1
|
Boboc AA, Ionescu MI, Tataranu E, Boboc C, Galos F. Exploring the Diagnostic Complexity of Diabetes Subtypes in Pediatric Obesity: A Case Report of an Adolescent With Prader-Willi Phenotype and Literature Review. Cureus 2024; 16:e66456. [PMID: 39135667 PMCID: PMC11317789 DOI: 10.7759/cureus.66456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 08/15/2024] Open
Abstract
Obesity among adolescents poses a significant global health concern with profound short- and long-term impact on physical and mental well-being. The intricate relationship between obesity and the onset of diabetes remains ambiguous, particularly in cases where the manifestation may differ from that observed in individuals with uncomplicated obesity. Herein, we present the case of a 14-year-old male adolescent with Prader-Willi phenotype and subsequent obesity, exhibiting symptoms of polyuria and polydipsia over a 10-day period, indicative of potential diabetes mellitus (DM). Laboratory assessments revealed a hemoglobin A1c level of 10%, confirming the suspected diagnosis. Notably, despite the absence of ketosis, elevated C-peptide levels and the presence of slightly positive islet-cell antibodies warranted further investigation. While the presence of antibodies typically aligns with a diagnosis of type 1 DM, recent research has highlighted the occurrence of anti-insulin pancreatic cell antibodies in type 2 DM cases. This article aims to delve into the multifaceted issues surrounding adolescent obesity, atypical presentations of DM with positive antibodies, and the long-term management of patients with genetic syndromes.
Collapse
Affiliation(s)
- Anca A Boboc
- Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, ROU
| | - Mara I Ionescu
- Physiology II - Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, ROU
- Functional Sciences, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Elena Tataranu
- Paediatrics, Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, ROU
| | - Catalin Boboc
- Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, ROU
| | - Felicia Galos
- Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, ROU
| |
Collapse
|
2
|
Zhen XM, Twigg SM, Wu T, Tabet E, McGill MJ, Constantino M, Mallawaarachchi A, Luo C, Thillainadesan S, Rahman Y, Wong J. Diabetic ketoacidosis in an adult with beta-ketothiolase deficiency (BKD) involving a novel ACAT1 variant : first report of established diabetes in BKD and a review of the literature. Clin Diabetes Endocrinol 2024; 10:17. [PMID: 38853254 PMCID: PMC11163784 DOI: 10.1186/s40842-024-00174-9] [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: 08/13/2022] [Accepted: 02/02/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Diabetes presenting in young adults is often challenging to classify. Diabetic ketoacidosis is typically seen in autoimmune type 1 diabetes mellitus and more rarely in young onset type 2 diabetes mellitus. Beta-ketothiolase deficiency (BKD) is a rare autosomal recessive condition affecting isoleucine catabolism and ketone body metabolism. BKD typically manifests in childhood as recurrent episodes of ketoacidosis, the frequency of which tends to reduce with age. There is a paucity of data with respect to the co-existence of persistent dysglycemia with BKD. CASE PRESENTATION AND LITERATURE REVIEW We present a novel case of diabetes presenting as diabetic ketoacidosis in a 34-year-old man with BKD, with genetically confirmed compound heterozygosity for variants in ACAT1, including a novel ACAT1 c.481T>C, p.(Tyr161His) variant. Diabetes in people with BKD presents unique diagnostic and management challenges. To further contextualize our findings, we conducted a comprehensive narrative review of the existing literature with respect to dysglycemia in those with BKD, especially in adulthood. There are no existing reports describing diabetes in adults with BKD. Stress hyperglycemia is not uncommon when children with BKD are acutely unwell, with several pediatric case reports describing short-lived hyperglycemia but normal HbA1c measurements during metabolic crises (indicating the absence of persistent hyperglycemia). CONCLUSIONS This is the first report of diabetic ketoacidosis in an adult with BKD, with an elevated HbA1c consistent with persistent hyperglycemia. This case highlights the importance of checking HbA1c in people with BKD and hyperglycemia in order to uncover potential coexisting diabetes, facilitating timely management and preventing complications. Increased reporting on the longitudinal outcomes of those with rare metabolic disorders is essential for identifying potential associations with conditions like diabetes.
