2023-10-31 16:15:21
The prevalence of prediabetes in children and adolescents
Prediabetes in children and adolescents, or what is called “prediabetes,” indicates the presence of high levels of glucose in the blood, but it is not yet high enough to diagnose type 2 diabetes. Here, those who suffer from this must be monitored. The situation closely; Because they may develop into diabetes of this type over time.
Blood sugar level
Glucose is the body’s primary fuel, and comes mostly from the food we eat. Insulin is a hormone made by the pancreas. The task of this hormone is to control the body’s ability to use glucose by the body’s cells, and also to store it in areas of the body.
After eating, glucose enters the blood. Here, insulin allows glucose to leave the blood and enter the cells so that they can use it to produce energy. This keeps blood glucose levels in the normal range. If the body does not produce enough insulin, or the body’s response to insulin is low, the blood glucose level rises.
Prediabetes
Prediabetes usually occurs in children and adolescents who already have some body sensitivity to insulin sensitivity. Insulin sensitivity means that the body does not recognize insulin as it should as a key factor in controlling the process of using glucose. Therefore, the body’s cells cannot absorb glucose from the blood very effectively. Those who suffer from insulin sensitivity produce more insulin than usual to overcome this sensitivity.
Although the causes of prediabetes and insulin sensitivity are not yet fully understood, there appears to be a strong relationship between some of the following factors and diabetes in children and adolescents:
– Overweight or obesity.
– Family history of type 2 diabetes.
– Inactivity and physical laziness.
If prediabetes develops into diabetes, the following symptoms may appear:
– Increased thirst.
– Increased frequency of urination.
– Waking up at night to urinate.
– exhaustion.
– Increase appetite.
– Unexplained weight loss.
Here it is worth communicating with the pediatrician. Diabetes diagnosis
Diabetes and pre-diabetes are diagnosed in a systematic manner. Simple blood tests are used to measure:
– Blood glucose levels during fasting.
– Oral glucose tolerance test.
– Levels of sugar accumulation in hemoglobin.
To clarify, a fasting blood glucose test is performed following not eating/drinking anything other than water for at least 8 hours. It is normal for the blood glucose level to be less than 100 mg/dL, or 5.6 mmol/L. A fasting glucose level between 100 and 125 mg/dL (5.6-6.9 mmol/L) indicates prediabetes. And even more so, diabetes. Measuring the level of cumulative sugar in hemoglobin (HbA1c) is another test to evaluate the average levels of sugar accumulation in the blood during the past three months. For this test, one does not need to fast. The normal accumulation level of sugar in hemoglobin is less than 5.7 percent. If the level is between 5.7 and 6.4 percent, this indicates the presence of a pre-diabetic condition. If it is 6.5 percent or higher, this indicates the presence of diabetes.
While HbA1c levels and fasting glucose (GF) levels are great screening methods for assessing prediabetes and diabetes, normal levels can be falsely reassuring.
That’s why the oral glucose tolerance test (OGTT) is the most reliable test available to confirm prediabetes and diabetes. This is done in the doctor’s office; Because it takes more than two hours.
Prevalence of diabetes among children
Recent medical reviews by researchers from the University of Virginia indicate that, using criteria from the American Diabetes Association (ADA) guidelines, the prevalence of pre-diabetes in children is already high, especially among children and adolescents with obesity. Among them, its prevalence ranges between 21 and 40 percent, depending on the criterion used and the categories of children examined.
Specifically, University of Virginia researchers stated that these studies noted that the prevalence of prediabetes in children with obesity varies by race/ethnicity. It is 54 percent among African American teens, 28 percent among Hispanic teens, and 18 percent among white American teens.
They added that they noticed that the incidence of prediabetes is 2.5 times higher in boys, compared to girls.
She also noted that perhaps — but not surprisingly — the prevalence of prediabetes and diabetes will continue to rise among adolescents. For example, using the standard 8-hour fasting glucose test, approximately 2 percent of adolescents had a disordered outcome (i.e., prediabetes) between 1988 and 1994.
The matter developed and increased in the period between 1999 and 2000, until the percentage of adolescents who had this disorder reached 7 percent. But the largest increase was observed in the period of 2007 and 2008; It reached 23 percent.
