Type 2 diabetes mellitus in children and adolescents

14. Children and Adolescents: Standards of Care in Diabetes-2025

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.

Visceral adiposity index, cardiorespiratory fitness, and fasting plasma glucose associations in adolescents

BACKGROUND

The global rise in the prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is partly linked to the increasing rates of childhood obesity and physical inactivity.

AIM

To explore the independent relationships of visceral adiposity index (VAI) and cardiorespiratory fitness (CRF) with fasting plasma glucose (FPG) in adolescents.

METHODS

This descriptive cross-sectional study included 403 adolescents (202 boys and 201 girls) aged 11-19 years. Participants were evaluated for VAI, CRF, and FPG. Regression models, adjusted for age and maturity status, were used to assess the associations between VAI, CRF, and FPG.

RESULTS

The prevalence of T2DM risk was 15.3% (girls = 7.4%; boys = 7.9%). In boys, high VAI was positively associated with FPG (β = 0.190, P = 0.009), while low CRF was negatively associated with FPG (β = -0.206, P = 0.010). These associations persisted even after adjusting for CRF and VAI. However, no significant associations between VAI, CRF, and FPG were observed in girls (P > 0.05). Adolescents with high VAI and low fitness levels demonstrated poorer glycemic profiles.

CONCLUSION

Among boys, both VAI and CRF were independently associated with T2DM risk, with CRF showing a stronger association. These associations were not observed in girls. Promoting regular aerobic exercise and healthy diets may serve as essential public health promotion strategies in preventing and managing T2DM risk in adolescents.

Downregulation of miR-25-3p and Its Impact on PTAFR and IGF2BP3 Expression in Type 2 Diabetes Mellitus: Implications for Biomarker Discovery and Disease Pathogenesis

Background

This study is designed to investigate the differential microRNA (miRNA) expression profiles in individuals with and without type 2 diabetes mellitus (T2DM). The focus is on miRNAs that play a crucial role in the onset and progression of T2DM, particularly in glucose metabolism, inflammation, platelet reactivity, and endothelial dysfunction.

Methods

Twenty samples were categorized into groups of T2DM and non-T2DM, and miRNA profiling was conducted using microarray analysis. The expression levels of the candidate miR-25-3p, as well as its target genes platelet-activating factor receptor (PTAFR) and insulin-like growth factor 2 mRNA binding protein 3 (IGF2BP3), were validated using quantitative polymerase chain reaction (qPCR).

Results

The present study revealed a significant reduction in the level of miR-25-3p in the T2DM group compared to the non-T2DM group. This suggests higher levels of PTAFR and IGF2BP3 in individuals with T2DM, indicating a potential biomarker for the condition.

Conclusions

The downregulation of miR-25-3p, which is associated with increased PTAFR levels, may contribute to heightened platelet reactivity and inflammation, worsening endothelial dysfunction, and potentially influencing vascular complications in diabetes. Additionally, the upregulation of IGF2BP3 is correlated with insulin resistance and β-cell dysfunction, which may contribute to elevated hyperglycemia and hyperinsulinemia, further aggravating the progression of diabetes. These findings highlight the potential of miR-25-3p and IGF2BP3 as biomarkers for T2DM and suggest their possible relevance for improving diagnosis and treatment strategies.

Novel indole based fused triazole-thiadiazole derivatives as anti-diabetic agents: in vitro and in silico approaches

Aim: The current research presents novel library of indole derived fused triazole-thiadiazole derivatives (1-17) for treatment of diabetes mellitus.Methods & results: These compounds were synthesized by treating 2-(1H-indol-3-yl)acetic acid with hydrazinecarbothiohydrazide followed by treating the resultant compound with substituted benzoic acid. Structural validation was achieved spectroscopically (1HNMR, 13CNMR and HREI-MS). The synthesized compounds were subjected to biological evaluation to assess their potential as anti-diabetic. Molecular docking study was employed to investigate the binding interactions of these analogs with relevant proteins. ADMET analysis was used to predict their drug-like properties. Notably, compound-10 (IC50 = 1.27 ± 1.25 and 2.18 ± 2.45 μM) bearing para-substituted F atom exhibited the highest potency due to strong inhibitory interactions through hydrogen bonding.Conclusion: This study identifies promising compounds with anti-diabetic activity, paving the way for the treatment of diabetes mellitus.

Type 2 diabetes in children and adolescents: Challenges for treatment and potential solutions

Historically perceived as a disease mainly affecting adults, the prevalence of type 2 diabetes mellitus (T2DM) among children and adolescents has been rising, mirroring the increasing rates of childhood obesity. Currently, youth-onset T2DM poses a significant public health challenge globally. Treating youth-onset T2DM poses numerous critical challenges, namely limited and inadequate therapeutic options, and difficulties with conducting therapeutic studies. As a result, current treatment guidelines are based on adult studies and expert consensus. Few prominent guidelines on the treatment of youth-onset T2DM have been published recently, i.e., by the American Diabetes Association (ADA) 2024, National Institute for Healthcare and Excellence United Kingdom (NICE UK) 2023, International Society Paediatric and Adolescents Diabetes (ISPAD) 2022, Australasian Paediatric Endocrine Group (APEG) 2020 and Diabetes Canada 2018. This review first explores the unique aspects of youth-onset T2DM. It then summarises the different treatment guidelines, discusses the different treatment modalities based on available evidence and identifies any gaps. The review also explores challenges in the treatment of youth-onset T2DM with potential solutions and discusses recent trials on the treatment of youth-onset T2DM. Continued research aims to optimise treatment, improve outcomes, and alleviate the burden of T2DM on youths.

Hyperglycemia influences the cell proliferation and death of the rat endocrine pancreas in the neonatal period

AIMS

To evaluate the cell proliferation and death, and structural morphology of the pancreatic islet cells of the rats with hyperglycemia in the first month of life and compare to those of the control rats.

MAIN METHODS

Female Sprague-Dawley newborn rats received Streptozotocin (a beta-cytotoxic drug) at birth for diabetes induction. Control and hyperglycemic animals were euthanized on different days of life: 5, 10, 15, and 30. The pancreas was collected and processed for immunohistochemical analysis of cleaved Caspase-3 (cell death), Ki-67 (cell proliferation), PDX-1 (transcription factor responsible for insulin synthesis), and endocrine hormones (insulin, glucagon, and somatostatin).

KEY FINDINGS

Control females showed a higher percentage (%) of Ki-67-positive(+) cells on D10 and D15, a higher % of insulin+ and somatostatin+ cells on D15 and D30, a lower % of PDX-1+ cells on D10, and a higher % of glucagon+ cells on D10 and D30. Hyperglycemic females showed a lower % of Ki-67+ cells on D15, a higher % of cleaved Caspase-3+ cells on D15, and insulin+ cells on D15 and D30. In the comparison among the experimental groups, the hyperglycemic females showed an increased % of cleaved Caspase-3+ and Ki-67+ cells and a lower % of PDX-1+ cells.

SIGNIFICANCE

This study enabled a better understanding of the abnormal pancreas development regarding cellular proliferation, apoptosis, and hormonal synthesis in the neonatal period. Thus, the pancreatic islets of hyperglycemic rats do not reestablish the normal endocrine cell population, and cellular apoptosis overcame the proliferative activity of these cells.

Temporal relationships between blood glucose, lipids and BMI, and their impacts on atherosclerosis: a prospective cohort study

OBJECTIVES

This study aimed to explore the temporal relationship between blood glucose, lipids and body mass index (BMI), and their impacts on atherosclerosis (AS).

DESIGN

A prospective cohort study was designed.

