Type 2 diabetes in youth: a new epidemic

The next generation cohort: a description of a cohort at high risk for childhood onset type 2 diabetes

Children of mothers with youth-onset (<18 years) type 2 diabetes (T2D) are at increased risk of youth-onset T2D. In Canada, the highest reported prevalence of youth-onset T2D is in First Nation youth, some of whom harbor a unique genetic predisposition HNF1α polymorphism which has been associated with age of onset and clinical presentation. To describe the characteristics of the Next Generation birth cohort (n=260) at 7–9 years (n=88) and 14–16 years of age (n=27). This is a cross-sectional study of offspring exposed in utero to T2D (Next Generation Birth Cohort). Annual assessments from age 7 include height and weight, and biochemical testing (glucose, insulin, lipids, HbA1c). Descriptive statistics were employed. χ2 tests and repeated-measures ANOVA were used to compare categorical and continuous characteristics, respectively. In total, 11.9% of the total cohort have developed T2D. Of those 14–16.9 years of age, 16.0% have developed T2D. 92% of the offspring ages 7–9 and 70.3% of offspring ages 14–16 are overweight or obese. Children had a significantly higher body mass index z-score than adolescents (2.9 v. 1.5, P=0.001). Comparing the different HNF1α genotypes (G/G wildtype, G/S heterozygote, S/S homozygote); HbA1c (GG: 5.5% v. G/S: 5.7% v. S/S: 8.8%; P=0.0052), insulin (GG: 103 v. G/S: 202; P=0.05) and T2D status (G/G: 5.7% v. G/S: 28.1% v. S/S: 72.7%; P<0.0001) were significantly different between groups. T2D is very common among adolescents of mothers with youth-onset T2D. Early childhood obesity and the HNF1α G319S allele are associated with the incidence of T2D in the Next Gen offspring.

The Mountain of Health: The Perceptions and Perceived Expectations of Youth Living With Type 2 Diabetes in Winnipeg, Manitoba, Canada, Through a Grounded Theory Study

OBJECTIVE

The objective of this study was to explore youth's perceptions of diabetes management.

METHODS

The study included 8 Manitoban youth with type 2 diabetes (n=7 girls). Each youth participated in a semistructured interview in person, via Skype or over the phone. The constructivist grounded theory methodologic approach guided the analysis of the data.

RESULTS

Discussions about diabetes and health and its management revealed 2 viewpoints: 1) youth's perceptions and 2) youth's perceptions of health-care providers' expectations. The Mountain of Health was used to conceptualize the complex nature of diabetes management. Youth perceived that health-care providers prioritized physical health-behaviour changes in order to achieve successful diabetes management. Conflictingly, many youth described their mental and emotional health as taking precedence over their physical health.

CONCLUSION

Future interventionists should be aware of the vast incongruence in patients' perceptions of health in type 2 diabetes and their perceptions of health-care providers' expectations during the development of interventions.

Obesity, adiposity, physical fitness and activity levels in cree children

OBJECTIVES

To describe the levels of obesity, adiposity measures, physical activity and fitness in Cree children aged 9-12 years.

STUDY DESIGN

Cross-sectional survey.

METHODS

The study took place in northern Quebec, Canada. Height, body mass, waist circumference and five skinfold thicknesses were measured. Physical activity was assessed by having children wear a pedometer for two days. Children performed the 20-metre shuttle run test (SRT) to determine their physical fitness level.

RESULTS

Of 82 participating children, 33% were overweight (but not obese) and 38% were obese according to an international reference. The mean sum of five skinfold measures exceeded the 95th percentile of Canadian children. Compared with the Third National Health and Nutrition Examination Survey, the majority of children exceeded the 85th percentile for waist circumference (62%) and at the suprailiac (80%), subscapular (72%), and triceps (54%) skinfold sites. 90% of children scored below the 20th percentile in the SRT compared with normative data from Quebec children. Based on pedometer scores, only 49% of children were sufficiently active.

CONCLUSIONS

There is a high prevalence of overweight and central adiposity in this population, with low physical activity and fitness levels. This profile may result in adverse health outcomes.

Kidney disease and youth onset type 2 diabetes: considerations for the general practitioner

Youth onset type 2 diabetes (T2DM) continues to increase worldwide, concomitant with the rising obesity epidemic. There is evidence to suggest that youth with T2DM are affected by the same comorbidities and complications as adults diagnosed with T2DM. This review highlights specifically the kidney disease associated with youth onset T2DM, which is highly prevalent and associated with a high risk of end-stage kidney disease in early adulthood. A general understanding of this complex disease by primary care providers is critical, so that at-risk individuals are identified and managed early in the course of their disease, such that progression can be modified in this high-risk group of children and adolescents. A review of the pediatric literature will include a focus on the epidemiology, risk factors, pathology, screening, and treatment of kidney disease in youth onset T2DM.

Validation of a pediatric diabetes case definition using administrative health data in manitoba, Canada

OBJECTIVE

To validate a case definition for diabetes in the pediatric age-group using administrative health data.

RESEARCH DESIGN AND METHODS

Population-based administrative data from Manitoba, Canada for the years 2004-2006 were anonymously linked to a clinical registry to evaluate the validity of algorithms based on a combination of hospital claim, outpatient physician visit, and drug use data over 1-3 years in youth 1-18 years of age. Agreement between data sources, sensitivity, specificity, negative (NPV) and positive predictive value (PPV) were evaluated for each algorithm. In addition, ascertainment rate of each data source, prevalence, and differences between subtypes of diabetes were evaluated.

RESULTS

Agreement between data sources was very good. The diabetes definition including one or more hospitalizations or two or more outpatient claims over 2 years provided a sensitivity of 94.2%, specificity of 99.9%, PPV of 81.6% and NPV of 99.9%. The addition of one or more prescription claims to the same definition over 1 year provided similar results. Case ascertainment rates of both sources were very good to excellent and the ascertainment-corrected prevalence for youth-onset diabetes for the year 2006 was 2.4 per 1,000. It was not possible to distinguish between subtypes of diabetes within the administrative database; however, this limitation could be overcome with an anonymous linkage to the clinical registry.

CONCLUSIONS

Administrative data are a valid source for the determination of pediatric diabetes prevalence that can provide important information for health care planning and evaluation.

Prevalence estimates of overweight and obesity in Cree preschool children in northern Quebec according to international and US reference criteria

OBJECTIVES

We estimated the prevalence of overweight and obesity in Cree Canadian children aged 5 years (n=1044) using international and US growth references and examined the longitudinal tracking of weight categories between ages 2 and 5 years (n=562).

METHODS

Weight categories based on body mass index (calculated from measured heights and weights) were derived from the International Obesity Task Force (IOTF) and the Centers for Disease Control and Prevention (CDC) references.

RESULTS

According to the IOTF reference, 52.9% of children were overweight (31.6%) or obese (21.3%) whereas with the CDC reference, 64.9% were overweight (27.5%) or obese (37.4%). The IOTF and CDC references provided dissimilar tracking of weight categories. Based on the IOTF reference, 4.9% of the children who were normal weight at age 2 years were obese at age 5 years. Based on the CDC reference, 14.9% of children categorized as normal weight at age 2 years were obese at age 5 years.

CONCLUSIONS

The IOTF reference provided more conservative estimates of obesity than the CDC reference, and longitudinal analyses showed dissimilar tracking of weight categories with the 2 references. Public health responses to obesity prevalence estimates should be made with awareness of methodological limitations.