Diabetes predictions grim

Several studies conducted by Hawaii researchers are predicting rates of type 2 diabetes, as well as other chronic conditions, will increase dramatically in the coming years among youth statewide.

One study from the University of Hawaii at Manoa found more than a quarter of hospitalized youth, and 12% of youth who visited an emergency department, had at least one chronic condition such as diabetes, chronic kidney disease or high blood pressure.


“It used to be only youth that typically got type 1 diabetes, but now, we have an increasing number of youth getting type 2 diabetes,” said Dr. Tetine Sentell, author of the study. “The whole country is following that increase.”

A recent study by the American Diabetes Association found that by 2060, type 2 diabetes in those under the age of 20 could increase by nearly 700% nationwide.

Over the last decade alone, type 2 diabetes among Asian and Pacific Islander youth increased by 50%.

“There’s an equity element in rates of chronic disease,” said Sentell, adding a wider perspective is needed to address the issue, taking into account housing, climate, and health care to ensure proper coverage and resources.

“The world we live in doesn’t promote healthy communities in which people can thrive in terms of food, environments, places to exercise,” she said.

As instances of type 2 diabetes occur earlier, so do complications resulting from the disease.

“We’re starting to see those who developed diabetes in their teens going into dialysis in their 30s and 40s, much sooner than previous generations, where if they went into dialysis, it would be in their 60s and 70s,” said Dr. Alan Parsa of the Pacific Diabetes &Endocrine Center in Honolulu. “I had a patient who had two strokes back-to-back, and he’s 41 years old — mainly because he had a hard time controlling his sugars for a few decades.”

Parsa added he’s seen patients going blind in their mid- to late-30s and getting amputations as early as their late 20s as a result of diabetes.

He recently completed a study involving 10th-grade students from Waipahu, Oahu, that found many students he tested had diabetes or prediabetes without knowing it.

“I looked at 100 people, and 8% of them had diabetes and had no clue that they even had it,” he said. “In that 8%, they had very poorly controlled diabetes and were at very high risk.”

Other surprises included the amount of students having fatty liver disease, a condition caused by poor diet and excess sugar consumption that can lead to diabetes and other chronic diseases.

“We know that fatty liver disease is, by 2026, going to become one of the leading causes of liver transplants,” said Parsa. “We cannot cure diabetes at this point, but we can reverse it and become diet-controlled, eat healthy, be healthy and lose excessive weight.”

Another factor causing concern is rising obesity rates among Native Hawaiian youths.

“We see in Native Hawaiians the onset of diabetes about 15 years earlier than the rest of the population,” said Dr. Marjorie Mau, head of the Center for Native and Pacific Health Disparities Research at the John A. Burns School of Medicine on Oahu. “That’s horrible, because when you’re in your 20s and 30s, that’s your peak earning years, that’s when you’re starting your family, you’re in a job hopefully building your career. And now all of a sudden, you have all these expenses for taking care of your blood sugars and trying to eat healthy.”

A joint study between UH-Manoa and the state Department of Health found that among those 5 to 29 who went to the hospital between 2015 and 2019, one in three were obese.

Additional research from the Office of Public Health Studies found Pacific Islanders, Native Hawaiians and Filipinos were more likely to be obese.

“Obesity, on a scientific level, we see as a form of stress, as well as things like discrimination, social determinants, poverty, homelessness,” Mau said. “There’s an abundance of data to show that Native Hawaiian communities and families, as well as other racial ethnic groups here in Hawaii, are constantly stressed by multiple factors outside of medical factors.”

Mau is also the author of a 2010 study in which 127 Native Hawaiian and Pacific Islanders participated in diabetes prevention programs with a community-centric approach. The study found that weight loss in high-risk minority populations can be achieved over a short period of time by using community-based methods, with Mau adding weight loss of just 7% can reduce the risk of getting type 2 diabetes by 60%.

“The name of the game right now is prevention, especially with type 2 diabetes,” she said. “When I started my career a number of decades ago, we thought this simplistic idea of if you just ate healthy and exercised regularly, your diabetes risk would go away. It turns out, there’s a lot more to that story.”

Each year, Mau has focused on a younger age group to help with prevention and treatment.

“My training is in adults, but it just seems like we’re treating the tail end of this vast number of people that have diabetes and complications,” she said. “I keep going younger and younger, and now, I’m at in-utero and infants.”

Mau added genome sequencing now iss playing a role, along with gestational diabetes, or diabetes that develops during pregnancy.

Gestational diabetes is highest among Filipinos, Native Hawaiians and Pacific Islanders, in that order.

“The prevalence of gestational diabetes in pregnant moms has tripled,” she said. “And if you’re Filipino and have gestational diabetes, five or 10 years later, you’ve got a one-in-two chance of getting type 2 diabetes. That’s scary.”

Email Grant Phillips at gphillips@hawaiitribune-herald.com.

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