SETTING AND PARTICIPANTS

A total of 2659 subjects from Harbin Cohort Study on Diet, Nutrition and Chronic Non-communicable Diseases, and aged from 20 to 74 years were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Body weight, height, fasting blood glucose (FBG) and 2-hour postprandial glucose (2-h PG), blood lipids including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) were measured at baseline and follow-up. Brachial ankle pulse wave velocity (baPWV) was examined at follow-up as a marker of AS risk. Logistic regression analysis, cross-lagged path analysis and mediation analysis were performed to explore the temporal relationships between blood glucose, lipids and BMI, and their impacts on AS risk.

RESULTS

Logistic regression analysis indicated that increased FBG, 2-h PG, TC, TG, LDL-c and BMI were positively associated with AS risk, while increased HDL-c was negatively associated with AS risk. The path coefficients from baseline blood parameters to the follow-up BMI were significantly greater than those from baseline BMI to the follow-up blood parameters. Mediation analysis suggested that increased FBG, 2-h PG, TC, TG and LDL-c could increase AS risk via increasing BMI, the effect intensity from strong to weak was LDL-c>TC>TG>FBG>2 h PG, while increased HDL-c could decrease AS risk via decreasing BMI.

CONCLUSIONS

Changes in blood glucose and lipids could cause change in BMI, which mediated the impacts of blood glucose and lipids on AS risk. These results highlight the importance and provide support for the early and comprehensive strategies of AS prevention and control.

Challenges and pitfalls of youth-onset type 2 diabetes

The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) are increasing. The rise in frequency and severity of childhood obesity, inclination to sedentary lifestyle, and epigenetic risks related to prenatal hyperglycemia exposure are important drivers of the youth-onset T2DM epidemic and might as well be responsible for the early onset of diabetes complications. Indeed, youth-onset T2DM has a more extreme metabolic phenotype than adult-onset T2DM, with greater insulin resistance and more rapid deterioration of beta cell function. Therefore, intermediate complications such as microalbuminuria develop in late childhood or early adulthood, while end-stage complications develop in mid-life. Due to the lack of efficacy and safety data, several drugs available for the treatment of adults with T2DM have not been approved in youth, reducing the pharmacological treatment options. In this mini review, we will try to address the present challenges and pitfalls related to youth-onset T2DM and summarize the available interventions to mitigate the risk of microvascular and macrovascular complications.

Functionality and Health-Promoting Properties of Polysaccharide and Plant-Derived Substances from Mesona chinensis

Mesona chinensis, in Thai called Chao Kuay and in Chinese Hsian-tsao, belongs to the Lamiaceae family. This herbal plant grows widely in Southern China, Taiwan (China), Malaysia, the Philippines, Indonesia, Vietnam, and Thailand. The Mesona plant is used to make functional products such as drinks and soft textured sweet treats, and also traditional medicine, to treat heat stroke, high blood pressure, heart attack, high blood sugar, hepatic diseases, colon diseases, inflammatory conditions, and to alleviate myalgia. The proximate composition of M. chinensis is a mixture of protein, fat, fiber, ash, and minerals. The main biological compounds in M. chinensis extracts are polysaccharides, terpenoids, flavonoids, and polyphenols, with wide-ranging pharmacological properties including antioxidant, antidiabetic, antilipidemic, carcinoma-inhibitory, renal-protective, antihypertensive, DNA damage-protective, and anti-inflammatory effects. This review investigated the proximate composition, polysaccharide type, and pharmacological properties of M. chinensis extracts. Phytochemical properties enhance the actions of the gut microbiota and improve health benefits. This review assessed the functional and medicinal activities of M. chinensis extracts. Future studies should further elucidate the in vitro/in vivo mechanisms of this plant extract and its impact on gut health.

Diabetes-related instrument to assess preventive behaviors among adolescents (DIAPBA): a tool development and psychometric research

BACKGROUND

Type 2 diabetes is a chronic but preventable disease that is on the rise among adolescents. Evaluating adolescents' behavior and planning to prevent it require a valid and reliable instrument. This study aims at designing a psychometric instrument to measure adolescents' behavior with respect to type-2 diabetes.

RESEARCH DESIGN AND METHODS

In this methodological research, 770 students (adolescent boys and girls aged 13-15 years) participated through multistage sampling. The Inclusion criteria were: junior high school students, students' willingness for participation and not suffering from type-1 or type-2 diabetes. The questionnaire was designed by examining the relevant literature and the existing questionnaires as well as considering the research team's comments. The validity of the study was determined through face validity and content validity both quantitatively and qualitatively. The construct validity was determined through exploratory and confirmatory factor analysis. Reliability was measured via intraclass consistency coefficient (ICC) and internal consistency reliability was measured by Cronbach Alpha. SPSS 16 and Eq. 6.1 were used for data analysis.

RESULTS

At first, a list of 47 initial items was designed and compiled, and after by removing similar (10 questions) or inappropriate sentences (12 questions), a draft questionnaire with 25 questions was designed. No items were removed in the face validity phase. Based on exploratory factor analysis, the number of items in the questionnaire was reduced to 20 items and was categorized in five dimensions of stress management, healthy food/healthy diet, unhealthy food/unhealthy diet, high-risk behavior, and self-care. The results of confirmatory factor analysis confirmed the model. The internal consistency coefficient was confirmed measuring Cronbach Alpha at 0.70 with ICC = 0.80.

CONCLUSION

The questionnaire designed has standard psychometric properties to assess adolescents' behavior with respect to type-2 diabetes prevention. The reliability and the validity of the questionnaire as well as its general structure were confirmed.

Determinants of obesity in Latin America

Obesity rates are increasing almost everywhere in the world, although the pace and timing for this increase differ when populations from developed and developing countries are compared. The sharp and more recent increase in obesity rates in many Latin American countries is an example of that and results from regional characteristics that emerge from interactions between multiple factors. Aware of the complexity of enumerating these factors, we highlight eight main determinants (the physical environment, food exposure, economic and political interest, social inequity, limited access to scientific knowledge, culture, contextual behaviour and genetics) and discuss how they impact obesity rates in Latin American countries. We propose that initiatives aimed at understanding obesity and hampering obesity growth in Latin America should involve multidisciplinary, global approaches that consider these determinants to build more effective public policy and strategies, accounting for regional differences and disease complexity at the individual and systemic levels.

The Burden of Type 1 and Type 2 Diabetes Among Adolescents and Young Adults in 24 Western European Countries, 1990-2019: Results From the Global Burden of Disease Study 2019

Objectives: As little is known about the burden of type 1 (T1DM) and type 2 diabetes (T2DM) in adolescents in Western Europe (WE), we aimed to explore their epidemiology among 10-24 year-olds. Methods: Estimates were retrieved from the Global Burden of Diseases Study (GBD) 2019. We reported counts, rates per 100,000 population, and percentage changes from 1990 to 2019 for prevalence, incidence and years lived with disability (YLDs) of T1DM and T2DM, and the burden of T2DM in YLDs attributable to high body mass index (HBMI), for 24 WE countries. Results: In 2019, prevalence and disability estimates were higher for T1DM than T2DM among 10-24 years old adolescents in WE. However, T2DM showed a greater increase in prevalence and disability than T1DM in the 30 years observation period in all WE countries. Prevalence increased with age, while only minor differences were observed between sexes. Conclusion: Our findings highlight the substantial burden posed by DM in WE among adolescents. Health system responses are needed for transition services, data collection systems, education, and obesity prevention.

Arterial Stiffness and Obesity as Predictors of Diabetes: Longitudinal Cohort Study

BACKGROUND

Previous studies have confirmed the separate effect of arterial stiffness and obesity on type 2 diabetes; however, the joint effect of arterial stiffness and obesity on diabetes onset remains unclear.

OBJECTIVE

This study aimed to propose the concept of arterial stiffness obesity phenotype and explore the risk stratification capacity for diabetes.

METHODS

This longitudinal cohort study used baseline data of 12,298 participants from Beijing Xiaotangshan Examination Center between 2008 and 2013 and then annually followed them until incident diabetes or 2019. BMI (waist circumference) and brachial-ankle pulse wave velocity were measured to define arterial stiffness abdominal obesity phenotype. The Cox proportional hazard model was used to estimate the hazard ratio (HR) and 95% CI.

