During the pandemic, body mass index of kids has doubled
Alejandra Guermes knew exactly what to do when the eldest of her two daughters “was chugging water like no tomorrow.”
The nurse practitioner used a finger stick test and was shocked to discover the child’s blood glucose at 300, more than twice the normal range. At the emergency room in Nicklaus Children’s Hospital later that night, doctors confirmed her fears.
“I was devastated; I was heartbroken,” Guermes recalled, her voice breaking even now. “I still get emotional thinking about it. I knew exactly what it entailed for her.”
That was in June 2020. Since learning she has Type 1 diabetes, Gabriella Mesa and her parents have learned to navigate the disease. The 8-year-old is on a continuous glucose monitor and she uses her new cellphone to call her mother whenever she’s not sure how a particular treat might affect her blood sugar.
She’s also a participant in research conducted by TrialNet, an international network of leading academic institutions,
More than two decades ago, the University of Miami’s Diabetes Prevention Program began recruiting people to take part in what would become a landmark nationwide study for the prevention of Type 2 diabetes in people at high risk for developing the disease.
Miami was one of 25 sites across the United States that enrolled 3,819 participants in the clinical trial to see if medication or changes in lifestyle such as weight loss and more exercise could delay the onset of Type 2 diabetes or its complications in prediabetic people with impaired glucose tolerance.
Beginning in 1996, the program recruited 144 local participants to join the national study. After careful screening, it randomized them into four groups: those who got a placebo, those in an intensive lifestyle group, and those who took Metformin, a drug commonly used for those who have already developed diabetes, or the new drug Troglitazone.
With help from a lifestyle coach and group exercise classes, those in the intensive lifestyle group were asked to aim for and maintain a 7 percent weight loss (14 pounds for someone who weighs 200) and to increase their weekly exercise activity by 150 minutes. For many, walking was the exercise of choice.
Troglitazone was dropped from the study in June 1998 and is no longer available after a patient at another center taking part in the DPP study developed serious liver damage and died despite a liver transplant.
But the two other options, taking Metformin as a preventative and making lifestyle
endocrinologists, physicians, scientists and healthcare teams studying Type 1 diabetes.
Little Gabriella is among the growing number of children being diagnosed with diabetes, both Type 1 and Type 2. A study that tracked millions of kids and teenagers in six areas of the U.S. found that young patients living with Type 1 diabetes had surged by 45 percent between 2001 and 2017. During that same 16-year period, there had been a 95 percent increase in the kids living with Type 2 diabetes. The study was published in the Journal of the American Medical Association.
South Florida endocrinologists have witnessed the alarming rise in their own offices. “Certainly, I see more children than I used to,” acknowledges
Dr. Adriana Carrillo Iregui, Gabriella’s doctor and a pediatric endocrinologist at Nicklaus. “And it’s for both types of diabetes.”
Dr. Adriana Carrillo Iregui
Dr. Robin Nemery, a pediatric endocrinologist with Joe DiMaggio Children’s Hospital, part of Memorial Healthcare System in Broward, adds: “This year we’ve already exceeded the number of new onset cases compared to all of last year. Diabetes has become one of the most common chronic diseases [of childhood].”
The JAMA study found that Type 1 grew most among white and Black youth, while Type 2 diabetes grew fastest among Black and Hispanic children. Physicians have also observed younger children in their practices. Nemery, for example, has been treating younger patients for Type 2 as well as diagnosing more babies with Type 1.
For Type 1, “we were usually seeing older kids and adolescents, but in general now they’re younger,” she said. Not long ago, she diagnosed an 8month-old baby.
At the University of Miami Health System, Dr. Janine Sanchez, a pediatric endocrinologist, noted more boys being diagnosed with Type
Dr. Janine Sanchez 2. Where it used to be
60% girls and 40% boys, those numbers are evening out. She blames unhealthy diets and less exercise, particularly during the pandemic.
“Not only are we seeing younger patients,” she adds, “but we’re also seeing more aggressive diabetes.”
In Type 1 diabetes, your pancreas doesn’t make insulin or makes very little of it. It’s usually diagnosed in children, teens and young adults.
Type 2 diabetes, which affects between 90 and 95 percent of the more than 34 million Americans with diabetes, most often develops as a result of a person being overweight or obese. Until recently, young children and teens rarely were diagnosed with Type 2.
But with a third of American kids overweight or obese, it’s become a significant issue.
Though chronic, both types of diabetes are treatable. But once diagnosed, a child requires regular physician visits to manage the disease, which results in an increased financial burden for the family. In addition, diabetes can result in lifelong complications, including high blood pressure, heart disease and stroke, nerve, kidney and eye damage, even osteoporosis.
DIFFERENCES BETWEEN TYPE 1, TYPE 2 DIABETES
Type 1 and Type 2 diabetes present in different ways.
Type 1 diabetes — Gabriella Mesa’s diagnosis — can develop quickly, sometimes in mere weeks. It was once known as juvenile diabetes, because it was usually diagnosed in childhood or adolescence.
Type 1 is an autoimmune disease. The body’s immune system attacks the beta cells that produce insulin. To keep blood glucose levels in the right range, patients inject synthetic insulin. There is no known cure.
Only 5 to 10 percent of Americans with diabetes have Type 1.
Physicians and researchers don’t yet understand why Type 1 has been steadily increasing, and why it’s showing up in younger patients. They do know that a genetic predisposition exists, with certain genes conferring a higher susceptibility. But genetics isn’t the sole culprit.
“If it were just genetic, twins would both develop it, but that’s been true only
Dr. Robin Nemery in 50% of the cases,” Nemery explains.
Something must trigger the expression of a gene. Among the potential possibilities? Viral infections, environmental factors, vitamin deficiency, even diet changes.
“Right now what we have is a lot of educated guesses,” Carrillo Iregui adds. “We’re still searching for what the activation is.”
In Type 2 diabetes, a patient is able to make insulin but the body doesn’t respond to it correctly. It was once labeled “adult-onset” diabetes, and a child being diagnosed with Type 2 was considered uncommon. That’s changed. Sanchez, of UHealth, recalls seeing five or so children with Type 2 when she began her practice 25 years ago. “Now we may see five in a week.”
Physicians know that, in addition to genetics, excess weight and a sedentary lifestyle contribute to its development. That’s why reports about the obesity epidemic among children are particularly worrisome.
A recent Centers for Disease Control and Prevention report revealed that children and teens gained weight at an accelerated rate during the pandemic. The study, the largest national tracking of weight gain rate among kids, found that the body mass index of kids ages 2 to 19 doubled between 2018 and 2020. About 22% were considered obese as of last August, a jump from 19% a year earlier.
EATING HEALTHY AND EXERCISING
In Type 2 cases, pediatric endocrinologists emphasize the importance of prevention — eating healthy and exercising. “It has to be a family affair,” explains Sanchez. “Everybody has to be in on it. We have to work directly with the parents.”
In many Type 2 cases, “a sizable number” of adult family members have also been diagnosed with the condition, she says.
For the Mesa family, Gabriella’s diagnosis has meant a renewed commitment to healthy eating and exercise, both lifestyle choices that the family had long practiced. The disease also has taught them a valuable lesson.
“We know there are worse situations,” says Alejandra Guermes. “We’ve learned not to put too much emphasis on the disease. I want her to have a childhood, to be a kid, just a kid.”