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Staimez LR, Dutta A, Beyh YS, Gupta R, Noule HK, Sapna V, Deepa K, Stein AD, Narayan KV, Prabhakaran D, Kalpana B, Prabhakaran P. Pancreatic Beta Cell Function in Infants Varies by Maternal Weight. Metabolites 2024; 14:208. [PMID: 38668336 PMCID: PMC11052198 DOI: 10.3390/metabo14040208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The Asian Indian Beta Cell function (ABCs) in Infants Study examined the associations of maternal weight on infant pancreatic beta cell function across 7 months postpartum. Pregnant women aged 18-35 years were recruited in Hyderabad, India. Women were classified by first trimester weight as underweight (UW), BMI < 18.5 kg/m2; normal weight (NW), BMI 18.5-22.9 kg/m2; or overweight (OW), BMI 23.0 through <28.5 kg/m2. At age > 7 months, infants had an oral glucose tolerance test (OGTT, 1.75 g glucose/kg bodyweight) following a 3 h fast. Infant blood samples were assayed for C-peptide and glucose. Infant beta cell function (HOMA2-B; disposition index, DI) and insulin resistance (HOMA2-IR) were compared across maternal weight groups. Mothers (UW n = 63; NW n = 43; OW n = 29) had similar age at delivery and second trimester 50 g glucose challenge test results. Cord HOMA2-B values were 51% greater for IUW (83.5, SD 55.2) and 44% greater for IOW (79.9, SD 60.8) vs. INW (55.4, SD 51.5), forming a U-shaped relationship between maternal weight and HOMA2-B. No qualitative differences in HOMA2-IR were found at birth. However, at 7 months postpartum, HOMA2-IR changed most within IUW (-64% median reduction) and changed the least in IOW (-7% median reduction). At seven months postpartum, DI was higher in IUW vs. the other groups (geometric mean IUW 1.9 SD 2.5; INW 1.3 SD 2.6 or vs. IOW mean 1.2 SD 3.7), reflecting a +49% difference in DI. Evidence from this study illustrates adaptations in the pancreatic functional response of infants associated with the maternal nutritional environment.
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Affiliation(s)
- Lisa R. Staimez
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322, USA; (Y.S.B.)
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Anubrati Dutta
- Centre for Chronic Disease Control, New Delhi 110016, Delhi, India; (A.D.); (R.G.); (D.P.); (P.P.)
| | - Yara S. Beyh
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322, USA; (Y.S.B.)
| | - Ruby Gupta
- Centre for Chronic Disease Control, New Delhi 110016, Delhi, India; (A.D.); (R.G.); (D.P.); (P.P.)
| | - Hari Krishna Noule
- Centre for Chronic Disease Control, New Delhi 110016, Delhi, India; (A.D.); (R.G.); (D.P.); (P.P.)
- Share India, MediCiti Institute for Medical Sciences, Medchal 501401, Telangana, India; (V.S.); (B.K.)
- Administrative Staff College of India, Hyderabad 500034, Telanaga, India
| | - Vyakaranam Sapna
- Share India, MediCiti Institute for Medical Sciences, Medchal 501401, Telangana, India; (V.S.); (B.K.)
| | - Kothapally Deepa
- Share India, MediCiti Institute for Medical Sciences, Medchal 501401, Telangana, India; (V.S.); (B.K.)
| | - Aryeh D. Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - K.M. Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322, USA; (Y.S.B.)
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi 110016, Delhi, India; (A.D.); (R.G.); (D.P.); (P.P.)
- Public Health Foundation of India, Gurgaon 110030, Haryana, India
| | - Basany Kalpana
- Share India, MediCiti Institute for Medical Sciences, Medchal 501401, Telangana, India; (V.S.); (B.K.)
| | - Poornima Prabhakaran
- Centre for Chronic Disease Control, New Delhi 110016, Delhi, India; (A.D.); (R.G.); (D.P.); (P.P.)
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Salama M, Biggs BK, Creo A, Prissel R, Al Nofal A, Kumar S. Adolescents with Type 2 Diabetes: Overcoming Barriers to Effective Weight Management. Diabetes Metab Syndr Obes 2023; 16:693-711. [PMID: 36923685 PMCID: PMC10010139 DOI: 10.2147/dmso.s365829] [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: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 03/12/2023] Open
Abstract
The prevalence of type 2 diabetes (T2DM) among children and adolescents has remarkably increased in the last two decades, particularly among ethnic minorities. Management of T2DM is challenging in the adolescent population due to a constellation of factors, including biological, socioeconomic, cultural, and psychological barriers. Weight reduction is an essential component in management of T2DM as weight loss is associated with improvement in insulin sensitivity and glycemic status. A family centered and culturally appropriate approach offered by a multidisciplinary team is crucial to address the biological, psychosocial, cultural, and financial barriers to weight management in youth with T2DM. Lifestyle interventions and pharmacotherapy have shown modest efficacy in achieving weight reduction in adolescents with T2DM. Bariatric surgery is associated with excellent weight reduction and remission of T2DM in youth. Emerging therapies for weight reduction in youth include digital technologies, newer GLP-1 agonists and endoscopic procedures.
