'Adult' diabetes hitting children

Driven by the obesity epidemic, type 2 diabetes -- once called ''adult-onset" -- is becoming increasingly common among children and teenagers, to the point where it now accounts for almost half of new diabetes cases in US teens, according to federal figures.

And a study released yesterday provides the first hard evidence that the disease is particularly dangerous when it strikes so early in life: Federal researchers presented data indicating that people who developed type 2 diabetes as children were far more likely to suffer severe kidney complications later in life than those diagnosed with diabetes as adults.

Obesity is a major risk factor for type 2 diabetes, and with over 15 percent of US children and adolescents now obese or overweight, the study underscores the toll the nation's losing battle with weight gain could exact on children, specialists said. Exposed at a young age to the damaging blood-sugar spikes characteristic of type 2 diabetes, children could suffer and die in vast numbers in coming years, they said.

''We have kids that are 10, 11 years old with type 2 diabetes," said Dr. Diego Botero, co-director of the type 2 diabetes program at Children's Hospital in Boston. ''They are going to be exposed to high blood sugar for a longer period of time than adult patients, and that's going to put them at risk for developing complications earlier in life."

Taneisha Menefee was 11 when her type 2 diabetes was diagnosed. Feeling ill one day almost four years ago, the heavyset Dorchester girl guzzled orange juice, but instead of rejuvenating her, the sugar-laden beverage nearly ended her life.

Taneisha slumped into a haze, her eyes rolling back into her head. Only after a frantic race to the hospital, did the cause become clear: The orange juice had sent her blood sugar soaring, nearly putting her in a coma.

''I can't remember anything that happened to me," said Taneisha, who is now 14 and being treated at the Joslin Diabetes Center in Boston.

Sitting in a Joslin exam room last week, she said she hated the disease. ''I keep thinking every day: Why am I the one who has diabetes? You never know what could happen to me."

The new data, presented at an American Diabetes Association conference in San Diego, is showing the specific risks Taneisha and other child diabetics will face.

Researchers with the National Institute of Diabetes and Digestive and Kidney Diseases examined medical records of Pima Native Americans who developed type 2 diabetes. The Arizona tribe has unusually high diabetes rates and has long served as sort of a laboratory for scientists.

The researchers found that those developing diabetes as children were five times as likely to get end-stage kidney disease as people with adult-onset cases. End-stage kidney disease often forces patients into dialysis, where they must get their blood mechanically cleaned almost daily, and can cause death within months or years.

In addition, those developing diabetes as children died earlier of natural causes than those stricken in adulthood, with the top causes of death being kidney failure and cardiovascular disease. Though not all the deaths could be definitively linked to diabetes, the researchers said they suspected the disease was largely the cause. In a news release, the diabetes association called the study a ''canary in the coal mine," warning about the coming costs of the obesity epidemic.

Many physicians suspect that diabetic children may be at higher risk for numerous health complications, such as stroke, heart problems, blindness, high blood pressure, and nerve damage requiring limb amputations. In type 2 diabetes, the body fails to produce enough insulin, the hormone that allows cells to ingest and burn sugar, or cells become unable to ingest insulin. As a result, sugar accumulates in the blood, harming tissues and thickening blood vessels.

Type 2 diabetes is distinguished from type 1, an inherited disorder in which pancreas cells fail to produce insulin. Type 2, once most common in those over 40, was long called adult onset diabetes, while type 1 is still known as juvenile diabetes because it emerges in youth.

Type 2 diabetes is increasingly showing up in children all over the world -- Southeast Asia, western Europe, the Middle East, South America, and the United States -- according to a recent study in the Journal of Pediatrics. Type 2 now accounts for up to 45 percent of new diabetes cases in US teenagers, up from 5 percent just over a decade ago, according to federal figures.

In Boston, about 15 percent of all diabetic children have type 2 diabetes, five times the percentage a decade ago though lower than national estimates, Botero said.

Just about all children with type 2 diabetes are also obese or overweight, said diabetes specialists. It's not clear how obesity causes type 2 diabetes, though aside from genetic factors, weight gain is the top risk factor.

''Five to 10 years ago, pediatricians began noticing a few kids with type 2 diabetes," said Dr. Kenneth E. Quickel, president of Joslin from 1987 to 2000. ''Initially people thought that these were unusual cases. But when it increased very significantly, it became clear that something real was going on."

Quickel said the understanding of type 2 diabetes in children remains limited: ''We haven't followed a generation of young patients, so we don't really know exactly what to expect. We'll be better at taking care of it 5 or 10 years from now."

The nation's major attempt to learn how to treat the disease in children is a federal government-run experiment, called the TODAY trial, launched in March 2004 at 12 medical centers , including Joslin. The trial compares various medications and diet and exercise plans, and results are expected in 2009.

''These children become lifetime consumers of healthcare," said Dr. Lori Laffel, chief of Joslin's pediatric and adolescent section, who is helping run the TODAY trial. ''I think that the risks are huge to the individual and society."

Though there are no reliable statistics, diabetes specialists said type 2 diabetes appears to be falling especially hard on minority youths, particularly Hispanics and African-Americans. Botero, of Children's Hospital, recently started a type 2 diabetes program at the Martha Elliot Health Center in Jamaica Plain.

''Eighty percent of the patients are Hispanic," he said, explaining that the program helps train pediatricians to manage diabetes. ''This is exactly where the program should be -- in the middle of the Hispanic community."

In retrospect, it is not surprising that Taneisha Menefee, an African-American, developed type 2 diabetes. The disease runs on her father's side of the family. Last October, her mother, Donna, 38, noticed her son Antonio running to the restroom twice during an hour-long church service. The 11-year-old boy, who like his older sister has struggled with weight gain, always seemed to be guzzling water, a classic diabetes symptom. Sure enough: Antonio, too, had type 2 diabetes, a doctor confirmed.

''We take the hand that God gave us and move on, I guess," said their mother.

Antonio is participating in the TODAY trial at Joslin and carefully watches his diet, to keep his blood sugar levels low. He said that he cannot eat his beloved Skittles candies. But he has become a deft patient, pricking his finger twice daily to monitor his blood sugar, taking his medications like clockwork, and playing basketball as exercise.

''Stay active, listen to my doctors, and then I'll probably be OK," he said.