Type 2 Diabetes Progresses Faster in Kids: Study
High blood pressure, other complications seen in adolescence
Initial signs of kidney disease, called microalbuminuria, almost tripled in four years -- from 6.3 percent of the children to almost 17 percent, the study found.
- Destruction of beta cells -- the cells that produce insulin -- in children and teens occurred at a rate almost four times higher than in adults.
- Metformin and rosiglitazone improved insulin sensitivity for the first six months of treatment. There was no change in insulin sensitivity for the patients who took metformin and made lifestyle changes, and there was a decrease in insulin sensitivity for youth on metformin alone. In adults, metformin generally improves insulin sensitivity.
- Children and teens with higher blood sugar levels had the poorest outcomes on oral medications, and needed to begin using insulin sooner.
- Over three years, the percentage of youth who needed medication to lower their LDL cholesterol (the bad type of cholesterol) increased from 4.5 percent to 10.7 percent. Lifestyle interventions didn't appear to help lower LDL cholesterol, although they did help lower the levels of triglycerides, another type of blood fat.
- Eye damage occurred at a rate similar to adults. About five years after diagnosis, 13.7 percent of the youths had nonproliferative retinopathy, a condition that blocks blood vessels in the eyes.
"The rapid progression of hypertension and kidney disease was surprising," said Dr. Jane Lynch, the lead author of the hypertension and kidney disease part of the study.
"We really felt like we were on top of these kids as far as treatments, and they still progressed," said Lynch, a professor of pediatrics in the division of endocrinology and diabetes at the University of Texas Health Science Center at San Antonio.
Lynch said the hormones of puberty, which cause insulin resistance, are likely a main reason for this accelerated progression. Researchers don't know what will happen once the teens are out of puberty.
"We don't know what the progression rates will be," Lynch said. "But we do know that the ages for kidney transplants have been dropping."
Prevention of type 2 diabetes in children is essential, the experts said. "We need to focus on creating good habits rather than trying to reverse bad habits," Lynch said. "The time to start talking is during pregnancy, and it needs to continue in schools."
Chiang agreed that there needs to be a huge push toward educating people about the prevention of diabetes and obesity. "Not all people will be able to prevent diabetes, but there are steps we can take in the right direction, like teaching healthy eating and the importance of physical activity," she said.