Dealing with diabetes
Researchers at the University of Manitoba and the Manitoba Institute of Child Health are working with health-care providers and First Nations communities to contain a surge in cases of childhood Type 2 diabetes
|Dr. Heather Dean talks with patient Charlotte Wood about the need to keep blood sugar levels in check.
BY SUSIE STRACHAN
Winnipeg Health Region
Wave, September / October 2012
Charlotte Wood knows the routine.
At least once a year, the 14-year-old girl, along with her mother
and siblings, visits the Diabetes Education Resource for Children and
Adolescents (DER-CA) on William Avenue in Winnipeg.
Once inside, Charlotte, her younger sisters, Savanah and Genevieve,
and older brother Curtis, are greeted by a nurse and prepped for their
"First I get weighed and they measure my height," explains Charlotte.
"Then they take my blood pressure. Then they do the blood work."
Charlotte and her siblings make regular visits to the clinic for checkups
because Type 2 diabetes runs in the family - their mom, Mary
Wood, has it, as do their grandparents, and some other family members.
So far, Charlotte is the only one of Mary's daughters diagnosed
with the condition. But the girl with the bright eyes and quick smile is
learning to keep it in check. "I have to take insulin shots,
and I can't eat sweets or junk food or pop," she says.
For most kids, doing without the occasional treat may
seem a bit daunting. But Charlotte takes it all in stride - she
knows it is important to keep her blood sugar levels in check, a
point that is emphasized during her visits to DER-CA.
She understands that her body does not produce enough insulin
or use the insulin it does produce to efficiently break down the
sudden surge in glucose (sugar) that would come from consuming
sweets. And she understands that a high level of glucose in her blood
can permanently change the structure and function of her organs, a
development that could lead to health issues such as kidney failure.
Not long ago, the notion that a child like Charlotte could be
vulnerable to Type 2 diabetes was considered beyond the realm of
possibility. Until recently, children were not generally tested for Type 2 diabetes because it was considered an
Over the last three decades, the
number of children diagnosed with Type
2 diabetes within the Winnipeg Health
Region's jurisdiction has soared from
zero to more than 70 a year. Many of
these cases originate in northeastern
Manitoba and northwestern Ontario. In
fact, the area is one of two hot spots in
North America that have recorded huge
increases in childhood Type 2 diabetes -
the other is in Arizona.
Health officials say the surge in cases
represents a major intergenerational
health threat, one that could escalate in
years to come. But efforts are underway
to help the children and their families.
In April, University of Manitoba Faculty
of Medicine professors and researchers
at the Manitoba Institute of Child Health
(MICH) formed a new research group
dedicated to tackling the Type 2 diabetes
problem. The group is called Diabetes
Research Envisioned and Accomplished
in Manitoba, or DREAM for short,
and features 10 researchers, including
members of MICH and DER-CA.
The DREAM team will support the
work being done by health-care providers
and representatives of First Nations
communities at DER-CA. In doing so, it
will significantly enhance efforts to better
diagnose, treat and, ultimately, prevent
childhood Type 2 diabetes.
The first cases of childhood diabetes in
northern Manitoba were identified in the
early 1980s by Dr. Heather Dean. Today,
Dean is Assistant Dean (Academic) and
professor of pediatrics and child health
at the University of Manitoba's Faculty
of Medicine, pediatric endocrinologist at
DER-CA, a member of the DREAM team
and one of Canada's leading experts on
pediatric Type 2 diabetes. But at the time,
she had just finished training in pediatrics
and pediatric endocrinology and was
working as a fly-in physician at northern
communities like St. Theresa Point and
During one of her many northern trips,
Dean encountered a 14-year-old girl who
was displaying unusual symptoms for a
child her age: she was overweight, thirsty
and hungry all the time. Dean decided
to do blood tests to find the underlying
cause. She was astounded when the tests
suggested the girl had Type 2 diabetes.
