Cukrzyca typu 2 u dzieci – Rokowania, prognozy i postęp choroby

Cukrzyca typu 2 u dzieci
Rokowania, prognozy i postęp choroby

Cukrzyca typu 2 u dzieci charakteryzuje się agresywnym przebiegiem i gorszym rokowaniem w porównaniu z postacią dorosłych, z szybszą progresją choroby i wcześniejszym wystąpieniem powikłań mikronaczyniowych (już w ciągu 5 lat od diagnozy) oraz koniecznością włączenia insulinoterapii. Badanie TODAY wykazało, że u 80% młodych pacjentów występuje niski poziom cholesterolu HDL, u 26% nadciśnienie, a u 10% hipertriglicerydemia w momencie rozpoznania. Kontrola glikemii na poziomie HbA1c ≤7% jest kluczowa dla zmniejszenia ryzyka powikłań mikronaczyniowych i makronaczyniowych, a wczesne obniżanie glikemii wiąże się z lepszym rokowaniem. Indeks Szans Dziecięcych (Child Opportunity Index, COI) jest istotnym markerem ryzyka, powiązanym z ciężkością prezentacji klinicznej, w tym kwasicą ketonową przy rozpoznaniu.

Prognoza cukrzycy typu 2 u dzieci

Agresywny przebieg choroby
Czynniki wpływające na rokowanie
Powikłania długoterminowe
Obciążenie ekonomiczne
Grupy szczególnego ryzyka
Wyzwania terapeutyczne
Strategie poprawy rokowania
Podejście rozwojowe do zarządzania chorobą
Kolejne rozdziały

Prognoza cukrzycy typu 2 u dzieci

Cukrzyca typu 2 u dzieci jest chorobą przewlekłą, która w porównaniu do postaci występującej u dorosłych, charakteryzuje się bardziej agresywnym przebiegiem i gorszymi rokowaniami długoterminowymi. Liczne badania wskazują na znacząco zwiększone ryzyko powikłań prowadzących do zwiększonej chorobowości i śmiertelności w najbardziej produktywnych latach życia pacjentów.¹² Prognozy dla dzieci z cukrzycą typu 2 są niepokojące – szacuje się, że młodzi pacjenci z tą chorobą mogą stracić około 15 lat życia w porównaniu z rówieśnikami bez cukrzycy.³⁴

Agresywny przebieg choroby

Wczesne wskaźniki sugerują, że cukrzyca typu 2 diagnozowana u młodzieży może być bardziej ciężka i trudniejsza w leczeniu niż u dorosłych.¹ Badania wykazały, że dzieci i młodzież z cukrzycą typu 2 doświadczają szybszej progresji choroby w porównaniu do osób dorosłych.² Badanie TODAY ujawniło, że spośród 704 młodych pacjentów z diagnozą cukrzycy typu 2, 80% miało niski poziom cholesterolu HDL, 26% nadciśnienie, a 10% hipertriglicerydemię już w momencie rozpoznania choroby.³

Wczesne wystąpienie cukrzycy typu 2 wiąże się z krótszym czasem do konieczności włączenia insulinoterapii, szybszym rozwojem powikłań cukrzycowych i chorób sercowo-naczyniowych w porównaniu zarówno z cukrzycą typu 2 o późnym początku, jak i cukrzycą typu 1.⁴ Pogorszenie kontroli glikemii może nastąpić już w ciągu 2 lat po rozpoznaniu, a powikłania mikronaczyniowe mogą pojawić się w ciągu 5 lat od diagnozy.⁵

Czynniki wpływające na rokowanie

Rokowanie u pacjentów z cukrzycą typu 2 jest silnie uzależnione od stopnia kontroli choroby. Przewlekła hiperglikemia wiąże się ze zwiększonym ryzykiem powikłań mikronaczyniowych, co wykazano w badaniu Diabetes Control and Complications Trial (DCCT) u osób z cukrzycą typu 1 oraz w badaniu United Kingdom Prospective Diabetes Study (UKPDS) u osób z cukrzycą typu 2.¹

Badanie brytyjskie wskazało, że poziom HbA1c osiągnięty 3 miesiące po początkowym rozpoznaniu cukrzycy typu 2 przewiduje późniejszą śmiertelność. Agresywne obniżanie poziomu glukozy po diagnozie wiąże się z lepszym rokowaniem długoterminowym.² Ścisła kontrola glikemii (HbA1c 7% lub niższy) jest wartościowa dla zmniejszenia ryzyka chorób mikronaczyniowych i makronaczyniowych u pacjentów z niedawno rozpoznaną chorobą, bez znanych chorób sercowo-naczyniowych i z dłuższą przewidywaną długością życia.³