RESULTS

Of the 12,298 participants, the mean baseline age was 51.2 (SD 13.6) years, and 8448 (68.7%) were male. After a median follow-up of 5.0 (IQR 2.0-8.0) years, 1240 (10.1%) participants developed diabetes. Compared with the ideal vascular function and nonobese group, the highest risk of diabetes was observed in the elevated arterial stiffness and obese group (HR 1.94, 95% CI 1.60-2.35). Those with exclusive arterial stiffness or obesity exhibited a similar risk of diabetes, and the adjusted HRs were 1.63 (95% CI 1.37-1.94) and 1.64 (95% CI 1.32-2.04), respectively. Consistent results were observed in multiple sensitivity analyses, among subgroups of age and fasting glucose level, and alternatively using arterial stiffness abdominal obesity phenotype.

CONCLUSIONS

This study proposed the concept of arterial stiffness abdominal obesity phenotype, which could improve the risk stratification and management of diabetes. The clinical significance of arterial stiffness abdominal obesity phenotype needs further validation for other cardiometabolic disorders.

The Role of Glutathione and Its Precursors in Type 2 Diabetes

Type 2 diabetes (T2D) is a major worldwide health crisis affecting about 6.2% of the world's population. Alarmingly, about one in five children in the USA have prediabetes. Glutathione (GSH) and its precursors play a promising role in the prevention and management of type T2D. Oxidative stress (OxS) is a probable factor in both T2D initiation and progression. GSH is the major cytosolic water-soluble chemical antioxidant and emerging evidence supports its role in improving T2D outcomes. Dietary supplementation with N-acetyl-cysteine (NAC) and/or glycine (GLY), which are GSH precursors, has also been studied for possible beneficial effects on T2D. This review will focus on the underlying pathophysiological and molecular mechanisms linking GSH and its precursors with T2D and OxS. In addition to their traditional antioxidant roles, the in vivo effects of GSH/NAC/GLY supplements will be evaluated for their potential abilities to modulate the complex pro-oxidant pathophysiological factors (e.g., hyperglycemia) driving T2D progression. Positive feedback loops that amplify OxS over long time intervals are likely to result in irreversible T2D micro- and macro-vascular damage. Most clinical studies with GSH/NAC/GLY have focused on adults or the elderly. Future research with pediatric populations should be a high priority since early intervention is critical.

14. Children and Adolescents: Standards of Care in Diabetes-2024

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.

Pediatric diabetes mellitus hospitalizations and COVID-19 pandemic response measures

AIMS

In the United States, evidence suggests that during the COVID-19 pandemic, admissions of patients with diabetes mellitus (DM) have increased. This study assessed hospital admission rates for pediatric type 1 (T1DM) and type 2 (T2DM) diabetes mellitus during 2019-2021, and the potential influence of the timing of various pandemic response measures.

METHODS

Retrospective chart reviews were conducted of 854 T1DM and 135 T2DM hospital admissions between January 2019 and December 2021 in patients < 20 years old to collect demographic data, admission type, body mass index (BMI), and area deprivation index (ADI, a measure of socioeconomic vulnerability). Patients were divided into three cohorts based on their admission year: 2019 (Pre-pandemic), 2020 (Pandemic, Pre-vaccine), and 2021 (Pandemic, Post-vaccine). Admissions were categorized within each cohort by diagnosis (T1DM or T2DM) and clinical presentation (new onset, diabetic ketoacidosis: DKA). Cohorts were compared using an independent samples t-test for continuous variables or a chi-square test for categorical variables.

RESULTS

The incidence of T2DM hospitalizations tripled during the pandemic, increasing from 18 in 2019 (Pre-pandemic), to 55 in 2020 (Pandemic, Pre-vaccine), and 62 in 2021 (Pandemic, Post-vaccine). The rate of patients presenting with DKA was 15.4 % (95 % CI: 4 %-26.9 %) higher in 2020 (Pandemic, Pre-vaccine) among patients with new-onset T1DM (72/139 vs. 52/143), and 22.5 % (95 % CI: 9.6 %-35.4 %) higher in 2020 (Pandemic, Pre-vaccine) among T2DM patients (9/40 vs. 0/14). This increased rate of new onset T2DM significantly correlated with younger age (P = 0.046) and higher ADI score (P = 0.017), but not with BMI.

CONCLUSION

The incidence of T1DM hospitalizations did not increase during the pandemic; however, they tripled for T2DM patients. All new onset DM pediatric patients during the pandemic were more likely to present in DKA. Patients admitted with new onset T2DM were socioeconomically more vulnerable. For T1DM, the peak of local pediatric diabetes admissions in 2020 occurred slightly later coinciding with the reopening of primary care physicians (PCP) offices and schools.

In-silico, in-vitro and in-vivo Biological Activities of Flavonoids for the Management of Type 2 Diabetes

In spite of the fact that many medicinal plants have been truly utilized for the management of diabetes all through the world, very few of them have been reported scientifically. Recently, a diverse variety of animal models have been established to better understand the pathophysiology of diabetes mellitus, and new medications to treat the condition have been introduced in the market. Flavonoids are naturally occurring substances that can be found in plants and various foods and may have health benefits in the treatment of neuropathic pain. Flavonoids have also been shown to have an anti-inflammatory impact that is significant to neuropathic pain, as indicated by a decrease in several pro-inflammatory mediators such TNF-, NF-B IL-6, and IL-1. Flavonoids appear to be a viable novel therapy option for macrovasular complications in preclinical models; however, human clinical data is still inadequate. Recently, several in silico, in-vitro and in-vivo aproaches were made to evaluate mechanisms associated with the pathogenesis of diabetes in a better way. Screening of natural antidiabetic agents from plant sources can be analysed by utilizing advanced in-vitro techniques and animal models. Natural compounds, mostly derived from plants, have been studied in diabetes models generated by chemical agents in the majority of research. The aim of this work was to review the available in silico, in-vitro and animal models of diabetes for screening of natural antidiabetic agents. This review contributes to the scientist's design of new methodologies for the development of novel therapeutic agents having potential antihyperglycemic activity.

Assessment of Alternative Medicine Use, Costs, and Predictors of Medication Adherence among Diabetes Mellitus Patients in Palestine

BACKGROUND

Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and has increased to 20.6% in 2020.

AIMS

This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs.

METHODS

A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire, including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients' socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal- Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A p-value < 0.05 was considered statistically significant.

RESULTS

More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These results are worth taking into consideration.

CONCLUSION

This study reflects the need for strengthening the patient-health care professionals' relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.

Effect of weight loss on proteinuria in adults with type 2 diabetes: A real-world study

AIMS

To assess the impact of weight loss on proteinuria in patients with type 2 diabetes (T2DM) in real-world settings.

METHODS

A total of 1054 participants were categorized based on weight change from baseline to one-year follow-up: weight gain (≥3%), stable weight, or weight loss (≥3%). Proteinuria outcomes were defined as urinary albumin/creatinine ratio (UACR) progression (≥30 % increase), UACR regression (≥30 % reduction), or UACR stable. Ordered logistic regression analysis evaluated the relationship between weight loss and UACR regression.

RESULTS

Of the 1054 participants, 44.5 % were overweight, and 24.1 % were obese. Patients with obesity were at higher risk of developing proteinuria (OR, 1.783; 95 %CI, 1.195 to 2.659). Weight loss was associated with an 83.3 % increase in UACR regression compared to weight gain (OR, 1.833; 95 % CI, 1.262 to 2.663; P = 0.001). This association remained consistent across most subgroups and stronger in males (P for interaction = 0.023), with a 6 % UACR regression for every 1 kg weight loss (OR, 1.06; 95 % CI, 1.02 to 1.10; P = 0.003).

