New data suggests a stark rise in the prevalence of Type 2 Diabetes in children. The study, which was published in the Journal of the American Medical Association (JAMA), found a 35 percent increase in Type 2 Diabetes between 2001 and 2009 amongst youth ages 10-19*. The authors go on to project that without significant changes in the factors that underlie the development of the disease, the number of adolescents with Type 2 Diabetes is likely to increase fourfold by 2050. While this report is disconcerting, sadly it is not surprising.
Type 2 diabetes is a chronic condition that impacts how the body metabolizes sugar. Individuals with the disease either resist the effect of insulin (a hormone that controls the amount of sugar in cells) or do not produce enough insulin to sustain a normal blood sugar. While there may be a genetic component involved, lifestyle risk factors -- mainly diet, physical activity, and subsequent body mass index (BMI) -- are significant determinants to the onset of Type 2 diabetes. Historically, the disease only manifested after years of compounding poor health behaviors, hence its former name "Adult Onset Diabetes." Unfortunately, the JAMA study confirms that today's youth are also susceptible.
How could it be that a disease once requiring a lifetime of questionable health behaviors is now presenting in children who are just 10 years old? The answer becomes clear upon evaluating trends in the critical risk factors amongst youth.
Caloric intake has increased by approximately 240 calories per day over the last 40 years. Unfortunately, this rise is not attributed to high-quality foods (i.e., fruits, vegetables, whole grains), but rather, to the consumption of refined grains, added sugars, and added fats and oils. While this data is at the population level, it is unlikely that a sample examining just children would be any different. At the same time, physical activity rates amongst youth have decreased, with only 30 percent of adolescents currently meeting CDC guidelines for physical activity. Many reasons underlie declining physical activity in youth, ranging from issues with neighborhood safety (i.e., crime and vehicular traffic), to urban density (and subsequent reductions in green space), to the substitution of what was once active time with screen-based entertainment.
As a result of this dangerous combination (i.e., more calories and less physical activity), childhood obesity rates have risen from 5 percent to 17 percent since 1970. Against this backdrop, the incidence of Type 2 diabetes in youth is hardly surprising, but that does not mean it should be accepted.
Treating this problem successfully requires going far beyond the bricks and mortar of the clinic. Public health advocates must push policy makers to craft legislation that targets the primary causes behind the growth of Type 2 diabetes in youth. Examples include:
- Restrictions on junk food marketing to youth
- More stringent requirements for comprehensive physical activity programs in the K-12 education system
- Revisiting K-12 health curriculum and considering a more extensive focus on nutrition
- Raising the minimum nutrition standards for school lunches
In addition, health care systems should partner with community organizations to create other (non-legislative) solutions that address the risk factors for Type 2 diabetes in youth. Moreover, successful pre-diabetes prevention programs should be customized for and implemented in at-risk youth where early intervention can halt the development of the disease.
The increase of Type 2 diabetes in youth should be received as nothing less than a public health crisis. Thankfully, there are numerous levers that can be pulled to reverse this trend. It would be a costly failure of public health and public policy if the diagnosis and treatment of Type 2 diabetes were to become standard practice in pediatrics.
*Note: The study's authors explicitly state that there was little change in how clinicians diagnose the disease during the research window, meaning the increased incidence cannot be explained by new methods of diagnosis.