Indeks Szans Dziecięcych (Child Opportunity Index, COI) jest znacząco niższy u młodzieży z cukrzycą typu 2 i silnie wiąże się z prezentacją kliniczną u młodzieży z nowo rozpoznaną cukrzycą, w tym z obecnością kwasicy ketonowej przy rozpoznaniu. COI może być szczególnie ważnym markerem ryzyka kwasicy ketonowej i cukrzycy typu 2 u młodzieży.⁴

Powikłania długoterminowe

Cukrzyca typu 2 może wpływać na prawie każdy narząd w ciele dziecka, w tym naczynia krwionośne, nerwy, oczy i nerki. Długoterminowe powikłania cukrzycy typu 2 rozwijają się stopniowo przez wiele lat. Ostatecznie powikłania cukrzycy mogą być poważne, a nawet zagrażające życiu.¹

Utrzymywanie poziomu cukru we krwi dziecka blisko standardowego zakresu przez większość czasu może drastycznie zmniejszyć ryzyko tych powikłań.² Kontrola glikemii poprawia ryzyko mikronaczyniowe, ale nie wpływa znacząco na ryzyko sercowo-naczyniowe.³

Pomimo wdrożonego leczenia, powikłania takie jak nadciśnienie, dyslipidemia i mikroalbuminuria utrzymują się po diagnozie, co jest zgodne z innymi badaniami podkreślającymi nieskuteczność obecnych strategii leczenia w zatrzymaniu progresji choroby.⁴

Obciążenie ekonomiczne

Obciążenie ekonomiczne związane z cukrzycą typu 2 znacząco wzrasta wraz z liczbą lat trwania choroby.¹ Ta ponura prognoza podkreśla, że nie tylko obciążenie chorobą będzie znaczące, ale także obciążenie ekonomiczne będzie wysokie u młodzieży zdiagnozowanej z cukrzycą typu 2.²

Nabycie cukrzycy typu 2 i jej chorób współistniejących w młodszym wieku nie tylko wpływa na zdolność jednostki do pełnego uczestnictwa w nauce i pracy, ale także zwiększa zachorowalność i śmiertelność w latach szczytowej zdolności zarobkowej i pracowniczej.³

Grupy szczególnego ryzyka

Dzieci i młodzież po przebytej chorobie nowotworowej są narażone na trzykrotnie większe ryzyko rozwoju cukrzycy typu 2 niż ich rodzeństwo. Jednak osoby rasy czarnej nie-latynoskiej doświadczają trzykrotnie większego ryzyka niż osoby białe nie-latynoskie.¹

Ryzyko genetyczne nieproporcjonalnie dotyka osoby pochodzenia afrykańskiego lub afroamerykańskiego, które wcześniej były leczone środkami alkilującymi.² W kontekście przeżycia choroby nowotworowej w dzieciństwie, czynniki genetyczne w obecności środków alkilujących mogą znacząco zwiększyć ryzyko cukrzycy typu 2.³

Wyzwania terapeutyczne

Cukrzyca typu 2 u dzieci i młodzieży stanowi poważny problem medyczny, który jest bardziej agresywny niż postać dorosła, trudniejszy do zdiagnozowania i ma ograniczone dostępne opcje leczenia.¹ Wiąże się również z wysokim odsetkiem powikłań związanych z cukrzycą i otyłością.²

Celem terapii jest osiągnięcie euglikemii.³ Pierwszą interwencją w leczeniu cukrzycy typu 2 pozostają zdrowe modyfikacje stylu życia, w tym modyfikacje dietetyczne oraz zwiększenie aktywności fizycznej i programów ćwiczeń w celu osiągnięcia stabilizacji masy ciała, a ostatecznie utraty wagi.⁴

Przestrzeganie interwencji terapeutycznych jest kluczowe dla osiągnięcia odpowiedniej kontroli cukrzycy i jest mocno podkreślane.⁵ Celem leczenia jest osiągnięcie normoglikemii oraz odpowiednie zarządzanie współchorobowością i powikłaniami, aby zapobiec przyszłemu pogorszeniu stanu zdrowia.⁶

Strategie poprawy rokowania

Młodzi ludzie z cukrzycą typu 2 powinni być leczeni w ramach pediatrycznego zespołu diabetologicznego, ściśle współpracującego ze specjalistami diabetologii dorosłych, podstawową opieką zdrowotną i innymi specjalnościami pediatrycznymi.¹

Pomaganie dziecku w zapobieganiu powikłaniom cukrzycy można osiągnąć poprzez:²

Współpracę z dzieckiem w celu utrzymania dobrej kontroli poziomu cukru we krwi w jak największym stopniu
Zdrowe wybory stylu życia, które mogą pomóc zapobiec cukrzycy typu 2 u dzieci

Leczenie obejmuje zdrową dietę, regularne ćwiczenia i utratę wagi. W niektórych przypadkach mogą być potrzebne leki i insulina.⁴ Cukrzyca typu 2 jest chorobą przewlekłą, która wymaga zmian w stylu życia, aby utrzymać zdrowy poziom glukozy we krwi. Ważne jest, aby ściśle współpracować z zespołem opieki zdrowotnej dziecka w celu stworzenia bieżącego planu, który działa dla danego dziecka.⁵