CONCLUSIONS

Our real-world study reveals that weight reduction is associated with UACR regression in patients with T2DM, regardless of the approach used for weight management, and the association was much stronger in males.

Health beliefs on type 2 diabetes: a methodological research for development and psychometric evaluation of "DIABA" (Diabetes-related Instrument to Assess Beliefs of Adolescents) health beliefs on type 2 diabetes

BACKGROUND

Several reports have shown an increase in the number of type-2 diabetics among adolescents creating an extra burden for this age group. However, there is no instrument assessing adolescents' attitude toward this disease. This study aims at designing a psychometric tool for assessing adolescents' health beliefs regarding type-2 diabetes.

RESEARCH DESIGN AND METHODS

In this methodological research, 770 boy and girl adolescents (between 13 and 15) from Tehran participated through multistage sampling. The Inclusion criteria were: junior high school students, students' willingness for participation and not suffering from type-1 or type-2 diabetes. The questionnaire was designed by extensive literature review and the related existing questionnaires, as well as considering the research team's comments. The validity of the questionnaire was determined through face and content validity. The construct validity was determined through exploratory and confirmatory factor analysis. Reliability was measured via internal consistency coefficient (ICC) and internal consistency reliability was measured by Cronbach Alpha. SPSS 16 and EQS6.1 were used for data analysis.

RESULTS

The pool of questions had 57 items, and by removing similar (23 questions) or inappropriate sentences (8 questions), a draft questionnaire with 26 questions was designed. No items were removed in the face validity phase. Based on the results of CVR and CVI, six items and 4 items in the exploratory factor analysis were removed. Finally, a questionnaire with 16 items in 4 dimensions of perceived self-efficacy, behavioral beliefs, perceived susceptibility and perceived severity was obtained. The results of confirmatory factor analysis confirmed the model. The internal consistency coefficient was confirmed measuring Cronbach Alpha at 0.78 and ICC = 0.73.

CONCLUSION

The questionnaire designed can be employed as a reliable and valid instrument to assess the psychological perceptions and health beliefs of adolescents with respect to type-2 diabetes.

DNA protection ability, antihyperglycemic potential and in-vivo toxicity assessment of arrowleaf tearthumb (Persicaria sagittata L.), a neglected aquatic plant species of Eastern Asia

Persicaria sagittata L. (common name arrowleaf tearthumb, American) is an herbaceous edible plant with characteristics sessile leaves mainly found in wetland areas of North America and Eastern Asia. In Eastern Himalayan Region of India, the ethnic communities consumed this plant as vegetables. The present investigation suggests the plant is endowed with bioactive compounds having potential DNA protection ability and antihyperglycemic activity. The DNA nicking assay revealed that the methanolic extract of this plant has the potential to protect plasmid DNA against hydroxyl damage. The α-glucosidase and α-amylase inhibitory assay of this methanolic extract suggest more effectiveness in inhibition of α-amylase than the α-glucosidase. Further, proximate composition, micronutrient, total phenolic and flavonoid content of this underutilised aquatic plant was determined. And lastly the in-vivo cytotoxicity study of Persicaria sagittata L. plant extract suggest that the plant is less toxic to in-vivo system.

Pediatric COVID-19 and Diabetes: An Investigation into the Intersection of Two Pandemics

Coronavirus disease 2019 (COVID-19) is a complex infectious disease caused by the SARS-CoV-2 virus, and it currently represents a worldwide public health emergency. The pediatric population is less prone to develop severe COVID-19 infection, but children presenting underlying medical conditions, such as diabetes mellitus, are thought to be at increased risk of developing more severe forms of COVID-19. Diabetic children face new challenges when infected with SARS-CoV-2. On one hand, the glycemic values become substantially more difficult to manage as COVID-19 is a predisposing factor for hyperglycemia. On the other hand, alongside other risk factors, high glycemic values are incriminated in modulating immune and inflammatory responses, leading to potentially severe COVID-19 cases in the pediatric population. Also, there are hypotheses of SARS-CoV-2 being diabetogenic itself, but this information is still to be confirmed. Furthermore, it is reported that there was a noticeable increase in the number of cases of new-onset type 2 diabetes among the pediatric population, and the complications in these patients with COVID-19 include the risk of developing autoimmune diseases under the influence of stress. Additionally, children with diabetes mellitus are confronted with lifestyle changes dictated by the pandemic, which can potentially lead to the onset or exacerbation of a potential underlying anxiety disorder or depression. Since the literature contains a series of unknowns related to the impact of COVID-19 in both types of diabetes in children, the purpose of our work is to bring together the data obtained so far and to identify potential knowledge gaps and areas for future investigation regarding COVID-19 and the onset of diabetes type 1 or type 2 among the pediatric population.

Managing type 2 diabetes in children and young people: challenges and solutions

Growing numbers of children and young people are diagnosed with type 2 diabetes, partly due to the obesogenic environment they grow up in. The increasing prevalence of type 2 diabetes is seen particularly in adolescent girls and in children and young people of non-white ethnic backgrounds. There are numerous challenges relating to the diagnosis, treatment and management of type 2 diabetes in children and young people, notably the fact that the condition can lead to serious complications and often triggers high levels of anxiety and stress in patients and families. This article outlines the challenges faced by children and young people with type 2 diabetes, their families and carers, and suggests ways in which nurses can support them with the aim of achieving optimal management and self-management.

Paediatric obesity: Documentation, screening, and pharmacotherapy in a national cohort

BACKGROUND

Multiple organizations have published guidelines for the screening and treatment of obesity and related comorbidities in youth, including the use of anti-obesity medications (AOM). This study aimed to determine which paediatric patients: (1) receive a diagnostic code for obesity; (2) are most likely to be screened for hyperlipidaemia, non-alcoholic fatty liver disease, and type 2 diabetes mellitus; and (3) are most likely to be prescribed AOM.

METHODS

A cohort of 35 898 patients 9 years 4 months to 17 years 6 months of age with a BMI > 30 or greater than the 95th% on three separate outpatient encounters was generated using the TriNetX database. Logistic regression models were used to estimate the associations between demographics in the study population and the likelihood of diagnosis of obesity, screening for comorbidities, and prescription of AOMs.

RESULTS

Asian, Black, and Hispanic youths had increased odds of having a diagnosis of obesity and being screened for all three comorbidities. Documentation of obesity was associated with increased odds of screening for all comorbidities. Female sex, documentation of obesity, and higher BMIs were associated with increased odds of being prescribed AOMs. Black and Native American races decreased the likelihood of being prescribed AOM.

CONCLUSIONS

Management of obesity in terms of documentation of disease, screening for comorbidities, and initiation of AOM continues to fall short of the guidelines put forth by multiple organizations. Race/ethnicity, sex, and BMI correlate with differences in care provided to obese paediatric patients. Further research is needed to identify the barriers to and causes of these disparities.

Adolescents diabetes awareness test (ADAT): Tool development and psychometrics evaluation research

BACKGROUND

During the last two decades, several reports have indicated an increase in the number of type-2 diabetes among adolescents. Therefore, an assessment of adolescents' awareness of this disease deserves serious consideration. This study aims at designing a psychometric tool for assessing adolescents' awareness of type-2 diabetes.

METHODS AND MATERIAL

In this methodological research, 770 students attending 10 middle schools (five girls "schools and five boys" schools) from Tehran participated in the study. The questionnaire was designed by examining the relevant literature and the existing questionnaires, as well as considering the research team's comments, and the initial pool of items with 57 questions was designed. Face validity, content validity, and construct validity were calculated to determine the validity of the instrument. Reliability was measured via internal consistency coefficient (ICC) and internal consistency reliability was measured with Cronbach Alpha. SPSS 16 was used for data analysis.

