Almost every week across Colorado, a child is diagnosed with a potentially deadly disease that used to occur only in adults.
These young patients are developing type 2 diabetes – what used to be called “adult onset” diabetes. The disease is strongly linked to obesity, and it used to take decades to develop in adults. But in the past two decades, the degenerative disease suddenly began showing up in children.
“It’s a known, predicted disaster if we do nothing – if we just sit back and watch,” said Chris Lindley, director of the Prevention Services Division of the Colorado Department of Public Health and Environment.
What’s not known is how big a disaster it could be.
“We have no idea what this disease is going to do in terms of numbers,” said Dr. Michael McDermott, president of the American Diabetes Association – Colorado Leadership Board. “We don’t even have data that could be possibly accurate, since we’ve never had a generation that grew up obese.”
It’s not yet apparent, however, that the entire state sees the urgency.
One thousand Coloradans are participating in Gov. John Hickenlooper’s TBD Colorado initiative to identify public policy changes needed in Colorado. They were polled recently, given a list of 10 policies and asked which should be top priorities to implement in the next two years.
Two of the three receiving the weakest support were exactly the types of remedies that anti-obesity advocates stress must be priorities. Healthy food choices for students were backed by fewer than 7 percent of the TBD participants, while physical education in schools was supported by the fewest – just 6 percent.
Raquel Villa was 12 years old and in seventh grade when she was diagnosed with type 2 diabetes. She weighed 250 pounds.
“I didn’t really know what it was,” the now-17-year-old Denver resident says. “I just know that it’s a disease that if you’re not careful, you can die from it. It can get out of control. You can lose body parts from it.”
Raquel’s doctor is Philip Zeitler, chief of endocrinology at Children’s Hospital Colorado and a world renown expert in type 2 diabetes among children. He was a co-author in 1996 of the first study in the U.S. documenting a marked increase in the disease among young people in the U.S. and internationally.
Back then, he sounded the alarm about a coming epidemic of childhood type 2 diabetes. But by the year 2000, the numbers of children diagnosed each year had leveled off, Zeitler says, and has remained relatively flat both in Colorado and across the nation.
About 50 Colorado children are diagnosed with type 2 diabetes each year, Zeitler estimates. There are no reliable surveys to pinpoint the number any more precisely than that. Nationwide, slightly fewer than 4,000 children are diagnosed with type 2 diabetes in the U.S. each year, according to the Centers for Disease Control and Prevention.
“That’s still 4,000 more than what we used to see,” Zeitler says.
“It may be that childhood obesity is leveling off,” says Dr. Richard Hamman, professor and founding dean of the University of Colorado School of Public Health. “But it is leveling off at a pretty high level, and it is not clear where those trends are going to go, particularly with minority populations.”
Colorado’s changing demographics make predicting the future of type 2 diabetes both difficult and worrisome. The numbers that predict higher incidence of type 2 diabetes are all rising in Colorado:
• Childhood obesity. Colorado children have been historically less obese than others, but childhood obesity rates have been rising faster here than almost anywhere in the nation. The most recent data available are from 2007 and show 14 percent of Colorado children are obese.
• Growing minority population. Type 2 diabetes is more prevalent in minority populations. And while the portion of African Americans and American Indians in Colorado is expected to remain steady, the population of Latinos is expected to nearly double by 2030, according to data from the State Demography Office.
• Growing poverty. Type 2 diabetes also is more prevalent among poorer populations. And the 2010 census found poverty rates among children had risen in every county in Colorado. Now one in six Colorado kids lives in poverty.
“I think it is difficult to be sure what the prevalence of diabetes will be in the future, as it is difficult do extrapolate from current rates of rise,” Zeitler said.
Indeed, estimates vary widely on how many Colorado children will develop diabetes by the time they grow up. The Colorado Health Foundation estimates that one of every eight Coloradans will have diabetes by the year 2030.
That includes both type 1 and type 2 diabetes. Type 1 is more rare, accounting for only 5 percent of diabetes cases. It’s believed to be related to an environmental trigger, such as a virus. Type 2 develops over time, when a person’s pancreas can no longer produce enough insulin, the hormone that regulates blood sugar.
Dr. Mark Wallace, executive director of the Weld County Department of Public Health & Environment who was tapped as an expert in the statewide TBD process, thinks the number will be closer to one in four.
“If we don’t begin to look at it, if we don’t change things, we’re going to go from 6.5 percent having diabetes to a place where 25 percent of our adults do – and that starts with childhood obesity,” Wallace said.
McDermott, the local Diabetes Association president and director of the Endocrinology and Diabetes Practice at University of Colorado Hospital, said he believes many people “are underestimating, because they’re not looking at the kids and teenagers. We’re estimating that growth based on adults.”
Raquel Villa sits at a table in the mobile home she shares with her father and younger brother on Denver’s west side, the vital tools of her health maintenance arrayed in front of her.
She slips a fresh test strip into the meter that will read her blood glucose level. She lances the tip of one finger, depositing a tiny drop of her blood on the end of the strip. A moment later, the meter registers a number.
Raquel weighs less now than when she was diagnosed with type 2 diabetes, though she admits to not having stepped on the scales recently. When Raquel was in eighth grade, her mother – battling brain cancer and diabetes – had to go live in a nursing home. Raquel went to live with an aunt.
“I lost 75 pounds when I lived with her, and my diabetes was really good,” recalls Raquel, who has pursued activities such as ROTC, to stay active.
“The doctors were really impressed, and it was really in control and I didn’t have to worry about it as much and that’s when I got off the insulin. And I started being physically active, and eating right.”
Zeitler, Raquel’s doctor, is watching her health closely. His latest published study shows that type 2 diabetes develops more rapidly in children than adults and also is less treatable – meaning children are more likely to have substantial health problems related to diabetes when they reach adulthood.
Raquel is trying to be optimistic.
“If I was at the point where I could lose an arm, or a leg – or like some people, their teeth or something like that – then I would be scared,” she said. “If I had out-of-control diabetes, I would be scared to die. But I’m not at that point. So, I’m not scared of anything.”