Phenotypic Differentiation in Pediatric Diabetes

Body habitus

Usually lean

Overweight or obesity (central adiposity common)

Usually lean or normal weight

Age at onset

Any age; peak 4–6 and 10–14 years

Typically post-puberty (≥ 10 years)

Neonatal (< 6 months) or adolescence/early adulthood

Onset pattern

Abrupt, often with DKA

Gradual, often incidental hyperglycemia

Mild, stable hyperglycemia; often detected on screening

Family history

Autoimmune diseases common

Strong family history of type 2 diabetes/metabolic syndrome

Strong autosomal dominant inheritance across generations

Signs of insulin resistance

Rare

Common (acanthosis nigricans, hypertension, dyslipidemia)

Absent

Associated conditions

Autoimmune (thyroid disease, celiac disease)

Obesity-related (MASLD, PMOS)

None; may have gene-specific features (eg, renal cysts, deafness)

Ketosis/DKA at diagnosis

Frequent

Less common, but possible

Rare