Type 2 Diabetes Development in Teens Appears to Follow Adult Model
With more teenagers developing type 2 diabetes, researchers at Cincinnati Children's are focusing on identifying the causes, progression, prevalence and incidence of the disease. New findings from a longitudinal study reveal the prevalence of abnormalities in glucose metabolism in adolescents.
Initial results indicate that the adult model of the progression of insulin resistance to type 2 diabetes mellitus in adolescents may be valid. "These findings suggest that the development of carbohydrate intolerance and diabetes in adolescents and adults may follow similar routes and implies common inherent and environmental causes," says lead author Lawrence Dolan, MD, of the Division of Endocrinology at Cincinnati Children's.
In addition, unlike the adult population where about half of adults with diabetes do not know they have the disease, the study shows that very few teenagers have undiagnosed diabetes. "Despite the increase in obesity, there does not appear to be a higher incidence of hidden diabetes among adolescents," Dr. Dolan says.
However, the prevalence of carbohydrate intolerance/near diabetes was 8.3 percent. Onethird of adolescents with diabetes mellitus could be classified as having type 2. "This shows us that lots of kids may be at increased risk to develop issues related to blood sugar later in their lives, so there is a lot of research still to be done," Dr. Dolan explains.
A Prospective Study
This study reports on findings from the first five years of the current Princeton School District study, a prospective, pidemiologic study of the development of type 2 diabetes mellitus in adolescents in a welldefined, racially integrated, urbansuburban school district. There is a wide range of socioeconomic status in each ethnic group. In grades 5 through 12, 2,501 of a total of 4,273 students participated in the study.
Over the years, researchers at Cincinnati Children's have worked collaboratively with the nearby school district. "Our research field team deserves the credit for the success of this study to date, and for building the relationships that resulted in such great participation," Dr. Dolan explains.
All blood samples for the study were processed in the core laboratory of the Cincinnati Children's General Clinical Research Center (GCRC), funded by the National Institutes of Health. While preparing their grant application for this study, Dr. Dolan and his colleagues also benefited from the input of the center's Scientific Advisory Committee. "Because the researchers on the committee review your project from a different perspective, their expertise enhances your work," he says.
Focused Diabetes Expertise
In addition, patients at Cincinnati Children's who are newly diagnosed with diabetes are admitted to the GCRC for needed care and intensive education by nurses with diabetes expertise. Follow-up visits occur at the outpatient unit next to the GCRC. As a result, patients with diabetes and their families have a home within the medical center, and researchers can access resources needed for a variety of studies.
"Because care and research are so closely tied together, it's been a dynamite relationship, with benefits for patients, families and the diabetes team," Dr. Dolan says.
As the Princeton School District study continues, Cincinnati Children's researchers will seek additional insights into the relationship between diabetes and cardiovascular disease. "Glucose, insulin, lipids and obesity all play a role in both diabetes and heart disease," Dr. Dolan says. "Our job is to identify the development of cardiovascular disease at the earliest possible time – the mechanisms of how it starts, then how it continues to develop. With cardiovascular disease killing half the population, developing strategies to intervene is a key goal."
