Published January 28, 2013
| The Wall Street Journal
American pediatricians, alarmed by the rise of type 2 diabetes in children and failure rates for oral medication, are recommending early aggressive treatments with insulin shots for many youth who are diagnosed with the disease.
The recommendation will be made Monday, when the American Academy of Pediatricians issues its first-ever clinical guidelines for type 2 diabetes—a grim milestone for a disease that used to be rare in children before obesity rates began to rise.
As a result of the guidelines, which also recommend kids improve their diets and get more exercise, children may now have to begin often temporary insulin regimens like those used to treat type 1, the autoimmune form of the disease, which requires immediate and lifelong insulin injections. Children who don't need insulin treatment should be started on the oral diabetes drug metformin, according to the recommendation.
The guidance, published in the journal Pediatrics, comes as doctors have recognized that childhood type 2 diabetes could lead to complications earlier than it does with adult patients and that lifestyle changes alone may not control the obesity-linked disease. It also shows how it can be difficult to distinguish initially between type 2 and type 1 in children, particularly as the growth of the disease means more cases are handled by family doctors without good access to specialists.
"Diabetes is an expensive disease, and complications are even more expensive," said Janine Sanchez, director of pediatric diabetes at the University of Miami Miller School of Medicine, who wasn't involved in drafting the new guidelines. "We definitely want to make sure that these kids are taken care of, because in the end we are all going to pay for that."
Three decades ago, type 2 diabetes was generally limited to adults. Now, one out of three new diabetes cases among patients under 18 is type 2. Doctors say they have diagnosed the disease in children as young as 6.
The number of American children with type 2 diabetes isn't well established, but estimates by the U.S. Centers for Disease Control and Prevention magazine suggest tens of thousands are affected. The CDC says about 17 percent of Americans under age 20—about 12.5 million people—are obese and at increased risk for the disease. Since 1980, obesity among the young has almost tripled, the agency says.
Type 2 diabetes occurs when the body can't effectively use insulin, which regulates blood sugar, and the disease can affect the body's ability to produce the hormone. It can usually be controlled by lifestyle changes, which makes it distinct from type 1, in which the immune system destroys pancreatic beta cells that produce insulin.
Type 2 raises the risk of heart attacks and strokes, kidney disease, blindness, amputations and nerve damage. Complications such as kidney disease and nerve damage are happening faster in children with type 2 than adults with type 2 or children with type 1, Dr. Sanchez said.
"The whole process seems to be accelerated," she said.