Childhood and Adolescent Type II Diabetes due to Obesity
Education is the key!
When I was taking a Nutrition Education class, I had to analyze 5 research papers and write about them. Then I had to give my views and health recommendations on what I understood from those papers. I chose to write about the rise of Childhood and Adolescent Type II Diabetes Mellitus due to Childhood Obesity.
Here is the actual paper I wrote and submitted in November or 2007. It has some great information and recommendations if anyone is concerned about their children or children they know. As always, comments, thoughts and ideas are greatly welcomed!
CHILDHOOD AND ADOLESCENT TYPE II DIABETES DUE TO OBESITY
The prevalence of obesity has become an epidemic throughout the world. Family History, environmental factors, lifestyle, glucose tolerance and insulin resistance are just some of the factors implicated in children and adolescents with obesity. The purpose of this paper is to show the increasing observations of childhood and adolescent type 2 diabetes mellitus throughout the world and to give some health recommendations how to combat this serious problem.
Atabek et al. (2007)1 determined that regardless of age, sex and pubertal stage, any obese child should be screened for impaired glucose tolerance (IGT) and, if diagnosed early enough, should have a strategy devised to prevent or treat this condition before it escalates to full blown type 2 diabetes mellitus (T2DM). One hundred ninety six children, aged 7-18 years took an oral glucose tolerance test. A homeostasis model for assessment of insulin resistance (HOMA-IR) was used.1 An insulin sensitivity index was used as well. The results showed that 15 children had an abnormal fasting glucose level, 35 had an impaired glucose tolerance test, 83 had insulin resistance and 6 had T2DM. The researchers concluded that impaired glucose tolerance, insulin resistance and T2DM are more common in obese Turkish children and adolescents that previously though.1 There have been other studies to show similar findings.
Haines et al. (2007)2 estimated the incidence of T2DM in children less than 17 years of age and also investigated its relationship with obesity in the United Kingdom (UK) and the Republic of Ireland (ROI). Pediatricians went through the British Pediatric Surveillance Unit and reported new cases monthly. One hundred sixty eight children participated in the study.2 Forty percent were diagnosed with T2DM. Children of ethnic minorities were overrepresented. According to the International Obesity Task Force, 95% of children who were diagnosed with T2DM were overweight and 83% were obese.2 Eighty four percent of children had a family history of T2DM. Something interesting about this study is that the ROI did not report any cases. This lack of case reporting could be because of underreporting or because they had a lesser number of ethnic minorities.2 The researchers concluded that T2DM is increasing in children in the UK. The incidence in ethnic minorities is more common that in Caucasians. Increased body fat and family of T2DM were also strongly associated with the diagnosis of T2DM in UK children.2
Druet et al. (2005)3 investigated both insulin resistance and insulin secretion in adolescents with T2DM. Six obese children with T2DM were followed from an age range of 2 months to 4.3 years to a median age of 15.4 years. Peripheral and hepatic insulin sensitivity were looked at using a euglycemic hyperinsulinemic clamp to measure hepatic glucose production (HGP).3 This clamp measures the amount of glucose necessary to compensate for an increased insulin level without causing hypoglycemia. In this procedure, the rate of glucose infused was adjusted based on plasma glucose concentrations taken every 5 minutes. Hepatic insulin sensitivity was evaluated as the ability of insulin to lower HGP.3 First phase insulin release was looked at after intravenous (IV) glucose stimulation. Graded IV infusions were done to stimulate glucose. Arginine stimulation given IV was used to look at insulin response.3 The results showed that all children had a decreased peripheral glucose uptake. Five of the children had hepatic insulin resistance. Two children had a very low first phase insulin release.3 Three children had an exaggerated response with the graded glucose infusions, but with arginine stimulation, insulin secretion was spared. Three other children, when fasting had a low insulin response under both glucose and arginine stimulation. Researchers concluded that decreased β-cell function and insulin resistance are major components of T2DM in children.3 Other studies used cell lines to prove the possibility of genes involved in mutations which may contribute to insulin resistance and or glucose intolerance.
