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As Diabetes Rises In Kids, So Do Treatment Challenges

Pong, soda and junk food: the beginning of the end for health?
Pong, soda and junk food: the beginning of the end for health?

More kids than ever have Type 2 diabetes, the kind that used to be referred to as the adult-onset variety.

It's a sign of our sedentary, calorie-rich times. Childhood obesity, a risk factor for Type 2 diabetes, is commonplace. For teens, about half of new cases of diabetes are now Type 2 compared with just 3 percent a few decades back.

So what's the best way to treat the growing number of kids? Results from a study, involving nearly 700 children over an average of almost four years, are downright discouraging.

Only about half of the children, ages 10-17 at the study start, were able to control their blood sugar adequately with the generic drug metformin (the only diabetes pill approved for kids) by itself. A combination of metformin and Avandia (a drug whose use has been severely restricted because of safety issues since the study started in 2004) did a little better — about 60 percent got their blood sugar under control.

But the real bummer was that adding lifestyle interventions to metformin to improve diet and exercise didn't seem to help.

The findings, made public at a meeting of pediatricians in Boston over the weekend, were published online by the New England Journal of Medicine.

An editorial about the results by David B. Allen, a pediatrician at the University of Wisconsin med school, is pretty troubling. Metformin didn't work in kids as well as it worked in adults, he points out. And the lifestyle intervention were a bust. So the findings suggest that most kids will need multiple drugs or insulin to deal with their Type 2 diabetes within a few years of being diagnosed, he writes.

On lifestyle, it's too easy to blame kids for a lack of willpower and an inability to stick with better eating habits and a more active lifestyle. Today's children are growing up in a "obesogenic world," Allen writes, and that undermines them.

"Fifty years ago, children did not avoid obesity by making healthy choices; they simply lived in an environment that provided fewer calories and included more physical activity for all," he writes.

The ultimate answer, he suggests, will depend on public policy: incentives to make healthful foods more available and attractive and encouragement for the construction of environments that "require physical movement."

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Scott Hensley edits stories about health, biomedical research and pharmaceuticals for NPR's Science desk. During the COVID-19 pandemic, he has led the desk's reporting on the development of vaccines against the coronavirus.