Na podstawie najnowszych badań identyfikacja pacjentów najbardziej zagrożonych cukrzycą typu 2 może umożliwić bardziej spersonalizowane możliwości interwencji i zapobiegać powikłaniom sercowo-naczyniowym w przyszłości.⁶

Podejście rozwojowe do zarządzania chorobą

Zrozumienie, jak pojawiają się trajektorie choroby i które czynniki oraz zdarzenia prowadzą do ścieżek powodujących chorobę, jest kluczowe nie tylko dla zrozumienia początku i zmiennej historii naturalnej choroby, ale także dla określenia sposobów jej zapobiegania i leczenia.¹

Wymagane jest podejście do rozwoju zdrowia w ciągu życia, które szczegółowo opisuje czynniki ryzyka i czynniki ochronne, a także strategie zapobiegawcze i lecznicze, umieszczone w kontekście etapu rozwojowego dziecka.² Organizacja opieki powinna uwzględniać cztery kluczowe etapy rozwojowe: poczęcie i życie wewnątrzmaciczne, niemowlęctwo, dzieciństwo (wczesne i środkowe) oraz adolescencję.³

Podsumowując, cukrzyca typu 2 u dzieci i młodzieży stanowi poważne wyzwanie zdrowotne o agresywnym przebiegu i gorszym rokowaniu w porównaniu z formą dorosłą. Wczesna diagnoza, ścisła kontrola glikemii, kompleksowe podejście do leczenia i zapobieganie powikłaniom są kluczowe dla poprawy długoterminowych wyników zdrowotnych. Istotne jest również uwzględnienie czynników socjoekonomicznych, genetycznych i rozwojowych, które wpływają na przebieg choroby i jej rokowanie.

