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Roberts AJ, Sauder K, Stafford JM, Malik FS, Pihoker C, Boghossian NS, Ehrlich S, Pettitt DJ, Dabelea D, Bellatorre A, D’Agostino R, Jensen ET. Preconception Counseling in Women With Diabetes: The SEARCH for Diabetes in Youth Study. Clin Diabetes 2023; 41:177-184. [PMID: 37092149 PMCID: PMC10115614 DOI: 10.2337/cd22-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Preconception counseling is recommended for all women with diabetes starting at puberty to convey the importance of optimal diabetes management for maternal and fetal outcomes. This study included 622 female participants from the SEARCH for Diabetes in Youth study with a mean age of 22.2 years (range 14-35 years). Only 53.7% reported ever receiving preconception counseling, which was significantly lower among women seeing pediatric providers than those seeing adult or all-age providers. Older age and history of prior pregnancy were associated with increased odds of reporting having received preconception counseling. Identification of barriers to delivering preconception counseling to young females with diabetes and strategies to overcome them are needed to reduce the risk for pregnancy complications and adverse offspring health outcomes.
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Affiliation(s)
| | - Katherine Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO
| | - Jeanette M. Stafford
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Faisal S. Malik
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | - Nansi S. Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Shelley Ehrlich
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO
| | - Anna Bellatorre
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO
| | - Ralph D’Agostino
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Elizabeth T. Jensen
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Malik FS, Sauder KA, Isom S, Reboussin BA, Dabelea D, Lawrence JM, Roberts A, Mayer-Davis EJ, Marcovina S, Dolan L, Igudesman D, Pihoker C, Lawrence JM, Hung P, Koebnick C, Li X, Lustigova E, Reynolds K, Pettitt DJ, Mayer-Davis EJ, Mottl A, Thomas J, Jackson M, Knight L, Liese AD, Turley C, Bowlby D, Amrhein J, Apperson E, Nelson B, Dabelea D, Bellatorre A, Crume T, Hamman RF, Sauder KA, Shapiro A, Testaverde L, Klingensmith GJ, Maahs D, Rewers MJ, Wadwa P, Daniels S, Kahn MG, Wilkening G, Bloch CA, Powell J, Love-Osborne K, Hu DC, Dolan LM, Shah AS, Standiford DA, Urbina EM, Pihoker C, Hirsch I, Kim G, Malik FA, Merjaneh L, Roberts A, Taplin C, Yi-Frazier J, Beauregard N, Franklin C, Gangan C, Kearns S, Klingsheim M, Loots B, Pascual M, Greenbaum C, Imperatore G, Saydah SH, Linder B, Marcovina SM, Chait A, Clouet-Foraison N, Harting J, Strylewicz G, D'Agostino R, Jensen ET, Wagenknecht LE, Bell RA, Casanova R, Divers J, Goldstein MT, Henkin L, Isom S, Lenoir K, Pierce J, Reboussin B, Rigdon J, South AM, Stafford J, Suerken C, Wells B, Williams C. Trends in Glycemic Control Among Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2022; 45:285-294. [PMID: 34995346 PMCID: PMC8914430 DOI: 10.2337/dc21-0507] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS The study included 6,369 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods of 2002-2007, 2008-2013, and 2014-2019, diabetes durations of 1-4, 5-9, and ≥10 years, and age groups of 1-9, 10-14, 15-19, 20-24, and ≥25 years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen, and diabetes duration, overall and stratified for each diabetes duration and age group. RESULTS Adjusted mean HbA1c for the 2014-2019 cohort of YYA with type 1 diabetes was 8.8 ± 0.04%. YYA with type 1 diabetes in the 10-14-, 15-19-, and 20-24-year-old age groups from the 2014-2019 cohort had worse glycemic control than the 2002-2007 cohort. Race/ethnicity, household income, and treatment regimen predicted differences in glycemic control in participants with type 1 diabetes from the 2014-2019 cohort. Adjusted mean HbA1c was 8.6 ± 0.12% for 2014-2019 YYA with type 2 diabetes. Participants aged ≥25 years with type 2 diabetes had worse glycemic control relative to the 2008-2013 cohort. Only treatment regimen was associated with differences in glycemic control in participants with type 2 diabetes. CONCLUSIONS Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.
