The media has focused lately on the link between childhood obesity and type 2 diabetes. While being overweight poses significant health risks -- including diabetes -- there is more to the story. Both type 2 and type 1 are on the rise in children.
"The incidence of both types of diabetes is increasing," says Carla Greenbaum, M.D. of the Benaroya Research Institute at Virginia Mason. "Public health efforts to improve the lifestyle of youth are important to change this picture. However, we must also understand how genetic and immune factors contribute to diabetes before we can truly conquer the disease."
Seattle, in particular, is a hub for diabetes treatment and research. For reasons still unknown to researchers, the incidence rate of type 1 diabetes in Seattle is on par with that of Sweden, which has the second highest rate of diabetes in youth worldwide. Seattle also is a center for research, studies and programs focusing on the disease.
Children's Hospital and Regional Medical Center in Seattle is one of six U.S. institutions contributing to a groundbreaking diabetes study called Search for Diabetes in Youth (SEARCH) that has been ongoing since 2001. Doctors and researchers have known for years that diabetes diagnoses were increasing among children, but the reports were from isolated centers. The SEARCH study is the first to assess prevalence and incidence of diabetes by type, age, gender and ethnicity in a consistent manner in populations at the six sites.
"The Centers for Disease Control and the National Institutes of Health renewed the funding for Children's for the next five years, during which time we will be looking at trends in incidence," says Catherine Pihoker, M.D. and principal investigator for SEARCH. "For example, are more young children developing diabetes, and how is the proportion of type 2 to type 1 changing?"
The study involves many regional collaborators, including UW Diabetes Care Center, UW Harborview, Group Health Cooperative, Mary Bridge Children's Hospital/Multicare Health Systems and Benaroya Research Institute at Virginia Mason.
So far, researchers from the six U.S. sites have reported that the incidence of newly diagnosed diabetes in the SEARCH study population was significantly higher than expected. The study has also uncovered that the distinction between the two types of diabetes is less clear than was previously thought. In type 1, the body ceases to produce insulin, usually due to an autoimmune process: The immune system damages the cells in the pancreas that produce insulin. In type 2, the body's tissues do not respond normally to the insulin that is produced. In the SEARCH study, some study participants diagnosed with type 2 also have autoimmune aspects of type 1.
"We don't fully understand what this means in terms of best management, but with the SEARCH study, we are following all cases from 2002 forward to answer this question," Pihoker says.
In addition to generating important benchmark statistical data, the study is also looking at the acute and chronic complications of the disease -- and quality of care and treatment -- by type of diabetes.
"Diabetes is so difficult because so much is left up to the child and family," Pihoker says. "There are many tasks that need to be done each day to avoid problems related to the disease-long and short term."
Working to Prevent Type 2
Perhaps the most important distinction between type 1 and type 2 diabetes is that the onset of type 2 can be delayed through healthier lifestyle. Clinics like the Odessa Brown Children's Clinic, located in the Central District, strive to educate parents about the health risks associated with being overweight. Odessa Brown works with a diverse and often low-income population and sees children who may be most susceptible to obesity and related health concerns like diabetes.
"We are seeing an increase of overweight in all children, though minority children are more at risk, and also more at-risk for type 2 diabetes," says Lenna Liu, M.D., MPH, clinic physician and a co-investigator on the SEARCH study.
Collaborations Fuel Type 1 Research
Benaroya Research Institute (BRI) at Virginia Mason is leading the way locally in the area of type 1 diabetes. In addition to collaborating with Children's on SEARCH, BRI has many other ongoing studies focused on type 1 treatment and prevention
BRI considers diabetes to be an epidemic in Seattle, and it partners closely with researchers in both Sweden and Finland where the disease incidence is also high.
On April 1, BRI -- along with other local institutions, including Children's Hospital in Seattle -- will sponsor the Seattle-Sweden Childhood Diabetes Awareness Day. The symposium, organized by Professor Ake Lernmark, PhD, working out of the University of Washington and Malmo, Sweden and the Consulate General of Sweden in Los Angeles, features presentations from Seattle and Swedish researchers, as well as biotech companies. Organizers encourage parents to attend the symposium since it is geared toward the public and will contain the latest information regarding local studies, research presentations (including the SEARCH study) and available new treatments.
For more information on the Childhood Diabetes Awareness Day, call 1-800-888-4187, the Juvenile Diabetes Research Foundation Northwest at 206-838-5153 or email jdrfnorthwest@jdrf.org.
Though BRI is seeking a diabetes cure, it also focuses on what can be done to help patients manage existing illness. One of the center's more prominent studies is testing the safety and efficacy of two drugs designed to stop or slow the destruction of beta or insulin-producing cells in individuals newly diagnosed with type 1 diabetes. If such a treatment were to be successful, it might render type 1 less destructive in the short-term and perhaps offset the disease's long-term complications such as kidney disease, eye problems and circulation disorders. Additionally, researchers hope that if the treatment is well-tolerated in those with diabetes, it could be used to actually prevent diabetes in high-risk individuals.
One of the more important recent research developments, Greenbaum notes, is the ability to determine an individual's risk of developing type 1 based upon genetics, diabetes-related auto antibodies and metabolic testing. For patients involved in research studies now, it is likely that researchers will identify the onset of type 1 diabetes before there are any clinical symptoms, such as weight loss, excessive thirst and urination or life-threatening ketoacidosis (insulin deficiency).
This testing, which has been available since the 1990s, may eventually bring researchers closer to answering the question of cause, which is currently suspected to be a mix of genetics and environmental factors. It also sets the stage for treatments to prevent the disease.
Individuals at risk for developing diabetes may have the opportunity to participate in studies aimed at delaying or preventing the development of the disease, Greenbaum adds.
Rhonda Aronwald is a Seattle communications consultant, freelance writer and mom.
Resources
- Benaroya Research Institute Diabetes Research Program
www.benaroyaresearch.org/programs/diabetes_program/index.shtml
More info: call 1-800-888-4187 or email: diabetes@benaroyaresearch.org - Type 1 Diabetes TrialNet, a network of 18 clinical centers working in cooperation with screening sites worldwide, including the U.S. www.DiabetesTrialNet.org
- American Diabetes Association www.diabetes.org
- Juvenile Diabetes Research Foundation www.jdrf.org
- Children's Hospital and Regional Medical Center www.seattlechildrens.org
- SKWIDDS (Super Kids With Insulin Dependent Diabetes). Contact Kathy Bolopue, 425-643-0592
