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Lewis SJ, Williams CL, Mortimer GL, Oram RA, Hagopian WA, Gillespie KM, Long AE. Islet autoantibody frequency in relatives of children with type 1 diabetes who have a type 2 diabetes diagnosis. Diabet Med 2024; 41:e15394. [PMID: 38937948 DOI: 10.1111/dme.15394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
AIM This study aimed to evaluate characteristics of autoimmunity in individuals who have a type 2 diagnosis and are relatives of children with type 1 diabetes. METHODS Pre-diagnosis samples (median 17 months before onset) from relatives who were later diagnosed with type 2 diabetes were measured for autoantibodies to glutamate decarboxylase 65 (GADA), islet antigen-2 (IA-2A), zinc transporter 8 (ZnT8A) and insulin (IAA) as well as the type 1 diabetes genetic risk score (GRS2). Associations between islet autoantibodies, insulin treatment and GRS2 were analysed using Fisher's exact and t-tests. RESULTS Among 226 relatives (64% men; mean age at sampling 41 years; mean age 54 years at diagnosis), 32 (14%) were islet autoantibody-positive for at least one autoantibody more than a decade before diagnosis. Approximately half of these (n = 15) were treated with insulin. GADA-positivity was higher in insulin-treated relatives than in non-insulin-treated relatives (12/18 [67%] vs. 6/18 [33%], p < 0.001). IAA-positivity was observed in 13/32 (41%) of relatives with autoantibodies. GRS2 scores were increased in autoantibody-positive relatives (p = 0.032), but there was no clear evidence for a difference according to treatment (p = 0.072). CONCLUSION This study highlights the importance of measuring islet autoantibodies, including IAA, in relatives of people with type 1 diabetes to avoid misdiagnosis.
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Affiliation(s)
- Shanice J Lewis
- Translational Health Sciences, Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire L Williams
- Translational Health Sciences, Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - Georgina L Mortimer
- Translational Health Sciences, Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - William A Hagopian
- Pacific Northwest Diabetes Research Institute, University of Washington, Seattle, Washington, USA
| | - Kathleen M Gillespie
- Translational Health Sciences, Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna E Long
- Translational Health Sciences, Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
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2
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Molina JM, Medina PG, Gomez RA, Herrera JR, Martínez NL, Hernández B, García Y. Autoantibodies against beta cells to predict early insulin requirements in pediatric patients with clinically diagnosed type 2 diabetes. World J Diabetes 2024; 15:1717-1725. [DOI: 10.4239/wjd.v15.i8.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/28/2024] [Accepted: 06/26/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Autoimmunity has emerged as a probable disease modifier in patients with clinically diagnosed type 2 diabetes mellitus (T2DM), that is, patients who have insulin resistance, obesity, and other cardiovascular risk factors, suggesting that the presence of glutamic acid decarboxylase (anti-GAD65), islet antigen 2 (anti-IA2), and zinc transporter 8 (anti-Zn8T) antibodies could have deleterious effects on beta cell function, causing failure and earlier requirement for insulin treatment.
AIM To evaluate anti-GAD65, anti-IA2 and anti-Zn8T as predictors of early insulin requirement in adolescents with a clinical diagnosis of T2DM.
METHODS This was a case–control study in patients with clinically diagnosed with T2DM (68 cases and 64 controls with and without early insulin dependence respectively), male and female, aged 12–18 years. Somatometry, blood pressure, glucose, insulin, C-peptide, glycated hemoglobin A1c, and lipid profiles were assessed. ELISA was used to measure anti-GAD65, anti-IA2, and anti-Zn8T antibodies. Descriptive statistics, Pearson's χ2 test, Student's t test, and logistic regression was performed. P < 0.05 was considered statistically significant.
RESULTS There were 132 patients (53.8% female), with a mean age was 15.9 ± 1.3 years, and there was a disease evolution time of 4.49 ± 0.88 years. The presence of anti-GAD65, anti-IA2, and anti-Zn8T positivity was found in 29.5%, 18.2%, and 15.9%, respectively. Dividing the groups by early or no insulin dependence showed that the group with insulin had a higher frequency of antibody positivity: anti-GAD65 odds ratio (OR): 2.42 (1.112–5.303, P = 0.026); anti-IA2: OR: 1.55 (0.859–2.818, P = 0.105); and anti-Zn8T: OR: 7.32 (2.039–26.279, P = 0.002).
CONCLUSION Anti-GAD65 positivity was high in our study. Anti-GAD65 and anti-Zn8T positivity showed a significantly depleted beta cell reserve phenotype, leading to an increased risk of early insulin dependence.
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Affiliation(s)
- Jorge M Molina
- Department of Endocrinology, Children’s Hospital Federico Gomez, Mexico 06720, Mexico
| | - Patricia G Medina
- Department of Endocrinology, Children’s Hospital Federico Gomez, Mexico 06720, Mexico
| | - Rita A Gomez
- National Medical Center "Siglo XXI", UMAE Hosp Especialidades, Unidad Invest Med Epidemiol Clin, Mexican Social Security Institute, Mexico 06720, Mexico
| | - Julia R Herrera
- Research Division, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexican Institute of Social Security, Mexico 06720, Mexico
| | - Nancy L Martínez
- Epidemiology Research Unit in Endocrinology and Nutrition, Federico Gómez Children’s Hospital, Mexico 06720, Mexico
| | - Brenda Hernández
- Epidemiology Research Unit in Endocrinology and Nutrition, Federico Gómez Children’s Hospital, Mexico 06720, Mexico
| | - Yesenia García
- Department of Endocrinology, Comprehensive Health Unit for Trans Persons, Mexico 11340, Mexico
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3
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Boboc AA, Ionescu MI, Tataranu E, Boboc C, Galos F. Exploring the Diagnostic Complexity of Diabetes Subtypes in Pediatric Obesity: A Case Report of an Adolescent With Prader-Willi Phenotype and Literature Review. Cureus 2024; 16:e66456. [PMID: 39135667 PMCID: PMC11317789 DOI: 10.7759/cureus.66456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 08/15/2024] Open
Abstract
Obesity among adolescents poses a significant global health concern with profound short- and long-term impact on physical and mental well-being. The intricate relationship between obesity and the onset of diabetes remains ambiguous, particularly in cases where the manifestation may differ from that observed in individuals with uncomplicated obesity. Herein, we present the case of a 14-year-old male adolescent with Prader-Willi phenotype and subsequent obesity, exhibiting symptoms of polyuria and polydipsia over a 10-day period, indicative of potential diabetes mellitus (DM). Laboratory assessments revealed a hemoglobin A1c level of 10%, confirming the suspected diagnosis. Notably, despite the absence of ketosis, elevated C-peptide levels and the presence of slightly positive islet-cell antibodies warranted further investigation. While the presence of antibodies typically aligns with a diagnosis of type 1 DM, recent research has highlighted the occurrence of anti-insulin pancreatic cell antibodies in type 2 DM cases. This article aims to delve into the multifaceted issues surrounding adolescent obesity, atypical presentations of DM with positive antibodies, and the long-term management of patients with genetic syndromes.
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Affiliation(s)
- Anca A Boboc
- Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, ROU
| | - Mara I Ionescu
- Physiology II - Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, ROU
- Functional Sciences, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Elena Tataranu
- Paediatrics, Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, ROU
| | - Catalin Boboc
- Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, ROU
| | - Felicia Galos
- Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Pediatrics, Marie Curie Emergency Children's Hospital, Bucharest, ROU
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4
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S258-S281. [PMID: 38078582 PMCID: PMC10725814 DOI: 10.2337/dc24-s014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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5
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Gagnon CA, Schmitt JA, Ashraf AP. Children and Adolescents With Hybrid Diabetes: A Management Conundrum. Endocr Pract 2024; 30:49-56. [PMID: 37913926 PMCID: PMC10843692 DOI: 10.1016/j.eprac.2023.10.134] [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: 09/01/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Hybrid diabetes (HD); ie, insulin resistance with positive diabetes-associated autoantibodies (DAAs) is increasing in children. We aimed to compare the characteristics of children with HD with those with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) at diagnosis and after 2 years. METHODS A retrospective review of patients aged 0 to 19 years, with C-peptide and 4 DAA measurements available, who were diangosed with new-onset diabetes from 2016 to 2020 were included in the analysis. RESULTS Overall, 102 subjects were included, 32 with T1DM, 21 with HD, and 49 with T2DM. Amongst the groups (T1DM vs HD vs T2DM), there were differences in the proportion of non-Hispanic Whites (81.3% vs 47.6% vs 16.4%, P < .001), frequency of family history of T2DM (37.5% vs 100% vs 85.4%, P < .001), acanthosis nigricans (0% vs 42.9% vs 93.9%, P <.001), median body mass index z-score (-0.55 vs 1.8 vs 2.4, P <.001), and median C-peptide (0.4 ng/mL vs 0.9 ng/mL vs 2.4 ng/mL, P <.001). At 2 years, differences were seen in median body mass index z-scores (0.3 vs 1.9 vs 2.3, P <.001), mean HDL-cholesterol (58.0 mg/dL vs 48.2 mg/dL vs 39.5 mg/dL, P <.001), and the use of basal insulin (100% vs 100% vs 74.4%, P <.001). CONCLUSION Phenotypic and metabolic differences were seen in youth with T1DM, HD, and T2DM at diagnosis and follow-up. At 2 years, all subjects with HD remained insulin dependent whereas some with T2DM were not, indicating the need for targeted interventions to address the etiopathogenesis.
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Affiliation(s)
- Charles A Gagnon
- Department of Pediatrics, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama.
| | - Jessica A Schmitt
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ambika P Ashraf
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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6
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Hitt TA, Hannon TS, Magge SN. Approach to the Patient: Youth-Onset Type 2 Diabetes. J Clin Endocrinol Metab 2023; 109:245-255. [PMID: 37584397 DOI: 10.1210/clinem/dgad482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/17/2023]
Abstract
Youth-onset type 2 diabetes is a growing epidemic with a rising incidence worldwide. Although the pathogenesis and diagnosis of youth-onset type 2 diabetes are similar to adult-onset type 2 diabetes, youth-onset type 2 diabetes is unique, with greater insulin resistance, insulin hypersecretion, and faster progression of pancreatic beta cell function decline. Individuals with youth-onset type 2 diabetes also develop complications at higher rates within short periods of time compared to adults with type 2 diabetes or youth with type 1 diabetes. The highest prevalence and incidence of youth-onset type 2 diabetes in the United States is among youth from minoritized racial and ethnic groups. Risk factors include obesity, family history of type 2 diabetes, comorbid conditions and use of medications associated with insulin resistance and rapid weight gain, socioeconomic and environmental stressors, and birth history of small-for-gestational-age or pregnancy associated with gestational or pregestational diabetes. Patients with youth-onset type 2 diabetes should be treated using a multidisciplinary model with frequent clinic visits and emphasis on addressing of social and psychological barriers to care and glycemic control, as well as close monitoring for comorbidities and complications. Intensive health behavior therapy is an important component of treatment, in addition to medical management, both of which should be initiated at the diagnosis of type 2 diabetes. There are limited but growing pharmacologic treatment options, including metformin, insulin, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors. Although long-term outcomes are not fully known, metabolic/bariatric surgery in youth with type 2 diabetes has led to improved cardiometabolic outcomes.