"We knew this shouldn't be happening
to a child," says Dean, recalling her
reaction to her findings. "We've always
had obese children in Manitoba but they
don't develop Type 2 diabetes. They
don't get high blood sugar. Their bodies
can accommodate and compensate. But
somehow these children's bodies were
not," she said noting that she went on to
identify about a dozen similar cases.
Initially, her diagnoses were met with
skepticism by diabetes experts. Type 1
diabetes? Maybe. Type 2 diabetes? Never.
The difference between the two types
of diabetes is significant. Type 1 diabetes,
which can affect people of all ages, is
triggered many months before symptoms
show. People with Type 1 do not produce
insulin, and require a daily source of it.
Type 2 diabetes is much more
common. It occurs when the body does
not produce enough insulin and does not
respond effectively to the insulin it does
produce. As a result, glucose levels in the
blood can increase unchecked. Studies
are starting to show that Type 2 diabetes
affects children more rapidly, with many
developing other health problems by the
time they are in their mid-twenties. In
other words, it can cause serious illness if
Initial doubts concerning the diagnosis
of children with Type 2 diabetes began
to wane as the evidence mounted. By
1988, Dean and Dr. Michael Moffatt,
who was a pediatrician at the time and is
now Executive Director of Research and
Applied Learning for the Winnipeg Health
Region, published a report in the journal
Arctic Medical Research about their
findings. By this time, they'd identified 15
cases of Type 2 diabetes in children.
"We had no idea what was going on.
These were kids who were very obese,
and all, with the exception of one, were
girls," says Dean.
Initially, it was thought Aboriginal
children were developing Type 2 diabetes
earlier than expected because of lifestyle
issues - poor diet and lack of exercise.
Once the findings of Dean and Moffatt,
who is also a professor of pediatrics
and child health and community health
sciences at the University of Manitoba's
Faculty of Medicine, were accepted, it
was thought these cases represented the
tip of a giant iceberg.
"After we sounded the alarm, Health
Canada originally thought this was a
problem generalized across all First
Nations people in Canada," says Dean.
But there was another twist in the
story. Research revealed that other First
Nations communities, including those in
nearby Saskatchewan, were not reporting
cases of Type 2 diabetes among children,
even though their lifestyles were similar
to those of young people in northeastern
Manitoba and northwestern Ontario.
"We soon discovered that it was
localized to people who are from the
Sandy Lake area in Ontario, and our
group in Manitoba," says Dean.
At that point, Dean began to suspect
that the emergence of Type 2 diabetes
among children could not be solely
attributed to a lack of exercise and a diet
heavy in sugars and fats. She began to
connect the dots, looking for a genetic
component that was shared from parents
Her suspicions were confirmed in the
mid-1990s when a study by researchers
at the University of Toronto discovered a
genetic variance among people living at
Sandy Lake First Nation, which had been
recording increases in childhood diabetes.
The researchers showed that if a person
had this genetic variance - called the
HNF-1 alpha polymorphism - they were
guaranteed to develop Type 2 diabetes by
the time they were 50.
"Using that, we looked at the
Manitobans and found they have the
same gene. There has been a lot of
intermarriage between the Oji-Cree
populations in the Island Lake area and
northwestern Ontario, so they share the
same genes," says Dean.
But Dean knew there was more going
on than a genetic variance that led to
diabetes later in life. This disease was
One theory attributed the problem
to a hormonal surge in obese
kids during puberty. But Dean's
numbers showed that 9.7
per cent of the children
diagnosed with Type 2
diabetes in the past
five years were
under the age of
10. That meant
that a hormonal
to growing up
could not be
the trigger. The
complex, she knew
- a combination of
genetic inheritance, the
environment and lifestyle,
and something else. Something
As the number of cases of Type 2
diabetes among young people continued
to grow during the 1980s and 1990s,
efforts were made to understand and
contain the problem.