Kolejne rozdziały

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Materiały źródłowe

#1 A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus | BMC Medicine | Full Text
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03349-4
Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. […] Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. […] Glycaemic control improves microvascular but not cardiovascular risk. […] This guideline is the first national guideline on managing type 2 diabetes in children and young people. It gives practical advice on managing this challenging and aggressive condition. […] The authors hope that this guideline will provide paediatricians with the necessary information about managing type 2 diabetes and associated complications.
#1 Pediatric Type 2 Diabetes: Prevention and Treatment Through a Life Course Health Development Framework | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-319-47143-3_10
Estimates project that one in three US adults may have diabetes in 2050. […] Early indicators suggest that the disease may be more severe and more difficult to manage when diagnosed in adolescents. […] It is projected that adolescents with T2DM will lose approximately 15 years of life. […] The economic burden of T2DM rises significantly as the years with disease increase. […] This grim forecast highlights that not only will the disease burden be significant but the economic burden will be high in youth diagnosed with T2DM. […] The risk for developing T2DM begins in utero. […] A major aim of this chapter is to demonstrate that a life course health development approach to pediatric T2DM is critical to a sound national strategy to prevent and treat pediatric T2DM. […] We review major factors known to influence the development of pediatric T2DM and track these across childhood.
#1 Type 2 Diabetes Mellitus: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/117853-overview
The prognosis in patients with diabetes mellitus is strongly influenced by the degree of control of their disease. Chronic hyperglycemia is associated with an increased risk of microvascular complications, as shown in the Diabetes Control and Complications Trial (DCCT) in individuals with type 1 diabetes and the United Kingdom Prospective Diabetes Study (UKPDS) in people with type 2 diabetes. […] Reversion to normal glucose regulation during attempts to prevent progression of prediabetes to frank diabetes is a good indicator of slowing disease progression, and it is associated with a better prognosis. […] In the UKPDS, more than 5000 patients with type 2 diabetes were followed up for up to 15 years. Those in the intensely treated group had a significantly lower rate of progression of microvascular complications than did patients receiving standard care.
#1 Type 2 diabetes in children – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318
Type 2 diabetes in children is a chronic disease that affects the way your child’s body processes sugar (glucose) for fuel. Without treatment, the disorder causes sugar to build up in the bloodstream, which can lead to serious long-term consequences. […] Type 2 diabetes in children is often associated with metabolic syndrome and polycystic ovarian syndrome. […] Type 2 diabetes can affect nearly every organ in your child’s body, including the blood vessels, nerves, eyes and kidneys. The long-term complications of type 2 diabetes develop gradually over many years. Eventually, diabetes complications may be severe or even life-threatening. […] Keeping your child’s blood sugar level close to the standard range most of the time can dramatically reduce the risk of these complications. You can help your child prevent diabetes complications by: Working with your child to maintain good blood sugar control as much as possible. […] Healthy-lifestyle choices can help prevent type 2 diabetes in children.
#1 Genetics predict type 2 diabetes risk and disparities in childhood cancer survivors – St. Jude Childrenâs Research Hospital
https://www.stjude.org/media-resources/news-releases/2024-medicine-science-news/genetics-type-2-diabetes-risk-disparities-childhood-cancer-survivors.html
Survivors of childhood cancer are at increased risk for cardiovascular disease, for which a risk factor is their greater prevalence of type 2 diabetes, with a disproportionate impact on those of non-European heritage. […] Childhood cancer survivors are at a three times increased risk of developing type 2 diabetes than their siblings. However, non-Hispanic Black survivors experience three times more risk than non-Hispanic white survivors. […] The genetic risk disproportionately affected survivors of African or African American ancestry previously treated with alkylating agents, Sapkota said. […] The two risk scores derived from multiple ancestries were strongly associated with type 2 diabetes risk in survivors of diverse ancestries compared to the score developed in European-only ancestry, Sapkota said.
#1 Type 2 diabetes mellitus in children and adolescents
https://www.racgp.org.au/afp/2016/june/type-2-diabetes-mellitus-in-children-and-adolescen
T2DM in children and youth is therefore a major health issue. […] T2DM in children and adolescents is a serious medical concern that is more aggressive than the adult-onset form, more challenging to diagnose, and has limited available treatment options. […] It is also associated with high rates of complications related to diabetes and obesity.
#1 Pediatric Type 2 Diabetes: Prevention and Treatment Through a Life Course Health Development Framework | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-319-47143-3_10
It is clear that there is much to do to understand the epidemic, to determine effective prevention strategies, and to develop interventions for those diagnosed with the disease. […] Understanding how these trajectories emerge, and which factors and events result in disease-causing pathways, is key to not only understanding the onset and variable natural history of the disease but in determining ways to prevent and treat it. […] A life course health development approach that details risks and protective factors, as well as preventive and treatment strategies, contextualized within the developmental stage of the child, is required. […] This chapter is organized around four key developmental stages: preconception and intrauterine life, infancy, childhood (early and middle), and adolescence.
#2 Type 2 diabetes mellitus in children and adolescents
https://www.racgp.org.au/afp/2016/june/type-2-diabetes-mellitus-in-children-and-adolescen
