Type 2 diabetes and metabolic syndrome in youth — branching viva

Station opening

Examiner: "Tell me the single bedside concept that frames every overweight adolescent with acanthosis nigricans, and why it matters." ^[7]

Strong candidate (must-hit)

• The concept is insulin resistance with progressive beta-cell decline, layered on obesity and the metabolic cluster. Resist insulin and the beta cell drives out more of it, producing the acanthosis, ovarian hyperandrogenism, fatty liver, dyslipidaemia and hypertension that travel together. Exhaust the beta cell and glucose rises. It matters because the disease is faster and more aggressive than adult type 2 diabetes — beta-cell function is already halved at diagnosis and declines about 15 to 20 percent per year — so the acanthosis is a call to assess, not a cosmetic aside. ^{[7] [1]}

Weak candidate

• "It is probably just a skin problem — I would refer to dermatology." ^[7]