S.A. among 12 sites for TODAY trial to test medicines, lifestyle changes in young

San Antonio (March 16, 2004) – “I didn’t take care of myself as I should have, so I push her and push her and I’m never going to stop.”

Juanita Aleman, who at the young age of 39 lives with severe complications of type 2 diabetes, said the words within earshot of her 15-year-old daughter, Marie. Marie helps care for her mother at their home on Southwest 39th Street, where Juanita is the best real-life teacher about diabetes that Marie could ever have. That’s important, because Marie already is on insulin and medication to control her own blood sugar.

Marie and Juanita represent the urgent need for clinical studies such as the five-year TODAY (Treatment Options for type 2 Diabetes in Adolescents and Youth) trial. Faculty and staff from The University of Texas Health Science Center at San Antonio and medical staff of the University Health System treat patients at the TDI, which is in the University Center for Community Health at 701 S. Zarzamora.

The TDI is one of 12 sites nationwide selected to recruit children ages 10 to 17 into the TODAY study for the purpose of comparing three treatments for type 2 diabetes – metformin alone, metformin and rosiglitazone together, and metformin plus intensive lifestyle change to lose weight and increase exercise.

The San Antonio investigators seek to enroll more than 60 young people who have been diagnosed with type 2 diabetes in the last two years, including many from Hispanic and African-American families in Bexar and surrounding counties.

Study-related medical care and medications are provided at no cost. A $3 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases supports the San Antonio site. For more information about the TODAY study, call toll-free 1-866-764-6450.

“The TDI, the largest center focusing solely on diabetes in the country, is the perfect place to recruit the children and teens who will benefit from this important clinical study,” said local Principal Investigator Daniel Hale, M.D., professor of pediatrics and chief of the division of pediatric endocrinology and diabetes at the Health Science Center and pediatric medical director at the TDI. “We need to know which medications will best help our precious patients such as Marie.”

For Juanita, the relatively new medications came along a decade too late. She is blind and undergoes renal dialysis three times a week. The first clues to the awful nature of the disease came in 1992, three years after she gave birth to Marie. She was at work in a restaurant and burned her foot. “I lost a toe. That’s when I found out my diabetes was beginning to worsen.”

Juanita had developed gestational diabetes while pregnant with both Marie and her older sister, Genevieve. But she was a working single mother and didn’t have much time to devote to monitoring her diabetes and making changes.

After 2000 her vision began to deteriorate, first in the right eye, then in the left. Within five months, her sight was gone. “It was scary because I had two teenagers,” Juanita said. “Thank God I’ve got two young ladies who have done well in school.”

A year ago, she took her physician’s advice and went on dialysis. “I didn’t want to, but I was getting pneumonia frequently,” she explained, noting that the clearance of the body’s toxins from her kidneys has made a huge difference in her energy level.

In diabetes, the body has difficulty regulating blood glucose and converting it to energy. Type 2 diabetes involves resistance to insulin, a substance secreted by the pancreas. Insulin converts blood glucose into energy. Over time, insulin production weakens, potentially leading to harmful changes in the eyes, kidneys, heart, nerves and blood vessels. The TODAY study is a response to the alarming increase of type 2 diabetes among children and teens, particularly among Hispanics, African Americans and American Indians.

Marie’s blood sugar readings were running 400 last year (normal is 85 to 125) and the busy teenager was using her blood glucose monitor as seldom as once a week. Now she’s testing herself three times a day. “She’s come a long way,” said Ruby Favela-Prezas, BSN, RN, a nurse who counsels Marie at the TDI Children’s Center.

“All teens, if they try hard, can do it, but it’s a lot of stress for a teenager,” Juanita said. “Ruby is a like a big sister doing a lot of coaching and convincing.”

Marie has learned to shop for more nutritious food such as vegetables and lean meats and to prepare healthy meals at home. She wants to be a nurse or a chef. She said a friend at school “drinks nothing but soda and I get mad at her.”

Marie even gets mad at herself for occasionally having high blood sugar. “It’s not your fault,” Ruby said to her. “Being a Latin American, you have a higher risk of developing diabetes.”

Marie has a much better chance to beat the complications of diabetes than her mother did. She helps out at home and continues to learn about type 2 diabetes. “If I had a plaque, I’d give her the biggest plaque for the year,” Juanita said, causing tears in Marie’s eyes. “I would pull down a star for her.”



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