When most people think about type 2 diabetes, they likely picture adults that have developed the chronic disease due to a family history or as the result of age-related insulin resistance, sedentary lifestyle, and/or weight gain.However, type 2 diabetes is no longer seen as “adult-onset.” As the rate of childhood obesity increases, the rate of type 2 diabetes is on the rise too.Diabetes 101:Type 1 diabetes is an autoimmune disease and roughly 10% of diabetes cases are type 1. In type 1 diabetes, the beta cells of the pancreas are damaged and unable to produce enough insulin to regulate blood sugar. It usually occurs early in life (before the age of 20), but may be diagnosed at any time. Individuals with type 1 diabetes will require insulin for the rest of their lives. This could be in the form of insulin shots or through an insulin pump, which provides insulin based on the amount of carbohydrate consumed per meal.Type 2 diabetes occurs when the body “rejects” or resists insulin in the body. Glucose cannot enter the cells to be used for energy and instead stays in the blood, resulting in higher-than-normal glucose levels. Insulin resistance can happen when a person has a family history of diabetes, is overweight or obese, or has a sedentary lifestyle. While excess sugar consumption does not cause diabetes, it may lead to obesity, which is a risk factor.The CDC estimates that close to 34 % of US adults (over age 18) have pre-diabetes, a condition of insulin resistance that may lead to diabetes. Lifestyle modifications including diet and exercise and medication may reverse insulin resistance and prevent type 2 diabetesChildhood Type 2 Diabetes:Recent studies indicate that 1 in 5 teens have pre-diabetes. One risk factor is exposure to gestational diabetes in utero. Adolescents born to mothers with diabetes, hyperglycemia, hyperlipidemia, and obesity are at elevated risk. Experts advise that the first 1,000 days of life are crucial in getting infants off to a healthy start to stave off diabetes. This includes breastfeeding if able, starting solid food between the ages of 4 to 6 months and limiting processed foods with added sugars. Previous measures to reduce pediatric obesity have revolved around behavioral changes such as increasing physical activity and controlling diet. However, these interventions may not be effective long term. A recent review in Current Obesity Reports suggests targeting community efforts to reduce childhood obesity. This includes promotion of healthier food choices through taxes of unhealthy food, increase in daily exercise beginning in kindergarten, and mandatory standards for school meals. How Can Healthcare Providers Make a Difference?Since the root of childhood obesity may be related to maternal nutrition, improving access to healthcare for high-risk pregnant women is a good start in preventing diabetes in their offspring. Programs such as WIC should be supported and encouraged. One study suggested that mothers who breastfed their children for up to 6 months were nearly 3 times more likely to utilize WIC services through 2 years of their child’s life than those that did not. WIC provides nutrition education in addition to SNAP benefits. In addition to encouraging WIC participation, healthcare professionals can suggest their students to get involved in DSME (diabetes self-management) programs. A recent study found that nursing, pharmacy and physical therapy students benefit from training as health coaches to help patients make behavioral changes in underserved, federally-qualified health centers. Finally, diet and exercise cannot be discounted in the treatment and prevention of diabetes. While most health professionals discourage strict dieting in children, the following may help when counseling clients:

1. Discourage regular soda consumption and counsel parents on the benefits of water and milk in young children. 
2. Encourage parents to feed kids nutrient-dense foods from a variety of sources to allow for proper growth and development.
3. Limit “kid-based” meals like mac n' cheese and chicken nuggets. These are high in sugar, fat, and sodium.
4. Get out and play with kids. Kick a ball, take a walk, ride bikes. Encourage physical activity throughout their childhood so it becomes a regular habit.
5. Be a role model. Kids are watching. Encourage healthy food choices by making them yourself. 

By Lisa Andrews, MEd, RD, LDReferences:

1. Diabetes Statistics | NIDDK (nih.gov)
2. Rughani A, Friedman JE, Tryggestad JB. Type 2 Diabetes in Youth: the Role of Early Life Exposures. Curr Diab Rep. 2020 Aug 7;20(9):45. doi: 10.1007/s11892-020-01328-6. PMID: 32767148.
3. Weihrauch-Blüher S, Wiegand S. Risk Factors and Implications of Childhood Obesity. Curr Obes Rep. 2018 Dec;7(4):254-259. doi: 10.1007/s13679-018-0320-0. PMID: 30315490.
4. Lakshmanan A, Song AY, Flores-Fenlon N, Parti U, Vanderbilt DL, Friedlich PS, Williams R, Kipke M. Association of WIC Participation and Growth and Developmental Outcomes in High-Risk Infants. Clin Pediatr (Phila). 2020 Jan;59(1):53-61. doi: 10.1177/0009922819884583. Epub 2019 Oct 31. PMID: 31672064; PMCID: PMC8345225.
5. Engelhard C, Lonneman W, Warner D, Brown B. The implementation and evaluation of health professions students as health coaches within a diabetes self-management education program. Curr Pharm Teach Learn. 2018 Dec;10(12):1600-1608. doi: 10.1016/j.cptl.2018.08.018. Epub 2018 Sep 14. PMID: 30527826.