Child diabetes a potential 'epidemic'
By Beverly Creamer
Advertiser Staff Writer
Concerned that Hawai'i children may be struck by juvenile diabetes in increasing numbers in the next two decades, the Centers for Disease Control has awarded local researchers a $3.2 million contract to quantify the type and number of diabetes cases developing in the state's children.
Jeff Widener • The Honolulu Advertiser
"This is potentially the epidemic of the next 20 years," said Dr. David Curb, chief executive officer and medical director of the Pacific Health Research Institute, who is one of six co-investigators on the project.
Project researcher Dr. David Curb wonders "what happens to a kid who has had diabetes for 40 years."
The federal grant from the Atlanta-based agency covers five years. Hawai'i's major medical insurers and medical institutions will assist in collecting the data.
The researchers' suspicion is that Type 2 diabetes — often the result of obesity and a sedentary lifestyle — is appearing at ever-younger ages because of a generation raised on television and fast food. It no longer is occurring primarily in adults.
"We believe the magnitude of the problem is greater than we can actually count," said Dr. Beatriz L. Rodriguez, principal investigator and a specialist in epidemiology. "Children can go undiagnosed for several years if they have no symptoms."
Rodriguez said that about one-quarter of the children with diabetes have other risk factors including high cholesterol and high blood pressure.
"The worrisome part," said Curb, "is you're now seeing kids who are at risk in their 30s and 40s of having major cardiovascular disease and other complications. It can lead to blindness, amputations, heart problems. The longer the person has this disease, the more time it has to do damage."
It can also lead to kidney failure and the need for dialysis. Already, the state's rate of kidney failure is 30 percent higher than the national rate.
Hawai'i was chosen for the research partly because of the state's diverse ethnic population, its fairly wide healthcare coverage, and its unique diabetes registry that lists approximately 30,000 people with diabetes.
"Diabetes is especially a problem in minority populations," said Rodriguez. "Native Hawaiians show rates about four times higher than Caucasians; and Japanese and Chinese and other ethnic groups are at high risk, too."
Rodriguez said the reason the disease shows up with greater incidence in these groups isn't clear.
Adult diabetes occurs in about 5 percent of the U.S population as a whole; but the rate here is 10-15 percent. For people older than 70, the rates skyrocket.
Among the 30-year-old Honolulu Heart Program's remaining 3,800 study subjects, 68 percent have either diabetes or a glucose metabolism abnormality, a pre-diabetic condition. By comparison, said Rodriguez, the over-70 rate in the rest of the nation is around 33 percent.
Although there are very little standardized statistics about children with Type 2 diabetes in Hawai'i, clinicians are reporting an increasing number, said Rodriguez. Co-investigator Dr. Teresa Hillier, a researcher with Kaiser Permanente's Center for Health Research/Northwest and Hawai'i, reviewed charts of Kaiser patients and discovered that one-third of the children with diabetes have Type 2, the type generally treatable by lifestyle change.
Type 1, the more severe type that generally requires insulin treatment, does occur in children but is fairly rare. But with the increase of Type 2 in children, there's concern that these patients will eventually require insulin injections, as well.
"What happens to a kid who has had diabetes for 40 years? That's something we don't know anything about," Curb said.
Rodriguez said that when Type 2 is diagnosed in children, it's often around puberty, when girls, especially, become less active and undergo hormonal changes.
"It could be because of dietary changes around this time — too many fries and soda and hamburgers — and the accumulation of more intra-abdominal fat (brought on by puberty)," Rodriguez said.
Rodriguez blames rising rates of diabetes primarily on the "epidemic of obesity" in young people in this country.
"Children are exposed to about 10,000 TV advertisements related to food every year, with candy, soda and sugary cereals," she said, "so a lot of it has to do with the environment we're providing.
"We, as a society and parents, are allowing kids to be influenced in a way that could create this epidemic. It's probably preventable if we emphasize the issues of diet and exercise."