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Affiliation(s)
- Talia A Hitt
- Division of Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 3114, Baltimore, MD 21287, USA
| | - Tamara S Hannon
- Division of Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
| | - Sheela N Magge
- Division of Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 3114, Baltimore, MD 21287, USA
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7
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Prasad N, Veeranki V, Bhadauria D, Kushwaha R, Meyyappan J, Kaul A, Patel M, Behera M, Yachha M, Agrawal V, Jain M. Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Changing Spectrum with Therapeutic Ascendancy. J Clin Med 2023; 12:1705. [PMID: 36836240 PMCID: PMC9964578 DOI: 10.3390/jcm12041705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Owing to changing epidemiology and therapeutic practices, a change in the spectrum of renal involvement in Type-2 diabetes mellitus (T2DM) has also been noted. The treatment of non-diabetic kidney disease (NDKD) differs from diabetic kidney disease (DKD) and the reversibility of NDKD in many cases to normal, prompts biopsy for rapid and accurate diagnosis. Data are scarce on kidney biopsy findings in T2DM. STUDY DESIGN & SETTING In this observational study, we prospectively collected the data of kidney biopsies of patients aged ≥ 18 years with T2DM admitted between 1 August 2005 and 31 July 2022. The clinical, demographic and histopathological data were evaluated. The spectrum of kidney involvement in the form of DKD and/or NDKD was studied. The impact of these findings with the use of drugs retarding disease progression was also analyzed. RESULTS A total of 5485 biopsies were performed during the study period and of these 538 patients had T2DM. The mean age of the study population was 56.9 ± 11.5 years and 81% were males. The mean duration of DM was 6.4 ± 6.1 years. Diabetic retinopathy (DR) was noted in 29.7%. The most common indication for biopsy was an acute rise in creatinine (147, 27.3%). Amongst the 538 diabetic patients who underwent biopsy, histological features only of DKD were noted in 166 patients (33%), NDKD alone in 262 (49%) and NDKD with DKD lesions in 110 (20%). On multivariate analysis, duration of DM less than 5 years, absence of CAD, absence of DR, oliguria at presentation, an acute rise in creatinine and low C3 were associated with NDKD. CONCLUSIONS The prevalence of NDKD among diabetics and ATIN in particular might be on an increasing trend in the current era of changing T2DM epidemiological patterns. The use of anti-pro-teinuric agents was associated with lesser degrees of histopathological chronicity in T2DM.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Vamsidhar Veeranki
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ravi Kushwaha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Jeyakumar Meyyappan
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Manas Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Manas Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Monika Yachha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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8
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Ginnard OZB, Redondo MJ, Lyons SK. Diabetes of Unclear Type in an Adolescent Boy With Multiple Islet-cell Autoantibody Positivity Successfully Managed With Glucagon-like Peptide-1 Receptor Agonist Alone: A Case Report. Can J Diabetes 2023; 47:90-93. [PMID: 36075851 PMCID: PMC10024250 DOI: 10.1016/j.jcjd.2022.07.006] [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: 09/16/2021] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 01/31/2023]
Abstract
Diabetes classification has traditionally considered type 1 and type 2 diabetes as 2 separate entities with different pathogenic mechanisms. However, clinicians and researchers see increasingly more exceptions to this conventional paradigm, leading to a concept of mixed phenotypes in diabetes classification. Herein we report the case of an adolescent with unclear diabetes type due to the presence of obesity, robust endogenous insulin production, multiple islet autoantibody positivity and severe hyperglycemia at diabetes diagnosis that has been successfully treated with liraglutide therapy alone. Our case report highlights the difficulty of diabetes classification and subsequent need for personalized medicine with regard to diabetes management.
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Affiliation(s)
- Olivia Z B Ginnard
- Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States.
| | - Maria J Redondo
- Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States
| | - Sarah K Lyons
- Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States
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9
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S230-S253. [PMID: 36507640 PMCID: PMC9810473 DOI: 10.2337/dc23-s014] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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10
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Welters A, Tittel SR, Reinehr T, Weghuber D, Wiegand S, Karges W, Freiberg C, Meissner T, Schloot NC, Holl RW. Clinical characteristics and cardiovascular risk profile in children and adolescents with latent autoimmune diabetes: Results from the German/Austrian prospective diabetes follow-up registry. Pediatr Diabetes 2022; 23:1602-1612. [PMID: 36334008 DOI: 10.1111/pedi.13450] [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: 07/20/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS To characterize children and adolescents with latent autoimmune diabetes of the young (LADY), and to assess the utility of classifying individuals as LADYs regarding their cardiovascular (CV) risk factors. METHODS Data from 25,520 individuals (age at diagnosis <18 years) of the Prospective Diabetes Follow-up Registry Diabetes-Patienten Verlaufsdokumentation (DPV) were analyzed. LADY was defined as positivity of ≥one islet autoantibody (iAb+) and an insulin-free interval of ≥6 months upon diabetes diagnosis. LADYs were compared to iAb+ individuals immediately requiring insulin ("immunologically confirmed" type 1 diabetes, T1DM), iAb-/Ins- individuals ("classical" T2DM) and to those clinically defined as T2DM (iAbs not measured). RESULTS Clinical characteristics of LADYs (n = 299) fell in between those with T1DM (n = 24,932) and T2DM (iAb-/Ins-, n = 152) or suspected T2DM (iAB not measured, n = 137). Stratifying LADYs according to their clinical diagnosis however revealed two distinct populations, highly resembling either T1DM or T2DM. Particularly, CV risk profile, precisely prevalence rates of arterial hypertension and dyslipidemia, was significantly higher in LADYs clinically classified as T2DM compared to LADYs classified as T1DM, and did not differ from those with "classical" T2DM. CONCLUSIONS In terms of CV risk, classifying children and adolescents with diabetes as LADYs provides no additional benefit. Instead, clinical diagnosis seems to better assign individuals to appropriate risk groups for increased CV risk profiles.
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Affiliation(s)
- Alena Welters
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital Düsseldorf, Dusseldorf, Germany
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten-Herdecke, Datteln, Germany
| | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Susanna Wiegand
- Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - Clemens Freiberg
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Meissner
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital Düsseldorf, Dusseldorf, Germany
| | - Nanette C Schloot
- Medizinische Fakultät der Heinrich-Heine Universität Düsseldorf, Dusseldorf, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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11
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Merjaneh L, Dolan LM, Suerken CK, D’Agostino R, Imperatore G, Saydah S, Roberts A, Marcovina S, Mayer-Davis EJ, Dabelea D, Lawrence JM, Pihoker C. A longitudinal assessment of diabetes autoantibodies in the SEARCH for diabetes in youth study. Pediatr Diabetes 2022; 23:1027-1037. [PMID: 36054435 PMCID: PMC9588609 DOI: 10.1111/pedi.13403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/26/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022] Open
Abstract
To assess changes in diabetes autoantibodies (DAs) over time in children and young adults with diabetes and determine whether observed changes were associated with demographic characteristics, clinical parameters and diabetes complications. Participants had DAs measured at baseline (10.3 ± 7.1 months after diabetes diagnosis) and at 12, 24 months and ≥5 years after the baseline measurement. At the ≥5-year follow-up, the presence of diabetes complications was assessed. We examined the associations between change in number of positive DAs and changes in individual DA status with the participants' characteristics and clinical parameters over time. Out of 4179 participants, 62% had longitudinal DA data and 51% had complications and longitudinal DA data. In participants with ≥1 baseline positive DA (n = 1699), 83.4% remained positive after 7.3 ± 2.3 years duration of diabetes. Decrease in number of positive DAs was associated with longer diabetes duration (p = 0.003 for 1 baseline positive DA; p < 0.001 for 2 baseline positive DAs) and younger age at diagnosis (p < 0.001 for 2 baseline positive DAs). No associations were found between change in number of positive DAs in participants with ≥1 baseline positive DA (n = 1391) and HbA1c, insulin dose, acute, or chronic complications after 7.7 ± 1.9 years duration of diabetes. DA status likely remains stable in the first 7 years after diabetes diagnosis. Younger age at diabetes diagnosis and longer duration were associated with less persistence of DAs. Measuring DAs after initial presentation may aid in diabetes classification but not likely in predicting the clinical course.
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Affiliation(s)
- Lina Merjaneh
- Department of Pediatrics, University of Washington,
Seattle, WA, USA
| | - Lawrence M. Dolan
- Department of Pediatrics, University of Cincinnati College
of Medicine, Cincinnati, OH, USA
| | - Cynthia K. Suerken
- Department of Biostatistical Sciences, Division of Public
Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ralph D’Agostino
- Department of Biostatistical Sciences, Division of Public
Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease
Control and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, Atlanta, GA, USA
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease
Control and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, Atlanta, GA, USA
| | - Alissa Roberts
- Department of Pediatrics, University of Washington,
Seattle, WA, USA
| | | | | | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public
Health, University of Colorado Denver, Aurora, CO, USA
| | - Jean M. Lawrence
- Division of Diabetes, Endocrinology, and Metabolic
Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National
Institutes of Health, Bethesda, MD
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington,
Seattle, WA, USA
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12
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Shah AS, Zeitler PS, Wong J, Pena AS, Wicklow B, Arslanian S, Chang N, Fu J, Dabadghao P, Pinhas-Hamiel O, Urakami T, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes 2022; 23:872-902. [PMID: 36161685 DOI: 10.1111/pedi.13409] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Since the 2018 ISPAD guidelines on this topic, follow-up of large cohorts from around the globe have continued informing the current incidence and prevalence of co-morbidities and complications in young adults with youth-onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youth-onset T2D, the initial and subsequent management of youth-onset T2D, and management of co-morbidities and complications. We include key updates from the observational phase of the multi-center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head-to-head comparison of youth onset vs adult-onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth-onset T2D, social determinants of health, and settings of care given COVID-19 pandemic.