The Diabetes Education Resource for
Children and Adolescents at the Health
Sciences Centre campus was established
in 1985 to help educate children and
their parents on how to manage the
condition. Dean was instrumental with
colleagues in Manitoba Health and
Children's Hospital in developing the
Mary Wood was one of the first
children to visit DER-CA. She was
diagnosed with Type 2 diabetes at
age 11 and was enrolled in a DER-CA
study by the time she was 12. By her
own admission, Mary did not treat her
diagnosis with the seriousness it deserved.
"When I was young, I didn't listen to my
grandparents," she says. "I did what I
wanted and ignored my diabetes."
Now, at the age of 40, Mary suffers
from a number of complications of the
disease, including kidney failure, vision
problems, and lack of feeling in her feet
and hands. She's
on dialysis three
times a week
and uses a wheel chair for mobility.
Experience is a tough teacher, but it
has made Mary much the wiser. Today,
she is doing everything she can to ensure
her children don't make her mistakes,
especially her two children who already
have Type 2 diabetes. "I'm talking to
you today because it's important that the
young people know they need to take
care of themselves," she says. "That's
what I'm telling my kids."
Mary and her children inspired Dean
to focus her research in a new direction.
She'd been studying a generation of kids
who had grown up and were having
children of their own.
The difference here is that never before
have there been young women with Type
2 diabetes prior to their pregnancies. This
was a whole new dynamic, says Dean,
where babies were being exposed to Type
2 diabetes from conception onward.
"We started seeing the offspring coming
through. That was when I said, 'Oh-oh.' I
knew we had to find the bigger picture -
and quickly," she says.
In response, Dean and her colleagues
at DER-CA launched the Next Generation
project in 2003.
The Next Generation project looks
at the children of First Nations mothers
living in Manitoba, who had Type 2
diabetes prior to their pregnancy. The
project found that these mothers have a
14 times higher risk of having a child with
Type 2 diabetes than mothers without the
"We asked ourselves if pregnancy was
the mechanism causing these women
to have more children with Type 2,"
says Dean. Perhaps a diabetic woman's
high blood sugars were affecting the
development of the fetus, causing the
child's metabolism to be disposed toward
obesity and Type 2 diabetes.
"We think there is an additional
risk factor during the fetal stage,"
says Dean. "We suspect that the
intrauterine environment is affecting
organ development and how genes are
affected by their environment and express
themselves. The mothers with Type
2 have children who inherit the gene
for lower secretion of insulin, so their
children have an additional inherited
inability to make insulin."
That glimpse of an answer has led to
more questions for Dean and the others
on the Next Generation project.
"Genes don't change that quickly,"
says Dean. "In my professional lifetime,
over the last 30 years, something has
changed quickly. We've no idea what the
accelerator is, so we're trying with the big
teams to intellectually understand what
the issues are."
That "big team," of course is
the DREAM team, which is
located within the Manitoba
Institute for Child Health
and is funded through a
$750,000 grant from the
"We were so
excited with the launch of DREAM," says Dean. "It will
help us connect the circle of science and
care, in that we're now doing scientific
research in conjunction with bedside
treatment. We have a unique problem in
Manitoba, and I'm thrilled that money has
been invested into the scientific minds
solving that problem."
The DREAM team is focusing on
two main research areas: finding out
why children are susceptible to Type 2
diabetes, including maternal and early
life factors; and preventing complications
in children who have Type 2 diabetes
by helping them better manage their
Dr. Grant Hatch, Canada Research
Chair in Molecular Cardiolipin
Metabolism and professor of
pharmacology and biochemistry and
medical genetics at the University of
Manitoba, and Dr. Jon McGavock,
assistant professor of pediatrics and
child health, lead a team of Manitoba
scientists. They include: Dean, fellow
pediatric endocrinologists Drs. Elizabeth
Sellers and Brandy Wicklow, pediatric
nephrologists Drs. Tom Blydt-Hansen
and Allison Dart, epigeneticist Dr. Jim
Davie, and scientists Drs. Kristi Wittmaier,
Christine Doucette and Vern Dolinsky.
