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One plus two makes trouble

Health experts report a rising incidence of "double diabetes" patients: children with symptoms of both type 1 and type 2 versions of the disease.
/ Source: a href="" linktype="External" resizable="true" status="true" scrollbars="true">The Washington Post</a

Health experts report a rising incidence of "double diabetes" patients: children with symptoms of both type 1 and type 2 versions of the disease.

Type 1 diabetes, usually diagnosed in children or teens, is the result of the body's inability to make insulin, which raises levels of blood sugar. Type 2 diabetes, traditionally found in overweight and inactive adults, occurs when the body's cells become resistant to insulin, also resulting in high sugar levels, which in turn raise the risk of heart disease, blindness and kidney damage. Type 2 is increasingly being diagnosed in children who are heavy and sedentary, and clinicians are noticing an overlap of the two conditions in children.

Dorothy Becker, chief of the Division of Pediatric Oncology at Children's Hospital of Pittsburgh, reported on the condition -- sometimes called type 1.5 or type 3 diabetes -- last month at an American Diabetes Association meeting.

In a study published in 2003, Becker and her team followed 260 youths diagnosed with diabetes and treated with insulin from 1979 to 1998. "We found that 25 percent of children who had type 1 diabetes developed features of type 2 diabetes."

The study also showed that more than 50 percent of overweight children with type 2 diabetes had features of type 1 diabetes.

It is not clear whether type 1 diabetes combined with obesity causes type 2, or whether type 2 triggers the symptoms of type 1 in susceptible individuals. Research is still at an early stage. But experts believe the epidemic of childhood obesity is one reason behind the increase in the number of children diagnosed with this condition.

According to the American Diabetes Association, 80 percent of youths found to have type 2 diabetes are overweight or obese at the time of diagnosis. Obesity has almost quadrupled among children and doubled among adolescents in the past 25 years, according to the National Institutes of Health. Since minority groups, including Native Americans, Hispanics and African Americans, have higher rates of childhood obesity, they are at greater risk of developing double diabetes.

"Almost all the [clinicians] I know admit to an increase in the number of cases," Becker said, but not everyone agrees with what to call it.

"My bias is that the term 'double diabetes' confuses rather than clarifies," said Phillip Zeitler, associate professor of pediatrics at the University of Colorado Health Sciences Center in Denver. "This is a combination of both types of diabetes, but it's not a new type of diabetes. It's the consequence of [having] type 1 diabetes in a progressively obese population."

A gray area
The overlap of the two versions has created a gray area in diagnosis, so that "differentiating between the types of diabetes is becoming increasingly challenging," Becker wrote in her 2003 paper.

Many times, overweight and obese children who show symptoms of diabetes -- such as dehydration, excessive urination or thirst -- are thought to have type 2, explained Fran Cogen, the diabetes program director at Children's National Medical Center in the District. "But when we do the lab work, we find that the results are consistent with the possibility of type 1." In addition to high blood and urine sugar, type 1 diabetics often have elevated levels of certain antibodies in their blood.

There is no agreement on a treatment for the combination condition, Becker said. "Some of us treat [the patients] with insulin [which is usually prescribed for type 1] along with medication [such as metformin, which is usually used for type 2]. And some think that children shouldn't be put on insulin" at all, she said.

It is too soon to determine what the long-term effects of double diabetes are. "That's one of the questions we're trying to answer -- if these patients get a double whammy of complications," Becker said. In addition to running the risk of the most dangerous effects of diabetes, people with type 2 diabetes sometimes develop thickened skin in neck and underarms. Obese people with diabetes may also suffer from problems related to obesity such as high blood pressure and sleep apnea.

Meanwhile, Becker recommended that overweight children have their blood sugar checked annually.

But experts agree that moving children toward an improved lifestyle -- a healthier diet and more physical activity -- is the best approach.

"The bottom line here is frustration," Becker said. "How do you get it across to the public that giving kids healthy food is not deprivation? How do you get across that feeding healthy food to children is better than what they want? We've got to start somewhere, and the public needs to know that it's important" to adopt a healthier lifestyle. ·