American Diabetes Association, meeting in Phila., to discuss growth of the illness among kids

Posted: June 09, 2012

What used to be called "adult-onset diabetes" — a leading cause of kidney failure, limb amputations, blindness, heart disease, and stroke among adults — is now a growing problem for American children, too.

This health challenge, and how to deal with it, will be one of the hottest topics at this weekend's American Diabetes Association conference. An expected 16,000 health professionals, researchers, advocates, and vendors from around the world are gathering at the Convention Center to share the latest in diabetes research.

Now called Type 2 diabetes, the disease has become staggeringly common — affecting 22 million U.S. adults — because it is closely tied to obesity.

The new research shows that in youngsters, Type 2 takes a toll on their health much faster and harder.

"They seem to have a somewhat different disorder than adults," said Philip Zeitler, a pediatric endocrinologist at Children's Hospital Colorado. "They need to go on insulin faster than adults. And they have a more rapid appearance" of complications.

The ongoing federal "Search for Diabetes in Youth" study, which will be discussed at the conference, has already reported troubling trends.

Type 1 diabetes, formerly called juvenile diabetes, is also increasing among youths, for unknown reasons. Type 1 is an autoimmune disorder in which the pancreas stops making insulin, the hormone that controls blood sugar.

Type 2 — in which the body makes insulin but becomes increasingly unable to use it — is also growing among people under 20, particularly low-income minorities. From 2002 to 2005, Type 2 was diagnosed in 3,600 youths a year.

Locally, the trend has been tracked by the Philadelphia Pediatric Diabetes Registry, founded by Terri Lipman, a pediatric nurse practitioner at Children's Hospital of Philadelphia.

"When it began in the early 1990s, we didn't see Type 2 at all in children," Lipman said. "Now, 20 to 30" children and teens are diagnosed annually in the city.

Not coincidentally, 30 percent of U.S. children are overweight or obese, compared with 5 percent in 1970, federal data show.

While the actual number of youths with Type 2 may seem small, the implications are so worrisome that the federal government sponsored a national study of recently diagnosed patients ages 10 to 17. The goal was to see whether oral medication — with or without a weight loss program to help the whole family eat healthier and exercise — would enable youngsters to control their blood sugar and avoid the need for insulin shots.

The results, released in April, will be explored, and no doubt lamented, at the conference.

Of the 699 youngsters, 46 percent failed to control their blood sugar and progressed to insulin. Half of the failures occurred within a year, a deterioration that usually takes a decade in an adult. The weight loss program, which involved frequent meetings for up to two years, made no difference.

"The behavioral lifestyle [coaches] went to their homes, their churches, the library — wherever the patients wanted to meet," said Silva A. Arslanian, a pediatric endocrinologist at Children's Hospital of Pittsburgh. "It was intensive. But it's very difficult to change behavior."

Indeed, after five years of follow-up, most youngsters ended up where they started — 50 to 70 pounds too heavy. Many needed drugs to treat high blood pressure or high cholesterol, or both.

Zeitler, who was part of the study, said, "The health burdens in these families are already high. Often, Mom and Grandma are on dialysis."

Why isn't the specter of disability a motivator?

"In general, teens don't see the future as something they worry about," Zeitler said. "And in many of these kids, there's a fatalism: ‘This is what happens in our family, no matter what I do.'?"

The conference has numerous sessions on lifestyle-changing interventions that worked with adults. But children, experts agree, are a more complex crisis.

"Fifty years ago, children did not avoid obesity by making healthy choices; they simply lived in an environment that provided fewer calories and more physical activity," University of Wisconsin pediatric endocrinologist David Allen wrote in an editorial about the treatment study. "Until a healthier ‘eat less, move more' environment is created for today's children, lifestyle interventions like that in the [study] will fail."

Contact Marie McCullough at 215-854-2720 or mmccullough@phillynews.com.

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