NEW YORK — Distinguishing between type 1 and type 2 diabetes can be difficult given the increase in the number of overweight and obese children, Dr. Larry C. Deeb said at the annual meeting of the Diabetes in Pregnancy Study Group of North America.
“It is not crystal clear,” he said.
The rising number of overweight and obese children in the United States means that more and more children are getting type 2 diabetes, but more children with type 1 diabetes also are overweight.
The classic picture of a child who is wasting away is frequently not the case in type 1 diabetes anymore. In fact, up to a quarter of children with type 1 diabetes might be overweight, said Dr. Deeb, president of medicine and science for the American Diabetes Association and medical director of the Diabetes Center at Tallahassee Memorial Hospital in Florida.
However, there are differences in presentation of illness that can help physicians distinguish between the two conditions.
Type 1 diabetes in children continues to be characterized by a short course of illness, Dr. Deeb said. About 35%–40% of subjects will have ketoacidosis. In children with type 1 diabetes, the C-peptide and insulin levels will decrease, but they might be preserved early on.
In some cases, family history can be a clue. About 5% of subjects have first- or second-degree relatives with type 1 diabetes.
Race and ethnicity also can help physicians figure out whether the diabetes is type 1 or type 2. Type 1 diabetes is still a disease mostly of whites and northern Europeans in the United States, he said.
When dealing with type 2 diabetes, overweight is a significant factor. About 85% of subjects with type 2 diabetes will be overweight.
In general, the course of type 2 diabetes in children will be indolent. But a significant proportion, about 33% of subjects, will have ketonuria. And a surprising number, 5%–25%, have mild ketoacidosis, Dr. Deeb said.
Many children and adolescents at highest risk for type 2 diabetes are not being seen by a physician, Dr. Deeb said. “You have some parents who bring children in, but the vast majority is not seen,” he said. “This teen group is at risk to develop diabetes, and by the time they're at risk, they're not being seen. Therefore, they very well be may be all the way to sick.”
In children with type 2 diabetes, C-peptide and insulin levels might increase, but they can be low at diagnosis with glucotoxicity and lipotoxicity.
Type 2 diabetes also is associated with insulin resistance, hypertension, dyslipidemia, polycystic ovary syndrome (PCOS), and acanthosis nigricans. “I never dreamed that I would treat so much PCOS as a pediatric endocrinologist,” Dr. Deeb said.
Family history can be a strong indicator of type 2 diabetes. Between 74% and 100% of these children will have a first- or second-degree relative with type 2 diabetes. In terms of race and ethnicity, type 2 diabetes is predominantly a disease of minority youth, but white children still have it, he said.
Type 1 diabetes is still a disease mostly of whites and northern Europeans in the United States. DR. DEEB