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Understanding and Treating Obesity and Type 2 Diabetes in Children

Pediatric endocrinologist Sonia Caprio, MD, recalls a time when obesity was so rare in children that they didn’t get type 2 diabetes, which was referred to as “adult onset diabetes.” Today, pediatric obesity has escalated to epidemic proportions and type 2 diabetes in children is on the rise.

Dr. Caprio’s research focuses on the pathophysiology of juvenile obesity and type 2 diabetes, as well as its treatment. To combat obesity, she worked with registered dietician Mary Savoye, on a study to develop Bright Bodies, a weight management program for children that uses education, exercise and lifestyle modification. Today, hundreds of children are enrolled in Bright Bodies and it is “the pearl of our clinical work,” according to Dr. Caprio, professor of pediatrics (endocrinology).

Yale was one of the first centers to point out the issue of pre-diabetes, which led to two major studies funded by the National Institute of Diabetes and Digestive and Kidney Diseases. The Treatment Options for Type 2 Diabetes in Youth (TODAY) examined different treatments for type 2 diabetes in adolescents and showed that these young patients have more rapidly progressive disease than those who are diagnosed as adults.

The Restoring Insulin Secretion (RISE) study, for which Yale is one of only three participating centers in the country, also involves adolescents with pre- and early type 2 diabetes. RISE aims to prevent full blown diabetes in these patients by testing a new approach - insulin followed by metformin - compared to metformin alone. “The rational for using insulin for pre-diabetes is that by diminishing the level of glucose toxicity we may be able to prevent further beta cell loss,” said Dr. Caprio.

She is conducting a study in the Hospital Research Unit with Robert Sherwin, MD, and Rajita Sinha, PhD, using functional MRI to study the effect of glucose and fructose on the brains of adolescents, who are the major consumers of soda in the U.S.

She is also working with Savoye on a study to reduce fat content in the liver - a precursor to diabetes - by increasing the content of omega fatty acids in the diet. This study utilizes the CTSA-supported metabolic kitchen to prepare meals and the Church Street Research Unit (CSRU), YCCI’s outpatient research facility, to conduct oral glucose tolerance testing. For the past decade, she has been using the CSRU to test children for diabetes or pre-diabetes. In fact, it’s the first stop for every patient in every study she does. “Without that, we can’t determine the next study to do on the child,” she said. “The CTSA is my second home.”