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Vajravelu ME, Hirschfeld E, Gebremariam A, Burant CF, Herman WH, Peterson KE, Meijer JL, Lee JM. Prospective Test Performance of Nonfasting Biomarkers to Identify Dysglycemia in Children and Adolescents. Horm Res Paediatr 2022; 96:316-324. [PMID: 36380614 PMCID: PMC10183477 DOI: 10.1159/000528043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Test performance screening measures for dysglycemia have not been evaluated prospectively in youth. This study evaluated the prospective test performance of random glucose (RG), 1-h nonfasting glucose challenge test (1-h GCT), hemoglobin A1c (HbA1c), fructosamine (FA), and 1,5-anhydroglucitol (1,5-AG) for identifying dysglycemia. METHODS Youth ages 8-17 years with overweight or obesity (body mass index, BMI, ≥85th percentile) without known diabetes completed nonfasting tests at baseline (n = 176) and returned an average of 1.1 years later for two formal fasting 2-h oral glucose tolerance tests. Outcomes included glucose-defined dysglycemia (fasting plasma glucose ≥100 mg/dL or 2-h plasma glucose ≥140 mg/dL) or elevated HbA1c (≥5.7%). Longitudinal test performance was evaluated using receiver-operating characteristic (ROC) curves and calculation of area under the curve (AUC). RESULTS Glucose-defined dysglycemia, elevated HbA1c, and either dysglycemia or elevated HbA1c were present in 15 (8.5%), 11 (6.3%), and 23 (13.1%) participants at baseline, and 16 (9.1%), 18 (10.3%), and 28 (15.9%) participants at follow-up. For prediction of glucose-defined dysglycemia at follow-up, RG, 1-h GCT, and HbA1c had similar performance (0.68 (95% CI: 0.55-0.80), 0.76 (95% CI: 0.64-0.89), and 0.70 (95% CI: 0.56-0.84)), while FA and 1,5-AG performed poorly. For prediction of HbA1c at follow-up, baseline HbA1c had strong performance (AUC 0.93 [95% CI: 0.88-0.98]), RG had moderate performance (AUC 0.67 [95% CI: 0.54-0.79]), while 1-h GCT, FA, and 1,5-AG performed poorly. CONCLUSION HbA1c and nonfasting glucose tests had reasonable longitudinal discrimination identifying adolescents at risk for dysglycemia, but performance depended on outcome definition.
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Affiliation(s)
- Mary Ellen Vajravelu
- Division of Pediatric Endocrinology, Diabetes and Metabolism, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Acham Gebremariam
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles F. Burant
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - William H. Herman
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Karen E. Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jennifer L. Meijer
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Weight and Wellness Center, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joyce M. Lee
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
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Hosey CM, Halpin K, Yan Y. Considering metformin as a second-line treatment for children and adolescents with prediabetes. J Pediatr Endocrinol Metab 2022; 35:727-732. [PMID: 35503504 DOI: 10.1515/jpem-2021-0200] [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: 03/20/2021] [Accepted: 03/30/2022] [Indexed: 01/08/2023]
Abstract
Overweight and obesity affect approximately 1/3 of children in the United States and are risk factors for prediabetes and type 2 diabetes. Progression from prediabetes to diabetes carries substantial long-term health burdens, culminating in decreased life-expectancy. Earlier development of type 2 diabetes is associated with poorer prognoses, and children lose glycemic control more rapidly than adults. Metformin is approved by the USFDA for the treatment of type 2 diabetes in children, has limited toxicity, and may help prevent the development of type 2 diabetes. The more rapid disease progression in children and the safety of metformin suggests that initiation of metformin treatment to children with prediabetes who have not effectively responded to lifestyle changes may help prevent short- and long-term health damage resulting from prediabetic and diabetic dysglycemia.
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Affiliation(s)
- Chelsea M Hosey
- Department of Pediatrics, Division of Clinical Pharmacology, Toxicology, & Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kelsee Halpin
- Division of Pediatric Endocrinology, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
| | - Yun Yan
- Division of Pediatric Endocrinology, Children's Mercy Kansas City, Kansas City, MO, USA
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Wallace AS, Rooney MR, Brady TM, Echouffo-Tcheugui J, Christenson R, Grams ME, Selvin E. The performance of glycated albumin as a biomarker of hyperglycemia and cardiometabolic risk in children and adolescents in the United States. Pediatr Diabetes 2022; 23:237-247. [PMID: 34775677 PMCID: PMC8844057 DOI: 10.1111/pedi.13281] [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: 07/20/2021] [Revised: 10/01/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Diabetes and prediabetes are growing concerns among US youth. Fasting glucose (FG) and HbA1c are standard diabetes screening tests, but HbA1c may be unreliable in some settings and fasting is burdensome in children. Glycated albumin (GA) is a non-fasting test that was recently cleared for clinical use in the United States, but studies in youth without diabetes are limited. RESEARCH DESIGN AND METHODS We conducted a cross-sectional analysis in 6826 youth without diabetes aged 8-19 years in the 1999-2004 National Health and Nutrition Examination Survey. We evaluated the associations of GA with HbA1c, FG, and cardiometabolic risk factors. RESULTS GA was poorly correlated with HbA1c (ρ = 0.074) and FG (ρ = -0.047) and was negatively associated with body mass index (BMI) and cardiometabolic risk factors. Compared to youth in the highest tertile of GA (≥13.5%), those in the lowest GA tertile (<12.4%) had a higher prevalence of obesity (29.9% vs. 7.6%), low high-density lipoprotein cholesterol (29.7% vs. 16.5%), and hypertensive blood pressure (4.0% vs. 2.7%). These inverse associations persisted after adjustment for age, sex, race/ethnicity, serum albumin, and C-reactive protein. CONCLUSIONS GA was poorly correlated with traditional markers of hyperglycemia in youth without diabetes. Counterintuitively, there was a negative association between GA and BMI. Among youth without diabetes, GA does not identify youth at high cardiometabolic risk, and it does not appear to be an appropriate biomarker for screening of hyperglycemia.
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Affiliation(s)
- Amelia S Wallace
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, United States
| | - Mary R Rooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, United States
| | - Tammy M Brady
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, United States
| | | | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, United States,Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, United States
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Gobor LC, Volanski W, Boritza KC, Souza SWD, Anghebem MIAMI, Picheth G, Rego FGDM. Evaluation of 1,5-Anhydroglucitol as a Biomarker for Type 2 Diabetes Mellitus in Patients without Overt Nephropathy. BRAZ J PHARM SCI 2021. [DOI: 10.1590/s2175-97902020000419078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Koutny F, Weghuber D, Bollow E, Greber‐Platzer S, Hartmann K, Körner A, Reinehr T, Roebl M, Simic‐Schleicher G, Wabitsch M, Widhalm K, Wiegand S, Holl RW. Prevalence of prediabetes and type 2 diabetes in children with obesity and increased transaminases in European German-speaking countries. Analysis of the APV initiative. Pediatr Obes 2020; 15:e12601. [PMID: 31810110 PMCID: PMC7079233 DOI: 10.1111/ijpo.12601] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD), prediabetes and type 2 diabetes mellitus are known to be closely linked with obesity as early as during childhood. OBJECTIVES The study aimed to determine the prevalence of prediabetes and T2DM in children with obesity with or without increased transaminases. METHODS Data from the observational multicentre (n = 51), cross-sectional Adipositas Patienten Verlaufsbeobachtung registry were analyzed. Mild increase (mild group) was defined by alanine transaminase (ALT) >24 to ≤50 U/L and moderate to severe increase (advanced group) by ALT > 50 U/L. Prediabetes and T2DM were defined according to recent IDF/ISPAD guidelines. RESULTS The prevalence of prediabetes and T2DM was 11.9% (95% CI: 11.0-12.8) and 1.4% (95% CI: 1.1-1.7) among all participants (n = 4932; male = 2481; mean age 12.9 ± 2.7 years; BMI-SDS 2.1 ± 0.5; Tanner stage 3.2 ± 1.5). The prevalence of impaired glucose metabolism (prediabetes and T2DM) was 13.8% (95% CI: 12.1-15.4) in the mild, 21.9% (95% CI: 18.8-25.1) in the advanced group, 10.7% (95% CI: 9.4-11.9) in the control group. Mild and advanced groups had greater odds ratios for prediabetes [1.42; 95% CI: 1.17-1.72, 2.26-fold; (1.78-2.86), respectively], the advanced group also for T2DM [2.39 (1.36-4.21)] compared to controls. While an increase in transaminases predominantly affected boys, girls within the advanced group had a higher T2DM prevalence than males (5.4 vs. male 2.1%). CONCLUSIONS Children with obesity and increased liver transaminases as surrogates of NAFLD should be screened for T2DM.