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Affiliation(s)
- Amy S Shah
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio, USA
| | - Philip S Zeitler
- Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital and Central Clinical School, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alexia S Pena
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Brandy Wicklow
- Division of Endocrinology, Winnipeg Children's Hospital and University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy Chang
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Junfen Fu
- Division of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Sackler School of Medicine, Tel-Aviv, Israel
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Maria E Craig
- The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Pediatrics & Child Health, School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
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13
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Rudman N, Kifer D, Kaur S, Simunović V, Cvetko A, Pociot F, Morahan G, Gornik O. Children at onset of type 1 diabetes show altered N-glycosylation of plasma proteins and IgG. Diabetologia 2022; 65:1315-1327. [PMID: 35622127 PMCID: PMC9283363 DOI: 10.1007/s00125-022-05703-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS Individual variation in plasma N-glycosylation has mainly been studied in the context of diabetes complications, and its role in type 1 diabetes onset is largely unknown. Our aims were to undertake a detailed characterisation of the plasma and IgG N-glycomes in patients with recent onset type 1 diabetes, and to evaluate their discriminative potential in risk assessment. METHODS In the first part of the study, plasma and IgG N-glycans were chromatographically analysed in a study population from the DanDiabKids registry, comprising 1917 children and adolescents (0.6-19.1 years) who were newly diagnosed with type 1 diabetes. A follow-up study compared the results for 188 of these participants with those for their 244 unaffected siblings. Correlation of N-glycan abundance with the levels and number of various autoantibodies (against IA-2, GAD, ZnT8R, ZnT8W), as well as with sex and age at diagnosis, were estimated by using general linear modelling. A disease predictive model was built using logistic mixed-model elastic net regression, and evaluated using a 10-fold cross-validation. RESULTS Our study showed that onset of type 1 diabetes was associated with an increase in the proportion of plasma and IgG high-mannose and bisecting GlcNAc structures, a decrease in monogalactosylation, and an increase in IgG disialylation. ZnT8R autoantibody levels were associated with higher IgG digalactosylated glycan with bisecting GlcNAc. Finally, an increase in the number of autoantibodies (which is a better predictor of progression to overt diabetes than the level of any individual antibody) was accompanied by a decrease in the proportions of some of the highly branched plasma N-glycans. Models including age, sex and N-glycans yielded notable discriminative power between children with type 1 diabetes and their healthy siblings, with AUCs of 0.915 and 0.869 for addition of plasma and IgG N-glycans, respectively. CONCLUSIONS/INTERPRETATION We defined N-glycan changes accompanying onset of type 1 diabetes, and developed a predictive model based on N-glycan profiles that could have valuable potential in risk assessment. Increasing the power of tests to identify individuals at risk of disease development would be a considerable asset for type 1 diabetes prevention trials.
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Affiliation(s)
- Najda Rudman
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Domagoj Kifer
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | | | - Vesna Simunović
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ana Cvetko
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Flemming Pociot
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Pediatrics E, Herlev Hospital, Herlev, Denmark
| | - Grant Morahan
- Centre for Diabetes Research, The Harry Perkins Institute for Medical Research, Perth, WA, Australia.
- University of Melbourne, Parkville, VIC, Australia.
| | - Olga Gornik
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia.
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14
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Zeitler P, El Ghormli L, Arslanian S, Caprio S, Isganaitis E, Kelsey MK, Weinstock RS, White NH, Drews K. Deterioration of Glycemic Control in Youth-Onset Type 2 Diabetes: What Are the Early and Late Predictors? J Clin Endocrinol Metab 2022; 107:e3384-e3394. [PMID: 35486388 PMCID: PMC9653021 DOI: 10.1210/clinem/dgac254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We examined predictors of early and late loss of glycemic control in individuals with youth-onset type 2 diabetes, as well as predictors of short-term deterioration in youth from the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. METHODS Demographic, physical, and biochemical measures at baseline and 48 months, and change over time, were examined in 584 participants separated into those with loss of glycemic control (sustained HbA1c ≥ 8%) before 48 months or at 48 months or later, and those who remained in control until the end of the study (median 6.8 years). Univariate and multivariate models, and receiver operating characteristic curve analyses were performed. RESULTS Approximately 45% of youth remained in control at 48 months; of these, 30% subsequently lost glycemic control prior to the end of follow-up. Predictors of early loss of glycemic control included baseline HbA1c, C-peptide index, oral disposition index, proinsulin, and proinsulin to insulin ratio. Predictors of late loss included baseline measures of insulin secretion and change in HbA1c and insulin processing at 48 months. A baseline HbA1c cutoff of ≥ 6.2% was optimally predictive of loss of glycemic control at any time, while an absolute rise in HbA1c > 0.5% related to loss of glycemic control within 3 to 6 months. CONCLUSION This analysis demonstrates that youth with type 2 diabetes at risk for loss of glycemic control, including impending rapid deterioration, can be identified using available clinical measures, allowing for closer monitoring of at-risk youth, and facilitating the design of research on better therapeutic options.
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Affiliation(s)
- Philip Zeitler
- University of Colorado
Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Laure El Ghormli
- The Biostatistics Center, George Washington University, Rockville, MD 20852,USA
| | - Silva Arslanian
- University of Pittsburgh, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213,USA
| | | | | | - Megan K Kelsey
- University of Colorado
Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ruth S Weinstock
- State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | - Neil H White
- Washington University in St. Louis School of Medicine, St. Louis, MO 63110,USA
| | - Kimberly Drews
- The Biostatistics Center, George Washington University, Rockville, MD 20852,USA
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15
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Wong J, Ross GP, Zoungas S, Craig ME, Davis EA, Donaghue KC, Maple-Brown LJ, McGill MJ, Shaw JE, Speight J, Wischer N, Stranks S. Management of type 2 diabetes in young adults aged 18-30 years: ADS/ADEA/APEG consensus statement. Med J Aust 2022; 216:422-429. [PMID: 35430745 DOI: 10.5694/mja2.51482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Type 2 diabetes in young adults (nominally, 18-30 years of age) is a more aggressive condition than that seen in older age, with a greater risk of major morbidity and early mortality. This first Australian consensus statement on the management of type 2 diabetes in young adults considers areas where existing type 2 diabetes guidance, directed mainly towards older adults, may not be appropriate or relevant for the young adult population. Where applicable, recommendations are harmonised with current national guidance for type 2 diabetes in children and adolescents (aged < 18 years). The full statement is available at https://www.diabetessociety.com.au, https://www.adea.com.au and https://www.apeg.org.au. MAIN RECOMMENDATIONS Advice is provided on important aspects of care including screening, diabetes type, psychological care, lifestyle, glycaemic targets, pharmacological agents, cardiovascular disease risk management, comorbidity assessment, contraception and pregnancy planning, and patient-centred education. Special considerations for Aboriginal and Torres Strait Islander Australians are highlighted separately. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT Management recommendations for young adults, which differ from those for adults, include: ▪screening for diabetes in young adults with overweight or obesity and additional risk factors, including in utero exposure to type 2 diabetes or gestational diabetes mellitus; ▪more stringent glucose targets (glycated haemoglobin ≤ 6.5% [≤ 48 mmol/mol]); ▪in the context of obesity or higher cardio-renal risk, glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors are preferred second line agents; ▪β-cell decline is more rapid, so frequent review, early treatment intensification and avoidance of therapeutic inertia are indicated; ▪a blood pressure target of < 130/80 mmHg, as the adult target of ≤ 140/90 mmHg is too high; ▪absolute cardiovascular disease risk calculators are not likely to be accurate in this age group; early statin use should therefore be considered; and ▪a multidisciplinary model of care including an endocrinologist and a certified diabetes educator.
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Affiliation(s)
- Jencia Wong
- Sydney Medical School and Charles Perkins Centre, University of Sydney, Sydney, NSW.,Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW
| | - Glynis P Ross
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | | | - Maria E Craig
- University of Sydney, Sydney, NSW.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW.,UNSW Sydney, Sydney, NSW
| | - Elizabeth A Davis
- Perth Children's Hospital, Perth, WA.,Telethon Kids Institute, Perth, WA
| | - Kim C Donaghue
- University of Sydney, Sydney, NSW.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW
| | - Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT.,Royal Darwin Hospital, Darwin, NT
| | - Margaret J McGill
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | | | - Jane Speight
- Deakin University, Geelong, VIC.,Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC
| | - Natalie Wischer
- National Association of Diabetes Centres, Sydney, NSW.,Monash University, Melbourne, VIC
| | - Stephen Stranks
- Flinders University, Adelaide, SA.,Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, SA
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16
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Chambers MA, Mecham C, Arreola EV, Sinha M. Rise in Pediatric New Onset Diabetes and Diabetic Ketoacidosis During the COVID-19 Pandemic. Endocr Pract 2022; 28:479-485. [PMID: 35189332 PMCID: PMC8855612 DOI: 10.1016/j.eprac.2022.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/15/2022] [Accepted: 02/14/2022] [Indexed: 01/08/2023]
Abstract
Objective Infection with SARS-CoV-2 induces a proinflammatory state that causes hyperglycemia and may precipitate diabetic ketoacidosis (DKA) in patients with known or new-onset diabetes. We examined the trends in new-onset diabetes and DKA prior to and following the onset of the COVID-19 pandemic. Methods This single-center retrospective observational study included pediatric patients (aged 0 to <18 years) hospitalized with new-onset type 1 diabetes or type 2 diabetes (T2D) before (March 1, 2018, to February 29, 2020) and after (March 1, 2020 to December 31, 2020) the pandemic onset. Demographic, anthropometrics, laboratory and clinical data, and outcomes were obtained. Results Among 615 children admitted with new-onset diabetes during the entire study period, 401 were admitted before the pandemic onset, and 214 were admitted after the pandemic onset. Children admitted with new-onset diabetes in the postpandemic period were significantly more likely to present with DKA (odds ratio, 1.76; 95% confidence interval, 1.24-2.52) than in the prepandemic phase. Children with DKA after the pandemic onset had higher lengths of hospitalization and were significantly more likely to experience severe DKA (odds ratio, 2.17; 95% confidence interval, 1.34-3.52). A higher proportion of children with DKA admitted to the pediatric intensive care unit required oxygen support after the pandemic onset than before the pandemic onset (8.85% vs 1.92%). Most cases of T2D with DKA occurred following the onset of the pandemic (62.5%). Conclusion A significant increase in T2D cases occurred following the onset of the COVID-19 pandemic with a greater risk of DKA and severe ketoacidosis. Racial disparity was evident with a higher proportion of Black and American Indian children presenting with ketoacidosis following the pandemic onset.
