Screening helps kids get jump on diabetes
Seattle Times medical reporter
Just off the ice, 10-year-old Samantha Brown lifts her right foot and shows off the "sweet spot" on her skate blade that helps her dizzying, graceful spins.
She's a talkative, happy girl, and she's had a good morning practice at the Everett Events Center rink. There's no way that her new world of coping with type 1 diabetes is slowing her down.
"Spins bring out your gracefulness," she says confidently.
Many children newly diagnosed with diabetes may be hospitalized for weeks while doctors bring down dangerous blood-sugar levels or deal with complications that can lead to a coma or death. Not Samantha.
The Camano Island girl's parents, Tracey and Steve Brown, knew from genetic screening that she might develop the disease, so they took her for treatment at the very first symptoms. By getting ahead of the disease, her transition to regular treatments and the daily routine of diabetes management was a matter of days rather than the weeks or months that many other kids need.
Samantha is among nearly 32,700 children who have been screened by Seattle's Pacific Northwest Research Institute to determine whether such early detection and treatment of type 1 diabetes can prevent hospitalizations and delay the more serious manifestations of the disease that already affects about 1.4 million people in the U.S.
Scientists hope eventually to develop medications that can prevent type 1 diabetes in people at highest risk, or at least encourage a milder form of the disease. Tests of at least one such drug already are under way.
But even in the near-term, the institute hopes the research will persuade state health authorities to add diabetes to a list of routine tests given to newborns.
"It's absolutely a slam dunk that you want to intervene before diagnosis if you can," says Dr. Bill Hagopian, director of the project, called Diabetes Evaluation in Washington and nicknamed "DEW-IT."
"You want to help before the horse is out of the barn."
A disabling disease
Type 1 diabetes is sometimes called juvenile diabetes because typically it is diagnosed during childhood or adolescence. In this form of the disease, the body's immune system inexplicably destroys cells in the pancreas that produce insulin, which is needed to transport sugar into cells for energy. Genetics contribute to the disease, but it's thought that other factors such as diet or viruses may also set off the immune reaction.
Type 2 diabetes typically affects adults and is much wider spread. It develops when cells become resistant to insulin or when the pancreas produces insufficient insulin. Obesity is a major risk factor for this type.
Over many years, diabetes can be disabling and life-threatening. Complications include diseases of the heart and blood vessels, increasing the risk of heart attack and stroke; nerve damage that can lead to foot or leg amputations; eye damage that can cause blindness; osteoporosis; and skin problems.
Catching it early
To assess the risk of type 1 diabetes, Pacific Northwest Research Institute scientists screen blood that is left over after state-required tests of newborns for 10 other diseases or disorders. With parental permission, they look for a particular version of the HLA DQ gene, a variation carried by 17 percent of the population. About one in 60 of those develop the disease. Overall, as many as 1 in 300 people in the U.S. are at risk for type 1 diabetes.
Over the past two years, the researchers have found 25 children who are at high risk and 29 others who already have disease. Those at high risk are tested annually, while the scientists counsel their parents to watch for even a trace of the symptoms: increased thirst and frequent urination, excessive hunger, weight loss and fatigue.
By treating children as soon as possible, scientists hope they will greatly slow the destruction of the pancreas' insulin-producing beta cells.
Three years ago, a University of Colorado study of 2,140 children at risk for type 1diabetes found that only 3 percent who were genetically screened and treated quickly after diagnosis needed hospitalization when diagnosed — compared with 44 percent who were not screened and treated early.
For now, though, state health officials say they need more evidence that the screening does a good job of identifying at-risk kids and that they benefit from it before requiring it as one of the newborn tests.
The goal: a normal life
Tracey Brown said she knew almost right away that Samantha had crossed the threshold of diabetes.
She was worried that her daughter was more thirsty than usual, and got tired more easily while training for a skating competition last summer. But the capper was when, uncharacteristically, Samantha wet the bed three nights in a row.
Her doctor's office sent her immediately to Children's Hospital & Regional Medical Center in Seattle for tests, which showed her blood sugar was sky high.
Samantha immediately started a daily routine of monitoring her blood sugar, frequent insulin injections and watching her diet.
Needles for several daily tests and insulin injections, she says, are "no big deal at all." She gets a little more tired than she used to after skating two or three times a week. But that's about it for symptoms.
"If I handle it right, I know I can have a normal life," Samantha says.
Warren King: 206-464-2247 or firstname.lastname@example.org
Copyright © 2007 The Seattle Times Company