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Affiliation(s)
- Florian Koutny
- Department of PediatricsParacelsus Private Medical SchoolSalzburgAustria,Obesity Research UnitParacelsus Private Medical SchoolSalzburgAustria
| | - Daniel Weghuber
- Department of PediatricsParacelsus Private Medical SchoolSalzburgAustria,Obesity Research UnitParacelsus Private Medical SchoolSalzburgAustria
| | - E. Bollow
- Institute of Epidemiology and Medical BiometryUniversity of Ulm, German Center for Diabetes ResearchUlmGermany
| | - S. Greber‐Platzer
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - K. Hartmann
- Medical Centre of Childhood and AdolescenceFrankfurtGermany
| | - A. Körner
- Center for Pediatric Research, Department of Women and Child HealthUniversity Hospital for Children & Adolescents, University of LeipzigLeipzigGermany
| | - T. Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents DattelnUniversity of Witten/HerdeckeDattelnGermany
| | - M. Roebl
- Department of Pediatrics and Pediatric NeurologyUniversity Medical Center GöttingenGöttingenGermany
| | | | - M. Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent MedicineUniversity Medical Center UlmUlmGermany
| | - K. Widhalm
- Division of Nutrition and Metabolism, Department of PediatricsMedical University of ViennaViennaAustria
| | - S. Wiegand
- Department of Pediatric Endocrinology and Diabetes, Center for social‐pediatric careCharité Universitätsmedizin BerlinBerlinGermany
| | - R. W. Holl
- Institute of Epidemiology and Medical BiometryUniversity of Ulm, German Center for Diabetes ResearchUlmGermany
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Abstract
Medical research in children typically lags behind that of adult research in both quantity and quality. The conduct of rigorous clinical trials in children can raise ethical concerns because of children's status as a 'vulnerable' population. Moreover, carrying out studies in pediatrics also requires logistical considerations that rarely occur with adult clinical trials. Due to the relatively smaller number of pediatric studies to support evidence-based medicine, the practice of medicine in children is far more reliant upon expert opinion than in adult medicine. Children are at risk of not receiving the same level of benefits from precision medicine research, which has flourished with new technologies capable of generating large amounts of data quickly at an individual level. Although progress has been made in pediatric pharmacokinetics, which has led to safer and more effective dosing, gaps in knowledge still exists when it comes to characterization of pediatric disease and differences in pharmacodynamic response between children and adults. This review highlights three specific therapeutic areas where biomarker development can enhance precision medicine in children: asthma, type 2 diabetes mellitus, and pain. These 'case studies' are meant to update the reader on biomarkers used currently in the diagnosis and treatment of these conditions, and their shortcomings within a pediatric context. Current research on surrogate endpoints and pharmacodynamic biomarkers in the above therapeutic areas will also be described. These cases highlight the current lack in pediatric specific surrogate endpoints and pharmacodynamic biomarkers, as well as the research presently being conducted to address these deficiencies. We finally briefly highlight other therapeutic areas where further research in pediatric surrogate endpoints and pharmacodynamic biomarkers can be impactful to the care of children.
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Spurr S, Bally J, Hill P, Gray K, Newman P, Hutton A. Exploring the Prevalence of Undiagnosed Prediabetes, Type 2 Diabetes Mellitus, and Risk Factors in Adolescents: A Systematic Review. J Pediatr Nurs 2020; 50:94-104. [PMID: 31786470 DOI: 10.1016/j.pedn.2019.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 11/16/2022]
Abstract
PROBLEM The prevalence of prediabetes and type 2 diabetes (T2D) is increasing in adolescents worldwide. Most studies have focused on the clinical features, treatment, and complications for adolescents and so the need to generate insight into the risk factors and prevalence of undiagnosed prediabetes and T2D in adolescents across the globe remains. ELIGIBILITY CRITERIA Relevant articles that were published from 2007 up to and including January 2017 were identified through electronic searches of CINAHL, Cochrane, Medline, PsycInfo, PubMed, Scopus, Web of Science, and Sociological Abstracts (Proquest). Four independent researchers examined the articles for eligibility. SAMPLE Sixteen studies were included that investigated the risk and prevalence of undiagnosed prediabetes and T2D in adolescents aged 12-19. RESULTS The most commonly measured risk factors included obesity/overweight, family history, and ethnicity. Other studies measured risk factors associated with insulin resistance, including hypertension, acanthosis nigricans, and dyslipidemia. Prevalence of undiagnosed prediabetes and T2D varied among regions globally with rates ranging from 3.3 to 14.3% and 0.1 to 2.2%, respectively. CONCLUSIONS Undiagnosed prediabetes and T2D and the associated risk factors are prevalent in many regions in countries worldwide, significantly impacting adolescents and their families. IMPLICATIONS Future research is required to inform interventions aimed at preventative measures for early screening and detection of prediabetes and T2D in adolescents, as well as the development of multi-disciplinary teams that include pediatric nurses and the specialized care they provide.
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Affiliation(s)
- Shelley Spurr
- University of Saskatchewan, College of Nursing, Saskatoon, Saskatchewan Canada.
| | - Jill Bally
- University of Saskatchewan, College of Nursing, Saskatoon, Saskatchewan Canada.
| | - Pauline Hill
- School of Nursing and Midwifery, University of Flinders, Australia.
| | - Katherine Gray
- School of Nursing and Midwifery, University of Newcastle, Australia
| | | | - Alison Hutton
- School of Nursing and Midwifery, University of Newcastle, Australia.
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Kim MS, Jo DS, Lee DY. Comparison of HbA1c and OGTT for the diagnosis of type 2 diabetes in children at risk of diabetes. Pediatr Neonatol 2019; 60:428-434. [PMID: 30497969 DOI: 10.1016/j.pedneo.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/10/2018] [Accepted: 11/02/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the correlation between plasma glucose and HbA1c and the diagnostic accuracy of HbA1c as a screening tool to identify asymptomatic diabetes mellitus in children and adolescents with obesity or asymptomatic glucosuria. METHODS A total of 190 subjects who underwent an oral glucose tolerance test (OGTT) to confirm diabetes were categorized into normal glucose tolerance (NGT; n = 117), impaired glucose tolerance (IGT; n = 33), and diabetes (DM; n = 40) according to the OGTT. Forty-seven patients with DM were diagnosed by either OGTT or HbA1c levels. The diagnostic accuracy for the detection of diabetes is based on 47 patients. Laboratory tests were performed after 12 h of fasting. RESULTS According to the HbA1c criterion, 107 (55.3%) subjects were in the NGT group, 41 (21.6%) were in the IGT group, and 42 (22.1%) were in the DM group. Diagnostic sensitivities of HbA1c and 2-hour plasma glucose level following OGTT (2-h OGTT) for DM were significantly higher than that of fasting plasma glucose, FPG (89.4, 85.1 vs. 63.8%). In addition, the area under the curves of diagnostic criteria was 0.970 for HbA1c, 0.939 for FPG and 0.977 for 2-h OGTT. Mean FPG and 2-h OGTT for HbA1c level >6.5% were 115.2 mg/dL and 181.8 mg/dL, respectively. The optimal HbA1c level cut-off point for predicting DM is 6.15%, with a sensitivity of 95.7% in Korean children and adolescents. CONCLUSION The HbA1c criterion ≥6.5% was adequate to detect DM among Korean children and adolescents with obesity or asymptomatic glucosuria. We also recommend HbA1c level of 6.15% as the optimal cut-off point for detecting DM in Korean children and adolescents.
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Affiliation(s)
- Min Sun Kim
- Department of Pediatrics, Chonbuk National University Medical School, South Korea; Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, South Korea
| | - Dae Sun Jo
- Department of Pediatrics, Chonbuk National University Medical School, South Korea; Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, South Korea
| | - Dae-Yeol Lee
- Department of Pediatrics, Chonbuk National University Medical School, South Korea; Research Institute of Clinical Medicine of Chonbuk National University- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, South Korea.
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Lee J, Lee YA, Kim JH, Lee SY, Shin CH, Yang SW. Discrepancies between Glycosylated Hemoglobin and Fasting Plasma Glucose for Diagnosing Impaired Fasting Glucose and Diabetes Mellitus in Korean Youth and Young Adults. Diabetes Metab J 2019; 43:174-182. [PMID: 30398041 PMCID: PMC6470094 DOI: 10.4093/dmj.2018.0046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 08/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Glycosylated hemoglobin (HbA1c) has been recommended as a diagnostic test for prediabetes and diabetes. Here, we evaluated the level of agreement between diagnoses based on fasting plasma glucose (FPG) versus HbA1c levels and determined optimal HbA1c cutoff values for these diseases in youth and young adults. METHODS The study included 7,332 subjects (n=4,129, aged 10 to 19 years in youth group; and n=3,203 aged 20 to 29 years in young adult group) from the 2011 to 2016 Korea National Health and Nutrition Examination Survey. Prediabetes and diabetes were defined as 100 to 125 mg/dL (impaired fasting glucose [IFG]) and ≥126 mg/dL for FPG (diabetes mellitus [DM] by FPG [DMFPG]), and 5.7% to 6.4% and ≥6.5% for HbA1c, respectively. RESULTS In the youth group, 32.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 72.2% with DMFPG had an HbA1c ≥6.5%. In the young adult group, 27.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 66.6% with DMFPG had an HbA1c ≥6.5%. Kappa coefficients for agreement between the FPG and HbA1c results were 0.12 for the youth group and 0.19 for the young adult group. In receiver operating characteristic curve analysis, the optimal HbA1c cutoff for IFG and DMFPG were 5.6% and 5.9% in youths and 5.5% and 5.8% in young adults, respectively. CONCLUSION Usefulness of HbA1c for diagnosis of IFG and DMFPG in Koreans aged <30 years remains to be determined due to discrepancies between the results of glucose- and HbA1c-based tests. Additional testing might be warranted at lower HbA1c levels to detect IFG and DMFPG in this age group.