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17
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Shah AS, Nadeau KJ, Dabelea D, Redondo MJ. Spectrum of Phenotypes and Causes of Type 2 Diabetes in Children. Annu Rev Med 2022; 73:501-515. [PMID: 35084995 PMCID: PMC9022328 DOI: 10.1146/annurev-med-042120-012033] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Several factors, including genetics, family history, diet, physical activity, obesity, and insulin resistance in puberty, appear to increase the risk of type 2 diabetes in youth. Youth-onset type 2 diabetes is often thought of as a single entity but rather exists as a spectrum of disease with differences in presentation, metabolic characteristics, clinical progression, and complication rates. We review what is currently known regarding the risks associated with developing type 2 diabetes in youth. Additionally, we focus on the spectrum of phenotypes of pediatric type 2 diabetes, discuss the pathogenic underpinnings and potential therapeutic relevance of this heterogeneity, and compare youth-onset type 2 diabetes with type 1 diabetes and adult-onset type 2 diabetes. Finally, we highlight knowledge gaps in prediction and prevention of youth-onset type 2 diabetes.
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Affiliation(s)
- Amy S. Shah
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio 45229, USA
| | - Kristen J. Nadeau
- Children’s Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Department of Epidemiology, and Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| | - Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
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18
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Khadilkar A, Oza C. Glycaemic Control in Youth and Young Adults: Challenges and Solutions. Diabetes Metab Syndr Obes 2022; 15:121-129. [PMID: 35046683 PMCID: PMC8759988 DOI: 10.2147/dmso.s304347] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/22/2021] [Indexed: 04/20/2023] Open
Abstract
Diabetes is the third most prevalent severe chronic disease of youth. Management of any chronic condition like type-1 diabetes (T1D) during adolescence, a time of rapid growth and physiological changes accompanied by important individuation and socialization processes, constitutes a major challenge for the youth, their family and the health-care team. The increasing prevalence of T1D in the adolescent age group and deteriorating glycaemic control from childhood to adolescence and youth, as well as the secular trend of worsening glycaemic control in youth and young adults with T1D, are a matter of real concern. Lack of monitoring, insufficient self-control, psychosocial factors, lack of family support and parental supervision, inadequate adherence to treatment, pubertal increase in insulin resistance and incompetent transition from paediatric to adult care are likely causes of deteriorating glycaemic control in youth. Efforts to improve insulin sensitivity by using pharmacological agents such as metformin are insufficient in resolving this problem. Interventions such as structured intervention, motivational interviews, development of youth friendly services and organization of diabetes camps for peer support can improve adherence in these individuals. Innovative technologies such as continuous subcutaneous insulin infusion and continuous glucose monitoring, comprehensive multidisciplinary teams with effective communication, parental support and supervision with planned transition from paediatric to adult care will not only reduce the risk of micro- and macrovascular complications in young adults with T1D but will also cause significant improvement in their quality of life.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
- Correspondence: Anuradha Khadilkar Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, 411001, IndiaTel +91 206057004 Email
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
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19
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Ciężki S, Kurpiewska E, Bossowski A, Głowińska-Olszewska B. Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children - From Disease Pathogenesis to Complications. Front Endocrinol (Lausanne) 2022; 13:890833. [PMID: 35784568 PMCID: PMC9243381 DOI: 10.3389/fendo.2022.890833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children's population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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21
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González-Villar F, Pérez-Bravo F. Determination of autoantibodies in dogs with diabetes mellitus. Vet World 2021; 14:2694-2698. [PMID: 34903927 PMCID: PMC8654766 DOI: 10.14202/vetworld.2021.2694-2698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: The classification of diabetes mellitus (DM) in dogs has been controversial as currently canine insulin-dependent DM is classified together with absolute insulin deficiency, non-insulin-dependent DM, and relative insulin deficiency. Studies on human autoantibodies evaluated in canines with DM, such as anti-glutamic acid decarboxylase (GAD65), anti-islet antigen 2 (IA2), and anti-zinc transporter isoform 8 (ZnT8), have been inconclusive. Thus, this study was designed to establish the serological profile of anti-GAD65, anti-IA2, and anti-ZnT8 antibodies in a group of dogs with and without DM. Materials and Methods: Sixty-one dogs, including 31 patients with DM (with and without insulin treatment) and 30 patients without DM (normal weight and obese), were included for determining autoantibodies using a human enzyme-linked immunosorbent assay (ELISA) detection system for type 1 DM. Results: This study found the presence of anti-IA2 antibodies in 58% of the sample (18/31 patients with DM); however, the presence of anti-GAD65 was not detected, and anti-ZnT8 was found in 3 (9.6%) patients with DM. Conclusion: This study showed a higher positive frequency of anti-IA2 antibodies in a sample of canine with DM, indicating that alterations in the signaling vesicle tyrosine phosphatase 2 lead to lower insulin release and thus to an increase in patients’ glycemia. These preliminary results should be taken with caution and corroborated by a canine-specific assay when an ELISA is available for such determination.
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Affiliation(s)
- Franco González-Villar
- Doctoral Program in Silvoagropecuary and Veterinary Sciences, University of Chile, South Campus, 11315 Santa Rosa, La Pintana, Santiago, Chile
| | - Francisco Pérez-Bravo
- Department of Nutrition, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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22
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The epidemiology, clinical, biochemical, immunological and radiological features of youth onset type 2 diabetes mellitus in the state of Qatar. Diabetol Int 2021; 13:381-386. [DOI: 10.1007/s13340-021-00548-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/01/2021] [Indexed: 01/16/2023]
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23
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Adler A, Bennett P, Colagiuri Chair S, Gregg E, Narayan KMV, Inês Schmidt M, Sobngwi E, Tajima N, Tandon N, Unwin N, Wild S, Yudkin J, Levitt N, Mohan V, Montgomery S, Nyirenda MJ, Tuomilehto J, Den Boon S, Hocking S. REPRINT OF: CLASSIFICATION OF DIABETES MELLITUS. Diabetes Res Clin Pract 2021:108972. [PMID: 34343595 DOI: 10.1016/j.diabres.2021.108972] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Executive Summary This document updates the 1999 World Health Organization (WHO) classification of diabetes. It prioritizes clinical care and guides health professionals in choosing appropriate treatments at the time of diabetes diagnosis, and provides practical guidance to clinicians in assigning a type of diabetes to individuals at the time of diagnosis. It is a compromise between clinical and aetiological classification because there remain gaps in knowledge of the aetiology and pathophysiology of diabetes. While acknowledging the progress that is being made towards a more precise categorization of diabetes subtypes, the aim of this document is to recommend a classification that is feasible to implement in different settings throughout the world. The revised classification is presented in Table 1. Unlike the previous classification, this classification does not recognize subtypes of type 1 diabetes and type 2 diabetes and includes new types of diabetes ("hybrid types of diabetes" and "unclassified diabetes").
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Affiliation(s)
| | - Peter Bennett
- Phoenix Epidemiology & Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, USA
| | | | - Edward Gregg
- Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Eugene Sobngwi
- Faculté de Medecine et des Sciences Biomedicales et Centre de Biotechnologie, Université de Yaounde 1, Cameroon
| | - Naoko Tajima
- Jikei University School of Medicine, Tokyo, Japan
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Nigel Unwin
- Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados, and MRC Epidemiology Unit, University of Cambridge, UK
| | | | | | - Naomi Levitt
- Diabetic Medicine and Endocrinology, Department of Medicine at Groote Schuur Hospital and University of Cape Town, South Africa
| | | | | | - Moffat J Nyirenda
- Medical Research Council/Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
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24
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Lee HS. Diagnosis and treatment of pediatric type 2 diabetes mellitus. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.6.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic diseases, and its increasing prevalence in children and adolescents is a worldwide problem. In the past ten years, the prevalence of T2DM has increased by more than two-fold. This review focuses on the recent advances in the diagnosis and treatment of T2DM in children and adolescents.Current Concepts: Pancreatic beta-cell dysfunction and insulin resistance are the key factors contributing to the development of T2DM. The diagnosis of T2DM is based on serum glucose levels or hemoglobin A1c levels. Currently, only insulin, metformin, and liraglutide (glucagon-like peptide-1 receptor agonist) have been approved for the treatment of T2DM in children and adolescents.Discussion and Conclusion: Early diagnosis and prevention of T2DM in children and adolescents are essential. Furthermore, the treatment of T2DM in children and adolescents is limited, unlike in adults. Further research is needed to evaluate the long-term efficacy and safety of the available treatments in children and adolescents with T2DM.
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Xiang Y, Liu B, Yun C, Zhou P, Li X, Luo S, Xie Z, Che Z, Lin J, Yang L, Li X, Huang G, Xu A, Zhou Z. Frequency, clinical features, inflammatory cytokines and genetic background of latent autoimmune diabetes in youth in youth-onset type 2 diabetes: Results from a nationwide, multicentre, clinic-based, cross-sectional study (LADA China). Diabetes Obes Metab 2021; 23:1282-1291. [PMID: 33528883 DOI: 10.1111/dom.14336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/16/2021] [Accepted: 01/28/2021] [Indexed: 12/15/2022]
Abstract
AIM To investigate the frequency, clinical phenotype, inflammatory cytokine levels and genetics of glutamic acid decarboxylase autoantibody (GADA)-positive phenotypic youth-onset type 2 diabetes. MATERIALS AND METHODS This nationwide, multicentre, cross-sectional study included 5324 newly diagnosed subjects with phenotypic type 2 diabetes aged 15 years or older enrolled in the LADA China study. GADA was screened in 248 subjects with youth-onset type 2 diabetes aged 15-29 years. Subjects who presented as GADA-positive were defined as having latent autoimmune diabetes in youth (LADY). We added subjects with LADY, type 1 diabetes, type 2 diabetes and controls from the Diabetes Center of Central South University, and measured serum concentrations of interleukin-6, lipocalin 2, high-sensitivity C-reactive protein, adiponectin and human leukocyte antigen (HLA) genotyping in subjects with LADY, age- and sex-matched GADA-negative type 2 diabetes, type 1 diabetes and controls. RESULTS Twenty-nine of the 248 subjects (11.7%) were GADA positive. Compared with subjects with type 2 diabetes, subjects with LADY were less probable to have metabolic syndrome (27.6% vs. 59.4%; p = .001). The fasting C-peptide levels tended to be lower in subjects with LADY than in subjects with type 2 diabetes, but the difference was not statistically significant (LADY vs. type 2 diabetes: 0.21 [0.17-0.64] vs. 0.47 [0.29-0.77] nmol/L; p = .11). The cytokine levels of subjects with LADY were indistinguishable from subjects with type 1 diabetes, but subjects with LADY presented increased adiponectin levels compared with subjects with type 2 diabetes after adjusting for age, sex and body mass index (7.19 [4.05-11.66] vs. 3.42 [2.35-5.74] μg/mL; p < .05). The frequency of total susceptible HLA genotypes (DR3/3, -3/9 and -9/9) in subjects with LADY and type 1 diabetes were similarly higher than controls (LADY and type 1 diabetes vs. controls: 21.4% and 30.8% vs. 2.6%, respectively; p < .001). CONCLUSIONS A high GADA positivity was observed in youth-onset type 2 diabetes subjects in China. As subjects with LADY had an increased susceptible HLA genetic load and different cytokine levels compared with subjects with type 2 diabetes, differentiating LADY from phenotypic type 2 diabetes subjects is important.
