What is a Type 2 child?

A Type 2 child is a child or adolescent who exhibits characteristics of Type 2 diabetes. This was previously referred to as “adult-onset diabetes” but is becoming increasingly common in children and teens, most likely related to the rise in childhood obesity.

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What causes a child to develop Type 2 diabetes?

Type 2 diabetes in children is primarily caused by excess weight and inactivity. Genetics and family history can also play a role. Some of the biggest risk factors for developing Type 2 diabetes as a child include:

Being overweight or obese

Having a family history of Type 2 diabetes
Being of certain ethnic backgrounds (e.g. African American, Hispanic/Latino, Native American, Asian American, Pacific Islander)
Experiencing signs of insulin resistance or conditions associated with insulin resistance like acanthosis nigricans (dark, velvety skin around neck or armpits)

Having high blood pressure or abnormal cholesterol levels
Being physically inactive
Having gone through puberty

Having a mother who had gestational diabetes

These risk factors can contribute to the development of insulin resistance and pancreatic beta cell dysfunction which underlie Type 2 diabetes.

At what age does Type 2 diabetes develop in children?

Type 2 diabetes most commonly develops in children over the age of 10, around the time of puberty. However, cases have been reported in children as young as 6 years old. Some research shows a peak incidence around 13-14 years old.

What are the signs and symptoms of Type 2 diabetes in children?

Signs and symptoms of Type 2 diabetes in children may include:

Increased thirst and frequent urination – As excess sugar builds up in the bloodstream, fluid is pulled from tissues. This causes increased thirst as the body attempts to compensate. Frequent urination results from excess sugar being excreted through urine.
Increased hunger – Despite increased eating, the body’s cells are unable to access blood glucose due to insulin resistance. This leads to persistent hunger.

Weight loss – Children with undiagnosed diabetes may lose weight unintentionally due to poor metabolism of glucose.
Fatigue – Lack of cellular access to blood glucose can cause constant tiredness and weakness.
Blurry vision – High blood sugar draws fluid from tissues like the lenses of the eyes, causing temporary visual changes.

Slow healing cuts/bruises – Poor circulation and elevated glucose can result in injuries healing more slowly.
Yeast infections – Candida fungi thrive in the presence of excess blood sugar.
Acanthosis nigricans – Darkening skin patches around the neck, armpits or groin may signal high insulin levels.

These symptoms can begin gradually or have a sudden onset but early detection and treatment is important to prevent long-term complications.

How is Type 2 diabetes diagnosed in children?

If Type 2 diabetes is suspected based on risk factors and symptoms, a doctor will check one or more of the following blood tests:

A1C – Provides average blood sugars over the past 2-3 months. An A1C of 6.5% or higher on two separate tests indicates diabetes.

Fasting blood glucose – Blood glucose is measured after an 8 hour fast. 126 mg/dL or higher confirms diabetes.
Random blood glucose – Blood glucose is tested without regard to last meal. 200 mg/dL or higher, along with symptoms, suggests diabetes.
Oral glucose tolerance test – Blood glucose is measured while fasting and after drinking a sugary drink. Results that meet diabetes thresholds confirm diagnosis.

Doctors may also check for insulin resistance, elevated cholesterol, kidney function, and for antibodies found in Type 1 diabetes to rule out misdiagnosis.

How is Type 2 diabetes in children treated?

Treatment of Type 2 diabetes focuses on achieving healthy blood sugar levels through a combination of:

Following a healthy diet – Emphasizes fruits, vegetables, whole grains and lean protein while limiting added sugars, refined carbohydrates and unhealthy fats. A registered dietitian can provide age-appropriate meal planning guidance.

Engaging in regular physical activity – A minimum of 60 minutes per day of exercise is recommended to improve insulin sensitivity, aid weight loss and promote wellness.
Taking oral medication – Metformin is typically the first medication prescribed to improve insulin sensitivity. Other agents like GLZ antagonists or insulin may be added later.
Monitoring blood sugar – Using a glucose meter to track blood sugar helps guide nutrition and medication decisions.

