Type 2 Diabetes in Youth is on the Rise

Type 2 diabetes has previously been considered an adult condition. However, it is becoming much more common in children.

Laura, Hieronymus, DNP, MSEd, RN, discusses Type 2 Diabetes in children, symptoms to be aware of and the steps to take if a child or adolescent is told they have Diabetes or prediabetes.
Type 2 Diabetes in Youth is on the Rise
Featured Speaker:
Laura Hieronymus, DNP, MSEd, RN
Laura Hieronymus earned a bachelor’s degree in nursing, master’s degree in allied health and education and doctor of nursing practice from the University of Kentucky. She is board certified in advanced diabetes management, a master licensed diabetes educator and a certified diabetes educator. She is also a fellow of the American Association of Diabetes Educators, where she served as diabetes educator of the year in 2006-2007.

Learn more about Laura Hieronymus
Type 2 Diabetes in Youth is on the Rise

Melanie Cole (Host): For decades, type 2 diabetes has been considered an adults only condition; however, with the advent of the rise in childhood obesity, what was once a disease mainly faced by adults, is becoming more common in children, and here to tell us about this today is Dr. Laura Hieronymus. She’s the Associate Director of Education and Quality Services for UK Barnstable Brown Diabetes Center at UK Healthcare. Dr. Hieronymus, how common is type 2 diabetes in youth? It used to be we only saw type 1 in youth. What do you see happening today?

Dr. Laura Hieronymus (Guest): Well you are correct, type 2 diabetes in youth is on the rise, and as you mentioned, it is largely influenced by the obesity epidemic. The majority of children and adolescents with diabetes still have type 1; however, experts estimate that we are seeing about 5,000 children and adolescents in the United States diagnosed with type 2 diabetes each year. In fact, the new cases of type 2 diabetes in youth, and we’re talking about youth that are less than 20 years old, are predicted to quadruple in the next 40 years.

Host: Wow, that’s quite a statement Dr. Hieronymus, so let’s talk about what causes it and some of the risk factors, as we mentioned a little bit about the epidemic of childhood obesity, but there’s also sedentary lifestyle and junk food and urban deserts and all of these things that contribute. Speak about the risk factors and the causes as you see it.

Dr. Hieronymus: Well I think as you mentioned, the environment that kids live in these days does sort of predispose them in general to being overweight and sedentary and so forth. First off the ratio of type 1 versus type 2 diabetes in kids differs among ethnic groups, so that’s an important factor to keep in mind. While non-Hispanic, white children in adolescents are usually diagnosed with type 1, type 2 accounts for about 55% of new cases of diabetes among African American adolescents over 10 years old. You mentioned risk factors and there are a number of risk factors for type 2 diabetes in kids. When a child is overweight, when their body mass index is greater than the 85th percentile for children or if they’re obese when the body mass index is greater than the 95th percentile for children, and they have one or more additional risk factors, and those are: one is if they have a maternal history of gestational diabetes. Meaning that their mother, while she was pregnant, had a diabetes that occurs in pregnancy called gestational diabetes. Gestational diabetes is a precursor for the type 2 as well. Family history of type 2 diabetes, primarily in the mother, but also in any other primary or secondary family member, secondary being such as a grandparent on either side. We mentioned if the child is African American, also Latino, Native American, or Pacific Islander, those individuals are at higher risks. A condition called insulin resistant, if that occurs in the child, and one way to identify that is a brownish, black, velvety hyperpigmentation, which we usually find in the folds of the skin, like in the neck, the back of the neck, the armpits and the groin. It’s called acanthosis nigricans and this is a sign of insulin resistance. Many times in screening children in the school setting, for example, in the public health arena, the acanthosis is something that would be looked for that would show a sign of insulin resistance, predisposing that child to type 2 diabetes. The child should be screened for type 2 diabetes, and if the results are normal, the child should then be screened at least a minimum of every three years and then more frequent screenings are recommended if the child’s body mass index continues to increase.

Host: Doctor, are there symptoms that you want parents to be aware of, and as type 1 is what we typically see in youth, and you hear about oh if your child’s thirsty or having various issues, how do you know the difference between type 1 and type 2 to get them into a doctor and get them tested?

Dr. Hieronymus: Well we need to screen and I say that of utmost importance because about 40% of youth with prediabetes or type 2 diabetes have no symptoms, and that’s why it’s important to be proactive about the child’s care, again if they have or present with certain risk factors. If the symptoms do occur, they’re similar to what you mentioned. An increase in urination, and that’s the kidney’s attempt to filter glucose out of the blood stream, the excess glucose; increase in thirst, which is due to dehydration caused by the increase in urination; tiredness relative to the body’s inability to use glucose from the blood for energy; blurry vision is sometimes a symptom, sores, inner skin infections that heal slowly, and if the child is an adolescent girl, she may have unexplainable, recurrent yeast infections. Only about 6% of youth between 10 and 19 years old present with a condition called DKA, which is severe hyperglycemia, and that’s very typical when type 1 is diagnosed, but not so much with type 2.