Collapse
Affiliation(s)
- Xi May Zhen
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
- Sydney Medical School (Central), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Department of Endocrinology, Blacktown Hospital, Sydney, NSW, Australia.
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Stephen M Twigg
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School (Central), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ted Wu
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Eddy Tabet
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School (Central), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Margaret J McGill
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School (Central), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Maria Constantino
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Amali Mallawaarachchi
- Clinical Genetics Service, Institute of Precision Medicine and Bioinformatics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Connie Luo
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Yusof Rahman
- Department of Genetic Medicine and ICPMR Chemical Pathology, Westmead Hospital, Sydney, NSW, Australia
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School (Central), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
3
|
Kim JH, Lee Y, Choi Y, Kim GH, Yoo HW, Choi JH. Etiologic distribution and clinical characteristics of pediatric diabetes in 276 children and adolescents with diabetes at a single academic center. BMC Pediatr 2021; 21:108. [PMID: 33663443 PMCID: PMC7931559 DOI: 10.1186/s12887-021-02575-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/24/2021] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of monogenic diabetes is estimated to be 1.1–6.3% of patients with diabetes mellitus (DM) in Europe. The overlapping clinical features of various forms of diabetes make differential diagnosis challenging. Therefore, this study investigated the etiologic distribution and clinical characteristics of pediatric diabetes, including monogenic diabetes, who presented at a single tertiary center over the last 20 years. Methods This study included 276 consecutive patients with DM diagnosed before 18 years of age from January 2000 to December 2019 in Korea. Clinical features, biochemical findings, β-cell autoantibodies, and molecular characteristics were reviewed retrospectively. Results Of the 276 patients, 206 patients (74.6%), 49 patients (17.8%), and 21 patients (7.6%) were diagnosed with type 1 DM, type 2 DM, and clinically suspected monogenic diabetes, respectively. Among 21 patients suspected to have monogenic diabetes, 8 patients had clinical maturity-onset diabetes of the young (MODY), and the remaining 13 patients had other types of monogenic diabetes. Among them, genetic etiologies were identified in 14 patients (5.1%) from 13 families, which included MODY 5, transient neonatal DM, developmental delay, epilepsy, and neonatal diabetes (DEND) syndrome, Wolfram syndrome, Donohue syndrome, immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome, Fanconi-Bickel syndrome, Wolcott-Rallison syndrome, cystic fibrosis-related diabetes, and maternally inherited diabetes and deafness. Conclusions Genetically confirmed monogenic diabetes accounted for 5.1% of patients evaluated at a single tertiary center over 20-year period. Based on the findings for our sample, the frequency of mutations in the major genes of MODY appears to be low among pediatric patients in Korea. It is critical to identify the genetic cause of DM to provide appropriate therapeutic options and genetic counseling. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02575-6.
