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Bai P, Barkmeier AJ, Hodge DO, Mohney BG. Incidence and sex differences of diabetes among youth: a 50-year population-based cohort study. Acta Diabetol 2024:10.1007/s00592-024-02314-0. [PMID: 38849657 DOI: 10.1007/s00592-024-02314-0] [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: 04/04/2024] [Accepted: 05/26/2024] [Indexed: 06/09/2024]
Abstract
AIMS Although the literature on childhood diabetes has traditionally focused on Type 1 diabetes (T1D), youth-onset Type 2 diabetes (T2D) and its associated morbidities have become increasingly prevalent. This study reports on the incidence and demographics of a population-based cohort of children diagnosed with diabetes over a 50-year period. METHODS Medical records of patients < 22 years diagnosed with diabetes from January 1, 1970, through December 31, 2019, were retrospectively reviewed using the Rochester Epidemiology Project, a database of clinics and hospitals in Olmsted County, Minnesota. RESULTS Of 606 children diagnosed with diabetes, 519 (85.6%) were diagnosed with T1D at a mean age of 10.9 ± 5.3 years. 87 (14.4%) were diagnosed with T2D at a mean age of 17.4 ± 3.4 years. The incidence of T2D increased 23-fold (p < 0.001) over the five-decade period (5 per 100,000 children/year) while T1D remained stable (26 per 100,000 children/year; p = 0.08). The mean body mass index at T2D diagnosis (35.5 kg/m2 ± 10.4) was significantly higher than in T1D (18.9 kg/m2 ± 4.6 [95% CI for difference 14.2-19.0]; p < 0.0001). Sixty-nine percent of children diagnosed with T2D were female, and the hazard ratio of developing diabetic retinopathy in females with T2D compared to males was 6.83 (95% CI 1.53-30.44; p = 0.012). CONCLUSIONS The incidence of youth-onset T2D increased significantly over the 50-year period while the incidence of T1D remained stable. A higher proportion of females were diagnosed with youth-onset T2D. Females with T2D were more than six times likelier to develop diabetic retinopathy than males.
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Affiliation(s)
- Patricia Bai
- Alix School of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Andrew J Barkmeier
- Department of Ophthalmology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - David O Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Brian G Mohney
- Department of Ophthalmology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
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Shapiro ALB, Coughlan C, Bettcher BM, Pauley ME, Kim J, Bjornstad P, Rajic B, Truong J, Bell C, Choi YJ, Walker KA, Potter H, Liese AD, Dabelea D, Whitlow CT. Biomarkers of Neurodegeneration and Alzheimer's Disease Neuropathology in Adolescents and Young Adults with Youth-Onset Type 1 or Type 2 Diabetes: A Proof-of-Concept Study. ENDOCRINES 2024; 5:197-213. [PMID: 38764894 PMCID: PMC11101213 DOI: 10.3390/endocrines5020014] [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] [Indexed: 05/21/2024] Open
Abstract
Adult-onset diabetes increases one's risk of neurodegenerative disease including Alzheimer's disease (AD); however, the risk associated with youth-onset diabetes (Y-DM) remains underexplored. We quantified plasma biomarkers of neurodegeneration and AD in participants with Y-DM from the SEARCH cohort at adolescence and young adulthood (Type 1, n = 25; Type 2, n = 25; 59% female; adolescence, age = 15 y/o [2.6]; adulthood, age = 27.4 y/o [2.2]), comparing them with controls (adolescence, n = 25, age = 14.8 y/o [2.7]; adulthood, n = 21, age = 24.9 y/o [2.8]). Plasma biomarkers, including glial fibrillary acidic protein (GFAP), neurofilament light chain protein (NfL), phosphorylated tau-181 (pTau181), and amyloid beta (Aβ40, Aβ42), were measured via Simoa. A subset of participants (n = 7; age = 27.5 y/o [5.7]) and six controls (age = 25.1 y/o [4.5]) underwent PET scans to quantify brain amyloid and tau densities in AD sensitive brain regions. Y-DM adolescents exhibited lower plasma levels of Aβ40, Aβ42, and GFAP, and higher pTau181 compared to controls (p < 0.05), a pattern persisting into adulthood (p < 0.001). All biomarkers showed significant increases from adolescence to adulthood in Y-DM (p < 0.01), though no significant differences in brain amyloid or tau were noted between Y-DM and controls in adulthood. Preliminary evidence suggests that preclinical AD neuropathology is present in young people with Y-DM, indicating a potential increased risk of neurodegenerative diseases.
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Affiliation(s)
- Allison L. B. Shapiro
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
- Section of Endocrinology, Department of Pediatrics, School of Medicine (SOM), CU-Anschutz, Aurora, CO 80045, USA
| | - Christina Coughlan
- University of Colorado Alzheimer’s and Cognition Center, CU-Anschutz, Aurora, CO 80045, USA
- Department of Neurology, SOM, CU-Anschutz, Aurora, CO 80045, USA
| | | | - Meghan E. Pauley
- Barbara Davis Center for Diabetes, CU-Anschutz, Aurora, CO 80045, USA
| | - Jeongchul Kim
- Radiology Informatics and Image Processing Laboratory, Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Petter Bjornstad
- Section of Endocrinology, Department of Pediatrics, School of Medicine (SOM), CU-Anschutz, Aurora, CO 80045, USA
- Division of Renal Diseases and Hypertension, Department of Medicine, SOM, CU-Anschutz, Aurora, CO 80045, USA
| | - Benjamin Rajic
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
| | - Jennifer Truong
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
| | - Christopher Bell
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
| | - Ye Ji Choi
- Section of Endocrinology, Department of Pediatrics, School of Medicine (SOM), CU-Anschutz, Aurora, CO 80045, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, MD 20814, USA
| | - Huntington Potter
- University of Colorado Alzheimer’s and Cognition Center, CU-Anschutz, Aurora, CO 80045, USA
- Department of Neurology, SOM, CU-Anschutz, Aurora, CO 80045, USA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
| | - Christopher T. Whitlow
- Radiology Informatics and Image Processing Laboratory, Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
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Zainal Abidin Z, Noor E, Mohd Nor NS, Mohamed Nazari NS, Anuar Zaini A, Azizi NZ, Soelar SA, Shahrizad MM, Abdul Halim R. Type 1 Diabetes Mellitus Patients' Self-perception of Periodontal Diseases. Eur J Dent 2024; 18:534-543. [PMID: 38049120 PMCID: PMC11132774 DOI: 10.1055/s-0043-1772777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVES The study aimed to evaluate type 1 diabetes mellitus (T1DM) patients' self-perceived periodontal health status and to identify the association between periodontal disease (PD) and DM. MATERIALS AND METHODS This cross-sectional study included 113 T1DM children between 3 and 18 years old from the Universiti Teknologi MARA and the University of Malaya. Periodontal health parameters, including plaque index, gingival index, probing pocket depth, simplified basic periodontal examination, and clinical attachment loss, were recorded. Self-perceived periodontal health status was assessed with questionnaires. STATISTICAL ANALYSIS Statistical analysis was performed to evaluate the sensitivity of the questionnaire and the relationship between T1DM and periodontal parameters. RESULTS The median age was 11.4 years. Half of them (50.4%) were females. A total of 83.5% rated their oral condition as good, whereas 27.5% reported a history of gingival bleeding. Clinical examination revealed that 48.7% had healthy gingiva, whereas 47.8% had gingivitis. The question "Do you have bleeding when brushing, flossing, or eating food?" showed good accuracy in the evaluation of PD (p < 0.001). CONCLUSION The questionnaire has a high potential to be used by medical professionals in identifying T1DM patients at risk of PD to guide nondental health care providers in making appropriate referrals to dental services.
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Affiliation(s)
- Zaridah Zainal Abidin
- Centre of Paediatric Dentistry and Orthodontics Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Erni Noor
- Centre of Studies for Periodontology, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Noor Shafina Mohd Nor
- Department of Paediatrics, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | | | - Azriyanti Anuar Zaini
- Paediatric Department, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nurul Zeety Azizi
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Aiman Soelar
- Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Marshah Mohamad Shahrizad
- Kuching Division Dental Office, Sarawak State Dental Health Department, Braang Bayur Dental Clinic, Sarawak, Malaysia
| | - Rohaida Abdul Halim
- Centre of Paediatric Dentistry and Orthodontics Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Kubota-Mishra E, Huang X, Minard CG, Astudillo M, Refaey A, Montes G, Sisley S, Ram N, Winter WE, Naylor RN, Balasubramanyam A, Redondo MJ, Tosur M. High Prevalence of A-β+ Ketosis-Prone Diabetes in Children with Type 2 Diabetes and Diabetic Ketoacidosis at Diagnosis: Evidence from the Rare and Atypical Diabetes Network (RADIANT). Pediatr Diabetes 2024; 2024:5907924. [PMID: 38765897 PMCID: PMC11100136 DOI: 10.1155/2024/5907924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background A-β+ ketosis-prone diabetes (KPD) in adults is characterized by presentation with diabetic ketoacidosis (DKA), negative islet autoantibodies, and preserved β-cell function in persons with a phenotype of obesity-associated type 2 diabetes (T2D). The prevalence of KPD has not been evaluated in children. We investigated children with DKA at "T2D" onset and determined the prevalence and characteristics of pediatric A-β+ KPD within this cohort. Methods We reviewed the records of 716 children with T2D at a large academic hospital and compared clinical characteristics of those with and without DKA at onset. In the latter group, we identified patients with A-β+ KPD using criteria of the Rare and Atypical Diabetes Network (RADIANT) and defined its prevalence and characteristics. Results Mean age at diagnosis was 13.7 ± 2.4 years: 63% female; 59% Hispanic, 29% African American, 9% non-Hispanic White, and 3% other. Fifty-six (7.8%) presented with DKA at diagnosis and lacked islet autoantibodies. Children presenting with DKA were older and had lower C-peptide and higher glucose concentrations than those without DKA. Twenty-five children with DKA (45%) met RADIANT A-β+ KPD criteria. They were predominantly male (64%), African American or Hispanic (96%), with substantial C-peptide (1.3 ± 0.7 ng/mL) at presentation with DKA and excellent long-term glycemic control (HbA1c 6.6% ± 1.9% at follow-up (median 1.3 years postdiagnosis)). Conclusions In children with a clinical phenotype of T2D and DKA at diagnosis, approximately half meet criteria for A-β+ KPD. They manifest the key characteristics of obesity, preserved β-cell function, male predominance, and potential to discontinue insulin therapy, similar to adults with A-β+ KPD.
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Affiliation(s)
- Elizabeth Kubota-Mishra
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
| | - Xiaofan Huang
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Charles G. Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Marcela Astudillo
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
| | | | - Graciela Montes
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie Sisley
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
- USDA/ARS Children’s Nutrition Research Center, Houston, TX, USA
| | - Nalini Ram
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
| | - William E. Winter
- Department of Pathology, University of Florida, Gainesville, FL, USA
| | - Rochelle N. Naylor
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, Departments of Pediatric and Medicine, University of Chicago, Chicago, IL, USA
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
| | - Maria J. Redondo
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
| | - Mustafa Tosur
- Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
- USDA/ARS Children’s Nutrition Research Center, Houston, TX, USA
| | - RADIANT Study Group
- The RADIANT Data Coordinating Center, Health Informatics Institute, University of South Florida, Tampa, FL, USA
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Andreae SJ, Reeves H, Casey T, Lindberg A, Pickett KA. A systematic review of diabetes prevention programs adapted to include family members. Prev Med Rep 2024; 39:102655. [PMID: 38390312 PMCID: PMC10882182 DOI: 10.1016/j.pmedr.2024.102655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024] Open
Abstract
Objectives Family-based programs may be a strategy to prevent health conditions with hereditary risk such as diabetes. This review examined the state of the science regarding interventions that adapted the Diabetes Prevention Program (DPP) lifestyle change curriculum to include family members. Methods CINAHL, Cochrane Central, PsycINFO, PubMed, and Scopus were searched for reports that were peer reviewed, written in English, evaluated interventions that adapted the DPP lifestyle change curriculum to be family-based, reported diabetes risk related outcomes, and published between 2002 and August 2023. Records were reviewed, data extracted, and quality assessed by two researchers working independently. A narrative synthesis was completed. Meta-analysis was not completed due to the small number of studies and the heterogeneity of the study characteristics. Results 2177 records were identified with four meeting inclusion criteria. Primary participants for three studies were adults and one study focused on youth. Family participants were adult family members, children of the primary participant, or caregivers of the enrolled youth. For primary participants, two studies found significant intervention effects on weight-related outcomes. Of the studies with no intervention effects, one was a pilot feasibility study that was not powered to detect changes in weight outcomes. Three studies assessed outcomes in family participants with one finding significant intervention effects on weight. Conclusions While DPP interventions adapted to include family showed promising or similar results as individual-based DPP interventions, additional studies are needed to better understand the mechanisms of action and the most effective methods to engage family members in the programs.
