Type 2 diabetes is affecting kids in a big way, but diet and exercise can help children avoid or reverse this condition.
Once upon a time, type 2 diabetes was called “adult-onset diabetes.” If children had diabetes, 99 times out of 100 it was type 1 diabetes; type 2 diabetes didn’t appear until midlife. Now, studies suggest that up to 45 percent of childhood diabetes cases are type 2 diabetes.
Type 2 Diabetes: Why the Increase?
“No one is certain why, but most experts believe that it is related in part to the obesity epidemic,” explains Frank Diamond, MD, clinical director for the University of South Florida Diabetes Center and professor of pediatrics at the University of South Florida in Tampa. “We now have approximately 17 percent of the pediatric population that is overweight. Genetically at-risk children may be acquiring the disease earlier because of the increased insulin resistance associated with their early obesity. We are seeing many children with adult weights in our pediatric clinics today.”
Dr. Diamond also notes that the increase may be due to a rise in the proportion of children with ethnic minority heritage that puts them at increased risk for type 2 diabetes.
Basically, says Paul Robertson, MD, president of medicine and science at the American Diabetes Association, and professor of medicine and pharmacology at the University of Washington in Seattle, the causes of childhood type 2 diabetes boil down to genetic risk mixed with physical inactivity and poor eating habits.
“We know if the diets are corrected and they lose the weight, the diabetes becomes undetectable,” says Dr. Robertson.
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Type 2 Diabetes: What Parents Can Do
The first step to preventing type 2 diabetes in childhood is to face the fact that it can happen to children, says Diamond. Then be on guard for symptoms and ask for diabetes screening.
“Symptoms include tiring easily, thirst, and increased urination. A darkening of the skin (acanthosis nigricans) on the back of the neck, under the arms, and in the groin area is associated with obesity and [is] a common finding with newly diagnosed type 2 diabetes children,” he says.
Also, bear in mind that if you had gestational diabetes during your pregnancy, your children are at increased risk of type 2 diabetes.
“Especially in families with a positive family history of type 2 diabetes, avoidance of excessive weight gain and encouragement of an active lifestyle are extremely important and the best tools to avoid the development of type 2 diabetes,” says Diamond. Some children may be candidates for a drug called metformin.
Type 2 Diabetes: Testing
Parents who are concerned that their child might have diabetes should ask for a fasting glucose screening test. That test determines how much sugar is in the blood before a person has eaten.
“A value over 99 mg/dL is abnormal and suggests ‘impending’ diabetes or glucose intolerance. A value equal to or greater than 126 mg/dL is diagnostic of diabetes,” says Diamond.
Any results above the normal range should be red flags for you and your family to:
* Eat a healthy diet rich in whole grains, lean proteins, fruits, and veggies. You can get help changing your family’s diet from a dietitian, if necessary.
* Get at least 30 minutes of exercise a day.
* Help your child lose at least 5 percent of his body weight if he is overweight.
Remember, childhood type 2 diabetes is within your family’s control.
“Lose weight, be active, eat the right foods,” says Robertson. “Lifestyle modifications can do a great deal in terms of staving off type 2 diabetes.”
Last Updated: 04/16/2009
This section created and produced exclusively by the editorial staff of EverydayHealth.com. © 2010 EverydayHealth.com; all rights reserved.
Showing posts with label children. Show all posts
Showing posts with label children. Show all posts
Tuesday, August 10, 2010
Friday, July 2, 2010
Obesity, Other Risk Factors for Youth Diabetes Improved by Broad, School-based Intervention Program
One of the important announcements coming out of the American Diabetes Association's 70th Scientific Sessions were the results of a little known NIH study titled, "The Healthy Study: Interventions to reduce early diabetes risk." This may be a new model of how we can prevent our children from getting diabetes....
The NIH made a major investment in our children by modifying lifestyles in the grade schools to prevent a number of diseases. They also have a website that has all of the materials used in the program available at no cost: www.healthystudy.com.
