Type 2 diabetes in the young: the evolving epidemic

Diabetes in the Cook Islands: a clinical audit

Introduction The global burden of diabetes mellitus (diabetes) is significant and of increasing concern with more pregnant women being diagnosed with gestational diabetes mellitus (GDM). The Cook Islands face mounting pressures to address diabetes alongside competing population health needs and priorities. Cook Islands residents frequently travel to New Zealand to access health services. Inadequate information systems also make it difficult for countries to prioritise preventative measures for investment. In the absence of good data to inform effective diabetes preventative and treatment measures, people with diabetes are likely to progress to complications which will burden society and health systems in the Cook Islands and New Zealand. Aim To determine the prevalence of diabetes and prediabetes, and incidence of GDM, in the Cook Islands. Methods We analysed two Te Marae Ora Cook Islands Ministry of Health datasets, the Non-Communicable Diseases (NCD) register examining demographic data for the period 1967 to December 2018 and same for the GDM register from January 2009 to December 2018. Results Of the 1270 diabetes cases, 53% were female and half were aged 45-64 years. There were 54 pre-diabetes cases and 146 GDM. Of the 20 GDM cases who developed type 2 diabetes, 80% were diagnosed before the age of 40 years. Data quality was poor. Discussion The Cook Islands diabetes registers provide important data to inform priorities for diabetes-related preventative and treatment measures. A data analyst has been employed to ensure quality, regularly audited data and information systems.

Onset age of diabetes and incident dementia: A prospective cohort study

BACKGROUND

Relationship between age at diagnosis of diabetes and dementia is lacking. The aim of the study was to investigate whether diabetes onset at a younger age was associated with a higher incidence of dementia.

METHODS

466,207 participants free of dementia in the UK biobank (UKB) were included in the analysis. Propensity score matching (PSM) was adopted to match diabetic and non-diabetic participants in different onset age of diabetes groups to evaluate onset age of diabetes and incident dementia.

RESULTS

Compared with non-diabetic participants, diabetes participants had an adjusted hazard ratio (HR) of 1.87 (95 % confidence interval [CI]: 1.73-2.03) for all-cause dementia, 1.85 (95 % CI: 1.60-2.04) for Alzheimer's disease (AD), and 2.86 (95 % CI: 2.47-3.32) for vascular dementia (VD). Among diabetic participants who reported onset age, the adjusted HRs for incident all-cause dementia, AD, and VD were 1.20 (95 % CI: 1.14-1.25), 1.19 (95 % CI: 1.10-1.29), and 1.19 (95 % CI: 1.10-1.28), respectively, per 10 years decrease in age at diabetes onset. After PSM, strength of association between diabetes and all-cause dementia increased with decreasing onset age of diabetes (≥60 years: HR = 1.47, 95 % CI: 1.25-1.74; 45-59 years: HR = 1.66, 95 % CI: 1.40-1.96; <45 years: HR = 2.92, 95 % CI: 2.13-4.01) after multivariable adjustment. Similarly, diabetic participants with onset age <45 years had greatest HRs for incident AD and VD, compared with their matched controls.

LIMITATIONS

Our results only reflect the characteristics of UKB participants.

CONCLUSIONS

Younger age at diabetes onset was significantly associated with a higher risk of dementia in this longitudinal cohort study.

Gut-Testis Axis: Microbiota Prime Metabolome To Increase Sperm Quality in Young Type 2 Diabetes

Young type 2 diabetes (T2D) affects 15% of the population, with a noted increase in cases, and T2D-related male infertility has become a serious issue in recent years. The current study aimed to explore the improvements of alginate oligosaccharide (AOS)-modified gut microbiota on semen quality in T2D. The T2D was established in young mice of 5 weeks of age with a blood glucose level of 21.2 ± 2.2 mmol/L, while blood glucose was 8.7 ± 1.1 mM in control animals. We discovered that fecal microbiota transplantation (FMT) of AOS-improved microbiota (A10-FMT) significantly decreased blood glucose, while FMT of gut microbiota from control animals (Con-FMT) did not. Sperm concentration and motility were decreased in T2D to 10% to 20% of those in the control group, while A10-FMT brought about a recovery of around 5- to 10-fold. A10-FMT significantly increased small intestinal Allobaculum, while it elevated small intestinal and cecal Lactobacillus in some extent, blood butyric acid and derivatives and eicosapentaenoic acid (EPA), and testicular docosahexaenoic acid (DHA), EPA, and testosterone and its derivatives. Furthermore, A10-FMT improved liver functions and systemic antioxidant environments. Most importantly, A10-FMT promoted spermatogenesis through the improvement in the expression of proteins important for spermatogenesis to increase sperm concentration and motility. The underlying mechanisms may be that A10-FMT increased gut-beneficial microbes Lactobacillus and Allobaculum to elevate blood and/or testicular butyric acid, DHA, EPA, and testosterone to promote spermatogenesis and thus to ameliorate sperm concentration and motility. AOS-improved gut microbes could emerge as attractive candidates to treat T2D-diminished semen quality. IMPORTANCE A10-FMT benefits gut microbiota, liver function, and systemic environment via improvement in blood metabolome, consequently to favor the testicular microenvironment to improve spermatogenesis process and to boost T2D-diminished semen quality. We established that AOS-improved gut microbiota may be used to boost T2D-decreased semen quality and metabolic disease-related male subfertility.

Effects of a 12-Month Hybrid (In-Person + Virtual) Education Program in the Glycemic Status of Arab Youth

This 12-month school-based intervention study investigated the effects of hybrid educational lifestyle modifications on glycemic control among Saudi youth with different glycemic statuses. A total of 2600 Arab adolescents aged 12−18 years were recruited from 60 randomly selected schools. Anthropometrics, blood glucose, and HbA1c were measured pre- and post-intervention. Participants were grouped according to baseline HbA1c into normal, prediabetes, and diabetes groups. All participants received lifestyle education at base line and at every 3-month interval to improve diet and exercise behavior. Diabetic and prediabetic participants received a tailored lifestyle intervention. Post-intervention, 643 participants were analyzed as follows: 20 participants from the diabetes group, 39 from prediabetes, and 584 from the normal group. A modest but significant improvement in the glycemic status of diabetic and prediabetic participants was observed, but not in the normal group. In the diabetes group, 11 (55%) participants achieved normal HbA1c levels, 5 had prediabetes levels, and only 4 remained within diabetes HbA1c levels. In the prediabetes group, 34 (87.2%) participants achieved normal HbA1c levels, while 2 (5.1%) participants remained prediabetic and 3 (7.7%) had diabetes HbA1c levels (p < 0.001). This hybrid lifestyle intervention program modestly reduces the risk of T2DM among youth with elevated HbA1c levels. The challenge of sustaining interest in adopting lifestyle changes for a longer duration should be addressed in further studies in this population.

