Rising obesity leads to a surge in type-2 diabetes in children

Karan's parents were worried about the excess weight he gained during the COVID pandemic. After the weighing scale crossed the 90 kg mark, they thought it was enough, and something had to be done. They decided Karan should undergo a health check-up. The sixteen-year-old didn't understand his parents' fuss about it because he didn't feel sick. The results of the tests, however, were shocking to his parents, as they showed a fasting glucose of 180 mg/dL (normal < 100 mg/dL) and glycosylated haemoglobin (HbA1c which indicates past 3 months of sugar control) was 8.7% (normal is < 5.7%). This meant that Karan had developed diabetes at a young age.

A few decades ago, diabetes in children meant insulin-dependent diabetes (now known as type 1 diabetes), an autoimmune disease leading to insulin deficiency. However, along with the surge of obesity among children in the past couple of decades, there has been an increase in childhood-onset type 2 diabetes, the most common type of diabetes in adults. The ICMR- INDIAB study has documented a decline in the age of onset of type 2 diabetes. So, a grandfather, father, and child present at a diabetes clinic with the same condition is not uncommon these days. About 6-8% of children under eighteen who develop diabetes have type 2 diabetes. It is estimated that by 2025, India may have 0.3 million children affected by this chronic condition.

What is type 2 diabetes?

Type 2 diabetes is a condition that occurs when the body needs to produce higher amounts of insulin due to obesity or genetic factors. It results in difficulty controlling blood sugar as the pancreas fails to produce the required insulin. This situation is like an overworked employee unable to complete his work. In type 1 diabetes, the pancreas's insulin-producing cells are destroyed by the body's immune system, leading to an absolute deficiency of insulin (like the missing key).

What are some symptoms of diabetes in children?

Typical symptoms of diabetes in children are excess urination (polyuria), excessive thirst (polydipsia), and weight loss despite eating normal or more than the normal amount of food (polyphagia). Sometimes diabetes can present with recurrent skin infections, styes (eyelid inflammation), or urinary infections. It is important to note that nearly half of the cases of type 2 diabetes may not have any of these symptoms and may be diagnosed only during a routine health check. Hence screening for diabetes is important for those with risk factors like obesity and family history.

Typically, type 2 diabetes is diagnosed during or after puberty. Most childhood type 2 diabetes cases are seen in overweight or obese children with one, or both parents affected with type 2 diabetes. Other signs of insulin resistance like acanthosis (dark discolouration of the neck, underarms, and other skin folds) or polycystic ovary syndrome (PCOS) are usually present. Other complications of obesity, like high cholesterol, high blood pressure, and fatty liver, are invariably present in these children.

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How is it different from type 1 diabetes?

Since type 1 diabetes has an absolute deficiency of insulin, it must be treated with insulin. No oral or alternative medications can be helpful in this situation. However, in type 2 diabetes, oral or injectable medications other than insulin can help the body's insulin work better. Several children may need insulin treatment at the time of diagnosis, particularly if blood sugar is very high or insulin deficiency is severe.

Is type-2 diabetes good news or bad news?

Childhood-onset type 2 diabetes is an aggressive disease with an early onset of complications and a higher risk of heart problems. It is often accompanied by other risk factors like high blood pressure, high cholesterol, and fatty liver. Given similar levels of control, type 2 diabetes has a higher risk of diabetes complications than type 1 diabetes in children. Psychological issues and poor adherence to treatment are very common, adding to the difficulties in managing this condition. An increasing number of type 2 diabetes patients in their youth also presents a poor outcome for the community and nation as it can lead to an unhealthy young workforce.

How is type-2 diabetes treated?

It is important to consult a paediatric endocrinologist or an endocrinologist as soon as a child is diagnosed with diabetes. In addition to diet and lifestyle modification, medications are necessary for childhood-onset type 2 diabetes. Very high blood sugar or those presenting with ketones (a type of acid produced in the presence of insulin deficiency) may need insulin in the initial few months of treatment. Metformin is a medicine that helps insulin work better and is the backbone of treatment. In some obese children, liraglutide, an injection that helps in weight loss and blood sugar control, may be necessary. Several other medications used for adults may be used in selected cases under expert guidance. Rarely, weight loss surgeries may be needed if other serious complications of obesity are also present.

How can type-2 diabetes be prevented?

Type 2 diabetes can be prevented by preventing obesity. Taking care of the mother's nutrition during pregnancy, exclusive breastfeeding of an infant in the first 6 months and timely and appropriate introduction of homemade solid food are some initial steps. Reducing foods high in sugars (like cold drinks, juices, and jam), refined carbs (cookies, white bread, noodles, momos, etc.), processed foods, high calorie, salted, and oily snacks are essential. So is the habit of regular exercise and reducing screen time.

Obesity should be diagnosed in time, and the help of a dietitian experienced in childhood obesity should be taken if ongoing weight gain is present. Obese children should be screened for diabetes by regular blood sugar testing, especially if one or both parents have a history of diabetes.

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