I have a 5 year old, African American who has Acanthosis Nigricans and insulin resistance. Does this mean she will get Type 2 diabetes and is there anything I can do to prevent the possibility?

The question of acanthosis nigricans in children and adolescence raises the possibilities of various situations including obesity, syndrome X forme fruste, glucose intolerance, hyperlipidemia, hypertension and hyperandrogenemia. You did not mention if this child was obese or not. You also did not mention family history since this would provide some clue to the genetics of all these potential problems. Current information does not allow us the luxury of predictions. However, the more of the syndrome X already present, the more likely this will be a future Type 2 patient.

The best advice would be to work diligently to avoid obesity, promote participation in vigorous sports that would decrease obesity and improve overall glucose tolerance, decrease hyperlipidemia and improve or prevent hypertension. Helping the parents to recognize these risk factors and get the whole family participating in these health-promoting endeavors would be enormously helpful. It’s reasonable to assume if the obesity can be prevented then at least some of the other factors may be ameliorated or postponed.

I’d certainly think that some routine monitoring of lipids, fasting glucose and blood pressure as well as weight would be appropriate.

There are beginning studies with pills for Type 2 diabetes in these patients: the thiazolidinedione -family of drugs in adults and now in some teens looking to see if this would help and the preliminary results look promising, but not yet ready for 5 year olds. Similarly, for drugs like biguanides (metformin) but also not for 5 year olds.

Lastly, there will be an American Diabetes Association Task Force working on a position statement about type 2 diabetes in children and adolescents in the USA since it is clearly epidemic among the population of Asian-American, Native American, Latino and African-American kids who are obese — and is also increasingly seen in the Caucasian population of obese kids as well.

SB