A broad-based program to fight obesity and diabetes, aimed at US middle-school students and conducted directly by their teachers and other local school officials and designed to profoundly change not only diet, but also attitudes about food and fitness, appeared to improve measures of adiposity, insulin resistance, and other diabetes risk factors in a prospective randomized trial. The findings were presented here on June 28 at the 70th ADA Scientific Sessions and published online June 27, 2010, in the New England Journal of Medicine.
However, there wasn't a significant difference between students at schools that ran the three-year program and control schools, where the program wasn't instituted, in the study's primary end point: change in the prevalence of kids who were overweight or obese, defined as a body-mass index (BMI) in the >85th percentile. The prevalence fell similarly at schools with and without the intervention program.
By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1.
The program, which followed the students from the beginning of sixth grade to the end of eighth grade, also did not show a significant benefit in lowering the overall prevalence of kids who were obese at its conclusion -- that is, who finished the study in the >95th percentile for BMI. That prevalence fell by 19% at program compared with nonprogram schools, but the difference fell just short of significance at p=0.05.
However, the proportion of kids with waist circumference in the >90th percentile fell significantly more (p=0.04) at program schools. Students at those schools also had significantly (p=0.04) smaller increases in fasting insulin levels over the three years.
The program's benefits in the overall school populations were even more pronounced, and more solidly significant, among the approximately one-half of students in the >85th percentile for BMI at the beginning of sixth grade.
"This would suggest that, although the intervention did not meet its primary outcome of altering the combined prevalence of overweight or obesity, it did have effects on obesity and other important risk factors for Type 2 diabetes, Dr. Gary D. Foster (Temple University, Philadelphia, PA) said at a briefing for medical reporters. Foster chaired the HEALTHY study -- a name, not an acronym, chosen by students who participated in the comprehensive program.
He also said that the falling overweight/obesity rates at schools with and without the intervention program are consistent with national-level trends observed in other analyses that suggest that "rates of obesity in high-risk children in sixth to eighth grade appear not to be steady or increasing, but actually appear to be declining."
The HEALTHY study randomized 42 schools in seven regions of the US to follow or not follow the comprehensive intervention program. Schools qualified for participation if at least 50% of their students were members of a minority (primarily Hispanic or African American) or at least 50% qualified for government-subsidized meal programs; minority and low-income kids, the researchers note, are known to be at increased risk for both obesity and diabetes. Girls made up 53% of the 4,603 students tracked in the study, who had to be free of recognized diabetes at baseline.
At the press briefing, Dr. Griffin P. Rodgers (National Institutes of Health, Bethesda, MD), who is director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the HEALTHY study's primary underwriter, but who isn't one of its investigators, underscored the importance of targeting kids at increased risk for diabetes. "Earlier onset of diabetes may foreshadow earlier appearance of complications," he noted.
When the HEALTHY study and its six preceding pilot studies were initially in development, he continued, "obesity rates in American youth had been climbing steadily for two decades. Then, medical centers around the country began reporting a disturbing new trend, Type 2 diabetes was increasingly being diagnosed in youths, especially black, Hispanic, and American Indian adolescents. By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1. We needed to find ways to contain the rising rate of Type 2 diabetes in kids, and schools were a logical place to start."
Dr. Cynthia L. Ogden (Centers for Disease Control and Prevention, Atlanta, GA), also on hand at the briefing but not a HEALTHY study researcher, showed 2007/08 data from the National Health and Nutrition Examination Survey suggesting that 31.7% of US children aged two to 19 are overweight or obese, amounting to 23.4 million children. Among them, she said, are the 17% of US kids in that age group, a total of about 12.5 million, who qualify as obese.
Also, Rodgers said, the HEALTHY pilot trials suggested that up to 40% of eighth graders at schools with high-risk populations had elevated fasting glucose levels. "So the question became, can changes in schools -- namely, longer and more intense gym classes, healthier food choices, and classroom activities that promote healthy behavior -- lower risk factors for Type 2 diabetes in youth?"
The program consisted of interventions grouped in four domains. (Details and the materials used are available on the study's website.) The nutritional component called for healthy improvements in the quality and quantity of food and beverages available at the schools' cafeterias, snack bars, and vending machines, and even at fundraisers and classroom parties, according to Hirst. Available choices shifted to those lower in fat, higher in fiber, heavier on fruit and vegetables, and lower in added sugar.
