Type 2 diabetes, once considered solely an adult disease, affects an increasing number of children under the age of 18.
In type 2 diabetes, the pancreas gradually loses its ability to produce enough insulin to control a person’s blood sugar levels. People with diabetes may develop serious complications, such as heart disease, stroke, kidney failure, blindness, and premature death.
According to SEARCH for Diabetes in Youth, a multicenter study funded by the Centers for Disease Control (CDC) and the National Institutes of Health, during 2008 and 2009 an estimated 18,436 people younger than 20 in the United States were newly diagnosed with type 1 diabetes each year. Also, 5,089 people younger than 20 were diagnosed with type 2 diabetes each year. The study cited obesity, exposure to diabetes in-utero, and endocrine-disrupting chemicals in common household products as possible causes of the rise in type 2 diabetes.
Type 2 diabetes disproportionately affects minority groups. According to the CDC, the incidence of type 2 diabetes among those 10 to 19 years old is highest among American Indians, followed by African Americans, Hispanics, and Asian or Pacific Islanders. It is lowest among non-Hispanic whites.
Today is World Diabetes Day, and Healthline sat down with two pediatricians to find out why more children are being diagnosed with type 2 diabetes and what can be done to keep kids from getting the disease.
More Young Children Now Diagnosed with Adult Diseases
Dr. Angela Lennon, a pediatric endocrinologist at the University of Kansas Hospital, told Healthline that she sees obese children 12 to 14 years old with kidney problems, heart problems, and high blood pressure.
“A lot of the complications start 10 years after getting diabetes. The earlier you get diabetes, the more you're prone to the complications. The typical complication is kidney disease, which is the number one reason for adults having dialysis. Diabetes is the number one reason for blindness. People with diabetes usually have poor circulation and poor wound healing, so some have to have limbs or legs cut off. Heart disease is also a problem. I saw an 18-year-old with all of these problems already,” said Lennon.
Lennon cited American Diabetes Association figures, which show that about 3,700 U.S. youths are diagnosed with type 2 diabetes per year, while 15,000 youths are diagnosed with type 1 diabetes. “Type 2 is one-fourth the incidence of type 1, but decades ago, less than 5 percent [of diagnosed children] had type 2. Now almost 20 percent will have type 2,” she said.
Prediabetes Is Also Cause for Concern
The majority of children Lennon sees are in the prediabetes stage, and although they feel well and are otherwise healthy, they are usually overweight. A thickening and darkening in the nape, or back of the neck, is a sign of high insulin levels, or insulin resistance.
“Most of the time, they feel fine. If they continue to gain weight and don’t eat well, eventually they develop type 2. When they have type 2 they start urinating a lot, drinking a lot, and having weight loss. They think they are actually doing fine because they are losing weight, but they feel tired and don’t feel healthy,” she said.
Dr. Stephen Lauer, a pediatrician at the University of Kansas Hospital, echoed Lennon’s concern. “Many of the kids we see are not going to hit formal diagnosis until their 20s and early 30s, but that is going to be a much different healthcare issue than being diagnosed with diabetes in their 50s and 60s. The number of kids who are in a prediabetic state, or insulin resistant, is many more than the number who have a formal diagnosis,” he said, adding, “The healthcare load is going to be enormous coming out of this.”
So why are these numbers climbing now? “One out of three children is either obese or overweight. We know the biggest risk factor that has changed is obesity. The CDC predicts that of those born in the year 2000, one out of three will also develop diabetes,” Lennon said.
While genetic predisposition is a huge risk factor for diabetes, all ethnic groups have been hit hard by rising obesity rates. Many groups are also living in neighborhoods that are so-called “food deserts,” where there are no supermarkets nearby and access to healthy food is limited.
“High calorie food is usually cheaper. Access to healthy affordable food is a common complaint of parents. It’s not necessarily that they don’t know or don’t want to improve their diet, but they have to feed big families and they have to set their budgets,” said Lennon.
“The kids are not allowed to walk around the neighborhood; the parents don’t feel it’s a safe area, and they don’t feel comfortable with their kids going to the park. You have to pay for sports in school and to go to a gym. Finances definitely play a very big part,” Lennon added.
What Can We Do to Stem the Rising Tide of Diabetes in Kids?
The availability of healthy foods in the urban core is a huge problem, one which the University of Kansas Medical Center recently tackled through a partnership with the Argentine Neighborhood Development Association and Save-a-Lot Food Stores. The partnership culminated in the opening of a supermarket in Kansas City's Argentine district in February of this year, following the closure in 2006 of the neighborhood’s only supermarket.
“The whole idea is to break into the food deserts — areas where they can’t get to a place that sells what we think of as healthy food ― and have regular food as an available item for families. This is a neighborhood interaction to improve health,” said Lauer.
Many times parents of overweight children are also overweight, and they don't eat well or exercise. “It tends to be a multigenerational issue. It’s very difficult to address because much of it is not truly medical. It’s the environment they live in and their ability on a day-to-day basis to live out these healthy lifestyles. If they are living in an environment that is not very healthy in terms of diet and exercise, that would put them at more risk," said Lauer.
Lauer makes it a point to discuss children’s growth charts with their parents at every visit. He points out that if there is an increase in the child’s weight, it is unhealthy.
Let Them Drink Milk, Water
One of the most important things Lauer advises is not to skip breakfast, because doing so throws the “whole eating cycle out of balance.”
Lauer also recommends kids, who are drinking more sports drinks, sodas, and fruit juices than ever before, only consume milk and water.
Children should also eat slowly. “They have to slow down, and sit down when they eat. They shouldn’t get seconds until after 15 minutes. It takes a while for your body to understand that you have eaten and that you are not hungry anymore,” said Lauer.
It’s also wise for parents to shop the outer perimeter of the supermarket. “If you look at the way supermarkets are laid out, produce is on one corner, fresh meat and fish are in the back. Most of the fresh, healthier food is around the perimeter. All the processed food and canned stuff sits in the middle. Stay out of the middle of the supermarket,” said Lauer.
Lauer can’t emphasize enough the importance of exercising. “You have to get up and move. While the number of calories we’ve taken has increased over the years, the decrease in the activity level of children is really marked, especially in the urban core.”
Lauer and Lennon are in favor of those children who have access to technology using apps to track how much they exercise in a day and what they’ve eaten, as well as to learn how many calories are in different foods.
Finally, Lennon recommends that parents not introduce excess calories to their kids' diets. “People say kids will outgrow baby fat when they are teens. The majority don’t outgrow the baby fat. A lot of overweight teens end up as overweight adolescents, and then overweight adults. There’s no magic time you start losing all your fat just because you have a growth spurt. That’s a misconception. We are very proactive now and have to start early,” she concluded.
Photo of Kim Kimminau, Ann Murguia, and Natty Malachi at a neighborhood grocery store opening. Courtesy of University of Kansas Medical Center.