ADVANCE for Physician Assistants
Issue Date: 2/1/2000
Type 2 Diabetes Rising Dramatically in Children
BY STEPHEN CORNELL
"Doctors fear disaster ahead" blared a recent headline on a paper released by the American
The ADA wasn't talking about the Y2K scare, which has since proven more lamb than lion. The
organization instead is warning that type 2 diabetes--often referred to as adult-onset
diabetes--isn't just for adults any more. And health care providers are worried that the
complications associated with the disease, such as heart disease, strokes, blindness and
amputations, will be striking people at younger ages if their condition is not diagnosed early.
"Type 2 diabetes was practically unheard of in young people until the last few years," says
Robin S. Goland, MD, co-director of the Naomi Berrie Diabetes Center at Columbia
Presbyterian Hospital in New York. "Because of the long-term damage that high blood sugar
levels can do to blood vessels throughout the body, we might see the devastating complications
of diabetes very early."
Type 2 diabetes strikes close to 15 million Americans, while between 500,000 and 1 million
people in the United States are estimated to have type 1 diabetes. But up to 5.4 million people
are have not been diagnosed.
The toll of diabetes is enormous. It is the seventh leading cause of death in the United States,
according to the ADA. Diabetes is the leading cause of new cases of blindness (12,000 to
24,000 cases a year) and the leading cause of end-stage kidney disease (about 40% of new
cases; 27,900 in 1995).
Diabetes also causes nerve damage in 60% to 70% of patients and significantly increases the
risk of nontraumatic lower-limb amputations. Clinicians perform more than 56,000 amputations
on diabetics every year.
Financially, diabetes costs an estimated $92 billion each year in direct health care costs and the
costs of lost productivity, according to the ADA.
One risk factor for type 2 diabetes is being older than 45, but if the incidence of diabetes in
children continues to rise, so will the cost incurred as a result of complications that occur
earlier, health care providers believe.
Several studies presented at the ADA's 59th annual Scientific Sessions dealt with the issue of
"adult-onset" diabetes in children.
A pair of studies conducted at the University of Manitoba and University of Toronto's Mount
Sinai Hospital and the University of Western Ontario showed a dramatic increase in type 2
diabetes among First Nation Cree-speaking children at a pediatric diabetes clinic in Manitoba
(Dean HJ. Incidence and prevalence of type 2 diabetes in youth in Manitoba, Canada,
1981-1998. Abstracts from the 59th Scientific Session of the American Diabetes Association.
Between 1981 and 1998, 82 children had been diagnosed with type 2 diabetes. During the
five-year period from 1981 to 1985, four cases (0.8 per year average) were reported. But during
the five-year period from 1994 to 1998, 42 cases were reported (8.4 cases a year).
The Mount Sinai study examined the prevalence of pediatric obesity and the associated
behavioral risk factors among the northwestern Ontario Oji Cree, who have high rates of adult
obesity and type 2 diabetes (Hanley A, Harris S, Gittelsohn J, et al. Pediatric obesity in a native
Canadian community with epidemic levels of type 2 diabetes mellitus. Abstracts from the 59th
Scientific Session of the American Diabetes Association. 1999:A169).
Researchers measured height and weight along with fitness level, television viewing habits,
dietary intake and body image perceptions in 445 children. They evaluated the prevalence of
pediatric obesity and associated behavioral risk factors among the northwestern Ontario Oji
Cree people, who have high rates of adult obesity and type 2 diabetes.
Obesity in the pediatric subjects aged 2 to 19 was higher than in the general population, and high
levels of TV viewing were positively associated with a significant increase in obesity in
pediatric subjects aged 10 to 19.
"Elevated obesity levels in children and teens is a harbinger of future diabetes risk for them,
because obesity is associated with insulin resistance, the first step in the development of type 2
diabetes," Bernard Zinman, MD, a senior scientist at the Samuel Lunenfeld Research Institute in
Toronto, told the ADA.
New York Study
The study at Columbia Presbyterian in New York involved 19 children aged 10 to 17 with type 2
diabetes who had been referred to the center over a two-year span. The subjects were all more
than 20% above ideal body weight and had acanthosis nigricans, which is a dark skin coloration
sometimes seen on the back of the neck and in skin folds and that is often associated with insulin
"The average blood glucose level of these children ... was extraordinarily high," Dr. Goland
said. "Because physicians are not expecting to see type 2 in youngsters, the diagnosis is not
until severe hyperglycemia has developed."
Most of these study participants were from ethnic minorities, one of the significant risk factors
for type 2 diabetes in children and adults.
In the Future
"The number of people worldwide with diabetes mellitus is likely to double in the next 10
years," according to a study conducted at St. Bartholomew's and the Royal London School of
Medicine and Dentistry, Queen Mary and Westfield College in London (Kopelman PG, Hitman
GA. Diabetes. Exploding type II. Lancet. 1998;352(suppl 4):SIV5).
Three main factors are linked to this "explosion" of diabetes cases, the researchers report:
increased incidence of obesity, declining physical activity and a genetic predisposition. The
news wasn't all negative, however. The researchers predict that the "confirmation of effective
management strategies are of benefit for patients with type 2 diabetes is a major and important
"We should be optimistic that the recent progress in our understanding of the etiology of the
condition will result in new strategies for its prevention and amelioration before the grim
prevalence predictions are fully realized," the researchers concluded. *
Warning Signs of Type 2 Diabetes
* Any type 1 symptoms (frequent urination, unusual thirst,
extreme hunger, unusual weight loss, extreme fatigue, irritability)
* Frequent infections
* Blurred vision
* Cuts or bruises that heal slowly
* Tingling or numbness in the hands or feet
* Recurring skin, gum or bladder infections
Source: American Diabetes Association
Type 2 Diabetes Outside the United States
Figures presented at the 1997 International Diabetes Federation Meeting held in Helsinki,
Finland in July 1997 estimated that there were 119.2 million people with type 2 diabetes in
developing and newly industrialized nations at that time (Bloomgarden ZT. Type 2 diabetes: its
prevalence, causes, and treatment. Diabetes Care. 1998;21:860-865).
Experts estimate that by 2011, 212.9 million people will have type 2 diabetes in those nations.
One researcher dubbed the process leading to the type 2 diabetes epidemic,
"Coca-Cola-nization" and called diabetes a "Western killer let loose in paradise."
The frequency of diabetes has doubled in many areas such as Papua New Guinea (8% to 16%),
Singapore (4% to 8%) and Hong Kong (2% to 5%). Researchers predict continued increases in
diabetes cases, particularly with the ongoing industrialization in China, where "there may be
more diabetics than the total populations of Australia and California."
Complications of Diabetes
* Blindness due to diabetic retinopathy
* Kidney disease due to diabetic nephropathy
* Heart disease and stroke
* Nerve disease and amputations
* Erectile dysfunction
Source: American Diabetes Association