Sellars and Wicklow are also professors
of pediatrics and child health at the
U of M, while Davie is a professor of
biochemistry and medical genetics and
cell biology. Doucette is an assistant
professor of physiology and Dolinsky is
an assistant professor of pharmacology.
Some of the DREAM research includes:
- Using magnetic resonance imaging
spectroscopy to look for fatty liver
disease, which is a promising early
warning sign of Type 2 diabetes.
- Studying why children with Type 2
diabetes are five to 10 times more likely
to have kidney failure than children with
Type 1 diabetes.
- Using an ophthalmology machine to
study corneas for changes that can predict
a loss of feeling in feet and hands.
The DREAM team is also hoping to
secure funding to research changes in
heart metabolism in children with Type 2
diabetes, says McGavock.
All of this research is aimed at mapping
better treatment for children with Type
2 diabetes by identifying ways to predict
how and when it will occur and how
to prevent complications, he says. It is
also hoped researchers will develop new
prevention strategies for women with
Type 2 diabetes while they are pregnant,
much in the way that women now take
folic acid supplements to prevent neural
tube defects in their infants.
To achieve its goals, the DREAM team
uses a bed-to-bench circle of science, in
which children's health conditions are
studied and replicated in animals in the
laboratory. The lessons learned in the
lab are then used to change the way the
children are treated.
One of the key objectives of DREAM
is to identify early warning signs of Type
2 diabetes. For example, animal studies
suggest that fat in the heart, liver and
pancreas is an early indicator that the
organ is going to fail or is not working
properly. This can lead to a loss of
glucose tolerance and eventually lead
to Type 2 diabetes. "We're using MRI
spectroscopy to look at the chemical
make-up of different organs of the body,"
says McGavock. "Our interest is in fat
accumulation in places it shouldn't be."
DREAM researchers have decided
to focus on the liver as the best spot to
predict the risk for Type 2 diabetes. "If
there is a fatty infiltration in the liver,
it turns out to be a pretty robust biomarker
of Type 2 diabetes in kids," says
McGavock. "The MRI is a non-invasive
study technique, something that's very
important to use when working with
children. We're also looking for a blood
test, something that a family doctor could
order, as another early risk test."
A second area of focus is research into
the complications of Type 2 diabetes,
in a study called I-Care, short for
Improving Cardiovascular Outcomes.
Here, Allison Dart made an important
discovery: children with Type 2 diabetes
have extraordinarily high rates of health
complications, at a rate of five to ten
times higher than children with Type 1
diabetes. The complications include endstage
renal disease and cardiovascular
events. "Allison started asking herself:
'Why do the kidneys fail so quickly in this
cohort of youth? Are there any biological
markers we could measure in a clinical
setting that would allow us to pick up the
high-risk kids?'" says McGavock.
To find those biological markers, Dart
has begun measuring kidney function in
children with Type 2 diabetes, looking
for the moment when kidney damage
begins showing up. She's also looking at
other influences, such as physical activity levels, sleep, diet, stress and early childhood trauma.
Her theory is that it is not only the child's physical
body, but the environment they're growing up in
that adds up to kidney failure. She suspects a socioeconomic
"Sixty per cent of the kids are living at the bottom
of the economic scale. Their families are dealing
with economic pressures, and this is reflected in their
diet, activity levels and more," says McGavock.
Both the environmental and physical sides of a child's
life are measured at DREAM. Testing of the children
occurs over 24 hours in the clinic and at home, allowing
researchers to accurately measure blood pressure
variations and urinary protein loss.
The clinical space has a non-invasive imaging suite
where researchers can do ultrasounds of the heart,
blood vessels, liver, and soon, the kidneys, to look at the
structure and function of these organs. They also have
a fitness testing room with a bike and treadmill, to test
fitness and do exercise training. Many of the kids enrolled
in the various studies are seen every three to four months,
so it's important to have a clinic that is welcoming.