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Affiliation(s)
- Susan J Andreae
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
| | - Hailey Reeves
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
| | - Thomas Casey
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna Lindberg
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
| | - Kristen A Pickett
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
- Program in Occupational Therapy, University of Wisconsin-Madison, Madison, WI, United States
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Martemucci G, Fracchiolla G, Muraglia M, Tardugno R, Dibenedetto RS, D’Alessandro AG. Metabolic Syndrome: A Narrative Review from the Oxidative Stress to the Management of Related Diseases. Antioxidants (Basel) 2023; 12:2091. [PMID: 38136211 PMCID: PMC10740837 DOI: 10.3390/antiox12122091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Metabolic syndrome (MS) is a growing disorder affecting thousands of people worldwide, especially in industrialised countries, increasing mortality. Oxidative stress, hyperglycaemia, insulin resistance, inflammation, dysbiosis, abdominal obesity, atherogenic dyslipidaemia and hypertension are important factors linked to MS clusters of different pathologies, such as diabesity, cardiovascular diseases and neurological disorders. All biochemical changes observed in MS, such as dysregulation in the glucose and lipid metabolism, immune response, endothelial cell function and intestinal microbiota, promote pathological bridges between metabolic syndrome, diabesity and cardiovascular and neurodegenerative disorders. This review aims to summarise metabolic syndrome's involvement in diabesity and highlight the link between MS and cardiovascular and neurological diseases. A better understanding of MS could promote a novel strategic approach to reduce MS comorbidities.
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Affiliation(s)
- Giovanni Martemucci
- Department of Agricultural and Environmental Sciences, University of Bari Aldo Moro, 70126 Bari, Italy;
| | - Giuseppe Fracchiolla
- Department of Pharmacy–Drug Sciences, University of Bari Aldo Moro, 70126 Bari, Italy; (M.M.); (R.T.); (R.S.D.)
| | - Marilena Muraglia
- Department of Pharmacy–Drug Sciences, University of Bari Aldo Moro, 70126 Bari, Italy; (M.M.); (R.T.); (R.S.D.)
| | - Roberta Tardugno
- Department of Pharmacy–Drug Sciences, University of Bari Aldo Moro, 70126 Bari, Italy; (M.M.); (R.T.); (R.S.D.)
| | - Roberta Savina Dibenedetto
- Department of Pharmacy–Drug Sciences, University of Bari Aldo Moro, 70126 Bari, Italy; (M.M.); (R.T.); (R.S.D.)
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8
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Belsky N, Tamaroff J, Shoemaker AH. Risk Factors for Progression to Type 2 Diabetes in a Pediatric Prediabetes Clinic Population. J Endocr Soc 2023; 7:bvad118. [PMID: 37841954 PMCID: PMC10569239 DOI: 10.1210/jendso/bvad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Indexed: 10/17/2023] Open
Abstract
Background Pediatric type 2 diabetes (T2D) is increasing in prevalence, yet it is unclear what definition of pediatric prediabetes predicts progression to T2D. Strategies are needed to better identify at risk individuals who could benefit from early intervention. Methods Retrospective chart review of a pediatric prediabetes clinic over 7 years. Inclusion criteria include hemoglobin A1c (HbA1C) and ≥1 glucose from oral glucose tolerance test. Exclusion criteria include type 1 diabetes, maturity onset diabetes of the young, or T2D on initial visit. Results A total of 552 patients were included, 6.5% (n = 36) progressed to T2D over 2.4 ± 1.5 years. At initial visit, T2D progressors had a higher body mass index (38.6 ± 6.5 vs 34.2 ± 8.4 kg/m2, P = .002), HbA1C (6.0 ± 0.3%, vs 5.7± 0.3, P < .001), 2-hour glucose (141 ± 28 vs 114 ± 29 mg/dL, P < .001), and C-peptide (4.8 vs 3.6 ng/mL, P = .001). Fasting glucose was not significantly different. In a multivariable model, male sex (hazard ratio [HR], 2.4; P = .012), initial visit HbA1C (HR, 1.3 per 0.1% increase; P < .001), and 2-hour glucose level (HR, 1.2 per 10 mg/dL increase; P = .014) were all predictive of T2D progression. Patients who progressed to T2D had an increase in body mass index of 4.2 kg/m2 and children consistently taking metformin took longer to progress (43 ± 21 vs 26 ± 16 months; P = .016). Discussion A total of 6.5% of patients with prediabetes developed T2D over a 7-year period. Initial visit laboratory values and weight trajectory may allow for risk stratification, whereas fasting plasma glucose is less helpful. Weight stabilization and metformin therapy could be important interventions for diabetes prevention in children.
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Affiliation(s)
- Natasha Belsky
- Vanderbilt University School of Medicine, Nashville, TN 37212, USA
| | - Jaclyn Tamaroff
- Division of Pediatric Endocrinology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Ashley H Shoemaker
- Division of Pediatric Endocrinology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
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Rodriguez BC, Astudillo M, Tosur M, Rafaey A, McKay S, Bacha F, Balasubramanyam A, Redondo MJ. Characteristics of Type 2 Diabetes in Female and Male Youth. Clin Diabetes 2023; 41:239-243. [PMID: 37092145 PMCID: PMC10115763 DOI: 10.2337/cd22-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The incidence of type 2 diabetes in children is rising and carries a worse prognosis than in adults. The influence of sex on pediatric type 2 diabetes outcomes has not been well investigated. We studied 715 youth with type 2 diabetes diagnosed at a median age of 13.7 years and compared sex differences in demographic, clinical, and laboratory characteristics within the first year of diagnosis. Females diagnosed with type 2 diabetes were younger and at a higher stage of pubertal development than males, yet presented with lower A1Cs, a lower prevalence of diabetic ketoacidosis, and higher HDL cholesterol levels.
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Affiliation(s)
| | - Marcela Astudillo
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Mustafa Tosur
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Ahmad Rafaey
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Siripoom McKay
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Fida Bacha
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
- USDA/ARS Children’s Nutrition Research Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX
| | - Maria J. Redondo
- Division of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
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Somuncu E, Ornek Z, Kardes H, Guven B, Somuncu MU. The relationship between metabolic syndrome criteria and pentraxin-3 levels in children. J Pediatr Endocrinol Metab 2023; 36:865-872. [PMID: 37531149 DOI: 10.1515/jpem-2023-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES While the positive correlation was shown in a few studies which investigated the relationship between obesity and pentraxin-3 (PTX-3) levels, different findings were obtained in other studies. We aimed to determine PTX-3 levels in obese and healthy children, and their relationship with Metabolic Syndrome (MetS) criteria. METHODS 105 children and adolescents were considered as the study population. Participants were divided into three groups; obese and MetS (OM+), obese and non-MetS (OM-) and the control group. Fasting glucose, blood lipids and PTX-3 levels were measured. Ultrasonography was performed to detect hepatic steatosis. MetS and hepatic steatosis were investigated by dividing the patients into two groups according to PTX-3 levels. RESULTS The study population consisted of 37 patients with OM+; 35 patients with OM- and 33 healthy children. OM+ patients had higher fasting insulin (p<0.001), homeostatic model assessment for insulin resistance (p<0.001), triglyceride (p<0.001) and lower high-density lipoprotein (p=0.001). The PTX-3 level was higher in the OM+ group compared to both OM- group and the control group (p=0.002). When two groups were generated according to PTX-3 level, a higher frequency of MetS was detected in the high PTX 3 group than in all three major MetS diagnostic criteria groups. Moreover, there was more hepatic steatosis in the high PTX-3 group independent from obesity and MetS. CONCLUSIONS Higher PTX-3 levels were present in children and adolescent obese patients with MetS.
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Affiliation(s)
- Eda Somuncu
- Department of Pediatrics, Zonguldak Gynecology and Childhood Hospital Zonguldak, Zonguldak, Türkiye
| | - Zuhal Ornek
- Department of Pediatrics, Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Türkiye
| | - Hakan Kardes
- Department of Pediatric Endocrinology, Karadeniz Technical University Farabi Hospital Trabzon, Zonguldak, Türkiye
| | - Berrak Guven
- Department of Biochemistry, Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Türkiye
| | - Mustafa Umut Somuncu
- Department of Cardiology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Türkiye
- Department of Cardiology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
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11
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Hassan S, Gujral UP, Quarells RC, Rhodes EC, Shah MK, Obi J, Lee WH, Shamambo L, Weber MB, Narayan KMV. Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. Lancet Diabetes Endocrinol 2023; 11:509-524. [PMID: 37356445 PMCID: PMC11070656 DOI: 10.1016/s2213-8587(23)00129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/27/2023]
Abstract
Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA.
| | - Unjali P Gujral
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Rakale C Quarells
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Jane Obi
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Wei-Hsuan Lee
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Luwi Shamambo
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Beth Weber
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - K M Venkat Narayan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
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12
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Shoaib M, Ye Q, IglayReger H, Tan MH, Boehnke M, Burant CF, Soleimanpour SA, Gagliano Taliun SA. Evaluation of polygenic risk scores to differentiate between type 1 and type 2 diabetes. Genet Epidemiol 2023; 47:303-313. [PMID: 36821788 PMCID: PMC10202843 DOI: 10.1002/gepi.22521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/11/2023] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
Polygenic risk scores (PRS) quantify the genetic liability to disease and are calculated using an individual's genotype profile and disease-specific genome-wide association study (GWAS) summary statistics. Type 1 (T1D) and type 2 (T2D) diabetes both are determined in part by genetic loci. Correctly differentiating between types of diabetes is crucial for accurate diagnosis and treatment. PRS have the potential to address possible misclassification of T1D and T2D. Here we evaluated PRS models for T1D and T2D in European genetic ancestry participants from the UK Biobank (UKB) and then in the Michigan Genomics Initiative (MGI). Specifically, we investigated the utility of T1D and T2D PRS to discriminate between T1D, T2D, and controls in unrelated UKB individuals of European ancestry. We derived PRS models using external non-UKB GWAS. The T1D PRS model with the best discrimination between T1D cases and controls (area under the receiver operator curve [AUC] = 0.805) also yielded the best discrimination of T1D from T2D cases in the UKB (AUC = 0.792) and separation in MGI (AUC = 0.686). In contrast, the best T2D model did not discriminate between T1D and T2D cases (AUC = 0.527). Our analysis suggests that a T1D PRS model based on independent single nucleotide polymorphisms may help differentiate between T1D, T2D, and controls in individuals of European genetic ancestry.
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Affiliation(s)
- Muhammad Shoaib
- Montreal Heart Institute Research Centre, Montréal, Québec, Canada
- Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Qiang Ye
- Montreal Heart Institute Research Centre, Montréal, Québec, Canada
- Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Heidi IglayReger
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Meng H. Tan
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles F. Burant
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott A. Soleimanpour
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah A. Gagliano Taliun
- Montreal Heart Institute Research Centre, Montréal, Québec, Canada
- Department of Medicine and Department of Neurosciences, Université de Montréal, Montréal, Québec, Canada
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13
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Holtz B, Mitchell K. Supporting Parents of Children With Type 1 Diabetes: Experiment Comparing Message and Delivery Types. JMIR Form Res 2023; 7:e41193. [PMID: 36735338 PMCID: PMC10013681 DOI: 10.2196/41193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is a chronic condition that typically affects young age group people and is estimated to afflict approximately 154,000 people younger than 20 years in the United States. Since T1D typically impacts children, parents must play an active role in helping their child manage the condition. This creates a substantial burden and responsibility for the parents. OBJECTIVE This pilot study sought to find ways to help parents with children with T1D in coping with stresses related to managing and monitoring their child's disease by providing informational support, either about parenting a child with T1D or general parenting messages through different channels. METHODS Parents (N=120) of children with T1D were recruited through an email listserv through local T1D Facebook groups. A total of 102 participants were included in the analysis. We conducted a 2×2 experimental study over an 8-week period to test 2 types of messages (diabetes specific vs general parenting) and the medium in which the messages were delivered (Facebook vs SMS text message). Diabetes behavior, informational support, emotional support, and quality of life were the main outcomes of interest. RESULTS The results suggested that the participants in the diabetes message groups showed improvement in diabetes behaviors (F1,99=3.69; P=.05) and were more satisfied with the intervention (F3,98=4.59; P=.005). There were no differences between message and medium groups on informational support, emotional support, or quality of life. CONCLUSIONS The results of this study demonstrate that the medium-Facebook or SMS text messaging-does not matter for parents' perceptions of social support or quality of life. The diabetes message group reported higher levels of disease management. Finally, the groups with the diabetes support messages were more satisfied than those who received general parenting messages. The findings provide starting guidance for the development of social support interventions for this population.
