Once rarely seen in the pediatric population, type 2 diabetes has an estimated prevalence of about 15 percent in children between 10 and 19 in the U.S. One of the big concerns, says Johns Hopkins Children’s Center pediatric endocrinologist Sheela Magge, is when these children will have the adult complications of diabetes: “Will they occur when these individuals are in the third or fourth decade of life? This could result in a tremendous public health concern.”

As the new director of Johns Hopkins Children’s Center’s Division of Pediatric Endocrinology, Magge seeks to learn how we might decrease the risk of diabetes and its cardiovascular complications by understanding how risk factors, such as different body compositions, may relate to these conditions.

In a study she is leading, for example, Magge and colleagues compare typically developing children with those with Down syndrome. Although doctors often use body mass index (BMI) to gauge cardiometabolic risk, she explains, BMI may not be the most accurate indicator for individuals with Down syndrome, whose altered body proportions could affect risk.

The researchers recruited 150 children with Down syndrome and 100 typically developing children matched for age, ethnicity, race, sex, and BMI percentile. They ‘re looking at the potential of different measures of body fat — such as waist circumference, BMI, waist-to height ratio, and others — to predict risk of abnormal lipids, inflammatory factors, and other risk factors.  Although individuals with Down syndrome have increased obesity risk, there is conflicting data about whether they have more cardiovascular disease and diabetes. Therefore, they will compare these risk factors in youth with Down syndrome and typically developing adolescents.

“People with Down syndrome are living longer because of medical advances. Their life expectancy is now 60 years,” Magge says. “We need to know how to take care of chronic illnesses in this population.”

The team is additionally studying racial differences in cardiovascular disease and diabetes risk.  Researchers have long known that people of South Asian descent have an increased risk of cardiometabolic disease at lower BMIs compared to those of European and African ancestry, but the reasons behind this phenomenon have been unclear.

She and her team will be searching for a mechanism by putting volunteers of different races through various tests, including oral glucose tolerance testing and modeling free fatty acid kinetics. If their hypothesis that South Asians have increased levels of free fatty acids proves correct, it could suggest new treatments to better treat diabetes — such as medications to decrease their free fatty acids instead of metformin as a first line of treatment.

“Being able to provide more targeted treatments based on each person’s unique risk factors — whether they’re race, ethnicity, body proportions, or underlying medical conditions — is the wave of the future for our field and virtually every other area of medicine. But to be able to do this, we need to understand the underlying mechanisms,” Magge says. “I’m proud to be able to lead a team at Johns Hopkins to better understand what drives these risk factors and help our patients achieve their best individual outcomes.”