Many obese children and
adolescents have impaired glucose tolerance, a condition that often appears
before the development of type 2 diabetes, according to researchers funded by
the National Institutes of Health (NIH). The study findings appear in the March
14 issue of The New England Journal of Medicine.
"This study suggests that many obese children
have a high risk for developing type 2 diabetes," said HHS Secretary Tommy G.
Thompson. "Researchers have a lot of information on how to prevent and treat
type 2 diabetes in adults, but we need to find better ways to prevent and treat
the disease in children."
Once seen only in adults, type 2 diabetes has
been rising steadily in children, especially minority adolescents — African
Americans, Hispanic Americans, and Native Americans, according to reports from
clinics around the country. Although there are no national, population-based
data, studies in Cincinnati, Charleston, Los Angeles, San Antonio, and other
cities indicate that the percentage of children with newly diagnosed diabetes
who are classified as having type 2 diabetes has risen from less than 5 percent
before 1994 to 30-50 percent in subsequent years.
"These results strongly imply that intensive
efforts to reduce obesity in children and youth who have impaired glucose
tolerance will help to prevent their developing type 2 diabetes," said Duane
Alexander, M.D., Director of the National Institute of Child Health and Human
Development (NICHD). Both NICHD and the National Center for Research Resources (NCRR),
another NIH component, funded the study.
The scientists from Yale University School of
Medicine conducted their study to determine if obese children and teens have
impaired glucose tolerance, which, in adults is a known risk factor for type 2
diabetes. The researchers found that the children with impaired glucose
tolerance frequently had insulin resistance, a condition that usually precedes
type 2 diabetes in adults and is characterized by the inability of fat, muscle,
and liver cells to use insulin properly. Eventually, the insulin-producing cells
of the pancreas cannot keep up with the body's increasing demand for insulin,
glucose builds up in the blood, and type 2 diabetes begins.
"The epidemic of childhood obesity in the United
States has been accompanied by a marked increase in the frequency of type 2
diabetes," the study authors wrote.
The researchers tested for impaired glucose
tolerance in 55 obese children from 4 to 10 years of age, and 112 obese
adolescents from 11 to 18 years of age. In all, 25 percent of the children and
21 percent of the adolescents had impaired glucose tolerance. The researchers
also found that four of the adolescents in the study had silent type 2 diabetes,
a form of diabetes that doesn't cause any symptoms.
"Impaired glucose tolerance is highly prevalent
among children and adolescents with severe obesity, irrespective of ethnic
group," the researchers wrote.
The National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK), the part of the NIH with lead responsibility for
diabetes research, is funding clinical trials to prevent and treat type 2
diabetes in children. These studies, currently being planned for recruitment
next year, will try to develop ways to stem the rising rate of type 2 diabetes
in children and to treat the disease safely and effectively in those who do
develop it.
The prevention trials will focus on developing
cost-effective interventions that can be widely applied in schools and
communities across the country. "For children who already have type 2 diabetes,
it's critical to give the safest, most effective therapy as early as possible,
yet we can't assume that the therapies used in adults have the same safety and
efficacy profiles for children," said study chair Dr. Francine Kaufman,
president elect of the American Diabetes Association and director of the
Comprehensive Diabetes Center at the Children's Hospital of Los Angeles. Many
drugs are available to treat type 2 diabetes, but only metformin has been
explicitly approved by the Food and Drug Administration for the treatment of
type 2 diabetes in children.
Type 2 diabetes in children, as in adults, is closely linked to obesity, a sedentary lifestyle, and a family history of diabetes. The prevalence of obesity has nearly tripled in adolescents in the past 20 years. According to The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, 13 percent of children 6 to 11 years old and 14 percent of adolescents 12 to 19 years old in the United States were overweight in 1999. Overweight children are at increased risk of developing type 2 diabetes during childhood and later in life. Genetic susceptibility as well as lack of physical activity and unhealthy eating patterns all play important roles in determining a child's weight. They also contribute to a child's risk for type 2 diabetes and other complications of overweight.
Source: Diabetes In Control Dot Com.
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