Pediatric Type 2 Diabetes: Signs, Treatments, and Prevention
By Andrew Briskin
The number of youths being diagnosed with type 2 diabetes each year is on the rise. Learn about the early signs of type 2 diabetes in children and adolescents, the latest approved treatments, methods of prevention, and much more.
The rising incidence of type 2 diabetes in children and adolescents continues to be an alarming public health issue in the United States. According to recent studies published in JAMA and the TODAY2 study in New England Journal of Medicine, rates of type 2 diabetes in youths have increased dramatically since 2001 and continue to increase steadily each year. Not only has the prevalence increased, but evidence also shows that people diagnosed with type 2 diabetes in childhood frequently develop diabetes-related complications at a younger age and significantly faster pace than those diagnosed in adulthood.
In light of this discouraging evidence, diaTribe spoke with Dr. Lily Chao, a pediatric endocrinologist who specializes in type 2 diabetes at Children’s Hospital Los Angeles and is an associate professor of clinical pediatrics at the University of Southern California. Dr. Chao shed light on the unique issues faced by children and teens with type 2 diabetes and their families. Additionally, she shared her insights on the signs and risks of developing pediatric type 2 diabetes, new medications, health disparities, and the effect of diabetes stigma on this population.
“Traditionally, type 1 diabetes has been much more common in children and adolescents than type 2,” Dr. Chao said. “But with the obesity epidemic on the rise, we’ve seen more and more children with type 2 diabetes, and for the first time this year, we have seen more children with type 2 than type 1 [at our hospital in Los Angeles].”
Healthcare professionals often recommend dietary and lifestyle changes for everyone in the family when they see a child with type 2 diabetes.
Risk for type 2 diabetes in children
There are several factors that are associated with an increase in a child’s likelihood of developing type 2 diabetes. Some of these risk factors include:
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A genetic history of diabetes. When a parent, grandparent, sibling, or other close family member has type 2 diabetes, it increases the risk for children.
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Food insecurity and a diet that consists of eating lots of starchy, high fat foods and sugar-sweetened beverages. This sort of diet has also become even more common in the pandemic, when the demand for processed, inexpensive food has been even higher globally.
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Excess weight or obesity (a BMI that places the child in the 85th percentile or higher for their weight).
If any of these risk factors apply to a member of your family or children in your community, consider keeping an eye out for early signs and symptoms of type 2 diabetes in childhood and seek to work with healthcare teams to avoid them.
Signs and symptoms of type 2 diabetes in children
Common signs of pediatric type 2 diabetes include:
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Frequent urination
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Excess thirst and fatigue
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Increased appetite
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Darkened skin, typically appearing as a patch of thickened, rippled, dirty skin under the arms or on the side of the neck. This is a condition called acanthosis nigricans, which is an early sign of insulin resistance. This physical change often improves with weight loss
In particular, Dr. Chao advocated for the importance of high-quality nutrition and emphasized the need for efforts across the entire family, especially given the link between genetics and type 2 diabetes.
“We need to make it clear that childhood diabetes does not only affect the individual. There needs to be a family approach to lifestyle modification and following a well-balanced diet,” said Dr. Chao. “If an older sibling is diagnosed with type 2 diabetes, the younger children are also at an increased risk for diagnosis. These nutritional recommendations can be beneficial for the whole family, and this is a healthy message for us to impart on all people who can benefit from healthy lifestyle changes.”
Treatments for type 2 diabetes in children
Along with promoting nutrition and healthy lifestyle changes to address pediatric type 2 diabetes, Dr. Chao said she was optimistic about the recent approval of medications for people with type 2 diabetes under the age of 18. Treatment options for those under the age of 18 are significantly more limited than those available for adults; metformin and a GLP-1 receptor agonist, Victoza, were the only non-insulin medications approved prior to July 2021. Another GLP-1 receptor agonist, Saxenda, is also approved for weight loss for those under 18 but is not indicated for treatment of type 2 diabetes.