RESULTS

The questionnaire was initially designed with 57 items. Based on the results of CVR and CVI, five questions were removed. The average CVR and CVI were 0.75 and 0.82, respectively. Following exploratory factor analysis, the 30 questions in the questionnaire were categorized into five dimensions: public awareness, symptoms, behavioral risk factors, long-term effects, and medium-term effects. The internal reliability was calculated for the whole questionnaire-ICC = 0.87 with a Cronbach alpha coefficient of 0.80.

CONCLUSIONS

The resulting questionnaire on adolescents' awareness of type-2 diabetes, with 30 questions in five dimensions, can be employed by researchers for its high factor loading in factor analysis and its standard psychometric properties.

School-based peer-led diabetes intervention among female adolescents: a cluster randomized trial

BACKGROUND

The prevalence of type 2 diabetes is increasing among adolescents and clear strategies are needed to prevent it. The aim of this study was to determine the effect of peer education on knowledge, health beliefs and preventive behaviors of type 2 diabetes in female adolescents.

METHODS

In this cluster randomized trial study, 168 students (84 people in each group) were enrolled. The data collection instrument was a questionnaire of knowledge (30 questions), health beliefs (16 questions) and behavior (20 questions) whose validity and reliability were confirmed. Then eight capable students were chosen as peer educators after being trained. The intervention group received 8 sessions of 90-min education through training, lectures, question and answer, and group discussion and with teaching aids such as pamphlets, educational clips and text messages. The post-test was administered two months after the treatment. Data collected using software SPSS16 and Chi-Square and ANCOVA test were used.

RESULTS

The result showed that the mean and standard deviation of general knowledge, disease symptoms, behavioral risk factors, mid-term outcomes and long-term outcomes, perceived self-efficacy, behavioral beliefs, perceived susceptibility, perceived severity, prevention of stress, healthy food/healthy diet, unhealthy food/unhealthy diet, high-risk behavior, and self-care in the intervention group has increased significantly 2 months after intervention compared of control group (P < 0.001).

CONCLUSIONS

Peer education increased knowledge and improved adolescents' health beliefs and behaviors. Therefore, training in adolescence in order to prevention of diabetes can be considered as an effective step, and the use of peer-led education in this field is recommended.

TRIAL REGISTRATION

Trial registration number IRCT20200811048361N1 from School of Public Health & Neuroscience Research Center-Shahid Beheshti University of Medical Sciences. Date applied: 30/12/2020. Date assigned: 01/12/2020.

A multi-centre investigation of macrovascular and non-ocular microvascular complications in children and adolescents with diabetes mellitus in southern Ghana

Objectives

To investigate the prevalence of macrovascular and non-ocular microvascular complications and the associated factors among children and adolescents with diabetes mellitus in selected hospitals in southern Ghana.

Design

A cross-sectional study.

Setting

The out-patient clinics of the Departments of Child Health, Medicine and Therapeutics, Family Medicine, Ophthalmology, and the National Diabetes Management and Research Centre, all at the Korle Bu Teaching Hospital, Accra, as well as from Cape-Coast Teaching Hospital in the Central Region of Ghana.

Participants

Fifty-eight children and adolescents aged 4-19 years who had been diagnosed with diabetes mellitus.

Main outcome measures

Macrovascular (peripheral artery disease and coronary heart disease) and non-ocular microvascular complications (neuropathy and nephropathy).

Results

Data from 58 children and adolescents with diabetes were analysed. The mean age of participants was 14.6±2.6 years, and a female preponderance was observed (45, 77.6%). The prevalence of macrovascular and non-ocular microvascular complications was 27.6% and 8.6%, respectively. Long duration of diabetes diagnosis (p=0.044) and low triglycerides (p=0.009) were associated with microvascular complications, while high triglycerides (p=0.032), lower HDL cholesterol (p=0.046), and abnormal body mass index (p=0.020) were associated with macrovascular complications.

Conclusions

Macrovascular and non-ocular microvascular complications are common among children and adolescents with diabetes in southern Ghana and are associated with a long duration of diabetes diagnosis, abnormal body mass index, low HDL cholesterol, and triglyceride levels. Therefore, the early institution of regular screening for diabetes-related complications to allow early detection and appropriate management is recommended.

Funding

University of Ghana Research Fund.

The Role of Natural Antioxidant Products That Optimize Redox Status in the Prevention and Management of Type 2 Diabetes

The worldwide prevalence of type 2 diabetes (T2D) and prediabetes is rapidly increasing, particularly in children, adolescents, and young adults. Oxidative stress (OxS) has emerged as a likely initiating factor in T2D. Natural antioxidant products may act to slow or prevent T2D by multiple mechanisms, i.e., (1) reducing mitochondrial oxidative stress, (2) preventing the damaging effects of lipid peroxidation, and (3) acting as essential cofactors for antioxidant enzymes. Natural antioxidant products should also be evaluated in the context of the complex physiological processes that modulate T2D-OxS such as glycemic control, postprandial OxS, the polyol pathway, high-calorie, high-fat diets, exercise, and sleep. Minimizing processes that induce chronic damaging OxS and maximizing the intake of natural antioxidant products may provide a means of preventing or slowing T2D progression. This "optimal redox" (OptRedox) approach also provides a framework in which to discuss the potential benefits of natural antioxidant products such as vitamin E, vitamin C, beta-carotene, selenium, and manganese. Although there is a consensus that early effective intervention is critical for preventing or reversing T2D progression, most research has focused on adults. It is critical, therefore, that future research include pediatric populations.

Obesity, overweight and hyperglycemia among primary school children in a low-middle income country with a multiethnic population

Objective

The number of children with cardiovascular risk factors is increasing steadily. However, limited data are available on the prevalence of overweight, obesity, and hyperglycemia among children in low-middle-income countries with multiethnic populations. Therefore, we assessed these factors in a school-based survey in Suriname, a low-middle-income country.

Methods

We invited pupils of 5th and 6th grade visiting the primary school to participate in this survey. We used a questionnaire and face to face interviews, and conducted measurements to collect data on biological factors (ethnicity, sex, length, weight, waist circumference, and fasting blood glucose levels), behavior (frequency of physical activity, breakfast, bedtime, screentime), consumption (fruit and vegetables, snack, dairy products) and social factors (parental education, living area).

Results

Overall, the percentage of children with overweight was 13.9%, obesity 13.3% and for elevated fasting blood glucose level (> 6 mmol/L) 4.5%. In the investigated group of individuals, obesity and overweight were associated with sex (girls showed a lower OR of 0.54 [95%CI: 0.39-0.75] for obesity), ethnicity (Javanese 2.1, 1.5-3.0 for overweight and 5.0, 3.1-8.2 for obesity, Maroon 2.2, 1.2-4.1 and Mixed ethnicity 1.7, 1.1-2.6, for obesity compared to Hindustani), behavior (Skip Breakfast: 1.4, 1.2-1.7, physical activity: 0.8, 0.7-0.9) and maternal education level (high 1.7, 1.0-2.7). Children with elevated fasting blood glucose levels showed an association with obesity (1.8, 1.2-2.7) and waist circumference (1.02, 1.01-1.03).

Conclusion

The results show that there is a high prevalence for overweight, obesity and elevated fasting blood glucose among children in Suriname. Furthermore, during childhood ethnicity is associated with obesity and overweight. We suggest that the modifiable risk factors such as BMI, WC, behavior, consumption are interesting for early intervention in children in a developing country.