Predicting youth diabetes risk using NHANES data and machine learning

Prediabetes and diabetes mellitus (preDM/DM) have become alarmingly prevalent among youth in recent years. However, simple questionnaire-based screening tools to reliably assess diabetes risk are only available for adults, not youth. As a first step in developing such a tool, we used a large-scale dataset from the National Health and Nutritional Examination Survey (NHANES) to examine the performance of a published pediatric clinical screening guideline in identifying youth with preDM/DM based on American Diabetes Association diagnostic biomarkers. We assessed the agreement between the clinical guideline and biomarker criteria using established evaluation measures (sensitivity, specificity, positive/negative predictive value, F-measure for the positive/negative preDM/DM classes, and Kappa). We also compared the performance of the guideline to those of machine learning (ML) based preDM/DM classifiers derived from the NHANES dataset. Approximately 29% of the 2858 youth in our study population had preDM/DM based on biomarker criteria. The clinical guideline had a sensitivity of 43.1% and specificity of 67.6%, positive/negative predictive values of 35.2%/74.5%, positive/negative F-measures of 38.8%/70.9%, and Kappa of 0.1 (95%CI: 0.06-0.14). The performance of the guideline varied across demographic subgroups. Some ML-based classifiers performed comparably to or better than the screening guideline, especially in identifying preDM/DM youth (p = 5.23 × 10-5).We demonstrated that a recommended pediatric clinical screening guideline did not perform well in identifying preDM/DM status among youth. Additional work is needed to develop a simple yet accurate screener for youth diabetes risk, potentially by using advanced ML methods and a wider range of clinical and behavioral health data.

Helicobacter pylori infection, a risk factor for Type 2 diabetes mellitus: a hospital-based cross-sectional study among dyspeptic patients in Douala-Cameroon

Diabetic mellitus patients are usually prone to chronic infections. However, there have been contradictory reports about the association between H. pylori infection and type II diabetes. The present study is aimed at evaluating the prevalence of Helicobacter pylori infection among type 2 dyspeptic diabetic patients in the littoral region of Cameroon. This cross sectional study comprised 93 type 2 diabetic dyspeptic patients and 112 non-diabetic dyspeptic patients attending the Gastroenterology Department at two reference hospitals in Douala-Cameroon. The study was approved by the local Ethical Committee of Medical Sciences. Participants were screened for the presence of both type 2 diabetes and H. pylori infection. Body mass index (BMI) of all the participants was also recorded. Data was analyzed using SSPS statistical package. H. pylori infection was found in 73.11% of diabetic patients versus 58.05% in non-diabetic participants, this difference was found to be significant (OR = 1.472, p = 0.0279). This relationship persists even when adjusted to factors such as age and income level of participants. Infected participants from age group ≥ 55 years and those with high income were those with a higher risk to develop diabetes. Infected patients with high BMI were more prone to develops diabetic mellitus compared with infected patients with normal BMI (p = 0.0034). Also, participant with high BMI were more prone to develops diabetic mellitus whether they were infected or not. Patients having both H. pylori + ve and BMI ≥ 25 kg/m2 were significantly more affected by diabetic mellitus than those in the others combined groups (p < 0.0001), suggested that high BMI and H. pylori infection together or not are factors that favor diabetes mellitus development. Separately or not, H. pylori infection and high BMI were risk factor for diabetes mellitus in our milieu.

Cycling to work: Business people, encourage more physical activity in your employees!

BACKGROUND

Cycling to work has been promoted all over the world. Contemporary employers invest in human capital (create a friendly work environment, care about the quality of life and health of employees).

OBJECTIVES

The aim of this study was to evaluate the popularity of cycling to work and the motivations and barriers to this activity.

METHODS

The study used data obtained from the survey Using cycling in everyday transportation conducted at the request of the Ministry of Sport and Tourism. The data were collected by means of computer-assisted personal interviewing (CAPI).

RESULTS

A mere 9.9% of Poles commute to work by bike, but they cycle to work on a regular basis (68.6% of respondents do this several times a week for 1 to 6 months). They mostly cycle to improve/maintain health and physical fitness and for reasons concerning environmental protection. According to 49.5% of respondents, the infrastructure at the workplace is insufficient for commuting by bike. A substantial problem is the lack of changing rooms or places to change clothes (44.0%) and no access to showers (22.2%). In the opinions of 66.7%, the promotion of regular commuting to work by bike requires extension of the cycling infrastructure.

CONCLUSIONS

The results indicate the necessity of employers' investment in the infrastructure and cycling facilities.

Impact of sports activity on Polish adults: Self-reported health, social capital & attitudes

The aim of our study was a quasi-experimental estimation of the relationship between sports activity and social capital, and an assessment made at an individual level of the impact of sports activity on health, beliefs and the social situation of Polish adults. Matching estimation method and Social Diagnosis data were used. The dataset enables not only an analysis of the self-reported health, but also of social capital. The panel structure of the data and the applied method allow for stratifying the sample using past characteristics, including past sports activity, as well as for assessing outcomes after the treatment—engaging in sports activity—takes place. Both allow for an interpretation of the results as reflections of a causal relationship. Even though publications applying matching estimation or IV estimation to assess the impact of sports activity have recently been increasing in number, ours is the first to concentrate on the effects on multidimensional social capital for adults using panel data and matching estimation. It is also the first to focus on a country that is neither one of the most developed in the world or one of the least developed. The results obtained suggest significant heterogeneity in terms of age, gender and place of living. We also found that sports contributed to building social networks and being socially active. Our research indicates that sports activity enhances social health. It can be used as a tool for a policy of social activation and strengthening the health potential of adults, especially those over 40.

Large body mass index and waist circumference are associated with high blood pressure and impaired fasting glucose in young Chinese men

BACKGROUND

Obesity is closely related to many chronic diseases and metabolic risk factors. The present study examined the relationship of obesity-related indices to blood pressure (BP) and fasting plasma glucose (FPG) among young Chinese men.

METHODS

A total of 1193 male college students aged 18-22 years participated in the study. Height, weight, waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and FPG were measured. High BP was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg. Impaired fasting glucose (IFG) was defined as FPG ≥5.6 mmol/L.

RESULTS

BMI, WC and WHtR were positively correlated with BP and FPG (rBMI-SBP = 0.455, rBMI-DBP = 0.367, rBMI-FPG = 0.113, rWC-SBP = 0.445, rWC-DBP = 0.382, rWC-FPG = 0.115, rWHtR-SBP = 0.396, rWHtR-DBP = 0.302, rWHtR-FPG = 0.106, P all < 0.01). When categorized by BMI (underweight, normal weight, overweight and obesity), the mean values of SBP, DBP, FPG and the prevalence of high BP and IFG increased with BMI, significant differences were observed among the four groups (P < 0.01). When categorized by WC and WHtR, similar differences were observed, with subjects in the large WC/WHtR group had a higher BP and FPG than their counterparts in the low WC/WHtR group (P < 0.01).

CONCLUSION

Large BMI and WC/WHtR are associated with high BP and IFG. Our results suggested that prevention of obesity in youth may be an effective approach for preventing the development of diabetes and hypertension in the future.

