By Bill Zeeble, KERA 90.1 reporter
Dallas, TX – Bill Zeeble , KERA 90.1 Reporter: 17 year-old Andrew Martinez lives in the heart of San Antonio's Hispanic barrio with his mom, an aunt, and diabetes.
Andrew Martinez: The whole family's diabetic in this household.
Zeeble: A second aunt has diabetes, while a third had it before she died. Martinez has had his Type 2 diabetes since he was 11. A decade ago, this would've been unheard of. But doctors are seeing this more and more, especially among Latino children. Genetics plays an obvious role, but there's more, says Dr. Dan Hale, Associate Professor of Pediatrics at the University of Texas Health Science Center in San Antonio.
Dan Hale, Associate Professor of Pediatrics at the University of Texas Health Science Center in San Antonio: If you have child getting six hours a week of physical activity and sitting and watching TV six hours a day, it's pretty clear your kid's not in good shape, and also a child that's not burning a lotta calories. In the barrios of San Antonio, about 29% of girls and 40% of boys are obese. These are in middle school, 6th-8th graders. [The] average male takes in 28 ounces of soda per day. Five percent of boys drink more than 60 ounces per day. If poorer and uneducated, [the] percentave goes up. Of course, we always like to do things bigger in Texas. Convenience stores in summer sell beverages of 62 ounces. If you buy that, they'll give you [a] grab bag of chips or Snickers so you can get 1000 calories for 99 cents. That translates into 7000 calories a week. 2 pounds a week. Or 20 pounds during summer. And then we play the game of why's everybody getting obese.
Bill Zeeble: Andrew Martinez says losing weight has been difficult. Martinez: At first I was like, close to 300, but now I'm 280. I've been trying my best. You get used to one type of diet but later on it's hard to keep controlling it. I'd been eating a lot of sugars before I noticed I was diabetic.
Zeeble: In addition to dieting, doctors tell Martinez to exercise to help control his blood sugars. He tries to walk, jog or ride an exercise bike every other day
Martinez: Matter of fact, we went to the mall and walked around. Me and my whole family.
Zeeble: Martinez gets help from the Texas Diabetes Institute, San Antonio's county-funded hospital nearby. It helped him get a home blood-sugar monitor and test strips that go with it. The institute's diabetes educator, Oscar Gonzalez, visits Martinez at home and at school. Gonzalez is convinced a personal relationship is essential in helping young diabetics control their disease. He talks about it as he drives away from the Martinez home.
[Ambient sound of automobile.]
Oscar Gonzalez, Diabetes Educator, Texas Diabetes Institute: We have a whole generation of children at risk. Not only here in San Antonio, but all over the U.S. Of course the most affected areas are here, where the Mexican-American population is the largest. I think there's more to these kids with Type 2 diabetes than just disease. That they are 159 individuals, capable, very smart, and as you can see, most are pretty big. [The] first thing you may focus on is their bigness. But you may not think of anything else about THEM. But they're very talented
Zeeble: Like the father many of these young, diabetic teens do not have, Gonzalez draws them and their families out about their lives.
[Ambient sound in the Martinez home, of Mom bragging about Andrew's bowling talents.]
Zeeble: Andrew Martinez's mother speaks proudly of her son's accomplishments as a champion high school bowler. To most, this might sound mundane, but not to Gonzalez. He listens as the 17 year-old pulls out a news clip from seven years ago, telling of the time he saved another child's life using the Heimlich maneuver.
Martinez: This one's me right here, and this is the one I saved right here.
Zeeble: Gonzalez didn't know any of this before, despite many visits he's had with Martinez. It's like something out of the movie "It's a Wonderful Life."
[Ambient sound of automobile.]
Gonzalez: It's important to be constantly reminding ?em of this, to keep [their] self-esteem up, ?cause if you do, it'll improve [the] chances of [the] disease being in better control. ?Cause they will feel good about [them]self. They'll believe in themselves. I tell them, do this good, and ten years from now you'll be free of this disease, you can do what you want, and don't give up. It's very important. It's very difficult. Pushing them, encouraging them is something that'll help their disease.
Zeeble: In Andrew Martinez's case, there's something else that's helping as well. Doctors have prescribed metformin. It's a Type 2 diabetes drug that limits glucose production in the liver, while often improving a patients' insulin response. But it's never been approved for children, just adults. That creates an ethical dilemma. With doctors are seeing more and more Type 2 children who fail to lose weight or control blood sugars, they conclude it's drugs, or nothing. So many prescribe metformin and get signed parental permission. Francine Kauffman, a pediatric endocrinologist who has at times given adult drugs to her young patients, says this is different.
[Ambient sound]
Dr. Francine Kauffman, Pediatric Endocrinologist: And we step back and say, "Type 2 in kids is [the] same as adults?" We don't even know that for sure. We've got a lot of work to do to be sure what the right roads are to take. To sit back and talk about using pharmacology for such a broad number of children. We've got to look - if this is really an epidemic, if [the] environment has changed, we must search for what it was and eradicate it. Drugs won't be the answer. People will be non-compliant; there'll be side effects; we'll end up with a lot of problems.
Zeeble: The Food and Drug Administration is about to calm the fears of some doctors who want to treat patients with drugs that haven't been approved for children. This December, drug makers will have to start testing new, adult drugs on children too, if it's possible children could use them for the same purpose. Doses must also be listed on the label. With drugs like metformin that are already used on youngsters, labeling will be required if its absence is deemed dangerous. For those alarmed that there's an over-reliance on pharmaceuticals, Dr. Lynn Stefen-Batey, an epidemiologist at the University of Texas School of Public Health in Houston, says good role models count too.
Dr. Lynn Stefen-Batey, Epidemiologist, University of Texas School of Public Health: Children model parent's behavior. So if mom and dad are watching TV and eating tater chips, kids will pick up habits also and follow through as adults.
Zeeble: The Centers for Disease Control and Prevention recently reported the single largest increase of Type 2 diabetes occurred among adults in their 30's. Through the 1990's, diabetes jumped 76% in this group. These are adults of child-bearing, child-rearing age. Their children, and other young teenagers increasingly diagnosed with Type 2 diabetes, scare doctors like Larry Deeb, a pediatric endocrinologist, because they know what it means for the future.
Dr. Larry Deeb, Pediatric Endocrinologist: Pediatricians think about prevention. We give shots to babies and all those things. The issue of 14 year-old being a 34 year-old with massive heart attack is frightening. If you look at Type 2 diabetes and look at 10 years out from diagnosis, there are serious and significant complications, morbidity and mortality, within 10 years of diagnosis.
Zeeble: These are the kinds of complications that used to strike diabetics in their 50's and 60's or older. Dr. Neil White, another pediatric endocrinologist, is not optimistic the trend towards more, and ever younger, diabetics can be stopped, or slowed. He knows compliance with diet and exercise programs often fail. He feels like the time bomb is ticking
Dr. Neil White, Pediatric Endocrinologist, Washington University: I don't think we yet know how to turn that time bomb off. We have to keep trying, as a public health issue; we have to keep trying as a science issue, to turn that time bomb off.
Zeeble: For KERA 90.1, I'm Bill Zeeble.