This study describes the clinical characteristics of childhood- and adolescent-onset type 2 diabetes mellitus (CAT2DM) seen at a diabetes center in southern India.
Research Design and Methods:
Between January 1992 and December 2009, 368 CAT2DM patients were registered. Anthropometric measurements were done using standardized techniques. Biochemical investigations included C-peptide measurements and glutamic acid decarboxylase antibody assay wherever feasible. Retinopathy was diagnosed by retinal photography; microalbuminuria, if urinary albumin excretion was between 30 and 299 mg/μg of creatinine; nephropathy, if urinary albumin excretion was ≥300 mg/μg; and neuropathy, if vibration perception threshold on biothesiometry was ≥20 V.
Results:
The proportion of CAT2DM patients, expressed as percentage of total patients registered at our center, rose from 0.01% in 1992 to 0.35% in 2009 (P<0.001). Among the 368 cases of CAT2DM, 96 (26%) were diagnosed before the age of 15 years. The mean age at first visit and age at diagnosis of the CAT2DM subjects were 22.2±9.7 and 16.1±2.5 years, respectively. Using World Health Organization growth reference charts, 56% of boys and 50.4% of girls were >85th percentile of body mass index for age. Prevalence rates of retinopathy, microalbuminuria, nephropathy, and neuropathy were 26.7%, 14.7%, 8.4%, and 14.2%, respectively. Regression analysis revealed female gender, body mass index >85th percentile, parental history of diabetes, serum cholesterol, and blood pressure to be associated with earlier age at onset of CAT2DM.
Conclusions:
CAT2DM appears to be increasing in urban India, and the prevalence of microvascular complications is high. Female predominance is seen at younger ages.
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References
1.
ShawJ. Epidemiology of childhood type 2 diabetes and obesity. Pediatr Diabetes, 2007; 8,Suppl 9:7–15.
2.
American Diabetes Association:. Type 2 diabetes in children and adolescents. Diabetes Care, 2000; 23:381–389.
3.
LiuLL, YiJP, BeyerJ, Mayer-DavisEJ, DolanLM, DabeleaDM, LawrenceJM, RodriguezBL, MarcovinaSM, WaitzfelderBE, FujimotoWY. SEARCH for Diabetes in Youth Study Group. Type 1 and type 2 diabetes in Asian and Pacific Islander U.S. youth: the SEARCH for Diabetes in Youth Study. Diabetes Care, 2009; 32,Suppl 2:S133–S140.
4.
ScottCR, SmithJM, CradockMM, PihokerC. Characteristics of youth onset non insulin dependent diabetes mellitus and insulin dependent diabetes mellitus. Pediatrics, 1997; 100:84–91.
5.
HotuS, CarterB, WatsonPD, CutfieldWS, CundyT. Increasing prevalence of type 2 diabetes in adolescents. J Paediatr Child Health, 2004; 40:201–204.
6.
RamachandranA, SnehalathaC, SatyavaniK, SivasankariS, VijayV. Type 2 diabetes in Asian-Indian urban children. Diabetes Care, 2003; 26:1022–1025.
7.
World Health Organization. Physical Status: The Use and Interpretation of Anthropometry: A Report of a WHO Expert Committee. Geneva: World Health Organization, 1995.
8.
SnehalathaC, RamachandranA, MohanV, ViswanathanM. Pancreatic beta cell response in insulin treated NIDDM patients limitations of a random C-peptide measurement. Diabete Metab, 1987; 13:27–30.
9.
RamachandranA, MohanV, SnehalathaC, BharaniG, ChinnikrishnuduM, MohanR, ViswanathanM. Clinical features of diabetes in the young as seen at a diabetes centre in south India. Diabetes Res Clin Pract, 1988; 4:117–125.
10.
AmuthaA, DattaM, UnnikrishnanIR, AnjanaRM, RemaM, Venkat NarayanKM, MohanV. Clinical profile of diabetes in the young seen between 1992 and 2009 at a specialist diabetes centre in south India. Prim Care Diabetes, 2011; 5:223–229.
11.
