Diabetes type 2 is spreading among children in the United States at an alarming rate since the past two decades which is a great matter of concern for clinicians and researchers who are involved in finding the root causes of this dreaded disease. It is the most common type of diabetes. In expert’s opinion, both genetics and environmental factors such as fatness and lack of exercise play a vital role in the occurrence of diabetes type 2.
In the article “Emerging Epidemic of Type 2 Diabetes in Youth” (Diabetes Care, February 1999, 22), it has been noted that “Prevention and treatment of type 2 diabetes in children is a daunting challenge because of the enormous behavioral influence and difficulty in reversing obesity in this age group”. It is need of the hour to wake up and find the root causes, primary and secondary prevention efforts, and evidence-based treatment for children with type 2 diabetes to arrest this fastest growing disease.
This paper focuses on the depth study of diabetes types 2 which is most severe disease accelerating at speedy rate among children in the United States today and has grim impact on the child’s ability to concentrate in learning in school. It has been observed that the emergence of type 2 diabetes mellitus in the America shows a new challenge for medical practitioners. This continual disease requires precautionary efforts, early diagnosis, and joint care of the patient and family within the perspective of a medical home.
Description of diabetes
Type 2 diabetes mellitus is a gruesome disease in children (Rosenbloom, 1999). It is a permanent disease that develops when the pancreas cannot make enough insulin or when the body’s tissues cannot use insulin well. A person becomes diabetic when the level of blood sugar is too high and remains all the time. Over time, high blood sugar can create problems with the eyes, heart, blood vessels, nerves, and kidneys. Diabetes carries an increased risk for heart attack, stroke, and complications related to poor circulation.
People with diabetes do have a higher risk of blindness than people without diabetes. One of the most common complications of diabetes is diabetic neuropathy in which the nerves are damaged that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs. People with diabetes can develop many different foot problems. When diabetes hit the child, he may feel sadness and think that life seems hopeless. It is a sign of severe depression.
It can be said that diabetes type 2 not only attacks physically but patient may become mentally weak which affects his school performance (www.diabetes.org). Regular monitoring is necessary to enhance the child’s school performance. Efforts should be made to maintain the blood glucose in the target range as determined by the health care team. If it is untreated, both high and low blood glucose levels can affect the child’s ability to concentrate on schoolwork and participate in school activities. Various risk factors which lead to type 2 diabetes in children are racial background, family history of type 2 diabetes, clinical evidence of insulin resistance, and female gender (American Diabetes Association, 2000).
Obesity appears to be an important risk factor. The increase in the dominance of obesity in children has strongly paralleled the increase in the prevalence of type 2 in this age group (Laron, 2002). Another risk factor is having relatives with type 2 diabetes. Reports indicate that 35 -100 percent of children with type 2 diabetes in childhood had relatives with diabetes. Lastly, one’s sex can provide extra risk. It has been found in numerous researches that girls are more prone to diabetes type 2 than boys got in childhood (Levitsky, 2002). Initially, children with this disease do not exhibit symptoms. If there are symptoms, they usually are mild such as they urinate more often, Feeling a little more thirsty than normal, Losing a little weight for no clear reason. A simple blood test is done to diagnose diabetes.
The diagnosis of type 2 diabetes in childhood can be a complex task requiring the test of biochemical characteristics as well as clinical signs. One important clinical sign for type 2 diabetes in childhood is Acanthosis Nigricans (AN), in which brownish-black, velvety skin patches usually found on the back of the neck, in the armpits, or on the thighs. AN shows high levels of insulin which indicate type 2 diabetes in childhood (diabetes.niddk.nih.gov).
The diagnosis of type 2 diabetes mellitus in a child usually will be made by an intelligent health care professional in a clinical setting. Psychosocial evaluation is recommended at diagnosis and informally at every visit. Assessment may be performed on the basis of patient history or by using a standardized screening tool. Health care professionals and dietitians should screen for eating disorders as part of the standard nutrition evaluation for all children with diabetes type 2 (Herpertz, 1998). The family’s strengths and needs should be assessed extend support ( www.diabetes.org).
Diabetes type 2 is prevalent in major section of the population. Clinicians suggest effective primary prevention and public health programs to advance people’s standard of living. Some programs have been started in the public schools, community programs and homes. In the model programs, patient with diabetes type 2 in childhood have been treated with oral diabetes medications, a healthy eating plan, and exercise.