Association between Irisin, hs-CRP, and Metabolic Status in Children and Adolescents with Type 2 Diabetes Mellitus

Proinflammatory cytokines and the novel myokine irisin, a cleavage product of FNDC5, have been found to play a role in obesity and type 2 diabetes mellitus (T2DM). Irisin has been shown to increase browning of adipose tissue, thermogenesis, energy expenditure, and insulin sensitivity, yet its association with inflammatory markers is still limited. Circulating irisin has been found to be increased in obesity, while in adult subjects with T2DM decreased levels have been found. However, data establishing the association of circulating irisin in children and adolescents with T2DM has not been described in the literature. The objective of this study was to determine irisin plasma concentration and its association with metabolic and adiposity markers and with hs-CRP, a surrogate marker of inflammation used in clinical practice, in a pediatric population with T2DM. A cross-sample of 40 Mexican children and adolescents aged 7-17 were recruited, 20 diagnosed with T2DM and 20 healthy controls. Plasma irisin levels were found to be lower in the T2DM group compared with controls, which could be attributed to a reduced PGC-1α activity in muscle tissue with a consequent decrease in FNDC5 and irisin expression. Irisin concentration was found to be positively correlated with HDL-c, LDL-c, and total cholesterol, while negatively correlated with BMI, waist circumference, and triglycerides. However, after multiple regression analysis, only HDL-c correlation remained significant. hs-CRP was higher in the T2DM group and positively associated with adiposity markers, unfavorable lipid profile, insulin levels, and HOMA-IR, but no association with irisin was found. Given the favorable metabolic effects attributed to irisin, the low plasma levels found in children and adolescents with T2DM could exacerbate the inflammatory and metabolic imbalances and the intrinsic cardiovascular risk of this disease. We propose an "irisin-proinflammatory/anti-inflammatory axis" to explain the role of irisin as a metabolic regulator in obesity and T2DM.

Dietary Interventions and Type 2 Diabetes in Youth: a Fresh Look at the Evidence

PURPOSE OF REVIEW

The incidence of type 2 diabetes among children and adolescents has sharply increased, highly influenced by prevalence of obesity in youth. Here, we provide an overview of the pathogenesis of diabetes, and summarize recent dietary interventions investigating effects of diet on metabolic risk factors in overweight and obese youth.

RECENT FINDINGS

Seven dietary interventions were identified randomly assigning participants to weekly or bi-weekly dietary counseling sessions over 12-24-week period, with mixed results. Four interventions showed significant reductions in fasting insulin and insulin resistance levels relative to baseline concentrations ranging from 26 to 50%. Recent evidence is mixed, with four studies showing improvements to insulin concentrations and insulin resistance in obese children and adolescents associated with energy restriction and/or change to carbohydrate consumption. Further work is needed to investigate long-term effects of dietary factors including carbohydrate quality and energy restriction on metabolic health and diabetes prevention early in life.

Evaluation of a combination digital retinal camera with spectral-domain optical coherence tomography (SD-OCT) that might be used for the screening of diabetic retinopathy with telemedicine: A pilot study

AIMS

Pilot study to determine whether an instrument combining a non-mydriatic retinal camera and spectral domain optical coherence tomography (SD-OCT) is effective for screening patients with diabetic retinopathy (DR).

METHODS

Case series conducted between 2012 and 2013. DR imaged with a retinal camera/SD-OCT instrument viewed remotely was compared to a dilated examination by a retina specialist.

RESULTS

The combination instrument was better than the retina specialist in detecting more severe retinopathy, primarily because of the SD-OCT. For severe retinopathy (grade ≥ 3), the image grader had better sensitivity (87.3% [95% CI: 75.5%, 94.7%]) than the retina examiner (76.4% [95% CI: 63.0%, 86.8%]). Specificities were similar between the instrument grader (96.0% [95% CI: 86.3%, 99.5%]) and retina examiner (100.0% [95% CI: 92.9%, 100.0%]). When identifying diabetic macular edema (ME), the retina examiner only identified 47.6% (20/42) of eyes with ME detected by SD-OCT. The instrument was better than a dilated retinal examination in detecting ME and not as good at detecting mild or proliferative retinopathy.

CONCLUSIONS

As used in this study, the instrument was more effective in identifying DR than was the current recommendation of a dilated and comprehensive eye examination. SD-OCT is needed to accurately identify DR in a screening setting.

Epidemiology and Impact of Health Care Provider-Diagnosed Anxiety and Depression Among US Children

OBJECTIVE

This study documents the prevalence and impact of anxiety and depression in US children based on the parent report of health care provider diagnosis.

METHODS

National Survey of Children's Health data from 2003, 2007, and 2011-2012 were analyzed to estimate the prevalence of anxiety or depression among children aged 6 to 17 years. Estimates were based on the parent report of being told by a health care provider that their child had the specified condition. Sociodemographic characteristics, co-occurrence of other conditions, health care use, school measures, and parenting aggravation were estimated using 2011-2012 data.

RESULTS

Based on the parent report, lifetime diagnosis of anxiety or depression among children aged 6 to 17 years increased from 5.4% in 2003 to 8.4% in 2011-2012. Current anxiety or depression increased from 4.7% in 2007 to 5.3% in 2011-2012; current anxiety increased significantly, whereas current depression did not change. Anxiety and depression were associated with increased risk of co-occurring conditions, health care use, school problems, and having parents with high parenting aggravation. Children with anxiety or depression with effective care coordination or a medical home were less likely to have unmet health care needs or parents with high parenting aggravation.

CONCLUSION

By parent report, more than 1 in 20 US children had current anxiety or depression in 2011-2012. Both were associated with significant comorbidity and impact on children and families. These findings may inform efforts to improve the health and well-being of children with internalizing disorders. Future research is needed to determine why child anxiety diagnoses seem to have increased from 2007 to 2012.

A Systematic Review and Meta-Analysis of the Effect of Lifestyle Modification on Metabolic Control in Overweight Children

Childhood obesity is associated with type 2 diabetes mellitus. We aimed to determine the effects of lifestyle modification programs on fasting plasma glucose (FPG) levels in overweight children. We queried six relevant electronic databases and manually searched for studies published before December 2016. Overweight/obese children who underwent a lifestyle modification for more than 6 months were included. A total of 3923 children from eight randomized controlled trials (RCTs) were included. Compared with the control group, the lifestyle modification group had significantly lower FPG levels by 1.3 mg/dL. The mean differences were significantly decreased for both secondary outcomes; BMI z-score decreased by 0.16 units and insulin levels decreased by 2.4 mU/L. The metaregression showed that the follow-up duration was associated with FPG levels and BMI and insulin levels and half year is a suitable follow-up duration for this population. This study showed that lifestyle modification programs may be effective in reducing the FPG levels of overweight/obese children. Further high-quality RCTs with longer follow-up periods are needed to evaluate the long-term effect of this complementary approach for diabetes mellitus prevention on overweight/obese children.

Real-Life Glycemic Control in Children with Type 2 Diabetes: A Population-Based Study

OBJECTIVES

To characterize children and adolescents with type 2 diabetes mellitus (T2DM) insured by a large health maintenance organization, and to identify variables associated with treatment quality and disease outcome.

STUDY DESIGN

Children and adolescents diagnosed with T2DM over a 9-year period were identified from the database of Clalit Health Services, a large health maintenance organization in Israel (1 213 362 members aged 0-18 years). Demographic, anthropometric, clinical, and laboratory data were analyzed.

RESULTS

A total of 96 patients (47 males) met our inclusion criteria. The mean age at diagnosis of T2DM was 14.25 ± 2.51 years. At the time of diagnosis, the median hemoglobin A1c (HbA1c) level was 7.8%, and additional components of the metabolic syndrome were present in 14.9%-67.4% of the patients. At the end of the follow-up period (3.11 ± 1.75 years), >50% of the patients were being treated with insulin; the median HbA1c value was 7.97%, and 44.6% of the patients achieved the target HbA1c of <7.0%. On multivariate linear regression analysis, the variables found to predict worse glycemic control (ie, higher HbA1c) were a higher HbA1c at diagnosis, a higher body mass index SD score at diagnosis, fewer annual HbA1c tests, and Arabic ethnicity [F(4,81) = 7.139; P < .001; R² = 0.271].

