Youth-onset type 2 diabetes is a heterogeneous disease with increasing prevalence in relation to increased rates of obesity in children. It has genetic, epigenetic, social, and environmental determinants. Youth-onset type 2 diabetes is alarming given a rapidly progressive course compared with the course of adult-onset disease, early-onset vascular complications, and long-term exposure to hyperglycemia and associated complications. It is often preceded by “prediabetes,” a disease phase where defects in β-cell function relative to insulin sensitivity emerge. Herein, we review the current understanding of the pathophysiology of prediabetes and type 2 diabetes in youth. We describe the mechanisms underlying insulin resistance, the precipitous decline of β-cell function, and the role of other hormonal abnormalities in the pathogenesis of the disease. We discuss the critical importance of social determinants of health in the predisposition and progression of these conditions and present current management strategies and the advances in therapeutic approaches. These must adapt to meet the unique needs of the individual patient and family. Significant knowledge gaps remain that need to be addressed in future research.

中文翻译：

---

青少年糖尿病前期和 2 型糖尿病的病理生理学和治疗


青年发病的 2 型糖尿病是一种异质性疾病，与儿童肥胖率的增加相比，患病率不断增加。它具有遗传、表观遗传、社会和环境决定因素。与成人发病的病程相比，青年发病的 2 型 2 型糖尿病病程进展迅速，早发性血管并发症以及长期暴露于高血糖和相关并发症，令人担忧。它通常发生在“糖尿病前期”之前，这是一个疾病阶段，相对于胰岛素敏感性，β细胞功能出现缺陷。在此，我们回顾了目前对青少年糖尿病前期和 2 型糖尿病病理生理学的理解。我们描述了胰岛素抵抗的潜在机制、β细胞功能的急剧下降以及其他激素异常在疾病发病机制中的作用。我们讨论了健康的社会决定因素在这些疾病的易感性和进展中的至关重要性，并介绍了当前的管理策略和治疗方法的进展。这些必须进行调整以满足个体患者和家庭的独特需求。仍然存在重大的知识差距，需要在未来的研究中加以解决。