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Affiliation(s)
- Mostafa Salama
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ana Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rose Prissel
- Division of Endocrinology and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Love-Osborne K, Ringwood H, Sheeder J, Zeitler P. Quality improvement efforts in a safety net institution: Increased diabetes screening is associated with lower HbA1c at diagnosis and improved HbA1c outcomes in youth with type 2 diabetes. Pediatr Diabetes 2022; 23:1579-1585. [PMID: 36300712 DOI: 10.1111/pedi.13438] [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: 11/12/2021] [Revised: 09/03/2022] [Accepted: 10/20/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Evaluate whether increased diabetes screening in youth is associated with lower HbA1c at T2D diagnosis and improved HbA1c outcomes in youth. RESEARCH DESIGN AND METHODS Diabetes screening rates from 2009 to 2018 were calculated. Electronic medical records identified obese youth ages 8-18 with first HbA1c ≥6.5% from 2009 to 2018; chart review confirmed incident T2D. Demographics, BMI and HbA1c values, and use of glucometer and diabetes medications were collected. RESULTS 142 youth had T2D. Median age was 14 years (range 8-18); 58% were female. 46% were identified on first HbA1c testing. 69 (49%) had 1st HbA1c 6.5%-6.9%, 43 (30%) 7.0%-7.9%, and 30 (21%) ≥8%. Follow-up from 1st to last HbA1c was median 2.6 years (range 0-10). 121 youth had follow-up testing ≥1 year after diagnosis; of these, 87 (72%) had persistent T2D-range HbA1c or were taking diabetes medications. 85% of youth with 1st HbA1c ≥7% had persistent T2D versus 52% of those with 1st HbA1c <7% (p < 0.001). Poorly controlled diabetes at last test was present in 19% of youth with baseline HbA1c 6.5%-6.9%, 30% with 7.0%-7.9%, and 63% with ≥8% (p < 0.001). 47 (68%) with HbA1c <7% were prescribed a glucometer; 9% of youth prescribed a meter and 41% of youth not prescribed a meter had poorly controlled diabetes at last test (p = 0.009). CONCLUSIONS Youth with HbA1c <7% at diagnosis were less likely to have poorly controlled diabetes at follow-up. Prescription of glucometers for youth with HbA1c in this range was associated with improved HbA1c outcomes and deserves further study including components of glucometer teaching.
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Affiliation(s)
- Kathy Love-Osborne
- Denver Health and Hospitals, Denver, Colorado, USA.,University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Haley Ringwood
- Denver Health and Hospitals, Denver, Colorado, USA.,University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeanelle Sheeder
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Phil Zeitler
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Children's Hospital Colorado, Aurora, Colorado, USA
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Cha E, Pasquel FJ, Yan F, Jacobs DR, Dunbar SB, Umpierrez G, Choi Y, Shikany JM, Bancks MP, Reis JP, Spezia Faulkner M. Characteristics associated with early- vs. later-onset adult diabetes: The CARDIA study. Diabetes Res Clin Pract 2021; 182:109144. [PMID: 34774915 PMCID: PMC8688278 DOI: 10.1016/j.diabres.2021.109144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/21/2022]
Abstract
AIMS Differences in risk profiles for individuals with early- (<40 years old) vs. later-onset (≥40 years old) diabetes were examined. METHODS A nested case-comparison study design using 30-year longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study was used. Survey data (socio-demographics, family history, medical records, and lifestyle behaviors), obesity-related measures (body mass index, weight), blood pressure, and laboratory data (insulin, fasting glucose, 2-h glucose, and lipids) were used to examine progression patterns of diabetes development in those with early-onset vs. later-onset diabetes. RESULTS Of 605 participants, 120 were in early-onset group while 485 were in later-onset group. Early-onset group had a lower A Priori Diet Quality Score, but not statistically significant at baseline; however, the between-group difference became significant at the time that diabetes was first detected (p = 0.026). The physical activity intensity score consistently decreased from baseline to the development of diabetes in both the early- and later-onset groups. Early-onset group showed more dyslipidemia at baseline and at the time that diabetes was first detected, and rapid weight gain from baseline to the development of diabetes. CONCLUSIONS Emphases on lifestyle modification and risk-based diabetes screening in asymptomatic young adults are necessary for early detection and prevention.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, South Korea; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA.
