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Children Getting Adult Diabetes
Once a true medical oddity, children with adult diabetes
are becoming commonplace. Doctors blame the twin evils of
too much food and too little exercise and fear a tragic
upswing in disastrous diabetic complications as this overweight
generation reaches adulthood.
At hospitals everywhere, boys and girls who range from chubby
to hugely obese are being diagnosed in unprecedented numbers
with type 2 diabetes. Most are barely into their teens.
Some are as young as 6.
This disease used to be called adult-onset diabetes, since
it rarely occurred before middle age. But over the past
decade, it has slowly become clear this is now a disease
of the young, as well.
Just how frequently is uncertain, since nationwide statistics
are still being gathered. Nevertheless, doctors are convinced
they see the leading edge of a dangerous shift, one that
will inevitably lead to kidney failure, blindness, heart
attacks, amputations and more as these young people live
another 10 or 20 years with their diabetes.
"There is an epidemic of type 2 diabetes in youth,
absolutely," says Dr. Lori Laffel, head of the pediatric
unit at Boston's Joslin Diabetes Center. "Over the
years, we always saw an occasional child with type 2. It
was a handful a year."
But in the early '90s, the pattern changed. Out of the blue,
it seemed, large children, usually accompanied by overweight
parents, began to show up with type 2 diabetes. During the
early '90s, Joslin's totals increased five times. Since
then, they have doubled again.
Until this shift, almost all diabetes in children was type
1, what was called juvenile diabetes. In many ways, it is
a different disease. Type 1 results from a misguided attack
by the immune system on the insulin-making cells in the
pancreas. Victims stop making insulin completely, so they
cannot convert sugar to energy.
But type 2 has always been a disease of people in their
50s, 60s and beyond. Their bodies still make insulin, just
not enough. They may go for years without realizing they
have it.
Around the country, doctors say Joslin's 10-fold rise in
childhood type 2 over the past decade is typical. Is it
because they are looking harder or doing a better job of
separating type 2 from type 1? Not likely, they say.
"It's not because we missed a lot of cases," says
Dr. Phillip Lee, head of pediatric endocrinology at UCLA.
"We just didn't see it. Now referrals of type 2 are
almost 50 percent of our diabetes cases."
Why? Doctors have little doubt. They blame inactivity and
overeating. The hours on end in front of the tube, for instance,
and the 20-ounce sodas in school vending machines. (Swilling
four of those a day is nothing special for many kids, one
doctor notes, and adds up to 1,000 calories, close to half
of a boy's daily needs, all from sugar.)
Virtually all children with type 2 are overweight, although
this hardly makes them unique. The Centers for Disease Control
and Prevention recently estimated that 15 percent of all
U.S. children and teenagers — and nearly a quarter
of black and Hispanic youngsters — weigh too much.
Still, the ones with diabetes tend to be especially big,
tall for their age and large all over. Twelve-year-olds
weigh 250 pounds. Invariably their parents are heavy, too.
"These are not little kids," says Dr. Morey Haymond,
head of diabetes care at Texas Children's Hospital. "Even
the 6-year-old is a big kid for his age."
Nearly all of them have a skin condition called acanthosis
nigricans, velvety, dirty-looking dark patches around the
neck and other skin folds. They are a sign of insulin resistance,
an inability to respond efficiently to insulin, which is
common in the overweight.
In girls, the insulin resistance often triggers hormone
upsets that result in facial hair, acne and ovarian cysts.
Young blacks and Hispanics have more of this kind of diabetes
than do whites. Their extra weight alone may explain some
of it, although experts believe these minorities also may
have an extra genetic tendency toward diabetes that is compounded
by their weight.
Many who do not have outright diabetes still have abnormalities
that put them at high risk for diabetes. Doctors estimate
that for every youngster with type 2, four or five others
have what's called syndrome X or metabolic syndrome, a combination
of obesity, insulin resistance, bad cholesterol counts,
high triglycerides and high blood pressure.
"Unless we make a significant alteration in their
lifestyles, they will likely progress to a deteriorating
course of insulin resistance, pre-diabetes and diabetes,"
says Dr. Francine Kaufman, endocrinology chief at Children's
Hospital Los Angeles and president of the American Diabetes
Association.