Collapse
Affiliation(s)
- Ja Hye Kim
- Department of Pediatrics, Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Yena Lee
- Department of Pediatrics, Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Yunha Choi
- Department of Pediatrics, Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Gu-Hwan Kim
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jin-Ho Choi
- Department of Pediatrics, Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
4
|
Karaoglan M, Nacarkahya G. Clinical and laboratory clues of maturity-onset diabetes of the young and determination of association with molecular diagnosis. J Diabetes 2021; 13:154-163. [PMID: 32710514 DOI: 10.1111/1753-0407.13097] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/12/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIM Maturity-onset diabetes of the young (MODY) is often misdiagnosed as other types of diabetes because it is overlooked due to atypical clinical presentations. This study aims to reveal the clinical and laboratory clues and examine their compatibility with MODY genotypes. METHODS Participants consisted of 230 children with atypical presentations for type1(T1DM) and type2 diabetes mellitus (T2DM). MODY-causing mutations were screened in the following genes:GCK-HNF1A-HNF4A-HNF1B-PDX1-NEUROD1-KLF11-CEL-PAX4-INS-BLK. Clinical and laboratory features were compared between children with MODY and children without MODY. RESULTS The most common reasons for MODY screening were as follows (n/%):low daily dose of insulin (DDI) requirement (122/53%), absence of beta-cell antibodies(58/25.3%), coincidental hyperglycemia(26/11.3%), family history of diabetes (12/5.2%), hypoglycemia/hyperglycemia episodes(7/3%), hyperglycemia related to steroids(3/1.4%) and renal glycosuria(2/0.8%). The markers with the most likelihood to distinguish MODY from T1DM were determined as follows: measurable C-peptide in follow-up, family history of early-onset diabetes and low DDI requirement (odds ratio:12.55, 5.53 and 3.43, respectively). The distribution of the most common causative genes in children with MODY(n = 24) is as follows (n/%):GCK(15/62.5%), HNF4A(7/29.1%), HNF1A(1/9.2%) and PDX1(1/9.2%).All children(n = 12) with GCK-MODY(MODY2) were screened for low DDI requirement, while beta-cell negativity was more common in HNF4A-MODY(MODY1). CONCLUSION The study shows that measurable C-peptide in follow-up, family history of early-onset diabetes, and low DDI are still remarkable clues to predict MODY in children with misdiagnosed T1DM. In addition, the most common mutations were found in the GCK and HNF4A genes. Among children misdiagnosed with T1DM, a low DDI requirement was found more frequently in MODY2, whereas beta-cell antibody negativity was more common in MODY1.
Collapse
Affiliation(s)
- Murat Karaoglan
- Department of Pediatric Endocrinology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Gulper Nacarkahya
- Department of Molecular Biology, Faculty of Medicine Gaziantep/Turkey, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|
5
|
Haliloğlu B, Abalı S, Buğrul F, Çelik E, Baş S, Atay Z, Güran T, Turan S, Bereket A. The Distribution of Different Types of Diabetes in Childhood: A Single Center Experience. J Clin Res Pediatr Endocrinol 2018; 10:125-130. [PMID: 29175806 PMCID: PMC5985381 DOI: 10.4274/jcrpe.5204] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Type 1 diabetes (T1D) is the most common cause of diabetes in childhood but type 2 diabetes (T2D) and maturity onset diabetes of the young (MODY) are emerging as noteworthy causes of diabetes at young ages. The aim is to determine the distribution, trends and clinical features of the different types of diabetes in childhood in one tertiary center. METHODS The records of children and adolescents aged 0-18 years who were diagnosed as “diabetes/persistent hyperglycemia” between January 1999 and December 2016, were reviewed. Clinical and laboratory characteristics of the patients at diagnosis and type of diabetes were recorded. RESULTS The mean ± standard deviation age of 835 patients (48.7% females) at diagnosis was 8.8±4.4 years. Eighty-four percent of the patients were diagnosed as T1D, 5.7% as T2D, 5.3% as clinical MODY and 5% as being cases of other types of diabetes. The frequency of diabetic ketoacidosis (DKA) and severe DKA in T1D were 48.4% and 11.6%, respectively. Fourteen patients (29.2%) with T2D presented with ketosis and two of them (4.2%) had DKA at diagnosis. Antibody positivity was 83.1% in T1D and 14.8% in T2D. A statistically significant increase in the frequency of T2D has clearly been demonstrated in recent years with a frequency of 1.9%, 2.4% and 7.9% in 1999-2004, 2005-2010 and 2011-2016, respectively (p<0.001). In MODY, genetic analysis was performed in 26 (59%) patients and HNF1A and GCK gene mutations were detected in 3 (11.5%) and 14 (53.8%) patients, respectively. CONCLUSION Although the most frequent cause of DM is T1D in childhood, a trend towards increase in the frequency of T2D in recent years is notable in our population.
