The federally funded study is the largest look yet at how to treat diabetes in teens. Earlier studies mostly have been in adults, and most diabetes drugs aren’t even approved for youths. The message is clear: Prevention is everything.

“Don’t get diabetes in the first place,” said Dr. Phil Zeitler of the University of Colorado Denver, one of the study leaders.

A third of American children and teens are overweight or obese. They are at higher risk of developing Type 2 diabetes, in which the body can’t make enough insulin or use what it does make to process sugar from food. Until the obesity epidemic, doctors rarely saw children with Type 2 diabetes. The more common kind of diabetes in children is Type 1, which used to be called juvenile diabetes.

Doctors usually start Type 2 treatment with metformin, a pill to lower blood sugar. If it still can’t be controlled, other drugs and daily insulin shots may be needed. The longer blood sugar runs rampant, the greater the risk of suffering vision loss, nerve damage, kidney failure, limb amputation — even heart attacks and strokes.

The goal of the study was simple: What’s the best way for teens to keep diabetes in check?

The study involved 699 overweight and obese teens recently diagnosed with diabetes. All had their blood sugar normalized with metformin, then were given one of three treatments to try to maintain that control: metformin alone, metformin plus diet and exercise counseling, or metformin plus a second drug, Avandia.

After nearly four years, half in the metformin group failed to maintain blood sugar control. The odds were a little better for the group that took two drugs but not much different for those in the lifestyle group.

Even so, Zeitler said doctors would not recommend this combination drug therapy because Avandia has been linked to higher risk of heart attacks in adults. Those risks became known after this study had started.

Another study leader from Children’s Hospital Los Angeles, Dr. Mitchell Geffner, agreed that Avandia can’t be recommended for teens, but said the study makes clear they will need more than metformin to control their disease.

“A single pill or single approach is not going to get the job done,” he said.

Among all the teens in the study, 1 in 5 had a serious complication such as very high blood sugar, usually landing them in the hospital.

The results were published online Sunday by the New England Journal of Medicine and presented at a pediatric meeting in Boston. The National Institutes of Health funded the study and drug companies donated the medications.

The “discouraging” results point to the need to create “a healthier ‘eat less, move more’” culture to help avoid obesity that contributes to diabetes, Dr. David Allen of the University of Wisconsin School of Medicine and Public Health wrote in an accompanying editorial.

Judith Garcia still struggles to manage her diabetes with metformin and insulin years after taking part in the study at Children’s Hospital Los Angeles. She has to remember to watch her diet and set aside time to exercise.

“Trust me, I’m working on it,” said the 19-year-old who lives in Commerce, Calif.

Kelsi Amer, a 14-year-old high school freshman from Patriot, Ind., knows how tough it is to keep her blood sugar from skyrocketing. Diagnosed at age 12, she takes metformin and gives herself insulin shots before school and at bedtime.

There are times when she has to miss class because she has to prick her finger to check her blood sugar or go with her mother to Cincinnati Children’s Hospital Medical Center for check-ups.

“I try real hard and all of a sudden, I’m back to high blood sugar” levels, said Kelsi, who was not part of the research.

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Online:

New England Journal of Medicine: http://www.nejm.org

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The biggest surprise? The largest Martian lava spiral measured 100 feet across — bigger than any on Earth. It is further evidence that Mars was volcanically active recently — geologically speaking within the past 20 million years.

For more than a decade, scientists debated whether this maze of valleys near the Martian equator was sculpted by ice or volcanic processes.

As part of a class project last year, Ryan analyzed about 100 high-resolution photos of the region snapped by the Mars Reconnaissance Orbiter, which has been photographing the Martian surface since 2006. One evening, while taking a second look at the images, Ryan zoomed in and noticed the lava coils. He counted 269 spirals ranging from 16 feet to 100 feet across.

Ryan said he was not surprised the features were overlooked in the past since they blended in with the terrain. The coils looked strikingly similar to Hawaiian lava flows, leading Ryan to conclude that lava — not ice — was the driving force.

Planetary scientist David Paige of the University of California, Los Angeles, said the new work provides convincing evidence that the curious patterns were forged from volcanic activity.

This “illustrates just how complicated Mars’ geologic history appears to really be,” Paige wrote in an email. He was not part of the research team.

It’s believed that rivers of molten lava flowed through the Martian valleys into a broad basin where they settled and formed the coil shapes. The spiral shapes were preserved as the lava cooled.

There are no clear signs that the region today is volcanically active. With more observations, Ryan said it is possible lava coils may exist elsewhere on the red planet.

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Online:

Science journal: http://www.sciencemag.org

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Using high-tech sonar, an expedition spearheaded by Bezos has discovered what he claimed were discarded engines from the mission lurking 14,000 feet deep.

