More Kids with Diabetes, Few Specialized Docs to Care for Them
March 10, 2008
March 10, 2008 (Newswise) - The rate of childhood obesity in the United States has more than doubled in the past 20 years, bringing with it more children at risk for developing type 1 and even type 2 diabetes.
Despite this growing trend, the number of board-certified pediatric endocrinologists – those physicians who specialize in caring for children with diabetes and obese children at risk for the disease – is not keeping pace with demand for their specialized care, say researchers at the University of Michigan C.S. Mott Children’s Hospital.
Results from a new study published in the March issue of The Journal of Pediatrics show that at the national level, for every 290 children with diabetes, there is only one board-certified pediatric endocrinologist available to care for them. It also finds that the ratio of obese children to board-certified pediatric endocrinologists is about 17,000 to one.
“Although the American Diabetes Association recommends that all children with diabetes be cared for by a pediatric endocrinologist as part of a diabetes team, there is a current shortage of pediatric endocrinologists in this country,” says study lead author Joyce Lee, M.D., MPH, a pediatric endocrinologist and member of the Child Health Evaluation and Research (CHEAR) Unit in the U-M Division of General Pediatrics. “This problem will likely only worsen due to the recent epidemic of childhood obesity.”
Currently, 16.5 percent of American children ages 6 to 19 are obese. These children are at an increased risk for developing diseases previously thought to be limited to adults, including type 2 diabetes, high blood pressure and high cholesterol. As a result, more children than ever before are being referred to pediatric specialists, such as pediatric endocrinologists who can screen, evaluate and manage children at risk for developing diabetes.
“Even if just a small fraction of obese children are referred to a pediatric endocrinologist for evaluation, the overall ratio of one pediatric endocrinologist to 17,000 obese children makes providing the necessary care extremely challenging,” says Lee, assistant professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School.
The bottom line: pediatric endocrinologists currently do not have the capabilities to see even a fraction of the large number of children with diabetes or at risk for diabetes. “The epidemic of childhood obesity has undoubtedly created new challenges for our health care, and we need to reassess the current system to ensure children with diabetes or at risk for diabetes receive appropriate care,” Lee notes.
Using data from the American Board of Pediatrics and the National Survey of Children’s Health, Lee and her colleagues compared the number of board certified pediatric endocrinologists by region to obese children and children with diabetes in those same areas.
Their research revealed that there are an estimated 229,249 children with diabetes, and only 790 board-certified pediatric endocrinologists in the country. And, in two states – Montana and Wyoming – there are no board-certified pediatric endocrinologists.
Further complicating matters, Lee and her colleagues found that the geographic distribution of children with diabetes and obesity does not match the geographic distribution of board-certified pediatric endocrinologists.
According to study results, the area with the greatest supply of pediatric endocrinologists was in the Northeast. In comparison, the Midwest fared the worst with regard to the supply of pediatric endocrinologists. The geographic disparity was even greater for ratios of children with obesity to board-certified pediatric endocrinologists by state, ranging from about 5,000 to one in Massachusetts to about 99,000 to one in Mississippi.
While the American Board of Pediatrics reports that the number of medical fellows entering the field of pediatric endocrinology since 1997 has increased annually by 12 percent – with about 76 pediatricians entering the field from 2005 to 2006 – Lee cautions that it is still not enough of an increase to meet growing demand for care.
“The increases in the endocrinology workforce are incremental. Ultimately, the pediatric endocrine workforce shortage raises the question of how health care delivery for U.S. children with diabetes and children at risk for diabetes should ideally be organized,” says Lee.
She notes that a critical reassessment of the current system of health care delivery for obese children is needed, along with the creation of sustainable models of care to effectively improve health outcomes for obese children who are at risk for developing chronic diseases in childhood.
