Just a few decades ago, type 2 diabetes in children or teenagers was considered extremely rare.
By the mid-1990s, health professionals suddenly saw rates of diabetes in young people spiking in the United States — and other countries including Canada, Japan, Austria, the United Kingdom, and Germany.
In this article, we’ll look at factors that significantly increase a young person’s risk of developing type 2 diabetes, the most common complications, the best treatment options, and tips for prevention.
Children & teens with the highest risk of developing type 2 diabetes
Type 2 diabetes amongst young people is significantly more common within several specific ethnic subgroups, according to 2013 research from the World Journal of Diabetes (WJD):
- Asian/Pacific Islanders
- American Indians
A difficult feature of type 2 diabetes in young people is how it is even more subtle — and often lacking symptoms entirely — than type 2 diabetes in adults.
For this reason, the WJD has recommended that clinicians be extra aware of screening young people who are at a higher risk of developing the condition.
Children and adolescents with the following factors face the highest risk of developing type 2 diabetes:
- Overweight or obese
- Relatives who have type 2 diabetes
- High blood pressure
- High cholesterol
- High triglycerides
- Polycystic ovarian syndrome (PCOS)
- Acanthosis nigricans (darkened skin around the neck, armpits, groin)
Research from the WJD has found significant differences in insulin levels and insulin resistance within one race versus another.
“African-American 7 to 11-year-old children have significantly higher insulin levels than age-matched white children,” explains the study.
“These data suggest that particular ethnic groups may have a genetic predisposition to insulin resistance, which may increase their risk for type 2 diabetes mellitus. In concordance, obese Swedish children have higher fasting glucose levels than obese German children.”
This simply continues to prove that nutrition, body weight, and exercise are not the central cause of type 2 diabetes but merely aspects of it.
Causes of type 2 diabetes in children & teens
While mainstream media would lead you to believe that the cause of type 2 diabetes in children is too much candy and too much time in front of the T.V., it isn’t that simple.
Type 2 diabetes in children and teens is generally a combination of several factors that, when combined, lead to persistently higher blood sugar levels.
- Insulin resistance
- Impaired beta-cell function
- BMI over 25
- A diet high in fast-food and other processed foods
- Regular consumption of sugar-sweetened beverages (soda, coffee drinks, teas, etc.)
- Injury or physical disability that limits physical activity
- Too little activity or exercise
- Body image challenges
- Limited access to safe areas for daily activity
- Genetic disposition to obesity
- Prescription medications that cause weight gain (antidepressants, steroids, etc.)
“Research studies show a 40 percent increased risk of developing type 2 diabetes for individuals who have one parent with the disease and up to a 70 percent increased risk if both parents are affected,” diabetes expert Ruth Ann Crouse, RMA, RDN told Insulin Nation.
A child’s or teenager’s genes could be directly related to weight gain, insulin resistance, and beta-cell dysfunction (insulin secretion).
Crouse points to a gene called “FTO” that has proven in research to have a tremendous impact on a person’s body weight. And even in those with healthy body weight, the FTO gene still significantly increases their risk of developing type 2 diabetes.
Another gene, Crouse points to, is called TCF7L2, and it has been largely associated with type 2 diabetes and decreased insulin secretion.
In the end, Crouse says that what a person eats and drinks, and how active they are on a daily basis, is what easily leads that genetic predisposition to actually developing the disease.
“As with most chronic diseases like type 2 diabetes, genetics + environment = outcome,” explains Crouse. “Although there is a genetic component to type 2 diabetes, diet and lifestyle are equally impactful on whether or not someone develops the disease.”
Puberty and type 2 diabetes
It’s important to take a closer look at puberty’s connection with type 2 diabetes because it can have a tremendous impact on insulin needs and blood sugar levels.
“Puberty appears to play a major role in the development of type 2 diabetes mellitus in children,” explains the WJD. “During puberty, there is increased resistance to the action of insulin, resulting in hyperinsulinemia.”
Puberty is the stage during late childhood and early teenage years when a girl or boy becomes “sexually mature.”
- Puberty stage for girls: age 10 to 14 years old
- Puberty stage for boys: age 12 to 16 years old
As growth hormone levels increase throughout puberty, insulin resistance increases, too. And this leads to a significant increase in the demand for insulin. If a child or teen’s body cannot keep up with this demand, blood sugar levels inevitably begin to rise.
“Given this information, it is not surprising that the peak age at presentation of type 2 diabetes mellitus in children coincides with the usual age of mid-puberty.”
But insulin resistance alone does not usually lead to type 2 diabetes in children and teens.
“For diabetes mellitus to develop, insulin resistance alone is not sufficient and inadequate β-cell insulin secretion is necessary,” explains the WJD.
This means that the combination of beta-cell dysfunction is a critical component of developing the condition, which means that a poor diet and too little exercise on their own do not cause type 2 diabetes.
