eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Diabetes Mellitus, Type 2: Differential Diagnoses & Workup

Author: Jean-Claude DesMangles, MD, Assistant Professor, Department of Pediatrics, Creighton University School of Medicine
Contributor Information and Disclosures

Updated: Jul 30, 2009

Differential Diagnoses

Diabetes Mellitus, Type 1
Diabetic Ketoacidosis

Other Problems to Be Considered

Atypical diabetes mellitus (ADM)
Maturity-onset diabetes of the young (MODY)
Diabetes secondary to mutations in mitochondrial DNA
Genetic defects of the beta-cell
Genetic defects in insulin action
Diseases of the exocrine pancreas
Endocrinopathies
Drug- or chemical-induced diabetes

Workup

Laboratory Studies

  • A random plasma glucose concentration of 200 mg/dL or greater in association with polyuria, polydipsia, or unexplained weight loss is diagnostic of diabetes.
  • In an asymptomatic patient, a fasting (ie, no caloric intake for at least 8 h) plasma glucose value of 126 mg/dL or greater or a 2-hour plasma glucose value of 200 mg/dL or greater during an oral glucose tolerance test are also diagnostic of diabetes.
  • Fasting C-peptide and insulin levels are usually elevated in type 2 diabetes.
  • Autoantibody results are usually negative.
  • Because the onset of type 2 diabetes frequently precedes the diagnosis by several years, testing for end-organ effects of the disease is important.
    • Evaluation for diabetic nephropathy: Testing for albuminuria can be performed by using 1 of 3 methods. Microalbuminuria is said to be present if urinary albumin excretion is 30 mg/24 h (equivalent to 20 µg/min with a timed specimen or 30 mg of albumin per gram creatinine with a random sample). The methods are as follows:
      1. Measurement of the albumin-to-creatinine ratio in a random spot collection
      2. A 24–hour collection for albumin and creatinine determinations, which allow for simultaneous measurement of creatinine clearance
      3. Timed (eg, 4-h or overnight) collection
    • Evaluation for dyslipidemia
      • Hypertriglyceridemia
      • Elevated very-low-density lipoproteins (VLDL) levels
      • Elevated low-density lipoprotein (LDL) cholesterol levels
      • Elevated lipoprotein(a) levels
      • Decreased high-density lipoprotein (HDL) cholesterol levels
    • Evaluation for retinopathy

More on Diabetes Mellitus, Type 2

Overview: Diabetes Mellitus, Type 2
Differential Diagnoses & Workup: Diabetes Mellitus, Type 2
Treatment & Medication: Diabetes Mellitus, Type 2
Follow-up: Diabetes Mellitus, Type 2
References
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References

  1. [Best Evidence] Loimaala A, Groundstroem K, Rinne M, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol. Apr 1 2009;103(7):972-7. [Medline].

  2. US Food and Drug Administration. Early Communication About Safety of Lantus (insulin Glargine). Available at http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm169722.htm. Accessed July 1, 2009.

  3. [Best Evidence] Kooy A, de Jager J, Lehert P, et al. Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with type 2 diabetes mellitus. Arch Intern Med. Mar 23 2009;169(6):616-25. [Medline].

  4. [Best Evidence] Home PD, Pocock SJ, Beck-Nielsen H, et al. Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Lancet. Jun 20 2009;373(9681):2125-35. [Medline].

  5. [Best Evidence] International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care. Jun 5 2009;[Medline].

  6. [Guideline] American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. Jan 2004;27 Suppl 1:S5-S10. [Medline].

  7. Alberti G, Zimmet P, Shaw J, et al. Type 2 diabetes in the young: the evolving epidemic: the international diabetes federation consensus workshop. Diabetes Care. Jul 2004;27(7):1798-811. [Medline].

  8. American Diabetes Association. Screening for type 2 diabetes. Diabetes Care. Jan 2004;27 Suppl 1:S11-4. [Medline].

  9. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. Jan 2004;27 Suppl 1:S15-35. [Medline].

  10. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care. Mar 2000;23(3):381-9. [Medline].

  11. Bavdekar A, Yajnik CS, Fall CH, et al. Insulin resistance syndrome in 8-year-old Indian children: small at birth, big at 8 years, or both?. Diabetes. Dec 1999;48(12):2422-9. [Medline].

  12. Bobo N, Evert A, Gallivan J, et al. An update on type 2 diabetes in youth from the National Diabetes Education Program. Pediatrics. Jul 2004;114(1):259-63. [Medline].

  13. Dabelea D, Pettitt DJ, Hanson RL, et al. Birth weight, type 2 diabetes, and insulin resistance in Pima Indian children and young adults. Diabetes Care. Jun 1999;22(6):944-50. [Medline].

  14. Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr. May 2000;136(5):664-72. [Medline].

