Barbara Schreiner, Sandy Upchurch, Doris Wright and Christine Brosnan (seated) conducting research to identify the signs of Type 2 diabetes in children

Four women from three different institutions within the Texas Medical Center are collaborating on a project to identify the signs of Type 2 diabetes in children, which, until recently, was rare.

"Right now, we see about 1,300 diabetic children at Texas Children’s Hospital on an ongoing basis, and each year we see about a 10-15 percent increase," says Barbara Schreiner, a nurse and diabetes specialist at Texas Children’s Hospital. "When we first started seeing children with diabetes about six years ago, we didn’t even think about Type 2.

"It's the aging of youth," she explains. "There are a lot of reasons for this. You’ve heard them on the news. Our kids are more sedentary, and they eat more starches and not enough green leafy vegetables. We’re trying to distinguish between the two types of diabetes so when children go to the doctor, they receive the appropriate treatment."

Sandy Upchurch, assistant professor of nursing at The University of Texas-Houston Health Science Center School of Nursing adds, "When I project 20 years out, the problems that a child with Type 2 could have are very alarming to me. But the literature doesn’t give a clear list of characteristics and risk factors for those children."

Diabetes occurs when the body is unable to use glucose properly, which happens in one of two ways. "Type 1 occurs when someone isn’t making enough insulin – the key that lets glucose into the muscle cells for energy," explains Ms. Shreiner. "Type 2 occurs when the body makes insulin but there’s something wrong with the key matching one of the locks at the cell."

Although diabetes shows up in blood tests, type and ultimately treatment, is determined by physical examination. So the four women are abstracting information from past records to help define the differences between the two types in children.

Christine Brosnan, assistant professor of nursing at The University of Texas-Houston Health Science Center School of Nursing, explains, "Clinicians over the years have felt that children who seem to have Type 2 are heavier than children with Type 1 and may be from minority backgrounds. Their families may have a history of Type 2 diabetes, and they may have some skin markings. But that’s all been anecdotal – just stories. What we’re going to do is look into a large number of records and see if we can find a statistical difference in kids who have Type 1 versus kids who have Type 2."

Ms. Schreiner says, "I’d like to think that projects like this will help paint a picture about what a child at risk looks like so that public health initiatives can be put into place early on, and so pediatricians and school nurses can identify these kids and stop what seems to be an almost monumental increase."

Doris Wright, assistant professor of nutrition and food sciences at Texas Woman’s University, states, "Interdisciplinary collaboration is critical in a project like this."

Dr. Upchurch adds, "It takes all of us with our individual skills to bring this together. It takes a long time to establish the validity of the information we’re abstracting and to make sure we are doing it in a reliable fashion. That’s where we are right now."

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