Receiving counseling – Therapists can help with motivation, developing healthy habits, managing stress and coping with diagnosis.

These interventions focus on weight management, insulin sensitivity, glycemic control and quality of life improvements.

What are possible complications of Type 2 diabetes in youth?

Consistently high blood sugar levels can lead to macrovascular (heart and blood vessels) as well as microvascular complications (eyes, kidneys and nerves) over time. Potential complications include:

Cardiovascular disease – Fatty deposits can clog arteries and damage blood vessels and the heart.
Nerve damage (neuropathy) – Excess sugar can injure nerve fibers affecting sensations and function.
Kidney disease (nephropathy) – Kidneys are forced to overwork to filter excess sugar, resulting in damage over time.

Eye damage (retinopathy) – Tiny blood vessels in the eyes can be irreversibly damaged, leading to vision loss.
Foot damage – Poor circulation and reduced feeling can increase risk of skin sores and limb amputation.

Engaging in proper diabetes management from the point of diagnosis can significantly reduce these risks. Regular screening for complications is also essential.

What is the prognosis for a child with Type 2 diabetes?

Type 2 diabetes is a chronic, progressive disease. However, children who maintain a healthy weight and keep blood sugars under control have a good long-term prognosis. The diabetes may even go into remission if managed intensively at first, particularly with significant weight loss. Ongoing monitoring and care are still required though to prevent future relapse. Without proper treatment, children face the threats of serious complications, disability and early death. However, being proactive reduces these risks significantly.

What research is being done on Type 2 diabetes in children?

Some examples of current research on Type 2 diabetes in youth includes:

The TODAY clinical trial – One of the largest studies on treatments for childhood Type 2 diabetes. It compared different medications and assessed complications.

The RESTORE trial – Looking at a hybrid closed loop insulin delivery system to improve glycemic control.
Genetic studies – Researching specific gene mutations associated with development of early onset Type 2 diabetes.
Prevention programs – Developing community and school initiatives that promote healthy lifestyles to reduce obesity and diabetes risks.

Researchers are also looking into the interplay between Type 2 diabetes, insulin resistance and puberty. Additional work focuses on disparities in Type 2 diabetes rates amongst different ethnic groups. Expanding access to care and treatment for low income families is another priority area.

What public health efforts aim to combat Type 2 diabetes in children?

Some public health strategies to address increasing Type 2 diabetes rates in the pediatric population include:

Supporting healthy eating in schools – For example, providing nutritious lunch options, removing junk food from vending machines and having filtered drinking water readily available.

Incorporating physical activity requirements – Setting minimum standards for recess, physical education, classroom movement breaks and after school sports programs and activity clubs.
Implementing community programs – Projects like building recreational facilities, establishing neighborhood farmer’s markets and launching nutrition assistance initiatives.
Increasing diabetes screening – Conducting blood sugar testing alongside other routine health screenings to improve early identification.

Raising awareness – Educating parents, caregivers, educators and the general public about childhood obesity, its consequences and prevention.

Public health departments also track diabetes surveillance data and work to expand access to care and testing for at-risk populations.

Conclusion

Type 2 diabetes was previously rare amongst children but rising rates parallel increasing childhood obesity. Genetics and lifestyle factors underlie insulin resistance development. Warning signs like increased thirst and weight loss may precede diagnosis, which requires blood sugar testing. Treatment emphasizes nutrition, activity and medication to control blood sugar levels and weight. Lifelong diligence is crucial to prevent complications like cardiovascular disease, neuropathy, nephropathy and retinopathy. Public health initiatives promoting healthy schools, communities and behaviors aim to curb Type 2 diabetes incidence through obesity prevention. More research and vigilance is needed to protect children’s health as Type 2 diabetes rates climb.