不同标准评估儿童青少年营养过剩发生率比较

目的采用常用的儿童青少年营养过剩评判标准,对同一研究人群进行超重与肥胖发生率描述,从而评估我国现行儿童青少年体质指数（BMI）标准。方法对7520例（年龄7～18岁,其中男／女：3725／3795例）中小学生的身高与体重值进行统计分析,分别按中国1995年发布的年龄别体重标准、美国国家疾病控制中心（CDC）2000年发布的BMI美国标准、中国2003年发布的试行BMI标准3项标准计算该人群超重、肥胖发生率,其中前2项标准的第90百分位定义为超重,第97百分位定义为肥胖,第3项标准则按已发布的超重与肥胖标准进行统计。比较两性别组营养过剩发生率差。结果“年龄别体重”标准对营养过剩以及肥胖检出率高于BMI标准检出率;采用美国CDC标准进行人群评价,漏查了相当数量的超重与肥胖个体,尤其是青春人群;中国儿童青少年BMI暂行标准更为可信。两性别组间比较可见,每一年龄段女孩的营养过剩发生率均显著低于男孩。结论作为儿童青少年人群超重与肥胖的筛查性指标,现行的中国儿童青少年BMI标准不失为一项有效标准;男孩组营养过剩的高检出率亦提出警示：该人群是超重与肥胖的重要防治人群。     

儿童青少年2型糖尿病的诊断及治疗

随着世界范围肥胖者的增加,2型糖尿病(T2DM)在儿童及青少年中的发病率也明显上升.儿童青少年T2DM的病因也是由遗传、环境等多因素相互作用的结果.重要的危险因素包括肥胖、T2DM家族史、高危种族及胰岛素抵抗表型.为及早诊断及治疗,对具有危险性的儿童应进行T2DM筛查.筛查的指征包括肥胖和其他2个危险因素.儿童青少年T2DM的诊断标准同成人,基于空腹、随机血糖及口服糖耐量试验的标准值.防治T2DM的重要措施是改善生活方式、减低或控制体质量.此外,还可应用二甲双胍和(或)胰岛素.控制高血压及血脂紊乱及监测微血管并发症也很必要.实用儿科临床杂志, 2009, 24(8 ): 638-640     

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。     

北京市儿童青少年青春期发育与肥胖相关关系的研究

目的 分析北京市6~18岁儿童青少年青春期发育与超重肥胖的关系。方法 利用2004年北京市儿童青少年代谢综合征调查总样本中19 085名6~18岁儿童青少年的青春期发育、体重指数（BMI）和体脂含量百分比（FMP）等数据。采用女性乳房和男性睾丸容积Tanner分期指标衡量青春期发育，结合个体年龄将群体分为早、晚发育组；以BMI和生物电阻抗法所测FMP作为反映体脂含量的指标；7~18岁人群超重和肥胖的诊断采用中国肥胖问题工作组（WGOC）推荐的中国学龄儿童青少年超重、肥胖筛查BMI值分类标准进行，6岁组采用美国疾病预防与控制中心 2000年发布的儿童超重和肥胖BMI标准第P85和第P95分位值进行诊断；采用多元线形回归、Logistic回归分析早发育与体脂含量和超重、肥胖的相关联系。结果 早发育组的超重（合并肥胖）率和肥胖率均高于晚发育组，女性两组间差异大于男性；控制可能的混杂因素后，女性BMI和FMP与早发育呈正相关（BMI：β=2.25，P<0.001；FMP：β=4.55，P<0.001）；而男性BMI和FMP与早发育的联系相反，早发育组的BMI高于晚发育组，而FMP却低于晚发育组；以晚发育为参照组，控制年龄、城郊居住地等因素的影响后，早发育预测超重、肥胖的OR值（95%CI）：女性为3.39（2.94~3.92）和3.12（2.53~3.85），男性为1.12（0.96~1.31）和1.31（1.06~1.62）。结论 北京市儿童青少年青春期发育与肥胖密切相关，在评价超重、肥胖率及进行不同地区间肥胖流行状况的比较时，要注意青春期发育的效应修正作用。     

