The old name for type 2 diabetes was “adult-onset” diabetes — but no longer. Now children and teenagers get this illness, too, all over the world.
Diabetes is tied into the obesity epidemic. At one time, kids were almost always type 1 diabetics, which can occur at any weight with genetic causes. Type 2 diabetes has its roots in genetics and lifestyle and, in children, tends to arrive after the age of 10. Being apple-shaped is a danger sign, and fat in the liver may be the big factor at work, research suggests. People seem to have different tipping points for diabetes; some people can tolerate a higher BMI than others.
One large study suggests that between 5 and 6 percent of white American teens ages 15 to 19 are type 2 diabetics. That portion soars to 17 percent for Hispanics and 19.4 among blacks at those ages. In another ominous sign, more children and youth are developing prediabetes, blood sugar levels that are higher than normal, a stage in the ordinary progression of the illness. Alarmingly, when researchers took blood samples from 1,740 eighth-graders, they discovered that — using the current cut-off a 100 mg/dl fasting glucose — more than 40 percent qualified as prediabetic. The study used a sample of mainly minority students at 12 schools in California, Texas, and North Carolina.
Adults tend to progress from prediabetes to diabetes over 5 to 10 years. That process can speed up to under 2 years in children and teens.
Diabetes isn’t just an inconvenience. The disease has proven to be more difficult to treat in children, and if their blood sugar level gets out of control, their chances of heart disease, eye problems, nerve damage, amputations, and kidney failure all rise. The longer you’re diabetic, the greater your risk. So a new generation may be growing up that will hit those unhappy milestones sooner in life — unless medical advances and healthier lifestyles turn things around. A diagnosis of either type 1 or 2 diabetes at the age of 10 now means you can expect to lose 19 years of life, on average, one study projected.
Children with type 2 diabetes are almost always started on a combination of weight loss, exercise, and the most common drug for adult diabetics, glucophage (Metformin).
More individualized treatments may be needed. One study of overweight children with type 2 diabetes found that only about half of them got their blood sugar levels low enough with Metformin alone over about four years, and many ended up getting insulin shots. Insulin is the preferred option if Metformin fails. Other oral diabetes drugs have not yet been tested for children.
Metformin alone failed in 52 percent of patients, Metformin plus rosiglitazone (Avandia), which is considered risky, failed in 39 percent, and Metformin plus a diet program failed in 47 percent. The failure rates were high even in patients who adhered strictly to their treatment programs.
For obese children with prediabetes, avoiding weight gain is the trick, another study concluded. They may not need to lose weight to bring down their blood sugar; their body mass index can fall if they’re growing and don’t gain. These are all powerful reasons to steer your children away from sweets and high-glycemic foods like bread and potatoes, and keep them active, especially if diabetes runs in the family.
June 09, 2016
Christopher Nystuen, MD, MBA