The Pharmaceutical Journal
Vol 268 No 7187 p274-79
2 March 2002

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Archives of Disease in Childhood (adc.bmjjournals.com)
International Journal of Obesity (www.naturesj.com/ijo)

Lifestyle advice needed to prevent increase in type 2 diabetes in children

Pharmacists are well placed to offer advice on healthy lifestyles to prevent an increase in obesity among adolescents, according to expert opinion. This follows reports of the first four recorded cases of type 2 diabetes in obese, white children. Further research has noted a sharp increase in obesity among children aged under five years.

Irene Gummerson, member of the Royal Pharmaceutical Society's diabetes task force said: "The modern diet and a sedentary lifestyle found in many children and adolescents can lead to obesity which is a risk factor for type 2 diabetes. Pharmacists are well placed to provide advice and leaflets on a healthy lifestyle. They can target this advice at parents of children and adolescents at risk."

The four cases of type 2 diabetes in obese, white children were reported by doctors from the Royal Hospital for Children, Bristol. A number of cases of type 2 diabetes have been described in children from ethnic groups known to be at higher risk, but these are the first cases in white children recorded in the United Kingdom.

Type 2 diabetes was identified in three girls and one boy aged between 13 and 15 years. All had a body mass index greater than 35kg/m² and have since been stabilised on treatment with dietary intervention and metformin. The doctors comment that the increase in prevalence of obesity in the UK is likely to precede an increase in incidence of type 2 diabetes in both white and ethnic minority groups. "It is therefore essential that clinicians appreciate the risk of clinical and unrecognised type 2 diabetes associated with obesity in white children as well as those from high risk populations," they say. (Archives of Disease in Childhood 2002;86:207).

Mrs Gummerson said that although research has not been carried out in children, evidence has shown that in adults a modest change in lifestyle and modest weight loss could reduce the risk of developing diabetes by 58 per cent. "Many people are unsure of what constitutes a healthy diet and might find a pharmacist's help useful." She suggested that pharmacists involved in diabetes screening services could also target obese children, particularly if they have a first-degree relative with type 2 diabetes.

She added that these cases should not be confused with a subtype of diabetes called Maturity Onset Diabetes of the Young (MODY) — an inherited condition not characterised by insulin resistance and obesity.

Meanwhile this week, an increase in obesity among children aged under five years was noted by researchers at the University of Plymouth. It found that a quarter of girls are already overweight before starting school and are developing insulin resistance which could lead to diabetes.