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Type 2 Diabetes Mellitus in Children:  Primary Care and Public Health Considerations

David S. Ludwig, MD, PhD; Cara B. Ebbeling, PhD
JAMA. 2001;286(12):1427-1430. doi:10.1001/jama.286.12.1427.
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Historically, diabetes mellitus has been classified as either juvenile-onset (now known as type 1) or adult-onset (type 2) due to distinct differences in the usual age of presentation of these 2 conditions. With the increasing prevalence of type 2 diabetes mellitus in children, these terms have become inaccurate. Recent estimates suggest that type 2 diabetes mellitus may now account for as many as half of all new cases of diabetes in certain pediatric populations. This apparent epidemic, attributable largely to the increased rates of obesity in children, carries enormous long-term public health implications. This article will consider these implications, examine the pathophysiology of type 2 diabetes mellitus in children, and review prevention and treatment strategies.

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Figure. The Natural History of Type 2 Diabetes Mellitus
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Diabetes mellitus is defined as a fasting plasma glucose level of 126 mg/dL (7.0 mmol/L) or higher, or a 2-hour postload plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher.



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