儿童2型糖尿病和糖调节异常筛查方案的研究

目的评价及比较在不同特征人群中进行2型糖尿病（T2DM）和糖调节异常（IGR）筛查的效果及成本，优化和推荐儿童青少年T2DM筛查方案。方法采用分层整群随机抽样方法获取19 593例北京市中小学生，用空腹指末梢血糖（FCBG）对其进行T2DM和IGR筛查，FCBG异常者（≥5.6 mmol·L-1）采用1999年WHO口服葡萄糖耐量试验标准进行诊断。并参照美国糖尿病协会建议儿童青少年T2DM筛查的高危对象标准和Dean提出的诊断标准进行T2DM的分型诊断。将研究人群分为一般人群、超重/肥胖和肥胖组，分别计算回访率、血糖异常阳性率、直接医疗成本和确诊每例成本，根据成本 效果推荐儿童青少年T2DM筛查方案。结果一般人群组，FCBG异常者回访率为47.97%(225/469)，超重/肥胖和肥胖组FCBG异常者回访率分别为59.29%（83/140）和68.00%（51/75），差异有统计学意义。一般人群组T2DM/IGR确诊率最低，为1.67/1 000例；总花费11.21万元和确诊每例T2DM/IGR的花费0.35万元，最高。肥胖组T2DM/IGR确诊率最高，为8.09/1 000例；总花费1.62万元和确诊每例T2DM/IGR的花费0.11万元，最低，较一般人群组分别下降85.55%和68.57%。超重/肥胖组介于两者之间。肥胖、超重/肥胖与一般人群组相比，肥胖组有2例T2DM（33.33%，2/6）漏诊，超重/肥胖组没有T2DM 漏诊。建议在超重/肥胖组中进行T2DM和IGR筛查。进一步选择除超重/肥胖外，与T2DM相关的危险因素（黑棘皮病、T2DM家族史和青春期），随调查对象具有危险因素数量的增加，患病危险性增加，筛查依从性增高，T2DM/IGR确诊率升高，筛查总成本和每例成本降低，但是从调查对象具有3个或以上危险因素开始，对T2DM/IGR筛查敏感度下降，与在一般人群组筛查相比，在4个危险因素人群中进行筛查，将有83.33%的T2DM得不到确诊。结论 本大样本研究以成本 效果分析说明：在儿童中符合健康经济学的T2DM筛查方案是在达到超重标准，同时具有1个以上危险因素（黑棘皮病、T2DM家族史和青春期）儿童青少年中进行目的性筛查。     

重视儿童青少年糖尿病的防治

随着我国的经济发展和人民生活的普遍提高 ,人们日常饮食也趋向高蛋白、高脂肪和高热量化 ,使儿童期的肥胖发生率徒升 ,并导致了一些疾病的发病率上升 ,糖尿病即是其中之一 ,特别是 2型糖尿病患儿明显增多。以往 ,我国儿科内分泌专科医师都以 1 5岁以下的 1型糖尿病患儿为防治工作的重点 ,因为 2型糖尿病较为罕见。但近年来国外众多文献报道儿童、青少年期 2型糖尿病的发病率普遍显著上升 :美国Pima族人 1 2～ 1 9岁组 2型糖尿病在 1 976～ 1 996年的 2 0年中发病率由 4 2‰上升至 5 0 9‰ ,增加了 1 0余倍 ;美国白人儿童青少年中诊断为 2…     

儿童2型糖尿病

糖尿病是一种常见的、具有遗传倾向的、葡萄糖代谢异常的内分泌疾病,是由于绝对或相对胰岛素分泌不足,或机体对胰岛素需求量增加共同作用导致特征性病理和临床表现形成的临床综合征。糖尿病一般可分为胰岛素依赖型（T1DM）和非胰岛素依赖型（T2DM）,儿童则以T1DM较常见,但随着人们生活水平的提高和生活方式的改变,肥胖儿童日益增多,儿童2型糖尿病的发病率也呈增长趋势。     

