Overweight and diabetes among children have increased dramatically in the last few decades. Being overweight in early childhood increases the risk of obesity later on. Children who have obesity are four times more likely to develop type 2 diabetes than their peers who have a normal BMI. While it is generally assumed that children with Type 2 diabetes are obese, studies show that up to one in four children with Type 2 diabetes have a normal weight. This means that relying solely on body mass measurements to diagnose Type 2 diabetes may not be effective. More sophisticated models that consider factors such as ethnicity, family history, lifestyle, hormones, and insulin production capacity may be needed.
What is Obesity?
Obesity is a condition that occurs when there is an excess of body weight caused by consuming more calories than are burned each day over an extended period of time. To determine whether a child is overweight or obese, the Body Mass Index (BMI) is used as a measure. A z-score is calculated based on the child's weight, height, age, and gender, and then compared with age and gender percentile-based norms to determine their weight status.
What is Type 2 Diabetes?
Type 2 diabetes (T2D) is caused by two main mechanisms: insulin resistance and insulin deficiency. It occurs when the body becomes resistant to insulin and the beta-cells in the pancreas are not able to produce enough insulin. Initially, the body compensates for insulin resistance by producing more insulin, called hyperinsulinemia, but over time, this leads to high blood sugar levels or hyperglycaemia.
What Causes Type 2 Diabetes in Children?
The causes of T2D are complex and include genetics, lifestyle factors like obesity, overeating, lack of physical activity, and sedentary behaviour. In children and adolescents with T2D, insulin resistance is common, along with other symptoms of metabolic syndrome such as high blood pressure, high cholesterol, dark patches on the skin, fatty liver disease, and polycystic ovary syndrome.
Children with Type 2 diabetes have lower insulin secretory capacity than adults with Type 2 diabetes. Beta cell dysfunction is also more severe in patients with positive autoimmunity than in those without. Further studies are needed to understand the different potential subgroups of children with Type 2 diabetes.
Comorbidities of Type 2 Diabetes
The most common comorbidity of T2D among children is obesity. There is a strong link between increasing rates of obesity in recent decades with increasing incidences of T2D among children. Poor glycaemic control can result in serious health complications such as nephropathy, retinopathy and cardiovascular disease.
Lifestyle Behaviours Among Obese and Overweight Children
Overweight and obese youth tend to exhibit less healthy lifestyle behaviours than their normal-weight peers. Having diabetes can make it more difficult to have good oral health. They are more likely to engage in sedentary behaviour, have less physical activity, and consume a poorer diet. Adolescents with T2D and their family members had no regular physical activity, low fibre intake, and high dietary fat intake. Adults with T2D frequently overrated, drank sweetened beverages, ate fast food, and had high rates of physical inactivity.
Youth with T2D had lower levels of cardiorespiratory fitness and less physical activity than youth without diabetes. Studies found that youth with T2D were significantly more sedentary than obese youth.
What Are The Treatment Options For Type 2 Diabetes?
The primary objective of treating Type 2 Diabetes (T2D) is to achieve normal blood sugar levels. This is done by prescribing daily medication such as metformin and insulin, along with monitoring of blood glucose levels, and other medications to manage accompanying conditions. Metformin, a medication that increases insulin sensitivity, has been proven to significantly improve glycaemic control in young patients with T2D.
Currently, only metformin and insulin are approved for use in young patients with T2D, but other medications are being considered pending further controlled studies. Education and lifestyle modifications are key factors in treating T2D. Patients and their families need to be educated on medication adherence and lifestyle changes to reduce obesity. However, managing T2D can be challenging for healthcare providers.
A survey of physicians caring for young patients with T2D highlighted several challenges, including high-risk behavioural lifestyles, behavioural and psychological problems, decreased motivation for self-care, and cultural barriers. Since most young patients with T2DM are overweight, they need to lose weight by focusing on improving their diet, increasing physical activity, and decreasing sedentary behaviour. Family involvement is crucial in promoting healthy lifestyle behaviours in children. Therefore, interventions should involve parents and other family members.
Prevalence of Type 2 Diabetes
Girls are more likely to develop Type 2 diabetes than boys, but boys with Type 2 diabetes are more likely to be obese than girls. Obesity is likely one factor that contributes to diabetes risk. Different racial and ethnic groups have different rates of Type 2 diabetes. Asian children tend to develop Type 2 diabetes at lower BMI levels than other groups. African American, Hispanic and Latino children have higher rates of Type 2 diabetes than White children, but similar rates of obesity. Some children with Type 2 diabetes have a normal body mass. In these cases, other factors such as insulin resistance and insulin secretory defects likely play a role in the development of diabetes.