According to researchers at the Centers for Disease Control and Prevention, almost half of all post-Millennial youth will be diagnosed with type 2 diabetes in their lifetime, with Latinos leading the way.

Although those numbers might startle some people, they don’t surprise Tatianna Alvarado and Jamie Karch, a pair of students enrolled in ASU’s College of Nursing and Health Innovation.

“Many of my family members have diabetes, and my mother is a type 2 diabetic. The last year of high school I took care of her,” said Alvarado, a 19-year-old sophomore. “I’d interact with her, told her what diabetes was, took her to the gym and tried to discipline her sometimes … but there was only so much I could do as a daughter.”

Now that she’s a bit older and better educated, Alvarado feels she can do much more. So does Karch, which is why the two undergrads are playing key roles in a community-based diabetes prevention program and study for obese Latino youth called “Every Little Step Counts.”

The five-year, $1.2 million study funded by the National Institute of Minority Health and Health Disparities tests the effects and incremental cost-effectiveness of a culturally grounded community-based lifestyle intervention on obesity-related health outcomes among Latino adolescents.

To date, 160 obese Latino youth, ages 14-16 have been enrolled in the randomized control trial. Participants in the 12-week intervention and their families engage in weekly nutrition education sessions where they learn behavioral strategies to prevent chronic health conditions related to obesity and type 2 diabetes at the Lincoln Center Family YMCA in Phoenix. In addition to nutrition classes, youth participate in three, one-hour moderate-to-vigorous physical activity sessions led by certified trainers. At the end of the trial, youth in the control arm of the study receive a free, one-year membership to the YMCA, and participate in exercise sessions at the YMCA and nutrition classes at ASU’s Nutrition Kitchen at the Downtown Phoenix campus.

Arizona State University nursing and health innovation student Tatiana Alvarado, 19, and St. Vincent De Paul Family Wellness Program Health Education Coordinator Ricardo Reyes speak to community members as they examine their blood work during a nutrition course at the ASU state-of-the-art food lab at the downtown campus Wednesday afternoon, September 23rd 2015. According to researchers at the Centers for Disease Control, almost half of all post-Millennial Latino youth will be diagnosed with type 2 diabetes. Photo by Deanna Dent/ASU News

Gabriel Shaibi, an associate professor with the College of Nursing and Health Innovation and the principal investigator on the trial, said past community-embedded intervention programs have failed to reach its intended audience because it has been a “top down” approach from doctor/researcher to patients. And the reality is patients don’t always listen to their doctor.

That might be one reason why the past decade has seen Arizona experience the largest statewide increase in the number of children and adolescents who are obese. Shaibi said those numbers translate to a myriad of problems, including rising diabetes rates.

“Once you are diagnosed with diabetes, it becomes a management issue,” Shaibi said. “This is a relatively new phenomenon with kids, but it can ultimately lead to neuropathy, blindness, kidney disease and ultimately heart attacks. Those kids on average lose about 15 years on life.”

Latinos are genetically predisposed to having diabetes. But the problem is compounded by the fact that, culturally and historically, Latinos have often used food to express themselves, Alvarado said.

“Anything that happens in the Latino culture, be it positive or negative — birthdays, graduations, weddings, anniversaries, promotions, funerals — food plays a big part,” Alvarado said. “It’s interaction and eating, but you don’t really notice you’re overeating until after the fact. Moderation is the key, and that’s what we’re trying to teach the Latino community.”

Which is why Shaibi has pushed Alvarado and Karch to the forefront of the trial program, but at opposite ends of the spectrum — Alvarado interacting with the community and dispensing exercise and nutrition advice, and Karch in the lab gathering blood samples, data and reviewing medical information.

“I am closer in age to these kids and have gone what they’ve gone through,” Alvarado said. “Age is a big thing and they feel as if they can come to me for advice.”

Karch said she is content in her role in the lab because she understands her work is just as vital.

“I do more of the background work, but mine and Tatianna’s goals are the same in that we want to give back to the Latino community,” Karch said.

That is also the goal of the ASU Sun Devil Family Association, who awarded Alvarado and Karch with $5,000 scholarships each for the academic year. These scholarships are awarded to individuals who have demonstrated financial need, a record of community service and a commitment to their education despite challenging circumstances.

This semester Alvarado and Karch have plans to meet their donors, who are also in the nursing field.

“I cannot wait to meet her and hug her,” Alvarado said. “I cannot believe she gave money to someone she didn’t even know. She has made my life so much easier because of her help.”

And it’s not lost on Alvarado or Karch that the help they receive from the Sun Devil Family Association goes right back into the community.

“That’s what I love about nursing,” Alvarado said. “It’s the art of caring for people.”

After several days of public outcry, including from several presidential candidates, Turing’s owner announced he was cutting the price, although he refused to say by how much.

This is not an isolated case. Nor is it the only one likely to spur continuing debate about the ethics and responsibilities of pharmaceutical companies.

Just days after the Turing episode, U.S.-based Alexion Pharmaceuticals filed a lawsuit in Canada challenging Canada’s Patented Medicine Prices Review Board and its authority to order drug-price reductions. Alexion’s drug Soliris, used to treat rare blood and genetic disorders, is reportedly priced at $500,000 to $700,000 per patient annually. Alexion’s suit, if successful, could put an end to Canada’s ability to control the price of patented drugs.

Offering some perspective on the responsibility of pharmaceutical companies and the changes needed in the health-care system is Dr. Victor Trastek, a former vice president of Mayo Clinic and CEO of Mayo Clinic in Arizona, and now director of the School for the Science of Health Care Delivery within ASU’s College of Health Solutions.

Question: How common is this practice of dramatically (and instantly) raising prices when a drug is acquired?

Answer: This is hard to know. But in the case of Turing Pharmaceuticals, the size of the change was remarkable. That particular medication has been around for a while, so raising the drug price to such a high level is, I believe, unreasonable — and hopefully rare. However, drug prices are always changing and vary depending on patent expirations, what country you live in or the type of health-care system you have. 

Q: Is there a responsibility that a pharmaceutical company has to keep prices reasonable? 

A: Yes. You would hope that is true of any company in any health-care sector. We are in a service industry and our profession is one of healing and caring, so we want medications to be reasonable for those of us trying to help patients. There are obviously going to be different levels of costs depending on how much research is being done with regard to individual medications, but we want them to be reasonable. 

"It would be nice to have a system that is more transparent, consistent and standardized."

Q: How often is one drug used to finance other research and development work, particularly to improve its therapeutic benefit?

A: In the pharmaceutical industry, there has to be a certain amount of revenue and profit to invest in research for the next newest drug, which can be a variation or improvement of an existing drug. It is the constant circle and business model for the industry. All drug makers are trying to improve drugs so that they are more efficacious. And, if they are used more often, they will sell more. In my mind, it is a stretch to expect that profits made from the sudden and dramatic rise of any given drug would all be funneled into researcher funding for that same drug [as Turing’s owner suggested]. Whether that really happens is hard to say.

Q: Does there need to be a change in the system? 

A: Yes. Pharmaceutical medications are part of the whole health-care system. It would be nice to have a system that is more transparent, consistent and standardized since different hospitals, countries and health systems pay different amounts for drugs. Health care is different from any other business; for example, a car dealership tends to be based more on a want than an actual need. At ASU, we are investing in our future health-care decision makers through our Science of Health Care Delivery program. We are working to develop a broad knowledge base for designing a better delivery system for future leaders, including pharmaceutical leaders, who can then create a better system and better care. If we educate others with this broader frame of reference in the science of health-care delivery, we can help change the system. It’s one way to bring about positive changes in this industry.