Type 2 diabetes was once considered an adult disease. Not so anymore. Kids are being diagnosed at an alarming rate, and now a new study says that these children are going to have a tougher time getting the disease under control.
Obesity and lack of physical activity are two of the most common reasons someone gets type 2 diabetes. During the past three decades, the tripling of obesity in children has gone hand in hand with an increase of type 2 diabetes in children.
What is type 2 diabetes? It begins when the body develops a resistance to insulin and cannot use insulin properly. The pancreas is no longer able to produce sufficient amounts of insulin to control blood sugar. Hyperglycemia is the medical term for high blood sugar levels. The reason it is so bad is that hyperglycemia can damage the vessels that supply blood to vital organs, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems.
In a large new trial looking at ways to slow the progression of type 2 diabetes in children and teens, the addition of a second drug to the mainstay treatment metformin was only marginally more effective at controlling blood sugar than metformin alone.
Within a year, on average, half of kids on metformin and some 40 percent taking both metformin and rosiglitazone (Avandia) ended up having to resort to insulin injections to control their blood sugar, researchers reported Sunday at the annual meeting of the Pediatric Academic Societies in Boston and in the New England Journal of Medicine online.
"The results of the study were discouraging," said Dr. David Allen from the University of Wisconsin School of Medicine and Public Health in an NEJM editorial. "These data imply that most youth with type 2 diabetes will require multiple oral agents or insulin therapy within a very few years after diagnosis."
All 699 children included in the study had been diagnosed with type 2 diabetes two years or less before enrollment, so the rapid advance of about half to needing insulin marks an early start to a potential lifetime of complications and side effects -- from the diabetes itself and the medications used to treat the disease.
Type 2 diabetes "progresses more rapidly" in youth, according to Dr. Phil Zeitler from the University of Colorado, Denver, who worked on the new study.
He and his colleagues were surprised at how quickly many of the youngsters needed to switch from oral medications to taking daily insulin shots, Zeitler told Reuters Health.
Also, Zeitler said, the teens in the study appeared to have complications, including infections and hospitalization, more often than adults do.
All the children in the study were overweight or obese, and ranged in age from 10 to 17 years old.
Children also may have a more difficult time taking their medications as instructed and are not usually in control of what is given to them to eat. Fast food dining has become a staple for many American families. School lunches are not much better in some regions, and kids are simply not as active as in past generations. Zeitler noted "the toxicity of your lifestyle must be pretty severe," for young children and teens to get type 2 diabetes before adulthood.
That's why all of the kids in the study got at least "basic lifestyle counseling," he emphasized -- for example, advice to stop drinking sugared sodas, eat less fast food, watch their diet in other healthy ways, take stairs instead of elevators and generally get more exercise.
Study enrollment began in July 2004 and follow-up continued through February 2011. All the kids in the study were taking metformin, a well-established diabetes drug, and a third were assigned to take the newer drug Avandia as well.
Another third of the kids were assigned a very intensive "lifestyle intervention," that involved more assignments for kids to complete, more interaction with counselors, and close involvement of at least one parent, in addition to taking metformin.
The kids' treatments were deemed failures if blood sugar and other signs pointed to their diabetes not being under control for a period of six months or more.
In the end, 52 percent of kids on metformin alone "failed" treatment, along with 39 percent of kids on metformin and Avandia and 47 percent of kids on metformin and lifestyle changes.
The median time it took for blood sugar control to be lost was just under a year.
The added benefit of Avandia was limited to girls, for reasons that are unclear, the researchers reported.
Also for unknown reasons, they noted, metformin alone was less effective for non-Hispanic black participants than other kids.
Overall, 19 percent of the participants developed serious adverse effects such as severe hypoglycemia, diabetic ketoacidosis and lactic acidosis.
The rate in the treatment groups was 18 percent in the metformin-only group, 15 percent in the double-drug group and 25 percent in the group that received the very intensive lifestyle intervention. The rate of specific problems such as hyperglycemia, were not significantly higher between the groups.
Fifty years ago," the editorial continues, "children did not avoid obesity by making healthy choices; they simply lived in an environment that provided fewer calories and included more physical activity for all. Until a healthier 'eat less, move more' environment is created for today's children, lifestyle interventions like that in the ...study will fail."
Type 2 diabetes can be difficult to diagnose in children because they may go without symptoms for a long time. A blood test to measure glucose metabolism is needed for an accurate diagnosis.
Mayoclinic.com gives these symptoms to be aware of.
- Increased thirst and urination. As excess sugar builds up in your child's bloodstream, fluid is pulled from the tissues. This may leave your child thirsty. As a result, your child may drink — and urinate — more than usual.
- Increased hunger. Without enough insulin to move sugar into your child's cells, your child's muscles and organs become depleted of energy. This triggers hunger.
- Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight. Without the energy sugar supplies to your cells, muscle tissues and fat stores simply shrink.
- Fatigue. If your child's cells are deprived of sugar, he or she may become tired and irritable.
- Blurred vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. This may affect your child's ability to focus clearly.
- Slow-healing sores or frequent infections. Type 2 diabetes affects your child's ability to heal and resist infections.
- Areas of darkened skin. Areas of darkened skin (acanthosis nigricans) may be a sign of insulin resistance. These dark patches often occur in the armpits or neck.
Treating type 2 diabetes is much more difficult than preventing it. Long-term diabetes can have devastating results on your health. That’s why it’s so important for families to be aware of the disease and what it takes to help prevent it.