Opinion | Stay on the Lookout for the Warning Signs of Pediatric Prediabetes

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Prediabetes in our youth has been rising at an alarming rate over the last several years and healthcare professionals play an essential role in tackling this increase. We are the first line of defense for families. We explain the risks, see the signs, and arm parents with resources that could turn the tide for an entire generation of children. In doing so, we must never dismiss the warning signs of diabetes in children, especially when some symptoms could be easily mistaken as something else.

A good place to start is by building awareness -- to refresh your memory on the warning signs and risk factors of diabetes.

The warning signs of diabetes can include increased thirst, increased urination, fatigue, hunger, and blurred vision. Another major warning sign we must make sure our patients' parents are aware of is a skin discoloration called acanthosis nigricans, which often occurs in the neck, groin, or armpits. All these symptoms are important to take note of with children and may be signs of other conditions.

However, these outward signs are not the only thing healthcare providers should be aware of. Tracking family history plays a critical role, too. Children with a parental history of diabetes have an increased risk for developing diabetes and early onset of its complications. Recently, we have seen just how important this type of awareness can be.

At the 81st Scientific Sessions of the American Diabetes Association (ADA) last year, we learned that hospitalization rates for children diagnosed with type 2 diabetes have doubled, while also increasing in severity during the COVID-19 pandemic. Sadly, the findings were not surprising due to rising rates of prediabetes in America's youth -- a concerning trend, even prior to the pandemic. According to another recent study, rates of type 2 diabetes among children have more than doubled in just under 20 years. The last thing we needed was a virus like SARS-CoV-2 to contribute to rising diabetes cases.

Early in the pandemic, the ADA funded research to explore the connection between COVID-19 and diabetes. We've long known that people with diabetes are at higher risk for severe COVID-19 illness, but we are now seeing reports that indicate a startling development: previous COVID-19 infection may lead to a higher risk for diabetes. A study in the U.S. found that people who have been infected with COVID-19 had a 28% higher risk of developing a new diabetes diagnosis than those not infected. The big message for clinicians is this: if you know a patient had a COVID-19 infection, this should raise awareness about potentially screening for diabetes, even in children.

Inactivity has had a major impact on children since the start of the COVID-19 pandemic. This has been due to many factors including lockdowns, cancellations of sports and extracurricular activities, and social distancing. This decrease in activity means insulin sensitivity could be affected, prompting diabetes symptoms and poorer health outcomes. Promoting more physical activity and less sedentary behavior and screen time can improve children's insulin sensitivity, which can become an effective strategy for combating prediabetes and type 2 diabetes.

At the ADA, we're helping to combat inactivity and prediabetes in youth through Project Power to help prevent type 2 diabetes and the complications that come with diabetes. Project Power is an engaging, free after school program for children ages 5 to 12, which aims to slow the trajectory of childhood obesity by promotion of healthy living through nutritional education, increased physical activity, and family involvement. Youth are empowered to make healthy lifestyle choices to develop lifelong habits. We want to ensure they get the tools early on that are necessary to live healthier lives well into adulthood. With prediabetes on the rise, a healthy lifestyle is a great place for youth and their families to start to reduce their risk, and healthcare professionals should be there to provide support every step of the way.

Awareness is key -- understanding your role in preventing diabetes could change everything. Healthcare providers must stay up to date on the latest findings on COVID-19 and diabetes, particularly as we learn more about the connection. The ADA will continue to highlight key learnings this year at the ADA's 82nd Scientific Sessions taking place in New Orleans, Louisiana from June 3 to 7.

At the first indication of diabetes warning signs, clinicians should be prepared to screen for diabetes. And if someone has prediabetes, it's still possible to prevent or delay diabetes -- it is not the end. It's important for our patients' families to understand that with lifestyle changes, and appropriate medical guidance, positive health outcomes are possible. Promoting physical over sedentary activities is a great step forward. Finding support through friends, family, or national organizations, may be just what is needed to make those changes. Healthcare providers should be ready to help in any way they can and will play a major role in the health of America's youth for the rest of their lives.

Robert Gabbay, MD, PhD, is chief scientific and medical officer for the American Diabetes Association.