COMMENTARY

Type 2 Diabetes in Children Has Researchers Concerned

Dana Dabelea, MD, PhD; Mark Harmel, MPH

Disclosures

September 28, 2017

From the SEARCH study, we have learned that the incidence and the risks of both type 1 and type 2 diabetes have been increasing for the past 10 years, especially so among minority children. Not only are these numbers burdensome, but these youth and young adults develop complications and comorbidities very early in life.

The burden of such complications is worrisome in both type 1 and type 2 diabetes; perhaps 1 in 3 youth with type 1 diabetes and 3 out of 4 youth with type 2 diabetes have at least one such complication by age 21 and after only a short, 8-year duration of disease.

This makes us think even harder at what causes diabetes. What causes these rises?

We have pretty solid evidence from other studies, including SEARCH, that these increases are mostly due to the environment in which these children are born and grow. A lot of research is focusing on identifying what causes type 1 diabetes so that we can develop effective interventions. Is it that children today are cleaner than they used to be years ago? Are there nutritional exposures that are introduced too early or too late in life that might increase their risk? These are all questions that are being heavily investigated so that we can design better interventions.

With type 2 diabetes, this is new as a pediatric condition. It used to be called adult-onset diabetes, but we are now seeing type 2 diabetes in children.

Minority children in this country tend to have more type 2 than type 1 diabetes if they do develop diabetes. The youngest child with type 2 diabetes that we have seen is 3 years old. This points to the harmful environment in which they are born or live their early life, and we have strong data that exposure in utero to maternal diabetes and obesity is a very strong risk factor for type 2 diabetes in these children as they grow.

This is new knowledge and knowledge that makes us want to act by designing studies to control either pregnancy diabetes or pregnancy obesity, or to develop other interventions to prevent obesity and type 2 diabetes later in life. A lot of work is going into this field of research.

Investigators are trying to break what we call the vicious cycle of obesity and diabetes at various points of time, conducting trials during pregnancy, trials in early life, perhaps promotion of breastfeeding as an effective intervention, and trials later to improve behaviors, nutritional factors, and physical activity patterns in high-risk children.

Given that we have had some success with prevention of type 2 diabetes in adults, and that we might be seeing a decrease in the rates of type 2 diabetes in adults due to programs like the Diabetes Prevention Program, we need to shift the focus from high-risk adults to healthy children and do what we call primordial prevention: preventing risk factors for obesity and diabetes in healthy children. By doing so, we will not only have healthier children, but we also will have a healthier nation for generations to come.

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