Type 2 diabetes on the rise

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An estimated 25 per cent of children and adolescents in North America are overweight and about 15 per cent are clinically obese. Troubling numbers, particularly in light of the serious implications obesity poses to our health and the health-care system.

For example, doctors at the diabetes/endocrinology clinic at BC Children’s Hospital have seen a 15-fold increase in children and youth with Type 2 diabetes in the last 10 years, and directly relate this increase to the obesity epidemic. Children as young as eight years old are being diagnosed with what was traditionally an adult onset disease.

New data from Statistics Canada show a 75 per cent rise over the last decade in the number of people dying from Type 2 diabetes. The 7,800 deaths recorded in 2002 represent almost an 11 per cent jump over 2001. One in three people with diabetes don’t know they have it Ð more than 60,000 British Columbians.

“Of the 100 patients in our Type 2 diabetes clinic, 50 per cent already have Type 2 diabetes and the other half are on their way,” explains Dr. Jean Pierre Chanoine, head of the diabetes/endocrinology clinic at BC Children’s. “Those most at risk include overweight patients and patients with acanthosis nigricans or polycystic ovarian syndrome. What’s of particular concern is how rapidly diabetes-related problems, such as retinopathy and nephropathy, occur in the younger population. It’s a compressed timeline when compared to adults who develop Type 2 diabetes later in life.”

A decade ago, doctors at BC Children’s rarely saw anyone under age 30 with Type 2 diabetes. Now, however, physicians routinely test fasting blood glucose levels to catch the disease early, which, along with good management of the disease, greatly reduces the risk of complications.

“This is already impacting our health-care resources significantly and we are only seeing the tip of the iceberg. We need to look at the big picture, and we need to work collaboratively in order to prevent a public health crisis.”

Part of this collaborative approach is reflected in a partnership program between BC Children’s and the Canadian Diabetes Association. Currently operating as a pilot project for youth, Cooking for Your Life! is based on the Association’s successful cooking classes for diabetic adults.

A total of 18 families will participate in the pilot. They attend three three-hour cooking classes on healthier recipes, and one two-hour shopping session to make better food choices. Participants will be followed for six months to assess changes in shopping, eating, and cooking behaviour. The classes and recipes are tailored not only for a diabetic-friendly diet but also to reflect the tastes and lifestyles of children and teens.

“The aim of the program is to provide hands-on practice in cooking healthy meals and snacks so families are further empowered to manage their diabetes,” said Doreen Yasui, a registered dietician at BC Children’s who teaches Cooking for Your Life! classes.

“Data from the pilot project will tell us what our patients and families learned. That analysis should be complete by October,” says Dr. Dina Panagiotopoulos, an endocrinologist with BC Children’s. “We’ve received valuable feedback from the parents and the youths already.”

Another innovative Vancouver program treating childhood obesity and the complications that can result is “Shapedown Vancouver”. The Shapedown program is a family-centred, multidisciplinary approach to treat childhood obesity. Shapedown was developed in the U.S. and includes contributions from nutrition, exercise physiology, endocrinology, psychology, family therapy, adolescent medicine, family medicine and behavioral and developmental pediatrics.

Two group programs were initially run last year by BC Children’s in conjunction with Vancouver Coastal Health and the South Slope YMCA as part of a research pilot project. The programs have now received funding approval and operators are providing the full Shapedown program, with hopes to expand to other areas of the province.

“As a physician, it is difficult to see children facing this type of serious health issue, that may be completely preventable. Hopefully by working together with programs such as Cooking for Your Life and Shapedown, and by instilling these lessons at an early age, we can help these young people improve their quality of life,” explains Dr. Panagiotopoulos.