Type 2 diabetes in young people: a serious disease requiring improved understanding and care
May 2008

Opinion of the International Diabetes Federation
The prevalence of type 2 diabetes in children and adolescents is growing worldwide, and mirrors the increase of the condition in adults. Type 2 diabetes in young people is a severe disease with very poor outcomes over 10 to 20 years. The International Diabetes Federation (IDF) recommends that provisions be made to deliver the best possible care, prevent long–term complications, and promote further research in order to reach a better understanding of the condition.

Type 2 diabetes in children and adolescents, as in adults, is due to a combination of insensitivity to insulin and the relative failure of beta–cell secretion. There are a number of genetic and environmental risk factors for insensitivity to insulin and limited beta–cell reserve, including ethnicity, obesity, sedentary behaviour, family history of type 2 diabetes, puberty, low birth weight, exposure to diabetes in the uterus, and female gender. There is ample evidence that certain ethnic groups have greater susceptibility than others.

Environmental factors play a key role in the development of type 2 diabetes. Globalization and industrialization are the underlying cause for the excess of high–density, low–nutrient food and drink throughout the world, and an increasing tendency for children to be sedentary and unfit. This has led to a global epidemic of obesity as a major risk factor for type 2 diabetes.

Type 2 diabetes is a serious disease in children and adolescents. It requires the involvement of an informed healthcare team and ongoing and frequent access to diabetes healthcare assessments. Adequate treatment requires resources equal to those required for the treatment of type 1 diabetes. As type 2 diabetes emerges as a worldwide public health problem, improved understanding of its pathogenesis, and identification of evidence–based care for young people with the condition must be coupled with a focus on prevention.

IDF’s position is that

• Preventing type 2 diabetes in children is possible.
• Appropriate investigation should be performed to determine the type of diabetes a child or adolescent may have.
• A multidisciplinary team should be involved in diabetes care, and ongoing healthcare visits, family–centred education and lifestyle counselling should be offered to children and their families.
• To avoid the development of complications, risk factors should be carefully monitored, including damage to eyes and kidneys, and nerve and macro–vascular disease, and others.
• Counselling should be offered to teenage girls as to how to reduce adverse pregnancy outcomes.
• Further research should be undertaken to improve understanding of the development of diabetes in young people and determine optimum evidence–based care.