To learn more about childhood obesity and diabetes care offered at C.S. Mott Children’s Hospital, visit these Web sites:
• Pediatric endocrinology, diabetes and metabolism services: http://www2.med.umich.edu/departments/mott/clinics/dsp_cliniclist.cfm?group_id=ENDO
• Pediatric Comprehensive Weight Management Center: http://www.med.umich.edu/MPOWER/index.shtml
In addition to Lee, U-M C.S. Mott Children’s Hospital co-authors are: Matthew M. Davis, M.D., M.A.P.P., associate professor of general pediatrics and internal medicine, and associate professor of public policy at the Gerald R. Ford School of Public Policy; Ram K. Menon, M.D., professor, Department of Pediatrics and Communicable Diseases, and director of Pediatric Endocrinology; and Gary L. Freed, M.D., MPH, Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery, and chief of the Division of General Pediatrics.
Lee’s work on this study was supported by the Clinical Sciences Scholars Program at the University of Michigan.
Reference: The Journal of Pediatrics, March 2008, Vol. 152, No. 3.
Posted by dlife at 03:06 PM | Comments (1)
Overweight Hispanic Children Shown To Have Vascular Inflammation
February 27, 2008
February 27, 2008 (Joslin Diabetes Center) — Overweight Hispanic children with normal blood glucose (sugar) levels showed elevated markers for blood vessel inflammation that may predispose them to developing both type 2 diabetes and cardiovascular disease, says a new study led by researchers from the Joslin Diabetes Center.
The study, published in the March issue of Diabetes Care, is the first to focus on Hispanic children, already known to be at high risk for developing type 2 diabetes as a result of both genetic and lifestyle factors.
“Our findings suggest that these children are not only at risk for type 2 diabetes, but also for cardiovascular disease,” said Dr. A. Enrique Caballero, lead investigator.
The study looked at 38 Hispanic children and adolescents, ages 10 through 18. Twenty-one were obese but with normal blood glucose levels, so they had not yet developed diabetes. The rest were considered lean. As a group, the obese subjects had significantly higher percentages of body fat than the lean group and were already showing signs of insulin resistance, meaning the insulin that their bodies produce is not working well and as a consequence their pancreases were being forced to work harder to produce more insulin to maintain normal blood sugar levels.
Overall, the obese group exhibited increased blood markers for subclinical or asymptomatic inflammation of the inner layer of blood vessels. “They are already exhibiting problems with circulation,” said Caballero, Director of the Latino Diabetes Initiative, Clinical Investigator, Staff Endocrinologist and Director, Medical Affairs, Professional Education at Joslin Diabetes Center, as well as an Assistant Professor of Medicine at Harvard Medical School. “There is an inflammatory process going on in the vessels.”
Such problems suggest these children may be at increased risk of developing cardiovascular problems at a young age, he said.
Subclinical vascular inflammation is a key element in the development of cardiovascular disease and is closely associated with insulin resistance. It also predicts the development of type 2 diabetes.
Earlier studies in overweight or obese children and adolescents showed similar vascular abnormalities, but were conducted primarily in non-Hispanic children.
Caballero wanted to study Hispanic children because they had not previously been studied and because they are a high-risk population for type 2 diabetes.
“We have found that overweight Hispanic children and adolescents have elevated markers of endothelial dysfunction and vascular inflammation closely related to excess body fat and increased insulin resistance,” the paper concluded. “This. . . may increase their risk of developing type 2 diabetes and cardiovascular disease, further emphasizing the need for obesity prevention strategies.”
Caballero said such strategies must be culturally appropriate.
“Even if these abnormalities may not be that different than those in Caucasian children, the strategies to prevent heart disease and diabetes need to be culturally oriented,’’ he said. “They need to be tailored to the population.”
Caballero stressed that the findings do not mean that such children will definitely develop type 2 diabetes or cardiovascular problems, but said the idea is to step in early to make sure they don’t.
“The problem is serious enough to warrant attention and a prevention strategy,” he said.
The research was funded by a grant from Sanofi Aventis and a National Institutes of Health grant for general clinical research at Beth Israel Deaconess Medical Center.
In addition to Dr. Caballero, other researchers participating in the study included: Dr. Ludivina Robles-Osorio, Valeria Montagnani, RN, Dr. Geetha Soodini, Dr. Sriurai Porramatikul, Dr. Osama Hamdy and Dr. Edward S. Horton from the Joslin and Kelb Bousquet-Santos and Dr. Antonio C.L. Nobrega from Fluminense Federal University in Brazil.
Posted by dlife at 11:20 AM | Comments (0)