Type 2 Diabetes

Type 2 diabetes mellitus is the most common form of diabetes, being found in roughly 20 million Americans and accounting for 80% of cases of diabetes (National Institute of Diabetes and Digestive and Kidney Diseases 2008). Unlike type 1 diabetes, the development of type 2 is typically contingent on lifestyle (particularly dietary consumption and exercise), with obesity being the number one risk factor for this disease (American Diabetes Association 2000). In addition, type 2 diabetes historically has been considered a disease with an adult onset, often not present until an individual was beyond age 30 years. Type 2 diabetes in children was thus considered relatively rare, although children might present with a prediabetic condition. More recently, however, an alarming increase has occurred in the number of children presenting with type 2 diabetes, which is undoubtedly directly related to the increase in childhood obesity (Alberti et al. 2004; American Diabetes Association 2000; Libman and Arslanian 2003). Indeed, by the year 2000, up to 46% of all new cases of diabetes diagnosed in childhood were type 2 (Nesmith 2001).

Type 1 diabetes is characterized by complete or near-complete insulin deficiency. In contrast, type 2 diabetes is characterized by insulin resistance (Cope-land et al. 2005), and children with type 2 diabetes present as obese, as insulin antibody negative, and as having acanthosis nigrican (American Diabetes Association 2000). They also present far less often in diabetic ketoacidosis than do children with type 1 diabetes.

When compared with the general population, certain subpopulations may have an increased risk for the development of type 2 diabetes, and the prevalence appears to be increasing fairly dramatically within these subpopulations. Included are children and adolescents of the following ethnic minority groups: Asian American, Native American, Mexican American, and African American (Alberti et al. 2004; Dabelea et al. 1998; Libman and Arslanian 2003; Ramachandran et al. 2006). One group in particular that has received attention is the Pima Indians who reside in southern Arizona and northern Sonora, Mexico. Over the past 40 years, preteen and adolescent Pima Indians have demonstrated a statistically significant increase in diagnoses of type 2 diabetes. One study of this group was helpful in elucidating the relationship between type 2 diabetes and obesity In this study, Fagot-Campagna et al. (2000) found that the vast majority (85%) of those who met criteria for type 2 diabetes were also morbidly obese. In addition to obesity, other possible risk factors for this disease in children and adolescents include family history of diabetes, female gender, and low birth weight (American Diabetes Association 2000).

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