AlbertiKG, ZimmetP. Definition diagnosis, classification of diabetes mellitus, its complications. Part 1: Diagnosis and classification of diabetes mellitus, provisional report of a WHO Consultation. Diabet Med, 1998; 15:539–553.
12.
FidaS, MyersM, MackayIR, ZimmetPZ, MohanV, DeepaR, RowleyMJ. Antibodies to diabetes-associated autoantigens in Indian patients with Type 1 diabetes: prevalence of anti-ICA512/IA2 and anti-SOX13. Diabetes Res Clin Pract, 2001; 52:205–211.
13.
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 1997; 20:1183–1197.
de OnisM, OnyangoAW, BorghiE, SiyamA, NishidaC, SiekmannJ. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ, 2007; 85:660–667.
16.
ZimmetP, AlbertiKG, KaufmanF, TajimaN, SilinkM, ArslanianS, WongG, BennettP, ShawJ, CaprioS. IDF Consensus Group. The metabolic syndrome in children and adolescents: an IDF consensus report. Pediatr Diabetes, 2007; 8:299–306.
17.
Early Treatment of Diabetic Retinopathy Study Research Group:. Grading diabetic retinopathy from stereoscopic colour fundus photographs: an extension of the modified Airlie House classification: ETDRS report number 10. Ophthalmology, 1991; 98:786–806.
18.
PradeepaR, AnjanaRM, UnnikrishnanR, GanesanA, MohanV, RemaM. Risk factors for microvascular complications of diabetes among South Indian subjects with type 2 diabetes—the Chennai Urban Rural Epidemiology Study (CURES) Eye Study-5. Diabetes Technol Ther, 2010; 12:755–761.
19.
PradeepaR, RemaM, VigneshJP, DeepaM, DeepaR, MohanV. Prevalence and risk factors for diabetic neuropathy in an urban South Indian population: the Chennai Urban Rural Epidemiology Study (CURES-55)Diabet Med, 2008; 25:407–412.
20.
McMahonSK, HaynesA, RatnamN, GrantMT, CarneCL, JonesTW, DavisEA. Increase in type 2 diabetes in children and adolescents in Western Australia. Med J Aust, 2004; 180:459–461.
21.
LikitmaskulS, KiattisathaveeP, ChaichanwatanakulK, PunnakantaL, AngsusinghaK, TuchindaC. Increasing prevalence of type 2 diabetes mellitus in Thai children and adolescents associated with increasing prevalence of obesity. J Pediatr Endocrinol Metab, 2003; 16:71–77.
22.
AnjanaRM, PradeepaR, DeepaM, DattaM, SudhaV, UnnikrishnanR, BhansaliA, JoshiSR, JoshiPP, YajnikCS, DhandhaniaVK, NathLM, DasAK, RaoPV, MadhuSV, ShuklaDK, KaurT, PriyaM, NirmalE, ParvathiSJ, SubhashiniS, SubashiniR, AliMK, MohanV. ICMR–INDIAB Collaborative Study Group. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose intolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR_INDAB) study. Diabetologia, 2011; 54:3022–3027.
MarwahaRK, TandonN, SinghY, AggarwalR, GrewalK, ManiK. A study of growth parameters and prevalence of overweight and obesity in school children from Delhi. Indian Pediatr, 2006; 43:943–952.
25.
RamachandranA, SnehalathaC, VinithaR, ThayyilM, KumarCK, SheebaL, JosephS, VijayV. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract, 2002; 57:185–190.
26.
ChhatwalJ, VermaM, RiarSK. Obesity among pre-adolescent and adolescents of a developing country (India)Asia Pac J Clin Nutr, 2004; 13:231–235.
27.
Shanthi RaniCS, RemaM, DeepaR, PremalathaG, RavikumarR, MohanA, SastryNG, RamuM, SarojaR, KayalvizhiG, MohanV. The Chennai Urban Population Study (CUPS)—methodological details—(CUPS PAPER NO. 1)Int J Diabetes Dev Countries, 1999; 19:149–155.
28.
DeepaM, PradeepaR, RemaM, AnjanaRM, DeepaR, ShanthiraniS, MohanV. The Chennai Urban Rural Epidemiology Study (CURES)—study design and methodology (urban component) (CURES-I)J Assoc Physicians India, 2003; 51:863–870.
