Ann Pediatr Endocrinol Metab.  2018 Sep;23(3):119-125. 10.6065/apem.2018.23.3.119.

Type 2 diabetes mellitus in children and adolescent: an Indonesian perspective

• Pulungan A
• Afifa IT
• Annisa D

• KMID: 2422474
• DOI: http://doi.org/10.6065/apem.2018.23.3.119

Abstract

The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents has increased globally over the past 2 decades. Metabolic syndrome, including obesity and overweight at a young age, increases the occurrence of T2DM. Studies in Indonesia have found that obese children and adolescents are more likely to have insulin resistance, a risk factor for T2DM. There are no data on the current incidence of T2DM in youth in Indonesia, but there has been a significant rise in the prevalence of overweight in adolescents. The diagnosis of T2DM in youth is similar to that in adults, with special consideration of when to test asymptomatic children. Management of T2DM in Indonesia follows the recommendations of the Indonesian Pediatric Society, which include lifestyle modifications, such as improving dietary habits and exercise, as well as appropriate medications. Metformin is the drug of choice for young T2DM patients; if marked hyperglycemia is present, basal insulin is given with metformin. Monitoring of T2DM is generally done through selfmonitoring of blood glucose and glycosylated hemoglobin.

Keyword

Type 2 diabetes mellitus; Insulin resistance; Child; Adolescent; Indonesia

MeSH Terms

Adolescent*
Adult
Blood Glucose
Child*
Diabetes Mellitus, Type 2*
Diagnosis
Food Habits
Hemoglobin A, Glycosylated
Humans
Hyperglycemia
Incidence
Indonesia
Insulin
Insulin Resistance
Life Style
Metformin
Obesity
Overweight
Prevalence
Risk Factors
Blood Glucose
Insulin
Metformin

Reference

References

1. Arslanian S. Type 2 diabetes in children: clinical aspects and risk factors. Horm Res. 2002; 57 Suppl 1:19–28.

2. Kitagawa T, Owada M, Urakami T, Yamauchi K. Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of animal protein and fat. Clin Pediatr (Phila). 1998; 37:111–5.

3. Likitmaskul S, Kiattisathavee P, Chaichanwatanakul K, Punnakanta L, Angsusingha K, Tuchinda C. Increasing prevalence of type 2 diabetes mellitus in Thai children and adolescents associated with increasing prevalence of obesity. J Pediatr Endocrinol Metab. 2003; 16:71–7.

4. Moelyo AG, Himawan IW, Pateda V, Fadil R. Indonesian national registry of children with type 2 diabetes mellitus. Int J Pediatr Endocrinol. 2013; 2013(1 Suppl):P8.

5. Indonesian Health Ministry. National basic health survey. Jakarta: Indonesian Health Ministry;2013.

6. Pettitt DJ, Talton J, Dabelea D, Divers J, Imperatore G, Lawrence JM, et al. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes in youth study. Diabetes Care. 2014; 37:402–8.

7. World Health Organization. Childhood overweight and obesity [Internet]. Geneva (Switzerland): World Health Organization;2016. [cited 2018 Jul 12]. Available from: http://www.who.int/dietphysicalactivity/childhood/en/.

8. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002; 346:802–10.

9. Alberti G, Zimmet P, Shaw J, Bloomgarden Z, Kaufman F, Silink M, et al. Type 2 diabetes in the young: the evolving epidemic: the international diabetes federation consensus workshop. Diabetes Care. 2004; 27:1798–811.

10. Caceres M, Teran CG, Rodriguez S, Medina M. Prevalence of insulin resistance and its association with metabolic syndrome criteria among Bolivian children and adolescents with obesity. BMC Pediatr. 2008; 8:31.

11. Hendarto A. Telaah peran leptin, adiponektin, tumor necrosis-, C reactive protein, asupan karbohidrat dan lemak terhadap resistensi insulin pada anak lelaki superobes usia 5-9 tahun. Disertasi. Jakarta: Fakultas Kedokteran Program Doktor Ilmu Kedokteran Universitas Indonesia;2009.

12. Pulungan AB, Puspitadewi A, Sekartini R. Prevalence of insulin resistance in obese adolescents. Paediatr Indones. 2013; 53:167–72.

13. Tirtamulia KS, Umboh A, Warous SM, Pateda V, Regina F. Achantosis nigricans and insulin resistance in obese children. Paediatr Indones. 2010; 50:274–7.

14. Hardy OT, Czech MP, Corvera S. What causes the insulin resistance underlying obesity? Curr Opin Endocrinol Diabetes Obes. 2012; 19:81–7.

15. Agius L. Targeting hepatic glucokinase in type 2 diabetes: weighing the benefits and risks. Diabetes. 2009; 58:18–20.

