Diabetes in adolescent patients: diagnostic dilemmas

Roles of Sonographers in the Management of Diabetes A Proposed Framework

Sonography plays an invaluable role in health care delivery worldwide. In Nigeria, most people involved in the sonography practice are medical imaging scientists (BSc radiographers). Ways in which sonographers can support the management of diabetes are explored in this article.

Type 2 diabetes in children and adolescents--the next epidemic?

OBJECTIVE

To provide an overview of the incidence of type 2 diabetes in children and adolescents and provide direction for clinicians who care for children and adolescents.

RESEARCH DESIGN AND METHOD

The data presented in this review were obtained from published literature and abstracts presented at scientific meetings. Clinical trials and review articles were identified using the search terms 'metabolic syndrome', 'type 2 diabetes mellitus', 'children', and 'adolescents' in a MEDLINE search from 1995-2005. Additionally, the bibliographies of the identified articles were reviewed.

RESULTS

Type 2 diabetes is rising rapidly in children and adolescents worldwide. Changing a child's living environment to include physical activity, and a well balanced, low fat, high fiber diet, are important for the maintenance of a desirable body weight and improving insulin sensitivity. Maintaining euglycemia with metformin, sulfonylureas, thiazolinediones, and insulin is recommended. Effective treatment of co-morbid problems such as hypertension and dyslipidemia can decrease the risk of cardiovascular complications.

CONCLUSIONS

The prevalence of type 2 diabetes in children will continue to rise until effective measures are taken to prevent obesity in this age group. Ensuring that children have a well-balanced low fat, high fiber, diet, combined with physical activity, will promote weight loss or maintenance, improve insulin sensitivity, and decrease the risk of diabetes and cardiovascular disease. Pharmacologic therapy is recommended for children who are unable to achieve satisfactory glycemic control through physical activity and diet.

The management of type 2 diabetes mellitus in children and adolescents

The medical community faces an emerging epidemic of type 2 diabetes mellitus (DM2) in children and adolescents with a disproportionate increase among certain ethnic groups. DM2 represents one arm of the metabolic syndrome and parallels an increasing prevalence of obesity. The metabolic syndrome includes insulin resistance, hyperlipidemia, and hypertension with a consequent risk of early cardiovascular disease. Thus, treatment of DM2 and the metabolic syndrome poses a challenge for pediatric endocrinologists and represents a huge public health issue. This review presents information about treatment of childhood DM2 with emphasis on indications for the use of insulin in management and normalization of blood glucose.