Mysteries of Type 2 Diabetes


Here is news nobody wanted to hear: “Childhood obesity rises during October Childhood Obesity Awareness Month.” Fortunately, this was a very localized report concerning Vigo County, IN, but the situation is not much brighter when the big picture is consulted.

Speaking of official months, we are now partway into American Diabetes Month, and the American Diabetic Association (ADA) marks the occasion by reminding us of the grim statistics: Nearly 26 million adults and children in the U.S. are afflicted by diabetes. By the year 2050, one-third of us could have the condition.

In the old days, pediatricians saw far less diabetes. Something is causing impaired glucose tolerance, more insulin resistance, and other metabolic defects. The relationship between childhood obesity, insulin resistance, and Type 2 Diabetes is observable, but what is the mechanism of the relationship? As a team searching for an effective drug phrased it:

Despite the increasing prevalence of type 2 diabetes in youth, there are few data to guide treatment.

Dr. Pretlow asked around at the recent conferences he attended. It turns out that researchers don’t really have a handle on why childhood obesity apparently leads to diabetes, which is why they continue to do research.

The ADA’s current public relations campaign involves a photo gallery called “A Day in the Life of Diabetes,” featuring the routine lives of diabetics, in pictures collected via Facebook. The ideal situation, of course, would be for no one to suffer from the condition and for the ADA’s Facebook page to be empty.

On the hard science side, a recent study by Sonia Caprio, M.D., of Yale University began with two facts: Obese children and teens have defects in insulin action, and their bodies tend to store fat not in the subcutaneous abdominal layer, but in muscle tissue, and amongst the liver and other organs. It’s the wrong place for fat to be.

Dr. Caprio set out to explore two questions:

1) What might lead to a reduced ability to store fat in the subcutaneous abdominal? Is the adipose cell from an obese adolescent with a low volume of abdominal subcutaneous layer different in size and in its ability to proliferate when compared to the cell from an obese adolescent with a large abdominal fat layer?

2) Do obese adolescents with marked insulin resistance have problems localized in their muscle which results in the reduced capacity of the muscle to burn more fat? Is accumulation of fat in the muscle related to impaired oxidative capacity (mitochondrial dysfunction) in obese adolescents?

Dr. Caprio sums up by saying that her team has started to unravel the mystery of one certain type of obesity, a variety associated with fat accumulations in the liver and in muscle. It is a fat tissue profile proven to be associated with diabetes risk. If one can be solved, the other can be prevented. Dr. Caprio indicates the direction that future studies should take:

Importantly, there is need for more studies aimed at understanding the impact of potential environmental factors on the genes involved in both forms of diabetes.

Your responses and feedback are welcome!

Source: “Childhood obesity rises during October Childhood Obesity Awareness Month,”, 10/08/12
Source: “A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes,”, 06/14/12
Source: “Mechanisms of insulin resistance in childhood obesity,”, 06/12
Image by Enrico Strocchi.

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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