A dramatic rise in the number of North Dakota children with Type 2 diabetes — a form of diabetes normally seen in adults — provides more evidence of a link between the disease and childhood obesity, experts say.

The likely connection between an increase in obesity and Type 2 diabetes in children and adolescents has come to light only in the past decade, and officials still are working to compile nationwide trend data and study the best ways to treat youth with Type 2.

Elizabeth Mayer-Davis at the University of North Carolina, a lead investigator of an ongoing national study on Type 2 diabetes in children, said the North Dakota data highlight the need to combat childhood obesity, which some are calling a modern-day epidemic.

"Obesity ... almost certainly plays a major role," Mayer-Davis said. Other unknown factors might also be in play, she said.

Type 2 diabetes, which stems from the body's failure to properly use insulin, typically is seen in people middle-age and older, said Sherri Paxon, director of the North Dakota Health Department's chronic disease division.

A study released earlier this fall that was coordinated by the department and Blue Cross Blue Shield of North Dakota found a large increase in the prevalence of childhood diabetes in North Dakota over a five-year period — from 2.8 per 1,000 youth age 18 and younger in 2003 to 4.5 per 1,000 in 2007. The estimated percentage of children with Type 2 diabetes — based on whether children had pharmacy claims of insulin — went from 23 percent to 31 percent in those years.

"I think science right now is pointing us to a lack of physical activity and poor nutrition, which leads to being overweight, as a primary cause of Type 2 diabetes" in youth, Paxon said.

David Hanekom, the medical director for Blue Cross Blue Shield, said adults must "step up to the plate" and deal with the problem.

"Really, it's a societal issue," he said. "It's not something the medical community can deal with. The medical community deals with the complications and effects."

The North Dakota study was possible because of cooperation between the state Health Department and Blue Cross Blue Shield, which covers the majority of the state's insured children. It did not calculate prevalence rates for Type 2 diabetes, only percentages.

Judith Fradkin, a division director at the National Institutes of Health, said Type 2 diabetes in children is a problem of the 21st century.

"Pediatricians, endocrinologists ... they were just telling us they were starting to see all these kids with Type 2 diabetes," she said.

"Almost all kids with Type 2 are obese or overweight (and) most are obese," she said.

The Centers for Disease Control and Prevention says childhood obesity has reached epidemic levels. The agency says the prevalence of obesity among children ages 6 to 11 has more than doubled since the 1960s.

"We know in adults that obesity is the major risk factor for diabetes," said Giueseppina Imperatore, a diabetes expert at the CDC. "We definitely think it is also the case in children."

Imperatore and Fradkin said an unborn child also has a greater risk of getting Type 2 diabetes if the pregnant mother has the disease.

"Essentially, it is a disease of reproductive age. Before, you got it later in life," Imperatore said.

A number of studies dealing with children and Type 2 diabetes are under way. Francine Kaufman, head of the diabetes center at Children's Hospital in Los Angeles, is heading a National Institutes of Health study on the best way to treat Type 2 diabetes in young people. The NIH and CDC are funding a study on the rates of Type 2 diabetes in children, and another national study is looking at the effects of changes in food service and physical education at 42 middle schools around the country.

The NIH and Indian Health Service are getting ready to launch a new curriculum for American Indian students to better educate them about diabetes and encourage some to pursue health-related fields, Kaufman said.

Researchers say minority children are more susceptible to Type 2 diabetes, and Fradkin says their environment is a factor.

For example, she said, children on American Indian reservations might not have easy access to stores with healthy food choices such as fresh fruits and vegetables, and minority children in the inner-city neighborhoods of urban centers might be kept indoors by parents who fear for their safety.

The results of the North Dakota study were not broken down by race, though Hanekom said he does not believe North Dakota's population of American Indians skewed the results. Blue Cross Blue Shield estimated only about 2 percent of its members are Indian.

Experts say changing people's attitudes is key to reducing the rate of diabetes. Many environmental factors can be changed, such as the amount of time children spend watching TV and playing video games. Fradkin said one study found people at high risk for the disease reduced their risk by nearly 60 percent by losing about 15 pounds.

"You don't have to become a marathon runner or have a model-size figure," she said. "Just making some small changes — losing 15 pounds — has just a huge effect on reducing diabetes."

Hanekom said reducing Type 2 diabetes in children will take more than just telling them to exercise.

"You can't just tell a child, 'eat less, move more,"' he said. "The way to address obesity would be the same way we address smoking — multiprong, legislation, attitude changes, etc.

"If our children are our future, then we have an issue," Hanekom said. "It's not going to go away unless there are some radical changes in the environment we bring kids up in."

