Prevalence of Risk for Type 2 Diabetes in School Children

By Urrutia-Rojas, Ximena; Menchaca, John | Journal of School Health, May 2006 | Go to article overview

Prevalence of Risk for Type 2 Diabetes in School Children


Urrutia-Rojas, Ximena, Menchaca, John, Journal of School Health


Throughout the world, among children and adolescents, type 2 diabetes mellitus (T2DM), historically called non-insulin-dependent diabetes mellitus or adult-onset diabetes, has increased parallel to the increase of overweight and obesity in the past 10-15 years. (1) It is estimated that globally the number of people with diabetes will increase from 140 million in 2002 to over 300 million in 2030. (2) In the United States, from 1980 through 2003, the number of Americans diagnosed with diabetes rose from 5.8 to 14.7 million; however, the total number is estimated to be more than 19 million as 5.2 million cases are undiagnosed. (3) T2DM accounts for 90-95% of all diabetes cases in the United States, and it represents 8-45% of all diabetes reported among children and adolescents. (4) According to the Centers for Disease Control and Prevention, 1 in 3 children born in 2000 in the United States will become diabetic; nearly 50% of African American and Hispanic children will develop diabetes. (5) Minority, female, and puberty status seem to be related to the onset of T2DM in children. (6-8)

Overall, the risk of death among individuals with diabetes is 2 times higher than that for individuals without diabetes. In 2000, diabetes was the sixth leading cause of death in the United States, and death due to lack of diabetes control and complications ranked third, with heart disease as the leading cause of diabetes-related deaths. Adults with diabetes-related heart disease are 2-4 times more likely to die or have a stroke than adults without diabetes. Other diabetes complications include high blood pressure (BP), blindness, kidney disease, nervous system damage, amputations, dental disease, and pregnancy complications. (9) In 2002, the associated economic consequences of T2DM in the United States were estimated to be $132 billion, with a direct cost of $92 billion and an indirect cost of $40 billion related to disability, work loss, and premature mortality, representing 11% of the national health care expenditures. (10) The average yearly health care cost for a person with diabetes was $13,243 in 2002 compared to $2560 for a person without diabetes. These estimates do not take into account the cost of undiagnosed diabetes care provided or expenditures for dental, optometry, and dietitian services that probably are used at higher rates by people with diabetes. (10)

RISK FACTORS

T2DM disproportionably affects minority (African Americans, Native Americans, and Hispanics) children and females as girls are 1.7 times more likely to develop T2DM than boys. (11-15) Acanthosis nigricans (AN), a skin lesion characterized by hyperpigmentation and a velvety thickening that occurs usually around the neckline, (16) and hypertension are associated with hyperinsulinemia and can be found in 90% of children diagnosed with T2DM. (8) In general, the greater the number of risk factors present, the greater the chance of developing the disease; (17) however, in children, overweight is the "hallmark" of diabetes (17) as it is the risk factor most strongly associated with the disease. (18) Approximately 85% of children diagnosed with diabetes are either overweight or obese at the time of diagnosis. (19)

The prevalence of overweight and obesity in children and adolescents is higher than it was 20 years ago in all racial/ethnic groups, and the rate of childhood overweight and obesity is increasing yearly, particularly among low-income and minority children. (20-22) According to the 1999-2000 National Health and Nutrition Examination Survey (NHANES), an estimated 15% of children and adolescents between 6 and 19 years of age were obese and over one fifth (22%) of low-income children under 5 years of age were overweight, body mass index (BMI) > 85th percentile. The rates are higher among Hispanic and Native American children and African American girls. (20-22) Overweight and obesity are end points of physical inactivity. Data regarding physical activity show that, similar to adults, children's inactivity increases their chances of overweight and obesity. …

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