Type-2 diabetes in childhood: incidence and prognosis

Type-2 diabetes is a global public health concern, and young people have not escaped the epidemic. However, there is a paucity of information – particularly population-based data – regarding the incidence, prevalence, and natural history of type-2 diabetes in young people, with a lack of uniformity in case definition, data collection, and follow-up. In some populations, type-2 diabetes accounts for more than 50% of incident cases of diabetes in 10–18-year-olds, with the highest rates found in ethnic minority groups. The rise in youth-onset type-2 diabetes has been attributed to environmental factors such as change in lifestyle, lack of exercise, and diet, and parallels the rise in childhood obesity. The risk of diabetes may begin in utero with fetal overgrowth and adiposity. Type-2 diabetes in young people is frequently complicated by other features of the metabolic syndrome, including hypertension and dyslipidaemia, and comorbidities such as microalbuminuria are more common than in type-1 diabetes. The increasing caseload of type-2 diabetes threatens to have a significant impact on morbidity and mortality in the current generation of overweight young people; there is an urgent need for the development of evidence-based strategies to intervene.