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Affiliation(s)
- Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Seong Yong Lee
- Department of Pediatrics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Panagiotopoulos C, Hadjiyannakis S, Henderson M. Type 2 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42 Suppl 1:S247-S254. [DOI: 10.1016/j.jcjd.2017.10.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Chan CL, Pyle L, Kelsey M, Newnes L, Baumgartner A, Zeitler PS, Nadeau KJ. Alternate glycemic markers reflect glycemic variability in continuous glucose monitoring in youth with prediabetes and type 2 diabetes. Pediatr Diabetes 2017; 18:629-636. [PMID: 27873436 PMCID: PMC5440227 DOI: 10.1111/pedi.12475] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine whether the alternate glycemic markers, fructosamine (FA), glycated albumin (GA), and 1,5-anhydroglucitol (1,5AG), predict glycemic variability captured by continuous glucose monitoring (CGM) in obese youth with prediabetes and type 2 diabetes (T2D). STUDY DESIGN Youth with BMI ≥85th%ile, 10-18 years, had collection of fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), FA, GA, and 1,5AG and 72 hours of CGM. Participants with HbA1c ≥5.7% were included. Relationships between glycemic markers and CGM variables were determined with Spearman correlation coefficients. Linear models were used to examine the association between alternate markers and CGM measures of glycemic variability-standard deviation (SD) and mean amplitude of glycemic excursions (MAGE)-after controlling for HbA1c. RESULTS Total n = 56; Median (25th%ile, 75th%ile) age = 14.3 years (12.5, 15.9), 32% male, 64% Hispanic, 20% black, 13% white, HbA1c = 5.9% (5.8, 6.3), FA=211 mmol/L (200, 226), GA= 12% (11%, 12%), and 1,5AG = 22mcg/mL (19, 26). HbA1c correlated with average sensor glucose, AUC, SD, MAGE, and %time > 140 mg/dL. FA and GA correlated with average and peak sensor glucose, %time >140 and >200 mg/dL, and MAGE. GA also correlated with SD and AUC180. 1,5AG correlated with peak glucose, AUC180, SD, and MAGE. After adjusting for HbA1c, all 3 markers independently predicted MAGE; FA and GA independently predicted SD. CONCLUSIONS Alternate glycemic markers predict glycemic variability as measured by CGM in youth with prediabetes and T2D. After adjusting for HbA1c, these alternate markers continued to predict components of glycemic variability detected by CGM.
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Affiliation(s)
- Christine L. Chan
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Laura Pyle
- Department of Pediatrics, Administrative Division, University of Colorado Anschutz Medical Campus, Aurora, CO 80045,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Megan Kelsey
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Lindsey Newnes
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Amy Baumgartner
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Philip S. Zeitler
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Kristen J. Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045
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van der Aa MP, Knibbe CAJ, Boer AD, van der Vorst MMJ. Definition of insulin resistance affects prevalence rate in pediatric patients: a systematic review and call for consensus. J Pediatr Endocrinol Metab 2017; 30:123-131. [PMID: 27984205 DOI: 10.1515/jpem-2016-0242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/05/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND As a result of the rising prevalence of childhood obesity, there is an increasing interest in the type 2 diabetes mellitus precursor insulin resistance (IR). The aim of this study is to review definitions (methods and cutoff values) to define IR in children and to apply these definitions to a previously described obese pediatric population. METHODS A systematic literature review on prevalence and/or incidence rates in children was performed. The extracted definitions were applied to an obese pediatric population. RESULTS In the 103 identified articles, 146 IR definitions were reported based on 14 different methods. Fasted definitions were used 137 times, whereas oral/intravenous glucose tolerance test-derived methods were used nine times. The homeostasis model for the assessment of insulin resistance (HOMA-IR) and fasted plasma insulin (FPI) were the most frequently used fasted methods (83 and 37 times, respectively). A wide range in cutoff values to define IR was observed, resulting in prevalence rates in the predefined obese pediatric population between 5.5% (FPI>30 mU/L) and 72.3% (insulin sensitivity indexMatsuda≤7.2). CONCLUSIONS To compare IR incidence and prevalence rates in pediatric populations, a uniform definition of IR should be defined.
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Groot CJD, Grond JVD, Delgado Y, Rings EHHM, Hannema SE, van den Akker ELT. High predictability of impaired glucose tolerance by combining cardiometabolic screening parameters in obese children. J Pediatr Endocrinol Metab 2017; 30:189-196. [PMID: 28076317 DOI: 10.1515/jpem-2016-0289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/21/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is debate on which overweight and obese children should be screened for the presence of impaired glucose tolerance (IGT) by oral glucose tolerance testing (OGTT). The objective of the study was to identify risk factors predictive of the presence of IGT. METHODS In a cohort of overweight children, who underwent OGTT, we determined the association of anthropometric and laboratory parameters with IGT and whether combining parameters improved the sensitivity of screening for IGT. RESULTS Out of 145 patients, IGT was present in 11, of whom two had impaired fasting glucose (IFG). Elevated blood pressure (p=0.025) and elevated liver enzymes (p=0.003) were associated with IGT, whereas IFG was not (p=0.067), screening patients with either one of these parameters predicted IGT with a high sensitivity of 1.00, and a number needed to screen of 5.7. CONCLUSIONS Screening all patients with either IFG, presence of elevated blood pressure and elevated liver enzymes, significantly increases predictability of IGT compared to using IFG alone.
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Newton KP, Hou J, Crimmins NA, Lavine JE, Barlow SE, Xanthakos SA, Africa J, Behling C, Donithan M, Clark JM, Schwimmer JB. Prevalence of Prediabetes and Type 2 Diabetes in Children With Nonalcoholic Fatty Liver Disease. JAMA Pediatr 2016; 170:e161971. [PMID: 27478956 PMCID: PMC5479314 DOI: 10.1001/jamapediatrics.2016.1971] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Nonalcoholic fatty liver disease (NAFLD) is a major chronic liver disease in children in the United States and is associated with insulin resistance. In adults, NAFLD is also associated with type 2 diabetes. To our knowledge, the prevalence of type 2 diabetes in children with NAFLD is unknown. OBJECTIVE To determine the prevalence of type 2 diabetes and prediabetes in children with NAFLD and assess type 2 diabetes and prediabetes as risk factors for nonalcoholic steatohepatitis (NASH). DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, cross-sectional study at 12 pediatric clinical centers across the United States participating in the National Institute of Diabetes and Digestive and Kidney Diseases NASH Clinical Research Network. Children younger than 18 years with biopsy-confirmed NAFLD enrolled in the NASH Clinical Research Network. MAIN OUTCOMES AND MEASURES The presence of type 2 diabetes and prediabetes as determined by American Diabetes Association screening criteria using clinical history and fasting laboratory values. RESULTS There were 675 children with NAFLD included in the study with a mean age of 12.6 years and mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 32.5. Most of the children were boys (480 of 675) and Hispanic (445 of 675).The estimated prevalence of prediabetes was 23.4% (95% CI, 20.2%-26.6%), and the estimated prevalence of type 2 diabetes was 6.5% (95% CI, 4.6%-8.4%). Girls with NAFLD had 1.6 (95% CI, 1.04-2.40) times greater odds of having prediabetes and 5.0 (95% CI, 2.49-9.98) times greater odds of having type 2 diabetes than boys with NAFLD. The prevalence of NASH was higher in those with type 2 diabetes (43.2%) compared with prediabetes (34.2%) or normal glucose (22%) (P < .001). The odds of having NASH were significantly higher in those with prediabetes (OR, 1.9; 95% CI, 1.21-2.9) or type 2 diabetes (OR, 3.1; 95% CI, 1.5-6.2) compared with those with normal glucose. CONCLUSIONS AND RELEVANCE In this study, nearly 30% of children with NAFLD also had type 2 diabetes or prediabetes. These children had greater odds of having NASH and thus were at greater long-term risk for adverse hepatic outcomes.