儿童糖尿病198例

目的 探讨儿童糖尿病(DM)的临床特点,为临床诊治提供理论依据.方法 对1999年1月-2009年3月在本院住院的198例DM患儿的临床表现和实验室检查进行回顾性临床分析.结果 198例DM患儿中,男97例,女101例.均为首诊病例;发病高峰年龄为5～6岁及9～11岁;首诊例数逐年增加,2008年较1999年增加了3.7倍;其中1型糖尿病(T1DM) 174例(占88.9％),2型糖尿病7例(占3.5％),新生儿DM 14例(占7.1％),其他3例(占1.5％).首诊的TlDM患者中,酮症酸中毒(DKA)的发生率为42.0％;发病前有感染史者55例,与无感染史者比较,DKA的发生率有统计学差异(P＜0.01).有DM家族遗传史者23例.并甲状腺功能亢进症2例;并暂时性甲状腺功能减低症31例;并肝功能异常30例,肾功能异常12例,血脂异常48例,尿蛋白阳性27例.糖化血红蛋白为(12.0±1.8)％;共分析了25例T1 DM患者的自身抗体,胰岛细胞抗体阳性率为28％,胰岛素自身抗体的阳性率为20％,谷氮酸脱羧酶自身抗体(GADA)阳性率为72％.结论 首诊的儿童DM逐年增加,以T1DM为主;新生儿DM增加明显;DKA是T1DM患者就诊的重要原因;首诊的T1DM者中,感染是发生DKA的重要诱因;儿童DM常合并暂时性甲状腺功能减低症、肝肾功能异常及血脂异常;糖尿病自身抗体中GADA的阳性率最高.     

儿童糖尿病临床与分子遗传学病因分析

目的 明确儿童单基因糖尿病的临床特点和分子遗传学病因。方法 回顾性分析2020年8月至2021年12月收治的76例糖尿病患儿的临床表现和初诊时实验室检查。按照儿童糖尿病分型,分为青少年的成人起病型糖尿病(MODY)组(n=7)、2型糖尿病(T2DM)组(n=7)和1型糖尿病(T1DM)组(n=62)。对其中21例疑似单基因糖尿病患儿行全外显子测序(WES)。结果 WES共发现7例单基因糖尿病,均为青少年的成人起病型糖尿病(MODY),3例为GCK变异所致MODY2,3例为HNF1A变异所致MODY3,1例为INS变异所致MODY10。共发现2种未见报道新变异：GCK的c.1124T>G(p.V375G),INS的c.110A>T(p.E37V)变异。7例中5例MODY患儿起病时无典型糖尿病症状,以偶然发现血糖升高入院。MODY组、T2DM组和T1DM组间初诊时空腹血糖、C肽、胰岛素、HbA1c差异均有统计学意义(P<0.05)。MODY组血糖及糖化血红蛋白较T1DM组降低;C肽水平较T1DM组升高,较T2DM组降低;胰岛素水平低于T1DM组和T2DM组,差异均有统计学...     

儿童1型糖尿病诊治新进展

糖尿病是由于胰岛素分泌能力或(和)胰岛素作用缺陷而致的以高血糖为特征的慢性代谢性疾病。在各种糖尿病类型中,1型糖尿病(T1DM)占5%~10%。近年来,美国等西方发达国家由于肥胖患病率的增加,儿童2型糖尿病(T2DM)的患病率上升幅度较为明显[1],但在我国及多数国家,儿童青少年仍以T     

儿童和青少年2型糖尿病诊治进展北大核心CSCD

随着肥胖的流行,儿童和青少年2型糖尿病（T2DM）在世界范围内明显增加,对高危人群的筛选和诊断 T2DM 非常重要。儿童和青少年 T2DM 除了生活方式的改变外,推荐的最佳药物治疗为二甲双胍和胰岛素。为减少心血管疾病的风险,应充分认识儿童和青少年 T2DM 和并发症,并更好地评价和管理。     

1型糖尿病儿童发生超重、肥胖的影响因素

过去认为在儿童1型糖尿病(T1DM)中多以体型消瘦为主, 超重、肥胖较少见, 因此重视程度不高。但近年随着儿童T1DM患病率的增高, 其超重和肥胖率也出现增长趋势, 这不仅影响患儿生长发育, 还可能增加其并发症的发生风险, 影响病情预后, 故现已成为T1DM长期管理中的一个新问题。现就T1DM儿童在随访中出现超重、肥胖的影响因素进行综述, 以提高临床对T1DM患儿超重、肥胖的重视, 做好对有风险因素群体的监测, 尽早给予关注和干预, 优化其治疗方案。     

