Skip to Main Content

INTRODUCTION

ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES

  • Polyuria (heavy diapers in infants), polydipsia, weight loss, and candidal infections.

  • Hyperglycemia and glucosuria, often with dehydration and ketonemia/ketonuria at presentation.

  • Diabetic ketoacidosis (DKA) can present as respiratory distress and/or severe nausea and vomiting.

Epidemiology & Description

Diabetes mellitus is defined by chronic hyperglycemia caused by defects in insulin secretion, insulin action, or a combination of the two.

A. Type 1 Diabetes

Type 1 diabetes (T1D) is characterized primarily by insulin deficiency. While it is the most common type of diabetes mellitus in people younger than 20 years, it can develop at any age and most cases are diagnosed after age 20. The classic presentation includes increased thirst (polydipsia), increased urination (polyuria), and weight loss; however, the patient may be overweight or even obese. T1D is further divided into T1a (autoimmune) (~ 95% of the cases) and T1b (idiopathic) diabetes. T1b is more common in individuals of African or Asian ancestry. In the United States, T1D affects an estimated 1.6 million people, including about 244,000 patients younger than 20. Incidence of T1D in youth is about 22 per 100,000 per year, with an annual increase of 2%–4% reported worldwide.

T1D incidence is the highest in children of European ancestry, followed by people of African American and Hispanic ancestry; rates are low in Asians and Native Americans. While most diagnoses occur in older school children, the distribution has shifted to include more infants and preschool age children. About 6% of siblings or offspring of persons with T1D also develop diabetes (compared to 0.2%–0.3% in the general population). However, fewer than 10% of children newly diagnosed with T1D have a parent or sibling with the disease.

B. Type 2 Diabetes

Type 2 diabetes (T2D) is characterized by resistance to the action of insulin. Insulin production may be high initially, but it gradually decreases leading to hyperglycemia. T2D has a heterogeneous phenotype and is diagnosed most often in persons older than 40 who are usually obese and initially not insulin dependent. T2D is rare before age 10; however, puberty is a time of heightened risk for development of T2D in susceptible individuals. Due to increased prevalence of excess weight in childhood, T2D has increased in frequency in older children. T2D is more common in youth of minoritized ethnic and racial groups, particularly the Native American and African American populations. Other risk factors include female sex, poor diet and sleep, and low socioeconomic status. The vast majority of the 29 million patients with diabetes in the United States have T2D, but only about 39,000 patients are younger than 20. Incidence of T2D between ages 10 and 20 in the United States is about 18 per 100,000 per year, with a peak at age 16 and has increased about 5% per year over ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

  • Create a Free Profile