BOSTON (AP) -- Once a true medical oddity, children with adult diabetes are becoming commonplace in the United States. Doctors blame the twin evils of too much food and too little exercise and fear a tragic upswing in disastrous diabetic complications as this overweight generation reaches adulthood.

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April 15, 2003

By Robert H. Shmerling, M.D.
Harvard Medical School

How does this article relate to me?

This article points out an important and troubling rise in diabetes among children in this country. It is reflected in the type of patients seen by diabetes specialists and even by the names doctors use when diagnosing and treating the condition. In fact, the title of this news item includes the term "adult diabetes," a term that doctors have largely abandoned. These developments follow directly from an even more important and troubling rise in obesity among children, a trend that demands the attention not only of kids, but of their parents and health-care providers as well.

During my medical training, I was taught that there were two types of diabetes: juvenile-onset and adult-onset. These names indicated not only when the disease started but also how it developed. In kids, most cases were due to too little insulin production by the pancreas, probably as a result of the immune system mistakenly attacking the insulin-producing cells — an autoimmune mechanism. This condition was also called "type 1" or "insulin-dependent" diabetes because these kids uniformly required insulin injections.

Adult-onset disease, on the other hand, was not so much due to too little insulin but by the body's resistance to its effects. The major cause of insulin resistance is obesity — patients might or might not need insulin treatment, but they were nearly always overweight. This adult form, also called type 2 diabetes, often could be treated with diet, weight loss and pills rather than routinely requiring insulin treatment.

We still call diabetes type 1(for the autoimmune form, with too little insulin in the body) and type 2 (for those with obesity and insulin resistance) but in recent years, so many kids are showing up with type 2 diabetes that it made little sense to hold on to the "adult-onset" label.

What changes do I need to make?

First and foremost, the factors contributing to obesity in children should be identified and modified. Not surprisingly, all indications point to the same factors that contribute to obesity in adults: poor dietary habits and lack of exercise. While getting kids to improve their diet and to exercise more may not be easy, it must be a priority if we are to reduce the adverse effects of obesity on the health of our children. In addition to diabetes and its complications, the risk of other health problems including arthritis and heart disease may rise as well, unless the observed trends in childhood obesity are reversed.

Talk with your children about diet and exercise and be a role model for them. Avoid fattening junk food in the house and limit time watching television, playing video games and or at the computer (unless it's for schoolwork). Encourage outdoor activities or join a community center or health club that encourages family memberships.

Finally, change how you think about diabetes. It is not always associated with obesity and it is not necessarily caused by eating sweets (although once the disease is present, the intake of sweets should be reduced). Learn more about the latest approaches to treatment, as several medications have been approved only in recent years.

What can I expect in the future?

It is not yet clear what the rising rate of type 2 diabetes among overweight children will mean to their future health. While newly diagnosed adults in their 50s and 60s may live with the disease for 30 years or so, children with type 2 diabetes have more time to develop complications (such as blindness, kidney disease or cardiovascular problems) but also more time to make changes to prevent these complications. You can also expect new recommendations from health-care providers. For example, testing for diabetes may become a more common practice among pediatricians over time.

You will hear much more about the epidemic of obesity in this country, including its rise among children. As researchers study the health effects of obesity in kids, it is likely that more bad news lies ahead. On the other hand, programs to encourage exercise and better dietary choices are also likely to be developed now that the magnitude of the problem has been so clearly described.

Related Areas:

Diabetes
Children’s Health
Fitness