Youth-onset Type 2 diabetes is derailing the lives of young adults

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Photo of a child measuring her sugar level in a doctor's office.
A child measures her sugar level in a doctor's office. New developments will help preclude this.

Jane Lynch, M.D., a pediatric endocrinologist at UT Health San Antonio, is truly on the front lines of San Antonio’s alarming increase of Type 2 diabetes in children. Since 2005, more than 1,000 youth under the age of 18 have been diagnosed with the disease in her clinic at the Texas Diabetes Institute on South Zarzamora Street. The youngest was only 5 years old at the time of diagnosis.

Type 2 diabetes was once known as adult-onset diabetes because of its usual manifestation when people are in their 40s or 50s, and often after years of struggling with being overweight or obese, poor diet and a lack of exercise. Increasingly, however, physicians are seeing much younger patients affected by the disease.

Heeding the warning signs, Dr. Lynch and collaborators nationwide initiated a study in 2004 called TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth). The study enrolled and treated adolescents with youth-onset Type 2 diabetes until 2011.

The study’s comparison of metformin, rosiglitazone and lifestyle intervention yielded underwhelming results. All participants declined in pancreatic function with each passing year.

At the conclusion of the study in 2011, all participants were invited to remain for an observational phase. It has followed 517 participants who have had the disease for an average of 12 years.

At annual patient visits, information was gathered using laboratory testing, echocardiograms, vessel function testing and eye examinations. Researchers also collected each participant’s medical history to chart any diabetes-related events. These data were presented at the 2019 American Diabetes Association meetings in San Francisco.

The researchers found the development of diabetes-related complications in individuals with youth-onset disease is often much more rapid than it isin individuals who develop the disease later in life. Now in their 20s, the TODAY participants are experiencing life-changing health consequences caused by Type 2 diabetes at the earliest stages of adulthood:

  • Five deaths have occurred in this young adult population.
  • More than 50% of participants have abnormal lipids.
  • More than 60% have high blood pressure.
  • About 40% of participants have evidence of early diabetic kidney disease.
  • Almost 50% of participants have evidence of diabetic retinal disease.
  • Up to 33% of participants demonstrate signs of early diabetic nerve disease.
  • 25% of pregnancies with known outcomes resulted in miscarriage or fetal death.
  • 24% of these pregnancies were preterm births.

The findings suggest health care professionals need to aggressively treat young patients battling Type 2 diabetes to minimize the damage from serious diabetes-related complications. This intensive management depends on coordinated care by teams of expert providers. It also requires families’ commitment to continue to seek care, even if their child’s disease has stabilized.

Additionally, more medications are needed for this disease in children. Until recently, metformin and insulin were the only therapies approved by the Food and Drug Administration for Type 2 in children. Encouragingly, data from an international study in which Dr. Lynch and her colleagues assisted, called Ellipse, led to FDA approval in June of a new injectable drug, liraglutide, for Type 2 diabetes in youth as young as age 10.

That is a bit of good news in an otherwise difficult landscape for these children and their families. Still, families must cope with aggressive symptoms, few medication options and challenging compliance. This is the hard reality on the front lines of this devastating epidemic.

However, research is the key to a better tomorrow. Dr. Lynch is part of a cadre of diabetes experts at UT Health San Antonio that is conducting visionary research and incorporating the latest findings into preeminent patient care. Lives will be changed as a result.

Young people are our greatest resource. We will fight this scourge with all our might to keep it from further harming the lives of our children.

San Antonio has a new designation: Dementia Friendly City

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If you look at our city’s greatest successes, they have been accomplished by individuals and groups working together toward a common goal. A great example of this is the announcement that San Antonio is now a Dementia Friendly City. This designation, from Dementia City America, was announced June 15 by our School of Nursing, which has been leading this initiative with the help of several partners. They include University Health System, the Bexar County Sheriff’s Office, the City of San Antonio, the Alzheimer’s Association and many others.

This designation recognizes that our city has a grassroots initiative in place to build a welcoming and supportive environment for individuals living with Alzheimer’s disease and other forms of dementia, and to provide helpful resources for their caregivers.

While the designation is a reason to celebrate, it also is a call to action for San Antonio to wrap its arms around those living with―and caring for―individuals with this health challenge. As Alzheimer’s and other dementias are on the rise nationally and in Texas, most of us have been touched by these diseases or know someone who has. Perhaps your grandparent had Alzheimer’s. Maybe you are caring for a parent with dementia while raising your children at the same time. Have you recently received the diagnosis yourself?

I say this because there is an approaching “tsunami” of Alzheimer’s and other forms of dementia as our population ages. Statistics from the Alzheimer’s Association show that:

  • In 2019, 5.8 million people in the U.S. are living with Alzheimer’s disease. This includes 200,000 people younger than age 65.
  • Alzheimer’s disease is the sixth-leading cause of death in the U.S. and has an economic burden of $290 billion.
  • Texas ranks fourth nationally for the prevalence of Alzheimer’s, with 390,000 individuals living with the disease.
  • The state is second in the number of Alzheimer’s-related deaths, with a 180% increase from 2000 to 2015.
  • Hispanics are about 1.5 times more likely to develop dementia, making San Antonio and South Texas particularly vulnerable to this disease.
  • Nationally, more than 16.2 million Americans provide unpaid care for people with Alzheimer’s or other dementias. That includes 1.4 million unpaid caregivers in Texas.
  • In the U.S., unpaid caregivers provide an estimated 18.5 billion hours of care each year, valued at nearly $234 billion.
  • Texas caregivers provided 1.6 billion hours of unpaid care at approximately $20.6 billion per year.

