Diabetic Ketoacidosis and Pediatric Type 2 Diabetes

For Physicians

Physicians at the Diabetes and Endocrinology Department at Texas Children’s Hospital are investigating the incidence of diabetic ketoacidosis (DKA) in children with newly diagnosed type 2 diabetes. DKA was previously considered an impossible diagnosis in type 2 diabetes, which usually has a more insidious onset. The increasing numbers of children with type 2 diabetes, however, is likely related to the increased incidence of DKA in children lacking typical characteristics of type 1 diabetes. 

Type 2 diabetes is becoming more common in children 

“With the increasing epidemic of obesity, we are seeing more and more patients with type 2 diabetes,” said Mustafa Tosur, MD, pediatric endocrinologist at Texas Children’s. “Based on the most recent numbers, almost 1 in 4 children with new onset diabetes is diagnosed with type 2 diabetes.” 

Many factors contribute to a type 2 diabetes diagnosis. The onset most often occurs after puberty, when the effects of genetic predisposition, excess weight and physical inactivity are augmented by hormones, which also cause some insulin resistance. The fat cells in an overweight or obese child contribute to obesity by releasing chemicals that augment insulin resistance. Many affected children have relatively decreased beta cell function and will therefore make less insulin, in addition to having factors contributing to insulin resistance. These forces usually result in a gradual elevation of blood sugar that can be tracked in a primary care clinic, where the diagnosis is eventually made.  

Can DKA be the first sign of type 2 diabetes in children? 

“About 10% of patients with new onset type 2 diabetes present with diabetic ketoacidosis at diagnosis,” said Dr. Tosur. “There is a concept that they may have a different type of diabetes, named ketosis-prone diabetes.” 

Ketosis-prone diabetes is a relatively new term, and its definition is still evolving. Currently, ketosis-prone diabetes is suspected when a patient is diagnosed with diabetes following an admission for DKA, but subsequently regains beta cell function to the point that their diabetes can be managed well on oral medications. Endocrinologists at Texas Children’s have been studying the incidence of ketosis-prone diabetes in the children who are diagnosed with type 2 diabetes through their emergency room.  

“Right now, it’s not well known in the literature if that ketosis-prone diabetes concept applies to children, so this is the very first step – just describing that there are those patients. The next step will be to find out the mechanisms leading to ketosis-prone diabetes, and then investigating the optimal treatment options in this condition will come after,” said Dr. Tosur. 

The importance of screening 

DKA is life-threatening for children and adults, which is why the American Diabetes Association recommends that all children, regardless of body habitus or other risk factors, be screened for diabetes after the onset of puberty. Risk factors, such as obesity, ethnicity and family history, however, play an important role in screening as well.  

“If there’s a strong family history of type 2 diabetes in younger age groups, those kids, even if they don’t have any symptoms, need regular screening,” said Dr. Tosur.  

Refer a patient to Texas Children's Diabetes and Endocrine Care Center through our online portal.