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Sørensen K, Hagen CP, Juul A. Higher peak height velocity in early maturing girls depends on insulin rather than fat mass or IGF-I. Eur J Endocrinol 2024; 191:381-388. [PMID: 39292994 DOI: 10.1093/ejendo/lvae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/16/2024] [Accepted: 09/16/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVE Age at pubertal onset has decreased over the recent decades. Early maturing girls have longer puberty duration, and higher peak height velocity (PHV) than late maturing girls. To what extent this is generated by increased insulin-like growth factor-I (IGF-I), fat mass, or fasting insulin levels is currently unknown. DESIGN, SETTING, PARTICIPANTS A population-based study-part of the COPENHAGEN puberty study-longitudinal part. Eighty-one girls evaluated biannually for a median of 10 (2-15) visits for a total of 815 evaluations. METHODS Pubertal staging, anthropometric measures, PHV, skin fold thickness (SFT), and IGF-I and fasting insulin levels were measured. RESULTS Early maturing girls achieved similar final height compared to late maturing girls (166.1 vs 167.1 cm, P = .36). Early pubertal onset was associated with significantly greater PHV (8.7 vs 7.4 cm/year, P < .001) and a longer puberty duration (age at onset of breast development to age at PHV [1.8 vs 1.1 years, P < .001]) compared with late maturation. After correcting for age at pubertal onset, neither body mass index, SFT, nor IGF-I levels differed between early vs late maturing girls. By contrast, fasting insulin levels were significantly higher in early compared with late maturing girls 1.5, 2.0, and 3.0 years after pubertal onset (all P = .039). CONCLUSION Growth velocity was higher and more prolonged in early compared with late maturing girls and associated with higher insulin levels. Thus, the higher insulin levels may compensate for the shorter total growth period by intensifying the pubertal growth period. CLINICAL TRIAL REGISTRATION NUMBER NCT01411527.
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Affiliation(s)
- Kaspar Sørensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Casper P Hagen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2100 Copenhagen, Denmark
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2
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Jadhav I, Chakole S. Effects of Type 1 Diabetes Mellitus on Linear Growth: A Comprehensive Review. Cureus 2023; 15:e45428. [PMID: 37859903 PMCID: PMC10581911 DOI: 10.7759/cureus.45428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/17/2023] [Indexed: 10/21/2023] Open
Abstract
Type 1 diabetes mellitus (T1DM) has a significant effect on the growth of children. The disease has a negative effect on growth when considered in relation to the time period and metabolic control. Studies in this review have suggested debilitated growth in children with T1DM and have a few anomalies in the growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis when compared to fit children. Some studies show that children with T1DM were taller before the onset of the disease and during early diagnosis. Moreover, the linear growth depends on the interaction between the gonadotropin hormone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and sex steroid hormones axis and GH-IGF-1; there's a rise in GH during puberty, which has an effect on the estrogen and testosterone, which leads to the pulsatile secretion of GH, this increment leads to insulin resistance. These studies suggest short stature in girls, and some suggest in both. The final height in boys was unchanged, but a slight decline was observed in girls. This review aims to provide the latest understanding of impaired height in children with T1DM. The most accepted and effective treatment of impaired growth is the administration of long-acting insulin or continuous rapid-acting insulin. However, height was affected by the administration of good basal insulin at puberty and was unaffected by the continuous subcutaneous insulin injection. Hence, new technologies are the therapeutic regimen in children, especially the prepubertal age group; it will be interesting to see their effects on growth patterns in these children with T1DM.
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Affiliation(s)
- Indrayani Jadhav
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarupa Chakole
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Kwarteng EA, Shank LM, Faulkner LM, Loch LK, Fatima S, Gupta S, Haynes HE, Ballenger KL, Parker MN, Brady SM, Zenno A, Tanofsky-Kraff M, Yanovski JA. Influence of puberty on relationships between body composition and blood pressure: a cross-sectional study. Pediatr Res 2023; 94:781-788. [PMID: 36750741 PMCID: PMC10403383 DOI: 10.1038/s41390-023-02503-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/03/2023] [Accepted: 01/15/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Fat mass (FM) and fat-free mass (FFM) are positively associated with blood pressure (BP) in youth. Yet, how puberty, independent of age, affects these relationships remains unclear. Given puberty may be a crucial period for cardiometabolic health, we examined how pubertal development moderates the associations of FM/FFM with BP. METHODS Pubertal development, resting BP, and body composition were assessed in a convenience sample of youth (5.5-17 years). General linear models were conducted to assess if pubertal development moderated the relationships between FM/FFM and systolic/diastolic BP standardized for age, sex, and height (SBPz/DBPz). RESULTS Among participants (N = 1405; age: M = 13.3 ± 2.9 years; 65.4% female; 53.2% racial/ethnic minority), FM/FFM were positively associated with SBPz and DBPz (ps ≤ 0.02). Pubertal development moderated the associations between FFM and BPz (ps ≤ 0.01), but not FM (ps > 0.43). For early/mid and late pubertal participants, there were positive associations between FFM and BP (DBPz: βs = 0.10-0.18, ps ≤ 0.01; SBPz: βs = 0.33-0.43, ps < 0.001); however, these relationships were attenuated, especially for prepubertal DBPz (DBPz: β = 0.01, p = 0.91; SBPz: β = 0.24, p = 0.001). CONCLUSIONS Puberty moderated the relationships between FFM and SBPz/DBPz in analyses that separately modeled the contributions of age and sex. These data suggest that the FFM-DBPz association may potentially be impacted by increasing sex hormone concentrations during puberty. IMPACT Fat mass (FM) and blood pressure (BP) were positively associated throughout puberty. Fat-free mass (FFM) and BP were positively associated throughout puberty; however, puberty moderated the FFM-BP relationship, such that there was a positive relationship in early/mid and late puberty, but the relationship was attenuated for prepubertal children. These findings contribute further insight into physiological and cardiometabolic changes occurring during puberty. Changes in hormone concentrations may explain the impact puberty has on the FFM-BP relationship. Understanding predictors of BP are important as childhood BP is associated with future cardiometabolic outcomes.
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Affiliation(s)
- Esther A Kwarteng
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD, USA
- Metis Foundation, San Antonio, TX, USA
| | - Loie M Faulkner
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Lucy K Loch
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Syeda Fatima
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Suryaa Gupta
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Hannah E Haynes
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, USA
- Metis Foundation, San Antonio, TX, USA
| | - Kaitlin L Ballenger
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Megan N Parker
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, USA
| | - Sheila M Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Anna Zenno
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, MD, USA.
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de Vries SAG, Verheugt CL, Mul D, Nieuwdorp M, Sas TCJ. Do sex differences in paediatric type 1 diabetes care exist? A systematic review. Diabetologia 2023; 66:618-630. [PMID: 36700969 PMCID: PMC9947056 DOI: 10.1007/s00125-022-05866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/25/2022] [Indexed: 01/27/2023]
Abstract
AIMS/HYPOTHESIS Sex differences are present in cardiovascular care and in outcomes among adults with type 1 diabetes mellitus, which typically commences in childhood. Whether sex influences care and outcomes in childhood is not known. This systematic review provides an overview of sex differences in children with type 1 diabetes, focusing on patient and disease characteristics, treatment, comorbidities and complications. METHODS Literature in MEDLINE up to 15 June 2021 was searched, using the terms diabetes mellitus, sex characteristics, sex distribution, children and/or adolescents. All primary outcome studies on children with type 1 diabetes that mentioned a sex difference in outcome were included, with the exception of qualitative studies, case reports or case series. Studies not pertaining to the regular clinical care process and on incidence or prevalence only were excluded. Articles reporting sex differences were identified and assessed on quality and risk of bias using Joanna Briggs Institute critical appraisal tools. Narrative synthesis and an adapted Harvest plot were used to summarise evidence by category. RESULTS A total of 8640 articles were identified, rendering 90 studies for review (n=643,217 individuals). Studies were of observational design and comprised cohort, cross-sectional and case-control studies. Most of the included studies showed a higher HbA1c in young female children both at diagnosis (seven studies, n=22,089) and during treatment (20 out of 21 studies, n=144,613), as well as a steeper HbA1c increase over time. Many studies observed a higher BMI (all ages, ten studies, n=89,700; adolescence, seven studies, n=33,153), a higher prevalence of being overweight or obese, and a higher prevalence of dyslipidaemia among the female sex. Hypoglycaemia and partial remission occurred more often in male participants, and ketoacidosis (at diagnosis, eight studies, n=3561) and hospitalisation was more often seen in female participants. Most of the findings showed that female participants used pump therapy more frequently (six studies, n=211,324) and needed higher insulin doses than male participants. Several comorbidities, such as thyroid disease and coeliac disease, appeared to be more common in female participants. All studies reported lower quality of life in female participants (15 studies, n=8722). Because the aim of this study was to identify sex differences, studies with neutral outcomes or minor differences may have been under-targeted. The observational designs of the included studies also limit conclusions on the causality between sex and clinical outcomes. CONCLUSIONS/INTERPRETATION Sex disparities were observed throughout diabetes care in children with type 1 diabetes. Several outcomes appear worse in young female children, especially during adolescence. Focus on the cause and treatment of these differences may provide opportunities for better outcomes. REGISTRATION This systematic review is registered in PROSPERO (CRD42020213640).
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Affiliation(s)
- Silvia A G de Vries
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Carianne L Verheugt
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Dick Mul
- Diabeter, Center for Paediatric and Adult Diabetes Care and Research, Rotterdam, the Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Theo C J Sas
- Diabeter, Center for Paediatric and Adult Diabetes Care and Research, Rotterdam, the Netherlands
- Department of Paediatrics, Division of Paediatric Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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Perng W, Conway R, Mayer-Davis E, Dabelea D. Youth-Onset Type 2 Diabetes: The Epidemiology of an Awakening Epidemic. Diabetes Care 2023; 46:490-499. [PMID: 36812420 PMCID: PMC10090267 DOI: 10.2337/dci22-0046] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/26/2022] [Indexed: 02/24/2023]
Abstract
In this narrative review, we describe the epidemiology (prevalence, incidence, temporal trends, and projections) of type 2 diabetes among children and adolescents (<20 years), focusing on data from the U.S. and reporting global estimates where available. Secondarily, we discuss the clinical course of youth-onset type 2 diabetes, from prediabetes to complications and comorbidities, drawing comparisons with youth type 1 diabetes to highlight the aggressive course of this condition, which, only recently, has become recognized as a pediatric disease by health care providers. Finally, we end with an overview of emerging topics in type 2 diabetes research that have potential to inform strategies for effective preventive action at the community and individual levels.
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Affiliation(s)
- Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca Conway
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Abstract
Objective Young people with type 1 diabetes are likely to gain body weight and not achieve optimal glycemic control with only high doses of insulin. This study examined the efficacy of the sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin as an adjunct-to-insulin therapy in young Japanese subjects with type 1 diabetes who had been diagnosed before 15 years old, were overweight, and had inadequate control despitereceiving intensive insulin therapy. Methods Twenty-two patients with type 1 diabetes (12 boys and 10 girls 16.0-33.9 years old) were involved in the study. All patients had a body mass index (BMI) >25 kg/m2, glycated hemoglobin (HbA1c) level >7.0%, and daily insulin dose >0.5 units/kg. They were treated with a low dose of dapagliflozin (5.0 mg/day) as an adjunctive therapy to insulin. Fourteen patients were treated with multiple daily injections of insulin, while eight used an insulin pump. Results The body weights and BMIs were significantly reduced during the 12-month study period (change of -4.4 kg and -1.7 kg/m2, p<0.001, respectively). Their insulin dose was significantly decreased (-0.17 units/kg, P <0.001), and glycemic control was significantly improved (fasting plasma glucose: -18.7 mg/dL, HbA1c: -0.62%, p<0.001) during the study period. There was one episode of diabetic ketoacidosis, with no other problematic adverse events, including severe hypoglycemia, observed. Conclusion The use of low-dose dapagliflozin as an adjunct therapy may be beneficial in overweight young people with poorly controlled type 1 diabetes.
