Ominous rise of adult diabetes in kids
Tuesday, April 15, 2003 Posted: 1:25 PM EDT (1725 GMT)
link to actual CNN.com story
BOSTON, Massachusetts (AP) -- 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.
'We just didn't see 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.
'The horizon is really dark'
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.
No easy solutions
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."
"Ominous rise of adult diabetes in kids"
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