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Affiliation(s)
- Kimberly P. Newton
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
| | - Jiayi Hou
- Clinical and Translational Research Institute, University of California San Diego School of Medicine, La Jolla, California
| | - Nancy A. Crimmins
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Joel E. Lavine
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University, New York, NY
| | - Sarah E. Barlow
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, TX
| | - Stavra A. Xanthakos
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center
| | - Jonathan Africa
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
| | - Cynthia Behling
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California,Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center
| | - Michele Donithan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Jeanne M. Clark
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD,Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Jeffrey B. Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California,Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, San Diego, California
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15
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Current status on obesity in childhood and adolescence: Prevalence, etiology, co-morbidities and management. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.obmed.2016.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Chan CL, Pyle L, Kelsey M, Newnes L, Zeitler PS, Nadeau KJ. Screening for type 2 diabetes and prediabetes in obese youth: evaluating alternate markers of glycemia - 1,5-anhydroglucitol, fructosamine, and glycated albumin. Pediatr Diabetes 2016; 17:206-11. [PMID: 25652226 DOI: 10.1111/pedi.12258] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 12/30/2014] [Accepted: 01/09/2015] [Indexed: 12/31/2022] Open
Abstract
Hemoglobin A1c (HbA1c) is increasingly performed over the oral glucose tolerance test (OGTT) as the initial screening test for type 2 diabetes in youth. However, the optimal strategy for identifying type 2 diabetes in youth remains controversial. Alternate glycemic markers have been proposed as potentially useful tools for diabetes screening. We examined the relationships among fructosamine (FA), glycated albumin (GA), and 1,5-anhydroglucitol (1,5-AG) with traditional screening tests, HbA1c and OGTT. Youth 10-18 yrs, BMI ≥85th‰, and HbA1c <7.5% had a single visit with measurement of HbA1c, 1,5-AG, FA, GA, and a standard OGTT. Distributions of FA, GA, and 1,5-AG by HbA1c and 2-hour glucose (2hG) categories were compared. Receiver operating characteristic (ROC)-curves were generated to determine the cut points at which alternate markers maximized sensitivity and specificity for predicting prediabetes and diabetes. One hundred and seventeen, 62% female, 59% Hispanic, 22% White, 17% black, median 14.1 yr, and body mass index (BMI) z-score 2.3 participated. Median values of each alternate marker differed significantly between prediabetes and diabetes HbA1c and 2hG categories (p < 0.017). Only GA medians differed (p = 0.006) between normal and prediabetes HbA1c. Area under the receiver operating characteristic curves (ROC-AUCs) for alternate markers as predictors of prediabetes (0.5-0.66) were low; however, alternate marker ROC-AUCs for identifying diabetes (0.82-0.98) were excellent. Although the alternate markers were poor predictors of prediabetes, they all performed well predicting diabetes by 2hG and HbA1c. Whereas the usefulness of these markers for identifying prediabetes is limited, they may be useful in certain scenarios as second line screening tools for diabetes in overweight/obese youth.
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Affiliation(s)
- Christine L Chan
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Denver, Aurora, CO, USA
| | - Laura Pyle
- Department of Pediatrics, Administrative Section, Children's Hospital Colorado and University of Colorado Denver, Aurora, CO, USA
| | - Megan Kelsey
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Denver, Aurora, CO, USA
| | - Lindsey Newnes
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Denver, Aurora, CO, USA
| | - Philip S Zeitler
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Denver, Aurora, CO, USA
| | - Kristen J Nadeau
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Denver, Aurora, CO, USA
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Yoo HY, Kwak BO, Son JS, Kim KS, Chung S. Value of serum 1,5-anhydroglucitol measurements in childhood obesity in the continuum of diabetes. Ann Pediatr Endocrinol Metab 2015; 20:192-7. [PMID: 26817006 PMCID: PMC4722158 DOI: 10.6065/apem.2015.20.4.192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 09/05/2015] [Accepted: 11/19/2015] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The prevalence of type 2 diabetes mellitus (T2DM) and obesity are currently increasing. Accordingly, the concept of "preventing diabetes" in high-risk groups has become more important in diabetic care, but the use of glycated hemoglobin (HbA1c) as a measure has limitations in this field. The aim of this study was to investigate the utility of 1,5-anhydroglucitol (1,5-AG) in assessing prediabetes status in obese children. METHODS The medical records of 74 subjects aged 6-19 years (of which 27 were overweight/obese and 47 had diabetes) who had 1,5-AG data were reviewed retrospectively. We compared 1,5-AG with HbA1c using the Pearson correlation test to assess the clinical utility of 1,5-AG. RESULTS 1,5-AG levels were higher (31.1±10.1 µg/mL vs. 7.4±7.3 µg/mL) and HbA1c levels were lower (5.5%±0.3% vs. 8.9%±2.7%) in the overweight/obese group than in the diabetics group. The range of 1,5-AG levels in obese children was wide (16.8-59.3 µg/mL), and did not have significance with HbA1c. A negative correlation between 1,5-AG and HbA1c was significant in the entire subject (r=-0.822, P<0.001), and also in the HbA1c range of 5.5% to 8% (r=-0.736, P<0.001). CONCLUSION 1,5-AG is a valuable index in the HbA1c range of 5.5%-8% and it might be considered an early glycemic control index in insulin-resistant obese children with an HbA1c level above 5.5%. Moreover, the 1,5-AG level assessment should be presented as a supplementary tool for better compliance, as well as being an improvement in diabetes management for the short-term glucose control in relatively well-controlled diabetes patients with an HbA1c level below 8%.
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Affiliation(s)
- Ha Yeong Yoo
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Byung Ok Kwak
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Sung Son
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyo Sun Kim
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Malkan UY, Gunes G, Corakci A. Rational diagnoses of diabetes: the comparison of 1,5-anhydroglucitol with other glycemic markers. SPRINGERPLUS 2015; 4:587. [PMID: 26543722 PMCID: PMC4628038 DOI: 10.1186/s40064-015-1389-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 09/29/2015] [Indexed: 12/16/2022]
Abstract
Diabetes mellitus (DM) is a frequently encountered disease with important morbidity and mortality. The aim of this study is to document the importance of 1,5-anhydroglucitol (1,5-AG) for the diagnosis of prediabetes and DM, as well as to compare the 1,5-AG with other glycemic markers in order to understand which one is the better diagnostic tool. Between April 2012 and December 2012, 128 participants enrolled in the study. Participants were split into five groups that are IFG, IGT, IFG+IGT, diabetic and control groups by their OGTT results. The diagnostic value of markers was compared by ROC (receiver operating characteristic) method. The mean serum 1,5-AG levels in the diabetic group (33.38 nmol/ml) were lower than, IFG (59.83 nmol/ml), IGT (54.44 nmol/ml), IFG+IGT (51.98 nmol/ml) and control groups (73.24 nmol/ml). When analyzed in the total study population serum 1,5-AG levels did not differ by gender significantly. When analyzed in the total study population, 1,5-AG correlates inversely with age significantly (p = 0.036). In subgroup analysis, in the control group, serum 1,5-AG level was also inversely correlated with age (p = 0.087). The best marker for the diagnosis of prediabetes and DM was fasting plasma glucose (FPG). 1,5-AG was not found to be effective for the diagnosis of DM. This study, contributes to our knowledge of the efficiency and cut-off values of 1,5-AG for the diagnosis of prediabetes and DM. In future, there is a need for larger studies with more standardized and commonly used measurement methods for 1,5-AG, in order to evaluate the efficiency of 1,5-AG for the diagnosis of prediabetes and DM.
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Affiliation(s)
- Umit Yavuz Malkan
- Department of Internal Medicine, School of Medicine, Ufuk University, Ankara, Turkey
| | - Gursel Gunes
- Department of Internal Medicine, School of Medicine, Ufuk University, Ankara, Turkey
| | - Ahmet Corakci
- Department of Endocrinology, School of Medicine, Ufuk University, Ankara, Turkey
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Jasik CB, King EC, Rhodes E, Sweeney B, Mietus-Snyder M, Grow HM, Harris JM, Lostocco L, Estrada E, Boyle K, Tucker JM, Eneli IU, Woolford SJ, Datto G, Stratbucker W, Kirk S. Characteristics of Youth Presenting for Weight Management: Retrospective National Data from the POWER Study Group. Child Obes 2015; 11:630-7. [PMID: 26440387 DOI: 10.1089/chi.2015.0053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND There are no existing multisite national data on obese youth presenting for pediatric weight management. The primary aim was to describe BMI status and comorbidities among youth with obesity presenting for pediatric weight management (PWM) at programs within the Pediatric Obesity Weight Evaluation Registry (POWER). METHODS Data were collected from 2009-2010 among 6737 obese patients ages 2-17. Patients were classified in three groups by BMI (kg/m(2)) cutoffs and percent of the 95th percentile for BMI: (1) obesity; (2) severe obesity class 2; and (3) severe obesity class 3. Weighted percentages are presented for baseline laboratory tests, blood pressure, and demographics. Generalized logistic regression with clustering was used to examine the relationships between BMI status and comorbidities. RESULTS Study youth were 11.6 ± 3.4 years of age, 56% female, 31% black, 17% Hispanic, and 53% publicly insured. Twenty-five percent of patients had obesity (n = 1674), 34% (2337) had severe obesity class 2, and 41% (2726) had severe obesity class 3. Logistic regression revealed that males (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.5-2.0), blacks (OR, 1.7; 95% CI, 1.5-2.0), age <6 years (OR, 2.0; 95% CI, 1.5-2.6), and public insurance (OR, 1.8; 95% CI, 1.5-2.0) had a higher odds of severe obesity class 3. Severe obesity class 3 was associated with higher odds of laboratory abnormalities for hemoglobin A1c (OR, 1.7; 95% CI, 1.3-2.2), alanine aminotransferase ≥40 U/L (OR, 1.9; 95% CI, 1.3-2.6), and elevated systolic blood pressure (OR, 2.5; 95% CI, 2.0-3.0). CONCLUSIONS Youth with obesity need earlier access to PWM given that they are presenting when they have severe obesity with significant comorbidities.