Collapse
Affiliation(s)
- Belma Haliloğlu
- Yeditepe University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey,* Address for Correspondence: Yeditepe University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey Phone: +90 505 267 01 97 E-mail:
| | - Saygın Abalı
- Acibadem University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Fuat Buğrul
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Enes Çelik
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Serpil Baş
- Necip Fazıl City Hospital, Clinic of Pediatric Endocrinology, Kahramanmaraş, Turkey
| | - Zeynep Atay
- Medipol University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tülay Güran
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| |
Collapse
|
6
|
Hutchins J, Barajas RA, Hale D, Escaname E, Lynch J. Type 2 diabetes in a 5-year-old and single center experience of type 2 diabetes in youth under 10. Pediatr Diabetes 2017; 18:674-677. [PMID: 27807935 DOI: 10.1111/pedi.12463] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 12/14/2022] Open
Abstract
The worrisome rise in pediatric type 2 diabetes (T2DM) is most prevalent among minority ethnic/racial populations. Typically, T2DM occurs during puberty in high risk obese adolescents with evidence of insulin resistance. Screening for T2DM in obese youth can be a daunting task for pediatricians and differentiating between pediatric T1DM and T2DM in obese youth can be challenging for pediatric endocrinologists. There is very limited data regarding the prevalence of T2DM among youth < 10 years of age. Here we present the case of a 5-year-old Hispanic male diagnosed with T2DM after referral by his pediatrician for abnormal weight gain, acanthosis nigricans and an elevated HbgA1c. He subsequently became symptomatic for diabetes with confirmed hyperglycemia and HbgA1c of 9.7% (83 mmol/mol) at the time of formal diagnosis. Type 1 diabetes autoantibodies (GAD65, Islet, and ZincT8) and monogenic diabetes genetic tests were negative. Due to elevated liver enzymes and baseline HbgA1c, he received basal insulin as his initial therapy. In this paper, we will discuss this case and present an IRB approved retrospective review of the characteristics of the 20 T2DM patients <10 years of age identified to date in our pediatric diabetes center. This review highlights that while uncommon, the diagnosis of T2DM merits consideration even in prepubertal children. This is especially true when working with a high risk population, such as our Hispanic South Texas youth.
Collapse
Affiliation(s)
- Jessica Hutchins
- Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rose Ann Barajas
- Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Daniel Hale
- Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Elia Escaname
- Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jane Lynch
- Department of Pediatrics, Division of Endocrinology & Diabetes & Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| |
Collapse
|
7
|
Bulut T, Demirel F, Metin A. The prevalence of dyslipidemia and associated factors in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab 2017; 30:181-187. [PMID: 27997351 DOI: 10.1515/jpem-2016-0111] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 08/29/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dyslipidemia increases the frequency and severity of micro and macrovascular complications of type 1 diabetes (T1D). The present study aims to determine the prevalence of dyslipidemia and its association with clinical and laboratory findings in diabetic children and adolescents. METHODS The study included 202 children and adolescents with T1D. Demographic data and laboratory findings were obtained from patients files. RESULTS Dyslipidemia prevalence was found to be 26.2%. Hypercholesterolemia (15.8%) and hyperglyceridemia (12.9%) were most common findings. Age, body mass index (BMI), hemoglobin A1c (A1C) and poor metabolic control were significantly higher in cases with dyslipidemia. Smoking rate was 14.1% in the pubertal group. Poor metabolic control and dyslipidemia was found higher among smokers (p<0.05). CONCLUSIONS Blood lipid levels should be monitored regularly and nutrition education should be repeated periodically to prevent and control dyslipidemia in patients with T1D. Smoking-related risks should be a part of patient education in the pubertal period.
