Youth-onset type 2 diabetes is a heterogeneous disease with increasing prevalence in relation to increased rates of obesity in children. It has genetic, epigenetic, social, and environmental determinants. Youth-onset type 2 diabetes is alarming given a rapidly progressive course compared with the course of adult-onset disease, early-onset vascular complications, and long-term exposure to hyperglycemia and associated complications. It is often preceded by “prediabetes,” a disease phase where defects in β-cell function relative to insulin sensitivity emerge. Herein, we review the current understanding of the pathophysiology of prediabetes and type 2 diabetes in youth. We describe the mechanisms underlying insulin resistance, the precipitous decline of β-cell function, and the role of other hormonal abnormalities in the pathogenesis of the disease. We discuss the critical importance of social determinants of health in the predisposition and progression of these conditions and present current management strategies and the advances in therapeutic approaches. These must adapt to meet the unique needs of the individual patient and family. Significant knowledge gaps remain that need to be addressed in future research.
Review Article|
September 09 2024
Pathophysiology and Treatment of Prediabetes and Type 2 Diabetes in Youth
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Fida Bacha
;
1USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
2Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
Corresponding author: Fida Bacha, [email protected]
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Tamara S. Hannon;
Tamara S. Hannon
3Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
4Pediatric Accelerator for Careers Engaged in Research, Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Mustafa Tosur
;
Mustafa Tosur
1USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
2Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
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Julie M. Pike;
Julie M. Pike
3Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
4Pediatric Accelerator for Careers Engaged in Research, Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Ashley Butler
;
Ashley Butler
5Division of Psychology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
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Kalie L. Tommerdahl
;
Kalie L. Tommerdahl
6Section of Endocrinology, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
7Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
8Ludeman Family Center for Women’s Health Research, Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Philip S. Zeitler
Philip S. Zeitler
6Section of Endocrinology, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
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Corresponding author: Fida Bacha, [email protected]
Diabetes Care dci240029
Article history
Received:
March 15 2024
Accepted:
July 20 2024
PubMed:
39250166
Citation
Fida Bacha, Tamara S. Hannon, Mustafa Tosur, Julie M. Pike, Ashley Butler, Kalie L. Tommerdahl, Philip S. Zeitler; Pathophysiology and Treatment of Prediabetes and Type 2 Diabetes in Youth. Diabetes Care 2024; dci240029. https://doi.org/10.2337/dci24-0029
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