Le diabète de type 2 des enfants et des adolescents

Previously, type 2 diabetes was regarded as a disease of middle-aged and older people. It is true that type 2 diabetes is still more prevalent in adults, but in recent decades the age of onset has decreased and type 2 diabetes has been reported in adolescents and children, worldwide, especially in certain ethnic groups. The incidence of type 2 diabetes in the young is rising in parallel with the incidence of overweight and obesity. The pathophysiology of type 2 diabetes in the young, similar to adults, is multifactorial, including genetic and environmental factors. Insulin resistance, strongly associated with obesity, is believed to be an early abnormality in the development of type 2 diabetes. Early on, preceding the impairment in insulin secretion, insulin - producing betacells are able to compensate for the insulin resistance by increasing insulin secretion. Type 2 diabetes in the young is associated with early microvascular disease and may also lead to early macrovascular disease. Treatment includes lifestyle modification and it is crucial to include the important role of the family in optimizing glycemia. In our countries metformin is available for treatment of children, but efficacy remains unproven. There are no other oral hypoglycaemic agents approved for use in the pediatric population even so sulfonylureas, glinides, and rosiglitazone have been tested in some studies. Insulin remains the most frequently used treatment. Hypertension and hyperlipidemia are common complications in type 2 diabetes in the young and require active intervention. Prevention must be the main strategy for the future. Prevention strategies should focus on environmental and lifestyle changes, involving participation of families, schools, the food industries and governmental agencies.