Type 2 diabetes in children is an urgent and growing issue that needs to be tackled now, say experts. But how can you help? Journalist Kay McIntosh investigates.
The number of children being treated for type 2 diabetes in paediatric units in England and Wales has shot up over 50% in five years. A disease that two decades ago was all but unknown in children now affects almost 1000 children and young people (CYP). And that is just those diagnosed and treated in secondary care – there may be many more out there.
The National Paediatric Diabetes Audit annual report 2020-21 found 973 CYP with type 2 diabetes being cared for in a unit, compared with 866 in 2019-20, an increase of more than 12% (Royal College of Paediatrics and Child Health (RCPCH), 2022). There were 230 newly diagnosed CYP within the audit year in England and Wales, up from 201 in 2019-20.
Dr Tabitha Randell, head of the British Society for Paediatric Endocrinology and Diabetes, says: ‘When I started as a consultant nearly 20 years ago, I maybe had one or two children with type 2 in my clinic. Now I have 20 with a condition that you would normally see in adults in their 40s or 50s or more.’
What’s going on exactly?
Obesity: a major factor
The data points to some key issues. Half of the children and young people with type 2 had high blood pressure, and 85% were obese (RCPCH, 2022). (There are no comparable figures available for Scotland or Northern Ireland.)
Diabetes UK warns that growing rates of obesity will mean more and more children are at risk. Senior policy officer Jack Doughty says: ‘Living with overweight or obesity is the main modifiable risk factor for type 2 diabetes in children and adults.’
Tabitha, a consultant in paediatric diabetes and endocrinology at Nottingham Children’s Hospital, says the link with obesity is overwhelming: ‘Less than 10% of children who have a label of type 2 are overweight or normal weight. And my concern is that actually those have been misdiagnosed and haven’t actually got type 2.’
There is a close interaction between ethnicity and obesity, she says. ‘If you are black or Asian your risk of developing type 2 is much higher at a lower level of obesity.’ The largest group of children affected in the UK are of Asian origin: making up over a third of the cohort, despite being only 7.5% of the UK population (RCPCH, 2022).
Faster progression for kids
If the rise in cases wasn’t enough, type 2 is also a more aggressive disease in children. Tabitha says: ‘If you develop type 2 in your teens you will get complications in your 20s and 30s. And some children have complications at diagnosis.’ These include high blood pressure, kidney problems and early signs of eye damage.
‘The thing we really worry about in these young people is cardiovascular disease,’ says Tabitha. ‘If you develop type 2 diabetes in your teens and 20s, that risk of cardiovascular disease is greatly increased and occurs earlier, in their 30s and 40s rather than 50s and 60s.’
There is hope, however. Some adults with type 2 can go into remission by losing weight and adopting a much healthier diet and lifestyle. Jack says: ‘There is early evidence of children going into remission but there’s still a lot to learn about whether findings from adults with type 2 will also apply to children, who have a more aggressive form of the condition.’
Poverty: a key issue
Deprivation is another, closely related, cause. Four in 10 CYP with type 2 are from the most disadvantaged areas, compared with only one in five from the least deprived (RCPCH, 2022).
Registered dietitian Aisling Pigott, based in Cardiff, speaks for the British Dietetic Association. ‘People often talk about this obesity crisis and I would say actually, we’ve got a nutritional crisis. People with the lowest income have the least access to healthy, nutritious foods. The environment is not conducive or supportive of healthy lifestyle choices.’
She cites ‘food deserts’ – communities where it’s hard to find stores selling nutritious food – as just one issue. If you don’t have a car, you may rely on an expensive corner shop that only has a tiny selection of fresh fruit and vegetables, pulses and so on.
Diabetes UK believes a direct approach to poverty is needed. Jack says: ‘We believe the government must take action to ensure all families have sufficient income to prevent the poverty that is strongly associated with childhood obesity, and increased likelihood of early onset type 2 diabetes. This includes reviewing social security levels.’
The cost of living crisis makes this even more pressing, as more and more families are pushed into food insecurity. Jack says: ‘We fear that this issue – coupled with rising obesity rates – is forming a “perfect storm”, which will translate into an even greater increase in the numbers of children with type 2 diabetes in the coming years.’
