Type 2 Diabetes in Children and Adolescents - The Next Epidemic?

Eva M. Vivian

Disclosures

Curr Med Res Opin. 2006;22(2):297-306. 

In This Article

Abstract and Introduction

Abstract

Objective: To provide an overview of the incidence of type 2 diabetes in children and adolescents and provide direction for clinicians who care for children and adolescents.
Research Design and Method: The data presented in this review were obtained from published literature and abstracts presented at scientific meetings. Clinical trials and review articles were identified using the search terms 'metabolic syndrome', 'type 2 diabetes mellitus', 'children', and 'adolescents' in a MEDLINE search from 1995-2005. Additionally, the bibliographies of the identified articles were reviewed.
Results: Type 2 diabetes is rising rapidly in children and adolescents worldwide. Changing a child's living environment to include physical activity, and a well balanced, low fat, high fiber diet, are important for the maintenance of a desirable body weight and improving insulin sensitivity. Maintaining euglycemia with metformin, sulfonylureas, thiazolinediones, and insulin is recommended. Effective treatment of co-morbid problems such as hypertension and dyslipidemia can decrease the risk of cardiovascular complications.
Conclusions: The prevalence of type 2 diabetes in children will continue to rise until effective measures are taken to prevent obesity in this age group. Ensuring that children have a well balanced low fat, high fiber, diet, combined with physical activity, will promote weight loss or maintenance, improve insulin sensitivity, and decrease the risk of diabetes and cardiovascular disease. Pharmacologic therapy is recommended for children who are unable to achieve satisfactory glycemic control through physical activity and diet.

Introduction

By the end of the 20th century the incidence of type 2 diabetes mellitus (DM) in children had increased dramatically. Once considered a disease of the overweight, middle age person, the incidence of type 2 diabetes is rising rapidly in children and adolescents worldwide, with the highest prevalence in those of American−Indian, Hispanic, African−American, and Asian descent.[1,2,3] However, an increasing prevalence of type 2 diabetes has also been reported in Japanese, Canadian, Australian, and Libyan children.[4,5]

The alarming incidence and prevalence of diabetes has been attributed to increasing obesity among younger people.[6] Children of obese parents have a 66% risk of becoming obese before adulthood,[1] falling to 50% if only one parent is obese.[7] The prevalence of obesity (body mass index [BMI] exceeding the 95th percentile) among US children and adolescents aged 6−19 years has jumped from approximately 4% in 1963 to 15% in 2000.[8]

A sedentary lifestyle, combined with a high calorie diet, has resulted in the increase of type 2 diabetes in the US. This article will provide an overview of the incidence of type 2 diabetes in children and adolescents, and provide direction for clinicians who care for these children.

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