Basically the treatment is aimed in eliminating symptoms of hyperglycemia, assisting the patient to maintain a body weight, decreasing cardiovascular risk factors such as hypertension, hyperlipidemia, hyperglycemia, microalbuminuria, sedentary lifestyle, and of tobacco products and achieving overall improvement in the child’s physical and emotional well-being. In the course of treatment, patient is advised for dietary modification, increase physical activity, decreased sedentary behaviors, and pharmacologic intervention. Education and other interventions that augment self-care behaviors are essential for the successful management of type 2 diabetes mellitus (diabetes.niddk.nih.gov).
Prevention is the best way to escape from disease. Every possible effort should be made to reduce the risk, incidence, and consequences of diabetes type 2 among children. Primary health care professionals must conduct program in two areas. Firstly, they should impart education in general community and secondly, they must perform clinically based activities. Clinically based health promotion activities should not replica of community-wide health promotion but these programs should propose extra benefits. For example, if major health education is offered at the community level, then motivational interviewing and mutual problem solving can be offered in the clinical setting.
When diabetes type 2 is the established diagnosis, secondary prevention efforts by primary health care professionals are important for the prevention of complications. Early diagnosis and best medical care are the major steps of effective secondary prevention. Existing data advocates that variable risks for diabetes type 2 is mainly due to obesity and lack of breastfeeding (Pettitt, 1998). Primary prevention efforts can focus on the prevention of obesity in children and the promotion of breastfeeding.
The role of health care professionals is very crucial in increasing community wakefulness about the importance of programs and facilities for physical activity and resources for healthy nutrition (American Academy of Pediatrics, 1999). Pediatricians and other health care professionals should sponsor for school policy that requires daily physical activity for every child and for physical fitness programs in the school and community.
They should advise schools to offer low-caloric foods of high nutritional value in appropriate portions. Health care professionals must convey prevention messages to the community on healthful lifestyles and good nutrition through local media such as radio, television, newspapers, and posters. Prevention messages need to be selflessly developed to resound with community and tribal culture and beliefs. Children whose body mass are greater than the 85th percentile for their age should be given effective counseling on nourishment, weight control, and physical activity. This step is highly important because data suggest that diabetes type 2 can be prevented by lifestyle interventions (www.diabetes.org).
It is essential to keep watch on the trend of disease spreading in community and immediately take corrective action instead of making situation worse. Children are the future of any society therefore it is proposed that every person must come forward and report to health care unit for occurrence of this disease. Medical experts are doing their best to curb the situation but public awareness and initiative will be helpful to build healthy society.
To accomplish the Healthy People 2010 objectives, the American Academy of Pediatrics believes that medical care for children should be provided within a medical home, which ideally should be accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. It should be delivered by expert physicians who provide primary care and manage and facilitate essentially all aspects of pediatric care. The physician should be known to the child and family and should be able to develop a partnership of mutual responsibility and trust with them (American Academy of Pediatrics, 2002).
To handle the cases of diabetes type 2, the team of a physician, a registered dietitian, a nurse clinician, a social worker, patient and the family should be developed. The diabetes team monitors the patient’s knowledge about diabetes and its acute and chronic complications. The team must continually evaluate the patient’s habits attitudes toward nutrition and physical activity. The team also promotes the use of medications, and problem-solving skills to perform better in school (www.diabetes.org).
To sum up, Type 2 diabetes mellitus in children is a matter of concern for society which will lead to significant increased morbidity and death during adulthood. Children with this disease do not execute normal function and their educational career is greatly affected. Medical professionals must address to diverse medical and psychosocial concerns within the context of a medical home with the objective of organizing wide-ranging services from health care professionals and the community. Health care professionals face many challenges of inspiring people to accept significant behavioral changes that look after for families affected by diabetes type 2.
Several interventions have proved effectual in preventing diabetes complications among adults, and assessment of these interventions in children with diabetes type 2 is immediately required. It is anticipated that clinical trials using effective behavioral and treatment interventions for children with diabetes will be developed. The increasing awareness among people and influential efforts on behalf of medical expert will improve the health of children with diabetes type 2 over their entire lifetime.
American Academy of Pediatrics, Committee on Community Health Services. The pediatrician’s role in community pediatrics. Pediatrics. 1999; 103 :1304 –1307.
Laron Z. Type 2 diabetes mellitus in childhood – a global perspective. J Pediatr Endocrinol Metab. 2002; 15:459-469.
Levitsky LL. Type 2 diabetes: the new epidemic of childhood. Presented at the American Academy of Pediatrics Annual Meeting; 2002; Boston, Massachusetts.
Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. 1999; 22 :345 –354.
Herpertz S, Albus C, Wagener R, et al. Comorbidity of diabetes and eating disorders. Does diabetes control reflect disturbed eating behavior? Diabetes Care. 1998; 21 Pp:1110 –1116.