In an online announcement Wednesday, Bezos said he is drawing up plans to recover the sunken engines, part of the mighty Saturn V rocket that launched Armstrong, Buzz Aldrin and Michael Collins on their moon mission.

It was not immediately clear when Bezos’ team spotted the Apollo engines. Bezos offered few details about the discovery and did not say how he knew the engines were from Apollo 11. The cost of the recovery was not disclosed, but Bezos said it will be done with private funds.

Amazon spokesman Drew Herdener said Bezos was not available for comment.

The five engines, which produced nearly 7.7 million pounds of thrust, dropped into the sea as planned minutes after liftoff in 1969. Four days later, Armstrong and Aldrin walked on the moon.

“We don’t know yet what condition these engines might be in,” he wrote. “They hit the ocean at high velocity and have been in salt water for more than 40 years. On the other hand, they’re made of tough stuff, so we’ll see.”

Bezos acknowledged the engines were the property of NASA, but said he hoped they will be displayed in museums.

NASA expressed excitement about the find. The space agency said it has not been formally contacted by Bezos and waited for more information.

“There has always been great interest in artifacts from the early days of space exploration and his announcement only adds to the enthusiasm of those interested in NASA’s history,” NASA spokesman Bob Jacobs said in a statement.

No timetable has been set for the recovery. When it happens, it’ll undoubtedly take longer to hoist the 19-foot engines off the sea floor than the 2 1/2 minutes it took for them to power off the launch pad.

The sea floor is littered with spent rockets and flight parts from missions dating back to the dawn of the Space Age and it’s unknown what survived decades later after crashing into the ocean.

In 2009, a private company salvaged Gus Grissom’s Mercury capsule that accidentally sank in the Atlantic after splashdown in 1961. It was restored and displayed at the Kansas Cosmosphere and Space Center.

Bezos’ planned Apollo recovery is the latest deep-sea adventure by the wealthy. “Avatar” director James Cameron over the weekend rode a mini-sub to Earth’s deepest spot in the western Pacific Ocean, seven miles below the surface, which he described as an alien world. Sir Richard Branson plans a similar dive to the deepest part of the Atlantic, the Puerto Rican trench, later this year.

The five engines, which produced nearly 7.7 million pounds of thrust, dropped into the sea as planned minutes after liftoff in 1969. Four days later, Armstrong and Aldrin walked on the moon.

“We don’t know yet what condition these engines might be in,” he wrote. “They hit the ocean at high velocity and have been in salt water for more than 40 years. On the other hand, they’re made of tough stuff, so we’ll see.”

Bezos acknowledged the engines were the property of NASA, but said he hoped they will be displayed in museums.

NASA expressed excitement about the find. The space agency said it has not been formally contacted by Bezos and waited for more information.

“There has always been great interest in artifacts from the early days of space exploration and his announcement only adds to the enthusiasm of those interested in NASA’s history,” NASA spokesman Bob Jacobs said in a statement.

No timetable has been set for the recovery. When it happens, it’ll undoubtedly take longer to hoist the 19-foot engines off the sea floor than the 2 1/2 minutes it took for them to power off the launch pad.

The sea floor is littered with spent rockets and flight parts from missions dating back to the dawn of the Space Age and it’s unknown what survived decades later after crashing into the ocean.

In 2009, a private company salvaged Gus Grissom’s Mercury capsule that accidentally sank in the Atlantic after splashdown in 1961. It was restored and displayed at the Kansas Cosmosphere and Space Center.

Bezos’ planned Apollo recovery is the latest deep-sea adventure by the wealthy. “Avatar” director James Cameron over the weekend rode a mini-sub to Earth’s deepest spot in the western Pacific Ocean, seven miles below the surface, which he described as an alien world. Sir Richard Branson plans a similar dive to the deepest part of the Atlantic, the Puerto Rican trench, later this year.

Bezos was 5 years old when he watched the moon landing on television and became hooked on getting to space. NASA “sure inspired me, and with this endeavor, maybe we can inspire a few more youth to invent and explore,” he wrote.

It was not immediately clear when Bezos’ team spotted the Apollo engines. Bezos offered few details about the discovery and did not say how he knew the engines were from Apollo 11. The cost of the recovery was not disclosed, but Bezos said it will be done with private funds.

Amazon spokesman Drew Herdener said Bezos was not available for comment.

Bezos’ Blue Origin has been developing a vertical takeoff and landing rocketship that would fly passengers to suborbital space. It has NASA funding to compete to go into orbit as a space taxi now that the space shuttle fleet is retired.

Last year, a test flight went awry when the vehicle became unstable at 45,000 feet and crashed.

Is it still relevant nearly eight years later? And will it still exist when the money dries up?

The answers could depend once again on voters and whether they’re willing to extend the life of the agency.

