Type 2 diabetes in children.

Obesity is a major healthcare problem with more than six out of 10 Australian adults (1), and around one in four of all children and adolescents (2), being overweight or obese – a situation that is predicted to continue to worsen over the next 15 years (1). Childhood obesity is associated with numerous comorbidities (3), including a propensity to insulin resistance, which can lead to type 2 diabetes mellitus (T2DM) in susceptible individuals. While T2DM is still most commonly diagnosed in overweight or obese middle-aged adults, it is now not unheard of in adolescents (and even younger children) with this condition (4), leading to claims that we now face an ‘epidemic’ of T2DM in youth (5). Data from the SEARCH for Diabetes in Youth Study Group highlight this, with reports of an incidence of T2DM in 15–19-year-olds (between 2002 and 2003) of 11.8 per 100 000 person years – a figure similar to the incidence of type 1 diabetes mellitus (T1DM) within this age group (6,7). Further inspection of these data, however, reveals that the majority of young people diagnosed with T2DM are from ethnic groups who are at much higher risk of the condition (e.g. African–American, Hispanic, Asian/Pacific Islanders and American Indians) and that, within the whole paediatric cohort surveyed, the overall incidence of T2DM remained low when compared with T1DM. This had led some workers to question the claims of an ‘epidemic’ of paediatric T2DM (8), although there is general agreement that T2DM in youth appears to be emerging as a serious clinical issue (9). Paediatric T2DM is associated with a number of novel and complex management issues not been previously encountered within routine paediatric practice, and it is important that we begin to address these if we are to develop effective management programmes. Diagnostic difficulties