Sunday 12 July 2009

Young people and diabetes

Young and diabetic a report from www.asiaone.com.sg

A sedentary lifestyle, obesity and poor eating habits are why more youngsters are becoming diabetic. -ST



IT USED to hit those above 45, but there are now more young children and adolescents diagnosed with Type 2 diabetes, at a rate doctors describe as alarming and worrying.

Dr Daphne Gardner, a registrar at the endocrinology department at Singapore General Hospital (SGH), says: "Type 2 diabetes in childhood or adolescence was uncommon in the past but now accounts for at least a third of childhood diabetes. Today, a child above the age of 12 who gets diagnosed with diabetes, has almost as much chance of having Type 2 diabetes as Type 1 diabetes."

While both Type 1 and Type 2 diabetes have a genetic component, studies have found that a sedentary lifestyle with poor eating habits and excessive weight gain are very strong contributing factors in the latter.

In Type 1 diabetes, patients' bodies produce little or no insulin, a hormone that is important for glucose metabolism. They have to be put on daily insulin injections to control their blood glucose level.

In Type 2 diabetes, patients are unable to utilise insulin. While these patients do not need insulin injections, they have to watch their diet, exercise and keep their weight down. Excess weight, particularly in the abdomen, affects one's ability to utilise insulin.

What is worrying, says Dr Goh Su-Yen, director of the diabetes clinical services at SGH, is that the younger the onset of diabetes, the longer the period of time the patient is being exposed to its complications in young adulthood.

"This ultimately increases the risk of cardiovascular disease, renal failure, blindness and limb amputations, all occurring in a younger age group. The rising trend in obesity, and consequently Type 2 diabetes, does not appear to be reaching a plateau, another observation that is worrying," adds Dr Goh.

What's also of concern is that it's easy to miss Type 2 diabetes in patients because it can be asymptomatic or the patient may present with general symptoms such as fatigue or repeated episodes of infections.

Hence the importance of medical screening, particularly for those at risk. Associate Professor Lee Yung Seng, a senior consult-ant with the University Children's Medical Institute at the National University Hospital, advises: "Type 2 diabetes usually affect older children, especially those in puberty. Children who are overweight and have a family history also have a higher risk of being hit by this type of diabetes. The American Diabetes Association has recommended considering screening children with risk factors, even if they do not appear to have any symptoms." When left undetected, patients are at risk of cardiovascular disease, renal failure, blindness and limb amputations.

While Type 2 diabetes can be controlled by oral medications and insulin injections, doctors say the mainstay of treatment is to lose weight by watching one's diet and exercising.

However, compliance is often an issue in the young sufferers.

Prof Lee says: "Young sufferers may have more risk-taking behaviour and may omit insulin injections, medications or forgo their dietary control.
"Physically, there are surges of sex and growth hormones during puberty which can affect their diabetes control too."

As diabetes is a chronic disease, prevention is definitely better than cure. Dr Gardner says: "There are many things we can do to prevent Type 2 diabetes in the young: we should encourage more physical activity and healthy meals. For kids who are overweight, some suggestions include limiting time spent on sedentary activities like watching television to less than four hours a day, avoiding carbonated drinks or sweet juices and limiting fast foods."

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