Obesity and the form of
diabetes linked to it are taking an even worse toll on America’s youths than medical experts had realized. As
obesity rates in children have climbed, so has the incidence of
Type 2 diabetes,
and a new study adds another worry: the disease progresses more rapidly
in children than in adults and is harder to treat.
“It’s frightening how severe this metabolic disease is in children,” said Dr.
David M. Nathan,
an author of the study and director of the diabetes center at
Massachusetts General Hospital. “It’s really got a hold on them, and
it’s hard to turn around.”
Before the 1990s, this form of diabetes was hardly ever seen in
children. It is still uncommon, but experts say any increase in such a
serious disease is troubling. There were about 3,600 new cases a year
from 2002 to 2005,
the latest years for which data is available.
The research is the first large study of Type 2 diabetes in children, “because this didn’t used to exist,” said Dr.
Robin Goland,
a member of the research team and co-director of the Naomi Berrie
Diabetes Center at Columbia University Medical Center in New York. She
added, “These are people who are struggling with something that
shouldn’t happen in kids who are this young.”
Why the disease is so hard to control in children and teenagers is not
known. The researchers said that rapid growth and the intense hormonal
changes at
puberty might play a part.
The study followed 699 children ages 10 to 17 at medical centers around
the country for about four years. It found that the usual oral medicine
for Type 2 diabetes stopped working in about half of the patients within
a few years, and they had to add daily shots of insulin to control
their blood sugar. Researchers said they were shocked by how poorly the
oral drugs performed because they work much better in adults.
The findings could signal trouble ahead because poorly controlled
diabetes significantly increases the risk of heart disease, eye
problems, nerve damage, amputations and
kidney failure.
The longer a person has the disease, the greater the risk. So in
theory, people who develop diabetes as children may suffer its
complications much earlier in life than previous generations who became
diabetic as adults.
“I fear that these children are going to become sick earlier in their
lives than we’ve ever seen before,” Dr. Nathan said.
But aggressive treatment can lower the risks.
Sara Chernov, 21, a college senior from Great Neck, N.Y., learned that
she had Type 2 diabetes when she was 16. Her grandfather had had both
legs amputated as a result of the disease, and one of the first
questions she asked was when she would lose her legs and her
eyesight.
A doctor scolded her for being fat and told her she had to lose weight
and could never eat sugar again. She left the office in tears and did
not go back; soon after, she joined the study at Columbia. Like many of
the children in the program, she did not even know how to swallow a
pill.
Ms. Chernov believes that the disease “is not a death sentence,” she
said, if she is careful about controlling her blood sugar. But it has
been a struggle. Her family tends to be overweight, she sometimes craves
sweets and she has orthopedic problems that have required surgery and
have made it hard for her to
exercise. She is also being treated for
high blood pressure.
A few weeks ago, because her blood sugar shot up despite the diabetes
pills she was taking, Ms. Chernov began using insulin.
Most of the participants in the study came from low-income families: 42
percent had yearly incomes under $25,000, and 34 percent below $50,000.
About 40 percent were Hispanic, 33 percent black, 20 percent white, 6
percent American Indian and less than 2 percent Asian. Poor people and
minority groups have some of the highest rates of obesity and diabetes
in both adults and children.
Dr. Phil Zeitler, an author of the study and a professor of
pediatrics
at the University of Colorado, Denver, said many participants lived
with a single parent or guardian and, like Ms. Chernov, came from
families with a history of diabetes and had relatives with kidney
failure or amputations.
“They’re wrapped up in a lot of family chaos,” Dr. Zeitler said, calling
them a “challenging population” with a lot of stress in their lives, on
top of the normal chaos of the teenage years.
Type 2 diabetes used to be so rare in children that it was called
adult-onset diabetes. Type 1, a much less common form, was most likely
to strike children and teenagers, and was called juvenile diabetes. Both
forms of the disease cause high blood sugar, but their underlying
causes are different.
Type 1 occurs because the patient’s own immune system mistakenly
destroys the cells in the pancreas that make insulin, a hormone needed
to control
blood sugar levels. Patients have to take insulin.
Type 2 is thought to be brought on by obesity and inactivity in people
who have a genetic predisposition to develop the disease when they gain
weight. And they may also have an inborn tendency to put on weight. The
pancreas still makes insulin, though not enough, and the body does not
use insulin properly — a condition called insulin resistance. High blood
pressure and
cholesterol
often come with the disease. Initial treatments include dietary
changes, exercise and oral medicines, but many people eventually need
insulin.
Doctors began noticing an alarming increase in Type 2 cases in children
in the 1990s, especially among blacks and Hispanics from poorer
families. The problem had started even earlier in American Indians, who
have had sharp increases in obesity in recent years.
The current study was meant to find the best treatment. The participants
were all overweight, some very obese. All, with a parent or guardian,
got diabetes education. They were then assigned at random to one of
three groups. One group took only metformin, a standard diabetes pill
(also called Glucophage). Another took metformin and a second drug,
rosiglitazone (also called
Avandia). A third group took metformin and went through an intensive
diet, exercise and weight-loss program (which has worked in adults). They were followed for an average of about four years.
The results were disappointing: all three regimens had high failure
rates, meaning that they could not control blood sugar. Metformin alone
failed in 52 percent of patients, metformin plus rosiglitazone failed in
39 percent, and metformin plus the diet program failed in 47 percent.
Metformin alone was least effective in blacks, and metformin combined
with rosiglitazone worked better in girls than in boys. The failure
rates were high even in the patients who adhered most strictly to their
treatment programs.
The obvious conclusion is that better treatments are needed. Adding
rosiglitazone is not a good option, researchers say, even though the
combination worked better than metformin alone; rosiglitazone has been
linked to an increased risk of
heart attack
and stroke in adults, and its use has been restricted by the Food and
Drug Administration. There are other oral diabetes drugs, but none have
been approved or tested in children. In the meantime, the doctors said,
the best solution is to move quickly to insulin shots if metformin does
not work.
Ideally, Type 2 diabetes should be preventable with improvements in diet
and exercise. But so far, that has been easier said than done.
Source: New York Times