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Affiliation(s)
- Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Japan
| | - Kei Yoshida
- Department of Pediatrics, Nihon University School of Medicine, Japan
| | - Junichi Suzuki
- Department of Pediatrics, Nihon University School of Medicine, Japan
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Sims EK, Cuthbertson D, Felton JL, Ismail HM, Nathan BM, Jacobsen LM, Paprocki E, Pugliese A, Palmer J, Atkinson M, Evans-Molina C, Skyler JS, Redondo MJ, Herold KC, Sosenko JM. Persistence of β-Cell Responsiveness for Over Two Years in Autoantibody-Positive Children With Marked Metabolic Impairment at Screening. Diabetes Care 2022; 45:2982-2990. [PMID: 36326757 PMCID: PMC9763026 DOI: 10.2337/dc22-1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We studied longitudinal differences between progressors and nonprogressors to type 1 diabetes with similar and substantial baseline risk. RESEARCH DESIGN AND METHODS Changes in 2-h oral glucose tolerance test indices were used to examine variability in diabetes progression in the Diabetes Prevention Trial-Type 1 (DPT-1) study (n = 246) and Type 1 Diabetes TrialNet Pathway to Prevention study (TNPTP) (n = 503) among autoantibody (Ab)+ children (aged <18.0 years) with similar baseline metabolic impairment (DPT-1 Risk Score [DPTRS] of 6.5-7.5), as well as in TNPTP Ab- children (n = 94). RESULTS Longitudinal analyses revealed annualized area under the curve (AUC) of C-peptide increases in nonprogressors versus decreases in progressors (P ≤ 0.026 for DPT-1 and TNPTP). Vector indices for AUC glucose and AUC C-peptide changes (on a two-dimensional grid) also differed significantly (P < 0.001). Despite marked baseline metabolic impairment of nonprogressors, changes in AUC C-peptide, AUC glucose, AUC C-peptide-to-AUC glucose ratio (AUC ratio), and Index60 did not differ from Ab- relatives during follow-up. Divergence between nonprogressors and progressors occurred by 6 months from baseline in both cohorts (AUC glucose, P ≤ 0.007; AUC ratio, P ≤ 0.034; Index60, P < 0.001; vector indices of change, P < 0.001). Differences in 6-month change were positively associated with greater diabetes risk (respectively, P < 0.001, P ≤ 0.019, P < 0.001, and P < 0.001) in DPT-1 and TNPTP, except AUC ratio, which was inversely associated with risk (P < 0.001). CONCLUSIONS Novel findings show that even with similarly abnormal baseline risk, progressors had appreciably more metabolic impairment than nonprogressors within 6 months and that the measures showing impairment were predictive of type 1 diabetes. Longitudinal metabolic patterns did not differ between nonprogressors and Ab- relatives, suggesting persistent β-cell responsiveness in nonprogressors.
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Affiliation(s)
- Emily K. Sims
- Pediatric Endocrinology and Diabetology, Wells Center for Pediatric Research, Department of Pediatrics, and the Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
| | - David Cuthbertson
- Pediatrics Epidemiology Center, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Jamie L. Felton
- Pediatric Endocrinology and Diabetology, Wells Center for Pediatric Research, Department of Pediatrics, and the Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
| | - Heba M. Ismail
- Pediatric Endocrinology and Diabetology, Wells Center for Pediatric Research, Department of Pediatrics, and the Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
| | | | - Laura M. Jacobsen
- Departments of Pediatrics and Pathology, University of Florida College of Medicine, Gainesville, FL
| | - Emily Paprocki
- Division of Pediatric Endocrinology and Diabetes, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Alberto Pugliese
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, University of Miami, Miami, FL
- Diabetes Research Institute, University of Miami, Miami, FL
| | | | - Mark Atkinson
- Departments of Pediatrics and Pathology, University of Florida College of Medicine, Gainesville, FL
| | - Carmella Evans-Molina
- Pediatric Endocrinology and Diabetology, Wells Center for Pediatric Research, Department of Pediatrics, and the Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
| | - Jay S. Skyler
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, University of Miami, Miami, FL
- Diabetes Research Institute, University of Miami, Miami, FL
| | - Maria J. Redondo
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Kevan C. Herold
- Department of Immunobiology and Department of Internal Medicine, Yale University, New Haven, CT
| | - Jay M. Sosenko
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, University of Miami, Miami, FL
- Diabetes Research Institute, University of Miami, Miami, FL
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Monzon AD, Patton SR, Koren D. Childhood diabetes and sleep. Pediatr Pulmonol 2022; 57:1835-1850. [PMID: 34506691 DOI: 10.1002/ppul.25651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/18/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022]
Abstract
Sleep modulates glucose metabolism, both in healthy states and in disease. Alterations in sleep duration (insufficient and excessive) and obstructive sleep apnea may have reciprocal ties with obesity, insulin resistance and Type 2 diabetes, as demonstrated by emerging evidence in children and adolescents. Type 1 diabetes is also associated with sleep disturbances due to the influence of wide glycemic fluctuations upon sleep architecture, the need to treat nocturnal hypoglycemia, and the need for glucose monitoring and insulin delivery technologies. In this article, we provide an extensive and critical review on published pediatric literature regarding these topics, reviewing both epidemiologic and qualitative data, and provide an overview of the pathophysiology linking sleep with disorders of glucose homeostasis.
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Affiliation(s)
- Alexandra D Monzon
- Department of Psychology and Applied Behavioral Science, Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Susana R Patton
- Department of Biomedical Research, Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Dorit Koren
- Department of Pediatrics, Pediatric Endocrinology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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Leister KR, Cilhoroz BT, Rosenberg J, Brown EC, Kim JY. Metabolic syndrome: Operational definitions and aerobic and resistance training benefits on physical and metabolic health in children and adolescents. Diabetes Metab Syndr 2022; 16:102530. [PMID: 35709585 DOI: 10.1016/j.dsx.2022.102530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The variation in parameters for childhood metabolic syndrome (MetS) has hindered the development of a consensus for the diagnostic criteria in this group. Despite these inconsistencies, it is accepted that exercise can ameliorate the deleterious effects of MetS. However, direct comparison between aerobic versus resistance exercise on MetS symptomology in adolescents is lacking. AIM Aim of this review was to discuss controversies associated with current MetS operation definitions in adolescents and present a review summarizing longitudinal studies relevant to the influence of aerobic and resistance training on children with MetS. METHODS Reviews of PubMed and Web of Science were conducted to identify literature focusing on the influence of aerobic and resistance training on children with MetS. Selected manuscripts featured longitudinal research only. RESULTS A universally accepted definition of MetS for the pediatric population has yet to be established. As such, consensus regarding diagnostic criteria for MetS among children is lacking despite the presence of various descriptions in the literature. Though studies support the importance of aerobic and resistance exercise to combat comorbidities associated with MetS, longitudinal studies investigating the benefits of each exercise type among adolescents are limited and inconsistent. CONCLUSION An improved understanding of the impact of aerobic and resistance training on children with MetS is clinically relevant because it may facilitate more appropriate exercise recommendations for children with MetS. Additional large cohort studies are warranted to determine optimal exercise type.
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Affiliation(s)
- Kyle R Leister
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Burak T Cilhoroz
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Jared Rosenberg
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | | | - Joon Young Kim
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA.
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10
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dos Santos WO, Gusmao DO, Wasinski F, List EO, Kopchick JJ, Donato J. Effects of Growth Hormone Receptor Ablation in Corticotropin-Releasing Hormone Cells. Int J Mol Sci 2021; 22:9908. [PMID: 34576072 PMCID: PMC8465163 DOI: 10.3390/ijms22189908] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 01/11/2023] Open
Abstract
Corticotropin-releasing hormone (CRH) cells are the dominant neuronal population responsive to the growth hormone (GH) in the paraventricular nucleus of the hypothalamus (PVH). However, the physiological importance of GH receptor (GHR) signaling in CRH neurons is currently unknown. Thus, the main objective of the present study was to investigate the consequences of GHR ablation in CRH-expressing cells of male and female mice. GHR ablation in CRH cells did not cause significant changes in body weight, body composition, food intake, substrate oxidation, locomotor activity, glucose tolerance, insulin sensitivity, counterregulatory response to 2-deoxy-D-glucose and ghrelin-induced food intake. However, reduced energy expenditure was observed in female mice carrying GHR ablation in CRH cells. The absence of GHR in CRH cells did not affect anxiety, circadian glucocorticoid levels or restraint-stress-induced corticosterone secretion and activation of PVH neurons in both male and female mice. In summary, GHR ablation, specifically in CRH-expressing neurons, does not lead to major alterations in metabolism, hypothalamic-pituitary-adrenal axis, acute stress response or anxiety in mice. Considering the previous studies showing that central GHR signaling regulates homeostasis in situations of metabolic stress, future studies are still necessary to identify the potential physiological importance of GH action on CRH neurons.
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Affiliation(s)
- Willian O. dos Santos
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo 05508-000, SP, Brazil; (W.O.d.S.); (D.O.G.); (F.W.)
| | - Daniela O. Gusmao
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo 05508-000, SP, Brazil; (W.O.d.S.); (D.O.G.); (F.W.)
| | - Frederick Wasinski
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo 05508-000, SP, Brazil; (W.O.d.S.); (D.O.G.); (F.W.)
| | - Edward O. List
- Edison Biotechnology Institute and Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA; (E.O.L.); (J.J.K.)
| | - John J. Kopchick
- Edison Biotechnology Institute and Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA; (E.O.L.); (J.J.K.)
| | - Jose Donato
- Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo 05508-000, SP, Brazil; (W.O.d.S.); (D.O.G.); (F.W.)
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Iacomino G, Lauria F, Russo P, Venezia A, Iannaccone N, Marena P, Ahrens W, De Henauw S, Molnár D, Eiben G, Foraita R, Hebestreit A, Kourides G, Moreno LA, Veidebaum T, Siani A. The association of circulating miR-191 and miR-375 expression levels with markers of insulin resistance in overweight children: an exploratory analysis of the I.Family Study. GENES AND NUTRITION 2021; 16:10. [PMID: 34243726 PMCID: PMC8272322 DOI: 10.1186/s12263-021-00689-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/18/2021] [Indexed: 02/08/2023]
Abstract
Background In recent years, the exciting emergence of circulating miRNAs as stable, reproducible, and consistent among individuals has opened a promising research opportunity for the detection of non-invasive biomarkers. A firm connection has been established between circulating miRNAs and glycaemic as well as metabolic homeostasis, showing that levels of specific miRNAs vary under different physio-pathological conditions. Objective In this pilot study, we investigated the expression of candidate miRNAs, hsa-miR-191-3p and hsa-miR-375, in relation to biomarkers associated with insulin sensitivity in a subgroup (n=58) of subjects participating to the European I.Family Study, a project aimed to assess the determinants of eating behaviour in children and adolescents and related health outcomes. The sample included overweight/obese children/adolescents since overweight/obesity is a known risk factor for impaired glucose homeostasis and metabolic disorders. Biological targets of candidate miRNAs were also explored in silico. Results We observed a significant association of the two miRNAs and early changes in glycaemic homeostasis, independent of covariates including country of origin, age, BMI z-score, puberty status, highest educational level of parents, total energy intake, energy from fats, energy from carbohydrates, and energy from proteins. Conclusion Identification of circulating miRNAs associated with insulin impairment may offer novel approaches of assessing early variations in insulin sensitivity and provide evidence about the molecular mechanisms connected to early changes in glycaemic homeostasis. Trial registration ISRCTN, ISRCTN62310987. Retrospectively registered, http://isrctn.com/ISRCTN62310987 Supplementary Information The online version contains supplementary material available at 10.1186/s12263-021-00689-1.
