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    Puberty As Trigger for Type 2 Diabetes

    Researchers reported a year ago that type 2 diabetes -- the type that usually only affects adults -- is fast becoming an epidemic among children, particularly African-American and Latino adolescents, due to genetics and environmental factors such as sedentary lifestyle and poor diet. New research now suggests that some children have pre-diabetes symptoms as early as age five and may develop full-blown type 2 diabetes when they hit puberty.

    In two separate studies that compared blood glucose levels in healthy (normal weight) black children and non-Hispanic white children, Silva A. Arslanian, M.D., professor of pediatrics at the University of Pittsburgh School of Medicine, found that African-American children with a strong family history of type 2 diabetes had partial insulin resistance even before age 10. Insulin resistance means that the body is unable to absorb blood sugar. This is the difference between type 2 diabetes and type 1 diabetes, which is caused by a deficiency in insulin production. Type 1 is the kind that was previously associated with childhood.

    Speaking at the American Diabetes Association's 60th Annual Scientific Sessions in San Antonio, Dr. Arslanian noted a correlation between the rise in obesity and the advent of type 2 diabetes in children. The National Health Study, for example, reported that from 1960 to 1990, obesity rose 69 percent in African-American boys and 96 percent in African-American girls, with super obesity up 122 percent among the girls. "Research shows that as body mass index (BMI) increases, so does insulin resistance," she said. Dr. Arslanian pointed out that the preponderance of type 2 diabetes cases in adolescents is among African American and Latino children who are very obese and have a family history of diabetes. Type and location of body fat also appears to be a predictor of type 2 diabetes in children: those with excessive adipose fat tissue in the abdominal area had the greatest risk for developing the disease.

    Arslanian noted that several studies have reported a 100 percent increase in the disease among these two groups of children in some regions of the country. "A few years back, it would be unheard of for a pediatrician to be discussing type 2 diabetes. This is a disease in its infancy," she stressed, adding that it's still unclear how many children actually have type 2 diabetes because physicians are having difficulty distinguishing between the two types, which manifest with similar symptoms. Noting that puberty appears to trigger the disease at about age 13, Arslanian suggested: "Only time will help in making a diagnosis because the future will prove if the child has transient dependence on insulin." According to Arslanian, type 2 diabetes appears in children in their teens and disappears when puberty is completed. However, these children are at increased risk for developing the disease later in life.

    Although diet and exercise might control type 2 diabetes in children, Ken Jones, M.D., professor of pediatrics at the University of California San Diego School of Medicine, says that this treatment approach usually doesn't work in the average "free-range adolescent" -- those without constant adult supervision. Without total adult control, such as the control a child would get in a group home, it's unlikely that the teen will permanently alter diet and activity enough to improve insulin absorption. Therefore, the majority of children with type 2 diabetes require medication, said Dr. Jones.

    Until recently, insulin injection was the only effective treatment for children with any form of diabetes. However, Metformin, an oral anti-diabetic agent used in adults for sometime, recently was proven effective for treating children with type 2 diabetes. Jones, who headed the clinical trials, says that 90 percent of children with type 2 diabetes responded to this alternative therapy alone or Metformin in conjunction with sulfonylurea therapy to stimulate insulin secretion. Metformin works by improving the body's ability to absorb insulin.

    But the real message here is that this form of diabetes is preventable. While some children may be at higher risk for developing the disease than others, environmental factors appear to be what's tipping the scales. "There needs to be a decrease in sedentary activity," emphasized Jones. "I'm not suggesting we encourage overweight kids to run marathons. But we do need to get them out from in front of the television and computer."



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