Commentary on &quot;The prevalence of diabetic peripheral neuropathy in youth with diabetes mellitus&quot

Purpose: This study aimed to investigate the impact of coronavirus disease 2019 (COVID-19) on type 2 diabetes mellitus (T2DM) in children and adolescents.Methods: Children and adolescents diagnosed with T2DM who visited the Korea University Hospital in 2019 and 2020 were retrospectively analyzed, including changes in body mass index (BMI)-standard deviation score (SDS), glycated hemoglobin (HbA1c), diabetes complications, and diabetes management from 2019 to 2020.Results: Patient mean age and disease duration were 15.48±2.15 and 2.56±1.51 years, respectively. Obese patients accounted for 70.6% of the study population. From 2019 to 2020, mean BMI-SDS (2.21±1.25 vs. 2.35±1.43, <i>P</i>=0.044), HbA1c level (6.5%±2.72% vs. 7.3%±3.70%, <i>P</i><0.001), blood pressure (BP), total cholesterol, and non–high-density lipoprotein cholesterol level in all patients increased significantly. Obesity was an independent predictor of increased HbA1c (95% confidence interval, 1.071–50.384; <i>P</i>=0.042). HbA1c levels did not increase significantly in nonobese patients, whereas HbA1c (6.45%±2.30% vs. 7.20%±3.05%, <i>P</i><0.001), BMI-SDS (2.88±0.75 vs. 3.08±0.98, <i>P</i>=0.045), diastolic BP (<i>P</i>=0.037), and total cholesterol values (<i>P</i>=0.019) increased in obese patients in 2020 compared to 2019.Conclusion: During the COVID-19 outbreak, glycemic control and diabetic complications worsened in children and adolescents with T2DM, particularly in obese patients. Close monitoring for glycemic control and diabetic complications is necessary in children and adolescents with T2DM, especially those with obesity.

Youth-Onset Type 2 Diabetes: The Epidemiology of an Awakening Epidemic

In this narrative review, we describe the epidemiology (prevalence, incidence, temporal trends, and projections) of type 2 diabetes among children and adolescents (<20 years), focusing on data from the U.S. and reporting global estimates where available. Secondarily, we discuss the clinical course of youth-onset type 2 diabetes, from prediabetes to complications and comorbidities, drawing comparisons with youth type 1 diabetes to highlight the aggressive course of this condition, which, only recently, has become recognized as a pediatric disease by health care providers. Finally, we end with an overview of emerging topics in type 2 diabetes research that have potential to inform strategies for effective preventive action at the community and individual levels.

Trust the gut: outcomes of gut microbiota transplant in metabolic and cognitive disorders

Type 2 diabetes mellitus (T2DM) is a main public health concern, with increasing prevalence and growingly premature onset in children, in spite of emerging and successful therapeutic options. T2DM promotes brain aging, and younger age at onset is associated with a higher risk of subsequent dementia. Preventive strategies should address predisposing conditions, like obesity and metabolic syndrome, and be started from very early and even prenatal life. Gut microbiota is an emerging target in obesity, diabetes and neurocognitive diseases, which could be safely modulated since pregnancy and infancy. Many correlative studies have supported its involvement in disease pathophysiology. Faecal material transplantation (FMT) studies have been conducted in clinical and preclinical settings to deliver cause-effect proof and mechanistic insights. This review provides a comprehensive overview of studies in which FMT was used to cure or cause obesity, metabolic syndrome, T2DM, cognitive decline and Alzheimer's disease, including the evidence available in early life. Findings were analysed to dissect consolidated from controversial results, highlighting gaps and possible future directions.

Serum 25-Hydroxyvitamin D Levels and Youth-Onset Type 2 Diabetes: A Two-Sample Mendelian Randomization Study

Observational studies have linked vitamin D insufficiency to pediatric type 2 diabetes (T2D), but evidence from vitamin D supplementation trials is sparse. Given the rising prevalence of pediatric T2D in all ethnicities, determining the protective role of vitamin D has significant public health importance. We tested whether serum 25-hydroxyvitamin D (25OHD) levels are causally linked to youth-onset T2D risk using Mendelian randomization (MR). We selected 54 single-nucleotide polymorphisms (SNPs) associated with 25OHD in a European genome-wide association study (GWAS) on 443,734 individuals and obtained their effects on pediatric T2D from the multi-ethnic PRODIGY GWAS (3006 cases/6061 controls). We applied inverse variance weighted (IVW) MR and a series of MR methods to control for pleiotropy. We undertook sensitivity analyses in ethnic sub-cohorts of PRODIGY, using SNPs in core vitamin D genes or ancestry-informed 25OHD SNPs. Multivariable MR accounted for the mediating effects of body mass index. We found that a standard deviation increase in 25OHD in the logarithmic scale did not affect youth-onset T2D risk (IVW MR odds ratio (OR) = 1.04, 95% CI = 0.96-1.13, p = 0.35) in the multi-ethnic analysis, and sensitivity, ancestry-specific and multivariable MR analyses showed consistent results. Our study had limited power to detect small/moderate effects of 25OHD (OR of pediatric T2D < 1.39 to 2.1). In conclusion, 25OHD levels are unlikely to have significant effects on the risk of youth-onset T2D across different ethnicities.

Development and Validation of a Diabetes Questionnaire for Middle School Students

OBJECTIVE

To develop and validate a questionnaire to assess diabetes knowledge, attitudes, beliefs, and intent to change among middle school students.

DESIGN

A cross-sectional validation analysis.

SETTING

Students in 3 urban middle schools in Utah participated in this study.

PARTICIPANTS

The 25-item questionnaire was validated in independent samples of 277 and 304 students in the seventh and eighth grades.

VARIABLES MEASURED

The questionnaire includes the following variables: diabetes knowledge, attitudes, beliefs, and intent to change dietary and physical activity behaviors.

ANALYSIS

Rigorous statistical approaches, including Cronbach's α (goodness of fit) calculation, test-retest reliability, and exploratory and confirmatory factor analyses, were employed to examine the reliability and construct validity.

RESULTS

The Cronbach's α coefficients were 0.7 for both subscales demonstrating acceptable internal consistency. All factor loadings were > 0.4, revealing close relations between factors and items. The confirmatory factor analysis model fit was 0.9 for the comparative fit index and Tucker-Lewis Index, indicating a reasonable model-data fit.

CONCLUSIONS AND IMPLICATIONS

This study demonstrated the validity of a diabetes questionnaire for middle school students. Future work is needed to validate its use in a diabetes prevention program, given the growing need for diabetes education among young adolescents.

High prevalence of periodontitis in children and adolescents with type 2 diabetes

BACKGROUND

The aim of the present study was to determine the prevalence of periodontitis in children and adolescents with type 2 diabetes, and if poor glycemic control is associated with increasing prevalence of the disease.

METHODS

This is a cross-sectional study involving children and adolescents with type 2 diabetes. A questionnaire related to oral health care history and oral health behaviors was administered to each participant and they then underwent a full-mouth oral evaluation. In addition, clinical and metabolic parameters were extracted from the clinical chart.

RESULTS

One hundred and twenty one children and adolescents (8-17 years, 11 months) participated. Overall, 45.5% presented some degree of periodontitis, with 10 (8.3%) mild, 36 (29.8%) moderate, and nine (7.4%) severe. The periodontitis group (PD-group) had higher mean gingival and plaque indexes, periodontal probing depth, and clinical attachment loss than the group without periodontitis (NoPD-group) (p<0.05). A statistically significant relationship between the prevalence of periodontitis and glycosylated hemoglobin (HbA1c) was verified in the bivariate (odds ratio [OR] 1.31 [95% CI, 1.13-1.53], p = 0.001) and multivariate (OR, 1.29 [95% CI, 1.03-1.61], p = 0.03) analysis. For the adjustment variables, associations were verified for duration of diabetes, age, body mass index z-score, lack of running water, insulin use, and acanthosis nigricans.

CONCLUSIONS

Children and adolescents with type 2 diabetes presented high rates of periodontitis comparable with that seen in previous studies in youth with diabetes. Uncontrolled HbA1c influences prevalence of periodontal disease. The lack of matched control group and radiographs are limitations of the study. Comprehensive periodontal examination is essential for children and adolescents with type 2 diabetes to prevent, identify, and treat periodontitis early.

Emerging trends in nano-based antidiabetic therapeutics: a path to effective diabetes management

This review aims to provide an overview of nanoparticles for diabetes mellitus therapy. It explores the properties, synthesis and/or functionalization, mechanistic aspects, and therapeutics for diabetes and its complications.

