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A Big Fat Problem
Detecting Type 2 Diabetes: A New Approach

by Jeff Worley

With type 2 diabetes in children on a rampage, wouldn't it be helpful if there were a clear marker for a kid's propensity to develop type 2? Well, there is. And UK's Leslie Scott in the College of Nursing has completed a study on this telltale mark and its potential as a screening tool for the disease.

Photo of Leslie Scott and Sharon BartonLeslie Scott (left) and Sharon Barton in the College of Nursing are working to teach children and their parents the value of healthy eating habits to help reverse Kentucky's alarming childhood obesity statistics.

"I've been looking at what's called Acanthosis Nigricans," says Scott, who recently completed her Ph.D. in nursing at UK and has been a pediatric diabetes nurse educator at UK since 1994. "And unless you have diabetes or know someone who does, you may have never heard of this. It's a skin condition that is symptomatic of high insulin levels in the body and is frequently associated with obesity. It's a darkening and thickening of the skin that can appear where skin-to-skin contact is made, but is found most often on the back of the neck." Parents often try to wipe this mark off, thinking it's dirt. Some studies indicate that certain populations such as African-American, Pima Indian and Mexican-American children are tagged with this mark more often—and have a higher prevalence of type 2 diabetes—than the national norm.

It is important to note this condition, Scott says, because these markings can help identify children and adolescents who run the risk of developing diabetes. Once young people at risk are identified, the necessary measures to lower insulin levels and reduce the risk of developing type 2 diabetes can be taken. "The only way this mark will fade is through exercise and proper nutrition."

Scott's idea of intervention grew into quite an ambitious project. "Elementary school nurses do height and weight screenings annually as part of regular school-based health, so I asked the medical director of the Healthy Kid's Clinics within the Fayette County school system if he thought that looking for Acanthosis Nigricans on the back of the neck could also be included as part of these screenings," Scott explains. The director thought it was a good idea and gave her the go-ahead.

Scott decided to focus her study on four school-based clinics, with the end goal of trying to determine by the presence of this marker how many children would benefit from further screening for type 2 diabetes. During the 2000-2001 academic year, she trained school nurses to identify Acanthosis Nigricans on the back of the neck of 4- to 12-year-old school children in these clinics. A total of 1,164 students were screened. Scott then reviewed the medical records of this group, looking for relationships between the presence of Acanthosis Nigricans, ethnicity, gender, age, family history of diabetes, and body mass index.

"In doing this work, my biggest surprise was the number of at-risk kids we found—already overweight or at risk for being overweight." In Scott's study, 39 percent of the children screened had BMIs greater than the 85th percentile, and 22 percent had BMIs above the 95th percentile.

"No, let me replace the word 'surprise' with the word 'shock,'" Scott says. "National studies were quoting that only 11 to 13 percent of kids were overweight in that age group. We found 22 percent—almost double what national studies are reporting."

Acanthosis Nigricans was identified in 26 percent of the kids, 49 percent of whom identified a family history of diabetes. According to the American Academy of Pediatrics and the American Diabetes Association screening guidelines for type 2 diabetes in children, nearly one-third of the children evaluated were eligible for further type 2 diabetes screening.

Rates for overweight, risk for overweight, and the presence of Acanthosis Nigricans among children in this study exceeded national reported estimates, Scott says. "Students in high-risk ethnic groups had higher rates of this marker when compared to non-Hispanic white students." Rates of Acanthosis Nigricans increased as BMI increased, regardless of ethnicity, age or gender. In discussing the importance of these stats, Scott underscores how obesity clearly walks arm-in-arm with diabetes down the road of bad health.

Sharon Barton, now Scott's colleague in the UK College of Nursing, has been working to improve the health and well-being of school-age kids and adolescents for 25 years. In recent years, she has focused her research on nutrition and infants, trying to understand how so many children become obese in the first place.

"We're seeing younger and younger children with type 2 diabetes," Barton says. "And from studies I've done of rural Kentucky, what I've seen our kids eat really disturbs me." Infants are getting all kinds of non-nutritious, fattening foods—pizza and fast foods, mashed potatoes and gravy, desserts, and cereal in the baby bottle. Babies under six months were drinking Mountain Dew and Kool-Aid. "And though I was studying rural mothers," Barton says, "I don't know that mothers in Lexington or Louisville or in New York City aren't doing exactly the same thing.

"If you're not being fed healthy foods when you're little, it's going to be very hard to choose healthy foods as you grow up." [For more on her research, check out "Mama's Little Baby Loves Pork & Beans."]

Scott's study on Acanthosis Nigricans was the focal point of her dissertation, and Barton was the chair of Scott's dissertation committee. So how does the mentor react to her former student's recent work?

"It's groundbreaking," Barton says. "It's the first time anyone has done such a study looking at so many children to determine how a simple, visible marker might be used to predict risk for type 2 diabetes in kids and adolescents. It's huge."

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