ABSTRACT
Traditionally, diabetes mellitus in youth was thought to be almost
esclusively type 1 diabetes, but there have been increasing numbers
of reports of type 2 diabetes among youth in the last 30 years. In 1971,
Dr Harvey Knowles wrote:
A second type of diabetes in young persons closely resembles that of
the stable middle-aged onset type. Herein the patients as a rule have
no symptoms, are overweight, can secrete insulin, and respond to sul-
fonylurea therapy. Often the diagnosis is made serendipitously. In the
Juvenile Diabetic Clinic at the Cincinnati General Hospital 11 of these
patients have been followed along with 300 patients with the unsta-
ble insulin deficient type of diabetes. The age of these 11 patients at
diagnosis ranged from 11 to 17 years. The prevalence of this type of
diabetes very likely is higher than presently appreciated, because of
Type 2 diabetes is increasingly being reported, especially in minority
populations.2-6 Type 2 diabetes has been reported in youth from the
Despite these recent reports, our understanding of the magnitude of
various types of diabetes in young people from different populations
remains limited. Furthermore, there is no ‘gold standard’ for differentiat-
ing the types of childhood diabetes. Many of the existing methods have
relied on such clinical factors as age at onset, obesity, family history,
acuteness of onset, and insulin therapy, but these factors do not reliably
differentiate the types. For example, adolescents with type 2 diabetes
can present with diabetic ketoacidosis (DKA), and patients with type 1
diabetes may be obese and not have severe acute symptoms at the time
of diagnosis. Misclassification may result in improper disease manage-
ment, which is one reason for the need to develop reliable and valid
classifications of diabetes. Such taxonomy should:
1. differentiate the types of diabetes in children and adolescents
2. be suitable for estimating the frequency of the types of diabetes in
various populations
3. provide effective classification(s) for clinical diagnosis, research
studies, and population surveillance.
