Pediatric Grand Rounds (RECORDING) Youth-Onset Type 2 Diabetes: Unique Clinical, Social, and Public Health Implications

This presentation is a recording of a Stanford Pediatric Grand Rounds Session.  World-renowned experts will present the latest research, practice guidelines, and treatment protocols to advance best practices in the care of pediatric patients. These online recordings will provide pediatricians and family physicians with up-to-date clinical information on a wide range of clinical issues encountered in daily pediatric practice. This presentation reviews the unique pathophysiology and demographics of type 2 diabetes with onset in youth, current understanding of complications, and the implications for these findings on treatment approaches.

  Release Date: March 23, 2023
  Expiration Date: March 22, 2024
  Estimated Time to Complete: 1.0 hour
  Registration Fee: FREE
 *Originally recorded 12/2/2022.

1. Review the unique pathophysiologic and demographic features of youth-onset type 2 diabetes.
2. Discuss a pathophysiologic approach to management of youth-onset type 2 diabetes.
3. Review complications and comorbidities of youth-onset type 2 diabetes.

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credits^TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Accessibility Statement
 Stanford University School of Medicine is committed to ensuring that its programs, services, goods and facilities are accessible to individuals with disabilities as specified under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Amendments Act of 2008.  If you have needs that require accommodations, please contact the CME Conference Coordinator.

Cultural and Linguistic Competency
The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: https://laneguides.stanford.edu/multicultural-health

References/Bibliography

Al-Saeed, A. H., Constantino, M. I., Molyneaux, L., D'Souza, M., Limacher-Gisler, F., Luo, C., Wu, T., Twigg, S. M., Yue, D. K., & Wong, J. (2016). An Inverse Relationship Between Age of Type 2 Diabetes Onset and Complication Risk and Mortality: The Impact of Youth-Onset Type 2 Diabetes. Diabetes care, 39(5), 823–829. https://doi.org/10.2337/dc15-0991

Bacha, F., Gungor, N., Lee, S., & Arslanian, S. A. (2009). In vivo insulin sensitivity and secretion in obese youth: what are the differences between normal glucose tolerance, impaired glucose tolerance, and type 2 diabetes?. Diabetes care, 32(1), 100–105. https://doi.org/10.2337/dc08-1030

Baranowski, T., Cooper, D. M., Harrell, J., Hirst, K., Kaufman, F. R., Goran, M., Resnicow, K., & STOPP-T2D Prevention Study Group (2006). Presence of diabetes risk factors in a large U.S. eighth-grade cohort. Diabetes care, 29(2), 212–217. https://doi.org/10.2337/diacare.29.02.06.dc05-1037

Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Montori, V. M., & Task Force, Endocrine Society (2010). Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism, 95(6), 2536–2559. https://doi.org/10.1210/jc.2009-2354

Constantino, M. I., Molyneaux, L., Limacher-Gisler, F., Al-Saeed, A., Luo, C., Wu, T., Twigg, S. M., Yue, D. K., & Wong, J. (2013). Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes. Diabetes care, 36(12), 3863–3869. https://doi.org/10.2337/dc12-2455

Kahn, S. E., Haffner, S. M., Heise, M. A., Herman, W. H., Holman, R. R., Jones, N. P., Kravitz, B. G., Lachin, J. M., O'Neill, M. C., Zinman, B., Viberti, G., & ADOPT Study Group (2006). Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. The New England journal of medicine, 355(23), 2427–2443. https://doi.org/10.1056/NEJMoa066224

Kelsey, M. M., Zeitler, P. S., Drews, K., & Chan, C. L. (2020). Normal Hemoglobin A1c Variability in Early Adolescence: Adult Criteria for Prediabetes Should Be Applied with Caution. The Journal of pediatrics, 216, 232–235. https://doi.org/10.1016/j.jpeds.2019.07.031

Libman, I. M., Barinas-Mitchell, E., Bartucci, A., Robertson, R., & Arslanian, S. (2008). Reproducibility of the oral glucose tolerance test in overweight children. The Journal of clinical endocrinology and metabolism, 93(11), 4231–4237. https://doi.org/10.1210/jc.2008-0801

Love-Osborne, K. A., Sheeder, J. L., Nadeau, K. J., & Zeitler, P. (2018). Longitudinal follow up of dysglycemia in overweight and obese pediatric patients. Pediatric diabetes, 19(2), 199–204. https://doi.org/10.1111/pedi.12570

Moran, A., Jacobs, D. R., Jr, Steinberger, J., Cohen, P., Hong, C. P., Prineas, R., & Sinaiko, A. R. (2002). Association between the insulin resistance of puberty and the insulin-like growth factor-I/growth hormone axis. The Journal of clinical endocrinology and metabolism, 87(10), 4817–4820. https://doi.org/10.1210/jc.2002-020517

Nadeau, K. J., Anderson, B. J., Berg, E. G., Chiang, J. L., Chou, H., Copeland, K. C., Hannon, T. S., Huang, T. T., Lynch, J. L., Powell, J., Sellers, E., Tamborlane, W. V., & Zeitler, P. (2016). Youth-Onset Type 2 Diabetes Consensus Report: Current Status, Challenges, and Priorities. Diabetes care, 39(9), 1635–1642. https://doi.org/10.2337/dc16-1066

