I hope everyone had a Happy New Year, a chance to see their family over the break, and goals set for 2019! Our last blog was from November near World Diabetes Day, but the website coordinator forgot to post it up, so that is why it came out this month. The good news is you are all, technically, going to get to read two January blogs! I also want to remind all University of Ottawa students of a fantastic resource that we often forget. Our University is subscribed to several different research journals so that we can access the articles in them for free. Otherwise, we would be required to pay a fee to view many articles online. This week, we are going to taking a look at a review article from a very prestigious journal, The Lancet, called: Type 2 diabetes in adolescents: a severe phenotype posing major clinical challenges and public health burden (Viner, White, & Christie, 2017). To find the article online, search the article’s title on https://biblio.uottawa.ca/en/find/search-plus, while logged into your uOttawa account.
The title of the article is pretty self-explanatory so we will jump right into the paper. Right from the abstract, the authors mention that adolescent Type 2 Diabetes (T2DM) is still “a rare disease.” This may be confusing because Canada alone has 11 million people affected either by diabetes or pre-diabetes. However, the respective prevalence of T2DM in adolescents (age 10-19) is considerably lower than most other age groups. In the introduction, it is stated that diabetes is characterized as a non-communicable disease, “driven by nutrition, sanitation, and health related to rapid economic development and social change over the past 30 years.” This statement is interesting, because it appears to attribute the increased prevalence of T2DM with environmental reasons more-so than genetic reasons. We can view this with a positive perspective, as that means we may have more control than we think about our management of T2DM. For example, we can choose the types of food that we eat to adjust our nutritional intake and take care of ourselves hygienically in order to stay clean. The introduction tells us the main purpose of the review, which is to examine the unique aspects of TD2M in adolescents.
After the introduction, the article discusses the cause and phenotype (expressed trait) of T2DM. The paper discusses several characteristics of T2DM in adolescents, but I will pinpoint some of the most general ones. Firstly, it is stated that obesity is nearly universal in adolescents with T2DM. There is also a strong association between low sociodemographic status as deprivation is associated with obesity and stress. The classical features of T2DM in adolescents is obesity, insulin resistance, absence of autoantibodies, and a strong family history of T2DM. Unlike T1DM, the age of onset of T2DM is rare before puberty, more common in a minority ethnicity, and symptoms typically persist longer than a month before presentation. I could continue to list on and on the characterizations of T2DM in adolescents, but it is something we can all read for ourselves. The section in the paper that interests me the most is the section on Management, which also identifies barriers to treatment and future directions. I applaud the authors for providing this section, as the information here could be really useful for many of us in understanding how to control diabetes on a personal level, but also how society, on multiple levels are trying to help. At the very core of the management regiment is weight control, reduced sedentary behavior, and a balanced diet with reduced carbohydrate, fat (saturated fat) too, as well as increased fiber intake. For adolescents and their guardians, they should set goals, and work together to try to follow these management tips. Additionally, most adolescents with T2DM do not meet daily physical activity durations of 60 minutes. Treatment of T2DM is difficult in adolescents for 2 main reasons: T2DM is likely a combination of diseases and triggers that do not respond equally to treatments, and individual variance in drug response. Furthermore, there are only two licensed drugs, metformin and insulin, in treatment of T2DM in adolescents, whereas there are several for adults. Thus, a barrier to effective management is the lack of approved drugs. The authors believe T2DM is preventable with the knowledge available, but that broader systemic efforts to reduce obesity should be implemented. The underlying reason that these efforts have not been seen yet, may be due to poor recognition of the severity of T2DM in adolescents. Identifying and understanding the amplitude of a problem may help shift more focus onto finding an effective solution. Only then may there be more treatment options, better ways to promote adherence to lifestyle regimens, and how-to best service the adolescents affected by T2DM.
I highly recommend this paper to anyone who is interested in how T2DM is unique in adolescents. It not only provides insight on the characteristics of T2DM itself but identifies potential approaches to alleviating the problem. Perhaps you may learn something that may be of use to someone you know, or you may be even inspired to think of another way we can address one of the many barriers to T2DM management mentioned in the article.
VP Research, Team Diabetes uOttawa
Viner, R., White, B., & Christie, D. (2017). Type 2 diabetes in adolescents: A severe phenotype posing major clinical challenges and public health burden. The Lancet, 389(10085), 2252-2260.