Celeryroot, Here's more news on the ever-expanding type II diabetes population:
Adult-Onset Diabetes Among Kids Alarms
Doctors (10/6)
By DON FINLEY
c.1997 San Antonio Express-News
SAN ANTONIO -- Across the nation, physicians who specialize in
children with diabetes are reaching the same startling conclusion: a
sizable percentage of their patients now have the adult, rather than the
juvenile, form of the disease.
The discovery has taken doctors by surprise. No studies guide them
on how to treat these children, most of whom are poor, overweight
and a member of an ethnic minority.
None of the drugs used to treat Type 2 - adult-onset diabetes - is
approved for children. And long-term weight loss, the main strategy
for adult diabetics, is almost impossible to achieve in obese children,
experts say.
Many of these children have been misdiagnosed and treated for Type
1 - juvenile-onset diabetes - with insulin, which can worsen the obesity
that is the underlying cause of their Type 2 diabetes. Some physicians,
however, have deliberately placed Type 2 children on short courses of
insulin to get their disease under control.
No one knows how many are out there. Researchers know that half of
adult diabetics are undiagnosed. With studies showing the percentage
of overweight Americans on the rise, doctors say the problem is likely
to explode.
''I think it truly is the beginnings of an epidemic,'' said Dr. Philip
Zeitler, assistant professor of pediatrics at the University of Colorado
Health Science Center.
Zeitler, who wrote perhaps the first paper on the phenomenon last
year in the Journal of Pediatrics, found that before 1992, 3 percent to
10 percent of new diabetes cases among children 19 and younger in
the Cincinnati area were Type 2.
In 1994, a third of them were Type 2.
That mirrors the experience of several pediatric endocrinologists
around the country - particularly those who work with large numbers
of minority patients - who find Type 2s now make up a quarter to a
third of their diabetic patients.
''Pediatricians have been taught forever that if it's diabetes in
childhood, it's Type 1,'' said Dr. Daniel Hale, a pediatric
endocrinologist and associate professor of pediatrics at the University
of Texas Health Science Center.
Hale and his partner now treat about 100 children with the adult form
and 350 or so with the juvenile form. A recent computer search turned
up few children in the San Antonio area with Type 2 diabetes before
1988.
Although both are called diabetes, Type 1 and Type 2 are different
diseases, with different underlying causes.
In Type 1, or juvenile-onset diabetes, the pancreas is faulty and
cannot produce enough insulin to help the body metabolize glucose, or
blood sugar.
Type 2 diabetics produce plenty of insulin - at least for a while - but
their cells are resistant to it.
The end result is the same as with Type 1 - high levels of blood sugar
damaging nerves, organs and blood vessels.
Doctors aren't certain how much of the problem is actually new, and
how much simply went unnoticed or misdiagnosed before.
''To be honest, the reason that we reported it was we had a non-
American come to the division and say, 'Wait a minute, this is really
bizarre,''' Zeitler said.
Frustrating those who work with these children is that little or no
research is being done to understand it. The Juvenile Diabetes
Foundation has focused its attention and resources specifically on
Type 1 diabetes.
''As you know, being overweight is a national problem,'' said Dr.
Robert Goldstein, vice president of research with the Juvenile
Diabetes Foundation. ''Society in general has to come to grips with
that, for a whole variety of reasons. What you're describing now
(Type 2 children), I'd say that's not our primary focus.''
But pediatric endocrinologists say Type 2 children may even be at
higher risk for the terrible complications that can come from diabetes -
blindness, kidney failure, amputations, heart disease and stroke.
Type 1 diabetics have a lot of motivation to take their insulin regularly.
If they don't, they quickly feel terrible, although one recent study
pointed to the problem of young women skipping their insulin to lose
weight.
But children with Type 2 may not feel that poorly, although the same
damage to nerves and organs is slowly taking place.
