- A recent study found that up to 1 in 4 children with type 2 diabetes don’t have obesity at the time of diagnosis.
- Current screening methods may be missing some children with a higher risk of type 2 diabetes.
- Screening guidelines do consider other risk factors for type 2 diabetes including family history of diabetes, race and ethnicity, and a child’s mother having diabetes during pregnancy.
Although rates of type 2 diabetes in children and teens are much lower than in adults, there has been a sharp increaseTrusted Source in cases among youth since the early 2000s.
This condition occurs when cells don’t respond normally to insulin. One of the risk factors for it is excess weight or obesity.
Which is why the American Diabetes Association recommends screening for type 2 diabetes in children 10 years or older who have excess weight or obesity, and who also have one or more other risk factors for the disease.
However, a recent study found that up to 1 in 4 children with type 2 diabetes don’t have obesity at the time of diagnosis.
This suggests that current screening methods may be missing some children and teens with a higher risk of type 2 diabetes.
Based on our results, “it is likely that [there is] a subgroup of children with normal body mass measures who may have diabetes, but are overlooked in the current body-mass centered screening,” study author Dr. M. Constantine Samaan, an associate professor in the Department of Pediatrics at McMaster University and McMaster Children’s Hospital in Hamilton, Ontario, told Healthline.
Factors other than body mass involved
Screening guidelines do consider other risk factors for type 2 diabetes, such as family history of diabetes, race and ethnicity, and a child’s mother having diabetes during pregnancy.
“However, it is likely that these factors are not always considered when children are not overweight,” said Samaan.
He said the results also suggest that there’s a need to develop a deeper understanding of the mechanisms — other than body mass — driving type 2 diabetes in children and teens.
This information could be used to develop new ways of screening children for type 2 diabetes and prediabetes, “using algorithms that capture the complexity of type 2 diabetes in children,” said Samaan.
“What these models look like is a work in progress,” he said.
In the new study, Samaan and his colleagues combined the results of 53 earlier studies from multiple countries looking at the rates of obesity in children and teens.
This meta-analysis, as it’s known, showed that around three-quarters of children and teens with type 2 diabetes had obesity.
The study was published Dec. 15 in the medical journal JAMA Network OpenTrusted Source.
Dr. Megan Kelsey, an associate professor in pediatric endocrinology at Children’s Hospital Colorado in Aurora, who was not involved in the new research, pointed out that the majority of youth with type 2 diabetes in the study still had obesity.
Many of the rest had a body mass index (BMI) in the overweight range, she said.
The rates of overweight and normal weight, though, varied widely among the studies reviewed by Samaan and his colleagues, so it’s not clear how many children of normal weight have type 2 diabetes.
Still, “this study confirms what we know about the association with weight struggles and [type 2] diabetes — that it largely affects youth with overweight or obesity,” Kelsey told Healthline.
The new study also found that about 8 in 10 males with type 2 diabetes had obesity, while 6 in 10 females did.
As to why some children with normal weight develop type 2 diabetes, Samaan said some of them may have an impaired production of or response to insulin.
“There is some evidence [related to this] from studies from Asia of subgroups of children with reduced insulin production,” he said, adding that more research in this area is needed.
Signs of type 2 diabetes to look for
One of the goals of screening for type 2 diabetes is to catch it early during the course of the disease, before complications occur.
Kelsey said most often, though, type 2 diabetes is detected before symptoms are present. However, the earliest symptoms that appear are often increased thirst and urination, she said.
Signs of more advanced type 2 diabetes — which requires urgent medical attention — include severe abdominal pain, vomiting, rapid breathing and unexplained weight loss, she added.
Samaan said type 2 diabetes is also associated with other medical conditions besides obesity, including abnormal levels of lipids in the blood, high blood pressure, obstructive sleep apnea, fatty liver disease and polycystic ovary syndrome in girls.
“For these patients, it is important to consider the diagnosis of type 2 diabetes and to screen for it,” he said. “Families can consult with their provider to assess the best approach.”
Rising cases in children
While type 2 diabetes is relatively uncommon among children and teens — and rare before puberty — between 2002 and 2015, the rate of type 2 diabetes among this age group increased about 5% each yearTrusted Source, according to the Centers for Disease Control and Prevention.
In addition, one group of researchers documented a steep rise in type 2 diabetes among children and teens during the COVID-19 pandemic. The reasons for this increase is not clear.
Kelsey said while this condition tends to be more difficult to treat in children and teens than in adults, most youth with risk factors for type 2 diabetes will not develop it during childhood.
Still, “we don’t know how to differentiate who will and will not develop [type 2] diabetes at a young age, even in those at risk,” she said.
However, maintaining a healthy lifestyle and healthy BMI can help lower the risk of type diabetes, she said.
In addition, she said a large multicenter research study currently being planned in the United States should provide a better understanding of who is at higher risk of developing type 2 diabetes and why.
“This should help us better design preventive strategies in the future,” she said.