Collapse
|
8
|
Jevalikar G, Kohli C, Bansal B, Mishra SK, Wasir JS, Singh S, Ahuja JK, Kaur P, Farooqui KJ, Mithal A. Childhood and Youth Onset Diabetes: A Single Centre Experience. Indian J Pediatr 2016; 83:792-8. [PMID: 26816135 DOI: 10.1007/s12098-015-2009-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/23/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify proportion of various types of diabetes and differences between type 1 and type 2 diabetes in patients with youth onset diabetes (onset below 25 completed years of age). In addition, concurrent autoimmune diseases in type 1 diabetes were studied in a subset of patients. METHODS A total of 577 patients (192 girls) with diabetes onset at median age of 14 y (range 1 mo-25 y) with median duration of 1 y (range day of diagnosis- 43 y) were included. Clinical details, investigations and complications were recorded in a proforma. Diabetes was classified using clinical criteria supported by laboratory tests of C peptide and anti GAD-65 antibody in a subset of patients. RESULTS Type 1 diabetes accounted for 368/421 (87.4 %) patients with age of onset <18 y and 99/156 (63.5 %) of patients with onset between 19 and 25 y of age. Proportion of type 2 diabetes was 36/421 (8.5 %) and 41/156 (26.2 %) in these two groups. Older age at onset, diabetes in one or both parents, absence of ketosis /weight loss and presence of acanthosis were significant predictors of type 2 diabetes. Hypothyroidism (TSH >10) and biopsy proven celiac disease was found in 11.6 and 9.7 % of type 1 diabetes patients respectively. CONCLUSIONS Type 1 diabetes is the most common type of diabetes in youth, however, a significant proportion of youth have type 2 diabetes. In these patients a combination of clinical factors, biochemical parameters and course over few months helps to guide the diagnosis.
Collapse
Affiliation(s)
- Ganesh Jevalikar
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India.
| | - Chhavi Kohli
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Beena Bansal
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Sunil Kumar Mishra
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Jasjeet Singh Wasir
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Shweta Singh
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Jasmine Kaur Ahuja
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Parjeet Kaur
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Khalid J Farooqui
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India
| |
Collapse
|
9
|
Klingensmith GJ, Connor CG, Ruedy KJ, Beck RW, Kollman C, Haro H, Wood JR, Lee JM, Willi SM, Cengiz E, Tamborlane WV. Presentation of youth with type 2 diabetes in the Pediatric Diabetes Consortium. Pediatr Diabetes 2016; 17:266-73. [PMID: 25951940 DOI: 10.1111/pedi.12281] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Type 2 diabetes (T2D) in youth is recognized as a pediatric disease, but few reports describe the characteristics during diagnosis. We describe the clinical presentation of 503 youth with T2D. METHODS The Pediatric Diabetes Consortium (PDC) T2D Clinic Registry enrolled T2D participants from eight pediatric diabetes centers in the USA. Clinical and laboratory characteristics at the time of diagnosis were analyzed. RESULTS In total 67% presented with symptoms of diabetes and confirming laboratory data, but 33% were identified by testing at risk children, 11% presented with diabetic ketoacidosis (DKA), and 2% with hyperglycemic hyperosmolar state (HHS). The mean age was 13.1 ± 2.3 yr (range, 4.6-19.8 yr) with 38 (8%) less than 10 yr of age at diagnosis. The majority was female (65%), Hispanic (54%) and had a family history of T2D (92%). The median body mass index (BMI) z-score was 2.3 (interquartile range 2.0-2.6). Fewer than half (46%) lived with both parents, only 30% had parents with education beyond high school, and 43% lived in a household with an income of <$25 000 per year. In the initial month after diagnosis, almost all (92%) were treated with insulin (30%), metformin (31%), or a combination of insulin and metformin (32%); 7% were treated with lifestyle modification alone. CONCLUSIONS The demographics of T2D in youth indicate significant social vulnerability which may affect outcomes. Metformin and insulin were the initial treatment in most youth. Importantly, T2D may occur at younger ages than previously thought and should be considered in all high-risk children presenting with diabetes.