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Affiliation(s)
- Yufei Xiang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bingwen Liu
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chuan Yun
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Pengcheng Zhou
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Medicine, Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, China
| | - Xiaojue Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shuoming Luo
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhiguo Xie
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhihong Che
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jian Lin
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lin Yang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Gan Huang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Aimin Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Medicine, Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
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Jones AG, McDonald TJ, Shields BM, Hagopian W, Hattersley AT. Latent Autoimmune Diabetes of Adults (LADA) Is Likely to Represent a Mixed Population of Autoimmune (Type 1) and Nonautoimmune (Type 2) Diabetes. Diabetes Care 2021; 44:1243-1251. [PMID: 34016607 PMCID: PMC8247509 DOI: 10.2337/dc20-2834] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/11/2021] [Indexed: 02/03/2023]
Abstract
Latent autoimmune diabetes of adults (LADA) is typically defined as a new diabetes diagnosis after 35 years of age, presenting with clinical features of type 2 diabetes, in whom a type 1 diabetes-associated islet autoantibody is detected. Identifying autoimmune diabetes is important since the prognosis and optimal therapy differ. However, the existing LADA definition identifies a group with clinical and genetic features intermediate between typical type 1 and type 2 diabetes. It is unclear whether this is due to 1) true autoimmune diabetes with a milder phenotype at older onset ages that initially appears similar to type 2 diabetes but later requires insulin, 2) a disease syndrome where the pathophysiologies of type 1 and type 2 diabetes are both present in each patient, or 3) a heterogeneous group resulting from difficulties in classification. Herein, we suggest that difficulties in classification are a major component resulting from defining LADA using a diagnostic test-islet autoantibody measurement-with imperfect specificity applied in low-prevalence populations. This yields a heterogeneous group of true positives (autoimmune type 1 diabetes) and false positives (nonautoimmune type 2 diabetes). For clinicians, this means that islet autoantibody testing should not be undertaken in patients who do not have clinical features suggestive of autoimmune diabetes: in an adult without clinical features of type 1 diabetes, it is likely that a single positive antibody will represent a false-positive result. This is in contrast to patients with features suggestive of type 1 diabetes, where false-positive results will be rare. For researchers, this means that current definitions of LADA are not appropriate for the study of autoimmune diabetes in later life. Approaches that increase test specificity, or prior likelihood of autoimmune diabetes, are needed to avoid inclusion of participants who have nonautoimmune (type 2) diabetes. Improved classification will allow improved assignment of prognosis and therapy as well as an improved cohort in which to analyze and better understand the detailed pathophysiological components acting at onset and during disease progression in late-onset autoimmune diabetes.
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Affiliation(s)
- Angus G Jones
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, U.K
- MacLeod Diabetes and Endocrine Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K
| | - Timothy J McDonald
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, U.K
- Blood Sciences, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K
| | - Beverley M Shields
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, U.K
| | | | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, U.K
- MacLeod Diabetes and Endocrine Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K
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27
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Rao G, Jensen ET. Type 2 Diabetes in Youth. Glob Pediatr Health 2021; 7:2333794X20981343. [PMID: 34036121 PMCID: PMC8126957 DOI: 10.1177/2333794x20981343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/07/2020] [Accepted: 11/24/2020] [Indexed: 01/21/2023] Open
Abstract
The incidence of type 2 diabetes in children and adolescents in the United States
rose at an annual rate of 4.8% between 2002-2003 and 2014-2015. Type 2 diabetes
progresses more aggressively to complications than type 1 diabetes. For example,
in one large epidemiological study, proliferative retinopathy affected 5.6% and
9.1% of children with type 1 and type 2 diabetes, respectively. Screening begins
at age 10 or at onset of puberty, and is recommended among children with a BMI%
≥85 with risk factors such as a family history and belonging to a high risk
racial or ethnic or racial group. HbA1C% is preferred for screening as it does
not require fasting. As distinguishing between type 1 and type 2 diabetes is not
straightforward, all children with new onset disease should undergo autoantibody
testing. Results of lifestyle interventions for control of type 2 diabetes have
been disappointing, but are still recommended for their educational value and
the potential impact upon some participants. There is limited evidence for the
benefit of newer mediations. Liraglutide, a GLP-1 agonist, however, has been
shown to significantly reduce HbA1C% in one study and is now approved for
children. Liraglutide should be considered as second line therapy.
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Affiliation(s)
- Goutham Rao
- University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
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28
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Serbis A, Giapros V, Kotanidou EP, Galli-Tsinopoulou A, Siomou E. Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents. World J Diabetes 2021; 12:344-365. [PMID: 33889284 PMCID: PMC8040084 DOI: 10.4239/wjd.v12.i4.344] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/31/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
During the last two decades, there have been several reports of an increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, especially among those belonging to minority ethnic groups. This trend, which parallels the increases in prevalence and degree of pediatric obesity, has caused great concern, even though T2DM remains a relatively rare disease in children. Youth T2DM differs not only from type 1 diabetes in children, from which it is sometimes difficult to differentiate, but also from T2DM in adults, since it appears to be an aggressive disease with rapidly progressive β-cell decline, high treatment failure rate, and accelerated development of complications. Despite the recent research, many aspects of youth T2DM still remain unknown, regarding both its pathophysiology and risk factor contribution, and its optimal management and prevention. Current management approaches include lifestyle changes, such as improved diet and increased physical activity, together with pharmacological interventions, including metformin, insulin, and the recently approved glucagon-like peptide-1 analog liraglutide. What is more important for everyone to realize though, from patients, families and physicians to schools, health services and policy-makers alike, is that T2DM is a largely preventable disease that will be addressed effectively only if its major contributor (i.e., pediatric obesity) is confronted and prevented at every possible stage of life, from conception until adulthood. Therefore, relevant comprehensive, coordinated, and innovative strategies are urgently needed.
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Affiliation(s)
- Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, Ioannina 45500, Greece
| | - Vasileios Giapros
- Department of Child Health, University of Ioannina, Ioannina 45500, Greece
| | - Eleni P Kotanidou
- Department of Pediatrics, Medical School, Aristotle University Thessaloniki, Thessaloniki 54636, Greece
| | | | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina 45500, Greece
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Affiliation(s)
- Dorit Koren
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Lynne L Levitsky
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
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30
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Molinari AM, Shubrook JH. Treatment options and current guidelines of care for pediatric type 2 diabetes patients: a narrative review. J Osteopath Med 2021; 121:431-440. [PMID: 33694353 DOI: 10.1515/jom-2020-0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Type 2 diabetes (T2D) mellitus, which was once considered a disease affecting adults, is a growing problem among youths. Research now shows that T2D in youths is more progressive and associated with earlier onset of complications than adult-onset T2D. OBJECTIVES To update practicing clinical physicians on what is currently known about pediatric T2D and share current guidelines to care for these patients. METHODS The authors conducted a literature review through the MEDLINE/PubMed, Google Scholar, and clinicaltrials.gov databases in July 2019 using the following search phrases: "youth-onset type 2 diabetes," "pediatric type 2 diabetes," "diabetes in youth," and "FDA-approved pediatric diabetes medications." Items published between 2010 and 2019 and written in English were included. RESULTS A total of 65 items were included after database review, including 44 articles, 10 FDA product inserts, six clinicaltrials.gov listings, three position statements/guideline documents, one website, and one FDA announcement. CONCLUSIONS There are very limited treatment options available to manage pediatric T2D. Prevention of pediatric T2D is paramount, which requires a high index of suspicion, routine screening of children and adolescents, and willingness to engage in family-based interventions for those at risk for prediabetes and T2D. Osteopathic physicians have a unique opportunity to help by applying the osteopathic principles to the whole person - including environmental, societal, and lifestyle factors - to help patients achieve their health and wellness goals.
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Affiliation(s)
- Antonia M Molinari
- College of Osteopathic Medicine, Touro University California, Vallejo, CA, USA
| | - Jay H Shubrook
- College of Osteopathic Medicine, Touro University California, Vallejo, CA, USA
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31
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Amutha A, Ranjit U, Anjana RM, Shanthi R CS, Rajalakshmi R, Venkatesan U, Muthukumar S, Philips R, Kayalvizhi S, Gupta PK, Sastry NG, Mohan V. Clinical profile and incidence of microvascular complications of childhood and adolescent onset type 1 and type 2 diabetes seen at a tertiary diabetes center in India. Pediatr Diabetes 2021; 22:67-74. [PMID: 32333449 DOI: 10.1111/pedi.13033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/22/2022] Open
Abstract
AIM To study the clinical characteristics and incidence of microvascular complications among childhood and adolescent onset type 1 (T1DM) and type 2 diabetes (T2DM) seen at a tertiary care diabetes center in India. METHODS From our electronic medical records, we retrieved clinical and biochemical details of 4555 individuals with childhood and adolescent onset diabetes (diagnosed below the age of 20 years) seen between 1992 and 2017. T1DM was diagnosed if there was history of ketoacidosis or fasting C-peptide <0.3 PMol/mL and stimulated C-peptide <0.6 PMol/mL or if insulin treatment was required from the time of diagnosis. T2DM was diagnosed based on absence of ketosis, or fasting C-peptide ≥0.6 PMol/mL and stimulated >1.0 PMoL/mL, or response to oral hypoglycemic agents for more than 2 years. We calculated the incidence rates of retinopathy (presence of at least one definite microaneurysm by retinal photography), nephropathy (urinary albumin excretion ≥30 μg/mg of creatinine) and neuropathy (vibration perception threshold ≥20 V) per 1000 person-years of follow up. RESULTS Among the 4555 individuals with childhood and adolescent-onset diabetes, 71.4% had T1DM, 19.5% T2DM and 9.1% other forms of diabetes. Age at first visit and duration of diabetes were significantly higher in T2DM when compared to T1DM. The age adjusted incidence of retinopathy was 52.9/1000 person years (Confidence Intervals [CI]: 42.9-62.8) in T1DM and 49.8/1000 person years (CI 30.8-68.8) in T2DM; nephropathy, 6.2 (CI 3.3-9.0) and 13.8 (CI 5.6-22.0); and neuropathy, 8.8(CI 3.6-14.0) and 24.0 (CI 9.8-38.2) in T1DM and T2DM, respectively. CONCLUSION The incidence of microvascular complications is high among childhood and adolescent-onset T1DM and T2DM and these calls for more aggressive control of diabetes.
