Children and Adolescents Diagnosed with Type 2 Diabetes Mellitus
Type 2 diabetes has been traditionally considered a disease that affects adults over age 40, however, it is now becoming more prevalent among children and teenagers. Until recently, type 2 diabetes accounted for two percent to three percent of all children diagnosed with diabetes mellitus in North America (Glaser, 1997). Over the past five years there has been a ten-fold increase in children under age 18 diagnosed with type 2 diabetes (Buck, 1999).
Currently, of all newly diagnosed cases of type 2 diabetes within the United States, between eight to 46 percent are children under age 18. This wide range of youth diagnosed with type 2 diabetes reflects the unequal distribution among the various ethnic groups who exhibit this condition (Libman & Arslanian, 1999). In addition, current percentage estimates of newly diagnosed children and adolescents with type 2 diabetes have been extrapolated from existing studies examining specific populations with this disease (Sones, 2001). For example, the Pima Indian youth of Arizona reportedly have the highest rates of type 2 diabetes in the world. The current prevalence of type 2 diabetes among Pima Indian youth within the 15-to-19-year age group is 51 per 1,000 compared to a prevalence of 4.5 per 1,000 for all U.S. American Indian populations. The prevalence of type 2 diabetes among youth from other ethnic groups within the U.S. has not been extensively researched and population-based prevalence estimates are currently unavailable (Centers for Disease Control and Prevention, 2002). Recent studies, however, indicate that the populations most at risk for type 2 diabetes include American and Canadian Indians, African-Americans, Pacific Islanders, Hispanics, Japanese, and Asian Indians (Ehtisham, Barrett, & Shaw, 2000). State and county statistics documenting the prevalence of type 2 diabetes in youth within California are also unavailable.
While the epidemiology, pathophysiology, and medical management of type 2 diabetes in adults has been extensively studied, very little is known about the disease in children. In adulthood, type 2 diabetes is associated with genetic, environmental and lifestyle risk factors such as obesity, high energy consumption, and low levels of physical activity (Pinhas-Hamiel et al., 1999). In childhood, however, the particular risk factors and characteristics associated with type 2 diabetes are just beginning to be identified.
The majority of children diagnosed with type 2 diabetes display certain traits and characteristics that differ from a diagnosis of type 1 diabetes. Children diagnosed with type 1 diabetes are typically of normal weight, do not have a family history of diabetes, rarely present with acanthosis nigricans, are dependent on insulin for survival, and are predominantly Caucasian (Libman & Arslanian, 1999). Current literature suggests that most youth diagnosed with type 2 diabetes are in middle to late puberty, are overweight or obese, have a strong family history of type 2 diabetes, and demonstrate signs of insulin resistance and hyperinsulinemia manifested either as acanthosis nigricans (AN), a cutaneous skin condition, polycystic ovarian syndrome (PCOS), or hirsutism (Beck et al., 2001; Glaser, 1997; Libman & Arslanian, 1999; Scott, Smith, Cradock, & Pihoker, 1997; Treviño, Marshall Jr, & Hale, 1999). Early identification of the characteristics and diabetes risk factors among children and adolescents may lead to early detection of diabetes and help delay the onset of this life-long disease.