This past July, however, the FDA approved exenatide extended release – a GLP-1 receptor agonist drug that has been shown to improve glucose control, lower risk of heart disease, and help with weight management in adults – for use in children and teens ages 10-18 with type 2 diabetes. Additionally, two other classes of drugs with demonstrated efficacy in the adult population, one SGLT-2 inhibitor and one DPP-4 inhibitor, are currently in clinical trials for approval in youths with type 2 diabetes.
“The impact of these additional drugs will be providing more oral medication options to patients [all GLP-1 drugs approved currently require injections]. In addition, they may potentially reduce the risks of complications like heart and kidney disease in the pediatric population,” Dr. Chao said. In adults, medications in the GLP-1 receptor agonist and SGLT-2 inhibitor classes have been shown to be cardioprotective and delay the progression of kidney disease. “While heart disease is not as common in children, we are seeing many cases of kidney disease. I am hopeful that future studies will examine whether earlier use of these medications in youth-onset type 2 diabetes can prevent complications.”
While type 2 diabetes makes up roughly 95% of adults with diabetes, the majority of children with diabetes have type 1, and pediatric type 2 diabetes has traditionally been quite rare. However, the gap between the number of children with type 1 versus type 2 is narrowing in the wake of the obesity epidemic.
According to Dr. Chao, while diagnoses of pediatric type 2 diabetes increased across the board, the greatest increases over time were observed in Hispanic, Black, and less affluent communities for which there has traditionally been far less health advocacy. This is supported by a recent study published in JAMA. Issues including access to nutritious foods, a lack of health insurance or being underinsured, and housing insecurity are all fundamentally tied to socioeconomic status. In communities of less affluence, these factors can severely limit the ability of families to adequately address pediatric type 2 diabetes through a healthy diet and appropriate medical treatment.
One of the most significant (and perhaps least talked-about) obstacles to addressing pediatric type 2 diabetes is the stigma surrounding the condition, Dr. Chao expressed. Specifically, she said that the shame and blame felt by children with type 2 diabetes and their parents tends to limit the discussion around pediatric type 2 diabetes, as some children and parents tend to avoid the conversation altogether. Contributing to the cause of these feelings can be the perception that type 2 diabetes is something “you did to yourself” rather than a complex disease caused by many different genetic and environmental factors, she said.
The link between genetics and diabetes has traditionally focused solely on type 1 diabetes, which Dr. Chao says is a misconception.
“The most common risk factor [for type 2 diabetes] is if other family members have type 2 diabetes. This risk factor is actually stronger for type 2 than it is for type 1, yet we typically only have this perception for type 1 diabetes,” said Dr. Chao. “Certainly, our environment and lifestyle play a role, but spreading this message and supporting healthy lifestyles for children with type 2 diabetes will go a long way in combating the stigma that exists today.”
Dr. Chao also stressed the importance of prevention and screening for type 2 diabetes in children who are most at risk for developing the disease. Some prevention strategies mentioned by Dr. Chao included following as healthy a diet as possible, getting daily exercise whenever possible, and focusing on weight management for children with excess weight or obesity. Additionally, keeping an eye out for the warning signs of childhood type 2 diabetes is crucial to addressing the progression of the disease early on.
Childhood screening for type 2 diabetes
According to the American Diabetes Association, screening for type 2 diabetes should begin at age 10 for children who are overweight and have two additional risk factors such as:
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A family history of type 2 diabetes.
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Signs of insulin resistance such as darkening and thickening of the skin at the back of the neck, or in skinfold areas, such as the armpits. This is a condition called acanthosis nigricans.
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A maternal history of gestational diabetes.
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Being a certain race or ethnicity: Asian, Black, Hispanic, and Native American communities experience disproportionately higher rates of pediatric type 2 diabetes.
“Noticing signs on children’s bodies and identifying children most at risk to get them screened for type 2 diabetes is crucial at an early stage,” said Dr. Chao. “By identifying the early progression of diabetes in a child, we have the power to significantly delay or possibly prevent a diabetes diagnosis altogether.”
If your child or a child close to you has been recently diagnosed with type 2 diabetes, you may have a lot of questions. Visit diaTribe’s resources on a variety of subjects to learn more:
