Type II Diabetes in Children

In the last 50 years the prevalence of childhood obesity has risen at an alarming rate, and with it Type 2 Diabetes (T2D). T2D was once considered an adult disease until more recently when children began developing the disease worldwide. With T2D children are more at risk for other chronic health problems and diseases. Children who grow up obese are more likely to remain obese into adulthood, to have Type 2 diabetes, to suffer cardiovascular problems, and to have a shorter lifespan (Johnson, 2012).

Likewise, these children suffer more teasing and rejection than their peers, which often leads to psychosocial issues such as depression and a poor self-image. Modifications to lifestyle factors can be successful in treating this disease. Parents, schools and the healthcare team can work together for successful outcomes in implementing necessary changes.

Obesity, a sedentary lifestyle, compromised nutrition, plus genetic components have contributed to this growing epidemic among children. T2D patients become insulin resistant and typically present with two or more coexisting conditions such as polyuria, polydipsia, hyperlipidemia, polycystic ovarian syndrome (PCOS), or acanthosis nigricans (Reinehr, 2013). Diabetics also often present with high waist circumference measurements. Excessive food and sugar intake, a lack of adequate physical activity, poor sleep habits, high rates of screen time, and familial incidence of T2D are also contributing factors to this disease in children. According to the Centers for Disease Control and Prevention (CDC) (2018), obesity rates have tripled since the1970s and 1 in 5 (20%) children were considered obese in 2016 compared to the study by Johnson (2012), who reported that there were only 5-7% of children considered to be within the BMI range of obesity about 50 years ago.

These factors are important to understanding how changes can be implemented to reverse this growing trend. Genetics cannot be changed; however, the markers that are expressed can be influenced by simple changes giving the child a greater chance to live a healthy life. Metabolism is affected by energy input and energy output. If the foods that are eaten are processed, high in sugar, or consumed above caloric needs, then it results in an unhealthy weight gain and high blood glucose levels. The body will continue to crave food when the nutritional needs are not being met. Johnson (2018) explains that often schools include vending machines that are full of sugary drink options or high calorie, high-fat snack items. In this way, schools can also be promoting unhealthy eating habits. Also, the lack of physical activity is influenced with high 'screen time' which includes television, video games, computers, and cell phones. Instead of seeking or lacking the opportunity to participate in moderate activity daily, a child can inadvertently spend a considerable time sitting and being inactive. The ease of transportation has reduced the amount of time walking or biking within our society as well. Poor sleep can occur with the lack of activity and screen time within close proximity to going to bed.

What can society do to change this growing epidemic? Screening children who are obese and have other factors that indicate diabetes risk would be the first step to identifying diabetes. Traditionally Metformin has been used as the first-line approach to insulin resistance. Non-pharmacological interventions have had positive results as well in managing T2D while reducing obesity and the disease's severity. Monitoring blood glucose levels and blood pressure on a regular basis, taking medicines as prescribed, and getting regular eye exams would also be important for these patients. Follow-up with a healthcare provider on a regular basis every 3 months works makes it easier to monitor short-range goals.

Whole family involvement has shown significant results in the effectiveness of an intervention and is more likely to have a permanent effect (Samaan, 2013). Parents can take small steps to build healthy habits early in life. These goals should include making nutritional changes such as avoiding sugary drinks, increasing the level of fruit and vegetable intake to 4-5 servings per day, eliminating or limiting fast food, and reducing processed foods and grains in the diet. Children should not be allowed to skip breakfast. "The skipping of breakfast and the overconsumption of screen media influence weight development in primary schoolchildren (Traub, Lauer, Keszty?s, Wartha, Steinacker, Keszty?s, & the Research Group, 2018)." Screen time should be reduced to no more than 2 hours a day (CDC, 2018) and not used within an hour of bedtime because it might affect the child's sleeping patterns.

