Incidence of Diabetes in the U.S.* Age 18-79 Years

Type 2 Diabetes in the Adult A Collision Course

Kathleen M. Dungan, MD Division of Endocrinology, Diabetes & Metabolism The Ohio State University If current trends continue, 1 in 3 Americans and 1 in 2 minorities born in 2000 will develop diabetes during their lifetime! *per 1000 Population

Prevalence of Diabetes by Age 2005

www.cdc.org

Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006 (*BMI ≥30, or about 30 lbs. overweight for 5’4” person) 1998

1990

% 25 20 15

2006

%

10 5 0 20

>60.9 No Data

www.cdc.org

180) Prepubertal Pubertal (Tanner 2 - 5) FBG >126 and HbA1c < 9% ketones negative Glucometer, Metformin (250 mg/day po) Refer to Endo for f/up consult

FBG > 126 or HbA1c > 9% ketones moderate or high

Refer to Endo for immediate insulin treatment

** If random blood sugar >200 mg/dl, check HbA1c and fasting blood sugar – then follow as below

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Prevention of Type 2 DM in Children

Adolescence Likely Increases Risk of Obesity

• Pediatricians need to teach healthy eating habits and encourage exercise.

• Early puberty leads to reduced insulin sensitivity

• Address overweight patients directly about weight. They won’t “grow out of it!”

• Insulin hyper-secretion: 9 compensation for reduced insulin sensitivity 9 response to increased GH

Adolescence Likely Increases Risk of Obesity • Sex-dependent changes in insulin sensitivity (Travers, et al. JCEM 80:172-178,1995) • Systolic BP changes with pubertal stage independent of age (Weir, et al. J Adolesc Health Care 9: 465-469, 1988)

• Lipid variability by pubertal stage (Belcher, et al. Prev Med 22:143-153,1993)

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Trends in Child & Adolescent Overweight Percent

Percent 20

20

Environmental causes of Obesity in Children • Food choices

15

15

Males 12-19 10

10

Males 6-11

Females 12-19 5

5

Females 6-11 0

0 1963-67 1966-70 1971-74

1976-80

1988-94

1999-2000

Note: Overweight is defined as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts for the United States. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination Surveys I, II, III and 1999-2000, NCHS, CDC.

BMI of Ohio’s 3rd Graders

9 Fast food

• Increased portion sizes • Sedentary behavior 9 Television 9 Video games

• Family environment • Socioeconomic issues

Summary • Type 2 diabetes in children is caused by the same disordered metabolism as in adults.

20.6% obese 17% overweight 36.6%

• Certain patients are at greater risk than others. • High risk patients should be screened for type 2 diabetes.

Boys = girls

• Type 2 diabetes can be prevented, but when present should be treated aggressively.

Poor, rural > urban

Ohio Dept Health, 2006

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