Diagnosis & Treatment of Type 2 Diabetes in Children
By Byron Cotton, John Parks and Alice Smith
a disease of older adults, Type 2 diabetes is increasingly being
diagnosed in children and adolescents due, in part, to increased
rates of childhood obesity. Some studies indicate that Type 2 diabetes
is becoming more common among children and adolescents, particularly
in African-Americans, Hispanic/Latinos and American Indians. In
addition, more children are presenting with risk factors associated
with Type 2 diabetes, including high blood pressure and high cholesterol.
2 diabetes is characterized by insulin resistance and relative insulin
deficiency, resulting in high levels of glucose in the blood. If
blood sugar levels are too high, damage can occur to many organs
in the body leading to blindness, kidney disease, heart disease,
amputations of lower-limbs and premature death.
at Children's Healthcare of Atlanta are working with parents and
children to combat this disease before onset. However, not all cases
are prevented in time, requiring accurate diagnosis and effective
treatment to prevent further complications.
One in four children who are overweight has insulin resistance and
is at risk for developing Type 2 diabetes. Research has shown that
lifestyle changes, including healthy eating and regular physical
activity, decrease insulin resistance and reduce the risk of developing
Type 2 diabetes. Awareness of the risk of diabetes, early testing
for risk factors, and effective nutrition and exercise intervention
programs can prevent or delay the development of Type 2 diabetes
in children and teens.
to crowded schedules, parents are relying more and more on physicians
to coach them about what their children need and how they can accomplish
realistic nutrition and physical activity goals.
Type 2 diabetes prevention program at Children's provides parents
of at-risk children with advice to curb many behaviors associated
with developing obesity, a primary risk factor. Families should
limit time in front of the television, computer or video games to
less than 2 hours a day. Families are advised to complete 15 minutes
of physical activity together every day. Children should work up
to at least one hour of vigorous physical activity every day and
an additional hour of a fun activity.
are also advised to reevaluate nutritional practices around the
house. For example:
" Cut back gradually on fast food in favor of meals prepared
" Offer healthy snacks like vegetables, fruits and foods low
in sugar and salt.
" Plan meals and snacks in advance. It is easier to avoid making
unhealthy choices if all of the decisions are already made. Remember
that snacks are "mini-meals" and should be healthy and
" Drink more water, low-fat milk or low-calorie drinks.
" Drink fewer sodas and sweet drinks, including juice.
" Strive for five servings daily of fruits and vegetables.
Try to serve fruits or vegetables with each meal or snack.
are also coached to remember that body size does not indicate fitness
and health. Even thin and average weight children should be encouraged
to exercise healthy choices. Above all, families should exercise
patience when making diet and lifestyle changes. Major changes take
time, but will benefit the entire family in the long run.
American Diabetes Association suggests that overweight children
be tested for diabetes every two years if two or more risk factors
are present, including: family history of diabetes, patient belongs
to certain minority groups (American Indian, African American, Hispanic
American, Asian/South Pacific Islander) or have signs of insulin
resistance, such as high blood pressure, high blood lipids, polycystic
ovary disease in girls, or acanthosis nigricans, or dark, velvety
textured skin at base of the neck, armpits and groin area. If the
child is overweight it is appropriate to inquire about symptoms
of Type 2 diabetes, such as history of fatigue, yeast infection
and increased thirst and bathroom use, especially at night.
of Type 2 diabetes occur gradually and may be mild, so they often
go unnoticed. Blood glucose testing is needed to make a diagnosis,
and should be done following an overnight fast. The child is considered
to have diabetes if their glucose level is 126 mg/dl or higher.
Levels between 100-125 mg/dl are classified as pre-diabetic. The
blood test must be processed by a certified laboratory to make an
accurate diagnosis. Fingerstick glucose meter tests are not reliable
enough to establish a diagnosis.
with fasting blood glucose just above 126 mg/dl who are asymptomatic
can be treated through a three month trial of family-focused lifestyle
changes, including healthy eating and physical activity habits.
Prior to the beginning of the lifestyle intervention program it
is best to administer a Hemoglobin A1C test, which provides a three-month
history of the child's blood sugar patterns. Following the intervention
trial another Hemoglobin A1C test should be administered to determine
any changes. The child should begin taking oral medications to regulate
the disease if there is no improvement after three to six months
of lifestyle modifications.
children with diabetes, especially those recently diagnosed, need
to be monitored on a monthly basis by checking weight gain/loss,
fasting glucose levels and the status of other symptoms.
who are symptomatic upon diagnosis should be immediately placed
on medicine and a family-focused lifestyle intervention program.
Cotton, M.D., is a primary practice physician at Children's Healthcare
of Atlanta. John Parks, M.D. is a pediatric endocrinologist at Children's
Healthcare of Atlanta and Emory University School of Medicine. Alice
Smith, MS, MBA, RD, is with the Type 2 diabetes prevention program
at Children's Healthcare of Atlanta. For more information about
Type 2 Diabetes prevention, diagnosis or treatment, visit www.choa.org
or call 404-250-kids.