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

Prevention

There are limited data available regarding the management of type 2 diabetes in children. As a result, the goals of treatment in type 2 diabetes in adults have been applied to children and adolescents. These goals include achieving psychological and physical well being, long term glycemic control (defined as a fasting plasma glucose < 130mg/dL and a HbA1c < 7%), and preventing microvascular and macrovascular complications.[7,28]

Lifestyle Changes

Weight reduction has been shown to improve blood pressure, insulin sensitivity, and prevent the onset of type 2 diabetes in adults, and may be as effective in obese children and adolescents. Rocchini et al.[31] evaluated the effects of a 20-week weight loss program on blood pressure and insulin concentrations in 50 obese adolescents. The investigators randomized 15 adolescents to a diet and behavioral change treatment arm, 18 to diet, behavior change and exercise, and 17 to a control arm. Patients in the weight loss treatment groups had significant reductions in fasting insulin concentration, and systolic and diastolic blood pressure ( p < 0.01) compared to the control arm.[31]

Freemark and Bursey[32] evaluated the effects of metformin on BMI and glucose tolerance in adolescents with hyperinsulinemia and a family history of type 2 diabetes. Twenty-nine patients, aged 12-19 years, were randomized to receive metformin 500 mg PO twice a day, or a placebo, for six months. Patients receiving metformin experienced a decline in mean fasting blood glucose from baseline (84.9 ± 2.2 mg% to 75.1 ± 2.7mg% at the end of study p < 0.02). Mean fasting blood glucose levels did not change significantly from baseline in the placebo group (77.2 ± 2.2mg% to 82.3 ± 2.7 mg%). Fasting insulin levels did not change significantly in the placebo group but declined from 31.5 ± 3.3 µU/mL at baseline to 19.2 ± 1.5 µU/mL ( p < 0.01) in the metformin group.[32]

This study was conducted in a small group of adolescents for only 6 months. The small number of subjects limited the investigators' ability to perform extensive analysis of the effects of metformin in subgroups matched for sex and race.[32]

Kay et al.[33] evaluated the beneficial effects of metformin in normoglycemic obese adolescents. Twenty-four Caucasian adolescents with BMI > 30 kg/m2 were placed on a low calorie (1500 kcal for girls and 1800 kcal for boys) meal plan. In addition, 12 patients were randomized to receive metformin 850 mg PO twice a day, and 12 patients received placebo, for 8 weeks. The percentage weight loss in the metformin group was greater than the placebo group, (6.5% ± 0.8% vs. 3.8 ± 0.4%, respectively; p < 0.01). The metformin group also had a greater decrease in body fat compared to the placebo group (-6.0 ± 0.62 kg vs. -2.7 ± 0.51 kg, respectively; p < 0.001). There was also a significant reduction in fasting insulin levels in the metformin group from baseline (43 ± 7 µU/mL to 22 ± 3 µU/mL) compared to the placebo group (37 ± 6 µU/mL to 26 ± 3 µU/mL) p < 0.05.[33]

In addition to inhibiting hepatic glucose output, metformin decreases free fatty acids and increases lipogenesis in patients with type 2 diabetes. Key et al. demonstrated that metformin may attenuate hyperinsulinemia and reduce body fat. Larger, long-term trials in children and adolescents from various ethic groups should be conducted to confirm these findings.[33]

Overweight children and adolescents may benefit from an exercise program that they can adhere to easily. Often adherence increases if a child is involved in an activity that he or she likes, such as dancing, biking, or a team sport. Exercise can be started slowly (three times a week for 15-30 minutes) and increased gradually in order to build tolerance.[34,35] Health care providers should refer the child and their caregiver to a dietician with experience in nutritional management in children. Medical nutrition therapy in children is similar to adults except it should be targeted at maintaining normal growth and development, while depleting fat stores. Medical nutrition therapy should include a reduction in saturated and polyunsaturated fat, with increasing amounts of soluble fiber. Consistent daily carbohydrate intake at meals and snacks is important as carbohydrate is the macronutrient with the greatest impact on postprandial glucose levels. Children, adolescents, and caregivers should be provided with basic instructions regarding the amount of carbohydrate to eat at meals and as snacks. Dietary recommendations should be culturally appropriate, sensitive to family resources, and provided to all caregivers.[34,35]

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....