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Pediatric Diabetes

Pediatric Diabetes 

  • The “Developmental Origins of Health and Disease” (DOHaD) model proposes that the susceptibility to type 2 diabetes originates in the intrauterine life by environmental fetal programming, further exaggerated by rapid childhood growth, i.e. a biphasic nutritional insult. Both fetal under nutrition (sometimes manifested as low birth weight) and over nutrition (the baby of a diabetic mother) increase the risk of future diabetes. The common characteristic of these two types of babies is their high adiposity. 1
  • An imbalance in nutrition seems to play an important role, and micronutrients seem particularly important. Normal to high maternal folate status coupled with low vitamin B(12) status predicted higher adiposity and insulin resistance in Indian babies.1
  • Low birth weight followed by rapid BMI gain during childhood and adolescence was a risk factor for both metabolic syndrome and diabetes.2 
  • Adulthood prediabetes and diabetes can be predicted from childhood fasting glucose levels especially in those with family history of diabetes.3
  • The tendency among South Asian adults to develop insulin resistance is apparent in childhood, though with higher insulin levels after a glucose load.
  • Primary prevention of insulin resistance, non-insulin dependent diabetes, and cardiovascular disease in high risk populations such as South Asians may need to begin before adult life.
  • Given that South Asian people are particularly sensitive to the metabolic consequences of obesity (currently increasing in prevalence among British children), the prevention of obesity in childhood and adolescence among South Asian people, with a combination of dietary measures and increased physical activity,  should be a strong priority.4
  • CAD   risk factors in South Asian are seen at much younger age. There is a higher percentage of body fat and higher insulin resistance for a given BMI in South Asian children and adolescents compared to their European counterparts.4-7 There is evidence to suggest that the prevalence of diabetes higher in South Asian children compared to European children. 4-7
  • Evidence of increased arterial stiffness has also been demonstrated in South Asian young adults aged between 20 and 30 years.8 There are scientist who believe that the origin of central obesity, increased adiposity and insulin resistance is preconceptual as suggested by the’ thrifty phenotype’ hypothesis.9  Others have found that compared to European infants, Indian infants had low birth weight but relatively high subcutaneous fat and high cord plasma insulin and leptin levels, suggesting that the thin–fat phenotype is present at birth in south Asian people.10-12

FAQ

1.How common is Type 2 diabetes (NIDDM) among children?

  • A. In 1980s type 2 diabetes in teens was virtually unheard of  but now 15% of new cases of diabetes among children and adolescents are type 2. Now the prevalence of Type  2 diabetes is as high as 48% among children and young adults in South India.

Sources

1. Yajnik CS, Deshmukh US. Maternal nutrition, intrauterine programming and consequential risks in the offspring. Rev Endocr Metab Disord. Sep 2008;9(3):203-211.

2. Fall CH, Sachdev HS, Osmond C, et al. Adult metabolic syndrome and impaired glucose tolerance are associated with different patterns of BMI gain during infancy: Data from the New Delhi Birth Cohort. Diabetes Care. Dec 2008;31(12):2349-2356.

3. Nguyen Q M, Srinivasan SR, Xu JH, Chen W, Berenson GS. Fasting plasma glucose levels within the normoglycemic range in childhood as a predictor of prediabetes and type 2 diabetes in adulthood: the Bogalusa Heart Study. Arch Pediatr Adolesc Med. Feb 2010;164(2):124-128.

4. Whincup PH, Gilg JA, Papacosta O, et al. Early evidence of ethnic differences in cardiovascular risk: cross sectional comparison of British South Asian and white children. Bmj. 2002;324(7338):635.

5. Ehtisham S, Crabtree N, Clark P, Shaw N, Barrett T. Ethnic differences in insulin resistance and body composition in United Kingdom adolescents. J Clin Endocrinol Metab. Jul 2005;90(7):3963-3969.

6. Shaw NJ, Crabtree NJ, Kibirige MS, Fordham JN. Ethnic and gender differences in body fat in British schoolchildren as measured by DXA. Arch Dis Child. Oct 2007;92(10):872-875.

7. Whincup PH, Gilg JA, Owen CG, Odoki K, Alberti KG, Cook DG. British South Asians aged 13-16 years have higher fasting glucose and insulin levels than Europeans. Diabet Med. Sep 2005;22(9):1275-1277.

8. Din JN, Ashman OA, Aftab SM, Jubb AW, Newby DE, Flapan AD. Increased arterial stiffness in healthy young South Asian men. J Hum Hypertens. Feb 2006;20(2):163-165.

9. Yajnik C S. Early life origins of insulin resistance and type 2 diabetes in India and other Asian countries. J Nutr. Jan 2004;134(1):205-210.

10. Yajnik C. S, Lubree HG, Rege SS, et al. Adiposity and hyperinsulinemia in Indians are present at birth. J Clin Endocrinol Metab. Dec 2002;87(12):5575-5580.

11. Yajnik CS, Yudkin JS. The Y-Y paradox. Lancet. Jan 10 2004;363(9403):163.

12. Joglekar CV, Fall CH, Deshpande VU, et al. Newborn size, infant and childhood growth, and body composition and cardiovascular disease risk factors at the age of 6 years: the Pune Maternal Nutrition Study. Int J Obes (Lond). Oct 2007;31(10):1534-1544.

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