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Introduction
A growing concern that has greatly impacted children within the last 15 years has been the
increasing prevalence of type 2 diabetes mellitus (T2DM), a disease in which affects the uptake of
glucose into the cell. Currently the prevalence rate is expected that 1 in 3 children born in 2000 will
develop the disease, with its onset occurring around age 13.1,2 Several risk factors have been determined
as a Body Mass Index (BMI) in the overweight or obese range, insulin resistance, acanthosis nigricans,
as well other factors that include ethnicity, socioeconomic status, and a family history of diabetes.1 While
many treatments have been shown to combat the risk factors of the disease one effective course of
action for this age group is a healthy diet, physical activity, and early detection. Studies have also
suggested that a key component of treatment includes patient and family adherence to lifestyle
modifications to improve risk factors.2 Because T2DM is associated with obesity and other diseases such
as heart disease, children with these conditions could expect lifelong complications as well as other
Current Research
The prevalence of T2DM among children has almost doubled two-fold in the last decade. Due to
the alarming rate to which T2DM is developing in children has put considerable strain on clinicians to
identify risk factors for early detection. In order to narrow the associated risk factors, a cross-sectional
study consisting of 971 students in grades 1 through 5 were selected based on health records and
physical assessment which included evaluating for BMI, the presence of acanthosis nigricans, gender,
ethnicity and/or current or family history of diabetes.1 From these results, the risk factors most associated
with meeting the follow-up requirements for a type 2 diabetes screening as recommended by the
American Diabetes Association could be used as markers to detect the disease. The most common
factors associated with needing a follow-up screening included: acanthosis nigricans (present in 26.9% of
the students), family history of diabetes (present in 48%), and the best indicator which included a BMI
greater than the 85th percentile (overweight).1 These results suggest factors such as nutrition and
environment are directly correlated with the diseases onset and of these nutrition especially is of great
1
importance to this age group due to parental or guardian influence over food choice, portioning, origin,
Ethnicity is also considered another underlying cause of T2DM as well as how cultural norms
could perceive risk factors of the disease. 3 A study on Mexican American immigrant families evaluated
parents perceived risks for their children. This study could play an important indicator of how these
perceptions and cultural norms could have influence over children of at-risk ethnicities such as African
Americans, Hispanics, Asian-Americans, Pacific Islander, and American Indians.3 For example, Latino
mothers perceive the appearance of good health as being moderately overweight, because comparatively
it is believed thinner children are more prone to disease and experience difficulty recovering from illness. 3
Similar cultural feelings towards health and well-being may exist amongst these other ethnic groups. The
study developed 5 focus groups consisting of 15 parents and their children. 3 Participant selections were
based on immigration status, Spanish as the primary spoken language, that their child was enrolled in the
associated Midwestern school conducting the study, and parents must be age 19 or older. Moderators
composed questions to lead discussion amongst the focus groups that aimed to determine factors related
to cultural adaptation to lifestyle in the U.S., parents level of self efficacy to their childrens eating and
behaviors, parents dilemma in controlling their childrens eating, and interest in more culturally competent
education approaches for parents. 3 The results indicated one factor that contrary to traditional Latino
values, many mothers worked outside of the home heavily relying on schools and child care to provide
meals, snacks, and sources of exercise.3 Another finding was that parents expressed great interest in
having more culturally competent education materials such as on diabetes. 3 Both of these findings could
Conclusion
The first studys purpose was to define specific risk factors as a way to detect T2DM early in
children. Strengths of this experiment design include how the participants were chosen based on risk
factors for the disease. By first selecting students based on these factors, the experiment is able to have
a decent pool size of children with already contributing risk factors of T2DM. In comparing these students
and factors, it is likely that individuals with more than one factor were at increased risk compared to their
classmates who may only be exhibiting underlying symptoms. Although this study did confirm several risk
2
factors there were many limitations. Firstly, students were measured by nurses for height and weight. 1
There is a possibility errors could be made during the measuring or calculation process. Secondly, nurses
were given a brief overview of the diagnosis of acanthosis nigricans which may have played a critical role
during the evaluation of children for a follow-up session as outlined the American Diabetes Association. 1
Thirdly, initial selection for the participants was based on a self-reported health record filled out by
parents.1 Due to the nature of how the information was reported, the criteria based for selection could
have several untruths. This study confirmed what most researchers and clinicians believe are risk factors
for children. However, this study did not provide any follow-up information regarding the children who did
continue with the follow-up diabetes screening and whether those findings could support or dismiss their
conclusion.
The second studys main strength consisted of studying an at-risk population. Considering their
participant pool consisted of new immigrants to the United States the study was also able to measure
several factors that most immigrants may face such as acculturation and adaptation, specifically diet and
exercise. Another strength was the method in which the study was conducted. By using focus groups and
open-ended discussion questions, the participants were more likely to participate which provided the
moderators more information than a typical survey which could include biases. 3 Limitations however
included, one of the criteria was that parents and students first language was Spanish, and many of them
only spoke that language.3 The researchers hired interpreters to lead the discussions based on the
researchers questioning.3 Any form of translation could cause information to be misinterpreted and/or not
perceived in the same manner. Another limitation included that although there was an agreed upon time
for focus groups meetings, participants did not complete the study and stopped coming resulting in less
data.3
Monitoring diet and intake is a method to keep blood sugar in control as well as a way to lose
weight and avoid unnecessary weight gain. Treating T2DM by a healthy diet can be challenging for this
age group because of lack of control over food choices as well as if there is not a commitment from family
members to also accept these lifestyle modifications. The American Diabetes Association (ADA)
recommends measuring intake to gauge spikes in blood sugar.4 They recommend choosing foods with 25
3
grams or less of carbohydrate and that contain at least 3 grams of fiber. They also recommend choosing
foods that are low in fat. 4 The guide also provides an easy to follow tool for reading food labels that both
parents and children can learn. Other recommendations include: getting adequate exercise, avoiding
sugary drinks like soda and juices, eating smaller portions, and not skipping meals.4
http://www.diabetes.org/living-with-diabetes/parents-and-kids/children-and-type-2/
References
(1) Scott L. Presence of type 2 diabetes risk factors in children. Pediatric Nursing. 2013; 39(4): 190-
180. Doi:
(2) Pulgaron E, Delmater A. Obesity and type 2 diabetes in children: epidemiology and
treatment. A.M. Curr Diab Rep. 2014 14: 508. doi:10.1007/s11892 -014-0508-y
(3) Baker S, Bar K, Head B. Mexican american parents perceptions of childhood risk factors for type
(4) American Diabetes Association Information for Youth and Their Families Living With Type 2
type-2/