Diabetes, Obesity-Linked Disorders Double in Kids

Diana Phillips

January 20, 2017

The number of children and adolescents diagnosed with type 2 diabetes more than doubled in recent years, and the increase appears to be coincident with a rise in obesity rates and other obesity-related conditions, according to an analysis of private insurance claims data.

"States varied in the prevalence of claims associated with pediatric type 2 diabetes and in the prevalence of nondiabetic, obesity-related, pediatric diagnoses — but there appeared to be a relationship between the two," the study authors write.

The findings were reported in a white paper by the independent, national nonprofit organization, FAIR Health.

Researchers looked at data for 0- to 22-year-olds from a database of more than 21 billion privately billed healthcare claims for the period from 2011 to 2015. The. private health insurance claim lines with a diagnosis of type 2 diabetes increased 109% and claim lines with a diagnosis of prediabetes increased 110%.

During the same time period, claim lines with an obesity diagnosis increased annually, but in varying degrees, in all age categories. The smallest increase, the authors observe, was in the 3- to 5-year-old age group, which rose 45%. The largest jump, 154%, occurred among 19- to 22-year-olds.

"Every age group above 5 years had a larger percent increase in obesity than had the group preceding it in age," they write.

Recently, there has been some dissention among experts regarding the prevalence of obesity in children, as reported by Medscape Medical News. Some experts point to national data suggesting rates have plateaued and even declined in some age groups, while others contend the trajectory is continuing upward.

The authors of the white paper acknowledge the conflicting reports, noting in particular that their data are at odds with data reported by the Centers for Disease Control and Prevention (CDC) showing a "fairly stable" obesity prevalence rate for children and adolescents from 2011 to 2014.

"A possible reason for the apparent difference between the two studies is that FAIR Health's results are based on actual health insurance claims for the privately insured population, with Medicaid excluded, whereas the CDC results are based on surveys based on interviews and physical examinations of a cross-section of the civilian, noninstitutionalized, US population," the authors write.

They note, however, that both reports "found a correlation between the increasing prevalence of obesity and increase in age among youth."

Although national data indicate that rates have somewhat stabilized in certain age groups and populations, "the rates are still extremely high historically and worsening in certain groups, particularly late teenagers/young adults," said Dr Christopher F. Bolling, chairperson of the American Academy of Pediatrics (AAP) Section on Obesity. "Additionally, the number of patients with severe obesity (BMI > 99th percentile) continues to climb at an alarming rate. This is the group where comorbidities are most seen."

"The stabilization and improvement seems most encouraging in the younger age groups," Dr Bolling told Medscape Medical News. "But while we are seeing some progress there, it certainly is not a dramatic improvement."

According to the white paper, obesity was diagnosed more frequently in females than males for all but the middle school age group (10 - 13 years), in which the diagnosis occurred at similar rates. From early high school through college age, "the rate of female obesity compared to male obesity increased continuously," the authors write. "It is not known how much of the difference between male and female diagnoses might be ascribed to more rampant obesity among females or how much might be due to females receiving more treatments for obesity. If the latter is true, it raises the question whether the greater cultural significance placed on female rather than male thinness might be a factor."

Unlike obesity diagnoses, type 2 diabetes diagnoses were generally more frequent for males than females during the period of review. "Claim lines with type 2 diabetes were more common for males, except for two age groups," the authors write. They note that the rates were equal for males and females in the 10- to 13-year-old age group, and they were slightly higher for females in the 19- to 22-year-old age group.

The increased prevalence of type 2 diabetes diagnoses in most male age groups in this report is inconsistent with the findings of other studies that have reported a higher prevalence in female children and adolescents, according to the authors. However, the findings may be consistent with studies showing that men have more baseline risk factors. "The relation of gender to type 2 diabetes prevalence in young people requires more study," they write.

Other Obesity-Related Conditions

In addition to the increased prevalence of diabetes in the pediatric population, other obesity-related conditions also appear to be on the rise, the authors report. Claim lines for hypertension increased 67% and were more common for males than females, particularly in the high school age range. Of the hypertension diagnoses among 14- to 18-year-olds, 68% were in males.

"These findings are consistent with observations that males in general are more likely to develop hypertension than females prior to the age of 55," the authors write. "It is possible that androgens, hormones such as testosterone that are present in higher levels in men than women, may contribute to increasing blood pressure."

Among the obesity-related conditions, obstructive sleep apnea saw the greatest increase in claim lines, rising 161%. As with hypertension, this condition was more likely to be diagnosed in males than in females at an increasing rate with age. The prevalence rate for hyperlipidemia, on the other hand, remained fairly constant.

The authors conclude that "[t]he epidemic of obesity is affecting society's youngest members, driving up rates of type 2 diabetes from infancy to the college years."

The AAP's Dr Bolling agrees. "I believe their conclusion is correct. Severe obesity is a cause of type 2 DM [diabetes mellitus].  Not the only cause, but a direct one. Increasing rates of obesity will lead to more type 2 DM."

Based on their findings, the authors write, "further research into the epidemiology, prevention and treatment of pediatric obesity and its sequelae, particularly type 2 diabetes, is merited, along with coordinated efforts by payors, providers, government officials and policy makers to improve the public health situation."

FAIR Health. January 2017. Full text.

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