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Affiliation(s)
- Giuseppe Iacomino
- Institute of Food Sciences, National Research Council, ISA-CNR, via Roma 64, 83100, Avellino, Italy.
| | - Fabio Lauria
- Institute of Food Sciences, National Research Council, ISA-CNR, via Roma 64, 83100, Avellino, Italy
| | - Paola Russo
- Institute of Food Sciences, National Research Council, ISA-CNR, via Roma 64, 83100, Avellino, Italy
| | - Antonella Venezia
- Institute of Food Sciences, National Research Council, ISA-CNR, via Roma 64, 83100, Avellino, Italy
| | - Nunzia Iannaccone
- Institute of Food Sciences, National Research Council, ISA-CNR, via Roma 64, 83100, Avellino, Italy
| | - Pasquale Marena
- Institute of Food Sciences, National Research Council, ISA-CNR, via Roma 64, 83100, Avellino, Italy
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstraße 30, 28359, Bremen, Germany
| | | | - Dénes Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Gabriele Eiben
- Sahlgrenska Academy at the University of Gothenburg, Medicinaregatan 3, 413 90, Göteborg, Sweden
| | - Ronja Foraita
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Giannis Kourides
- Research and Education Institute of Child Health, ave, #205 2015, Strovolos, 138, Limassol, Cyprus
| | - Luis A Moreno
- University of Zaragoza, Domingo Miral, s/n, 50009, Zaragoza, Spain
| | - Toomas Veidebaum
- National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Alfonso Siani
- Institute of Food Sciences, National Research Council, ISA-CNR, via Roma 64, 83100, Avellino, Italy
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Abstract
Objectives. The onset of puberty in humans is followed by an increase in insulin resistance and this transient phenomenon decreases at the end of the puberty. However, the insulin resistance during puberty has not been described in mice. Thus, in the present study we performed a temporal characterization of the development of insulin resistance during puberty in male and female C57BL/6 mice.Methods. From the fourth week of life male (n=18) and female (n=32) C57BL/6 wild-type mice were weekly subjected to insulin tolerance tests until the seventh week of life. Blood glucose levels were determined using a glucose meter through samples collected from the tail tip. Vaginal opening was assessed daily in female mice. Preputial separation was determined in a subgroup of males.Results. We observed a transient increase in the area under the curve of the insulin tolerance tests and in basal glycemia in female mice at the time of vaginal opening (between the fourth and fifth week of life) compared with previous and subsequent weeks of pubertal development. In contrast, male mice show no changes in insulin sensitivity during puberty.Conclusions. Our findings demonstrate that the insulin resistance at puberty can also be observed in female mice and this peak occurs at the time of vaginal opening. Our temporal characterization can be used as a reference for future studies that aim to study glucose homeostasis during puberty in rodents.
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Sharma R, Kopchick JJ, Puri V, Sharma VM. Effect of growth hormone on insulin signaling. Mol Cell Endocrinol 2020; 518:111038. [PMID: 32966863 PMCID: PMC7606590 DOI: 10.1016/j.mce.2020.111038] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022]
Abstract
Growth hormone (GH) is a pleiotropic hormone that coordinates an array of physiological processes, including effects on bone, muscle, and fat, ultimately resulting in growth. Metabolically, GH promotes anabolic action in most tissues except adipose, where its catabolic action causes the breakdown of stored triglycerides into free fatty acids (FFA). GH antagonizes insulin action via various molecular pathways. Chronic GH secretion suppresses the anti-lipolytic action of insulin and increases FFA flux into the systemic circulation; thus, promoting lipotoxicity, which causes pathophysiological problems, including insulin resistance. In this review, we will provide an update on GH-stimulated adipose lipolysis and its consequences on insulin signaling in liver, skeletal muscle, and adipose tissue. Furthermore, we will discuss the mechanisms that contribute to the diabetogenic action of GH.
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Affiliation(s)
- Rita Sharma
- Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA
| | - John J Kopchick
- Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA; Edison Biotechnology Institute, Ohio University, Athens, OH, 45701, USA; Diabetes Institute, Ohio University, Athens, OH, 45701, USA
| | - Vishwajeet Puri
- Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA; Diabetes Institute, Ohio University, Athens, OH, 45701, USA
| | - Vishva M Sharma
- Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA; Diabetes Institute, Ohio University, Athens, OH, 45701, USA.
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Marwitz SE, Gaines MV, Brady SM, Mi SJ, Broadney MM, Yanovski SZ, Hubbard VS, Yanovski JA. Cross-Sectional and Longitudinal Examination of Insulin Sensitivity and Secretion across Puberty among Non-Hispanic Black and White Children. Endocrinol Metab (Seoul) 2020; 35:847-857. [PMID: 33202518 PMCID: PMC7803592 DOI: 10.3803/enm.2020.771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Few studies using criterion measures of insulin sensitivity (SI) and insulin secretory capacity (ISC) have been conducted across puberty to adulthood. We examined how SI and ISC change from pre-puberty through adulthood. METHODS Hyperglycemic clamp studies were performed in a convenience sample of non-Hispanic Black (NHB) and White children evaluated at age 6 to 12 years and at approximately 5-year intervals into adulthood (maximum age 27 years). SI and ISC (first-phase and steady-state insulin secretion) were determined cross-sectionally in 133 unique participants across puberty and in adulthood. Additionally, longitudinal changes in SI and ISC were compared at two timepoints among three groups defined by changes in pubertal development: pre-pubertal at baseline and late-pubertal at follow-up (n=27), early-pubertal at baseline and late-pubertal at follow-up (n=27), and late-pubertal at baseline and adult at follow-up (n=24). RESULTS Cross-sectionally, SI was highest in pre-puberty and early puberty and lowest in mid-puberty (analysis of covariance [ANCOVA] P=0.001). Longitudinally, SI decreased from pre-puberty to late puberty (P<0.001), then increased somewhat from late puberty to adulthood. Cross-sectionally, first-phase and steady-state ISC increased during puberty and decreased in adulthood (ANCOVA P<0.02). Longitudinally, steady-state and first-phase ISC increased from pre-puberty to late puberty (P<0.007), and steady-state ISC decreased from late puberty to adulthood. The NHB group had lower SI (P=0.003) and greater first-phase and steady-state ISC (P≤0.001), independent of pubertal development. CONCLUSION This study confirms that SI decreases and ISC increases transiently during puberty and shows that these changes largely resolve in adulthood.
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Affiliation(s)
- Shannon E. Marwitz
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Megan V. Gaines
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Sheila M. Brady
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Sarah J. Mi
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Miranda M. Broadney
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Susan Z. Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Van S. Hubbard
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Tester JM, Stiers KB, Garber A, Leung CW. Whole Grain Intake and Impaired Fasting Glucose in Adolescents, National Health and Nutrition Examination Survey, 2005-2014. Prev Chronic Dis 2020; 17:E130. [PMID: 33092687 PMCID: PMC7587298 DOI: 10.5888/pcd17.190439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Large prospective cohort studies show a lower risk of developing type 2 diabetes among adults with higher whole grain consumption. Less is known about the relationship between whole grain consumption and precursors for diabetes risk in adolescents. We examined whether intake of whole grains was associated with impaired fasting glucose (IFG) in adolescents. METHODS We analyzed data on dietary intake from an average of two 24-hour diet recalls from fasting, nondiabetic adolescents aged 12-18 years (N = 2,286) across 5 cycles of the National Health and Nutrition Examination Survey (NHANES 2005-2014). We used logistic regression to calculate the odds of having IFG (100-125 mg/dL) with respect to servings of whole and refined grains, as well as percentage of whole grains, adjusting for sex, age, race/ethnicity, annual household income, obesity, total energy, and diet quality. RESULTS IFG was present in 17% of participants. After adjusting for covariates, number of servings per day of whole grains was significantly associated with lower odds of IFG, but there was no relationship between IFG and servings of refined grains or percentage of whole grains. Consuming at least 1 ounce-equivalent serving (16 g) of whole grains daily, compared with consuming no whole grains, was associated with a 40% reduction in the adjusted odds of having IFG (adjusted odds ratio = 0.60; 95% CI, 0.38-0.93). CONCLUSION Analysis of 10 years of national cross-sectional data suggests that US adolescents whose daily diets consist of a minimum threshold amount of whole grains may be less likely to have IFG, a finding that has implications for diabetes prevention in adolescents.
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Affiliation(s)
- June M Tester
- UCSF Benioff Children's Hospital Oakland, 747 52nd St, Oakland, CA 94609.
| | - Katharine B Stiers
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrea Garber
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Cindy W Leung
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Askari S, Imran N, Fawwad A, Butt A, Riaz M, Naseem R, Basit A. Health-related quality of life of Pakistani adolescents with type 1 diabetes and their parents. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00800-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Hasan R, Perez-Santiago D, Churilla JR, Montes B, Hossain J, Mauras N, Darmaun D. Can Short Bouts of Exercise ("Exercise Snacks") Improve Body Composition in Adolescents with Type 1 Diabetes? A Feasibility Study. Horm Res Paediatr 2020; 92:245-253. [PMID: 32007996 DOI: 10.1159/000505328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/07/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Puberty is associated with a deterioration of blood glucose control in children with type 1 diabetes (T1D). The literature suggests that exercise improves homeostasis in adults with diabetes, but lack of time often precludes the performance of exercise. Besides, in earlier work, supplementation with glutamine, a nonessential amino acid, when administered prior to exercise, decreased overnight post-exercise blood glucose in adolescents with long-standing T1D, suggesting that glutamine increased insulin sensitivity or enhanced tissue glucose uptake. The purpose of the current study therefore was to determine the feasibility of a novel form of exercise ("exercise snacks," that is, short bouts of exercise spread throughout the day) with or without a supplemental amino acid, glutamine, and its impact on blood glucose homeostasis and body composition in adolescents with T1D. METHODS Twelve sedentary adolescents with T1D (HbA1c 8.1 ± 0.6%) performed exercise snacks (6 × 1 min of resistance-based activities) 3 times daily for 3 months; in addition, they were randomized to consume a drink containing either placebo or glutamine (0.5 g/kg/day). Continuous glucose monitoring, HbA1c, and dual X-ray absorptiometry were obtained before and after 3 months of each intervention. RESULTS Exercise snacks were easy to perform and well tolerated and were associated with a 2.2% loss of body fat mass when both groups were analyzed together (p = 0.015) after 3 months, whereas the change in lean body mass was not significant (p = 0.21). Metabolic control (HbA1c and glucose sensor data) was unchanged as result of the intervention regardless of group, and total daily insulin dose did not decrease. CONCLUSION Short bouts of exercise are sustainable over a 3-month period and can improve body composition in adolescents with poorly controlled T1D. Although metabolic control was unchanged as a result of the intervention regardless of group, this was a short-term intervention, hence assessment of metabolic impact will require long-term study.
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Affiliation(s)
- Reham Hasan
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Deliamille Perez-Santiago
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, Florida, USA
| | - James R Churilla
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, Florida, USA
| | - Brittany Montes
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, Florida, USA
| | - Jobayer Hossain
- Department of Biostatistics, Nemours/Alfred. I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Nelly Mauras
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Dominique Darmaun
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, Florida, USA, .,INRAE and University of Nantes, UMR 1280, CRNH-Ouest, Nantes, France,
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18
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Blotsky AL, Rahme E, Dahhou M, Nakhla M, Dasgupta K. Gestational diabetes associated with incident diabetes in childhood and youth: a retrospective cohort study. CMAJ 2020; 191:E410-E417. [PMID: 30988041 DOI: 10.1503/cmaj.181001] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Indicators of childhood- and youth-onset diabetes may be useful for early detection of diabetes; there is a known association between composite exposure of parental type 2 diabetes and gestational diabetes mellitus with childhood- and youth-onset diabetes. We examined associations between gestational diabetes mellitus and incidence of childhood- and youth-onset diabetes in offspring. METHODS Using public health insurance administrative databases from Quebec, Canada, we randomly selected singleton live births with maternal gestational diabetes mellitus (1990-2007) and matched them 1:1 with singleton live births without gestational diabetes mellitus. Follow-up was to Mar. 31, 2012. We examined associations of diabetes in offspring with maternal gestational diabetes mellitus through unadjusted and adjusted Cox proportional hazards models. In secondary analyses, we separately considered age groups ranging from birth to age 12 years, and age 12 to 22 years. RESULTS Incidence of pediatric diabetes (per 10 000 person-years) was higher in offspring born to mothers with gestational diabetes mellitus (4.52, 95% confidence interval [CI] 4.47-4.57) than in mothers without gestational diabetes mellitus (2.4, 95% CI 2.37-2.46). In an adjusted Cox proportional hazards model, maternal gestational diabetes mellitus was associated with development of pediatric diabetes overall (birth to age 22 yr: hazard ratio [HR] 1.77, 95% CI 1.41-2.22), during childhood (birth to age 12 yr: HR 1.43, 95% CI 1.09-1.89), and in youth (age 12 to 22 yr: HR 2.53, 95% CI 1.67-3.85). INTERPRETATION Gestational diabetes mellitus is associated with incident diabetes in offspring during childhood and adolescence. Future studies are needed to examine longer-term outcomes in patients with pediatric diabetes with a maternal history of gestational diabetes mellitus, to ascertain how they compare with other patients with childhood- or youth-onset diabetes, in terms of disease severity and outcomes.
