The changes of subtypes in pediatric diabetes and their clinical and laboratory characteristics over the last 20 years

Triglyceride glucose index is superior biomarker for predicting type 2 diabetes mellitus in children and adolescents

The triglyceride-glucose (TyG) index is associated with predicting type 2 diabetes mellitus (T2DM), but its relationship with homeostatic model assessment of insulin resistance (HOMA-IR) in T2DM is not established. We aimed to investigate the role of TyG index for detection of T2DM in children and adolescents and compare it with HOMA-IR. A cross sectional study was performed in 176 overweight or obese children and adolescents with mean age of 11.34 ± 3.24 years. TyG index was calculated as ln (fasting triglyceride (TG) [mg/dL] × fasting glucose [mg/dL]/2). Of a total of 176 subjects, 57 (32%) were diagnosed with T2DM. Significant differences were observed in the TyG index between T2DM and non-T2DM (p < 0.001). The TyG index had a positive correlation with fasting glucose (r = 0.519, p < 0.001), HOMA-IR (r = 0.189, p < 0.017), HbA1c (r = 0.429, p < 0.001), total cholesterol (TC) (r = 0.257, p = 0.001), TG (r = 0.759, p < 0.001), and low-density lipoprotein cholesterol (LDL-C)(r = 0.152, p < 0.001), and a negative correlation with high-density lipoprotein cholesterol (HDL-C)(r = -0.107, p < 0.001) after controlling for sex, age and BMI standard deviation scores (SDS). In multiple regression analyses, 91.8% of the variance in TyG index was explained by age, glucose, HOMA-IR, TG, LDL-C, and HDL-C (p < 0.001). In the receiver operating characteristic (ROC) analysis, the TyG index [area under the curve (AUC) 0.839)] showed a better performance compared to HOMA-IR (AUC 0.645) in identifying patients with T2DM (p < 0.001). In conclusion, the TyG index had significant association with insulin resistance in T2DM and was superior to HOMA-IR in predicting T2DM in children and adolescents.

A population-based study of TyG index distribution and its relationship to cardiometabolic risk factors in children and adolescents

The purpose of this study was to present age- and sex-specific distributions of the triglyceride-glucose (TyG) index and to evaluate their relationship with cardiometabolic risk factors in children and adolescents. A total of 7404 participants aged 10-18 years from the Korean National Health and Nutrition Survey were included as the reference population. The TyG index was calculated as ln(fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The percentile of the TyG index exhibited a steady linear relationship with age for both sexes. TyG index significantly correlated with waist circumference (WC) standard deviation score (SDS; r = 0.110, p < 0.001), systolic blood pressure (SBP; r = 0.104, p < 0.001), diastolic blood pressure (DBP; r = 0.083, p < 0.001), glucose (r = 0.220, p < 0.001), high-density lipoprotein cholesterol (HDL-C; r = - 0.325, p < 0.001), and triglycerides (TG; r = 0.926, p < 0.001). Multiple linear regression analysis revealed that the TyG index was significantly associated with WC SDS (β = 0.116, p < 0.001), SBP (β = 2.009, p < 0.001), DBP (β = 1.464, p < 0.001), glucose (β = 3.376, p < 0.001), HDL-C (β =  - 6.431, p < 0.001), and TG (β = 85.518, p < 0.001). Our results suggest that the TyG index has a steady linear distribution for sex and age in children and adolescents and constitutes an indicator for predicting metabolic disorders that could lead to cardiovascular disease later in life.

Diagnosis and treatment of pediatric type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic diseases, and its increasing prevalence in children and adolescents is a worldwide problem. In the past ten years, the prevalence of T2DM has increased by more than two-fold. This review focuses on the recent advances in the diagnosis and treatment of T2DM in children and adolescents.Current Concepts: Pancreatic beta-cell dysfunction and insulin resistance are the key factors contributing to the development of T2DM. The diagnosis of T2DM is based on serum glucose levels or hemoglobin A1c levels. Currently, only insulin, metformin, and liraglutide (glucagon-like peptide-1 receptor agonist) have been approved for the treatment of T2DM in children and adolescents.Discussion and Conclusion: Early diagnosis and prevention of T2DM in children and adolescents are essential. Furthermore, the treatment of T2DM in children and adolescents is limited, unlike in adults. Further research is needed to evaluate the long-term efficacy and safety of the available treatments in children and adolescents with T2DM.

Impact of Type 2 Diabetes Mellitus and Antidiabetic Medications on Bone Metabolism

PURPOSE OF REVIEW

This review focuses on the complex interactions between hyperglycemia and bone fragility and the effects of antidiabetic medications on bone metabolism.

RECENT FINDINGS

Type 2 diabetes (T2D) is associated with increased risk of bone fracture even in those with increased or normal bone mineral density (BMD). The pathophysiology of diabetic bone disease is not completely understood, but it is thought to be multifactorial and associated with complex cross talk among factors such as AGEs, IGF-1, enteric hormones, and pro-inflammatory cytokines. Treatment for T2D may have an impact on bone metabolism. Diabetic bone disease should be considered a serious complication of long-standing T2D.