The physical-activity component was aimed at increasing both participation and activity levels in physical education classes, emphasizing activities that raised the heart rate.
Dr. Kathryn Hirst (George Washington University School of Public Health, Washington, DC) provided more details of the intervention program, which consisted of "multiple components that were designed to change the school environment radically." Experts on the study's staff at its seven regional field offices provided "training, guidance, assistance, materials, and support" for instituting the program to the faculties and staff at each of the schools, "who were the ones who actually delivered the intervention," she noted.
Teachers received instruction on holding school-wide events that promoted physical activity. Minimum weekly durations of physical education classes were instituted.
The third component, focused on behavior, according to the report, promoted classroom and family-outreach activities to educate and sharpen self-awareness and decision-making, self-monitoring, and goal-setting skills consistent with the overall program.
The fourth component, communication, focused on the use of marketing techniques to promote the program's goals within the schools and establish a "brand" to characterize and identify the changes to menus and physical activities that were part of the program.
Healthy Study Group. A school-based intervention for diabetes risk reduction. New Engl J Med 2010; DOI:10.1056/NEJMoa1001933. Available at www.nejm.org.
The NIH made a major investment in our children by modifying lifestyles in the grade schools to prevent a number of diseases. They also have a website that has all of the materials used in the program available at no cost: www.healthystudy.com.
A broad-based program to fight obesity and diabetes, aimed at US middle-school students and conducted directly by their teachers and other local school officials and designed to profoundly change not only diet, but also attitudes about food and fitness, appeared to improve measures of adiposity, insulin resistance, and other diabetes risk factors in a prospective randomized trial. The findings were presented here on June 28 at the 70th ADA Scientific Sessions and published online June 27, 2010, in the New England Journal of Medicine.
However, there wasn't a significant difference between students at schools that ran the three-year program and control schools, where the program wasn't instituted, in the study's primary end point: change in the prevalence of kids who were overweight or obese, defined as a body-mass index (BMI) in the >85th percentile. The prevalence fell similarly at schools with and without the intervention program.
By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1.
The program, which followed the students from the beginning of sixth grade to the end of eighth grade, also did not show a significant benefit in lowering the overall prevalence of kids who were obese at its conclusion -- that is, who finished the study in the >95th percentile for BMI. That prevalence fell by 19% at program compared with nonprogram schools, but the difference fell just short of significance at p=0.05.
However, the proportion of kids with waist circumference in the >90th percentile fell significantly more (p=0.04) at program schools. Students at those schools also had significantly (p=0.04) smaller increases in fasting insulin levels over the three years.
The program's benefits in the overall school populations were even more pronounced, and more solidly significant, among the approximately one-half of students in the >85th percentile for BMI at the beginning of sixth grade.
"This would suggest that, although the intervention did not meet its primary outcome of altering the combined prevalence of overweight or obesity, it did have effects on obesity and other important risk factors for Type 2 diabetes, Dr. Gary D. Foster (Temple University, Philadelphia, PA) said at a briefing for medical reporters. Foster chaired the HEALTHY study -- a name, not an acronym, chosen by students who participated in the comprehensive program.
He also said that the falling overweight/obesity rates at schools with and without the intervention program are consistent with national-level trends observed in other analyses that suggest that "rates of obesity in high-risk children in sixth to eighth grade appear not to be steady or increasing, but actually appear to be declining."
The HEALTHY study randomized 42 schools in seven regions of the US to follow or not follow the comprehensive intervention program. Schools qualified for participation if at least 50% of their students were members of a minority (primarily Hispanic or African American) or at least 50% qualified for government-subsidized meal programs; minority and low-income kids, the researchers note, are known to be at increased risk for both obesity and diabetes. Girls made up 53% of the 4,603 students tracked in the study, who had to be free of recognized diabetes at baseline.
At the press briefing, Dr. Griffin P. Rodgers (National Institutes of Health, Bethesda, MD), who is director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the HEALTHY study's primary underwriter, but who isn't one of its investigators, underscored the importance of targeting kids at increased risk for diabetes. "Earlier onset of diabetes may foreshadow earlier appearance of complications," he noted.