Bouatia-Naji et al. (2007)4 looked into the relation between genetic variations and glucose intolerance or insulin resistance which are common factors for T2DM. The gene they were working with was the Secretory Granule NeuroEndocrine protein I (SGNE I), which has been linked to obesity. The researchers wanted to see whether or not this gene was linked to T2DM in children and adolescents.4 Case control studies were done in 1229 obese French Caucasian children and adults for genetic mutations of the SGNE I gene single nucleotide polymorphisms (SNP). One thousand five hundred thirty-five people with T2DM and 1363 controls were also studied. The results did not show any relation between SGNE I SNPs and childhood or adult obesity.4 SNPs did not associate with the risk of T2DM but rather associated with the incidence of T2DM. Researchers concluded that the SGNE I does not add to obesity and T2DM but may worsen glucose intolerance and insulin resistance, especially in early onset obesity.4 The last study was done over a long period of time, and looked at health issues with type 2 diabetic children and adolescents.
Kemper et al. (2006)5 looked at whether or not type I diabetes mellitus (T1DM) or T2DM was more prevalent and how they were correlated to demographic changes. They used administrative claims because the amount of data was enormous. They also used pharmacy claims to assess the amount of medications being prescribed for those children and also because they wanted to see how many of the diagnosed diabetic children were actually taking their prescribed medications.5 The study was done between 1998 and 2002. A cross-sectional study of a national sample of children below 18 years of age was used. Demographic changes like age, urban residence and number of children getting treated, were adjusted and the prevalence of diabetes was recognized.5 T2DM had increased from 183 cases per 100,000 children in 2002, however, the researchers observed that the number of T1DM cases were more commonly seen. They concluded that the estimate of the overall prevalence of diabetes is consistent with the national data.5
Type 2 Diabetes Mellitus is a growing problem in children and adolescents throughout the world. Based on the research studies, impaired glucose tolerance, insulin resistance, family and demographic distribution all play major roles in type 2 diabetes due to obesity in children and adolescents. Another paper also states that certain genetic mutations may not predispose to obesity but may contribute to type 2 diabetes mellitus by worsening insulin resistance or glucose intolerance in children. More research needs to be done to understand the correlation between T2DM and obesity in children and adolescents to hopefully find better prevention and treatment measures.
Health Professional Recommendations-
Encourage parents of overweight or obese children to prepare more nutritious meals for their children. Have a set time schedule for meals at home. Have children help their parents or guardians prepare meals. This way, they know what foods they are getting and it may help them make healthier choices in the future. Encourage children to bring healthy lunches and snacks from home to school instead of using the vending machines. Try to discourage children from drinking soda or eating too much fat or sugar laden snacks. Encourage children to go outside to play and encourage them to take the stairs instead of the elevator or escalator. Set a time limit of no more than 2 hours per day for television, video or computer games.
Atabek ME, Pirgon O, Kurtoglu S. Assessment of abnormal glucose homeostasis and insulin resistance in Turkish obese children and adolescents. Diabetes Obes Metab. 2007; 9: 304-310
Haines L, Wan KC, Lynn R, Barrett TG, Shield JPH. Rising incidence of type 2 diabetes mellitus in children in the UK. Diabetes Care. 2007; 30(5): 1097-1011
Druet C, Tubiana-Rufi N, Chevenne D, Rigal O, Polak M, Levy-Marchal C. Characterization of insulin secretion and resistance in type 2 diabetes of adolescents. J Clin Endocrin Metab. 2006; 91(2): 401-404
Bouatia-Naji N, Vatin V, Lecouer C, et al. Secretory granule neuroendocrine protein I (SGNE I) genetic variation and glucose intolerance in severe childhood and adult obesity. BMC Med Gen. 2007; 8: 44-53
Kemper AR, Dombokowski KJ, Menon RK, Davis MM. Trends in diabetes mellitus among privately insured children, 1998-2002. Ambul Peds. 2006; 6(3): 178-181