Inside Pediatrics Spring 2025

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ENDOCRINOLOGY

Study aims to reveal type 2 diabetes conversion culprits

The issue is particularly relevant to Alabama, which is one of 15 states considered to be in the “Diabetes Belt” because the incidence of type 2 diabetes is about one-third higher than the national average. Children’s cares for more than 80% of the state’s pediatric type 2 diabetes patients, with nearly 650 such children referred for evaluation for new-onset cases between March 2017 and March 2021. Additionally, hospital admissions for new-onset pediatric type 2 diabetes cases in Alabama more than doubled over a two-year span that led up to the early stages of the pandemic.

Researchers at Children’s and UAB are joining others from 15 prominent institutions across the U.S. in a study designed to determine what factors lead to type 2 diabetes conversion among children who are overweight or obese.

Alabama is one of 15 states in the “Diabetes Belt” 1 / 15

80% of Alabama’s type 2 patients are cared for by COA 80 %

children will enroll in the study in the next two years 3,600

The DISCOVERY study aims to uncover these factors to help them more precisely predict which children are at the highest risk. “Even though we understand that high BMI predisposes someone to type 2 diabetes, what is really unclear is what prompts a child who has all these risk factors to convert,” said Ambika Ashraf, M.D. (top), DISCOVERY co-investigator and director of the Division of Pediatric Endocrinology at Children’s. “This study is designed to recruit at-risk children and see who actually converts to type 2 diabetes, looking at a broad suite of factors—everything from social risk factors to biological factors,” said study co-investigator Barbara Gower, Ph.D. (bottom), chair of the Department of Nutrition Sciences at UAB.

Over the next two years, DISCOVERY will enroll approximately 3,600 children and teens ages 9–14, all with a BMI at or above the 85th percentile and HbA1c levels of 5.5% or higher. Children will be tracked for between two-and-a-half and four years, completing comprehensive annual visits, including a three-hour oral glucose tolerance test and detailed physiological assessments. They will also undergo a brief visit every six months, along with telephone checks every three months to monitor for type 2 diabetes. “If we can determine the risk factors that predispose certain individuals to develop type 2 diabetes, that could have a huge impact,” Ashraf said. “It may have a global impact, too, because type 2 diabetes is going to cause a huge economic impact throughout the world.”

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