CONCLUSION

This population-based study of pediatric patients with T2DM demonstrates that reasonable glycemic control can be achieved in both community and outpatient hospital settings. Nevertheless, there is room for improvement in intervention programs to optimize outcomes and decrease the risk of complications.

Number and Severity of Type 2 Diabetes among Family Members Are Associated with Nutrition and Physical Activity Behaviors

AIM

A binary measurement of type 2 diabetes (T2D) has been found not to influence behaviors. We aimed to examine the influence of other measures of family history such as number of relatives, genetic closeness of relatives, and severity of T2D of family members on nutrition and physical activity behaviors among college students.

METHODS

Students across four colleges in Texas were sampled. Multiple linear regression models, controlling for covariates, were used to model results. Cross-sectional data were used.

RESULTS

More number of relatives with T2D was associated with vegetable consumption (β = 0.131, p = 0.007) and exercise (β = 0.129, p = 0.037). Having relatives with severe T2D was associated with vegetable consumption (β = 0.157, p = 0.002) and exercise (β = 106, p = 0.027). Closer genetic relationship with someone with T2D was associated with increased vegetable consumption (β = 0.107, p = 0.023) and exercise (β = 0.096, p = 0.047).

CONCLUSION

It is likely that the severe complications that may accompany the relatives T2D or having an immediate family member living with T2D may in fact motivate other family members without T2D to modify their attitudes, beliefs, and knowledge about T2D, thus encourage health-protective behaviors.

Should bariatric surgery be performed in adolescents?

Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.

Childhood temperament predictors of adolescent physical activity

Background

Physical inactivity is a leading cause of mortality worldwide. Many patterns of physical activity involvement are established early in life. To date, the role of easily identifiable early-life individual predictors of PA, such as childhood temperament, remains relatively unexplored. Here, we tested whether childhood temperamental activity level, high intensity pleasure, low intensity pleasure, and surgency predicted engagement in physical activity (PA) patterns 11 years later in adolescence.

Methods

Data came from a longitudinal community study (N = 206 participants, 53% females, 70% Caucasian). Parents reported their children’s temperamental characteristics using the Child Behavior Questionnaire (CBQ) when children were 4 & 5 years old. Approximately 11 years later, adolescents completed self-reports of PA using the Godin Leisure Time Exercise Questionnaire and the Youth Risk Behavior Survey. Ordered logistic regression, ordinary least squares linear regression, and Zero-inflated Poisson regression models were used to predict adolescent PA from childhood temperament. Race, socioeconomic status, and adolescent body mass index were used as covariates.

Results

Males with greater childhood temperamental activity level engaged in greater adolescent PA volume (B = .42, SE = .13) and a 1 SD difference in childhood temperamental activity level predicted 29.7% more strenuous adolescent PA per week. Males’ high intensity pleasure predicted higher adolescent PA volume (B = .28, SE = .12). Males’ surgency positively predicted more frequent PA activity (B = .47, SE = .23, OR = 1.61, 95% CI: 1.02, 2.54) and PA volume (B = .31, SE = .12). No predictions from females’ childhood temperament to later PA engagement were identified.

Conclusions

Childhood temperament may influence the formation of later PA habits, particularly in males. Boys with high temperamental activity level, high intensity pleasure, and surgency may directly seek out pastimes that involve PA. Indirectly, temperament may also influence caregivers’ perceptions of optimal activity choices for children. Understanding how temperament influences the development of PA patterns has the potential to inform efforts aimed at promoting long-term PA engagement and physical health.

Pharmacokinetics and pharmacodynamics of dapagliflozin in children and adolescents with type 2 diabetes mellitus

AIMS

To evaluate the pharmacokinetic (PK)/pharmacodynamic (PD) and safety profile of dapagliflozin in paediatric patients aged 10-17 years with type 2 diabetes mellitus (T2DM).

METHODS

Patients were randomized to a single oral dose of dapagliflozin 2.5, 5 or 10 mg. The PK characteristics for individual patients were derived by non-compartmental methods. Urinary glucose excretion (UGE), fasting plasma glucose (FPG) and ease of swallowing were also evaluated.

RESULTS

A total of 24 patients with a mean (range) body weight of 99.7 (61.5-169.5) kg received dapagliflozin. Dapagliflozin was rapidly absorbed after oral administration (median time to maximum plasma concentration ∼1.5 h) and systemic exposures to dapagliflozin and its 3-O-glucuronide metabolite appeared dose-proportional. The mean 24-h UGE increased in a dose-related manner (52.8, 62.4 and 89.0 g for the 2.5, 5 and 10 mg groups, respectively). Mean FPG concentrations were lower for all dose groups on day 2 (6.9, 6.2 and 6.8 mmol/l for 2.5, 5 and 10 mg groups, respectively) than they were predose on day 1 (9.5, 8.5 and 8.2 mmol/l for 2.5, 5 and 10 mg groups, respectively). Six patients (25%) experienced ≥1 adverse event (AE), however, there was no dose-related pattern. All AEs occurred only once and most were mild in intensity. Nearly all patients (n = 23; 95.8%) reported easy swallowing of the dapagliflozin tablets.

CONCLUSIONS

Dapagliflozin was well tolerated in this paediatric population, with no significant safety findings. PK/PD characteristics were similar to those observed in adults with T2DM, thereby supporting the hypothesis that the same dapagliflozin dosage as that used in adults can be evaluated in future phase III paediatric studies.

TNF-alpha -308G/A and -238G/A polymorphisms and its protein network associated with type 2 diabetes mellitus

Several reports document the role of tumor necrosis factor alpha (TNF-α) and lipid metabolism in the context of acute inflammation as a causative factor in obesity-associated insulin resistance and as one of the causative parameter of type 2 diabetes mellitus (T2DM). Our aim was to investigate the association between -308G/A and -238G/A polymorphisms located in the promoter region of the TNF-α gene in T2DM in the Indian population with bioinformatics analysis of TNF-α protein networking with an aim to find new target sites for the treatment of T2DM. Demographics of 100 diabetes patients and 100 healthy volunteers were collected in a structured proforma and 3 ml blood samples were obtained from the study group, after approval of Institutional Ethics Committee of the hospital (IEC). The information on clinical parameters was obtained from medical records. Genomic DNA was extracted; PCR-RFLP was performed using TNF-α primers specific to detect the presence of SNPs. Various bioinformatics tools such as STRING software were used to determine its network with other associated genes. The PCR-RFLP studies showed that among the -238G/A types the GG genotype was 87%, GA genotype was 12% and AA genotype was 1%. Almost a similar pattern of results was obtained with TNF-α -308G/A polymorphism. The results obtained were evaluated statistically to determine the significance. By constructing TNF-α protein interaction network we could analyze ontology and hubness of the network to identify the networking of this gene which may influence the functioning of other genes in promoting T2DM. We could identify new targets in T2DM which may function in association with TNF-α. Through hub analysis of TNF-α protein network we have identified three novel proteins RIPK1, BIRC2 and BIRC3 which may contribute to TNF-mediated T2DM pathogenesis. In conclusion, our study indicated that some of the genotypes of TNF-α -308G/A, -238G/A were not significantly associated to type 2 diabetes mellitus, but TNF-α -308G/A polymorphism was reported to be a potent risk factor for diabetes in higher age (>45) groups. Also, the novel hub proteins may serve as new targets against TNF-α T2DM pathogenesis.

