What is Pediatric Type 2 Diabetes?
Type 2 diabetes mellitus (T2DM) is a health condition where the body becomes resistant to insulin and the cells that normally produce it fail to compensate, leading to high blood sugar levels. This condition, previously considered just an adult issue, is now increasingly common in children as well. Kids have the same risk factors as adults for this condition, including ethnicity, family history, being overweight, and not getting enough exercise. However, the way the disease shows itself and is managed can be different for kids compared to adults. Kids with any form of diabetes face higher risks for a range of health problems. This is why it’s important to promptly detect, test, and treat children and teenagers with type 2 diabetes to prevent serious complications from the disease in the long run.
What Causes Pediatric Type 2 Diabetes?
Hyperglycemia is a condition where there is too much glucose, or sugar, in the blood compared to insulin. This often happens in Type 2 Diabetes (T2DM), where the body’s resistance to insulin leads to the pancreas producing more insulin. The problem arises when the pancreas isn’t able to make enough insulin to control the amount of sugar in the blood.
Too much sugar in the blood can harm various organs like the kidneys, eyes, heart, and nerves. It can also disrupt the balance of electrolytes, especially in children. Also, kids with T2DM usually develop complications from the disease earlier than adults, and it can be harder to manage their condition.
Diagnosis of T2DM has been on the rise, likely due to increasing levels of obesity. The reasons for T2DM in adults and children are generally the same, although there are some differences in how the disease develops.
Risk Factors and Frequency for Pediatric Type 2 Diabetes
Type 1 diabetes is the most common type of diabetes in kids. However, a growing number of children are now being diagnosed with type 2 diabetes, making up about 20% to 33% of new diabetes cases in kids. Despite a stabilizing of obesity rates, type 2 diabetes continues to rise in children. Girls are more affected than boys.
Risk factors for type 2 diabetes include:
- Being of certain ethnic backgrounds, such as African American, Hispanic, Native American, Pacific Islanders, and Asian American
- Having a close family member with the disease
- Being overweight
- Having a low birth weight
- Having a mother who had diabetes while pregnant
- Being female
It’s also worth noting that teens are more likely to be diagnosed with type 2 diabetes. This is because changes during adolescence can make the body more resistant to insulin.
Signs and Symptoms of Pediatric Type 2 Diabetes
Children with type 2 diabetes can often show no symptoms, but regular screening can help detect this condition early. When symptoms are present, they might include frequent urination, excessive thirst, constant hunger, and weight loss. Compared to adults, children with this condition, specifically those from ethnic minorities, are more likely to face a serious diabetes complication called Diabetic Ketoacidosis, or DKA. Another complication can be Hyperglycemic Hyperosmolar Syndrome, or HHS, which is also more common in adolescents with Type 2 diabetes.
A child with type 2 diabetes may also exhibit certain physical signs during a medical examination. One such sign is a dark, velvety rash on the underarms or neck, known as acanthosis nigricans. The American Diabetes Association recommends screenings for kids who are 10 years old, or those reaching puberty if they are overweight, obese, or carry two or more risk factors.
- Have a family history of diabetes
- Belong to a high-risk ethnicity
- Show signs of insulin resistance like Polycystic Ovary Syndrome (PCOS) or acanthosis nigricans, or symptoms of diabetes
- Have a medical history of gestational diabetes in their mothers
Testing for Pediatric Type 2 Diabetes
The American Diabetes Association advises checking for type 2 diabetes every three years from the age of 10 (or when puberty starts). They recommend this screening for those who fall into the following categories:
* Seriously overweight (their Body Mass Index, or BMI, is in the top 5% for their age group)
* Overweight (their BMI falls within the top 15%, but not the top 5% for their age group) and also have at least two additional risk factors. These can include a history of diabetes in the family or specific ethnic backgrounds that have been linked to increased diabetes rates, symptoms of insulin resistance, or a history of gestational diabetes in their mother.
Doctors can diagnose type 2 diabetes through the following tests:
* In people experiencing increased thirst, frequent urination, or weight loss, a random blood sugar test where levels are equal to or above 200 milligrams per deciliter (mg/dL).
* In people not experiencing symptoms, a fasting blood sugar test where levels are equal to or higher than 126 mg/dL.
* An oral glucose tolerance test, where blood sugar levels rise to 200 mg/dL or more, two hours after drinking a sugary solution.
* If your hemoglobin A1c levels, a long-term measurement of blood sugar control, are over 6.5%.
If a doctor is unsure whether a patient has type 1 or type 2 diabetes, certain tests can help clarify the situation. These may measure levels of insulin or a protein called C-peptide (which are usually high or normal in people with type 2 diabetes, but low in those with type 1), or the presence of certain antibodies typically associated with type 1 diabetes.
Treatment Options for Pediatric Type 2 Diabetes
The American Academy of Pediatrics (AAP) advises that the first steps in treating Type 1 or Type 2 diabetes should be changes in lifestyle and taking metformin. They suggest exercising at a moderate to intense level for 60 minutes every day, limiting time spent in front of screens to under 2 hours daily, and considering a dietary referral.