‘If you develop type 2 in your teens you will get complications in your 20s and 30s. And some children have complications at diagnosis’
Tabitha says the government must act fast: ‘They’ve done all these reviews. They’ve had the Dimbleby review [National Food Strategy, 2021; 2020], which was really clear and gave them good evidence. They should be implementing it and not hiding behind the cost of living crisis as an excuse to not go head to head with the big food companies, because there are huge commercial vested interests here.’
The Dimbleby review warned of a ‘junk food cycle’, where people eat calorie-dense foods that don’t satisfy hunger. They then go on to consume excess calories. It argued industry was commercially driven to promote such foods. Recommendations included a £3/kg tax on sugar and a £6/kg tax on salt sold for use in processed foods, restaurants and catering (National Food Strategy, 2021).
The Department of Environment, Food and Rural Affairs (Defra) produced a food strategy in response. It called for ‘government and industry to work together to better enable individuals to make healthier choices’ (Defra, 2022).
The strategy pledged government to ‘set out further measures to reduce obesity by setting out our approach to working with the food industry to create a healthier food environment for all’ in the expected health disparities white paper (Defra, 2022). But with uncertainty about what the next prime minister’s priorities will be, there’s no guarantee this will be out any time soon.
The Department of Health and Social Care could only tell Community Practitioner: ‘We will provide further details on timing and plans for the white paper in due course.’
Diabetes UK called on ministers to introduce the Dimbleby proposals, including the sugar tax, expanding free school meals and support for low-income households. Jack says: ‘The government should be delivering these recommendations but instead they are instigating delays to important measures to prevent childhood obesity, such as the 9pm curfew on junk food advertising which was shortly to come into force.’
Aisling supports calls to tax high-fat or high-sugar foods but warns the revenue must be dedicated to nutrition, ‘making healthier, nutritious foods more accessible and more available to those that most need them’.
How can you help?
So, as government drags its feet, what can community practitioners do? It’s largely about educating and supporting families. Tabitha says: ‘A lot of people are a bit paranoid that if we tell children they’re overweight, they’ll end up with an eating disorder. But eating disorders aren’t about weight but about control and general unhappiness.’
Professionals need to have straightforward conversations about healthy eating, she stresses. Parents should be ‘making sure that they haven’t got a cupboard full of snacks that children can go help themselves to.’ Children have poor impulse control, but if you don’t buy it, they can’t eat it.
‘There is no need to snack between meals,’ adds Tabitha. ‘It’s okay to feel a bit hungry when it’s your next meal time.’
And if you are aware of clients struggling to feed their families at all, suggest a local foodbank, reassuring them there is no stigma about this. Citizens Advice can help.
Aisling says it’s essential to avoid ‘blaming or shaming families’ because they may stop engaging. Instead, the experts agree, supporting families so they can help their children live healthier lives is key to limiting the numbers who go on to develop diabetes and its often devastating complications.
If you look after children with type 2 diabetes
Diabetes UK says school nurses and other community health professionals should:
- Explain the diagnosis appropriately to children and their family, including what they can do to manage the condition, and what they should expect from their diabetes team to help them live healthily.
- Help them to understand the role their diet plays in managing type 2 diabetes, and arrange a referral to a dietitian to help them make any changes needed.
- Help get the children the right medications to reduce their sugar levels, explaining any possible side effects and what to do if they experience them.
- Ensure regular checks of blood sugar levels, weight and height.
- Give them access to emotional support and advice to help them manage their feelings and cope with the effect of managing type 2.
- The latest data on child diabetes, including the growth in type 2 is in the National Paediatric Diabetes Audit (NPDA) annual report 2020-21 bit.ly/NPDA_2020-21
- The Dimbleby report analyses the problems with access to healthy food nationalfoodstrategy.org
- Diabetes UK – resources for professionals and for parents and families diabetes.org.uk
Defra. (2022) Government food strategy. See: gov.uk/government/publications/government-food-strategy/government-food-strategy (accessed 9 August 2022).
National Food Strategy. (2021) The plan. See: nationalfoodstrategy.org (accessed 9 August 2022).
National Food Strategy, (2020) Part one. See: nationalfoodstrategy.org/part-one (accessed 9 August 2022).
Royal College of Paediatrics and Child Health. (2022) National paediatric diabetes audit annual report 2020-21: care processes and outcomes. See: www.rcpch.ac.uk/sites/default/files/2022-04/National%20NPDA%20report%202020-21%20Summary%20Report.pdf (accessed 9 August 2022).
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