Type 2 diabetes in the young - The evolving epidemic

Type 2 diabetes is becoming an increasingly prevalent disorder among young persons who are driven, as is the case in adults, by lifestyle factors leading to increased body weight. Genetic and familial factors, fetal environmental factors, particularly maternal gestational diabetes and intrauterine growth retardation, and lack of physical activity during childhood and adolescence lead to increasing levels of insulin resistance that appear to be crucial in the pathogenesis of type 2 diabetes in the young. The disorder is associated with microvascular disease, with a suggestion of greater risk of nephropathy than of retinopathy, and may also lead to early macrovascular disease. Treatment includes lifestyle modification and the pharmacotherapeutic approaches utilized in adults with type 2 diabetes, with studies to date supporting the roles of insulin and metformin, suggesting the importance of studying insulin secretagogues and thiazolidinediones as approaches in the treatment of type 2 diabetes in the young. The development of effective approaches to disease prevention will be of great importance.