RISE Consortium (2018). Metabolic Contrasts Between Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes: II. Observations Using the Oral Glucose Tolerance Test. Diabetes care, 41(8), 1707–1716. https://doi.org/10.2337/dc18-0243

RISE Consortium (2014). Restoring Insulin Secretion (RISE): design of studies of β-cell preservation in prediabetes and early type 2 diabetes across the life span. Diabetes care, 37(3), 780–788. https://doi.org/10.2337/dc13-1879

RISE Consortium, & RISE Consortium Investigators (2019). Effects of Treatment of Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes With Metformin Alone or in Combination With Insulin Glargine on β-Cell Function: Comparison of Responses In Youth And Adults. Diabetes, 68(8), 1670–1680. https://doi.org/10.2337/db19-0299

SEARCH for Diabetes in Youth Study Group, Liese, A. D., D'Agostino, R. B., Jr, Hamman, R. F., Kilgo, P. D., Lawrence, J. M., Liu, L. L., Loots, B., Linder, B., Marcovina, S., Rodriguez, B., Standiford, D., & Williams, D. E. (2006). The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics, 118(4), 1510–1518. https://doi.org/10.1542/peds.2006-0690

TODAY Study Group (2013). Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and β-cell function in TODAY. Diabetes care, 36(6), 1749–1757. https://doi.org/10.2337/dc12-2393

TODAY Study Group, Bjornstad, P., Drews, K. L., Caprio, S., Gubitosi-Klug, R., Nathan, D. M., Tesfaldet, B., Tryggestad, J., White, N. H., & Zeitler, P. (2021). Long-Term Complications in Youth-Onset Type 2 Diabetes. The New England journal of medicine, 385(5), 416–426. https://doi.org/10.1056/NEJMoa2100165

TODAY Study Group, Zeitler, P., Hirst, K., Pyle, L., Linder, B., Copeland, K., Arslanian, S., Cuttler, L., Nathan, D. M., Tollefsen, S., Wilfley, D., & Kaufman, F. (2012). A clinical trial to maintain glycemic control in youth with type 2 diabetes. The New England journal of medicine, 366(24), 2247–2256. https://doi.org/10.1056/NEJMoa1109333

Vidal, J., & Kahn, S. E. (2001). Regulation of insulin secretion in vivo. In: Genetics of Diabetes Mellitus, Lowe, W. L. Jr. (ed.), 109-131.

Weiss, R., Taksali, S. E., Tamborlane, W. V., Burgert, T. S., Savoye, M., & Caprio, S. (2005). Predictors of changes in glucose tolerance status in obese youth. Diabetes care, 28(4), 902–909. https://doi.org/10.2337/diacare.28.4.902

Williams, D. E., Cadwell, B. L., Cheng, Y. J., Cowie, C. C., Gregg, E. W., Geiss, L. S., Engelgau, M. M., Narayan, K. M., & Imperatore, G. (2005). Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 1999-2000. Pediatrics, 116(5), 1122–1126. https://doi.org/10.1542/peds.2004-2001

For CME general questions, please contact 
     Email: [email protected]

Mitigation of Relevant Financial Relationships

Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education. 

There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity, except those listed in the table below. All of the relevant financial relationships listed for these individuals have been mitigated.

Member Information

Role in activity

Nature of Relationship(s) / Name of Ineligible Company(s)

Alan R. Schroeder, MD
Clinical Professor
Stanford University

Co-Course Director

Nothing to disclose

Olivera Marsenic Couloures, MD
LPCH

Course Director and Reviewer

Nothing to disclose

Phil Zeitler, MD, PhD

Faculty

Consulting Fee-Merck and Company, Inc. (Relationship has ended)|Consulting Fee-Eli Lilly and Company|Consulting Fee-Boehringer-Ingelheim|Grant or research support-Johnson and Johnson

Debra Babcock, MD
Stanford Childrens (PCHA)

Planner

Nothing to disclose

Lisa Jo Chamberlain, MD
Professor of Pediatrics – General Pediatrics
Stanford Children's Health

Planner

Nothing to disclose

Baraka Dechelle Floyd, MD
Clinical Assistant Professor and Associate Chair for Diversity, Equity, and Inclusion
Stanford University School of Medicine

Planner

Nothing to disclose

Charles Gawad, MD, PhD
Associate Professor
Stanford

Planner

Ownership-BioSkryb Genomics

Allison Guerin, EdD
Stanford

Planner

Nothing to disclose

Mary Beth Leonard, MD, MSCE
Arline and Pete Harman Professor and Chair, Department of Pediatrics
Stanford University

Planner

Nothing to disclose

Ryan Lion, MD, MS
Stanford University

Planner

Nothing to disclose

Lauren E O'Brien, MD
Clinical Assistant Professor
LPCH

Planner

Nothing to disclose

Stephen J Roth, MPH, MD
Attending, Cardiovascular ICU
Lucile Packard Children's Hospital Stanford

Planner

Nothing to disclose

Stephanie Squires, MD
Pediatric Hospital Medicine Fellow
Stanford Health Care/ Stanford Children's Hospital

Planner

Nothing to disclose

Ke-You Zhang, MD
Stanford University

Planner

Nothing to disclose