McGavock uses the fitness room to study the impact
of rigorous physical activity in overweight kids who
have Type 2 diabetes. In particular, he's looking at how exercise affects insulin sensitivity, and why
some of the children go on to develop changes
in the function of their heart, and others don't.
Along with putting children through exercise
programs, McGavock is hoping to secure a
grant to do ultrasound imaging of the kids'
Like other research tracks at DREAM,
studying the children in the clinic leads to
questions to be answered by the scientists.
For example, McGavock's research with
children will be duplicated in the lab.
Here, scientist Vern Dolinsky will work
on specially bred mice that have Type 2
diabetes, looking to see how quickly they
develop heart trouble, and whether exercise
has a positive effect on their heart. "The
research team will try to understand how
energy production problems arise and can
be managed in these mice. Collectively,
we'll make a small advancement in research,
which will advance our knowledge in both
directions," says McGavock. His research
at DREAM goes beyond the confines of
the clinic and laboratory walls. This fall,
McGavock launched a lifestyle and exercise
study, working with teens at R.B. Russell High
School. He's hoping to enroll 20 students
from this inner-city vocational school as peer
mentors, and develop exercises and lifestyle
programming that can be used in Manitoba's
north for teens living in similar socio-economic
"We look at what's been successful in the
past at achieving weight loss and increasing
physical activity in kids," he says.
The daily programming features 45 minutes
of games, like basketball and soccer, that get
the blood pumping. There's also a healthy
snack and 45 minutes of education on
healthy eating, goal-setting, self-esteem and
environmental engineering - how to change
your life to make healthy decisions and avoid
"Depending on what you're exposed to and
your background, people think it's a simple
message. But until you walk a mile in their
shoes, you don't know how hard it is. Support
is a key here," says McGavock.
In her work within the DREAM team,
Elizabeth Sellers is also focusing on the
complications associated with Type 2 diabetes, from kidney failure and vision problems
through to heart disease and high lipids.
Children with Type 2 diabetes will have
one or more serious health complications
by the time they are 30.
"There is data suggesting that
complications for Type 2 diabetes are
more aggressive in children than adults
who get the disease later in life," says
Sellers. "The onset of complications in
these kids is also more aggressive than it
is for kids with Type 1 diabetes."
One of those complications is
neuropathy - a change in nerve structure
that causes people with diabetes to lose
feeling in their hands and feet. Sellers
says that in the five years between the
ages of 18 and 23, many who have Type
2 diabetes will develop neuropathy.
She's studying a way to detect early
warning signs of nerve damage by looking
deep into people's eyes. Her test uses
corneal confocal microscopy. This looks
for damage in nerves in the eye's cornea,
as a predictor of nerve damage elsewhere
in the body.
The microscopy machine, normally
used by ophthalmologists and other
eye specialists, is relatively portable, so
Sellers can take it on the outreach visits
the DER-CA team makes to northern
Manitoba to look at the eyes of all
children who have Type 2 diabetes.
"We've shown that the kids will
tolerate the test, because it's noninvasive,"
says Sellers. "The next step
is to show its accuracy and that using
it is a way to monitor nerve damage so
we can try to prevent progression of the
Sellers is also a member of the team
that writes the clinical practice guidelines
for pediatric diabetes care in Canada.
"At the moment, lifestyle management
is the mainstay of treatment for Type 2
diabetes in youth. There haven't been
that many studies of medication use in
children, so I tend to be more aggressive
in using insulin and lifestyle changes,"
says Sellers, adding that most of the
children need shots of a mix of shortacting
and longer-acting insulin twice
a day. "Between the work we
do treating the
kids in the clinic and the research done at
DREAM, we're helping fill in the gaps in
All the research underway in the
area of pediatric Type 2 diabetes could
not take place without the help of all
the community health-care staff and
community partners, including those in
First Nations organizations.
As Dean explains, most of the youth
in the various studies live in remote
communities, and any treatment strategy
has to be culturally sensitive. She says
workers like Bertha Flett, who was the
first clinical research nurse in the Next
Generation project, are critical to future
success. "Bertha knows everyone in the
North, and if we can't find someone, we
ask her for help," says Dean.
