Type 2 Diabetes in the Young
The evolving epidemic
- CVD, cardiovascular disease
- HNF, hepatic nuclear factor
- IGT, impaired glucose tolerance
- IRS, insulin resistance syndrome
- MODY, maturity-onset diabetes of the young
- NHANES III, Third National Health and Nutrition Examination Survey
- OGTT, oral glucose tolerance test
- PCOS, polycystic ovarian syndrome
The topic of the International Diabetes Federation Consensus conference, held 7–9 February 2003 in Santa Monica, California, was “Type 2 Diabetes in the Young: The Evolving Epidemic” (1). The topic has become a clinical and health economic priority, with important implications for an increasing health care burden throughout the world. Aspects of these conditions have recently been reviewed (1,2).
We are in the midst of an epidemic of lack of exercise, of obesity, of the insulin resistance syndrome (IRS), and of diabetes in young persons. The diabetogenic process begins in fetal life, with low birth weight and poor nutrition combining with sedentary lifestyle and dietary factors to produce an insulin-resistant phenotype that may accelerate the development of renal pathology and cardiovascular disease (CVD). Worldwide, the number of persons with diabetes has tripled since 1985. In Australia, 1.7 and 1.4% of persons aged 35–44 and 45–54 years, respectively, had diabetes in 1981, and these rates increased to 2.5 and 6.2% in 2000 (3), suggesting a trend to earlier age of onset of diabetes.
The prevalence rates of obesity (BMI exceeding the 95th percentile) among U.S. children and adolescents aged 6–11 and 12–19 years, respectively, were 4.2 and 4.6% in 1963–1970, 4.0 and 6.1% in 1971–1974, 6.5 and 5.0% in 1976–1980, 11.3 and 10.5% in 1988–1994, and 15.3 and 15.5% in 1999–2000, an alarming rate of increase. Obesity (weight corrected for height >95th percentile) among U.S. children increased between 1988 and 1999 from 7 to 10% among those aged 2–5 years (Fig. 1) (4,5). In a cross-sectional survey of children 9–12 years old in Hong Kong, 38% of girls, but 57% of boys, were overweight, with overweight children of both sexes showing higher systolic blood pressure, triglyceride, and insulin and lower HDL cholesterol than the normal-weight group …