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Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Pawar KB, Desai S, Bhonde RR, Bhole RP, Deshmukh AA. Wound with Diabetes: Present Scenario and Future. Curr Diabetes Rev 2021; 17:136-142. [PMID: 32619172 DOI: 10.2174/1573399816666200703180137] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 11/22/2022]
Abstract
Diabetes is a chronic metabolic disorder of the endocrine system characterized by an increase in blood glucose level. Several factors, such as pancreatic damage, oxidative stress, infection, genetic factor, obesity, liver dysfunction, play a vital role in the pathogenesis of diabetes, which further leads to serious diabetic complications. The diabetic wound is one such complication where the wound formation occurs, especially due to pressure and its healing process is disrupted due to factors, such as hyperglycemia, neuropathy, nephropathy, peripheral vascular disease, reduction of blood flow, atherosclerosis, impaired fibroblast. The process of wound healing is delayed due to different abnormalities like alteration in nitric oxide level, increase in aldose reductase, sorbitol, and fructose. Therefore, diabetic wound requires more time to heal as compared to the normal wound. Healing time is delayed in diabetic wound due to many factors, such as stress, decreased oxygenation supply, infection, decreased blood flow, impaired proliferation and migration rate, impaired growth factor production, impaired keratinocytes proliferation and migration, and altered vascular endothelial mediators. The current treatment for diabetic wounds includes wound patches, oxygenation therapy, hydrogel patches, gene therapy, laser therapy, and stem cell therapy. Medications with phytoconstituents are also one way to manage the diabetic wound, but it is not more effective for quick healing. The objective of this review is to understand the potential of various management options which are available for diabetic wound, with a special focus on biological cells.
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Affiliation(s)
- Kuldeep B Pawar
- Department of Pharmacology, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pune, India
| | - Shivani Desai
- Department of Pharmacology, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pune, India
| | | | - Ritesh P Bhole
- Department of Pharmaceutical Chemistry, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pune, India
| | - Atul A Deshmukh
- Department of Pharmacology, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pune, India
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Application of elastin-like biopolymer-conjugated C-peptide hydrogel for systemic long-term delivery against diabetic aortic dysfunction. Acta Biomater 2020; 118:32-43. [PMID: 33035695 DOI: 10.1016/j.actbio.2020.09.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 01/28/2023]
Abstract
Due to their short half-lives, repeated administration of anti-hyperglycemic drugs can cause pain, discomfort, tissue damage, and infection in diabetic patients. Therefore, there is a need to develop long-term drug delivery systems to treat diabetes and its complications. C-peptide can prevent diabetic complications, including diabetic vasculopathy, but its clinical application is limited by its short half-life. Here, we developed K9-C-peptide (human C-peptide conjugated to an elastin-like biopolymer) and investigated its long-term influence on hyperglycemia-induced vascular dysfunction using an aortic endothelium model in diabetic mice. Using pharmacokinetics and in vivo imaging, we found that subcutaneously injected K9-C-peptide formed a hydrogel depot that slowly released human C-peptide into the blood circulation for 19 days. Administration of K9-C-peptide, human C-peptide, or K8 polypeptide had no effect on body weight or blood glucose levels. The slow release of C-peptide from K9-C-peptide hydrogels provided prolonged prevention of oxidative stress, inflammatory responses, and endothelial apoptosis in a hyperglycemia-induced vascular dysfunction model using the diabetic mouse aorta. Subcutaneous administration of unbound human C-peptide and K8 polypeptide were used as negative controls and had no effects. These results suggest that K9-C-peptide is suitable for the long-term delivery of human C-peptide for treating vascular dysfunction in diabetic patients.
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Faulkner MS, Quinn L, Fritschi C, Tripp N, Hayat MJ. Heart Rate Variability and Cardiorespiratory Fitness in Non-Hispanic Black Versus Non-Hispanic White Adolescents With Type 1 Diabetes. J Cardiovasc Nurs 2020; 34:372-379. [PMID: 31343621 PMCID: PMC6690789 DOI: 10.1097/jcn.0000000000000590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence indicates that fewer non-Hispanic black versus non-Hispanic white youths with type 1 diabetes are meeting treatment goals for optimal glycemic outcomes, predisposing them to risks for cardiovascular (CV) morbidity and mortality in adulthood. PURPOSE We sought to assess the association of sex and race with heart rate variability (HRV) and cardiorespiratory fitness in adolescents with type 1 diabetes. The association between the HRV and cardiorespiratory outcomes with glucose control was also examined. METHODS A secondary data analysis of 95 adolescents with type 1 diabetes (n = 66 non-Hispanic white n = 29 non-Hispanic black) was used. Using 24-hour Holter recordings, spectral and time domain measures of HRV were obtained. Cardiorespiratory fitness using a graded exercise test was completed. Descriptive statistics and Pearson correlation coefficients were used to assess associations between glucose control and study outcomes, and general linear models were applied to explore and quantify associations of sex and race with HRV and cardiorespiratory fitness. RESULTS Body mass index (mean [standard deviation]) was similar between non-Hispanic black (23.5 [3.9]) and non-Hispanic white (22.7 [3.8]) adolescents. Females and non-Hispanic black adolescents had significantly lower HRV and cardiorespiratory fitness levels. Moderate associations were found between lower HRV and poorer glycemic control (HbA1c). Recent HbA1c was significantly higher in non-Hispanic black (9.7 [1.8]) than non-Hispanic white (8.2 [1.2]). CONCLUSION Findings support the importance of early identification of CV health risks in adolescents with type 1 diabetes, particularly for non-Hispanic black adolescents. Interventions focused on overall improvement in glycemic control for adolescents with type 1 diabetes are a priority for minimizing future CV complications.
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Affiliation(s)
| | - Laurie Quinn
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Cynthia Fritschi
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Natalie Tripp
- Department of Population Health Sciences, School of Public Health, Georgia State Univesity
| | - Matthew J. Hayat
- Department of Population Health Sciences, School of Public Health, Georgia State Univesity
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Bapputty R, Talahalli R, Zarini S, Samuels I, Murphy R, Gubitosi-Klug R. Montelukast Prevents Early Diabetic Retinopathy in Mice. Diabetes 2019; 68:2004-2015. [PMID: 31350303 PMCID: PMC6754245 DOI: 10.2337/db19-0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
Chronic inflammation and oxidative stress are critical components in the pathogenic cascade of early diabetic retinopathy, characterized by neuronal and vascular degeneration. We investigated pharmacologic inhibition of the proinflammatory leukotriene cascade for therapeutic benefit in early diabetic retinopathy. Using the streptozotocin-induced diabetes mouse model, we administered montelukast, a leukotriene receptor antagonist, and diabetes-related retinal pathology was assessed. Early biochemical and cellular function measures were evaluated at 3 months' diabetes duration and included vascular permeability, superoxide production, leukotriene generation, leukocyte-induced microvascular endothelial cell death, and retinal function by electroretinography. Histopathology assessments at 9 months' diabetes duration included capillary degeneration and retinal ganglion cell loss. Leukotriene receptor antagonism resulted in a significant reduction of early, diabetes-induced retinal capillary leakage, superoxide generation, leukocyte adherence, and leukotriene generation. After 9 months of diabetes, the retinal microvasculature from untreated diabetic mice demonstrated a nearly threefold increase in capillary degeneration compared with nondiabetic mice. Montelukast inhibited the diabetes-induced capillary and neuronal degeneration, whether administered as a prevention strategy, immediately after induction of diabetes, or as an intervention strategy starting at 4.5 months after confirmation of diabetes. Pharmacologic blockade of the leukotriene pathway holds potential as a novel therapy to prevent or slow the development of diabetic retinopathy.
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Affiliation(s)
- Reena Bapputty
- Department of Pediatrics, School of Medicine, Case Western Reserve University, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Ramaprasad Talahalli
- Department of Pediatrics, School of Medicine, Case Western Reserve University, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Simona Zarini
- Department of Pharmacology, University of Colorado, Aurora, CO
| | - Ivy Samuels
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - Robert Murphy
- Department of Pharmacology, University of Colorado, Aurora, CO
| | - Rose Gubitosi-Klug
- Department of Pediatrics, School of Medicine, Case Western Reserve University, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH
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Validity, Reliability, and Measurement Invariance of the Diabetes Stress Questionnaire-Short Form. J Pediatr Psychol 2018; 44:442-452. [DOI: 10.1093/jpepsy/jsy078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/14/2022] Open
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Kamody RC, Berlin KS, Rybak TM, Klages KL, Banks GG, Ali JS, Alemzadeh R, Ferry RJ, Diaz Thomas AM. Psychological Flexibility Among Youth with Type 1 Diabetes: Relating Patterns of Acceptance, Adherence, and Stress to Adaptation. Behav Med 2018; 44:271-279. [PMID: 28524766 DOI: 10.1080/08964289.2017.1297290] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Psychological flexibility, a complex concept encompassing both acceptance and action related factors, has been identified as a target for intervention for diabetes management. Research suggests acceptance, self-management, and stress, all factors that influence psychological flexibility, have an impact on adaptation to type 1 diabetes (T1D) by youth independently. However, yet to be explored is individually varying patterns of these variables and how they may relate to diabetes adaptation outcomes. The present study aimed to establish individual variations of patterns of these factors to derive profiles of psychological flexibility, and examine their relations to the adaptation outcomes of glycemic control and health-related quality of life. Youth (N = 162, aged 12-17 years) with T1D completed the Acceptance and Action Diabetes Questionnaire, Diabetes Stress Questionnaire, Self-Care Inventory, and Pediatric Quality of Life-Diabetes Module. Hemoglobin A1c values were abstracted from medical records. Latent profile analysis yielded three profiles: High Acceptance & Adherence/Low Stress, Low Acceptance/Moderate Adherence & Stress, and Low Acceptance & Adherence/High Stress. The High Acceptance & Adherence/Low Stress group displayed significantly higher health-related quality of life and lower HbA1c compared to other groups. Fluid psychological variables, such as acceptance and diabetes stress, and adherence behaviors may be salient targets to increase psychological flexibility for individual psychosocial interventions aimed at improving adaptation to type 1 diabetes in youth.
