HJAR Sep/Oct 2019

46 SEP / OCT 2019 I  HEALTHCARE JOURNAL OF ARKANSAS Jon Oden, MD James H. Hamlen II Endowed Chair in Pediatric Endocrinology Section Chief of Endocrinology, Division of Endocrinology, Diabetes, and Obesity, Arkansas Children’s Associate Professor Pediatric Endocrinology, UAMS Department of Pediatrics COLUMN CHILDREN’S HEALTH Understanding Risk Factors, Diagnosis, and Treatment Services include high caloric intake and sedentary lifestyle, which includes excessive screen time. Though all forms of diabetes result in elevated blood sugars, it is essential to understand the key differences present in youth with T2D. Blood glucose is tight- ly regulated through a delicate balance between the body’s muscle, liver, and ad- ipose tissues to utilize insulin (sensitivity) and the health of the pancreatic beta-cells, which secrete insulin. A reduction in tissue sensitivity to insulin results in an increase in insulin secretion in otherwise healthy individuals. A decline in beta-cell produc- tion results, eventually, in elevated blood sugars. This can be caught relatively early during a period of impaired glucose toler- ance (IGT), or “pre-diabetes,” or relatively late as T2D (see definitions). Of note, there is a significant difference in both degree of insulin resistance and compensatory insulin secretion when one compares youth to adults; youth exhibit a higher degree of insulin resistance even when corrected for adipose mass (2). Fur- ther, children with T2D experience a more rapid loss in beta-cell function when com- pared to adults (1) and experience poten- tially more significant complications (3). Therefore, it is critical to identify IGT and T2D as early as possible in order to ad- dress lifestyle modifications and oral med- ications early in the course of the disease. Although the primary form of oral medi- cation approved for children (metformin) seems to be effective for most, at least in the beginning, some chil- dren with T2D need more intensive treatments such as insulin. Unfor- tunately, available approved medi- cations for children remain limited. I cannot stress enough that the treatment of T2D should be the re- sponsibility of or in consult with a Pediatric Endocrinologist. There is a complicated and specific sequence of medications, based on several factors, including A1c and blood As a resident in the nineties, I saw few children with Type 2 Diabetes (T2D). Un- fortunately, over the past two decades, the incidence of T2Dhas risen to approximate- ly .05 percent of pediatric patients less than 19-years of age; 1 in 370 in the obese population (1). Nationally, however, ap- proximately 3,700 patients under 20-years are diagnosed annually. It is estimated that many more children in Arkansas have yet to be diagnosed. Therefore, the prevalence of this disease in Arkansas is expected to rise in the years to come. There are several well-known risk fac- tors prevalent in youth with T2D. It is more commonly found in the obese population (though an obese childmay have Type 1 Di- abetes) and commonly diagnosed during puberty. It is more commonly seen in the Hispanic and Af- rican American communities, although other ethnicities are also at an increased risk, in- cluding Asian/Pacific Island- ers and American Indians. Further, patients usually have a strong family history of dia- betes or have been the product of a pregnancy complicated by gestational diabetes. Finally, modifiable risk factors for T2D PEDIATRIC TYPE 2 DIABETES: