Doug Thompson illustration
Sedentary lifestyles — high on fast food and low on exercise — are increasingly common, and so is the incidence of type 2 diabetes, often triggered by obesity. Nationally, 57 million people are at high risk for the disease. In Richmond, physicians are particularly alarmed by the number of children and adolescents diagnosed. "Twenty years ago, it was rare that a child would be diagnosed with type 2 diabetes, and now it is a third of all diabetic cases, and in some populations about 40 percent," says Dr. Gary Francis, head of VCU Medical Center's Division of Pediatric Endocrinology and Metabolism. He refers to the trend as "an epidemic."
Mary Henck, nutrition clinical coordinator at Richmond's Children's Hospital, notes that rising obesity in young people is a major cause. "It used to be that we only saw it in patients over the age of 40."
The increasing prevalence of youth cases concerns endocrinologists because of diabetes' long-term effects on patients' health, says Dr. John Clore of VCU's endocrinology and metabolism division. "The longer you have diabetes, the greater risk of complications," he says. Complications can include kidney disease, heart disease, high blood pressure, blindness and nervous-system damage. Diabetes, a disease marked by high levels of blood sugar, results from the body's inability to produce or properly use insulin, a hormone that converts starches, sugar and other food into energy.
The American Diabetes Association, which currently is observing American Diabetes Month, warns that if unhealthy trends continue, one in three newborns will eventually contend with diabetes. The disease affects an estimated 23.6 million people in the United States, including nearly 6 million undiagnosed cases, according to the Centers for Disease Control and Prevention.
Local doctors began recognizing type 2 diabetes more widely in children about a decade ago. Until then, it was frequently thought that most children with diabetes had type 1, says Dr. Meredith M. Berger, a partner in Virginia Diabetes and Endocrinology. "It was a big change in our thinking."
In many cases, Francis adds, type 2 is difficult to diagnose, because symptoms develop slowly. Among them are increased thirst, frequent urination, weight loss, fatigue and blurred vision. He encourages yearly screening for adults and children in high-risk groups. Besides obesity, risk factors include ethnicity (African Americans, Hispanics and American Indians are affected at higher rates), family history and, for women, a previous diagnosis of gestational diabetes. For children, obesity is the highest risk factor. Screenings involve the testing of a person's fasting blood sugar.
Though the cause of type 1 diabetes is still unknown, the good news is that type 2 can be prevented, even in high-risk cases, through diet and exercise.
"There is nothing fancy," Henck says. "It is smaller portions, eating less fat, healthier food choices — high fiber and less sugar."
Berger adds that pre-diabetics can reduce by 60 percent the risk of developing full-blown diabetes by limiting carbohydrates to 45 grams per meal, exercising 30 minutes a day and losing weight. In some cases, type 2 diabetes will disappear if a patient is highly motivated. "Even 10 pounds makes a difference," Berger says. At-risk children should exercise for 60 minutes per day, eat smaller portions and reduce their consumption of sodas and high-calorie meals.
Advancements in treatment since the late 1980s have made it easier for diabetics to control their blood-sugar levels. Among those innovations are fast-acting insulins that allow diabetic patients to match their insulin to what they eat and cell phone-size pumps that allow patients to monitor their insulin levels without having multiple daily injections. Still, health complications from diabetes are increasing.
While controlling blood sugar reduces health risks, "We have more people with diabetes than ever before," Clore says, "and many of them do not have good blood-sugar control, so that leads to an increasing number of patients with diabetes on dialysis."