ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Lancet Diabetes Endocrinol 2018; 6:69-80

The prevalence of T2DM in youth is increasing dramatically worldwide, but the bulk of the increase is expected to take place in Africa, South East Asia and South America. Although genetic factors may seem to be the obvious reason for such geographical differences, a careful analysis of the existing literature suggests that many factors need to be considered: ethnic differences in the genes associated with obesity or with insulin action/secretion have not been clearly identified; the role of intrauterine retardation and postnatal growth that has been well-studied in India may not be as relevant in other settings, the importance of environmental factors; of chronic infections/inflammation and of the nutritional transition may differ from country to country; little data is available on physical activity in youth living in different cultures and the effect of the known differences in the quality of the national healthcare systems on the recognition and management of T2DM remains poorly understood. Understanding the determinants underpinning the expected worldwide increase in the prevalence of T2DM in youth is important as it may lead to country-specific guidelines for the prevention of this public health epidemic that are different from guidelines published in high-income countries where most studies are performed.

This review also raises the important question of access to medicines. Access to insulin is presently insufficient in many low-income countries and could further aggravate the economic consequences of this epidemic.