Childhood Type 2 Diabetes Yields Dialysis, Miscarriage, Death in 20s: Tragedies Ahead As We Reap Results of Obese Children

6/17/2002

From: Diane Tuncer, 703-299-5510 Mark Overbay, 703-549-1500, ext 2290 Newsroom June 14-18: Room 220, Moscone Center, San Francisco, Calif., 415-978-3733

SAN FRANCISCO, June 17 -- The coming of age of the first crop of children who developed a type of diabetes that normally occurs only in adults is yielding alarming results -- kidney failure and dialysis, miscarriages, and death in their 20s, according to reports here on Sunday at the American Diabetes Association's 62nd Annual Scientific Sessions.

"Type 2 diabetes was practically unheard of in young people until the early 1980s," explains Heather Dean, M.D., professor of pediatrics at the University of Manitoba in Winnipeg, Canada. She has been following a central Canada group of native First Nations people who have a high incidence of type 2 diabetes.

Of the 51 pediatric diabetes clinic "graduates," diagnosed before age 17 and now ages 18 to 33, seven have died (two sudden deaths on dialysis of young women 25 and 31, two from trauma, and three from unrelated illnesses). Three others are on dialysis; one young woman became blind at age 26; one had a toe amputation. Further, of 56 pregnancies, only 35 resulted in live births. Also, although only 33 had had a medical assessment in the prior year, nearly two-thirds of these had severely high levels of A1C, a long-term measure of blood sugar control.

The mortality, morbidity, and miscarriages seen in this group suggest a dire future for the thousands of young children now developing type 2 diabetes. Obesity in children and teens seems to play a major role in the early development of the disease.

More than 17 million Americans have diabetes, a group of serious diseases characterized by high blood sugar levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as blindness, kidney disease, heart disease and amputations. It is the fifth leading cause of death by disease in the U.S.

Although major studies in the U.S. and U.K. have shown that the risk of diabetes complications can be markedly reduced with good blood glucose control, it can be difficult to assure that children and teens receive the proper medical care and self-care required, as this study revealed.

CAUSES AND CONSEQUENCES OF TYPE 2 IN CHILDREN

"Our youngsters spend too much time in front of a screen -- a computer or a TV -- instead of being outside jumping rope and playing ball, and many schools have cut down on their physical education programs," warned Silva Arslanian, M.D., professor of pediatrics at the University of Pittsburgh School of Medicine. "Plus they are surrounded with calorically dense food -- high fat, high simple sugars, and low fiber -- all of which lead to obesity, which is associated with insulin resistance, an early abnormality in the course of developing type 2 diabetes in adults and children." Dr. Arslanian chaired a symposium on insulin resistance, type 2, and cardiovascular disease in children.

"When an adult of 50 gets diabetes and then develops cardiovascular disease, that's bad enough," said Dr. Arslanian. "But when 14-year-old children already have indications of complications, that's more serious because their longevity can be cut extremely short."

Another speaker reported that the Bogalusa Heart Study found that very young children with risk factors of hypertension and high cholesterol levels already have indicators of atherosclorosis in their coronary arteries. "We know these changes can start as early as age 3, so we must go after the risk factors, including obesity," said Janet Silverstein, M.D., Professor of Pediatrics at the University of Florida in Gainesville. She reported that a multicenter trial is in the planning stages to seek ways to prevent diabetes in youth.

PLANNING AHEAD

"We did this study to document not only the consequences of type 2 in children and young adults but also to help the community evaluate the services available and have a baseline to evaluate our intervention programs," said Dr. Dean. This is the first group of youngsters with diabetes in whom outcomes have been documented.

"The high morbidity and mortality is alarming because it shows these youngsters are a very vulnerable, high-risk population for severe diabetes consequences," emphasized Dr. Dean. "We need to look at our systems and find ways of assuring that these youngsters get better care."

All the experts agreed that lifestyle modification - increased physical activity and better nutrition - should be the cornerstone of therapy. However, many youngsters also will need oral medications and insulin injections.

"But compliance is terrible with these youngsters," warns Dr. Arslanian. "Many people in their families have diabetes and they don't perceive that their actions can do anything to stop the consequences they see around them. That has to change. Parents need to know that obesity is not just about appearance but can place their children at severe medical risks."

The American Diabetes Association is the nation's leading voluntary health organization supporting diabetes research, information and advocacy. Founded in 1940, the Association has offices in every region of the country, providing services to hundreds of communities.