• Increase in pediatric diabetes raises new concerns

    June 2006

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    Over the past few years, researchers have noted an alarming rise in the number of children developing diabetes. While type 1, or juvenile diabetes, is the more common form, the rapid increase of type 2 is particular cause for concern.

    “Many experts believe the increase [in type 2 diabetes] parallels the steadily rising rate of obesity among children. . .” 

    Type 2 diabetes affects 90 percent of the 18 million U.S. diabetics, but until recently it rarely showed up in children. The American Diabetes Association now estimates as many as 8 to 45 percent of new cases of pediatric diabetes may be type 2. A national study conducted by Express Scripts, a company that provides pharmacy benefit management services, revealed a doubling in the number of type 2 diabetes prescriptions among children from 2002 to 2005.

    It has long been established that type 2 diabetes is more common among older adults and individuals who are overweight or obese. While there is little data on the cause of type 2 diabetes in children, many experts believe the increase parallels the steadily rising rate of obesity among children ages six through 11. Rates are even higher among Native American, Hispanic and African-American children.

    What is diabetes?

    Diabetes occurs when the body can’t turn blood sugar, or glucose, into energy, either because it doesn’t make enough insulin— the hormone produced in the pancreas that metabolizes glucose—or because it doesn’t use insulin correctly.

    In type 1 diabetes, the immune system attacks the insulin producing cells in the pancreas, creating an insulin deficiency that requires a lifelong regimen of insulin shots. Initial symptoms of type 1 diabetes include excessive thirst, constant hunger, excessive urination and sudden weight loss for no apparent reason. Dehydration, vomiting and drowsiness may follow.

    Type 2 diabetes is a disease of insulin resistance. The body produces insulin, but it isn’t sufficient because it’s not used properly. Medication and lifestyle changes are the most common treatments for type 2 diabetes at all ages. As in adults, it may take years for this form of diabetes to manifest itself in children, possibly resulting in many being misdiagnosed. Signs of type 2 diabetes include dark, rough, thickened areas of the skin, known as acanthosis nigricans; high blood pressure; and high cholesterol levels.

    Classifying diabetes

    Insulin resistance is characteristic of obesity in childhood. It can lead to hyperinsulinemia, a condition in which the body secretes excessive amounts of insulin to compensate for the insulin resistance. Both insulin resistance and hyperinsulinemia may progress to type 2 diabetes.

    A study by the Children’s Hospital of Pittsburgh revealed a link between obesity and type 1 diabetes. Researchers reported a three-fold increase from the 1980s to the 1990s in the prevalence of a child being overweight and developing type 1 diabetes.

    Classifying the type of diabetes in children can pose difficulties. A second study by the same researchers found that many children and adolescents with diabetes actually developed characteristics of both type 1 and type 2. Such patients still need insulin to bring their blood glucose levels under control as quickly as possible. Treatment may involve a combination of insulin injections and medications for insulin resistance.

    Preventing diabetes

    While genetic and environmental factors have been identified as possible causes of type 1 diabetes, maintaining a healthy weight and exercising during childhood are important to prevent further complications. Type 2 diabetes may be cured or even avoided altogether by these measures.

    The long-term public health implications for rising rates of diabetes among children are enormous. This disease puts them at increased risk for heart disease, kidney problems, blindness and nerve damage, as well as foot and skin complications.

    Two important studies under way to treat or prevent pediatric diabetes include the STOPP-T2D Prevention Trial and TrialNet, which targets type 1 diabetes. STOPP-T2D is a school-based trial to prevent middle school children from developing risk factors for type 2 diabetes.

    TrialNet is a network of 18 diabetes centers dedicated to conducting diabetes prevention research and studying intervention therapies for children and adults with newly diagnosed diabetes. UK HealthCare is participating in this trial. Call the UK Clinical Research Organization Clinic at (859) 323-2737 for more information.

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Page last updated: 8/7/2015 2:15:59 PM
  • What the news means for you

    Doctors seeing more children with type 2 diabetes

    Jefferson P. Lomenick, MD
    Pediatric Endocrinology

    Wright, Heather, MDWe’re seeing type 2 diabetes in children frequently now. I would estimate 10 to 20 percent of the new diagnoses of diabetes I see in children younger than 18 are type 2. They often present in a mild fashion. For example, a high blood sugar level may be found incidentally at a physical exam.