A dramatic rise in the number of North Dakota children with Type 2 diabetes — a form of diabetes normally seen in adults — provides more evidence of a link between the disease and childhood obesity, experts say.

The likely connection between an increase in obesity and Type 2 diabetes in children and adolescents has come to light only in the past decade, and officials still are working to compile nationwide trend data and study the best ways to treat youth with Type 2.

Elizabeth Mayer-Davis at the University of North Carolina, a lead investigator of an ongoing national study on Type 2 diabetes in children, said the North Dakota data highlight the need to combat childhood obesity, which some are calling a modern-day epidemic.

"Obesity ... almost certainly plays a major role," Mayer-Davis said. Other unknown factors might also be in play, she said.

Type 2 diabetes, which stems from the body's failure to properly use insulin, typically is seen in people middle-age and older, said Sherri Paxon, director of the North Dakota Health Department's chronic disease division.

A study released earlier this fall that was coordinated by the department and Blue Cross Blue Shield of North Dakota found a large increase in the prevalence of childhood diabetes in North Dakota over a five-year period — from 2.8 per 1,000 youth age 18 and younger in 2003 to 4.5 per 1,000 in 2007. The estimated percentage of children with Type 2 diabetes — based on whether children had pharmacy claims of insulin — went from 23 percent to 31 percent in those years.

"I think science right now is pointing us to a lack of physical activity and poor nutrition, which leads to being overweight, as a primary cause of Type 2 diabetes" in youth, Paxon said.

David Hanekom, the medical director for Blue Cross Blue Shield, said adults must "step up to the plate" and deal with the problem.

"Really, it's a societal issue," he said. "It's not something the medical community can deal with. The medical community deals with the complications and effects."

The North Dakota study was possible because of cooperation between the state Health Department and Blue Cross Blue Shield, which covers the majority of the state's insured children. It did not calculate prevalence rates for Type 2 diabetes, only percentages.

Judith Fradkin, a division director at the National Institutes of Health, said Type 2 diabetes in children is a problem of the 21st century.

"Pediatricians, endocrinologists ... they were just telling us they were starting to see all these kids with Type 2 diabetes," she said.

"Almost all kids with Type 2 are obese or overweight (and) most are obese," she said.

The Centers for Disease Control and Prevention says childhood obesity has reached epidemic levels. The agency says the prevalence of obesity among children ages 6 to 11 has more than doubled since the 1960s.

"We know in adults that obesity is the major risk factor for diabetes," said Giueseppina Imperatore, a diabetes expert at the CDC. "We definitely think it is also the case in children."

Imperatore and Fradkin said an unborn child also has a greater risk of getting Type 2 diabetes if the pregnant mother has the disease.

"Essentially, it is a disease of reproductive age. Before, you got it later in life," Imperatore said.

A number of studies dealing with children and Type 2 diabetes are under way. Francine Kaufman, head of the diabetes center at Children's Hospital in Los Angeles, is heading a National Institutes of Health study on the best way to treat Type 2 diabetes in young people. The NIH and CDC are funding a study on the rates of Type 2 diabetes in children, and another national study is looking at the effects of changes in food service and physical education at 42 middle schools around the country.

The NIH and Indian Health Service are getting ready to launch a new curriculum for American Indian students to better educate them about diabetes and encourage some to pursue health-related fields, Kaufman said.

Researchers say minority children are more susceptible to Type 2 diabetes, and Fradkin says their environment is a factor.

For example, she said, children on American Indian reservations might not have easy access to stores with healthy food choices such as fresh fruits and vegetables, and minority children in the inner-city neighborhoods of urban centers might be kept indoors by parents who fear for their safety.

The results of the North Dakota study were not broken down by race, though Hanekom said he does not believe North Dakota's population of American Indians skewed the results. Blue Cross Blue Shield estimated only about 2 percent of its members are Indian.

Experts say changing people's attitudes is key to reducing the rate of diabetes. Many environmental factors can be changed, such as the amount of time children spend watching TV and playing video games. Fradkin said one study found people at high risk for the disease reduced their risk by nearly 60 percent by losing about 15 pounds.

"You don't have to become a marathon runner or have a model-size figure," she said. "Just making some small changes — losing 15 pounds — has just a huge effect on reducing diabetes."

Hanekom said reducing Type 2 diabetes in children will take more than just telling them to exercise.

"You can't just tell a child, 'eat less, move more,"' he said. "The way to address obesity would be the same way we address smoking — multiprong, legislation, attitude changes, etc.

"If our children are our future, then we have an issue," Hanekom said. "It's not going to go away unless there are some radical changes in the environment we bring kids up in."