Susan A Phillips and Kenneth L Jones
Type 2 diabetes mellitus has moved from the status of a disease which rarely occurs in children, to one that is reaching epidemic proportions. 1,2 This change is requiring physicians who treat children to learn about the diagnosis, treatment, and prevention of this 'new disease'. It is now important to recognize not only the microvascular complications of insulin-deficient type 1 diabetes but also to address and prevent the macrovascular complications such as arteriosclerotic, cardiovascular, and peripheral vascular occlusive disorders associated with the insulin resistant syndrome (IRS) and type 2 diabetes. One must also consider the therapy of the other disorders frequently associated with these conditions, including hypertension, obesity, dyslipidemia, ovarian hyperan-drogenemia, and nonalcoholic steatohepatititis (NASH). This discussion will deal only with the management of the hyperglycemia; therapy of co-morbid conditions will be mentioned only briefly, as it is beyond the scope of this chapter.
This chapter begins with the general therapeutic goals in children with type 2 diabetes, moving then to the specifics of glycemic management. When relevant, these approaches to glycemic management in type 2 diabetes will be compared and contrasted to those usually employed in treating type 1 diabetes. The methods to achieve glycemic control discussed here are presented in the light of the underlying pathophysiology of type 2 diabetes and include methods of and success of lifestyle changes.