Parent Corner: Type 2 Diabetes in children and adolescents--
An emerging epidemic
By Arnold Ronning, MD
Cascade Valley Arlington Pediatrics
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Type 2 Diabetes Mellitus (DM), formerly called Adult-onset DM, is a serious and costly disease affecting more than 18 million Americans. Type 2 DM was once a rare disease among children. Recent studies show 15 to 45 percent of all children with DM have Type 2 DM. This should cause great alarm to both health providers and parents.
Diabetes Mellitus is a complex disorder associated with glucose being out of balance in the body. To understand this better, we need to know a little more about the role of two molecules, glucose and insulin. Glucose, the sugar molecule, is the main source of fuel for the body. Insulin, a hormone made by the pancreas, pushes glucose out of the blood for use by the cells of the body. When you eat, glucose in your blood starts to rise. In response, your pancreas pumps out insulin to keep blood sugar levels stable. The difference between Type I and Type 2 DM is, the glucose levels of Type I diabetics, are high because their pancreas can no longer make insulin. They need insulin shots to control their glucose levels. Type 2 diabetics can make their own insulin, but their bodies don't respond to it as well. This is called insulin resistance. Insulin resistance may be present for many years before DM becomes apparent.
This emerging Type 2 DM epidemic is driven by several factors, the most important of which is the increase in the obesity of our children. The Center for Disease Control and Prevention predicts if the current rate of obesity continues, one-third of the children born in 2000 will develop DM. Although not all children and teenagers with Type 2 DM are obese, studies show, up to 85% of affected children are obese. Obese diabetics are also insulin resistant. The major culprits for the increasing obesity in children are; increased caloric intake, sedentary lifestyle, and lack of physical activity. Large amounts of high calorie fast foods, combined with more time spent in front of TV sets, computers, and video games, have produced a generation of overweight children. Unfortunately, at the same time, many schools have limited their sports program and are offering cheaper, high-calorie lunches.
Other risk factors implicated include genetics, race, gender and puberty.
- 45%-80% of diabetics have at least one parent with DM or a history of DM over several generations.
- Type 2 DM is more common among African-Americans, Mexican-Americans and American Indians. An increase in Type 2 DM is also being seen in Japanese and Chinese children.
- Girls are nearly twice as likely to develop type 2 DM, as are boys. This is due to a greater insulin resistance.
- Most cases of DM in children are diagnosed between the ages of 12-16. During puberty there is increased resistance to insulin action, resulting in hyperinsulinemia. Growth hormone, which increases slightly in puberty, also has anti-insulin effects.
Whether genetic or environmental influences are more important in the development of obesity and type 2 DM is unknown. It is clear changes in diet and physical activity can reduce the chance of developing diabetes if your child is at risk for the condition. A study of 3,200 individuals showed lifestyle changes in diet and physical activity reduced the occurrence of type 2 DM by 58%. Medication alone only reduced incidence by 31%.
Prevention of obesity needs to begin in infancy. In order to stay healthy our children need to be encouraged to be physically active and not eat high caloric foods and snacks. At a community level, schools, religious organizations, youth and family organization, and government agencies need to assume some responsibility for promoting healthy lifestyles. School programs should promote healthy food and increased sports activity. Each of us needs to do our part in stemming this epidemic. The message in this study is clear: Children need to eat less and exercise more.
Disclaimer: This information is provided for educational purposes only. It should not replace a visit with your health care professional. Call your doctor if you need more information or have additional questions.