Once believed to afflict mainly older adults, type 2 diabetes is being diagnosed in children at such an alarming rate that the disease has shed its alternate name — adult-onset diabetes. It's now a disease of childhood too.

According to the results from the national research study Treatment Options for type 2 Diabetes in Adolescents & Youth (TODAY), children who develop type 2 diabetes risk developing heart, kidney, and eye problems faster and at higher rates than adults who develop type 2 diabetes.

Pediatricians in the School of Medicine at the University of Texas Health Science Center randomized 699 adolescents into three treatment groups. One group received first-line diabetes drug metformin (Glucophage), a second group took a commonly prescribed combination of metformin and rosiglitazone (Avandia), and the third was given metformin together with an intensive lifestyle intervention. The intensive lifestyle intervention consisted of a regimen of focused exercise and diet modification, as well as weight reduction among overweight individuals.

The researchers found that the children in the combined medication groups did better, but all groups experienced a functional decline in beta cells — the cells responsible for storing and releasing insulin. Whereas adults showed a yearly decline of 7-11 percent, children experenced a 20-35 percent decline in function.

Boys and girls developed kidney disease at almost the same rates, but boys were 81 percent more likely to develop hypertension. A third of participants needed medication to treat hypertension or kidney disease as soon as 3.9 years after joining the study. 

The children kept getting sicker, despite having relatively normal blood pressure, receiving the best possible care, education, and medical support.

"What's especially challenging for these children is that many also develop fatty liver, which limits our use of the drugs that control hypertension," Dr. Jane Lynch, a professor of pediatric endocrinology at the School of Medicine and principal investigator, said.

The results of the intensive lifestyle intervention group were especially disappointing for the researchers because the rise in type 2 diabetes among children has been linked to the obesity epidemic across the country.

"It's really a public health issue," Lynch said.

She also pointed out that children and young people with type 2 diabetes already have a hard time dealing with other health problems.

"In puberty, everyone becomes somewhat insulin-resistant," she said. "And when you're insulin-resistant you're hungry, plus when you have diabetes you're thirsty. This becomes a huge issue when there's the tendency to make poor choices."

According to the U.S. Centers for Disease Control and Prevention, there are around 151,000 people below the age of 20 with diabetes, and 8 to 46 percent of these adolescents have type 2. Type 2 diabetes occurs as the body gradually becomes resistant to insulin, the hormone that allows cells to process glucose. Simultaneously, the pancreas gradually loses its ability to produce insulin as well. The prevalance of type 2 diabetes in children is driven primarily by the same lifestyle factors that contribute to obesity, as well as exposure to diabetes in utero.

Researchers will monitor participating children for the next 10 to 15 years, in order to develop better ways to prevent the disease, predict complications, and to evaluate long-term outcomes.

The study was published in the journal Diabetes Care.

 

Source: TODAY Study Group. Rapid Rise in Hypertension and Nephropathy in Youth With Type 2 Diabetes: The TODAY clinical trial. Diabetes Care. June 2013.