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Affiliation(s)
- Andrea L Blotsky
- Department of Medicine (Blotsky, Rahme, Dasgupta), McGill University; Centre for Outcomes Research and Evaluation (Blotsky, Rahme, Dahhou, Nakhla, Dasgupta), Research Institute of the McGill University Health Centre; Department of Pediatrics (Nakhla), Division of Endocrinology and Metabolism, McGill University, Montréal, Que
| | - Elham Rahme
- Department of Medicine (Blotsky, Rahme, Dasgupta), McGill University; Centre for Outcomes Research and Evaluation (Blotsky, Rahme, Dahhou, Nakhla, Dasgupta), Research Institute of the McGill University Health Centre; Department of Pediatrics (Nakhla), Division of Endocrinology and Metabolism, McGill University, Montréal, Que
| | - Mourad Dahhou
- Department of Medicine (Blotsky, Rahme, Dasgupta), McGill University; Centre for Outcomes Research and Evaluation (Blotsky, Rahme, Dahhou, Nakhla, Dasgupta), Research Institute of the McGill University Health Centre; Department of Pediatrics (Nakhla), Division of Endocrinology and Metabolism, McGill University, Montréal, Que
| | - Meranda Nakhla
- Department of Medicine (Blotsky, Rahme, Dasgupta), McGill University; Centre for Outcomes Research and Evaluation (Blotsky, Rahme, Dahhou, Nakhla, Dasgupta), Research Institute of the McGill University Health Centre; Department of Pediatrics (Nakhla), Division of Endocrinology and Metabolism, McGill University, Montréal, Que
| | - Kaberi Dasgupta
- Department of Medicine (Blotsky, Rahme, Dasgupta), McGill University; Centre for Outcomes Research and Evaluation (Blotsky, Rahme, Dahhou, Nakhla, Dasgupta), Research Institute of the McGill University Health Centre; Department of Pediatrics (Nakhla), Division of Endocrinology and Metabolism, McGill University, Montréal, Que.
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Santi E, Tascini G, Toni G, Berioli MG, Esposito S. Linear Growth in Children and Adolescents with Type 1 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193677. [PMID: 31574933 PMCID: PMC6801810 DOI: 10.3390/ijerph16193677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 11/16/2022]
Abstract
Ensuring normal linear growth is one of the major therapeutic aims in the management of type one diabetes mellitus (T1DM) in children and adolescents. Many studies in the literature have shown that pediatric patients with T1DM frequently present some abnormalities in their growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis compared to their healthy peers. Data on the growth of T1DM children and adolescents are still discordant: Some studies have reported that T1DM populations, especially those whose diabetes began in early childhood, are taller than healthy pediatric populations at diagnosis, while other studies have not found any difference. Moreover, many reports have highlighted a growth impairment in T1DM patients of prepubertal and pubertal age, and this impairment seems to be influenced by suboptimal glycemic control and disease duration. However, the most recent data showed that children treated with modern intensive insulin therapies reach a normal final adult height. This narrative review aims to provide current knowledge regarding linear growth in children and adolescents with T1DM. Currently, the choice of the most appropriate therapeutic regimen to achieve a good insulin level and the best metabolic control for each patient, together with the regular measurement of growth parameters, remains the most important available tool for a pediatric diabetologist. Nevertheless, since new technologies are the therapy of choice in young children, especially those of pre-school age, it would be of great interest to evaluate their effects on the growth pattern of children with T1DM.
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Affiliation(s)
- Elisa Santi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06123 Perugia, Italy.
| | - Giorgia Tascini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06123 Perugia, Italy.
| | - Giada Toni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06123 Perugia, Italy.
| | - Maria Giulia Berioli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06123 Perugia, Italy.
| | - Susanna Esposito
- Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
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Desai MK, Brinton RD. Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Front Endocrinol (Lausanne) 2019; 10:265. [PMID: 31110493 PMCID: PMC6501433 DOI: 10.3389/fendo.2019.00265] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/10/2019] [Indexed: 12/12/2022] Open
Abstract
Women have a higher incidence and prevalence of autoimmune diseases than men, and 85% or more patients of multiple autoimmune diseases are female. Women undergo sweeping endocrinological changes at least twice during their lifetime, puberty and menopause, with many women undergoing an additional transition: pregnancy, which may or may not be accompanied by breastfeeding. These endocrinological transitions exert significant effects on the immune system due to interactions between the hormonal milieu, innate, and adaptive immune systems as well as pro- and anti-inflammatory cytokines, and thereby modulate the susceptibility of women to autoimmune diseases. Conversely, pre-existing autoimmune diseases themselves impact endocrine transitions. Concentration-dependent effects of estrogen on the immune system; the role of progesterone, androgens, leptin, oxytocin, and prolactin; and the interplay between Th1 and Th2 immune responses together maintain a delicate balance between host defense, immunological tolerance and autoimmunity. In this review, multiple autoimmune diseases have been analyzed in the context of each of the three endocrinological transitions in women. We provide evidence from human epidemiological data and animal studies that endocrine transitions exert profound impact on the development of autoimmune diseases in women through complex mechanisms. Greater understanding of endocrine transitions and their role in autoimmune diseases could aid in prediction, prevention, and cures of these debilitating diseases in women.
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Affiliation(s)
- Maunil K. Desai
- School of Pharmacy, University of Southern California, Los Angeles, CA, United States
| | - Roberta Diaz Brinton
- Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
- Departments of Pharmacology and Neurology, College of Medicine, University of Arizona, Tucson, AZ, United States
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Muller M, Wheeler BJ, Blackwell M, Colas M, Reith DM, Medlicott NJ, Al-Sallami HS. The influence of patient variables on insulin total daily dose in paediatric inpatients with new onset type 1 diabetes mellitus. J Diabetes Metab Disord 2018; 17:159-163. [PMID: 30918850 DOI: 10.1007/s40200-018-0355-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/06/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Insulin dose requirements at new diagnosis of type 1 diabetes mellitus (T1DM) vary widely. Current guidelines recommend an initial total daily dose (TDD) ranging from 0.5 to 1.0 IU/kg/day. It often takes several days of frequent dose adjustments before an optimal insulin dose is achieved. The aim of this study was to identify the influence of patient variables on the dose-requirement of insulin in newly diagnosed children with T1DM. METHODS A retrospective chart review of children (≤ 18 years old) admitted to hospital between 2010 and 2016 due to new onset T1DM was undertaken. Demographic, clinical, insulin dosing, and laboratory data were recorded. The influence of patient characteristics on insulin TDD was analysed statistically by performing univariate and multivariate linear regression analyses. RESULTS Complete clinical records for 70 patients were available for analysis. The median insulin TDD on first day of admission was 21 (4.5 to 75 units) and that on the day before discharge was 27 (5.5 to 124 units). In the multivariate regression analysis, body size (total body weight and fat-free mass), glycated haemoglobin (HbA1C), and blood ketone concentration were found to be significant predictors of optimal insulin TDD (p < 0.05). CONCLUSION In addition to body size, HbA1c and ketone concentrations are useful in calculating initial TDD in newly diagnosed children with T1DM. This could potentially decrease the number of days needed to reach a stable dose and result in improved early glycaemic control.
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Affiliation(s)
- Marion Muller
- 1School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Benjamin J Wheeler
- 2Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Miranda Blackwell
- 2Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Mathilde Colas
- 1School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - David M Reith
- 2Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Natalie J Medlicott
- 1School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Hesham S Al-Sallami
- 1School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
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Pinto CA, Stafford JM, Wang T, Shankar RR, Lawrence JM, Kim G, Pihoker C, D’Agostino RB, Dabelea D. Changes in diabetes medication regimens and glycemic control in adolescents and young adults with youth-onset type 2 diabetes: The SEARCH for diabetes in youth study. Pediatr Diabetes 2018; 19:1065-1072. [PMID: 29761619 PMCID: PMC6237662 DOI: 10.1111/pedi.12691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/29/2018] [Accepted: 05/06/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe recent medication patterns and changes in medication patterns and glycemic control in adolescents and young adults with incident type 2 diabetes (T2D). METHODS Using data from the SEARCH for Diabetes in Youth Study, we conducted a cross-sectional analysis of treatments for adolescents and young adults with incident T2D in 2 periods (2002-2005 vs 2008/2012), and a longitudinal analysis of medications and glycemic control for a subset with baseline and follow-up visits. Comparisons were performed using χ2 , Fisher's exact, or ANOVA. RESULTS Of 646 individuals in the cross-sectional analysis, a majority in each period received metformin (64.9% vs 70.4%) and/or insulin (38.1% vs 38.4%), while fewer used sulfonylureas (5.6% vs 3.6%) with non-significant changes over time. There was a significant reduction in thiazolidinedione use (5.0% vs 2.0%, P < .05). In the longitudinal analysis, 322 participants were followed for 7 years, on average. Baseline metformin users had a lower A1C (6.4% [46.7 mmol/mol]) compared to insulin (8.4% [68.2 mmol/mol], P < .001) or insulin plus any oral diabetes medication (ODM) users (7.7% [60.4 mmol/mol], P < .001). Among baseline metformin users (n = 138), 29.7% reported metformin at follow-up, with the remainder adding (19.6%) or switching to insulin (8.0%), ODM (15.9%), or lifestyle only (26.8%). Of those receiving insulin (±ODM) (n = 129), 76% reported insulin use at follow-up. Overall, 35% were at A1C goal (<7.0%, 53 mmol/mol) at follow-up. CONCLUSIONS Youth-onset T2D is still largely being treated with metformin and/or insulin. The majority treated were not at American Diabetes Association (ADA)-recommended goal 7 years after diagnosis.
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Affiliation(s)
- Cathy Anne Pinto
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, NJ USA
| | - Jeanette M. Stafford
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Tongtong Wang
- Department of Pharmacoepidemiology, Merck & Co., Inc., Kenilworth, NJ USA
| | - R. Ravi Shankar
- Department of Clinical Research, Merck & Co., Inc., Kenilworth, NJ USA
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Grace Kim
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | | | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
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24
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Al Khalifah R, Thabane L, Tarnopolsky MA, Morrison KM. The prognosis for glycemic status among children and youth with obesity 2 years after entering a weight management program. Pediatr Diabetes 2018; 19:874-881. [PMID: 29577539 DOI: 10.1111/pedi.12675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To address gaps in knowledge of the longitudinal trajectory of dysglycemia in children with obesity, this study aimed to: (1) describe the changes in glycemic status over 2 years; (2) establish a predictive model for development of prediabetes among children with euglycemia; and (3) evaluate the influence of change in body mass index (BMI) z-score on glycemic status. METHODS Children aged 5 to 17 years entered this prospective, longitudinal study at the time of entry to a weight management program. Measures included a 75-g oral glucose tolerance test (OGTT), fasting blood glucose, hemoglobin A1c (HbA1c), lipid profile, liver enzymes and anthropometric measures at baseline, 1 and 2 years. Cox proportional hazard was used to build a predictive model for prediabetes. RESULTS The cohort included 270 children, mean age: 11.6 ± 2.7 years and BMI z-score: 3.1. The baseline prevalence of prediabetes, based upon elevated 2-hour glucose in OGTT or HbA1c, was 100/270 (37.0%). Among children with prediabetes at baseline, 53 (53.0%) continued to have prediabetes over the following 2 years, 15 (15.0%) were euglycemic at 1 year and had prediabetes at 2 years, 20 (20.0%) became euglycemic and remained so. Change in BMI z-score predicted dysglycemic status at 2 years. Among those euglycemic at baseline, the incidence of prediabetes was 14 (8.2%) after 1 year, 20 (12.8%) at 2 years. Predictors of incident prediabetes were baseline BMI z-score; hazard ratio (HR): 1.72, 95th confidence interval (CI: 1.08, 2.74) and baseline HbA1c HR: 1.26, 95th CI (1.02-1.56) when controlling for age, family history of diabetes and sex. CONCLUSION Prediabetes presents significant morbidity in children with obesity. Family-based lifestyle interventions might delay prediabetes progression.
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Affiliation(s)
- Reem Al Khalifah
- Department of Pediatrics, McMaster University, Hamilton, Canada.,Department of Pediatrics, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Lehana Thabane
- Department of Pediatrics, McMaster University, Hamilton, Canada
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Patel P, Charles L, Corbin J, Goldfine ID, Johnson K, Rubin P, De León DD. A unique allosteric insulin receptor monoclonal antibody that prevents hypoglycemia in the SUR-1 -/- mouse model of KATP hyperinsulinism. MAbs 2018; 10:796-802. [PMID: 29589989 DOI: 10.1080/19420862.2018.1457599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Loss-of-function mutations of the ß-cell ATP-sensitive potassium channels (KATP) cause the most common and severe form of congenital hyperinsulinism (KATPHI), a disorder of ß-cell function characterized by severe hypoglycemia. Children with KATPHI are typically unresponsive to medical therapy and require pancreatectomy for intractable hypoglycemia. We tested the hypothesis that inhibition of insulin receptor signaling may prevent hypoglycemia in KATPHI. To test this hypothesis, we examined the effect of an antibody allosteric inhibitor of the insulin receptor, XMetD, on fasting plasma glucose in a mouse model of KATPHI (SUR-1-/- mice). SUR-1-/- and wild-type mice received twice weekly intraperitoneal injections of either XMetD or control antibody for 8 wks. Treatment with XMetD significantly decreased insulin sensitivity, and increased hepatic glucose output and fasting plasma glucose. These findings support the potential use of insulin receptor antagonists as a therapeutic approach to control the hypoglycemia in congenital hyperinsulinism.
