The Changing Face of Diabetes Diagnosis for Children

As the obesity epidemic gathers momentum children and young people are at increased risk of developing diabetes.  Doctors are seeing a large increase in the incidence of Type II diabetes, previously known as “maturity onset” diabetes, in children.  This had led to misdiagnosis in some cases, with treatment for Type II diabetes being given to children who actually had Type I.

In Type I diabetes, weight may not be an issue, as this is the result of an auto-immune disorder in which the patient’s body destroys its own ability to produce insulin.  Type II diabetes occurs typically in overweight people whose cycle of constantly spiking blood sugar and insulin has caused their tissue to lose the ability to respond to insulin.

In the past doctors would consider any young person who presented with diabetic symptoms, such as extreme fatigue, weight loss, increased thirst, and excessive urination, to be a likely Type I diabetes case.  Type II diabetes was generally seen only in elderly people, particularly those who were overweight.

However, one-third of adults in the US are now classified as obese and the problem is spreading to our children, with 17% of children and people under 20 – 12.5 million –  now obese.  Western lifestyles also mean young people are frequently eating an unhealthy diet high in fats, sugars and carbohydrates, with insufficient fiber, and are exercising far less than they should.  Typical American children spend time in front of the television or computer, rather than taking part in sports and other outdoor activities.

Misdiagnosis of diabetes in children can work both ways.  A doctor may be more inclined to diagnose Type I diabetes in a child or young person because in the past Type II diabetes was extremely uncommon in younger people.  However, when an overweight or obese child shows diabetic symptoms a doctor may be inclined to diagnose Type II because he is aware of the current trends and associates Type II with obesity.  Studies of records over 10 years showed over one third of cases of pediatric Type I diabetes in San Diego was misdiagnosed in the first instance as Type II.

Because treatment for Types I and II differs, this means some patients were not receiving the correct medication for their condition, paving the way for complications.  These include conditions such as diabetic ketoacidosis, a life threatening state and medical emergency, and diabetic neuropathy, in which nerve endings are damaged by high blood sugar levels.

Speaker Dr. Avnish Tripathi commented at the American Diabetes Association’s annual scientific sessions that these factors called for greater care in the diagnosis of diabetes, with laboratory tests to confirm which type of diabetes a patient actually had.  He said the obesity crisis was “changing the demographics and clinical manifestations of diabetes in children.”

To add to the problems of misclassification, the disease may sometimes present with variations such as double diabetes, in which a patient has symptoms of both types at once, and ketosis-prone diabetes.  This latter occurs when patients with Type II diabetes develop diabetic ketoacidosis.

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