DIABETES in very young children

NOT too long ago, certain lifestyle diseases were only associated with adults, but a lot has changed in recent times. Now more than ever, children are developing diabetes, hypertension and high cholesterol levels, which will impact them for life.

Last week the international press reported that a three-yearold who tipped the scales at 35 kilograms (77 pounds) had become one of the youngest people ever diagnosed with a lifestyle-related form of diabetes that strikes adults.

Weighing as much as an average 11-year-old, and double the average for her own age, the toddler was brought to a paediatric clinic in Texas to examine her weight gain as well as excessive urination and thirst — classic symptoms of diabetes.

AFP reported that the girl tested negative for an array of conditions including type 1 diabetes — a chronic illness which is usually diagnosed in children and requires lifelong insulin therapy. She was instead diagnosed with type 2 diabetes, a much more common form of the disease that affects adults.

Lifestyle factors such as a lack of exercise and being overweight are believed to be contributing factors for type 2 diabetes, which until a few years ago was almost unheard of in people under 30. The girl had been born at a normal weight of 3.2 kilograms.

“A review of the child’s diet revealed poor family nutritional habits, with uncontrolled counting of calories and fat,” said a statement issued by the European Association for the Study of Diabetes. The case study was presented at the association’s annual meeting in Stockholm.

The girl’s doctor, Michael Yafi of the University of Texas, said the incidence of type 2 diabetes “has increased dramatically worldwide in children due to the epidemic of child obesity”. “Clinicians should be aware of the possibility of type 2 diabetes even in very young obese children,” he said.

Unlike type 1 diabetes, type 2 can be easily managed through diet, exercise and medicine, and the sooner the intervention, the better, he said. In this case, the girl was given a daily dose of a diabetes medicine, then put on a diet and exercise regimen. Doctors have been warning of children being diagnosed with type 2 diabetes at increasingly younger ages.

Most of them are overweight. This girl, was “thought to be one of the youngest ever people to present with the condition,” said the statement. Over time, diabetes can cause damage to the heart, blood vessels, eyes, kidneys and nerves, according to the World Health Organization, and increases the risk of heart attack and stroke.

Many patients lose limbs through nerve damage and reduced blood flow. Dr Jomo James, internist, said type two diabetes is usually characterised by high glucose level in the blood as a result of mainly non-functioning insulin or impairment in its secretion as opposed to type one where insulin is deficient or absent.

He said preconditions for higher risk include obesity — for which childhood occurrences have soared; positive family history; being female; genetic susceptibility and ethnicity — native Americans, blacks and Hispanics.

Of note, Dr James said there are many implications for a child or young adult who develops type two diabetes, explaining that these are mainly physiological, psychological and economic. “The physiological are the most consequential. Diabetes can have profound effects on the body in the short and long term.

The short-term complications relate to high glucose levels in the blood which can quickly lead to coma and death if not treated,” he said. “Long-term complications are effects on the blood vessels to major organs leading to premature strokes, heart attacks, renal failure and poor circulation in the legs.

The blood vessels in the eyes can be affected as well, leading to blindness.” He said diabetes is associated with other attending comorbidities that go hand-in- hand, so there is an increased risk for high blood pressure and high cholesterol. Additionally, Dr James said psychologically the burden of having a chronic disease, particularly when young, can be overwhelming.

“There are increased rates of depression in adolescents, and failure to adhere to treatment protocols and medications is very high,” he explained. With regards to the economic burden, he said missed school can limit a child’s eventual employment marketability and prospects, which further lowers their quality of life.

Treatment also involves the parent who must pay due diligence,” he said. He pointed to a programme called the Diabetes Self- Management Education and Support (DSME) that provides the framework and information for preparing a family to take responsibility for their child’s diabetes care.

It facilitates the transition to self-care as the child matures and it is a comprehensive education and counselling tool. He said through proper lifestyle adjustment, weight loss, diet and exercise, the need for medication can be lessened or not acquired at all.