29.
AnjanaRM, PradeepaR, DeepaM, DattaM, SudhaV, UnnikrishnanR, NathLM, DasAK, MadhuSV, RaoPV, ShuklaDK, KaurT, AliMK, MohanV. The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) Study: methodological details. J Diabetes Sci Technol, 2011; 5:906–914.
30.
UnnikrishnanAG, BhatiaE, BhatiaV, BhadadaSK, SahayRK, KannanA, KumaravelV, SarmaD, GanapathyB, ThomasN, JohnM, JayakumarRV, KumarH, NairV, SanjeeviCB. Type 1 diabetes versus type 2 diabetes with onset in persons younger than 20 years of age. Ann NY Acad Sci, 2008; 1150:239–244.
31.
EhtishamS, HattersleyAT, DungerDB, BarrettTG. First UK survey of paediatric type 2 diabetes and MODY. Arch Dis Child, 2004; 89:526–529.
DeepaM, FarooqS, DeepaR, ManjulaD, MohanV. Prevalence and significance of generalized and central body obesity in an urban Asian Indian population in Chennai, India (CURES: 47)Eur J Clin Nutr, 2009; 63:259–267.
34.
MisraA. We need ethnic-specific criteria for classification of BMI. Medeiros-NetoG, HalpernA, BouchardC. Progress in Obesity Research, 9. London: John Libbey Eurotext Ltd., 2003; 547–553.
35.
DasS, SamalKC, BaliarsinhaAK, TripathyBB. Lean (underweight) NIDDM—peculiarities and differences in metabolic and hormonal status—a pilot study. J Assoc Physicians India, 1995; 43:339–342.
36.
VikramNK, TandonN, MisraA, SrivastavaMC, PandeyRM, MithalA, SharmaS, AjmaniA, MadhuSV, BatraCM, GuptaN. Correlates of Type 2 diabetes mellitus in children, adolescents and young adults in north India: a multisite collaborative case-control study. Diabet Med, 2006; 23:293–298.
37.
LudvigssonJ, CarlssonA, ForsanderG, IvarssonS, KockumI, LernmarkA, LindbladB, MarcusC, SamuelssonU. C-peptide in the classification of diabetes in children and adolescents. Pediatr Diabetes, 2012; 13:45–50.
38.
TuomilehtoJ, ZimmetP, MackayIR, KoskelaP, VidgrenG, ToivanenL, Tuomilehto-WolfE, KohtamäkiK, StengårdJ, RowleyMJ. Antibodies to glutamic acid decarboxylase as predictors of insulin-dependent diabetes mellitus before clinical onset of disease. Lancet, 1994; 343:1383–1385.
39.
KlingensmithGJ, PyleL, ArslanianS, CopelandKC, CuttlerL, KaufmanF, LaffelL, MarcovinaS, TollefsenSE, WeinstockRS, LinderB. TODAY Study Group. The presence of GAD and IA-2 antibodies in youth with a type 2 diabetes phenotype: results from the TODAY Study. Diabetes Care, 2010; 33:1970–1975.
40.
ReinehrT, SchoberE, WiegandS, ThonA, HollR. DPV-Wiss Study Group. Beta-cell autoantibodies in children with type 2 diabetes mellitus: subgroup or misclassification?Arch Dis Child, 2006; 91:473–477.
41.
BonneyM, HingSJ, FungAT, StephensMM, FairchildJM, DonaghueKC, HowardNJ, SilinkM. Development and progression of diabetic retinopathy: adolescents at risk. Diabet Med, 1995; 12:967–973.
42.
YokoyamaH, OkudairaM, OtaniT, SatoA, MiuraJ, TakaikeH, YamadaH, MutoK, UchigataY, OhashiY, IwamotoY. Higher incidence of diabetic nephropathy in type 2 than in type 1 diabetes in early-onset diabetes in Japan. Kidney Int, 2005; 58:302–311.
43.
EppensMC, CraigME, CusumanoJ, HingS, ChanAK, HowardNJ, SilinkM, DonaghueKC. Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care, 2006; 29:1300–1306.
