Understanding Type 2 Diabetes and Its Rising Levels in Children

Displaying conditions associated with insulin resistance such as hypertension, dyslipidemia, polycystic ovarian syndrome.

HYDERABAD:

Type 2 diabetes also known

as “non–insulin-dependent diabetes” or “adult-onset diabetes” is a metabolic disorder that accounts for 90–95% of all diabetic cases worldwide. The prevalence of type 2 diabetes has seen a significant increase in global pediatric population affected by obesity. The progression from normal glucose tolerance (NGT) to type 2 diabetes involves intermediate stages of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), also known as prediabetes. In adults, the transition from prediabetes to Type 2 diabetes is usually a gradual phenomenon. Compared to adults, obese children have shown a faster progression in insulin resistance to Type 2 diabetes. The disorder more often develops during the 20s, coinciding with associated physiological changes such as pubertal insulin resistance. In addition, most children who develop Type 2 diabetes have a first- or second-degree relative affected by this pathology.

Epidemiology

According to study conducted by Pinhas and Hameil, the increased prevalence of type 2 diabetes in obese children is matched with an equally increased prevalence of prediabetes conditions globally. Regardless of ethnicity, 25% of children and 21% of adults with severe obesity were shown to have IGT. Type 2 diabetes is no more a condition exclusive to adults, as more than 45% of adolescents have been recorded affected by it. Although there hasn’t been any official recorded data, experts say that India is also witnessing similar alarming trends.

Criteria for Testing Type 2 diabetes in Asymptomatic Children:

Children presenting with the following conditions are at risk for developing Type 2 Diabetes. The screening for diabetes in such children should begin at age 10 years or at onset of puberty. The frequency of tests should be every three years.

Overweight with raised BMI levels.

Family history of type 2 diabetes in first or second degree relative

Displaying conditions associated with insulin resistance such as hypertension, dyslipidemia, polycystic ovarian syndrome.

Being born with a low birth weight, or born to mothers with a history of Gestational Diabetes.

Criteria for Diagnosing Type 2 Diabetes:

The following factors help to decide whether a child falls under the diabetic spectrum:

• Fasting Glucose >126mg/dL
• 2-h Glucose > or = 200mg/dL during an Oral Glucose Tolerance Test
• A1C > or = 6.5%
• Random Glucose > or = 200mg/Dl in a patient with classic symptoms of hyperglycemia.

Prevention

• Going by the present scenario, preventative actions are the need of the hour to restrain the rising levels of Type 2 diabetes in Indian youth.
• For children showing prediabetes symptoms, a comprehensive counselling program should be undertaken.
• Intensive diet management aimed at 7% weight loss in obese patients.
• Including moderate intensity physical activity of at least 150 min/week.
• Annual monitoring, follow-up and management programs are a must.