    “Type 1 diabetes isn’t preventable. . . .Type 2 is. If there is no obesity, there is no type 2 diabetes in children.” 

    Like adults, children frequently do not have a lot of symptoms. Occasionally, you may have a child who presents with a more severe picture, like someone with type 1 diabetes. And if they’re overweight, it’s sometimes hard to distinguish if they have type 1 or type 2 diabetes.

    Complicated diabetes

    One recent patient coming into Emergency Services at UK Chandler Hospital was a 13-year-old boy who was vomiting and had abdominal pain. He reported experiencing urination at night and increased thirst. Additionally, he weighed about 300 pounds and his mother had type 2 diabetes—both risk factors for the child having type 2 diabetes. Blood tests showed very high blood sugar levels. He also had one of the main physical manifestations of type 2 diabetes in children— acanthosis nigricans, a thick, velvety, darkening of the skin usually on the back of the neck or other skin folds such as under the arm. The exact cause of acanthosis nigricans is unknown, but it is related to hyperinsulinism, a precursor of type 2 diabetes.

    Laboratory tests measuring his islet cell antibodies were positive, indicating he had type 1 diabetes. Yet he had a slightly elevated insulin level, more typical of type 2. Since he was very ill and had such high blood sugar levels, we treated him with insulin injections. He required a tremendous amount of insulin, also typical of type 2. Once his levels came down, we started him on the most common oral medication, metformin, but he has to continue taking shots.

    “We have a handful of kids who’ve lost enough weight by lifestyle changes that they can come off treatment altogether.” 

    Weight control is crucial

    The more overweight a child with type 2 diabetes is, the more likely he or she will need insulin injections. If the child is less overweight and the diabetes isn’t severe, they typically respond well to oral medications alone. We have a handful of kids who’ve lost enough weight by lifestyle changes that they can come off treatment altogether.

    Even a small amount of weight loss has beneficial effects on high blood pressure and on insulin dosing requirements. But for a child with type 2 diabetes to lose weight, the whole family has to change its lifestyle. It’s nearly impossible for the child to do it alone.

    Since children with type 2 diabetes, like adults, may not show a lot of symptoms, it’s becoming more routine for doctors to screen overweight children for abnormal glucose. Type 1 diabetes isn’t preventable, at least for now. Type 2 is. If there is no obesity, there is no type 2 diabetes in children.

    Managing type 1 diabetes in children and adolescents

    With many of the new forms of insulin available today, it is possible for a person with type 1 diabetes to maintain the lifestyle to which he or she is accustomed. Our goal is to make the diabetes just a minor nuisance, not dominate the child’s life. It used to be that children with diabetes had to eat on a certain schedule and consume very specific amounts of sugars, or carbohydrates, at specific times of the day. Now they can eat and drink when and what they want as long as the carbohydrates are “covered” with insulin.

    We typically prescribe a regimen of one injection per day of a long-acting insulin called glargine (Lantus) in combination with multiple injections per day of a short-acting insulin. The long-acting insulin keeps the child’s glucose regulated when they are not eating. The short-acting insulin is dosed according to the amount of carbohydrate consumed at meals or snacks. These insulins are also available in pen devices, making them more convenient than a vial and syringe.

    Diabetes can be a particular problem in the teen years. Some teens get tired of taking shots. They have a meal or snack and don’t cover it with insulin. If they do that often, the overall diabetes control suffers. For younger children, the biggest hurdle is getting used to the injections; however, most seem to quickly adapt to glucose testing, as well as insulin shots, typically within a couple of weeks.

    There are also many misconceptions about diabetes. Sometimes parents immediately assume their child will get complications of diabetes such as blindness or kidney problems, which isn’t the case. This only occurs if there is chronic poor control of diabetes. Studies have shown quite clearly that the better the overall glucose control, the lower the risk of these problems.

    Sometimes families assume that the child can no longer eat sugar, that they can’t go to birthday parties or enjoy the types of food they once did. Again, this is not true. They can eat the same things the other kids eat as long as the carbs are covered with insulin. Much of the time I spend in the hospital is clarifying myths like these about diabetes.

    Dr. Lomenick is a pediatric endocrinologist at Kentucky Children’s Hospital and an assistant professor of pediatrics at UK College of Medicine.

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