Lowering Risk for Type 2 Diabetes in High-Risk Youth

By Bobo, Nichole; Shantz, Shirley et al. | American Journal of Health Education, September-October 2009 | Go to article overview

Lowering Risk for Type 2 Diabetes in High-Risk Youth


Bobo, Nichole, Shantz, Shirley, Kaufman, Francine R., Kollipara, Sobha, American Journal of Health Education


ABSTRACT

Among children and youth who develop type 2 diabetes (T2DM) there are a number of genetic and environmental factors that lead to a combination of insulin resistance and relative-cell secretory failure of the pancreas. These factors include ethnicity (highest in American Indian youth), obesity, sedentary behavior, family history of T2DM, puberty, low birth weight, intrauterine diabetes exposure and female gender. The American Diabetes Association (ADA) has recommended guidelines to screen children and youth for diabetes risk. School nurses in a National Association of School Nurses' program use the ADA guidelines, and then refer at-risk children to a health care provider for further evaluation and intervention. The HEALTHY trial funded by the National Institutes of Health is assessing whether school-based strategies can reduce diabetes risk. Prevention and intervention of overweight and obesity in children--a risk factor for the development of T2DM in children and youth--is a shared responsibility among parents, schools, health care providers and communities.

INTRODUCTION

The epidemic of childhood overweight and obesity has become a leading national and international public health issue. The long-term consequences are yet to be realized, although most believe that this issue will adversely affect the health and health care costs in our nation and throughout the world. As a result of obesity, it is estimated that this generation of young people will be the first expected not to live as long as their parents, and for children born in 2000, the lifetime risk of developing diabetes is estimated to be 30% in girls and 40% in boys, if nothing is done. (1)

YOUTH AT RISK FOR TYPE 2 DIABETES

Overweight and obese children are presented with multiple co-morbid conditions that had previously been thought of as diseases of adults, most significant of which is type 2 diabetes (T2DM). (2-5) The SEARCH for Diabetes in Youth Study has helped define the prevalence of diabetes in youth in the United States (U.S.). (6) SEARCH collected data from six states: California, Colorado, Hawaii, Ohio, South Carolina and Washington to determine the prevalence of diabetes in two age groups (0-9 years and 10-19 years), and for non-Hispanic Whites, Hispanics, African Americans, Asian/Pacific Islanders and American Indians. The study determined that race/ethnicity and gender differences accounted for the different prevalence rates of type 1 (T1DM) and T2DM. (6)

In the 0-9 year age group, T1DM accounted for more than 80% in the total cohort. For American Indian children in this age group, T2DM accounted for 13%. For the 10-19 year age group, the percentage of T2DM was highest in American Indian youth (76%), 40% in Asian/Pacific Islander youth, 33% in African American youth and 22% in Hispanic youth. T2DM rates were the lowest among non-Hispanic Whites in the 10-19 year age group, accounting for only 6% of diabetes, whereas T1DM accounted for more than 91%. In general, the incidence of T2DM is increasing nationally. In one clinic-based study there was a ten-fold increase over a 12-year period. T2DM now accounts for 15% to 45% of newly diagnosed cases of diabetes, (7) with the incidence dependent on the ethnicity of the population being studied.

Among children and youth, as in adults, T2DM is due to the combination of insulin resistance and relative [beta]-cell secretory failure. There are a number of genetic and environmental risk factors for insulin resistance and limited [beta]-cell reserve including ethnicity, obesity, sedentary behavior, family history of T2DM, puberty, intrauterine growth retardation, intrauterine diabetes exposure and female gender. Environmental factors also play a key role in development of diabetes. Globalization and industrialization are making high-density, low-nutrient food and drinks available to people worldwide and also are responsible for an increasing tendency for children to be sedentary and unfit. …

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