KINGWOOD, W.Va. -- When Aubrey Duckworth was 10 years old, West Virginia University's CARDIAC screeners came to Preston County's Kingwood Elementary. They checked fifth-graders' blood pressure, cholesterol, height and weight.
They also checked the back of each child's neck. They were looking for a dark patch of skin, a signal that the child is at risk of type 2 diabetes.
A week or so later, Aubrey's mother, Gwen, got a letter from CARDIAC saying they had found an AN marker, a dark linear patch, on Aubrey's neck. "They said to show the letter to her doctor," Gwen said.
She took Aubrey to the family doctor. "He looked at the back of her neck and said, 'We need to keep an eye on that.'"
"An AN marker is a warning signal to check for type 2 diabetes," said pediatrician Dr. Pamela Murray, chief of the Division of General Pediatrics and Adolescent Medicine at WVU Medical Center.
West Virginia is facing a diabetes epidemic that threatens to swamp the state health-care system, Murray said. One in 3 Americans will be diabetic by 2050 if preventative measures are not taken, the Centers for Disease Control and Prevention predicts.
"If we can catch it now in children, we absolutely should," Murray said.
Thousands of West Virginia children -- 1 in 20 -- have the diabetes-linked marker, according to the CARDIAC project, which screens statewide.
"The fancy name is acanthosis nigricans," Murray said. It translates "dark area."
"Lots of times, it looks like a smudge or dirt," she said. "It used to be only adults, but now, as kids get type 2 diabetes too, it turns up on children too."
In the past 11 years, CARDIAC screeners have checked 78,751 West Virginia fifth-graders' necks. On average, 5.2 percent had a marker. That's 762 children in the fifth grade alone.
When insulin behaves abnormally in the body, AN markers may appear as brown-to-black velvety areas encircling the back of the neck, under the arms or in the crook of the elbow or knee, Murray said. "The bad thing is, many parents don't know what it is," she said.
Many teachers don't recognize it either, said Kelli Caseman, director of the West Virginia School-Based Health Assembly. Teachers sometimes refer children to the health center for hygiene issues, she said, "only to find that the dirt on the back of students' necks was AN."
Murray emphasizes that:
"It's usually easier to identify on darker-skinned individuals, but in West Virginia, it's frequent and more visible on white children," Murray said. Nationwide, black children develop AN -- and diabetes -- at a higher rate than white children do.
AN markers often fade away if people bring their blood sugar into normal range, she said.
Aubrey Duckworth's marker didn't fade, but she did gain weight. By age 13, she was 6-foot-1 and weighed 287 pounds. Her family doctor referred her to Morgantown.
Murray -- who specializes in childhood diabetes and obesity -- ordered blood tests. They showed that Aubrey has type 2 diabetes.
"The good news is, we caught it early enough to prevent serious damage," Murray said. Exercise and eat right, she told Aubrey, and you may eventually be able to manage it without medication.
Now Aubrey and her mother do Zumba four times a week. "It's great her mother does it with her," Murray said. The whole family improved their diet, Gwen Duckworth said. "We're all in this with her," she said.