Children with type 2 diabetes mellitus most often present during asymptomatic screening.

Children may have the typical symptoms of polyuria, polydipsia, polyphagia, and weight loss. Children with type 2 diabetes mellitus are more likely than adults with the disorder to present in DKA (5% to 13%), especially if they are of ethnic minority descent. Adolescents with type 2 diabetes mellitus may also present in Hyperosmolar Hyperglycemic State (HHS). 

Physical exam findings can include acanthosis nigricans (dark, velvety rash present in the axillae and neck). The American Diabetes Association recommends screening children at 10 years old or at the start of puberty in children who are obese (> 95th percentile BMI for age) or are overweight (BMI > 85th percentile for age or > 120% ideal body weight) and have two risk factors. These factors can be positive family history, high-risk ethnicity, signs of insulin resistance (polycystic ovary syndrome (PCOS), acanthosis, symptoms), or history of maternal gestational diabetes mellitus.

The American Diabetes Association recommends screening for type 2 diabetes mellitus  every three years starting at age ten years (or at the onset of puberty) for patients who are:[8][9][10]

• Obese (body mass index (BMI) greater than or equal to the 95th percentile for age)
• Overweight (BMI greater than or equal to the 85thpercentile) and have at lease two risk factors (positive family history, higher risk race or ethnicity, signs of insulin resistance, maternal history of gestational DM). 

Diagnostic criteria:

• Random plasma blood glucose 200 mg/dl or greater with symptoms of polyuria, polydipsia, or weight loss.

• Fasting blood glucose of 126 mg/dl or higher in an asymptomatic patient. 

• Oral glucose tolerance test with blood sugar 200 mg/dl or greater at two hours post ingestion.

• Hemoglobin A1c > 6.5%. 

If the diagnosis between type 1 and type 2 diabetes mellitus is not clear, helpful labs include fasting insulin or c peptide (both usually high or normal in type 2 diabetes mellitus, low in type 1 diabetes mellitus ), and autoantibodies for type 1 diabetes mellitus.

The American Academy of Pediatrics recommends lifestyle modifications and Metformin as the first line therapy. Lifestyle changes include moderate to vigorous exercise for 60 minutes per day, limiting screen time to less than two hours per day, and a dietary referral.[11][12][13][14]

Metformin and/or insulin should be started at diagnosis. Metformin is first line and available as a liquid. Start at 500 mg/day and increase by 500 mg every one to two weeks to a maximum of 2000 mg twice a day. The gradual increase of the medication and taking it with food helps to prevent gastrointestinal side effects.

Insulin should be started for patients who are ketotic or in diabetic ketoacidosis (DKA), have a random blood glucose > 250 mg/dl, an A1C > 9.0%, or in whom the diagnosis of type 1 vs. type 2 is not clear. May use a basal/bolus regimen like in type 1 diabetes mellitus, but typically type 2 diabetes mellitus patients require higher doses (2 unit/kg/day - 3 unit/kg/day). Insulin should be initiated and managed by pediatric endocrinologists. Insulin takers have a risk of hypoglycemia; therefore frequent monitoring is required.

Home glucose monitoring is recommended for those who take insulin, have not met glucose control goals, are changing medications, or are sick.

A1C test goals vary by association. American Diabetes Association and the American Academy of Pediatrics list an A1C test goal of < 7%, while the American Association of Clinical Endocrinologists places the goal at < 6.5%.

• ADM

• MODY

• Diabetes secondary to mutations in DNA

• Diseases of the exocrine pancreas

• Drug or chemical induced diabetes

• DKA

• Endocrinopathies

• Genetic defects of beta cells 

• Genetic defects in insulin action 

• Type 1 DM

Complications of type 2 diabetes in children are similar to that of adults. Complications tend to occur after a person has had the disease for many years. Those who are diagnosed in childhood have the disease for longer periods of time. Therefore, strict control and management of blood glucose are crucial to help prevent these complications. All people with diabetes should have regular dilated eye exams (to examine for diabetic retinopathy), urine microalbumin screening at appropriate intervals (evaluated for renal involvement), hyperlipidemia screens/treatment, hypertension screening/treatment, and regular monitoring.

Type 2 diabetes in children is best managed by an interprofessional team that includes a pediatrician, primary care provider, diabetic nurse, endocrinologist, and relevant specialists. The American Academy of Pediatrics recommends lifestyle modifications and metformin as first-line therapy. Lifestyle changes include moderate to vigorous exercise for 60 minutes per day, limiting screen time to less than two hours per day, and a dietary referral.

It is vital to ensure that these children are also evaluated by the ophthalmologist, nephrologist, cardiologist and dental surgeon. Complications of type 2 diabetes in children are similar to that of adults. Complications tend to occur after a person has had the disease for many years. Those who are diagnosed in childhood have the disease for longer periods of time. Therefore, strict control and management of blood glucose are crucial to help prevent these complications. All people with diabetes should have regular dilated eye exams (to examine for diabetic retinopathy), urine microalbumin screening at appropriate intervals (evaluated for renal involvement), hyperlipidemia screens/treatment, hypertension screening/treatment, and regular monitoring.[15]