The purpose of this study is to evaluate the prevalence of Type 2 diabetes or impaired
glucose tolerance in a subset of children 10-19 years of age in an inner city community
clinic. The demographics of the clinic are 75% African American, 20% Hispanic, 5% other.
African American and Hispanic patients have a higher prevalence of diabetes with significant
morbidity, predominantly from microvascular and macrovascular disease. Obesity is commonly
seen in patients with Type 2 diabetes and contributes to the underlying insulin resistance
seen in the disease. Obesity is an increasing health problem among adolescents. Since Type
2 diabetes can be present for several years before diagnosis, it is worrisome that younger
children will have undiagnosed Type 2 diabetes for years. This will increase the risk of
earlier complications in these patients as young adults.
We hypothesize that the occurrence of abnormal glucose metabolism in 400 children with
either a history of obesity, family history of diabetes mellitus, or symptoms suggestive of
diabetes mellitus will be higher than the general pediatric population. We believe that a
family based educational program can reduce fasting plasma glucose.
This is a two part study. The first part is a diabetes screening study of 400 adolescent
children who have a risk factor for type 2 diabetes to determine the prevalence of abnormal
glucose metabolism in such patients. At the time of glucose screening all children will be
given a dietary habit survey and two measures of depression/self-esteem to complete so that
we may measure the correlation of depression and obesity and depression and abnormal glucose
The second part tests the efficacy of a family based educational program in lowering fasting
glucose in children who screen positive for type 2 DM, hyperinsulinemia, or impaired glucose
tolerance. This educational assessment will be administered in an observational
non-randomized, non-blinded fashion. The dietary habit survey and the measures of
self-esteem and depression will aid us in creating this family based educational study.
Inclusion criteria for screening will be patients who have one of the following:
1. 120% of ideal body weight or BMI> 27
2. Weight greater than 75th percentile
3. Family history of type 2 diabetes in first or second degree relative
4. Acanthosis nigricans or skin tags as signs of insulin resistance
5. Symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, or recurrent
6. Symptoms or signs of PCOS (hyperandrogenism, hirsutism, irregular menses)