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Affiliation(s)
- Puja Patel
- a Division of Endocrinology, Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | - Lawrenshey Charles
- a Division of Endocrinology, Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania
| | | | - Ira D Goldfine
- c Department of Medicine , University of California San Francisco , San Francisco , California
| | | | - Paul Rubin
- b XOMA Corporation , Berkeley , California
| | - Diva D De León
- a Division of Endocrinology, Department of Pediatrics , The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania.,d Department of Pediatrics , Perelman School of Medicine at the University of Pennsylvania , Philadelphia , Pennsylvania
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Goldsammler M, Merhi Z, Buyuk E. Role of hormonal and inflammatory alterations in obesity-related reproductive dysfunction at the level of the hypothalamic-pituitary-ovarian axis. Reprod Biol Endocrinol 2018; 16:45. [PMID: 29743077 PMCID: PMC5941782 DOI: 10.1186/s12958-018-0366-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/03/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Besides being a risk factor for multiple metabolic disorders, obesity could affect female reproduction. While increased adiposity is associated with hormonal changes that could disrupt the function of the hypothalamus and the pituitary, compelling data suggest that obesity-related hormonal and inflammatory changes could directly impact ovarian function. OBJECTIVE To review the available data related to the mechanisms by which obesity, and its associated hormonal and inflammatory changes, could affect the female reproductive function with a focus on the hypothalamic-pituitary-ovarian (HPO) axis. METHODS PubMed database search for publications in English language until October 2017 pertaining to obesity and female reproductive function was performed. RESULTS The obesity-related changes in hormone levels, in particular leptin, adiponectin, ghrelin, neuropeptide Y and agouti-related protein, are associated with reproductive dysfunction at both the hypothalamic-pituitary and the ovarian levels. The pro-inflammatory molecules advanced glycation end products (AGEs) and monocyte chemotactic protein-1 (MCP-1) are emerging as relatively new players in the pathophysiology of obesity-related ovarian dysfunction. CONCLUSION There is an intricate crosstalk between the adipose tissue and the inflammatory system with the HPO axis function. Understanding the mechanisms behind this crosstalk could lead to potential therapies for the common obesity-related reproductive dysfunction.
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Affiliation(s)
- Michelle Goldsammler
- Montefiore’s Institute for Reproductive Medicine and Health, Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Montefiore Medical Center, Hartsdale, NY USA
| | - Zaher Merhi
- 0000 0004 1936 8753grid.137628.9Department of Obstetrics and Gynecology, Division of Reproductive Biology, NYU School of Medicine, New York, NY USA
- 0000000121791997grid.251993.5Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY USA
| | - Erkan Buyuk
- Montefiore’s Institute for Reproductive Medicine and Health, Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Montefiore Medical Center, Hartsdale, NY USA
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Nimptsch K, Wu K. Is Timing Important? The Role of Diet and Lifestyle during Early Life on Colorectal Neoplasia. CURRENT COLORECTAL CANCER REPORTS 2018; 14:1-11. [PMID: 30140177 PMCID: PMC6101255 DOI: 10.1007/s11888-018-0396-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF THE REVIEW To summarize the current evidence on the most important dietary and lifestyle factors in colorectal carcinogenesis during different stages of a lifetime with special emphasis on studies investigating exposure during childhood, adolescence and young adulthood. RECENT FINDINGS A number of studies showed that independent of adult obesity, higher body fatness during childhood, adolescence and young adulthood is associated with risk of colorectal cancer later in life. In one large cohort study, the Nurses' Health Study II, adherence to a western pattern diet during adolescence was associated with higher risk of advanced adenoma. The current evidence relating consumption of individual foods and nutrients as well as physical activity during early life to colorectal cancer is sparse and less consistent, at least in part due to limitations in study design, such as sample size, limited data on potential confounders or lack of a validated dietary assessment instrument. SUMMARY As colorectal carcinogenesis is a long process and can take up to several decades to develop, early life risk factors may also be etiologically relevant. The recent rise in early-onset colorectal cancer incidence and mortality in the US, i.e., in individuals younger than 55 years at diagnosis, strongly supports that early life risk factors may influence colorectal carcinogenesis. Considering that the majority of colorectal cancers are preventable, there is an urgent need for well-designed investigations on the role of diet and lifestyle factors throughout the life course and risk of colorectal cancers.
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Affiliation(s)
- Katharina Nimptsch
- Molecular Epidemiology Research Group, Max Delbrück Center
for Molecular Medicine (MDC), Berlin, Germany
- Department of Nutrition, Harvard T.H. Chan School of Public Health,
Boston, Massachusetts, USA
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health,
Boston, Massachusetts, USA
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28
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Causes of low peak bone mass in women. Maturitas 2017; 111:61-68. [PMID: 29673833 DOI: 10.1016/j.maturitas.2017.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/09/2017] [Accepted: 12/12/2017] [Indexed: 12/18/2022]
Abstract
Peak bone mass is the maximum bone mass that accrues during growth and development. Consolidation of peak bone mass normally occurs during early adulthood. Low peak bone mass results from failure to achieve peak bone mass genetic potential, primarily due to bone loss caused by a variety of conditions or processes occurring at younger ages than usual. Recognized causes of low peak bone mass include genetic causes, endocrine disorders, nutritional disorders, chronic diseases of childhood or adolescence, medications, and idiopathic factors.
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29
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Al Khalifah RA, Alnhdi A, Alghar H, Alanazi M, Florez ID. The effect of adding metformin to insulin therapy for type 1 diabetes mellitus children: A systematic review and meta-analysis. Pediatr Diabetes 2017; 18:664-673. [PMID: 28145083 DOI: 10.1111/pedi.12493] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022] Open
Abstract
We aimed to assess the effectiveness of adding metformin to insulin in type 1 diabetes mellitus (T1DM) children for improving metabolic outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) conducted on children age 6 to 19 years who are diagnosed with T1DM, and examined the effect of adding Metformin to standard insulin therapy. We performed literature searches on Ovid Midline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from the date of inception of the database to February 15, 2016. Two reviewers screened titles and abstracts independently, assessed full text eligibility, and extracted information from eligible trials. The primary outcome is glycated hemoglobin (HbA1c), and the secondary outcomes are health-related quality of life, body mass index (BMI), lipid profile, total insulin daily dose, hypoglycaemia, and diabetes ketoacidosis. We screened 736 studies, and included 6 RCTs with 325 patients. All RCTs were of low risk of bias, and included adolescents (mean age 15 years). The meta-analysis showed that the addition of Metformin resulted in decreased total insulin daily dose (TIDD) (unit/kg/d) (mean difference [MD] = -0.15, 95%CI, -0.24, -0.06), and reduced BMI kg/m2 (MD -1.46, 95%CI -2.54, 0.38), and BMI z-score (MD= - 0.11, 95%CI -0.21, -0.01), and similar HbA1c (%) (MD= - 0.05, 95%CI, -0.19, 0.29). The overall evidence quality was high to moderate. Current evidence does not support use of Metformin in T1DM adolescents to improve HbA1c. However, Metformin may provide modest reduction in TIDD and BMI.
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Affiliation(s)
- Reem A Al Khalifah
- Department of Pediatrics, Division of Pediatric Endocrinology, King Saud University, Riyadh, Saudi Arabia
| | | | - Hassan Alghar
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alanazi
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Ivan D Florez
- Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Pyziak A, Zmyslowska A, Bobeff K, Malachowska B, Fendler W, Wyka K, Baranowska-Jazwiecka A, Szymanska M, Szadkowska A, Mlynarski W. Markers influencing the presence of partial clinical remission in patients with newly diagnosed type 1 diabetes. J Pediatr Endocrinol Metab 2017; 30:1147-1153. [PMID: 29016353 DOI: 10.1515/jpem-2017-0100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/28/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of the study was to compare the selected markers in children with and without partial clinical remission (CR) of newly diagnosed type 1 diabetes (T1D). METHODS The study group consisted of 186 patients (F/M; 87/99) at onset of T1D and 24 months of follow-up. Partial CR was defined as insulin requirement <0.5 IU/kg and glycated hemoglobin (HbA1c) <7%. RESULTS Partial CR was observed in 115/186 (61.83%) of patients. At diagnosis body mass index standard deviation (BMI SDS) was higher among remitters than in non-remitters (p=0.0051) and remitters were younger (p=0.0029). In the follow-up a higher triglyceride concentration in non-remitters compared to remitters (p=0.0455) and a lower high density lipoprotein (HDL) cholesterol level (p=0.0119) were noticed. CONCLUSIONS Younger age and higher BMI at diagnosis of T1D can predispose to partial CR in children. In patients with CR of T1D after 2 years of follow-up a lipid profile improvement is observed.
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Resaland GK, Aadland E, Nilsen AKO, Bartholomew JB, Andersen LB, Anderssen SA. The effect of a two-year school-based daily physical activity intervention on a clustered CVD risk factor score-The Sogndal school-intervention study. Scand J Med Sci Sports 2017; 28:1027-1035. [PMID: 28759129 DOI: 10.1111/sms.12955] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/28/2022]
Abstract
To evaluate changes in clustered cardiovascular disease (CVD) risk factors in 9-year-old children following a 2-year school-based physical activity intervention. In total, 259 children (age 9.3 ± 0.3 years) were invited, of whom 256 participated. The intervention group (63 boys, 62 girls) carried out 60-minute teacher-controlled daily physical activity over two school years. The control group (62 boys, 69 girls) had the curriculum-defined amount of physical education (45 minutes twice each week). Of these, 67% (171 total, 91 intervention) successfully completed both baseline and post-intervention of six CVD risk factors: systolic blood pressure (SBP), triglyceride (TG), total cholesterol-to-high-density lipoprotein cholesterol ratio (TC:HDL ratio), waist circumference (WC), the homeostasis model assessment for insulin resistance (HOMA), and peak oxygen uptake (VO2peak ). All variables were standardized by sex prior to constructing a cluster score (sum of z scores for all variables). The effect of the intervention on the cluster score was analyzed using linear multiple regression. The cluster score improved after the intervention (ES = .29). Furthermore, the analyses showed significant effects in favor of the intervention group for systolic blood pressure (ES = .35), total cholesterol-to-HDL-c ratio (ES = .23), triglyceride (ES = .40), and VO2peak (ES = .57). A teacher-led school-based physical activity intervention that is sufficiently long and includes a substantial amount of daily physical activity can beneficially modify children's clustered CVD risk profile.
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Affiliation(s)
- G K Resaland
- Faculty of Teacher Education and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - E Aadland
- Faculty of Teacher Education and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - A K O Nilsen
- Faculty of Teacher Education and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - J B Bartholomew
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - L B Andersen
- Faculty of Teacher Education and Sports, Western Norway University of Applied Sciences, Sogndal, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - S A Anderssen
- Faculty of Teacher Education and Sports, Western Norway University of Applied Sciences, Sogndal, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Åkerman L, Ludvigsson J, Swartling U, Casas R. Characteristics of the pre-diabetic period in children with high risk of type 1 diabetes recruited from the general Swedish population-The ABIS study. Diabetes Metab Res Rev 2017; 33. [PMID: 28371132 DOI: 10.1002/dmrr.2900] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/10/2017] [Accepted: 03/27/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a need for increased understanding of the pre-diabetic period in individuals with high risk of type 1 diabetes from the general population. METHODS High-risk children (n = 21) positive for multiple islet autoantibodies were identified by autoantibody screening within the All Babies in Southeast Sweden study. The children and their parents were enrolled in a 2-year prospective follow-up study aiming to characterize the pre-diabetic period. Blood samples were collected every 6 months for measurement of C-peptide, HbA1c, fasting glucose, and autoantibodies. Human leukocyte antigen-genotype was determined, and oral glucose tolerance test was performed every 12 months. RESULTS Despite positivity for multiple autoantibodies, 9 out of 21 individuals had low-risk human leukocyte antigen-genotypes. Children who progressed to manifest diabetes (progressors, n = 12) had higher levels of IA2A and ZnT8A than children who did not (non-progressors, n = 9). Impaired glucose tolerance and impaired fasting glucose was observed to the same extent in progressors and non-progressors, but HbA1c increased over time in progressors in spite of increased C-peptide. CONCLUSIONS Autoantibodies to IA2 and ZnT8 may be useful discriminators for disease progression in at-risk children from the general population. Dysglycemia was observed long before diagnosis, and difficulties in maintaining glucose homeostasis despite increased C-peptide indicate that insulin resistance might be an important accelerator of disease in risk individuals.