Using Clinical Indices to Distinguish MODY2 (GCK Mutation) and MODY3 (HNF1A Mutation) from Type 1 Diabetes in a Young Chinese Population

INTRODUCTION

Accurate diagnosis of maturity-onset diabetes of the young (MODY) is required in order to select appropriate treatment options and to assess prognosis. The aim of this study was to explore potential clinical indicators that could be used to differentiate MODY2, MODY3, and type 1 diabetes (T1D) in young subjects.

METHODS

Twelve patients with MODY3 and 29 patients with MODY2 were characterized and compared to 26 patients with T1D. These three groups were matched for age and gender. Clinical profiles of the 67 patients were collected. Receiver operating characteristic (ROC) curves were used to identify the optimal cutoff values of clinical indicators.

RESULTS

Compared to patients with T1D, subjects with MODY3 had higher fasting C-peptide levels (1.34 ± 1.51 vs. 0.29 ± 0.22 ng/mL; P  < 0.001) and lower high-sensitivity C-reactive protein (hsCRP) levels (0.18 ± 0.15 vs. 1.22 ± 1.49 mg/L, P  = 0.004); patients with MODY2 had lower hsCRP (0.37 ± 0.39 vs. 1.22 ± 1.49 mg/L; P  = 0.003), total cholesterol (4.12 ± 0.68 vs. 4.61 ± 0.81 mmol/L, P  = 0.034), and low-density lipoprotein cholesterol (LDL-C) (2.24 ± 0.68 vs. 2.67 ± 0.79 ng/L, P  = 0.002) levels and higher fasting C-peptide levels (0.96 ± 0.42 vs. 0.29 ± 0.22 ng/mL, P  = 0.002). The ROC-derived hsCRP values for discriminating MODY2 from T1D, MODY3 from T1D, and MODY3 from MODY2 were 0.675, 0.833, and 0.763, respectively. The ROC-derived fasting C-peptide levels for discriminating MODY2 from T1D and MODY3 from T1D were 0.951 and 0.975, respectively. The ROC-derived total cholesterol and LDL-C values for discriminating MODY2 from T1D were 0.670 and 0.662, respectively; the ROC-derived triglyceride value for discriminating MODY3 from MODY2 was 0.756. Additionally, a combination of indicators permitted better discrimination of MODY subtypes than any single parameter.

CONCLUSION

Our findings suggest that fasting C-peptide, hsCRP, and lipid levels permit good discrimination among MODY2, MODY3, and T1D. These clinical indicators could be used as markers of MODY2 and MODY3 in young patients with diabetes.

Glycated hemoglobin A1c as a screening test for detecting type 2 diabetes mellitus in obese children and adolescents

BACKGROUND

The diagnostic cutoff points for indicators of type 2 diabetes mellitus (T2DM) in the pediatric population have not been defined thus far.

METHODS

A retrospective, single-center study was conducted from April 2003 to May 2016. We enrolled 236 overweight or obese children and adolescents aged 4-17 years. Thirty-nine (26.9%) of 145 patients had T2DM according to the oral glucose tolerance test results.

RESULTS

A glycated hemoglobin (HbA1c) level of 6.5% had a sensitivity and specificity of 87.2% and 98.5%, respectively, for detecting T2DM. The optimal HbA1c cutoff level for T2DM was >6.2% (94.7% sensitivity, 95.5% specificity).

CONCLUSIONS

We observed that the use of an HbA1c level of 6.5% had a lower sensitivity for detecting T2DM than an HbA1c level of >6.2%.

HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents

BACKGROUND

Oral glucose tolerance test (OGTT) is a traditional diagnostic tool for diabetes. Hemoglobin A1c (HbA1c) is an alternative method used in adults; however, its application in youths has been controversial. We evaluated the diagnostic performance of HbA1c and determined optimal cutoff points for detecting prediabetes and diabetes in youth.

METHODS

This retrospective study included 389 obese children (217 boys, 55.8%) who had undergone simultaneous OGTT and HbA1c testing at six hospitals, Korea, between 2010 and 2016. Subjects were diagnosed with diabetes (fasting glucose ≥ 7.0 mmol/L; 2-hour glucose ≥ 11.1 mmol/L) or prediabetes (fasting glucose 5.6-6.9 mmol/L; 2-hour glucose 7.8-11.0 mmol/L). The diagnostic performance of HbA1c for prediabetes and diabetes was determined using the area under the receiver operating characteristic curve (AUC).

RESULTS

At diagnosis, 197 (50.6%) subjects had normoglycemia, 121 (31.1%) had prediabetes, and 71 (18.3%) had diabetes. The kappa coefficient for agreement between OGTT and HbA1c was 0.464. The optimal HbA1c cutoff points were 5.8% (AUC, 0.795; a sensitivity of 64.1% and a specificity of 83.8%) for prediabetes and 6.2% (AUC, 0.972; a sensitivity of 91.5% and a specificity of 93.7%) for diabetes. When HbA1c (≥ 6.2%) and 2-hour glucose level were used to diagnose diabetes, 100% were detected.

CONCLUSION

Pediatric criteria for HbA1c remain unclear, therefore, we recommend the combination of fasting and 2-hour glucose levels, in addition to HbA1c, in the diagnosis of childhood prediabetes and diabetes.