Diabetes Awareness Month: How To Prevent Type 2 Diabetes In Children

It gets overwhelming for parents when their child develops type 2 diabetes. It is important to understand that to avoid future complications, initial aggressive management is the key

Diabetes Awareness Month | Getty Images

The grave reality: It is sad that what used to be a disease of adulthood is now more commonly also seen in children. 

Type 2 Diabetes: We are looking at just the tip of the iceberg. 

India has been battling with undernutrition for ages now but on the other end, the affordable class in this millennial era has been seeing a new problem of overnutrition. Since the boom of the food industry, there has been increased access to take-aways, eating outside, processed foods that have taken over the good old tradition of eating simple home-cooked foods. And in conjunction with overnutrition, more convenient modes of transport, and the lesser need to walk, children are tending to gain more weight. Type 2 Diabetes has been on the steep rise in children in the last decade, which has significantly increased following the pandemic lockdown. About 10 to 15 children out of 100 are affected by prediabetes or type 2 diabetes. This is just the tip of the iceberg, and sadly soon we will be taking care of children and young adults, the majority of who will be suffering from type 2 diabetes putting them at risk of early-onset heart disease and early strokes. India is now being considered the world capital of Diabetes. 

Knowing that your child is at risk of type 2 Diabetes

Type 2 diabetes is considered a disease of polygenic inheritance which means that multiple genes are involved in the development of this type of diabetes. Having a family history of diabetes puts you at significantly increased risk of diabetes. But it doesn’t stop at genetics, environmental factors play a big role in the presentation of diabetes. High body mass index and higher waist circumference to hip ratio are some factors that lead to a metabolically unhealthy state. Indians are considered at an ethnic disadvantage and have a higher risk of Diabetes and other metabolic abnormalities even at a lower weight. For this reason, in adults, a body mass index that is more than 23 kg/m2 is considered overweight, and more than 27 kg/m2 is considered obese as compared to WHO standards of 25 kg/m2 being overweight and 30 being obese. Similarly in children, these parameters differ, and Indian children have a separate growth chart for their body mass index classifying them into normal, overweight or obese category. Body mass index on these charts should be plotted to start at 5 years of age and plotted till 18 years of age. This helps in identifying children and adolescents with higher BMI that are at future risk of type 2 diabetes. 

How and the whys of prediabetes and type 2 diabetes

Insulin is a key hormone in the regulation of blood glucose levels. It helps with glucose homeostasis. If insulin hormone is not produced or is unable to work properly, then blood glucose levels increase. Excessive weight gain may lead to this insulin hormone not functioning at its best and lead to insulin resistance which slowly over time progresses to problems with insulin hormone release thus leading to prediabetes which progresses to type 2 diabetes. 

What can be done to prevent type 2 diabetes in children?

Diet and exercise are the key players in the prevention of type 2 diabetes. 

Adopting a healthy meal plate helps with eating a well-balanced diet.  

Some easy dos and don’ts in diet: 

- Sweetened drinks like juice, sweet lassi are pure empty calories that are best avoided.

- Portion control is the key which means when eating outside or take away should be eaten in moderation and less frequently. 

- Green leafy vegetables and salad intake should be significantly increased. 

- Understanding the difference between actual hunger and boredom. Children, as well as adults, tend to eat more when bored. It’s best to have some water and use distraction towards other enjoyable activities instead of trying to grab a bite when feeling bored. 

Physical activity: 45 minutes to 1 hour of moderate to vigorous activity daily helps to maintain a good energy balance. 

Management of Type 2 Diabetes: What next?

It gets overwhelming for parents when their child develops type 2 diabetes. It is important to understand that to avoid future complications, initial aggressive management is the key but also equally important is the sustained results in weight control and consistency in blood glucose control. With significantly elevated blood glucose, initial insulin therapy may be needed along with weight management with the help of diet and exercise. Once insulin is started, it can be slowly tapered down to minimal doses, and very frequently it is possible to completely discontinue insulin therapy by aggressive measures. It has to be remembered that lifestyle changes incorporating diet and exercise have to be maintained with an underlying risk of insulin dysregulation. More and more studies are showing the risk of an unhealthy state remains even with a higher body mass index without even overt diabetes, thus making a healthy lifestyle should remain a priority starting from a younger age group. 

Shaping the future generation in a way to make better food choices and implement a healthy lifestyle will protect them from these chronic lifestyle-related disorders. Let’s start early!

(The author is a Consultant Pediatric & Adolescent Endocrinologist at Artemis Hospital, Gurgaon.

She is an American Board Certified in Pediatric Endocrinology, and a member of ISPAE, PES, USA, Endocrine Society, USA. )