The global increase in diabetes: Unique issues for mothers and children

It is now well documented that obesity and diabetes mellitus (DM) are increasing globally in epidemic proportions across all age groups. As a result, type 2 DM is for the first time being seen frequently in children and young adults in many populations. An increase in the incidence of gestational diabetes mellitus (GDM) has also been well documented in Australia and the United States, and there are some data suggesting the same trend in India. However, universal screening for GDM is not practiced in many areas of the world, making it difficult to estimate its true prevalence. The increase in type 2 DM in youth has implications beyond the burgeoning number of persons affected. First, the younger the patient at onset of disease, the greater is the lifetime risk of developing complications of diabetes and/or cardiovascular disease. Secondly, intrauterine exposure to the metabolic environment of maternal diabetes, or GDM, is associated with increased risk of obesity and altered glucose homeostasis (impaired fasting glucose, impaired glucose tolerance and type 2 DM) in the offspring, beginning in childhood and probably reflected in more GDM in the next generation as well. In addition, impaired intrauterine growth (under-nutrition) is associated with a similar childhood phenotype and similar adult chronic disease risks. Thus, alterations in the intrauterine metabolic environment may be important contributing factors to the ongoing epidemics of obesity and type 2 diabetes.