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<h1>Fighting the growing type 2 diabetes epidemic in children</h1>
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By The Partnership for Public Service, <span class="">Published: January 6 | </span>
<span class="">Updated: Tuesday, January 8, <span class="">12:01 AM</span></span>
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<p>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.</p>
<p>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.</p><p>“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.”</p><p>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.</p><p>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.</p><p>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. </p><p>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. </p><p>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. </p><p>“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.”</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>“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.”</p><p>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. </p><p>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.</p><p>“What she is doing now to coordinate and implement research will influence the lives of millions of people worldwide.”</p><p>
<em>This article was jointly prepared by the Partnership for Public
Service, a group seeking to enhance the performance of the federal
government, and <a href="http://washingtonpost.com">washingtonpost.com</a>. Go to <a href="http://www.servicetoamericamedals.org/nominate">www.servicetoamericamedals.org/nominate</a> to nominate a federal employee for a Service to America Medal and <a href="http://washingtonpost.com/wp-srv/politics/fedpage/players/">http://washingtonpost.com/wp-srv/politics/fedpage/players/</a> to read about other federal workers who are making a difference.</em>
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