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Affiliation(s)
| | - Kristoffer S Berlin
- b Department of Psychology , The University of Memphis.,c Department of Pediatrics , University of Tennessee Health Science Center
| | | | | | | | | | - Ramin Alemzadeh
- c Department of Pediatrics , University of Tennessee Health Science Center.,d Le Bonheur Children's Hospital
| | | | - Alicia M Diaz Thomas
- c Department of Pediatrics , University of Tennessee Health Science Center.,d Le Bonheur Children's Hospital
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Miliku K, Mesu A, Franco OH, Hofman A, Steegers EAP, Jaddoe VWV. Maternal and Fetal Folate, Vitamin B 12, and Homocysteine Concentrations and Childhood Kidney Outcomes. Am J Kidney Dis 2017; 69:521-530. [PMID: 28143670 PMCID: PMC5408932 DOI: 10.1053/j.ajkd.2016.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/14/2016] [Indexed: 12/21/2022]
Abstract
Background Folate, vitamin B12 and homocysteine concentrations during pregnancy are important factors for early development and may persistently influence kidney function in the offspring. We examined the associations of folate, vitamin B12, and homocysteine concentrations during pregnancy with kidney outcomes in school-aged children. Study design Population-based prospective cohort study from fetal life onwards. Settings & participants This study was performed among 4,226 pregnant women and their children. Predictors Folate, vitamin B12 and homocysteine blood concentrations measured in early pregnancy (median gestational age 13.2 weeks (25th to 75th percentiles 12.2, 14.8) and at birth (cord blood). Outcomes & measurements At the median age of 6.0 years (25th to 75th percentiles 5.9, 6.3) we measured combined kidney volume with ultrasound, estimated glomerular filtration rate based on creatinine (eGFRcreat) and cystatin C (eGFRcystC) concentrations and microalbuminuria. Results We observed that higher maternal folate concentrations were associated with larger childhood combined kidney volume, whereas higher maternal vitamin B12 concentrations were associated with higher childhood eGFRcystC (p-values <0.05). These associations were independent of homocysteine concentrations. Higher maternal homocysteine concentrations were associated with smaller combined kidney volume and lower childhood eGFRcystC (p-values <0.05). The association of maternal homocysteine concentrations with childhood eGFRcystC was largely explained by combined kidney volume. Higher cord blood homocysteine concentrations were associated with larger combined kidney volume and lower eGFRcystC (p-values <0.05). Folate, vitamin B12 or homocysteine concentrations were not associated microalbuminuria. Limitations Observational study, so causality cannot be established. Conclusion Our findings suggest that folate, vitamin B12 and homocysteine concentrations during fetal life are associated with offspring kidney development. However, the effect sizes are small. Further studies are needed to replicate these findings and assess the causality and consequences for kidney health in later life.
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Affiliation(s)
- Kozeta Miliku
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anne Mesu
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Goffinet L, Barrea T, Beauloye V, Lysy PA. Blood versus urine ketone monitoring in a pediatric cohort of patients with type 1 diabetes: a crossover study. Ther Adv Endocrinol Metab 2017; 8:3-13. [PMID: 28203360 PMCID: PMC5298446 DOI: 10.1177/2042018816681706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of our study was to determine the influence of routine ketone monitoring on hyperglycemic events (HE) and ketosis in youngsters with type 1 diabetes (T1D). METHODS Our single-site, controlled and randomized study was conducted on children and adolescents with T1D outside of remission phase. During two crossover periods of 6 months, patients (n = 22) experiencing HE tested ketones alternatively with a blood ketone meter or urine ketone test strips and gave their opinion on screening methods after completion of clinical trial. Moreover, we evaluated levels of awareness of ketone production in a series of 58 patients and sometimes parents via a multiple-choice questionnaire. RESULTS Based on self-monitoring data, patients experienced a mean of 4.8 HE/month (range 0-9.3). Patients performed accurate ketone tests more frequently during urine (46%) than during blood-testing (29%) periods (p < 0.05); while globally, 50% of ketone tests were inaccurate (i.e. without HE). Ketosis occurred significantly more often during urine (46.4%) than during blood (14.8%) monitoring (p = 0.01), although no episodes of diabetic ketoacidosis (DKA) were noticed. Duration of hyperglycemia was not different whether patients measured ketones or not, suggesting that ketone monitoring did not affect correction of glycemia. Patients evaluated blood monitoring more frequently as being practical, reliable, and useful compared with urine testing. Scores in the awareness questionnaire were globally low (36.8%) without difference between patients and their parents. CONCLUSIONS Although our study shows differences in outcomes (e.g. accurate use, detection of ketosis) of urine versus blood ketone monitoring, these did not affect the occurrence of HE. Whereas ketone monitoring is part of standardized diabetes education, its implementation in daily routine remains difficult, partly because patient awareness about mechanisms of ketosis is lacking.
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Affiliation(s)
- Line Goffinet
- Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Thierry Barrea
- Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Véronique Beauloye
- Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium
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Bakker H, Gaillard R, Hofman A, Reiss IK, Steegers EAP, Jaddoe VWV. Fetal first trimester growth is not associated with kidney outcomes in childhood. Pediatr Nephrol 2017; 32:651-658. [PMID: 27796619 PMCID: PMC5334431 DOI: 10.1007/s00467-016-3537-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Impaired fetal growth is associated with increased risks of kidney diseases in later life. Because human development rates are highest during the first trimester, this trimester may be a particularly critical period for kidney outcomes. We have therefore examined the association of fetal first trimester growth with kidney outcomes in childhood. METHODS This study was embedded in a prospective population-based cohort study among 1176 pregnant women and their children. We used fetal first trimester crown-length as the growth measure among mothers with a regular menstrual cycle and a known first day of the last menstrual period. At the childhood age of 6 (median 5.7-6.8) years, we measured combined kidney volume, microalbuminuria and estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C concentrations. RESULTS No consistent associations of fetal first trimester crown-rump length with childhood combined kidney volume, eGFR and microalbuminuria were observed. Compared to children with a fetal first trimester crown-rump length in the highest quintile, those in the lowest quintile had a larger childhood combined kidney volume (difference 5.32 cm3, 95 % confidence interval 1.06 to 9.57), but no differences in kidney function. CONCLUSION Our results do not support the hypothesis that fetal first trimester growth restriction affects kidney size and function in childhood. Further studies are needed to focus on critical periods in early life for kidney function and disease in later life.
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Affiliation(s)
- Hanneke Bakker
- 000000040459992Xgrid.5645.2The Generation R Study Group (Na-29-15), Erasmus University Medical Center, Box 2040, 3000 CA Rotterdam, The Netherlands ,000000040459992Xgrid.5645.2Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands ,000000040459992Xgrid.5645.2Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Romy Gaillard
- 000000040459992Xgrid.5645.2The Generation R Study Group (Na-29-15), Erasmus University Medical Center, Box 2040, 3000 CA Rotterdam, The Netherlands ,000000040459992Xgrid.5645.2Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands ,000000040459992Xgrid.5645.2Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- 000000040459992Xgrid.5645.2Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands ,000000041936754Xgrid.38142.3cDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Irwin K. Reiss
- 000000040459992Xgrid.5645.2Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eric A. P. Steegers
- 000000040459992Xgrid.5645.2Department of Obstetrics & Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vincent W. V. Jaddoe
- 000000040459992Xgrid.5645.2The Generation R Study Group (Na-29-15), Erasmus University Medical Center, Box 2040, 3000 CA Rotterdam, The Netherlands ,000000040459992Xgrid.5645.2Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands ,000000040459992Xgrid.5645.2Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands
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Moriya K, Nakamura M, Nishimura Y, Kitta T, Kanno Y, Chiba H, Kon M, Shinohara N. Long-term impact of unilateral hypo/dysplastic kidney in infants with primary vesicoureteral reflux. J Pediatr Urol 2016; 12:287.e1-287.e6. [PMID: 27106531 DOI: 10.1016/j.jpurol.2016.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Renal abnormality is not a rare finding in infants with primary VUR. The pathophysiology of the renal abnormality is considered to be congenital or acquired. Congenital hypo/dysplastic kidney is a common finding in infants with primary VUR, especially in boys. However, the long-term impact of unilateral hypo/dysplastic kidney has not been elucidated. The aim of the current study is to clarify the long-term impact of unilateral hypo/dysplastic kidney with primary vesicoureteral reflux diagnosed in infancy. MATERIAL AND METHODS The medical records of patients with primary VUR detected in infancy with unilateral hypo/dysplastic kidney on initial nuclear renal scan (<40% relative renal function) and no scar on the contralateral kidney were reviewed retrospectively. Among them, 29 patients who were followed for more than 5 years were included in this study. Their clinical outcomes including chronic kidney disease (CKD) stage using estimated glomerular filtration rate (GFR) and the incidences of hypertension and proteinuria were analyzed. RESULTS Mean age at final visit was 12.4 years (range 5.9-22.2). Estimated GFR was evaluated in 26 patients at a mean age of 12.0 years (5.9-22.2). CKD stage was 1 in all. According to the guidelines of the Japanese Society of Hypertension, while none exceeded the standard level of systolic blood pressure (BP), two patients slightly exceeded the standard level of diastolic BP. In addition, no significant proteinuria was detected in all patients, although microalbuminemia was detected in 7.7% of patients. DISCUSSION The prognosis of reflux nephropathy depends on the remnant renal tissue mass, that is, the number of normal nephrons. The normal congenital solitary kidney is reported to be hyperplastic with normal-sized glomeruli rather than hypertrophic ones with larger nephrons, and to have better long-term outcome regarding renal function. Accordingly, we speculated that patients with unilateral hypo/dysplastic kidney would have a similar number of nephrons to those without hypo/dysplastic kidney who have no or minimal scar as far as the contralateral kidney is well preserved. Long-term outcome of the current retrospective study was consistent with our speculation in terms of estimated GFR, proteinuria, or hypertension. CONCLUSIONS The present study demonstrated that significant clinical findings related to unilateral hypo/dysplastic kidney detected in infancy were rarely observed in the long term. Accordingly, unilateral hypo/dysplastic kidney seems to be a benign condition. To confirm this finding, further follow-up of these patients is necessary.
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Affiliation(s)
- Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Michiko Nakamura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoko Nishimura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Miliku K, Vogelezang S, Franco OH, Hofman A, Jaddoe VWV, Felix JF. Influence of common genetic variants on childhood kidney outcomes. Pediatr Res 2016; 80:60-6. [PMID: 26959481 PMCID: PMC5496666 DOI: 10.1038/pr.2016.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/15/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kidney measures in early life are associated with kidney disease in later life. We hypothesized that these associations are partly explained by common genetic variants that lead to both smaller kidneys with lower kidney function in early childhood and kidney disease in adulthood. METHODS We examined in a population-based prospective cohort study among 4,119 children the associations of a weighted genetic risk score combining 20 previously identified common genetic variants related to adult eGFRcreat with kidney outcomes in children aged 6.0 years (95% range 5.7-7.8). Childhood kidney outcomes included combined kidney volume, glomerular filtration rate (eGFR) based on creatinine levels, and microalbuminuria based on albumin and creatinine urine levels. RESULTS We observed that the genetic risk score based on variants related to impaired kidney function in adults was associated with a smaller combined kidney volume (P value 3.0 × 10(-3)) and with a lower eGFR (P value 4.0 × 10(-4)) in children. The genetic risk score was not associated with microalbuminuria. CONCLUSION Common genetic variants related to impaired kidney function in adults already lead to subclinical changes in childhood kidney outcomes. The well-known associations of kidney measures in early life with kidney disease in later life may at least be partly explained by common genetic variants.