儿童2型糖尿病及糖尿病前期患病率研究

目的：了解近10年2型糖尿病（T2DM）和肥胖儿童中糖尿病（DM）前期的患病情况及T2DM的发病趋势。方法：对2000年10月至2010年9月住院且新诊断的DM以及肥胖患儿的临床资料进行回顾性分析。结果：（1）共诊断DM患儿503例,其中T2DM 31例。前后5年比较,T2DM构成比则从0.05‰上升到0.18‰（P<0.01）。与前5年相比,近5年T1DM病例数增加了1.35倍,T2DM增加了4.20倍,T2DM构成比的增长幅度大于1型糖尿病（T1DM）（P<0.05）。（2）1301例肥胖儿童接受口服葡萄糖耐量试验,其中29例确诊为T2DM,255例为DM前期。DM前期255例中,合并脂代谢紊乱133例,非酒精性脂肪肝病138例,高血压53例。结论：近5年T1DM和T2DM患病率均有明显增加,T2DM的增长快于T1DM。肥胖儿童DM前期的发生率较高,潜在发生T2DM以及心血管病变风险大。     

FTO基因SNP rs9939609, rs1421085多态性与儿童青少年肥胖及其代谢指标的相关性研究

目的 研究FTO(fat-mass and obesity associated)基因SNP rs9939609和rs1421085多态性与儿童青少年单纯性肥胖及其代谢指标的相关性。方法 以2004至2006年于复旦大学附属儿科医院内分泌门诊就诊的汉族单纯性肥胖和超重儿童青少年分别作为肥胖组和超重组;选择上海市某中学正常体重汉族学生作为正常对照组。分别测量身高和体重,计算BMI。测定血清空腹葡萄糖（FPG）、空腹胰岛素(FIns)、三酰甘油(TG)和总胆固醇(TC)水平。计算胰岛素抵抗指数（HOMA-IR）和胰岛素敏感指数（QUICKI）。抽提外周血基因组DNA,采用Taqman-MGB探针技术检测FTO基因SNP rs9939609和rs1421085多态性,分析不同基因型与代谢指标和BMI的相关性。结果 肥胖组纳入236例,超重组纳入239例,正常对照组纳入241名。①肥胖+超重组的BMI、FPG、FIns、TG和 HOMA-IR显著高于正常对照组;②肥胖、超重和正常对照组rs9939609分型成功率分别为94.9%（224/236例）、97.9（234/239例）和95.9%（231/241名）,rs1421085分型成功率分别为92.8%（219/236例）、97.1% （232/239例）和95.4%（230/241名）。rs9939609 AA基因型频率：肥胖组为2.7%,超重组为0.4%,正常对照组为1.7%,肥胖+超重组A等位基因频率显著高于正常对照组（OR=1.437,P=0.048）;rs1421085 CC基因型频率：肥胖组为2.7%,超重组为0.9%,正常对照组为1.7%,肥胖+超重组C等位基因频率高于正常对照组,但差异无统计学意义（OR=1.388,P=0.076 0）;③rs1421085 TC +CC基因型和rs9939609 TA +AA 基因型儿童青少年的BMI显著高于TT基因型（rs9939609：P=0.000 3;rs1421085：P=0.000 5）;rs1421085 TC +CC基因型和rs9939609 TA +AA 基因型与FPG、FIns、TG、TC、HOMA-IR、QUICKI无显著相关性。结论 FTO基因SNP rs9939609和rs1421085多态性与中国汉族儿童青少年肥胖和（或）超重存在相关性。A等位基因频率远低于欧洲人群,对BMI的作用效果与欧洲人群相似,但对代谢指标影响存在显著差异。     

