In recent years, the incidence of type 2 diabetes in children and adolescents has increased significantly. Compared with adult T2DM, type 2 diabetes in children and adolescents progresses more rapidly and can be accompanied by vascular complications at an early stage, and long-term hyperglycemia puts this group at higher risk of long-term complications, so more attention needs to be paid to this group. A review published in the December issue of the journal Diabetes Care provides insight into the pathophysiological mechanisms and treatment strategies for prediabetes and type 2 diabetes in children and adolescents1. Professor Gong Qiuhong, Endocrinology Center of Fuwai Hospital, Chinese Academy of Medical Sciences, was invited to interpret this review.
Insulin resistance
Insulin resistance is characterized by a reduced response of skeletal muscle, fat, and liver to insulin, resulting in disrupted sugar, fat, and protein metabolism. Excessive increase in body fat is a major risk factor for insulin resistance in adolescents. Several factors affect insulin resistance. Maternal environment, such as maternal obesity or high blood sugar during pregnancy, may lead to impaired insulin sensitivity in the offspring. Environmental and social behavioral factors, such as sedentary lifestyles, excessive caloric intake, and ultra-processed foods/diets rich in saturated fatty acids, are directly linked to obesity and increased rates of pre-diabetes and type 2 diabetes in children and adolescents. In addition, insulin sensitivity decreases by 25% to 30% during adolescence, which can lead to prediabetes and type 2 diabetes in children and adolescents already at risk for diabetes.
heal
The therapeutic goal is to implement individualized treatment and prevention measures for metabolic dysfunction and its different disease stages. Interventions need to target insulin resistance, beta cell dysfunction, and hormone imbalances, while taking into account weight management and vascular protection2
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