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Affiliation(s)
- Bree Holtz
- Department of Advertising and Public Relations, College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, United States
| | - Katharine Mitchell
- Department of Advertising and Public Relations, College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, United States
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14
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Brown MC, Hawley C, Ornelas IJ, Huber C, Best L, Thorndike AN, Beresford S, Howard BV, Umans JG, Hager A, Fretts AM. Adapting a cooking, food budgeting and nutrition intervention for a rural community of American Indians with type 2 diabetes in the North-Central United States. HEALTH EDUCATION RESEARCH 2023; 38:13-27. [PMID: 36342521 PMCID: PMC9853931 DOI: 10.1093/her/cyac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 05/24/2023]
Abstract
American Indian (AI) communities experience persistent diabetes-related disparities, yet few nutrition interventions are designed for AI with type 2 diabetes or address socio-contextual barriers to healthy eating. We describe our process of adapting the evidence-based Cooking Matters® program for use by AI adults with type 2 diabetes in a rural and resource-limited setting in the North-Central United States. We conducted three focus groups with AI adults with diabetes to (i) identify Cooking Matters® adaptations and (ii) gather feedback on appropriateness of the adapted intervention using Barrera and Castro's cultural adaptation framework. Transcripts were coded using an inductive, constant comparison approach. Queries of codes were reviewed to identify themes. Contextual considerations included limited access to grocery stores and transportation barriers, reliance on government food assistance and the intergenerational burden of diabetes. Adaptations to content and delivery included incorporating traditional and locally available foods; appealing to children or others in multigenerational households and prioritizing visual over written content. Our use of Barrera and Castro's framework adds rigor and structure to the cultural adaptation process and increases the likelihood of future intervention success. Other researchers may benefit from using this framework to guide the adaptation of evidence-based interventions in AI communities.
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Affiliation(s)
- Meagan C Brown
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA and Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Caitie Hawley
- Department of Medicine, University of Washington, Health Sciences Building, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA
| | - India J Ornelas
- Department of Health Systems and Population Health, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Corrine Huber
- Missouri Breaks Industries Research Inc., 18 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA
| | - Lyle Best
- Missouri Breaks Industries Research Inc., 18 South Willow Street, P.O. Box 1824, Eagle Butte, SD 57625, USA
| | - Anne N Thorndike
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA and Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Shirley Beresford
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Barbara V Howard
- Field Studies Division, Medstar Health Research Institute, 6525 Belcrest Rd #700c, Hyattsville, MD 20782, USA
- Georgetown and Howard Universities Center for Clinical and Translational Science, 4000 Reservoir Rd NW #7, Washington, DC 20057, USA
| | - Jason G Umans
- Georgetown and Howard Universities Center for Clinical and Translational Science, 4000 Reservoir Rd NW #7, Washington, DC 20057, USA
- Field Studies Division and Biomarker, Biochemistry, and Biorepository Core, Medstar Health Research Institute, 6525 Belcrest Rd #700c, Hyattsville, MD 20782, USA
| | - Arlette Hager
- Cheyenne River Sioux Tribe Adult Diabetes Program, 24276 166th St. Airport Road, P.O. Box 590 Eagle Butte, SD 57625, USA
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
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15
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Xie J, Wang M, Long Z, Ning H, Li J, Cao Y, Liao Y, Liu G, Wang F, Pan A. Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: systematic analysis of the Global Burden of Disease Study 2019. BMJ 2022; 379:e072385. [PMID: 36740855 PMCID: PMC9727920 DOI: 10.1136/bmj-2022-072385] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate the global burden of type 2 diabetes in adolescents and young adults (aged 15-39 years) from 1990 to 2019. DESIGN Systematic analysis. DATA SOURCE Global Burden of Disease Study 2019. Participants aged 15-39 years from 204 countries and territories, 1990-2019. MAIN OUTCOMES MEASURES Age standardised incidence rate, age standardised disability adjusted life years (DALY) rate, and age standardised mortality rate for type 2 diabetes in people aged 15-39 years from 1990 to 2019, and proportional DALY attributable to different risk factors. RESULTS From 1990 to 2019, significant increases in age standardised incidence rate and age standardised DALY rate were found for type 2 diabetes in adolescents and young adults globally (P<0.001). Age standardised incidence rate (per 100 000 population) increased from 117.22 (95% confidence interval 117.07 to 117.36) in 1990 to 183.36 (183.21 to 183.51) in 2019, and age standardised DALY rate (per 100 000 population) increased from 106.34 (106.20 to 106.48) in 1990 to 149.61 (149.47 to 149.75) in 2019. The age standardised mortality rate (per 100 000 population) was modestly increased from 0.74 (0.72 to 0.75) in 1990 to 0.77 (0.76 to 0.78) in 2019. When grouped by countries with different sociodemographic indexes, countries with a low-middle and middle sociodemographic index had the highest age standardised incidence rate and age standardised DALY rate in 2019, whereas countries with a low sociodemographic index had the lowest age standardised incidence rate but the highest age standardised mortality rate. Women generally had higher mortality and DALY rates than men at ages <30 years, but differences between the sexes were reversed in those aged >30 years except in countries with a low sociodemographic index. The main attributable risk factor for DALY for early onset type 2 diabetes was high body mass index in all regions by sociodemographic index. The proportional contribution of other risk factors varied across regions, however, with higher proportions of ambient particulate air pollution and smoking in countries with a high sociodemographic index and higher proportions of household air pollution from solid fuels and diet low in fruit in countries with a low sociodemographic index. CONCLUSIONS Early onset type 2 diabetes is a growing global health problem in adolescents and young adults, especially in countries with a low-middle and middle sociodemographic index. A greater disease burden in women aged <30 years was found. Specific measures are needed in countries with different levels of socioeconomic development because of the variable attributable risk factors for type 2 diabetes in adolescents and young adults.
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Affiliation(s)
- Jinchi Xie
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Maoqing Wang
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Zhiping Long
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Hua Ning
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jingkuo Li
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yukun Cao
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yunfei Liao
- Department of Endocrinology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Fan Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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16
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Karavanaki K, Paschou SA, Tentolouris N, Karachaliou F, Soldatou A. Type 2 diabetes in children and adolescents: distinct characteristics and evidence-based management. Endocrine 2022; 78:280-295. [PMID: 36029440 DOI: 10.1007/s12020-022-03172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Since the dramatic rise of obesity prevalence in childhood and adolescence has contributed to increased rates of type 2 diabetes (T2D) in youth, we sought to explore current evidence-based management options for pediatric T2D patients. METHODS A comprehensive literature search was performed for studies of T2D in childhood and adolescence until September 2021. RESULTS Special pathophysiological and diagnostic characteristics of T2D in this age are presented, while the main focus of the article is on management. Lifestyle interventions with healthy diet and exercise are of great importance for the treatment of T2D in children and adolescents. Metformin and insulin remain the traditional therapeutical means, while liraglutide recently gained indication for children older than 10 years both in USA and Europe. Data on the use, efficacy, safety and therapeutic considerations of other pharmacological treatments in children and adolescents with T2D are critically discussed. CONCLUSION Although many new and promising therapeutic strategies have been introduced during recent years for the management of T2D in adults, available therapeutic options for the management of pediatric T2D remain limited.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Obesity Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicholas Tentolouris
- Diabetes Centre, First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laikon" General Hospital, Athens, Greece
| | - Foteini Karachaliou
- Diabetes and Endocrine Clinic, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Obesity Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece.
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17
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Pedicelli S, Fintini D, Ravà L, Inzaghi E, Deodati A, Spreghini MR, Bizzarri C, Mariani M, Cianfarani S, Cappa M, Manco M. Prevalence of prediabetes in children and adolescents by class of obesity. Pediatr Obes 2022; 17:e12900. [PMID: 35144324 PMCID: PMC9286831 DOI: 10.1111/ijpo.12900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND To evaluate prevalence of prediabetes (impaired fasting glucose, IFG; impaired glucose tolerance, IGT; and high glycated haemoglobin, h-HbA1c) in children and adolescents in relation to class of age and obesity; to appraise association with estimates of insulin metabolism, cardiovascular risk factors and alanine aminotransferase (ALT) levels. METHODS Study of marginal prevalence (i.e., as function of sex, age and obesity class) of isolated and combined IFG, IGT and h-HbA1c in children (age 4-9.9 years) and adolescents (age 10-17.9 years) and association to blood pressure (BP), total, HDL and non-HDL cholesterol, triglycerides, ALT and insulin sensitivity/secretion indexes. RESULTS Data of 3110 participants (51% males, 33% children; 33% overweight, 39% obesity class I, 20.5% class II, 7.5% class III) were available. Unadjusted prevalence of prediabetes was 13.9% in children (2.1% IFG, 6.7% IGT, 3.9% h-HbA1c, IFG-IGT 0.06%) and 24.6% in adolescents (3.4% IFG, 9.4% IGT, 5.5% h-HbA1c, IFG-IGT 0.09%). Combined h-HBA1c was found in very few adolescents. Prevalence of prediabetes increased significantly by class of obesity up to 20.5% in children and 31.6% in adolescents. Phenotypes of prediabetes were differently but significantly associated with increased systolic and diastolic BP (by 2-7.3 and ~8 mmHg, respectively), triglycerides (by 23-66 mg/dl), and ALT levels (by 10-22 UI/L) depending on the prediabetes phenotype. CONCLUSION AND RELEVANCE It is worth screening prediabetes in children aged <10 years old with obesity classes II and III and in adolescents. In those with prediabetes, monitoring of blood pressure, triglycerides and ALT levels must be encouraged.
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Affiliation(s)
- Stefania Pedicelli
- Unit of Endocrinology, Dipartimento Pediatrico UniversitarioUniversità di Tor VergataRomeItaly
| | - Danilo Fintini
- Unit of Endocrinology, Dipartimento Pediatrico UniversitarioUniversità di Tor VergataRomeItaly
| | - Lucilla Ravà
- Clinical EpidemiologyBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Elena Inzaghi
- Unit of Endocrinology, Dipartimento Pediatrico UniversitarioUniversità di Tor VergataRomeItaly
| | - Annalisa Deodati
- Unit of Endocrinology, Dipartimento Pediatrico UniversitarioUniversità di Tor VergataRomeItaly
| | - Maria Rita Spreghini
- Unit of Endocrinology, Dipartimento Pediatrico UniversitarioUniversità di Tor VergataRomeItaly
| | - Carla Bizzarri
- Unit of Endocrinology, Dipartimento Pediatrico UniversitarioUniversità di Tor VergataRomeItaly
| | - Michela Mariani
- Unit of Endocrinology, Dipartimento Pediatrico UniversitarioUniversità di Tor VergataRomeItaly
| | - Stefano Cianfarani
- Unit of Endocrinology, Dipartimento Pediatrico UniversitarioUniversità di Tor VergataRomeItaly,Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Marco Cappa
- Unit of Endocrinology, Dipartimento Pediatrico UniversitarioUniversità di Tor VergataRomeItaly
| | - Melania Manco
- Research Area for Multifactorial Diseases and Complex PhenotypesBambino Gesù Children's HospitalRomeItaly
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18
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Sarfo-Kantanka O, Asamoah-Boaheng M, Arthur J, Agyei M, Barnes NA, Tenkorang EY, Midodzi W. Trends in type 1 diabetes diagnosis in Ghana. Int Health 2022; 14:442-446. [PMID: 32050027 PMCID: PMC9248061 DOI: 10.1093/inthealth/ihz096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/26/2019] [Accepted: 09/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite the fact that the rate of type 1 diabetes (T1D) is increasing worldwide, there exists a dearth of information on the disease in most sub-Saharan African countries. The goal of this study was to determine the enrolment trend of T1D using data compiled over 28 y from a teaching hospital in Kumasi, Ghana. METHODS Information collected included sex, age at diagnosis and date of T1D diagnosis. We identified trends from 1992 to 2018, divided into 3 y intervals. RESULTS From 1992 to 2018, 1717 individuals with T1D were enrolled in the diabetes clinic at the Komfo Anokye Teaching Hospital. The male:female ratio was 1:1.2. The number of individuals diagnosed with T1D decreased among the 10-19 y age group during the 1992-1994 period, followed by a progressive increase within the same age group during the subsequent period (from 35.4% in 1995-1997 to 63.2% in 2016-2018). There was a decline in the proportion of children 0-9 y of age diagnosed during the study period (from 5.1% in 1992-1994 to 3.6% in 2016-2018). CONCLUSIONS In our study population, a decreasing trend of T1D enrolments was observed in general while among adolescents an increasing trend was observed.