广西南宁儿童青少年高血压现状及其与肥胖关系的研究

目的 了解广西南宁地区6~18 岁儿童青少年高血压现状及超重/ 肥胖与高血压发生的关系。方法 采用随机整群抽样方法对南宁地区7 893 名 6~18 岁儿童青少年进行问卷调查并测量血压、身高、体重等生长发育指标。结果 男女生收缩压（SBP）和舒张压（DBP）均随着年龄的增长呈递增趋势。高血压、高收缩压（HSBP）、高舒张压（HDBP）检出率分别为6.58%、4.02%、3.81%,其中男生高血压、HSBP 检出率明显高于女生（P<0.05）。正常组、超重组、肥胖组高血压检出率分别为3.87%、9.84%、19.23%。高血压、HSBP 及HDBP 检出率均表现为肥胖组> 超重组> 正常组 （P<0.05）。与正常组相比,超重组、肥胖组高血压发生的相对危险度（95%CI）分别为2.71（1.69~5.96）和5.91（3.46~7.63）。血压与年龄、身高、体重及体重指数均呈正相关（P<0.01）。结论 广西南宁6~18 岁儿童青少年血压的分布特征为：血压值与儿童青少年的性别、年龄、身高、体重和体重指数相关; 肥胖与高血压患病率密切相关,随着体重的增加,儿童青少年患高血压的危险亦增加。     

脂联素基因SNP276多态性与儿童青少年肥胖的相关性研究

目的研究脂联素（APM1）基因SNP276 G/T多态性与儿童青少年单纯性肥胖及其代谢指标的相关性。方法以2004至2006年于复旦大学附属儿科医院内分泌门诊就诊的单纯性肥胖或超重儿童青少年分别作为肥胖组和超重组;选择某中学正常体重学生作为正常对照组。分别测量身高和体重,计算体重指数（BMI）。测定血清空腹葡萄糖（FPG）、空腹胰岛素(FIns)、三酰甘油(TG)和总胆固醇(TC)水平。计算胰岛素抵抗指数（HOMA-IR）和胰岛素敏感指数（QUICKI）。抽提外周血基因组DNA,采用Taqman-MGB探针技术检测APM1基因SNP276 G/T多态性,分析不同基因型与代谢指标和BMI间的关联性。 结果肥胖组纳入227例,超重组纳入231例,正常对照组纳入216名。①肥胖+超重组的BMI、FPG、FIns、TG和HOMA-IR均显著高于正常对照组。②基因分布频率符合Hardy-Weinberg平衡。③肥胖组、超重组和正常对照组的G等位基因频率分别为71.4％、72.5％和69.7％,GG基因型频率分别为50.2％、52.4％和45.8％,GT基因型频率分别为42.3％、40.3％和47.7％;各组差异均无统计学意义（P均>0.05）。 ④SNP276 GG、GT和TT基因型的BMI、FPG、FIns、TG、TC、HOMA-IR和QUICKI差异均无统计学意义（P＝0.49~0.99）。⑤肥胖+超重组IFG儿童青少年中GG+GT型有70例,TT型4例;正常对照组IFG儿童青少年中GG+GT型有10例,TT型0例;两组差异无统计学意义（P＝0.45）。结论APM1基因SNP276 G/T多态性与青少年儿童单纯性肥胖及其代谢指标间无显著关联性,提示该SNP位点可能存在种族特异性。     

血尿酸水平与维吾尔族超重/肥胖儿童青少年代谢综合征的关系

目的 探讨维吾尔族超重/肥胖儿童青少年的血尿酸（SUA）水平与代谢综合征（MS）之间的关系。方法 研究对象为维吾尔族儿童青少年超重/肥胖患者（n=173）和体重正常者（n=200）。测量其身高、体重、腰围及总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）、空腹血糖及 SUA。结果 超重组和肥胖组的 SUA 水平分别为 235±42、285±42 μmol/L,均明显高于对照组（199±32 μmol/L）,差异有统计学意义（PPP2,SUA 水平增加 5.74 μmol/L。结论 维吾尔族超重/肥胖儿童青少年的 SUA 水平明显升高;SUA水平升高,MS 及其组分发生率增加;SUA 与体重指数呈正相关。     

儿童生长发育和营养状况评价标准的应用及局限性

衡量儿童青少年生长发育和营养状况的参考标准较多，有WHO推荐的生长参考标准、国际肥胖问题工作组（IOTF）针对营养过剩的肥胖标准，也有各个国家建立的本国儿童生长发育标准。在中国，除了WHO生长参考标准和IOTF肥胖标准外，常用的还有中国9城市7岁以下儿童体格发育参考值和中国学龄儿童青少年超重、肥胖筛查体重指数（BMI）值分类标准等。     