Flett worked with the Next Generation
project until she retired in 2009, testing
children in northern communities for
Type 2 diabetes. Flett says that out of the
900-some children she tested in nursery
to Grade 12 classes over the years, six
had Type 2 diabetes. In comparison,
the Canadian average is 1.5 in 100,000
children. In British Columbia, where
the numbers are 2 in 100,000 kids,
all the affected children are of Indo-
Asian heritage, and children from Haiti.
Saskatchewan is not even on the radar,
because it has only recorded five cases in
total. When you compare the Manitoba to
the national numbers, finding six in 900
is like finding over 650 children out of
In the course of her work for the
Next Generation project, Flett worked
with the schools, setting up tests, and
then reassuring the children who tested
positive. She spoke with their parents, and
referred the children to the local health
clinic for treatment, along with recruiting
them for study at DER-CA.
"You have to hunt for the kids with
Type 2 diabetes, because they don't feel
sick when they first have it," says Flett,
who was diagnosed with Type 2 diabetes
herself when she was an adult. "And
people - despite all the education
we do and workshops we
teach - don't listen to
the message: that
they should be taking care of themselves
so they won't get diabetes."
Flett's work with the Next Generation
project came with both a professional and
a personal motivation.
Years earlier, her own daughter had
been mistakenly diagnosed as having
Type 1 diabetes. This came about before
the medical community understood that
children could develop Type 2 diabetes.
As a result, the proper treatment wasn't
put in place, and her daughter's Type 2
diabetes worsened rapidly.
"My daughter died at age 25,"
says Flett, who is now raising her
granddaughter. "It's hard. It's hard to
know that she's gone. It's hard that I have
the same thing. But it gave me direction. I
wanted to work with kids who have Type
2 so they can have hope."
Part of that hope might come from an
idea generated by the Next Generation
project to encourage new mothers to
breastfeed their infants. Breastfeeding
has been associated with a lower risk of
Type 2 diabetes in children. This may
require one-on-one support, coaching
the mothers through the experience,
along with talking about serving healthy
food and increasing their daily amount of
Summer student Karla Muskego is
another integral part of the community
outreach being done by the Next
Generation project. A fourth-year
biochemistry student at the University
of Manitoba who hails from northern
Manitoba, Muskego's job this past
summer was to encourage the families to
come in for their check-ups. She says it
took patience and persistence to do the
"There are about 130 kids in the cohort
in Manitoba. My role is to try to get 80
per cent of those kids in for testing,"
says Muskego. "But it's challenging.
Most of the people live up north and
find it hard to come into Winnipeg. But
I'm so thrilled when they do come in. It
shows their commitment to keeping their
Life in remote communities comes with
a number of problems that need to be
solved, before children and their parents
can be healthy, says Lyna Hart, the acting
Tribal Nursing Officer with the Southeast
Resource Development Council.
Since the call to action in 1999, when
representatives from tribal councils and
independent First Nations communities
in Manitoba came together to talk about
treating Type 2 diabetes, they knew they
would be fighting a disease that was affecting three generations at once. It's
also a disease that needs more than a
diabetes-only health care program to
tackle, says Hart.
People living in remote communities
in Manitoba are dealing with a lack of
fresh food, clean drinking water and
quality housing. Many are survivors of
the residential school system, and have
to cope with the trauma of those years,
which can lead to family violence,
substance abuse and suicide. That stress
affects a person's health, including
pregnant mothers who have Type 2
diabetes and their children.
"Food insecurity is a big issue," says
Hart. "When you go into a store in the
North, and the fruit and vegetables are
beyond ripe, you don't buy them. We
know that breast feeding is the first line of
defense for mothers who are diabetic and
who have babies. But those mothers can't
meet their nutritional needs, so they can't
Many communities in the North are
under water boiling advisories. Bottled
water is too expensive to fly in, so
people drink pop instead. "People eat
what's available, and what's available
isn't nutritious, so it's no wonder obesity
is a big problem," says Hart, who was
diagnosed with Type 2 diabetes in midlife.
