Health - Diabetes in Children;Emerging Epidemic

DR. RANJIT UNNIKRISHNAN AND DR. V. MOHAN


Jogging one’s way to health: Physical activity is crucial in keeping lifestyle diseases at bay.


Ravi (name changed), a 14-year-old, Class 10 student, was secretly happy when he started losing weight without any effort on his part. He had always been on the chubby side and was tired of being teased by his classmates. However, his parents were wo rried. Ravi did not seem well and felt tired always. Of late he was also feeling thirsty and passing unusually large quantities of urine. A visit to the family doctor left the family devastated — Ravi had diabetes, with extremely high blood sugars. His parents were surprised; agreed, Ravi’s parents had diabetes but how could their son have gotten the disease at this young age?

Diabetes does not immediately spring to mind when thinking about childhood diseases. Most people think that only obese, well-to-do, middle-aged individuals develop the disease. Not any longer — no age is exempt from diabetes and the incidence in young people, often in the middle and lower income groups, is increasing by leaps and bounds.

Increasing prevalence

Even in the past, diabetes in children was not unknown. However, most children who developed diabetes in the past had Type 1 or insulin-dependent diabetes. This is a disorder which damages the insulin-secreting cells of the pancreas, rendering the individual incapable of secreting enough insulin to maintain blood sugars at normal levels. Untreated, the disease is fatal. Inadequately treated, affected children can develop complications such as eye disease, heart disease and kidney disease. Lifelong treatment with insulin injections, along with strict adherence to diet and lifestyle advice, can help patients to live a near-normal life and avoid complications.

Devastating as the diagnosis of Type 1 diabetes might be to affected children and their families, the disease is luckily rare and has been so for the past several decades. However, there is another form of diabetes, which is silently assuming epidemic proportions and threatening to hold an entire generation in its grip.

Diabetic capital

Type 2, earlier referred to as non-insulin dependent diabetes, is steadily increasing in prevalence throughout the world. The largest number of patients with this disease is found in India, earning the country the unwanted sobriquet of the “Diabetic Capital” of the world. The most alarming thing about this epidemic is that it is now affecting individuals at younger and younger ages. Whereas it was rare to find a 20 year old person with Type 2 diabetes 10 years ago, nowadays people are developing the disease even in their teens, as in Ravi’s case.

Why are our children falling prey to this disease of middle age? Heredity does play a role. In Ravi’s case, his father and mother had diabetes and they could have passed the gene on to their son. Unfortunately, we still do not know the exact genes that cause Type 2 diabetes. Even if we did discover any of those genes, it might not be of much help in preventing or treating the disease. In any case, hereditary factors cannot explain the increased prevalence of diabetes in the last 30 years — after all, genes do not change in such a short time!

A more important reason for the epidemic of diabetes in India is the drastic changes in lifestyle that have occurred over the past 30 years. Nowhere has this been more evident than in our children, and especially in urban areas. Children nowadays have no time for sports and games. All their time is taken up by academics. Any free time that they get is spent in front of the TV or computer. Food habits have gone from bad to worse, with easy availability of calorie-rich junk foods. No wonder childhood obesity is increasing in prevalence, and along with it, childhood Type 2 diabetes. Studies at Dr. Mohan’s Diabetes Specialities Centre and the Madras Diabetes Research Foundation have shown a 10-fold increase in childhood onset Type 2 diabetes in the last 20 years. In addition to Type 2 and Type 1 diabetes, there are other forms of diabetes with affect children such as maturity onset diabetes of youth (MODY) and fibrocalculous pancreatic diabetes but as these are rarer forms of diabetes and do not have the danger of rising to epidemic proportions even in the future, they are not discussed further in this article.

Especially vulnerable

Getting diabetes is never a good idea at any age, but children with diabetes are at a particular disadvantage. Firstly, whether you develop diabetic complications or not depends to a large extent, on the duration of diabetes. A child getting diabetes has much more time in which to develop complications than a person getting diabetes in middle age. Secondly, diabetic control in children is often very difficult, particularly in teenagers, in whom hormonal changes and rebelliousness combine to make treatment especially challenging. Thirdly, girls with diabetes are feted to go through their subsequent pregnancies and deliveries as diabetic patients, with increased danger to both mother and baby.

So much for the bad news. The good news is that Type 2 diabetes can be prevented. Unlike Type 1 diabetes, which cannot be prevented, simple lifestyle modification can prevent diabetes from developing, or at least postpone it to a later age in those predisposed to the disease.

The first step is to identify those children at highest risk for developing diabetes. These are children whose father or mother or both have Type 2 diabetes. The second important clue is the presence of obesity. In girls there is often evidence of polycystic ovary disease with irregular periods and some signs of virilism including excessive facial hair growth. Targeting preventive steps towards the above groups of children will thus bear the maximum fruit.

Encouraging regular physical activity is an essential step in any diabetes prevention programme. Time should be set apart for physical education and games, whatever be the age of the child. Most children need no second invitation to go out and play; what is needed is a change of attitude on the side of parents and teachers. Parents should also serve as role models by indulging in regular exercise themselves and making exercise a family activity. Sedentary activities like TV viewing should be kept to a minimum. Attention should also be paid to the diet by cutting down on junk foods, fried items and soft drinks and encouraging intake of fresh fruits and vegetables. These good habits inculcated in childhood will remain with the child throughout his or her life and help them in warding off not only diabetes, but also lifestyle-related diseases like obesity, high blood pressure and heart disease.

The focus of this year’s World Diabetes Day theme is diabetes in childhood and adolescence and is very relevant to India where childhood diabetes is emerging as a major threat to the future health of our nation. India is on the verge of emerging as an economic superpower and this is largely driven by our IT and other young professionals. Diabetes has the power to cripple the health of the nation unless urgent preventive steps are taken. It would be a pity to allow our children to fall prey to this serious disease when there are easy and inexpensive ways of preventing it. Action on the part of everyone concerned is essential to prevent the diabetes epidemic from assuming monstrous proportions.

The writers are Chennai-based Consultant Diabetologists.