| | | | - Fengxia Yan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | | | - Yuni Choi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA; Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, USA
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Vidmar AP, Naguib M, Raymond JK, Salvy SJ, Hegedus E, Wee CP, Goran MI. Time-Limited Eating and Continuous Glucose Monitoring in Adolescents with Obesity: A Pilot Study. Nutrients 2021; 13:nu13113697. [PMID: 34835953 PMCID: PMC8624400 DOI: 10.3390/nu13113697] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 01/25/2023] Open
Abstract
Due to its simplicity, time-limited eating (TLE) may represent a more feasible approach for treating adolescents with obesity compared to other caloric restriction regimens. This pilot study examines the feasibility and safety of TLE combined with continuous glucose monitoring (CGM) in adolescents. Fifty adolescents with BMI ≥95th percentile were recruited to complete a 12-week study. All received standard nutritional counseling, wore a CGM daily, and were randomized to: (1) Prolonged eating window: 12 h eating/12 h fasting + blinded CGM; (2) TLE (8 h eating/16 h fasting, 5 days per week) + blinded CGM; (3) TLE + real-time CGM feedback. Recruitment, retention, and adherence were recorded as indicators of feasibility. Weight loss, dietary intake, physical activity, eating behaviors, and quality of life over the course of the intervention were explored as secondary outcomes. Forty-five participants completed the study (16.4 ± 1.3 years, 64% female, 49% Hispanic, 75% public insurance). There was high adherence to prescribed eating windows (TLE 5.2 d/wk [SD 1.1]; control 6.1 d/wk [SD 1.4]) and daily CGM wear (5.85 d/wk [SD 4.8]). Most of the adolescents (90%) assigned to TLE reported that limiting their eating window and wearing a CGM was feasible without negative impact on daily functioning or adverse events. There were no between-group difference in terms of weight loss, energy intake, quality of life, physical activity, or eating behaviors. TLE combined with CGM appears feasible and safe among adolescents with obesity. Further investigation in larger samples, with a longer intervention duration and follow-up assessments are needed.
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Affiliation(s)
- Alaina P. Vidmar
- Center for Endocrinology, Diabetes and Metabolism, Diabetes & Obesity Program, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (M.N.); (J.K.R.); (E.H.); (M.I.G.)
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
- Correspondence: ; Tel.: +1-323-361-3385
| | - Monica Naguib
- Center for Endocrinology, Diabetes and Metabolism, Diabetes & Obesity Program, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (M.N.); (J.K.R.); (E.H.); (M.I.G.)
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Jennifer K. Raymond
- Center for Endocrinology, Diabetes and Metabolism, Diabetes & Obesity Program, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (M.N.); (J.K.R.); (E.H.); (M.I.G.)
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Sarah Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA 90048, USA;
| | - Elizabeth Hegedus
- Center for Endocrinology, Diabetes and Metabolism, Diabetes & Obesity Program, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (M.N.); (J.K.R.); (E.H.); (M.I.G.)
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Choo Phei Wee
- Department of Population and Public Health Sciences, Keck School of Medicine, Southern California Clinical and Translational Science Institute (SC-CTSI), Los Angeles, CA 90007, USA;
| | - Michael I. Goran
- Center for Endocrinology, Diabetes and Metabolism, Diabetes & Obesity Program, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (M.N.); (J.K.R.); (E.H.); (M.I.G.)
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
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Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study. Diabetes Care 2020; 43:2469-2477. [PMID: 32778555 PMCID: PMC7510035 DOI: 10.2337/dc20-0760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the relationship between health care coverage and HbA1c in young adults with youth-onset type 2 diabetes who transitioned to community diabetes care after receiving care during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. RESEARCH DESIGN AND METHODS Participants completed questionnaires annually. HbA1c was measured in a central laboratory. Data from 2 years before and after transitioning to community care (2013-2016) were examined and compared between states with and without expanded Medicaid. RESULTS In 2016 (n = 427; mean age 24 years), 2 years after transitioning to community care, 93% of participants in states with Medicaid expansion had health care coverage compared with 68% (P < 0.0001) in states without Medicaid expansion. Mean HbA1c was 9.8% in participants with government coverage, 9.3% with commercial coverage, and 10.1% in those with no coverage (P = 0.0774). Additionally, 32%, 42%, and 66% of those with government coverage, commercially covered, and no coverage, respectively, were not attending outpatient diabetes visits (P < 0.0001). Of those with government coverage, 83% reported they had adequate coverage for insulin syringes/needles/pens, and 89% for glucose-monitoring supplies, with more limited coverage in those with commercial plans. Participants with commercial coverage had higher education attainment (P < 0.0001); 52% had HbA1c ≥9.0% compared with 64% of those who were government covered and 58% with no coverage (P = 0.0646). CONCLUSIONS More young adults with type 2 diabetes from the TODAY cohort had health care coverage in states with expanded Medicaid but glycemic control remained poor, regardless of coverage. New therapies and approaches are needed for this vulnerable population.
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