Teaching the child to have an active part in planning their meals could contribute to personalizing these life habits while making it fun. MedlinePlus, U.S. National Library of Medicine's fact sheet (2018) recommends teaching children the steps to choosing healthy foods. A dietician should be consulted to determine the nutritional and calorie needs of the child. Parents can use color as a motivator by letting them choose fruits and vegetables from different color groups. Children could be taught to measure out the 4-5 portions with instructions about how to use fruits and vegetables for snacks. Foods could be prepared in different ways for variety. Making a checklist of each food group and the recommended servings for the child's age could also be used to teach the child to track their nutrition. Eating what is recommended from each food group while spacing out the carbohydrates evenly through the day will help to keep blood sugar levels stable. If they have to eat out or have pre-cooked meals, choose those that must comply with whole food and nutrition recommendations. Eat the recommended amounts from each food group and seek to avoid eating excess calories. Planning ahead can reduce the chances of making unhealthy food choices when they are hungry. Snacking on whole, raw foods or "free foods" can limit grabbing empty calorie choices. A list of "free foods" could include such things as carrot sticks, cucumber slices, and apples. Have the child learn to daily drink the amount of water required for their age and perhaps help them learn to chart it themselves. This could eliminate much of the sugary drinks.

Activity should also be planned into the child's day. They should get regular exercise that is at a moderate-vigorous pace (increases the heart rate and builds up a sweat) for at least 60 minutes a day. These 60 minutes can be broken down to smaller amounts of time if necessary. "Physical activity may be gained either through structured games and sports or through everyday activities, such as walking (Copeland, Silverstein, Moore, Prazar, Raymer, Shiffman,...Flinn, 2013)." This can be combined with cutting screen time down to 2 hours or less and encouraging active play.

Attending a support group or individualized counseling is also beneficial. According to the study done by Mameli, Krakauer, Krakauer, Bosetti, Ferrari, Schneider,...Zuccotti (2017), the family and child often need support to adhere to these interventions in order to have a successful outcome. Making small steps to develop habits makes lifestyle changes easier to implement into everyday life.

It is important for healthcare providers to be addressing T2D early to try and turn the health condition around while the child is still growing and their lifestyle habits are still being formed. Parents need to be made aware of factors that can contribute to obesity and Type 2 Diabetes with its comorbidities that can have lasting effects on their children. Schools should promote healthy habits by providing time for physical activities, and healthy school meals, and by removing vending machines. By working together with families, providers, and the community can help to reduce this disparity in our country and the world.

References:

1. Centers for Disease Control and Prevention (CDC). (2018). Childhood obesity facts [Fact Sheet]. Retrieved from https://www.cdc.gov/healthyschools/obesity/facts.htm
2. Copeland, K.C., Silverstein, J., Moore, K.R., Prazar, G.E., Raymer, T., Shiffman, R.N., ...Flinn, S.K. (2013). Management of newly diagnosed Type 2 diabetes mellitus (T2DM) in children and adolescents. American Academy of Pediatrics, 131(2). Retrieved from www.pediatrics.org/cgi/doi/10.1542/peds.2012-3494
3. Johnson, S.B., (2012). The nation's childhood obesity epidemic: Health disparities in the making, CYF News, 7. Retrieved from https://www.apa.org/pi/families/resources/newsletter/2012/07/childhood-obesity.aspx
4. Mameli, C., Krakauer, J.C., Krakauer, N.Y., Bosetti, A., Ferrari, C.M., Schneider,...Zuccotti, G.V. (2017). Effects of a multidisciplinary weight loss intervention in overweight and obese children and adolescents: 11 years of experience. PLoS One, 12(7), e0181095. http://dx.doi.org/10.1371/journal.pone.0181095PMCID: PMC5509286
5. MedlinePlus, U.S. National Library of Medicine (2018). Diabetes type 2 - meal planning [Fact Sheet]. Retrieved from https://medlineplus.gov/ency/article/007429.htm
6. Reinehr, T. (2013). Type 2 diabetes mellitus in children and adolescents. World Journal of Diabetes, 4(6), 270-281. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874486/
7. Samaan, M.C. (2013). Management of pediatric and adolescent Type 2 diabetes. International Journal of Pediatrics, 2013, 1-9. http://dx.doi.org/10.1155/2013/972034
8. Traub, M., Lauer, R., Keszty?s, T., Wartha, O., Steinacker, J.M., Keszty?s, D., & the Research Group "Join the Healthy Boat". (2018). Skipping breakfast, overconsumption of soft drinks and screen media: a longitudinal analysis of the combined influence on weight development in primary schoolchildren. BMC Public Health, 18(363), 1-10. https://doi.org/10.1186/s12889-018-5262-7

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