Briana Johnson was 8 years old when her doctor tested her for diabetes.
"My camp counselor said it would be a good idea, since I was always using the bathroom, always thirsty," said Johnson, recalling the last summer she could eat popsicles or drink juice just to keep cool.
With a simple blood test, Johnson's days as a carefree camper came to an end. Her blood glucose was 500 milligrams per deciliter, a far cry from the normal 70-to-100 range. Her heavy weight, African-American heritage and family history of type 2 diabetes -- all risk factors for the disease -- had conspired against her.
Each year, more than 3,600 American kids are diagnosed with type 2 diabetes, a chronic condition once reserved for overweight adults. And in half of those kids, traditional treatments don't work, a new study found.
"Our study showed that type 2 diabetes in children and adolescents is a particularly aggressive condition, more so than in adults, and that traditional ways of treating type 2 diabetes may not be sufficient for many children," said Dr. Leona Cuttler, professor of pediatrics at UH Rainbow Babies and Children's Hospital in Cleveland, Ohio, and coauthor of the study published Sunday in the New England Journal of Medicine.
The study followed nearly 700 children aged 10 to 17 with type 2 diabetes. Of those who took the drug metformin, the gold standard in the treatment of type 2 diabetes, 52 percent failed to keep their blood sugar under control. Adding another drug called Avandia into the mix helped, lowering the treatment failure rate to 39 percent. But Avandia's cardiovascular side effects make it risky for use in kids. Adding a lifestyle intervention that promoted healthy habits also came up short, with no benefit over metformin alone.
"It's concerning that we don't have a treatment that works very well for most kids," said Cuttler, describing how uncontrolled diabetes raises the risk of cardiovascular disease, blindness and kidney failure. "This makes us worry about the future of child who develops diabetes because they may be at a high risk for the complications at a relatively young age, complications that are really debilitating and sometimes life threatening."
Cuttler said type 2 diabetes was nearly unheard of in children 25 years ago, calling it an "old disease in a new population." One factor driving the increase is obesity, which affects one in six U.S. children, according to the U.S. Centers for Disease Control and Prevention.
In an editorial accompanying the study, Dr. David Allen of the University of Wisconsin in Madison said today's children are "immersed from a young age in a sedentary, calorie-laden environment that may well have induced and now aggravates their type 2 diabetes… Indeed, this is the essential maddening conundrum of the epidemic of type 2 diabetes – collective failure to adhere to a lifestyle healthy enough to prevent the disease."
But Cuttler stressed that genes play a role, too.
"Certainly we think the development of type 2 diabetes is related to obesity as well as genetic factors," she said. "A good question is whether obesity is related to resistance to treatment. That's what we hope to tease out."
Growing Up With Type 2 Diabetes
For Johnson, being diagnosed with diabetes was a life-changing moment. While other fourth graders learned long division, she learned to how to monitor her blood glucose by testing a drop of blood from her finger. She also learned how to inject a dose of insulin during a diabetic attack.
"They educated me, helped me gain better understanding of what diabetes meant," she said of the doctors who diagnosed her. "Before that I had never heard of type 2 diabetes, even though my mom had it. I never knew what she took that medication for. Now we're each other's reminder."
While there is no cure, type 2 diabetes is manageable.
"We have treatments, and that's a good thing. But these treatments are very burdensome," said Cuttler. "You think of carefree, spontaneous children. You can't be so carefree and spontaneous when you have to take care of diabetes."
Now an 18-year-old high school senior, Johnson takes metformin twice a day to keep her diabetes under control. Small portion sizes and daily workouts with her school's track-and-field team also keep her blood sugar levels in check, and help her maintain her body weight.
"Diabetes is no joke," said Johnson, who will attend Bowling Green State University in the fall. "If you don't take care of yourself, it can be deadly."