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Commentaries on both new and classic studies of importance for the treatment of diabetes are posted here monthly.
Type 2 Diabetes in Children
Knut Borch-Johnsen |
Click here to download PowerPoint slides of this commentary. |
Comment on:
Haines L, Wan KC, Lynn R, Barrett TG, Shield JPH. Rising incidence of type 2 diabetes in children in the U.K. Diabetes Care. 2007;30:1097-1101.
Background
Since the first alarming reports of cases of Type 2 diabetes in children in the USA, childhood Type 2 diabetes has not only been a hot topic in the scientific literature but has also been a front-page item in the lay press. Very few studies of the prevalence and incidence of Type 2 diabetes in children have been published, but this condition tends to attract more attention from journalists than does the much larger number of children with Type 1 diabetes.
The likely reason for this attention may stem from the rapid increase in the prevalence of severe obesity in children together with the decreasing physical activity levels found in children. Consequently, the occurrence of Type 2 diabetes in children is seen as a ‘red light’ or warning that action is needed now if we are to minimise the future diabetes epidemic.
Methods and Key Results
A prospective monthly surveillance system was established to identify all cases of non–Type 1 diabetes diagnosed before the age of 17 years in the UK and Republic of Ireland. The study included all cases diagnosed from 1 October 2004 to 31 October 2005. During this period, 168 cases of confirmed non–Type 1 diabetes were identified including 67 classified as Type 2 diabetes, 17 as maturity-onset diabetes of the young (MODY), 37 as secondary diabetes, 13 as diabetes as part of a recognized syndrome, and 34 as unclassified.
Among the 67 cases (57% females) with confirmed Type 2 diabetes, mean age at diagnosis was 13.3 ± 1.7 years for girls and 14.1 ± 2.0 years for boys. Ethnic minorities were grossly overrepresented, contributing 43% of all cases of Type 2 diabetes. Ninety-five percent of those diagnosed with Type 2 diabetes were overweight and 83% obese according to the International Obesity Task Force guidelines. In 71% of cases, a first-degree relative also had a history of Type 2 diabetes.
The incidence of Type 2 diabetes in this survey was 0.53 cases per 100,000 per year but with marked ethnic variation, with an incidence of 3.9/100,000/year for blacks and 1.25/100,000/year for South Asians but only 0.35/100,000/year for whites.
Clinical Implications
This is the first study to provide reliable estimates of the incidence of Type 2 diabetes in children in the UK. It confirms the clinical impression that the cases exist, but the incidence is low, and also confirms that the incidence is markedly higher in some ethnic minority populations than in the white population.
The low incidence of Type 2 diabetes compared with an incidence of Type 1 diabetes of 15-20/100,000/year clearly shows that Type 1 diabetes remains the central diabetes-related problem in children and that the focus should still be on this group of patients. This being said, the mere occurrence of Type 2 diabetes in children is alarming, especially from a public health perspective. Type 2 diabetes is to a large extent a lifestyle-driven condition, and the fact that it is now seen even in children sends a significant signal. Physical inactivity and obesity are major risk factors not only for diabetes but also for a number of other diseases including hypertension, dyslipidaemia, cardiovascular disease, and several types of cancers. Thus, Type 2 diabetes in children can be seen as a sign of alarm that requires action.
Other studies have demonstrated similar alarming signals. Recently, a Danish study demonstrated prevalence rates of impaired glucose tolerance between 8% and 10% in women aged 30 to 40 years; this is a group that will contribute grossly to the future incidence of Type 2 diabetes (Glümer et al, 2003).
Several studies have noted that low-income groups and specific populations are at markedly higher risk than the rest of the population. This presents a special challenge in diabetes prevention and calls for development of new intervention programmes. Recent studies demonstrating that diabetes is preventable through lifestyle intervention were based on selected and highly motivated groups of participants (Chiasson et al, 2002; Diabetes Prevention Program Research Group, 2002; Pan et al, 1997; Tuomilehto et al, 2001). It would be naïve to assume that the same strategy could be applied with the same effect on groups at very high risk who may have fewer resources. Strategies should be developed and tested nationally, focusing on these high-risk groups, and there is an urgent need for developing a ‘learning environment’ wherein classical epidemiological and endocrinological science meets with public health to ensure that new knowledge is shared and implemented with high speed. We are facing a hard battle against lifestyle-driven diseases. It is a battle that will be very hard to win, but it is a battle we cannot afford to lose.
References
This Website Feature is funded by an unrestricted educational grant from Pfizer Inc.
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