Several camps that support stem cell research think taxpayers should not pay another cent given the state’s budget woes.

“It would be so wrong to ask Californians to pony up more money,” said Marcy Darnovsky of the Center for Genetics and Society, a pro-stem cell research group that opposed Proposition 71, the state ballot initiative that formed CIRM.

Last December, CIRM’s former chairman, Robert Klein, who used his fortune and political connections to create Prop 71, floated the possibility of another referendum.

CIRM leaders have shelved the idea of going back to voters for now, but may consider it down the road. The institute recently submitted a transition plan to Gov. Jerry Brown and the Legislature that assumes it will no longer be taxpayer-supported after the bond money runs out. CIRM is exploring creating a nonprofit version of itself and tapping other players to carry on its work.

“The goal is to keep the momentum going,” board Chairman Jonathan Thomas said in an interview.

So far, CIRM has spent some $1.3 billion on infrastructure and research. At the current pace, it will earmark the last grants in 2016 or 2017. Since most are multi-year awards, it is expected to stay in business until 2021.

So what have Californians received for their money so far?

The most visible investment is the opening of sleek buildings and gleaming labs at a dozen private and public universities built with matching funds. Two years ago, Stanford University unveiled the nation’s largest space dedicated to stem cell research — 200,000 square feet that can hold 550 researchers.

There are no cures yet in the pipeline and CIRM has shifted focus, channeling money to projects with the most promise of yielding near-term results. Most of the money early on was funneled toward learning the basics and recruiting scientists.

One researcher lured to California was Paul Knoepfler, a stem cell and cancer expert who was deciding between positions at University of California, Davis and an East Coast school.

“I was getting more interested in embryonic stem cells and I knew California would be a more friendly climate for that,” said Knoepfler, whose work focuses on why some embryonic stem cells trigger tumor growths.

Knoepfler favors another bond measure to keep CIRM afloat, but recognizes the average Californian may disagree.

Scientists have prized embryonic stem cells since their discovery over a decade ago because of their potential to transform into any cell of the body. If researchers could harness these flexible cells, they might create replacement tissues to treat diabetes, spinal cord injury and other debilitating conditions.

For all the medical promise that embryonic stem cells hold, the payoff will take years and it’s not surprising that there are still no treatments on the market. Their use has been debated because human embryos from fertility clinic leftovers have to be destroyed to harvest the cells.

When Prop 71 was approved, there were limits on federal spending to a small number of cell lines made before 2001. The restrictions, enacted by the Bush administration, were lifted eight years later by President Barack Obama in 2009 — a move that expanded the number of stem cell lines available for government funding. With that hurdle gone, some question whether California should stay in the stem cell business once funding ends.

Some observers say CIRM lost precious time because legal challenges prevented it from getting off the ground for nearly two years.

“The initial hope was that CIRM would give California a head start,” and ramp up stem cell research, said Roger Noll, professor emeritus of economics at Stanford.

Despite the delay, Noll said CIRM’s legacy has yet to be written.

“CIRM spent a lot of money and there’s a lot of stuff going on, but it’s too early to know whether it was worth it,” Noll said.

While CIRM has found its stride, it is a victim of its early supporters’ hype, said John Simpson of Consumer Watchdog.

“The impression you got was, if you just passed this bond measure, Christopher Reeve will be jumping out of his wheelchair and walking next week,” said Simpson, referring to the late paralyzed actor who appeared in TV ads backing Prop 71. “They’re having to live down the super high expectations that they raised.”

Since handing out the first pot of money in late 2006, CIRM has been dogged by questions about its grant-awarding process with critics charging that many of the awards have gone to universities associated with the agency’s board. CIRM says all proposals go through peer review and board members with a stake recuse themselves. The institute employs 50 people and has an operating budget of about $18 million.

CIRM suffered a blow last year when Geron Corp. abandoned the stem cell field to concentrate on its lucrative cancer therapies instead. CIRM had loaned the company $25 million to support its spinal cord injury trial, the first embryonic stem cell trial approved in the U.S.

Though Geron paid back the amount spent plus interest, the episode put increased pressure on CIRM to support work with more practical payoff.

David Jensen, who runs the blog California Stem Cell Report, said Californians have benefited, but whether it will be worth the $6 billion the state has to pay back remains unclear.

“The agency’s responsibility is now to get the biggest bang for the buck, which is no easy task given the tentative nature of much of the science involved,” he said in an email.

Some think CIRM has left a mark whether or not it will exist in the future.

Its “legacy will be felt in part by the stimulus that it has had on stem cell” research in California, said Fred Gage of the Salk Institute for Biological Studies.

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Online:

http://www.cirm.ca.gov/

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Follow Alicia Chang’s coverage at http://www.twitter.com/SciWriAlicia