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Affiliation(s)
- Linda Åkerman
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Johnny Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Pediatric Clinic, County Council of Östergötland, Linköping, Sweden
| | - Ulrica Swartling
- Division of Diabetes and Celiac disease, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Rosaura Casas
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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33
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Reina SA, Llabre MM, Vidot DC, Isasi CR, Perreira K, Carnethon M, Parrinello CM, Gallo LC, Ayala GX, Delamater A. Metabolic Syndrome in Hispanic Youth: Results from the Hispanic Community Children's Health Study/Study of Latino Youth. Metab Syndr Relat Disord 2017; 15:400-406. [PMID: 28829223 DOI: 10.1089/met.2017.0054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is being diagnosed in youth. Specific diagnostic criteria used to define MetS influence prevalence estimates and populations considered at risk for cardiovascular disease. The National Cholesterol Education Program's Adult Treatment Panel III (ATP), the World Health Organization (WHO), and the International Diabetes Federation (IDF) provide three MetS definitions used in medical research. This study examined concordance among these definitions in 1137 children 10-16 years of age, who participated in the Hispanic Community Children's Health Study/Study of Latino Youth. METHODS Prevalence of MetS and of individual components was estimated using SAS. Mplus was used to test a single-factor model of MetS components (triglycerides, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, waist circumference, and fasting glucose). RESULTS The ATP definition identified most MetS cases in 10-15 (N = 19, 4.7%) and 16-year-old girls (N = 3, 7.3%). The IDF definition identified most cases of MetS in 10-15 (N = 16, 3.1%) and 16-year-old boys (N = 2, 2.8%). Fewest cases of MetS were identified with the WHO definition across age and sex groups. CONCLUSION Only one participant was classified as having MetS across all three definitions. Confirmatory factor analysis indicated fasting glucose and systolic blood pressure did not reliably cluster with other risk factors that define MetS in Hispanic/Latino adolescents. We conclude that prevalence estimates of MetS in youth are unstable across current criteria, calling into question the accuracy of defining and diagnosing MetS in youth.
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Affiliation(s)
- Samantha A Reina
- 1 Department of Psychology, University of Miami , Coral Gables, Florida
| | - Maria M Llabre
- 1 Department of Psychology, University of Miami , Coral Gables, Florida
| | - Denise C Vidot
- 1 Department of Psychology, University of Miami , Coral Gables, Florida
| | - Carmen R Isasi
- 2 Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, New York
| | - Krista Perreira
- 3 Department of Social Medicine, University of North Carolina , Chapel Hill, North Carolina
| | - Mercedes Carnethon
- 4 Department of Preventive Medicine, Northwestern University , Chicago, Illinois
| | - Christina M Parrinello
- 2 Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, New York
| | - Linda C Gallo
- 5 Department of Psychology, San Diego State University , San Diego, California
| | - Guadalupe X Ayala
- 5 Department of Psychology, San Diego State University , San Diego, California
| | - Alan Delamater
- 1 Department of Psychology, University of Miami , Coral Gables, Florida
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Raisingani M, Preneet B, Kohn B, Yakar S. Skeletal growth and bone mineral acquisition in type 1 diabetic children; abnormalities of the GH/IGF-1 axis. Growth Horm IGF Res 2017; 34:13-21. [PMID: 28482269 PMCID: PMC5516798 DOI: 10.1016/j.ghir.2017.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/23/2017] [Accepted: 04/27/2017] [Indexed: 12/29/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases diagnosed in childhood. Childhood and adolescent years are also the most important period for growth in height and acquisition of skeletal bone mineral density (BMD). The growth hormone (GH)/insulin like growth factor -1 (IGF-1) axis which regulates growth, is affected by T1DM, with studies showing increased GH and decreased IGF-1 levels in children with T1DM. There is conflicting data as to whether adolescents with TIDM are able to achieve their genetically-determined adult height. Furthermore, data support that adolescents with T1DM have decreased peak BMD, although the pathophysiology of which has not been completely defined. Various mechanisms have been proposed for the decrease in BMD including low osteocalcin levels, reflecting decreased bone formation; increased sclerostin, an inhibitor of bone anabolic pathways; and increased leptin, an adipocytokine which affects bone metabolism via central and peripheral mechanisms. Other factors implicated in the increased bone resorption in T1DM include upregulation of the osteoprotegerin/ receptor-activator of the nuclear factor-κB ligand pathway, elevated parathyroid hormone levels, and activation of other cytokines involved in chronic systemic inflammation. In this review, we summarize the clinical studies that address the alterations in the GH/IGF-I axis, linear growth velocity, and BMD in children and adolescents with T1DM; and we review the possible molecular mechanisms that may contribute to an attenuation of linear growth and to the reduction in the acquisition of peak bone mass in the child and adolescent with T1DM.
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Affiliation(s)
- Manish Raisingani
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York University School of Medicine, New York, NY 10016, United States
| | - Brar Preneet
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York University School of Medicine, New York, NY 10016, United States
| | - Brenda Kohn
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York University School of Medicine, New York, NY 10016, United States
| | - Shoshana Yakar
- David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, NY 10010-4086, United States.
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Wu H, Zhong J, Yu M, Wang H, Gong W, Pan J, Fei F, Wang M, Yang L, Hu R. Incidence and time trends of type 2 diabetes mellitus in youth aged 5-19 years: a population-based registry in Zhejiang, China, 2007 to 2013. BMC Pediatr 2017; 17:85. [PMID: 28330444 PMCID: PMC5361693 DOI: 10.1186/s12887-017-0834-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/08/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of type 2 diabetes mellitus (T2DM) has been increasing globally over the past two decades in children and adolescents. There are currently a dearth of comprehensive population-based estimates of T2DM incidence and time trends in Chinese youth. METHODS A population-based diabetes registry system in 30 representative districts in Zhejiang has been established for diabetes surveillance. All newly cases diagnosed by physicians in local hospitals and wards were registered using the registry system through web services and direct network report. The data were primarily abstracted from medical records in hospitals and wards. Annual incidence rates and their 95% confidence intervals (CIs) by age groups and sex were calculated per 100 000 person-years. Poisson regression models were applied to assess the effects of diagnosis year, age groups, sex and residence area on T2DM incidence and to examine the average annual percentage change in incidence. RESULTS There were 392 newly diagnosed cases of T2DM (210 boys and 182 girls) over the study period. The mean annual age-standardized incidence was 1.96/100 000 person-years (95% CIs: 1.85-2.08). No statistically significant difference in incidence was found between boys and girls. However, the risk for T2DM was 1.49 times higher in urban area than in rural area. Besides, the mean annual incidence in youth increased with age. The age-standardized incidence was about 5 times higher in 2013 than in 2007. Steep rising incidence was observed, with an average annual increase of 26.6% in youth aged 10-19 years. CONCLUSIONS The incidence of T2DM in children and adolescents was low in Zhejiang relative to other countries, whereas it increased markedly over the study period. Preventive strategies for T2DM are necessary in pediatric population.
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Affiliation(s)
- Haibin Wu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jieming Zhong
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Min Yu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Hao Wang
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Weiwei Gong
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jin Pan
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Fangrong Fei
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Meng Wang
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Li Yang
- Zhejiang Provincial Center for cardio-cerebrovascular diseases control and prevention, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China
| | - Ruying Hu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China.
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Ramkissoon CM, Aufderheide B, Bequette BW, Vehi J. A Review of Safety and Hazards Associated With the Artificial Pancreas. IEEE Rev Biomed Eng 2017; 10:44-62. [DOI: 10.1109/rbme.2017.2749038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sharifi A, De Bock MI, Jayawardene D, Loh MM, Horsburgh JC, Berthold CL, Paramalingam N, Bach LA, Colman PG, Davis EA, Grosman B, Hendrieckx C, Jenkins AJ, Kumareswaran K, Kurtz N, Kyoong A, MacIsaac RJ, Speight J, Trawley S, Ward GM, Roy A, Jones TW, O'Neal DN. Glycemia, Treatment Satisfaction, Cognition, and Sleep Quality in Adults and Adolescents with Type 1 Diabetes When Using a Closed-Loop System Overnight Versus Sensor-Augmented Pump with Low-Glucose Suspend Function: A Randomized Crossover Study. Diabetes Technol Ther 2016; 18:772-783. [PMID: 27835037 DOI: 10.1089/dia.2016.0288] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We compared glycemia, treatment satisfaction, sleep quality, and cognition using a nighttime Android-based hybrid closed-loop system (Android-HCLS) with sensor-augmented pump with low-glucose suspend function (SAP-LGS) in people with type 1 diabetes. MATERIALS AND METHODS An open-label, prospective, randomized crossover study of 16 adults (mean [SD] age 42.1 [9.6] years) and 12 adolescents (15.2 [1.6] years) was conducted. All participants completed four consecutive nights at home with Android-HCLS (proportional integral derivative with insulin feedback algorithm; Medtronic) and SAP-LGS. PRIMARY OUTCOME percent continuous glucose monitoring (CGM) time (00:00-08:00 h) within target range (72-144 mg/dL). Secondary endpoints: percent CGM time above target (>144 mg/dL); below target (<72 mg/dL); glycemic variability (SD); symptomatic hypoglycemia; adult treatment satisfaction; sleep quality; and cognitive function. RESULTS The primary outcome for all participants was not statistically different between Android-HCLS and SAP-LGS (mean [SD] 59.4 [17.9]% vs. 53.1 [18]%; p = 0.14). Adults had greater percent time within target range (57.7 [18.6]% vs. 44.5 [14.5]%; p < 0.006); less time above target (42.0 [18.7]% vs. 52.6 [16.5]%; p = 0.034); lower glycemic variability (35 [10.7] mg/dL vs. 46 [10.7] mg/dL; p = 0.003); and less (median [IQR]) time below target (0.0 [0.0-0.4]% vs. 0.80 [0.0-3.9]%; p = 0.025). In adolescents, time below target was lower with Android-HCLS vs. SAP-LGS (0.0 [0.0-0.0]% vs. 1.8 [0.1-7.9]%; p = 0.011). Nocturnal symptomatic hypoglycemia was less (1 vs. 10; p = 0.007) in adolescents, but not adults (5 vs. 13; p = 0.059). In adults, treatment satisfaction increased by 10 points (p < 0.02). Sleep quality and cognition did not differ. CONCLUSIONS Android-HCLS in both adults and adolescents reduced nocturnal hypoglycemia and, in adults, improved overnight time in target range and treatment satisfaction compared with SAP-LGS.
