Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.
Dale Garber, MD, is a board-certified pediatrician currently practicing in South Florida.
Type 2 diabetes is a disorder of the endocrine system that develops over time and causes hyperglycemia (high blood sugar). It occurs when the body cannot use glucose (sugar) efficiently.
Children who develop type 2 diabetes are more likely to have family members who have it. They often carry excess weight in the abdomen and are more sedentary. Type 2 diabetes in kids typically occurs after age 10 but can develop earlier.
Learn about type 2 diabetes in children, including its causes, treatment, diagnosis, and how to cope.
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Symptoms of type 2 diabetes in kids are similar to that in adults. It can range from asymptomatic (no apparent symptoms other than incidental findings on routine blood work or urine samples) to symptoms of hyperglycemia. However, kids with type 2 diabetes are more likely to experience diabetic ketoacidosis, a life-threatening complication of diabetes, which is common among certain underserved racial and ethnic populations in the United States.
Symptoms of type 2 diabetes in children include:
In recent years, there has been an increase in type 2 diabetes in children. Children considered obese are at increased risk of developing type 2 diabetes, high blood pressure, and high cholesterol.
Type 2 diabetes is caused by hyperglycemia (high blood sugar). High blood sugar occurs when cells resist insulin, leaving sugar in the bloodstream. As a result, the pancreas compensates by making more insulin. Over time, the pancreas cannot make as much insulin, causing glucose to accumulate in the blood and blood sugar to rise to levels associated with type 2 diabetes.
Insulin resistance is a precursor to type 2 diabetes and is related to excess fat in the abdomen (called abdominal adiposity). Genetics and lifestyle factors contribute to insulin resistance.
Many children with type 2 diabetes come from traditionally underserved racial/ethnic populations, have low socioeconomic status, and often experience multiple psychosocial stressors.
Risk-based screening for prediabetes and/or type 2 diabetes should occur in children and adolescents after puberty or when 10 years old or older (whichever occurs first), who are experiencing overweight or obesity, and who have one or more additional risk factors for diabetes.
Blood tests, such as fasting plasma glucose and hemoglobin A1C, can be used. The oral glucose tolerance test, which includes drinking a sugary beverage and having blood drawn to assess blood sugar levels, is also used to diagnose diabetes. Children with overweight or obesity where a type 2 diabetes diagnosis is being considered should also be tested for autoantibodies to rule out type 1 diabetes.
The obesity epidemic complicates healthcare providers' ability to differentiate between type 1 and type 2 diabetes in children. Many children with type 1 diabetes have obesity, which was once thought to only affect kids with type 2 diabetes. In certain children, obesity contributes to the development of type 1 diabetes.
Treatment for type 2 diabetes in children should include diabetes self-management education that takes into consideration the family’s culture, lifestyle, and access to care. Lifestyle changes, such as exercising more and following a healthy diet, are also part of a diabetes treatment plan.
Lifestyle changes are the first-line treatment. As with all children, kids with type 2 diabetes should participate in 60 minutes of moderate-to-intense physical activity daily. They should get muscle and bone strength training three days a week, as well.
Screen time, which is the amount of time spent on electronic devices such as smartphones, televisions, and computers, is a sedentary behavior. Although recommendations vary based on age, children ages 6 and older should establish consistent limits on screen time and that it should never replace healthy activities like sleep, exercise, and social interaction.
Children should eat more nutrient-dense foods (fruits, vegetables, whole grains, lean protein, and healthy fat) while reducing fast food, sugary beverages, and snack foods. Nutritional education about carbohydrates and portion sizes are also important as these foods impact blood sugars the most. A registered dietitian can help you and your child develop an eating plan.
Children should never be put on a no-carbohydrate diet or any other highly restrictive diet. These diets can increase the risk of disordered eating. Adequate nutrition is important for a child's physical and mental development.
Children are encouraged to maintain weight while they grow. However, if weight loss is advised, it should be guided by a medical professional and should occur at a slow pace. Long-term weight management with weight loss of 7% to 10% is necessary for some children with type 2 diabetes.
Behavior and lifestyle modification may not be enough for all children with type 2 diabetes. Some children need medication to get their blood sugar in a safe range. Medications may include:
Treatment options should be individualized and consider a child's blood sugar levels, weight, activity, family support, culture, lifestyle, and access to supplies.
Metabolic or bariatric surgery may be considered in adolescents with type 2 diabetes who have severe obesity and other health conditions (comorbidities) despite lifestyle changes and medication. Some studies have shown that surgery can put diabetes in remission.
Kids with type 2 diabetes are at increased risk of having elevated LDL (low-density lipoprotein) cholesterol (considered “bad” cholesterol), low HDL (high-density lipoprotein) cholesterol (considered “good” cholesterol), and high triglycerides, precursors to heart disease. They may also need to have their blood pressure evaluated regularly and have a dilated eye exam.
Children with type 2 diabetes can manage their blood sugar with diet, exercise, and medication. However, because they are diagnosed at an earlier age, tight blood sugar control is important in preventing long-term complications of diabetes.
For some people, weight loss can lead to diabetes remission by reversing insulin resistance. This has been seen in adults and limited studies on children. Children and families must work closely with their medical team to ensure safe weight loss and assess their options.
Coping with a type 2 diabetes diagnosis can be difficult for the entire family. Daily tasks such as blood sugar monitoring, meal preparation, and medications can be overwhelming and burdensome. Receiving thorough education and support for the whole family will be important for long-term success.
A multidisciplinary approach is ideal and should include a pediatrician, certified diabetes care and education specialist, endocrinologist, psychologist or social worker, and other specialists as needed. Since children spend most of their time in school, close communication with school personnel is important.
Type 2 diabetes can occur in children. Lifestyle factors, genetics, and ethnicity increase the disease's risk. Early detection, intervention, and treatment can help kids and families with type 2 diabetes live healthy lives and prevent complications.
If you think your child is at risk, schedule a visit with your pediatrician. In the meantime, you can take steps to prevent the disease. Eating a nutritious diet, moving more, reducing screen time, and getting adequate sleep are simple steps to feel better.
If you are concerned that your child has type 2 diabetes or is at increased risk, make an appointment with your primary care provider or pediatrician. Early detection, intervention, and treatment can prevent complications of diabetes. Reaching out for help is the first step in getting your child on a healthy path.
The annual incidence of diagnosed diabetes in youth was estimated at 18,200 with type 1 diabetes and 5,800 with type 2 diabetes.
If you have a family member with type 2 diabetes, you are at increased risk, but genetics alone does not cause diabetes. The lifetime risk of developing type 2 diabetes is 40% for individuals who have one parent with type 2 diabetes, and 70% if both parents are affected. People who have a first-degree relative with type 2 diabetes are estimated to be three times more likely to develop the disease.
Children younger than 18 with COVID-19 were at higher risk of developing diabetes more than 30 days after their COVID-19 infection. However, the findings did not include laboratory data at the time of diagnosis and could not reliably distinguish between type 1 and type 2 diabetes.
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Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.
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