Type 2 diabetes is a chronic condition that can develop at any age. It often has a slow, gradual onset, which can make it difficult to detect and diagnose in children.

In this article, we look at what type 2 diabetes is and describe its symptoms, causes, and risk factors in children.

We also explore how a doctor diagnoses and treats the condition, ways to help prevent it, and the complications that it can cause.

What is type 2 diabetes?

Type 2 diabetes is a chronic condition characterized by high levels of blood sugar, or glucose.

The pancreas produces a hormone called insulin that helps to control the amount of sugar in the blood.

In a person with type 2 diabetes, either the body does not produce enough insulin, or it does not respond to the hormone appropriately, and this is called insulin resistance.

In the past, the medical community called type 2 diabetes either adult-onset diabetes or non-insulin dependent diabetes. However, the condition is affecting an increasing number of children and adolescents, as rates of obesity continue to rise.

According to the National Center for Chronic Disease Prevention and Health Promotion, doctors in the United States diagnosed around 5,300 children and adolescents aged 10–19 years with type 2 diabetes between 2011 and 2012.

Type 2 diabetes is a long-term illness that can lead to serious complications if a person does not receive treatment. At the moment, there is no cure.

Symptoms

Type 2 diabetes often has a slow, gradual onset. Because of this, it can be difficult to detect in children.

General signs and symptoms of both types of diabetes are similar. Children and adults may experience:

• Increased urination. When there is an excess of sugar in the blood, the kidneys have to work harder to absorb and filter it. This can result in increased urination.
• Increased thirst. Increased urination can cause dehydration. A person may feel especially thirsty and need to drink more than usual.
• Fatigue. When the body is less able to use blood sugar properly, this can cause fatigue, as can many issues that may be common in people with diabetes, such as dehydration.
• Blurred vision. High blood sugar levels can draw fluid from the lenses of the eyes, making it more difficult to focus.
• Darkened skin. Insulin resistance can cause certain areas of skin to darken. The medical term for this is acanthosis nigricans, and it often affects the armpits and the back of the neck.
• Wounds healing slowly. High blood sugar levels can lead to longer healing times for sores and skin infections.

Causes and risk factors

Anyone can develop type 2 diabetes, including children. The condition is more likely to develop in adults and children who are overweight or obese.

Obesity increases the risk of type 2 diabetes by causing insulin resistance. This occurs when organs and tissues do not respond appropriately to insulin and do not absorb enough sugar from the blood.

Insulin resistance results in high blood sugar levels, a lower tolerance for glucose, more inflammation, and an overproduction of glucose in the liver.

According to the Centers for Disease Control and Prevention (CDC), obesity affected 13.7 million children and adolescents aged 2–19 years between 2015 and 2016 in the US.

Authors of a study from 2017 found that children and adults below the age of 25 who fell into the BMI ranges for obesity were four times more likely to develop type 2 diabetes than those in the normal ranges.

Other risk factors for type 2 diabetes in children include:

• having a parent or sibling with the condition, because it has a genetic component
• being of Asian, Pacific Islander, African, Native American, or Latino descent
• having signs of insulin resistance, such as acanthosis nigricans

Diagnosis

To diagnose type 2 diabetes, a doctor will ask about the child's symptoms, and they may take a blood sample to check glucose levels. The doctor may also use a simple urine test to screen for sugar in the urine.

In the US, possible blood tests include:

• Fasting blood glucose. Doctors take this test in the morning when the child has an empty stomach. The medical community considers a person with a fasting blood glucose of greater than 126 milligrams per deciliter (mg/dl) to have diabetes.
• Glycated hemoglobin (A1C). This checks the amount of glucose attached to red blood cells over time. Doctors consider a person to have diabetes if their A1C measurement is greater than 6.5%, or 48 millimoles per mole.
• Random blood glucose. A doctor asks for this test at a random time during the day. The medical community considers someone to have diabetes if their random blood glucose level is higher than 200 mg/dl.

For a reliable diagnosis, a medical professional should perform these tests on two separate occasions.

To confirm a diagnosis, a doctor may also request multiple tests, or they may check other factors, such as glucose tolerance.

Treatment

Treatment for type 2 diabetes is generally similar in children and adults.

The most important treatments are often lifestyle interventions, which include weight management, dietary changes, and exercise.

A doctor may also prescribe insulin or other medications that help the body respond better to insulin. The child may also need to regularly monitor their blood glucose levels.

The doctor will tailor the treatment plan according to the child's age, needs, and the severity of the condition.

It is important for parents and caregivers to communicate the treatment plan to the child's caretakers, teachers, coaches, and anyone else who supervises the child away from home.

Prevention

Prevention of type 2 diabetes largely involves developing healthful lifestyle habits, such as:

Maintaining a healthy weight

Ensuring that weight stays at a healthful level can lower the risk of type 2 diabetes. A doctor or dietician can advise about healthy weight ranges for children and recommend programs for losing weight, if necessary.

Eating a well-balanced diet

A child's diet should contain limited amounts of added sugars and simple carbohydrates. Breads and pastries made with white flour may be problematic, and the diet should instead include plenty of fruits, vegetables, lean proteins, and whole grains. This will lower the risk of obesity and type 2 diabetes.

Exercising

Exercise is essential in maintaining a healthy weight and overall health. The World Health Organization (WHO) recommends that children aged 5–17 years get at least 60 minutes of moderate or vigorous physical activity every day. Encourage kids to play outside and engage in sports, and limit time spent in front of a screen. This may mean cutting back on video games, television, and similar devices.

Complications

Children with type 2 diabetes are at risk for potentially serious complications, including heart disease and stroke.

Other complications and associated conditions can include:

• high blood pressure
• high blood cholesterol levels
• eye damage, which the medical community calls diabetic retinopathy
• nerve damage, or diabetic neuropathy
• kidney damage or failure, or diabetic nephropathy

Outlook

Type 2 diabetes is becoming more common in children, as rates of childhood obesity continue to climb.

The condition can be difficult to detect and diagnose in children, and doctors are not yet sure of the long-term effects of having it at a young age.

Focusing on healthful lifestyle habits involving, for example, a well-balanced diet and plenty of physical activity, can help prevent and treat type 2 diabetes in children.