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Affiliation(s)
- Amin Sharifi
- 1 Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Melbourne, Australia
| | - Martin I De Bock
- 2 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia
| | - Dilshani Jayawardene
- 1 Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Melbourne, Australia
| | - Margaret M Loh
- 1 Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Melbourne, Australia
| | - Jodie C Horsburgh
- 1 Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Melbourne, Australia
| | - Carolyn L Berthold
- 2 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia
| | - Nirubasini Paramalingam
- 2 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia
| | - Leon A Bach
- 3 Department of Endocrinology and Diabetes, Alfred Hospital , Melbourne, Australia
| | - Peter G Colman
- 4 Department of Diabetes and Endocrinology, Royal Melbourne Hospital , Melbourne, Australia
| | - Elizabeth A Davis
- 2 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia
| | | | - Christel Hendrieckx
- 6 The Australian Centre for Behavioural Research in Diabetes , Diabetes Victoria, Australia
- 7 School of Psychology, Deakin University , Geelong, Australia
| | - Alicia J Jenkins
- 1 Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Melbourne, Australia
- 8 Department of Medicine, University of Melbourne , St. Vincent's Hospital Melbourne, Melbourne, Australia
- 9 University of Sydney , NHMRC Clinical Trials Centre, Australia
| | - Kavita Kumareswaran
- 3 Department of Endocrinology and Diabetes, Alfred Hospital , Melbourne, Australia
| | | | - Andrew Kyoong
- 10 Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Melbourne , Melbourne, Australia
| | - Richard J MacIsaac
- 1 Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Melbourne, Australia
- 8 Department of Medicine, University of Melbourne , St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jane Speight
- 6 The Australian Centre for Behavioural Research in Diabetes , Diabetes Victoria, Australia
- 7 School of Psychology, Deakin University , Geelong, Australia
- 11 AHP Research , Hornchurch, Essex, United Kingdom
| | - Steven Trawley
- 6 The Australian Centre for Behavioural Research in Diabetes , Diabetes Victoria, Australia
- 7 School of Psychology, Deakin University , Geelong, Australia
| | - Glenn M Ward
- 1 Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Melbourne, Australia
- 8 Department of Medicine, University of Melbourne , St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Anirban Roy
- 5 Medtronic Diabetes , Northridge, California
| | - Timothy W Jones
- 2 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children , Perth, Australia
| | - David N O'Neal
- 1 Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Melbourne, Australia
- 8 Department of Medicine, University of Melbourne , St. Vincent's Hospital Melbourne, Melbourne, Australia
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Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev 2016; 37:467-520. [PMID: 27459230 PMCID: PMC5045492 DOI: 10.1210/er.2015-1104] [Citation(s) in RCA: 727] [Impact Index Per Article: 90.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 07/20/2016] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) was hypothesized to result from functional ovarian hyperandrogenism (FOH) due to dysregulation of androgen secretion in 1989-1995. Subsequent studies have supported and amplified this hypothesis. When defined as otherwise unexplained hyperandrogenic oligoanovulation, two-thirds of PCOS cases have functionally typical FOH, characterized by 17-hydroxyprogesterone hyperresponsiveness to gonadotropin stimulation. Two-thirds of the remaining PCOS have FOH detectable by testosterone elevation after suppression of adrenal androgen production. About 3% of PCOS have a related isolated functional adrenal hyperandrogenism. The remaining PCOS cases are mild and lack evidence of steroid secretory abnormalities; most of these are obese, which we postulate to account for their atypical PCOS. Approximately half of normal women with polycystic ovarian morphology (PCOM) have subclinical FOH-related steroidogenic defects. Theca cells from polycystic ovaries of classic PCOS patients in long-term culture have an intrinsic steroidogenic dysregulation that can account for the steroidogenic abnormalities typical of FOH. These cells overexpress most steroidogenic enzymes, particularly cytochrome P450c17. Overexpression of a protein identified by genome-wide association screening, differentially expressed in normal and neoplastic development 1A.V2, in normal theca cells has reproduced this PCOS phenotype in vitro. A metabolic syndrome of obesity-related and/or intrinsic insulin resistance occurs in about half of PCOS patients, and the compensatory hyperinsulinism has tissue-selective effects, which include aggravation of hyperandrogenism. PCOS seems to arise as a complex trait that results from the interaction of diverse genetic and environmental factors. Heritable factors include PCOM, hyperandrogenemia, insulin resistance, and insulin secretory defects. Environmental factors include prenatal androgen exposure and poor fetal growth, whereas acquired obesity is a major postnatal factor. The variety of pathways involved and lack of a common thread attests to the multifactorial nature and heterogeneity of the syndrome. Further research into the fundamental basis of the disorder will be necessary to optimally correct androgen levels, ovulation, and metabolic homeostasis.
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Affiliation(s)
- Robert L Rosenfield
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637
| | - David A Ehrmann
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637
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Velasquez-Mieyer P, Neira CP, Nieto R, Cowan PA. Review: Obesity and cardiometabolic syndrome in children. Ther Adv Cardiovasc Dis 2016; 1:61-81. [DOI: 10.1177/1753944707082800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The cardiometabolic syndrome is highly prevalent among overweight youth. The risk of developing the cardiometabolic syndrome is likely triggered or exacerbated by concurrent obesity, unhealthy lifestyle/eating habits, and hormonal changes (puberty). Current screening recommendations include measurement of blood pressure, fasting insulin and glucose, and total cholesterol. However, limiting assessments to these measures underestimates cardiometabolic risk in overweight youth, particularly minorities. Early identification of cardiometabolic risk in its incipient stages may justify early and more aggressive intervention to prevent progression and complications. This review provides rationale for additional assessments to determine cardiometabolic risk in overweight youth and recommends treatment options.
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Affiliation(s)
- Pedro Velasquez-Mieyer
- Dept. of Pediatrics LeBonheur Children's Medical Center 50 North Dunlap Memphis, TN 38103
| | | | - Ramfis Nieto
- Department of Physiology, Universidad Centro-Occidental “Lisandro Alvarado” (UCLA). Barquisimeto, Venezuela
| | - Patricia A. Cowan
- Department of Nursing, University of Tennessee Health Science Center, Memphis, TN 38103, USA
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Abstract
Puberty is a time of considerable metabolic and hormonal change. Notably, puberty is associated with a marked decrease in insulin sensitivity, on par with that seen during pregnancy. In otherwise healthy youth, there is a nadir in insulin sensitivity in mid-puberty, and then it recovers at puberty completion. However, there is evidence that insulin resistance (IR) does not resolve in youth who are obese going into puberty and may result in increased cardiometabolic risk. Little is known about the underlying pathophysiology of IR in puberty, and how it might contribute to increased disease risk (e.g., type 2 diabetes). In this review, we have outlined what is known about the IR in puberty in terms of pattern, potential underlying mechanisms and other mediating factors. We also outline other potentially related metabolic changes that occur during puberty, and effects of underlying insulin resistant states (e.g., obesity) on pubertal changes in insulin sensitivity.
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Affiliation(s)
- Megan M Kelsey
- Pediatric Endocrinology, University of Colorado School of Medicine, Children's Hospital Colorado School of Medicine, 13123 E 16th Ave, B265, Aurora, CO, 80045, USA.
| | - Philip S Zeitler
- Pediatric Endocrinology, University of Colorado School of Medicine, Children's Hospital Colorado School of Medicine, 13123 E 16th Ave, B265, Aurora, CO, 80045, USA
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Sperling MA. Traditional and novel aspects of the metabolic actions of growth hormone. Growth Horm IGF Res 2016; 28:69-75. [PMID: 26194064 DOI: 10.1016/j.ghir.2015.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 11/20/2022]
Abstract
Growth hormone has been known to be diabetogenic for almost a century and it's diabetogenic properties fostered consideration of excessive and abnormal GH secretion as a cause of diabetes, as well as a role in the microvascular complications, especially retinopathy. However, besides inducing insulin resistance, GH also is lipolytic and a major anabolic hormone for nitrogen retention and protein synthesis. These actions are best illustrated at the extremes of GH secretion: Gigantism/acromegaly is characterized by excessive growth, CHO intolerance, hyperplasia of bone, little body fat and prominent muscle development, whereas total deficiency of GH secretion or action is associated with adiposity, poor growth, and poor muscle development. These actions also become apparent during puberty and pregnancy, times when GH secretion is increased and account for the characteristic changes in body composition and tendency to diabetes. More recently, tissue specific deletions of the GH receptor (GHR), have uncovered newer metabolic effects including it's essential role in triglyceride export from the liver when GHR is deleted in the liver, leading to hepatic steatosis and ultimately to hepatic adenoma formation, effects which may explain these findings in obesity, a state of diminished GH secretion and action. In addition deletion of GH action in muscle and fat is associated with specific patterns of disturbed phenotype and metabolic effects in CHO, fat, and protein metabolism affecting the specific tissue and whole body function. This chapter provides an overview of these classic and newer metabolic functions of GH, placing this hormone and its actions in a central role of body fuel economy in health and disease.
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Affiliation(s)
- Mark A Sperling
- Department of Pediatrics, Division of Endocrinology, Diabetes and Metabolism, Children's Hospital, University of Pittsburgh School of Medicine, United States
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García-Espinosa V, Curcio S, Castro JM, Arana M, Giachetto G, Chiesa P, Zócalo Y, Bia D. Children and Adolescent Obesity Associates with Pressure-Dependent and Age-Related Increase in Carotid and Femoral Arteries' Stiffness and Not in Brachial Artery, Indicative of Nonintrinsic Arterial Wall Alteration. Int J Vasc Med 2016; 2016:4916246. [PMID: 27066273 PMCID: PMC4811097 DOI: 10.1155/2016/4916246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/10/2016] [Accepted: 02/14/2016] [Indexed: 01/12/2023] Open
Abstract
Aim. To analyze if childhood obesity associates with changes in elastic, transitional, and/or muscular arteries' stiffness. Methods. 221 subjects (4-15 years, 92 females) were assigned to normal weight (NW, n = 137) or obesity (OB, n = 84) groups, considering their body mass index z-score. Age groups were defined: 4-8; 8-12; 12-15 years old. Carotid, femoral, and brachial artery local stiffness was determined through systodiastolic pressure-diameter and stress-strain relationships. To this end, arterial diameter and peripheral and aortic blood pressure (BP) levels and waveforms were recorded. Carotid-femoral, femoropedal, and carotid-radial pulse wave velocities were determined to evaluate aortic, lower-limb, and upper-limb regional arterial stiffness, respectively. Correlation analysis between stiffness parameters and BP was done. Results. Compared to NW, OB subjects showed higher peripheral and central BP and carotid and femoral stiffness, reaching statistical significance in subjects aged 12 and older. Arterial stiffness differences disappeared when levels were normalized for BP. There were no differences in intrinsic arterial wall stiffness (elastic modulus), BP stiffness relationships, and regional stiffness parameters. Conclusion. OB associates with BP-dependent and age-related increase in carotid and femoral (but not brachial) stiffness. Stiffness changes would not be explained by intrinsic arterial wall alterations but could be associated with the higher BP levels observed in obese children.
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Affiliation(s)
- Victoria García-Espinosa
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800 Montevideo, Uruguay
| | - Santiago Curcio
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800 Montevideo, Uruguay
| | - Juan Manuel Castro
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800 Montevideo, Uruguay
| | - Maite Arana
- Pediatric Clinic “C”, School of Medicine, Republic University, Pediatric Hospital Center Pereira Rossell, ASSE, Ministry of Public Health, Bulevar Artigas 1550, 11600 Montevideo, Uruguay
| | - Gustavo Giachetto
- Pediatric Clinic “C”, School of Medicine, Republic University, Pediatric Hospital Center Pereira Rossell, ASSE, Ministry of Public Health, Bulevar Artigas 1550, 11600 Montevideo, Uruguay
| | - Pedro Chiesa
- Pediatric Cardiology Department, Pediatric Hospital Center Pereira Rossell, ASSE, Ministry of Public Health, Bulevar Artigas 1550, 11600 Montevideo, Uruguay
| | - Yanina Zócalo
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800 Montevideo, Uruguay
| | - Daniel Bia
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800 Montevideo, Uruguay
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Goh CSY, Mohamed A, Lee YS, Loke KY, Wee HL, Khoo EYH, Griva K. The associations of self-care, illness perceptions and psychological distress with metabolic control in Singaporean adolescents with Type 1 Diabetes Mellitus. Health Psychol Behav Med 2016. [DOI: 10.1080/21642850.2015.1115728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Urakami T, Kuwabara R, Aoki M, Okuno M, Suzuki J. Efficacy and safety of switching from insulin glargine to insulin degludec in young people with type 1 diabetes. Endocr J 2016; 63:159-67. [PMID: 26632171 DOI: 10.1507/endocrj.ej15-0245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We evaluated the efficacy and safety of switching to insulin degludec (IDeg) from insulin glargine (IGlar) as basal-bolus therapy in young people with type 1 diabetes. The subjects were 36 patients, 21.3±1.0 years of age, with type 1 diabetes. IGlar had previously been injected once daily in 25 patients and twice daily in 11. They were then switched from IGlar to once-daily injection of IDeg. Both fasting plasma glucose (FPG) and HbA1c levels decreased significantly from 134±3.9 mg/dL and 7.9±0.2% at baseline to 116±2.2 mg/dL and 7.4±0.2% at 12 months after starting IDeg (P<0.0001 and P≤0.001, respectively). Overall and nocturnal hypoglycemia (PG<70 mg/dL) frequencies also decreased significantly from 4.9±0.7 and 2.0±0.3 times/month to 2.4±0.3 and 0.4±0.1 times/month at 12 months after starting IDeg (P≤0.005 and P<0.0005, respectively). The daily basal insulin dose was significantly reduced from 0.48±0.04 units/kg/day at baseline to 0.38±0.03 units/kg/day at the end of the study period (P<0.0001), which corresponded to 79.2% of the baseline value. Trends were similar in patients receiving the once-daily injection and those given twice-daily injections, but basal-insulin value reductions from baseline were more marked in patients receiving twice-daily injections of basal insulin (76.0% vs. 82.6% of the baseline value). These results suggest that switching from IGlar to an appropriate dose of IDeg may effectively control hyperglycemia while reducing the frequency of hypoglycemia episodes in young Japanese people with type 1 diabetes.