儿童1型糖尿病的诊治与展望

儿童糖尿病主要为儿童1型糖尿病(T1DM),根据我国大中城市的大样本纵向调查,其年发病率增幅约为世界平均增幅的3倍,5岁以下儿童增幅较高,提示我国儿童T1DM低龄化趋势。T1DM的病因机制复杂,遗传易感和环境因素促发是其发病的主要原因。年幼起病、长病程、血糖控制欠佳除导致糖尿病慢性并发症高发外,还影响患儿精神运动发育。药物治疗、血糖监测、健康教育、运动和营养管理是儿童T1DM良好血糖控制的根本举措。人工胰腺、干细胞胰岛分化与移植、免疫干预未来有可能从根本上改善未来T1DM的治疗和预后。     

1型糖尿病儿童甲状腺抗体的检测

目的：明确1型糖尿病（T1DM）儿童甲状腺抗体阳性的发生率及其相关因素。方法：回顾性分析我院2005年5月至2011年4月T1DM病例的临床资料,分析甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)与细胞因子IL-2、IL-4、IL-6、IL-10、TNF、IFN-γ和CD3+、CD4+、CD8+淋巴细胞的关系。结果：经筛选后共获得甲状腺双抗体资料完整的T1DM患儿186例,其中甲状腺双抗体正常143例,甲状腺抗体阳性43例（23.1％）,其中双抗体阳性21例。诊断为自身免疫性多腺体综合征3型变异型患儿18例（9.7%）。甲状腺抗体阳性组有糖尿病家族史的比例显著高于甲状腺抗体正常组（27.9% vs 14.7%,P＜0.05）。甲状腺抗体阳性组患儿年龄大于甲状腺抗体正常组（10.1±3.2岁vs 8.1±4.0岁,P＜0.05）。甲状腺抗体阳性组IL-2水平显著高于甲状腺抗体正常组（4.48 ±1.27 pg/mL vs 2.82 ±0.84 pg/mL,P＜0.05）,而其CD3+细胞比例低于甲状腺抗体正常组［（61±11)% vs (66±11）%, P＜0.05）］。结论：儿童T1DM甲状腺抗体阳性率增高可能与遗传背景和T细胞免疫功能紊乱,尤其是IL-2异常升高有关。     

上海市卢湾区青少年2型糖尿病患病率调查

[摘要] 目的：通过调查获得上海地区青少年2型糖尿病患病率及相关高危因素。 方法：对上海市卢湾区12所中学，共10442名中学在校生进行晨尿尿糖筛查，对尿糖阳性者进行尿糖复查，并进行空腹血糖及OGTT检查，以确诊糖尿病。对确诊的糖尿病患儿进行糖尿病临床分型诊断，并收集2型糖尿病患儿家族史、出生史、既往史及饮食习惯等资料。统计上海地区青少年2型糖尿病患病率并分析其高危因素和基本特征。 结果： 1.第一次尿糖阳性人数为125人，第二次尿糖阳性人数为15人；2.发现2型糖尿病患儿5名，其中男性3名，女性2名，11～14岁2名，15～18岁3名；3.随机抽取其中一所中学，同时进行OGTT检查，空腹及2小时血糖达糖尿病诊断标准者2名，且与尿糖筛查结果相符；4.2型糖尿病患病率为4.79／10,000，男性为4.34／10，000，女性为5.68／10,000，按年龄分11～14岁为3.87／10,000，15～18岁为5.69／10，000；5.筛查出的2型糖尿病患儿抗体检查（GADAB、ICA及IAA）结果均阴性；6.本次筛查出的2型糖尿病患儿体重指数均属肥胖或超重范围，且均有2型糖尿病家族史。 结论：上海地区青少年2型糖尿病患病率较高，且随年龄增大呈增高趋势，女孩患病率较男孩高，肥胖及有糖尿病家族史是青少年2型糖尿病的高危因素。     

