Obesity in Children Quadruples Their Risk of Type 2 Diabetes

April 26, 2017

Children who are obese have a fourfold increased risk of developing type 2 diabetes compared with their normal-weight counterparts, UK investigators have found in an electronic health record study.

Examining data on more than 350,000 children, the researchers determined that although the number of type 2 diabetes cases remains relatively low in comparison with type 1 diabetes in children, the incidence of the former has risen markedly in recent years, to a rate of more than 33 per 100,000 children in 2013, and is a strongly associated with obesity.

The research was published online on April 25 in the Journal of the Endocrine Society, an open-access journal introduced in January this year.

Speaking to Medscape Medical News, lead author Ali Abbasi, MD, PhD, from the department of primary care and public-health sciences, King's College London, United Kingdom, said that it is important that general practitioners, family doctors, and society at large are aware of these trends.

This represents "an important public-health message," he stressed, adding: "We have to invest in…research projects to understand the trends, including trends in obesity, in this generation of children and how we should prioritize prevention and interventions in the future."

Although recent studies have suggested that approximately one-third of children in the United Kingdom are overweight or obese, there has been little study of the association between obesity and temporal trends in the incidence of diabetes in this age group.

In the United States, a recent analysis of private healthcare insurance claims data showed that the number of children and adolescents diagnosed with type 2 diabetes has more than doubled in recent years, and the increase appears to be coincident with a rise in obesity rates.

Type 2 Diabetes Rising in Parallel With Obesity

Dr Abbasi and colleagues therefore examined medical health records from the UK Clinical Practice Research Datalink (CPRD) database, comprising 375 primary-care practices in England.

Specifically, they collected demographic data on individuals aged 2 to 15 years who had their body mass index (BMI) measured between 1994 and 2013, alongside any diagnosis of diabetes more than 12 months after the start of an individual's CPRD record.

Children were deemed to have type 1 diabetes if they were prescribed insulin but not an oral glucose-lowering medication. Type 2 diabetes was defined as: a diagnosis of the disease, an oral glucose-lowering medication prescription only, or a diabetes mellitus diagnosis/HbA1c ≥6.5% without an insulin prescription.

The population consisted of 369,362 individuals with an available BMI. The mean age was 8.8 years, and 49.5% were female. Overall, 12.3% of the individuals were overweight, while 16.7% were classified as obese.

There were 654 incident cases of type 2 diabetes and 1318 cases of type 1 diabetes during the study period.

The incidence of type 2 diabetes increased from 6.4 per 100,000 persons in 1994–1998 to 33.2 per 100,000 persons in 2009–2013, while that for type 1 diabetes between the same two time periods increased from 38.2 to 562.1 per 100,000 persons.

The incidence of type 2 diabetes increased significantly among children who were overweight, from 0 per 100,000 persons in 1994–1998 to 22.8 per 100,000 persons in 2009–2013 (P = .01), and among those who were obese, from 5.7 to 103.3 per 100,000 persons (P < .01).

Obese individuals, who made up 47.1% of type 2 diabetes cases, had a significantly increased risk of incident type 2 diabetes compared with normal-BMI individuals, at an odds ratio of 3.7 and an incidence rate ratio of 4.33.

Examining BMI as a continuous variable, the team also found that each one-standard-deviation increase in BMI Z-score was associated with an odds ratio of incident type 2 diabetes of 1.6.

There were no significant associations between obesity or BMI and the risk of developing type 1 diabetes.

The team says: "Taken together, we update observational evidence that the rate of type 2 diabetes incidence, although less common than type 1, is rising among the UK children and young adults in parallel with increasing childhood obesity over the past decades."

Dr Abbasi noted that the study raises some questions as to how to prioritize investment in type 2 diabetes prevention and management in children and young adults, such as: "What exactly contributes to the incidence and burden of diabetes in children and young adults and to what extent?"

This is especially important, he emphasized, as children who develop type 2 diabetes "are at risk of developing other complications" and the total healthcare and public costs, as well as overall burden, of diabetes is likely to be higher than in someone who develops the disease later in life.

The authors declare no relevant financial relationships.

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J Endocr Soc. Published online April 25, 2017. Abstract

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