The prevalence of impaired fasting glucose and type 2 diabetes in a population‐based sample of overweight/obese children in the Middle East

Moadab MH, Kelishadi R, Hashemipour M, Amini M, Poursafa P. The prevalence of impaired fasting glucose and type 2 diabetes in a population‐based sample of overweight/obese children in the Middle East. Background: Type 2 diabetes mellitus (T2DM) and impaired fasting glucose (IFG) are increasing in young population who are facing an escalating trend of overweight. The aim of this study was to determine the prevalence of IFG and T2DM for the first time in a population‐based sample of Iranian obese children. Methods: This cross‐sectional, population‐based study was conducted in Isfahan, the second large city of Iran. Overall, 672 overweight and obese school students, selected from 7554 students, aged 6–19 yr, were screened for IFG and T2DM. Fasting plasma glucose (FPG) and lipid profile were measured in all participants. Oral glucose tolerance test and insulin level were measured in those children with IFG. Insulin resistance was defined as homeostasis model assessment for insulin resistance (HOMA‐IR) > 3.10. Results: Among the7554 students (48.7% boys and 51.3% girls) studied, 9.34% (n = 706) were overweight and 5.3% (n = 403) were obese. A number of 672 overweight and obese students including 302 (44.9%) boys and 370 (55.1%) girls, with a mean age of 12.8 ± 3.10 yr underwent biochemical work up. Overall, the prevalence of IFG was 4.61% (n = 31), the corresponding figure was 2% (n = 4) in the 6–10 yr age group, and 5% (n = 27) in those aged 10.1–19 yr. The prevalence of T2DM was 0.1% (n = 1; age, 18.00 yr). Impaired glucose tolerance and insulin resistance were detected in three and six participants with IFG, who consisted 0.4 and 0.8% of total obese and overweight students, respectively. Conclusions: Although the prevalence of T2DM is low in Iranian obese children, IFG is not uncommon. Preventive measures and screening of FPG should be considered for these children.     

Screening Copenhagen school children at risk of type 2 diabetes mellitus using random capillary blood glucose

AIM: To screen adolescents at risk of type 2 diabetes mellitus (T2DM) using random capillary blood glucose (RCBG). METHODS: Ninth grade pupils who were overweight and/or had a family history of T2DM were offered to have RCBG measured and were referred for further investigation if the value was > or = 7.8 mmol/L. RESULTS: Two thousand four hundred and eleven pupils were examined, 19% were overweight, 4% being obese. 589 met inclusion criteria and 384 participated. Ethnic minorities and pupils in low socio-economic school-areas (SESA) were significantly more overweight than ethnic Danes and pupils in high SESA. Compared to ethnic Danish pupils, the relative risk of having a positive parent history of T2DM was increased five-fold for ethnic Turkish and Arab pupils and 13-fold for ethnic Pakistani pupils. One pupil had a diagnosed T2DM. Two had elevated RCBG values. One of these had an undiagnosed T2DM. CONCLUSION: Our study shows a high prevalence of overweight adolescents in Copenhagen, especially in school areas with low socio-economic standard and in pupils with Turkish, Pakistani and Arab ethnicity. Only three out of the 10 pupils with the highest risk participated. New strategies to reach and motivate risk groups to follow health recommendations and new methods of screening should be developed.     

Overweight,obesity and features of metabolic syndrome in children with diabetes treated with insulin pump therapy

There has been no specific evaluation of atherogenic risk factors in children with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII). We, therefore, studied the prevalence of overweight/obesity and metabolic syndrome among these patients. Five hundred children with T1DM treated with CSII and multiple daily insulin (MDI) regimen were included in the study. Anthropometric data/physical examination, data concerning diabetes, and a lipid profile were assessed in this group, and compared with respect to treatment method (CSII vs. MDI). Almost one-third (30.2%) of the children were overweight/obese. The body mass index (BMI) values at the time of the present evaluation were significantly higher in comparison with the BMI values 3–6 months after the diagnosis. Dyslipidemia was recognized in 51.6%, hypertension in 4.8%, and the metabolic syndrome in 3.2%. of the subjects. The overweight/obese children differed from their normal-weight counterparts with respect to metabolic control, the incidence of hypertension, dyslipidemia, and metabolic syndrome. The girls showed higher prevalence of overweight/obesity and higher BMI values compared to the boys. The children treated with CSII had the same prevalence of overweight/obesity, but a lower incidence of dyslipidemia, and a better metabolic control compared to the children treated with MDI regimen. Our study shows a high prevalence of overweight/obesity and dyslipidemia in children with T1DM including those treated with an insulin pump.     

Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth Study

Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C, Dabelea D, Hamman R, Waitzfelder B, Kahn HS. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth Study.
Objective: Obesity's association with type 2 diabetes (T2DM) is well established, but is less clear with type 1 diabetes (T1DM). We calculated the prevalence of overweight and obesity among diabetic youth in the USA from a six-center, population-based study of racially and ethnically diverse youth with diabetes, and we compared these rates with estimates among nondiabetic youth.
Design/setting: Diabetic participants were examined in 2001−2004 for the SEARCH for Diabetes in Youth study (SEARCH) and nondiabetic participants were examined during the same years of the National Health and Nutrition Examination Survey (NHANES).
Participants: 3953 diabetic youth and 7666 nondiabetic youth aged 3−19 yr.
Main outcome measures: Overweight was defined as body mass index (BMI) from the 85th to <95th percentile for age and sex and obesity defined as ≥95th percentile. Diabetes type was categorized as T1DM or T2DM based on physician diagnosis.
Results: Among youth with T2DM, the prevalence of overweight was 10.4% and obesity was 79.4%. Among youth with T1DM, 22.1% were overweight. The prevalence of overweight among youth with T1DM was higher than among those without diabetes overall (22.1% vs. 16.1%) (P <.05). The obesity rate for T1DM was 12.6% overall (range Non-Hispanic White 10.7%−African-American 20.1%).
Conclusions: As expected, most of the youth with T2DM were obese. Youth with T1DM had a higher prevalence of overweight, but not of obesity, than nondiabetic youth. Future studies of obesity among youth with diabetes of all types will further our understanding of the impact of obesity on diabetes both as a risk factor and a comorbidity.     

Type 2 diabetes in a 5‐year‐old and single center experience of type 2 diabetes in youth under 10

The worrisome rise in pediatric type 2 diabetes (T2DM) is most prevalent among minority ethnic/racial populations. Typically, T2DM occurs during puberty in high risk obese adolescents with evidence of insulin resistance. Screening for T2DM in obese youth can be a daunting task for pediatricians and differentiating between pediatric T1DM and T2DM in obese youth can be challenging for pediatric endocrinologists. There is very limited data regarding the prevalence of T2DM among youth < 10 years of age. Here we present the case of a 5‐year‐old Hispanic male diagnosed with T2DM after referral by his pediatrician for abnormal weight gain, acanthosis nigricans and an elevated HbgA1c. He subsequently became symptomatic for diabetes with confirmed hyperglycemia and HbgA1c of 9.7% (83 mmol/mol) at the time of formal diagnosis. Type 1 diabetes autoantibodies (GAD65, Islet, and ZincT8) and monogenic diabetes genetic tests were negative. Due to elevated liver enzymes and baseline HbgA1c, he received basal insulin as his initial therapy. In this paper, we will discuss this case and present an IRB approved retrospective review of the characteristics of the 20 T2DM patients <10 years of age identified to date in our pediatric diabetes center. This review highlights that while uncommon, the diagnosis of T2DM merits consideration even in prepubertal children. This is especially true when working with a high risk population, such as our Hispanic South Texas youth.     

Does obesity cause type 2 diabetes mellitus (T2DM)? Or is it the opposite?

Obesity is believed to be a promoter of type 2 diabetes mellitus (T2DM). Reports indicate that severe obesity in childhood and adolescence increases the risk of T2DM in youth and young adults. T2DM, which is commonly asymptomatic, frequently is not recognized until random blood glucose is measured. Screening blood glucose levels measured in obese individuals are more effective for identifying undiagnosed persons, than screening the general population and therefore introduces a selection bias for discovery. The following commentary will indicate why these observations do not indicate that obesity is the cause of T2DM. Also, it will be shown that the insulin resistance of T2DM occurs primarily in the muscles of lean individuals predisposed to diabetes before they become obese. This insulin resistance is not secondary to, but instead, is the cause of the excessive fat accumulation associated with T2DM. Moreover, this early muscle insulin resistance is the etiology of the hyperlipidemia and excess fat accumulation characteristic of T2DM.     