Symptoms of type 2 diabetes in children and teens
The symptoms of type 2 diabetes in children and teens are identical to the symptoms for adults:
- Increased urination
- Increased thirst
- Unexplained weight-loss
- Changes in vision
- Increased appetite
- Fatigue / oddly lethargic
- Yeast infections (mostly in girls)
- More irritable than normal (especially after eating)
Diagnosing type 2 diabetes in children and teens
The criteria for a type 2 diabetes diagnosis in a child or teenager is the following:
- Increased urination
- Increased thirst
- Unexplained weight-loss
- “Casual” blood glucose level at/above 200 mg/dL
- Fasting blood glucose level at/above 126 mg/dL
- HbA1c at/above 6.5 percent
- If a child presents without physical symptoms, blood glucose level tests should be repeated on a different day.
If a child or teenager presents with these symptoms, it is important they also be tested for autoantibodies. A presence of two or more autoantibodies indicates type 1 diabetes, not type 2.
This calls for an entirely different treatment protocol and long-term care plan than type 2 diabetes and should be addressed immediately.
Treating type 2 diabetes in children and teens
Like with all types of diabetes, healthy nutrition and regular physical activity are hugely important aspects of treating type 2 diabetes in children and teens, but the treatment protocol is more complex than lifestyle habits alone.
“The ideal goal of treatment is normalization of blood glucose values and HbA1c,” explains the WJD according to the American Academy of Pediatrics.
Children and teens with type 2 diabetes should check their blood sugar daily as directed by their healthcare team, and have quarterly A1c tests performed to evaluate the efficacy of their treatment plan
Managing the most common comorbidities — namely high blood pressure, high cholesterol, and high triglycerides — are also key aspects of improving the child’s or teenager’s longterm health.
Overall, the goal of treating any young person’s type 2 diabetes is to reduce their risk of or less the development of known diabetes complications, including:
- Retinopathy (diabetic eye disease)
- Neuropathy (nerve damage in the extremities)
- Nephropathy (diabetic kidney disease)
Since diabetes medications have not been widely studied in children and teenagers, most treatment methods have been determined through what is effective in adults with type 2 diabetes.
- Eat a more “plant-based” (more vegetables)
- Aim for a sustainable 80/20 approach: 80 percent healthy foods, 20 percent less healthy
- Reduce consumption of highly processed/packaged foods
- Reduce consumption of high-sugar foods and beverages
- Reduce consumption of fast food
- Increase daily physical activity level
- Lose weight
- Quit smoking
“All children with type 2 diabetes mellitus should receive comprehensive self-management education,” explains the WJD.
Unfortunately, most children and teens with type 2 diabetes do tend to need prescription medication to bring their blood sugar levels down to a healthy range.
Let’s take a look at the pharmacological options available to young people with type 2 diabetes.
Pharmacological treatment options
If a young person with type 2 diabetes has an A1c at or higher than 7 percent, they will likely be placed on at least one diabetes medication.
Metformin and insulin are the only two types of medications FDA-approved for use in young people with diabetes.
Unfortunately, most of today’s newer medications used to treat type 2 diabetes in adults have not been FDA-approved, but many pediatric endocrinologists use these unapproved medications anyway.
“Metformin (biguanide) is undoubtedly the most appropriate starting point for pharmacological treatment in children with type 2 diabetes mellitus,” explains the WJD.
Metformin not only reduces the amount of glucose produced by your liver, but it’s also shown to cause some weight loss thanks to its impact on your appetite.
Be aware, though, that metformin causes digestive issues for many. These can be managed and reduced by splitting the dose or asking your doctor for the “extended-release” version.
Metformin, in combination with insulin, if necessary, is the first path of treatment for young people with type 2 diabetes after making lifestyle changes.
According to the WJD and the American Academy of Pediatrics, insulin is often the only truly effective method of bringing high blood sugar levels down in young people with diabetes.
Because insulin comes with the inevitable risk of hypoglycemia (low blood sugar), it’s important to consider the different options and regimens when prescribing it to children.
- Taking one injection per day of long-acting insulin
- Taking two injections per day of long-acting insulin
- Taking meal-based injections of rapid-acting insulin
Depending on the child’s age, blood sugar levels, and the ability to make effective lifestyle changes, one patient’s ideal insulin regimen will be significantly different than another’s.
Other diabetes medications
Many pediatric endocrinologists prescribe diabetes medications that have not received FDA-approval. The majority simply haven’t been studied properly in young people thus cannot be approved for use in this population.
Regardless of the treatment regimen, it’s critical that any young person diagnosed with type 2 diabetes works towards improving overall lifestyle habits, particularly around nutrition and exercise. Without improving these two aspects, it will be increasingly difficult to achieve healthier blood sugar levels.