April 22, 2015 | Patti Wieser
Jane Kim, MD
Type 2 diabetes in children is an emerging epidemic. During the past decade, the number of children with this condition – long considered an adult disease – has risen dramatically. Type 2 diabetes among youths aged 10 to 19 increased by 35 percent between 2001 and 2009 (from 0.34 per 1,000 to 0.46 per 1,000), according to the SEARCH for Diabetes in Youth study and reported online last year in Medscape.
For Jane Kim, MD, gaining a better understanding of type 2 diabetes in children is the key to preventing or managing it. Kim received a pilot project award from the Clinical and Translational Research Institute (CTRI) in 2014 to conduct a study, "Profiling Metabolomic Signatures in Children with Type 2 Diabetes." Metabolomics is the study of metabolites, which are small molecules found in cells. The metabolome can provide a wealth of information about an individual's state of health.
"Type 2 diabetes in children is a relatively new field," said Kim, a pediatric endocrinologist at Rady Children's Hospital-San Diego and an assistant professor in the Division of Pediatric Endocrinology at UC San Diego School of Medicine. "From what we know, the nature of the disease in children seems to be different than it is in adults. One of our goals with this pilot project is to really better understand the underlying pathophysiology of what we are seeing in kids with this condition."
Obesity is believed to be a significant risk factor in type 2 diabetes in children. Genetic influences also play a role. Kim's study includes three groups of adolescents: obese children who do not have type 2 diabetes; obese children with type 2 diabetes; and children at a normal, healthy weight who are age and gender-matched to the groups.
"We are capturing a total of 90 adolescents, so we have 30 in each group," Kim said. The first two groups are recruited through the Rady Children's Hospital-San Diego Endocrinology/Diabetes Outpatient Clinic and the third through regular office visits and as siblings of patients from the clinic, among other recruitment methods.
Recruitment for the study is nearly complete. Urine and plasma samples will be collected from the test subjects and submitted for metabolomic analysis using mass spectrometry. "The intent is to generate distinct metabolite signatures that can predict the development of type 2 diabetes in children, as well as help identify diabetic children at higher risk for complications and premature death," Kim said. Chronic kidney disease is a major risk in type 2 diabetes patients, and is especially aggressive in children with the disease. It can often be successfully treated if diagnosed early.
Once the data is back, the investigator will carefully pore through and manually curate it, and work with a biostatistician and computational biologist to analyze the biological relevancy in the datasets. "My understanding of metabolism helps make sense of the data," said Kim, who splits her time between the clinic and research. She also is interested in creating a better clinical test for kidney disease than the microalbumin test employed for type 2 diabetes patients. Microalbumin in the urine indicates kidney disease, but is only effective about 30 percent of the time. "A metabolomic signature may be a better biomarker than microalbumin," Kim said.
If the metabolomic signatures can identify who is at risk of developing the disease or who with type 2 diabetes is likely to develop kidney disease, education about the importance of nutrition and exercise can be targeted to individuals and populations most at risk. "We see diabetes patients all the time and clearly lifestyle is important," Kim said.
The study is expected to conclude this summer.
"I'm very grateful to CTRI for the opportunity for this pilot project, which enables me to integrate my clinical life with my research, and to see the fulfillment of my research," Kim said.
About UC San Diego Altman Clinical and Translational Research Institute:
UC San Diego Altman Clinical and Translational Research Institute (ACTRI) is part of a national Clinical and Translational Science Award consortium, led by the National Institutes of Health National Center for Advancing Translational Science. Established in 2010, ACTRI provides infrastructure and support for basic, translational and clinical research throughout the San Diego region to bring discoveries from the laboratory to the bedside, and facilitates training and education of the next generation of researchers. ACTRI carries out its activities in collaboration with institutional and corporate partners and currently has more than 1,500 members.