Adult-onset' diabetes now kids' epidemic

April 13, 2003

BOSTON--Once a true medical oddity, children with adult diabetes are
becoming commonplace. Doctors blame the twin evils of too much food and too
little exercise and fear a tragic upswing in disastrous diabetic
complications as this overweight generation reaches adulthood.

At hospitals everywhere, boys and girls who range from chubby to hugely
obese are being diagnosed in unprecedented numbers with Type 2 diabetes.
Most are barely into their teens. Some are as young as 6.

This disease used to be called adult-onset diabetes. But in the last
decade, it has slowly become clear this is now a disease of the young, as

Just how frequently is uncertain, since nationwide statistics are still
being gathered. Nevertheless, doctors are convinced they see the leading
edge of a dangerous shift, one that will inevitably lead to kidney failure,
blindness, heart attacks, amputations and more as these young people live
another 10 or 20 years with their diabetes.

''There is an epidemic of Type 2 diabetes in youth, absolutely,'' said Dr.
Lori Laffel, head of the pediatric unit at Boston's Joslin Diabetes Center.
''Over the years, we always saw an occasional child with Type 2. It was a
handful a year.''

But in the early '90s, the pattern changed. Out of the blue, it seemed,
large children, usually accompanied by overweight parents, began to show up
with Type 2 diabetes. During the early '90s, Joslin's totals increased five
times. Since then, they have doubled again.

Until this shift, almost all diabetes in children was Type 1, what was
called juvenile diabetes. In many ways, it is a different disease. Type 1
results from a misguided attack by the immune system on the insulin-making
cells in the pancreas. Victims stop making insulin completely, so they
cannot convert sugar to energy.

But Type 2 has always been a disease of people in their 50s, 60s and
beyond. Their bodies still make insulin, just not enough. They may go for
years without realizing they have it.

Dr. Phillip Lee, head of pediatric endocrinology at UCLA, says the surge in
cases is not because doctors are looking harder for it.

''It's not because we missed a lot of cases,'' he said. ''We just didn't
see it. Now referrals of Type 2 are almost 50 percent of our diabetes

Why? Doctors have little doubt. They blame inactivity and overeating. The
hours on end in front of the tube, for instance, and the 20-ounce sodas in
school vending machines. (Swilling four of those a day, one doctor notes,
adds up to 1,000 calories, close to half of a boy's daily needs, all from

Virtually all children with Type 2 are overweight. Young blacks and
Hispanics have more of this kind of diabetes than do whites. Their extra
weight alone may explain some of it.

Since the problem is so new, no one knows exactly what will befall those
who start the disease in their teens. But many fear the complications will
emerge in early adulthood.

''The horizon is really dark,'' said Dr. Jorge Calles-Escandon, a Wake
Forest University endocrinologist. ''We know what happens to adults with
Type 2 diabetes who don't take care of it properly. They die prematurely.
They have heart attacks, strokes, blindness, renal failure. There is no
reason to believe this will be different for adolescents.''