Hart says federal funding for diabetes
programs in Manitoba's First Nations
communities is limited, so she's effusive
in her praise for work being done by Dr.
Heather Dean and the team of researchers
at DER-CA and DREAM. "They keep
us in the loop. We're very happy to be
guiding the questions they ask. We're
hopeful they will lead the work to find
an answer," she says. "I believe that all
children need to be screened for Type 2
diabetes, both First Nations and non-First
Nations. People worry that it will cost
money, but it's better than waiting until
those children grow up, and their health
is worse by the time they find out they
have it. We have to ensure the future of
Maintaining contact with people living
in far-flung communities is part of the role
of the Maestro Project, an outreach effort
on the part of DREAM to ensure children
with diabetes make a successful jump
from pediatric to adult care, no matter
where they're living in the province.
Maestro - named so because Dean
envisioned a conductor reminding the
musicians in an orchestra of when it
was time to play their part - forms a
bridge of contact for patients leaving
pediatric diabetes care at age 18 and
who are struggling to learn to take care of
themselves as adults.
The Maestro Project was established
in 2002 to support youth with Type 1
diabetes who were transferring to adult
care. As the numbers of children with
Type 2 diabetes began growing, there
soon was a need for a parallel program,
which has been named Maestro 2.
"Young adults have a bad habit
of not showing up for their medical
appointments," says Catherine
MacDonald, Transition Care Co-ordinator
for Maestro. "They don't always make the
best choices at 18, 19 and 20. And when
they do end up re-engaging with healthcare
services, there's often irreversible
damage done to them, complications that
often can't be reversed."
The numbers back up the decision
to launch Maestro 2. Ten years after
diagnosis, the survival rate for children
with Type 2 diabetes is 91.4 per cent,
compared to 99.5 per cent in children
with Type 1, and 100 per cent in children
without either disease. Renal survival is
only 55 per cent after 20 years in youth
and young adults with Type 2 diabetes.
Maestro is tracking 1,600 young adults
between the ages of 18 and 25, including
387 with Type 2 diabetes. MacDonald
first makes contact with patients when
they are around 14 years old, to begin
building a relationship that will help the
young adults know who to turn to when
they get into the somewhat bewildering
adult side of diabetes treatment. She uses
the phone, e-mail, Facebook and texts to
keep in contact with the adults.
"We've had 82 people graduate from
us at age 25," she says. "But during the
time from 2002 to 2011, we've had 16
deaths, including five from complications
of Type 2. Our goal is to reduce the dropout
from follow-up care in pediatrics
from 60 to 30 per cent, and to track 80
per cent of those moving on to adult
care, using programs like the Diabetes
Integration Project in rural and northern
Between the DREAM researchers
and the clinic and educational efforts
at DER-CA, Dean and her colleagues
hope to get a handle on pediatric Type 2
diabetes in the next five years and be able
to offer new treatments and preventions.
It's an ambitious goal, but one that must
be met in order to contain the surge in
childhood Type 2 diabetes.
"I'm an optimistic person," says Dean.
"We have a great team of researchers,
clinicians, community leaders and
families working on the problem."
As Charlotte and her siblings grow
older, they will come to depend more and
more on the work being done by these
health-care and research teams. Charlotte
is as full of life as any 14-year-old, and
should be able to keep her condition
under control. And she can count on her
mother to keep a watchful eye on her
compliance with her medication and diet.
"Diabetes put me through the gutter,"
says Mary Wood. "That's what's so
important for the kids. The elders tell us
that we'll run into trouble with our health
if we don't look after our diabetes. So I
tell my kids, look after your sugars, or
you'll be like me in 20 or 30 years. That's
why I'm talking to you about this, so that
everyone will know."
Susie Strachan is a communications advisor with the Winnipeg Health Region.
Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.
Read the September / October 2012 issue of Wave