Building Competency in Diabetes Education THE ESSENTIALS

4-8 | CHAPTER 4

type 2 diabetes. Studies of African American, Caucasian, Hispanic and American Indian or Indigenous youth document a first- or second-degree relative with type 2 diabetes in 50 to 100% of families (19,13). The Canadian surveillance study reported a first or second degree relative with diabetes in 91% of the cases of youth with type 2 diabetes (21). The combination of environmental factors (such as level of physical activity and nutrient intake) and genetic factors are thought to be the primary contributors to the increased rate of type 2 diabetes in these populations. The majority of youth with type 2 diabetes are diagnosed following the onset of puberty (4). This is likely related to the insulin resistance that occurs in early puberty and peaks mid puberty (20,22). Although the mean age in most reports varies between 12 and 14 years (19), there have been reports of type 2 diabetes diagnosed in children as young as four years of age in the Ojibway-Cree and Pima Indian populations (20,23). In the 41 children with type 2 diabetes who attended the diabetes clinic at the Hospital for Sick Children, Toronto, the mean age at diagnosis was 13.5 years (range 8.8 to 17.5 years). An interesting difference in the age prevalence was seen in the SEARCH study done with youth in the United States where they reported only 3.6% of cases of type 2 diabetes in the under 10 age group (12). These differences may be related to the methods used to choose these study sites.

Studies have documented a greater prevalence of type 2 diabetes in female versus male youth (12,24). The female-to-male ratio in the Hospital for Sick Children group was 1.7 (26 female/15 male) and the Canadian study reported 58% were female (132/227) (25,21). These findings are consistent with the International Society for Pediatrics and Adolescent Diabetes (ISPAD), the SEARCH study and the TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) study reports, which clearly document a female preponderance (12,19,20,24).

High Risk Youth for Type 2 Diabetes Identified in the TODAY Study: • Late pubertal • Predominantly Female • Obese • Minority • Come from families with: o Strong family history of diabetes o Limited education attainment

It is not known precisely why adolescent girls are more likely to develop this type of diabetes, but it may be related to a greater degree of insulin resistance in pubertal girls than in pubertal boys (26,27). In addition, insulin resistance is more severe in postpubertal girls with polycystic ovarian syndrome (PCOS) (28). PCOS is characterized by hyperandrogenism with chronic anovulation and is associated with oligo- or amenorrhea, hirsutism and hyperinsulinism (29). o Low income o Single parent