When Diabetes Strikes Children
Perry, Leah, Drug Topics
What was once a disease essentially unheard of in children and adolescents as recently as 10 years ago is now a growing concern among physicians and parents alike. Type 2 diabetes is on the rise in children, and health officials, physicians, and pharmacists are taking notice and taking action.
Up until the early to mid-1990s, there were almost no reported cases of Type 2 diabetes in children and teens. It was most commonly diagnosed in middleaged persons and typically associated with obesity. Today, up to 45% of newly diagnosed children with diabetes-an average of 3,700 cases each year for the past several years-are now classified as Type 2. The trend has become so widespread diat, in fact, no longer is Type 1 referred to as "juvenile diabetes" or Type 2 considered adult-onset.
Type 2 diabetes in children is extremely complex and often hard to diagnose; its symptoms can be mild and/or similar to those of Type 1, in which the body does not produce insulin-caused by a defect in the immune system, leading to the destruction of the insulin-producing beta cells. In Type 2, the body produces insulin but does not use it properly. The patient becomes insulin resistant and as the need for insulin increases, the pancreas begins to lose its ability to produce sufficient amounts of insulin to regulate blood sugar.
Type 2 diabetes produces "extreme complications in children," said Larry Deeb, M.D., a pediatric endocrinologist and president of the Medicine and Science division of the American Diabetes Association (ADA). "It causes blood pressure problems and cardiovascular disease. So, in addition to controlling die diabetes, blood pressure, cholesterol, and lipids need to be followed throughout one's lifetime as well."
In recent years, a number of studies have been conducted in an attempt to further understand the causes, prevention, and treatment of Type 2 diabetes in children. And while the trend has been well documented, still very little is known about this disease as it occurs in children.
Symptoms of Type 2 diabetes in children include an absence of ketones in the urine; little or no thirst and no increased urination; a family history of diabetes (45% to 80% have at least one parent with diabetes); and the presence of dark shiny patches on the skin, often found between the fingers, toes, and on the back of the neck, referred to as acanthans nigrans.
Some risk factors of Type 2 diabetes are also known and include the following:
* Puberty. Changes in hormone levels during tliis period of development cause insulin resistance and decreased insulin action.
* Obesity. Obese children produce too much insulin. When the need for more insulin occurs, diey are unlikely to be able to produce more. In addition, the presence of too much fatty tissue leads to insulin resistance.
* Origin. Children with Type 2 diabetes are typically of African, Hispanic, Asian, or American Indian origin.
Because Type 2 diabetes in children is still considered a new phenomenon, very little is known about appropriate treatment plans for this particular patient population. Studies, however, indicate that this form of diabetes is aggressive and, in most cases, requires the use of oral agents and/or insulin.
"Overall, treatment for Type 2 diabetes is more aggressive in children than in adults," explained Francine Kaufman, M.D., a pediatric endocrinologist and head of the Diabetes Center at Children's Hospital, Los Angeles.
"For average Type 2 adults, by die time they are symptomatic and diagnosed, they have had diabetes for perhaps five years already and by that time have had a significant decrease in insulin capacity. Kids are more abrupt. At 10 years of age, they have not had five years of being Type 2.
"We see almost no child under the age of 10 who is Type 2. This disease presenting in an 11-year-old, for example, is most likely related to environmental and genetic factors," said Kaufman. …