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Until the 1970s, the care of childhood diabetes was pursued by
internists, pediatricians, nephrologists, and general physicians.
In 1971 it was estimated that visits for diabetes by those 0 to 15
years of age were equally divided among internists, general physicians,
and general pediatricians.1 At that
time there were few pediatric endocrinologists, and most of them
did not consider diabetes to be an endocrine disorder. By 1993,
pediatricians accounted for two thirds of all visits of 0- to 21-year-old diabetes
patients, and over half of these were to pediatric endocrinologists;
the remainder were to internists (most likely the older adolescents
and young adults).2 The contemporary epidemic of
obesity-related type 2 diabetes (T2D) in youth has confronted pediatricians
and pediatric diabetes specialists with responsibility for a condition
that was previously rare in the pediatric age group. This obesity/T2D
epidemic has had pediatricians dealing with various comorbidities
of insulin resistance that were formerly the exclusive domain of
physicians treating adults.3
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The diagnosis of diabetes includes a wide variety of diseases
characterized by hyperglycemia. Because insulin is the only physiologically
important hypoglycemic hormone, hyperglycemia is the result of either impaired
secretion of insulin from the beta cells of the pancreas (type 1
diabetes) or resistance to the effect of insulin in the liver, muscle,
and fat cells exceeding a limited capacity of the pancreas to compensate (type
2 diabetes). Criteria for the diagnosis of diabetes were revised
in 2005 and prediabetes categories of impaired glucose tolerance
and impaired fasting glucose added; this change reflected the recognition that
these preclinical glucose intolerance states are associated with
increased cardiovascular morbidity.4 The information
in Table 544-1 is based on the current recommendations
of the American Diabetes Association.4
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