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Affiliation(s)
- Kozeta Miliku
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Suzanne Vogelezang
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Vincent WV Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Miliku K, Voortman T, Franco OH, McGrath JJ, Eyles DW, Burne TH, Hofman A, Tiemeier H, Jaddoe VWV. Vitamin D status during fetal life and childhood kidney outcomes. Eur J Clin Nutr 2015; 70:629-34. [PMID: 26695721 DOI: 10.1038/ejcn.2015.216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/28/2015] [Accepted: 11/09/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND/OBJECTIVES Maternal vitamin D deficiency during pregnancy may influence offspring kidney health. We aimed to examine the associations of 25-hydroxyvitamin D (25(OH)D) blood levels during fetal life with kidney outcomes at school age. SUBJECTS/METHODS This study was embedded in a population-based prospective cohort study among 4212 mother-child pairs. We measured maternal second trimester (18-25 weeks) and fetal cord blood (at birth) 25(OH)D levels. At a median age of 6.0 years, we measured children's combined kidney volume, glomerular filtration rate (eGFR) from creatinine and cystatin C serum levels, and microalbuminuria from albumin and creatinine urine levels. RESULTS Of all mothers, 21.9% had severely deficient levels (25(OH)D <25.0 nmol/l), 25.7% had deficient levels (25.0-49.9 nmol/l), 25% had sufficient levels (50.0-74.9 nmol/l) and 27.4% had optimal levels (⩾75.0 nmol/l). Maternal 25(OH)D levels were not consistently associated with childhood combined kidney volume. Higher maternal 25(OH)D levels were associated with lower childhood eGFR (difference -0.94 ml/min per 1.73 m(2) (95% confidence interval, -1.73; -0.15) per 1 standard deviation (s.d.) increase in 25(OH)D). Maternal 25(OH)D levels were not associated with microalbuminuria. Cord blood 25(OH)D levels were not associated with childhood kidney outcomes. The associations of maternal 25(OH)D levels with childhood eGFR were partly explained by childhood vitamin D status. CONCLUSIONS Our findings suggest that maternal 25(OH)D levels during pregnancy may influence childhood kidney outcomes. These results should be considered hypothesis generating. Further studies are needed to replicate the observations, to examine the underlying mechanisms and to identify the long-term clinical consequences.
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Affiliation(s)
- K Miliku
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - T Voortman
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - O H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J J McGrath
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, Queensland, Australia
| | - D W Eyles
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, Queensland, Australia
| | - T H Burne
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, Queensland, Australia
| | - A Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - H Tiemeier
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - V W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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14
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Geloneck MM, Forbes BJ, Shaffer J, Ying GS, Binenbaum G. Ocular Complications in Children with Diabetes Mellitus. Ophthalmology 2015; 122:2457-64. [PMID: 26341461 PMCID: PMC4769865 DOI: 10.1016/j.ophtha.2015.07.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The effectiveness of annual eye examinations in diabetic children is unclear. We sought to determine the prevalence and onset of ocular pathology in children with diabetes mellitus (DM), identify risk factors for ocular disease, and recommend a screening regimen for asymptomatic children. DESIGN Retrospective, consecutive cohort study. PARTICIPANTS Children aged less than 18 years with type 1 or 2 DM examined over a 4-year period. METHODS All children underwent a complete eye examination, including dilated fundoscopy and cycloplegic refraction. A literature review was performed, identifying the youngest reported age and shortest reported duration of DM before the diagnosis of diabetic retinopathy (DR). MAIN OUTCOME MEASURES Prevalence of DR, cataract, high refractive error, and strabismus. RESULTS A total of 370 children (mean age, 11.2 years; range, 1-17.5 years) had 693 examinations, with a mean DM duration of 5.2 years (range, 0.1-16.2 years) and a mean hemoglobin A1c (HbA1c) of 8.6 (range, 5-≥14). No children had DR. A total of 12 children had cataract; 5 required extraction but were identified by decreased vision, not diabetic screening. A total of 19 children had strabismus; only 1 was microvascular paralytic strabismus. A total of 41 children had high refractive error. There were no associations between these conditions and duration or control of DM. In the literature, the youngest age at diagnosis of severe DR was 15 years, and the shortest duration of disease was 5 years. CONCLUSIONS Diabetic retinopathy is rare in children regardless of duration and control of DM. On the basis of our study and literature review, screening examinations for type 1 diabetes could begin at age 15 years or at 5 years after the diagnosis of DM, whichever occurs later, unless the child is judged by the endocrinologist as being at unusually high risk. Other ocular complications are identifiable through existing amblyopia screening methods.
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Affiliation(s)
- Megan M Geloneck
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian J Forbes
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James Shaffer
- Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-shuang Ying
- Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gil Binenbaum
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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15
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Miliku K, Voortman T, van den Hooven EH, Hofman A, Franco OH, Jaddoe VWV. First-trimester maternal protein intake and childhood kidney outcomes: the Generation R Study. Am J Clin Nutr 2015; 102:123-9. [PMID: 25971715 PMCID: PMC5408936 DOI: 10.3945/ajcn.114.102228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/25/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nutritional exposures during in utero development may have long-lasting consequences for postnatal renal health. Animal studies suggest that specifically maternal dietary protein intake during pregnancy influences childhood kidney function. OBJECTIVE We examined the associations of total, animal, and vegetable maternal protein intake during pregnancy with kidney volume and function in school-aged children. DESIGN This study was conducted in 3650 pregnant women and their children who were participating in a population-based cohort study from early life onward. First-trimester energy-adjusted maternal protein intake was assessed with a food-frequency questionnaire. At the child's age of 6 y, we assessed kidney volume, estimated glomerular filtration rate (eGFR) using serum creatinine and cystatin C concentrations, and microalbuminuria using urine albumin:creatinine ratios. RESULTS First-trimester maternal total protein intake was associated with a higher childhood creatinine-based eGFR (difference: 0.06 mL × min(-1) × 1.73 m(-2); 95% CI: 0.01, 0.12 mL · min(-1) · 1.73 m(-2) per gram of protein intake). This association was mainly driven by vegetable protein intake (0.22 mL × min(-1) × 1.73 m(-2); 95% CI: 0.10, 0.35 mL · min(-1) · 1.73 m(-2) per gram of vegetable protein intake). These associations were not explained by protein intake in early childhood. First-trimester maternal protein intake was not significantly associated with childhood kidney volume, cystatin C-based eGFR, or the risk of microalbuminuria. CONCLUSIONS Our findings suggest that higher total and vegetable, but not animal, maternal protein intake during the first trimester of pregnancy is associated with a higher eGFR in childhood. Further follow-up studies are needed to investigate whether maternal protein intake in early pregnancy also affects the risk of kidney diseases in later life.
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Affiliation(s)
- Kozeta Miliku
- The Generation R Study Group and the Departments of Epidemiology and Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- The Generation R Study Group and the Departments of Epidemiology and Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Edith H van den Hooven
- The Generation R Study Group and the Departments of Epidemiology and Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | | | - Vincent W V Jaddoe
- The Generation R Study Group and the Departments of Epidemiology and Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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16
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Ferenci T, Körner A, Kovács L. The interrelationship of HbA1c and real-time continuous glucose monitoring in children with type 1 diabetes. Diabetes Res Clin Pract 2015; 108:38-44. [PMID: 25666106 DOI: 10.1016/j.diabres.2015.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/03/2014] [Accepted: 01/15/2015] [Indexed: 01/18/2023]
Abstract
AIMS The aim of this observational study is to investigate the relationship between age, duration of diabetes, HbA1c and the parameters of glucose levels measured with real-time CGM in children with type 1 diabetes. METHODS Glucose level was characterized with the relative time spent in hyper- and hypoglycemia, central tendency, variability and MAGE during (real-time) CGM. These parameters were measured in 57 children with type 1 diabetes mellitus. The univariate association of the measured parameters was investigated with scatterplots as well as with linear and distance correlation coefficients. RESULTS Age and duration of diabetes were not clinically relevantly associated with any descriptor of glucose level. HbA1c had an overall positive association with variability and MAGE observed during CGM. Slight, but non-significant, positive association of HbA1c was observed with the time spent in hyperglycemia and the central tendency of glucose level. With the exception of MAGE, the associations of the descriptors with HbA1c are non-monotonic, with a temporary break in the positive correlation at 10%. CONCLUSIONS The results confirmed the well-known positive association of HbA1c with the central tendency of glucose level. The non-monotonic relationship between HbA1c and the indicators of the central tendency of glucose level might be caused by the changed adherence of the patients during the period of CGM. HbA1c's positive association with MAGE without non-monotonicity underlines MAGE's usefulness in the reliable assessment of the patients' glycemic state.
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Affiliation(s)
- Tamás Ferenci
- Óbuda University, John von Neumann Faculty of Informatics, Physiological Controls Group, Bécsi út 96/b, H-1034 Budapest, Hungary.
| | - Anna Körner
- Semmelweis University, 1st Department of Paediatrics, Bókay János u. 53-54, H-1083 Budapest, Hungary.
| | - Levente Kovács
- Óbuda University, John von Neumann Faculty of Informatics, Physiological Controls Group, Bécsi út 96/b, H-1034 Budapest, Hungary.
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17
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Miliku K, Voortman T, Bakker H, Hofman A, Franco OH, Jaddoe VWV. Infant Breastfeeding and Kidney Function in School-Aged Children. Am J Kidney Dis 2015; 66:421-8. [PMID: 25747235 DOI: 10.1053/j.ajkd.2014.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/30/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Early life factors may influence kidney growth and function throughout the life course. We examined the associations of breastfeeding duration and exclusivity and age at introduction of solid foods with kidney outcomes at school age. STUDY DESIGN Prospective cohort study from fetal life onward. SETTING & PARTICIPANTS 5,043 children in the Netherlands. PREDICTORS Infant feeding was assessed prospectively using questionnaires. OUTCOMES & MEASUREMENTS In children at a median age of 6.0 years, we measured kidney volume with ultrasound, estimated glomerular filtration rate (eGFR) from serum creatinine level, and microalbuminuria from urinary albumin and creatinine levels. RESULTS 92% of all children were ever breastfed, of whom 27% were breastfed for more than 6 months and 21% were breastfed exclusively for at least 4 months. Compared with ever-breastfed children, never-breastfed children had smaller combined kidney volumes (-2.69 [95% CI, -4.83 to -0.56] cm(3)) and lower eGFRs (-2.42 [95% CI, -4.56 to -0.28] mL/min/1.73 m(2)) at school age. Among breastfed children, shorter duration of breastfeeding was associated with smaller combined kidney volume and lower microalbuminuria risk (P<0.05). Compared to exclusive breastfeeding for 4 months, nonexclusive breastfeeding in the first 4 months was associated with smaller combined kidney volume and lower eGFR (both P<0.05). Associations with eGFR were explained largely by kidney volume. Age at introduction of solid foods was not associated with any kidney outcome. LIMITATIONS Observational study, so causality cannot be established. Follow-up measurements were available for 76% of children. CONCLUSIONS These results suggest that breastfeeding is associated with subclinical changes in kidney outcomes in childhood. Further studies are needed to explore whether early life nutrition also affects the risk of kidney disease in adulthood.
