Previously considered an adult disease, type 2 diabetes begins as an insulin resistant condition with components in addition to high blood glucose that must be addressed. Those components include abnormalities of blood lipids, high blood pressure and blood clotting disorders that are risk factors for cardiovascular disease.

In contrast, children with type 1 diabetes have an autoimmune disorder that destroys the insulin-producing islets in the pancreas. Their treatment involves replacing insulin, which is necessary to prevent microvascular complications such as kidney, eye and nerve damage that appears to result from elevated blood glucose.

Most practitioners who see children for medical problems, including diabetes, were told throughout their training that type 2 diabetes does not exist in children. As a result, they are hesitant to consider this or make it the initial diagnosis, Dr. Jones observes.

"About 10 years ago, some of us started seeing what we thought was type 2 diabetes in obese Mexican-American and African American children with diabetes in their families," says Dr. Jones, professor of pediatrics at the University of California, San Diego. "When we treated them for type 1 diabetes, the only diabetes previously recognized in children, their response was different from the typical child with type 1 who is insulin deficient. The children with type 2 diabetes were insulin resistant and treating them with insulin resulted in weight gain which worsened the insulin resistance."

Dr. Jones spoke today in New York City at an American Medical Association media briefing on advances in diabetes treatment and care.

"As a nation, we are all getting obese and it is starting in childhood. One of the major consequences of this is that more and more of our children will develop type 2 diabetes," he observed. "This is a major public health problem and we are going to have to make major lifestyle changes to prevent it. This will not be easy and will resemble the problem society has faced with lung cancer and smoking."

Dr. Jones concluded, "We need to change very basic aspects of our lifestyle, how we eat, what we eat, the amount we eat and how much we exercise."

"Physicians are also facing a treatment dilemma in type 2 diabetes in children. Will the same medications used in treating type 2 diabetes in adults work as safely and efficaciously in children; are the same treatment strategies appropriate?" questions Dr. Jones. "In adults, the treatment traditionally has started with suggested lifestyle change: increase your activity, change your diet and lose weight. In my experience, this has not been terribly effective for adolescents."

Dr. Jones announced that metformin, an anti-diabetes drug frequently used in adults, is both safe and efficacious in children. He was the principal investigator on the first study evaluating metformin as a therapy for children. The paper has been submitted for publication, and Dr. Jones reports the abstract reporting the results was well received at the American Diabetes Association meeting last June.

"I predict that in a few years we will have found that many of the diabetes drugs currently used for adults are efficacious and safe for use in children and that treatment strategies used in adults with type 2 diabetes will prove appropriate for children as well," Dr. Jones predicts.

The complications of type 2 diabetes seem to differ somewhat between whites, blacks, Latinos and the different Asian populations. Blacks have more strokes, while American Indians and Mexican Americans have more heart disease; therefore, the patterns of complications of diabetes may be different in these different populations. Japanese Americans do not need to gain nearly as much weight as other ethnic groups in order to develop diabetes -- and type 2 diabetes is more common in children in Japan than type 1 diabetes.

"We have come from thinking of diabetes as two conditions, type 1 and type 2, to recognizing more than 20 and maybe as many as 40 conditions that can cause diabetes and require different therapeutic approaches. So it has become much more complex. In recognizing this complexity, we are going to be able to develop more specific treatments and, hopefully, prevent the complications of this devastating disease even better than we do now," Dr. Jones predicted.

18-Jan-2001