Collapse
Affiliation(s)
- Georgeanna J Klingensmith
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA
| | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
| | | | - Heidi Haro
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA
| | - Jamie R Wood
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Joyce M Lee
- Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI, USA
| | - Steven M Willi
- Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Eda Cengiz
- Pediatric Endocrinology, Yale University, New Haven, CT, USA
| | | | | |
Collapse
|
10
|
Protudjer JLP, Dumontet J, McGavock JM. My voice: a grounded theory analysis of the lived experience of type 2 diabetes in adolescence. Can J Diabetes 2015; 38:229-36. [PMID: 25092643 DOI: 10.1016/j.jcjd.2014.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/30/2014] [Accepted: 05/22/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aims of this study were to (1) describe the lived experiences of youth with type 2 diabetes from the perspectives of youth, their primary caregivers and healthcare professionals; (2) explore the barriers and facilitators to adopting lifestyle approaches for diabetes self-management; and (3) generate a relevant grounded theory. METHODS This qualitative study was based on a grounded theory framework and consisted of interviews and focus groups with youth with type 2 diabetes (n=8), their primary caregivers (n=6) and healthcare professionals (n=8). Youth and their primary caregivers were purposely selected to represent extremes of successful self-management through lifestyle therapy. Focus groups were held with healthcare professionals (allied health [n=5]; pediatric endocrinologists [n=3]) in an effort to triangulate responses with youth and their primary caregivers. RESULTS Youth with type 2 diabetes, their primary caregivers and their healthcare professionals described supportive relationships as being important determinants of adopting healthful-living self-management behaviours. All 3 groups also recognized that social determinants of health (i.e. food insecurity, poverty) were significant barriers to adopting healthful living behaviours for families with youth who have type 2 diabetes. Healthcare professionals recognized that the barriers to self-management were different for youth with type 2 diabetes than for youth with type 1 diabetes and felt that families would benefit from a clinic dedicated to meet their unique needs. CONCLUSIONS Supportive relationships and social determinants of health are perceived as being significant determinants of the adoption of healthful behaviours by youth with type 2 diabetes and should be considered in clinical management and future therapeutic trials.
Collapse
Affiliation(s)
| | | | - Jonathan M McGavock
- Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada; Department of Pediatrics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
11
|
Kumar RB, Gupta M, Feldman BJ. The development of next-generation screening and diagnostic platforms will change diabetes care. Expert Rev Mol Diagn 2015; 15:291-4. [PMID: 25583407 DOI: 10.1586/14737159.2015.1002468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Diabetes mellitus is a common disease with a rising incidence and the findings of hyperglycemia and glucosuria. However, there are multiple types of diabetes, each with distinct etiologies. The two major types of diabetes are type 1, which is caused by an autoimmune process, and type 2, which is thought to be primarily metabolic, resulting from insulin resistance, often in the setting of obesity. Historically, the distinction between these two types was obvious. Here, we discuss how this paradigm has dramatically changed because of both the evolving epidemiology of diabetes mellitus and new and emerging tools, and therapies to diagnose and treat diabetes. As we believe that understanding these changes is critical to providing optimal care to patients with diabetes, we have developed a novel plasmonic gold chip platform that is able to meet the new and emerging demands of modern diabetes care.
Collapse
Affiliation(s)
- Rajiv B Kumar
- Department of Pediatrics, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | | | | |
Collapse
|
12
|
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]
|
13
|
Zhang B, Kumar RB, Dai H, Feldman BJ. A plasmonic chip for biomarker discovery and diagnosis of type 1 diabetes. Nat Med 2014; 20:948-53. [PMID: 25038825 PMCID: PMC4736508 DOI: 10.1038/nm.3619] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 12/11/2013] [Indexed: 12/21/2022]
Abstract
Type 1 diabetes (T1D) is an autoimmune disease, whereas type 2 diabetes (T2D) results from insulin resistance and beta cell dysfunction. Previously, the onset of these two separate diseases was easily distinguished, with children being most at risk for T1D and T2D occurring in overweight adults. However, the dramatic rise in obesity, coupled with the notable increase in T1D, has created a large overlap in these previously discrete patient populations. Delayed diagnosis of T1D can result in severe illness or death, and rapid diagnosis of T1D is critical for the efficacy of emerging therapies. However, attempts to apply next-generation platforms have been unsuccessful for detecting diabetes biomarkers. Here we describe the development of a plasmonic gold chip for near-infrared fluorescence-enhanced (NIR-FE) detection of islet cell-targeting autoantibodies. We demonstrate that this platform has high sensitivity and specificity for the diagnosis of T1D and can be used to discover previously unknown biomarkers of T1D.