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Affiliation(s)
- Kozeta Miliku
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Trudy Voortman
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Hanneke Bakker
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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18
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Willi SM, Miller KM, DiMeglio LA, Klingensmith GJ, Simmons JH, Tamborlane WV, Nadeau KJ, Kittelsrud JM, Huckfeldt P, Beck RW, Lipman TH. Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics 2015; 135:424-34. [PMID: 25687140 PMCID: PMC4533245 DOI: 10.1542/peds.2014-1774] [Citation(s) in RCA: 262] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous research has documented racial/ethnic disparities in diabetes treatments and outcomes. It remains controversial whether these disparities result from differences in socioeconomic status (SES) or other factors. We examined racial/ethnic disparities in therapeutic modalities and diabetes outcomes among the large number of pediatric participants in the T1D Exchange Clinic Registry. METHODS The cohort included 10 704 participants aged <18 years with type 1 diabetes for ≥1 year (48% female; mean age: 11.9 ± 3.6 years; diabetes duration: 5.2 ± 3.5 years). Diabetes management and clinical outcomes were compared among 8841 non-Hispanic white (white) (83%), 697 non-Hispanic black (black) (7%), and 1166 Hispanic (11%) participants. The population included 214 high-income black and Hispanic families. RESULTS Insulin pump use was higher in white participants than in black or Hispanic participants (61% vs 26% and 39%, respectively) after adjusting for gender, age, diabetes duration, and SES (P < .001). Mean hemoglobin A1c was higher (adjusted P < .001) in black participants than in white or Hispanic participants (9.6%, 8.4%, and 8.7%). More black participants experienced diabetic ketoacidosis and severe hypoglycemic events in the previous year than white or Hispanic participants (both, P < .001). There were no significant differences in hemoglobin A1c, diabetic ketoacidosis, or severe hypoglycemia between white and Hispanic participants after adjustment for SES. CONCLUSIONS Even after SES adjustment, marked disparities in insulin treatment method and treatment outcomes existed between black versus Hispanic and white children within this large pediatric cohort. Barriers to insulin pump use and optimal glycemic control beyond SES should be explored in all ethnic groups.
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Affiliation(s)
- Steven M. Willi
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Kristen J. Nadeau
- University of Colorado Denver and Children’s Hospital Colorado, Denver, Colorado
| | - Julie M. Kittelsrud
- Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota; and
| | | | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, Florida
| | - Terri H. Lipman
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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19
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Kooijman MN, Bakker H, Franco OH, Hofman A, Taal HR, Jaddoe VWV. Fetal Smoke Exposure and Kidney Outcomes in School-Aged Children. Am J Kidney Dis 2015; 66:412-20. [PMID: 25641064 DOI: 10.1053/j.ajkd.2014.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/06/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fetal smoke exposure may result in developmental adaptations that permanently affect the developing kidney. In this study, the associations of maternal and paternal smoking during pregnancy with childhood kidney size and function were assessed. STUDY DESIGN Prospective cohort study from fetal life onward. SETTING & PARTICIPANTS This study was conducted in a group of 5,622 children in Rotterdam, the Netherlands. PREDICTORS Maternal and paternal smoking were assessed during pregnancy by questionnaires. OUTCOMES & MEASUREMENTS At a median age of 6.0 (5th-95th percentile, 5.6-7.9) years, we measured childhood kidney volumes, estimated glomerular filtration rate (eGFR), and albumin-creatinine ratio. RESULTS The confounder model, which included size at birth, shows that compared with children from mothers who did not smoke during pregnancy, those from mothers who continued smoking during pregnancy had smaller combined kidney volumes at the age of 6 years. The strongest effect estimate was observed for mothers who smoked 5 or more cigarettes per day during pregnancy (difference for combined kidney volume, -2.80 [95% CI, -5.15 to -0.45] cm(3)). Similarly, continued maternal smoking during pregnancy also was associated with a lower eGFR in childhood (difference, -2.25 [95% CI, -3.70 to -0.79] mL/min/1.73 m(2)). First-trimester-only smoking was associated with a higher risk of increased albumin-creatinine ratio (OR, 1.45; 95% CI, 1.05-2.01). Among mothers who did not smoke during pregnancy, paternal smoking was associated with smaller childhood combined kidney volume (difference, -1.78 [95% CI, -3.48 to -0.07] cm(3)), but not with childhood kidney function measures. LIMITATIONS Smoking behavior was measured with questionnaires. Follow-up measurements were available for only 70% of the children. CONCLUSIONS Continued maternal smoking during pregnancy is associated with smaller combined kidney volume and lower eGFR in school-aged children. Stronger effect estimates for maternal versus paternal smoking suggest that intrauterine adaptive responses may play a role as underlying mechanisms.
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Affiliation(s)
- Marjolein N Kooijman
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands
| | - Hanneke Bakker
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands
| | - Albert Hofman
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands
| | - H Rob Taal
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands.
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20
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Protein intake in infancy and kidney size and function at the age of 6 years: The Generation R Study. Pediatr Nephrol 2015; 30:1825-33. [PMID: 25956700 PMCID: PMC4549379 DOI: 10.1007/s00467-015-3096-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND High protein intake has been linked to kidney growth and function. Whether protein intake is related to kidney outcomes in healthy children is unclear. METHODS We examined the associations between protein intake in infancy and kidney outcomes at age 6 years in 2968 children participating in a population-based cohort study. Protein intake at 1 year was assessed using a food-frequency questionnaire and was adjusted for energy intake. At age 6 years we measured the kidney volume and urinary albumin/creatinine ratio (ACR) of all participating children, and we estimated glomerular filtration rate (eGFR) using serum creatinine and cystatin C levels. RESULTS In models adjusted for age, sex, body surface area, and sociodemographic factors, a higher protein intake was associated with a lower ACR and a higher eGFR but was not consistently associated with kidney volume. However, after further adjustment for additional dietary and lifestyle factors, such as sodium intake, diet quality, and television watching, higher protein intake was no longer associated with kidney function. No differences in associations were observed between animal and vegetable protein intake. CONCLUSIONS Our findings show that protein intake in early childhood is not independently associated with kidney size or function at the age of 6 years. Further study is needed on other early life predictors of kidney size and function in later life.
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21
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Bakker H, Kooijman MN, van der Heijden AJ, Hofman A, Franco OH, Taal HR, Jaddoe VWV. Kidney size and function in a multi-ethnic population-based cohort of school-age children. Pediatr Nephrol 2014; 29:1589-98. [PMID: 24599444 DOI: 10.1007/s00467-014-2793-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/21/2014] [Accepted: 02/13/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Subclinical impaired kidney growth and function in childhood may lead to kidney diseases and high blood pressure in adulthood. We assessed the cross-sectional associations of childhood characteristics with kidney size and function in a multi-ethnic cohort. METHODS This study was embedded in a population-based cohort study of 6,397 children with a median age of 6.0 years.Kidney volume, creatinine and cystatin C blood levels, microalbuminuria and blood pressure were measured, and glomerular filtration rate (GFR) was estimated. RESULTS Childhood anthropometrics were positively associated with kidney volume, creatinine level and blood pressure (all p < 0.05). We observed ethnic differences in all kidney size and function measures (all p < 0.05). Children with smaller kidneys had higher creatinine and cystatin C blood levels, leading to a lower estimated GFR [difference 5.68 ml/min/1.73 m2 (95% confidence interval 5.14-6.12) per 1 standard deviation increase in kidney volume]. Larger kidney volume was associated with an increased risk of microalbuminuria. CONCLUSIONS Childhood kidney volume and function are influenced by body mass index and ethnicity. Kidney volume is related with kidney function but not with blood pressure. These results may help to identify individuals at risk for kidney disease in an early stage.
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Affiliation(s)
- Hanneke Bakker
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
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22
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Zeitler P, Fu J, Tandon N, Nadeau K, Urakami T, Barrett T, Maahs D. ISPAD Clinical Practice Consensus Guidelines 2014. Type 2 diabetes in the child and adolescent. Pediatr Diabetes 2014; 15 Suppl 20:26-46. [PMID: 25182306 DOI: 10.1111/pedi.12179] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Affiliation(s)
- Phil Zeitler
- The Children's Hospital Colorado, Aurora, CO, USA
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23
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Maahs DM, Daniels SR, de Ferranti SD, Dichek HL, Flynn J, Goldstein BI, Kelly AS, Nadeau KJ, Martyn-Nemeth P, Osganian SK, Quinn L, Shah AS, Urbina E. Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the American Heart Association. Circulation 2014; 130:1532-58. [PMID: 25170098 DOI: 10.1161/cir.0000000000000094] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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24
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Maahs DM, Hermann JM, DuBose SN, Miller KM, Heidtmann B, DiMeglio LA, Rami-Merhar B, Beck RW, Schober E, Tamborlane WV, Kapellen TM, Holl RW. Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries. Diabetologia 2014; 57:1578-85. [PMID: 24893863 DOI: 10.1007/s00125-014-3272-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/22/2014] [Indexed: 01/17/2023]
Abstract
AIMS/HYPOTHESIS The study aimed to compare participant characteristics, treatment modalities and clinical outcomes in registry participants less than 6 years old. METHODS Participant characteristics, treatment modalities and clinical outcomes (HbA1c, severe hypoglycaemia [SH] and diabetic ketoacidosis [DKA]) as well as frequencies of attaining HbA1c goals in line with the International Society for Pediatric and Adolescent Diabetes (<7.5% [<58 mmol/mol]) and ADA (<8.5% [<69 mmol/mol]) were compared. RESULTS Insulin pump use was more frequent (74% vs 50%, p < 0.001) and HbA1c levels lower in the Prospective Diabetes Follow-up Registry (DPV) than in the T1D Exchange (T1DX) (mean 7.4% vs 8.2%, p < 0.001). A lower HbA1c level was seen in the DPV compared with the T1DX for both pump users (p < 0.001) and injection users (p < 0.001). More children from DPV were meeting the recommended HbA1c goals, compared with children from T1DX (HbA1c <7.5%: 56% vs 22%, p < 0.001; HbA1c <8.5%: 90% vs 66%, p < 0.001). The adjusted odds of having an HbA1c level <7.5% or <8.5% were 4.2 (p < 0.001) and 3.6 (p < 0.001) higher for the DPV than the T1DX, respectively. The frequency of SH did not differ between registries or by HbA1c, whereas the frequency of DKA was higher for the T1DX and greater in those with higher HbA1c levels. CONCLUSIONS/INTERPRETATION DPV data indicate that an HbA1c of <7.5% can frequently be achieved in children with type 1 diabetes who are under 6 years old. An improved metabolic control of type 1 diabetes in young patients appears to decrease the risk of DKA without increasing SH. The greater frequency of suboptimal control in young patients in the T1DX compared with the DPV is not fully explained by a less frequent use of insulin pumps and may relate to the higher HbA1c targets that are recommended for this age group in the USA.
