Steve Freed, R.Ph., CDE
Publisher of www.diabetesincontrol.com
Diabetes is one of the most common chronic diseases in children and adolescents: about 151,000 people below the age of 20 years have diabetes.1
When diabetes strikes during childhood, it is routinely assumed to be type 1, or juvenile-onset diabetes. However, in the last two decades, type 2 diabetes (formerly known as adult-onset diabetes) has been reported among U.S. children and adolescents with increasing frequency.
Children and adolescents diagnosed with type 2 diabetes are generally between 10 and 19 years old, obese, have a strong family history for type 2 diabetes, and have insulin resistance. Generally, children and adolescents with type 2 diabetes have poor glycemic control (A1c = 10% - 12%). If an adult gets diabetes at the age of 40 or 50, becomes educated about the disease, maintains a healthy diet, and increases their physical activity, they can reduce their risk of complications. However, if a child gets diabetes at the age of 10 or 20, will they maintain a healthy diet and increase their physical activity for the next 40-60 years?
There are a total of 25.8 million children and adults in the United States with diabetes -- 8.3% of the population. Approximately 1.9 million new cases of diabetes were diagnosed in 20101.
- The CDC has stated that 1 in 3 children will get diabetes and if you are African, Hispanic, or Native American, every other child will get type 2 diabetes.1
- The epidemics of obesity and the low level of physical activity among young people, as well as exposure to diabetes in utero, may be major contributors to the increase in type 2 diabetes during childhood and adolescence.
How to find children with type 2 diabetes?
Prior to 2010 the only way to diagnose diabetes was to do a fasting blood sugar and if it was 126mg/dL or higher, the patient was diagnosed as diabetic: prediabetes was not even in our vocabulary. You could also do an OGTT (oral glucose tolerance test).
A patient could also go to the doctor's office for a physical exam where a venous blood draw is done and sent out to the lab for a fasting blood sugar result. The problem with that method is that a patient could have a normal fasting blood sugar of less than 126mg/dL, and then go out for dinner and eat a large portion of pasta with some garlic bread and dessert, and have a blood sugar well over 200mg/dL: no one would ever know. By the time a patient is diagnosed with diabetes in a doctor's office with a fasting blood sugar of >125mg/dL, they probably have had diabetes for 10-15 years and have lost 80% of the function of their beta cells.
As of 2010, the ADA has approved the A1c test for the diagnosis of diabetes and prediabetes. Providing screenings for the children of parents with diabetes is a great place to start. According to the ADA, an A1c of 6.5% is the diagnosis of diabetes and an A1c of 5.7-6.4% is the diagnosis of prediabetes*. (See Note)
As you are filling prescriptions for people with diabetes, provide a brochure offering an A1c screening for their children. Or if you see a child that is overweight or has Acanthosis Nigiricans (A darkening of the skin on the neck or arms can mean insulin resistance.) you can offer an A1c screening.
The A1cNow is available through your wholesaler in a professional pack of 10 or 20 tests or at www.a1ctest.com. They are NGSP certified, CLIA waived and provides a result within five minutes. Provide the patient with a form (Quality of Life Test - http://www.diabetesincontrol.com/articles/features/10712) that explains exactly what the number represents.
Catching diabetes early can be a huge benefit for children, because with a few minor changes such as reducing their carb intake, reading food labels, or just increasing their physical activity, parents can provide their children with a better quality of life.
*In the April 2011 publication of Diabetes Care, The ADA suggested that an A1C of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents and they reported, an A1c of 5.8% in children is a better diagnostic target to diagnosis diabetes, but more studies suggested.
12011 National Diabetes Fact Sheet
Information on CE programs on diabetes go to www.rxschool.com and register for the next "Diabetes-Prediabetes, It's Not Just About Blood Sugars" Live CE program.