Type 2 diabetes in children and adolescents
Diabetes is a terminal illness that interrupts with body processes of managing glucose. There is type 1 and type 2 diabetes. Type 2 diabetes is a condition in which there are abnormalities with glucose in the blood. In type 2 diabetes, the body resists insulin effects or is unable to produce adequate insulin that maintains normal levels of glucose .Diabetes state organization in Australia (2012) describes it as mature onset diabetes related to other unstable conditions of the body such as high blood pressure and cholesterol levels.
Type 2 diabetes is a complicated illness that puts the body under risk of long-term diseases such as kidney and heart diseases. It is common in children depending on the rate of increase in childhood obesity (AIHW , 2014).. The difference between type 2 diabetes and type 1 diabetes is that type 2 diabetes is unrelated to lifestyle habits and it is purely an autoimmune condition. It is common to adults of forty years and above and children though anyone is at risk of contracting it. According to diabetes state organizations (2012), lifelong insulin injections and tablets manage Type 1 diabetes. Regular blood glucose checkups and proper eating habits as well as regular exercises manage type 2 diabetes.
This paper will answer questions such as;
What is the prevalence of type 2 diabetes in Australia among children and adolescents?
What are the symptoms, risk factors, causes, effects, and diagnosis of type 2 diabetes?
What are common barriers while addressing type 2 diabetes in indigenous Australia?
What are prevention measures of diabetes 2 in adolescents and young children?
Other studies on Australian type 2 diabetes among children and adults.
What treatment is offered to type 2 diabetes patients. What are the recommendations?
Type 2 diabetes in children and adolescents in Australia
More than one million Australians have been diagnosed with Diabetes with type 2 diabetes having a higher prevalence than type 1 diabetes. Baker IDI heart and diabetes institute(2012), indicates that type 2 diabetes is the leading cause of end-stage kidney diseases. It has led to complications in eyes, feet, kidney, cardiovascular health, nerve damage and therefore ranked among the top most causes of death in Australia. The rates of diabetes 2 in children and adults are higher in Australian non-indigenous areas compared to indigenous areas.
Azzorpardi et al. ( 2012) comments that type 2 diabetes affects indigenous adolescents and children than non-indigenous areas. In Australia most children and young adults have a family history of type 2 diabetes and are asymptomatic during diagnosis. They are obese or overweight as well as having signs and symptoms of hyperinsulinism such as acanthosis nigricans, which initiates during adolescence (AIHW, 2014). The onset of type 2 diabetes in Australia indigenous is premature which adds stress to their families.
A change in lifestyle from hunting and gathering in indigenous areas to sedentary lifestyles in urban areas has contributed to this difference. Management of this type is a big challenge to Australian citizens due to their inadequate resources (Marple-Brown, Sinha, & Davis, 2010).However, with continued blood glucose monitoring, proper diets, exercises, and diabetes education programs, diabetes 2 is manageable.
In Australia, Type 2 diabetes has increased 10-folds in children aged 6-12 years in the last 20 years. A rate of 0.2 per 100,000 patients per year was diagnosed in the year 1976 to 1980. This rate increased to 2.0 per 100,000 per year 1991 to 1995.
Over the same period, the rates doubled among adolescents aged 13 to 15 years from 7.3 to 13.9 per 100,000 per year (Dr, Shaw, 2004).
A cohort study of indigenous Australian children aged between 7 and 18 years was carried out in 1989 and 1994 (Marple-Brown, Sinha, & Davis, 2010). The result indicated a double increase of type 2 diabetes from 1.3% to 8.1%.further studies indicate that 18% of this population was obese and one-third had high cholesterol levels. National data from 1988 to 1994 of 3000 persons ranging from 12-19 years showed IFG prevalence of 1.8% ,elevated HbAic(>6%) was 0.4%. The prevalence for all types’ diabetes was 0.4% in 600000 adolescents. In Australia Sex specific BMI cut offs are equivalent to 25 and 30kg/m2 among eighteen year olds. Statistics indicate that 5% of children are obese and 16% are overweight. These rates have doubled over the last ten years.
Studies carried out in Princess Margaret Hospital for children below the age of 16 in Western Australia, demonstrated an increase in type 2 diabetes diagnosis in children and adolescents and frequent comorbidities. Database records from this hospital were retrieved which indicated an approximate of 99% referrals of children with type 1 and 2 diabetes. These records also contained data obtained from regular visits in 11 rural centers.
The analysis included children and adolescents below 17 years with type 2 diabetes diagnosed between 1990 and 2002. Examination findings, anthropometry that included mass indexes of weight and body, presence of acanthosis nigricans, c-peptide levels, family history of type 2 diabetes, and absence of autoantibodies differentiated data from type 2 diabetes and type 1 diabetes.