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Affiliation(s)
- David M Maahs
- Barbara Davis Centre for Childhood Diabetes, Aurora, CO, USA
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Fekete A, Vannay Á. [Importance of diabetic nephropathy in childhood. Clinical findings and basic research in recent decades]. Orv Hetil 2014; 155:141-50. [PMID: 24440726 DOI: 10.1556/oh.2014.29814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past decades diabetes mellitus is becoming a global pandemic affecting more than 371 million people worldwide. Parallel with the increasing prevalence of type 1 diabetes, there is a growing number of type 2 diabetes cases among children and adolescents that poses new challenges to pediatricians. Diabetic nephropathy is one of the major causes of end stage renal disease, developing in approximately 30% of diabetic patients. However, overt nephropathy is rare in childhood; screening and ongoing assessment for the earliest manifestation of renal injury is extremely important in this young population, as well. Although in the past decades intensive research activity focused on understanding of the pathomechanism of diabetic nephropathy and invention of new therapeutic approaches, prevention and definitive care are still urgently needed. The clinical section of the article summarizes the present state of epidemiology, diagnosis and current therapies of childhood diabetic nephropathy. Then, the authors discuss the state of basic research and show a few promising targets for drug development.
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Affiliation(s)
- Andrea Fekete
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika, MTA-SE Lendület Diabétesz Kutatócsoport Budapest Bókay J. u. 53. 1083
| | - Ádám Vannay
- MTA-SE Gyermekgyógyászati és Nephrologiai Kutatócsoport Budapest
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26
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Kooijman MN, Bakker H, van der Heijden AJ, Hofman A, Franco OH, Steegers EAP, Taal HR, Jaddoe VWV. Childhood kidney outcomes in relation to fetal blood flow and kidney size. J Am Soc Nephrol 2014; 25:2616-24. [PMID: 24812167 DOI: 10.1681/asn.2013070746] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Impaired fetal abdominal blood flow may lead to smaller kidneys and subsequent impaired kidney function in later life. In a prospective cohort study among 923 pregnant women and their children, we measured fetal growth, kidney volumes, and umbilical and cerebral artery blood flow (median gestational age of 30.3 weeks; 95% range, 28.5-32.7 weeks). We used a higher umbilical/cerebral artery pulsatility index ratio as an indicator of preferential fetal blood flow to the upper body parts at the expense of the intra-abdominal organs. At a median age of 5.9 years (95% range, 5.7-6.6 years), we measured childhood kidney volumes, creatinine and cystatin C blood levels, microalbuminuria, BP, and eGFR. A preferential fetal blood flow to the upper body parts at the expense of the intra-abdominal organs associated only with a smaller combined kidney volume in childhood. Fetal combined kidney volume positively associated with childhood combined kidney volume and eGFR, and inversely associated with childhood creatinine and cystatin C levels (all P values <0.05), but did not associate with childhood microalbuminuria and BP. Children within the highest tertile of fetal umbilical/cerebral ratio and the lowest tertile of fetal combined kidney volume had the lowest eGFR (difference, -6.36 ml/min per 1.73 m(2); 95% confidence interval, -11.78 to -0.94 compared with children within the middle tertiles). These data suggest that impaired fetal blood to the abdominal organs and smaller fetal kidney size are associated with subclinical changes in kidney outcomes in school-aged children.
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Affiliation(s)
| | - Hanneke Bakker
- The Generation R Study Group, Departments of Epidemiology, Pediatrics, and
| | | | | | | | - Eric A P Steegers
- Gynecology and Obstetrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Vincent W V Jaddoe
- The Generation R Study Group, Departments of Epidemiology, Pediatrics, and
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Bakker H, Gaillard R, Franco OH, Hofman A, van der Heijden AJ, Steegers EAP, Taal HR, Jaddoe VWV. Fetal and infant growth patterns and kidney function at school age. J Am Soc Nephrol 2014; 25:2607-15. [PMID: 24812164 DOI: 10.1681/asn.2013091003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Low birth weight is associated with ESRD. To identify specific growth patterns in early life that may be related to kidney function in later life, we examined the associations of longitudinally measured fetal and infant growth with kidney function in school-aged children. This study was embedded in a population-based prospective cohort study among 6482 children followed from fetal life onward. Fetal and childhood growth was measured during second and third trimesters of pregnancy, at birth, and at 6, 12, 24, 36, and 48 months postnatally. At the age of 6 years, we measured kidney volume by ultrasound. GFR was estimated using blood creatinine levels. Higher gestational age-adjusted birth weight was associated with higher combined kidney volume and higher eGFR (per 1 SD score increase in birth weight; 1.27 cm(3) [95% confidence interval, 0.61 to 1.93] and 0.78 ml/min per 1.73 m2 [95% CI, 0.16 to 1.39], respectively). Fetal weight, birth weight, and weight at 6 months were positively associated with childhood kidney volume, whereas higher second trimester fetal weight was positively associated with higher GFR (all P values<0.05). Fetal and childhood lengths were not consistently associated with kidney function. In this cohort, lower fetal and early infant weight growth is associated with smaller kidney volume in childhood, whereas only lower fetal weight growth is associated with lower kidney function in childhood, independent of childhood growth. Whether these associations lead to an increased risk of kidney disease needs to be studied further.
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Affiliation(s)
- Hanneke Bakker
- The Generation R Study Group, and Departments of Epidemiology, Pediatrics, and
| | - Romy Gaillard
- The Generation R Study Group, and Departments of Epidemiology, Pediatrics, and
| | | | | | | | - Eric A P Steegers
- Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Vincent W V Jaddoe
- The Generation R Study Group, and Departments of Epidemiology, Pediatrics, and
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Campbell MS, Schatz DA, Chen V, Wong JC, Steck A, Tamborlane WV, Smith J, Beck RW, Cengiz E, Laffel LM, Miller KM, Haller MJ. A contrast between children and adolescents with excellent and poor control: the T1D Exchange clinic registry experience. Pediatr Diabetes 2014; 15:110-7. [PMID: 23957219 PMCID: PMC4164957 DOI: 10.1111/pedi.12067] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 06/14/2013] [Accepted: 06/28/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Optimizing glycemic control in pediatric type 1 diabetes (T1D) is essential to minimizing long-term risk of complications. We used the T1D Exchange database from 58 US diabetes clinics to identify differences in diabetes management characteristics among children categorized as having excellent vs. poor glycemic control. METHODS Among registry participants 6-17 yr old with diabetes duration ≥ 2 yr, those with excellent control [(A1c <7%)(53 mmol/mol) (N = 588)] were compared with those with poor control [(A1c ≥ 9% )(75 mmol/mol) (N = 2684)] using logistic regression. RESULTS The excellent and poor control groups differed substantially in diabetes management (p < 0.001 for all) with more of the excellent control group using insulin pumps, performing blood glucose monitoring ≥ 5 ×/d, missing fewer boluses, bolusing before meals rather than at the time of or after a meal, using meal-specific insulin:carbohydrate ratios, checking their blood glucose prior to giving meal time insulin, giving insulin for daytime snacks, giving more bolus insulin, and using a lower mean total daily insulin dose than those in poor control. After adjusting for demographic and socioeconomic factors, diabetes management characteristics were still strongly associated with good vs. poor control. Notably, frequency of severe hypoglycemia was similar between the groups while DKA was more common in the poorly controlled group. CONCLUSIONS Children with excellent glycemic control tend to exhibit markedly different diabetes self-management techniques than those with poor control. This knowledge may further inform diabetes care providers and patients about specific characteristics and behaviors that can be augmented to potentially improve glycemic control.
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Affiliation(s)
- Meredith S Campbell
- College of Medicine, University of Florida, P. O. Box 100296, Gainesville, FL 32610, USA
| | - Desmond A Schatz
- College of Medicine, University of Florida, P. O. Box 100296, Gainesville, FL 32610, USA
| | - Vincent Chen
- Jaeb Center for Health Research, Tampa, FL 33647, USA
| | - Jenise C Wong
- Department of Pediatrics, School of Medicine, University of San Francisco, San Francisco, CA 94143, USA
| | - Andrea Steck
- Barbara Davis Center for Childhood Diabetes, Aurora, CO 80045, USA
| | - William V Tamborlane
- Department of Pediatrics, School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Jennifer Smith
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL 33647, USA
| | - Eda Cengiz
- Department of Pediatrics, School of Medicine, Yale University, New Haven, CT 06520, USA
| | | | | | - Michael J Haller
- College of Medicine, University of Florida, P. O. Box 100296, Gainesville, FL 32610, USA
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Wood JR, Miller KM, Maahs DM, Beck RW, DiMeglio LA, Libman IM, Quinn M, Tamborlane WV, Woerner SE. Most youth with type 1 diabetes in the T1D Exchange Clinic Registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines. Diabetes Care 2013; 36:2035-7. [PMID: 23340893 PMCID: PMC3687259 DOI: 10.2337/dc12-1959] [Citation(s) in RCA: 315] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the proportion of youth with type 1 diabetes under the care of pediatric endocrinologists in the United States meeting targets for HbA1c, blood pressure (BP), BMI, and lipids. RESEARCH DESIGN AND METHODS Data were evaluated for 13,316 participants in the T1D Exchange clinic registry younger than 20 years old with type 1 diabetes for ≥1 year. RESULTS American Diabetes Association HbA1c targets of <8.5% for those younger than 6 years, <8.0% for those 6 to younger than 13 years old, and <7.5% for those 13 to younger than 20 years old were met by 64, 43, and 21% of participants, respectively. The majority met targets for BP and lipids, and two-thirds met the BMI goal of <85th percentile. CONCLUSIONS Most children with type 1 diabetes have HbA1c values above target levels. Achieving American Diabetes Association goals remains a significant challenge for the majority of youth in the T1D Exchange registry.
