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[IP] NYTimes.com Article: Attacking Juvenile Diabetes With Education About Eating

This article from NYTimes.com 
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Here is an article I found interesting.  The term Juvenile Diabetes applied to type 2 diabetics, but who are "Juveniles"   
Denise Guerin
Type 1 46 years
Minimed 507 2 1/2 years

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Attacking Juvenile Diabetes With Education About Eating

February 20, 2001


Every Tuesday after school, 9-year-old Ashley Moreno and a few
classmates get together and play how-to-prevent-diabetes games 
not the sort of extracurricular activity that would thrill most
fourth graders.

 But Ashley looks forward to the program, called Bienestar, Spanish
for well-being.

 "I go because I want to stop the diabetes, like if you have it you
could die," Ashley said. "We do fun things at Bienestar, like we
make these books and we play a game where we divide into groups and
hop around and try to pop a balloon that has questions inside about

 Ashley attends Collins Garden Elementary School in San Antonio.
She is one of a growing number of children throughout the country
participating in diabetes prevention programs sponsored by the
National Institutes of Health. Such programs would have been
unheard of even a few years ago. Certainly health education has
been popular for decades, but experts rarely discussed Type 2
diabetes with children. It has always been considered an adult
disease, brought on, in part, by years of eating too much.

 Now, pediatricians say, this kind of diabetes is striking more
teenagers, who are at risk for all of the same consequences that
afflict adults with diabetes, like diseases of the eyes, heart and

 Most children with diabetes are afflicted with Type 1, or juvenile
diabetes, an autoimmune disease in which the body's defense system
attacks insulin-producing cells, crucial for using and storing
sugar. In Type 2 diabetes, the body makes insulin but not enough to
overcome defects in the sugar metabolism pathway.

 No national statistics are kept, but clinics report increases in
Type 2 diabetes diagnoses among children. The illness seems to
afflict poor children in certain ethnic groups, like American
Indians, blacks and Hispanics. Some evidence suggests these
children may be prone to problems with sugar metabolism, raising
the risk of diabetes. This inborn vulnerability combined with poor
eating and lack of exercise can disrupt the insulin system.

 Such reports have prompted pediatricians and endocrinologists to
organize programs, like Bienestar, that teach children about
nutrition and physical fitness. In Bienestar, some of the children
have signs of prediabetes like glucose intolerance. And some,
including Ashley, are at high risk because of obesity and family

 Many programs are directed at 9- and 10- year-olds: children at
those ages are considered old enough to understand health messages,
but they have not yet hit their cynical teenage years. The
lingering question is whether these one- or two-year programs will
encourage children to make lifelong changes in the way they eat and

 Doctors know they are battling bigger issues than simply urging
young patients to have willpower. They are also fighting poverty.
Many of the children come from families that do not have money for
sporting equipment or even access to markets with fresh produce. So
doctors are finding new, practical strategies to persuade children
to adopt healthier habits. 

 "In 1992 most pediatric endocrinologists in major medical centers
would have said that about 2 to 4 percent of their patients with
diabetes had Type 2," said Dr. Francine Kaufman, a professor of
pediatrics at the school of medicine at the University of Southern
California. "Now the data is somewhere between 8 and 40 percent,
depending on the center and the ethnic mix."

 Dr. Kaufman, who is also head of the division of endocrinology at
Children's Hospital of Los Angeles, presented the data in October
at the meeting of the American Academy of Pediatrics in Chicago.

 Dr. Michael Englegau, an epidemiologist at the Centers for Disease
Control and Prevention, said doctors first noticed Type 2 diabetes
among American Indian children. Since then, they have been
searching for and finding the illness among children in other
ethnic groups.

 In one recent week, Dr. Kaufman said, her center diagnosed five
cases of Type 2 diabetes in children. "The youngest was 8, though
that is very rare," she said.

 A study at the University of North Carolina found that 7 percent
of 700 children already had three risk factors for Type 2 diabetes.
The factors are high insulin levels, high blood pressure and either
elevated levels of fat or not enough H.D.L., the "good"
cholesterol. Obese children were 53 times as likely to have all
three risk factors compared with other children, said researchers
who presented their results in November at the American Heart
Association meeting in New Orleans. 

 Dr. Kaufman said that black children tended to have higher insulin
levels than white children. Among blacks, girls have higher levels
of insulin than boys. The higher level is a signal that the body
does not break down sugar effectively. Puberty adds an extra burden
by causing the insulin system to work less efficiently, Dr. Kaufman
said. This is probably because of increases in growth hormones, she

 The real culprit, experts say, is not the inclination toward the
disease but the surge in obesity among children. They blame schools
for cutting physical education programs and for stocking the
cafeterias with junk food instead of fresh fruits and vegetables.
They add that poor families suffer the most obesity and, therefore,
the increased risk of diabetes. 

