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Diabetes

Type 2 diabetes on the rise in children and young people in England and Wales

Inadequate public health education and too little sleep found to be risk factors in addition to obesity.

The number of children and young people with type 2 diabetes being managed in paediatric diabetes units (PDUs) has increased each year for the past three years, according to a national audit.

The ‘National paediatric diabetes audit 2015–16’, published by the Royal College of Paediatrics and Child Health, has found that there are now more than 600 children and young people in England and Wales reported to have type 2 diabetes, and the actual figure, including young patients being managed outside of PDUs, is likely to be even higher. 

Since 2013, the number of children and young people reported in the audit to have type 2 diabetes has increased by 114 individuals; from 507 in the 2013–2014 audit, to 543 in the 2014–2015 audit, to the most recent figure of 621. Unlike type 1 diabetes, type 2 is usually diagnosed in adults aged over 30 years, but a rise in obesity is thought to be contributing to the increase in childhood cases. 

Furthermore, twice as many female children and young people with type 2 diabetes were being managed in PDUs than males and there was a higher representation of black and Asian ethnic backgrounds and individuals from deprived areas.

The National Paediatric Diabetes Audit is funded by NHS England and the Welsh government and aims to compare the care and outcomes of all children and young people with diabetes receiving care from PDUs in England and Wales.

“Type 2 diabetes can lead to long-term health problems such as vision loss and blindness, kidney failure and stroke,” explained Justin Warner, clinical lead for the Royal College of Paediatrics and Child Health’s National Paediatric Diabetes Audit. “The good news is, it is largely preventable — but the single biggest risk factor for children developing type 2 diabetes is being overweight,” he added.

Warner described obesity as “a major public health threat” but said that positive steps were being made, such as the introduction of the soft drinks industry levy or ‘sugar tax’ which aims to reduce the amount of sugar in the nation’s diet. However, he said, the government needed to do still more.

“There is a major loophole in advertising laws which allows junk food to be marketed at children on television during ‘family’ programmes before the 9pm watershed.

“There must be tougher action to tackle obesity and it needs to be taken quickly,” he said.

But, according to Philip Newland-Jones, consultant pharmacist specialising in diabetes and endocrinology, type 2 diabetes is not the result of obesity alone.

“There is a combination of factors, with inadequate public health education delivery to school children and families, along with increased access to cheap, high-calorie food,” he said.

“Genetics play as much of a part in type 2 diabetes in children as it does in adults, with a higher risk of developing type 2 diabetes in Black and Asian minority ethnic backgrounds.”

Referring to the trends seen in young females, Newland-Jones said this could in part be attributed to the difference in physical activity levels compared with young males.

“It is well documented that teenage girls are less likely to engage in physical activity, sometimes due to the social stigma and concerns with physical appearance during and after exercise,” he explained, adding that the only way to stop the growth of type 2 diabetes is to embed health education more tightly into the curriculum along with increased provision of education to families where there may be a higher risk. 

A recent study published in Pediatrics (online, 15 August 2017) found an inverse association between sleep duration and type 2 diabetes risk markers in children, such as a higher body mass index[1]. The researchers concluded that sleep intervention studies could provide a simple and cost-effective strategy for early type 2 diabetes prevention.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20203406

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