2.3.0.0 Di­ag­nos­tic Chal­lenges

Given the cur­rent obe­si­ty epi­dem­ic, dis­tin­guish­ing be­tween type 1 and type 2 di­a­betes in chil­dren can be difficult. Over­weight and obe­si­ty are com­mon in chil­dren with type 1 di­a­betes (23), and di­a­betes-‍as­so­ci­at­ed au­toan­ti­bod­ies and ke­to­sis may be pre­sent in pe­di­atric pa­tients with fea­tures of type 2 di­a­betes (in­clud­ing obe­si­ty and acan­tho­sis ni­gri­cans) (129). The pres­ence of islet auto-‍an­ti­bod­ies has been as­so­ci­at­ed with faster pro­gres­sion to in­sulin deficien­cy (129). At onset, DKA oc­curs in ~6% of youth aged 10–19 years with type 2 di­a­betes (134). Al­though un­com­mon, type 2 di­a­betes has been ob­served in pre­pu­ber­tal chil­dren under the age of 10, and thus it should be part of the dif­fer­ential in chil­dren with sug­gestive symp­toms (135). Fi­nal­ly, obe­si­ty (136) and type 2 di­a­betes–as­so­ci­at­ed ge­net­ic fac­tors may (137) con­tribute to the de­vel­op­ment of type 1 di­a­betes in some in­di­vid­u­als, which fur­ther blurs the lines be­tween di­a­betes types. How­ev­er, ac­cu­rate di­ag­no­sis is crit­i­cal, as treat­ment reg­i­mens, ed­u­ca­tional ap­proaches, di­etary ad­vice, and out­comes dif­fer marked­ly be­tween pa­tients with the two di­ag­noses.