Insulin resistance at diagnosis in Japanese children with type 2 diabetes mellitus

Background: Insulin resistance at diagnosis was investigated in Japanese children with type 2 diabetes mellitus (T2DM). Methods: A total of 160 children with T2DM were divided into groups on the basis of percent overweight at time of diagnosis: group A (n= 28), <20%; group B (n= 55), 20–39%; group C (n= 37), 40–59%; group D (n= 40), ≥60%. Indicators of insulin resistance at diagnosis were compared among the four patient groups, and also between the children with T2DM and the 201 age‐matched normal Japanese children. Results: There were no significant differences in plasma glucose (PG) levels among the four patient groups. The mean concentration of fasting plasma immunoreactive insulin (IRI) was significantly higher in group D than in groups A and B (39.2 µU/mL vs 16.2 µU/mL and 24.1 µU/mL, P < 0.05, respectively). The mean homeostasis model assessment (HOMA‐R) was significantly higher in group D than in all the other three groups (17.6 vs 7.8, 10.8 and 12.7, P < 0.05, respectively). The indicators HOMA‐R and fasting IRI were significantly higher in each diabetes group, even in non‐obese group A, than in normal children (P < 0.01, respectively). Conclusions: Japanese children with T2DM had insulin resistance at diagnosis regardless of percent overweight, and the degree of insulin resistance gradually increased with rise in percent overweight.     

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。     

Altered plasma adipokines and markers of oxidative stress suggest increased risk of cardiovascular disease in First Nation youth with obesity or type 2 diabetes mellitus

Objective:  To evaluate cardiovascular disease risk in First Nation youth with and without type 2 diabetes mellitus (T2DM) or obesity by comparing pro- and anti-inflammatory adipokines, markers of oxidative stress and the plasma phospholipid fatty acid profile.
Method:  Self-declared First Nation youth (12–15 yr) with T2DM (n = 24) as well as age-, gender-, and body mass index-matched controls (obese group; n = 19) and unmatched controls (control group; n = 34) were recruited from a pediatric diabetes clinic.
Results:  Plasma tumor necrosis factor-α, ultrasensitive C-reactive protein, resistin, and total antioxidant status were not different among the three groups. Plasma total leptin, soluble leptin receptor, and free leptin were significantly higher in the T2DM group than the control group (p < 0.001, p = 0.019, p < 0.001, respectively) but did not differ from the obese group. Similarly, oxidized low-density lipoprotein was higher in the T2DM group compared with controls (p = 0.002) but not in the obese group. However, interleukin-6 was significantly higher (p < 0.001) in the T2DM group compared with both the control and the obese groups, suggesting that T2DM, but not an increase in adiposity, was responsible for this elevation. Adiponectin was significantly lower in the T2DM group compared with the control group only (p = 0.035).
Conclusions:  Changes in plasma adipokines and oxidative stress can already be detected in youth with T2DM; however, many of the changes are mirrored in obese youth, suggesting that both these populations are at an increased risk for future cardiovascular complications.     

Type 2 Diabetes Mellitus in Children and Youth

Type 2 diabetes mellitus (T2DM) which used to be a disease of adults is now seen commonly at an early age in children and adolescents. T2DM is now an important diagnostic consideration in children who present with signs and symptoms of diabetes. The emerging epidemic of obesity in children throughout the world and the resultant insulin resistance contributes to the increasing prevalence of T2DM in this population. The recommended treatment options include metformin and insulin. Optimal glycemic control is essential considering the lifelong nature of the disease and therefore, the increased risk of long term complications – both microvascular and macrovascular. This review article summarizes the classification, diagnosis, pathogenesis, management, complications and screening of T2DM in children, incorporating and contextualizing guidelines from various professional associations.