The overall prevalence of type 2 diabetes has increased 5-fold in the United States since the 1960s, and children and adolescents are among those affected. However, children often exhibit no symptoms. Therefore, physicians need to be alert for this disease in children and open to the possibility that patients in their 20s might be suffering from the long-term complications of preexisting type 2 disease.
Although many children are at risk for type 2 diabetes, currently "we have rather poor information on its prevalence in the United States," said Peter H. Bennett, MB, from the Phoenix, Arizona, research branch of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health. Scientists first identified type 2 (formerly "adult onset") diabetes among the Pima Indians in the mid-1960s. In a recent survey, approximately 20% of the diabetes diagnosed by physicians in Pima Indians younger than 20 years was type 2. "We’ll have more definitive information fairly shortly" about national prevalence, Dr. Bennett told the audience.
"One of the difficulties — still — is in making the clinical decision of whether a child has type 1 or type 2 diabetes," Dr. Bennett explained. There are several characteristics that differentiate the two. Dr. Bennett reported that among the Pima, 92% of children with type 2 diabetes also had a family history of type 2 disease, most often in the mother. Other features include obesity (body mass index of 30 kg/m2 or greater), (68%), being asymptomatic (78%), and ketoacidosis (about 10%). These children and adolescents are not insulin-dependent and may stay that way for years, he said. They are also glutamic acid decarboxylase (GAD) antibody– and islet cell antibody (ICA)–negative.
Acanthosis nigricans has received attention as a type 2 diabetes sign, but Dr. Bennett noted that this dermatologic condition may simply indicate increased insulin resistance. He emphasized that children with type 1 diabetes do have symptoms, while those with type 2 usually do not. Hispanic children, African-American children, and those of Polynesian heritage also seem more vulnerable to developing type 2 diabetes than white children, although obesity and being female clearly increase the risk in all ethnic groups, he said.
Surprisingly, "breast-feeding is protective" against type 2 diabetes, Dr. Bennett said. Pima Indian children who are breast-fed for at least 2 months are 40% less likely to develop the disease, and this protective effect has been confirmed by studies among Aboriginal Canadians. There also appears to be a dose-response relationship, with more protection conferred to children who were breast-fed longer.
Presented April 14, 2007. AACE 16th Annual Meeting and Clinical Congress: General Session