Building Competency in Diabetes Education THE ESSENTIALS

CHANGES ACROSS THE LIFESPAN| 4-7

In 2017, it was estimated that 1.1 million children worldwide had type 1 diabetes with an additional 96,000 being diagnosed each year (4). Canada (Newfoundland) has the third highest mean annual incidence rate for type 1 diabetes (0-14 year age group) in the world. Until recently, a child or adolescent diagnosed with diabetes was assumed to have autoimmune type 1 diabetes, or monogenic diabetes (previously referred to as maturity onset diabetes of the young or MODY). Type 2 diabetes was a diagnosis primarily reserved for the adult population. However, throughout the past 10 to 15 years, we have seen a significant increase in the incidence of type 2 diabetes diagnosed in youth. In a Canadian prospective national surveillance study, the incidence rate of type 2 diabetes in children was found to be 1.54 per 100,000 per year in children aged <18 years (11). Similarly, the SEARCH for Diabetes in Youth study reported over 20,000 youth aged <20 in the United States with type 2 diabetes (12). The increasing incidence of type 2 diabetes in children and adolescents is now a public health concern (2,13). It has been noted that the rate of diagnosis of type 2 diabetes in childhood parallels the rising rate of childhood obesity (4,14). Among the differences noted between type 1 and type 2 diabetes in children is that the presence of impaired insulin sensitivity and relative insulin deficiency in type 2 diabetes requires different treatment modalities (15,16) than the autoimmune induced type 1 diabetes (2). Type 1 diabetes in the child is more frequently diagnosed in the first decade of life whereas the average age for the diagnosis of type 2 diabetes in the child in Canada was found to be 13.7 years of age with only 8% presenting before 10 years (10,15). An alarming statistic also revealed in the Canadian surveillance is that 37% of the children with type 2 diabetes had at least one comorbidity at diagnosis (17). This highlights the need for early and frequent screening for complications in this population. These statistics also clearly identify that type 2 diabetes in children and adolescents presents numerous challenges in the medical and behavioural realms (15). Characteristics of type 2 diabetes in youth The most prevalent characteristic shared by youth with type 2 diabetes is obesity. This is supported by the findings of the Canadian Diabetes Surveillance where 95% of the Canadian children diagnosed with type 2 diabetes were reported as obese (18). Although the definition of obesity varies between reports, the range of mean body mass index (BMI) in children with type 2 diabetes has been reported at 29 to 38 kg/m 2 , with the vast majority above the 85 th percentile for age and sex norms (10,13,19,20). A strong family history of type 2 diabetes in multiple family members from more than one generation is also characteristic of youth with