Obesity and physical inactivity are raising the risk of Type 2 diabetes in children today. PROF DR MUSTAFFA EMBONG tells us about the importance of early detection and the warning signs parents need to watch out for

FUNNILY enough, many people think that diabetes affects only fat or overweight adults, which is true to a certain extent. But it's no longer a laughing matter when they discover that this "mother of all diseases" is also one of the most common chronic diseases of childhood.
Diabetes, in fact, can occur in children of any age, including toddlers and infants. And today, the number of children afflicted with this global epidemic is on the rise.

The International Diabetes Federation (IDF) estimates each year, 65,000 children under the age of 15 develop Type 1 diabetes worldwide, with studies showing that Type 1 diabetes is growing by three per cent among children and adolescents and by five per cent among pre-school children. Of the estimated total of 430,000 prevalent cases of Type 1 diabetes at childhood, more than a quarter come from Southeast Asia.

Type 2 diabetes, once regarded as an adult disease, is today increasing at a disturbing rate among children and adolescents. In Japan, according to the IDF, the number of children with Type 2 diabetes has doubled over a period of 20 years, making Type 2 diabetes among Japanese children more common than Type 1. This trend is not only limited to Japan, however, as childhood Type 2 diabetes has become the main kind in many parts of the world.

Until recently, the only kind of diabetes frequent in children was Type 1 diabetes. Type 1, previously known as insulin-dependent or childhood-onset diabetes, occurs when the pancreas, as a result of immune destruction, produces very little or no insulin (the hormone that regulates the absorption of glucose into cells). Without daily insulin shots, Type 1 diabetes is usually rapidly fatal.

Type 2 diabetes, where the pancreas is unable to produce enough insulin to overcome the body's resistance to insulin (insulin resistance), is the more common form of the disease. In Malaysia, this usually occurs after the age of 30. But today, owing to the global rise of childhood obesity and physical inactivity, Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) has become much more widespread among children in developed and developing countries.

Most children with Type 2 diabetes have a family history of the disease. Research shows hat at least 75 per cent of children with Type 2 diabetes have a parent, brother or sister with the disease.

However, it's not all to do with genes. Other factors that come into play include obesity or being overweight, insufficient exercise and unhealthy eating habits. Obesity is one of the major risk factors for Type 2 diabetes, especially when excess body fat is concentrated around the abdomen.

Children who have reached puberty are also more likely to develop Type 2 diabetes compared with younger children, as insulin resistance normally increases about 30 per cent at puberty -- this possibly because of the effects of growth hormones. Gender plays a role as well, with girls being more prone to Type 2 diabetes than boys.

Type 2 diabetes in young children is made more severe as a result of complications that may arise because of the longer duration of the disease and poor management. The earlier a child develops diabetes, the more likely he or she will have long-term health problems, such as diseases related to the eyes, heart, blood vessels, nerves and kidneys. Studies show that children with Type 2 diabetes will also develop the above-mentioned diabetes-related micro- and macro-vascular complications, just as in the case of adults.

Diabetes also affects children mentally and physically more than adults. Their daily activities are disrupted by the need for medication and a close watch on their diet and physical activity. They also need to monitor their blood glucose level, leaving them often unable to indulge in the many childhood activities enjoyed by their friends.

Children with Type 1 diabetes may not have the energy to fully concentrate in school. This lack of energy, coupled with increased fatigue and irritability, the need to have insulin shots and the frequent desire to go to the bathroom (when diabetes is not well-controlled), can affect their ability to study and mingle with friends. It can also make them feel lonely and different from other children.

While children with Type 1 diabetes usually have obvious (and abrupt) symptoms, those with Type 2 may not notice many of the usual symptoms and the disease may develop slowly over a period of time. In fact, some children with Type 2 diabetes may not exhibit any symptoms or signs. While others may experience:

• - increased thirst


• - frequent urination


• - extreme hunger


• - weight loss


• - fatigue


• - blurred vision


• - slow-healing wounds/sores or frequent infections

Some children (especially girls) with Type 2 diabetes may also have a dark patches of skin around the neck or in the armpits. This condition, called acanthosis nigricans, could be a sign of insulin resistance.

It's important to keep in mind that not everyone with Type 2 diabetes develops these symptoms, and that not everyone with these signs necessarily has Type 2 diabetes. But if your child does exhibit any of these symptoms, it's best to consult a doctor immediately as early detection is crucial. It is also prudent to bring your child for a check up if he/she is at high risk of developing diabetes as a result of being overweight or obese, especially when there is a history of diabetes in the family.

There's a reason why diabetes is called the "mother of all diseases". If left undetected or untreated at childhood, it can lead to many life-threatening complications, including heart attacks and stroke. And the risk of falling victim to these diseases is even higher when your child develops diabetes at a young age.

Though there are no effective ways to prevent Type 1 diabetes at present, the good news is that studies have shown that Type 2 diabetes can be prevented or delayed.

All that needs to be done is to help your children lead a healthy lifestyle: encourage them to watch their weight and diet and make sure that they are physically active and get sufficient exercise. If you have diabetes yourself, be extra vigilant as your children's chances of developing the disease are higher.

Once you realise that diabetes doesn't favour any age group, you'll know that what's important is cultivating a healthy lifestyle in your loved ones from the earliest age possible.

In our next article, we'll take a look at how you can prevent your young ones from developing diabetes through healthy lifestyle tips for the whole family.

Emeritus Professor Datuk Dr Mustaffa Embong is consultant diabetologist and endocrinologist at the National Diabetes Institute.