Annual screening detects celiac disease in children with type 1 diabetes

Objective:  To investigate the prevalence of celiac disease (CD) in a cohort of type 1 diabetes mellitus (T1DM) children and adolescents at the time of clinical diagnosis and to evaluate the screening procedure and possible role of human leukocyte antigen (HLA)-DQ during a 5-yr follow-up.
Research design and methods:  The study group was a cohort of 300 newly diagnosed T1DM children and youths younger than 20 yr followed for 5 yr at six clinical centers for pediatric diabetes in the region Skåne in Sweden. Immunoglobulin A endomysium antibodies were used to screen the patients annually to be considered for an intestinal biopsy. All patients were analyzed for HLA-DQA1-B1 genotypes.
Results:  While 0.7% (2/300) already had a diagnosed symptomatic CD, an additional 3% (10/300) had silent CD at the diagnosis of T1DM. During follow-up, another 6% (17/300) developed CD as follows: 10 after 1 yr, 5 after 2 yr, 1 after 3 yr, and 1 after 5 yr. Therefore, the cumulative frequency of CD confirmed by intestinal biopsies was 10% (29/300). HLA genotypes among T1DM patients developing CD were not different from those among patients with T1DM alone.
Conclusions:  Our study confirmed the low prevalence (0.7%) of diagnosed symptomatic CD at the time of clinical diagnosis but document by screening an increasing prevalence of silent CD during a 5-yr follow-up to reach an overall prevalence of 10%. We suggest that children with T1DM should be screened for CD at the onset of T1DM and annually for a minimum of at least 2 yr. HLA genotypes among T1DM patients developing CD were not different from those among patients with T1DM alone.     

Type 2 diabetes mellitus is rare but not absent in children under 15 years of age in Austria

Until recently, most children with diabetes mellitus had type 1 diabetes (T1DM). The prevalence of type 2 diabetes (T2DM) is on the rise in North America, especially in risk populations such as the American Indians. Few epidemiological data on the incidence of the disease exist in Europe. In a prospective population-based epidemiological study, all newly diagnosed cases of diabetes mellitus in patients under 15 years of age were registered nation-wide in Austria between 1999 and 2001. Differential diagnosis (according to the American Diabetes Association diagnostic criteria) was based on clinical case definition. During the 3 years of the study period, 529 cases of DM <15 years were documented, of which 510 were clinically assigned to T1DM (271 boys, 239 girls) resulting in an incidence rate of 12.4/100,000. In the same network, eight cases were diagnosed as T2DM (one boy, seven girls) and two cases with an atypical form of T2DM (two girls). The age of onset of T2DM was 12–15 years and all patients were overweight (body mass index >90th percentile).The calculated incidence for T2DM <15 years in Austria was 0.25/100,000. Conclusion: at present, type 2 diabetes mellitus is rare but exists in children aged under 15 years in Austria. Follow-up of this registration will help to describe the secular trend.Abbreviations BMI body mass index - GAD glutamic acid decarboxylase - IAA insulin autoantibody - IA2 tyrosine like phosphatase - MODY maturity onset diabetes in the young - T1DM type 1 diabetes mellitus - T2DM type 2 diabetes mellitus Members of the Austrian Diabetes Incidence Study Group: Arocker W., Bauer M., Baumgartner F., Bali C., Borkenstein M., Bittmann B., Coradello H., Dorninger L., Fussenegger J., Jäger A., Gröblacher H., Guttenberger K. H., Häckel F., Heijbl L., Höller W., Holzer H, Holzleitner C., Jäger A., Jürgenssen O. A., Kovac U., Kitzler P., Köfler T. H., Kurnik P., Lindauer E., Meisel A., Moser G., Mühleder J., Müller G., Müllner M., Paier R., Popper-Preising C., Prchla C., Rausch-Schott G., Rauscher R., Reindl R., Resch R., Rezaka E., Rittinger O., Rubens K., Salzer H., Schally-Stebl A., Schermann A., Schlager J., Schmitt K., Schneider U., Sellner-Horstmann S., Sonnberger H, Stainer A., Steichen E., Stöllinger O., Sulzer M., Von den Thannen T., Walser I, Wakolbinger G., Weinhandl G., Wutte A., Zieglauer H., Zwiauer K.     

25-羟维生素D与儿童1型糖尿病及酮症酸中毒的相关性研究

目的探讨血清25-羟维生素D[25-(OH)D]水平与儿童1型糖尿病(T1DM)及酮症酸中毒(DKA)的相关性。方法选取2006年1月—2009年12月期间152例住院患儿,其中52例为首次发病的T1DM患儿,包括酮症酸中毒(DKA组)21例,以及非酮症酸中毒(非DKA组)31例,其余100例为非T1DM组。检测并比较三组患儿的血清25-(OH)D水平,分析血清25-(OH)D水平与儿童T1DM及DKA的相关性。结果 DKA组患儿的血清25-(OH)D平均为(53.6±27.8)nmol/L,显著低于非DKA组的(69.7±27.9)nmol/L和非T1DM组的(81.8±28.3)nmol/L(P<0.05);非DKA组患儿的血清25-(OH)D水平显著低于非T1DM组(P<0.05)。结论 T1DM患儿的血清25-(OH)D水平低,尤以DKA患儿最为明显,维生素D在儿童T1DM发病中的潜在保护效应值得关注。     

