Type 2 diabetes in the Young: The Evolving Epidemic. The International Diabetes Federation Consensus Workshop

1. The aims of the consensus meeting were to review the epidemiology, pathophysiology, management, and implications of the rising prevalence of type 2 diabetes in young people and to suggest means by which the continuing rise in incidence and prevalence might be prevented. 2. The overall global prevalence of type 2 diabetes is rising steadily. Previously, type 2 diabetes was predominantly a disease of middle-aged and older people. In recent decades, the age of onset has decreased and type 2 diabetes has been reported in adolescents and children worldwide, particularly in high-prevalence populations. Japan has seen an approximate fourfold rise in the incidence of type 2 diabetes in 6- to 15-year-olds, and between 8 and 45% of newly presenting children and adolescents in the U.S. have type 2 diabetes. The problem is particularly noticeable in indigenous peoples. Population-based data, however, are sparse and indeed absent in most countries. 3. Additional cardiovascular risk factors are often associated with type 2 diabetes in the young and microangiopathy is as common or commoner in those developing type 2 diabetes at a young age as in those with type 1 diabetes. This has profound societal implications. 4. Diagnostic separation of type 2 from other types of diabetes in young people can be difficult, and sophisticated testing may be necessary. 5. Data on the pathophysiology in the young are sparse, but there is no evidence to suggest differences from adults. The incidence of type 2 in the young is rising in parallel with the incidence of overweight and obesity, suggesting a possible causal relationship, particularly when the obesity is central and in relation to decreased physical activity. Other factors include family history, gestational diabetes in the mother, and low birth weight. All of these are associated with insulin resistance, although decreased insulin secretion is also required. 6. Mass screening for type 2 diabetes in the young has been carried out in certain countries (Taiwan and Japan) but is probably appropriate only for individuals at very high risk. The best screening test for young people is not known. 7. Treatment should be aimed at physical and psychological well-being and avoidance of long-term complications. Lifestyle modification must accompany other forms of therapy. In certain countries, metformin is available for treatment of children, but efficacy remains unproven. Newer oral agents have not been tested systematically in children or adolescents. Insulin remains the most frequently used treatment. Hypertension and dyslipidemia are also common and require active intervention. 8. Prevention must be the main strategy for the future, School-based programs have been shown to be effective in the U.S. and Singapore. Major governmental actions that focus on lifestyle will be required. 9. Recommendations for action are made.