Greater vertical loading rate in obese compared to normal weight young adults

BACKGROUND

Obesity is a risk factor for knee osteoarthritis. Altered gait biomechanics are common in obese individuals, and may contribute to the development of knee osteoarthritis. Research has focused on older obese adults with knee osteoarthritis, and it is unclear if young obese individuals display similar aberrant biomechanics. The purpose of this study was to compare gait biomechanics between normal-weight and obese young adults.

METHODS

15 normal-weight (body mass index=21.5 (1.1)) and 15 obese (body mass index=33.5 (3.7)) young adults were recruited and categorized by body mass index. Lower extremity kinematics and kinetics were collected while participants walked at standardized (1m/s) and self-selected speeds. Analysis of variance (group by condition) was used to compare peak vertical ground reaction force, vertical loading rate, peak internal knee extension moment, peak internal knee abduction moment, peak knee flexion angle, and knee flexion excursion between groups.

FINDINGS

Gait biomechanics did not differ between groups during walking at a self-selected speed. When walking at a standardized speed, obese subjects displayed greater instantaneous vertical loading rates (46.2 vs. 35.0 N/s, P<0.001), and lesser knee flexion excursion (5.5° vs. 7.7°, P=0.04). Instantaneous vertical loading rate was greater during walking at a self-selected speed compared to a standardized speed in the obese (P=0.007) and normal weight groups (P=0.001).

INTERPRETATION

As greater loading rates are related to cartilage degeneration, these results suggest that obesity may contribute to knee osteoarthritis. Prospective studies are needed to identify the influence of higher loading rates on knee osteoarthritis.

LInking EDCs in maternal Nutrition to Child health (LINC study) - protocol for prospective cohort to study early life exposure to environmental chemicals and child health

Background

The presence of chemicals in the environment is ubiquitous. Human biomonitoring studies have shown that various chemicals can be detected in the majority of the population, including pregnant women. These compounds may pass the placenta, and reach the fetus. This early life exposure in particular may be detrimental as some chemicals may disrupt the endocrine system, which is involved in various processes during development. The LINC study is a prospective birth cohort designed to study associations between early life environmental exposures and child health, including growth and neurodevelopment. The purpose of this paper is to give an overview of this cohort.

Methods and design

Recruitment for this cohort has started in 2011 in three Dutch areas and is still ongoing. To date over 300 mother-child pairs have been included. Women are preferably included during the first trimester of pregnancy. Major congenital anomalies and twin births are reasons for exclusion. To assess exposure to environmental chemicals, cord blood, placenta, meconium and vernix are collected. Parents collect urine of the child shortly after birth and breast milk in the second month of life. Exposure to a broad range of environmental chemicals are determined in cord plasma and breast milk. Furthermore various hormones, including leptin and cortisone, are determined in cord plasma, and in heel prick blood spots (thyroxine). Data on anthropometry of the child is collected through midwives and youth health care centres on various time points until the child is 18 months of age. Furthermore cognitive development is monitored by means of the van Wiechen scheme, and information on behavioral development is collected by means of the infant behavior questionnaire and the child behavior checklist. When the child is 12 months of age, a house visit is scheduled to assess various housing characteristics, as well as hand-to-mouth behavior of the child. At this visit exposure of the child to flame retardants (with endocrine disrupting properties) in house dust is determined by means of body wipes. They are furthermore also measured in a saliva sample of the child. Next to these measurements, women receive questionnaires each trimester regarding amongst others lifestyle of the parents, general health of the parents and the child, and mental state of the mother.

Discussion

This study was approved by the medical ethics committee of the VU University Medical Centre. Consent for the infant is given by the mother, who is specifically required to give consent for both herself as well as her child. Results will be published regardless of the findings of this study, and will be widely disseminated among related medical stakeholders (e.g. midwives and pediatricians), policy makers, and the general public.

The prevalence, risk factors, and screening measure for prediabetes and diabetes among Emirati overweight/obese children and adolescents

Background

The aim of the study was to estimate the prevalence of prediabetes and type 2 diabetes (T2D) among overweight/obese children and adolescents using different diagnostic/screening methods in comparison.

Methods

We recruited overweight/obese Emirati students; grade 6–12 (age 11–17 years) from 16 government schools in Sharjah (UAE). Anthropometric, demographic, and clinical history data was measured by standard methods. Body mass index (BMI) was categorized according to BMI percentile charts for age and sex – CDC. Capillary fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were measured by finger prick test, followed by confirmatory oral glucose tolerance tests (OGTT) and venous HbA1c for students with abnormal capillary FBG and/or HbA1c.

Results

Of a total of 1034 participants (45 % females) median age 14.7 years, 443 (43 %) students had abnormal screening results. The prevalence of prediabetes and T2D was 5.4 % and 0.87 %, respectively, based on OGTT (gold standard). HbA1c showed a considerable discrepancy regarding the prevalence of prediabetes (21.9 %), but not diabetes. There was a statistically significant difference in the BMI Z-scores between the three different groups of students showing normal glycemic testing, prediabetes and T2D (p = 0.041). Univariate logistic regression analysis showed that glycemic status was significantly associated with family history of T2D first-degree relatives [OR 1.87: 95 % CI: 1.04–3.36; P = 0.036], parents employment [OR 1.79: 95 % CI: 1.06–3.02; P = 0.029] and levels of triglycerides [OR 2.28: 95 % CI: 1.11–4.68; P = 0.024].

Conclusions

The prevalence of prediabetes and diabetes was high among overweight/obese Emirati children and adolescents. The numbers for prediabetes were considerably higher when using HbA1c as compared to OGTT. Overall adiposity, family history of T2D, employment and high levels of triglycerides were risk factors associated with abnormal glycemic testing.

National surveillance for type 1, type 2 diabetes and prediabetes among children and adolescents: a population-based study (SAUDI-DM)

Background

There is a paucity of data on the national prevalence of diabetes and prediabetes among youth. The Saudi Abnormal Glucose Metabolism and Diabetes Impact Study (SAUDI-DM) was used to assess the prevalence of type 1 and type 2 diabetes as well as impaired fasting glucose (IFG) among children and adolescents.

Methods

Sociodemographic, anthropometric and clinical data were collected through a nationwide household randomly selected 23 523 children and adolescents aged ≤18 years. Known participants with diabetes were classified according to their diabetes type, while participants without diabetes were subjected to fasting plasma glucose assessment and patients with diabetes were identified using the American Diabetes Association (ADA) criteria. All the studied participants were tested for lipid parameters. Multivariate logistic regression analysis was used to assess different risk factors.

Results

The overall prevalence of diabetes was 10.84%, of which 0.45% were known type 1 and type 2 patients with diabetes and 10.39% were either newly identified cases of diabetes (4.27%) or IFG (6.12%) with more than 90% of the participants with diabetes being unaware of their disease. The prevalence of known type 1 and type 2 diabetes as well as the newly identified cases was higher than what has been reported internationally. Age, male gender, obesity, urban residency, high family income and presence of dyslipidaemia were found to be significant risk factors for diabetes and IFG.

Conclusions

Diabetes and IFG are highly prevalent in this society with the majority of the patients being unaware of their disease, which warrants urgent adoption of early detection, treatment and prevention programmes.

