Not Just for Adults Anymore
Type 2 diabetes, once considered an “adults-only” disease, is appearing in children and teens in epidemic proportions. In 2000, an expert panel of the American Diabetes Association estimated that on average 20 percent of newly diagnosed diabetes in children was type 2, and 85 percent of those children were obese.
This alarming surge in childhood type 2 diabetes has been fueled by the fast food, video-centric culture that is part of today's lifestyle. Children lead a more sedentary lifestyle centered around passive entertainment media like television and online gaming; supersized, high-fat, low-fiber convenience food has become a dietary staple in the quest for quick and easy.
As a result, an estimated 19 percent of children six to 11 years old and 17 percent of adolescents 12 to 19 years old in the United States are overweight according to the U.S. CDC. A 2002 study published in the New England Journal of Medicine found that impaired glucose tolerance and insulin resistance are highly prevalent in children and adolescents who are obese.
Kids at Risk
The same factors that place adults at great risk for type 2 diabetes apply to children as well. Obesity is by far the primary threat in this age group.
Acanthosis nigricans (darkening of the skin) is a sign of insulin resistance that appears in up to 90 percent of children and adolescents who develop type 2 diabetes These dark, velvety patches typically appear in areas where skin folds gather (e.g., neck, armpits, groin) and are more common in people with darker skin pigmentation.
Having a family history of type 2 diabetes among first- and second-degree relatives and being of African American, Native American, Asian, or Hispanic descent also increase the likelihood that overweight children will develop the disease.
The majority of childhood type 2 cases are diagnosed at puberty or beyond. Puberty itself is the cause of a certain degree of insulin resistance in adolescents, which is thought to be triggered by a natural rise in growth hormone during this time. In children who are already disposed toward the disease, insulin resistance remains even after growth hormone returns to normal levels.
Treating Kids for an Adult Disease
Diagnoses of type 2 in children are sometimes difficult to make, especially in children who are not overtly obese. Many physicians still consider type 2 diabetes an adults-only disease. And it can present the same way as type 1, with DKA or, in extreme cases, HHNS. Often because of the age of the patient, type 1 is initially suspected and the child begins insulin treatment. However, long-term use of insulin after blood sugars have stabilized can contribute to further weight gain, which can worsen the problem.
Children diagnosed with type 2 diabetes can usually be treated through a combination of diet and exercise. Oral medications may be helpful, but clinical data is limited on their long-term effects in children. As of early 2008, metformin was the only oral agent FDA-approved for use in pediatric populations (over age 10). However, other oral agents are sometimes prescribed for off-label use in children. Off-label use is when a medication is prescribed for an indication, or purpose, other than what it has been legally approved for by the FDA.
My daughter is overweight, but we have no history of diabetes in our family. Should I really be concerned about her weight?
Yes. Weight problems in childhood can lead to the development of a host of medical problems, like atherosclerosis, hypertension, respiratory infections, sleep apnea, and type 2 diabetes. Talk to her pediatrician about a weight-loss strategy. And remember, diet and exercise should become a family affair to ensure the greatest chance of success for your daughter.