Diabetes may be undetected in many children in the UK
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《英国医生杂志》
EDITOR—Cases of children showing type 2 diabetes have been linked to the rising prevalence of paediatric obesity. We are concerned that the true number of children with this form of diabetes may be far larger than paediatricians realise.
A recent representative survey in England found 18% of schoolchildren to be overweight and a further 6% to be obese.1 On this basis, some 1.8m children in the United Kingdom are overweight and a further 700 000 children are obese.
The prevalence of type 2 diabetes has been recorded in 0.14% to over 4% of obese children, with impaired glucose tolerance found in 4.5% to 14.9%.2-5 Using a conservative estimate of 0.2% prevalence for type 2 diabetes and 3% for glucose intolerance, and ignoring overweight non-obese children, we would expect some 1400 children to be currently diagnosed with type 2 diabetes in the United Kingdom, and over 20 000 children with impaired glucose tolerance.
That we are not recording these high numbers indicates that the problem may be hidden. Most of the cases detected in surveys were undiagnosed before screening. In early diabetes patients may be asymptomatic or present with symptoms such as vaginal monolilial infection. The children may not be aware of relevant symptoms, or not realise that they should report them.
We must be sure that, when children do express discomfort in some form, we listen to them. There are high costs associated with missing a case of diabetes through lack of attention, ignorance, or unconscious discrimination against overweight children.
Tim Lobstein, childhood obesity programme coordinator
tlobstein@iotf.org
Rachel Leach, senior policy officer
International Obesity TaskForce, London NW1 2NS
Competing interests: None declared.
References
Stationery Office. The health survey for England 2002: the health of children and young people. Available at: www.official-documents.co.uk/documents/deps/doh/survey02/hcyp/tables/ch9t6.htm (accessed 24 Mar 2004).
Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346: 802-10.
Freedman DS, Srinivasan SR, Bereneson GS. Risk of cardiovascular complications. In: Burniat W, Cole T, Lissau I, Poskitt EME, eds. Child and adolescent obesity. Causes and consequences; prevention and management. Cambridge: Cambridge University Press, 2002: 221-39.
Invitti C, Guzzaloni G, Gilardini L, Morabito F, Viberti G. Prevalence and concomitants of glucose intolerance in European obese children and adolescents. Diabetes Care 2003;26: 118-24.
Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obesity Rev 2004;5(suppl 1): 1-104.
A recent representative survey in England found 18% of schoolchildren to be overweight and a further 6% to be obese.1 On this basis, some 1.8m children in the United Kingdom are overweight and a further 700 000 children are obese.
The prevalence of type 2 diabetes has been recorded in 0.14% to over 4% of obese children, with impaired glucose tolerance found in 4.5% to 14.9%.2-5 Using a conservative estimate of 0.2% prevalence for type 2 diabetes and 3% for glucose intolerance, and ignoring overweight non-obese children, we would expect some 1400 children to be currently diagnosed with type 2 diabetes in the United Kingdom, and over 20 000 children with impaired glucose tolerance.
That we are not recording these high numbers indicates that the problem may be hidden. Most of the cases detected in surveys were undiagnosed before screening. In early diabetes patients may be asymptomatic or present with symptoms such as vaginal monolilial infection. The children may not be aware of relevant symptoms, or not realise that they should report them.
We must be sure that, when children do express discomfort in some form, we listen to them. There are high costs associated with missing a case of diabetes through lack of attention, ignorance, or unconscious discrimination against overweight children.
Tim Lobstein, childhood obesity programme coordinator
tlobstein@iotf.org
Rachel Leach, senior policy officer
International Obesity TaskForce, London NW1 2NS
Competing interests: None declared.
References
Stationery Office. The health survey for England 2002: the health of children and young people. Available at: www.official-documents.co.uk/documents/deps/doh/survey02/hcyp/tables/ch9t6.htm (accessed 24 Mar 2004).
Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346: 802-10.
Freedman DS, Srinivasan SR, Bereneson GS. Risk of cardiovascular complications. In: Burniat W, Cole T, Lissau I, Poskitt EME, eds. Child and adolescent obesity. Causes and consequences; prevention and management. Cambridge: Cambridge University Press, 2002: 221-39.
Invitti C, Guzzaloni G, Gilardini L, Morabito F, Viberti G. Prevalence and concomitants of glucose intolerance in European obese children and adolescents. Diabetes Care 2003;26: 118-24.
Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obesity Rev 2004;5(suppl 1): 1-104.