14. Children and Adolescents: Standards of Care in Diabetes-2023

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.

Effects of green tea polyphenol extract and epigallocatechin-3-O-gallate on diabetes mellitus and diabetic complications: Recent advances

Diabetes mellitus is one of the major non-communicable diseases accounting for millions of death annually and increasing economic burden. Hyperglycemic condition in diabetes creates oxidative stress that plays a pivotal role in developing diabetes complications affecting multiple organs such as the heart, liver, kidney, retina, and brain. Green tea from the plant Camellia sinensis is a common beverage popular in many countries for its health benefits. Green tea extract (GTE) is rich in many biologically active compounds, e.g., epigallocatechin-3-O-gallate (EGCG), which acts as a potent antioxidant. Recently, several lines of evidence have shown the promising results of GTE and EGCG for diabetes management. Here, we have critically reviewed the effects of GTE and EGCC on diabetes in animal models and clinical studies. The concerns and challenges regarding the clinical use of GTE and EGCG against diabetes are also briefly discussed. Numerous beneficial effects of green tea and its catechins, particularly EGCG, make this natural product an attractive pharmacological agent that can be further developed to treat diabetes and its complications.

Hydroethanolic Extract of Urtica dioica L. (Stinging Nettle) Leaves as Disaccharidase Inhibitor and Glucose Transport in Caco-2 Hinderer

Herbal treatment for diabetes mellitus is widely used. The pharmacological activity is thought to be due to the phenolic compounds found in the plant leaves. The present study aims to investigate the phytochemical composition of Urtica dioica (UD) hydroethanolic extract and to screen its antidiabetic activity by disaccharidase hindering and glucose transport in Caco-2 cells. The results have shown that a total of 13 phenolic compounds in this work, viz. caffeic and coumaric acid esters (1, 2, 4-7, 10), ferulic derivative (3), and flavonoid glycosides (8, 9, 11-13), were identified using HPLC-DAD-ESI/MS². The most abundant phenolic compounds were 8 (rutin) followed by 6 (caffeoylquinic acid III). Less predominant compounds were 4 (caffeoylquinic acid II) and 11 (kaempferol-O-rutinoside). The UD hydroethanolic extract showed 56%, 45%, and 28% (1.0 mg/mL) inhibition level for maltase, sucrase, and lactase, respectively. On the other hand, glucose transport was 1.48 times less at 1.0 mg/mL UD extract compared with the control containing no UD extract. The results confirmed that U. dioica is a potential antidiabetic herb having both anti-disaccharidase and glucose transport inhibitory properties, which explained the use of UD in traditional medicine.

Type 2 diabetes: an exploratory genetic association analysis of selected metabolizing enzymes and transporters and effects on cardiovascular and renal biomarkers

OBJECTIVES

This study sought to identify potential pharmacogenetic associations of selected enzymes and transporters with type 2 diabetes (T2D). In addition, pharmacogenomic profiles, concentrations of asymmetric dimethylarginine (ADMA) or kidney injury molecule-1 (KIM-1), and several covariates were investigated.

METHODS

Whole blood was collected from 63 patients, with 32 individuals with T2D. A pharmacogenomic panel was used to assay genetic profiles, and biomarker ELISAs were run to determine subject concentrations of ADMA and KIM-1. Additive genetic modeling with multiple linear and logistic regressions were performed to discover potential SNPs-outcome associations using PLINK.

RESULTS

Ten SNPs were found to be significant (p<0.05) depending on the inclusion or exclusion of covariates. Of these, four were found in association with the presence of T2D, rs2231142, rs1801280, rs1799929, and rs1801265 depending on covariate inclusion or exclusion. Regarding ADMA, one SNP was found to be significant without covariates, rs1048943. Five SNPs were identified in association with KIM-1 and T2D in the presence of covariates, rs12208357, rs34059508, rs1058930, rs1902023, and rs3745274. Biomarker concentrations were not significantly different in the presence of T2D.

CONCLUSIONS

This exploratory study found several SNPs related to T2D; further research is required to validate and understand these relationships.

Screening for metabolic complications of childhood and adolescent obesity: A scoping review of national and international guidelines

The rise in prevalence of childhood obesity is paralleled by an increase in obesity-related metabolic complications, which add significantly to the population burden of cardiovascular morbidity in the long term. Early detection of obesity-related metabolic complications through appropriate screening strategies forms a crucial aspect of obesity management. We performed a scoping review of international and national guidelines on the management of pediatric obesity to evaluate the recommendations on screening for metabolic complications, namely, hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease. Thirty guidelines were included, 23 (76.7%) of which had some guidance on screening for metabolic complications. However, there were significant variations in the extent and details of recommendations for screening for these metabolic complications. There has been no consensus on the body mass index (BMI) thresholds, age of onset, frequency, and screening tests recommended for detecting hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease between guidelines. These variations did not appear to be polarized based on geographical location or population ethnicity. We provide our recommendations on metabolic screening based on the strength of evidence in the guidelines, also incorporating recommendations from key childhood hypertension, diabetes, and lipid guidelines. Appropriate implementation of screening strategies is crucial to improve detection of metabolic complications, to allow for earlier or more intensified interventions for affected children with obesity.

Type 2 diabetes in children and adolescents: distinct characteristics and evidence-based management

PURPOSE

Since the dramatic rise of obesity prevalence in childhood and adolescence has contributed to increased rates of type 2 diabetes (T2D) in youth, we sought to explore current evidence-based management options for pediatric T2D patients.

METHODS

A comprehensive literature search was performed for studies of T2D in childhood and adolescence until September 2021.

RESULTS

Special pathophysiological and diagnostic characteristics of T2D in this age are presented, while the main focus of the article is on management. Lifestyle interventions with healthy diet and exercise are of great importance for the treatment of T2D in children and adolescents. Metformin and insulin remain the traditional therapeutical means, while liraglutide recently gained indication for children older than 10 years both in USA and Europe. Data on the use, efficacy, safety and therapeutic considerations of other pharmacological treatments in children and adolescents with T2D are critically discussed.

CONCLUSION

Although many new and promising therapeutic strategies have been introduced during recent years for the management of T2D in adults, available therapeutic options for the management of pediatric T2D remain limited.

Pharmacotherapy in paediatric type 2 diabetes mellitus: a protocol for a systematic review and network meta-analysis of randomised trials

INTRODUCTION

The rates of type 2 diabetes mellitus (T2DM) in children and adolescents have risen globally over the past few years. While a few diabetes pharmacotherapies have been used in this population, their comparative benefits and harms are unclear. Thus, we will conduct a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) to compare the efficacy and safety of pharmacotherapies for managing paediatric T2DM.

METHODS AND ANALYSIS

We will include RCTs that enrolled T2DM patients ≤18 years of age and who were randomised to monotherapy or combination pharmacotherapies with or without lifestyle interventions. Comparator groups will include placebo or non-pharmacological treatments including lifestyle interventions.Treatment outcomes will include change from baseline in glycated haemoglobin A1c, body mass index z-score, weight, systolic/diastolic blood pressure, fasting plasma glucose, fasting insulin and lipid profiles, T2DM-related complications, as well as the incidence of treatment-related adverse events.Literature searches will be conducted in Medline, Embase, CINAHL, CENTRAL and Web of Science. We will also search the grey literature and the reference list of included trials and relevant reviews. Two reviewers will assess the eligibility of articles identified through our searches and will extract data from eligible studies independently. We will use a modified Cochrane instrument to evaluate the risk of bias. Disagreements will be resolved through consensus or arbitration by a third reviewer.A frequentist random-effects model will be used for conducting NMA. The quality of evidence will be assessed using the Confidence in Network Meta-Analysis platform. We will assess the effect modification through network meta-regression and subgroup analyses for sex, age at study inclusion, duration of T2DM, follow-up duration and risk of bias ratings.