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Affiliation(s)
| | | | | | - Brooke Sweeney
- 4 Children's Mercy Hospitals and Clinics , Kansas City, MO
| | | | | | | | | | | | - Katie Boyle
- 9 Connecticut Children's Medical Center , Hartford, CT
| | | | | | | | - George Datto
- 13 Nemours/Alfred I. duPont Hospital for Children , Wilmington, DE
| | | | - Shelley Kirk
- 2 Cincinnati Children's Hospital , Cincinnati, OH
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Cochran J, Baus A. Developing Interventions for Overweight and Obese Children using Electronic Health Records Data. ON-LINE JOURNAL OF NURSING INFORMATICS 2015; 19:http://www.himss.org/ResourceLibrary/GenResourceDetail.aspx?ItemNumber=39758. [PMID: 26843807 PMCID: PMC4734759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Childhood obesity and the resulting co-morbid conditions have become a massive burden for primary caregivers in West Virginia and across the United States. Building culturally sensitive clinical interventions to meet population health needs presents a multi-factorial challenge. Historically it has been is difficult to accurately assess the demographic characteristics of clinic populations. Fortunately, the use of electronic health records (EHR) has created a major shift in clinical documentation and ability to routinely collect essential demographic and clinical data. While data for Meaningful Use under the Centers for Medicare and Medicaid Services is increasingly used to evaluate clinical care and outcomes, use of EHR data outside of the Meaningful Use umbrella has not received sufficient attention. This study explores use of EHR data beyond Meaningful Use to obtain demographic characteristics of an obese and overweight pediatric population in a rural primary care center for the purpose of informing appropriate, locally relevant intervention strategies. We find that the breadth and depth of information recorded on each patient can collectively provide valuable information to describe and evaluate the clinic population, identify priority areas to address, and measure change over time. Application of EHR data to understand the demographic characteristics of this particular patient population highlights the ability to identify target patient populations, uncover critical patient-level and population-level outcomes, inform intervention development and implementation, and add value to efforts in quality improvement systems transformation. Use of EHR data outside of the Meaningful Use umbrella needs increased attention in primary care.
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Affiliation(s)
- Jill Cochran
- Department of Clinical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901
| | - Adam Baus
- School of Public Health, West Virginia University, Morgantown, WV 26506
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Berhan YT, Möllsten A, Carlsson A, Högberg L, Ivarsson A, Dahlquist G. Five-region study finds no evidence of undiagnosed type 2 diabetes in Swedish 11- to 13-year-olds. Acta Paediatr 2014; 103:1078-82. [PMID: 24976437 DOI: 10.1111/apa.12729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 02/07/2014] [Accepted: 06/24/2014] [Indexed: 01/14/2023]
Abstract
AIM Childhood obesity is now an established public health problem in most developed countries, and there is concern about a parallel increase of type 2 diabetes. The aim of this study was to estimate the prevalence of undiagnosed type 2 diabetes in overweight Swedish school children from 11 to 13 years of age. METHODS Body mass index (BMI) was measured in 5528 schoolchildren in the 6th grade, from 11 to 13 years of age, in five different regions in Sweden. Overweight was defined by international age- and sex-specific BMI cut-offs, corresponding to adult BMI cut-offs of 25 kg/m(2) at 18 years of age (ISO-BMI ≥25, n = 1275). Haemoglobin A1c (HbA1c) was measured in 1126 children with ISO-BMI ≥25. Children with a Diabetes Control and Complications Trial aligned HbA1c ≥6.1% on two occasions underwent an oral glucose tolerance test (OGTT) to establish the diabetes diagnosis. RESULTS Of 1126 children with ISO-BMI ≥25, 24 (2.1%) had at least one HbA1c value ≥6.1%. Three of them had HbA1c ≥6.1% on two occasions, and all of them had a normal OGTT. CONCLUSION In this cross-sectional, population-based screening study of a high-risk group of 11- to 13-year-old Swedish school children, we found no indication of undiagnosed diabetes or impaired glucose tolerance.
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Affiliation(s)
- Yonas T. Berhan
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
| | - Anna Möllsten
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
| | - Annelie Carlsson
- Department of Clinical Sciences, Pediatrics; Lund University; Lund Sweden
| | - Lotta Högberg
- Division of Pediatrics; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health; Umeå University; Umeå Sweden
| | - Gisela Dahlquist
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
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Irizarry KA, Brito V, Freemark M. Screening for metabolic and reproductive complications in obese children and adolescents. Pediatr Ann 2014; 43:e210-7. [PMID: 25198445 PMCID: PMC4331647 DOI: 10.3928/00904481-20140825-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Childhood obesity is associated with a number of metabolic comorbidities. These include glucose intolerance and type 2 diabetes mellitus, hyperlipidemia, fatty liver disease, and reproductive complications, such as polycystic ovary syndrome. The occurrence of these complications in a child or adolescent may result in progressive health decline at an early age. We, therefore, advocate screening and early diagnosis. This purpose of this review is to outline a rational, evidence-based approach to screening obese children and adolescents for metabolic and reproductive complications. In each section, the aim is to provide the primary care provider with a review of the literature supporting current screening practices. As such, this review is designed to assist the primary care provider in the selection and interpretation of screening tests and to make recommendations regarding the referral of patients for subspecialty care.
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Hosking J, Metcalf BS, Jeffery AN, Streeter AJ, Voss LD, Wilkin TJ. Divergence between HbA1c and fasting glucose through childhood: implications for diagnosis of impaired fasting glucose (Early Bird 52). Pediatr Diabetes 2014; 15:214-9. [PMID: 25705748 DOI: 10.1111/pedi.12082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE An HbA1c threshold of ≥ 6.5% has recently been adopted for the diagnosis of diabetes in adults, and of ≥ 5.7% to identify adults at risk. Little,however, is known of HbA1c's behaviour or diagnostic value in youth. Our aim was to describe the course of HbA1c during childhood, and its association with fasting glucose. RESEARCH DESIGN AND METHODS HbA1c and glucose were measured every year in a cohort of 326 healthy children (162 boys) from 5 to 15 years. Mixed effects modelling was used to establish the determinants of HbA1c and its development over time. ROC analysis was used to determine the diagnostic value of HbA1c in the 55 individuals who showed impaired fasting glucose(IFG – glucose ≥ 5.6 mmol/L). RESULTS Glucose rose progressively from 4.3 mmol/L at 5 years to 5.1 mmol/Lat 15 years, and although there were positive associations between HbA1c and glucose, from 10 to 13 years, HbA1c fell while glucose continued to rise. IFG developed in 55 children, but HbA1c exceeded 5.7% in only 16 of them. The maximum area under the ROC curve was 0.71 at the age of 14 (p<0.001), and the sensitivity and specificity were optimal at 50 and 80% respectively,corresponding to HbA1c of 5.4%. CONCLUSIONS Although HbA1c retains a positive association with glucose throughout childhood, it is weak, and their trends diverge from 10 years,suggesting that factors other than glycaemia systematically influence the variance of HbA1c in youth. These findings therefore limit the interpretation of HbA1c for the diagnosis of IFG during childhood.
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Affiliation(s)
- Joanne Hosking
- Department of Endocrinology and Metabolism, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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van der Aa MP, Fazeli Farsani S, Kromwijk LAJ, de Boer A, Knibbe CAJ, van der Vorst MMJ. How to screen obese children at risk for type 2 diabetes mellitus? Clin Pediatr (Phila) 2014; 53:337-42. [PMID: 24243989 DOI: 10.1177/0009922813509480] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recommended screening to identify children at risk for diabetes and its precursors impaired glucose tolerance (IGT) and insulin resistance (IR) is fasted plasma glucose (FPG). This study evaluates the added value of fasted plasma insulin (FPI). METHODS This study analyzed routinely collected data of an oral glucose tolerance test (OGTT) of 311 obese children (age 10.8 ± 3.2 years). Diabetes and IGT were defined according to the American Diabetes Association criteria, IR as homeostasis model assessment (HOMA)-IR ≥3.4. RESULTS Cases diagnosed with an OGTT if FPG ≥5.6 mmol/L, compared with an OGTT performed if FPG ≥5.6 mmol/L or HOMA-IR ≥3.4, were, respectively, 4 (80%) versus 5 (100%) with diabetes, 7 (28%) versus 16 (64%) with IGT, and 0 (0%) versus 93 (100%) with IR. CONCLUSIONS Screening with FPG and FPI has equal burden compared with screening with FPG alone, identifies all patients with diabetes, and identifies more patients with precursors of diabetes.
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Juarez DT, Demaris KM, Goo R, Mnatzaganian CL, Wong Smith H. Significance of HbA1c and its measurement in the diagnosis of diabetes mellitus: US experience. Diabetes Metab Syndr Obes 2014; 7:487-94. [PMID: 25349480 PMCID: PMC4208352 DOI: 10.2147/dmso.s39092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The 2014 American Diabetes Association guidelines denote four means of diagnosing diabetes. The first of these is a glycosylated hemoglobin (HbA1c) >6.5%. This literature review summarizes studies (n=47) in the USA examining the significance, strengths, and limitations of using HbA1c as a diagnostic tool for diabetes, relative to other available means. Due to the relatively recent adoption of HbA1c as a diabetes mellitus diagnostic tool, a hybrid systematic, truncated review of the literature was implemented. Based on these studies, we conclude that HbA1c screening for diabetes has been found to be convenient and effective in diagnosing diabetes. HbA1c screening is particularly helpful in community-based and acute care settings where tests requiring fasting are not practical. Using HbA1c to diagnose diabetes also has some limitations. For instance, HbA1c testing may underestimate the prevalence of diabetes, particularly among whites. Because this bias differs by racial group, prevalence and resulting estimates of health disparities based on HbA1c screening differ from those based on other methods of diagnosis. In addition, existing evidence suggests that HbA1c screening may not be valid in certain subgroups, such as children, women with gestational diabetes, patients with human immunodeficiency virus, and those with prediabetes. Further guidelines are needed to clarify the appropriate use of HbA1c screening in these populations.