Metformin is the preferred first-line treatment, and you can take it as a liquid. It is usually started at a dose of 500 mg per day, and this can be increased each week or fortnight by 500 mg until reaching a maximum of 2000 mg twice a day. It’s important to increase the dose slowly to prevent stomach problems. Also, taking metformin with food can help to reduce these side effects.
Insulin should be started in patients where ketosis or Diabetic Ketoacidosis (DKA) is present, those with a higher than normal blood sugar level (>250 mg/dl), or an A1C level above 8.5%, and in cases where it’s uncertain whether the patient has Type 1 or Type 2 diabetes. The dosage usually needed by Type 2 diabetes patients is higher than that for Type 1; they typically require 2 to 3 units per kilogram of body weight per day. The insulin should be overseen by a pediatric endocrinologist because usage carries a risk of hypoglycemia and requires careful monitoring.
It is also recommended that patients who are on insulin, not meeting their glucose control targets, changing their medications, or feeling unwell, monitor their glucose levels at home.
There is some difference of opinion between associations on the target levels for the Hemoglobin A1C test, which measures average blood sugar control over the past 3 months. The American Diabetes Association (ADA) and the AAP both recommend an A1C level below 7%, whereas the American Association of Clinical Endocrinologists recommends a target of under 6.5%.
What else can Pediatric Type 2 Diabetes be?
When trying to diagnose type 2 diabetes in children, doctors have to consider various other conditions that might show similar symptoms. These include:
- Uncommon forms of diabetes
- A type of diabetes that usually appears in young adults
- Diabetes caused by changes in the DNA
- Diseases affecting the pancreas, which produces insulin
- Diabetes caused by certain drugs or chemicals
- A serious complication of diabetes known as diabetic ketoacidosis
- Hormonal diseases
- Genetic conditions that affect insulin-producing cells
- Genetic conditions that affect how the body uses insulin
- Type 1 diabetes, another form of diabetes typically diagnosed in childhood
Careful evaluation and testing are necessary for determining the exact cause of the symptoms.
What to expect with Pediatric Type 2 Diabetes
There haven’t been any long-term outlook studies for type 2 diabetes in children. This outlook – the prognosis – is a big concern for medical experts, mainly because of the potential for serious complications later in life. With the right treatment, healthy lifestyle changes and regular check-ups, many kids and teenagers are able to manage their blood sugar well and lead healthy lives.
However, even though this condition can be managed, it can lead to significant health problems if not properly controlled. There’s a real and ongoing risk of complications like heart disease, kidney issues, and eye problems. The long-term outlook for kids with type 2 diabetes heavily depends on how well they follow their treatment plans, keep a healthy lifestyle, and get regular medical care.
Spotting the condition early, teaching kids and their families about it, and having strong support systems in place are all key to improving the outlook and cutting the risk of severe complications with type 2 diabetes in kids.
Possible Complications When Diagnosed with Pediatric Type 2 Diabetes
Kids with Type 2 Diabetes Mellitus (T2DM) often experience serious long-term complications. These health issues tend to appear earlier than they do in adults with the same disease. Research indicates that within ten years of developing the disease, these kids may face kidney complications, nerve damage, the need for dialysis, the risk of amputation, and even blindness. When compared to children without diabetes, those with the disease have almost 40 times greater risk of needing dialysis.
For adults with T2DM, they tend to have a shorter lifespan compared to people without the disease. However, because pediatric T2DM has only recently risen among the general population, there’s no current data on how T2DM impacts the life expectancy of these young patients.
Beyond that, data suggests that adults with T2DM are at higher risk of other complications including cancers and other issues not related to blood vessels. About a quarter of children with T2DM will develop high blood pressure, and little more than 20% will have a condition called albuminuria, which is an abnormal amount of a protein called albumin in the urine.
Common Health Risks Related To T2DM:
- Kidney complications
- Nerve damage
- Need for dialysis
- Risk of amputation
- Blindness
- Increased risk of cancers for adults
- High blood pressure for kids
- Albuminuria for kids
Preventing Pediatric Type 2 Diabetes
There’s a known link between type 2 diabetes in children (pediatric T2DM) and family history. However, there are other factors that can be controlled to help prevent this disease. These include obesity and a lack of physical exercise. Encouraging healthy eating, regular exercise, and weight control can greatly decrease the chances of a child developing this disease. Efforts from public health campaigns, school programs, and community initiatives to promote healthy lifestyles are crucial in preventing diabetes.
It’s really important to educate children and their caregivers about pediatric T2DM. They should understand why healthy diet choices and controlling food portions matter, and how regular exercise plays a critical role. Teaching kids how to test their own blood glucose and how to take medicines properly, if they’re needed, can also be useful. The education should be constant and fit the child’s age and understanding level.
When doctors include both prevention strategies and thorough education in their practice, health outcomes can improve and instances of pediatric T2DM can decrease. By giving children and their families the knowledge and tools to make healthy choices, the medical community can help ease the effects of this increasingly common health problem.