The epidemic increase in the incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is presenting enormous challenges to the medical profession. The combination of factors such as obesity, ethnicity, puberty, and genetic predisposition has contributed to the development of T2DM in younger ages. These factors affect the regulatory mechanism of insulin secretion, insulin action, and hepatic gluconeogenesis. In contrast to adults, children appear to have a shorter latency to disease, a more rapid development of symptoms, and an increased ketoacidosis. There are limited therapeutic options to prevent or manage T2DM in children. Although the role of diet and exercise (lifestyle intervention) has not been adequately evaluated in children, they will remain important adjuncts in the prevention and treatment of T2DM. Insulin and metformin are currently the only approved medications for the treatment of T2DM in children. Clinical trials involving other oral agents used in adults are currently being conducted to evaluate their safety and efficacy in children.

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