 "Diabetes is a poor person's disease," said Dr. Roberto Trevino,
director of the Social and Health Research Center in San Antonio
and founder of Bienestar. Among Mexican-Americans in San Antonio,
diabetes strikes about 5 percent of those who are rich and 17
percent of those who are poor, he added. "We spend so much time
looking for genes, but we ignore the behavioral risk factors
effecting this disease," he said.

 Bienestar is a 32-lesson plan that includes cooking, games,
theatrical play and exercise. Once a month parents are invited to
learn tips for healthy cooking.

 Dr. Trevino has also invaded the cafeteria at Collins Garden
Elementary School, teaching the staff to cook healthier meals and
serve smaller portions. Student volunteers patrol the cafeteria to
ensure that children are actually eating their fruits and

 Doctors also take blood samples periodically from the children in
the program and measure their weight and body fat composition to
assess the success of the program.

 Two years ago, Dr. Trevino's team studied eight schools in San
Antonio. Four were in the nutrition program and the rest served as
control groups. Among the schools in the program, scores on
physical fitness tests increased by about 4.6 percent. The amount
of fat eaten daily by those in the schools with healthy-eating
programs decreased to about 31 percent of their total calories,
from 34 percent. Fiber consumption, mainly from fruits and
vegetables, increased from 10 to 13 grams a day. Not more than 30
percent of a child's daily calories should be from fat, Dr. Trevino
said. A 9-year-old should eat about 14 grams of fiber daily.

 Among children in the control groups, physical fitness increased
by only 0.8 percent, fat consumption stayed constant at 34 percent
daily and fiber consumption decreased to 8 grams from 10.

 Most important, 14 children who started the program with impaired
glucose metabolism had normal glucose metabolism by the end of the
school year.

 Dr. Trevino said changes in diet and exercise could prevent many
of the cases of Type 2 diabetes. "We Americans expect the magic
pill or we wait for the transplant," Dr. Trevino said. "But
changing human behavior is a lot of work. We don't have a magic
pill and yet we were able to accomplish something."

 Though Dr. Trevino's program is hailed as one of the most
intensive, similar programs are offered elsewhere.

 At the Yale University School of Medicine, obese children meet
twice a week to learn weight-loss tips. About one-fifth of 180
overweight children have impaired glucose metabolism, a sign that
they are already placing stress on their insulin systems or are
becoming diabetic, said Dr. Sonia Caprio, an associate professor of
pediatrics at Yale. Dr. Caprio is also starting a health program at
Dunbar School in a disadvantaged area of Bridgeport, Conn., with
the help of Charles Smith, a former player for the New York Knicks.
The program includes periodic blood tests to measure glucose levels
and other signs of the risk of diabetes.

 Dr. Kaufman, of U.S.C., is starting a Kids and Fitness program in
schools in the Los Angeles area that will include screening for
diabetes. She said some students were already showing signs of
complications resulting from impaired glucose metabolism, like
polycystic ovarylike syndrome, in which a girl's body makes too
many male hormones.

 In New York, doctors from Bronx-Lebanon Hospital Center are
sending health workers into Taft High School, which serves many
disadvantaged students. The doctors plan to add diabetes prevention
tips to an after-school H.I.V.-prevention program. 

 And in Miami, health educators from the University of Miami have
screened 10th graders for high blood pressure. Those who have it
are offered more tests to assess their risk of developing diabetes.

 Researchers have found that children who have high blood pressure
are more likely to be overweight and to have higher fats and higher
insulin  "all the features that lead to Type 2 diabetes," said Dr.
Jay Skyler, a professor at the University of Miami School of
Medicine, where he directs the endocrinology, diabetes and
metabolism division. 

 While a few short-term studies suggest that children in the
program tend to lose weight and that some no longer have impaired
glucose, the real test is whether these lifestyle changes last
until adulthood. No one knows how these children will eat and
exercise once they leave the structured programs. Nor does anyone
know whether these children will grow weary of eating apples
instead of brownies. 

 As for 9-year-old Ashley Moreno, she said changing her diet had
been easy so far. She has switched from whole milk to milk with 2
percent fat.

 "I tell my mom to give me less food, so I eat two slices of pizza
instead of three," she said. "But the exercise is the hardest part;
I try doing side-bends and jumping jacks, and I ride my bike."

 Ashley's mother, Cristina Moreno, said that she joined her
daughter after school and that she had attended a meeting for
parents, where she was taught healthy cooking techniques, like
simmering meat without lard and switching from flour tortillas to
corn tortillas, which have less fat and fewer calories.

 Ms. Moreno said she was happy to be involved with the program
because she had seen the devastating effect of diabetes.

 "I have an aunt with diabetes," Ms. Moreno said. "She's been very
ill with heart problems and when she gets sores, it's hard for them
to heal."

 Ms. Moreno admits that she cannot predict whether Ashley will
maintain her motivation.

 "The program makes you think about it now, but she is growing and
may change later on," Ms. Moreno said. "Right now it's working. I
know I'll work hard for her. Ashley has asthma already, and I want
to do anything to prevent any other disease that would harm her. I
would be devastated if she got diabetes." 



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