The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing, mirroring the epidemic of paediatric obesity. […] Early-onset T2DM is associated with poor long-term outcomes. […] Early-onset T2DM is more associated with shorter duration to insulin requirement, development of diabetic complications and cardiovascular disease than adult-onset T2DM and T1DM. […] Early-onset T2DM is associated with significant long-term morbidity and mortality. […] Adolescents diagnosed with T2DM are predicted to lose 15 years from their remaining life expectancy when compared with their peers who do not have T2DM. […] Complications of diabetes are also common and present even earlier than in adolescents with type 1 diabetes mellitus (T1DM). […] Acquiring T2DM and its comorbidities at a younger age not only affects an individual’s ability to fully participate in study and work, but also increases morbidity and mortality during the years of peak earning and working capacity.
#2 Exploring the Surge in Paediatric Type 2 Diabetes in an Inner-City London CentreâA Decade-Long Analysis of Incidence, Outcomes, and Transition
https://www.mdpi.com/2227-9067/11/2/173
The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. […] Children and adolescents with T2D have a more aggressive disease evolution compared to adults. […] The TODAY trial showed that amongst 704 youths diagnosed with T2D, 80% had low HDL cholesterol, 26% had hypertension, and 10% had hypertriglyceridemia at diagnosis. […] Studies have also demonstrated that microvascular complications in youth-onset T2D can manifest within 5 years of diagnosis, whilst deterioration in glycaemic control can begin within 2 years after diagnosis. […] The aim of treatment is to achieve normoglycaemia and to adequately manage co-morbidities and complications to prevent future deterioration.
#2 Type 2 Diabetes Mellitus: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/117853-overview
The total follow-up was 20 years, half while in the study and half after the study ended. […] A British study indicated that the HbA1c level achieved 3 months after the initial diagnosis of type 2 diabetes mellitus predicts subsequent mortality. In other words, according to the report, aggressive lowering of glucose after diagnosis bodes well for long-term survival. […] Overall, these studies suggest that tight glycemic control (HbA1c 7% or lower) is valuable for microvascular and macrovascular disease risk reduction in patients with recent-onset disease, no known cardiovascular diseases, and a longer life expectancy. […] In patients with known cardiovascular disease, a longer duration of diabetes (15 or more years), and a shorter life expectancy, however, tighter glycemic control is not as beneficial, particularly with regard to cardiovascular disease risk.
#2 Type 2 diabetes in children – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318
Type 2 diabetes in children is a chronic disease that affects the way your child’s body processes sugar (glucose) for fuel. Without treatment, the disorder causes sugar to build up in the bloodstream, which can lead to serious long-term consequences. […] Type 2 diabetes in children is often associated with metabolic syndrome and polycystic ovarian syndrome. […] Type 2 diabetes can affect nearly every organ in your child’s body, including the blood vessels, nerves, eyes and kidneys. The long-term complications of type 2 diabetes develop gradually over many years. Eventually, diabetes complications may be severe or even life-threatening. […] Keeping your child’s blood sugar level close to the standard range most of the time can dramatically reduce the risk of these complications. You can help your child prevent diabetes complications by: Working with your child to maintain good blood sugar control as much as possible. […] Healthy-lifestyle choices can help prevent type 2 diabetes in children.
#2 Pediatric Type 2 Diabetes: Prevention and Treatment Through a Life Course Health Development Framework | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-319-47143-3_10
Estimates project that one in three US adults may have diabetes in 2050. […] Early indicators suggest that the disease may be more severe and more difficult to manage when diagnosed in adolescents. […] It is projected that adolescents with T2DM will lose approximately 15 years of life. […] The economic burden of T2DM rises significantly as the years with disease increase. […] This grim forecast highlights that not only will the disease burden be significant but the economic burden will be high in youth diagnosed with T2DM. […] The risk for developing T2DM begins in utero. […] A major aim of this chapter is to demonstrate that a life course health development approach to pediatric T2DM is critical to a sound national strategy to prevent and treat pediatric T2DM. […] We review major factors known to influence the development of pediatric T2DM and track these across childhood.
#2 Genetics predict type 2 diabetes risk and disparities in childhood cancer survivors – St. Jude Childrenâs Research Hospital
https://www.stjude.org/media-resources/news-releases/2024-medicine-science-news/genetics-type-2-diabetes-risk-disparities-childhood-cancer-survivors.html
Survivors of childhood cancer are at increased risk for cardiovascular disease, for which a risk factor is their greater prevalence of type 2 diabetes, with a disproportionate impact on those of non-European heritage. […] Childhood cancer survivors are at a three times increased risk of developing type 2 diabetes than their siblings. However, non-Hispanic Black survivors experience three times more risk than non-Hispanic white survivors. […] The genetic risk disproportionately affected survivors of African or African American ancestry previously treated with alkylating agents, Sapkota said. […] The two risk scores derived from multiple ancestries were strongly associated with type 2 diabetes risk in survivors of diverse ancestries compared to the score developed in European-only ancestry, Sapkota said.
#2 Type 2 diabetes mellitus in children and adolescents
https://www.racgp.org.au/afp/2016/june/type-2-diabetes-mellitus-in-children-and-adolescen
T2DM in children and youth is therefore a major health issue. […] T2DM in children and adolescents is a serious medical concern that is more aggressive than the adult-onset form, more challenging to diagnose, and has limited available treatment options. […] It is also associated with high rates of complications related to diabetes and obesity.
#2 Pediatric Type 2 Diabetes: Prevention and Treatment Through a Life Course Health Development Framework | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-319-47143-3_10