ETHICS AND DISSEMINATION

This study will not require ethics approval. We will disseminate our findings through publication in a peer-reviewed journal and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42022310100.

Knowledge, Attitudes, and Behaviors towards Proper Nutrition and Lifestyles in Italian Diabetic Patients during the COVID-19 Pandemic

Prevention of diabetes mellitus is mainly based on a healthy lifestyle. The lockdown measures imposed during the COVID-19 pandemic resulted in major changes in daily life and social behavior, which may have an influence on diabetes self-management and glycemic control. The present work aims to assess the relationship between diabetic patients' knowledge, attitudes, and behaviors towards proper nutrition and lifestyles in order to plan strategies for educational intervention from a health literacy perspective. Attitudes, behaviors, and knowledge of diabetic patients attending the Diabetes and Metabolic Diseases Department of the Local Health Authority of Sassari (ASL1-SS) were assessed with a cognitive survey conducted from April to July 2022. Three hundred twenty-one questionnaires were administered during the survey period. Fifty-two percent of diabetic patients were female and 48% male, with a mean age of 61.1 ± 18.5 years and 62.0 ± 15.1 years, respectively. The overall level of knowledge about the role of food and proper nutrition with respect to the risk of diabetes and its complications appeared to be generally unsatisfactory and inadequate. Nonetheless, females showed a significantly higher level of knowledge than males (p < 0.0001). Moreover, knowledge was seen to decrease according to the age of the patients (p = 0.035). As for the possible impact played by the COVID-19 pandemic on lifestyles, it should be noted that about 70% of the respondents stated that they had maintained a reasonable dietary standard or even improved it throughout. Thus, the study underlines the need to improve the knowledge of diabetic subjects about nutrition and, in particular, their self-management, positively influencing behaviors and attitudes.

Single-centre case-control study investigating the association between acanthosis nigricans, insulin resistance and type 2 diabetes in a young, overweight, UK population

OBJECTIVE

To determine the extent to which the presence of acanthosis nigricans confers additional risk for insulin resistance, in addition to obesity alone (body mass index, BMI) within a young, overweight, UK population.

RESEARCH DESIGN AND METHODS

Retrospective data were collected to compare the degree of insulin resistance within a sample of 94 young people with acanthosis nigricans, and a matched cohort of 94 participants with obesity alone. Insulin resistance was assessed by fasting glucose, fasting insulin and Homeostatic Model Assessment of insulin resistance (HOMA-IR) score (a mathematical model derived to measure insulin resistance).

RESULTS

The acanthotic and control group were well matched for age, BMI, BMI SDS and sex, although the groups were not matched for ethnicity. The acanthotic group showed a significantly greater median fasting insulin (215 pmol/L), mean fasting glucose (4.7 mmol/L) and median HOMA-IR score (6.4), compared with the control group (126 pmol/L, 4.5 mmol/L and 3.7, respectively). The presence of acanthosis nigricans as an indicator of insulin resistance was found to have a positive predictive value of 81% (within this study population).

CONCLUSION

Individuals with both acanthosis nigricans and obesity had significantly greater degrees of insulin resistance than individuals with obesity alone. The findings support the potential for acanthosis nigricans as a visible marker of type 2 diabetes in young people.

Docking study, molecular dynamic, synthesis, anti-α-glucosidase assessment, and ADMET prediction of new benzimidazole-Schiff base derivatives

The control of postprandial hyperglycemia is an important target in the treatment of type 2 diabetes mellitus (T2DM). As a result, targeting α-glucosidase as the most important enzyme in the breakdown of carbohydrates to glucose that leads to an increase in postprandial hyperglycemia is one of the treatment processes of T2DM. In the present work, a new class of benzimidazole-Schiff base hybrids 8a–p has been developed based on the potent reported α-glucosidase inhibitors. These compounds were synthesized by sample recantations, characterized by ¹H-NMR, ¹³C-NMR, FT-IR, and CHNS elemental analysis, and evaluated against α-glucosidase. All new compounds, with the exception of inactive compound 8g, showed excellent inhibitory activities (60.1 ± 3.6–287.1 ± 7.4 µM) in comparison to acarbose as the positive control (750.0 ± 10.5). Kinetic study of the most potent compound 8p showed a competitive type of inhibition (K_i value = 60 µM). In silico induced fit docking and molecular dynamics studies were performed to further investigate the interaction, orientation, and conformation of the title new compounds over the active site of α-glucosidase. In silico druglikeness analysis and ADMET prediction of the most potent compounds demonstrated that these compounds were druglikeness and had satisfactory ADMET profile.

Type-2 Diabetes Mellitus (T2DM): Spatial-temporal Patterns of Incidence, Mortality and Attributable Risk Factors from 1990 to 2019 among 21 World Regions

PURPOSE

Type-2 diabetes Mellitus (T2DM) is one of the leading causes of death and disability worldwide. This study examines temporal patterns of the global, regional, and national burden of T2DM in the last three decades.

DATA AND METHODS

The estimates of age, sex and location-wise incident cases, deaths, prevalent cases, and disability-adjusted-life-years (DALYs) and risk factors for 21 regions and 204 countries are retrieved from the Global Burden of Disease 2019 study from 1990 to 2019. Socio-demographic index (SDI) is used as the indicator of the development status of countries, and quadratic regression is employed to examine the relationship between country-level age-standardized rates and SDI.

RESULTS

Globally, incident cases of T2DM more than doubled from 8.4 million[95% uncertainty interval, 7.8-9.1 million] in 1990 to 21.7 million[20.0-23.5 million] in 2019, and deaths more than doubled from 606,407[573,069-637,508] to 1.5 million[1.4-1.6 million] between 1990 and 2019. Global T2DM prevalence increased from 148.4 million[135.5-162.6 million] in 1990 to 437.9 million[402.0-477.0 million] in 2019. In 2019, global age-standardized prevalence rate stood at 5282.8/100,000[4853.6-5752.1], varying from 2174.5/100,000[1924.3-2470.5] in Mongolia to 19876.8/100,000[18211.1-21795.3] in American Samoa. SDI exhibited inverted-U shaped relationship with country-level age-standardised rates. Globally, high body-mass-index (51.9%), ambient particulate matter pollution (13.6%), smoking (9.9%) and secondhand smoke (8.7%) were the major contributing risk factors towards T2DM DALYs in 2019.

CONCLUSION

With ubiquitously rising prevalent cases globally, particularly in low and middle-income countries and regions, T2DM requires immediate attention and targeted policy response worldwide centered on lifestyle interventions (e.g., physical activity, smoking, diet, and obesity), air pollution control and cost-effective timely treatment.

The effect of metformin on vitamin B12 level in pediatric patients

PURPOSE

Metformin is a common medication for patients with hyperglycemia. In adults, one well-documented side effect of metformin is vitamin B12 deficiency. However, this side effect has rarely been studied in pediatric patients. This study examined the changes of vitamin B12 level in pediatric patients being treated with metformin.

METHODS

Data were collected from pediatric patients (n=151) with at least 3 months of consecutive metformin intake. The effects of dose of metformin on the mean vitamin B12 level were investigated at 6, 12, 24, and 36 months. The effect of compliance of metformin intake on vitamin B12 level also was studied.

RESULTS

There was no significant decrease in mean vitamin B12 level at 6, 12, 24, or 36 months in patients treated with metformin. Mean vitamin B12 decrease was only noticeable (p<0.05) in patients taking a high dose of metformin with good compliance. Despite this change, the mean vitamin B12 remained well within the normal reference range. Furthermore, of the 151 patients studied, only 1 demonstrated vitamin B12 deficiency after 12 months of treatment. However, his B12 level was normal at 24 and 36 months without any vitamin B12 supplements.

CONCLUSION

Our findings suggest that metformin treatment in children does not cause vitamin B12 deficiency; however, the effect of long-term consistent high-dose treatment on vitamin B12 level remains unknown.