Type 2 diabetes, once largely confined to adults, is increasingly being seen in teenagers, and even pre-teens.
This shift is being fuelled by the rising rates of childhood obesity, sedentary lifestyles and high-calorie diets.
Type 2 diabetes is associated with insulin resistance, where the body’s cells fail to respond effectively to insulin, leading to elevated blood glucose (sugar) levels.
It is strongly associated with obesity, as excess body fat, especially around the abdomen, interferes with insulin signalling and worsens insulin resistance.
While genetics play a role, lifestyle factors are major contributors to the condition.
The growing epidemic of childhood obesity is a significant driver of type 2 diabetes.
Worldwide, the number of children who are overweight has surged, affecting about 20-30% of school-age children in many countries.
Similarly, in Malaysia, we are seeing alarming rates of childhood obesity.
Data from the National Health and Morbidity Survey (NHMS) 2022 shows that about one in three Malaysian adolescents aged 13 to 17 is overweight or obese.
While type 1 diabetes, an autoimmune condition, remains the most common form of diabetes in children, the rise of type 2 diabetes among them, which is usually associated with adults, is alarming.
Factors contributing to this include increased screen time (and the accompanying sedentary time), less physical activity, and the easy availability of processed foods high in sugars and unhealthy fats.
Signs and symptoms
Type 2 diabetes in children often progresses insidiously over weeks to months, making it crucial to recognise warning signs.
The symptoms can be subtle, but may include:
High blood sugar causes excess glucose to enter the urine, pulling water along with it, which leads to increase urination, dehydration and increased thirst.
Children might also start bedwetting at night due to increased urination.
The body is not able to utilise glucose effectively as an energy source due to insulin resistance and a relative insulin deficiency, leading to tiredness.
Over time, the body starts to break down fats as an alternative energy fuel, leading to weight loss.
People with diabetes are more prone to infections because high blood glucose levels can weaken the immune system.
Common infections are urinary tract infections, skin infections and foot infections.
Regular screening for at-risk children can make a difference.
In children with obesity, a family history of diabetes, low birth weight (small for gestational age) or signs of insulin resistance, routine monitoring should be done starting at the age of 10 years or at the onset of puberty.
Puberty is a pivotal time when insulin resistance naturally increases due to hormonal changes.
Insulin resistance often causes skin changes, particularly in areas like the neck, armpits and groin.
These darkened skin changes are known as acanthosis nigricans.
Diagnosis
A blood glucose check can identify elevated blood sugar levels early.
A simple finger prick test using a glucometer should be done at the clinic if a child is unwell with typical symptoms of diabetes, as this can give an immediate result.
An HbA1c test can provide insight into blood sugar control over the previous three months.
After a diagnosis of diabetes is made, further tests such as pancreatic antibodies and C-peptide (a reflection of the body’s endogenous insulin) should be done to differentiate between type 1 and type 2 diabetes.
Diagnosis of pre-diabetes and diabetes is based on levels below.
In the absence of symptoms or with mildly elevated levels, two tests on two separate occasions should be taken before a diagnosis is made.
Prediabetes is when blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes, indicating an increased risk.
- Random plasma glucose: 11.1 mmol/L or higher if the person has typical symptoms of diabetes.
- Fasting blood sugar test (fast for at least eight hours): Prediabetes – 5.6 to 6.9 mmol/L; Diabetes – 7.0 mmol/L or higher on two separate tests.
- Oral glucose tolerance test (glucose levels two hours after a glucose load): Prediabetes – 7.8 to 11.0 mmol/L; Diabetes – 11.1 mmol/L or higher.
- Glycated haemoglobin (HbA1C) test (average blood sugar level for the past three months): Prediabetes – 5.7% to 6.4%; Diabetes – 6.5% or higher on two separate tests
Certain conditions can make the A1C test inaccurate, such as if you’re pregnant or have an uncommon form of haemoglobin.
Without early detection and treatment, type 2 diabetes can lead to severe complications.
Acute complications include diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS).
DKA is more commonly associated with type 1 diabetes, but can also occur in type 2, especially under stress or illness.
HHS, which is also life-threatening, is marked by extreme dehydration and high blood sugar levels.
Left unmanaged, type 2 diabetes can lead to chronic complications, some of which appear sooner in younger patients than in adults.
These include heart disease, kidney and vision problems.
Treatment and prevention
With timely intervention, type 2 diabetes is manageable, and in some cases, can even see a reversal of insulin resistance.
These include:
A healthy weight, balanced diet and regular physical activity are essential.
Encouraging children and family to choose nutritious, low- sugar foods, and to be active for at least 60 minutes a day, can significantly impact their health.
Encouraging activities like sports, cycling and walking as family routines can make lifestyle changes enjoyable.
Lifestyle changes alone is often not enough in adolescents who have a more aggressive type of diabetes, and medication might be necessary.
Metformin, for instance, is often the first-line treatment for adolescents with type 2 diabetes as it helps reduce blood sugar by improving the body’s response to insulin.
Insulin treatment is indicated if there are complications such as DKA or if the diabetes is poorly controlled despite lifestyle modifications and medications.
Children and adolescents need a positive and supportive environment to maintain lifestyle changes.
Involvement of the whole family is needed.
Regular follow-ups with a paediatric endocrinologist is crucial for managing blood sugar levels and monitoring potential complications.
Preventing type 2 diabetes in children requires a community effort to create a healthy environment.
Schools, healthcare providers and policymakers all have a role to play.
Schools, for example, can promote physical education and provide healthier meal options.
Environments that support healthy lifestyles, such as establishing parks and recreation centres, encourage children to be active.
With the rise in childhood obesity and unhealthy lifestyles, type 2 diabetes is increasingly being seen among adolescents.
Raising awareness is crucial, as diabetes in young people impacts not only their health, but also their quality of life and self-esteem.
While prevention is the ultimate goal, early detection and timely interventions can make diabetes manageable and improve long-term outcomes.
Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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