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The prevalence of childhood-onset type 2 diabetes mellitus (T2DM) has increased globally, reflecting the pediatric epidemic of overweight and obesity. Children with T2DM have a higher prevalence of other comorbidities at diagnosis, including obesity, elevated blood pressure, dyslipidemia, fatty liver disease and microalbuminuria, compared to youth with type 1 diabetes of a similar age.
A retrospective chart review of the last twenty five children with documented diagnosis of Type 2 diabetes was performed
Patients ranged in age from 8 to 15 years at diagnosis. The female:male ratio was 1.3:1. Sixty percent of patients were Hispanics. All BMIs were above 85th percentile for age and sex. Twelve percent of them had micro or macroalbuminuria at diagnosis (only 60% had persistent microalbuminuria after follow up) while only 5% had documented persistent hypertension.
Screening for renal disease in children with T2DM should begin at diagnosis and annually thereafter. The best recommended test is a first-morning or random urine for albumin to creatinine ratio. Careful laboratory documentation of persistent albuminuria is critical since transient albuminuria can be caused by acute hyperglycemia at diagnosis. It is therefore important to demonstrate persistent albuminuria over a three- to six month period. Persistent albuminuria is defined as an elevated urine albumin to creatinine ratio in two of three urine samples taken over three to six months.
The diagnosis of T2DM in young children raises concern regarding the possibility of related comorbidities including renal involvement as a similar concern of adult presentation