Study finds youth diabetes
risk higher than expected
"Fifty years ago," Dr. David B. Allen (University of Wisconsin School of Medicine and Public Health) said in the online New England Journal of Medicine today, "children did not avoid obesity by making healthy choices; they simply lived in an environment that provided fewer calories and included more physical activity for all."
Illinois ranks 4th highest in the nation for childhood obesity, which often leads to diabetes. Over a third of children 10-17 years residing in the state are overweight, four out of 10 in Cook County. These figures are considerably worse than the national averages. Total health care costs for diabetes in the United States have been estimated at approximately $100 billion per year. This means that more than ten percent of our total health care expenditures go to a disease that is PREVENTABLE.
The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study Dr. Allen commented on involved 699 youth 10 to 17 years of age. Each had been found to have high body mass index and was diagnosed with T2DM.
Even when lifestyle changes were combined with two prescription medicines, only about 60% of the young subjects could keep blood sugar under control for more than six months. The study provided critical new information about T2DM in youth and tested the benefits of early aggressive drug treatment and the efficacy of lifestyle intervention.
"The results of the study were discouraging," said Dr. Allen. "These data imply that most youth with type 2 diabetes will require multiple oral agents or insulin therapy within a very few years after diagnosis."
Harder to help young people than adults
For younger people, the prospects of getting better are not so bright as for adults. The youth diabetes epidemic will worsen the existing statistics, because the disease progresses more rapidly in adolescents. Also, complications like infections and hospitalization arise more often for younger patients. Many of them do not take meds as instructed. Finally, the longer one has diabetes, the worse are its effects.
Dr. Allen points out that our children are "immersed from a young age in a sedentary, calorie-laden environment that may well have induced and now aggravates their type 2 diabetes." Allen feels that the currently used lifestyle modifications are likely to fail for today's children until a healthier “eat less, move more” environment is created.
Existing diabetes prevention programs
One-third of Americans who have diabetes are not aware that their health is seriously compromised. The National Institutes of Health sponsors a landmark Diabetes Prevention Program targeted toward these prediabetic and diabetic adults. It's based on studies that examined patients from 27 locations nationwide and followed them up after 10 years.
Endocrinologists conducting these investigations came to a simple conclusion:
Modest weight loss (5-7% of total body weight) combined with 150 minutes (two and a half hours) of physical activity per week (about 20 minutes a day) can considerably reduce the risk of adults developing type 2 diabetes. For adults over 60, the risk reduction is a whopping 70%.
A community-based national prevention program called Small Steps, Big Rewards stresses that people at risk for type 2 diabetes can gain huge rewards--delay or prevention of type 2 diabetes and its complications--just by taking small steps toward a healthy lifestyle.
Spreading the word to youth
Local organizations such as YMCAs periodically offer the Small Steps, Big Rewards course, and large chain drugstores are also becoming involved.
Clearly, schools need to take part in the program also, stressing that students should eat less fast food, give up sugary sodas, watch their diet, and generally get more exercise, even if it means walking to school and taking stairs instead of elevators. Schools also need to provide healthy lunches and mandate phys ed and/or sports for all. (Illinois has neither sugar-sweetened soda restrictions nor required phys ed.) And churches and other community groups could cut down on the bake sales....
Not only do primary care doctors, nurse-practitioners, and physician assistants need to drive home the diabetes message--neonatologists and pediatricians now also need to help it take hold. And Small Steps. Big Rewards needs tweaking to apply to a younger patient base.
Sandy Dechert: Health Report
29 April 20123