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Historically, type II diabetes mellitus (formerly known as non-insulin-dependent diabetes mellitus) has been considered a disease of adults and older individuals and not a pediatric condition. However, at the tum of the century it was recognized that some children who had diabetes presented with a mild and slowly progressive disease unlike type I diabetes mellitus.1 Type II diabetes mellitus is a polygenic condition in which insulin is not essential for survival, although it may be required for adequate metabolic control. It has a strong hereditary component and results from a combination of insulin resistance, increased hepatic glucose output, and progressive decline of glucose-stimulated insulin secretion. Unlike type I diabetes mellitus, where insulin secretion is almost nil, patients with type II diabetes mellitus have insulin secretory capacity, but insulin levels are inadequate to overcome the concomitant peripheral insulin resistance, causing hyperglycemia. This article discusses the recent emergence of type II diabetes mellitus as a pediatric condition.
EPIDEMIOLOGY
The prevalence of type II diabetes mellitus varies among different populations and throughout the world.2 It is common among adults in the United States, affecting 6.6% of those 20 to 74 years of age and 17.1% of those 65 to 74 years of age.3 The prevalence is highest among Native Americans, with the Pima Indians of Arizona having the highest rate in the world (approximately 50% of those older than 35 years of age).4 African Americans and Mexican Americans have rates that exceed those for the Caucasian population.3
Among children, type II diabetes mellitus has been reported to account for 2% to 3% of all diabetes mellitus.5 More recently, several publications reported an increasing prevalence among children and especially adolescents with a greater representation among African Americans, Hispanics, and Native Americans.6"8 A recent study demonstrated a tenfold increase in type II diabetes mellitus between 1982 and 1994.5 Among patients 10 to 19 years of age, type II diabetes mellitus accounted for 33% of all newly diagnosed cases of diabetes in 1994. This related to the increasing prevalence of obesity.
Typically, rates of type I diabetes mellitus are lower in African-American children than in Caucasians. However, a recent analysis from Pennsylvania showed, for the first time, a higher incidence for African Americans (17.6 per 100,000) than for Caucasians (16.5 per...