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Affiliation(s)
- Osei Sarfo-Kantanka
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana
| | - Michael Asamoah-Boaheng
- Faculty of Medicine, Clinical Epidemiology Unit, Memorial University of Newfoundland, St John’s, NL, Canada
| | - Joshua Arthur
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Martin Agyei
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nana Ama Barnes
- Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St Johns, NL, Canada
| | - William Midodzi
- Faculty of Medicine, Clinical Epidemiology Unit, Memorial University of Newfoundland, St John’s, NL, Canada
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19
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Vinker-Shuster M, Eldor R, Green I, Golan-Cohen A, Manor I, Merzon E. Glycemic Control and Diabetes Related Complications in Adults with Type 1 Diabetes Mellitus and ADHD. J Atten Disord 2022; 26:1235-1244. [PMID: 34933573 DOI: 10.1177/10870547211068039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the correlation of co-morbid ADHD and diabetes-related complications in patients with type-1-diabetes-mellitus (T1DM). METHODS A retrospective cross-sectional study was conducted during 2018 using the Leumit-Health-Services(LHS) database. Diabetes-related complications were assessed in patients with T1DM and ADHD (T1DM-ADHD+) and compared with patients with T1DM alone (T1DM-ADHD-). RESULTS Out of 789 adult-patients with T1DM, 75 (9.5%) were T1DM-ADHD+, matched to 225 T1DM-ADHD-. HbA1C levels were higher in T1DM-ADHD+ patients (8.1% ± 1.6 vs. 7.4% ± 1.2, p < .01), as well as diabetes-related complications: neuropathy (22.7% vs. 5.8%, p < .01), ulcers (8% vs. 0.9%, p < .05), limb amputation (5.3% vs. 0.9%, p < .05), albuminuria (15.5% vs. 2.8%, p < .01), chronic renal failure (10.6% vs. 2.5%, p = .01), and emergency room admissions rate (26.7% vs. 15.1%, p < .05). In sub-analysis, lower average HbA1C levels and diabetic ulcer rates were found among ADHD patients treated with stimulants, all p < .05. CONCLUSION Co-morbidity of ADHD and T1DM is associated with poor glycemic control and higher complication rates.
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Affiliation(s)
| | - Roy Eldor
- Tel Aviv Sourasky Medical Center, Israel.,The Sackler Faculty of Medicine Tel Aviv University, Israel
| | - Ilan Green
- Leumit HMO, Tel Aviv, Israel.,Tel Aviv University, Israel
| | | | - Iris Manor
- The Sackler Faculty of Medicine Tel Aviv University, Israel.,Geha MHC, Petah Tikva, Israel.,Clalit Health Services, Tel Aviv, Israel
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20
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Patton SR, Pierce JS, Fox L, Benson M, Mc Donough R, Clements MA. Remedy to Diabetes Distress (R2D2): Development protocol for a scalable screen-to-treat program for families of school-age children. Contemp Clin Trials 2022; 119:106829. [PMID: 35716992 DOI: 10.1016/j.cct.2022.106829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND School-age children with type 1 diabetes (T1D) need help from parents or other adult caregivers (caregivers) to effectively manage T1D, resulting in greater vulnerability to Diabetes Distress (DD) for both children and caregivers. Unfortunately, there are no scalable screen-to-treat programs for clinics to adopt to identify and treat DD in school-age families. METHODS AND ANALYSES We aim to design a scalable, clinic-based screen-to-treat program for DD in families of school-age children and to test whether our new program to reduce caregiver and child DD also reduces child glycemic levels. Our Remedy to Diabetes Distress (R2D2) program will target caregivers and children with T1D who are between 8 and 12 years old. It will merge routine and automated surveillance of DD in the clinical setting with at home digital delivery of a theory-based behavioral and psychological treatment of DD. We will use the ORBIT Model for Behavioral Intervention development to guide four small and cost-effective formative studies to develop our R2D2 program and assess initial treatment effects. In tandem, we will implement clinic-based DD screening in school-age families and assess feasibility and acceptability of our screening platform as a Quality Improvement activity. The study started in September 2020 and is scheduled to conclude in 2025. CONCLUSIONS The study will use a single Institutional Review Board (IRB) with Children's Mercy-Kansas City operating as the IRB of record. We will disseminate study results through presentations at scientific conferences and through peer-reviewed journals read by the psychology and diabetes care communities.
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Affiliation(s)
- Susana R Patton
- Nemours Children's Health-Jacksonville, 807 Children's Way, Jacksonville, FL 32207, United States of America.
| | - Jessica S Pierce
- Nemours Children's Health-Florida, 6900 Lake Nona Blvd, Orlando, FL 32827, United States of America.
| | - Larry Fox
- Nemours Children's Health-Jacksonville, 807 Children's Way, Jacksonville, FL 32207, United States of America.
| | - Matthew Benson
- Nemours Children's Health-Jacksonville, 807 Children's Way, Jacksonville, FL 32207, United States of America.
| | - Ryan Mc Donough
- Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States of America.
| | - Mark A Clements
- Children's Mercy-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States of America.
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21
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Nieto T, Castillo B, Nieto J, Redondo MJ. Demographic and diagnostic markers in new onset pediatric type 1 and type 2 diabetes: differences and overlaps. Ann Pediatr Endocrinol Metab 2022; 27:121-125. [PMID: 34634866 PMCID: PMC9260368 DOI: 10.6065/apem.2142170.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Type 1 diabetes (T1D) is the most common type of diabetes in children, but the frequency of type 2 diabetes (T2D) is increasing rapidly. Classification of diabetes is based on a constellation of features that vary by type. We aimed to compare demographic, clinical, and laboratory characteristics at diagnosis of pediatric T1D and T2D. METHODS We studied children who visited a large academic hospital in Houston, Texas (USA) with a new diagnosis of T2D (n=753) or T1D (n=758). We compared age, sex, race/ethnicity, presence of obesity, glucose, hemoglobin A1c, islet autoantibody positivity, C-peptide, and presence of diabetic ketoacidosis (DKA) at diabetes diagnosis. RESULTS At diagnosis, children with T2D, compared with those with T1D, were older (13.6 years vs. 9.7 years), more likely female (63.2% vs. 47.8%), of racial/ethnic minority (91.1% vs. 42.3%), and obese (90.9% vs. 19.4%) and were less likely to have DKA (7.8% vs. 35.0%) and diabetes autoantibodies (5.5% vs. 95.4%). Children with T2D also had significantly lower glucose, lower hemoglobin A1c and lower C-peptide level (all comparisons, p<0.0001). In multiple logistic regression analysis, older age, racial/ethnic minority, obesity, higher C-peptide, and negative islet autoantibodies were independently associated with T2D (all, p<0.05), while sex, glucose, hemoglobin A1c, and DKA were not (model p<0.0001). CONCLUSION There are important demographic, clinical, and laboratory differences between T1D and T2D in children. However, none of the characteristics were unique to either diabetes type, which poses challenges to diabetes classification at diagnosis.
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Affiliation(s)
| | - Beatriz Castillo
- Baylor College of Medicine, School of Medicine, Houston, TX, USA
| | | | - Maria J. Redondo
- Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA,Address for correspondence: Maria J. Redondo Texas Children’s Hospital. Diabetes and Endocrinology. 6701 Fannin St. MWT 10th floor. Houston, TX 77030. USA
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22
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Pastor-Fajardo MT, Fajardo-Giménez MT, Bosch-Giménez VM, Pastor-Rosado J. Changes from 1986 to 2018 in the prevalence of obesity and overweight, metabolic control and treatment in children with type 1 diabetes mellitus in a Mediterranean area of Southeast Spain. BMC Pediatr 2022; 22:274. [PMID: 35549683 PMCID: PMC9097405 DOI: 10.1186/s12887-022-03330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background In recent decades, a global increase in the prevalence of childhood overweight and obesity has been observed in children and adolescents with type 1 diabetes. Methods This retrospective, cross-sectional, population study examined three groups (1986, 2007, and 2018) of children and adolescents aged < 16 years diagnosed with type 1 diabetes. Overweight and obesity were defined according to the World Health Organization recommendations. Results The prevalence of overweight and obesity in diabetic children and adolescents was 30.2% (95% CI: 23.1–38.3). There was a significant increase from 1986 to 2007 (11.9% to 41.7%, p = 0.002) and from 1986 to 2018 (11.9% to 34.8%, p = 0.012), but no significant differences were found from 2007 to 2018 (41.7% to 34.8%, p = 0.492). The age at diagnosis was lower in the group with excess body mass (p = 0.037). No significant differences were observed in age (p = 0.690), duration of diabetes (p = 0.163), distribution according to sex (p = 0.452), metabolic control (HbA1c, p = 0.909), or insulin units kg/day (p = 0.566), between diabetic patients with overweight or obesity and those with normal weight. From 2007 to 2018, the use of insulin analogs (p = 0.009) and a higher number of insulin doses (p = 0.007) increased significantly, with no increase in the prevalence of overweight and obesity. Conclusions The prevalence of overweight and obesity in diabetic children and adolescents increased in the 1990s and the beginning of the twenty-first century, with stabilization in the last decade. Metabolic control and DM1 treatment showed no association with this trend.
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Affiliation(s)
| | | | | | - José Pastor-Rosado
- Department of Pediatrics, Hospital General Universitario de Elche, Elche, Spain
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23
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Galderisi A, Perilongo G, Caprio S, Da Dalt L, Di Salvo G, Gatta M, Giaquinto C, Rizzuto R, Robb A, Sly PD, Simonelli A, Staiano A, Vettor R, Baraldi E. Pediatric Preventive Care in Middle-High Resource Countries-The Padova Chart for Health in Children. Front Pediatr 2022; 10:803323. [PMID: 35498805 PMCID: PMC9047691 DOI: 10.3389/fped.2022.803323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Importance The Padova Chart for Health in Children (PCHC) aims to gather the evidence of healthcare promotion and protection for chidren and adolescents (i.e., aged <18 y) into a single document in order to guide families, healthcare providers and social actors on healthy choices. No more than 2% of Europeans and North Americans aged <30 y have a healthy lifestyle. This, together with metabolic and brain plasticity during childhood, creates the ideal opportunity to implement preventive strategies. Guided interventions promoting healthy lifestyle in children and families therefore have a key role in abating the unprecedented pandemic of non-communicable diseases (NCDs) in adulthood. Observations The PCHC is divided into four sections: nutrition, cardiovascular health, respiratory health, and mental and social health. Each section is structured in an ALICE approach (assessment, lobbying, intervention, call-for-action, evaluation): assessment of necessity, describing relevance to healthcare; lobbying to identify those who can effect the proposed interventions; interventions involving family, school and peers; a call-for-action to define priorities among the proposed interventions; and objective evaluation measures that can be applied on a population basis. Conclusions and Relevance Interventions promoting health in childhood require joint action from multiple institutional, local and family representatives, with the shared goal of promoting health across the entire age group. These lifestyle interventions have the potential to change the lifetime risk trajectory for NCDs.