初发1型糖尿病患儿外周血单个核细胞FOXP3和CTLA-4表达的研究

目的：研究初发1型糖尿病患儿外周血叉状头转录因子( FOXP3)和细胞毒性T细胞相关抗原-4(CTLA-4)表达水平,探讨它们在1型糖尿病发病中的作用。方法选取50例初发1型糖尿病患儿和30例健康儿童,采用real-time PCR法研究FOXP3和CTLA-4 mRNA表达;ELISA方法检测血清中可溶性FOXP3( sFOXP3)和CTLA-4( sCTLA-4)蛋白水平;分别应用免疫印记法、高效液相离子层析法和电化学发光法测量糖尿病抗体、HbA1C及C肽。结果1型糖尿病患儿FOXP3 mRNA及蛋白表达低于对照组[0.95±0.48 vs.2.11±0.79,(6.27±1.49) ng/ml vs.(9.02±2.37) ng/ml,均P<0.01],而CTLA-4 mRNA及蛋白表达高于对照组[2.43±0.83 vs.1.94±0.84,(77.88±22.34) ng/ml vs.(65.97±12.11) ng/ml,P<0.01];1型糖尿病患儿FOXP3和CTLA-4基因与蛋白表达均呈正相关(r＝0.758、0.396,均P<0.05);FOXP3与CTLA-4蛋白表达具有相关性(r＝－0.624,P<0.05)。结论初发1型糖尿病患儿外周血FOXP3和CTLA-4的基因及蛋白表达异常,FOXP3调控CTLA-4在调节性T 细胞的表达,提示免疫机制参与1型糖尿病的发生。     

Delayed diagnosis in type 1 diabetes mellitus

Children with suspected type 1 diabetes mellitus (T1DM) should have same day referral to a paediatric diabetes team. 99 children (54 male; median age 10.5 years, range 0.9-15.9 years) were diagnosed with T1DM at our hospital between January 2004 and June 2007. 27 (27.2%) presented in diabetic ketoacidosis (DKA). 37 (37.3%) required hospital admission, while the rest had ambulatory management. In 21 (21.2%) children, diagnosis was delayed >24 h (median 3.0 days, range 1-14 days) due to missed diagnosis at the local hospital (four) or by the general practitioner (seven), arranging a fasting blood glucose test (nine) and outpatient appointment requested via fax (one). Children with delayed diagnosis presented more frequently in DKA (52.3% vs 20.5%, p<0.01), with a higher median presenting HbA1c (12.3% vs 10.9%, p<0.05). There were no differences in age and sex between the delayed diagnosis and immediate referral groups. Healthcare providers need to be aware of the importance of immediate referral of children newly diagnosed with T1DM.     

Type 2 diabetes mellitus in children and adolescents is still a rare disease in Germany: a population-based assessment of the prevalence of type 2 diabetes and MODY in patients aged 0–20 years

Objective: To assess the prevalence of type 2 diabetes mellitus (T2DM) and maturity onset diabetes of the young (MODY) in children and adolescents aged 0−20 yr in Baden-Württemberg (BW), Germany, and to compare our results with those from other European countries.
Methods: Our study involved every children's hospital (n = 31), each diabetologist in private practice (n = 122), and every internal medicine unit (n = 164) in BW. A written questionnaire and a telephone survey were used to identify children with T2DM and MODY who had been examined at any of these institutions between 2004 and 2005. Population data were drawn from the national census of 1987 and the subsequent annual updates.
Results: The prevalence of T2DM for the age range from 0 to 20 yr is 2.30/100 000, whereas the prevalence of MODY in the same age range is 2.39/100 000. The median age of patients with T2DM was 15.8 yr, and 13.9 yr for MODY patients. The majority of patients with either T2DM or MODY were treated in children's hospitals and by consultant diabetologists. A molecular genetic analysis was done to substantiate the clinical diagnosis in less than half of the recruits (14.3% of T2DM and 44.8% of MODY patients).
Conclusions: The prevalence of T2DM and MODY is considerably lower than the prevalence of type 1 diabetes. Type 2 diabetes thus continues to be a rare disease in children and adolescents in Germany, as is also the case in other European countries.     

