Helping kids with diabetes is a passion for National Institutes of Health (NIH) clinical researcher Stephanie Chung, M.B.B.S. You can hear it in her voice when she talks about "my kiddos" at the clinic she runs at Children's National Hospital in Washington, D.C.
There, she and a team of specialists help children who either have type 2 diabetes or are at high risk for getting the disease.
She says, "We focus on partnering with patients and their families, empowering them from the beginning" to improve their health.
From her many years of treating minority children, Dr. Chung understands the challenges her patients can face.
"We focus on partnering with patients and their families, empowering them from the beginning."
- Stephanie Chung, M.B.B.S.
"Minority youth can have so many additional factors that affect their health, such as the family food budget, neighborhood safety, and access to transportation," Dr. Chung says.
For example, being physically active is important for managing diabetes. "But what if they don't feel safe going outside? That just adds to their burden and stress," she says.
Dr. Chung also helps lead diabetes research at NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Her recent research has focused on African American youths with the disease.
These days, there's a new urgency to her research and her clinical work. Recent studies have shown an alarming increase in type 2 diabetes in children and adolescents. Specifically, there are more than 5,000 new cases every year among those under 20, particularly among blacks and Hispanics.
Recent NIH-funded research adds to the growing evidence that diabetes is more aggressive in youths. It has shown that metformin, the standard drug used to control the disease in adults, is much less effective in those under 20.
The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, funded by NIDDK, recently found that metformin fails 50% of the time in those ages 10 to 17.
"Metformin is not preventing the disease from progressing in kids," Dr. Chung says. "It's like a Band-Aid over the problem."
All this makes it more urgent to treat children who have prediabetes. Dr. Chung notes that there is an opportunity to control the disease early, before it worsens and medication is needed.
"I explain prediabetes to them by drawing a line that represents the A1C test cutoff for type 2 diabetes. The A1C test measures the average blood sugar levels over the last two to three months, and a reading of 6.5% or higher is used to diagnose diabetes," Dr. Chung says. "Then I draw a line below that that represents a normal blood sugar reading of 5.7%. I then shade in the area between the two lines and tell them that's where they are and explain what they can do to keep from getting the full-fledged disease."
The good news is that in 2019 the U.S. Food and Drug Administration (FDA) approved the drug liraglutide in children age 10 or older. It's the first non-insulin drug approved by the FDA to treat type 2 diabetes in pediatric patients in nearly 20 years.
"It gives us a second drug to try," says Dr. Chung. "It's very exciting."