Increasing Type 2 diabetes among children a worrying trend, say doctors

Many doctors across the city said that an increasing number of children, as young as five-year-olds and teenagers, are getting diagnosed with type 2 diabetes

Mumbai Last week, the parents of an eight-year-old Mahim resident took their child to PD Hinduja Hospital to treat dark patches around the nape of his neck, knuckles and underarms. Initially, when they visited a paediatrician, he ruled out all possibilities such as allergy, hypothyroidism that can lead to pigmentation and referred the child to an endocrinologist.

While doctors such as Chauhan would get cases of type 2 diabetes and pre-diabetes in the younger population once a year, they now see at least one case every week (HT File)

On examination, Dr Phulrenu Chauhan, consultant endocrinologist at PD Hinduja Hospital, asked for a blood sugar level test, which revealed that the class 4 student had type 2 diabetes, also known as adult-onset diabetes. This is marked by an impairment in the way the body regulates and uses sugar (glucose) as a fuel. According to Chauhan, the boy had a fasting blood sugar level of 120mg/dl and post lunch blood sugar level as 180mg/dl. In non-diabetics, the normal range for fasting is 80mg/dl and post-lunch blood sugar level is 100-110mg/dl.

The boy will now have to take medications twice a day and aggressively make lifestyle changes to reduce weight.

This is not an isolated case. Many paediatric endocrinologists across the city said that an increasing number of children, as young as five-year-olds and teenagers, are getting diagnosed with type 2 diabetes due to a sedentary lifestyle over the past couple of years.

While doctors such as Chauhan would get cases of type 2 diabetes and pre-diabetes in the younger population once a year, they now see at least one case every week. Many children referred to her with pigmentation, associated with accelerated weight gain in the last one year, have tested positive for type 2 diabetes.

“While we have seen high borderline fasting blood sugar levels in these children, the post-meal levels were higher for their age. We have also seen many children falling under the pre-diabetic category,” said Chauhan.

While there are no guidelines for pre-diabetic children, doctors refer to adult pre-diabetes guidelines where HBA1C levels (three-month average blood glucose) below 5.7% is normal, 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes.

“At present, almost 30% of children detected with diabetes under my care suffer from the type 2 version. Earlier 98-99% of the children treated were those with type 1 diabetes (genetic disorder that prevents the pancreas from producing insulin). The proportion of children with type 2 diabetes is rapidly increasing and is a worrying trend,” said Dr Shweta Budyal, paediatric endocrinologist, Fortis Hospital, Mulund.

She added that a decade ago, type 2 diabetes was largely seen among adults in the age group of 40-50, but gradually, the age limit has come down due to poor lifestyle choices.

“Due to schools being closed and the absence of outdoor activities are taking a toll on these children,” Budyal said.

According to her observation, a sedentary lifestyle coupled with junk food has led to an average weight gain of 7-8 kg in a child. “Lot of children are severely obese too. I am treating 15–16-year-olds weighing 80-120kgs for type 2 diabetes,” she said.

While parents usually do not associate their child with blood sugar imbalance, paediatric endocrinologists said they have been visiting paediatricians for different health reasons.

Dr Ruchi Parikh, paediatric and adolescent endocrinologist, SRCC Children’s Hospital, Haji Ali, said, “Paediatricians notice major changes in weight. Weight gain has been associated with the need to check blood sugar levels and be referred to an endocrinologist. A weight gain of 25kg in a child in the last two years is the maximum I have seen. The average has been 10-15kgs in two years.”

Parikh said that apart from weight gain, in girls, early onset of puberty, irregular menstrual cycles, increased acne or hair fall can be associated with the possibility of blood sugar imbalance. Among boys, it can be behavioural issues like being socially withdrawn or underconfident. Doctors said that the child can also have symptoms like lack of energy, muscle cramps, itching in the body.

Parikh, who is treating a five-year-old child for type 2 diabetes in the last one year, said that with no physical activity and schools being shut down, weight gain has become an issue. “In the last two years, they have been at home and have not been disciplined at all about eating habits and sleep hours,” she said.

Polycystic Ovary Syndrome and prediabetes among adolescent girls

Paediatric endocrinologists have also observed adolescent girls getting diagnosed with a combination of Polycystic Ovary Syndrome (PCOS)- most common endocrine condition seen in adult women- and pre-diabetes.

Chauhan said, “PCOS in teens along with pre-diabetic status is another worrying trend. We are seeing a lot of girls around puberty developing PCOS. They have hormonal imbalance and are pre-diabetic because of weight gain. The cause of PCOS and type 2 diabetes in these girls are linked with insulin resistance.”

Dr Vimal Pahuja, metabolic physician at Dr LH Hiranandani Hospital, Powai said that many teenage girls with PCOS and falling under pre-diabetic category have visited his clinic.

“We recently had a 15-year-old-girl from Vikhroli who had gained 10-15 kilos in the last few months. She had irregular menstrual cycles. Her HBA1C test value was around 6.8%, which indicated her pre-diabetic status,” he said.

Pahuja said that the girl was home during the pandemic, and was on a high calorie diet with sleep disturbance. “This has been a pattern in all the cases of PCOS and type 2 diabetes we are seeing in teens. Various studies have shown a rise of 15 to 20% in diabetes as compared to the pre-pandemic era. Multitude of reasons during lockdown like closed schools, increase in screen time, poor eating and sleeping patterns, behavioural and mood changes, reduced physical activity and delayed presentation for care has contributed in terms of diabetic compilations like ketoacidosis” said Pahuja.

‘Type 2 diabetes can be reversed’

Doctors say that while type 2 diabetes in children has been a worrying trend, the condition can be reversed with intensive changes in lifestyle and weight loss

“Parents should increase physical activity as per the liking of the child. It can be jogging, cycling, swimming, playing football etc. The idea is that physical activity should be sustainable,” said Chauhan.

She also said parents should ensure that children don’t eat junk food. “Children should eat home-cooked food, and portions should be controlled. Parents should also reduce the time their kids spend on screen. Making sure that the child gets seven to eight hours of sleep is also an essential component to reverse diabetes,” added Chauhan.