Type 2 Diabetes Mellitus Emerging In Children And

http://www.100md.com 2001年9月6日 中国医学论坛表

     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.

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