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Affiliation(s)
- Jamie R Wood
- Children's Hospital Los Angeles, Los Angeles, California, USA
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McVeigh GE, Gibson W, Hamilton PK. Cardiovascular risk in the young type 1 diabetes population with a low 10-year, but high lifetime risk of cardiovascular disease. Diabetes Obes Metab 2013; 15:198-203. [PMID: 22998614 DOI: 10.1111/dom.12013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/23/2012] [Accepted: 09/13/2012] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus is associated with excess cardiovascular mortality that is evident in all age groups, but is most pronounced in young people with type 1 diabetes. Cardiovascular risk estimation models generally estimate the probability of future events over a 10-year time horizon. Due to the dependency on age, children and adolescents with type 1 diabetes would be considered at low short-term risk but high life-time risk of developing a cardiovascular event. Guidelines recommend screening particularly for microvascular complications including nephropathy and retinopathy beginning around puberty. Identification of early microvascular abnormalities in children and adolescents not only predict later development of long-term microvascular complications and further end-organ damage but are associated with an increased risk for future macrovascular events. This may be because of the fact that the same glycaemic mechanisms responsible for the occurrence of microvascular disease may also apply to the development of atherosclerosis. Alternatively, interventions that reduce the development of microvascular end-organ damage may also delay the development of associated macrovascular disease. Screening for subclinical atherosclerosis, especially in the coronary and carotid vessels, has been advocated as a means of detecting early atherosclerotic disease in asymptomatic individuals with the aim of potentially reclassifying cardiovascular risk and guiding therapeutic interventions. Currently there is no randomized clinical trial evidence that additional screening using non-invasive imaging techniques alters cardiovascular disease outcomes. We do not know the best approach or combination of approaches to assess risk and reduce cardiovascular disease burden in type 1 diabetes mellitus. All screening interventions carry harms as well as benefits and until further evidence becomes available additional screening using non-invasive imaging tests for the detection of subclinical atherosclerosis cannot be currently recommended for patients with type 1 diabetes.
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Affiliation(s)
- G E McVeigh
- Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, UK.
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31
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Maahs DM, Dabelea D, D’Agostino RB, Andrews JS, Shah AS, Crimmins N, Mayer-Davis EJ, Marcovina S, Imperatore G, Wadwa RP, Daniels SR, Reynolds K, Hamman RF, Dolan LM. Glucose control predicts 2-year change in lipid profile in youth with type 1 diabetes. J Pediatr 2013; 162:101-7.e1. [PMID: 22795314 PMCID: PMC3807690 DOI: 10.1016/j.jpeds.2012.06.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 05/11/2012] [Accepted: 06/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To test the hypothesis that a change in glycated hemoglobin (A1c) over a follow-up interval of approximately 2 years would be associated with concomitant changes in fasting lipids in individuals with type 1 diabetes (T1D). STUDY DESIGN All subjects with T1D diagnosed in 2002-2005 in the SEARCH for Diabetes in Youth study with at least 2 study visits ∼12 and ∼24 months after an initial visit were included (age at initial visit, 10.6 ± 4.1 years; 48% female; diabetes duration, 10 ± 7 months; 76% non-Hispanic white; A1c = 7.7% ± 1.4%). Longitudinal mixed models were fit to examine the relationship between change in A1c and change in lipid levels (total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-c], low-density lipoprotein-cholesterol [LDL-c], log triglycerides [TG], and non-HDL-c) with adjustment for possible confounders. RESULTS Change in A1c over time was significantly associated with changes in TC, HDL-c, LDL-c, TG, and non-HDL-c over the range of A1c values. For example, for a person with an A1c of 10% and then a 2% decrease in A1c 2 years later (to 8%), the model predicted concomitant changes in TC (-0.29 mmol/L, -11.4 mg/dL), HDL-c (0.03 mmol/L, 1.3 mg/dL), LDL-c (-0.23 mmol/L, -9.0 mg/dL), and non-HDL-c (-0.32 mmol/L, -12.4 mg/dL) and an 8.5% decrease in TG (mmol/L). CONCLUSIONS Improved glucose control over a 2-year follow-up was associated with a more favorable lipid profile but may be insufficient to normalize lipids in dyslipidemic T1D youth needing to decrease lipids to goal.
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Affiliation(s)
- DM Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO,Colorado School of Public Health, Department of Epidemiology, University of Colorado Denver,The Children’s Hospital Colorado, Aurora, CO
| | - D Dabelea
- Colorado School of Public Health, Department of Epidemiology, University of Colorado Denver
| | | | - JS. Andrews
- Wake Forest School of Medicine, Winston-Salem, NC
| | - AS Shah
- Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | - N Crimmins
- Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | - EJ. Mayer-Davis
- University of North Carolina, School of Medicine, Chapel Hill, NC
| | - S Marcovina
- Northwest Lipid Research Laboratory, Seattle, WA
| | - G Imperatore
- Division of Diabetes Translation, The Centers for Disease Control and Prevention, Atlanta, GA
| | - RP Wadwa
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO
| | - SR Daniels
- The Children’s Hospital Colorado, Aurora, CO
| | - K Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California Pasadena, CA
| | - RF Hamman
- Colorado School of Public Health, Department of Epidemiology, University of Colorado Denver
| | - LM Dolan
- Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
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Maahs DM. Cardiovascular disease (CVD) limbo: how soon and low should we go to prevent CVD in diabetes? Diabetes Technol Ther 2012; 14:449-52. [PMID: 22472062 DOI: 10.1089/dia.2012.0078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Marcovecchio ML, Dunger DB. Evaluating cardio-renal protection for adolescents with type 1 diabetes: the current AdDIT trial. PRACTICAL DIABETES 2012. [DOI: 10.1002/pdi.1684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Minuto N, Emmanuele V, Vannati M, Russo C, Rebora C, Panarello S, Pistorio A, Lorini R, d'Annunzio G. Retinopathy screening in patients with type 1 diabetes diagnosed in young age using a non-mydriatic digital stereoscopic retinal imaging. J Endocrinol Invest 2012; 35:389-94. [PMID: 21985859 DOI: 10.3275/8016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diabetic retinopathy seriously impairs patients' quality of life, since it represents the first cause of blindness in industrialized countries. AIM To estimate prevalence of retinopathy in young Type 1 diabetes patients using a non-mydriatic digital stereoscopic retinal imaging (NMDSRI), and to evaluate the impact of socio-demographic, clinical, and metabolic variables. SUBJECTS AND METHODS In 247 young patients glycated hemoglobin (HbA1c), gender, age, pubertal stage, presence of diabetic ketoacidosis (DKA), HLA-DQ heterodimers of susceptibility for Type 1 diabetes, and β-cell autoimmunity at clinical onset were considered. At retinopathy screening, we evaluated age, disease duration, pubertal stage, body mass index (BMI-SDS), insulin requirement, HbA1c levels, other autoimmune diseases, diabetes-related complications, serum concentrations of cholesterol and triglycerides, systolic and diastolic blood pressure. RESULTS Retinopathy was found in 26/247 patients: 25 showed background retinopathy, and 1 had a sight-threatening retinopathy. A significant relationship between retinopathy and female gender (p=0.01), duration of disease ≥15 yr (p<0.0001), serum triglycerides levels >65 mg/dl (p=0.012) and mean HbA1c ≥7.5% or >9% (p=0.0014) were found at the multivariate logistic analysis. CONCLUSIONS Metabolic control is the most important modifiable factor and promotion of continuous educational process to reach a good metabolic control is a cornerstone to prevent microangiopathic complications. Symptoms appear when the complication is already established; a screening program with an early diagnosis is mandatory to prevent an irreversible damage.
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Affiliation(s)
- N Minuto
- Pediatric Clinic, University of Genoa, IRCCS G. Gaslini Institute, Largo G. Gaslini 5, Genoa, Italy
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Kidney disease and youth onset type 2 diabetes: considerations for the general practitioner. Int J Pediatr 2012; 2012:237360. [PMID: 22315622 PMCID: PMC3270413 DOI: 10.1155/2012/237360] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/11/2011] [Indexed: 12/15/2022] Open
Abstract
Youth onset type 2 diabetes (T2DM) continues to increase worldwide, concomitant with the rising obesity epidemic. There is evidence to suggest that youth with T2DM are affected by the same comorbidities and complications as adults diagnosed with T2DM. This review highlights specifically the kidney disease associated with youth onset T2DM, which is highly prevalent and associated with a high risk of end-stage kidney disease in early adulthood. A general understanding of this complex disease by primary care providers is critical, so that at-risk individuals are identified and managed early in the course of their disease, such that progression can be modified in this high-risk group of children and adolescents. A review of the pediatric literature will include a focus on the epidemiology, risk factors, pathology, screening, and treatment of kidney disease in youth onset T2DM.
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Barat P, Tastet S, Vautier V. Impact neuropsychologique à long terme du diabète de type 1 chez l’enfant. Arch Pediatr 2011; 18:432-40. [DOI: 10.1016/j.arcped.2011.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/28/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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Salem M, Moneir I, Adly AM, Esmat K. Study of coronary artery calcification risk in Egyptian adolescents with type-1 diabetes. Acta Diabetol 2011; 48:41-53. [PMID: 20706852 DOI: 10.1007/s00592-010-0214-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 07/26/2010] [Indexed: 10/19/2022]
Abstract
The objective of the study is to assess coronary artery calcification (CAC) among adolescents with type-1 diabetes and to determine its relation with high-sensitivity C-reactive protein (hs-CRP), dyslipidaemia, glycaemic control and microvascular complications. The study included sixty patients with type-1 diabetes. Their ages ranged from 12 to 18 years and their diabetes duration ranged between 10 and 15 years. Patients were compared with 60 healthy subjects who served as controls. Clinical examination and laboratory investigations were done for evaluation of glycaemic control and presence of microvascular complications. Lipid profile, hs-CRP and multislice spiral computed tomography were done. Hs-CRP, total cholesterol, triglycerides and low-density lipoproteins levels were significantly higher in patients with diabetes compared to controls (P < 0.001). Twelve patients with diabetes (20%) had positive CAC. The mean calcium score was significantly higher in patients with diabetes compared to controls (P < 0.05). Smoking significantly affects CAC as 50% of smokers with diabetes had evidence of CAC compared to 9.1% of non-smokers with diabetes (P < 0.001). Fifty percent of patients with diabetes on angiotensin-converting enzyme inhibitor (ACEI) had evidence of CAC compared to 0% of patients without history of ACEI therapy (P < 0.001). Diabetics with CAC had significantly elder age, longer disease duration and higher mean glycosylated hemoglobin compared to diabetics without CAC (P < 0.05). Blood pressure percentiles, albumin creatinine ratio and serum lipids were significantly higher in patients with CAC compared to those without CAC (P < 0.001). All diabetics with severe retinopathy had positive CAC compared to 0% with normal Fundus (P < 0.001). All diabetics with overt nephropathy had positive CAC compared to 13.3% and 0% in micro- and normo-albuminuric patients (P < 0.001). Young patients with diabetes have evidence of CAC. Smoking, microvascular complications and dyslipidaemia might contribute to this risk.
