Children diagnosed with type 2 diabetes face a high likelihood of developing complications before age 30, a new study suggests. Black kids and Hispanic kids were 80 percent and 57 percent more likely, respectively, to develop complications than white kids were, according to the findings.
Researchers found that among 500 children and teenagers with type 2 diabetes, 60 percent developed at least one complication over the next 15 years — including nerve damage, eye disease and kidney disease.
Type 2 diabetes, which is often associated with older age and obesity, was once seen almost exclusively in adults. But as childhood obesity has climbed in recent decades, more kids are being diagnosed with the condition.
Type 2 diabetes arises when the body can no longer properly use the hormone insulin, which regulates blood sugar levels. As a result, those sugar levels can soar, and that can damage blood vessels and various organs over time.
The new findings — published in the New England Journal of Medicine — show just how rapidly complications can arise.
By the end of the study period, participants were 26 years old, on average. Yet 55 percent had kidney disease, one-third had nerve damage, and half had eye disease related to blood vessel damage.
“To some extent, this confirms what we’d suspected, but didn’t know,” Dr. Philip Zeitler, a pediatric endocrinologist at Children’s Hospital Colorado, in Aurora and one of the researchers on the study says.
“There remains a question of whether kids develop complications any faster than adults do. But it doesn’t happen more slowly,” Zeitler adds.
Even in children, he says, “the disease is potentially very aggressive. It needs to be taken seriously.”
There is no simple solution, however. Oral medication, like metformin, as well as insulin can be used to control elevated blood sugar.
But even in young people, diabetes commonly goes hand-in-hand with elevated blood pressure and unhealthy levels of LDL (“bad”) cholesterol, which are themselves risk factors for the complications seen in this study.
At the outset, when study participants were 14 years old, on average, about 20 percent had unhealthy blood pressure or cholesterol levels. By their late 20s, 67 percent had high blood pressure and just over half had high cholesterol.
A healthy diet, regular exercise and weight loss, if needed, are central to managing all those problems. But, Zeitler says, that’s easier said than done for families who can’t afford healthy foods or have no safe place for their kids to exercise.
“This is really a social problem,” he adds. “It’s a reflection of the breakdown in our social safety net.”
Dr. Molly Regelmann, a pediatric endocrinologist at Children’s Hospital at Montefiore in New York City, says that kids with type 2 diabetes fare best when families are able to make changes to the whole household’s diet and exercise habits. And that can be a challenge.
“Rates of obesity and type 2 diabetes tend to be higher in ‘food deserts’ — areas with limited access to fresh and healthful foods in grocery stores and farm stands,” according to Regelmann.
Those same areas may lack safe places for exercise, too. And the pandemic likely compounded that problem, Regelmann adds.
“School closures during the COVID-19 pandemic have led to fewer opportunities for organized sports and physical education classes,” Regelmann says. “The pandemic has also caused gym closures, and in areas where public transportation is necessary to reach open spaces, families have had to weigh risks and benefits of exercise with potential exposures to infection.”
As for medication, there is often hesitancy to use it to manage kids’ blood pressure and cholesterol, according to Zeitler.
But Zeitler’s center they are “more aggressive” in prescribing those medications to kids with type 2 diabetes.
Regelmann agrees that the “threshold” for starting medication is lower for kids who have diabetes than for those without.
There also are fewer options for controlling kids’ blood sugar, compared with adults. At the time of the study, the only approved treatments for patients under 18 were metformin and insulin Zeitler notes.
Some newer medications approved for adults have been shown to not only lower blood sugar, but also curb the risk of complications, according to Regelmann.
“This study highlights the need to test these medications in younger patients,” she concludes.
Because obesity is the leading cause of children developing type 2 diabetes, it is important that you make sure your child is eating healthy and staying active. Children and adolescents aged six and older need at least 60 minutes of physical activity every day. They also need at least a few days per week of bone- and muscle-strengthening exercises. Children, who are younger than six years old, need three hours of activity every day with one hour or more dedicated to moderate to vigorous physical activity.
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