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Affiliation(s)
- Anandakumar Amutha
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Unnikrishnan Ranjit
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | | | | | | | | | - Routray Philips
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Sengottuvel Kayalvizhi
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Prasanna Kumar Gupta
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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33
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Kononenko IV, Smirnova OM, Mayorov AY, Shestakova MV. Classification of diabetes. World Health Organization 2019. What’s new? DIABETES MELLITUS 2020. [DOI: 10.14341/dm12405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The review focuses on the new WHO classification published in 2019. Unlike the previous classification, this classification does not recognize subtypes of T1DM and T2DM and offers new types of diabetes: “hybrid types of diabetes” and “unclassified diabetes”. This classification provides practical guidance to clinicians for assigning a type of diabetes to individuals and choose appropriate treatment (whether or not to start treatment with insulin), particularly at the time of diagnosis. This review presents the variety of forms of diabetes, the features of their clinical picture, and also emphasizes the importance of molecular genetic and immunological studies to identify types of diabetes and determine personalized therapy. The selection of “hybrid forms” of diabetes is due to the fact that the treatment of these types of diabetes has its own characteristics associated with the specific pathogenesis of diseases. However, it is obvious that further studies should relate to the study of the mechanisms of damage and decrease in the function of в-cells. Perhaps future classification systems and, as a consequence, personalized treatment will focus on various mechanisms of damage to β-cells.
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Affiliation(s)
| | | | | | - Marina V. Shestakova
- Endocrinology Research Centre; I.M. Sechenov First Moscow State Medical University
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Savic Hitt TA, Katz LEL. Pediatric Type 2 Diabetes: Not a Mini Version of Adult Type 2 Diabetes. Endocrinol Metab Clin North Am 2020; 49:679-693. [PMID: 33153674 PMCID: PMC7772966 DOI: 10.1016/j.ecl.2020.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pediatric type 2 diabetes mellitus (T2DM) is increasing in incidence, with risk factors including obesity, puberty, family history of T2DM in a first-degree or second-degree relative, history of small-for-gestational-age at birth, child of a gestational diabetes pregnancy, minority racial group, and lower socioeconomic status. The pathophysiology of T2DM consists of insulin resistance and progression to pancreatic beta-cell failure, which is more rapid in pediatric T2DM compared with adult T2DM. Treatment options are limited. Treatment failure and nonadherence rates are high in pediatric T2DM; therefore, early diagnosis and treatment and new pharmacologic options and/or effective behavioral interventions are needed.
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Affiliation(s)
- Talia Alyssa Savic Hitt
- Division of Endocrinology & Diabetes, Department of Pediatrics, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Buerger Building -12th Floor, Philadelphia, PA 19104, USA.
| | - Lorraine E Levitt Katz
- Division of Endocrinology & Diabetes, Department of Pediatrics, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Buerger Building -12th Floor, Philadelphia, PA 19104, USA
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35
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Siller AF, Tosur M, Relan S, Astudillo M, McKay S, Dabelea D, Redondo MJ. Challenges in the diagnosis of diabetes type in pediatrics. Pediatr Diabetes 2020; 21:1064-1073. [PMID: 32562358 DOI: 10.1111/pedi.13070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/07/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
The incidence of diabetes, both type 1 and type 2, is increasing. Health outcomes in pediatric diabetes are currently poor, with trends indicating that they are worsening. Minority racial/ethnic groups are disproportionately affected by suboptimal glucose control and have a higher risk of acute and chronic complications of diabetes. Correct clinical management starts with timely and accurate classification of diabetes, but in children this is becoming increasingly challenging due to high prevalence of obesity and shifting demographic composition. The growing obesity epidemic complicates classification by obesity's effects on diabetes. Since the prevalence and clinical characteristics of diabetes vary among racial/ethnic groups, migration between countries leads to changes in the distribution of diabetes types in a certain geographical area, challenging the clinician's ability to classify diabetes. These challenges must be addressed to correctly classify diabetes and establish an appropriate treatment strategy early in the course of disease for all. This may be the first step in improving diabetes outcomes across racial/ethnic groups. This review will discuss the pitfalls in the current diabetes classification scheme that is leading to increasing overlap between diabetes types and heterogeneity within each type. It will also present proposed alternative classification schemes and approaches to understanding diabetes type that may improve the timely and accurate classification of pediatric diabetes type.
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Affiliation(s)
- Alejandro F Siller
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Mustafa Tosur
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Shilpi Relan
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Marcela Astudillo
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Siripoom McKay
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maria J Redondo
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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Miravet-Jiménez S, Pérez-Unanua M, Alonso-Fernández M, Escobar-Lavado F, González-Mohino Loro B, Piera-Carbonell A. Manejo de la diabetes mellitus tipo 2 en adolescentes y adultos jóvenes en atención primaria. Semergen 2020; 46:415-424. [DOI: 10.1016/j.semerg.2019.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022]
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37
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Pastore I, Bolla AM, Montefusco L, Lunati ME, Rossi A, Assi E, Zuccotti GV, Fiorina P. The Impact of Diabetes Mellitus on Cardiovascular Risk Onset in Children and Adolescents. Int J Mol Sci 2020; 21:ijms21144928. [PMID: 32664699 PMCID: PMC7403998 DOI: 10.3390/ijms21144928] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022] Open
Abstract
The prevalence of diabetes mellitus is rising among children and adolescents worldwide. Cardiovascular diseases are the main cause of morbidity and mortality in diabetic patients. We review the impact of diabetes on establishing, during childhood and adolescence, the premises for cardiovascular diseases later in life. Interestingly, it seems that hyperglycemia is not the only factor that establishes an increased cardiovascular risk in adolescence. Other factors have been recognized to play a role in triggering the onset of latent cardiovascular diseases in the pediatric population. Among these cardiovascular risk factors, some are modifiable: glucose variability, hypoglycemia, obesity, insulin resistance, waist circumference, hypertension, dyslipidemia, smoking alcohol, microalbuminuria and smoking. Others are unmodifiable, such as diabetes duration and family history. Among the etiological factors, subclinical endothelial dysfunction represents one of the earliest key players of atherosclerosis and it can be detected during early ages in patients with diabetes. A better assessment of cardiovascular risk in pediatric population still represents a challenge for clinicians, and thus further efforts are required to properly identify and treat pediatric patients who may suffer from cardiovascular disease later in early adulthood.
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Affiliation(s)
- Ida Pastore
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Andrea Mario Bolla
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Laura Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Maria Elena Lunati
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
| | - Emma Assi
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, 20157 Milan, Italy;
| | - Gian Vincenzo Zuccotti
- Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano and Department of Pediatrics, Buzzi Children’s Hospital, 20157 Milan, Italy;
| | - Paolo Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy; (I.P.); (A.M.B.); (L.M.); (M.E.L.); (A.R.)
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, 20157 Milan, Italy;
- Nephrology Division, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-617-919-2624
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Yoshida K, Urakami T, Mine Y, Kuwabara R, Morioka I. Juvenile case with the coexistence of maturity-onset diabetes of the young 1 and later-onset latent autoimmune diabetes in youth. J Diabetes Investig 2020; 11:1010-1013. [PMID: 31960584 PMCID: PMC7378418 DOI: 10.1111/jdi.13215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 01/16/2023] Open
Abstract
We present the case of a 12-year-old Japanese girl, who was positive for markers of both maturity-onset diabetes of the young and latent autoimmune diabetes in youth. She was initially diagnosed with maturity-onset diabetes of the young 1 based on the molecular analysis, and she later developed an autoimmune response, leading to β-cell-associated antibody-positive diabetes. She was treated with incretin-associated drugs and maintained adequate glycemic control. Pathophysiologically, there was an overlap between the two different types of diabetes, because the hyperglycemia and β-cell stress seen in non-autoimmune diabetes can cause β-cell autoimmunity over time.
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Affiliation(s)
- Kei Yoshida
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Tatsuhiko Urakami
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Yusuke Mine
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Remi Kuwabara
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Ichiro Morioka
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
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39
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Peña AS, Curran JA, Fuery M, George C, Jefferies CA, Lobley K, Ludwig K, Maguire AM, Papadimos E, Peters A, Sellars F, Speight J, Titmuss A, Wilson D, Wong J, Worth C, Dahiya R. Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines. Med J Aust 2020; 213:30-43. [PMID: 32578226 DOI: 10.5694/mja2.50666] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The incidence of type 2 diabetes mellitus has increased in children and adolescents due largely to the obesity epidemic, particularly in high risk ethnic groups. β-Cell function declines faster and diabetes complications develop earlier in paediatric type 2 diabetes compared with adult-onset type 2 diabetes. There are no consensus guidelines in Australasia for assessment and management of type 2 diabetes in paediatric populations and health professionals have had to refer to adult guidelines. Recent international paediatric guidelines did not address adaptations to care for patients from Indigenous backgrounds. MAIN RECOMMENDATIONS This guideline provides advice on paediatric type 2 diabetes in relation to screening, diagnosis, diabetes education, monitoring including targets, multicomponent healthy lifestyle, pharmacotherapy, assessment and management of complications and comorbidities, and transition. There is also a dedicated section on considerations of care for children and adolescents from Indigenous background in Australia and New Zealand. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES Published international guidelines currently exist, but the challenges and specifics to care for children and adolescents with type 2 diabetes which should apply to Australasia have not been addressed to date. These include: recommendations regarding care of children and adolescents from Indigenous backgrounds in Australia and New Zealand including screening and management; tighter diabetes targets (glycated haemoglobin, ≤ 48 mmol/mol [≤ 6.5%]) for all children and adolescents; considering the use of newer medications approved for adults with type 2 diabetes under the guidance of a paediatric endocrinologist; and the need to transition adolescents with type 2 diabetes to a diabetes multidisciplinary care team including an adult endocrinologist for their ongoing care.
