Martin Silink, Kaichi Kida, and Arlan L Rosenbloom
Evolution is usually a process of slow change that can only be appreciated after a considerable amount of time has passed. Although we think of epidemics as being more revolutionary than evolutionary, we have witnessed the evolution of two concurrent global non-communicable disease epidemics, or pandemics, in less than 25 years. The epidemics of obesity and type 2 diabetes, unlike acute and time-limited epidemics of infections in the past, pose an insidious and continuing profound effect on individual and public health. These pandemics are intimately linked, with the epidemic of obesity preceding and setting the scene for the development of type 2 diabetes. In the evolutionary process, these diseases are now affecting progressively younger age groups. No longer can we think of type 2 diabetes as maturity onset diabetes. In many parts of the world and among certain ethnic groups, the incidence of type 2 diabetes in the adolescent age group is now equal to or greater than that of type 1 diabetes and it is even being recognized in prepubertal children, as young as 4-6 years in the USA and UK. 1
Although 2-3% of pediatric diabetes had been recognized as being type 2 at least 30 years ago, 2-4 type 2 diabetes has only emerged as a common pediatric disease in the past decade. 5 Concomitantly, recognition of the epidemic of obesity and its multiple deleterious effects on lifelong health, of which type 2 diabetes is only one aspect, has moved this disease of civilization to the forefront of pediatric concerns.