ABSTRACT
This chapter discusses controversies related to the diagnosis of type 2 diabetes in childhood and outlines factors that play important roles in disease pathogenesis. It aims to describe potential complications that may arise in the short and long terms and to outline approaches to disease prevention and treatment. Many children and adolescents with type 2 diabetes are asymptomatic at the time of diagnosis and for long periods of time thereafter. Many children with type 1 diabetes have mild hyperglycemia and limited symptoms for weeks to months prior to diagnosis, and most present without ketoacidosis. Type 2 diabetes is the endpoint of a process of metabolic decompensation in which genetic background, environmental determinants, and changes in body composition conspire to induce abnormalities in insulin production and action. Peripubertal children and adolescents with type 2 diabetes, in contrast to children with type 1 diabetes or maturity onset diabetes of the young, commonly have acanthosis nigricans, a marker of insulin resistance.
