SENIOR doctors have warned that Bradford could face a significant public health problem unless action is taken to address the causes of type 2 diabetes in children.
Paediatricians at Bradford Teaching Hospitals NHS Foundation Trust have seen an increase in the number of young people now being diagnosed with the condition, once known as ‘adult-onset diabetes’.
A monthly children’s type 2 diabetes clinic at Bradford Royal Infirmary, part of the Trust, is currently treating 18 patients under the age of 16.
Taibah (not her real name) was diagnosed with the condition aged 14.
“It was shocking because I didn’t know I had diabetes. I just felt like I had stomach ache,” she said.
“I do feel ashamed. In school we’ve been told about diabetes and how it’s something people get later in life if they’re overweight,” she said. “I’ve got relatives who have it but they’re much older. I didn’t think I’d get it.”
Consultant Paediatrician Dr Mathew Mathai (pictured) started working with children with diabetes 18 years ago when children’s clinics predominantly managed type 1 diabetes, which is not linked to diet or lifestyle. Now, around 10 per cent of his young diabetes patients are children with this form of the condition.
He said: “Type 2 diabetes when it develops in children appears to have a much worse course than when it develops in adulthood. Complications develop earlier and can be evident just a few years after diagnosis.
“They include damage to the small blood vessels of the eye, the kidneys and to other important organs. And therefore we really need to try and see how we can reduce that risk, but there are very few treatment options.
“In adults a range of medication has been licensed for use but for children there is really only one oral medication – metformin, which lowers the amount of sugar in the blood. And if that’s not working children go onto insulin injections.”
Dr Mathai added: “Around the country between 95-98 per cent of children with diabetes have type 1. But in Bradford it’s 85 per cent. That’s quite a difference.
“We now have a monthly clinic for children with type 2 diabetes because we are seeing more and more children with this condition.
“We don’t know whether diabetes can be completely reversed in children by addressing their diet, weight and exercise. However, we now know from experiences in the US that children who are diagnosed with type 2 Diabetes can have serious diabetes-related complications in their 20s and will therefore have to live with this burden for several decades.
“People of South Asian origin, girls and those with a family history of type 2 diabetes are most at risk of developing it.”
One of Dr Mathai’s patients was diagnosed four years ago aged 10, and was initially given metformin in tablet form, but had difficulty swallowing it. She then tried the syrup form – but didn’t like the taste – and was subsequently advised to inject insulin, but started to miss her weekly treatments.
That changed this summer when she went to stay with relatives in Pakistan, swapping junk food and visits to takeaways near her Bradford home for her gran’s home-cooked meals and fresh fruit.
At her latest appointment with doctors at the paediatric diabetic clinic, she was still considered obese but had lost 5kg.
Professor John Wright, Director of Research at the Bradford Institute for Health Research, who leads the Born in Bradford study, which is tracking 14,000 babies born in Bradford between 2007 and 2009, said: “We know that our South Asian children in the first year of life have pretty similar physical activity to white children, but by three or four they’re more sedentary.
“By five or six they’re really considerably less physically active and by 10 and 11 that’s really starting to pull away – and particularly in South Asian girls. So we’re seeing those trajectories of physical activity really at an early stage, and that divergence between ethnic groups.”
With the help of Alison Woodhead, a paediatric diabetes dietitian at Bradford Teaching Hospitals, Taibah now plans to change her diet and exercise routine to lower her own blood sugar levels.
Making sustainable lifestyle changes, however, is not easy and requires the support of immediate and extended family members and the wider community, including health and social care professionals, the local authority, and education sector.
Dr Mathai said: “We need to create a better environment. Having 25 takeaway shops within walking distances of some homes and local areas with no green spaces or sporting facilities is not helpful.
“I believe we are seeing the tip of the iceberg. As a diabetes team we fear that there may be a significant proportion of children who we currently don’t know about who are on the cusp of developing diabetes. A tidal wave may be coming, and we need to think about addressing this in a much more holistic way – and urgently.
