“In recent times, we’ve seen a changing face of Type 2 diabetes” says Dr Gideon Mlawa, consultant physician and endocrinologist at Queen’s Hospital in London, UK. “In the past, physicians used to see Type 2 diabetes in older patients who had slightly higher weight, didn’t exercise, ate unhealthy food and lived with obesity. These days, with more people living with obesity, Type 2 diabetes prevalence is increasing in younger people,” he adds.
Weight gain, especially in the form of belly fat, as is often observed in obesity, is a risk factor for Type 2 diabetes. This is because obesity induces chronic inflammation in the adipose tissue, which leads to metabolic anomalies — like insulin resistance. Insulin resistance occurs when cells in the body don’t respond well to insulin and the body struggles to use blood glucose for energy.
Initially, insulin resistance has no symptoms. However, some children may develop patches of thick, dark, velvety skin around the back of their neck, armpits or groin — a condition called acanthosis nigricans. In other cases, comorbidities may also present alongside insulin resistance. They include:
- high cholesterol levels
- increased blood pressure
- polycystic ovary syndrome in girls and young women
Research shows that in the United States, Type 2 diabetes in young people is more common among non–white populations, including black populations, than among white populations. In addition to ethnicity, other risk factors for Type 2 diabetes include a family history of diabetes, cultural factors, and socioeconomic considerations.
Children are particularly influenced by the choices of the adults around them and if reduced income leads to the consumption of excess fat and sugar in food or drink, obesity can quickly spread within in the family.
In addition, puberty hormones play a role in the development of Type 2 diabetes, and consequently, there’s an increased risk of teenagers developing Type 2 diabetes when compared with younger children. Research (1,2) has shown that growth hormone, estrogen and androgens can all affect insulin sensitivity.
A 10-year-old with Type 2 diabetes
Dr Glennis Williams, a GP with a special interest in Diabetes and Medical education, Grove Park Terrace Surgery, London, UK talks about diabetes in children. In her practice, she met Isha*, a 10-year-old girl of West African background who became the youngest person in her county to receive a diagnosis of Type 2 diabetes.
Isha had a family history of Type 2 diabetes, ate a lot of food rich in carbohydrates and snacked on chocolates during the night. On presentation at the surgery, Isha was in the 99th percentile of her height/weight chart, complained of fatigue, and excessive thirst — all symptoms of Type 2 diabetes.
Case study: 10-year-old Isha. Source: Diabetes Care for People of African and Caribbean Origin, ‘Everything you always wanted to ask’ event series (2021), Diabetes Africa
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Preventing Type 2 diabetes in children
Thankfully, with the inclusion of medications, nutritional education, and increased physical activity, Isha’s condition improved. To avoid a Type 2 diabetes diagnosis parents can take the lead role in their child’s nutrition. A few ways to do this is by encouraging the following behaviors:
- drinking more water, reducing carbonated and sugar-sweetened drinks
- eating more fruits and vegetables
- reducing refined carbohydrates and processed foods
Resources exist to support people living with diabetes and their family to better navigate their way to a healthier lifestyle, including culturally-relevant material, such as Carbs and Cal’s World Foods guide, or HEAL-D’s Help Sheets.
Another takeaway is the importance of healthcare professionals paying special attention to children of African and Caribbean origin who are living with obesity, and who present with symptoms of high blood sugar. The diagnosis could be Type 2 diabetes.
This echoes the personal experience of Aisha T., a woman of African origin living in the UK whose teenage daughter was initially and mistakenly diagnosed with Type 1 diabetes. Based on her experience, Aisha says, “healthcare professionals should factor in people’s cultures when giving a diagnosis.” “They should also take into consideration that age, especially for young children, doesn’t automatically equate to a Type 1 diagnosis,” she adds. Her daughter was later diagnosed with Type 2 diabetes.
*Names have been changed to protect identities
This article was written following a virtual event series organised by Diabetes Africa. Novo Nordisk provided sponsorship to support the costs of running the virtual event series. Novo Nordisk did not have any input into selection of speakers, programme content or agendas.