  15. Goran MI, Bergman RN, Cruz ML, Watanabe R. Insulin resistance and associated compensatory responses in african-american and Hispanic children. Diabetes Care. Dec 2002;25(12):2184-90. [Medline].

  16. Grinstein G, Muzumdar R, Aponte L, et al. Presentation and 5-year follow-up of type 2 diabetes mellitus in African-American and Caribbean-Hispanic adolescents. Horm Res. 2003;60(3):121-6. [Medline].

  17. Home PD, Pocock SJ, Beck-Nielsen H, et al. Rosiglitazone Evaluated for Cardiovascular Outcomes -- An Interim Analysis. N Engl J Med. Jun 5 2007;[Medline]. [Full Text].

  18. Kirpichnikov D, Sowers JR. Diabetes mellitus and diabetes-associated vascular disease. Trends Endocrinol Metab. Jul 2001;12(5):225-30. [Medline].

  19. Krakoff J, Lindsay RS, Looker HC, et al. Incidence of retinopathy and nephropathy in youth-onset compared with adult-onset type 2 diabetes. Diabetes Care. Jan 2003;26(1):76-81. [Medline].

  20. Macaluso CJ, Bauer UE, Deeb LC, et al. Type 2 diabetes mellitus among Florida children and adolescents, 1994 through 1998. Public Health Rep. Jul-Aug 2002;117(4):373-9. [Medline].

  21. Mahler RJ, Adler ML. Clinical review 102: Type 2 diabetes mellitus: update on diagnosis, pathophysiology, and treatment. J Clin Endocrinol Metab. Apr 1999;84(4):1165-71. [Medline].

  22. Mc Afee AT, Koro C,Landon J,et al. Coronary heart disease outcomes in patients receiving antidiabetic agents. Pharmacoepidemiol Drug Saf. June 2007;[Medline]. [Full Text].

  23. Morales AE, Rosenbloom AL. Death caused by hyperglycemic hyperosmolar state at the onset of type 2 diabetes. J Pediatr. Feb 2004;144(2):270-3. [Medline].

  24. Neufeld ND, Raffel LJ, Landon C, et al. Early presentation of type 2 diabetes in Mexican-American youth. Diabetes Care. Jan 1998;21(1):80-6. [Medline].

  25. Palmert MR, Gordon CM, Kartashov AI, et al. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab. Mar 2002;87(3):1017-23. [Medline].

  26. Pihoker C, Scott CR, Lensing SY, Cradock MM, Smith J. Non-insulin dependent diabetes mellitus in African-American youths of Arkansas. Clin Pediatr (Phila). Feb 1998;37(2):97-102. [Medline].

  27. Pinhas-Hamiel O, Standiford D, Hamiel D, et al. The type 2 family: a setting for development and treatment of adolescent type 2 diabetes mellitus. Arch Pediatr Adolesc Med. Oct 1999;153(10):1063-7. [Medline].

  28. Pinhas-Hamiel O, Zeitler P. Insulin resistance, obesity, and related disorders among black adolescents. J Pediatr. Sep 1996;129(3):319-20. [Medline].

  29. Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. Feb 1999;22(2):345-54. [Medline].

  30. Silverman BL, Metzger BE, Cho NH, Loeb CA. Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes Care. May 1995;18(5):611-7. [Medline].

  31. Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab. Jun 2004;89(6):2526-39. [Medline].

  32. Wei JN, Sung FC, Li CY, et al. Low birth weight and high birth weight infants are both at an increased risk to have type 2 diabetes among schoolchildren in taiwan. Diabetes Care. Feb 2003;26(2):343-8. [Medline].

  33. Weyer C, Bogardus C, Mott DM, Pratley RE. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest. Sep 1999;104(6):787-94. [Medline].

  34. Yokoyama H, Okudaira M, Otani T, et al. Higher incidence of diabetic nephropathy in type 2 than in type 1 diabetes in early-onset diabetes in Japan. Kidney Int. Jul 2000;58(1):302-11. [Medline].

  35. Young TK, Martens PJ, Taback SP, et al. Type 2 diabetes mellitus in children: prenatal and early infancy risk factors among native canadians. Arch Pediatr Adolesc Med. Jul 2002;156(7):651-5. [Medline].

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Further Reading

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Keywords

diabetes mellitus type 2, type 2 diabetes mellitus, NIDDM, non–insulin-dependent diabetes mellitus, adult-onset diabetes mellitus, type 2 diabetes mellitus, insulin resistance, type 2 diabetes, diabetes, type 2 diabetes in children

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Contributor Information and Disclosures

Author

Jean-Claude DesMangles, MD, Assistant Professor, Department of Pediatrics, Creighton University School of Medicine
Jean-Claude DesMangles, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Bone and Mineral Research, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Arlan L Rosenbloom, MD, Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology
Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Florida Pediatric Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London), Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece
George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfizer, Inc. Honoraria Consulting

 
 
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