“At the clinic we give advice on diet and exercise, how to lose weight and on blood glucose and monitoring weight. We usually see our young patients every three months. As a team we feel we need to be more creative in our solutions. Bradford is now a hotspot for type 2 Diabetes in children.”
To help with how we might do this, Dr Vicki Lee, a clinical psychologist at Bradford Teaching Hospitals, has recently undertaken qualitative research exploring young people’s perceptions of their diagnosis, how they manage the condition and how we might be able to shape clinics to better address their needs.
“The Born in Bradford project also provides us with a unique opportunity to look at potential interventions and study the effect,” Dr Mathai added.
“Bradford can be a beacon for change. Everyone needs to be part of the conversation.”
Dr Junaid Azam, a local GP and clinical lead for diabetes at NHS Bradford district and Craven clinical commissioning groups (CCGs), added: “We recognise that type 2 diabetes and obesity in children in Bradford is increasing. Reducing obesity in both adults and children is one of our key priorities and we are working on initiatives to support people in Bradford to be healthier.
“This year we launched Living Well, in partnership with Bradford Council, which will make it easier for people of all ages and abilities to be more active and eat a balanced diet. This includes a Living Well service, supported by a website and digital tools, to help people make small lifestyle changes which can make a big difference to their weight.
“Living Well also involves working with organisations across the Bradford district to make a healthy lifestyle the norm. We are developing a charter to encourage local businesses to provide a healthy option on their menus and are also working with schools to develop healthy standards for children.
“By supporting families to eat healthily and stay active, this will help to ensure they have a happy and healthy future.”
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Note to Editors:
- Bradford Teaching Hospitals NHS Foundation Trust:
Bradford Teaching Hospitals NHS Foundation Trust is responsible for providing hospital services for the people of Bradford and communities across Yorkshire. We serve a core population of around 500,000 and provide specialist services for 1.1 million people.
Our 5,500 staff work over several sites, including Bradford Royal Infirmary, which provides the majority of inpatient services, and St Luke’s Hospital, which predominantly provides outpatient and rehabilitation services. We also manage local community hospitals at Westwood Park, Westbourne Green, and Eccleshill.
In early 2017, a new £28 million wing opened at Bradford Royal Infirmary, part of a £75m investment to improve patient care across our hospitals over a five-year period. It provides world-class facilities for elderly care, children’s services, a state-of-the-art intensive care unit with increased single-room provision and a retail concourse.
The new wing is a continuation of our work to improve patient experience after our new £2 million neonatal unit officially opened in January 2015. Our maternity services were recently shortlisted for the Royal College of Midwives’ (RCM) Midwifery Service of the Year Award, recognising excellence and innovation in the provision of maternity care.
In 2017, we also completed a £2m refurbishment of our Emergency Department (ED) as part of an ambitious vision to create a more efficient acute medicine service for the people of Bradford. It has been designed to provide a slicker and more efficient service, with faster senior clinical involvement at an early stage in the patient pathway.
As a teaching hospital, we are at the forefront of education and development in healthcare, and have an excellent reputation for research performance. We are one of the leading centres in conducting applied research in the country, particularly in quality and safety, elderly care and rehabilitation.
The Trust is home to the Bradford Institute for Health Research (BIHR) where researchers have led the development, validation and implementation of the award-winning Bradford Electronic Frailty Index (eFI) which helps calculate an elderly person’s risk of disability, impairment, falls and complications of chronic diseases, as well as their diminishing independence and capability. This is now being used by 98% of all GPs across the country.
Our award-winning Ophthalmology department is home to numerous worldwide clinical trials taking the lead in eye care research and we are one of only three sites in the United Kingdom to be enlisted in the Perioperative Enhanced Recovery Hip Fracture Care of Patients with Dementia (PERFECTED) study, which will investigate how the NHS can introduce better standards of care to improve outcomes for people with dementia.
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The Trust has its own Bradford Hospitals Charity: www.bradfordhospitals.nhs.uk/charity