''A lot of these kids we see for a few visits and they never come back
to the clinic,'' said Dr. Carla Scott, assistant professor of pediatric
endocrinology at the Medical University of South Carolina in
Charleston.
''Part of it is that they don't feel bad most of the time, even without
therapy. They get up and pee five times a night, but you know what?
So does Mom. So it's perceived as not being that big of a deal.''
That goes to the underlying genetics of Type 2 diabetes. Blacks,
Hispanics, American Indians and Asians are at higher risk of
developing the disease. And the vast majority of Type 2 children fall
into one of those groups. Most have one or more immediate relatives
with the disease.
''We always thought this was something seen in adults. All of a
sudden we started looking for it in children, and guess what? It's
there,'' said Dr. Ruth Ann Plotkin, the only pediatric endocrinologist in
the Lower Rio Grande Valley. ''They've had diabetes for years, and
just haven't been brought to medical attention,'' said Plotkin, who is
treating about 75 Type 2 children - representing about a quarter of her
diabetes practice.
A small meeting on the issue was held in Tucson last November,
co-sponsored by the Indian Health Service and the University of
Arizona. What was clear to many participants was how little anyone
knows about the problem.
''We really don't have any good studies to decide what treatment is
best for them,'' said Scott, whose own paper on Type 2 children in
Arkansas was published in July in the journal Pediatrics.
Many specialists use oral drugs like the recently approved metformin,
although it hasn't been approved for children and no guidelines for
dosages exist.
''You start low and work up,'' Scott said. ''We've used it with good
success, but it's not been studied.''
While the problem is first being noticed in minorities, Zeitler predicted
no group will be spared.
''In Cincinnati, the first ones to pop up were the kids at the greatest
risk from a genetic basis, the black kids. But in recent years we've
started seeing more white kids.''
That reflects a growing national problem of obesity. In March, the
government-sponsored National Health and Nutrition Examination
Survey reported that the proportion of overweight children and
adolescents had increased 6 percent between 1980 and 1994.
About 14 percent of children between ages 6 and 11, and 12 percent
of adolescents ages 12 to 17, are overweight.
''This is not so much about diabetes as it is about obesity,'' Hale said.
''You can't do much about your genetic heritage. But you can
certainly do something about whether your genetic heritage sneaks
around and bites you on the butt.''
Part of the problem is that teen-agers today are more inactive than
their parents, a problem that lies in part with schools, said Nicky
Teufel, an anthropologist at the University of Arizona.
''The most inactive time is when they're at school,'' said Teufel, whose
studies have focused on adolescent American Indians. ''Phys-ed, if it
occurs, is oriented towards those people who already are athletically
competent. There's no effort to make it fun for those people who are
klutzes.''
Scott also blames influences at home: ''Many of these kids have family
situations where they have long periods of time where the TV is their
baby sitter, and they're left unattended and feed themselves. Many
have families who tend to be obese already.''
''What I hear from people all over the country who are studying this
intensively is, the kids are eating pretty much the same thing, but their
activity is down,'' said Dr. Henry McGill, senior scientist at Southwest
Foundation for Biomedical Research in San Antonio.
McGill, whose 12-year-old study of autopsy results of young people
who died between ages 15 and 34, reported two years ago that both
obesity and high blood sugar accelerated the arterial blockage and
scarring known as atherosclerosis, even early in life.
Some discussions also are under way to screen children at high risk
and to take a more active approach to slow the surge in Type 2
diabetes among children.
''The pediatric community has been very concerned about obesity for
probably 20 years,'' Hale said. ''And they've been concerned on a
theoretical basis: 'Oh well, if we don't do something about obesity in
childhood, we're going to be dealing with diabetes and high blood
pressure and heart disease when these people are 25 or 30 or 40.'
''Well, I've got news for you,'' Hale said. ''This is a wake-up call. It's
not waiting until they're 25 and 30. These are kids who are showing
up with a serious medical condition called diabetes at 12.''
NYT-10-06-97 1718EDT< |