When the HEALTHY study and its six preceding pilot studies were initially in development, he continued, "obesity rates in American youth had been climbing steadily for two decades. Then, medical centers around the country began reporting a disturbing new trend, Type 2 diabetes was increasingly being diagnosed in youths, especially black, Hispanic, and American Indian adolescents. By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1. We needed to find ways to contain the rising rate of Type 2 diabetes in kids, and schools were a logical place to start."
Dr. Cynthia L. Ogden (Centers for Disease Control and Prevention, Atlanta, GA), also on hand at the briefing but not a HEALTHY study researcher, showed 2007/08 data from the National Health and Nutrition Examination Survey suggesting that 31.7% of US children aged two to 19 are overweight or obese, amounting to 23.4 million children. Among them, she said, are the 17% of US kids in that age group, a total of about 12.5 million, who qualify as obese.
Also, Rodgers said, the HEALTHY pilot trials suggested that up to 40% of eighth graders at schools with high-risk populations had elevated fasting glucose levels. "So the question became, can changes in schools -- namely, longer and more intense gym classes, healthier food choices, and classroom activities that promote healthy behavior -- lower risk factors for Type 2 diabetes in youth?"
The program consisted of interventions grouped in four domains. (Details and the materials used are available on the study's website.) The nutritional component called for healthy improvements in the quality and quantity of food and beverages available at the schools' cafeterias, snack bars, and vending machines, and even at fundraisers and classroom parties, according to Hirst. Available choices shifted to those lower in fat, higher in fiber, heavier on fruit and vegetables, and lower in added sugar.
The physical-activity component was aimed at increasing both participation and activity levels in physical education classes, emphasizing activities that raised the heart rate.
Dr. Kathryn Hirst (George Washington University School of Public Health, Washington, DC) provided more details of the intervention program, which consisted of "multiple components that were designed to change the school environment radically." Experts on the study's staff at its seven regional field offices provided "training, guidance, assistance, materials, and support" for instituting the program to the faculties and staff at each of the schools, "who were the ones who actually delivered the intervention," she noted.
Teachers received instruction on holding school-wide events that promoted physical activity. Minimum weekly durations of physical education classes were instituted.
The third component, focused on behavior, according to the report, promoted classroom and family-outreach activities to educate and sharpen self-awareness and decision-making, self-monitoring, and goal-setting skills consistent with the overall program.
The fourth component, communication, focused on the use of marketing techniques to promote the program's goals within the schools and establish a "brand" to characterize and identify the changes to menus and physical activities that were part of the program.
Healthy Study Group. A school-based intervention for diabetes risk reduction. New Engl J Med 2010; DOI:10.1056/NEJMoa1001933. Available at www.nejm.org.
Wednesday, June 16, 2010
Mental decline from diabetes can start in middle age
(Reuters Health) - Diabetes can lead to a decline in memory, thinking speed, and mental flexibility in middle age, but controlling the blood sugar disorder might prevent some of these effects, new research from the Netherlands suggests.
Health
While the mental decline may be invisible to the individual, the fact that the drop-off starts accumulating in middle age puts diabetics at greater risk later on because of reduced "brain reserves," Dr. David Knopman, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.
"Like a bicycle tire that's been partially deflated -- you'll be OK riding around but if you develop another little leak you'll be much closer to a flat tire much faster," said Knopman, who was not involved in the Dutch study.
Astrid Nooyens and colleagues at the National Institute for Public Health and the Environment in the Netherlands examined the health records and mental acuity scores of more than 2,600 men and women between the ages of 45 and 70 who enrolled in a large ongoing study into lifestyle effects on health.
At the five-year mark, of the 139 participants with type 2 diabetes, 61 were diabetics at the beginning of the study and 78 developed the chronic disease within the next five years.
The study confirmed the findings of earlier research, by Knopman and others, of an association between diabetes and declines in such mental functions as the ability to think quickly and recall words, but this is the first project to test memory and demonstrate how quickly the drop-off can occur.
