT OF TYPE 2 TREATMENT OF TYPE 2 DIABETES IN CHILDRENDIABETES IN CHILDREN

Sample-RHK

Outline of DiscussionOutline of Discussion

The importance of the problem Diagnosis of type 2 diabetes in children Special problems in children with T2DM Management based on presentation The metformin trial Comorbid conditions

ELEVATED GLUCOSE

PANCREAS

1. IncreasedHepatic GlucoseProduction

Pathogenesis of Type 2 Pathogenesis of Type 2 DiabetesDiabetes

2. Impaired Pancreatic Insulin Secretion

3. PeripheralInsulin Resistance

MUSCLE

LIVER

L

L

L

Mokdad et al. Diabetes Care. 2000;23:1278.

Diabetes Trends in the United Diabetes Trends in the United StatesStates

Prevalence of diagnosed diabetes increased by 33% from 1990 to 1998

Age (y) % Increase30–39 7040–49 4050–59 31

Highly correlated with prevalence of obesity (r = 0.64, P < 0.001)

World wide trend of Type 2 Diabetes from 2000 to 2010World wide trend of Type 2 Diabetes from 2000 to 2010

Numbers of people with diabetes (in millions) for 2000 and 2010 (top and middle values, respectively), and the percentage increase.Source : Nature 414, 782 - 787 (2001)

Projected Obesity prevalence from 1960 to 2025Projected Obesity prevalence from 1960 to 2025

Source: Nature 404, 2000

J Pediatr. May 2000.

Type 2 Diabetes in ChildrenType 2 Diabetes in ChildrenEpidemiology: Population-BasedEpidemiology: Population-Based

Population Age (y) Sample Size Prevalence

per 1000 Navajo Indians 12–19 142 14.1

10–14 672 22.3 Pima Indians

15–19 530 50.9

4–19 717 11.1 Cree and Ojibway

10–19 – 0 for males 36 for

females US Caucasians, African Americans (AA), and Mexican Americans (MA)

12–19 2867 4.1

0

2

4

6

8

10

12

14

16

1990 1991 1992 1993 1994 1995 1996 1997 1998

Pat

ien

tsType 2 Diabetes in Children:Type 2 Diabetes in Children:

Diagnosis by YearDiagnosis by Year

Prevalence of IFG in Nondiabetic US Adolescents Prevalence of IFG in Nondiabetic US Adolescents (Aged 12–19 Yrs)(Aged 12–19 Yrs)

ADA Guidelines for Screening, ADA Guidelines for Screening, Treatment of Children, AdolescentsTreatment of Children, Adolescents

ADA Guidelines for Screening, ADA Guidelines for Screening, Treatment of Children, Adolescents (cont.)Treatment of Children, Adolescents (cont.)

C-Peptide Values at C-Peptide Values at Diagnosis in T1DM and T2DMDiagnosis in T1DM and T2DM

Unstimulated C-peptide values C

-pep

tid

e (%

UL

N)

N=38

N=42

P<0.001140

120

100

80

60

40

20

0

T1DM T2DM

Special Issues In ChildrenSpecial Issues In Children

Risk of misdiagnosis Need for initial use of insulin because

of uncertainty or DKA Lack of information regarding safety

and efficacy of oral agents

Special Issues in Children Special Issues in Children With T2DMWith T2DM

Risk of misdiagnosis Need for initial use of insulin because

of uncertainty or DKA Lack of information regarding safety

and efficacy of oral agents

Need for Initial Insulin Use in Need for Initial Insulin Use in ChildrenChildren

At least 10% of children with new-onset type 2 diabetes present with DKA

A multicenter therapeutic study found 20% of suspected type 2 adolescents were antibody-positive

Sometimes the diagnosis is just not initially clear and must await the return of immune markers and C-peptide

Some anxious parents want the blood glucose reduced quickly and don’t want to wait for the slower response to oral agents

SummarySummary

The approaches to glycemic therapy in type 2 diabetes in children do not differ from those in adults

Therapy by lifestyle change is difficult to implement and ineffective in children

A double-blind, placebo-controlled trial of metformin in children showed it to be safe and effective in this age group

Sample

Health & Medicine

Transcript of Sample