It is clear that there is much to do to understand the epidemic, to determine effective prevention strategies, and to develop interventions for those diagnosed with the disease. […] Understanding how these trajectories emerge, and which factors and events result in disease-causing pathways, is key to not only understanding the onset and variable natural history of the disease but in determining ways to prevent and treat it. […] A life course health development approach that details risks and protective factors, as well as preventive and treatment strategies, contextualized within the developmental stage of the child, is required. […] This chapter is organized around four key developmental stages: preconception and intrauterine life, infancy, childhood (early and middle), and adolescence.
#3 Pediatric Type 2 Diabetes: Prevention and Treatment Through a Life Course Health Development Framework | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-319-47143-3_10
Estimates project that one in three US adults may have diabetes in 2050. […] Early indicators suggest that the disease may be more severe and more difficult to manage when diagnosed in adolescents. […] It is projected that adolescents with T2DM will lose approximately 15 years of life. […] The economic burden of T2DM rises significantly as the years with disease increase. […] This grim forecast highlights that not only will the disease burden be significant but the economic burden will be high in youth diagnosed with T2DM. […] The risk for developing T2DM begins in utero. […] A major aim of this chapter is to demonstrate that a life course health development approach to pediatric T2DM is critical to a sound national strategy to prevent and treat pediatric T2DM. […] We review major factors known to influence the development of pediatric T2DM and track these across childhood.
#3 Exploring the Surge in Paediatric Type 2 Diabetes in an Inner-City London CentreâA Decade-Long Analysis of Incidence, Outcomes, and Transition
https://www.mdpi.com/2227-9067/11/2/173
The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. […] Children and adolescents with T2D have a more aggressive disease evolution compared to adults. […] The TODAY trial showed that amongst 704 youths diagnosed with T2D, 80% had low HDL cholesterol, 26% had hypertension, and 10% had hypertriglyceridemia at diagnosis. […] Studies have also demonstrated that microvascular complications in youth-onset T2D can manifest within 5 years of diagnosis, whilst deterioration in glycaemic control can begin within 2 years after diagnosis. […] The aim of treatment is to achieve normoglycaemia and to adequately manage co-morbidities and complications to prevent future deterioration.
#3 Type 2 Diabetes Mellitus: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/117853-overview
The total follow-up was 20 years, half while in the study and half after the study ended. […] A British study indicated that the HbA1c level achieved 3 months after the initial diagnosis of type 2 diabetes mellitus predicts subsequent mortality. In other words, according to the report, aggressive lowering of glucose after diagnosis bodes well for long-term survival. […] Overall, these studies suggest that tight glycemic control (HbA1c 7% or lower) is valuable for microvascular and macrovascular disease risk reduction in patients with recent-onset disease, no known cardiovascular diseases, and a longer life expectancy. […] In patients with known cardiovascular disease, a longer duration of diabetes (15 or more years), and a shorter life expectancy, however, tighter glycemic control is not as beneficial, particularly with regard to cardiovascular disease risk.
#3 A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus | BMC Medicine | Full Text
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03349-4
Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. […] Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. […] Glycaemic control improves microvascular but not cardiovascular risk. […] This guideline is the first national guideline on managing type 2 diabetes in children and young people. It gives practical advice on managing this challenging and aggressive condition. […] The authors hope that this guideline will provide paediatricians with the necessary information about managing type 2 diabetes and associated complications.
#3 Type 2 diabetes mellitus in children and adolescents
https://www.racgp.org.au/afp/2016/june/type-2-diabetes-mellitus-in-children-and-adolescen
The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing, mirroring the epidemic of paediatric obesity. […] Early-onset T2DM is associated with poor long-term outcomes. […] Early-onset T2DM is more associated with shorter duration to insulin requirement, development of diabetic complications and cardiovascular disease than adult-onset T2DM and T1DM. […] Early-onset T2DM is associated with significant long-term morbidity and mortality. […] Adolescents diagnosed with T2DM are predicted to lose 15 years from their remaining life expectancy when compared with their peers who do not have T2DM. […] Complications of diabetes are also common and present even earlier than in adolescents with type 1 diabetes mellitus (T1DM). […] Acquiring T2DM and its comorbidities at a younger age not only affects an individual’s ability to fully participate in study and work, but also increases morbidity and mortality during the years of peak earning and working capacity.
#3 Genetics predict type 2 diabetes risk and disparities in childhood cancer survivors – St. Jude Childrenâs Research Hospital
https://www.stjude.org/media-resources/news-releases/2024-medicine-science-news/genetics-type-2-diabetes-risk-disparities-childhood-cancer-survivors.html
We saw very consistently, in three out of our four identified variants, and all of our polygenic risk scores, a significant increase in diabetes risk when survivors were exposed to alkylating agents during their initial treatment, Sapkota said. So genetic factors in the presence of alkylating agents can significantly enhance type 2 diabetes risk. […] We hope this information will help reduce disparities in the type 2 diabetes burden, Sapkota said. Now we know how to identify childhood cancer survivors most at risk of type 2 diabetes so we can provide more personalized opportunities for interventions and prevent cardiovascular complications down the road.
#3 Pediatric Type 2 Diabetes: Prevention and Treatment Through a Life Course Health Development Framework | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-319-47143-3_10
