Transcript
CRAIG JEFFRIES: What we have done is got all the two together got 21 years and we have realised we have a low rate but its persistent it is here to stay and it is slowly increasing by about three to four percent per year. There is a lot of people thinking we might be overwhelmed by type II [diabetes] but no. But it is there and its persistent. So the bad news is it is here to stay and it is slowly increasing. The good news is the rates aren't as high as what people were probably predicting ten years ago.
JAMIE TAHANA: Because it only first emerged in children in the 1990s didnt it?
CJ: Yes so we tracked back, 1995 you started to see a couple of cases. Prior to that we, it was before my time but you know people just don't recall seeing anybody. So what we see now is an overall rate for all ethnicities of 1.5 per 100,000 that is pretty low. To give you an idea type I diabetes is about 25. But in the Pacific islands it is about 4 per 100,000 and in Maori it is about 3.5. Now comparatively type I in children that is just about a third of what we see for type I. That is pretty impressive given we never saw this 20 years ago.
JT: Do we know what brought on that emergence? Because of course the obesity rates and stuff inclined but your data suggests that the link isn't as strong as it would suggest?
CJ: I think you are very right. We have this overwhelming obesity drive in New Zealand and a lot of other countries do. But you have still got to be a relatively specific ethnic group and within that you still have to have normally a strong family history of type II diabetes. Almost all the kids we see they have got parents or especially a mother who got type II diabetes on insulin in pregnancy. So it is almost like they are programmed metabolically ahead of time. Then they are getting obese they are hitting adolescense which causes you to need more insulin and everything it is probably where it kicks in then. So some of the drivers are there. I think obesity is a driver but it is not the whole play. A lot of these kids often say to us, why have I got diabetes I am not the biggest kid in my class? You know you should go and see Johnny next to me he is huge. And we say no well Johnny doesn't have a mum or dad with type II this is some combination of bad genes and bad environment.
JT: An increasing number of children in Auckland but the rates amongst Pasifika and Maori are 18 times higher than the European.
CJ: Yeah because we almost see no Europeans. So it is a worse stat than it probably is in real life. It is just that we almost see no Europeans with type II at that age group. And the reason that we do it at the really young ones under 15 is that over 15 it is very hard to capture what are true cases or not. No one really knows. And most of the government statistics on type II are really take off from about the age of 30. So the relative risk is very high, meaning Maori vs European but the absolute risk in the community if you go to try and track them down is it is still a very rare disease. For example in adolescent kids one in ten of the kids now has type II diabetes. Whereas 20 years ago we would never even have considered type II diabetes.
JT: Yes and you are saying there is no data above 30 and it wasn't even considered, I notice you are saying that people still dont think that children can get diabetes let alone type II.
CJ: Yes. The reason we mention that is that irrespective of what type people just assume diabetes is a disease of old people. So you know we are saying if anyone has got symptoms of diabetes get a diabetes check and we will work out from there what type it is.
JT: Does that suggest that people aren't even sort of looking for symptoms or if they have got the symptoms that they are not equating it to diabetes?
CJ: Yeah so in type II adolescents we are seeing half of them are what we call classically symptomatic meaning they have increased thirst, weight loss, drinking loss, getting up at night. They are sort of classic symptoms your blood sugar is really high. Another are almost randomly checked they had a boil or a infection or they are just tired or someone has done a blood sugar because mum was worried. So some of the kids can be. Have very high blood sugars and have almost no symptoms.
JT: Do you think this brings you sort of any clues as to why it has become persistent and is slowly increasing in the past 20 years or so?
CJ: It think it is multi-factual. I think we have this big driver for obesity. That is not helping. We have a big driver for food and diet that is not great. But we also have families with type II that are having lots of children and we are just seeing the tip of the iceberg. You know I think that other family members will probably get type II diabetes but may not for 10 or 20 years. And the ones that we see that are probably the most affected. So some of our kids will be the fifth or sixth kids in the family. But mum only got diabetes in pregnancy and had this type II now probably with their pregnancy and they were the biggest baby born. They were probably the highest at risk. So when your mum has diabetes during her pregnancy that is a very high risk factor for the child getting it. So we may well come away at some point saying. You know if you have had diabetes in pregnancy you should get your child checked for diabetes when they are 10 to think of a number because that is often when we are seeing them present with a disease without any known symptoms.