Effect of the Healthy Schools Program on prevalence of overweight and obesity in California schools, 2006-2012

INTRODUCTION

The Alliance for a Healthier Generation's Healthy Schools Program (HSP) is a national evidence-based obesity-prevention initiative aimed at providing the schools in greatest need with onsite training and technical assistance (TTA) and consultation with national experts (HSP national advisors) to create sustainable healthy change in schools' nutrition and physical activity environments. The objective of this study was to evaluate the impact of HSP on the prevalence of overweight and obesity in California schools, from HSP's inception in 2006 through 2012.

METHODS

We used statewide body mass index (BMI) data collected annually from 5th-, 7th-, and 9th-grade students to determine whether enrolling in the HSP's onsite intervention reduced the prevalence of overweight and obesity in intervention schools (n = 281) versus propensity-score matched control schools (n = 709) and whether increasing exposure to the program (TTA and contact with HSP national advisors) was associated with reductions in the prevalence of overweight and obesity.

RESULTS

Analyses showed no difference between HSP schools and control schools in overweight or obesity prevalence. However, program exposure varied widely among participating schools, and each additional contact with TTA or HSP national advisors was associated with a 0.3% decline in overweight and obesity prevalence (P < .05).

CONCLUSION

HSP appears to be an important means of supporting schools in reducing obesity. Although participation in HSP alone was not sufficient to improve weight status in California schools, there was a clear dose-response relationship to the program. HSP serves as an effective model for addressing childhood obesity among engaged schools.

Predictive validity of the attitudes toward medical help-seeking scale

Objective

This study examines the predictive validity of the action/intention subscale of the attitudes toward seeking medical help scale in a college sample.

Participants

Participants were 51 female undergraduates recruited from psychology classes. Data were collected at two time points between January and April, 2011.

Methods

Students completed the attitudes subscale and a measure of medical contacts twice, over a two month interval.

Results

Internal consistency and test–retest reliability of the measure were supported. Correlations between time one attitudes and medical contacts/intentions at time two provide evidence for predictive validity of the measure.

Conclusion

This relatively brief, psychometrically sound measure of attitudes toward medical help seeking can be used to identify individuals who may be reluctant to seek health care and to assess the effectiveness of health education programs.

•

Predictive validity of a measure of attitudes toward medical help seeking was assessed.

•

The scale demonstrated predictive validity and is reliable.

•

This brief measure can be used to identify characteristics of those reluctant to seek health care.

•

The scale may be used to evaluate interventions to promote medical adherence.

Male-female differences in diabetic retinopathy?

The purpose of this paper is to review male-female differences in the incidence and prevalence of diabetes and diabetic retinopathy. These differences will be established primarily through results from our present research and a review of related literature. Previously, we have demonstrated that neuroretinal dysfunction can be used to predict the location of future retinopathy up to three years before it is manifest. Our current research suggests that, for type 2 diabetes, the normal differences in neuroretinal function between nondiabetic males and females under 50 years of age are altered in patients with type 2 diabetes. Furthermore, local neuroretinal function in type 2 diabetes is more abnormal in adult males compared with adult females. The literature also suggests that there are male-female differences in the occurrence of diabetes. In adolescence, the incidence of type 1 diabetes is greater in males, whereas in type 2 diabetes, the incidence is greater in females. This excess of females in type 2 diabetes shifts to a more equal incidence between the two sexes in adults. In addition, advanced retinopathy in type 1 diabetes appears to be more common in males, and the presence and severity of diabetic retinopathy at the time of diagnosis in type 2 diabetes appears to be more associated with male sex. Although the reasons for male-female differences identified in this review are unknown, sex appears to be a significant factor in certain aspects of diabetes incidence and diabetic retinopathy.

Population-based incidence of diabetes in Australian youth aged 10-18 yr: increase in type 1 diabetes but not type 2 diabetes

BACKGROUND

Global incidence of childhood type 2 diabetes has increased, with a greater rise amongst certain ethnic groups.

OBJECTIVES

To examine the change in the incidence of type 1 and type 2 diabetes in Australian youth, aged 10-18 yr, in New South Wales, Australia.

METHODS

Prospective population-based incidence study (2001-2008). Primary case ascertainment was from the Australasian Paediatric Endocrine Group Diabetes Register, secondary independent ascertainment from the National Diabetes Register.

RESULTS

There were 202 incident cases of type 2 diabetes (96 boys, 48%). The mean age at diagnosis (±SD) was 14.6 ± 2.5 yr; 93% were overweight (International Obesity Taskforce Grade ≥1). Mean HbA1c was 8.8 ± 2.8%. Ethnicity was Caucasian 31%, Indigenous Australian 20%, Southeast Asian 11%, North African/Middle Eastern 9%, and NewZealander/Melanesian/Polynesian 8%. The mean annual incidence of type 2 diabetes was 3.0 per 100 000 per year (95% confidence interval (CI): 2.6-3.4) and did not change over time. The mean annual incidence of type 1 diabetes was 22.0 per 100 000 per year (95% CI: 20.8-23.1), and increased by 3.8% per year [incidence rate ratio IRR: 1.04, 95% CI: 1.02-1.06, p = 0.001]. Incidence was higher in Indigenous vs. non-Indigenous youth, IRR: 6.9 (95% CI: 4.7-10.2, p < 0.001).

CONCLUSION

In 10-18 yr old youth, in Australia, the incidence of type 2 diabetes has remained steady during the last decade; however, the incidence of type 1 diabetes continues to rise. Most common diabetes in Australian youth is type 1 diabetes.

Is diabetes color-blind? Growth of prevalence of diagnosed diabetes in children through 2030

Diabetes knows no age and affects millions of individuals. Preventing diabetes in children is increasingly becoming a major health policy concern and focus. The objective of this study is to project the number of children, aged 0-17 years, with diagnosed diabetes in the United States through 2030, accounting for changing demography, and diabetes and obesity prevalence rates. The study team combined historic diabetes and obesity prevalence data with US child population estimates and projections. A times-series regression model was used to forecast future diabetes prevalence and to account for the relationship between the forecasted diabetes prevalence and the lagged prevalence of childhood obesity. Overall, the prevalence of diagnosed diabetes is projected to increase 67% from 0.22% in 2010 to 0.36% in 2030. Lagged obesity prevalence in Hispanic boys and non-Hispanic black girls was significantly associated with increasing future diabetes prevalence. The study results showed that a 1% increase in obesity prevalence among Hispanic boys from the previous year was significantly associated with a 0.005% increase in future prevalence of diagnosed diabetes in children (P ≤ 0.01). Likewise, a unit increase in obesity prevalence among non-Hispanic black girls was associated with a 0.003% increase in future diabetes prevalence (P < 0.05). Obesity rates for other race/ethnicity combinations were not associated with increasing future diabetes prevalence. To mitigate the continued threat posed by diabetes, serious discussions need to focus on the pediatric population, particularly non-Hispanic black girls and Hispanic boys whose obesity trends show the strongest associations with future diabetes prevalence in children.

Glycosylated haemoglobin is markedly elevated in new and known diabetes patients with hyperglycaemic ketoacidosis

BACKGROUND

Glycosylated haemoglobin (HbA1c) and random blood glucose are markers of chronic and acute hyperglycaemia respectively.

OBJECTIVE

We compared HbA1c levels in ketoacidosis (DKA) occurring in known and newly diagnosed diabetes.

METHODS

Retrospective review of medical records for 83 DKA admissions in 2008 and 2009 with results for HbA1c at presentation.