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Affiliation(s)
- Alfonso Galderisi
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Giorgio Perilongo
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Sonia Caprio
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Liviana Da Dalt
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Giovanni Di Salvo
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Michela Gatta
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Carlo Giaquinto
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
| | - Rosario Rizzuto
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Adelaide Robb
- Division of Psychiatry and Behavioral Sciences, Children's National Hospital, Washington, DC, United States
| | - Peter David Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University Federico II, Naples, Italy
| | - Roberto Vettor
- Department of Medicine, University Hospital of Padova, Padova, Italy
| | - Eugenio Baraldi
- Department of Woman and Child's Health, University Hospital of Padova, Padova, Italy
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24
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Jackson S, Creo A, Al Nofal A. Management of Type 1 Diabetes in Children in the Outpatient Setting. Pediatr Rev 2022; 43:160-170. [PMID: 35229106 DOI: 10.1542/pir.2020-001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Sarah Jackson
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine
| | - Ana Creo
- Division of Pediatric Endocrinology and Metabolism and Division of Endocrinology, Mayo Clinic, Rochester, MN
| | - Alaa Al Nofal
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Vermillion, SD
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25
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Syed S, Yassin SM, Almalki AY, Ali SAA, Alqarni AMM, Moadi YM, Alkhaldi AM, Alqahtani NM, Hosmani J, Heboyan A, Patil S. Structural Changes in Primary Teeth of Diabetic Children: Composition and Ultrastructure Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030317. [PMID: 35327689 PMCID: PMC8946940 DOI: 10.3390/children9030317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 12/30/2022]
Abstract
Diabetes affects the developing enamel by altering the mineralization process, which can have a detrimental effect on oral health. The objectives of this study were to examine the ultrastructure and composition of surface enamel in primary teeth of diabetic children and its clinical implications. Hundred extracted primary teeth from diabetic children (Test group: n = 50) and healthy children (Control group: n = 50), between 6 and 12 years of age, were subjected to scanning electron microscopy to qualitatively examine the enamel surface. Energy dispersive X-ray (EDX) analysis was performed to investigate the mass percentage of calcium (Ca) and phosphorous (P) in the surface enamel. Ultrastructural aberrations of surface enamel were observed in the test group teeth. Additionally, prism perforations were seen at the junction of rod and inter-rod enamel and the prisms were loosely packed. An even aprismatic layer of surface enamel was evident in the control group teeth. There was a statistically significant difference (p < 0.05) of Ca and P mass percentage between the test and control group teeth. The mean mass percentage rates of Ca and P were 33.75% and 16.76%, respectively. A poor surface characteristic and elemental composition of the enamel surface of primary teeth is observed in diabetic children. Therefore, appropriate caries preventive measures are mandatory to maintain the structural integrity of the tooth in these patients.
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Affiliation(s)
- Sadatullah Syed
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 61471, Saudi Arabia; (S.A.A.A.); (J.H.)
- Correspondence: (S.S.); (S.P.)
| | - Syed M. Yassin
- Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha 61471, Saudi Arabia; (S.M.Y.); (A.M.M.A.); (Y.M.M.); (A.M.A.)
| | - Abdulrahman Yahya Almalki
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan 25412, Saudi Arabia;
| | - Salma Abubaker Abbas Ali
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 61471, Saudi Arabia; (S.A.A.A.); (J.H.)
| | - Abdulaziz M. Maken Alqarni
- Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha 61471, Saudi Arabia; (S.M.Y.); (A.M.M.A.); (Y.M.M.); (A.M.A.)
| | - Yousef M. Moadi
- Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha 61471, Saudi Arabia; (S.M.Y.); (A.M.M.A.); (Y.M.M.); (A.M.A.)
| | - Abdulrahman Masoud Alkhaldi
- Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha 61471, Saudi Arabia; (S.M.Y.); (A.M.M.A.); (Y.M.M.); (A.M.A.)
| | - Nasser M. Alqahtani
- Department of Prosthodontics, College of Dentistry, King Khalid University, Abha 61471, Saudi Arabia;
| | - Jagadish Hosmani
- Department of Diagnostic Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 61471, Saudi Arabia; (S.A.A.A.); (J.H.)
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan 0025, Armenia;
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia
- Correspondence: (S.S.); (S.P.)
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26
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Kazemi M, Kim JY, Wan C, Xiong JD, Parry SA, Azziz R, Lujan ME. Comprehensive evaluation of disparities in cardiometabolic and reproductive risk between Hispanic and White women with polycystic ovary syndrome in the United States: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 226:187-204.e15. [PMID: 34384776 DOI: 10.1016/j.ajog.2021.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/17/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to comprehensively compare cardiometabolic and reproductive health risk between Hispanic and White women with polycystic ovary syndrome in the United States in response to the call by the international guideline for polycystic ovary syndrome to delineate health disparities. DATA SOURCES Databases of MEDLINE, Web of Science, and Scopus were initially searched through October 25, 2020, and confirmed on February 1, 2021. STUDY ELIGIBILITY CRITERIA Observational studies comparing glucoregulatory, lipid profile, anthropometric, blood pressure, androgen, ovarian morphology, oligoanovulation, and infertility status between Hispanic and White women with polycystic ovary syndrome were included. The primary outcome was metabolic syndrome risk. Furthermore, major cardiovascular events (stroke, coronary heart disease, and heart failure) and mortality rate (cardiovascular death and total mortality) data were evaluated. Studies on adolescents (<2 years after menarche), pregnant, or menopausal-aged women (>50 years) were excluded. METHODS Data were pooled by random-effects models and expressed as mean differences and 95% confidence intervals. Risk of bias was assessed by the Newcastle-Ottawa Scale. RESULTS A total of 11 studies (n=2267; 589 Hispanic and 1678 White women) were eligible. All studies, including both White and Hispanic women, had high-quality assessment (Newcastle-Ottawa Scale score of ≥8). Hispanic women exhibited comparable metabolic syndrome prevalence (7% [95% confidence interval, -1 to 14]; P=.06; I2=0%); however, Hispanic women exhibited higher modified Ferriman-Gallwey score (0.60 [95% confidence interval, -0.01 to 1.21]; P=.05; I2=0%), fasting insulin (5.48 μIU/mL [95% confidence interval, 3.11-7.85]; P≤.01; I2=40.0%), and homeostatic model assessment of insulin resistance (1.20 [95% confidence interval, 0.50-1.89]; P≤.01; I2=43.0%) than White women. The 2 groups had comparable glucose, lipid profile, waist circumference, blood pressure, and androgen status (all P≥.08). Findings about group differences in certain reproductive outcomes (ie, ovarian dysmorphology and infertility) were contradictory and described only narratively as inclusion in the meta-analyses was not possible. No study reported on cardiovascular events or mortality. CONCLUSION Hispanic women with polycystic ovary syndrome exhibited greater impairments in glucoregulatory status than White women. Disparities in reproductive risks could not be concluded. The degree to which glucoregulatory aberrations translate into patient-pressing diseases (diabetes mellitus and infertility) remains a major roadblock given the paucity of available evidence. Our observations have supported the consideration of these disparities in the diagnostic, monitoring, and management practices for polycystic ovary syndrome and reinforced the need to elucidate mechanisms that account for the observed disparities to foster equity in polycystic ovary syndrome care.
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Affiliation(s)
- Maryam Kazemi
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Joy Y Kim
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Cynthia Wan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Julia D Xiong
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Stephen A Parry
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY
| | - Ricardo Azziz
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL; Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY
| | - Marla E Lujan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Cornell University, Ithaca, NY.
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27
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Kahkoska AR, Sarteau AC, Igudesman D, Reboussin BA, Dabelea D, Dolan LM, Jensen E, Wadwa RP, Pihoker C, Mayer-Davis EJ. Association of Insulin Regimen and Estimated Body Fat Over Time among Youths and Young Adults with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study. J Diabetes Res 2022; 2022:1054042. [PMID: 35127949 PMCID: PMC8816579 DOI: 10.1155/2022/1054042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
AIMS To explore how changes in insulin regimen are associated with estimated adiposity over time among youths and young adults with type 1 diabetes and whether any associations differ according to sex. MATERIALS AND METHODS Longitudinal data were analyzed from youths and young adults with type 1 diabetes in the SEARCH for Diabetes in Youth study. Participants were classified according to insulin regimen categorized as exclusive pump ("pump only"), exclusive injections ("injections only"), injection-pump transition ("injections-pump"), or pump-injection transition ("pump-injections") for each follow-up visit completed. Estimated body fat percentage (eBFP) was calculated using validated equations. Sex-specific, linear mixed effects models examined the relationship between the insulin regimen group and change in eBFP during follow-up, adjusted for baseline eBFP, baseline insulin regimen, time-varying insulin dose, sociodemographic factors, and baseline HbA1c (≥9.0% vs. <9.0%). RESULTS The final sample included 284 females and 304 males, of whom 80% were non-Hispanic white with mean diagnosis age of 12.7 ± 2.4 years. In fully adjusted models for females, exclusive pump use over the study duration was associated with significantly greater increases in eBFP compared to exclusive use of injections (difference in rate of change = 0.023% increase per month, 95%CI = 0.01, 0.04). Injection-to-pump transitions and pump-to-injection transitions were also associated with greater increases in eBFP compared to exclusive use of injections (difference in rate of change = 0.02%, 95%CI = 0.004, 0.03, and 0.02%; 95%CI = 0.0001, 0.04, respectively). There was no relationship between the insulin regimen and eBFP among males. CONCLUSIONS Among females with type 1 diabetes, exclusive and partial pump use may have the unintended consequence of increasing adiposity over time compared to exclusive use of injections, independent of insulin dose.
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Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Lawrence M. Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - R. Paul Wadwa
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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28
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Kahkoska AR, Pokaprakarn T, Alexander GR, Crume TL, Dabelea D, Divers J, Dolan LM, Jensen ET, Lawrence JM, Marcovina S, Mottl AK, Pihoker C, Saydah SH, Kosorok MR, Mayer-Davis EJ. The Impact of Racial and Ethnic Health Disparities in Diabetes Management on Clinical Outcomes: A Reinforcement Learning Analysis of Health Inequity Among Youth and Young Adults in the SEARCH for Diabetes in Youth Study. Diabetes Care 2022; 45:108-118. [PMID: 34728528 PMCID: PMC8753766 DOI: 10.2337/dc21-0496] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate difference in population-level glycemic control and the emergence of diabetes complications given a theoretical scenario in which non-White youth and young adults (YYA) with type 1 diabetes (T1D) receive and follow an equivalent distribution of diabetes treatment regimens as non-Hispanic White YYA. RESEARCH DESIGN AND METHODS Longitudinal data from YYA diagnosed 2002-2005 in the SEARCH for Diabetes in Youth Study were analyzed. Based on self-reported race/ethnicity, YYA were classified as non-White race or Hispanic ethnicity (non-White subgroup) versus non-Hispanic White race (White subgroup). In the White versus non-White subgroups, the propensity score models estimated treatment regimens, including patterns of insulin modality, self-monitored glucose frequency, and continuous glucose monitoring use. An analysis based on policy evaluation techniques in reinforcement learning estimated the effect of each treatment regimen on mean hemoglobin A1c (HbA1c) and the prevalence of diabetes complications for non-White YYA. RESULTS The study included 978 YYA. The sample was 47.5% female and 77.5% non-Hispanic White, with a mean age of 12.8 ± 2.4 years at diagnosis. The estimated population mean of longitudinal average HbA1c over visits was 9.2% and 8.2% for the non-White and White subgroup, respectively (difference of 0.9%). Within the non-White subgroup, mean HbA1c across visits was estimated to decrease by 0.33% (95% CI -0.45, -0.21) if these YYA received the distribution of diabetes treatment regimens of the White subgroup, explaining ∼35% of the estimated difference between the two subgroups. The non-White subgroup was also estimated to have a lower risk of developing diabetic retinopathy, diabetic kidney disease, and peripheral neuropathy with the White youth treatment regimen distribution (P < 0.05), although the low proportion of YYA who developed complications limited statistical power for risk estimations. CONCLUSIONS Mathematically modeling an equalized distribution of T1D self-management tools and technology accounted for part of but not all disparities in glycemic control between non-White and White YYA, underscoring the complexity of race and ethnicity-based health inequity.
