In May, NYU Langone launched the Robert I. Grossman, MD, and Elisabeth J. Cohen, MD, Pediatric Diabetes Center, funded by a $10 million gift from an anonymous donor. “Our goal is to provide comprehensive, fully integrated services to families faced with this condition,” explains Mary Pat Gallagher, MD, a distinguished pediatric endocrinologist, who was recruited earlier this year as the center’s inaugural director. “Patients and their loved ones will be able to see a doctor, a certified diabetes educator, a dietitian, a psychologist, and a social worker—all in one visit, under one roof.” The new center is part of the Hassenfeld Children’s Hospital at NYU Langone.
Diabetes is a growing epidemic among children and adolescents, affecting an estimated 208,000 youngsters in the United States. Characterized by high levels of glucose in the blood, diabetes results from the body’s inability to produce or respond to insulin, a hormone that controls blood sugar. If not properly controlled, the condition can lead to severe complications—from cardiovascular problems to blindness to kidney failure. Dr. Gallagher shares her insights on preventing, diagnosing, and treating this complex disease.
1. Adult-Onset Diabetes Isn’t Just for Grownups
Not long ago, the two most common forms of diabetes were primarily defined by their age of onset. Type 1 diabetes was known as juvenile diabetes because it typically emerged in childhood. Type 2 diabetes was called adult-onset diabetes because it rarely affected people under 20. In fact, type 1 diabetes can be diagnosed at any age, and type 2 is increasingly seen in very young adolescents. Type 1 occurs when the immune system mistakenly attacks insulin-producing cells in the pancreas, which can occur as early as infancy. Type 2 develops when the body is resistant to insulin, and the insulin-producing cells are unable to compensate. (Most people with insulin resistance will not go on to develop type 2 diabetes.) The prevalence of type 2 in children soared by 30 percent from 2001 to 2009, the latest year for which figures are available—a trend thought to be associated with rising rates of childhood obesity. But there is some good news: more recent data suggests that the surge is leveling off.
Dr. Gallagher and her colleagues try to increase parents’—and children’s—sense of confidence and control. “This is a marathon, not a sprint,” she reminds them. “It’s hard work, but they can make it.”
2. Obesity Isn’t the Whole Story
Rates of type 1 diabetes in children have also risen over the past two decades, though the reasons remain unknown. “There may be some environmental factor that triggers the immune system,” Dr. Gallagher suggests. “It could be exposure to certain chemicals, foods, or viruses—or a lack of exposure to different infections. Researchers are investigating all of those possibilities.” What’s clear, however, is that genes play a key role in all forms of diabetes. Studies show that when one twin has type 1, the other twin develops it about half the time. About 80 percent of children diagnosed with type 2 have at least one parent with the disease. Although there are rare forms of diabetes that are caused by mutations in single genes, called monogenic diabetes, scientists are still learning which combinations of genes are involved in types 1 and 2 diabetes.
3. Diagnosing Which Type of Diabetes a Child Has Can Be Tricky
Type 1 diabetes is often diagnosed after a patient develops ketoacidosis, a dangerous condition caused by a severe insulin deficiency. Symptoms include extreme thirst, frequent urination, vomiting, and fruity-smelling breath. In addition to high glucose and low insulin levels, most often a blood test will show evidence of an autoimmune reaction to confirm the cause. By contrast, type 2 may go unnoticed until a child has a routine checkup, and a hemoglobin A1C test detects persistently high levels of blood sugar. But the truth can be elusive. While type 2 is commonly associated with obesity, an overweight patient may prove to have type 1. Just as surprisingly, a patient with an autoimmune marker may turn out to have type 2.
4. Treating Type 2 Diabetes in Young People Can Be Challenging
Although type 1 represents only 5 percent of diabetes cases in the US, it’s by far the most common form in youngsters. Fortunately, it can usually be controlled by administering insulin. “These children are healthy,” Dr. Gallagher explains. “They can play sports and eat ice cream just like their peers.” Treating young people with type 2, however, is a different story. Although insulin and medication can help control blood sugar levels, neither will work without lifestyle changes. “Getting teenagers to cut carbs and exercise regularly isn’t easy,” notes Dr. Gallagher, “so we try to work with the whole family to help them make healthy changes.”
5. Childhood Diabetes Can Be Just as Hard on Parents
Constantly monitoring a child’s glucose levels and medications can feel overwhelming, and anxiety over possible complications may add to the burden. “I emphasize to parents that they shouldn’t feel guilty because they didn’t cause their child’s condition,” Dr. Gallagher says. Instead, she and her colleagues try to increase parents’—and children’s—sense of confidence and control. “This is a marathon, not a sprint,” she reminds them. “It’s hard work, but they can make it.”