The prevalence of childhood obesity in the United States continues to rise. Clinicians are also seeing more children with clinical features of type 2 diabetes mellitus (T2DM) present at diagnosis.1 As a result, it is becoming more difficult to differentiate between type 1 diabetes mellitus (T1DM) and T2DM in this patient population.

Although the incidence of T2DM in children is increasing, this condition remains relatively rare, with a reported incidence of 8.4 per 100,000 non-Hispanic white youths.2

As the more prevalent condition (affecting 1 in 300 children),3 T1DM must be ruled out. Making the appropriate diagnosis is critical given the differences in treatment regimens, educational approaches, and dietary counseling strategies. To illustrate, consider the following case study.

Case study

Adam, an 11-year-old non-Hispanic white male, was referred to the pediatric diabetes clinic for evaluation and management of new-onset T2DM. He presented to his primary-care provider (PCP) five days earlier with complaints of upper-respiratory infection/allergy symptom exacerbation and fatigue with weight loss (11 lbs. over the previous three months).

Adam’s mother casually mentioned a recent history of polydipsia, polyuria, and nocturia. A fingerstick blood glucose level obtained in the office measured >300 mg/dL. The PCP then ordered further studies (Table 1).

Adam was started on metformin (Fortamet, Glucophage, Glumetza, Riomet) 500 mg daily and twice-daily blood glucose monitoring. He was then referred to the pediatric diabetes clinic for further evaluation, dietary instruction, and diabetes self-management training.