We at UT Health San Antonio are doing our best to stem this tide through our Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, where we are providing the latest evidence-based care, conducting research and educating the next generation of health professionals to care for this growing segment of the population.

Through the Caring for the Caregiver program, led by Carole White, Ph.D., RN, our School of Nursing is providing regularly scheduled training classes for new caregivers, social opportunities for caregivers and their loved ones, and even a choir called Grace Notes. Caring for the Caregiver supports the Dementia Friendly City advisory board and is the community champion for this initiative.

Thanks to the Dementia Friendly initiative, there is a strong core of organizations looking for additional ways to embrace those living with dementia and their caregivers, but there is always room for more.

Our colleagues at University Hospital System have the distinction of being the first Dementia Friendly hospital system in Texas. They are training their nursing staff to recognize dementia and support families while their loved one is hospitalized. They also are providing Alzheimer’s and dementia information in their clinics.

The Bexar County Sheriff’s Office is working with our School of Nursing to provide training for deputies on how to recognize dementia in order to provide appropriate support to those community members and their families. They also initiated a vehicle sticker program for families living with Alzheimer’s to help law enforcement officers recognize that a person with dementia may be on board.

The San Antonio & South Texas Chapter of the Alzheimer’s Association provides statistics on these diseases, and supports those who are diagnosed, their caregivers and the medical professionals who care for them. The organization raises funds for needed research, provides support groups, education programs and volunteer opportunities.

However, some of the most important voices we need to hear are yours and those of families living with Alzheimer’s disease. You can help by thoughtfully listening to the concerns of your patients, learning more about the community resources available for them and investigating ways to refer your patients and their caregivers to research studies. Through collaboration, we can better understand these diseases and help our patients live through these challenging times.

I am proud of the work being done by so many members of the UT Health San Antonio family to improve the quality of life for people living with Alzheimer’s disease and other dementias, while always keeping in mind the welfare of their families and caregivers. We will continue to work tirelessly to tackle and eventually annihilate this terrible disease.

We invite you to join the Dementia Friendly City initiative, and learn about the many resources available to family caregivers, by visiting utcaregivers.org or calling (210) 450-8862. Information about research and patient care is available through the Biggs Institute at biggsinstitute.org and (210) 450-9960.

Fluzone vaccine available

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Fluzone High-Dose, an influenza vaccine designed specifically for people age 65 and older, is available in the Wellness 360 clinic in the School of Nursing. UT Select members should bring their insurance card and ID badge; walk-ins 8 a.m. to 5 p.m. Monday-Friday.

Women in Medicine Month, Part IV

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Read the newsletter

September is Women in Medicine Month. Read about the achievements and talents of some of UT Health San Antonio’s women faculty in the fourth in a series of newsletters.

 

Dr. Sung receives UT System Faculty STARs award

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Patrick Sung, D.Phil., the Robert A. Welch Distinguished Chair in Chemistry at UT Health San Antonio

UT Health San Antonio biochemist Patrick Sung, D.Phil., has been awarded a UT System Faculty STARs award in the amount of $1.786 million to support his work on BRCA1 and BRCA2 cancer biology.

Dr. Sung joined UT Health San Antonio in 2019 from Yale, where he was a professor of molecular biophysics and biochemistry, therapeutic radiology and epidemiology. A $6 million grant from the Cancer Prevention and Research Institute of Texas supported his recruitment.

He is one of the world’s leading researchers in BRCA1 and BRCA2, which are tumor suppressor genes. When these genes are mutated, the loss of function leads to cancer. Primarily known for increasing risk of breast cancer in women, BRCA1 and BRCA2 mutations also are associated with ovarian cancer, prostate and breast cancer in men, and a childhood cancer called neuroblastoma. A related gene is associated with aggressive pancreatic cancer.

“I am really honored to receive a UT System Faculty STARs award,” Dr. Sung said. “The resources from this award will help us advance our goals in BRCA and DNA repair research and provide the infrastructure for the training of students and fellows from across the UT Health San Antonio campus in methods for tackling major questions regarding the role of DNA repair in cancer avoidance.”

Dr. Sung recently received a highly competitive National Cancer Institute (NCI) Outstanding Investigator Award. The award, which began Sept. 9, will provide $6.1 million through 2026.

Dr. Sung occupies the Robert A. Welch Distinguished Chair in Chemistry and is a professor in the Department of Biochemistry and Structural Biology at UT Health San Antonio. He also serves as associate dean for research in the Long School of Medicine, and leads a new research program in genetic integrity at the Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center.

Dr. Sung was born and raised in Hong Kong. He earned a Bachelor of Science degree at the University of Liverpool in 1981 and a Doctor of Philosophy degree at the University of Oxford in 1985, both in biochemistry. He then completed eight years of postdoctoral fellowship training at the University of Rochester in upstate New York.

This is Dr. Sung’s second stint at UT Health San Antonio. He joined the faculty here in 1997 as associate professor, and ultimately was promoted to professor and the Zachry Distinguished Professor of Molecular Medicine. He left UT Health San Antonio in 2003 to join the Department of Molecular Biophysics and Biochemistry at Yale University.

His decision to return to South Texas was partly personal and partly due to the level of science being conducted. He said he and his wife wanted to come back to San Antonio, the leadership of UT Health San Antonio is top-tier, and the level of investigation at the university is outstanding.

“We have good science, amazing people and we love San Antonio,” he said.

The UT System Board of Regents authorized the Science and Technology Acquisition and Retention (STARs) program in 2004. Multiple types of STARs awards support enhancement of UT institutions across the state.