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Affiliation(s)
- Deborah Taira Juarez
- Daniel K Inouye College of Pharmacy, University of Hawaii at Hilo, Honolulu, HI, USA
- Correspondence: Deborah Taira Juarez, Daniel K Inouye College of Pharmacy, University of Hawaii at Hilo, 677 Ala Moana Boulevard, Suite 1025, Honolulu, HI 96813, USA, Email
| | - Kendra M Demaris
- Daniel K Inouye College of Pharmacy, University of Hawaii at Hilo, Honolulu, HI, USA
| | - Roy Goo
- Daniel K Inouye College of Pharmacy, University of Hawaii at Hilo, Honolulu, HI, USA
| | | | - Helen Wong Smith
- Daniel K Inouye College of Pharmacy, University of Hawaii at Hilo, Honolulu, HI, USA
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Love-Osborne KA, Sheeder J, Svircev A, Chan C, Zeitler P, Nadeau KJ. Use of glycosylated hemoglobin increases diabetes screening for at-risk adolescents in primary care settings. Pediatr Diabetes 2013; 14:512-8. [PMID: 23659706 DOI: 10.1111/pedi.12037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine rates of diabetes screening in obese adolescents in an ethnically diverse primary care health care system before and after an internal recommendation to use HbA1c-based screening. RESEARCH DESIGN AND METHODS Adolescents 12-18-years old with BMI > 95% were identified through electronic medical record review during two 18-month periods in 8 community health clinics and 13 school-based health centers: period 1 (P1, 19 April 2008 to 19 October 2009) and period 2 (P2, 3 May 2010 to 3 November 2011). Testing for diabetes in the 2 yr preceding the most recently elevated BMI was reviewed. RESULTS A total of 2870 obese adolescents were identified in P1 and 3940 in P2. Ethnicity was primarily Hispanic, with smaller populations of Black and White youth. The percent of obese teens screened for diabetes increased from 40% in P1 to 47% in P2. Use of HbA1c increased 493% during P2. Older teens (>15 yr), those seen during P2, and those with BMI ≥ 30 kg/m2 were more likely to be screened. Record review confirmed equal rates of type 2 diabetes in the two periods: 8 incident (0.7%) cases in P1 and 13 (0.7%) in P2. CONCLUSIONS The use of HbA1c, a non-fasting and logistically simpler test, was associated with increased diabetes screening in primary care. The percentage of screened patients with confirmed type 2 diabetes remained unchanged. Thus, despite potential pitfalls, the use of HbA1c for screening appears to be as successful as previous approaches in identifying adolescents with diabetes.
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Affiliation(s)
- Kathryn A Love-Osborne
- Pediatrics/Adolescent Medicine, Denver Health and Hospitals and University of Colorado School of Medicine, Denver, CO, 80205, USA
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Affiliation(s)
- M A Sabin
- Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia
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Type 2 diabetes mellitus in children and youth. Indian J Pediatr 2013; 80 Suppl 1:S87-94. [PMID: 23430571 DOI: 10.1007/s12098-013-0962-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 01/08/2013] [Indexed: 01/18/2023]
Abstract
Type 2 diabetes mellitus (T2DM) which used to be a disease of adults is now seen commonly at an early age in children and adolescents. T2DM is now an important diagnostic consideration in children who present with signs and symptoms of diabetes. The emerging epidemic of obesity in children throughout the world and the resultant insulin resistance contributes to the increasing prevalence of T2DM in this population. The recommended treatment options include metformin and insulin. Optimal glycemic control is essential considering the lifelong nature of the disease and therefore, the increased risk of long term complications - both microvascular and macrovascular. This review article summarizes the classification, diagnosis, pathogenesis, management, complications and screening of T2DM in children, incorporating and contextualizing guidelines from various professional associations.
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Abstract
Diagnostic criteria for diabetes in children have not been established with nearly the rigor as that employed in adults. Recently revised American Diabetes Association (ADA) criteria allowed utilization of hemoglobin A(1c) (HbA1c) ≥ 6.5 % for diagnosis of diabetes. A recent series of pediatric studies appear to show that HbA1c has lower sensitivity than Fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT). However, FPG and OGTT have themselves never been validated in children. Studies to validate diagnostic thresholds in children appear unlikely to take place. Thus, accepting the major ADA diagnostic criteria appears to be the best course of action for the pediatric community. One area in which correlation studies between HbA1c and FPG or OGTT might shed light is in the definition of criteria for intervention in 'pre-diabetes,' as the Diabetes Prevention Program Trial did not use HbA1c. However, such treatment, and the exact diagnostic thresholds at which it should be initiated in children, remains unproven.
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Affiliation(s)
- Chirag R Kapadia
- Division of Endocrinology and Diabetes, Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA.
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Yeşiltepe Mutlu G, Özsu E, Çizmecioğlu FM, Hatun Ş. Can HbA1c and one-hour glucose concentration in standard OGTT be used for evaluation of glucose homeostasis in childhood? J Clin Res Pediatr Endocrinol 2013; 5:80-4. [PMID: 23748058 PMCID: PMC3701926 DOI: 10.4274/jcrpe.889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/22/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate whether glycosylated hemoglobin (HbA1c) and 1-hour glucose level in oral glucose tolerance test (OGTT) are useful parameters for evaluation of glucose homeostasis in childhood. METHODS The medical records of 106 obese/overweight children aged from 7 to 18 years who underwent OGTT were evaluated retrospectively. The subjects were divided into 2 groups according to their one-hour glucose concentration. Group 1 consisted of subjects whose one-hour glucose level was <155 mg/dL, and Group 2 consisted of subjects whose one-hour glucose level was ≥155 mg/dL. The fasting and 2-hour glucose concentrations of the groups were compared. The sensitivity and specificity levels were determined using the ROC curve to assess the predictive value of HbA1c for impaired glucose tolerance (IGT). RESULTS The mean 2-hour glucose concentration of the subjects in Group 2 was significantly higher than that of the subjects in Group 1 (137.8±35.5 mg/dL versus 113.1±21.2 mg/dL, p<0.05). If a 5.5% cut-off value for HbA1c was accepted as predictor of IGT, the sensitivity was 63% and specificity was 70%. 31% of the subjects with HbA1c levels at or above 5.5% had IGT. This rate was significantly lower in subjects who had HbA1c levels below 5.5% (p<0.05). CONCLUSIONS Obese/overweight children and adolescents whose 1-hour glucose level is ≥155 mg/dL in the standard OGTT carry a high risk for IGT. Obese/overweight children and adolescents whose HbA1c level is at or above 5.5% may have IGT even though their fasting glucose level is normal, thus, OGTT is necessary to evaluate the glucose tolerance.
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Affiliation(s)
- Gül Yeşiltepe Mutlu
- Kocaeli University Medical Faculty, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Kocaeli, Turkey
| | - Elif Özsu
- Kocaeli University Medical Faculty, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Kocaeli, Turkey
| | - Filiz Mine Çizmecioğlu
- Kocaeli University Medical Faculty, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Kocaeli, Turkey
| | - Şükrü Hatun
- Kocaeli University Medical Faculty, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Kocaeli, Turkey
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Kapadia C, Zeitler P. Hemoglobin A1c measurement for the diagnosis of Type 2 diabetes in children. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2012; 2012:31. [PMID: 23256825 PMCID: PMC3564771 DOI: 10.1186/1687-9856-2012-31] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 11/12/2012] [Indexed: 01/04/2023]
Abstract
Laboratory measurements of hemoglobin A1c above 6.5% were approved as an additional diagnostic criteria for diabetes mellitus by the American Diabetes Association in 2010. Several recent pediatric studies have cast HbA1c measurement in children in an unfavorable light in the pediatric population, by comparing HbA1c measurements to results on oral glucose tolerance test (OGTT) or fasting plasma glucose (FPG). However, many of these studies do not recognize that diabetes diagnostic criteria are based upon long-term health outcomes. In this sense, OGTT and FPG have themselves never been validated in the pediatric population. Studies to validate diagnostic tests for diabetes in pediatric populations may take a substantial period of time, and may prove unfeasible. However, studies that tie diagnostic results as a child to diagnostic results as an adult may be more feasible and may provide the data needed to determine which pediatric diagnostic criteria to use. Thus, for the time being, except for cases of hemoglobinopathy, cystic fibrosis, and a few other exceptions, describing HbA1c as ‘lacking in sensitivity or specificity’ in the pediatric population because of lack of correlation with OGTT is not scientifically sound.