Diagnosis done on the patients included oral glucose tolerance tests, fasting urine levels, and glycohaemoglobin and C-peptide tests. Antibodies tests included autoantibodies (glutamic acid decarboxylase 65kDaisoform (GAD65) antibodies and iset-cell antibodies (ICA). Demographic data, which offered information on birth dates, sex, dates of diagnosis, postcodes at diagnosis and ethnicity, was obtained from databases. Data containing weight and health, blood pressure, lipid, and HbAlc levels was obtained during clinic visits for all children. Hypertension levels were either systolic or diastolic. Hypercholesterolemia was defined greater than or equal to 5.2 mmol/L in greater than or equal to 200 mg/dl. HbAlc level was measured through inhibition of agglutination immunoassay (Ames DCA 2000, non-insulin-dependent diabetes mellitus reference less than 6.2%).
BMIZ scores were obtained by subtracting the values of median reference of a certain population from the observed value and division of SD of reference population. The median (50 Th percentile) was equal to zero scores of AZ and 2.00 in Z scores is equal to the 97th percentile.
The statistics from the population were sourced from Australian Bureau of Statistics census data. Epidemiology branch of the WA department of Health carried out estimates of 5.6 from the indigenous population based on census counts in 20011 and annual birth and death adjustments. Poison regression calculated incidence ratios. Epi Info 7 calculated BMIZ scores in 2000 centers for disease and Control and Prevention growth (Craig et al., 2006)
The results showed that a total of 43 children and adolescents below seventeen years were diagnosed and proved positive to diabetes 2 tests done at Princess Margaret Hospital between 1990 and 2002. Among this population 23(53%) of the patients were from indigenous areas, and 18(42%) came from rural areas (McMahon et al, 2004). 5% of these patients presented with diabetic ketoacidosis, 38% with polyuria and polydipisia symptoms, 57% were diagnosed incidentally. The mean scores for BMIZ at diagnosis were 1.94(0.59).The standard deviation for HbAlc levels at diagnosis were 10 %( 3.2%). They had common co morbidities where acanthosis nigricans was 26/36(72%), hyperlipidaemia was diagnosed in 9/38(24%) patients, and hypertension was 23/39(59%). The overall rates of type 2 diabetes were higher in indigenous population than in non-indigenous population.
These results indicate that there has been marked increase in diagnosis of type 2 diabetes than type 1 diabetes among children and adolescents in the past seven years in Western Australia. These results increase with the increase in obesity among children and adolescents. Explanations given are that at ages 13 and 14 is the peak age at puberty, which disrupts the levels of insulin due to imbalance in hormonal levels. Clinical marker for type 2 diabetes is Acanthosis nigricans for hyperinsulinism (Box 1).
Difficulties in detecting type 1 diabetes restrict patients to having this skin finding. This tool is useful in children and adolescents. Observations made from this study indicate that most type 2 diabetic patients had hypertension or hyperlipidaemia. As a result, there are public health implications in Australian hospitals (McMahon et al, 2004). Health institutions have therefore campaigned for increased physical activities, reduction in sedentary behavior and intake of balanced diets with an aim of decreasing obesity among children and youth. The health sectors have suggested achievable goal setting, completely family involvement, and use of developmental methods, offering education on nutrition and incorporating physical activities in school hours.
Type 2 diabetes in Australian children
Type 2 diabetes in children is associated with poor eating habits, lack of exercises, obesity, diabetic family history and ethnic backgrounds (American Diabetes Association consensus statement, 2000). According to American Diabetes Consensus statement (2000), type 2 diabetes is a serious condition in children since prolonged periods of under treatment leads to long-term complications such as heart and kidney disease at younger ages.
Children manage type 2 diabetes by eating healthy, engaging in physical activities and exercises as well as frequent testing and monitoring of blood glucose. Preparation of tablets and insulin injections is necessary. In addition, type 2 diabetes is treatable through proper living styles and diets.
Causes of Diabetes
Factors such as gene formation, extra weight, and metabolic syndrome, too much glucose from liver, bad cell communication, broken beta cells, and physical inactivity are among the causes of type 2 diabetes (Australian institute of health and welfare, 2010).
Different types of DNA bits affect the production of insulin in the body resulting in Diabetes 2.
Overweight among children and adolescents come from changes in lifestyles in indigenous communities. These communities have changed from hunting and gathering to adoption of sedentary lifestyle and consuming western diets. These conditions have increased levels of obesity due to lack of exercises. Obese individuals especially those with greater weights around the middle part of their body, are at a higher risk of getting diabetes. Studies done indicate that type 2 diabetes affects children and adolescents because of their child hood obesity.
Insulin resistance is a metabolic syndrome, demonstrated by high blood pressure, triglycerides, and high cholesterol.
Excess glucose from liver
In type two diabetes, the liver not regulating its emission of sugar after eating. The level of blood sugar is usually low before eating and regulated by production of glucose by the liver. This production lowers after eating. However, type 2 diabetes individuals experience a condition in which their liver continues to produce glucose to the blood.
Bad communication between cells
A chain reaction of some cells sending the wrong messages affects the working of cells in their production and manufacture of insulin. This leads to progression of type 2 diabetes.
Broken beta cells
Broken beta cells are because of excess production of blood sugar by insulin, which damages these cells since there are wrong amounts of insulin in the blood at the wrong time.