Over a five-year period, decline in overall mental functioning in people with type 2 diabetes, while small, was nearly 3 times more pronounced than in non-diabetics.
But it didn't take many years for the impact to be felt. Even those who developed diabetes after beginning the study saw twice as much of a decline as their non-diabetic counterparts.
Compared to the "healthy" participants, participants who had long-term diabetes registered the largest declines in mental function. Those who developed diabetes during the trial saw less pronounced declines than their long-term counterparts in most areas except information processing, where they appeared to do a little better than the "healthy" people.
Type 2 diabetes is characterized by high blood sugar levels caused by the body's inability to process sugar properly. The illness can usually be controlled through diet and exercise but may also require drugs.
The Nooyens group found that while memory continues to decline for those with diabetes, the drop-off in thinking speed appears to occur in the first five years and then level off. That led the authors to suggest that early treatment and control of blood sugar levels could help thinking speed, but probably not memory, they note in the journal Diabetes Care.
The researchers found that for a small group of people who had lived with diabetes for nearly seven year, blood sugar levels did not explain the entire decline in mental function. In those people, they suspect other conditions related to diabetes such as high blood pressure and obesity.
The study did not look at whether patients with well-controlled diabetes experienced less mental decline compared to their poorly controlled counterparts, although the authors point out that there are other reasons, such as heart disease, to control sugar levels as well.
They also note that the random blood tests of both the long- and short-term diabetics suggested what treatment they were getting was "insufficient."
SOURCE: link.reuters.com/xyd69k Diabetes Care, online June 2, 2010
Health
While the mental decline may be invisible to the individual, the fact that the drop-off starts accumulating in middle age puts diabetics at greater risk later on because of reduced "brain reserves," Dr. David Knopman, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.
"Like a bicycle tire that's been partially deflated -- you'll be OK riding around but if you develop another little leak you'll be much closer to a flat tire much faster," said Knopman, who was not involved in the Dutch study.
Astrid Nooyens and colleagues at the National Institute for Public Health and the Environment in the Netherlands examined the health records and mental acuity scores of more than 2,600 men and women between the ages of 45 and 70 who enrolled in a large ongoing study into lifestyle effects on health.
At the five-year mark, of the 139 participants with type 2 diabetes, 61 were diabetics at the beginning of the study and 78 developed the chronic disease within the next five years.
The study confirmed the findings of earlier research, by Knopman and others, of an association between diabetes and declines in such mental functions as the ability to think quickly and recall words, but this is the first project to test memory and demonstrate how quickly the drop-off can occur.
Over a five-year period, decline in overall mental functioning in people with type 2 diabetes, while small, was nearly 3 times more pronounced than in non-diabetics.
But it didn't take many years for the impact to be felt. Even those who developed diabetes after beginning the study saw twice as much of a decline as their non-diabetic counterparts.
Compared to the "healthy" participants, participants who had long-term diabetes registered the largest declines in mental function. Those who developed diabetes during the trial saw less pronounced declines than their long-term counterparts in most areas except information processing, where they appeared to do a little better than the "healthy" people.
Type 2 diabetes is characterized by high blood sugar levels caused by the body's inability to process sugar properly. The illness can usually be controlled through diet and exercise but may also require drugs.
The Nooyens group found that while memory continues to decline for those with diabetes, the drop-off in thinking speed appears to occur in the first five years and then level off. That led the authors to suggest that early treatment and control of blood sugar levels could help thinking speed, but probably not memory, they note in the journal Diabetes Care.
The researchers found that for a small group of people who had lived with diabetes for nearly seven year, blood sugar levels did not explain the entire decline in mental function. In those people, they suspect other conditions related to diabetes such as high blood pressure and obesity.
The study did not look at whether patients with well-controlled diabetes experienced less mental decline compared to their poorly controlled counterparts, although the authors point out that there are other reasons, such as heart disease, to control sugar levels as well.
They also note that the random blood tests of both the long- and short-term diabetics suggested what treatment they were getting was "insufficient."
SOURCE: link.reuters.com/xyd69k Diabetes Care, online June 2, 2010
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