Lilly Branka, 5, a kindergartner in Medfield, Mass., and Richard Zarate, 12, a seventh-grader in San Antonio, live in different worlds, but they have something in common: diabetes.
Until recently, almost all children had the type of diabetes Lilly has: type 1, the form of the disease caused by the immune system's destruction of cells in the pancreas that produce insulin. People with type 1, who account for 5 to 10 percent of those with diabetes, require daily injections of insulin to survive.
Richard and a growing number of children and teens have the more common form of diabetes, type 2, which used to be called adult-onset diabetes because it did not occur in children.
But the nationwide trend toward more high-fat food and less high-activity play has run smack into a genetic predisposition for diabetes in some communities, especially those with large Latino populations, sparking what pediatrician Jane Lynch of the Texas Diabetes Institute calls a "very scary, very alarming" epidemic of type 2 diabetes in children.
"We have close to 300 children we follow with type 2 diabetes," some as young as 7, Lynch says. "When I trained in the early '90s, it was essentially unheard of."
The increasing incidence of diabetes in children threatens to offset the benefits of improved diabetes treatment that have led to reductions in many of the disease's deadly or disabling complications.
Richard is being treated at the diabetes institute as part of a national study, Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY), and his mother, Christine Zarate, who also has diabetes, is grateful.
She had long suspected her only child, who she says always has been overweight, might also have the disease, because he had an area of darkened skin on the back of his neck, a marking doctors call acanthosis nigricans. It is often caused by high levels of insulin, which can occur when people are overweight and their bodies don't use insulin efficiently. The body tries to compensate for that by churning out extra insulin.
Zarate, who works as a private nurse, says she recognized the discoloration and knew what it meant. "I've tried to get him diagnosed since he was about 6 or 7, but the pediatrician he had at that time — I didn't have insurance — she never did a blood test on him."
Two years ago, at age 10, Richard began having symptoms, such as unusual thirst and frequent urination, and his mother checked his blood with her own glucose meter. The reading indicated Richard's blood sugar level was about five times higher than normal. She took him to the emergency room, where he was diagnosed and given insulin. They were told to see a diabetes specialist, but local doctors had months-long waiting lists.
The diabetes institute "was a godsend," Zarate says. As a participant in a clinical trial, Richard gets free diet and exercise counseling, medications and regular checkups. He is "doing wonderful," his mom says. He's taking two medications but is off insulin. "He's real careful, watches his carbs," she says. But "he's still a kid who wants to eat a hamburger."
For doctors, type 1 diabetes is familiar in children, but treating kids with type 2 is uncharted ground. Only insulin and the drug metformin are approved for use in children, but insulin as a first-line treatment can cause weight gain in kids who already are overweight, Lynch says, and metformin alone is often not enough.