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26 June 2009

Most type 2 diabetes can be stopped in childhood

When you're 8 years old, it can be darn hard not eating a cupcake when everyone else is having one. But that's the way life is for Nyla Wright, a Philadelphia-area second-grader who was diagnosed with type 2 diabetes last year. She still gets treats now and then, but overall has to watch what she pops into her mouth.
An increasing number of children are being diagnosed with type 2 diabetes, a condition medical experts blame on a culture steeped in junk food and inactivity that has led to more obese kids. Aggressive early treatment and lifestyle changes can help, and even snuff out disease symptoms, but more sweeping health care system changes, including better health insurance for older teens and people in their 20s, are required for young diabetics to age into healthy older adults, experts say.

TEENS: Not defined by their diabetes

"It's really stunning how the percentages for type 2 diabetes are going up in younger and younger Americans. Clearly, diabetes is following obesity, and both have huge ramifications on long-term health," says Siri Atma Greeley, a pediatric endocrinologist at the University of Chicago Medical Center.

ON THE WEB: from experts at Nemours
About 150,000 children in the USA have been diagnosed with diabetes, most with type 1, according to the Centers for Disease Control and Prevention. But the number of children with type 2 diabetes has been rising steadily in the past decade, says Ann Albright with the CDC. About 3,700 youth were newly diagnosed with type 2 diabetes from 2002 to 2003 — that's about five in every 100,000 children, according to the CDC. Type 2 is especially affecting Hispanic, African American and American Indian youth.

FIND MORE STORIES IN: University of Chicago | Thomas Jefferson
Possible 'genetic mutations' in children

In type 1 diabetes, the body's pancreas does not make any or enough of the special cells that produce insulin. Insulin helps the body turn food into energy. In type 2 diabetes, the pancreas makes insulin, but the cells in the body aren't able to use it properly. Over time, the disease can cause serious health problems.

There are various theories about why type 2 diabetes is appearing in greater numbers in the young now, says Melinda Sothern, professor of public health at Louisiana State University Health Sciences Center in New Orleans.

"We have a new generation of children who are metabolically different. We think there's been a series of genetic mutations — linked to environmental and lifestyle changes — over the last few generations that have led to this," says Sothern, who presented research earlier this month on the topic at the American Diabetes Association's annual meeting in New Orleans.

Why a child's body stops using insulin properly — called insulin sensitivity — isn't clear, but Sothern says her government-funded study suggests a child's current body fat is the strongest predictor of poor insulin sensitivity.

While the majority of chubby kids don't get diabetes, if a child has a family history, or a mother who had gestational diabetes was obese while pregnant or did not breast-feed, they can be at risk, Sothern says.

You top that with high-calorie, high-fat eating habits and a lack of exercise, and you can push an at-risk individual over the edge and into diabetes earlier in life, says Rebecca Lipton, associate professor in pediatric endocrinology at the University of Chicago.

In Nyla's case, her father has diabetes, and Nyla is 25 pounds overweight, says Martha Zeger, Nyla's pediatric endocrinologist at Thomas Jefferson University Hospital in Philadelphia.

Nyla takes metformin to lower blood sugar, and the family's health habits have been upgraded, says mom Stephanie. Macaroni and cheese has been replaced by whole grains, veggies and proteins. Nyla swims competitively, too.

Ongoing support from a team of health experts, including a nutritionist, helps, but parents make the biggest difference, Zeger says.

A chilling prognosis for type 2 kids

Still, larger efforts, such as large-scale government programs at the preschool level, are needed to reverse the habits of a junk-food nation and curb the disease, Sothern says.

Anxiety runs high for what aging children with diabetes will be up against in the years ahead.

"The health insurance system is just horrible for these kids as they age. They get kicked out of their cozy pediatric health care systems, knocked off their parents' health plans, then stop care and suffer the consequences," Lipton says.

Long-term complications of untreated diabetes that previously affected adults in their 60s — blindness, kidney failure, amputations and cardiovascular disease — will appear sooner.

"We are already seeing some 20- and 25-year-old kids now on dialysis for kidney failure. It's chilling," Lipton says.

"We're still on the front wave of this epidemic," says Larry Deeb, a Tallahassee pediatric endocrinologist and past president of the American Diabetes Association. "It's a long ways from 17 to 80."

Nyla swims, watches her diet and takes medication.

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