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"We found it was almost certainly the result of an unbelievable epidemic of obesity in this country," says Kenneth Lee Jones, chief of the division of pediatric diabetes and endocrinology at the University of California, San Diego (UCSD) School of Medicine. Jones estimates that 10 percent of all pediatric diabetes is type 2, and that the percentage is higher in minority children.
According to Jones, 21 percent of the Mexican-American children in his UCSD pediatric diabetes clinic have type 2 diabetes, as compared with only 3 percent of the non-Hispanic diabetic children. Jones also points out that type 2 diabetes has nearly doubled the incidence of type 1 diabetes in the Native American, Pacific Islander, Asian, Indian and Japanese populations of children.
Type 2 diabetes is most commonly diagnosed in people around the age of 50, which is why it has been given the label of "adult onset diabetes." Clinicians are deeply concerned, however, about this new epidemic.
"The average age of onset of type 2 diabetes is shifting downward with increasing obesity," say Arlen Rosenbloom, MD, a pediatric endocrinologist at the University of Florida in Gainesville. Rosenbloom, like Lee, has treated an increasing number of minority children with type 2 diabetes at his clinic. Rosenbloom also feels that there is probably a high number of people in their 20s and 30s with type 2 diabetes as well, even though nobody in that age range was observed for this study.
Robin Goland of the Naomi Berrie Diabetes Center of Columbia-Presbyterian Medical Center in New York City says that type 2 diabetes is being diagnosed in 10 to 20 percent of the center's new pediatric patients. She also points out that obesity is the key to why so many of these children have type 2 diabetes.
"There is an interplay between obesity, their environment, and a genetic predisposition to diabetes," says Goland.
According to recent data from the National Health and Nutrition Examination Surveys, it was discovered that one in five American children is overweight, and the number of obese children has doubled in the past 20 years. Minority children are at greater risk because many of them come from lower income families whose parents work all the time. These children do not have access to recreational gyms or programs and, oftentimes, eat fast food because parents have little time to prepare home-cooked meals.
According to the March 15 Clinical Insights in Diabetes Treatments (a newsletter sponsored by the National Diabetes Education Initiative), among Japanese schoolchildren, the incidence of type 2 diabetes has increased more than 30-fold over the past 20 years. Changes in Japan's food patterns and the growing rate of obesity among the country's schoolchildren were cited as primary factors for the increase.
Treatment for children with type 2 diabetes is difficult because oral agents have not been formally approved by the Food and Drug Administration for pediatric use, although they are often prescribed. Clinical trials of metformin for pediatric use are just getting under way.
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