Ann Pediatr Endocrinol Metab.  2018 Sep;23(3):113-118. 10.6065/apem.2018.23.3.113.

Clinical characteristics in Japanese children with nonobese type 2 diabetes

• Urakami T

• KMID: 2422473
• DOI: http://doi.org/10.6065/apem.2018.23.3.113

Abstract

It is well known that the incidence of youth-onset type 2 diabetes is increasing worldwide. On the other hand, most studies have shown that the majority of youth-onset type 2 diabetes occurs in obese individuals, generally with a body mass index (BMI) greater than the 90th or 95th centile for sex- and age-matched children and adolescents. However, we identified some Japanese children with nonobese type 2 diabetes and BMI less than 90th centile by a urine glucose screening program at schools in the Tokyo Metropolitan Area. According to the results obtained from the screening, clinical characteristics of patients with nonobese type 2 diabetes seemed to be different from those in obese type 2 diabetes. Nonobese patients tended to show lower insulin secretion abilities and milder, but evident, insulin resistance from the time of diagnosis. Female, low birth weight (small for gestational age), and genetic background, not related to β-cell-associated autoimmunity, may play a role in development of nonobese type 2 diabetes. In addition, nonobese patients tend to progress earlier to pharmacological treatment including oral hypoglycemic drugs and insulin. Further studies are needed to confirm to these findings and clarify the pathophysiology of children with nonobese type 2 diabetes.

Keyword

Type 2 diabetes; Child; Nonobese; Insulin resistance; Insulin secretion; Pharmacological treatment

MeSH Terms

Adolescent
Asian Continental Ancestry Group*
Autoimmunity
Bodily Secretions
Body Mass Index
Child*
Diagnosis
Female
Genetic Background
Glucose
Hand
Humans
Hypoglycemic Agents
Incidence
Infant, Low Birth Weight
Infant, Newborn
Insulin
Insulin Resistance
Mass Screening
Glucose
Hypoglycemic Agents
Insulin

Figure

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  Fig. 1. Urine glucose screening program at schools in the Tokyo Metropolitan Area. FPG, fasting plasma glucose; HbA1c, glycated hemoglobin; OGTT, oral glucose tolerance test; PG, plasma glucose; IRI, immunoreactive insulin; AST, aspartate aminotransferase; ALT, alanine aminotransferase; T. Chol, total cholesterol; TG, triglyceride; GAD-Antibodies, antibodies against glutamic acid decarboxylase. *Urine glucose≥100 mg/dL. **OGTT, 1.75 g/kg of glucose, maximum 75 g.

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  Fig. 2. Birth weight in children with nonobese type 2 diabetes. SD, standard deviation.

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  Fig. 3. Laboratory data at diagnosis in children with nonobese type 2 diabetes. IRI, immunoreactive insulin; HOMA-IR, homeostasis model assessment of insulin resistance; PG, plasma glucose.

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  Fig. 4. Comparison of fasting IRI levels and HOMA-IR at diagnosis among children with type 2 diabetes of different % overweight. IRI, immunoreactive insulin; HOMA-IR, homeostasis model assessment of insulin resistance. % overweight: aNonobesity: n=17, <20%; Mild obesity: n=37b, n=30c; dSevere obesity:n=26.

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  Fig. 5. Distribution of subcutaneous fat (SF) and visceral fat (VF) in patient with nonobese type 2 diabetes. WC, waist circumference; BMI, body mass index; SF, subcutaneous fat; VF, visceral fat.

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  Fig. 6. Pharmacological treatment in patients with nonobese and obese type 2 diabetes. SU, sulfonyl urea; α-GI, α-glucosidase inhibitors; DPP-4, dipeptidyl peptidase-4 inhibitors; GLP-1, inhibitors and glucagon-like peptide-1 receptor agonists.

Reference

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