Type 2 Diabetes & Its Rising Levels in Children
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 the 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 pre-diabetes.
In adults, the transition from pre-diabetes 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 most often develops during the second decade of life, 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.
The increased prevalence of type 2 diabetes in obese children is matched with an equally increased prevalence of pre-diabetes conditions globally. Regardless of ethnicity, 25% of children and 21% of adolescents with severe obesity were shown to have IGT. Type 2 diabetes is no more a condition exclusive to adults as it accounts up to 45% of all the new onset diabetes in adolescents. 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 an 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 pre-diabetes symptoms, a comprehensive lifestyle counseling 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.
- TV viewing < 2 hours a day