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Diabetes tipo 2, obesidad y cetoacidosis diabética en niños.: Reporte de caso Translated title: Type 2 diabetes, obesity and diabetic ketoacidosis in children: Case report

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      Abstract

      Se reporta el caso de una niña con obesidad que acudió a nuestro hospital por presentar cetoacidosis diabética. El manejo inicial incluyó hidratación enérgica e insulina endovenosa. El análisis de anticuerpos anti-GAD fue negativo y el péptido C fue normal. El control metabólico a largo plazo fue con metformina, dieta y ejercicio.Tradicionalmente, la diabetes tipo 2 ha sido considerada una enfermedad de adultos. Sin embargo, a medida que aumenta la prevalencia de obesidad en niños, aumenta el número de casos de diabetes tipo 2 en este grupo etáreo. La hiperglicemia sostenida puede deteriorar la secreción de insulina por parte de las células beta del páncreas. Este fenómeno, llamado glucotoxicidad, puede explicar porque algunos pacientes con diabetes tipo 2 presentan cetoacidosis diabética. No todos los niños que debutan con cetoacidosis diabética tienen diabetes tipo 1.(Rev Med Hered 2011;22:139-142).

      Translated abstract

      A 14-year-old woman presented with recent history of type 2 diabetes and diabetic ketoacidosis. Initial treatment included hydration and IV insulin. The anti-GAD was negative, and C-peptide was normal. Clinical evolution was good. Long-term treatment included metformin, diet and exercise. Type 2 diabetes has traditionally been viewed as a disorder of adults. However, as the prevalence of obesity in youth is increasing, type 2 diabetes is now occurring in children and adolescents. Sustained hyperglycemia can impair the secretion of insulin by the beta-cells of the pancreas. Glucose toxicity explains why some patients newly diagnosed with type 2 diabetes have weight loss, diabetic ketoacidosis, and low measured insulin and C-peptide. Diabetic ketoacidosis in obese adolescents with new-onset diabetes does not imply the diagnosis of type 1 diabetes.(Rev Med Hered 2011;22:139-142).

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      Most cited references 32

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      Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective.

      To review the magnitude, characteristics, and public health importance of type 2 diabetes in North American youth. Among 15- to 19-year-old North American Indians, prevalence of type 2 diabetes per 1000 was 50.9 for Pima Indians, 4.5 for all US American Indians, and 2.3 for Canadian Cree and Ojibway Indians in Manitoba. From 1967-1976 to 1987-1996, prevalence increased 6-fold for Pima Indian adolescents. Among African Americans and whites aged 10 to 19 years in Ohio, type 2 diabetes accounted for 33% of all cases of diabetes. Youth with type 2 diabetes were generally 10 to 19 years old, were obese and had a family history of type 2 diabetes, had acanthosis nigricans, belonged to minority populations, and were more likely to be girls than boys. At follow-up, glucose control was often poor, and diabetic complications could occur early. Type 2 diabetes is an important problem among American Indian and First Nation youth. Other populations have not been well studied, but cases are now occurring in all population groups, especially in ethnic minorities. Type 2 diabetes among youth is an emerging public health problem, for which there is a great potential to improve primary and secondary prevention.
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        Acute and chronic complications of type 2 diabetes mellitus in children and adolescents.

        With the increase in prevalence of type 2 diabetes mellitus in adolescents, a rise in incidence of secondary comorbidities--including hypertension, hyperlipidaemia, nephropathy, and retinopathy--is anticipated. Furthermore, findings of studies in young adults have suggested that the development and progression of clinical complications might be especially rapid when the onset of type 2 diabetes is early, raising the possibility of a serious public-health challenge in the next few decades. To date, reports of the epidemiology and natural history of secondary complications specifically in adolescents with type 2 diabetes have been scarce. Yet, we must begin to understand the extent of the coming challenge. To this end, we have reviewed reports on acute and long-term comorbidities associated with type 2 diabetes in young people and have looked at mounting evidence that this group could be at increased risk for development of early complications.
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          Type 2 Diabetes in the Young: The Evolving Epidemic: The International Diabetes Federation Consensus Workshop

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            Author and article information

            Affiliations
            [1 ] Hospital Nacional Arzobispo Loayza Perú
            [2 ] Hospital Nacional Cayetano Heredia Perú
            [3 ] Universidad Peruana Cayetano Heredia Perú
            [4 ] Hospital Nacional Alcides Carrión
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Journal
            rmh
            Revista Medica Herediana
            Rev Med Hered
            Universidad Peruana Cayetano Heredia. Facultad de Medicina "Alberto Hurtado" (Lima )
            1729-214X
            July 2011
            : 22
            : 3
            : 139-142
            S1018-130X2011000300008

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Peru
            Categories
            HEALTH CARE SCIENCES & SERVICES
            HEALTH POLICY & SERVICES
            MEDICAL ETHICS
            MEDICAL INFORMATICS
            MEDICAL LABORATORY TECHNOLOGY
            MEDICINE, GENERAL & INTERNAL
            MEDICINE, LEGAL
            MEDICINE, RESEARCH & EXPERIMENTAL
            PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

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