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Affiliation(s)
- Faisal S Malik
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Katherine A Sauder
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Alissa Roberts
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | | | - Lawrence Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daria Igudesman
- Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill, NC
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Lawrence JM, Divers J, Isom S, Saydah S, Imperatore G, Pihoker C, Marcovina SM, Mayer-Davis EJ, Hamman RF, Dolan L, Dabelea D, Pettitt DJ, Liese AD. Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the US, 2001-2017. JAMA 2021; 326:717-727. [PMID: 34427600 PMCID: PMC8385600 DOI: 10.1001/jama.2021.11165] [Citation(s) in RCA: 220] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Changes in the prevalence of youth-onset diabetes have previously been observed. OBJECTIVE To estimate changes in prevalence of type 1 and type 2 diabetes in youths in the US from 2001 to 2017. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional observational study, individuals younger than 20 years with physician-diagnosed diabetes were enumerated from 6 areas in the US (4 geographic areas, 1 health plan, and select American Indian reservations) for 2001, 2009, and 2017. EXPOSURES Calendar year. MAIN OUTCOMES AND MEASURES Estimated prevalence of physician-diagnosed type 1 and type 2 diabetes overall and by race and ethnicity, age, and sex. RESULTS Among youths 19 years or younger, 4958 of 3.35 million had type 1 diabetes in 2001, 6672 of 3.46 million had type 1 diabetes in 2009, and 7759 of 3.61 million had type 1 diabetes in 2017; among those aged 10 to 19 years, 588 of 1.73 million had type 2 diabetes in 2001, 814 of 1.85 million had type 2 diabetes in 2009, and 1230 of 1.85 million had type 2 diabetes in 2017. The estimated type 1 diabetes prevalence per 1000 youths for those 19 years or younger increased significantly from 1.48 (95% CI, 1.44-1.52) in 2001 to 1.93 (95% CI, 1.88-1.98) in 2009 to 2.15 (95% CI, 2.10-2.20) in 2017, an absolute increase of 0.67 per 1000 youths (95%, CI, 0.64-0.70) and a 45.1% (95% CI, 40.0%-50.4%) relative increase over 16 years. The greatest absolute increases were observed among non-Hispanic White (0.93 per 1000 youths [95% CI, 0.88-0.98]) and non-Hispanic Black (0.89 per 1000 youths [95% CI, 0.88-0.98]) youths. The estimated type 2 diabetes prevalence per 1000 youths aged 10 to 19 years increased significantly from 0.34 (95% CI, 0.31-0.37) in 2001 to 0.46 (95% CI, 0.43-0.49) in 2009 to 0.67 (95% CI, 0.63-0.70) in 2017, an absolute increase of 0.32 per 1000 youths (95% CI, 0.30-0.35) and a 95.3% (95% CI, 77.0%-115.4%) relative increase over 16 years. The greatest absolute increases were observed among non-Hispanic Black (0.85 per 1000 youths [95% CI, 0.74-0.97]) and Hispanic (0.57 per 1000 youths [95% CI, 0.51-0.64]) youths. CONCLUSIONS AND RELEVANCE In 6 areas of the US from 2001 to 2017, the estimated prevalence of diabetes among children and adolescents increased for both type 1 and type 2 diabetes.
