Poor Diabetes Management Portends

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Basic lifestyle changes could save children with obesity-related diabetes from a lifetime of complications. But making changes in areas such as diet and exercise is more difficult than adjusting to medical management of the disease, a Vanderbilt study shows.

“Type 2 diabetes in children is such a new problem that we don’t know a lot about these kids,” says Dr. Russell Rothman, assistant professor of medicine and pediatrics and deputy director of the Prevention and Control Division of the Vanderbilt Diabetes Research and Training Center. “This study is one of the most comprehensive to date to examine who these kids are and the challenges they and their families face.”

The study of 103 adolescents with Type 2 diabetes, most of whom are overweight, shows many children and teens do not possess good self-management behaviors. Most children in the study were either overweight or obese, with a body mass index (BMI) at more than 85 percent of the average for their age and weight.

Russell Rothman
Photo by Anne Rayner

The study was conducted by the Vanderbilt Diabetes Research and Training Center, working with patients at the Vanderbilt Eskind Pediatric Diabetes Clinic. Rothman and Shelagh Mulvaney, assistant professor of pediatrics and nursing, along with physicians and nurses from the diabetes clinic, questioned adolescents about their diabetes management in a telephone survey.

Respondents reported that medical management included daily medicines, blood-sugar monitoring and injections of insulin. More children (37 percent) reported the most difficult part of managing their disease was changing health habits like diet and exercise; 31 percent perceived taking insulin to be the most difficult part, and 18 percent had the toughest time adjusting to finger sticks for blood-sugar tests.

More than 80 percent of patients reported taking medication regularly, and nearly 60 percent monitored their glucose twice daily. However, about 70 percent reported watching at least two hours of TV each day, and 63 percent said they did not currently participate in physical education classes. Children reported that barriers to making healthy lifestyle changes included difficulty in dealing with cravings or temptations, feeling stressed or sad, and frequently eating outside the home.

The study also found racial disparities. African American patients had worse blood-sugar control and were slightly more likely to act like adolescent peers without diabetes–such as drinking sugary drinks and eating junk foods with regularity. The reasons for the disparities are not clear, opening up the possibility for future surveys to explore reasons for the differences.

“These results indicate children are having a very difficult time now, and so you might think it would be very difficult to take care of themselves long-term,” Rothman says. “This will mean a major health crisis for the country to deal with later. We owe it to ourselves, as well as to these young patients, to find better ways to help them manage their obesity and diabetes.”

The study’s findings were published in the April issue of the journal Pediatrics.