Type 2 Diabetes Mellitus in Children: Risk Factors and Treatment

Introduction

A growing concern that has greatly impacted children within the last 15 years has been the

increasing prevalence of type 2 diabetes mellitus (T2DM), a disease in which affects the uptake of

glucose into the cell. Currently the prevalence rate is expected that 1 in 3 children born in 2000 will

develop the disease, with its onset occurring around age 13.1,2 Several risk factors have been determined

as a Body Mass Index (BMI) in the overweight or obese range, insulin resistance, acanthosis nigricans,

as well other factors that include ethnicity, socioeconomic status, and a family history of diabetes.1 While

many treatments have been shown to combat the risk factors of the disease one effective course of

action for this age group is a healthy diet, physical activity, and early detection. Studies have also

suggested that a key component of treatment includes patient and family adherence to lifestyle

modifications to improve risk factors.2 Because T2DM is associated with obesity and other diseases such

as heart disease, children with these conditions could expect lifelong complications as well as other

factors that may be passed on hereditarily if not treated or well-managed.

Current Research

The prevalence of T2DM among children has almost doubled two-fold in the last decade. Due to

the alarming rate to which T2DM is developing in children has put considerable strain on clinicians to

identify risk factors for early detection. In order to narrow the associated risk factors, a cross-sectional

study consisting of 971 students in grades 1 through 5 were selected based on health records and

physical assessment which included evaluating for BMI, the presence of acanthosis nigricans, gender,

ethnicity and/or current or family history of diabetes.1 From these results, the risk factors most associated

with meeting the follow-up requirements for a type 2 diabetes screening as recommended by the

American Diabetes Association could be used as markers to detect the disease. The most common

factors associated with needing a follow-up screening included: acanthosis nigricans (present in 26.9% of

the students), family history of diabetes (present in 48%), and the best indicator which included a BMI

greater than the 85th percentile (overweight).1 These results suggest factors such as nutrition and

environment are directly correlated with the diseases onset and of these nutrition especially is of great

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importance to this age group due to parental or guardian influence over food choice, portioning, origin,

and cooking method.

Ethnicity is also considered another underlying cause of T2DM as well as how cultural norms

could perceive risk factors of the disease. 3 A study on Mexican American immigrant families evaluated

parents perceived risks for their children. This study could play an important indicator of how these

perceptions and cultural norms could have influence over children of at-risk ethnicities such as African

Americans, Hispanics, Asian-Americans, Pacific Islander, and American Indians.3 For example, Latino

mothers perceive the appearance of good health as being moderately overweight, because comparatively

it is believed thinner children are more prone to disease and experience difficulty recovering from illness. 3

Similar cultural feelings towards health and well-being may exist amongst these other ethnic groups. The

study developed 5 focus groups consisting of 15 parents and their children. 3 Participant selections were

based on immigration status, Spanish as the primary spoken language, that their child was enrolled in the

associated Midwestern school conducting the study, and parents must be age 19 or older. Moderators

composed questions to lead discussion amongst the focus groups that aimed to determine factors related

to cultural adaptation to lifestyle in the U.S., parents level of self efficacy to their childrens eating and

behaviors, parents dilemma in controlling their childrens eating, and interest in more culturally competent

education approaches for parents. 3 The results indicated one factor that contrary to traditional Latino

values, many mothers worked outside of the home heavily relying on schools and child care to provide

meals, snacks, and sources of exercise.3 Another finding was that parents expressed great interest in

having more culturally competent education materials such as on diabetes. 3 Both of these findings could

easily be applied to many diverse families living within the U.S.

Conclusion

The first studys purpose was to define specific risk factors as a way to detect T2DM early in

children. Strengths of this experiment design include how the participants were chosen based on risk

factors for the disease. By first selecting students based on these factors, the experiment is able to have

a decent pool size of children with already contributing risk factors of T2DM. In comparing these students

and factors, it is likely that individuals with more than one factor were at increased risk compared to their

classmates who may only be exhibiting underlying symptoms. Although this study did confirm several risk

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factors there were many limitations. Firstly, students were measured by nurses for height and weight. 1

There is a possibility errors could be made during the measuring or calculation process. Secondly, nurses

were given a brief overview of the diagnosis of acanthosis nigricans which may have played a critical role

during the evaluation of children for a follow-up session as outlined the American Diabetes Association. 1

Thirdly, initial selection for the participants was based on a self-reported health record filled out by

parents.1 Due to the nature of how the information was reported, the criteria based for selection could

have several untruths. This study confirmed what most researchers and clinicians believe are risk factors

for children. However, this study did not provide any follow-up information regarding the children who did

continue with the follow-up diabetes screening and whether those findings could support or dismiss their

conclusion.

The second studys main strength consisted of studying an at-risk population. Considering their

participant pool consisted of new immigrants to the United States the study was also able to measure

several factors that most immigrants may face such as acculturation and adaptation, specifically diet and

exercise. Another strength was the method in which the study was conducted. By using focus groups and

open-ended discussion questions, the participants were more likely to participate which provided the

moderators more information than a typical survey which could include biases. 3 Limitations however

included, one of the criteria was that parents and students first language was Spanish, and many of them

only spoke that language.3 The researchers hired interpreters to lead the discussions based on the

researchers questioning.3 Any form of translation could cause information to be misinterpreted and/or not

perceived in the same manner. Another limitation included that although there was an agreed upon time

for focus groups meetings, participants did not complete the study and stopped coming resulting in less

data.3

Public Information Sources

Monitoring diet and intake is a method to keep blood sugar in control as well as a way to lose

weight and avoid unnecessary weight gain. Treating T2DM by a healthy diet can be challenging for this

age group because of lack of control over food choices as well as if there is not a commitment from family

members to also accept these lifestyle modifications. The American Diabetes Association (ADA)

recommends measuring intake to gauge spikes in blood sugar.4 They recommend choosing foods with 25

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grams or less of carbohydrate and that contain at least 3 grams of fiber. They also recommend choosing

foods that are low in fat. 4 The guide also provides an easy to follow tool for reading food labels that both

parents and children can learn. Other recommendations include: getting adequate exercise, avoiding

sugary drinks like soda and juices, eating smaller portions, and not skipping meals.4

http://www.diabetes.org/living-with-diabetes/parents-and-kids/children-and-type-2/

References

(1) Scott L. Presence of type 2 diabetes risk factors in children. Pediatric Nursing. 2013; 39(4): 190-

180. Doi:

(2) Pulgaron E, Delmater A. Obesity and type 2 diabetes in children: epidemiology and

treatment. A.M. Curr Diab Rep. 2014 14: 508. doi:10.1007/s11892 -014-0508-y

(3) Baker S, Bar K, Head B. Mexican american parents perceptions of childhood risk factors for type

2 diabetes. The Journal of School Nursing. 2011; 27(1): 51-60. Doi:

(4) American Diabetes Association Information for Youth and Their Families Living With Type 2

Diabetes Web Site. http://www.diabetes.org/living-with-diabetes/parents-and-kids/children-and-

type-2/