Type 2 diabetes in children on the rise

Lifestyle, genetics to blame for onset of ‘adult’ disease

Andrew Sain Staff

Heather Dean is on the front lines of the fight against type 2 diabetes in children. One of the first researchers to encounter the disease in children, she works with Aboriginal communities in Manitoba in order to raise awareness of the disease and methods to treat and prevent it. Aboriginal communities have been the hardest hit by the disease.

Type 2 diabetes, formerly known as adult-onset diabetes, occurs when the pancreas does not secrete enough insulin or the body is not able to use the insulin that is produced. This is the most common type of diabetes, making up 90 per cent of all cases, according to the Canadian Diabetes Association. In type 1 diabetes, the pancreas is unable to produce any insulin.

A professor of pediatrics at the University of Manitoba and the medical director with the Diabetes Education Resource for Children, Dean has had extensive experience with the disease, which was first documented in this province in 1985. Dean was one of the first to recognize that type 2 diabetes was, in fact, occurring in children.

“It took 10 years for the world to believe me that we were seeing type 2 diabetes in children in this province,” said Dean. “In 1996 we had our first type 2 diabetes in children conference in Tucson, Arizona, an international conference, and it was at that meeting that suddenly the world of diabetes believed us, because the Americans were seeing [type 2] diabetes in their children.”

Certain populations are at a higher risk for type 2 diabetes: in Canada, Aboriginal peoples are at particular risk. Dean said that Anishinaabe-Cree and Cree populations in Manitoba and western Ontario show the highest number of cases in Canada, due to the genetic influence on the disease. Dean pointed to a gene called G319N that has been identified as a mutation affecting the amount of insulin produced.

‘If you’re born with a lower rate of insulin secretion, and then something else happens in the environment — and the environment can be the prenatal environment or the post-natal environment — something happens that pushes your need for insulin secretion and you can’t . . . you’re going to develop diabetes earlier.”

Obesity also contributes greatly to the development of type 2 diabetes.

“Type 2 diabetes is a lifestyle event, and the reason why we’re seeing type 2 diabetes in children now is another aspect of the obesity epidemic,” said Dean.

Dean noted that the number of exceedingly overweight people has increased by 400 per cent over the last 20 years.

“That has mirrored what has happened to us in the last 20 years in terms of type 2 diabetes in children,” she said.

Dean spends much of her time working with Aboriginal communities in Manitoba, travelling through northern Manitoba, educating affected populations about prevention and treatment of the disease.

“Our problem mirrors what is happening in the rest of the country, but it’s much greater and it’s a very unique population. We’re only getting the tip of the iceberg; we don’t yet have a good sense of how many infected children are out there, because children with type 2 diabetes don’t present acute symptoms, often they’re just tired.”

According to Dean, the complications that can arise with diabetes, such as blindness and kidney problems and failures, are occurring within a much younger age group.

Despite the efforts of Dean and her team, type 2 diabetes in children is a relatively new occurrence that she expects will continue to rise in the future.

“It’s going to get worse before it gets better,” she noted. Future generations will be at even greater risk for developing type 2 diabetes: more parents have the disease, developed either as children or while pregnant, which in turn increases the risk.

But Dean said the impetus for changing this cycle will have to come from the affected communities themselves.

“It will be that it’s not okay to smoke, it will be that it’s not okay to sit and watch TV for six hours, you will just know that’s not an okay thing to do because it’s just socially not acceptable anymore.”