© Springer India 2016 401
A. Bhansali et al., Clinical Rounds in Endocrinology,
DOI 10.1007/978-81-322-2815-8_12
12
Diabetes in the Young
12.1 Clinical Rounds
- How to define diabetes in the young?
Diabetes in the young is defined as onset of diabetes at or below 30 years of
age. The differential diagnosis of diabetes is challenging in younger individu-
als as compared to the middle aged and elderly. This is because diabetes in an
individual <30 years of age could be due to type 1 diabetes, type 2 diabetes,
maturity- onset diabetes of the young (MODY), latent autoimmune diabetes
of adults (LADA), fibro-calculus pancreatic diabetes (FCPD), lipodystrophic
diabetes, or rarely, neonatal diabetes mellitus (NDM), whereas diabetes in
middle- aged and elderly individuals is usually due to type 2 diabetes mellitus.
Further, therapeutic strategies are different in younger individuals depending
on the etiology of diabetes.- How do islet cells develop during embryogenesis?
During embryogenesis, the pancreas develops from the foregut. Outpouching
from the foregut results in formation of ventral and dorsal buds: the former
develops into posterior part of the head of the pancreas, while the latter forms
anterior part of the head, body, and tail of the pancreas. Endocrine pancreas
develops from undifferentiated ductal epithelial cell derived from these buds
under the influence of transcription factors (e.g., PDX 1 and ISL1). The
development of endocrine pancreas is exclusively dependent on exocrine
pancreas. α- and β-cells appear by 8–9 weeks of gestation, and in early gesta-
tion, α-cells are more abundant than β-cells. However, the number of β-cells
progressively increases during second and third trimester, and the proportion
of α-to β-cell is almost equal in a newborn.