Over 29 million individuals in the United States currently manage diabetes (Hassanein, 2023). Experts are warning that diabetes cases to experience a significant surge among young individuals in the coming decades, highlighting the need to prioritize health in the United States. A comprehensive study funded by the federal government examined the rise in diabetes cases between 2002 and 2017 and projected future trends until 2060. The research also explored health-equity factors and predicted that among children with Type 2 diabetes, non-Hispanic Black children would have the highest rates, closely followed by Hispanic children. White children and those in the “all others” category are projected to have significantly lower rates. For Type 1 diabetes, the study predicted that white children would have the highest rates, followed by Hispanic children and then non-Hispanic Black children. Children in the “all others” category were expected to have the lowest rates in comparison (Villalpando, 2023).
According to a recent study by the Centers for Disease Control and Prevention (CDC), by 2060, the number of individuals younger than 20 years old with Type 2 diabetes could reach as high as 220,000—an alarming increase of nearly 700%. Additionally, cases of Type 1 diabetes, the most common type among young people, could rise by 65%. The study’s overall estimates suggest that over half a million young individuals may be affected by diabetes in 2060 if current trends persist alongside population growth. In 2017, the number stood at 213,000, as reported in the research published by the American Diabetes Association’s Diabetes Care journal (Hassanein, 2023).
Based on the most recent data provided by the CDC, approximately 283,000 children and teenagers under 20 have been diagnosed with diabetes. Most of these cases, around 244,000, are attributed to Type 1 diabetes. Recent studies have also indicated a rise in Type 2 diabetes among children and adolescents. Between 2017 and 2020, nearly 14.7 million young individuals, accounting for almost 20% of this population, experienced obesity—a known risk factor for Type 2 diabetes. It is noteworthy that Hispanic and Black children faced the highest rates of obesity, highlighting disproportionate health disparities within these communities (Hassanein, 2023). These latest research findings should serve as a wake-up call to raise awareness and take action. We must prioritize our efforts to prioritize the health and well-being of all Americans, particularly our young population.
Diabetes Mellitus
Diabetes mellitus is a chronic medical condition that hinders the body’s ability to convert food, particularly sugars (carbohydrates), into energy for the body. If left untreated, high blood glucose levels from diabetes can harm the heart, blood vessels, kidneys, eyes, and nervous system over an extended period (American Academy of Pediatrics Section on Endocrinology, 2020).
There are two prevalent types of diabetes, type 1 and type 2 diabetes, which can affect anyone. However, children are more susceptible to type 1 diabetes; type 1 diabetes results when the pancreas fails to produce enough insulin, which may lead to sugar accumulation in the bloodstream. These unused sugars, or glucose, exit the body in urine, carrying water (American Academy of Pediatrics Section on Endocrinology, 2020).
Although type 1 diabetes can commence at any age, the peak periods are around 5-6 years and 11-13 years. Frequent urination, especially at night, which can lead to bedwetting in potty-trained children, increased thirst and fatigue, weight loss, and heightened appetite, are common early signs (American Academy of Pediatrics Section on Endocrinology, 2020).
It is crucial to identify the symptoms of type 1 diabetes early because uncontrolled diabetes can lead to high blood sugar levels and dehydration, which can be hazardous and necessitate pediatric emergency or critical care unit visits for intravenous insulin and fluids (American Academy of Pediatrics Section on Endocrinology, 2020).
Type 2 diabetes, once known as “adult-onset” diabetes due to its rarity in children, is becoming more prevalent among young people due to the rise in childhood obesity rates. Children with a family history of the disease, born to a mother with diabetes while pregnant (gestational diabetes), and those with medical conditions that affect insulin handling are at higher risk of developing type 2 diabetes. Symptoms of type 2 diabetes are like those of type 1, with darkened skin areas, particularly around the neck or armpits, being frequent (American Academy of Pediatrics Section on Endocrinology, 2020).
Due to the global rise in type 2 diabetes cases among children before the pandemic, and the well-established fluctuation in childhood diabetes rates over time, a nationwide examination of medical records was initiated by researchers. This comprehensive review aimed to evaluate the pandemic’s effects on the prevalence and management of type 2 diabetes in children. Through an analysis of medical records, the researchers aimed to understand the impact of the pandemic on the patterns and trends of childhood diabetes rates. Researchers at Johns Hopkins Children’s Center and other medical centers across the U.S. have documented a significant increase in type 2 diabetes among children during the COVID-19 pandemic. A steep rise in cases was noted, likely due to environmental factors such as the switch to virtual learning and the shutdown of sports and school activities, which reduced physical activity and weight gain. The researchers compared rates of new-onset type 2 diabetes among people aged 8 to 21 in the two years before the pandemic (3/1/2018-2/29/2020) to the first year of the pandemic (3/1/2020-2/28/2021), finding that the average number of new diagnoses per year increased from 825 to 1,463, a rise of 77%. The study documented increased cases with increased body mass index measures and higher blood glucose and hemoglobin A1c test results. The researchers noted that Hispanic and Black youth saw the highest increases in diagnoses. The results emphasize the importance of pediatricians and other primary care physicians being vigilant in screening for type 2 diabetes. Additionally, parents must discuss any weight increases with their children’s doctors (Johns et al., 2022).
