Thirty years ago, type 2 diabetes was considered a disorder found only in adults. Now, this disorder is on the rise in adolescents. Doctors at Children’s Hospital Colorado are learning how it’s different in younger patients and how to best treat them. In fact, they’ve tailored a clinic specifically for adolescents with type 2 diabetes and their families that includes specialists in endocrinology, exercise, nutrition, and behavior change.
“We’re still learning a lot about this disorder in kids,” says Megan Kelsey, M.D., director of lifestyle medicine endocrinology and medical director of metabolic and bariatric surgery at Children’s Hospital Colorado.
What doctors do know is that “at least in half of kids with diabetes, it’s more aggressive than in adults,” says Kelsey. “Even in kids who have only had diabetes for a relatively short period of time, they’re starting to show complications of their diabetes and associated comorbidities like high cholesterol, high blood pressure, and early signs of kidney disease and early signs of eye disease.”
Treatments, such as changes to diet and exercise and diabetes medications, can keep blood glucose under control and prevent some of these health issues, so it’s important to diagnose and treat children early.
Screening for Type 2 Diabetes
This past January, the American Diabetes Association (ADA) released recommendations for screening youth for type 2 diabetes.
The ADA recommends screening for type 2 diabetes in children age 10 or older who are overweight or obese—with one additional risk factor such as a family history of type 2 diabetes or a mom’s diabetes during pregnancy (see below for more details).
“We use the presence of overweight or obesity as our first way of screening,” says Jane Reusch, M.D., president of medicine and science at the ADA and a professor of medicine, biochemistry, and bioengineering at the University of Colorado Anschutz Medical Campus. Pediatricians or family practitioners can then test for type 2 diabetes using an A1C fasting blood glucose test or an oral glucose tolerance test.
Kelsey says that puberty is a time when insulin doesn’t work as well for all kids, not just for those at risk for diabetes. Parents shouldn’t panic about one mildly abnormal number because a doctor can use a second test to confirm diabetes. Kelsey adds that you don’t typically see type 2 diabetes in normal weight kids or before puberty.
Why It’s On the Rise, and What’s Ahead
“One of the reasons [for more cases of type 2 diabetes] is that obesity is more common, but we think it’s more complicated than that,” says Kelsey. “We know that the exposure to diabetes in pregnancy is a very important risk factor and as diabetes goes up in adults and occurs sooner, more kids are going to be exposed.” Reusch also says the maternal environment while the baby grows plays a significant role in a child’s risk for type 2 diabetes.
Children’s Hospital Colorado has taken a unique approach to helping these kids. Rather than integrating them into the type 1 diabetes clinic, these children begin in the weight management program where lifestyle changes like exercising regularly, eating healthy foods, and taking medications are the focus. Children can also be evaluated for bariatric surgery. While still fairly new in kids, bariatric surgery has shown potential for putting diabetes into remission. Longer-term studies are still needed.
“Even though this is an alarming situation, it’s still really quite rare,” says Reusch about type 2 diabetes in children. “Unfortunately, obesity in children is highly prevalent right now…It’s not like this is a new disease but this much obesity in childhood is just sort-of revealing kids’ tendencies to develop type 2 diabetes.”
Type 1 versus Type 2 Diabetes
- In type 1 diabetes, your body attacks its own insulin-making cells (beta cells), and usually you must take insulin shots immediately to survive. In type 2 diabetes, your beta cells don’t work as well or there aren’t enough to them. Also, you may not be as sensitive to insulin. Sometimes there are no symptoms.
- While type 2 diabetes is on the rise in youth, it is still less common that type 1 diabetes in youth. An estimated 5,300 adolescents between ages 10 and 19 were diagnosed with type 2 diabetes and 17,900 children and adolescents younger than 20 years of age were diagnosed with type 1 diabetes during one year, according to statistics from 2011-2012.
Ask your doctor about screening if your child has started puberty or is 10 or older, and is overweight (with a body mass index more that the 85th percentile for age and gender). Additional risk factors include:
- Mother had diabetes (type 2 or gestational) during pregnancy
- Family history of type 2 diabetes
- Race or ethnicity of Native American, African American, Asian American, or Pacific Islander
- Conditions such as high blood pressure, high cholesterol, and others