Adults with type 2 diabetes face many complications that
shorten or worsen their lives, although these can be reduced
or prevented with medicines, weight loss and exercise.
Since the problem is so new, no one knows exactly what
will befall those who start the disease in their teens rather
than their 50s. But many fear the complications will emerge
in early adulthood.
"The horizon is really dark," says Dr. Jorge
Calles-Escandon, a Wake Forest University endocrinologist.
"We know what happens to adults with type 2 diabetes
who don't take care of it properly. They die prematurely.
They have heart attacks, strokes, blindness, renal failure.
There is no reason to believe this will be different for
adolescents."
One follow-up study suggests he is right. Researchers from
the University of Manitoba tracked down 51 people, mostly
in their 20s and 30s, who had been diagnosed with type 2
diabetes as children. Two had died on kidney dialysis, and
three others were still on it. One 26-year-old woman had
lost a toe to amputation, while another had gone blind.
In an attempt to find out how many young Americans actually
have the disease, the CDC will count all the diabetes cases
among 6 million people under age 20 for five years. It expects
6,000 of them to have it at the start and 800 more to be
diagnosed annually, 30 percent of them type 2.
"Whatever we get will be an underestimate of the true
disease," says the CDC's Dr. Desmond Williams, since
the study will not go looking for youngsters with diabetes,
only record those who come to doctors' attention.
The diabetes association recommends testing children for
type 2 diabetes if they are overweight and have two other
risk factors, such as a parent with the disease, signs of
insulin resistance or if they are black, Hispanic or American
Indian.
Nevertheless, outside of big hospital obesity clinics,
experts say this kind of testing is rare. Pediatricians
and family physicians simply are not trained to think about
adult diabetes in the young, and without obvious symptoms,
children are likely to be missed.
"It's possible that we are looking at the tip of the
iceberg, the ones with the most severe disease or with pediatricians
who are attuned to looking for this," says Dr. Stephen
Daniels, a pediatric cardiologist at Children's Hospital
Medical Center in Cincinnati.
If so, what can be done? Doctors understand what they are
up against — a culture of cheap, high-calorie food
and sedentary pleasures — and can think of no easy
solutions. These are, after all, teenagers. They feel immortal
and are loathe to do anything their friends do not, such
as ordering a salad or joining an aerobics class.
Some wonder if refocusing the exercise and eating habits
of the entire society is the only solution. Others think
about more focused approaches, such as luring overweight
girls into after-school workouts, where they might learn
something both fun and sweaty, like break dancing.
Some experts believe exercise is as crucial as weight control
in preventing type 2. Pediatrics professor Bernard Gutin
of the Medical College of Georgia notes that physical activity
stimulates movement of sugar into cells and improves the
body's response to insulin.
"Vigorous exercise in kids is especially important,"
says Gutin, who is testing the effects of basketball, soccer
and dancing on overweight boys and girls. "That translates
simply into running rather than walking."
But the first, and often biggest, hurdle is getting youngsters
and their parents to acknowledge they actually have a problem,
that the weight must go. Often they come from families where
everyone is overweight, where nobody exercises in any way.
"It's difficult to change what you have grown to accept
as normal all your life, and you are surrounded with an
environment that is not willing to change," says Dr.
Silva Arslanian, director of clinical research at Children's
Hospital of Pittsburgh.
One large federally financed study, involving several thousand
young people in North Carolina, Texas and California, will
see if modest changes at school can make a difference. It
will test whether healthier choices in the cafeteria, better
access to water and improved phys ed programs, among other
things, have an effect on youngsters' risk of type 2 diabetes.
"Can we really reverse things?" asks Kaufman,
who's directing that study. "We're not going back to
the 1950s, but we could make this a healthier time in which
to live."
___
EDITOR'S NOTE: Medical Editor Daniel Q. Haney is a special
correspondent for The Associated Press.
More info on Type II Diabetes here
On the Net:
Canadian Diabetes association: http://www.diabetes.org
CDC: http://www.cdc.gov/diabetes/pubs/factsheets/search.htm
Article Source: Associated Press
Article Author: Daniel Q. Haney
Net Reference 102
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