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Affiliation(s)
- M Salem
- Paediatric Department, Ain Shams University, Cairo, Egypt.
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Marcovecchio ML, Chiarelli F. Microvascular disease in children and adolescents with type 1 diabetes and obesity. Pediatr Nephrol 2011; 26:365-75. [PMID: 20721674 DOI: 10.1007/s00467-010-1624-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/13/2010] [Accepted: 07/14/2010] [Indexed: 12/16/2022]
Abstract
The incidence of type 1 diabetes (T1D) is increasing worldwide and is associated with a significant burden, mainly related to the development of vascular complications. Over the last decades, concomitant with the epidemic of childhood obesity, there has been an increasing number of cases of type 2 diabetes (T2D) among children and adolescents. Microvascular complications of diabetes, which include nephropathy, retinopathy and neuropathy, are characterized by damage to the microvasculature of the kidney, retina and neurons. Although clinically evident microvascular complications are rarely seen among children and adolescents with diabetes, there is clear evidence that their pathogenesis and early signs develop during childhood and accelerate during puberty. Diabetic vascular complications are often asymptomatic during their early stages, and once symptoms develop, there is little to be done to cure them. Therefore, screening needs to be started early during adolescence and, in the case of T2D, already at diagnosis. Identification of risk factors and subclinical signs of complications is essential for the early implementation of preventive and therapeutic strategies, which could change the course of vascular complications and improve the prognosis of children, adolescents and young adults with diabetes.
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Salardi S, Balsamo C, Zucchini S, Maltoni G, Scipione M, Rollo A, Gualandi S, Cicognani A. High rate of regression from micro-macroalbuminuria to normoalbuminuria in children and adolescents with type 1 diabetes treated or not with enalapril: the influence of HDL cholesterol. Diabetes Care 2011; 34:424-9. [PMID: 21216861 PMCID: PMC3024361 DOI: 10.2337/dc10-1177] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the frequency of normalization, the persistence of remission, and the impact on normalization of glycemic control and lipid profile, we analyzed data from a retrospective observational cohort study of type 1 diabetic children and adolescents with abnormal urinary albumin excretion (UAE). RESEARCH DESIGN AND METHODS All diabetic children and adolescents (n = 41) who had persistent abnormal UAE in the period of 1984 to 2008 and followed up until 2009 (follow-up duration = 13.1 ± 6.2 years) were included in the study. Nine patients progressed to macroalbuminuria; 24 patients were administered ACE inhibitor treatment. RESULTS The cumulative prevalence of abnormal UAE was 9%. During follow-up, 14 of 17 untreated and 19 of 24 treated patients reverted to normoalbuminuria. In the remission group compared with the nonremission group, A1C levels during follow-up decreased (7.5 ± 1.0 vs. 9.4 ± 1.2%, P < 0.0001) and serum HDL cholesterol increased (52.7 ± 11.3 vs. 42.7 ± 8.6 mg/dL, P < 0.05). The micro-macroalbuminuric patients had lower HDL cholesterol (51.0 ± 11.4 vs. 62.4 ± 13.6 mg/dL, P < 0.0001) than 134 normoalbuminuric diabetic patients. CONCLUSIONS Microalbuminuria and macroalbuminuria were not permanent in most of our diabetic children and adolescents. If abnormal UAE values are high and persist for >1 year, only long-lasting treatment with ACE inhibitors seems able to induce persistent remission, especially when associated with good metabolic control and high HDL cholesterol levels.
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Affiliation(s)
- Silvana Salardi
- Department of Pediatrics, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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Ruhayel SD, James RA, Ehtisham S, Cameron FJ, Werther GA, Sabin MA. An observational study of type 2 diabetes within a large Australian tertiary hospital pediatric diabetes service. Pediatr Diabetes 2010; 11:544-51. [PMID: 20337972 DOI: 10.1111/j.1399-5448.2010.00647.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is emerging as a significant clinical problem within the pediatric population. OBJECTIVE The objective of this study was to identify patients with T2DM in a large tertiary hospital diabetes service and examine aspects relating to clinical course and management. METHODS An initial audit of our diabetes service (over 6 yr) was followed by a 2-yr period of prospective case ascertainment to identify patients with T2DM. Comprehensive data collection was then undertaken in these individuals. RESULTS Within our service (n = 1574), 33 young people with T2DM were identified. Significant levels of co-morbidity were evident - dyslipidaemia (56%), microalbuminuria (45%), hypertension (30%) and abnormal retinal findings (25%). Hypertension was more likely in those with greater initial and follow-up body mass index (BMI) [mean (SD) BMI: 36.3 (5.0) vs. 28.0 (6.3) kg/m(2) , p = 0.001, and 36.8 (5.3) vs. 28.5 (7.8) kg/m(2) , p = 0.007, respectively] and BMI standard deviation score (SDS) [mean (SD) BMI SDS: 2.34 (0.30) vs. 1.72 (0.66), p = 0.001, and 2.26 (0.31) vs. 1.38 (0.87), p < 0.001, respectively], whereas abnormal retinal findings were seen in those with higher HbA1c values at last appointment [geometric mean (range) 10.9 (8.4-13.6) vs. 7.4 (5.6-12.5)%, p = 0.01) and those with greater increases in HbA1c over time (+4.1 (3.1) vs. +0.2 (1.9)%, p = 0.009). Of the 33,9 (27%) were lost to follow-up. CONCLUSIONS At present, T2DM in youth remains a low burden on our services. Patients with this diagnosis, however, have significant problems that present a major challenge to the development of effective management strategies.
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Affiliation(s)
- Sandra D Ruhayel
- Department of Endocrinology and Diabetes at the Royal Children's Hospital, Parkville, Victoria, Australia
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Abstract
This article describes the epidemiology of type 1 diabetes mellitus (T1D) around the world and across the lifespan. Epidemiologic patterns of T1D by demographic, geographic, biologic, cultural, and other factors in populations are presented to gain insight about the causes, natural history, risks, and complications of T1D. Data from large epidemiologic studies worldwide indicate that the incidence of T1D has been increasing by 2% to 5% worldwide and that the prevalence of T1D is approximately 1 in 300 in the United States by 18 years of age. Research on risk factors for T1D is an active area of research to identify genetic and environmental triggers that could potentially be targeted for intervention. Although significant advances have been made in the clinical care of T1D with resultant improvements in quality of life and clinical outcomes, much more needs to be done to improve care of, and ultimately find a cure for, T1D. Epidemiologic studies have an important ongoing role to investigate the complex causes, clinical care, prevention, and cure of T1D.
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Affiliation(s)
- David M Maahs
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, PO Box 6511, Mail Stop A140, Aurora, CO 80045, USA.
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van Vliet M, Van der Heyden JC, Diamant M, Von Rosenstiel IA, Schindhelm RK, Aanstoot HJ, Veeze HJ. Overweight is highly prevalent in children with type 1 diabetes and associates with cardiometabolic risk. J Pediatr 2010; 156:923-929. [PMID: 20223481 DOI: 10.1016/j.jpeds.2009.12.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 10/06/2009] [Accepted: 12/09/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the prevalence of traditional cardiometabolic risk factors and to assess the effect of overweight/obesity on the occurrence of these risk factors in a cohort of children with type 1 diabetes mellitus (T1DM). STUDY DESIGN Two hundred eighty-three consecutive patients (3 to 18 years of age) attending an outpatient clinic for T1DM care were included. The prevalence of cardiometabolic risk factors, the metabolic syndrome, and high alanine aminotransferase, were assessed before and after stratification for weight status. RESULTS Of all children (median age, 12.8 years; interquartile range, 9.9 to 16.0; median diabetes duration, 5.3 years; interquartile range, 2.9 to 8.6), 38.5% were overweight/obese (Z-body mass index > or =1.1). Overall, median HbA1c levels were 8.2% (interquartile range, 7.4 to 9.8), and HbA1c > or =7.5% was present in 73.9%. Microalbuminuria was found in 17.7%, high triglycerides (>1.7 mmol/L) in 17.3%, high LDL-cholesterol (>2.6 mmol/L) in 28.6%, low HDL-cholesterol (<1.1 mmol/L) in 21.2%, and hypertension in 13.1% of patients. In the overweight/obese children with T1DM, versus normal-weight children, a higher prevalence of hypertension (23.9% vs 5.7%), the metabolic syndrome (25.7% vs 6.3%), and alanine aminotransferase >30 IU/L (15.6% vs 4.5%) was found (all P < .05). CONCLUSIONS Overweight/obesity and cardiometabolic risk factors were highly prevalent in a pediatric cohort with T1DM. Hypertension, the metabolic syndrome, and high alanine aminotransferase were significantly more prevalent in overweight/obese compared with normal-weight children with T1DM.
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Affiliation(s)
- Mariska van Vliet
- Department of Pediatrics, Slotervaart Hospital, Amsterdam, The Netherlands; Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Michaela Diamant
- Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Roger K Schindhelm
- Department of Clinical Chemistry, Isala Clinics, Zwolle, The Netherlands
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Alleyn CR, Volkening LK, Wolfson J, Rodriguez-Ventura A, Wood JR, Laffel LMB. Occurrence of microalbuminuria in young people with Type 1 diabetes: importance of age and diabetes duration. Diabet Med 2010; 27:532-7. [PMID: 20536948 PMCID: PMC2966306 DOI: 10.1111/j.1464-5491.2010.02983.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To determine the occurrence of microalbuminuria in young people with Type 1 diabetes mellitus followed prospectively for 2 years and to relate the presence of persistent elevations in urinary albumin excretion (UAE) to age, diabetes duration, puberty and other factors. METHODS During a 2 year period, random urine samples were obtained from 471 patients, aged 8-18 years (mean +/-sd 12.9 +/- 2.3 years) with Type 1 diabetes duration 5.6 +/- 3.0 years, as part of routine clinical care. Urine albumin and creatinine concentrations were measured in 1310 samples (median, 3 samples per patient) and the albumin:creatinine ratio was calculated (in micrograms albumin per milligram creatinine). Height, weight, blood pressure (BP), glycated haemoglobin (HbA(1c)), blood glucose monitoring frequency and Tanner staging were collected from patients' medical records. RESULTS Twenty-three per cent of patients had one or more sample with elevated UAE (> or =20 microg/mg) and 9.3% had persistent elevations (> or =2 samples > or =20 microg/mg). Those with and without persistent microalbuminuria did not differ significantly in age, diabetes duration, z-score for body mass index, pubertal status or BP percentile. Ten per cent of children <13 years old and 9% of children > or =13 years old had persistent microalbuminuria. Persistent microalbuminuria was significantly associated with diabetes duration only in older children (duration 0.5-3 years, 4%; 4-6 years, 8%; > or =7 years, 14%; P = 0.02, trend test). Mean HbA(1c) over the 2 years was 8.7 +/- 1.2%. In a logistic regression model, mean HbA(1c) was the only significant predictor of persistent microalbuminuria (odds ratio 1.3, 95% confidence interval 1.0-1.6, P = 0.05). CONCLUSIONS Microalbuminuria in older children with Type 1 diabetes is likely to be clinically significant. In younger children, it may reflect functional, reversible renal changes. Longitudinal analysis is needed to confirm the probable transient nature of microalbuminuria in young patients with Type 1 diabetes.