Celiac disease prevalence in children and adolescents with type 1 diabetes from Serbia

Background: The association between celiac disease (CD) and type 1 diabetes mellitus (T1DM) is well known. Up to now, CD prevalence in children and adolescents with T1DM in Serbia has not been reported. The aim of the present study was to determine CD prevalence and its clinical manifestations in patients with T1DM. Methods: One hundred and twenty‐one patients (70 girls, 51 boys; mean age, 10.8 years) with T1DM (mean duration of diabetes, 3.4 years) and 125 control group participants (75 girls, 50 boys; mean age, 10.4 years) were tested for CD on tissue transglutaminase antibodies (tTG). In seven serologically positive T1DM patients endoscopic small bowel biopsies were taken and examined on histopathology. In all patients with CD and T1DM age, duration of T1DM, height for age, body mass index, glycosylated hemoglobin and clinical symptoms were noted. Results: Nine patients with T1DM were positive on IgA tTG antibodies. In seven of them small bowel biopsy was performed, and all were proven to have CD on histopathology. The prevalence of biopsy‐proven CD in children and adolescents with T1DM was significantly higher in the study group compared to controls (5.79%. vs 0.8%, P < 0.05). Conclusion: The significantly higher prevalence of CD in children with type 1 diabetes, in accordance with the large volume of data published in the literature, underlines the need for yearly screening of CD in patients with diabetes in order to promptly start a gluten‐free diet when appropriate.     

Serum vitamin D levels are lower in Australian children and adolescents with type 1 diabetes than in children without diabetes

Vitamin D is synthesised in the skin through the action of UVB radiation (sunlight), and 25‐hydroxy vitamin D (25OHD) measured in serum as a marker of vitamin D status. Several studies, mostly conducted in high latitudes, have shown an association between type 1 diabetes mellitus (T1DM) and low serum 25OHD. We conducted a case–control study to determine whether, in a sub‐tropical environment with abundant sunlight (latitude 27.5°S), children with T1DM have lower serum vitamin D than children without diabetes. Fifty‐six children with T1DM (14 newly diagnosed) and 46 unrelated control children participated in the study. Serum 25OHD, 1,25‐dihydroxy vitamin D (1,25(OH)₂D) and selected biochemical indices were measured. Vitamin D receptor (VDR) polymorphisms Taq1, Fok1, and Apa1 were genotyped. Fitzpatrick skin classification, self‐reported daily hours of outdoor exposure, and mean UV index over the 35 d prior to blood collection were recorded. Serum 25OHD was lower in children with T1DM (n = 56) than in controls (n = 46) [mean (95%CI) = 78.7 (71.8–85.6) nmol/L vs. 91.4 (83.5–98.7) nmol/L, p = 0.02]. T1DM children had lower self‐reported outdoor exposure and mean UV exposure, but no significant difference in distribution of VDR polymorphisms. 25OHD remained lower in children with T1DM after covariate adjustment. Children newly diagnosed with T1DM had lower 1,25(OH)₂D [median (IQR) = 89 (68–122) pmol/L] than controls [121 (108–159) pmol/L, p = 0.03], or children with established diabetes [137 (113–153) pmol/L, p = 0.01]. Children with T1DM have lower 25OHD than controls, even in an environment of abundant sunlight. Whether low vitamin D is a risk factor or consequence of T1DM is unknown.     

Increasing prevalence of type 2 diabetes mellitus in Thai children and adolescents associated with increasing prevalence of obesity

Type 2 diabetes mellitus (DM) is being diagnosed more frequently in children and adolescents. Thailand has a low incidence of childhood DM. This study reviewed patients with DM in the Division of Pediatric Endocrinology, Faculty of Medicine, Siriraj Hospital compared to our previous study. The results demonstrate that type 2 DM in Thai children and adolescents has increased from 5% during 1986-1995 to 17.9% during 1996-1999. Mean age was 11.6 years. Mean BMI was 27.8 kg/m2. Fifty-six percent were diagnosed on routine examination. The period of increase in type 2 DM is associated with an increase of obesity prevalence from 5.8% in 1990 to 13.3% in 1996. This result emphasizes the importance of encouraging daily physical activity and healthy diet in our populations and also alerts our pediatricians and endocrinologists to the possibilities of type 2 DM in these age groups.