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Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Teeranan Pokaprakarn
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - G. Rumay Alexander
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tessa L. Crume
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | - Jasmin Divers
- Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, NY
| | - Lawrence M. Dolan
- Division of Endocrinology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Santica Marcovina
- Department of Medicine, Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA
| | - Amy K. Mottl
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Sharon H. Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Albanese-O'Neill A, Grimsmann JM, Svensson AM, Miller KM, Raile K, Akesson K, Calhoun P, Biesenbach B, Eeg-Olofsson K, Holl RW, Maahs DM, Hanas R. Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective. Diabetes Technol Ther 2022; 24:32-41. [PMID: 34524026 DOI: 10.1089/dia.2021.0225] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants ≥25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives.
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Affiliation(s)
| | - Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Ann-Marie Svensson
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetes, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Akesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Beate Biesenbach
- Department of Pediatrics, University Hospital Linz, Kepler University, Linz, Austria
| | - Katarina Eeg-Olofsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - David M Maahs
- Division of Pediatric Endocrinology, Stanford Diabetes Research Center, Stanford, California, USA
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California, USA
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Child ST, Ruppel EH, Albert MA, Lawton L. Network Support and Negative Life Events Associated With Chronic Cardiometabolic Disease Outcomes. Am J Prev Med 2022; 62:e21-e28. [PMID: 34670683 PMCID: PMC9238305 DOI: 10.1016/j.amepre.2021.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Stress from negative life events may be an important risk factor for chronic cardiometabolic conditions, which are increasingly prevalent among young adults. Support from personal networks is known to buffer stress from negative life events. Yet, evidence for these relationships among both young and older adults remains unclear. METHODS Longitudinal data came from the University of California, Berkeley Social Networks Study (2015-2018), which followed young (aged 21-30 years) and late middle-aged (aged 50-70 years) adults over 4 years. Weighted hybrid fixed and random effects models (completed in 2020) were used to examine the causal relationships among 4 negative life events, distinct forms of network support (e.g., social companionship, emergency help), and self-reported chronic cardiometabolic disease outcomes (i.e., hypertension, diabetes, or a heart condition). RESULTS Among young adults, both the death of a close tie (average marginal effect=0.10, p<0.001) and financial difficulties (average marginal effect=0.07, p<0.05) were associated with a higher probability of chronic cardiometabolic outcomes. Higher numbers of confidants (average marginal effect= -0.03, p<0.01) and practical helpers (average marginal effect= -0.02, p<0.01) were associated with a lower probability of chronic cardiometabolic outcomes, whereas higher numbers of social companions were associated with a higher probability of having chronic cardiometabolic outcomes among young adults (average marginal effect=0.02, p<0.01). CONCLUSIONS Negative life events may be important risk factors for chronic cardiometabolic disease outcomes, particularly among young adults. Although there is no evidence of network support mediating the effects of negative life events, increases in network support were directly associated with chronic cardiometabolic outcomes.
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Affiliation(s)
- Stephanie T Child
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;.
| | - Emily H Ruppel
- Berkeley Sociology, University of California, Berkeley, Berkeley, California
| | - Michelle A Albert
- UCSF School of Medicine, University of California San Francisco, San Francisco, California
| | - Leora Lawton
- Berkeley Demography, University of California, Berkeley, Berkeley, California
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Impact of Age on Emergency Resource Utilization and Outcomes in Pediatric and Young Adult Patients Supported with a Ventricular Assist Device. ASAIO J 2021; 68:1074-1082. [PMID: 34743138 PMCID: PMC9061895 DOI: 10.1097/mat.0000000000001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
There are minimal data describing outcomes in ambulatory pediatric and young adult ventricular assist device (VAD)-supported patient populations. We performed a retrospective analysis of encounter-level data from 2006 to 2017 Nationwide Emergency Department Sample (NEDS) to compare emergency department (ED) resource utilization and outcomes for pediatric (≤18 years, n = 494) to young adult (19-29 years, n = 2,074) VAD-supported patient encounters. Pediatric encounters were more likely to have a history of congenital heart disease (11.3% vs. 4.8%). However, Pediatric encounters had lower admission/transfer rates (37.8% vs. 57.8%) and median charges ($3,334 (IQR $1,473-$19,818) vs. $13,673 ($3,331-$45,884)) (all p < 0.05). Multivariable logistic regression modeling revealed that age itself was not a predictor of admission, instead high acuity primary diagnoses and medical complexity were: (adjusted odds ratio; 95% confidence intervals): cardiac (3.0; 1.6-5.4), infection (3.4; 1.7-6.5), bleeding (3.9; 1.7-8.8), device complication (7.2; 2.7-18.9), and ≥1 chronic comorbidity (4.1; 2.5-6.7). In this largest study to date describing ED resource use and outcomes for pediatric and young adult VAD-supported patients, we found that, rather than age, high acuity presentations and comorbidities were primary drivers of clinical outcomes. Thus, reducing morbidity in this population should target comorbidities and early recognition of VAD-related complications.
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Astudillo M, Tosur M, Castillo B, Rafaey A, Siller AF, Nieto J, Sisley S, McKay S, Nella AA, Balasubramanyam A, Bacha F, Redondo MJ. Type 2 diabetes in prepubertal children. Pediatr Diabetes 2021; 22:946-950. [PMID: 34363430 DOI: 10.1111/pedi.13254] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Puberty-induced insulin resistance is considered critical in the pathogenesis of type 2 diabetes (T2D) in youth. The development of T2D before puberty suggests distinct risk factors and pathophysiology but, because of its rarity, this has not been well studied. We aimed to describe the clinical characteristics of children with T2D diagnosed before the onset of puberty. RESEARCH DESIGN AND METHODS We retrospectively studied all children with autoantibody-negative T2D and available pubertal development assessment seen at our center between July 2016 and July 2019, and compared characteristics of those at Tanner stage I (prepubertal, n = 35) versus those at Tanner II-V of pubertal development (n = 341). RESULTS At T2D diagnosis, prepubertal children compared with those at Tanner II-V had higher body mass index z-score (p = 0.003) and higher C-peptide (p = 0.003) (while glucose levels were not significantly different), with differences retaining significance after adjustment for glucose, race/ethnicity and sex. Dyslipidemia occurred in 100% of prepubertal children versus 89.7% of those diagnosed later (p = 0.036). Of the prepubertal children diagnosed under age 10 (n = 13), 69.2% were female, 100% racial/ethnic minority, 100% had obesity with history of dyslipidemia and none with diabetic ketoacidosis. CONCLUSIONS T2D, although rarely, can develop before puberty. Children with T2D diagnosed in the prepubertal period have more severe obesity, greater insulin resistance, and more frequent dyslipidemia than older youth. These findings suggest that children with prepubertal T2D are at increased risk for associated morbidity compared with older youth and underscore the significance of interventions to prevent and treat obesity in early childhood.
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Affiliation(s)
- Marcela Astudillo
- Diabetes and Endocrinology Section, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Mustafa Tosur
- Diabetes and Endocrinology Section, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Beatriz Castillo
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ahmad Rafaey
- College of Natural Sciences and Mathematics, University of Houston, Houston, Texas, USA
| | - Alejandro F Siller
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Jacobo Nieto
- Undergraduate School, Rice University, Houston, Texas, USA
| | - Stephanie Sisley
- Diabetes and Endocrinology Section, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
- Children's Nutrition Research Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Siripoom McKay
- Diabetes and Endocrinology Section, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Aikaterini A Nella
- Diabetes and Endocrinology Section, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology, and Metabolism, Baylor College of Medicine, Houston, Texas, USA
| | - Fida Bacha
- Children's Nutrition Research Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Maria J Redondo
- Diabetes and Endocrinology Section, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Moon SJ, Jung I, Park CY. Current Advances of Artificial Pancreas Systems: A Comprehensive Review of the Clinical Evidence. Diabetes Metab J 2021; 45:813-839. [PMID: 34847641 PMCID: PMC8640161 DOI: 10.4093/dmj.2021.0177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022] Open
Abstract
Since Banting and Best isolated insulin in the 1920s, dramatic progress has been made in the treatment of type 1 diabetes mellitus (T1DM). However, dose titration and timely injection to maintain optimal glycemic control are often challenging for T1DM patients and their families because they require frequent blood glucose checks. In recent years, technological advances in insulin pumps and continuous glucose monitoring systems have created paradigm shifts in T1DM care that are being extended to develop artificial pancreas systems (APSs). Numerous studies that demonstrate the superiority of glycemic control offered by APSs over those offered by conventional treatment are still being published, and rapid commercialization and use in actual practice have already begun. Given this rapid development, keeping up with the latest knowledge in an organized way is confusing for both patients and medical staff. Herein, we explore the history, clinical evidence, and current state of APSs, focusing on various development groups and the commercialization status. We also discuss APS development in groups outside the usual T1DM patients and the administration of adjunct agents, such as amylin analogues, in APSs.
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Affiliation(s)
- Sun Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Inha Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Amatruda M, Gembillo G, Giuffrida AE, Santoro D, Conti G. The Aggressive Diabetic Kidney Disease in Youth-Onset Type 2 Diabetes: Pathogenetic Mechanisms and Potential Therapies. ACTA ACUST UNITED AC 2021; 57:medicina57090868. [PMID: 34577791 PMCID: PMC8467670 DOI: 10.3390/medicina57090868] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 02/07/2023]
Abstract
Youth-onset Type 2 Diabetes Mellitus (T2DM) represents a major burden worldwide. In the last decades, the prevalence of T2DM became higher than that of Type 1 Diabetes Mellitus (T1DM), helped by the increasing rate of childhood obesity. The highest prevalence rates of youth-onset T2DM are recorded in China (520 cases/100,000) and in the United States (212 cases/100,000), and the numbers are still increasing. T2DM young people present a strong hereditary component, often unmasked by social and environmental risk factors. These patients are affected by multiple coexisting risk factors, including obesity, hyperglycemia, dyslipidemia, insulin resistance, hypertension, and inflammation. Juvenile T2DM nephropathy occurs earlier in life compared to T1DM-related nephropathy in children or T2DM-related nephropathy in adult. Diabetic kidney disease (DKD) is T2DM major long term microvascular complication. This review summarizes the main mechanisms involved in the pathogenesis of the DKD in young population and the recent evolution of treatment, in order to reduce the risk of DKD progression.
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Affiliation(s)
- Michela Amatruda
- Unit of Pediatric Nephrology with Dialysis, AOU Policlinic G Martino, University of Messina, 98125 Messina, Italy;
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (A.E.G.); (D.S.)
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, 98125 Messina, Italy
| | - Alfio Edoardo Giuffrida
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (A.E.G.); (D.S.)
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (A.E.G.); (D.S.)
| | - Giovanni Conti
- Unit of Pediatric Nephrology with Dialysis, AOU Policlinic G Martino, University of Messina, 98125 Messina, Italy;
- Correspondence:
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Lawrence JM, Divers J, Isom S, Saydah S, Imperatore G, Pihoker C, Marcovina SM, Mayer-Davis EJ, Hamman RF, Dolan L, Dabelea D, Pettitt DJ, Liese AD. Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the US, 2001-2017. JAMA 2021; 326:717-727. [PMID: 34427600 PMCID: PMC8385600 DOI: 10.1001/jama.2021.11165] [Citation(s) in RCA: 238] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Changes in the prevalence of youth-onset diabetes have previously been observed. OBJECTIVE To estimate changes in prevalence of type 1 and type 2 diabetes in youths in the US from 2001 to 2017. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional observational study, individuals younger than 20 years with physician-diagnosed diabetes were enumerated from 6 areas in the US (4 geographic areas, 1 health plan, and select American Indian reservations) for 2001, 2009, and 2017. EXPOSURES Calendar year. MAIN OUTCOMES AND MEASURES Estimated prevalence of physician-diagnosed type 1 and type 2 diabetes overall and by race and ethnicity, age, and sex. RESULTS Among youths 19 years or younger, 4958 of 3.35 million had type 1 diabetes in 2001, 6672 of 3.46 million had type 1 diabetes in 2009, and 7759 of 3.61 million had type 1 diabetes in 2017; among those aged 10 to 19 years, 588 of 1.73 million had type 2 diabetes in 2001, 814 of 1.85 million had type 2 diabetes in 2009, and 1230 of 1.85 million had type 2 diabetes in 2017. The estimated type 1 diabetes prevalence per 1000 youths for those 19 years or younger increased significantly from 1.48 (95% CI, 1.44-1.52) in 2001 to 1.93 (95% CI, 1.88-1.98) in 2009 to 2.15 (95% CI, 2.10-2.20) in 2017, an absolute increase of 0.67 per 1000 youths (95%, CI, 0.64-0.70) and a 45.1% (95% CI, 40.0%-50.4%) relative increase over 16 years. The greatest absolute increases were observed among non-Hispanic White (0.93 per 1000 youths [95% CI, 0.88-0.98]) and non-Hispanic Black (0.89 per 1000 youths [95% CI, 0.88-0.98]) youths. The estimated type 2 diabetes prevalence per 1000 youths aged 10 to 19 years increased significantly from 0.34 (95% CI, 0.31-0.37) in 2001 to 0.46 (95% CI, 0.43-0.49) in 2009 to 0.67 (95% CI, 0.63-0.70) in 2017, an absolute increase of 0.32 per 1000 youths (95% CI, 0.30-0.35) and a 95.3% (95% CI, 77.0%-115.4%) relative increase over 16 years. The greatest absolute increases were observed among non-Hispanic Black (0.85 per 1000 youths [95% CI, 0.74-0.97]) and Hispanic (0.57 per 1000 youths [95% CI, 0.51-0.64]) youths. CONCLUSIONS AND RELEVANCE In 6 areas of the US from 2001 to 2017, the estimated prevalence of diabetes among children and adolescents increased for both type 1 and type 2 diabetes.
