[Vision2020] Fighting the growing type 2 diabetes epidemic in children

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   Fighting the growing type 2 diabetes epidemic in children By The
Partnership for Public Service, Published: January 6 | Updated: Tuesday,
January 8, 12:01 AM

More than a decade ago, pediatricians across the country began seeing an
alarming increase in children with type 2 diabetes, particularly among
minorities and youngsters from low-income families.

Dr. Barbara Linder made it her mission to understand this growing problem
and between 2006 and 2011 led two multi-year clinical trials sponsored by
the National Institutes of Health (NIH) which developed and tested
strategies to prevent and treat type 2 diabetes in youth.

“Barbara Linder has led the federal effort to address type 2 diabetes in
children,” said Dr. Judith Fradkin of the NIH’s National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK). “Her accomplishments in
advancing research to prevent and treat type 2 diabetes in youth have
far-reaching benefits for children, their families and the broader public
health.”

Diabetes, the seventh leading cause of death in the United States, is a
chronic disease in which blood glucose (sugar) levels are above normal due
to defects in insulin production or in the body’s ability to use insulin.
Long-term complications include heart disease, stroke, blindness, kidney
failure, nerve disease, gum disease and amputation of the foot or leg.

According to the Centers for Disease Control and Prevention (CDC), almost
26 million Americans have diabetes, including 215,000 people younger than
20 with type 1 or type 2 diabetes. A study funded by the CDC and NIH found
that about 4,000 new cases of type 2 diabetes are now diagnosed nationally
every year in those under age 20.

One of the studies overseen by Linder, known as HEALTHY, demonstrated that
a middle school-based program to improve nutrition and increase physical
activity could successfully reduce the children’s risk for type 2 diabetes.

The HEALTHY trial involved more than 4,000 students at 42 middle schools
with predominantly Hispanic and African-American children from low-income
households, most of whom were eligible for free or reduced-price lunches.
Some schools pushed back on HEALTHY’s efforts to reform nutrition. Vending
machines with unhealthy snacks and sodas were very profitable for schools
with tight budgets. Other schools faced pressure to improve test scores and
were wary of sacrificing classroom time for more time in physical education
classes.

Linder oversaw scientists who negotiated with test schools to ensure they
made substantial changes in food offerings and provided expanded
opportunities for exercise. She also oversaw an agreement for the
researchers to collect routine medical data, such as blood pressure and
body mass index, and to carry out tests related to diabetes risk factors.

“The research findings from this study can inform future school-based
efforts to reduce the escalating problems of overweight and obese American
children,” said Fradkin. “U.S. research and health care efforts can build
on HEALTHY’s wealth of information.”

A second clinical trial led by Linder compared the safety and efficacy of
three treatment strategies for 699 overweight children with type 2
diabetes. One group in the study took a single drug, a second group took
two medicines and a third group took one medication and engaged in an
intensive lifestyle intervention. Up to this point, physicians treating
youth with type 2 had been guided by evidence of therapeutic regimens
tested only in adults.

This study— the Treatment Options for type 2 Diabetes in Adolescents and
Youth (TODAY), published in April 2012 — found that type 2 diabetes is much
harder to manage in teens than adults. Researchers found that 52 percent of
the participants treated only with the drug most commonly used in adults
failed to maintain acceptable blood sugar within one year.

Linder currently is involved in a joint survey by CDC and the NIH that
seeks to more accurately determine the incidence and prevalence rates for
childhood diabetes across the country.

Linder, the senior advisor for childhood diabetes research at NIDDK, laid
the groundwork for the HEALTHY and TODAY studies by gathering leading
pediatric endocrinologists and diabetes experts to identify the biggest
public health concerns related to type 2 diabetes in children.

She then led groups of scientists from academic centers across the country
to create common study designs and oversaw the implementation of both
studies and the recruitment and continued participation of children in the
research.

“The unique thing about her is that she can mobilize large numbers of
smart, opinionated people to work together for a common cause.” said Dr.
Gary Foster of the Center for Obesity Research and Education at Temple
University. “These are people from different perspectives, disciplines and
generations. She has an unusual knack for integrating people’s opinions
into the larger picture.”

The rise of type 2 diabetes is a huge public health problem, Linder said,
and getting it early in life may lead to complications such as heart or
kidney disease in the prime of life, since those complications are partly
related to how long a person lives with the disease.

Dr. Griffin Rodgers, director of NIDDK, said Linder’s work has been
essential to developing strategies to deal with this growing diabetes
epidemic among children.

“What she is doing now to coordinate and implement research will influence
the lives of millions of people worldwide.”

*This article was jointly prepared by the Partnership for Public Service, a
group seeking to enhance the performance of the federal government, and
washingtonpost.com. Go to www.servicetoamericamedals.org/nominate to
nominate a federal employee for a Service to America Medal and
http://washingtonpost.com/wp-srv/politics/fedpage/players/ to read about
other federal workers who are making a difference.*

**
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