Type 2 Diabetes in America

As we know, America today has become more and more obese. Americans are eating more calories a day than ever before. With increased calorie consumption there is increased carbohydrate consumption. This increased carbohydrate consumption has led to an increase in diabetes in not only adults but children and adolescences as well. Previously type 2 diabetes was very uncommon in children but with the recent increase in calorie intake it has become more prevalent. Type 2 diabetes is preventable.

Type 2 diabetes is a condition that can develop at any age.

It is a Chronic condition of elevated blood glucose levels in the blood. For a person with type 2 diabetes the either cannot produce enough insulin or the body can no longer respond to insulin. This is called insulin resistance. Type 2 diabetes in children has grown significantly over the past two decades. As of 2017, 8.3% of the population is living with type 2 diabetes with over 19,000 cases of type 2 diabetes in children and adolescents. This is up from 5,300 children and adolescences in 2010 and 2011. The criteria for the diagnosis of type 2 diabetes is the same for children, adolescence and adults. It the presence of key symptoms the diagnosis focuses on blood glucose levels. Some blood glucose levels that indicate type 2 diabetes are A1C levels greater than 6.5%, fasting plasma glucose greater than 126 mg/dL, 2-hour plasma glucose levels greater than 200 mg/dL and random plasma glucose levels greater than 200 mg/dL.

It is believed that there are many causes of type 2 diabetes including genetic and obesity. There are more children overweight today than ever before. In the united states 17% or 12.7 million children and adolescents aged 2-19 are overweight or obese with a BMI above the 95 percentiles. Along with being overweight or obese, visceral fat is most predictive of insulin resistance. to measure visceral fat, you would use a CT scan, but because this is not practical on a large scale, techniques are use. Looking at anthropometric measures like skin fold thickness, waist circumference and BMI help access the risk for insulin resistance. It is important to identify the risk in obese children as early as possible to prevent progression or even permanent damage. Some other causes or risk factors that can put a child at risk for type 2 diabetes are if a parent or sibling has the disease. Genetics is a risk factor for type 2 diabetes. Minorities are also at a higher risk with groups such as Native Americans, Hispanics/Latinos and blacks. Minorities aged 15-19 is the largest youth group in the United States affected by type 2 diabetes. Signs of insulin resistance such as Acanthosis nigricans can also be a sign of type 2 diabetes.

Type 2 diabetes can be very hard to diagnose in children because it generally has a slow, gradual onset. Even though it may be harder to diagnose in children the symptoms are relatively the same for both adults and children. Increased urination and increased thirst go hand in hand. With increased glucose in the blood the kidneys work harder to absorb and filter it resulting in increased urination. This may cause dehydration causing increased consumption of drinks. Acanthosis nigricans is characterized as a dark velvety rash around the neck or under arm. If somebody has Acanthosis Nigricans it is usually a visual marker for endocrine disfunction and type 2 diabetes. When the body cannot use glucose properly the body may become very fatigued. This is one of the very common signs of type 2 diabetes. If some or all these symptoms are noticed it is important to receive medical help before permanent or irreversible damage is done.

Type 2 diabetes is considered a preventable disease that is also reversible. There are well established guidelines set to prevent type 2 diabetes in children. Even with the guidelines and knowledge, incidence of type 2 diabetes is still increasing. By 2050, future estimates predict that 1 in 3 people will have type 2 diabetes. This has a direct effect on not only children today but also future children because we know that type 2 diabetes can be genetic.  Type 2 diabetes has become a direct threat to children and adolescences. Obesity rates for children and adolescences has quadrupled over the past 30 years. Something to look at is the link between diabetes and Cardiovascular disease. Cardiovascular disease is the leading cause of death worldwide. According to the American Heart association "At least 68% of the population with diabetes will die from some form of heart disease. Also, in recent years the American Diabetes Association and The American Heart Association have released statements that "diabetes is now considered a coronary artery disease risk equivalent rather than a risk factor. A study called The Framingham Heart Study indicated that patients with Type 2 diabetes have a "2- to 3-fold increase in heart disease". It is important to identify the risk factors in children before it is to late but who can help?

The school nurse is in a position where they can see every kid in the school and be able to assess them, educate them and talk to them about the importance of being healthy.  In a study done by Brackney and Cutshell, they talk about the importance of the school nurse. The nurse can promote school activities to children and promote the benefit of physical activity. Physical activity helps with insulin sensitivity. Also, the school nurse can promote healthy eating through school lunches. Children in the study who ate diets higher in dietary fiber and limiting high fat and high sugar food, found to have their beta cells preserved. it was found that this alone is still not enough and that multifaceted strategies are needed to reduce the risk for type 2 diabetes. However, there are some challenges in this. the School nurse can only do so much as the parents have to work together with the school and their children. Transportation to community centers where a child can get plenty of physical activity comes down to the parents. Eating healthy foods for dinner at home also is the parents job to limit high fat and high sugar foods.

Preventing Type 2 diabetes in children should be one the main goals not only for the parents but for the world. Type 2 diabetes is a preventable disease. Helping children maintain a healthy weight will help prevent type 2diabetes. many children struggle with this and educating the parents and even the children can help to maintain a healthy weight. Doctors and Dietitians can help in determining a healthy weight for children. Also, eating a healthy diet will help prevent type 2 diabetes. Diets higher in dietary fiber and limiting high sugar and high fat foods with help with a healthy diet. Limiting sugary juices or soda and exchanging them for water is a very good place to start. Children need to exercise to help maintain a healthy weight. The World Health Organization recommends that children aged 5-17 get at least 60 minutes of moderate or vigorous physical activity a day. Encouraging kids to go outside and play with friends instead of playing video games and sitting in front of the tv every day. Encouraging kids to join sports is a great way for them to make friends and get their daily physical activity. Parents should also bring children to the local parks and community centers to help with physical activity.

Children and adolescents are the future of the country. It is important to help in the prevention of type 2 diabetes. But knowledge is not enough. More and more children each year are diagnosed as diabetic and prediabetic and not only does that affect them but will also affect their children when they get older. By the year 2050 it is estimated that 1 in 3 people will be diagnosed with type 2 diabetes. encouraging children to be active and eat a healthy diet can change many lives and change many more lives in the future. Type 2 diabetes is a preventable disease and a reversible disease and if everyone can work together, doctors, parents, school, and children, type 2 diabetes can be limited.

When researching type 2 diabetes you want to make sure you are finding the right information. Looking for peer reviewed journals or systematic reviews should give the best information. When looking at the sources I used for this research I found the systematic review (Prevention of Type 2 Diabetes Among Youth: A Systematic Review, Implications for the School nurse.) to be the best source. Many of my other sources had a lot of the same information but maybe added a few other points. The major point from all my sources was that Type 2 diabetes is considered preventable and that physical activity and healthy diet is important in prevention. Also, the rise of reported cases of type 2 diabetes in children and adolescences is staggering and shows that education alone is not enough in preventing type 2 diabetes. one of my sources (Type 2 diabetes in children and adolescents) was a source that I used the least. It was based in Canada and talked about many things that my other sources talked about and described better. The online blog that I used (What are symptoms of type 2 diabetes in children?) was a great source that had an easier and simpler version of all the information.

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