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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EA study of the medical records of 1027 consecutive pediatric patients from birth to age 19 years found that the number with a new diagnosis of type 2 diabetes mellitus (T2DM) rose from approximately 4% before 1992 to 16% in 1994 [Pinhas-Hamiel O et al. \u003Cem\u003EJ Pediatr\u003C\/em\u003E 1996], and the trend has only accelerated over time.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EA study of the medical records of 1027 consecutive pediatric patients from birth to age 19 years found that the number with a new diagnosis of type 2 diabetes mellitus (T2DM) rose from approximately 4% before 1992 to 16% in 1994 (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Pinhas-Hamiel O et al. \u003Cem\u003EJ Pediatr\u003C\/em\u003E 1996], and the trend has only accelerated over time. Silva Arslanian, MD, Children\u0027s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA, discussed the presentation and management of T2DM in the young, including clinical characteristics, pathophysiology, risk factors, and treatments.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/11\/30\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Ten-Fold Increase in the Incidence of T2DM Between 1982 and 1994 in a Pediatric Diabetes Clinic.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1726339312\u0022 data-figure-caption=\u0022Ten-Fold Increase in the Incidence of T2DM Between 1982 and 1994 in a Pediatric Diabetes Clinic.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/11\/30\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/11\/30\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/11\/30\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12515\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-3\u0022 class=\u0022first-child\u0022\u003ETen-Fold Increase in the Incidence of T2DM Between 1982 and 1994 in a Pediatric Diabetes Clinic.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from S. Arslanian, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-4\u0022\u003EAccording to Dr. Arslanian, the prevalence of T2DM in children is not yet epidemic but is increasing rapidly. In describing the clinical characteristics, she said that the disease is common in minorities, the age of diagnosis occurs between 12 and 14 years, and T2DM affects more females than males with body mass index from 29 to 38 kg\/m\u003Csup\u003E2\u003C\/sup\u003E. Ketoacidosis affects between 5% and 53% of patients.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ERecent data from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) cohort show similar findings. The cohort included various racial\/ethnic groups with low socioeconomic status and a family history of diabetes; clinical and biochemical abnormalities and comorbidities were prevalent within 2 years of T2DM diagnosis [Copeland KC et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EHyperglycemic hyperosmolar nonketotic coma (HHNK) can occur as a serious complication of borderline and unrecognized T2DM. Foutner et al. found that HHNK affected 3.7% of patients, with a mean serum osmolality 393 mOsm\/L, glucose level of 88.4 mmol\/L, and case fatality of 14.3% [Fourtner SH et al. \u003Cem\u003EPediatr Diabetes\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe TODAY study [The TODAY Study Group. \u003Cem\u003EPediatr Diabetes\u003C\/em\u003E 2007] showed that most youngsters can achieve satisfactory glycemic control when treated with metformin alone, following initial insulin therapy. In a randomized controlled trial, Jones et al. [\u003Cem\u003EDiabetes Care\u003C\/em\u003E 2002] found that the adjusted mean change from baseline in fasting plasma glucose was \u22122.4 mmol\/L (\u221242.9 mg\/dL) for metformin compared with 1.2 mmol\/L (+24.1 mg\/dL) for placebo (p\u0026lt;0.001). Mean HbA1C vales, adjusted for baseline, were also significantly lower with metformin compared with placebo (7.5% vs 8.6%, respectively; p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EAccording to Dr. Arslanian, rosiglitazone, sulfonylureas, and bariatric surgery are not approved by the United States Food and Drug Administration for treatment of T2DM in pediatric patients. Even though youth with newly diagnosed T2DM respond to lifestyle change plus metformin (1000 mg BID; \u003Ca id=\u0022xref-fig-2-2\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E), severe cases (with hyperglycemia, polyuria, polydipsia, weight loss, and ketonuria or ketoacidosis) call for insulin in combination with lifestyle change and metformin to rapidly control and correct the hyperglycemia and the metabolic derangements.\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/11\/30\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022HbA1C at Week 16.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1726339312\u0022 data-figure-caption=\u0022HbA1C at Week 16.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/11\/30\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/11\/30\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/11\/30\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12517\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EHbA1C at Week 16.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from S. Arslanian, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EIn pediatric patients with newly diagnosed T2DM, glycemic control, as measured with HbA1C, improves with implementation of treatment and is maintained within the goal range for almost 2 years, after which there is gradual deterioration with increasing HbA1C levels. Unlike adults, children with T2DM require increasing insulin doses over a 4-year period, and ketoacidosis at diagnosis predicts greater \u03b2-cell decline over time [Levitt Katz LE et al. \u003Cem\u003EJ Pediatr\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EBefore the 1990s, it was rare for pediatric centers to have patients with T2DM. With the rapid rise in obesity, however, their presence has dramatically increased worldwide [The TODAY Study Group. \u003Cem\u003EPediatr Diabetes\u003C\/em\u003E 2007]. New treatments that are on the horizon include GLP-1R agonists, such as exenatide and liraglutide, and DPP-4 inhibitors, such as sitagliptin.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/11\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmyb2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmyb2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}