Overweight and insulin resistant at 13, diabetic with heart disease at 30?
Health risks related to being overweight and obese are not limited to adults. They are increasingly being described in adolescents and children. A study by Dr. Francine Kaufman, a pediatric endocrinologist and author of the book “Diabesity,” appears in this month’s issue of Diabetes Care. Dr. Kaufman and her colleagues in the STOPP-T2D (stop type 2 diabetes) Prevention Study Group studied 1,740 eighth grade kids in 12 middle schools across the country. There were a large number of minority children: 53% were Hispanic, 23% African American, 2% Native American and 6.3% “other race/ethnicity.” Only 15% were Caucasian.
Here is what they found. Almost 50% of these kids had a BMI at or above the 85th percentile (this is approximately equivalent to a BMI of 25 kg/m2 in adults). A little over 40% of the kids had a fasting glucose of 100 mg/dl which means they had impaired fasting glucose. A very small number (less than 1%) had fasting glucose levels in the frank diabetes range. Mean fasting insulin levels were elevated in 36% of study participants suggesting these individuals were resistant to insulin. Only 2% raised their glucose levels to the abnormal range after an oral glucose challenge.
By and large, fasting and post-glucose challenge levels increased as BMI increased. There was a difference in the results across racial/ethnic groups. Hispanic and Native American students had the highest rates of impaired fasting glucose.
All three risk factors for developing type 2 diabetes (BMI at or above the 85th percentile, impaired fasting glucose, and elevated insulin levels) were present in almost 15% of the children studied. Only 28% of the students had normal levels of all three risk factors.
Although only a small number of 8th graders in this study had type 2 diabetes, a large number had one or more risk factors for developing the disease in the future. An astonishing 15% had a very high likelihood of developing type 2 diabetes because of the presence of all three risk factors for the disease.
Complications of type 2 diabetes, such as nerve damage, blindness, and kidney failure, occur after the person has had the condition, untreated or suboptimally treated, for one or two decades. Some complications, such as heart attacks and strokes, may occur even before someone meets the criteria for diagnosis of type 2 diabetes.
When I was first in training in endocrinology in the early 80s, we called type 2 diabetes “adult-onset diabetes.” It was most often diagnosed in middle-aged people. Onset of complications typically occur 10-20 years later. If we extrapolate this timeline to kids who are developing insulin resistance, glucose intolerance and type 2 diabetes in their teen-age years, it suggests that we could be seeing heart attacks, strokes, kidney failure and other diabetes-related complications in people in their 30’s. This is why many experts are raising concern that the years of seeing ever-increasing longevity in the Western world could be halted or even reversed by the epidemic of obesity and type 2 diabetes. Pretty scary!