The significant increase in the prevalence of obesity in children and adolescents over past decades caused the concomitant rise in the incidence of glucose intolerance and diabetes. Impaired glucose tolerance is present in 10-27% of obese children, while type 2 diabetes accounts for more than 10% of all cases of diabetes in Caucasian adolescents. Obesity may also accelerate the onset of type 1 diabetes. Insulin resistance with visceral and intramyocellular lipid accumulation, reduced adiponectin level and elevation of inflammatory cytokines play an important role in the pathogenesis of glucose metabolism disturbances. This article presented the influence of obesity on the development and clinical presentation of different types of diabetes and addresses the problems of differential diagnosis of diabetes type in obese children and adolescents. The recommendations for case finding and the treatment options taking into account the pathophysiology underlying hyperglycemia were discussed.
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