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Affiliation(s)
- Alexia S Peña
- Robinson Research Institute, University of Adelaide, Adelaide, SA.,Women's and Children's Hospital, Adelaide, SA
| | | | | | | | | | - Kristine Lobley
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW
| | | | - Ann M Maguire
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW.,University of Sydney, Sydney, NSW
| | - Emily Papadimos
- Queensland Children's Hospital, Brisbane, QLD.,Menzies School of Health Research, Darwin, NT
| | - Aimee Peters
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW
| | | | - Jane Speight
- Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC.,Deakin University, Geelong, VIC
| | - Angela Titmuss
- Menzies School of Health Research, Darwin, NT.,Royal Darwin Hospital, Darwin, NT
| | | | - Jencia Wong
- University of Sydney, Sydney, NSW.,Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW
| | | | - Rachana Dahiya
- Queensland Children's Hospital, Brisbane, QLD.,University of Queensland, Brisbane, QLD
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40
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Abstract
The purpose of this review is to provide an update on the changing face of paediatric type 1 diabetes and type 2 diabetes. Paediatric diabetes is on the rise, with extensive research dedicated to understanding its pathophysiology, comorbidities and complications. As obesity continues to increase among all youth, differentiating between type 1 diabetes and type 2 diabetes has become increasingly difficult but remains important for optimising treatment, anticipating complications and predicting disease risk. Novel treatments are emerging, with the ultimate goal being to achieve glycaemic control, limit weight gain, improve quality of life and reduce comorbidities. In this review, we focus on updates regarding the epidemiology, clinical presentation, comorbidities and complications of paediatric type 1 diabetes and type 2 diabetes and conclude with current and emerging treatments.
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Affiliation(s)
- Amy S Shah
- University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA.
- Cincinnati Children's Hospital Medical Center, Division of Endocrinology, 3333 Burnet Ave, ML 7012, Cincinnati, OH, 45229, USA.
| | - Kristen J Nadeau
- University of Denver, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Division of Endocrinology, Aurora, CO, USA
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41
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Tam BT, Morais JA, Santosa S. Obesity and ageing: Two sides of the same coin. Obes Rev 2020; 21:e12991. [PMID: 32020741 DOI: 10.1111/obr.12991] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/30/2019] [Indexed: 02/06/2023]
Abstract
Conditions and comorbidities of obesity mirror those of ageing and age-related diseases. Obesity and ageing share a similar spectrum of phenotypes such as compromised genomic integrity, impaired mitochondrial function, accumulation of intracellular macromolecules, weakened immunity, shifts in tissue and body composition, and enhanced systemic inflammation. Moreover, it has been shown that obesity reduces life expectancy by 5.8 years in men and 7.1 years in women after the age of 40. Shorter life expectancy could be because obesity holistically accelerates ageing at multiple levels. Besides jeopardizing nuclear DNA and mitochondrial DNA integrity, obesity modifies the DNA methylation pattern, which is associated with epigenetic ageing in different tissues. Additionally, other signs of ageing are seen in individuals with obesity including telomere shortening, systemic inflammation, and functional declines. This review aims to show how obesity and ageing are "two sides of the same coin" through discussing how obesity predisposes an individual to age-related conditions, illness, and disease. We will further demonstrate how the mechanisms that perpetuate the early-onset of chronic diseases in obesity parallel those of ageing.
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Affiliation(s)
- Bjorn T Tam
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Quebec, Montreal, Canada.,Metabolism, Obesity, and Nutrition Lab, PERFORM Centre, Concordia University, Quebec, Montreal, Canada
| | - Jose A Morais
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Quebec, Montreal, Canada.,Division of Geriatric Medicine and Research Institute, McGill University Health Centre, Quebec, Montreal, Canada
| | - Sylvia Santosa
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Quebec, Montreal, Canada.,Metabolism, Obesity, and Nutrition Lab, PERFORM Centre, Concordia University, Quebec, Montreal, Canada.,Research Centre, Centre intégré universitarie de santé et de services sociaux du Nord-de-I'Île-de-Montréal, Hôpital du Sacré-Cœur de Monréal (CIUSS-NIM, HSCM), Quebec, Montreal, Canada
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42
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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43
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Hatun S, Yesiltepe Mutlu G, Cinaz P, Turan S, Ekberzade A, Bereket A, Erbas MY, Akcay T, Onal H, Bolu S, Arslanoglu I, Doger E, Yilmaz AA, Ucakturk A, Karabulut GS, Tuhan HÜ, Demir K, Erdeve SS, Aycan Z, Nalbantoğlu Ö, Kara C, Gungor N. Characteristics of Turkish children with Type 2 diabetes at onset: a multicentre, cross-sectional study. Diabet Med 2019; 36:1243-1250. [PMID: 31099079 DOI: 10.1111/dme.14038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 12/30/2022]
Abstract
AIMS To describe the baseline clinical and laboratory findings and treatment modalities of 367 children and adolescents diagnosed with Type 2 diabetes in various paediatric endocrinology centres in Turkey. METHODS A standard questionnaire regarding clinical and laboratory characteristics at onset was uploaded to an online national database system. Data for 367 children (aged 6-18 years) newly diagnosed with Type 2 diabetes at 37 different paediatric endocrinology centres were analysed. RESULTS After exclusion of the children with a BMI Z-score < 1 SD, those with genetic syndromes associated with Type 2 diabetes, and those whose C-peptide and/or insulin levels were not available, 227 cases were included in the study. Mean age was 13.8 ± 2.2 (range 6.5-17.8) years, with female preponderance (68%). Family history of Type 2 diabetes was positive in 86% of the children. The mean BMI was 31.3 ± 6.5 kg/m2 (range 18.7-61) and BMI Z-score was 2.4 ± 0.8 (range 1-5). More than half (57%) of the children were identified by an opportunistic diabetes screening due to existing risk markers without typical symptoms of diabetes. Only 13% (n = 29) were treated solely by lifestyle modification, while 40.5% (n = 92) were treated with metformin, 13% (n = 30) were treated with insulin, and 33.5% (n = 76) were treated with a combination of insulin and metformin initially. Mean HbA1C levels of the insulin and combination of insulin and metformin groups were 98 (11.1%) and 102 mmol/mol (11.5%), respectively, and also were significantly higher than the lifestyle modification only and metformin groups mean HbA1C levels (70(8.6%) and 67 mmol/mol (8.3%), respectively). CONCLUSIONS An opportunistic screening of children who are at high risk of Type 2 diabetes is essential, as our data showed that > 50% of the children were asymptomatic at diagnosis. The other important result of our study was the high rate of exclusion from the initial registration (38%), suggesting that accurate diagnosis of Type 2 diabetes in youth is still problematic, even for paediatric endocrinologists.
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Affiliation(s)
- S Hatun
- Koç University School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - G Yesiltepe Mutlu
- Koç University School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - P Cinaz
- Gazi University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - S Turan
- Marmara University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - A Ekberzade
- Marmara University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - A Bereket
- Marmara University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - M Y Erbas
- Kanuni Sultan Suleyman Training and Research Hospital, Turkey
| | - T Akcay
- Kanuni Sultan Suleyman Training and Research Hospital, Turkey
- Istinye University, Medical Park Gaziosmanpasa Hospital, Pediatric Endocrinology Unit, Turkey
| | - H Onal
- Kanuni Sultan Suleyman Training and Research Hospital, Turkey
| | - S Bolu
- Düzce University, Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - I Arslanoglu
- Düzce University, Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - E Doger
- Gazi University, School of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - A A Yilmaz
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Turkey
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Endocrinology, Turkey
| | - A Ucakturk
- University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Endocrinology, Turkey
| | - G S Karabulut
- Kocaeli University, Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - H Ü Tuhan
- Dokuz Eylül Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - K Demir
- Dokuz Eylül Faculty of Medicine, Division of Pediatric Endocrinology and Diabetes, Turkey
| | - S S Erdeve
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Turkey
| | - Z Aycan
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Turkey
| | - Ö Nalbantoğlu
- University of Health Sciences, Dr. Behçet Uz Children Diseases and Surgery Training and Research Hospital, Department of Pediatric Endocrinology, Turkey
| | - C Kara
- Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Turkey
| | - N Gungor
- Department of Pediatrics, Division of Endocrinology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Yohena S, Penas-Steinhardt A, Muller C, Faccinetti NI, Cerrone GE, Lovecchio S, Ridner E, Valdez S, Frechtel G. Immunological and clinical characteristics of latent autoimmune diabetes in the elderly. Diabetes Metab Res Rev 2019; 35:e3137. [PMID: 30743316 DOI: 10.1002/dmrr.3137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Latent autoimmune diabetes in adults (LADA) is determined by both a noninsulin-dependent clinical presentation and an autoimmune pathogenic process. Glutamic acid decarboxylase antibody (GADA) constitutes the most important marker, although IA-2A and ZnT8A also define LADA presentation. Type 2 diabetes mellitus (T2DM) is the most prevalent type particularly over 65 years old. Studies about autoimmunity in this age group are scarce. OBJECTIVE The aim of this work was to determine whether three autoantibodies for diabetes autoimmunity were present in elderly T2DM patients, and to assess the distinctive clinical features of autoantibody-positive patients. RESEARCH DESIGN AND METHODS We recruited 153 patients with diabetes with onset of diabetes after 65 years of age and a BMI under 30 kg/m2 . RESULTS The prevalence of at least one of the autoantibodies was 15.68% (24/153). The most prevalent autoantibody was GADA with 8.49% (13/153), followed by ZnT8A with 6.50% (10/153) and IA2A with 1.96% (3/153). The autoimmunity-positive group presented higher HbA1c (7.01 ± 1.98 vs 6.35 ± 1.01; P = 0.007) and more prevalent insulin therapy (25% vs 10.85%; P = 0.047). GADA-positive patients with diabetes presented higher FPG (7.79 ± 3.79 mmol/L vs 6.43 ± 1.6 mmol/L; P = 0.014) and insulin therapy more frequently (46% vs 10.71%; p = 0.015). GADA titre levels in the individuals with BMI under 27 kg/m2 were higher (35.00 ± 4.20) than those in the group with BMI over 27 kg/m2 (8.83 ± 3.041; P = 0.0005). CONCLUSION Autoantibodies GADA and Znt8A may be useful markers in identifying a subgroup of older patients with a clinical presentation of diabetes which could be characterized as latent autoimmune diabetes in the elderly.
