Clinical Characteristics of Type 2 Diabetes Mellitus in Overweight European Caucasian Adolescents

Abstract

Aim: To present the clinical features of Type 2 diabetes mellitus (T2DM) in overweight European Caucasian children and adolescents.

Methods: We report the clinical characteristics of 16 non-syndromal overweight European Caucasian adolescents with T2DM (10 boys, 6 girls, SDS-BMI in median + 2.8, range + 1.6 to + 3.4) treated in 5 specialised centres for obesity and diabetes.

Results: None of the adolescents manifested with ketoacidosis. 13 were asymptomatic (3 adolescents with polyuria), 12 showed features of metabolic syndrome (dyslipidaemia or hypertension), 8 demonstrated acanthosis nigricans and 12 had relatives with T2DM. 11 adolescents were extremely obese and all patients were pubertal. Mean age at diagnosis was 14.2 years (range 11.0 - 16.9). Median insulin was 19 µU/ml, insulin resistance index (HOMA) 8.5, C-peptide 2.3 ng/ml, HbA1c 6.9 %, fasting blood glucose 176 mg/dl and blood glucose at 2 hours with the oGTT 229 mg/dl at manifestation. Fasting blood glucose and HBA1c were in the normal range in 4 and 6 adolescents respectively, while oGTT always fitted the diagnosis of T2DM.

Conclusion: Since T2DM occurred in Caucasian overweight adolescents and is frequently asymptomatic, it is essential that clinicians perform diagnostic procedures to identify T2DM in high-risk groups of overweight Caucasian adolescents (extreme obesity, features of metabolic syndrome, relatives with T2DM).

Type 2 diabetes - adolescents - European Caucasian - clinical manifestation

References

• 1 Alberti K G, Zimmet P Z. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.  Diabet Med. 1998;  15 539-553
• 2 Allard P, Delvin E E, Paradis G, Hanley J A, O'Loughlin J, Lavallee C, Levy E, Lambert M. Distribution of fasting plasma insulin, free fatty acids, and glucose concentrations and of homeostasis model assessment of insulin resistance in a representative sample of Quebec children and adolescents.  Clinical Chemistry. 2003;  49 644-649
• 3 American Academy of Pediatrics . National Cholesterol Education Program: Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents.  Pediatrics. 1992;  89 525-584
• 4 American Diabetes Association . Type 2 diabetes in children and adolescents.  Diab Care. 2000;  23 381-389
• 5 Arslanian S A, Kalhan S C. Correlation between fatty acid and glucose metabolism: potential explanation of insulin resistance of puberty.  Diabetes. 1994;  43 908-914
• 6 Arslanian S A, Suprasongsin C. Differences in the in vivo insulin secretion and sensitivity in healthy black versus white adolescents.  J Pediatr. 1996;  129 440-444
• 7 Arslanian S A. Type 2 diabetes in children: Clinical aspects and risk factors.  Horm Res. 2002;  57 (Suppl 1) 19-28
• 8 Research Group D CCT. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.  New Engl J Med. 1993;  329 977-986
• 9 Drake A J, Smith A, Betts P R, Crowne E C, Shield J P. Type 2 diabetes in obese white children.  Arch Dis Child. 2002;  86 207-208
• 10 Ebbeling C A, Pawlak D B, Ludwig D S. Childhood obesity: public-health crisis, common sense cure.  Lancet. 2002;  360 473-482
• 11 Fagot-Campagna A, Pettitt D J, Engelgau M M, Burrows N R, Geiss L S, Valdez R, Beckles G L, Saaddine J, Gregg E W, Williamson D F, Narayan K M. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective.  J Pediatr. 2000;  136 664-672
• 12 Glaser N S. Non-insulin-dependent diabetes mellitus in childhood and adolescence.  Pediatr Clin North Am. 1997;  44 303-337
• 13 Kapellen T M, Böttner A, Galler A, Raile K, Nietzschmann U, Kiess W. Treatment of adolescents with type 2 diabetes.  Klin Padiatr. 2004;  216 57-61
• 14 Kiess W, Bottner A, Raile K, Kapellen T, Muller G, Galler A, Paschke R, Wabitsch M. Type 2 diabetes mellitus in children and adolescents: a review from a European perspective.  Horm Res. 2003;  59 (Suppl 1) 77-84
• 15 Kromeyer-Hauschild K, Wabitsch M, Geller F, Ziegler A, Geiß H C, Hesse V, v. Hippel, Jaeger U, Johnsen D, Kiess W, Korte W, Kunze D, Menner K, Müller M, Niemann-Pilatus A, Remer Th, Schaefer F, Wittchen H U, Zabransky S, Zellner K, Hebebrand J. Percentiles of body mass index in children and adolescents evaluated from different regional German studies.  Monatsschr Kinderheilkd. 2001;  149 807-818
• 16 Makovi H, Soltesz G, Hermann R. Clinical heterogeneity of childhood diabetes in Baranya county.  Orv Hetil. 2002;  143 2489-2492
• 17 Matthews D R, Hosker J P, Rudenski A S, Naylor B A, Treacher D F, Turner R C. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;  28 412-419
• 18 Rami B, Schober E, Nachbauer E, Waldhör T. Type 2 diabetes mellitus is rare but not absent in children under 15 years of age in Austria.  Eur J Ped. 2003;  162 850-852
• 19 Reaven G M, Hoffman B B. A role for insulin in the aetiology and course of hypertension?.  Lancet. 1987;  2 435-437
• 20 Rosner B, Prineas R J, Loggie J M, Daniels. Blood pressure normograms for children and adolescents by height, sex, and age, in the United States.  J Pediatr. 1993;  123 871-886
• 21 Sinha R, Fisch G, Teague B, Tamborlane W V, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin R S, Caprio S. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity.  N Eng J Med. 2002;  346 802-810
• 22 Stratton I M, Adler A I, Neil H A, Matthews D R, Manley S E, Cull C A, Hadden D, Turner R C, Holman R R. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.  BMJ. 2000;  321 405-412
• 23 Velho G, Froguel P. Genetic metabolic and clinical characteristics of maturity onset diabetes of the young.  Eur J Endocrinol. 1998;  138 233-239
• 24 Wabitsch M, Hauner H, Hertrampf M, Muche R, Hay B, Mayer H, Kratzer W, Debatin K M, Heinze E. Type 2 diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany.  Int J Obes Relat Metab Disord. 2004;  28 307-313