Type 2 Diabetes in children

A different Diabetes in Childhood, deviation from tradition!

Childhood Diabetes Mellitus is traditionally called Type1 Diabetes or Juvenile Diabetes where pancreas fails to produce the key enzyme Insulin, as a result the child becomes dependent on Insulin for whole of his/her life. We all know the incidence of Diabetes is increasing very rapidly all over the world but fortunately we do not have much cases of type 1 Diabetes in our country as opposed to the west.

The problem in our country is the adult type of Diabetes, so called type 2 Diabetes where body does produce Insulin but the insulin is either less in amount or lacks quality or both. We use diet and tablets to make the Insulin work better, at least in the initial stage. This is the type of Diabetes which is increasing in India in epidemic proportion, so much so that India has been labelled as the diabetic capital of the world. Far worse news is that we are getting Diabetes at least 10 years earlier as our counterparts in the west.

Modernisation, lack of exercise, easy availability and palatability (!) of fast food all are to share the responsibility along with the change of the environmental pollution etc. In India, 15-20 % of people living in cities aged 20 years+ have Diabetes as opposed to 4-5 % in the villages. This so called “TV and Couch syndrome” is catching our children and that is the worst we can think of.

Older children and adolescents are fond of fast food, watching TV and computer game (physical inactivity). Typically the child is obese and has family history of type 2 Diabetes (they are born with the gene).

They may have peripheral marker of Insulin resistance called Acanthosis Nigricans (a blackish appearance in the skin fold areas). We do not know exactly what is the percentage of type 2 Diabetes in childhood and adolescence as there is no population based study yet available in our country but we are seeing this more and more in our day-to-day clinical practice.

We need to do a lot better to prevent this and at the same time to treat the affected. Not only concentrating on the patient, we need to educate families as almost all have positive family history of type 2 Diabetes.

We need to create awareness of this type of Diabetes in young among health care providers (be it general Practitioner, Physician, Paediatrician, nurse), governmental and non-governmental agencies involved in health care, pharmaceutical companies and charitable foundations.

Till today our knowledge is limited, we do not know what is the best way to treat this group, but as we see Insulin may not be required from the day 1 of the diagnosis unlike juvenile or type 1 Diabetes where Insulin is a must.

We need good quality research to explore the problem, its pathogenesis, prevention and treatment. As Bangalorean, we are proud to be a part of multinational multicentric research study to find out the best treatment option of type 2 Diabetes in childhood and adolescence.