Early Recognition, Clinical Intervention Key to Improving Outcomes for Pediatric Type 2 Diabetes, Obesity, and PCOS

The rates of obesity and type 2 diabetes continue to increase among pediatric patients. According to a report published by the CDC in 2020, the rate of new cases of type 2 diabetes among those less than 20 years of age increased 4.8% between 2002 and 2015, and those numbers are probably even higher today.¹ The CDC also reports that obesity in the pediatric patient population is a growing health issue in the United States, with 1 in 5 children and adolescents classified as having obesity.²

A recent study that reviewed the medical records of 432,000 patients aged 2-19 years in the United States revealed the number of children and adolescents with obesity had increased to 22.4% in August 2020, up from 19.3% in 2019, exacerbating a longstanding obesity epidemic in the United States.³

Research has also revealed polycystic ovarian syndrome (PCOS) is increasing among adolescent girls.⁴ In addition, adolescents with PCOS have higher prevalence of cardiovascular risk factors.⁵ Many patients with undiagnosed and untreated PCOS are often insulin-resistant and at greater risk for type 2 diabetes. PCOS is also associated with a range of cardiometabolic diseases, including hypertension and dyslipidemia, as well as mental health disorders and future infertility.^4,6,7  Moreover, girls with type 2 diabetes and PCOS are at a heightened risk of depression.⁸

While research has established that among adolescent girls with type 2 diabetes, the risk of developing polycystic ovarian syndrome increases, the incidence among this patient population is unknown. In a recent publication in JAMA Network Open, researchers sought to ascertain the prevalence of PCOS in girls with type 2 diabetes and to evaluate the correlation of obesity and race with this prevalence. In this systematic review and meta-analysis involving 470 adolescent girls across 6 studies, the prevalence of PCOS was 19.58%, a prevalence that is considerably greater than that of the general adolescent population.

The authors concluded that PCOS is a common morbidity in girls with type 2 diabetes, and it is crucial that active screening for PCOS in girls with type 2 diabetes is initiated at the time of diabetes diagnosis and follows international evidence-based guidelines for diagnosing PCOS in adolescents.⁹ The authors also noted associations of obesity and race with the incidence of PCOS among girls with type 2 diabetes require additional assessment to aid in defining at-risk subgroups and to implement early evaluation and treatment approaches to enhance management of this diabetes-related comorbidity.⁹

The findings of this meta-analysis clearly highlight the significance of the multiple comorbidities associated with undiagnosed and untreated PCOS among adolescent girls. These findings also emphasize the need to expand awareness about the impact of early recognition and clinical intervention to diminish the clinical manifestations associated with PCOS and its related comorbidities. The growing incidence of chronic diseases among pediatric patients also indicates an urgent need to improve patient education initiatives, which will help young patients and their parents/caregivers understand how important routine health care is to overall optimal health.

To address the issue of obesity, the CDC indicates that it is critical to increase health care access to promote healthy behaviors. Some of these efforts include screening for body mass index, food security, and other social determinants of health by providers; augmenting access to evidence-based pediatric weight management programs and food assistance resources; and state, community, and school efforts to expand access to healthy eating, physical activity, and chronic disease prevention.³

References:

1. Divers J, Mayer-Davis EJ, Lawrence JM, et al. Trends in incidence of type 1 and type 2 diabetes among youths – selected counties and Indian reservations, United States, 2002–2015. Morb Mortal Wkly Rep. 2020;69:161-165. doi:10.15585/mmwr.mm6906a3
2. Childhood Overweight & Obesity. Centers for Disease Control and Prevention. Reviewed August 30, 2021. Accessed February 28, 2022. https://www.cdc.gov/obesity/childhood/index.html
3. Lange SJ, Kompaniyets L, Freedman DS, et al. Longitudinal trends in body mass index before and during the COVID-19 pandemic among persons aged 2-19 years – United States, 2018-2020. Morb Mortal Wkly Rep. 2021;70:1278-1283. doi:10.15585/mmwr.mm7037a3
4. Fazleen NE, Whittaker M, Mamun A. Risk of metabolic syndrome in adolescents with polycystic ovarian syndrome: a systematic review and meta-analysis.  Diabetes Metab Syndr. 2018;12(6):1083-1090. doi:10.1016/j.dsx.2018.03.014
5. Arslanian SA, Lewy VD, Danadian K. Glucose intolerance in obese adolescents with polycystic ovary syndrome: roles of insulin resistance and beta-cell dysfunction and risk of cardiovascular disease. J Clin Endocrinol Metab. 2001;86(1):66-71. doi:10.1210/jcem.86.1.7123
6. Çoban ÖG, Tulacı ÖD, Adanır AS, Önder A. Psychiatric disorders, self-esteem, and quality of life in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2019;32(6):600-604. doi:10.1016/j.jpag.2019.07.008
7. Sari SA, Celik N, Cicek AU. Body perception, self-esteem, and comorbid psychiatric disorders in adolescents diagnosed with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2020;33(6):691-696. doi:10.1016/j.jpag.2020.08.018
8. Benson J, Severn C, Hudnut-Beumler J, et al. Depression in girls with obesity and polycystic ovary syndrome and/or type 2 diabetes. Can J Diabetes. 2020;44(6):507-513. doi:10.1016/j.jcjd.2020.05.015
9. Cioana M, Deng J, Nadarajah A, et al. Prevalence of polycystic ovary syndrome in patients with pediatric type 2 diabetes: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(2):e2147454. doi:10.1001/jamanetworkopen.2021.47454