September 6th, 2021

The pandemic has taken an amazing toll on human health. According to two new studies that are not yet in print, the pandemic caused a doubling in diabetes in children. This is not a trivial matter as insulin resistance, diabetes, obesity and metabolic syndrome in general are the diagnostic diseases associated with increased risk for cancer, coronary artery disease and early death from issues like COVID. The antecedent triggers have been well studied and discussed in this newsletter. Sedentary behavior coupled to a high fat, high refined carbohydrate diet are the main drivers of disease and the pandemic forced many a child's hand. They were less likely to exercise and move during the poor quality zoom events. Physical education classes were non existent. Food quality plummeted from a poor school based place to a worse home based place.

If you missed it, listen or read the Insulin resistance newsletter from June 27th of this year to really gain a greater appreciation for the why we are here question.

Diabetes has a very long latency period from which a child is metabolically destroying his or her system for years. Waiting for the markers of diabetes to be noted is to wait way too long. Type II diabetes is a COMPLETELY PREVENTABLE DISEASE! It is a disease of poor parental stewardship, poor governmental policy and poor corporate food promotion that prioritizes convenience, profit and taste over health at every turn. As I have said before, the United States Federal Government hauled in 3.5 trillion dollars in taxes in 2019 making the problem of access to funds non existent.

Let us look at some numbers. In 2019, the United States government spent 39.2 billion dollars on foreign aid and 686.1 billion on defense. According to the federal government, 50.8 million children attended primary K-12 school. 29.7 million children received government sponsored food costing 13.7 billion dollars. If every child received 2 meals a day for 180 days of school, that equates to 10 billion meals. That is roughly a governmental allowance of less than 1.50$ per child per meal. What can you truly buy with 1.37$ per meal? Simple answer- government sponsored junk quality food!

Give me the 39.2 billion foreign aid dollars earmarked for people that have nothing to do with our children, our country and our lives and we are dining in style! Is a foreign country more important than our own children's health and future? Is the defense budget that much more important then the health and welfare of the next generation? How am I even asking this question in 2021? I don't care where you take the money from as long as we feed our children healthy nourishing food that grows their minds, bodies and spirit.

For me the issue is simple. Stop feeding our children garbage food in schools now that they have returned. The United States provides 66% of the food that the average K-8th grader consumes in a school day. Thus, we are culpable for 10 of 21 meals in a week, almost half of the caloric intake. We must change the nourishment that enters the mouth of a school child before these issues destroy anymore lives through disease. Increase physical education for every child regardless of what condition they are in. We have to ask our children to push themselves in a graded safe fashion back to a place of health. We must stop accepting that being poorly conditioned is ok. It is not normal to be out of shape and it is not healthy. There is no debate here. This matter is settled scientifically. It is only an issue because of poor federal and local stewardship coupled to political and media pressure to normalize being unhealthy. We, again, are not talking about body size or appearance at all. We are only talking about the inputs that ruin health versus those that promote it.

We have a great opportunity here to see and be scared by the statistics of our children's health. They are scary: - These numbers are a a few years old as new numbers are not available. My comments are in italics.

Diabetes in youth
• About 210,000 Americans under age 20 are estimated to have diagnosed diabetes, approximately 0.25% of that population. Which means a much larger number are insulin resistant on the way to diabetes
• In 2014—2015, the annual incidence of diagnosed diabetes in youth was estimated at 18,200 with type 1 diabetes, 5,800 with type 2 diabetes.

Diabetes by race/ethnicity
The rates of diagnosed diabetes in adults by race/ethnic background are:
• 7.5% of non-Hispanic whites
• 9.2% of Asian Americans
• 12.5% of Hispanics
• 11.7% of non-Hispanic blacks
• 14.7% of American Indians/Alaskan Natives (ADA)

According to the ADA, the American Diabetes Association, here are the Recommendations for recognizing type 2 diabetes in children: my comments are in italics as I do not agree with the current plan of care
1) Risk-based screening for prediabetes and/or type 2 diabetes should be considered in children and adolescents after the onset of puberty or ≥10 years of age, whichever occurs earlier, who are overweight (BMI ≥85th percentile) or obese (BMI ≥95th percentile) and who have one or more additional risk factors for diabetes - This is way too late to start to screen and or educate
2) If tests are normal, repeat testing at a minimum of 3-year intervals E, or more frequently if BMI is increasing. Should be yearly in all children on an unhealthy diet regardless of weight
3) Fasting plasma glucose, 2-h plasma glucose during a 75-g oral glucose tolerance test, and A1C can be used to test for prediabetes or diabetes in children and adolescents. Serum insulin levels are the best way to catch early insulin resistance or better yet a continuous glucose monitor. By the time the HgB A1C is abnormal, the child has been insulin resistant for a long time
4) Children and adolescents with overweight/obesity in whom the diagnosis of type 2 diabetes is being considered should have a panel of pancreatic autoantibodies tested to exclude the possibility of autoimmune type 1 diabetes. I would submit that any body size where type 2 DM is being considered should have antibody testing performed

The COVID pandemic is leaving behind a plethora of problems and we must start NOW to reverse the reversible trends in disease.

1) First and foremost, we must stop subsidies for poor quality school food however that can be done
2) We must keep working with our parents and their children to pack a healthier lunch from home if the powers that be prefer disease to health through their policies
3) We need to spend time with parents discussing what healthy food looks like
4) We need to get kids moving again in school and after school to burn the calories, reduce insulin resistance and increase fitness
5) We need to monitor screen time to assure another layer of health impediment reduction

See the excellent sticker below of the Salisbury Pediatric food plate produced by Zach Strong, NP.

My 2 cents,
Dr. M

MDEdge Article
ADA Position Statement
Serbis World J of Diabetes