Considerations Regarding the Diagnosis and Treatment of Childhood Type 2 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.

Relationships among stressful life events and physiological markers, treatment adherence, and psychosocial functioning among youth with type 2 diabetes

OBJECTIVE

To examine the relationships between stressful life events and physiological measures, adherence to prescribed oral medication regimens, depressive symptoms, and impaired quality of life (QoL) in adolescents with recent-onset type 2 diabetes (T2D).

STUDY DESIGN

Data were collected from 497 ethnically diverse participants (66% female) in the final year of the Treatment Options for Type 2 Diabetes in Adolescents and Youth multicenter clinical trial. Exposure to 32 possible events over the previous year and rating of subsequent distress were collected by self-report and summarized as a major stressors score. This score was analyzed for relationship to glycemic control (hemoglobin A1c and treatment failure), body mass index, diagnosis of hypertension or triglyceride dyslipidemia, adherence to a prescribed oral medication regimen, presence of depressive symptoms, and impaired QoL.

RESULTS

The total number of major stressful life events in the adolescents with T2D was calculated, with 33% reporting none, 67% reporting ≥ 1, 47% reporting ≥ 2, 33% reporting ≥ 3, and 20% reporting ≥ 4. There were no associations between the major stressors score and physiological measures or diagnosis of comorbidities. The odds of medication nonadherence increased significantly from those reporting ≥ 1 major stressor (OR, 1.58; P = .0265) to those reporting ≥ 4 major stressors (OR, 2.70; P = .0009). Significant odds of elevated depressive symptoms and impaired QoL were also found with increased reporting of major stressors.

CONCLUSION

Exposure to major stressful life events is associated with lower adherence to prescribed oral medication regimens and impaired psychosocial functioning in adolescents with T2D.

Depression and quality of life in youth-onset type 2 diabetes mellitus

Type 2 Diabetes Mellitus (T2DM) was characteristically an adult-onset illness until recently, when it became recognized as an increasing problem among youth in conjunction with escalating rates and associated risks of pediatric. Youth-onset T2DM is associated with a range of psychosocial risk factors, and research underscores the relevancy of depressive symptoms and quality of life factors in illness diagnosis, management and prognosis. This review paper summarizes available findings on depression and health-related quality of life for youth-onset T2DM, and provides recommendations for clinical practice and a conceptual framework for further studies.

Success with lifestyle monotherapy in youth with new-onset type 2 diabetes

BACKGROUND

Evidence is lacking to support the efficacy of lifestyle modification as first-line therapy in the clinical management of type 2 diabetes mellitus (T2DM) in adolescents.

METHODS

A retrospective chart review of youth diagnosed with T2DM between 1999 and 2008 was conducted. The authors describe the percentage of youth presenting with glycosylated hemoglobin (HbA1c) of <9% who achieved/maintained target glycemic control (HbA1c ≤7.0%) with lifestyle monotherapy during the year following diagnosis.

RESULTS

Among the 275 youth with T2DM, 38% (n=104) presented with an HbA1c <9% and were prescribed lifestyle monotherapy at diagnosis. Of the 80 youth who had sufficient follow-up data over 12 months, 54% successfully maintained target glycemic control solely with lifestyle management. The mean HbA1c score at diagnosis was lower in youth who where successful on lifestlye monotherapy compared with those who were not successful.

CONCLUSIONS

A significant proportion of youth newly diagnosed with T2DM presenting with an HbA1c <9% effectively achieved/maintained target glycemic control with lifestyle recommendations alone for 12 months.

BACKGROUND

Evidence is lacking to support the efficacy of lifestyle modification as first-line therapy in the clinical management of type 2 diabetes mellitus (T2DM) in adolescents.

METHODS

A retrospective chart review of youth diagnosed with T2DM between 1999 and 2008 was conducted. The authors describe the percentage of youth presenting with glycosylated hemoglobin (HbA1c) of <9% who achieved/maintained target glycemic control (HbA1c ≤7.0%) with lifestyle monotherapy during the year following diagnosis.

RESULTS

Among the 275 youth with T2DM, 38% (n=104) presented with an HbA1c <9% and were prescribed lifestyle monotherapy at diagnosis. Of the 80 youth who had sufficient follow-up data over 12 months, 54% successfully maintained target glycemic control solely with lifestyle management. The mean HbA1c score at diagnosis was lower in youth who where successful on lifestlye monotherapy compared with those who were not successful.

CONCLUSIONS

A significant proportion of youth newly diagnosed with T2DM presenting with an HbA1c <9% effectively achieved/maintained target glycemic control with lifestyle recommendations alone for 12 months.

Is diabetes mellitus a continuous spectrum?

BACKGROUND

Diabetes mellitus has been historically divided into type 1 and type 2 diabetes, with type 1 being an autoimmune disease and type 2 being primarily a metabolic disease.

CONTENT

The current diabetes classification scheme needs to be reevaluated because of the accumulating evidence of immune system involvement in the pathophysiology of type 2 diabetes.

SUMMARY

There are similarities and differences between type 1 and type 2 diabetes with regard to pathogenesis, pathophysiology, and genetics. We propose a resolution to the dilemma of the current classification scheme.