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Affiliation(s)
- C R Alleyn
- Pediatric, Adolescent & Young Adult Section, Joslin Diabetes Center, Boston, MA 02215, USA
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Faulkner MS, Michaliszyn SF, Hepworth JT. A personalized approach to exercise promotion in adolescents with type 1 diabetes. Pediatr Diabetes 2010; 11:166-74. [PMID: 19968815 PMCID: PMC4354713 DOI: 10.1111/j.1399-5448.2009.00550.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE This exploratory study tested the feasibility of conducting a novel, personalized exercise intervention based upon the current fitness levels of adolescents with type 1 diabetes (T1DM). The relationships of perceptions of benefits and barriers to exercise, exercise self-efficacy and family support to exercise adherence and changes in cardiovascular (CV) fitness, quality of life (QOL), and glycemic control were studied. METHODS Adolescents who were sedentary received a graded exercise test to determine their current fitness level (VO(2peak)). A 16-wk personalized exercise program was developed for each adolescent based upon individual fitness level and exercise preferences. Pretest and posttest measures of exercise self-efficacy, benefits and barriers to exercise, family support, and diabetes QOL were completed. A1c levels were obtained using the DCA2000. Adherence to exercise was measured using the Actigraph Accelerometer. RESULTS Twelve adolescents completed the study. Accelerometry data revealed adherence to 60 min of moderate-to-vigorous physical activity (MVPA) per day for a mean of 45.5 (SD = 23.9)% of the days the accelerometer was worn. Adolescents' perceptions of family support for exercise improved following the intervention (p = 0.03). Adolescents who had more daily bouts of exercise lasting 60 min increased their CV fitness (r = 0.59, p = 0.04). A1c remained unchanged. CONCLUSIONS Encouraging 60 min of accumulated exercise bouts/d can improve fitness levels in adolescents with T1DM, minimizing future CV risks. Although physical activity increased in adolescents, family based strategies are required to promote current physical activity recommendations.
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Affiliation(s)
- Melissa Spezia Faulkner
- College of Nursing, University of Arizona, 1305 N. Martin Avenue, P. O. Box 210203, Tucson, AZ 85721-0203, USA.
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Bruni V, Dei M, Peruzzi E, Seravalli V. The anorectic and obese adolescent. Best Pract Res Clin Obstet Gynaecol 2010; 24:243-58. [DOI: 10.1016/j.bpobgyn.2009.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 09/25/2009] [Indexed: 11/24/2022]
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Dalla Pozza R, Netz H, Schwarz HP, Bechtold S. Subclinical atherosclerosis in diabetic children: results of a longitudinal study. Pediatr Diabetes 2010; 11:129-33. [PMID: 19515025 DOI: 10.1111/j.1399-5448.2009.00540.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CONTEXT Cardiovascular disease caused by atherosclerosis is a major cause of morbidity and mortality in adult diabetic patients. In children, we detected signs of subclinical atherosclerosis in a large patient cohort. This study reports the results of a longitudinal observation in this patient group. PATIENTS AND METHODS Of the 37/150 diabetic children in whom an increased intima-media thickness (IMT) of the carotid artery had been found, 27 (mean age 14.6 +/- 2.6 yrs) could be reevaluated 2 yrs after the initial study. Of the 27, 5 patients were on medication with angiotensin-converting enzyme (ACE) inhibitors, and all patients underwent detailed counselling of their lifestyle, sports activity, and nutritional habits. RESULTS Mean IMT increased significantly (0.49 +/- 0.02 mm vs. 0.51 +/- 0.026 mm, p < 0.05) However, there was no significant change compared to normal values (mean IMT z-score 2.4 +/- 0.3 vs. 2.6 +/- 0.5). Of the 27, 13 patients (48%) showed a progression of the IMT whereas in 14/27 patients the IMT values remained stable. In these subgroups, patients with IMT progression showed a higher hemoglobin A1c (HbA1c) (7.5 +/- 0.8 vs. 7.1 +/- 0.7, p < 0.05) and a slightly higher systolic blood pressure (120 +/- 14.4 vs. 113.9 +/- 12.1, p = 0.08). CONCLUSIONS In a well-selected group of diabetic children, mean IMT progression during a 2-yr period did not exceed the physiological increase. Children with a higher HbA1c and a higher systolic blood pressure showed a progression of the IMT. Control of atherogenic risk factors in diabetic children may help to avoid subclinical atherosclerosis progression.
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Affiliation(s)
- Robert Dalla Pozza
- Department of Pediatric Cardiology, University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
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Viklund G, Wikblad K. Self-perceived health and burden of diabetes in teenagers with type 1 diabetes: psychometric properties of the Swedish measure 'check your health'. Acta Paediatr 2010; 99:422-6. [PMID: 19958300 DOI: 10.1111/j.1651-2227.2009.01615.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The aim of this study was to test the psychometric properties of the instrument 'Check your health' in teenagers with type 1 diabetes. The instrument measures 'self-reported health' and 'burden of diabetes'. A convenience sample of 199 teenagers, 12-17 years of age, completed the questionnaires 'Check your health' and DisabKids when visiting the diabetes clinic. Forty-seven patients completed the questionnaires at home a second time. In the reliability test, the correlation between test and retest was found to be satisfactory, (0.94-0.62, except for social burden, 0.41). Convergent validity was moderate (0.62-0.38), while the instrument showed good discriminant validity. Self-reported health and burden of diabetes were different in boys and girls, in patients with good or poor metabolic control or who reported high and low disease severity. The domain burden of diabetes turned out to be very sensitive. CONCLUSION The instrument 'Check your health' showed clinical utility in teenagers with diabetes. Reliability and validity tests of the measure showed promising results in Swedish teenagers, and it can probably be used in clinical settings. To further strengthen the convergent validity, it should be compared with other QoL instruments, and to obtain normative values, it has to be used in a larger context.
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Affiliation(s)
- G Viklund
- Department of Medical Sciences, Section of Nursing Research - Medicine, Uppsala University, Uppsala, Sweden.
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Faulkner MS, Quinn L, Fritschi C. Microalbuminuria and heart rate variability in adolescents with diabetes. J Pediatr Health Care 2010; 24:34-41. [PMID: 20122476 PMCID: PMC2819478 DOI: 10.1016/j.pedhc.2009.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 12/20/2008] [Accepted: 01/10/2009] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Limited clinical and research data are available on early renal and cardiovascular complications in youth with diabetes. The possible associations of elevated microalbuminuria to creatinine (MC) ratios with heart rate variability (HRV) were explored in adolescents with type 1 (T1DM) or type 2 (T2DM) diabetes. METHODS A descriptive study was conducted with 41 adolescents with diabetes (n = 31 T1DM vs. n = 10 T2DM). Twenty-four hour Holter recordings for determining HRV, urine spot checks for MC ratio, and the most recent measures of glycosylated hemoglobin (A1c) were obtained. RESULTS HRV was significantly lower in the T2DM group, while body mass index percentile, triglycerides, and diastolic blood pressure were significantly higher. For the T1DM group, clinical case examples provided evidence of elevated MC ratios (>30 mirog/mg) occurring in two female subjects who also had decreased HRV measures. DISCUSSION Although HRV was not significantly associated with MC ratios for the sample, individual clinical findings can be a warning sign for some adolescents with diabetes. Current recommendations for screening of early renal complications and associated treatment are provided.
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Affiliation(s)
- Melissa Spezia Faulkner
- Diabetes Research and Education, College of Nursing, University of Arizona, P.O. Box 210203, Tucson, AZ 5721-0203, USA.
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Hovnik T, Dolzan V, Bratina NU, Podkrajsek KT, Battelino T. Genetic polymorphisms in genes encoding antioxidant enzymes are associated with diabetic retinopathy in type 1 diabetes. Diabetes Care 2009; 32:2258-62. [PMID: 19752172 PMCID: PMC2782987 DOI: 10.2337/dc09-0852] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Oxidative stress plays an important role in the development of microangiopathic complications in type 1 diabetes. We investigated polymorphic markers in genes encoding enzymes regulating production of reactive oxygen species in association with diabetic retinopathy or diabetic nephropathy. RESEARCH DESIGN AND METHODS A total of 124 patients with type 1 diabetes were investigated in this case-control study. All subjects were matched for sex, age, and duration of diabetes. Genotyping was conducted using real-time PCR for p.Val16Ala polymorphism in the MnSOD gene and c.C-262T in the promoter region of the CAT gene. Multiplex PCR method was used for determination of GSTM1 and GSTT1 polymorphic deletions. Fluorescence-labeled PCR amplicons and fragment analysis was used for assessing the number of pentanucleotide (CCTTT)n repeats in inducible nitric oxide synthase. RESULTS A positive association of MnSOD genotype Val/Val (odds ratio [OR] 2.49, 95% CI 1.00-6.16, P = 0.045) and GSTM1-1 genotype (2.63, 1.07-6.47, P = 0.031) with diabetic retinopathy but not with diabetic nephropathy was demonstrated. Additionally, the combination of the two genotypes conveyed an even higher risk (4.24, 1.37-13.40, P = 0.009). No other investigated genetic polymorphisms were associated with either diabetic retinopathy or diabetic nephropathy. CONCLUSIONS Selected polymorphisms in genes encoding MnSOD and GSTM1 could be added to a panel of genetic markers for identification of individuals with type 1 diabetes at an increased risk for developing diabetic retinopathy.
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Affiliation(s)
- Tinka Hovnik
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
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Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ. Type 2 diabetes in children and adolescents. Pediatr Diabetes 2009; 10 Suppl 12:17-32. [PMID: 19754615 DOI: 10.1111/j.1399-5448.2009.00584.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Arlen L Rosenbloom
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32608, USA.
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