Almost all children and adolescents with T2DM are also overweight or obese, and excess adiposity, particularly visceral adiposity, is associated with insulin resistance. […] Evidence of impaired glucose tolerance, elevated fasting glucose, insulin resistance, and/or previously undiagnosed silent T2DM has been documented in multiple samples of obese youth. […] The goal of therapy is to achieve euglycemia. […] The first intervention for treatment of T2DM remains healthy lifestyle modifications including dietary modifications and increasing physical activity and exercise regimens to achieve weight stabilization and ultimately weight loss. […] Adherence to therapeutic interventions is key for achieving adequate diabetes control and is strongly emphasized. […] Because T2DM is most likely diagnosed during or shortly after puberty, the emphasis in adolescence is focused on understanding the components of care for the disease, including the surveillance for and management of comorbidities.
#3 Type 2 diabetes in children – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318
Type 2 diabetes in children is a chronic disease that affects the way your child’s body processes sugar (glucose) for fuel. Without treatment, the disorder causes sugar to build up in the bloodstream, which can lead to serious long-term consequences. […] Type 2 diabetes in children is often associated with metabolic syndrome and polycystic ovarian syndrome. […] Type 2 diabetes can affect nearly every organ in your child’s body, including the blood vessels, nerves, eyes and kidneys. The long-term complications of type 2 diabetes develop gradually over many years. Eventually, diabetes complications may be severe or even life-threatening. […] Keeping your child’s blood sugar level close to the standard range most of the time can dramatically reduce the risk of these complications. You can help your child prevent diabetes complications by: Working with your child to maintain good blood sugar control as much as possible. […] Healthy-lifestyle choices can help prevent type 2 diabetes in children.
#3 Pediatric Type 2 Diabetes: Prevention and Treatment Through a Life Course Health Development Framework | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-319-47143-3_10
It is clear that there is much to do to understand the epidemic, to determine effective prevention strategies, and to develop interventions for those diagnosed with the disease. […] Understanding how these trajectories emerge, and which factors and events result in disease-causing pathways, is key to not only understanding the onset and variable natural history of the disease but in determining ways to prevent and treat it. […] A life course health development approach that details risks and protective factors, as well as preventive and treatment strategies, contextualized within the developmental stage of the child, is required. […] This chapter is organized around four key developmental stages: preconception and intrauterine life, infancy, childhood (early and middle), and adolescence.
#4 Type 2 diabetes mellitus in children and adolescents
https://www.racgp.org.au/afp/2016/june/type-2-diabetes-mellitus-in-children-and-adolescen
The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing, mirroring the epidemic of paediatric obesity. […] Early-onset T2DM is associated with poor long-term outcomes. […] Early-onset T2DM is more associated with shorter duration to insulin requirement, development of diabetic complications and cardiovascular disease than adult-onset T2DM and T1DM. […] Early-onset T2DM is associated with significant long-term morbidity and mortality. […] Adolescents diagnosed with T2DM are predicted to lose 15 years from their remaining life expectancy when compared with their peers who do not have T2DM. […] Complications of diabetes are also common and present even earlier than in adolescents with type 1 diabetes mellitus (T1DM). […] Acquiring T2DM and its comorbidities at a younger age not only affects an individual’s ability to fully participate in study and work, but also increases morbidity and mortality during the years of peak earning and working capacity.
#4 Child Opportunity Index and clinical characteristics at diabetes diagnosis in youth: type 1 diabetes versus type 2 diabetes | BMJ Open Diabetes Research & Care
https://drc.bmj.com/content/12/2/e003968
COI is associated with differing characteristics at diagnosis in youth-onset T1D and T2D but is worse among youth with T2D overall. […] In a large retrospective cohort of youth with new-onset T1D and T2D, low and very low COIs were more than twice as common among youth with T2D and were present in half of the cohort, underscoring that adverse socioeconomic status is a common experience for youth with T2D. […] COI was associated with DKA in both T1D and T2D and may therefore be a useful risk-stratification marker when designing population-level interventions to prevent DKA at diagnosis. […] COI is significantly lower in youth with T2D and is strongly associated with clinical presentation in youth with new-onset diabetes, including presence of DKA at diagnosis. COI may be a particularly important marker of risk for DKA and for youth-onset T2D and should be the focus of future studies to guide screening and prevention efforts.
#4 Exploring the Surge in Paediatric Type 2 Diabetes in an Inner-City London CentreâA Decade-Long Analysis of Incidence, Outcomes, and Transition
https://www.mdpi.com/2227-9067/11/2/173
The objective of our study is to analyse the presentation, management and outcomes of children and adolescents diagnosed with T2D over the last 10â15 years in our local area in London, in order to inform future care strategies. […] The incidence of paediatric T2D in our cohort doubled between 2008â2013 and 2014â2018. […] Youth-onset T2D is associated with a high frequency of complications at diagnosis, evident in our cohort and consistent with studies highlighting an accelerated development of complications compared to adults with T2D or children with T1D. […] Despite initiated treatments, complications such as hypertension, dyslipidaemia, and microalbuminuria persisted post-diagnosis similar to other studies, underscoring the failure of current management in halting disease progression. […] In conclusion, our study has highlighted the increasing incidence of youth-onset T2D, the severity of the disease at diagnosis with a high burden of co-morbidities and complications, and the ineffectiveness of current management strategies in achieving adequate clinical outcomes.
#4 Pediatric Type 2 Diabetes: Prevention and Treatment Through a Life Course Health Development Framework | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-319-47143-3_10
