Diabetes is a chronic disease that occurs when, at the cellular level, our body has difficulty up taking glucose. Glucose is the cell’s main fuel source and is important for cellular function. Insulin, a hormone produced by beta cells in our pancreas, must be present for glucose to enter the cell. Diabetes occurs when there is a dysfunction in the production of insulin or the way our cells interpret the insulin available.
There are three types of diabetes: Type 1, Type 2, and Gestational Diabetes. Type 1 diabetes is an autoimmune disease involving the body’s beta cells, where the body no longer produces insulin. Type 2 diabetes occurs when the body either is not making enough insulin to keep up with the demand or the body’s cells aren’t as responsive to the insulin being produced (insulin resistance). Gestational Diabetes is a temporary condition seen only during pregnancy; it resolves after birth. This article will speak to Type 2 Diabetes, the most prevalent of the three.
Type 2 diabetes accounts for 90-95% of all cases of diabetes. Particularly concerning is the increasing number of Type 2 diabetes diagnoses among children and adolescents. A Canadian National Surveillance Study in 2010 noted the incidence of Type 2 diabetes in children and adolescents < 18 years of age was 1.54 per 100,000. In the United States, a large longitudinal from 2002-2017 showed an annual increase of 4.8% in the number of cases of Type 2 diabetes diagnosed in children or adolescents.
These statistics are particularly concerning given individuals with diabetes have an increased risk for cardiovascular disease (heart disease, stroke, elevated blood pressure), kidney damage (nephropathy), eye damage (retinopathy), nerve damage (neuropathy), infections, limb amputations, and mental health conditions.
Of further concern is the fact that Type 2 diabetes is highly hereditary. In youth diagnosed with Type 2 diabetes, 90% have a 1st or 2nd degree relative with the condition (6,7). Ethnicity also plays a significant role, as 75% of Canadians with Type 2 diabetes belong to an ethnic group considered high-risk. The following ethnic groups are considered high risk: Indigenous, African-American, Hispanic, and South Asian. In Canada, Type 2 diabetes disproportionately affects the indigenous population. Recent statistics show that indigenous persons account for 44% of new diagnoses each year.
While genetics can play a significant role in the risk of developing Type 2 diabetes, the following environmental factors are things that can be controlled to help prevent the onset of this disease:
Breastfeeding: Exclusive breastfeeding until the age of 6 months has been shown to reduce the risk of diabetes.
Decreasing sedentary activity: In 2015, among Canadians 5-17 years of age, 19% were considered overweight, and a further 12% were known to be obese. Health Canada has endorsed the Canadian 24-hour movement guide for children and youth to tackle this statistic. In a healthy 24-hour period, the following principle of the 4 S’ should be followed:
- SWEAT: 60 minutes of moderate to vigorous physical activity, with muscle and bone strengthening incorporated at least 3 days/week;
- STEP: Several hours of structured/unstructured light physical activities;
- SLEEP: Uninterrupted 9-11 hours of sleep (age 5-13) and 8-10 hours (ages 14-17) with consistent schedules; and
- SEDENTARY BEHAVIOR: No more than 2 hours of recreational screen time or other sedentary activities.
Optimizing Sleep: Improving sleep quality and quantity contributes to an overall healthy lifestyle and improved metabolic rates help prevent, or delay, a Type 2 diabetes diagnosis.
Balanced Diet: Eating a healthy balanced diet and decreasing the consumption of sugars/artificial sweeteners, as a diet high in sugars/artificial sweeteners has been linked to an increased rate of diabetes and obesity.
Limiting Screen Time: Limiting the amount of screen time and time spent on other sedentary activities, as a lack of activity has been linked with increased rates of obesity, a higher presence of visceral fat, and increased rates of diabetes.
In summary, the incidence of Type 2 diabetes in children and adolescents is increasing at an alarming rate. Given the known health risks associated with diabetes, there is a valid concern about the health impacts from youth-onset diabetes. While genetics may establish a predisposition towards developing Type 2 diabetes, optimizing one’s health and wellness by eating a balanced diet, getting the required amount of sleep, and incorporating exercise on a regular basis can help prevent the disease.
Shelby Sheppard,
Nurse Practitioner