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Affiliation(s)
- Silvina Yohena
- Sirio Libanés Hospital, Buenos Aires, Argentina
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
| | - Alberto Penas-Steinhardt
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
- National University of Luján, Department of Basic Sciences, Computational Genomics Laboratory, Luján, Buenos Aires, Argentina
| | | | - Natalia I Faccinetti
- Chair of Immunology, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
| | - Gloria E Cerrone
- Institute of Immunology, Genetics and Metabolism, Clinical Hospital and Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
- Chair of Genetics, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
| | - Silvia Lovecchio
- Sirio Libanés Hospital, Buenos Aires, Argentina
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
| | - Edgardo Ridner
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
| | - Silvina Valdez
- Chair of Immunology, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
| | - Gustavo Frechtel
- Sirio Libanés Hospital, Buenos Aires, Argentina
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
- Institute of Immunology, Genetics and Metabolism, Clinical Hospital and Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
- Chair of Genetics, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
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45
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Rudman N, Gornik O, Lauc G. Altered N-glycosylation profiles as potential biomarkers and drug targets in diabetes. FEBS Lett 2019; 593:1598-1615. [PMID: 31215021 DOI: 10.1002/1873-3468.13495] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
Abstract
N-glycosylation is a ubiquitous protein modification, and N-glycosylation profiles are emerging as both biomarkers and functional effectors in various types of diabetes. Genome-wide association studies identified glycosyltransferase genes as candidate causal genes for type 1 and type 2 diabetes. Studies focused on N-glycosylation changes in type 2 diabetes demonstrated that patients can be distinguished from healthy controls based on N-glycome composition. In addition, individuals at an increased risk of future disease development could be identified based on N-glycome profiles. Moreover, accumulating evidence indicates that N-glycans have a major role in preventing the impairment of glucose-stimulated insulin secretion by maintaining the glucose transporter in proper orientation, indicating that interindividual variation in protein N-glycosylation might be a novel risk factor contributing to diabetes development. Defective N-glycosylation of T cells has been implicated in type 1 diabetes pathogenesis. Furthermore, studies of N-glycan alterations have successfully been used to identify individuals with rare types of diabetes (such as the HNF1A-MODY), and also to evaluate functional significance of novel diabetes-associated mutations. In conclusion, both N-glycans and glycosyltransferases emerge as potential therapeutic targets in diabetes.
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Affiliation(s)
- Najda Rudman
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia
| | - Olga Gornik
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia.,Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Gordan Lauc
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia.,Genos Glycoscience Research Laboratory, Zagreb, Croatia
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46
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Luk AOY, Lau ESH, Lim C, Kong APS, Chow E, Ma RCW, Chan JCN. Diabetes-Related Complications and Mortality in Patients With Young-Onset Latent Autoimmune Diabetes: A 14-Year Analysis of the Prospective Hong Kong Diabetes Register. Diabetes Care 2019; 42:1042-1050. [PMID: 30967437 DOI: 10.2337/dc18-1796] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Young-onset diabetes is heterogeneous in etiology and disease progression. We compared the incidence of diabetes-related complications and mortality in patients with young-onset type 2 diabetes with or without anti-GAD antibodies and patients with type 1 diabetes. We determined changes in glycemic control before and after commencement of insulin therapy stratified by antibody status. RESEARCH DESIGN AND METHODS Between 1994 and 2012, 1,504 consecutively enrolled patients with type 2 diabetes who had received a diagnosis at <40 years of age and had available anti-GAD antibody status and 251 patients with type 1 diabetes from the Hong Kong Diabetes Register were followed for incident cardiovascular disease (CVD), end-stage renal disease (ESRD), severe hypoglycemia, and all-cause mortality until June 2015. Information on insulin use and HbA1c levels during follow-up was obtained. RESULTS Anti-GAD antibodies were positive in 8.1% of patients with type 2 diabetes (GAD+). By multivariate Cox regression, patients with GAD+ had a lower hazard of CVD (hazard ratio [HR] 0.43, P = 0.048), a higher hazard of severe hypoglycemia (HR 1.63, P = 0.032), and a similar hazard of ESRD and mortality compared with counterparts without anti-GAD antibodies (GAD-). Compared with patients with type 1 diabetes, ESRD was more likely to develop (HR 2.91, P = 0.043) in patients with GAD+, but no differences were detected in the hazards of severe hypoglycemia, CVD, and mortality. Among new insulin users (n = 304), patients with GAD+ had larger reductions in HbA1c than patients with GAD-after 12 months of insulin use (-2.30 ± 3.80% [25 ± 42 mmol/mol] vs -0.72 ± 1.86% [8 ± 20 mmol/mol], P = 0.05). CONCLUSIONS Anti-GAD positivity identifies a group of patients with a different prognosis compared with patients without antibodies and those with type 1 diabetes. Patients with GAD+ responded differently to insulin compared with patients with GAD-.
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Affiliation(s)
- Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China .,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Eric S H Lau
- Asia Diabetes Foundation, Hong Kong Special Administrative Region, People's Republic of China
| | - Cadmon Lim
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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47
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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48
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Al-Kandari H, Al-Abdulrazzaq D, Davidsson L, Sharma P, Al-Tararwa A, Mandani F, Al-Shawaf F, Al-Hussaini F, Qabazard M, Haddad D, Al-Mahdi M, Al-Jasser F, Alanezi A, Al-Sanea H, Al-Basari I, Al-Adsani A, Shaltout A, AbdulRasoul M. Incidence of Type 2 Diabetes in Kuwaiti Children and Adolescents: Results From the Childhood-Onset Diabetes Electronic Registry (CODeR). Front Endocrinol (Lausanne) 2019; 10:836. [PMID: 31866943 PMCID: PMC6904274 DOI: 10.3389/fendo.2019.00836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/18/2019] [Indexed: 01/06/2023] Open
Abstract
Background: Type 2 Diabetes (T2D) in children and adolescents has become an important public health concern due to the increase in childhood obesity worldwide. The urgency to address T2D is evident as children and adolescents are at a higher risk of complications due to prolonged disease duration. We aimed to estimate the incidence rate (IR) of T2D in Kuwaiti children and adolescents aged 14 years and younger between 2011 and 2013 and to describe their clinical characteristics at the time of diagnosis. Material and Methods: All newly diagnosed patients were registered through the Childhood-Onset Diabetes electronic Registry implemented in Kuwait. Cases who met the 2018 ISPAD guidelines for diagnosis of T2D were included. Results: A total of 32 patients were included, equally distributed gender-wise, with a mean age 12.2 years (±1.7 SD), lower for females than males (11.5 vs. 12.2, p < 0.025). Data ascertainment was 94.1% (95%CI; 91.6-96.6%). Overall IR was 2.56 (95% CI; 1.78-3.56) per 100,000 Kuwaiti children and adolescents per year. Most of the patients (n = 30; 93.8%) presented with T2D between the ages 10-14 years, with age-specific IR of 8.0 (95%CI; 5.5-11.3). No statistically significant difference between males and females with regards to BMI z scores or HbA1C at diagnosis. Conclusion: The true incidence of T2D in Kuwaiti children and adolescents is expected to be considerably higher as we have reported only symptomatic cases. Future research should focus on screening children and adolescents at risk to enable accurate estimates. More efforts are needed to better understand the clinical course of T2D early in life to improve management, prevent complications and improve quality of life.
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Affiliation(s)
- Hessa Al-Kandari
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Pediatrics, Farwaniya Hospital, Ministry of Health, Sabah Al Nasser, Kuwait
| | - Dalia Al-Abdulrazzaq
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
- Department of Pediatrics, Mubarak Al-Kabeer Hospital, Ministry of Health, Jabriya, Kuwait
- *Correspondence: Dalia Al-Abdulrazzaq ;
| | - Lena Davidsson
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Prem Sharma
- Special Services Facilities, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Abeer Al-Tararwa
- Department of Pediatrics, Farwaniya Hospital, Ministry of Health, Sabah Al Nasser, Kuwait
| | - Fawziya Mandani
- Department of Pediatrics, Sabah Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Faisal Al-Shawaf
- Department of Pediatrics, Mubarak Al-Kabeer Hospital, Ministry of Health, Jabriya, Kuwait
| | - Fatma Al-Hussaini
- Department of Pediatrics, Adan Hospital, Ministry of Health, Hadiya, Kuwait
| | - Mariam Qabazard
- Department of Pediatrics, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Dania Haddad
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Maria Al-Mahdi
- Department of Pediatrics, Adan Hospital, Ministry of Health, Hadiya, Kuwait
| | - Fahad Al-Jasser
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Pediatrics, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Ayed Alanezi
- Department of Pediatrics, Jahra Hospital, Ministry of Health, Al Jahra, Kuwait
| | - Hala Al-Sanea
- Department of Pediatrics, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Iman Al-Basari
- Department of Pediatrics, Mubarak Al-Kabeer Hospital, Ministry of Health, Jabriya, Kuwait
| | - Afaf Al-Adsani
- Department of Medicine, Sabah Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Azza Shaltout
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mejedah AbdulRasoul
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
- Department of Pediatrics, Adan Hospital, Ministry of Health, Hadiya, Kuwait
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49
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Urakami T, Miyata M, Yoshida K, Mine Y, Kuwabara R, Aoki M, Suzuki J. Changes in annual incidence of school children with type 2 diabetes in the Tokyo Metropolitan Area during 1975-2015. Pediatr Diabetes 2018; 19:1385-1392. [PMID: 30101568 DOI: 10.1111/pedi.12750] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/15/2018] [Accepted: 08/02/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To analyze changes in the annual incidence of school students with type 2 diabetes detected by urine glucose screening at schools in the Tokyo Metropolitan Area during 1975-2015. METHODS Trend in temporal changes in the annual incidence rate were analyzed using a joinpoint regression model and the joinpoints. Annual percent change (APC) was calculated for each segmented line regression. Average annual percent change (AAPC) was also calculated for the whole period analyzed. RESULTS In total, 301 students, including 64 primary school students and 237 junior high school students, were diagnosed with type 2 diabetes. The overall incidence of type 2 diabetes (per 100 000/year) during the entire study period was 2.58 in all students, 0.80 in primary school students, and 6.41 in junior high school students. AAPC during the entire study period was estimated at -1.5 (not significant), and the incidence significantly increased during 1975-1982 (APC = 17.49, P < 0.05), but tended to decrease during 1982-2015 (APC = -1.01). In primary school students, the incidence significantly increased during1975-2010 (APC = 3.30, P < 0.05), and tended to decrease during 2010-2015 (APC = -29.61). In junior high school students, the incidence did not significantly change during the entire study period (APC = 0.06). CONCLUSIONS We found increasing trend in the overall incidence of school students with type 2 diabetes during 1975-1982, but a decreased tendency in recent years. This could be due to changes observed during the same time period in the primary school students. Lifestyle changes might contribute to improved incidence of childhood type 2 diabetes.
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Affiliation(s)
- Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Midori Miyata
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Kei Yoshida
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mine
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Remi Kuwabara
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Masako Aoki
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Junichi Suzuki
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
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50
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Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association. Diabetes Care 2018; 41:2648-2668. [PMID: 30425094 PMCID: PMC7732108 DOI: 10.2337/dci18-0052] [Citation(s) in RCA: 196] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, PA
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Fida Bacha
- Children's Nutrition Research Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Margaret Grey
- Yale School of Nursing, New Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | - Neil H White
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Philip Zeitler
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO
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