My colleague, David Mendosa, recently commented on the status of Type 2 diabetes in children. This topic came up because of a recent New York Times article noting that there might be a societal reversal in the onset of Type 2 Diabetes in children/adolescents based on developmental behavior and teenage rebellion.
“I’m sure that mine (David’s) is a minority position. Certainly the expert on children with diabetes doesn’t share my optimism that a turnaround in childhood diabetes is imminent. He is Jeff Hitchcock, the creator, editor, and webmaster of Children with Diabetes as well as being a friend and colleague in the war on diabetes for almost two decades. “I don’t know the science to be able to give you an assessment,” Jeff told me when I called him today. “Certainly kids do rebel against their parents.” But he says that what he sees is tied to more than just the relationship between children and their parents. Many of them live in lifestyles conducive to obesity, a big risk factor for type 2 diabetes. “So I don’t know that just the historical teenage rebellion against parents is something that kids can fight,” Jeff continued. “If they get heavy at 5 or 6, they certainly can rebel against their parents, but they can’t change their food situation at that age. I for one would not be optimistic that just the teenage rebellion will do much to stave off the explosion of obesity and type 2 in kids.”
A blog I posted several months ago discussed the TODAY study in April edition of The New England Journal of Medicine. The results of the TODAY study (Treatment Options for Type 2 Diabetes in Adolescents and Youth) were not encouraging.
The results indicate that the majority of children and adolescents with type 2 diabetes seem to require treatment with combinations of oral medications or insulin therapy within a few years of their diagnosis. Unfortunately, this study confirms what clinicians have seen on a day-to-day basis with type 2 diabetes patients. My conclusion was:
The key, therefore, remains intervention before the onset of type 2 diabetes in our vulnerable populations. Intervention will require multiple tactics at different levels: the nuclear and extended family, school, extracurricular venues, fast food establishments, and ultimately, societal influence.
I certainly wish that rebellion in the teenage years would prevent the development of type 2 diabetes. However, type 2 diabetes is fraught with too many variables that begin very early in a child’s development of which the child has no control (diet, exercise, family of origin etc.) In many families, type 2 diabetes is so prevalent within the immediate and extended family that it is not even considered a significant illness when diagnosed in children as young as 9 years of age. Anecdotal evidence is available to support the relative lack of concern in regard to a new diagnosis of type 2 diabetes in many instances:
- Lack of patient follow-up in Concepts Classes for new onset type 2 diabetes (after the initial survival skill class) at Children’s National Medical Center
- Lack of clinic attendance (we have had to cancel type 2 diabetes clinics due to lack of patients keeping appointments) at Children’s National.
Behavior change is inordinately difficult. Because the child/adolescent with type 2 diabetes may not need insulin initially, there is a different mind set. The teens that rebel against parents usually do so with impulsive risk-taking behavior including drugs and alcohol as well as eating things they know that they probably should avoid. Unfortunately, fast food is not going to disappear, safer places for play are not imminent (especially in the inner city), and healthy food remains expensive and sometimes unattainable.
In addition, biology is not contributing fast enough to stave off increasing obesity. Evolutionary adaption has not caught up to our present way of living. Thus, in combination with biology, family circumstances, and adolescent lifestyle, I am not optimistic about curbing the type 2 diabetes epidemic until we can improve the rates of obesity in our children. I also believe the current model of type 2 diabetes care is incorrect. Change needs to occur gradually in the home environment and community in terms of life style, etc. Intervention will need to be conducted in places different than the usual healthcare setting: homes/churches/schools, recreation centers. In this way, all family members may be targeted instead of only the child with type 2 diabetes.
Published On: September 04, 2012