But the University of Virginia researchers also said that, however, there is a discrepancy in the estimates obtained using the HbA1c test versus the fasting glucose test. This stated that 4.4 percent of American adolescents had prediabetes, according to the criteria for analyzing the glycated hemoglobin levels, during the period between 1999 and 2014, compared to 15 percent, according to the criteria used for fasting glucose levels. “Which indicates that some criteria may detect disturbances in blood sugar levels at an early stage in the development of the condition,” they said.
Treating diabetes disorders in children and adolescents
> Among the medical consultations received in the “Your Health” supplement in “Asharq Al-Awsat”, the following question was mentioned: “I have a 9-year-old child. I had his blood sugar analyzed. He had an increase in the normal rate of 5.8, so how can I protect him from diabetes and reduce the cumulative score? Note that he does not suffer from symptoms, but I went to check on him when I noticed that he was eating a lot of sugar.”
Given the distinctive characteristics of prediabetes and type 2 diabetes in adolescents, preventive and therapeutic treatment includes intensive programs to modify daily lifestyle behaviors, as the main and reliable intervention, with repeated tests performed regarding every 6 months or less.
In short, and without any complications (physically and psychologically exhausting) for the child and adolescent, the approach to modifying daily lifestyle behaviors combines 3 things:
– Changes in diet.
– Raising the level of physical activity.
– Sleep for a sufficient number of hours (9 hours a day for children and adolescents).
Because changes in the nutritional system alone inevitably lead to a lower level of metabolic processes in the body, and thus no clear difference will appear in blood sugar levels. But combining physical activity with it increases the level of metabolism, and thus there are clear results on blood sugar levels. Increasing the level of physical activity and sleeping a sufficient number of hours at night also has a beneficial effect on increasing insulin sensitivity, independent of the amount of adipose tissue present in the body.
It is known that a high amount of adipose tissue in the body increases the level of sensitivity and weakens the body to the beneficial effects of insulin in controlling blood sugar levels. The American Endocrine Society’s clinical practice guidelines suggest at least 30 minutes of moderate to vigorous physical activity each day, with a goal of 60 minutes per day. It is also recommended to practice low-level aerobic exercises, such as jogging, swimming, and resistance exercises to activate the muscles, combined together. Because this seems to improve insulin sensitivity. Encouraging exercise and adequate sleep does not often cause parents “huge” problems with their teenager or child. But this will appear when dealing with daily nutrition to adjust it according to a healthy pattern. Here, things should be simplified to ensure the cooperation of the child and teenager. Parents should also be role models in ensuring healthy nutrition, controlling body weight, and exercising.
The main approach recommended by the American Academy of Pediatrics, the American Heart Association, and the World Health Organization is to increase consumption of vegetables and fruits, reduce saturated fat intake, and completely eliminate sugar-sweetened beverages. Many studies have confirmed that consuming foods containing a high percentage of fiber was linked to increased insulin sensitivity and improved blood sugar levels. It should be noted that a diet that contains a high percentage of fiber provides many beneficial effects, such as increasing satiety, slowing the absorption of carbohydrates, and adding low-energy foods to the diet.
When should a blood sugar test be performed for children and adolescents?
> The pressing question for many parents, when they want to reassure themselves regarding the safety of their children and teenagers, especially those who notice that they are gaining weight or binging on sugar, is: When should children and teenagers have sugar tests? Is it for all children and adolescents, on a regular basis, or are there controls for that?
According to a review of many medical sources, because universal screening of all children and adolescents is unlikely to be effective in terms of cost-benefit, the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend that only Screening children and adolescents who are at high risk of developing disorders in blood sugar levels.
This includes children and adolescents who are healthy and obese, following the onset of puberty or at the age of 10 years or older (whichever occurs first), if they have one or more of the following risk factors:
– Family history of type 2 diabetes in a first or second degree family member (for a child or teenager who is obese).
– The patient’s mother has a history of diabetes or gestational diabetes (GDM) during pregnancy with the child or adolescent himself (who is obese).
– The presence of conditions or signs associated with the body’s sensitivity to insulin in a child or adolescent (who has obesity), including high blood pressure, cholesterol and triglyceride disorders in the blood, polycystic ovary syndrome (PCOS) in females, and the condition of small body size at birth. .
Here, the recommendations of the American Diabetes Association also advise the following: This examination should be repeated at least every two to three years. Or earlier if there are clear increases in body weight.
They are required to either perform an analysis of the rate of sugar accumulation in hemoglobin, or measure the sugar level during fasting. For a diagnosis to be confirmed, abnormal results must be confirmed, either using the same test on a different day, or evaluating with a different test.
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