ABSTRACT
Evolution is usually a process of slow change that can only be appreci-
ated after a considerable amount of time has passed. Although we think
of epidemics as being more revolutionary than evolutionary, we have
witnessed the evolution of two concurrent global non-communicable
disease epidemics, or pandemics, in less than 25 years. The epidemics of
obesity and type 2 diabetes, unlike acute and time-limited epidemics of
infections in the past, pose an insidious and continuing profound effect
on individual and public health. These pandemics are intimately linked,
with the epidemic of obesity preceding and setting the scene for the
development of type 2 diabetes. In the evolutionary process, these dis-
eases are now affecting progressively younger age groups. No longer can
we think of type 2 diabetes as maturity onset diabetes. In many parts of
the world and among certain ethnic groups, the incidence of type 2 dia-
betes in the adolescent age group is now equal to or greater than that of
type 1 diabetes and it is even being recognized in prepubertal children,
Although 2-3% of pediatric diabetes had been recognized as being
type 2 at least 30 years ago,2-4 type 2 diabetes has only emerged as a
common pediatric disease in the past decade.5 Concomitantly, recogni-
tion of the epidemic of obesity and its multiple deleterious effects on
lifelong health, of which type 2 diabetes is only one aspect, has moved
this disease of civilization to the forefront of pediatric concerns.
