8 de março de 2019 Author : Pires Soares While type 2 diabetes used to be associated with adults, as it manifested itself only after years of obesity and a sedentary lifestyle, things are very different today. In recent years, an increase in obesity in children and adolescents has led to a rise in the appearance of the disease in younger age groups. It is symptomatic that around 30% of new cases of type 2 diabetes mellitus diagnosed in the United States occur in obese children and young people. In Portugal, child obesity has been rising alarmingly and rates are higher than the European average. It is therefore easy to conclude that type 2 diabetes mellitus is on the rise among our young people. This is cause for concern. When and how does type 2 diabetes occur in children and adolescents? Type 2 diabetes mellitus occurs when an increase in insulin resistance means it is not secreted in sufficient quantities. As a result, the disease is often associated with other characteristics of insulin resistance syndrome , such as: High blood fat levels; High blood pressure; Kidney disease; Polycystic ovary syndrome; Non-alcoholic fatty liver. Type 2 diabetes mellitus occurs in children and adolescents in the following circumstances: In youth, often aged from 10-19, coinciding with the physiological peak of insulin resistance during puberty; In all ethnic groups, but with much higher prevalence in black Africans, native Americans, Hispano-Americans, East Asians and Indians; In young Europeans and Americans with a body mass index (BMI) higher than the 85 percentile for their age and sex; In rarer cases, such as MODY-type diabetes (maturity-onset diabetes of the young), – a sub-type of diabetes mellitus, characterised by early onset. Type 2 diabetes in children and adolescents: from education to treatment Basic treatment consists of educating young people and their families , with particular emphasis on changes in behaviour. A change in lifestyle is essential in creating patterns of healthy eating and physical exercise. BMI , along with height and weight, should be measured and recorded in percentile curves in all children from their first year of life. This makes it possible to identify and correct any tendency towards excess weight in its early stages. Children with parents who are obese or diabetic or suffer from cardiovascular diseases should be monitored particularly closely . The treatment goals of type 2 diabetes mellitus are basically as follows: Weight loss; Increase in physical exercise; Normalisation of blood sugar; Control of high blood pressure, blood fat levels, kidney disease and non-alcoholic hepatic steatosis. It is necessary to fight social factors that lead to consumption of high-calorie foods with a low nutritional value . There are also causes that lead to a breakdown in eating habits , such as: No family meals; Greater use of ready-made meals that are rich in fats and sugars. Physical activity must be encouraged at school and at home, including more free time for play and sports, fewer car rides and video games and less television. The change in lifestyle should be complemented with medication . In most countries, only metformin and insulin are approved for use in children and adolescents with type 2 diabetes mellitus. All other available drugs have only been approved for use over the age of 18. Weight-loss surgery should be considered in selected cases. In conclusion, prevention of type 2 diabetes mellitus requires the prevention of obesity. The fight against the child obesity epidemic should involve governments and society as a whole, on pain of having to witness a reduction in life expectancy of affected populations over the next few decades. Meet the endocrinology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
