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.
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.
“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.”
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.
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.
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.
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.
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.
“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.”
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.
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.
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.
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.
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.
“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.”
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.
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.
“What she is doing now to coordinate and implement research will influence the lives of millions of people worldwide.”