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Abstract
PURPOSE OF REVIEW This review focuses on recent literature on insulin resistance in youth with type 2 diabetes mellitus (T2DM). Insulin resistance is associated with a variety of cardiometabolic problems leading to increased morbidity and mortality across the lifespan. RECENT FINDINGS Functional pancreatic β-cell changes play a role in the transition from obesity to impaired glucose tolerance (IGT). Insulin resistance drives islet cell upregulation, manifested by elevated glucagon and c-peptide levels, early in the transition to IGT. Surrogate measurements of insulin resistance and insulin secretion exist but their accuracy compared to clamp data is imperfect. Recent large longitudinal studies provide detailed information on the progression from normoglycemia to T2DM and on the phenotype of T2DM youth. Defining prediabetes and T2DM remains a challenge in youth. Lifestyle interventions do not appear as effective in children as in adults. Metformin remains the only oral hypoglycemic agent approved for T2DM in youth. SUMMARY New insights exist regarding the conversion from insulin resistance to T2DM, measurement of insulin resistance and phenotypes of insulin resistance youth, but more information is needed. Surrogate measurements of insulin resistance, additional treatment options for insulin resistance and individualization of treatment options for T2DM adolescents in particular require further investigation.
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Affiliation(s)
- Kara Mizokami-Stout
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver and the Children's Hospital Colorado, Denver, Colorado, USA
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Sharma S, Fleming SE. Use of HbA(1C) testing to diagnose pre-diabetes in high risk African American children: a comparison with fasting glucose and HOMA-IR. Diabetes Metab Syndr 2012; 6:157-162. [PMID: 23158980 DOI: 10.1016/j.dsx.2012.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to compare the discriminating power of HbA(1C) with other pre-diabetes diagnostic tests specifically in high-risk African American children. RESEARCH DESIGN AND METHODS A cross-sectional analysis was performed on a sample of 172 children (70 boys and 102 girls) aged 9-11 years with BMI's above the 85th percentile. Fasting glucose, insulin and HbA(1C) were analyzed from the plasma samples. RESULTS Of the 172 participants included in this analysis, 21 (12.2%) had HbA(1C) concentrations above the cutoff of 5.7 used to identify pre-diabetes. None (0%) of these 21 participants, however, were observed to have a glucose concentration above the pre-diabetes cutoff of 110 mg/dl, and only 13 of 21 participants had HOMA-IR above the pre-diabetes cutoff of 2.5. When compared to the previously identified glucose cutoff of 110 mg/dl and HOMA-IR cutoff of 2.5 for pre-diabetes, HbA(1C) showed high specificity (88 and 93%, respectively) but very low sensitivity (0 and 21%, respectively). Glucose, insulin and HOMA-IR were significantly interrelated, but HbA(1C) was not significantly correlated with these biochemical prediabetes assessment variables, nor with anthropometric (BMIz, WC) risk factors. CONCLUSION Our results suggest that HbA(1C) had poor discrimination power to identify prediabetes in overweight and obese 9- to 11-year-old African American children. Future studies are recommended to compare the feasibility, sensitivity and predictive power of different screening tests currently recommended to avoid inadequacy when screening for prediabetes and diabetes.
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Affiliation(s)
- Sushma Sharma
- Dr Robert C and Veronica Atkins Center for Weight and Health, University of California, Berkeley, CA 94720-3104, USA.
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Mehta SN, Schwartz N, Wood JR, Svoren BM, Laffel LM. Evaluation of 1,5-anhydroglucitol, hemoglobin A1c, and glucose levels in youth and young adults with type 1 diabetes and healthy controls. Pediatr Diabetes 2012; 13:278-84. [PMID: 22060802 PMCID: PMC3767297 DOI: 10.1111/j.1399-5448.2011.00830.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Serum 1,5-anhydroglucitol (1,5-AG) is a marker of hyperglycemic excursions in adults with diabetes and hemoglobin A1c (HbA1c) < 8%. We compared 1,5-AG levels among youth and young adults with and without type 1 diabetes (T1D) and investigated the utility of 1,5-AG in the assessment of glycemic status in pediatric T1D. METHODS We compared 1,5-AG, HbA1c, and plasma glucose levels in 138 patients with T1D (duration ≥1 yr) and 136 healthy controls, aged 10-30 yr. Within each group, we investigated associations between 1,5-AG and clinical characteristics, HbA1c and random plasma glucose. For patients with T1D, 1,5-AG was further analyzed according to HbA1c strata: <8, 8-9, and >9%. RESULTS Compared to controls, patients with T1D had higher HbA1c (8.5 ± 1.6 vs. 5.1 ± 0.4%, p < 0.0001), lower 1,5-AG (4.0 ± 2.0 vs. 24.7 ± 6.4 µg/mL, p < 0.0001), and higher glucose (11.1 ± 5.2 vs. 5.1 ± 0.9 mmol/L, p < 0.0001). Males had higher 1,5-AG than females within patients (4.5 ± 2.3 vs. 3.4 ± 1.6 µg/mL, p = 0.003) and controls (26.0 ± 6.6 vs. 23.5 ± 6.0 µg/mL, p = 0.02). 1,5-AG was not correlated with glucose in either group. 1,5-AG was significantly correlated to HbA1c in patients, but not controls. For patients with HbA1c < 8%, 1,5-AG demonstrated the widest range and was not predicted by HbA1c; 1,5-AG levels were narrowly distributed among patients with HbA1c ≥ 8%. CONCLUSIONS Youth and young adults with T1D demonstrate similar 1,5-AG levels which are distinct from controls. 1,5-AG assessment may provide unique information beyond that provided by HbA1c in the mid-term assessment of glycemic control in young patients with T1D and HbA1c < 8%.
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Affiliation(s)
- Sanjeev N. Mehta
- Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Boston, MA, 02215, USA
| | - Natalie Schwartz
- Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Boston, MA, 02215, USA
| | - Jamie R. Wood
- Center for Diabetes, Endocrinology and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, 90027, USA
| | - Britta M. Svoren
- Division of Pediatric Endocrinology, Golisano Children’s Hospital, Rochester, NY, 14642, USA
| | - Lori M.B. Laffel
- Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Boston, MA, 02215, USA
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Olson ML, Maalouf NM, Oden JD, White PC, Hutchison MR. Vitamin D deficiency in obese children and its relationship to glucose homeostasis. J Clin Endocrinol Metab 2012; 97:279-85. [PMID: 22072738 PMCID: PMC3251943 DOI: 10.1210/jc.2011-1507] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of the study was to compare the prevalence of vitamin D deficiency in obese and non-overweight children in North Texas, to examine relationships between dietary habits and 25-hydroxyvitamin D [25(OH)D] level in obese children, and to examine the relationship between 25(OH)D level and markers of abnormal glucose metabolism and blood pressure. PATIENTS AND METHODS Using a cross-sectional design, systolic and diastolic blood pressure, dietary information, serum 25(OH)D, fasting glucose and insulin, 2-h glucose from oral glucose tolerance test, hemoglobin A1c, and homeostasis model assessment of insulin resistance were recorded for 411 obese subjects (6-16 yr old) at an obesity referral clinic. 25(OH)D was also obtained from 87 control non-overweight subjects (6-16 yr old). RESULTS Ninety-two percent of obese subjects had a 25(OH)D level below 75 nmol/liter, and 50% were below 50 nmol/liter. Among non-overweight subjects, these frequencies were 68 and 22%, respectively (both P < 0.01 compared with obese subjects). 25(OH)D was negatively associated with soda intake (P < 0.001), juice intake (P = 0.009), and skipping breakfast (P < 0.001). 25(OH)D was negatively correlated with homeostasis model assessment of insulin resistance (r = -0.19; P = 0.001) and 2-h glucose (r = -0.12; P = 0.04) after adjustment for body mass index and age but was not correlated with hemoglobin A1c, systolic blood pressure Z score, or diastolic blood pressure Z score. CONCLUSIONS Vitamin D deficiency is common in children in this southern United States location and is significantly more prevalent in obese children. Lower 25(OH)D level is associated with risk factors for type 2 diabetes in obese children.
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Affiliation(s)
- Micah L Olson
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA
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Young KL, Demeule M, Stuhlsatz K, Janzen D, Porter RM, Pomettio M, Braun S, Lipton M, Ayon S, Stolzman S, Peterson T. Identification and treatment of obesity as a standard of care for all patients in children's hospitals. Pediatrics 2011; 128 Suppl 2:S47-50. [PMID: 21885644 DOI: 10.1542/peds.2011-0480c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Obese children and adolescents have unique needs for specialized medical equipment while hospitalized and might require special diets and physical activity options as part of their medical treatment. It is important that patients with a diagnosis of obesity be identified on admission so that appropriate equipment and resources can be provided. We examined what components a healthy hospital environment should include and sought to determine if children's hospitals provide a healthy hospital environment that offers these components. In addition, we sought to determine if children's hospitals have policies in place to identify children with obesity so that appropriate resources and services can be offered to treat that diagnosis. We surveyed National Association of Children's Hospitals and Related Institutions member hospitals via a Web-based questionnaire and found that the majority of them do not have policies in place to identify patients with obesity. We did find that the majority of hospitals reported innovative programs or services to provide a healthy hospital environment for their patients, visitors, and staff but acknowledged limitations in providing some services. Specifically, children's hospitals can and should improve on their identification and management of obese pediatric patients.
