Along with the epidemic of obesity among children and adolescents in the United States, additional risk factors for type 2 diabetes among these age groups are becoming increasingly apparent. This article discusses the case of a young adolescent with multiple risk factors for type 2 diabetes. Issues relevant to the diagnosis and classification of diabetes in many young patients are explored, along with the importance of initiating therapy that will allow rapid attainment of glycemic control.
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As an unfortunate consequence of the current epidemic of obesity among children and adolescents, physicians can logically expect to encounter increasing numbers of young patients presenting initially with signs and symptoms associated with uncontrolled hyperglycemia and relatively advanced cases of diabetes. Understanding the wide array of risk factors for type 2 diabetes that frequently accompany obesity can facilitate diagnosis and proper classification of the condition, especially within these younger age groups for whom diagnoses of type 1 diabetes were once handed down practically by default.
While the decision to initiate insulin therapy can be made independently of diabetes classification in cases where hyperglycemia is severe, the type of diabetes will affect how much insulin is required for adequate treatment. The priority in such cases is to bring blood glucose levels under control as quickly as possible. Once under adequate control, various options for glycemic management can be implemented based on type of diabetes, patient lifestyle, motivation, family support, and other factors.
The following case and suggestions for therapeutic intervention are presented for purposes of educational discussion. Although based on an authentic case, the actual treatment course and outcome have not been disclosed. The case presentation has been condensed, and some details have been modified in order to both protect the patient's privacy and to facilitate discussion.