16. Ait-Omar A, Monteiro-Sepulveda M, Poitou C, Le Gall M, Cotillard A, Gilet J, et al. GLUT2 accumulation in enterocyte apical and intracellular membranes: a study in morbidly obese human subjects and ob/ob and high fat-fed mice. Diabetes. 2011; 60:2598–607.

17. Choi CHJ, Cohen P. How does obesity lead to insulin resistance? Elife. 2017; Dec. 14. 6. pii: e33298.

18. Juárez-López C, Klünder-Klünder M, Medina-Bravo P, Madrigal-Azcárate A, Mass-Díaz E, Flores-Huerta S. Insulin resistance and its association with the components of the metabolic syndrome among obese children and adolescents. BMC Public Health. 2010; 10:318.

19. Vaag A. Low birth weight and early weight gain in the metabolic syndrome: consequences for infant nutrition. Int J Gynaecol Obstet. 2009; 104 Suppl 1:S32–4.

20. Fabricius-Bjerre S, Jensen RB, Færch K, Larsen T, Mølgaard C, Michaelsen KF, et al. Impact of birth weight and early infant weight gain on insulin resistance and associated cardiovascular risk factors in adolescence. PLoS One. 2011; 6:e20595.

21. Zhou PZ, Zhu YM, Zou GH, Sun YX, Xiu XL, Huang X, et al. Relationship between glucocorticoids and insulin resistance in healthy individuals. Med Sci Monit. 2016; 22:1887–94.

22. Feeney ER, Mallon PW. Insulin resistance in treated HIV infection. Best Pract Res Clin Endocrinol Metab. 2011; 25:443–58.

23. Deng C. Effects of antipsychotic medications on appetite, weight, and insulin resistance. Endocrinol Metab Clin North Am. 2013; 42:545–63.

24. Kobaissi HA, Weigensberg MJ, Ball GD, Cruz ML, Shaibi GQ, Goran MI. Relation between acanthosis nigricans and insulin sensitivity in overweight Hispanic children at risk for type 2 diabetes. Diabetes Care. 2004; 27:1412–6.

25. Raitakari OT, Juonala M, Rönnemaa T, Keltikangas-Järvinen L, Räsänen L, Pietikäinen M, et al. Cohort profile: the cardiovascular risk in Young Finns Study. Int J Epidemiol. 2008; 37:1220–6.

26. Cruz ML, Weigensberg MJ, Huang TT, Ball G, Shaibi GQ, Goran MI. The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab. 2004; 89:108–13.

27. Ferrannini E, Natali A, Capaldo B, Lehtovirta M, Jacob S, Yki-Järvinen H. Insulin resistance, hyperinsulinemia, and blood pressure: role of age and obesity. European Group for the Study of Insulin Resistance (EGIR). Hypertension. 1997; 30:1144–9.

28. American Diabetes Association. Standards of medical care in diabetes – 2018. Diabetes Care. 2018; 41(Suppl 1):S1–159.

29. American Diabetes Association. Children and adolescents: standards of medical care in diabetes 2018. Diabetes Care. 2018; 41(Suppl 1):S126–36.

30. Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC, et al. ISPAD clinical practice consensus guidelines 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2014; 15 Suppl 20:4–17.

31. Copeland KC, Silverstein J, Moore KR, Prazar GE, Raymer T, Shiffman RN, et al. Management of newly diagnosed type 2 Diabetes Mellitus (T2DM) in children and adolescents. Pediatrics. 2013; 131:364–82.

32. Endocrinology Working Group; Indonesian Pediatric Society. Diagnosis and treatment of type 2 diabetes mellitus. Jakarta: Indonesian Pediatric Society;2018.

33. Indonesian Pediatric Society. National consensus on management of type II DM in children and adolescents. Jakarta: Indonesian Pediatric Society;2015.

34. Robertson K, Riddell MC, Guinhouya BC, Adolfsson P, Hanas R; International Society for Pediatric and Adolescent Diabetes. ISPAD clinical practice consensus guidelines 2014. Exercise in children and adolescents with diabetes. Pediatr Diabetes. 2014; 15 Suppl 20:203–23.

35. Rewers MJ, Pillay K, de Beaufort C, Craig ME, Hanas R, Acerini CL, et al. ISPAD clinical practice consensus guidelines 2014. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes. 2014; 15 Suppl 20:102–14.

36. Hanas R, John WG; International HbA1c Consensus Committee. 2013 Update on the worldwide standardization of the hemoglobin A1c measurement. Pediatr Diabetes. 2014; 15:e1. –2.

37. Delamater AM, de Wit M, McDarby V, Malik J, Acerini CL. Psychological care of children and adolescents with type 1 diabetes. Pediatric Diabetes. 2014; 15(20 Suppl):232–44.

38. Lange K, Swift P, Pańkowska E, Danne T; International Society for Pediatric and Adolescent Diabetes. ISPAD clinical practice consensus guidelines 2014. Diabetes education in children and adolescents. Pediatr Diabetes. 2014; 15 Suppl 20:77–85.