Lack of exercise is the major contributor of overweight and obesity among children and young adults. There has been a decline in physical activity among young children who spend most of their time watching televisions. Cigarette smoking, higher BMI levels, pregnancy, and lower parental education are among the contributing factors to physical inactivity in Australian adolescents.
Risk factors and prevention
Risk factors such as age, genes, and ethnicity are unavoidable while other factors such as pre-diabetes, heart and blood vessel disease, cholesterol levels, high triglycerides, obesity, overweight babies, high blood pressure, depression, stress, smoking and having little or excess sleep are great risks to Diabetes 2 (Australian institute of health and welfare, 2010).
Genetics: the risks of adolescents contracting type 2 diabetes increase through type 2 diabetes family history.
Weight: the resistance of insulin is due to too much weight especially around the waist. Urine resistance causes too much sugar from liver to the blood stream causing diabetes 2.
Ethnicity: different backgrounds affect the production and consumption of sugar in the body. People from indigenous backgrounds are at higher risks of contracting type 2 diabetes compared with other people.
Levels of physical activity: lack of exercises and physical activities causes resistance to insulin, which leads to type two diabetes.
Development of type 2 diabetes in adolescents
Type 2 diabetes in adolescents begins with urine resistance, which indicates that the body is not functioning properly. In young adults, insulin produced increases the level of glucose in their blood, since the pancreas does not regulate the amount of insulin to overcome its resistance. Factors such as increase in hormonal levels during puberty increase resistance of insulin in their bodies.
Type 2 diabetes symptoms are mild and can go unrecognized in both groups. They include extra thirst, extra peeling, blurred vision, irritability, hands and feet numbness, fatigue, and recurrent yeast infections. Presence of type 2 diabetes increases the risks of cardiovascular diseases in children and adolescents. Other factors associated with type 2 diabetes identified by this health sector include, disrupted sleep, polycystic ovary syndrome, psychological and orthopaedic disorders and hepatic steatosis. From the above results, obesity is the leading cause of type 2 diabetes among adolescents and children (Eppens et al., 2006).
Doctors diagnose include medical assessments on risk factors and symptoms and other signs of insulin resistance. Doctors tests Type 2 diabetes using two different methods in children and adolescents. These are fasting plasma glucose and Oral glucose tolerance test (OGTT). Plasma glucose test measures the level of blood sugar on an empty stomach. Individuals for diagnosis do not eat but drink water only for a period of eight hours.
Oral glucose tolerance test (OGTT) checks the level of blood glucose before and after taking sweet drinks at intervals of two hours. This monitors the response of the body to blood sugar.
Untreated type 2 diabetes over a long period causes damage in eyes, kidneys, pregnancy, and liver (Baker IDI heart and diabetes institute, 2012.
Management of type 2 diabetes
Adolescents manage type 2 diabetes by eating healthy diets, having regular exercises and physical activities, regulating their weights to normal levels, monitoring their blood glucose regularly, taking diabetes drugs and insulin injections, and visiting the hospital for regular checkups. Adolescents take education programs on diabetes self-management (Diabetes state organizations, 2012). Regular reviews of diabetes self-management by credentialed diabetes educator, accredited exercise physiologist and social workers has positive results when managing diabetes.
Type 2 diabetes is treated by using pharmaceutical agents such as insulin to treat acute metabolic decompenstaion, metformin as initial pharmacologic treatment in cases when there is no severe hyperglycemia, and sulfonylurea in patients with mutations in HNFIα and HNF4α. Thiazolidinediones reduce visceral fat, α-Glucose inhibitors, therapies to lower lipids, and hypertension detection (Diabetes Victoria, 2015) .
Barriers to treatment
There are various barriers to addressing type 2 diabetes in Australians among adolescents and children. People located in remote and rural areas experience a problem of accessing health facilities. (Australian Indigenous Health Info Net, 2007) indicates that there are limited resources in indigenous areas in individual and health sectors. High concentration of the affected group in rural areas limits their access and provision of resources. Their social economic status is low which limits them to access best treatments(Azzorpadi et al., 2012).
Adolescents pose a challenge when under treatment. Adolescent stage is marked with risk-taking behaviors, non-compliance, inadequate long-term planning, and resistance to change to various lifestyles. Dysfunctions in family and ethnic origins affect adolescents. Poverty and isolation leads to depression and substance abuse (Maple-Brown et al., 2010). Heavy family burdens and illnesses add stress to adolescents thus making it difficult to treat them. The doctors are faced with a challenge of differentiating type 1 diabetes and type 2 diabetes.
Because of high rates of type 2 diabetes in adolescents and young children in Australia, Dr Shaw (2015) has issued various recommendations to manage this disease. A study of population-based prevalence in at risk populations is required, to understand the outcomes gained. Standardization of study methods depending on classification, diagnostic criteria, and methods is important in health sectors (Australian institute of health and welfare, 2010). Education programs on individual change in lifestyle, physical activity, promote healthy living. Breastfeeding and strategies avoid low birth weight babies as well as treating gestational diabetes if taught to women by clinicians.
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