Prevention of Diabetes
The healthcare system faces a significant challenge with the increasing prevalence of type 2 diabetes mellitus (T2DM) among adolescents. Lifestyle interventions focusing on weight reduction are critical to managing adolescents with T2DM. However, these interventions may face various biological, socioeconomic, cultural, psychological, and financial obstacles when applied to adolescents with T2DM. To achieve weight management for these individuals, a family-centered, culturally appropriate, and multidisciplinary approach is recommended (Sullivan et al. et al., 2013).
To manage diabetes in children, educating parents is crucial. Educating patients about healthy eating habits is essential, which is a critical part of T2DM management. Therefore, as part of intensive lifestyle therapy, all patients with T2DM should receive comprehensive nutritional education. Recommended dietary changes include reducing the consumption of sugary beverages and increasing the intake of whole-grain bread and cereals, fruits, and vegetables. Additionally, caloric intake should be reduced to achieve weight loss goals (Sullivan et al., 2013).
Diabetes and Mental Health
Multiple studies have revealed a higher prevalence of depression and anxiety among both adults and young individuals in the United States who have diabetes compared to those without the condition. Additionally, research has indicated an increased likelihood of other mental disorders, such as attention-deficit/hyperactivity disorder (ADHD), in individuals with diabetes (CDC, 2022). The prevalence of depression is significantly higher in individuals with diabetes than those without the condition, with studies showing that they are 2 to 3 times more likely to experience depression. Unfortunately, there is a concerning gap in diagnosing and treating depression among people with diabetes, as only 25% to 50% of individuals with both conditions receive appropriate diagnosis and treatment for depression (CDC, 2023).
The diagnosis of diabetes can be overwhelming for parents/caregivers, who are often expected to quickly acquire knowledge and skills related to diabetes management within a short timeframe, usually 1 to 2 days, due to shortened hospital stays. In some cases, outpatient treatment and education are provided to parents/caregivers when the child’s symptoms are mild to moderate. Following the diagnosis, whether during hospitalization or outpatient care, parents/caregivers must rapidly grasp complex disease-related concepts such as managing hypoglycemia and hyperglycemia, regulating carbohydrate intake, and performing invasive technical tasks like blood glucose monitoring and insulin injections. This sudden demand for knowledge and skills can leave parents/caregivers feeling initially inadequate, lacking confidence, and experiencing stress and anxiety when caring for their child’s condition (Sullivan et al., 2013).
The diagnosis of diabetes can be a challenging and emotional experience for both children and parents. It is not uncommon for family members to go through various stages of grief as they come to terms with the lifelong nature of the condition and its potential implications. During the initial months following diagnosis, children and adolescents may experience emotions such as sadness, loneliness, anxiety, and irritability. While these emotional responses are common, it is crucial to be mindful of more concerning signs such as frequent temper outbursts, pessimism about the future, and refusal to adhere to treatment or attend school. Parents, particularly mothers, may also experience depression and anxiety, which can be triggered by guilt or concerns about their child’s future (Frank, 2005).
Conclusion
There is no cure for diabetes, but with proper management, children with this condition can live everyday lives. Treatment involves monitoring blood sugar levels, administering insulin therapy, which may involve multiple daily injections or insulin pump use, and maintaining a healthy diet. Keeping blood sugar levels within the normal range is critical to reducing the risk of long-term health problems associated with poor diabetes control. Children can also manage their condition by exercising for at least thirty minutes daily and eating healthily (American Academy of Pediatrics Section on Endocrinology, 2020). Both lifestyle interventions and pharmacotherapy have shown a modest effect on weight reduction in adolescents with T2DM (Sullivan et al., 2013). The most effective preventive measure against psychological challenges in children and adolescents with diabetes is the presence of a strong and supportive family. When families receive guidance and support from a team of professionals who understand the psychological and physical aspects of diabetes and respond to them appropriately, they are better equipped to navigate the challenges that arise. This collaborative approach helps families find strength and direction in managing the psychological and physical implications of diabetes, fostering a healthier and more adaptive coping mechanism for all involved (Frank, 2005).
To conclude, effective diabetes care depends heavily on parents assuming the responsibility of day-to-day management, which is crucial for achieving optimal control of the condition. As treatment goals and technologies evolve, parents must rapidly acquire complex skills and adapt to using various tools. Their understanding of diabetes management significantly impacts their child’s long-term health and ability to maintain stable blood sugar levels. This innovative teaching approach will facilitate the educational process for parents. Considering that diabetes affects the entire family, enhancing early teaching sessions for parents of newly diagnosed children may have a profound and wide-ranging impact (Sullivan et al., 2013). For future clinicians working with children, adolescents, and families living with diabetes, there is a need for improved awareness, screening, access to mental health support, and a multidisciplinary approach to address the significant comorbidity of mental health difficulties and diabetes.
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About the Author
Stephany Aguiar, M.S., is a dedicated clinical psychology PsyD candidate in her fourth year of study. With a focus on the child track, she is strongly committed to providing comprehensive psychological assessments and therapy services to individuals of all ages, including adults, children, adolescents, couples, and families. Stephany’s genuine passion for clinical practice is driven by her desire to make a positive impact within her community. Her particular interest lies in understanding the unique needs and challenges experienced by children, adolescents, and families. Through her ongoing academic pursuits and practical experiences, Stephany aims to contribute to clinical psychology and enhance the well-being of those she serves.
