Diabetes mellitus is a condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use it properly. The hormone insulin is needed to allow glucose to pass into the body cells to provide energy.

Glucose comes from the digestion of starchy foods such as bread, rice, potatoes, from fruit, from some dairy products and from sugar and other sweet foods. Glucose is also stored and released from the liver. Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance).

The vast majority of children with diabetes have Type 1 diabetes, but an increasing number are now developing Type 2 diabetes. Children most at risk of Type 2 diabetes are those (1):

• between 10-20 years old
• of non-white European descent who have a close family member with Type 2 diabetes 

In 2002 The National Diabetes Audit (2) identified 102 children with Type 2 diabetes in the UK, an increase of 36 per cent from the previous year. The children were mainly from black and minority ethnic (BME) groups and this number continues to rise and spread through all communities and all backgrounds as children become less active and more overweight.

In October 2004 a Diabetes UK report Diabetes in the UK estimated that the number of children with Type 2 diabetes in the UK could be as high as 1,400 (3). This estimate was based on a survey of the number of overweight and obese schoolchildren in the UK.

Once the diagnosis has been made, the child should be referred to a paediatric specialist diabetes team including a registered dietitian so that close monitoring and support is available to give help to make the necessary changes in lifestyle. A positive attitude to this is necessary, as the child's weight problems may not have been recognised within the family, especially if other family members are overweight.

Important points to remember:

• The whole family must be involved in the necessary lifestyle changes.
• The child's level of physical activity should be increased to one hour per day (4).
• A healthy eating plan is necessary to achieve weight control and good blood glucose levels.
• A child with Type 2 diabetes and their family should be referred to a registered dietician who has knowledge and experience looking after children with diabetes (1)
• Medication to help achieve good blood glucose control may be used. This is usually a tablet called Metformin. It works by reducing the amount of glucose produced by the liver and by making it easier for the muscle cells to accept insulin. Because of the way it works, it doesn't lower the blood glucose enough to cause hypoglycaemia. It can help in weight loss with changes to healthy eating. Other medication, including insulin injections, may also be required. 
• Your child's paediatric diabetes team will check your child at least every year to make sure that they are not developing any of the complications of diabetes. If signs of complications are found, treatment is available.
• Your child’s paediatric diabetes team will test your child's blood regularly to check that the kidneys are not affected by the medication. It is very important to continue the treatment as raised blood glucose levels are known to cause complications that may seriously affect the eyes, kidneys and later the heart, nerves and legs and feet.

The importance of preventing Type 2 diabetes in children cannot be overstated, as this is a progressive, lifelong condition that can lead to serious complications. 

Effective prevention:

• Keep your child's weight at the right level for their height. The 'centile' lines can be found in your child's health record book and your family doctor or health visitor will be able to explain what these are.
• Try to encourage active hobbies. These are even more enjoyable if the family joins in, so think about going out for a walk together, going swimming or for a bike ride.
• If you are concerned that your child is overweight or is at risk of developing diabetes you should ask your GP, health visitor or school nurse for further advice and support.

International Society for Paediatric and Adolescent Diabetes (ISPAD) have produced guidelines for the management of Type 2 diabetes, visit their site for further information (www.ispad.org).   

References:

1. International Society for Paediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines (2009) (http://www.ispad.org/
2. Diabetes UK in collaboration with Royal College of Nursing, Royal College of Paediatrics and Child Health & British Society for Paediatric Endocrinology and Diabetes (2004) The National Paediatric Diabetes Audit:  Results from the audit year 2002 London: Diabetes UK
3. Lobstein T & Leach R (2004) Diabetes may be undetected in many children in the UK British Medical Journal 328: 1261-1262 (22 May)
4. Department of Health (2004) At least five a week: Evidence on the impact the impact of physical activity and its relationship to health London: Department of Health