IN 2019, the International Diabetes Federation Atlas reported 977 cases of diabetes in children below 18 in Malaysia. This was more than double the number of cases registered in 2008 under the Diabetes in Children and Adolescents Registry Malaysia.
Of the two types, type 1 diabetes is more common in children, accounting for more than 90 per cent of diabetes mellitus cases worldwide, with rates in children rising and diagnoses being made in younger children.
In Malaysia, the average age of diagnosis is between seven to eight years of age.
In the case of type 2 diabetes, a known risk factor is obesity, which is on the rise in Malaysia. Type 2 diabetes is typically seen in the adolescent age group.
Excessive thirst, excessive urination, waking at night to pass urine or wetting the bed at night, are important symptoms to be aware of in children, as it may indicate a diagnosis of diabetes says IMU Healthcare consultant paediatric endocrinologist and senior lecturer in paediatrics at the International Medical University, Dr Meenal Mavinkurve.
Some parents may even report ants in the toilet, because the ants are attracted to the "sweet urine" (glucose in the urine).
Children can also experience infections (fungal infections), unexplained weight loss or a failure to gain weight despite being hungry.
Dr Meenal says if parents notice any signs or symptoms, they should consult a doctor urgently and enquire about the possibility of a diagnosis of diabetes and ask whether a test for glucose and ketones should be done.
"One of the important steps that can lead to an earlier diagnosis is the awareness that diabetes mellitus is a disease that also affects children and that early recognition of symptoms can lead to early diagnosis and treatment."
If symptoms are not picked up early, it can progress to a more severe presentation of diabetes mellitus with the child experiencing vomiting, lethargy, breathlessness and tummy pain, adds Dr Meenal. These are symptoms of diabetic ketoacidosis (DKA), a severe presentation of diabetes.
Unfortunately, these same symptoms can sometimes be confused with other common paediatric conditions, resulting in misdiagnosis, with children below five having a higher risk of being misdiagnosed.
The prevalence of diabetes among Malaysians is heading towards an upward trajectory says Sunway Medical Centre consultant endocrinologist Dr Teoh Wei Leng.
"One of the most worrying phenomena is that people are getting diagnosed with type 2 diabetes at a much younger age. Paediatric endocrinologists are seeing type 2 diabetes in children which was never the case before," adds Dr Teoh.
She points out that while genetic predisposition does play a role, lifestyle choices significantly contribute to diabetes.
Poor dietary habits, sedentary lifestyles and obesity are prominent triggers. "We need education about good healthy food choices from childhood so that we can form healthy lifelong eating habits to reduce the rise of obesity. Addressing these factors is crucial in our battle against diabetes."
TAKING CHARGE
Managing childhood diabetes requires a partnership between parents, the child and the healthcare team, says Dr Meenal.
However, it is important for parents to gradually hand over the responsibility of diabetes self-care to their kids, while continuing to be supportive at all times.
This enables the child to become independent, responsible and confident in diabetes self-care over time.
Young children with diabetes can be involved in their diabetes care by doing simple things like getting the items ready for a glucose check, which will progress to unsupervised glucose checks once the child is more independent. School going children with type 1 diabetes will need to learn how to self-inject insulin too.
"It's about handing over responsibility slowly, while ensuring that you are there as a constant support."
Having diabetes doesn't mean a diet that is completely devoid of sweets and sugar. Dr Meenal says it's all about moderation and following a healthy diet as even a child without diabetes should.
For the obese or overweight child with type 2 diabetes, there would be a greater emphasis on limiting calorie-dense food options.
Childhood Diabetes - More Children At Risk
THE National Health and Morbidity Survey 2022 (Adolescent Health Survey) clearly indicates that the diet and lifestyle of Malaysian children leaves much to be desired, putting them at serious risk of developing type 2 diabetes.
The survey indicates that:
*1 in 3 are overweight or obese
*2 in 3 are sedentary
*4 in 5 do not eat enough fruits and vegetables
*1 in 3 consume carbonated soft drinks every day
*1 in 10 eat fast food at least three days a week.
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