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February 21, 2002

Emory Physicians at Grady See Growing Trend of Younger, Obese Adults With Diabetes

Traditionally, Type 2 diabetes has been thought of as an older person's disease. Yet more recently, younger adults and even some children and teens are being diagnosed and treated for Type 2 diabetes, a disease that affects 16 million Americans, and continues to grow at epidemic proportions.

Emory University physicians at Grady Memorial Hospital's Diabetes Clinic say the rising rate of diabetes among younger adults is strongly linked to obesity. Imad M. El-Kebbi, M.D., associate professor of medicine at the Emory University School of Medicine and endocrinologist at Grady's Diabetes Clinic, said he now sees a growing number of patients in their late teen-age years, and others in their 20s and 30s.

"We're seeing more 20- and 30-year olds with Type 2 diabetes than people would have expected several years ago," Dr. El-Kebbi said. "A lot of that could be related to the problem of obesity, which is increasing in the United States and across the world."

In an analysis conducted in 1999 and presented to the American Diabetes Association National Meeting in 2000, Dr. El-Kebbi compared 2,539 younger and older adults at Grady with Type 2 diabetes seen at Grady between 1991 and 1999. He concluded that younger patients were more obese, had worse glycemic control, and did not respond as well to nutritional and drug management. Those same patients, who averaged 25 years of age with a Body Mass Index of 37.8, needed aggressive treatment to lower their blood sugar. (Body Mass Index, which is a ratio of weight to height, is an accepted measure for obesity. A BMI of 30 or above is defined as obese, and 40 or above is defined as severely obese.) Younger age was recognized as a risk factor for poor control in African-American patients in the Grady analysis.

Diabetes results from the body's inability to produce or properly use insulin, which is necessary for the body to use sugar. High blood sugar over time damages the body's small blood vessels and can also lead to atherosclerosis. Therefore, diabetes can damage the kidneys, nerves, and the blood vessels of the heart. Obesity and sedentary lifestyles often play significant roles in the development of Type 2 diabetes. Type 1 diabetes, by contrast, begins when the pancreas totally loses its ability to produce insulin, usually in childhood.

Obese children – especially those of African-American and Hispanic descent - are at increased risk for Type 2 diabetes. And while Grady's Diabetes Clinic does not serve children and teen-agers, pediatricians at nearby Hughes Spalding Children's Hospital, which is part of the Grady Health System, are treating more children for Type 2 diabetes. And according to a recent study in the Journal of the American Medical Association, for example, 21 percent of African-American and Hispanic-American children ages 4 to 12 were considered overweight, as compared to 12 percent of non-Hispanic white children.

Dr. El-Kebbi stressed that younger patients with type 2 diabetes need aggressive management.

"The best way to lower damage from diabetes, as far as we know right now, is to bring the sugar down to normal and keep the blood pressure and cholesterol under control," Dr. El-Kebbi said. "All of these issues are extremely important. If it's harder for younger people to lower their blood sugar, that means we (physicians) have to work harder to bring it down. Already, more of our young people are on insulin. Insulin alone or in combination with oral medications tends to be the last line of therapy."

Dr. El-Kebbi hopes to develop interventions, projects and programs that would make significant improvements in treating younger diabetes patients.

About the Grady Diabetes Clinic

The Grady Diabetes Clinic was founded in the early 1970s. The clinic pioneered culturally appropriate dietary management, and has been active in research for 30 years. It is reportedly the largest clinic for African-Americans with diabetes in the country. Over the past three decades, research and teaching efforts have been improved and expanded. The clinic provides care for more than 4,000 established patients and about 1,000 new patients each year.

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