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Affiliation(s)
- Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo 101-8309, Japan
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Desai NA, Patel SS. Increased insulin-like growth factor-1 in relation to cardiovascular function in polycystic ovary syndrome: friend or foe? Gynecol Endocrinol 2015; 31:801-7. [PMID: 26288196 DOI: 10.3109/09513590.2015.1075497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The incidence of cardiovascular disease (CVD) in patients with polycystic ovary syndrome (PCOS) is very high and conventional risk factors only partially explain excessive risk of developing CVD in patients of PCOS. The pathophysiology of PCOS is very unique, and several hormonal and metabolic changes occur. Several observations suggest that serum IGF-1 levels decrease in insulin resistance, which results in IGF-1 deficiency. In patient of PCOS, close relationships have been demonstrated between insulin resistance and serum IGF-1 levels. Hyperinsulinemic insulin resistance results in a general augmentation of steroidogenesis and LH release in PCOS. The action of IGF-1 varies in different tissues possibly via autocrine or paracrine mechanisms. The increase or decrease in IGF-1 in different tissues results in differential outcomes. Several studies suggest that lowered circulating IGF-1 levels play important role in the initiation of the cardiac hypertrophic response which results in the risk of cardiovascular disease. While recent results suggests that individual with elevated IGF-1 is protected against cardiovascular disease. Thus IGF-1 shows versatile pleiotropic actions. This review provides a current perspective on increased level of IGF-1 in PCOS and also adds to the current controversy regarding the roles of IGF-1 in cardiovascular disease.
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Affiliation(s)
- Namrata Ajaykumar Desai
- a Department of Pharmacology , Institute of Pharmacy, Nirma University , Ahmedabad , Gujarat , India
| | - Snehal S Patel
- a Department of Pharmacology , Institute of Pharmacy, Nirma University , Ahmedabad , Gujarat , India
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Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: the search for shared mechanisms. Lancet Diabetes Endocrinol 2015; 3:461-471. [PMID: 25995124 DOI: 10.1016/s2213-8587(15)00134-5] [Citation(s) in RCA: 365] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/23/2015] [Accepted: 01/27/2015] [Indexed: 02/07/2023]
Abstract
Depression is twice as common in people with type 1 or type 2 diabetes as in the general population, and is associated with poor outcomes. Evidence is growing that depression and type 2 diabetes share biological origins, particularly overactivation of innate immunity leading to a cytokine-mediated inflammatory response, and potentially through dysregulation of the hypothalamic-pituitary-adrenal axis. Throughout the life course, these pathways can lead to insulin resistance, cardiovascular disease, depression, increased risk of type 2 diabetes, and increased mortality. Proinflammatory cytokines might directly affect the brain, causing depressive symptoms. In type 1 diabetes, mediators of depression are not well studied, with research hindered by inconsistent definitions of depression and scarcity of observational, mechanistic, and interventional research along the life course. Despite few studies, evidence suggests that familial relationships and burden of a lifelong disorder with an onset early in personality development might contribute to increased vulnerability to depression. Overall, longitudinal research is needed to identify risk factors and mechanisms for depression in patients with diabetes, particularly early in the life course. Ultimately, improved understanding of shared origins of depression and diabetes could provide the potential to treat and improve outcomes of both disorders simultaneously. These shared origins are targets for primary prevention of type 2 diabetes.
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Affiliation(s)
- Calum D Moulton
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
| | - John C Pickup
- Diabetes and Nutritional Sciences Division, King's College London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
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Shikha D, Singla M, Walia R, Potter N, Umpaichitra V, Mercado A, Winer N. Ambulatory Blood Pressure Monitoring in Lean, Obese and Diabetic Children and Adolescents. Cardiorenal Med 2015. [PMID: 26195970 DOI: 10.1159/000381629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIM To determine if children and adolescents who have obesity (Ob) or type 2 diabetes (T2DM) of relatively short duration have impaired cardiovascular function compared with lean subjects using 24-hour ambulatory blood pressure as a surrogate measure of evaluation. METHODS We enrolled 100 African-Caribbean subjects (45 males/55 females), mean ages 14.4-15.2 years (range 11.8-18.5 years) and Tanner stage 4.2-4.8. Mean BMI for the Ob (n = 40), T2DM (n = 39) and lean (n = 21) groups were 40.3, 34.2 and 20.8, respectively (p < 0.01, Ob and T2DM vs. lean). Mean hemoglobin A1c in lean and Ob was 5.4 and 5.5% compared to 8.8% in T2DM (p < 0.001, T2DM vs. lean and Ob). Ambulatory blood pressure was recorded every 20 min over 24 h using Spacelabs 70207. RESULTS Mean 24-hour, daytime and nighttime systolic blood pressure was significantly higher in Ob and T2DM compared with lean subjects (mean 24-hour 117 and 120 vs. 109 mm Hg; daytime 121 and 123 vs. 113 mm Hg; and nighttime 109 and 115 vs. 101 mm Hg; p < 0.01 for all time periods). The nocturnal systolic dip in Ob and T2DM did not differ from that of lean, whereas nocturnal diastolic dip decreased significantly in Ob and T2DM compared to lean (11.5 and 10.4 vs. 20.6 mm Hg; p < 0.01). Mean pulse pressure was significantly increased in the Ob and T2DM groups compared to lean subjects (51 and 54 vs. 45 mm Hg; p < 0.01). CONCLUSION Adolescent Ob and T2DM groups share adverse risk factors, which may be harbingers of adult cardiovascular events.
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Affiliation(s)
- Deep Shikha
- Division of Endocrinology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., USA
| | - Montish Singla
- Department of Internal Medicine, Mount Sinai St. Luke's Hospital, New York, N.Y., USA
| | - Rachna Walia
- Division of Endocrinology, Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, N.Y., USA
| | - Natia Potter
- Division of Endocrinology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., USA
| | - Vatcharapan Umpaichitra
- Division of Endocrinology, Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, N.Y., USA
| | - Arlene Mercado
- Division of Endocrinology, Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, N.Y., USA
| | - Nathaniel Winer
- Division of Endocrinology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y., USA
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48
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Huxley RR, Peters SAE, Mishra GD, Woodward M. Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2015; 3:198-206. [PMID: 25660575 DOI: 10.1016/s2213-8587(14)70248-7] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies have suggested sex differences in the mortality rate associated with type 1 diabetes. We did a meta-analysis to provide reliable estimates of any sex differences in the effect of type 1 diabetes on risk of all-cause mortality and cause-specific outcomes. METHODS We systematically searched PubMed for studies published between Jan 1, 1966, and Nov 26, 2014. Selected studies reported sex-specific estimates of the standardised mortality ratio (SMR) or hazard ratios associated with type 1 diabetes, either for all-cause mortality or cause-specific outcomes. We used random effects meta-analyses with inverse variance weighting to obtain sex-specific SMRs and their pooled ratio (women to men) for all-cause mortality, for mortality from cardiovascular disease, renal disease, cancer, the combined outcome of accident and suicide, and from incident coronary heart disease and stroke associated with type 1 diabetes. FINDINGS Data from 26 studies including 214 114 individuals and 15 273 events were included. The pooled women-to-men ratio of the SMR for all-cause mortality was 1·37 (95% CI 1·21-1·56), for incident stroke 1·37 (1·03-1·81), for fatal renal disease 1·44 (1·02-2·05), and for fatal cardiovascular diseases 1·86 (1·62-2·15). For incident coronary heart disease the sex difference was more extreme; the pooled women-to-men ratio of the SMR was 2·54 (95% CI 1·80-3·60). No evidence suggested a sex difference for mortality associated with type 1 diabetes from cancer, or accident and suicide. INTERPRETATION Women with type 1 diabetes have a roughly 40% greater excess risk of all-cause mortality, and twice the excess risk of fatal and nonfatal vascular events, compared with men with type 1 diabetes. FUNDING None.
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Affiliation(s)
- Rachel R Huxley
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; The George Institute for Global Health, University of Sydney, Sydney, Australia.
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gita D Mishra
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of Sydney, Sydney, Australia; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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49
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Abstract
In the late 1980s all Danish children with type 1 diabetes were invited for a nationwide evaluation of glycemic control. Approximately 75% (n = 720) participated and have later been referred to as The Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). The results were surprisingly poor glycemic control among these young patients which lead to a great emphasis on glycemic control in the Danish Pediatric Departments. In 1995 the participants were invited for yet another evaluation but this time with main focus on early signs of microvascular complications - 339 participated. The mean HbA1c had remained at high levels (9.6%) and 60% of the participants had some level of Diabetic Retinopathy (DR). However, as the patients with DR mostly had the very milder forms it was believed that stricter glycemic control would reverse or at least stop progression of the disease in accordance with results from the large intervention study DCCT. This was investigated further at follow-up in 2011. The first study in the present thesis aimed to describe the 16-year incidence, progression and regression of DR in 185 participants from the DCPD1987 cohort. The 16-year incidence of proliferative retinopathy (PDR), 2-step progression and regression of DR was 31.0, 64.4, and 0.0%, respectively. As expected, the participants with PDR at follow-up had significantly higher HbA1c-values at both baseline and follow-up than those without PDR. However; a significantly larger decrease in HbA1c was also observed in the group with PDR over the study period, which in accordance with DCCT should have prevented the development of PDR to some extent. A surprisingly high incidence of proliferative retinopathy amongst young patients with type 1 diabetes in Denmark was found despite improvements in HbA1c over time. The improvement in HbA1c was either too small or happened too late. This study highlights that sight-threatening diabetic retinopathy remain a major concern in type 1 diabetes and the importance of early glycemic control. Identifying high-risk patients at a very early stage is not only desired for prevention of diabetic retinopathy - neuropathy and nephropathy similarly remain frequent in type 1 diabetes. Early risk stratification will allow for timely implementation of effective interventions and for individualized screening and diabetes care. The second and third studies of this thesis provide the longest prospective studies to date on both retinal vessel calibers and retinal fractal dimensions and their predictive value on diabetic microvascular complications. Semi-automated computer software has been developed to measure smaller changes in the retinal vessels on retinal photographs. Two of the first parameters to be reliably estimated by these programs were retinal vessel calibers and retinal vascular fractal dimensions (a quantitative measure on vascular complexity). There is very limited knowledge on their predictive value on diabetic complications thus far. In the second and third study, a consistent relation between narrower retinal arteriolar calibers, wider retinal venular calibers, lower fractal dimensions and the 16-year incidences of diabetic neuropathy, nephropathy and proliferative retinopathy was found. This has never been shown before. The results on vessel analyzes provides indications of a common pathogenic pathway for diabetic microvascular complications and therefore a possibility of universal risk estimation for development of neuropathy, nephropathy and retinopathy in type 1 diabetes.
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Affiliation(s)
- Rebecca Broe
- Department of Ophthalmology; Odense University Hospital; Odense C Denmark
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50
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Adipose tissue dysregulation and metabolic consequences in childhood and adolescent obesity: potential impact of dietary fat quality. Proc Nutr Soc 2014; 74:67-82. [PMID: 25497038 DOI: 10.1017/s002966511400158x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Evidence suggests that at a population level, childhood and adolescent obesity increase the long-term risk of chronic diseases such as type 2 diabetes and CVD. At an individual level, however, the metabolic consequences of obesity in youth vary immensely. Despite comparable BMI, some adolescents develop impaired glucose tolerance while others maintain normal glucose homeostasis. It has been proposed that the variation in the capacity to store lipid in the subcutaneous adipose tissue (SAT) may partially discriminate metabolically healthy from unhealthy obesity. In positive energy balance, a decreased capacity to expand SAT may drive lipid accumulation to visceral adipose tissue, liver and skeletal muscle. This state of lipotoxicity is associated with chronic low-grade inflammation, insulin resistance and dyslipidaemia. The present review examines the differential adipose tissue development and function in children and adolescents who exhibit metabolic dysregulation compared with those who are protected. Additionally, the role of manipulating dietary fat quality to potentially prevent and treat metabolic dysfunction in obesity will be discussed. The findings of the present review highlight the need for further randomised controlled trials to establish the effect of dietary n-3 PUFA on the metabolic phenotype of obese children and adolescents. Furthermore, using a personalised nutrition approach to target interventions to those at risk of, or those with established metabolic dysregulation may optimise the efficacy of modifying dietary fat quality.
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