For the second year in a row, Louisiana received an overall grade of "D" in the Pennington Biomedical Research Center's report card on children's health. A major reason for this dismal score: 36 percent of the state's children ages 10-17 years are overweight or obese, exceeding the national rate of 31 percent. Another factor was our teens' increase in passive activities, specifically the amount of "screen" time vegging out with the TV or computer, where the grade slipped from D to D minus. Both of these negative components contribute to a growing problem locally, as well as nationally – an increase of type 2 diabetes in juveniles. The Centers for Disease Control and Prevention projects that if present trends continue, one in three children born today will develop diabetes during their lifespan.

 

Unfortunately, more Louisiana practitioners are witnessing this trend firsthand. Family practice specialist Dr. Ben Doga of Lafayette saw his first teen with type 2 diabetes right out of residency. The 13-year-old patient presented with symptoms "very typical of those in an elder adult with type 2 diabetes," he recalled. Common signs include fatigue, excessive thirst, frequent urination and recurrent urinary tract infections. "I really didn't know how to treat it at the time," he said.

 

The problem is that medications prescribed for adult diabetics have not been fully tested in juveniles. While doctors treat average-sized 17- to 18-year-olds similarly to adults, they don't have FDA stamp of approval for medicating younger patients. "For starters, we just don't have the research on the multitude of oral medications that we provide for adults," Doga said. "So, we don't know in depth how the medications are going to affect a 12- or 13-year-old."

 

In the past, children with diabetes were typically diagnosed with type 1, where the pancreas cannot make insulin, and were treated with injections. With type 2 –inefficiency processing of insulin or insulin-resistance – the mainstay of treatment for juveniles is lifestyle changes.

 

Step one is diet. "The less sugar, the fewer simple carbohydrates that you put into your body, the less you are going to have to process," Doga explained. "We have to get their weights down, and get their diet much better – concentrating on proteins, complex carbohydrates and a good balanced meal, rather than some of the sugary snacks and fast food which are so readily available nowadays."

 

Next is exercise. "Exercise will burn up a good bit of glucose, our sugar in our system, because we use it as energy," he expounded. "So, if we become more active and exercise on a regular basis, our body won't have to process it – we'll just burn it up."

 

Doga reports that "almost always," juveniles with type 2 diabetes are obese. This link is confirmed by PRBC's Associate Executive Director for Population Science, Peter Katzmarzyk, PhD. "Childhood obesity is fast becoming the greatest public health challenge facing America," he said in a statement issued by PBRC on Louisiana's Report Card on Physical Activity and Health for Children and Youth – 2009. "During the 1980s and 1990s, the number of overweight and obese children skyrocketed, resulting in a growing number of children facing health consequences that were traditionally only experienced by adults."

 

A common pattern Doga sees with younger type 2 patients is having family members with diabetes. "There usually is a genetic link – one of the patient's parents, aunts or uncles have diabetes, and oftentimes, several individuals in the family have diabetes," he observed. "They might have been diagnosed later on in adulthood. But, because we are seeing the obesity so much now in our teens, we are beginning to see this type of diagnosis being made."

 

Why the increase? Most of the research points to poor diet. Fatty, sugary foods are readily available to youngsters in snack machines at schools and drive-thru windows on almost every corner. "It's fast, it's cheap, it's easy, it's accessible," Doga noted. "And, everybody kind of gets caught up in their busy lifestyles. It's just easier to eat pre-packaged foods, things that are just not as healthy."

 

Children are also less active today than in the past. Playing video games and IM-ing inside, rather than playing traditional sports outside, are the major sources of entertainment for today's teens. Tracking this trend, PBRC made specific suggestions in its report card, using the theme "Better Health for All Children." For parents, researchers recommend spending more time with their children in outdoor activities and making sure that kids have adequate free time for free play. At schools, teachers and administrators are encouraged to add physical activity breaks during the day and restructure P.E. programs to introduce a variety of sports. As an incentive, Pennington suggests that policy makers provide tax credits to parents of kids who participate in organized physical activities.

 

Recently, the American Diabetes Association issued guidelines for screening children at risk for sugar diabetes. The ADA recommends screening children ages 10 and over every three years if they have two or more risk factors for type 2 diabetes and are overweight (BMI greater than 85^th percentile for age and gender, weight for height). Red flags include: a strong family history (first degree relative) for diabetes; high risk ethnicity (African-American, Native American or Hispanic), and signs of insulin resistance (fatigue, drowsiness after meals, intense mood changes, high triglycerides, hypertension and dark skin patches on the neck and armpit areas). "We should be screening these people before the symptoms show up," Doga opined. "Otherwise, we are screening individuals who show up with symptoms which could be related to any number of things."

 

Now that researchers have identified the risk factors for developing juvenile type 2 diabetes, their next challenge is treating young patients with the disease. While Metformin, an oral drug, is now generally accepted as safe for treating older adolescents, "medications are just not certified for the younger age group," Doga reported. Insulin injections are also an option in some cases.

 

An even bigger issue for youngsters is compliance. So, Doga recommends getting the entire family involved. "It is very difficult to get a 13-year-old or a 14-year-old to be compliant with diet if the family is not," he said. "So, Mom and Dad have to be involved, and they have to change their own diet. Oftentimes, they, too, have diabetes or are overweight, so it is good for the whole family. Plus, all of the siblings are at increased risk. So, in order to prevent that, you have to get the whole family involved – they have to become more active as a family, and they have to be more conscious of their food intake."