Children's Hospital is studying ways to prevent, delay and treat type 1 diabetes at a time when the disease is reaching epidemic proportions.

A series of research projects at Children's will attempt to prevent diabetes in high-risk individuals, reduce onset in those with early signs, and preserve insulin production in those who develop type 1.

It is seeking recruits for research projects that also will try determining what causes type 1.

Health officials long have acknowledged a national epidemic in type 2, which affects mostly overweight and inactive adults. But a spike in childhood diabetes reveals about one quarter, and possibly more, have "double diabetes," a troubling combination of type 1 and type 2.

It represents a factor in the rising incidence of childhood diabetes.

"Double diabetes," also known as type 1 1/2 or hybrid diabetes, was coined to describe adults with type 2 who also had antibodies typical of type 1.

But at Children's, researchers began seeing overweight children with reduced ability to produce insulin, typical of type 1, coupled with insensitivity to the insulin they produce or inject, indicating type 2.

A decade ago, Children's annually diagnosed and treated 60 to 70 children with type 1. But in in recent years, the numbers have risen, reaching 240 cases last year.

Dr. Dorothy J. Becker, Children's director of endocrinology, said children with type 1 usually are thin from weight loss caused by an autoimmune reaction that damages their ability to produce insulin -- the hormone that lets glucose enter cells and be used as energy. Without enough insulin the body must burn its own fat for energy. But double diabetes usually involves overweight children.

One theory suggests that when children susceptible to developing type 1 become overweight, the onset occurs earlier. "Type 1 is increasing," Dr. Becker said. "Studies show that kids developing diabetes worldwide are taller and weigh more than their siblings."

The onset often occurs during puberty when children require more insulin.

"The theory is that all this excess weight gain and insufficient activity is causing both epidemics" of type 1 and 2, Dr. Becker said, noting that diabetes has various causes. For that reason, she said, she advocates replacing the terms "type 1" and "type 2" with "insulin dependent" and "noninsulin dependent."

Children's is trying to counter the childhood epidemic with hopeful research.

The project "Teddy" opts to determine the causes of type 1, including environmental triggers. The international study will screen thousands of children worldwide "to determine if they are at increased risk for type 1." A second part of the study will determine what in a child's life may lead to diabetes.

Children's, among other research centers, is seeking newborns under the age of 3 months with a family history of diabetes. Blood samples will determine the child's risk for type 1. Children at high risk can be enrolled in a second phase. For more information on any of the trials, call 412-692-5250 or send an e-mail to margaret.franciscus @chp.edu.

"Trigger," a nutritional intervention study for newborns, will attempt to prevent or delay development of type 1. Pregnant women with type 1 or with partners with type 1, along with pregnant women with a child with type 1, are eligible. No further volunteers are needed for this trial.

"TrialNet" will screen relatives of people with type 1 to find out if they are at risk of developing diabetes. Brothers, sisters and parents of children with type 1 between the ages of 1 and 45, and cousins 1 to 20, are eligible for the study. The study also is seeking adults diagnosed with type 1 in the last two months. For information, call 412-692-5210 or visit www.diabetestrialnet.org.

The Pittsburgh Family Study, ongoing for more than 25 years, also is looking for ways to predict the risk of type 1 diabetes. Brothers, sisters and parents of children with type 1 between the ages of 1 and 45 are eligible. For more information, call 412-692-7241.

The Diabetes Genetics Consortium also is collecting samples and information from families with type 1 with the hope of figuring out what genes contribute to disease. The study is seeking families with at least two siblings with type 1. It also is seeking Mexican-American and African-American families with one child with diabetes. For more information, call 412-692-3477 or visit www.t1dgc.org.

As research already has proven, antibodies show up when an autoimmune response begins damaging one's insulin-producing islet cells. By measuring the types and numbers of antibodies, onset can be predicted.

Even after onset of type 1, the body still produces insulin. The study will determine whether it is possible to prevent further destruction of insulin production during a "honeymoon period" to reduce insulin therapy and health consequences.

"You don't get diabetes until you lose 80 percent of your insulin production," Dr. Becker said. Preserving the final 20 percent can prevent full onset and reduce the need for insulin injections.

One preventative method under study involves oral insulin, which is not a treatment for diabetes. Instead, it breaks down into proteins in the digestive system. Dr. Becker said animal studies show these proteins prevent destruction of islet cells. In a pilot study of 260 people, 20 percent fewer people developed diabetes.

Children's also is screening people 3 to 45 to test for antibodies. This winter, a study will seek patients with recent onset of diabetes to see if the use of dendritic cells will stop rogue white blood cells from destroying one's islet cells. They also plan to test a type 1 vaccine and whether suppression of the immune system will prevent the onset of type 1.

"Ultimately we want to prevent the antibodies, but if you have antibodies, we want to prevent diabetes, and if you get diabetes, we want you to have a honeymoon forever," Dr. Becker said.