This is the next in a series of article excerpts by me discussing all forms of diabetes and metabolic syndrome and which were originally published in the Caller Times and reposted here with permission. You can also download an iPod friendly .zip file of me reading this article here.

In my experience seeing thousands of South Texas boys and girls with obesity and diabetes, I have discovered that childhood obesity starts at birth and maybe even before birth.

Infants born overweight (greater than 9 pounds) are more likely to develop diabetes and obesity earlier in life, as well as develop other serious health problems such as high blood pressure, high cholesterol and polycystic ovary disease than their lighter-weight counterparts. The mothers of these heavyweight babies often have gestational diabetes, which may go away after the baby is delivered, or they develop permanent diabetes within the next 10 years.

Research suggests that the baby’s brain is programmed to eat more when born too small, but if weight is gained too quickly after birth, it will create a new “set point” in the baby’s brain to become a weight much heavier than should happen.

The rest of this article is posted in the archives at the Corpus Christi Caller-Times. Registration is required using your email address and a password that you select and manage.

Prompted by a post over at Living With Diabetes, I realized that very few people know what’s involved in diagnosing and treating kids with type 2 diabetes. These are not just miniature versions of adults with type 2. As growing children, they have very special needs.

I live and practice pediatric endocrinology about 400 miles south of Dallas, Texas. We serve all of South Texas (overall, an area the size of South Carolina). As of August 31st of this year, 47% of ALL new cases of children’s diabetes seen in my practice and at my children’s hospital were due to type 2 diabetes. We have extensive experience with managing type 2 diabetes in children. I’ve written and spoken frequently about this epidemic and its management over the years.

I can tell you two things here:

1) About 15% of cases of what appear on the surface to be type 2 diabetes actually have evidence of the same process that causes type 1 diabetes (autoimmunity directed towards the beta cells).

The implication of this finding is that we may be talking about a blended disease process: that is, insulin resistance (the inciting cause of type 2 diabetes in most persons) combined with a destructive process driven by the patient’s own immune system (the underlying cause of type 1 diabetes in most persons). Ironically, the government funded study investigating the best management of type 2 diabetes in children excludes these children from study.

2) There are good oral medications that can work.

Metformin (also called Glucophage) is remarkably safe and I have hundreds of children with type 2 diabetes using this medicine both safely and effectively. However, at diabetes onset, some children with type 2 diabetes need insulin to stabilize their blood sugar control until the metformin can begin to help them. This is a common scenario and in these cases, the insulin may be weaned off rather quickly without ill effects to the child. Furthermore, insulin therapy may be associated with an unwanted side effect of additonal weight gain: the one thing most of these children don’t need.

However, each case is in many ways unique and factors other than medicine will steer the course of their disease. I now see entire families with type 2 diabetes (parents and children), so the role of the family is never to be underestimated. Also, financial issues will influence the clinical course since many of our children with type 2 diabetes are on public assistance programs (Medicaid or SCHIP) and one of these is on the cusp of disappearing!

MedScape recently reported a study of several trials concerning the beneficial effects of Vitamin D:

Intake of ordinary doses of vitamin D supplements seems to be associated with decreases in total mortality rates, according to a meta-analysis of randomized controlled trials published in the September 10 issue of Archives of Internal Medicine.

“Ecological and observational studies suggest that low vitamin D status could be associated with higher mortality from life-threatening conditions including cancer, cardiovascular disease, and diabetes mellitus that account for 60% to 70% of total mortality in high-income countries,” write Philippe Autier, MD, and Sara Gandini, PhD, from the International Agency for Research on Cancer in Lyon, France. “We examined the risk of dying from any cause in subjects who participated in randomized trials testing the impact of vitamin D supplementation (ergocalciferol [vitamin D2] or cholecalciferol [vitamin D3]) on any health condition.”

In an even more relevant body of research published by Michael F. Holick, M.D., Ph.D., Vitamin D appears to have great potential as a strategy for preventing diabetes and other autoimmune responses.

“Several studies suggest that vitamin D supplementation in children reduces the risk of type 1 diabetes. Increasing vitamin D intake during pregnancy reduces the development of islet autoantibodies in offspring.

For 10,366 children in Finland who were given 2000 IU of vitamin D per day during their first year of life and were followed for 31 years, the risk of type 1 diabetes was reduced by approximately 80% (relative risk, 0.22; 95% CI, 0.05 to 0.89).

Among children with vitamin D deficiency the risk was increased by approximately 200% (relative risk, 3.0; 95% CI, 1.0 to 9.0). In another study, vitamin D deficiency increased insulin resistance, decreased insulin production, and was associated with the metabolic syndrome.

Another study showed that a combined daily intake of 1200 mg of calcium and 800 IU of vitamin D lowered the risk of type 2 diabetes by 33% (relative risk, 0.67; 95% CI, 0.49 to 0.90) as compared with a daily intake of less than 600 mg of calcium and less than 400 IU of vitamin D. ”

Source: From the Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, the Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center, Boston. Address reprint requests to Dr. Holick at Boston University School of Medicine, 715 Albany St., M-1013, Boston, MA 02118, or at mfholick@bu.edu N Engl J Med 2007;357:266-81. Copyright © 2007 Massachusetts Medical Society.

Now here’s where this gets interesting. Since Vitamin D is so readily available, will industry get behind this and sponsor the research that needs to continue? Oh yeah, you can’t patent sunshine - a great source of Vitamin D and something that we all get less of today vs. 100 years ago. Hopefully our friends inside of ADA and JDRF can put this important research on their agenda and see to it that this makes rapid progress. In fact, from what I’ve read Vitamin D supplementation is probably a good thing to do anyway and the risk of overdose or adverse effects would require massive amounts so it’s pretty safe.

Why wait on more research when you can take a walk today? That’s a 2-for-1!