Endocrinology

Non-type 1 diabetes (Type 2 Diabetes) 1

When this study was undertaken, the epidemic of childhood obesity led to concerns that there may have been a parallel increase in the number of children with type 2 diabetes, given that type 2 diabetes had a link with obesity in adults. If the increased incidence of childhood obesity in the UK was associated with an increase in the prevalence of type 2 diabetes, there was likely to be a significant impact on health service resources. The survey would establish the incidence of non-type 1 diabetes in children as well as early clinical features of type 2 diabetes and its association with obesity. The follow-up would identify clinical management, confirm how many non-type 1 cases are type 2 and examine short-term morbidity.

By bpsu · October 1, 2004

Lead investigator

Dr J Shields

About the study

When this study was undertaken, the epidemic of childhood obesity led to concerns that there may have been a parallel increase in the number of children with type 2 diabetes, given that type 2 diabetes had a link with obesity in adults.

Although early reports of type 2 in children were in specific ethnic populations, four cases were reported in obese white adolescents in the UK. A national survey of UK paediatric endocrinologists in 2000 identified 25 cases in children under 16 years of age. If, as in the USA, the increased incidence of childhood obesity in the UK was associated with an increase in the prevalence of type 2 diabetes, then there was likely to be a significant impact on health service resources. If the number of children with type 2 diabetes were rising, it would become increasingly important to classify the type of diabetes correctly, as the appropriate treatment was often different.

Although children with type 1 diabetes often presented with an acute illness (such as diabetic ketoacidosis (DKA)), type 2 diabetes had a slower, more insidious onset, the clinical presentation of children with type 2 diabetes may have been indistinguishable from type 1. Certain clinical features were highly suggestive of type 2 diabetes, including obesity, a family history of type 2 diabetes, acanthosis nigricans and polycystic ovarian syndrome.

The presence of antibodies to glutamic acid decarboxylase-65 (GAD-65), tyrosine phosphatase (IA-2α), and islet cells (ICA) could confirm autoimmune diabetes in children where there was diagnostic doubt, and the absence of autoantibodies in children with obesity-related diabetes strongly suggests type 2 diabetes. However, 10% of children with type 2 diabetes also had a positive antibody test.

The survey would establish:

  • The incidence of non-type 1 diabetes in children.
  • The early clinical features of type 2 diabetes and its association with obesity.
  • The follow-up questionnaire at one year would identify clinical management, and confirm how many non-type 1 cases are type 2. It would also examine short-term morbidity.

Duration

October 2004 – October 2005

Published papers

Diabetes UK | helpline@diabetes.org.uk