Emory
Physicians at Grady See Growing Trend of Younger, Obese Adults With
Diabetes
Traditionally,
Type 2 diabetes has been thought of as an older person's disease. Yet
more recently, younger adults and even some children and teens are being
diagnosed and treated for Type 2 diabetes, a disease that affects 16
million Americans, and continues to grow at epidemic proportions.
Emory University physicians
at Grady Memorial Hospital's Diabetes Clinic say the rising rate of
diabetes among younger adults is strongly linked to obesity. Imad M.
El-Kebbi, M.D., associate professor of medicine at the Emory University
School of Medicine and endocrinologist at Grady's Diabetes Clinic, said
he now sees a growing number of patients in their late teen-age years,
and others in their 20s and 30s.
"We're seeing more 20- and
30-year olds with Type 2 diabetes than people would have expected several
years ago," Dr. El-Kebbi said. "A lot of that could be related to the
problem of obesity, which is increasing in the United States and across
the world."
In an analysis conducted
in 1999 and presented to the American Diabetes Association National
Meeting in 2000, Dr. El-Kebbi compared 2,539 younger and older adults
at Grady with Type 2 diabetes seen at Grady between 1991 and 1999. He
concluded that younger patients were more obese, had worse glycemic
control, and did not respond as well to nutritional and drug management.
Those same patients, who averaged 25 years of age with a Body Mass Index
of 37.8, needed aggressive treatment to lower their blood sugar. (Body
Mass Index, which is a ratio of weight to height, is an accepted measure
for obesity. A BMI of 30 or above is defined as obese, and 40 or above
is defined as severely obese.) Younger age was recognized as a risk
factor for poor control in African-American patients in the Grady analysis.
Diabetes results from the
body's inability to produce or properly use insulin, which is necessary
for the body to use sugar. High blood sugar over time damages the body's
small blood vessels and can also lead to atherosclerosis. Therefore,
diabetes can damage the kidneys, nerves, and the blood vessels of the
heart. Obesity and sedentary lifestyles often play significant roles
in the development of Type 2 diabetes. Type 1 diabetes, by contrast,
begins when the pancreas totally loses its ability to produce insulin,
usually in childhood.
Obese children – especially
those of African-American and Hispanic descent - are at increased risk
for Type 2 diabetes. And while Grady's Diabetes Clinic does not serve
children and teen-agers, pediatricians at nearby Hughes Spalding Children's
Hospital, which is part of the Grady Health System, are treating more
children for Type 2 diabetes. And according to a recent study in the
Journal of the American Medical Association, for example, 21 percent
of African-American and Hispanic-American children ages 4 to 12 were
considered overweight, as compared to 12 percent of non-Hispanic white
children.
Dr. El-Kebbi stressed that
younger patients with type 2 diabetes need aggressive management.
"The best way to lower damage
from diabetes, as far as we know right now, is to bring the sugar down
to normal and keep the blood pressure and cholesterol under control,"
Dr. El-Kebbi said. "All of these issues are extremely important. If
it's harder for younger people to lower their blood sugar, that means
we (physicians) have to work harder to bring it down. Already, more
of our young people are on insulin. Insulin alone or in combination
with oral medications tends to be the last line of therapy."
Dr. El-Kebbi hopes to develop
interventions, projects and programs that would make significant improvements
in treating younger diabetes patients.
About the Grady Diabetes
Clinic
The Grady Diabetes Clinic
was founded in the early 1970s. The clinic pioneered culturally appropriate
dietary management, and has been active in research for 30 years. It
is reportedly the largest clinic for African-Americans with diabetes
in the country. Over the past three decades, research and teaching efforts
have been improved and expanded. The clinic provides care for more than
4,000 established patients and about 1,000 new patients each year.
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