Almost all children and adolescents with T2DM are also overweight or obese, and excess adiposity, particularly visceral adiposity, is associated with insulin resistance. […] Evidence of impaired glucose tolerance, elevated fasting glucose, insulin resistance, and/or previously undiagnosed silent T2DM has been documented in multiple samples of obese youth. […] The goal of therapy is to achieve euglycemia. […] The first intervention for treatment of T2DM remains healthy lifestyle modifications including dietary modifications and increasing physical activity and exercise regimens to achieve weight stabilization and ultimately weight loss. […] Adherence to therapeutic interventions is key for achieving adequate diabetes control and is strongly emphasized. […] Because T2DM is most likely diagnosed during or shortly after puberty, the emphasis in adolescence is focused on understanding the components of care for the disease, including the surveillance for and management of comorbidities.
#4 Type 2 Diabetes in Children – Stanford Medicine Children’s Health
https://www.stanfordchildrens.org/en/topic/default?id=type-2-diabetes-in-children-90-P01978
Diabetes is a condition in which the body can’t make enough insulin, or can’t use insulin normally. Type 2 diabetes is a metabolic disorder. […] Risk factors for type 2 diabetes include family history, excess weight, and not enough exercise. […] Children at higher risk of type 2 diabetes should be screened. Screening is done with blood tests. […] Treatment includes a healthy diet, regular exercise, and weight loss. Medicines and insulin may be needed in some cases. […] Type 2 diabetes is a chronic condition. It requires lifestyle changes in order to keep healthy blood glucose levels. Its important to work closely with your child’s healthcare team to create an ongoing plan that works for your child.
#5 Exploring the Surge in Paediatric Type 2 Diabetes in an Inner-City London CentreâA Decade-Long Analysis of Incidence, Outcomes, and Transition
https://www.mdpi.com/2227-9067/11/2/173
The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. […] Children and adolescents with T2D have a more aggressive disease evolution compared to adults. […] The TODAY trial showed that amongst 704 youths diagnosed with T2D, 80% had low HDL cholesterol, 26% had hypertension, and 10% had hypertriglyceridemia at diagnosis. […] Studies have also demonstrated that microvascular complications in youth-onset T2D can manifest within 5 years of diagnosis, whilst deterioration in glycaemic control can begin within 2 years after diagnosis. […] The aim of treatment is to achieve normoglycaemia and to adequately manage co-morbidities and complications to prevent future deterioration.
#5 Pediatric Type 2 Diabetes: Prevention and Treatment Through a Life Course Health Development Framework | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-319-47143-3_10
Almost all children and adolescents with T2DM are also overweight or obese, and excess adiposity, particularly visceral adiposity, is associated with insulin resistance. […] Evidence of impaired glucose tolerance, elevated fasting glucose, insulin resistance, and/or previously undiagnosed silent T2DM has been documented in multiple samples of obese youth. […] The goal of therapy is to achieve euglycemia. […] The first intervention for treatment of T2DM remains healthy lifestyle modifications including dietary modifications and increasing physical activity and exercise regimens to achieve weight stabilization and ultimately weight loss. […] Adherence to therapeutic interventions is key for achieving adequate diabetes control and is strongly emphasized. […] Because T2DM is most likely diagnosed during or shortly after puberty, the emphasis in adolescence is focused on understanding the components of care for the disease, including the surveillance for and management of comorbidities.
#5 Type 2 Diabetes in Children – Stanford Medicine Children’s Health
https://www.stanfordchildrens.org/en/topic/default?id=type-2-diabetes-in-children-90-P01978
Diabetes is a condition in which the body can’t make enough insulin, or can’t use insulin normally. Type 2 diabetes is a metabolic disorder. […] Risk factors for type 2 diabetes include family history, excess weight, and not enough exercise. […] Children at higher risk of type 2 diabetes should be screened. Screening is done with blood tests. […] Treatment includes a healthy diet, regular exercise, and weight loss. Medicines and insulin may be needed in some cases. […] Type 2 diabetes is a chronic condition. It requires lifestyle changes in order to keep healthy blood glucose levels. Its important to work closely with your child’s healthcare team to create an ongoing plan that works for your child.
#6 Exploring the Surge in Paediatric Type 2 Diabetes in an Inner-City London CentreâA Decade-Long Analysis of Incidence, Outcomes, and Transition
https://www.mdpi.com/2227-9067/11/2/173
The rising prevalence of paediatric type 2 diabetes (T2D) is concerning, particularly with limited medical intervention despite evidence of accelerated disease progression. […] Children and adolescents with T2D have a more aggressive disease evolution compared to adults. […] The TODAY trial showed that amongst 704 youths diagnosed with T2D, 80% had low HDL cholesterol, 26% had hypertension, and 10% had hypertriglyceridemia at diagnosis. […] Studies have also demonstrated that microvascular complications in youth-onset T2D can manifest within 5 years of diagnosis, whilst deterioration in glycaemic control can begin within 2 years after diagnosis. […] The aim of treatment is to achieve normoglycaemia and to adequately manage co-morbidities and complications to prevent future deterioration.
#6 Genetics predict type 2 diabetes risk and disparities in childhood cancer survivors – St. Jude Childrenâs Research Hospital
https://www.stjude.org/media-resources/news-releases/2024-medicine-science-news/genetics-type-2-diabetes-risk-disparities-childhood-cancer-survivors.html
We saw very consistently, in three out of our four identified variants, and all of our polygenic risk scores, a significant increase in diabetes risk when survivors were exposed to alkylating agents during their initial treatment, Sapkota said. So genetic factors in the presence of alkylating agents can significantly enhance type 2 diabetes risk. […] We hope this information will help reduce disparities in the type 2 diabetes burden, Sapkota said. Now we know how to identify childhood cancer survivors most at risk of type 2 diabetes so we can provide more personalized opportunities for interventions and prevent cardiovascular complications down the road.