Jan. 18, 2001 (New York) -- The rise of "adult" diabetes among children is alarming researchers, who are warning parents to keep their kids active and away from unhealthy foods. Diabetes experts addressed this issue at a special briefing held here Thursday by the American Medical Association and American Diabetes Association.
The two most common forms of diabetes are divided into types 1 and 2. Type 2 diabetes has long been known as an "adult" disease because it develops gradually, usually beginning in middle age, as the body becomes less sensitive to insulin (called insulin resistance). Its prevalence is now termed an epidemic -- and kids are increasingly getting it, not just type 1 "childhood" diabetes, where the pancreas completely stops manufacturing insulin.
"In some of the populations that we're seeing, 30% to nearly 50% of the new adolescents appearing with diabetes have type 2," says Kenneth Jones, MD, a pediatrics professor at the University of California at San Diego. "This is up from the 1% that we saw 15 or 20 years ago."
The rise is closely linked to our nation's bulging waistline and our decline in physical activity. "We have met the enemy, and it is us," Jones says.
"You've got to get your kids out and get them exercising again, get them playing games, and get the food that's fattening out of the house," Henry Ginsberg, MD, a professor of medicine at Columbia University School of Medicine, tells WebMD. Parents increasingly have to crack the exercise whip themselves because many schools have stopped physical education programs.
Karmeen Kulkarni, RD, a diabetes clinician at Saint Mark's Hospital in Salt Lake City, Utah, tells WebMD that kids are less likely than adults to plunge into potentially high fat/high protein "weight loss" fad diets. But that doesn't necessarily mean they're eating right. "Teenagers are so focused on how they look, so it's more vegetarian or no-fat. But parents should encourage a variety of foods, including a lot of fruit and vegetables and whole grains."
Since diabetes has a strong genetic component, tending to run in families, Jones tells WebMD that those with a history of the disease in their close relatives should keep an especially close eye on their kids' lifestyle.
There are plenty of unknowns and complexities to type 2 diabetes in children. Jones notes that girls are more likely to suffer the disease, and there are risk differences depending on ethnicity, with Native Americans at high risk and Americans of African, Asian, and Latino descent also more likely to get the disease than others. Jones says that individuals born at low weights also are at a greater risk of getting type 2 diabetes, for reasons that aren't yet clear.
So why is type 2 diabetes such a big deal? Its complications are a big part of the answer. Those who suffer from the disease are resistant to their own insulin, which results in too much sugar being kept in the bloodstream. These individuals usually also have high blood pressure and abnormal levels of blood fats, and can have difficulty with blood clotting.
With those trademarks, type 2 diabetes greatly ups the odds that an individual will get cardiovascular diseases. Ginsberg says that fact brings up scary possibilities for those children with type 2 diabetes. "It raises the terrible possibility that people who develop type 2 diabetes at age 15 will have their first heart attack at age 30. It used to be that type 2 diabetes struck those around 40 and they had heart attacks when they were 55 or 60 years old."
Ginsberg isn't sure that young type 2 diabetics will actually suffer these dread consequences so early. He asks, "Will they be partially protected because they are still young, since part of the artery-narrowing process is aging itself?"
Still, the question raises "critical" considerations, he tells WebMD. "Should we be treating 15-year-olds with a statin [medication] to lower their cholesterol? Should we put them on blood pressure medicines, if it's above a certain level?" Both potential moves, he notes, could be hugely expensive and bring drug side effects to children.
What do we do about treating type 2 diabetes in kids? First, Jones notes an initial problem: Many doctors may not be aware that the disease is a risk for children. But beyond that, there's some hope. The recently approved new drug for children, Glucophage, is safe and effective in children for treating some aspects of the disease, and blood sugar monitoring technology has made big strides. Meanwhile, a series of adult-geared diabetes drugs at various points in the research pipeline also carry promise, but there's still little data on their impact with children.
John Bose, MD, director of the diabetes care center at the University of North Carolina School of Medicine at Chapel Hill, tells WebMD, "If I knew my daughter was going to develop diabetes, I'm pretty sure I could prevent it." He cites a class of diabetes drugs known as glitazones. "I think they'll prevent diabetes," he predicts. "The studies so far suggest they will."
Even so, Bose notes that those drugs work in cell nuclei and alter how genes are turned on, which raises concerns about their use in younger children who are still being genetically "activated."
And Bose notes another potential problem. "If you give rats that are overweight these glitazone drugs before they get diabetes, they get really fat. So it may be that by preventing diabetes, we create much greater obesity."