Type 2 diabetes

Maintain a healthy suspicion for type 2 diabetes in kids

The number of children and teens being diagnosed with type 2 diabetes (T2DM) in Australia is on the rise with a concerning amount of cases being reported in children as young as ten years old.

Speaking to the limbic Dr Aveni Haynes from the Princess Margaret Hospital for Children in WA said her research investigating cases in Western Australia revealed the rate of increase in new diagnoses each year is about 9-11%.

Across all children and teenagers, numbers are on the rise but according to Dr Haynes there is a disproportionate rate of under 16 year old girls and indigenous children in WA being diagnosed with T2D.

“Just under 66% of our patients are of indigenous descent so they are grossly over represented in terms of our clinic but the changes that are resulting in more children and adolescents being diagnosed with T2D is happening across the board irrespective of genetic background.”

The youngest children treated at the clinic are aged between eight and 10 years and many are under the age of 16 but Dr Haynes said case reports of children as young as three and five have been reported overseas.

While the condition is considered to be a relatively new disease in terms of paediatrics Dr Haynes urged clinicians to think about T2D more actively, even in an asymptomatic child particularly if they’ve got obesity or other risks factors and think about screening them.

“You can’t just presume that if you see a child with diabetes it will be type 1 – in younger people we need to think about other signs, a family history, if the child is overweight or of an ethnic minority group of if the mother has had gestational diabetes then it might be worth screening for T2D.”

According to Dr Haynes many of the children who get referred to the Princess Margaret Hospital for treatment already have high blood pressure, abnormal lipids, or even early signs of kidney disease.

“These kids are coming in and they are pretty sick; their risks are future heart disease and the need for dialysis so their mortality will be significantly higher than a background population and possibly higher than those kids we’re seeing with type 1 diabetes”.

She also noted that evidence from studies like the TODAY trial showed that T2D was a much more rapidly progressing and aggressive disease compared to type 1 diabetes when it occurs in youth.

“There is a lot of work to be done in terms of trying to work out how we can make sure we are diagnosing these children early because by the time we are seeing them about a fifth of them will have signs of other concerning comorbidities.”

The findings track with some research nationally, which has pointed to the growing rate of obesity-related health conditions among young adults.

With child obesity rates in Australia rising, Dr Haynes said it’s no surprise more children are being treated for the condition.

“There’s no doubt that one of the main risk factors and underlying causes of the increase is due to the overweight and obesity and a large proportion of the children we see in our clinic are either overweight or obese.”

Another major concern was the fact that many of the drugs typically used to manage T2DM are not approved for use in children.

“Metformin and insulin are the only drugs we know of that you can use in children but findings from the TODAY study show that children tend to progress from metformin to needing insulin much sooner than adults” she said.

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