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Commentary: Prediabetes in Children—5 Things Parents Need to Know

29/10/20 Andrew Calabria, MD, The Children's Hospital of Philadelphia|Perelman School of Medicine at The University of Pennsylvania;

It’s a fact of life in today’s society: diabetes isn’t just a concern for adults. Nearly one in five adolescents are living with prediabetes and are at greater risk of developing type 2 diabetes.

It’s a health risk that should be on every parent’s radar.

What is Diabetes?

Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin it does produce. It can lead to a host of health complications involving the eyes, kidneys and nerves and can even increase the risk for earlier onset of heart attack and stroke.

Diabetes is broadly divided into two types:

  • Type 1 diabetes is an autoimmune condition that occurs when the pancreas produces little or no insulin due to destruction of its insulin-producing cells. Symptoms of type 1 diabetes often start quickly and be include increased thirst, increased urination, bedwetting and unintentional weight loss.
  • Type 2 diabetes occurs because the cells in the body do not respond adequately to insulin (called insulin resistance) and cannot make enough insulin to make up for insulin resistance. Type 2 diabetes is more commonly associated with genetic predisposition and obesity. The onset of type 2 diabetes is more gradual and can develop over years. Children with type 2 diabetes may present without symptoms or with symptoms similar to patients with type 1 diabetes.

Over the last 25 years, type 2 diabetes has become much more common in children.

What is Prediabetes?

Prediabetes is when there’s a problem with how the body handles glucose and blood sugar levels are too high to be normal but not high enough to meet criteria for diabetes. Prediabetes is a critical warning sign in children at risk of developing type 2 diabetes.

Preventing that progression from prediabetes to type 2 diabetes means recognizing prediabetes signs and taking proactive steps to reduce blood sugar levels. Here are five things parents should know about recognizing and addressing prediabetes in children.

1. Prediabetes is Reversible

The good news: prediabetes can be prevented and reversed, typically through lifestyle changes that doctors recommend first before prescribing drugs. The not-so-good news: these changes are challenging for kids to stick with over the long term.

2. There are Warning Signs for Prediabetes

Generally, doctors screen at-risk kids for diabetes when they are approaching or during puberty. But parents should be alert for things that increase a child’s risk of diabetes and that should prompt an earlier conversation with their doctor. Obesity in children is one of the biggest red flags. Also, children of Latino, African American, Native American, and Asian American descent are at increased risk. Additionally, some children may have darker patches of skin around the neck, armpit or groin, a condition known as acanthosis nigricans, that is associated with insulin resistance. Other risk factors include high blood pressure, high cholesterol and, for girls, polycystic ovary syndrome.

3. Family History Plays a Significant Role

In addition to the above warning signs, family history can be a significant predictor. About half of children with prediabetes have a first-degree relative with diabetes, and that percentage climbs to 90 percent when you include grandparents.

That means that when children are struggling with prediabetes or diabetes, another family member often is as well. This creates an opportunity to tackle issues like healthy eating and exercise as “family projects” where different members support each other’s efforts. But it’s also important to give kids autonomy in making better lifestyle choices, especially as they get older. They may not be able to control their family history, but they can control their approach to staying healthy.

4. Healthy Eating is Essential

Here are a few actionable steps parents can encourage to help reduce obesity and the risk of prediabetes in their children:

  • Don’t drink your calories – limit fruit juices, soda and other sugary beverages.
  • Avoid processed foods – opt for fresh, whole foods over fast food and packaged snacks.
  • Limit portion sizes – eat smaller meals and save the leftovers. Review suggestions on
  • Limit snacking between meals focus on the main meals of the day.
  • Limit eating out at restaurants – avoid the temptation of high-calorie or fried foods.

5. Routine Physical Activity is More Important than Ever

COVID-19 has disrupted our daily routines in so many ways. Previously, kids were getting exercise at school—at recess, while in gym class, and even just walking between classes and to and from school. Now, kids are spending more time at home and more time in front of screens.

To prevent and reverse prediabetes, it’s important to help kids establish healthy physical activity routines throughout the day. Make sure children are getting up and moving around and engaging in physical activities away from their TV, laptop, or phone.

To learn more about prediabetes and diabetes in children, check out the Manuals page on diabetes in children and the Manuals Quick Facts on the topic.

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