Host: So if a child is at risk, and they’re getting screened, and maybe their pediatrician has told them that they have prediabetes, what is the first line of defense doctor, and what do you want the listeners to know about staving it off if you’re told you have prediabetes or that you’re at a high risk or if the child is told they have full blown type 2 diabetes?

Dr. Hieronymus: Well that’s a good question and those are two different issues. First off, prediabetes is when the blood glucose levels are not normal, but they’re not high enough to have type 2 diabetes. What we do know about prediabetes is that it’s generally a precursor to type 2 diabetes, and so we need to do something about it. If we find about it – find out about the prediabetes early on, we need to do something about it, and it’s important to start with lifestyle modification, really for the whole family, before the child develops type 2 diabetes. Data support in the adult population losing about 5% to 10% of the total body weight in a physical activity regimen of 150 minutes weekly. In children, it’s recommended that kids between 5 and 17 years old, get at least 60 minutes of moderate or vigorous physical activity on a daily basis. So encouraging that playing outside, engaging in sports activities, cutting back on screen time, which is really important and then looking toward a healthy meal planning in terms of using fruit, veggies, proteins that don’t include added fat, whole grains, fresh fruit, all of those things that can be healthy eating – healthful eating.

Host: I think you brought up a really good point, doctor, about the whole family having to be involved, and if the child does have diabetes, as you look at the parents, they may be overweight as well, so the whole family might be at risk in that way, so what do you want them to know about beginning because that’s the hard part, doctor, is getting that whole family involved and getting them to understand what healthy eating is, or getting them to take a walk after dinner, how do you get started?

Dr. Hieronymus: Well I think one of the key pieces is education and what the family and the child would, the information that they would get from a diabetes education program. I’m a diabetes educator by trade, and what they would get is a full detailed explanation of what type 2 diabetes is, and what we can do for it, how we can prevent it if indeed the person has prediabetes, or at least delay the onset of type 2 diabetes, but keep in mind as we mentioned earlier, this is a genetic disorder, so if a child has type 2 diabetes, the odds are one or more of their primary family members either has it or will potentially get it and so it’s learning for everyone. You know if you think about it, everyone should eat healthy, not just because you have diabetes should you eat healthy, everyone should eat healthy, it’s just that what you know are specific consequences of not eating healthy when you have diabetes. So I think that’s key and very important emphasis in the family who has a child with type 2 diabetes.

Host: Where would you advise people go for more information about getting started on an exercise program for the whole family about getting screened for diabetes if your child or anyone in your family is at high risks, where would you like people to go for more information and wrap it up for us, what would you like them to know about this rise in type 2 diabetes in children and what it might mean for their future?

Dr. Hieronymus: Well I think the first thing is if a parent suspects that their child at least is at risk for type 2 diabetes based on the discussion we’ve had today, they should be proactive and ask the pediatrician or the family care provider to screen their child. The second thing is if the child does have diabetes, it’s a good idea for that child to be followed by a pediatric endocrinologist. Type 2 diabetes in youth is more aggressive than it is in adults, and obviously the child is much younger than say a newly diagnosed middle aged person with type 2 diabetes. We know that the children are at risk for cardio metabolic disorders, those with type 2 diabetes including dyslipidemia or disorders of the lipids, hypertension, so it’s important to look at the big picture and all of those additional comorbidities and then working with a pediatric endocrinologist, that provider, if they see the child with type 2 diabetes, they’re going to refer them for education, and education is about learning the disease state but it’s also about self care behaviors that both the family and the child should learn. It includes healthful eating and being active, but it also includes monitoring the condition over time, taking potentially the medications that are recommended, problem solving what to do in certain situations, risk reduction, making sure that the overall big picture health is looked at, and finally, and maybe even the most important is healthy coping, coping with chronic illness over time. Diabetes doesn’t go away per se, so it’s important for that child to learn how to manage it but also how to cope with having that chronic disease over time.

Host: Wow, thank you so much, really it’s great information for family’s to hear. It’s so important in this day and age that they hear your message and they speak with their pediatricians and they get screened and they take charge of their health, thank you again doctor for joining us today. This is UK Healthcast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu, that’s ukhealthcare.uky.edu. I’m Melanie Cole, thanks so much for listening.