RESULTS

There were 52 and 31 DKA admissions in known and newly diagnosed diabetes patients respectively. Fifty of the 83 DKA admissions were in females. The mean age (per admissions) and HbA1c of all admissions are 43.4 ± 20.3 years (n=83) and 12.7 ± 3.4 % (n=83) respectively. Mean HbA1c in known Type 1, known Type 2 and newly diagnosed diabetes patients were similarly very high: 12.4 ± 3.3 %, 12.5 ± 3.3 %, 13.1 ± 3.7 %; P = 0.6828. The HbA1c levels in newly diagnosed diabetes patients less than 30 years (likely Type 1 diabetes) and ≥ 30 years (likely Type 2 diabetes) were similar. There was a tendency to significantly positive correlation between blood glucose and HbA1c in new diabetes patients.

CONCLUSIONS

In our setting, DKA is associated with markedly elevated HbA1c levels in known type 1, known type 2 and new onset diabetes.

A cross-sectional study to determine the prevalence of obesity and other risk factors for type 2 diabetes among school children in Trinidad, West Indies

BACKGROUND

Our previous work has shown that type 2 diabetes mellitus is a problem in the school-aged population of Trinidad, West Indies. The current study evaluated the prevalence in this population of selected risk factors for diabetes, viz: obesity, family history of diabetes and acanthosis nigricans.

OBJECTIVE

To assess the prevalence of the following risk factors for type 2 diabetes (T2DM) in school children in Trinidad: obesity, family history of diabetes in first- or second-degree relatives and the presence of acanthosis nigricans (AN).

METHODS

A cross-sectional survey was performed among school children aged 7-18 years from September 2009 to June 2010. A convenience sample was selected from a random sample of 32 schools drawn from all educational districts. A self-administered questionnaire was employed to record family history, gender and ethnicity. AN was assessed and scored clinically at the neck and obesity was measured by anthropometry and bio-impedance.

RESULTS

There were 2130 participants in the study. Fifteen per cent were obese and 17% were overweight. Primary school children had a higher prevalence of obesity (22·9% vs 11·0%) and overweight (20·0% vs 15·6%) than secondary school children (P<0·05). A greater proportion of males than females had combined overweight/obesity as measured by BMI for age (35·8 vs 29·4%, P<0·05). The overall prevalence of AN was 43·4%. However, just over 18% of all school children have a degree of AN greater than grade 2, which clinically is readily recognisable. Females displayed this physical sign more commonly than males (P<0·05). The prevalences of a family history of diabetes in first- and second-degrees relatives were 11·0% and 1·1%, respectively. Forty-three per cent had one risk factor for diabetes, 23·1% had two and 2·9% had three.

CONCLUSION

Risk factors for T2DM are very common among school children in Trinidad. More than 40% had at least one risk factor. Strategies aimed at reducing risk factors for T2DM, especially obesity, among Trinidadian school children are urgently warranted.

Adolescent and young adult male health: a review

Adolescent and young adult male health receives little attention, despite the potential for positive effects on adult quality and length of life and reduction of health disparities and social inequalities. Pediatric providers, as the medical home for adolescents, are well positioned to address young men's health needs. This review has 2 primary objectives. The first is to review the literature on young men's health, focusing on morbidity and mortality in key areas of health and well-being. The second is to provide a clinically relevant review of the best practices in young men's health. This review covers male health issues related to health care access and the Centers for Disease Control and Prevention's Healthy 2020 objectives for adolescents and young adults, focusing on the objectives for chronic illness, mortality, unintentional injury and violence, mental health and substance use, and reproductive and sexual health. We focus, in particular, on gender-specific issues, particularly in reproductive and sexual health. The review provides recommendations for the overall care of adolescent and young adult males.

Pharmacologic treatment strategies in children with type 2 diabetes mellitus

We treated 80 obese and 28 nonobese children diagnosed as having type 2 diabetes mellitus (T2DM). Among these patients, 26 obese and 23 nonobese children were assigned to pharmacologic therapies during the course of diabetes. Pharmacologic therapies were started if the HbA1c (NGSP) value exceeded 7.0% despite dietary and exercise management. For the 26 obese patients, metformin alone or in combination with an additional medication was frequently used. Only 2 patients independently received sulfonylureas (SUs) in the form of glimepiride. In addition, 9 patients were treated with basal insulin supported with oral hypoglycemic drugs (OHDs) or biphasic premix insulin. On the other hand, the 23 nonobese patients were frequently treated with insulin alone or in combination with an additional medication followed by SUs. The nonobese patients tended to require pharmacologic therapies, in particular insulin, at an earlier stage of diabetes as compared with the obese patients. New antidiabetic drugs, DPP-4 inhibitors and GLP-1 receptor agonists, seemed to exert positive effects on glycemic control without occurrence of hypoglycemic episodes in some patients regardless of the type of diabetes. These results suggest that pharmacologic treatment strategies in childhood T2DM should be tailored to individual patient characteristics.

What is the ideal blood pressure goal for patients with diabetes mellitus and nephropathy?

There appears to be a broad consensus among professional health organizations that a blood pressure (BP) of 130/80 mm Hg or less is the recommended therapeutic BP target for subjects with diabetes mellitus. This review focuses on key studies that have examined the relationship between BP reduction and its impact on diabetic complications. An attempt is being made to identify the BP level at which maximum protection against diabetic complications is conferred, and below which further reduction no longer delivers a benefit that exceeds risk. Specific attention has been accorded to data contributing to establishing ideal BP goals in diabetic patients with nephropathy. On the basis of recent studies, it would appear that a BP below 140/90 mm Hg should be recommended for all diabetic individuals, and around 135/85 mm Hg for most. BP should be closer to, but not below, 130/80 mm Hg for those subjects at the highest cardiovascular risk. For those diabetic subjects at highest risk for stroke, lower BP may provide greater protection against stroke as shown in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. In younger individuals with diabetes and hypertension of shorter duration, it may be possible to lower BP below 130/80 mm Hg without untoward side effects and in fact with cardiovascular benefit, but this remains to be demonstrated. The ideal BP goal in diabetic patients with nephropathy remains questionable, and for now, the recommended target must be considered the same as that for the general diabetic population.

Observing anthropometric and acanthosis nigrican changes among children over time

This study assessed the anthropometrics and acanthosis nigricans (AN) in a sample of 7,337 children at two assessments. Four groups of children were identified based on the presence of AN at both time points: those who never had the marker, those who gained the marker, those who lost the marker, and those who maintained the marker. Group differences in height, weight, body composition, and the amount of change in these variables over time were explored. Our findings demonstrated that children who maintain or gain the AN marker had the greatest height, weight, and body composition changes over time. It is apparent that the AN marker does disappear in some children and that this is associated with lower weight gain and body composition loss. If interventions can be developed targeting children who present with the marker, it is likely that their risk of developing type 2 diabetes could be reduced.

School-community partnerships: a cluster-randomized trial of an after-school soccer program

IMPORTANCE

Identifying community-based programs that increase physical activity among diverse youth could yield sustainable tools to reduce obesity and obesity disparities.

OBJECTIVE

To evaluate the impact of a community-based after-school soccer and youth development program, America SCORES, on students' physical activity, weight status, and fitness.

DESIGN

Cluster-randomized trial. Study measures were collected in the fall (baseline), winter (midpoint), and spring (end point) of the 2009-2010 school year.