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Affiliation(s)
- Karen L Young
- Division of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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Diagnosis of diabetes using hemoglobin A1c: should recommendations in adults be extrapolated to adolescents? J Pediatr 2011; 158:947-952.e1-3. [PMID: 21195416 PMCID: PMC3210198 DOI: 10.1016/j.jpeds.2010.11.026] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 09/14/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare test performance of hemoglobin A1c (HbA1c) for detecting diabetes mellitus/pre-diabetes for adolescents versus adults in the United States. STUDY DESIGN Individuals were defined as having diabetes mellitus (fasting plasma glucose [FPG] ≥ 126 mg/dL; 2-hour plasma glucose (2-hr PG) ≥ 200 mg/dL) or pre-diabetes (100 ≤ FPG < 126 mg/dL; 140 ≤ 2-hr PG < 200 mg/dL. HbA1c test performance was evaluated with receiver operator characteristic (ROC) analyses. RESULTS Few adolescents had undiagnosed diabetes mellitus (n = 4). When assessing FPG to detect diabetes, an HbA1c of 6.5% had sensitivity rates of 75.0% (30.1% to 95.4%) and 53.8% (47.4% to 60.0%) and specificity rates of 99.9% (99.5% to 100.0%) and 99.5% (99.3% to 99.6%) for adolescents and adults, respectively. Additionally, when assessing FPG to detect diabetes mellitus, an HbA1c of 5.7% had sensitivity rates of 5.0% (2.6% to 9.2%) and 23.1% (21.3% to 25.0%) and specificity rates of 98.3% (97.2% to 98.9%) and 91.1% (90.3% to 91.9%) for adolescents and adults, respectively. ROC analyses suggested that HbA1c is a poorer predictor of diabetes mellitus (area under the curve, 0.88 versus 0.93) and pre-diabetes (FPG area under the curve 0.61 versus 0.74) for adolescents compared with adults. Performance was poor regardless of whether FPG or 2-hr PG measurements were used. CONCLUSIONS Use of HbA1c for diagnosis of diabetes mellitus and pre-diabetes in adolescents may be premature, until information from more definitive studies is available.
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Lagunova Z, Porojnicu AC, Lindberg FA, Aksnes L, Moan J. Vitamin D status in Norwegian children and adolescents with excess body weight. Pediatr Diabetes 2011; 12:120-6. [PMID: 21352427 DOI: 10.1111/j.1399-5448.2010.00672.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The prevalence of childhood and adolescent obesity has increased during the past decades. A high body mass index (BMI) is associated with a low vitamin D status. The purpose of this study was to determine the prevalence of vitamin D deficiency and insufficiency in Norwegian children and adolescents with excess body weight. METHODS Vitamin D status and seasonal variations of 25(OH)D and 1,25(OH)(2)D were analyzed in 102 children and adolescents (70 girls and 32 boys), 8-19 yr of age, with overweight and obesity. RESULTS Overall, 50% of the children and adolescents included in the study had a low vitamin D status (25(OH)D <75 nmol/L) and 19% had vitamin D deficiency (25(OH)D <50 nmol/L). This was most prevalent in adolescents. Only 42% of teenagers had 25(OH)D levels ≥75 nmol/L vs. 72% of preteens. Both 25(OH)D and 1,25(OH)(2)D showed seasonal variations. A peak in serum 25(OH)D concentrations was observed during the summer while the lowest values were seen during the spring. In contrast, serum 1,25(OH)(2)D had a peak during the spring and the lowest concentrations during the winter. CONCLUSIONS The prevalence of vitamin D deficiency and insufficiency is higher in obese and overweight adolescents than in overweight children. This might be related to low outdoor activities and low vitamin D intake in teenagers. Seasonal variations of both the vitamin D metabolites were observed.
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Affiliation(s)
- Zoya Lagunova
- Department of Radiation Biology, Oslo University Hospital, The Norwegian Radium Hospital, 0310 Oslo, Norway.
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Bedi A, Fox AJ, Harris PE, Deng XH, Ying L, Warren RF, Rodeo SA. Diabetes mellitus impairs tendon-bone healing after rotator cuff repair. J Shoulder Elbow Surg 2010; 19:978-88. [PMID: 20303293 PMCID: PMC5257255 DOI: 10.1016/j.jse.2009.11.045] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 11/08/2009] [Accepted: 11/09/2009] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Studies have demonstrated a significant decrease in skeletal mass, bone mineral density, and impaired fracture healing in the diabetic population. However, the effect of sustained hyperglycemia on tendon-to-bone healing is unknown. MATERIALS AND METHODS Forty-eight male, Lewis rats underwent unilateral detachment of the supraspinatus tendon followed by immediate anatomic repair with transosseous fixation. In the experimental group (n = 24), diabetes was induced preoperatively via intraperitoneal injection of streptozotocin (STZ, 65 mg/kg) and confirmed with both pre- and post-STZ injection intraperitoneal glucose tolerance tests (IPGTT). Animals were sacrificed at 1 and 2 weeks postoperatively for biomechanical, histomorphometric, and immunohistochemical analysis. Serum hemoglobin A1c (HbA1c) levels were measured at 2 weeks postoperatively. Statistical comparisons were performed using Student t tests with significance set at P < .05. RESULTS IPGTT analysis demonstrated a significant impairment of glycemic control in the diabetic compared to control animals (P < .05). Mean HbA1c level at 2 weeks postoperatively was 10.6 ± 2.7% and 6.0 ± 1.0% for the diabetic and control groups, respectively (P < .05). Diabetic animals demonstrated significantly less fibrocartilage and organized collagen, and increased AGE deposition at the tendon-bone interface (P < .05). The healing enthesis of diabetic animals demonstrated a significantly reduced ultimate load-to-failure (4.79 ± 1.33 N vs 1.60 ± 1.67 N and 13.63 ± 2.33 N vs 6.0 ± 3.24 N for control versus diabetic animals at 1 and 2 weeks, respectively) and stiffness compared to control animals (P < .05). DISCUSSION Sustained hyperglycemia impairs tendon-bone healing after rotator cuff repair in this rodent model. These findings have significant clinical implications for the expected outcomes of soft tissue repair or reconstructive procedures in diabetic patients with poor glycemic control.
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Affiliation(s)
- Asheesh Bedi
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY,Reprint requests: Asheesh Bedi, MD, Fellow, Sports Medicine & Shoulder Surgery, Laboratory for Soft Tissue Research, Hospital For Special Surgery, 535 East 70th Street. New York City, NY 10021. (A. Bedi)
| | - Alice J.S. Fox
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY
| | | | - Xiang-Hua Deng
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY
| | - Liang Ying
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY
| | - Russell F. Warren
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY
| | - Scott A. Rodeo
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY
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Amed S, Daneman D, Mahmud FH, Hamilton J. Type 2 diabetes in children and adolescents. Expert Rev Cardiovasc Ther 2010; 8:393-406. [PMID: 20222817 DOI: 10.1586/erc.10.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The emergence of Type 2 diabetes (T2D) in children and adolescents parallels the rising rates of childhood obesity. As a condition of impaired insulin sensitivity and relative insulin deficiency resulting in hyperglycemia, T2D has a complex underlying physiology that is reflected by the multiple approaches used to optimize medical care and prevent the myriad of diabetes-related complications. T2D diagnosed in children and adolescents represents a distinct and challenging condition to evaluate and treat. Here, we highlight the epidemiology, pathophysiology, risk factors, clinical presentation and diagnosis, treatment and public health impact of T2D in children and adolescents.
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Affiliation(s)
- Shazhan Amed
- The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada
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Ciangura C, Basdevant A. Bariatric surgery in young massively obese diabetic patients. DIABETES & METABOLISM 2010; 35:532-6. [PMID: 20152740 DOI: 10.1016/s1262-3636(09)73462-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Obesity is the most important lifestyle-related risk factor for type 2 diabetes (T2DM). The prevalence of T2DM in adolescents is increasing in parallel with the increasing incidence of major obesity. In adult obese subjects, the greatest degree of T2DM prevention, improvement or recovery has been reported in patients who have undergone bariatric surgery. However, few studies are available on the benefits and risks of bariatric surgery in adolescents with T2DM. The indications for obesity surgery in this population are unusual, and should only be considered in academic settings after comprehensive interdisciplinary evaluation.
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Affiliation(s)
- C Ciangura
- Pôle d'Endocrinologie, Faculté de Médecine Pierre & Marie Curie -Paris 6 University-CNRH-IDF, AP-HP, Pitié-Salpêtrière, Paris, France
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Highlander P, Shaw GP. Current pharmacotherapeutic concepts for the treatment of cardiovascular disease in diabetics. Ther Adv Cardiovasc Dis 2009; 4:43-54. [PMID: 19965897 DOI: 10.1177/1753944709354305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
With the growing worldwide obesity epidemic, obesity, type 2 diabetes mellitus and hypertension leading to premature cardiovascular events, are increasingly prevalent. Diabetes mellitus is a significant public health concern and more aggressive management of the condition and its complications, particularly cardiovascular disease, is warranted. Endothelial cell dysfunction is now known to be present at the earliest stages of metabolic syndrome, and insulin resistance and may precede the clinical diagnosis of type 2 diabetes mellitus by several years. The current focus on endothelial cell function as a potential target of pharmacotherapy in the management of cardiovascular disease in diabetics seems warranted, though not all drugs currently prescribed target endothelial cell function equally. In this review, we consider the six classes of drugs currently prescribed for the treatment of hypertension as they impact endothelial cell function and advocate for the development of novel drugs that can repair the endothelium and enhance nitric oxide availability thus preventing future cardiovascular events.
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Affiliation(s)
- Peter Highlander
- School of Podiatric Medicine, Barry University, Miami Shores, FL, USA
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