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Affiliation(s)
- Jean M. Lawrence
- Division of Epidemiologic Research, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jasmin Divers
- Division of Health Services Research, Department of Foundations of Medicine, New York University Langone School of Medicine, Mineola
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sharon Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Santica M. Marcovina
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle
| | | | - Richard F. Hamman
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora
| | - Lawrence Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | | | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia
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Rakotoambinina B, Hiffler L, Gomes F. Pediatric thiamine deficiency disorders in high-income countries between 2000 and 2020: a clinical reappraisal. Ann N Y Acad Sci 2021; 1498:57-76. [PMID: 34309858 PMCID: PMC9290709 DOI: 10.1111/nyas.14669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 12/20/2022]
Abstract
Often thought to be a nutritional issue limited to low- and middle-income countries (LMICs), pediatric thiamine deficiency (PTD) is perceived as being eradicated or anecdotal in high-income countries (HICs). In HICs, classic beriberi cases in breastfed infants by thiamine-deficient mothers living in disadvantaged socioeconomic conditions are thought to be rare. This study aims to assess PTD in HICs in the 21st century. Literature searches were conducted to identify case reports of PTD observed in HICs and published between 2000 and 2020. The analyzed variables were age, country, underlying conditions, clinical manifestations of PTD, and response to thiamine supplementation. One hundred and ten articles were identified, totaling 389 PTD cases that were classified into four age groups: neonates, infants, children, and adolescents. Eleven categories of PTD-predisposing factors were identified, including genetic causes, lifestyle (diabetes, obesity, and excessive consumption of sweetened beverages), eating disorders, cancer, gastrointestinal disorders/surgeries, critical illness, and artificial nutrition. TD-associated hyperlactatemia and Wernicke encephalopathy were the most frequent clinical manifestations. The circumstances surrounding PTD in HICs differ from classic PTD observed in LMICs and this study delineates its mutiple predisposing factors. Further studies are required to estimate its magnitude. Awareness is of utmost importance in clinical practice.
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Affiliation(s)
- Benjamin Rakotoambinina
- Cellular Nutrition Research GroupLagny sur MarneFrance
- LRI Isotopic Medicine Physiology LabUniversity of AntananarivoAntananarivoMadagascar
| | | | - Filomena Gomes
- The New York Academy of SciencesNew YorkNew York
- NOVA Medical SchoolUniversidade NOVA de LisboaLisboaPortugal
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Perng W, Francis EC, Schuldt C, Barbosa G, Dabelea D, Sauder KA. Pre- and Perinatal Correlates of Ideal Cardiovascular Health during Early Childhood: A Prospective Analysis in the Healthy Start Study. J Pediatr 2021; 234:187-194. [PMID: 33741366 PMCID: PMC8238850 DOI: 10.1016/j.jpeds.2021.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/05/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To characterize prevalence of ideal cardiovascular health (ICVH) during early childhood (4-7 years of age), and to identify pre- and perinatal biological, sociodemographic, metabolic, and behavioral correlates of ICVH. STUDY DESIGN Among 350 mother-child pairs in the Healthy Start Study, we defined ICVH as no exposure to second hand smoke; ≥1 hour/day of moderate-to-vigorous physical activity; body mass index ≤85th percentile; systolic and diastolic blood pressure <90th percentile; cholesterol <170 mg/dL, fasting glucose <100 mg/dL; and healthy diet, per the American Heart Association. Pre- and perinatal characteristics were obtained from questionnaires, medical records, and in-person visits. Because of low prevalence of ICVH, we focused on prevalence of meeting ≥6 metrics in the analysis. We examined bivariate associations of each characteristic with % meeting ≥6 metrics and included those that were significant (P < .05) in a multivariable logistic regression model. RESULTS ICVH prevalence at mean ± SD age 4.7±0.6 years was 6.9%; boys had twice the prevalence as girls (9% vs 4.4%). Most (>85%) children met criteria for second hand smoke, body mass index, blood pressure, cholesterol, and glucose, and only one-third met criteria for physical activity (31.4%) and diet (35.1%). In multivariable analyses, key correlates of ICVH were maternal weight status (ORoverweight/obese vs nonoverweight/obese = 0.41 [0.23, 0.73]) and offspring sex (ORmale vs female = 2.14 [1.22, 3.65]). CONCLUSIONS At age 4-7 years, ICVH prevalence is already low, with diet and adequate physical activity being the limiting factors. Healthy maternal weight prior to pregnancy and male sex are potential determinants of childhood ICVH. Additional work is required to explore associations of early-life ICVH with future health outcomes.
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Affiliation(s)
- Wei Perng
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO.
| | - Ellen C Francis
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Caylor Schuldt
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Gregory Barbosa
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Dana Dabelea
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Pediatrics, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Katherine A Sauder
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Pediatrics, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
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Dabelea D, Sauder KA, Jensen ET, Mottl AK, Huang A, Pihoker C, Hamman RF, Lawrence J, Dolan LM, Agostino RD, Wagenknecht L, Mayer-Davis EJ, Marcovina SM. Twenty years of pediatric diabetes surveillance: what do we know and why it matters. Ann N Y Acad Sci 2021; 1495:99-120. [PMID: 33543783 PMCID: PMC8282684 DOI: 10.1111/nyas.14573] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 12/23/2022]
Abstract
SEARCH for Diabetes in Youth (SEARCH) was initiated in 2000 as a multicenter study to address major gaps in the understanding of childhood diabetes in the United States. An active registry of youth diagnosed with diabetes at age <20 years since 2002 assessed prevalence, annual incidence, and trends by age, race/ethnicity, sex, and diabetes type. An observational cohort nested within the population-based registry was established to assess the natural history and risk factors for acute and chronic diabetes-related complications, as well as the quality of care and quality of life of children and adolescents with diabetes from diagnosis into young adulthood. SEARCH findings have contributed to a better understanding of the complex and heterogeneous nature of youth-onset diabetes. Continued surveillance of the burden and risk of type 1 and type 2 diabetes is important to track and monitor incidence and prevalence within the population. SEARCH reported evidence of early diabetes complications highlighting that continuing the long-term follow-up of youth with diabetes is necessary to further our understanding of its natural history and to develop the most appropriate approaches to primary, secondary, and tertiary prevention of diabetes and its complications. This review summarizes two decades of research and suggests avenues for further work.
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Affiliation(s)
- Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Departments of Epidemiology and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Departments of Epidemiology and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amy K. Mottl
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Alyssa Huang
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | - Richard F. Hamman
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Departments of Epidemiology and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jean Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Lawrence M. Dolan
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ralph D’ Agostino
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lynne Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Wszoła M, Nitarska D, Cywoniuk P, Gomółka M, Klak M. Stem Cells as a Source of Pancreatic Cells for Production of 3D Bioprinted Bionic Pancreas in the Treatment of Type 1 Diabetes. Cells 2021; 10:1544. [PMID: 34207441 PMCID: PMC8234129 DOI: 10.3390/cells10061544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/14/2022] Open
Abstract
Type 1 diabetes (T1D) is the third most common autoimmune disease which develops due to genetic and environmental risk factors. Often, intensive insulin therapy is insufficient, and patients require a pancreas or pancreatic islets transplant. However, both solutions are associated with many possible complications, including graft rejection. The best approach seems to be a donor-independent T1D treatment strategy based on human stem cells cultured in vitro and differentiated into insulin and glucagon-producing cells (β and α cells, respectively). Both types of cells can then be incorporated into the bio-ink used for 3D printing of the bionic pancreas, which can be transplanted into T1D patients to restore glucose homeostasis. The aim of this review is to summarize current knowledge about stem cells sources and their transformation into key pancreatic cells. Last, but not least, we comment on possible solutions of post-transplant immune response triggered stem cell-derived pancreatic cells and their potential control mechanisms.
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Affiliation(s)
- Michał Wszoła
- Foundation of Research and Science Development, 01-793 Warsaw, Poland; (M.W.); (P.C.); (M.G.)
- Polbionica Ltd., 01-793 Warsaw, Poland;
- Medispace Medical Centre, 01-044 Warsaw, Poland
| | | | - Piotr Cywoniuk
- Foundation of Research and Science Development, 01-793 Warsaw, Poland; (M.W.); (P.C.); (M.G.)
| | - Magdalena Gomółka
- Foundation of Research and Science Development, 01-793 Warsaw, Poland; (M.W.); (P.C.); (M.G.)
| | - Marta Klak
- Foundation of Research and Science Development, 01-793 Warsaw, Poland; (M.W.); (P.C.); (M.G.)
- Polbionica Ltd., 01-793 Warsaw, Poland;
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Denton JJ, Fernandez JR. The role of family history of diabetes as a predictor of insulin activity in a sample of diverse, normal weight children. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Encapsulation Strategies for Pancreatic Islet Transplantation without Immune Suppression. CURRENT STEM CELL REPORTS 2021. [DOI: 10.1007/s40778-021-00190-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ludwig K, Craig ME, Donaghue KC, Maguire A, Benitez-Aguirre PZ. Type 2 diabetes in children and adolescents across Australia and New Zealand: A 6-year audit from The Australasian Diabetes Data Network (ADDN). Pediatr Diabetes 2021; 22:380-387. [PMID: 37609994 DOI: 10.1111/pedi.13169] [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: 07/02/2020] [Revised: 10/10/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess the clinical and demographic characteristics of children and adolescents across Australia and New Zealand (NZ) with type 2 diabetes. METHODS We performed a descriptive audit of data prospectively reported to the Australasian Diabetes Data Network (ADDN) registry. Data were collected from six tertiary pediatric diabetes centers across Australia (New South Wales, Queensland, South Australia, Western Australia, and Victoria) and NZ (Auckland). Children and adolescents diagnosed with type 2 diabetes aged ≤ 18 years with data reported to ADDN between 2012 and 2017 were included. Age, sex, ethnicity, HbA1c, blood pressure, BMI, waist circumference and lipid profile at first visit were assessed. RESULTS There were 269 cases of type 2 diabetes in youth reported to ADDN between 2012 and 2017. The most common ethnicities were Indigenous Australian in 56/243 (23%) and NZ Maori or Pacifica in 47 (19%). Median age at diagnosis was 13.7 years and 94% of participants were overweight or obese. Indigenous Australian and Maori/Pacifica children were younger at diagnosis compared with nonindigenous children: median 13.3 years (indigenous Australian); 13.1 years (Maori/Pacifica); 14.1 years (nonindigenous), p = 0.005. HbA1c was higher in indigenous Australian (9.4%) and Maori/Pacifica youth (7.8%) compared with nonindigenous (6.7%) p < 0.001. BMI-SDS was higher in Maori/Pacifica youth (2.3) compared with indigenous Australian (2.1) and nonindigenous (2.2) p = 0.011. CONCLUSIONS Indigenous Australian and Maori/Pacifica youth in ADDN were younger and had worse glycaemic control at diagnosis of type 2 diabetes. Our findings underscore the need to consider targeted and earlier screening in these "high-risk" populations.
