Type 2: Diabetes on rise among children

Sachin Mittal

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Shubham was 16 when he was diagnosed with type 2 diabetes mellitus (T2DM), traditionally seen in adults. His weight had increased from 100 kg to 128 kg during the pandemic lockdown due to increased intake of junk food and decreased physical activity. He had breathing issues, darkening of skin and a family history of diabetes and heart disease.

Doctors are seeing a rising number of T2DM cases among adolescents in the last seven to eight years. Post pandemic, the number has increased manifold. Children as young as 10, mostly obese, are being diagnosed with T2DM. The number of pre-diabetes cases is also rising among adolescents and can develop into diabetes if not aggressively controlled.

Obesity In children and adolescents, it has emerged as the primary factor. Excess weight leads to insulin resistance (in this condition, pancreas produce excess insulin to keep blood glucose levels normal), a precursor to T2DM. Eventually, the pancreas get exhausted and pre-diabetes develops. If not checked in time with lifestyle modifications and in some cases medication, it develops into type 2 diabetes.

Besides a sedentary lifestyle and unhealthy diet, other factors fuelling this rise in obesity in younger population include:

Family history Chances of obesity and diabetes are more in children and adolescents if parents have similar medical issues. Family history increases the chances of diabetes among adolescents or young.

Sleep As young people get by on less sleep due to various reasons, this has altered sleeping habits and disturbed sleep patterns, raising stress levels that cause altered hormonal response, and leads to weight gain.

Wrong Social perceptions In Indian society, thinness is equated with weakness and having some fat is considered healthy. We are genetically prone to accumulate fat. Most studies say Indians are predisposed to developing metabolic issues like T2DM or heart disease. Obesity acts as a catalyst and magnifies the underlying problems. The combination of diabetes and obesity, known as diabesity, is dangerous.

Symptoms

The usual diabetes symptoms in adults like increased thirst, dryness of mouth, frequent urination, fatigue, unexplained weight loss, skin infections and blurring of vision are present in adolescents, too, but not in all cases. Darkening of skin at back of neck, armpits and groin may be a sign of insulin resistance and may be present even before the onset of T2DM. Its presence should alarm parents. It’s important to remember that sometimes children may not show symptoms. So, it’s best to be proactive and get an evaluation done if the child is overweight.

Related complications

Untreated or poorly controlled diabetes can cause complications like retinopathy or eye disease, nephropathy or kidney disease, heart disease, stroke, etc. These complications can occur at a much earlier age than traditionally seen in older adults.

In young girls, PCOD is often a related complication; sometimes PCOD is present before type 2 diabetes. PCOD is integrally related to insulin resistance. Many studies have shown that girls with PCOD have a manifold risk of developing type 2 diabetes later in life. Regular screening of thyroid, lipid, insulin-resistance profile is advised in overweight children.

Diabesity and COVID-19

Experience during the pandemic has shown that in infectious illnesses, the outcomes are much worse in those having diabetes or obesity. As the lockdown led to a more sedentary life, obesity cases increased. In most obese persons, inflammatory markers in blood were more, there was less oxygenation of lungs, and a severe Covid. This led to more use of steroids as a life-saving measure. This, too, has precipitated and triggered diabetes in many young and adult people and subsequently impacted the body’s metabolism. In most cases, blood sugar levels returned to normal later, but some remained affected.

Can it be reversed

Insulin levels can become normal or rather go into remission with proper medication, strict diet and proper exercise, but chances of relapse are always there if the patient is not careful with diet, exercise or medication. Clinicians and parents must motivate and support healthy eating and exercise habits. Obese kids should never be blamed or shamed.

Bariatric surgery

Bariatric surgery is considered in severe cases with BMI more than 35kg/m2 or 30 kg/m2 with at least two obesity-related complications.

— The writer is endocrinologist,

Fortis Hospital, Mohali