Collapse
Affiliation(s)
- Bo Zhang
- 1] Stanford University, Stanford, California, USA. [2] Department of Chemistry, Stanford University School of Humanities and Sciences, Stanford, California, USA. [3]
| | - Rajiv B Kumar
- 1] Stanford University, Stanford, California, USA. [2] Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA. [3]
| | - Hongjie Dai
- 1] Stanford University, Stanford, California, USA. [2] Department of Chemistry, Stanford University School of Humanities and Sciences, Stanford, California, USA
| | - Brian J Feldman
- 1] Stanford University, Stanford, California, USA. [2] Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA. [3] Program in Regenerative Medicine, Stanford University, Stanford, California, USA
| |
Collapse
|
14
|
Kuraeva TL, Sechko EA, Eremina IA, Ivanova ON, Prokof’ev SA. MODY3 in the child with type 2 diabetes mellitus phenotype: case report. DIABETES MELLITUS 2013. [DOI: 10.14341/2072-0351-3762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
MODY is a heterogeneous group of diseases that stem from certain genetic mutations and are characterized by beta-cell dysfunction, early clinical onset (before the age of 25) and autosomal dominant inheritance. Nowadays many studies address atypical variants of diabetes mellitus (DM) and consequential problems in differential diagnosis. Though generally patients with MODY have normal body weight, the ongoing spread of obesity will probably produce comorbid forms and thus alter clinical picture. We present a case of DM in a 13-year-old patient that characterizes development of MODY3 in type 2 DM-like phenotype.
Collapse
|
15
|
Redondo MJ, Rodriguez LM, Escalante M, O'Brian Smith E, Balasubramanyam A, Haymond MW. Beta cell function and BMI in ethnically diverse children with newly diagnosed autoimmune type 1 diabetes. Pediatr Diabetes 2012; 13:564-71. [PMID: 22642603 DOI: 10.1111/j.1399-5448.2012.00875.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To examine the relationship between BMI and beta-cell function at diagnosis of autoimmune type 1 diabetes (T1D) in a large group of ethnically diverse children. METHODS Cross-sectional analysis of 524 children (60.8% White, 19.5% Hispanic, 14.5% African-American, 5.2% other non-Hispanic; mean age = 9.8 yr [SD = 2.5]) with newly diagnosed autoimmune T1D. RESULTS As much as 22.2% of children were overweight or obese. Median random serum C-peptide was 0.40 ng/mL (25th-75th percentiles = 0.3-0.8), with median glycemia of 366 mg/dL (25th-75th percentiles = 271-505). Median C-peptide was 0.3, 0.5, 0.7, and 0.85 ng/mL, respectively, in underweight, normal weight, overweight, and obese children (p < 0.0001, Kruskal-Wallis). In the final model (p < 0.0001), the odds of having preserved C-peptide (≥0.6 ng/mL) were increased by 2.4-fold (95% CI = 1.2-4.9, p < 0.015) and 4.1-fold (1.9-8.5, p < 0.0001), respectively, in overweight and obese compared to lean children; 1.3-fold per each year of age; 2.5-fold in girls compared to boys; 4-fold in children who presented without, compared to with, diabetes ketoacidosis (DKA); and decreased by 21% for each point increase in HbA1c. Tanner stage, race/ethnicity, glycemia, and number of anti-islet antibodies expressed were not independently associated with preserved C-peptide. The association between BMI and C-peptide levels was significant in children with and without preserved C-peptide. Excluding patients who presented with DKA and/or using BMI obtained 5 wk after diagnosis did not alter the results. CONCLUSION Obese and overweight children compared to lean children have greater beta-cell function at the onset of autoimmune T1D. Prospective studies on the relationships among BMI, beta-cell function, and progression to clinical T1D are warranted.
Collapse
Affiliation(s)
- Maria J Redondo
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Jordan DN, Jordan JL. Pediatric type 2 diabetes mellitus complications: a systematic review of the literature. ACTA ACUST UNITED AC 2012. [DOI: 10.7243/2050-0866-1-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|