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Affiliation(s)
- Karissa Ludwig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ann Maguire
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Paul Z Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Greenup E, Sunil B, Barr MM, Ashraf AP. Glycaemic control and outcomes in children with type 2 diabetes diagnosed at or before 10 years of age. Endocrinol Diabetes Metab 2021; 4:e00192. [PMID: 33855201 PMCID: PMC8029508 DOI: 10.1002/edm2.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 12/30/2022] Open
Abstract
Background Type 2 diabetes (T2DM) in children is considered rare before puberty. Objective Describe the characteristics and outcomes of children with T2DM diagnosed at or before 10 years of age. Methods Retrospective electronic medical record review of children diagnosed with T2DM at a University Children's Hospital over 12 years was conducted. Patient characteristics at diagnosis, 2-3-year follow-up, and 4-5-year follow-up were analysed as a whole and by age groups, 5-8 and 9-10 years. Results There were 42 children ≤ 10 years with T2DM (5-8-year age group, n = 8 and 9-10-year age group, n = 34). There were 88.1% African American, 11.9% Caucasian, and 88.1% females. Body mass index (BMI) was ≥95th percentile in 95.2%. Average BMI z score was 2.5 ± 0.4 and higher in the 5-8-year age group (2.7 ± 0.5 vs 2.4 ± 0.4, P = .02). Average haemoglobin A1C at diagnosis was 10.5 ± 2.4%, and improvement was seen at 2-3 years, but subsequent worsening was noted at 4-5 years in both age groups. At 4-5 years after diagnosis, 93.9% required insulin for management of their hyperglycaemia, 21.2% had hypertension requiring treatment, 28.6% had low-density lipoprotein ≥130 mg/dL, and 28.6% had high-density lipoprotein <40 mg/dL. Conclusions T2DM at or below 10 years of age disproportionately affected females and ethnic minorities and was associated with morbid obesity. The majority of these children did not achieve glycaemic control and required insulin for management of their hyperglycaemia after 4-5 years, indicating the need for increased awareness of T2DM and intensive treatment in this special group.
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Affiliation(s)
- Erin Greenup
- Department of Pediatrics/Division of Pediatric Endocrinology and DiabetesUniversity of Alabama at BirminghamBirminghamALUSA
| | - Bhuvana Sunil
- Department of Pediatrics/Division of Pediatric Endocrinology and DiabetesUniversity of Alabama at BirminghamBirminghamALUSA
| | - Mary Margaret Barr
- University of Alabama School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Ambika P. Ashraf
- Department of Pediatrics/Division of Pediatric Endocrinology and DiabetesUniversity of Alabama at BirminghamBirminghamALUSA
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Berlin KS, Klages KL, Banks GG, Rybak TM, Ankney RL, Semenkovich K, Keenan ME, Ellis DA, Diaz-Thomas AM, Alemzadeh R, Eddington AR. Toward the Development of a Culturally Humble Intervention to Improve Glycemic Control and Quality of Life among Adolescents with Type-1 Diabetes and Their Families. Behav Med 2021; 47:99-110. [PMID: 31580213 DOI: 10.1080/08964289.2019.1660299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Type-1 Diabetes (T1D) is a prevalent and costly disorder associated with substantial morbidity that differentially impacts low-income and/or minority adolescents and their families. The primary study objective was to develop a guiding model to inform culturally humble interventions for Mid-southern youth with T1D presenting with multiple correlates of suboptimal glycemic control and their families. In order to develop a clinic specific guiding model, conceptualizations of health, the need/type of intervention thought to be most helpful, the optimal structure, and strategies to improve the cultural/regional fit was ascertained from (A) youth with T1D (n = 13) and caregivers (n = 11) via qualitative interviews and, (B) pediatric endocrinologists and nurse practitioners (n = 6), and (C) nurses, diabetes educators, dietitians, and social workers (n = 9) via focus groups. Qualitative themes were synthesized to guide the treatment development model whereby Quality of Life and Glycemic Control would be directly enhanced by interventions to promote Coping, Support, Education, and Improved Psychosocial Functioning and indirectly through improved Adherence and T1D Autonomy delivered in a culturally humble way that affirms youths' T1D identify. These finding suggest that existing evidence-based treatments may provide a great fit for low-income, and/or minority youth with T1D and their families living in the mid-south, provided these interventions are delivered in culturally humble manner.
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Affiliation(s)
- Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
| | | | | | - Tiffany M Rybak
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | | | - Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | | | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
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The Prevalence of Type 1 Diabetes in Hispanic/Latino Populations in the United States: Findings from the Hispanic Community Health Study/Study of Latinos. Epidemiology 2021; 31:e7-e8. [PMID: 31596792 DOI: 10.1097/ede.0000000000001125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Seral-Cortes M, De Miguel-Etayo P, Zapata P, Miguel-Berges ML, Moreno LA. Effectiveness and process evaluation in obesity and type 2 diabetes prevention programs in children: a systematic review and meta-analysis. BMC Public Health 2021; 21:348. [PMID: 33579237 PMCID: PMC7881469 DOI: 10.1186/s12889-021-10297-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 01/20/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Obesity in children is one of the most severe public health challenges of the current century and Type 2 Diabetes Mellitus (T2DM) frequency is also escalating. More so, the importance of process evaluation (PE) in complex interventions is increasingly recognized. The present review, aims to identify the effectiveness in terms of body composition parameters in a generation of articles to prevent obesity and T2DM in children. We hypothesise that those studies reporting PE applying the latest implementation guidelines suggested by the researchers would potentially show positive changes in body composition compared to those not reporting it. Additionally, we will evaluate the implementation degree of PE in those articles considering it and describe the PE subcomponents. Lastly, we aim to assess the intervention target used and its results. METHODS A literature review was performed in parallel by 2 independent reviewers. A final number of 41 studies were selected for inclusion criteria. RESULTS Meta-analysis of BMI and zBMI found non-significant effects of the proposed interventions. Sub-group analysis revealed only a significant effect in studies which performed PE. Moreover, PE was reported in 42% effective studies and 57% non-effective studies. Fidelity and satisfaction were the most implemented PE subcomponents, although there was a generally low grade of PE use (7/41). The highest proportion of effectiveness (83%) was shown in interventions of physical activity alone while the intervention most used was 3-arm target (diet, PA and BS). CONCLUSIONS Overall, obesity and T2DM prevention studies included in this review are not effective in terms of BMI and zBMI. Those studies performing PE reported to be effective in terms of BMI, while studies not reporting PE did not have positive results in terms of BMI and zBMI. In addition, none of the intervention studies included all PE indicators and most studies, which included PE in their interventions, did not provide full report of the PE components, according to the guidelines used for the present review. PROSPERO registration number: CRD42018093667.
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Affiliation(s)
- M Seral-Cortes
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain
- Department of Psychiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - P De Miguel-Etayo
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
| | - P Zapata
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain
- Departamento de nutrición y dietética, Universidad de Antioquia, Medellín, Colombia
| | - M L Miguel-Berges
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain
- Department of Psychiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - L A Moreno
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain
- Department of Psychiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Life-Course Implications of Pediatric Risk Factors for Cardiovascular Disease. Can J Cardiol 2021; 37:766-775. [PMID: 33581191 DOI: 10.1016/j.cjca.2021.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/19/2022] Open
Abstract
The concept that origins of cardiovascular disease (CVD) begin in childhood is supported by substantial evidence. Prospective studies beginning in childhood report associations of childhood obesity, abnormal blood pressure (BP), dyslipidemia, diabetes, and tobacco use with intermediate CVD markers, including left ventricular hypertrophy and vascular stiffness in young adulthood. Trajectory analyses from longitudinal studies describe discrete BP pathways from childhood to young adult status of hypertension and prehypertension. Among individuals with familial hypercholesterolemia, abnormal low-density lipoprotein cholesterol levels are present in childhood. Some children are at risk for future CVD owing to hereditary factors, psychosocial stress, race, low birth weight, or other nonmodifiable exposures. Behavioural factors, including suboptimal diet, sedentary activity, and tobacco use, in childhood augment risk and can be modified to reduce risk. Pharmacologic treatments are reserved for those at high levels of the BP and cholesterol distributions and for those with diabetes and additional risk factors.
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Praveen PA, Madhu SV, Viswanathan M, Das S, Kakati S, Shah N, Chadha M, Bhadada SK, Kaur T, Dhaliwal RS, Das AK, Yajnik CS, Tandon N. Demographic and clinical profile of youth onset diabetes patients in India-Results from the baseline data of a clinic based registry of people with diabetes in India with young age at onset-[YDR-02]. Pediatr Diabetes 2021; 22:15-21. [PMID: 31885113 DOI: 10.1111/pedi.12973] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/25/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We here report the demographic and clinical profile of the patients enrolled in the Indian Council of Medical Research funded Registry of people with diabetes in India with young age at onset (YDR) from 1 January 2000 to 31 July 2011. METHODS The YDR registry recruits all diabetes cases (newly diagnosed or treated) reporting on or after 1 January 2000 with age of diagnosis ≤25 years, and residing within the assigned geographical area of the reporting centres. A baseline proforma was used to obtain information on demographic and clinical details at registration. RESULTS The registry has enrolled 5546 patients (49.5% male; 50.5% female) with youth onset diabetes from 205 reporting centres linked to 8 regional collaborating centres (RCC) across India. T1DM (63.9%; n = 3545) and T2DM (25.3%; n = 1401) were the commonest variants of youth onset diabetes, though their relative proportion varied across RCCs. The mean (SD) age at diagnosis for T1DM was 12.9 (6.5) years, while that for T2DM was 21.7 (3.7) years. Nearly half the T1DM patients were registered within 6 months of the onset of disease. Most cases of T2DM (47.3%) were registered after 3 years from their date of diagnosis. 56.1% of patients had at least one episode of hospitalization at registration. CONCLUSION The observations from YDR registry indicate the need to establish a surveillance system in India to monitor diabetes in youth, not only to understand its complex etiology and natural history but also due to its detrimental socio economic impact.
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Affiliation(s)
- Pradeep A Praveen
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | | | - Mohan Viswanathan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Siddhartha Das
- SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Sanjeeb Kakati
- Department of Medicine, Assam Medical College, Dibrugarh, Assam, India
| | - Nalini Shah
- Department of Endocrinology, Seth G S Medical College, K.E.M. Hospital Parel, Mumbai, Maharashtra, India
| | - Manoj Chadha
- P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mumbai, Maharashtra, India
| | - Sanjay K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Kaur
- Division of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | - Ashok K Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - C S Yajnik
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, Maharashtra, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Papachrisanthou MM, Fuller KM. Pediatric Screenings: Helpful or Hinderance? J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hu Y, Liu J, Yao H, Yin D, Zhang J, Feng G. Different Percentile Regression of Blood Glucose Among Adolescents Aged 12-20 - United States, 1999-2018. China CDC Wkly 2021; 3:46-49. [PMID: 34594954 PMCID: PMC8392935 DOI: 10.46234/ccdcw2021.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/01/2020] [Indexed: 11/14/2022] Open
Abstract
WHAT IS ALREADY KNOWN ON THIS TOPIC? The incidence of diabetes is on the rise in the world, and it is increasingly affecting young people. The American Diabetes Association (ADA) has published the 2020 Diabetes Medical Standard, but there is no blood glucose standard for teenagers by age and sex. WHAT IS ADDED BY THIS REPORT? In this study, quantile regression was used to analyze the data of National Health and Nutrition Examination Survey (NHANES) and found that blood glucose varied significantly based on demographics. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE? This study provides reference for formulating the normal ranges of adolescent blood glucose and helping to screen out high-risk groups at an early stage for key interventions. The quantile regression method can give a set of curves, which could better describe the situation.
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Affiliation(s)
- Yuehua Hu
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, Chinaevention, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing, China
| | - Junting Liu
- Epidemiology Office, Children’s hospital capital institute, Beijing, China
| | - Hongyan Yao
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, Chinaevention, Beijing, China
| | - Dapeng Yin
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, Chinaevention, Beijing, China
| | - Jian Zhang
- National Institute Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guoshuang Feng
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing, China
- Big Data and Engineering Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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