Diabetes in Adolescents

Childhood obesity & diabetes have been linked by many studies; a paper published in Diabetes Care in 2011 by Ebe D’Adamo & Sonia Capro, titled Type 2 Diabetes in Youth: Epidemiology & Pathophysiology, is one of the more recent papers to have been written on the subject. The authors highlight the fact that the progression of obese children with insulin resistance to type 2 diabetes (T2DM) is faster than what’s seen in adults; this is made even more pertinent by the knowledge T2DM occurs more frequently in the second decade of life, coinciding with pubertal insulin resistance.

The knowledge of the occurrence of T2DM in adolescents has been quite recent; previously, the diagnoses of young people with diabetes were almost type 1 diabetes (insulin dependent diabetes). However, there has been a steady increase in the incidence of T2DM in children over the past few years, and this is mainly due to the concurrent rise in the incidence of childhood obesity seen in many urbanized countries.

South Asia, with its fast rate of development and urbanization, is now grappling with T2DM, similar to developed countries like the United States. The increase in childhood obesity in South Asia has been linked as a causal factor for this increased incidence of T2DM. A news article, published on 26th February 2012, in the Sunday Times (Sri Lanka) said that “one in four urban adolescents” had a high risk of developing diabetes. At that time, Dr. Mahen Wijesuriya, was carrying out a clinical trial, called DIABRISK-SL, to assess the efficacy of intensive lifestyle modification therapy in the young urban Sri Lankans. The patients for this study were screened on 4 risk factors: increased body mass index (BMI), increased waist circumference (WC), reduced physical activity and family history. The results were surprising: 24% of adolescents in the age group 10-14 had two or more risk factors for the development of T2DM. The study highlighted the lack of information with regards to diabetes, especially in the young population of Sri Lanka, seeing as 3 of the risk factors were modifiable risk factors, while the subject’s family history was not.

As per the recent Diabetes Atlas, available online from the International Diabetes Federation (http://www.idf.org/diabetesatlas), even though South East Asia has the lowest diabetes related expenditure in the world (mainly due to the public health sector), the region also has the highest mortality rate across the regions; Sri Lanka is the third highest country for number of people with diabetes.

With the World Diabetes Day coming up next week (November 14th) it is of great importance to realize that reducing childhood obesity can prevent the onset of diabetes in adolescents. This can be achieved with lifestyle modification, e.g. reduction in the intake of fast food and an increase in the amount of daily physical activity (to mention a few). This can only be achieved if more and more parents are educated and informed of the risk factors for adolescent T2DM and how to prevent them. It is also pertinent to educate parents about how to look for signs of diabetes and the importance of diagnosing diabetes early. However, a diagnosis of diabetes in your child does not mean that it is too late; control of the disease also involves eating well, regular exercise, taking medication regularly and routine care. With proper guidance & counseling, living with diabetes is made easy for the patient and immediate family members.

Intervention for pediatric diabetes is also gaining traction; there are many studies being carried out to assess new interventions with regards to controlling diabetes, aimed at increasing the efficacy of the intervention along with reducing unwanted side effects. RemediumOne is currently contracted with managing two pediatric (10-17 years) studies that assess the efficacy of a combination therapy compared to metformin monotherapy in the treatment of T2DM. These studies also have a lifestyle modification component for the patient, where they are advised by endocrinologists on how to change their diet & exercise regime to better cope with diabetes.