Call for action to make an impact at the community level

 School group tours of the Diabetes Management & Education Centre at the Banting Homestead Heritage Park in Alliston, Ontario, begin with 15 to 20 minutes of exercise to emphasize the importance of physical activity to reduce the risk of type 2 diabetes. Sir Frederick Banting Legacy Foundation

School group tours of the Diabetes Management & Education Centre at the Banting Homestead Heritage Park in Alliston, Ontario, begin with 15 to 20 minutes of exercise to emphasize the importance of physical activity to reduce the risk of type 2 diabetes. Sir Frederick Banting Legacy Foundation

Research shows that unhealthy weight is a major risk factor for type 2 diabetes in youth, says Dr. Shazhan Amed, clinical associate professor in the Department of Pediatrics at BC Children’s Hospital and co-lead of a study, supported by the Canadian Paediatric Surveillance Program, to track the disease, that was virtually non-existent in this country 25 years ago.

Dr. Amed, who led the first study to research the incidence of type 2 diabetes in Canadian youth 10 years ago, is currently repeating the study to determine trends. Early indications are that there is an increasing incidence of under-18s with the disease, she says.

“We also know from very good studies that the earlier the onset of type 2 diabetes, the higher the risk of early death,” says Dr. Amed. She adds that the first study revealed that one-third of the cases – diagnosed at an average age of 13 and half years – already had one complication such as high blood pressure, high cholesterol, evidence of kidney disease and fatty liver disease.

Type 2 diabetes is the consequence of the body not adequately responding to insulin, resulting in insulin resistance. Eventually the cells are unable to maintain normal levels of blood sugar, resulting in type 2 diabetes.

Unhealthy diet and inactive lifestyle are also key risk factors. Some ethnic groups – South Asian, Hispanic, African and Indigenous people – are at a higher risk to develop the disease. (See: Check Your Risk)

“What is very alarming is that the onset of complications such as renal disease, eye disease and cardiovascular disease happens much faster [in children] than in adults. This disease in children is different [than in adults],” says Dr. Amed.


We hope the study will inspire and motivate governments and funding agencies to provide the resources that are needed to make an impact at the community level.
— Dr. Shazhan Amed, clinical associate professor in the Department. of Pediatrics at BC Children’s Hospital

While the overall number of children and youth with type 2 diabetes is low compared to the numbers in adults, the disease is a significant public health crisis, she says.

“These youth become adults, and in the years when they are supposed to be in university or in college or contributing to the economy and working, they’re actually going to be in hospital or utilizing the health-care system to treat and manage not just their diabetes, but the complications that result from it, which are very serious.”

But obesity in childhood is a very complex issue, says Dr. Amed. Many factors, ranging from poverty and culture to personal beliefs and parenting, contribute to children having access to healthy food. Other influences are the environment youth live in: the safety of their neighbourhood, their access to recreation within their neighbourhood, and the policies in their schools and in places such as rec centres where concessions sell unhealthy options like potato chips, juice and pop, she says.

“There needs to be action across all sectors of society – the healthcare system, our education system and local governments who set the policies across a geographic community. The environment has to be reassessed to ensure it supports children in being active,” she adds.

“My hypothesis, based on our first year of research, is that we are seeing more cases of type 2 diabetes in the under-18 population. We’re not making a dent yet. We need to take more action, and that action needs to be focused on prevention,” she says.

“If there’s one thing we know as clinicians, it is that once a child has obesity and type 2 diabetes, it’s very difficult to reverse.

“We hope the study will inspire and motivate governments and funding agencies to provide the resources that are needed to make an impact at the community level,” says Dr. Amed.

Achieving continuity of care as children transition to the adult health-care system is also a challenge, says David Sadleir, president of the Sir Frederick Banting Legacy Foundation (SFBLF).

This challenge is one of SFBLF’s priorities and was the stimulus to initiate the Banting Legacy Symposium for health-care professionals that focuses on clinical innovation and process improvement to smooth the transition from pediatric to adult health care. This year the symposium will be held on November 14.

For more information see bantinglegacy.ca.