Glucose metabolism disorders in children and adolescents with obesity
Authors:
Lenka Veselá 1,2; Zdeněk Šumník 3; Irena Aldhoon Hainerová 1
Authors‘ workplace:
Klinika dětí a dorostu, 3. lékařská fakulta, Univerzita Karlova a Fakultní nemocnice Královské Vinohrady, Praha
1; Dětské oddělení, Oblastní nemocnice Kolín, a. s., nemocnice Středočeského kraje
2; Pediatrická klinika, 2. lékařská fakulta, Univerzita Karlova a Fakultní nemocnice Motol, Praha
3
Published in:
Čes-slov Pediat 2026; 81 (Supplementum): 5-12.
Category:
doi:
https://doi.org/10.55095/CSPediatrie2026/019
Overview
Obesity in children and adolescents is frequently associated with disturbances in glucose metabolism, such as insulin resistance, prediabetes, or type 2 diabetes. These conditions pose an increased risk of early-onset metabolic and cardiovascular complications. Prediabetes represents an intermediate state between normoglycemia and overt diabetes, with the highest risk of progression to type 2 diabetes observed in adolescents with severe obesity. A combination of marked insulin resistance and rapid deterioration of pancreatic β-cell function characterizes the pathophysiology of type 2 diabetes at this age.
This article summarizes current knowledge on the prevalence, pathogenesis, diagnosis, and treatment options for glucose homeostasis disorders in children and adolescents with obesity. Special attention is paid to the importance of multidisciplinary care, patient education, regular monitoring, and individualized therapy.
Keywords:
obesity – insulin resistance – type 2 diabetes – prediabetes
Sources
1. American Diabetes Association Professional Practice Committee. Children and adolescents: standards of care in diabetes—2025. Diabetes Care 2025; 48(Suppl 1): S283–S305.
2. Shah AS, Barrientos-Pérez M, et al. ISPAD clinical practice consensus guidelines 2024: type 2 diabetes in children and adolescents. Horm Res Paediatr 2024; 97(6): 555–583.
3. Bacha F, Hannon TS, et al. Pathophysiology and treatment of prediabetes and type 2 diabetes in youth. Diabetes Care 2024; 47(12): 2038–2049.
4. Bacha F, Lee S, et al. From pre-diabetes to type 2 diabetes in obese youth: pathophysiological characteristics along the spectrum of glucose dysregulation. Diabetes Care 2010; 33 : 2225–2231.
5. Bacha F, Gungor N, et al. Progressive deterioration of β-cell function in youth-onset type 2 diabetes. Diabetes 2013; 62(2): 689–697.
6. Kurtoglu S, Hatipoglu N, et al. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol 2010; 2(3): 100–106.
7. Shashaj B, Luciano R, et al. Reference ranges of HOMA-IR in normal-weight children: a multicenter European study. Diabetes Care 2016; 39(1): e1–e3.
8. Lee SH, Ahn MB, et al. Comparison of different criteria for the definition of insulin resistance and its relationship to metabolic risk in children and adolescents. Ann Pediatr Endocrinol Metab 2020; 25(4): 227–233.
9. Aldhoon-Hainerová I, Zamrazilová H, et al. Glucose homeostasis and insulin resistance: prevalence, gender differences and predictors in adolescents. Diabetol Metab Syndr 2014; 6(1): 100.
10. Castorani V, Polidori N, et al. Insulin resistance and type 2 diabetes in children. Ann Pediatr Endocrinol Metab 2020; 25(4): 217–226.
11. Ball GDC, Merdad R, et al. Managing obesity in children: a clinical practice guideline. CMAJ 2025; 197(14): E372–E389.
12. Lawrence JM, Divers J, et al. Trends in prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001–2017. JAMA 2021; 326(8): 717–727.
13. Tönnies T, Brinks R, et al. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2060: the SEARCH for diabetes in youth study. Diabetes Care 2023; 46(2): 313–320.
14. Šumník Z, Venháčová J, et al. Five years of improving diabetes control in Czech children after the establishment of the population-based childhood diabetes register ČENDA. Pediatr Diabetes 2020; 21 : 77–87.
15. Arslanian S, Bacha F, et al. Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Diabetes Care 2018; 41(12): 2648–2668.
16. Perng W, Conway R, et al. Youth-onset type 2 diabetes: the epidemiology of an awakening epidemic. Diabetes Care 2023; 46(3): 490–
499.
17. NHS England. Diagnosis and management of type 2 diabetes (T2DM) in children and young people (CYP): clinical practice guideline. NHS England Midlands, 2019. Dostupné z: https://www.england.nhs.uk/midlands/wpcontent/uploads/sites/46/2019/09/Diagnosis-and-management-of-Type-2-Diabetes-T2DM-in-Chidlren-and-Young-PeopleCYP-Clinical-Practice-Guideline.pdf
18. Dabelea D, Mayer-Davis EJ, et al. Etiological approach to characterization of diabetes type: the SEARCH for Diabetes in Youth Study. Diabetes Care 2014; 37(2): 291–298.
19. Hampl SE, Hassink SG, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 2023; 151(2): e2022060640.
20. Bergman M, Manco M, et al. International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes. Diabetes Res Clin Pract 2024; 209 : 111589.
21. Elgart JF, Torrieri R, et al. Prediabetes is more than a pre-disease: additional evidences supporting the importance of its early diagnosis and appropriate treatment. Endocrine 2023; 79(1): 80–85.
22. Bergman M, Abdul-Ghani M, et al. Review of methods for detecting glycemic disorders. Diabetes Res Clin Pract 2020; 165 : 108233.
23. Bergman M, Manco M, et al. International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes. Diabetes Res Clin Pract 2024; 209 : 111589.
24. Peng M, He S, et al. Efficacy of 1-hour postload plasma glucose as a suitable measurement in predicting type 2 diabetes and diabetes-related complications: a post hoc analysis of the 30-year follow-up of the Da Qing IGT and Diabetes Study. Diabetes Obes Metab 2024; 26(6): 2329–2338.
25. Aldhoon Hainerová I, Karbanová L. Návod pro praktické lékaře pro děti a dorost při řešení dítěte s nadměrnou tělesnou hmotností: vyšetření a léčba. Vox Pediatr 2023; 23(9): 19–25.
26. Styne DM, Arslanian SA, et al. Pediatric obesity—assessment, treatment, and prevention: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102(3): 709–757.
27. Mousavi SS, Namayandeh SM, et al. Comparing the effectiveness of metformin with lifestyle modification for the primary prevention of type II diabetes: a systematic review and meta-analysis. BMC Endocr Disord 2023; 23 : 198.
28. Arslanian SA, Lewy V, et al. Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to adrenocorticotropin with reduction of insulinemia/insulin resistance. J Clin Endocrinol Metab 2002; 87(4): 1555–1559.
29. Kendall D, Vail A, et al. Metformin in obese children and adolescents: the MOCA trial. J Clin Endocrinol Metab 2013; 98(1): 322–329.
30. Kelly AS, Auerbach P, et al. A randomized, controlled trial of liraglutide for adolescents with obesity. N Engl J Med 2020; 382(22): 2117–2128.
31. Weghuber D, Barrett T, et al. Once-weekly semaglutide in adolescents with obesity. N Engl J Med 2022; 387(24): 2245–2257.
32. Hannon TS, Tamborlane WV, et al. Tirzepatide for youth-onset type 2 diabetes: a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2025; 406(10424): 1484–96.
33. Jancev M, Vissers TACM, et al. Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis. Diabetologia 2024; 67(5): 798–810.
Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2026 Issue Supplementum
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