When doctors in the UKreported the first four cases of very overweight white British teenagers with Type 2 diabetes (also known as 'adult-onset'
diabetes) in February this year, they warned of a huge crisis ahead.
Type 2 diabetes has already been rising steadily in all adults. It is one and a half times more common in the poorest fifth of the population, six times more common in people of South Asian descent and up to three times more common in those of African and African-Caribbean descent. Although Type 2 diabetes has already been seen in a few teenage children from ethnic minorities, this latest report on four 13-to 15-year-olds shows that before long, many children of all origins will be affected, unless obesity is tackled. In America, bigger numbers of obese children of all origins are already developing the condition, as another recent study has revealed.
But the number of people with Type 1 ('juvenile-onset') diabetes is also rocketing, making diabetes one of the major health issues of our time, says the charity Diabetes UK.
Around 5.2 billion of the NHS annual budget goes on treating diabetes and its complications. A Department of Health spokesperson confirmed the scale of the problem, 'An estimated 3.2 per cent of the adult population in England, around 1.3 million people, have diagnosed diabetes. Around 5 per cent of total NHS resources, and up to 10 per cent of hospital in-patient resources, are used for the care of people with diabetes.
'Most of the costs arise from the long-term complications resulting if diabetes is not properly managed - blindness, renal failure, lower limb problems leading to amputation and cardiovascular disease.'
Reasons for rise
The rise in Type 2 is linked to obesity, poor diet and lack of exercise. Type 1 is thought to be the result of an unfavourable interaction between environmental factors and an inherited predisposition to the disease. Nobody really knows what the environmental triggers are, but theories include various viruses, chemical toxins in foods, cows' milk in newborns and low levels of vitamin D.
Dr Julian Shield, based at the Royal Hospital for Children in Bristol, co-wrote a paper on the four white children with Type 2 diabetes. Asked how serious the problem is, he told Nursery World, 'We do not yet know. However, given the huge increase in the prevalence of obesity in the childhood population, the implications could be enormous.'
Dr Shield points to a recent US study, where researchers at Yale University looked at nearly 167 obese children aged between four and 18. About a quarter of them already had abnormal glucose handling and four had Type 2 diabetes. So how early can children develop Type 2? 'Again, we do not know, but probably obese children will get Type 2 diabetes in adolescence or early adult life,' says Dr Shield.
He stresses parents and early years practitioners can protect children from an early age, and advises, 'Get children to exercise more - walk to school, play more organised formal games, and so on. They should watch less TV and play far fewer computer games. They should not snack so much and should eat less refined carbohydrates and fat.'
Signs and treatment
Dr Julie Edge, a consultant paediatrician at Oxford's John Radcliffe Hospital, has not seen Type 2 diabetes in nursery-age children. However, she confirms the dramatic increase of Type 1 diabetes in the under-fives. Across Europe, Type 1 diabetes is increasing at a rate of 3 to 4 per cent per year in the under-15s, most markedly in children under five, according to a 1997 study in the British Medical Journal. No large-scale figures have become available since then, 'although what we know is that over the previous decade, the incidence of Type 1 diabetes in under fives has doubled', says Dr Edge.
'We have 14 children aged under five in our diabetes clinic, out of 220-odd patients,' she adds. 'If you look at the age of diagnosis of the 220, 76 were diagnosed when they were under the age of five. That's a lot.'
Unlike Type 2, Type 1 is impossible to prevent, says Dr Edge. This makes it all the more important that parents and childcarers look for the early signs and catch it soon, before complications arise.
Once diagnosed, children have to endure regular insulin injections, and blood tests up to six times a day to measure blood glucose levels. They have to eat a careful diet with regular snacks and need plenty of exercise.
The under-fives are particularly hard to treat. 'It's difficult to get good blood sugar control in toddlers because of their erratic eating patterns and activity,' says Dr Edge. Too much insulin causes blood sugar to fall (hypoglycaemia); too little causes it to rise (hyperglycaemia).
She says that the NHS needs more specialist nurses with an interest in this age group. There is also an urgent need to develop new therapies, including better insulin and injection devices. And she would like to see the NHS invest more in this area of research.
The Government's National Service Framework on Diabetes set out new standards for caring for adults and children last December. Everyone is still waiting for part two of the document, which will outline how the standards are to be achieved.
'The first part is certainly a step in the right direction,' says Bill Hartnett, acting PR spokesperson at Diabetes UK. 'But we need practical details. We are guarded in our optimism. We think this would be a very wise place to invest money, because a lot of health costs are spent on the complications.'
