Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association

Arslanian, Silva; Bacha, Fida; Grey, Margaret; Marcus, Marsha D.; White, Neil H.; Zeitler, Philip

doi:10.2337/dci18-0052

Cited by 349Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association

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Arslanian, Silva, Bacha, Fida, Grey, Margaret, Marcus, Marsha D., White, Neil H., Zeitler, Philip·2018·Diabetes Care

DOI 10.2337/dci18-0052PMC PMC7732108

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Abstract

Although all types of diabetes result in hyperglycemia, the pathophysiology of each type of diabetes is different. These guidelines summarize available data specific to the comprehensive care of youth with type 2 diabetes. The objective is to enrich the recognition of type 2 diabetes in youth, its risk factors, its pathophysiology, its management, and the prevention of associated complications. Glucose homeostasis is maintained by a balance between insulin secretion from the pancreatic β-cells and sensitivity to insulin in skeletal muscle, adipose tissue, and liver (1). When insulin sensitivity declines, insulin secretion must increase to maintain glucose tolerance, and, in most youth, decreased insulin sensitivity due to puberty and/or obesity is compensated by increased insulin secretion. However, when β-cells cannot secrete sufficient insulin to compensate for insulin resistance, abnormalities in glucose homeostasis ensue, potentially progressing to prediabetes and type 2 diabetes as β-cell function deteriorates further (2–9). The relationship between β-cell function and insulin sensitivity in adults and youth has been demonstrated to be a hyperbolic function and can be described mathematically as the product of insulin sensitivity and β-cell function, called the disposition index (DI) (1). The DI essentially expresses the amount of insulin being secreted relative to the degree of insulin resistance and is a constant for a given degree of glucose tolerance in any one individual. Overweight and obesity are major acquired contributors to the development of insulin resistance, particularly in the face of the physiologic insulin resistance characteristic of puberty. Robust pancreatic β-cell compensatory insulin secretion maintains normal glucose homeostasis. However, in adolescents with obesity who develop type 2 diabetes, there is severe peripheral and hepatic insulin resistance, with ∼50% lower peripheral insulin sensitivity than peers with obesity without diabetes, along with increased fasting hepatic glucose production and inadequate first- and second-phase insulin secretion, resulting …

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Recent ADA clinical guidance concluded that A1C, FPG, or 2-h PG could be used to test for prediabetes or type 2 diabetes in children and adolescents.
“However, recent ADA clinical guidance concluded that A1C, FPG, or 2-h PG could be used to test for prediabetes or type 2 diabetes in children and adolescents (113).”
From 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024 (2024) · cites this paper as [113]
ADA clinical guidance concluded that A1C, FPG, or 2-h PG also could be used to test for prediabetes or type 2 diabetes in children and adolescents.
“However, ADA clinical guidance concluded that A1C, FPG, or 2-h PG also could be used to test for prediabetes or type 2 diabetes in children and adolescents (114).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [114]

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Authors: Arslanian, S., Bacha, F., Grey, M., Marcus, M. D., White, N. H., & Zeitler, P.
Affiliations: University of Pittsburgh (US)
Baylor College of Medicine (US)
Yale University (US)
Washington University in St. Louis (US)
Children's Hospital Colorado (US)
Corresponding author: Arslanian, Silva
ORCID: Arslanian, Silva
Bacha, Fida
Grey, Margaret
Marcus, Marsha D.
White, Neil H.
Zeitler, Philip
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2018-11-12
Volume: 41
Issue: 12
Pages: 2648-2668
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dci18-0052
PMC: PMC7732108
OpenAlex: W2901878590
Cited by: 349
References: 267
Citations by year: 2026: 35 · 2025: 42 · 2024: 48 · 2023: 37 · 2022: 52 · 2021: 64 · 2020: 50 · 2019: 19 · 2018: 2
FWCI: 5.19
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.diabetesjournals.org/content/license (vor, 8 d)
Locations: Diabetes Care (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (UL1TR002345)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: youth-onset type 2 diabetes, adolescents, insulin resistance, beta-cell function, disposition index, obesity, puberty, prediabetes, diabetes management, diabetes prevention, complications, glucose homeostasis

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Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association

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