SETTING

After-school programs in 6 schools within a large urban school district.

PARTICIPANTS

All 4th and 5th grade students in after-school programs at the study schools were eligible.

INTERVENTION

Three schools were randomized to receive the SCORES after-school program, delivered via the train-the-trainer model.

MAIN OUTCOME MEASURES

Change in minutes of after-school moderate-to-vigorous physical activity (MVPA), fitness (maximal oxygen consumption), and body mass index over 1 school year.

RESULTS

Participants (n = 156) were diverse (42% Latino, 32% Asian, and 12% African American) and 76 (49%) had a body mass index at or above the 85th percentile. There were no significant group differences in the change in physical activity, fitness, or weight status among all students. However, among students with a body mass index at or above the 85th percentile, SCORES significantly increased MVPA after school (3.4 min/d; 95% CI, 0.3-6.5) and on Saturdays (18.5 minutes; 95% CI, 3.4-33.6).

CONCLUSIONS AND RELEVANCE

Existing community-based programs such as SCORES can increase physical activity among low-income youth, particularly those most at risk for weight-related comorbidities. While evaluating existing programs presents special challenges, partnerships between communities, schools, and researchers are an important component of translational research to address obesity.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01156103.

The influence of body mass index and velocity on knee biomechanics during walking

Obesity has been associated with both the development and progression of knee osteoarthritis. Being overweight or obese from a young age is likely to decrease the age of onset for co-morbidities of obesity such as osteoarthritis. However, research on osteoarthritis has thus far focused on older adults. Therefore, the purpose of this study was to determine whether young adults who are overweight or obese exhibit biomechanical risk factors for knee osteoarthritis at either their preferred walking velocity or at 1m/s, which was slower than the preferred velocity. Thirty healthy young adults formed three equal groups according to body mass index. Three dimensional kinetics and kinematics were collected while participants walked overground at both velocities. Joint moments were normalized to fat free weight and height. The preferred walking velocity of obese participants was slower than that of normal weight individuals. There were no differences in knee flexion excursion, peak knee flexion angle, normalized peak knee flexion moment or normalized peak knee adduction moment among groups. Obese participants walked with lower peak knee adduction angle than both overweight and normal body mass index participants and several shifted towards knee abduction. All groups had smaller knee flexion excursion, peak knee flexion angle, peak knee flexion moment and peak knee adduction moment at 1m/s compared to preferred walking velocity. Overall, young and otherwise healthy overweight and obese participants have knee biomechanics during gait at preferred and slow walking velocities that are comparable to normal weight adults.

Clinical, immunologic and insulin secretory characteristics of young black South African patients with diabetes: Hospital based single centre study

AIMS

To classify and characterize the clinical features of various diabetes classes among young black South Africans.

METHODS

Cross sectional study of 60 black patients with diabetes, all less than 30 years of age and attending Nelson Mandela Academic Hospital, Mthatha, South Africa. Diabetes was classified as Types 1A, 1B and 2 based on the anti-glutamic acid decarboxylase status and serum C-peptide response to intravenous injection of glucagon.

RESULTS

Mean age was 19.6±4.8 years (n=60) with similar gender distribution. The mean duration of diabetes was 24.2±45.1 months. Type 1A was the class of diabetes in 55% (n=33/60) of patients. Type 1B and 2 accounted for 30% (n=18/60) and 15% (n=9/60) of patients respectively. Patients classified as Type 2 had higher waist circumference and higher prevalence of acanthosis nigricans than Types 1A and 1B groups. History of diabetes in a first degree relative and hypertension were found in similar proportions of patients with Types 1A, 1B and 2 diabetes. Five Type 1A diabetes patients had body mass index of 26.2-41kg/m(2) and this included two newly diagnosed patients with body mass index of 26.7kg/m(2) and 33.2kg/m(2).

CONCLUSION

The majority of our young black South Africans with diabetes are of the Type 1A class. Acanthosis nigricans was not found in any patient with Type 1 A diabetes. A minority of Type 1 A diabetes patients were obese at initial diagnosis.

Pharmacologic treatment strategies in children with type 2 diabetes mellitus

We treated 80 obese and 28 nonobese children diagnosed as having type 2 diabetes mellitus (T2DM). Among these patients, 26 obese and 23 nonobese children were assigned to pharmacologic therapies during the course of diabetes. Pharmacologic therapies were started if the HbA1c (NGSP) value exceeded 7.0% despite dietary and exercise management. For the 26 obese patients, metformin alone or in combination with an additional medication was frequently used. Only 2 patients independently received sulfonylureas (SUs) in the form of glimepiride. In addition, 9 patients were treated with basal insulin supported with oral hypoglycemic drugs (OHDs) or biphasic premix insulin. On the other hand, the 23 nonobese patients were frequently treated with insulin alone or in combination with an additional medication followed by SUs. The nonobese patients tended to require pharmacologic therapies, in particular insulin, at an earlier stage of diabetes as compared with the obese patients. New antidiabetic drugs, DPP-4 inhibitors and GLP-1 receptor agonists, seemed to exert positive effects on glycemic control without occurrence of hypoglycemic episodes in some patients regardless of the type of diabetes. These results suggest that pharmacologic treatment strategies in childhood T2DM should be tailored to individual patient characteristics.

Screening for diabetes in schoolchildren in Trinidad, West Indies

BACKGROUND

Although the epidemic of diabetes in adults is well established and documented, information on the epidemiology of type 2 diabetes mellitus (T2DM) in children and adolescents in Trinidad and Tobago is limited. Anecdotal reports suggest an increase in children and especially adolescents with T2DM amongst clinic attendees.

OBJECTIVE

To assess the prevalence of diabetes mellitus in schoolchildren screened by mass urinary testing in Trinidad and to determine the effectiveness and cost-effectiveness of this screening method.

DESIGN AND METHODS

During January to June 2009, a cross-sectional survey was undertaken in schoolchildren aged 5-17 years, in the island of Trinidad only. Children were instructed to collect an early-morning, pre-breakfast urine sample at home and to bring it to school for testing for glycosuria. Those with an initially positive result underwent a second urine test. Those with two consecutively positive urine tests were invited to undertake an oral glucose tolerance test.

RESULTS

67,000 (53·6%) children from a school-age population of 125,000 were screened. Twenty-three were found to have persistent glycosuria and 21 agreed to undergo an oral glucose tolerance test. Eight fulfilled the American Diabetes Association's criteria for diabetes and five for pre-diabetes. Of the eight with confirmed diabetes (aged 7-18 years), one (male, age 12 years) was slim and ketotic and required insulin for control. Of the other seven, five were overweight (three females, two males) with a BMI >85th per centile and two females were obese (BMI >95th per centile). Five children (four females, one male) aged 12-14 years were diagnosed as pre-diabetic. There is a prevalence of 10·4/100,000 schoolchildren with T2DM, and 7·5/100,000 with impaired glucose intolerance among schoolchildren in Trinidad. Urine screening had a positive predictive value (PPV) of 65% for detecting T2DM in schoolchildren. The cost of screening 67,000 children was US$55,080, a per capita cost of <US$1. The cost of finding one case was US$4286. Economic analysis revealed that investing to find one case today yields a net present value of >US$7000, representing a 63% saving.

CONCLUSION

Despite the low PPV of urine glucose testing, our data support the view that mass screening of schoolchildren in Trinidad for T2DM is both feasible and cost-effective.