The most common type of diabetes seen in children used to be type 1 diabetes, also known as ”juvenile diabetes,” a condition caused by autoimmune reaction that leads to destruction of insulin producing beta cells of the pancreas.
But since the mid-1990’s, we have noticed a new pattern emerging – more children and adolescents are being diagnosed with type 2 diabetes, a condition that used to be the disease of adults only. Type 2 diabetes is linked to insulin resistance and obesity, and its occurrence in children follows the trends of rising obesity rates in this population.
Both type 1 and type 2 diabetes carry the risk of serious long-term complications, including blindness, kidney failure and chronic pain due to nerve damage. It appears that those complications appear earlier in individuals with type 2 diabetes. In addition, children diagnosed with type 2 diabetes tend to become insulin dependent at a much faster rate than adults.
A recent study published in the Journal of the American Medical Association reports an ominous trend: the incidence of both types of diabetes seems to be increasing in American children and adolescents. In 2001, about 14.8 in every 10,000 children were diagnosed with type 1 diabetes. By 2009, that rate had risen to 19.3 kids in every 10,000, a 21 percent increase. The increase in new cases of type 2 diabetes is even more pronounced — in the same time period, it rose by 31 percent (from 3.4 to 4.6 kids per 10,000).
That’s why prevention of type 2 diabetes has become a critical public health objective. In order to achieve it, it is imperative that providers screen at-risk populations effectively. Current guidelines recommend screening children older than 10 if:
1) They have a body mass index (BMI) greater than 85 percent and two of the following risk factors:
- First-degree relatives with type 2 diabetes
- High-risk group by ethnicity: African-American, Hispanic and Pacific Islander population
- Mother’s history of gestational diabetes during pregnancy
- Signs of insulin resistance: acanthosis, a darkening of skin folds around the neck or elsewhere on the body; hypertension; abnormal lipid profile; polycystic ovarian syndrome.
2) They have a BMI greater than 95 percent — regardless of associated risk factors.
It appears that most effective preventive measure is weight management – numerous studies have shown that at-risk children who are able to maintain their weight have a much lower chance of developing diabetes. It is very important that we develop effective programs that help children at risk and their families achieve this objective.
Ines Guttmann-Bauman, M.D.
Assistant Professor of Pediatrics, Division of Pediatric Endocrinology
OHSU Doernbecher Children’s Hospital
Pediatric Medical Director, Harold Schnitzer Diabetes Health Center