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. About 4,000 new cases of type 2 diabetes are now diagnosed nationally every year in those under age 20
One of studies overseen by Linder, known as HEALTHY, demonstrated that improved nutrition and increased physical activity among overweight children could reduce the risk for type 2 diabetes. The trial results were published in 2010. A standard recommendation for adults with type 2 diabetes has been weight loss, but the effectiveness of this approach had never been tested in youth.
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 669 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 have been guided by evidence of therapeutic regimens tested only in adults.
This study, known as TODAY and published in April 2012, found that type 2 diabetes is much harder to manage in teens than adults. Researchers said that 46 percent of the participants treated with one drug, either alone, with intensive weight-loss counseling, or in combination with another medication, failed to maintain healthy blood sugar levels and needed to be put on more potent insulin injections within slightly less than a year, on average.
Linder also is currently involved in a joint survey by NIH and the CDC that is seeking 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.
Following these meetings, Linder led groups of more than 100 scientists from academic centers across the country to create common study designs. She 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.”
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,” he said.
Linder said the rise of type 2 diabetes is very troubling.
“When people get it in their teens, we’re talking about a huge public health problem,” said Linder. “I want to see where this epidemic is coming from and how to fix it.”