Diabetes—A Pediatric Perspective

As a practicing pediatric endocrinologist in Los Angeles, California, I have witnessed significant changes over the past 30 years. During that time, there has not been a single week in which the Center for Diabetes at the Childrens Hospital Los Angeles has not diagnosed at least three children with diabetes. Recently, that number has doubled. Because Los Angeles is one of the world’s melting pots, we make that diagnosis in hundreds of languages and in children of all races who have come from literally all corners of the world.

Some of these children are babies. They will have to learn to walk and talk already burdened with diabetes. Others have just started school, and they must take their diabetes to school with them every day. Their challenge is to determine who will help them check their blood sugar levels and take their insulin shots and make sure they are safe. Still others are teenagers, facing the challenges of establishing themselves as individuals, developing a sense of independence from their parents and growing into adulthood. All of these children have parents who are shocked by the diagnosis of diabetes, overwhelmed by its demands, and concerned about the future. All of these children have siblings, grandparents, friends, and communities that are all affected by the diagnosis. What I see in Los Angeles is a diabetes landscape that is shared by my colleagues around the world. We are all experiencing the effects of the global increase in childhood diabetes. It is our challenge to bring this reality to the attention of decision-makers and, through the media, to the public.

Currently, it is estimated that at least half a million children have diabetes worldwide. The incidence of both type 1 and type 2 diabetes is increasing rapidly. The incidence of type 1 diabetes is increasing by about 3% (range about 2–5%) per year, with the greatest rate of rise in children under the age of four years. Type 2 diabetes was rare in pediatrics until recently. However, the epidemic of childhood overweight and obesity has been a catalyst for the development of type 2 diabetes in older youth and teens. Since 1990, there has been a rising incidence of type 2 diabetes in adolescents in Japan, so that type 2 diabetes is now seven times more common than type 1 in Japanese children. This represents an increase in incidence of more than 30-fold over the past 20 years. In the US, one in 523 children and young adults under the age of 20 years has diabetes; 79% of these are between the ages of 10 and 19 years.

Type 2 diabetes has a variable rate among these youth depending on race/ethnicity: 6% of white, 40% of Asian/Pacific Islander, 33% of black, 22% of Hispanic, and 76% of American Indian youth have type 2 diabetes. This is mirrored across the globe, so that South-East Asians, Pacific Islanders, Hispanics, African-Americans, and the Native North Americas (also called Aboriginals or First Nations in Canada and North American Indians in the US) are at high risk. In many countries, the greatest rates of type 2 diabetes are seen among immigrant children.

The rise in type 2 diabetes in youth relates to lifestyle changes that have occurred throughout the world. In almost every culture and every location children are becoming more sedentary and less physically active—even in school. This comes as a consequence of urbanization, global access to television, computers, and electronic games, and concerns about safety. Over the past decade, there have been profound changes in the quality, quantity, and source of food consumed in almost all countries. Processed food and sugar-added beverages offer greater caloric content but lower nutritional value at a lower cost. This has tipped the energy balance for many of the world’s children so that it is now estimated that 10–20% are overweight and obese. Since once established obesity becomes a chronic condition, there is an ever-increasing tendency to develop type 2 diabetes and cardiovascular disease.