Experts do not agree as to whether diminished insulin secretion or insulin resistance is the primary problem in the population of adults with type 2 diabetes. From what has been observed in children the abnormality appears to be that of inappropriate insulin action progressing to later failure of the insulin-producing cells. Puberty has been identified as important in the development of type 2 diabetes in children. Changes in hormone levels during this period cause insulin resistance and decreased insulin action. Therefore it is quite understandable that type 2 diabetes in children most often occurs during mid-puberty although cases as young as 4 years of age have been reported.
Obesity is another significant factor.
It is well understood that obese children produce too much insulin so that when the need for more insulin arises, they are likely to be unable to produce enough more. Only children who have risk factors for the development of type 2 diabetes need to be screened. Since type 2 diabetes in children has traditionally been a rare occurrence, little is know about treatment. The panel of experts can draw conclusions and make recommendations based on experience in adults. Studies indicate that this form of diabetes is progressive.