Type 2 diabetes in children in the Netherlands: the need for diagnostic protocols.
OBJECTIVE
The worldwide trend towards obesity in childhood is also observed in the Netherlands and one of the consequences may be type 2 diabetes. In this study, we assessed the number of children with type 2 diabetes, diagnosed by paediatricians, in the Netherlands.


METHODS
In 2003 and 2004 the Dutch Paediatric Surveillance Unit, a nationwide paediatric register, was used to assess new cases of diabetes mellitus. Data on socio-demographic and clinical characteristics were collected by means of a questionnaire. A second questionnaire was sent to the reporting paediatrician if the diagnosis was inconclusive or if the diagnosis was type 1 diabetes in combination with overweight or obesity, according to international criteria.


RESULTS
During the 24 months of registration, the paediatricians reported 1142 new cases of diabetes, 943 of which were eligible for analysis. Initially, 14 patients (1.5%) were reported with type 2 diabetes. Only seven of these patients were classified as type 2 diabetes according to the ADA criteria, as information on C-peptides or antibodies was often missing. Based on clinical characteristics, the other seven patients were very likely to have type 2 diabetes. After the second questionnaire, six more patients met the ADA criteria and two were very likely to have type 2 diabetes. Most of the patients were female (95%), 14% were of Turkish and 18% of Moroccan origin.


CONCLUSIONS
This study shows a discrepancy between the number of patients with type 2 diabetes diagnosed by paediatricians in daily practice and diagnosed according to the ADA criteria. Moreover, a considerable amount of reported patients were misclassified. Finally, 2.4% patients were classified as (very likely) type 2 diabetes. The development of programmes and protocols for prevention, diagnosis and classification applicable in daily practice is warranted.
Department of Pediatrics, Institute for Clinical and Experimental Neuroscien ces, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. j.rotteveel@vumc.nl
Joost
J
Rotteveel
Eline J
EJ
Belksma
Carry M
CM
Renders
Remy A
RA
Hirasing
Henriette A
HA
Delemarre-Van de Waal
D000293:Adolescent; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002096:C-Peptide / Q000097:blood; D002648:Child; D002675:Child, Preschool; D048909:Diabetes Complications / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009018:Morocco / Q000208:ethnology; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D011159:Population Surveillance; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014421:Turkey / Q000208:ethnology
D002096:C-Peptide