Concern and Care 关爱
Start on March 17, 2006, updated on Dec. 12, 2008
An Overview of Diabetes Mellitus
Type 1 v. Type 2
University of Chicago, General Pediatrics
Maureen Grundy MSIII, Yingshan Shi, MD
Pathogenesis
Type I Diabetes Mellitus
 Autoimmune destruction of pancreatic beta cells
 absolute insulin deficiency  glycogenolysis
and gluconeogenesis  hyperglycemia
 Increase in glucagon, epinephrine, GH, and
cortisol  lipolysis, FA release, ketoacid
synthesis  DKA
Type II Diabetes Mellitus
 Relative insulin resistance with progressive
decline in insulin secretion
Epidemiology
 Most common childhood endocrine disease
 1/500 children and adolescents
Risk Factors
 Family history, especially 1st degree relative with
IDDM
 + DR3/DR4 MHC Ag
History and
Physical Exam
 New onset weight loss, polydipsia, polyphagia,
polyuria
 New onset diabetics often present in DKA 
acutely ill, dehydration, polyuria, polydipsia,
fatigue, headache, nausea, emesis, abdominal
pain, altered mental status
 Physical findings in DKA = tachycardia,
hyperpnea, fruity breath
 If suspected DKA, inquire about last insulin dose,
diet in last day, recent illness or stressors
 Diabetic retinopathy, neuropathy, renal dysfunction, cardiovascular diseases, etc.
 DKA = metabolic acidosis, hyperglycemia, dehydration, lethargy with progression to coma and death
 Cerebral Edema = indicated by changing mental status, unequal pupils, posturing, and/or seizures
Complications
Differential
Diagnosis
Diagnostic
Evaluation
Treatment
 Only 2-3% of diabetes cases in children
 Increasing incidence with increasing prevalence
of childhood obesity
 Family history
 Obesity
 Sedentary lifestyle
 Diet
 Prevalence is highest among native Americans,
African Americans, and Hispanics
 Usually asymptomatic at presentation; may
have symptoms similar to Type I DM.
 Obesity
 Acanthosis nigricans
 PCOS
 Hypertension
 Dyslipidemia
 Cushing’s syndrome, exogenous glucocorticoids, hyperthyroidism, pheochromocytoma, GH excess
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Fasting glucose ≥ 126 mg/dL
Two random glucose ≥ 200mg/dL with symptoms
2-hour postchallenge glucose ≥200 mg/dL during a 75-g oral glucose tolerance test
Elevated HbA1c:

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Exogenous insulin (mainstay treatment for pediatric Type 1 and 2 DM)
Oral medications mainly for Type 2 DM
Diet and exercise
Regular follow up
Concern and Care 关爱
Start on March 17, 2006, updated on Dec. 15, 2008
Who Should Be Screened for Diabetes?
Type 1 Diabetes
Screening children for DM1 is not indicated. Children with DM1 will present clinically with new onset
weight loss, polyuria, polyphagia, and/or polydipsia. Findings on history and physical dictate further
work up to diagnose DM1.
Type 2 Diabetes
Most pediatric patients with DM2 will be asymptomatic at clinical presentation. Therefore, screening
children and adolescents who meet certain criteria for DM2 is indicated.
1. What are the criteria for testing for DM2 in children and teens?


Overweight (BMI>85th percentile for age and gender, weight for height >85 th percentile, OR
weight > 120% of ideal for height) AND
Any 2 of the following risk factors:
- Family history of Type 2 DM in first or second
degree relatives
- Race/ethnicity of American Indian, African
American, Hispanic/Latino, Asian/American, or
Pacific Islander
- Signs of insulin resistance (acanthosis nigricans, hypertension,
dyslipidemia, PCOS)
2. At what age should testing for DM2 begin?
 10 years OR at onset of puberty if earlier than 10yo
3. What test should be used?
 Fasting plasma glucose: A fasting plasma glucose > or = 126mg/dL is diagnostic for diabetes.
Fasting is defined as no food or beverage other than water for at least 8 hours before the test
4. How often should testing occur?
 Every 2 years
References:
UpToDate – www.uptodate.com
DynaMed – www.dynamicmedical.com
Blueprints Pediatrics 3rd Edition 2004, p57-59.
AACE DM guidelines. Glycemic management Endocr Pract 2007 May-Jun;13(Suppl 1):16-34. [178
references]
Management of diabetes mellitus: Glycemic management AACE 2000 Jan (revised 2007). NGC:005853
AAP Clinical Report: Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special
Emphasis on American Indian and Alaska Native Children. Pediatrics 2003; 112; e328-e347.
(Downloaded from http://www.pediatrics.org/cgi/content/full/112/4/e328)
An Update on Type 2 Diabetes in Youth from the National Diabetes Education Program. (Downloaded
from http://www.pediatrics.org)
Type 2 Diabetes in Children and Adolescents. Pediatrics 2000;105; 671-680. (Downloaded from
http://www.pediatrics.org)
ADA Position Statement. Standards of Medical Care in Diabetes 2006. Diabetes Care 2006; 29; S26-S29.