Type 2 Diabetes Epidemic
In Children Coming
By Suzanne Rostler
NEW YORK (Reuters Health) - Imagine that you are an overweight child who is diagnosed with a disease that will guarantee a premature death in middle age. Over the years, you might develop heart disease or kidney failure. Arterial disease may cost you your sight, or a limb.
Now, suppose that you could avoid these problems by replacing your favorite high-fat, sugary snacks with foods like apples, bananas and low-fat yogurt, and exercising regularly to maintain a normal weight.
This is a very real scenario for the increasing number of American children diagnosed with type 2 diabetes. The rise in type 2 diabetes cases in young people has led experts to label the disease an emerging epidemic.
Until recently, the disorder was known as adult-onset diabetes because it occurred mostly in men and women over age 50. Type 1 diabetes, which requires insulin treatment, was thought to be the only form of the disease that occurred in children and adolescents. But the past 20 years has seen a steady rise in the number of children and adolescents who are diagnosed with type 2 diabetes, interviews with medical experts reveal.
``If you go back 20 years, about 2% of all cases of new onset diabetes (type 2) were in people between 9 and 19 years old. Now, it's about 30% to 50%,'' noted Dr. Gerald Bernstein, a past president of the American Diabetes Association (ADA) and an endocrinologist with Beth Israel Medical Center in New York City.
Health experts blame the trend on burgeoning rates of obesity among children and adolescents during the past three decades.
The trend has profound implications for the long-term health of America as many children go undiagnosed. While more and more young people are showing up in their doctor's offices with symptoms, it still does not occur to many physicians to run a diagnostic blood test, since the disease is still considered rare among children. But because symptoms can only be controlled after a diagnosis is made, many children are at risk for serious medical complications.
Among adults, diabetes is the leading cause of blindness, kidney failure, limb loss, a major cause of heart disease and the sixth leading cause of death, Bernstein said. ``All of this is preventable if you control blood sugar, but in order to do that you have to know that the disease is present.''
For instance, a boy who develops type 2 diabetes in his teens and is left untreated will have problems with his eyes, kidneys, lower extremities and heart by the time he reaches his early 30s.
Indeed, the emerging epidemic of type 2 diabetes among children reflects a trend in the population at large. Last month, the Centers for Disease Control and Prevention (CDC) issued a report chronicling a 70% rise in the number of 30- to 39-year-old adults with the disorder between 1990-1998. Over the same period, rates of the disease rose by 40% among those aged 40 to 49, and by 31% among those aged 50 to 59, according to the report.
Problems have been simmering for decades as Americans have continued to put on weight. Researchers estimate that nearly half of all adults are overweight and nearly one-fifth are obese, or at least 30 pounds overweight.
Likewise, about 11% of the nation's 6- to 17-year-olds were overweight in 1998, compared with about 5% in 1970. As young people continue to gobble up sweets and fatty foods, researchers expect to see type 2 diabetes more frequently in children.
Other risk factors besides obesity include race, ethnicity and low socioeconomic status. Blacks, Hispanics and Native Americans are at greater risk than whites, partially due to greater consumption of processed foods. Research has also shown that these populations may be genetically predisposed to obesity due to slower metabolisms, a trait that has evolved over thousands of years.
While there is no cure for diabetes, diet and exercise are often enough to control the disease and prevent complications.
``Diet and exercise are keystones to treatment,'' Dr. Michael M. Engelgau, a medical epidemiologist with the CDC's division of diabetes, said. ``In some cases, it may be all that's needed.''
Ostensibly, diet and exercise are crucial to weight loss. But studies have also shown that exercise can help to stabilize blood glucose, the primary goal of diabetes treatment, and make the cells more responsive to insulin. Obesity and inactivity appear to increase the cells' resistance to insulin.
But while a thrifty metabolism is useful when there is little food to go around--as in prehistoric times--it is a recipe for chronic disease in modern-day America, where there is enough food to provide each person with about 3,800 calories a day, said Dr. Marion Nestle, director of the department of Nutrition and Food Studies at New York University. Most adults, she said, need between 2,000 to 2,500 calories a day to survive.
``The surplus makes the food system competitive and food companies must sell food by getting people to eat more...or seek new audiences for their products--i.e., children,'' Nestle said. ``That's why marketing to children has become so fierce. The pressure to eat more and often fosters obesity; obesity fosters diabetes.''
Health experts suggest the only way to reverse the trend and avoid the medical complications and healthcare costs is to put America's kids on a diet and encourage physical activity. According to Dr. Arlan Rosenbloom, a pediatric endocrinologist in Gainesville, Florida, diet and exercise could reduce the rate of type 2 diabetes in children by 60% to 80%.
That prescription could be difficult to fill in a country that does not seem to value physical education in the schools. According to a recent report, only 25% of US public schools require students to take physical education class, down from 42% in 1991. In addition, many have canceled after-school activities at a time when they are needed the most.
``Physical education needs to be mandatory and fun,'' Rosenbloom said. ``We need after-school programs for non-athletes, a much greater investment in group physical activity, and we need to encourage families. That's where churches and community centers come in.''
These initiatives, he said, are investments in the future health of America's youth.
In addition to boosting health, such initiatives could save considerable amounts of healthcare dollars. The CDC put the annual cost of treating diabetes (90%-95% of people with diabetes have type 2, with type 1 diabetes accounting for the remainder) at $98 billion in 1997, the latest year for which data are available. Those costs include doctor visits, medications and hospitalization in addition to indirect costs such as short-term disability and premature death.
Bernstein estimates that over the next 25 years, the number of Americans with diabetes will rise to 50 million from the current 16 million. The cost of treating people with diabetes will amount to about $1 trillion annually, with patients with type 2 diabetes accounting for the bulk of these costs, he said.
``Children are simply one part of it,'' the diabetes expert said.

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