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Affiliation(s)
- Jean M. Lawrence
- Division of Epidemiologic Research, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jasmin Divers
- Division of Health Services Research, Department of Foundations of Medicine, New York University Langone School of Medicine, Mineola
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sharon Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Santica M. Marcovina
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle
| | | | - Richard F. Hamman
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora
| | - Lawrence Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | | | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia
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Divers J, Mayer-Davis EJ, Lawrence JM, Isom S, Dabelea D, Dolan L, Imperatore G, Marcovina S, Pettitt DJ, Pihoker C, Hamman RF, Saydah S, Wagenknecht LE. Trends in Incidence of Type 1 and Type 2 Diabetes Among Youths - Selected Counties and Indian Reservations, United States, 2002-2015. MMWR Morb Mortal Wkly Rep 2020; 69:161-165. [PMID: 32053581 PMCID: PMC7017961 DOI: 10.15585/mmwr.mm6906a3] [Citation(s) in RCA: 205] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Powell J, Isom S, Divers J, Bellatorre A, Johnson M, Smiley J, Begay Q, Benally C, Hu D, Saydah S, Pettitt DJ, Pihoker C, Dabelea D. Increasing burden of type 2 diabetes in Navajo youth: The SEARCH for diabetes in youth study. Pediatr Diabetes 2019; 20:815-820. [PMID: 31260152 PMCID: PMC6786918 DOI: 10.1111/pedi.12885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/16/2019] [Accepted: 06/18/2019] [Indexed: 11/28/2022] Open
Abstract
AIM SEARCH has recently reported that both prevalence and incidence of youth onset type 2 diabetes (YT2D) increased among most US race/ethnic groups in the early 2000s. This study reports on the incidence (2002-2013) and prevalence (2001, 2009) of YT2D in the Navajo Nation among youth age < 20 years from 2001 to 2013. METHODS SEARCH sought to identify prevalent YT2D cases in 2001 (N = 75) and 2009 (N = 70) and all incident YT2D cases in three periods: 2002 to 2005 (N = 53), 2006 to 2009 (N = 68), and 2010 2013 (N = 90) in Navajo Nation. Denominators were based on the active Indian Health Service user population for eligible health care facilities. Prevalence (per 100 000) and period-specific incidence rates (per 100 000 person-years) were computed for youth aged 10 to 19 years. Changes in prevalence were tested with a two-sided skew-corrected inverted score test, while changes in incidence were tested with Poisson regression. RESULTS YT2D prevalence was high but stable in 2001 and 2009, overall [146.6 (116.8, 184.0) vs 141.5 (112.0, 178.8), P = .65) and in all subgroups. In contrast, incidence rates increased particularly between the second and third periods overall and in most subgroups by age and by sex. CONCLUSIONS These data confirm the high burden of YT2D among Navajo youth and suggest an increasing risk in more recent years. However, recent improvements in obesity reduction in this population demonstrate optimism for potential reductions in YT2D in Navajo Nation.
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Affiliation(s)
- Jeffrey Powell
- Community Health Division, Shiprock Service Unit, Navajo Area Indian Health Service, Shiprock NM
| | - Scott Isom
- Department of Biostatistics, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jasmin Divers
- Department of Biostatistics, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Anna Bellatorre
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Melissa Johnson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Janelia Smiley
- Community Health Division, Shiprock Service Unit, Navajo Area Indian Health Service, Shiprock NM
| | - Quanna Begay
- Community Health Division, Shiprock Service Unit, Navajo Area Indian Health Service, Shiprock NM
| | - Christine Benally
- Community Health Division, Shiprock Service Unit, Navajo Area Indian Health Service, Shiprock NM
| | - Diana Hu
- Pediatrics Department, Tuba City Regional Health Care Center, Tuba City, AZ
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
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Kim G, Divers J, Fino NF, Dabelea D, Lawrence JM, Reynolds K, Bell RA, Mayer-Davis E, Crume T, Pettitt DJ, Pihoker C, Liu L. Trends in prevalence of cardiovascular risk factors from 2002 to 2012 among youth early in the course of type 1 and type 2 diabetes. The SEARCH for Diabetes in Youth Study. Pediatr Diabetes 2019; 20:693-701. [PMID: 30903717 PMCID: PMC6785186 DOI: 10.1111/pedi.12846] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/18/2019] [Accepted: 03/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Given diabetes is an important risk factor for cardiovascular disease (CVD), we examined temporal trends in CVD risk factors by comparing youth recently diagnosed with type 1 diabetes (T1D) and type 2 diabetes (T2D) from 2002 through 2012. METHODS The SEARCH for Diabetes in Youth Study identified youth with diagnosed T1D (n = 3954) and T2D (n = 706) from 2002 to 2012. CVD risk factors were defined using the modified Adult Treatment Panel III criteria for metabolic syndrome: (a) hypertension; (b) high-density lipoprotein cholesterol ≤40 mg/dL; (c) triglycerides ≥110 mg/dL; and (d) waist circumference (WC) >90th percentile. Prevalence of CVD risk factors, stratified by diagnosis year and diabetes type, was reported. Univariate and multivariate logistic models and Poisson regression were fit to estimate the prevalence trends for CVD risk factors individually and in clusters (≥2 risk factors). RESULTS The prevalence of ≥2 CVD risk factors was higher in youth with T2D than with T1D at each incident year, but the prevalence of ≥2 risk factors did not change across diagnosis years among T1D or T2D participants. The number of CVD risk factors did not change significantly in T1D participants, but increased at an annual rate of 1.38% in T2D participants. The prevalence of hypertension decreased in T1D participants, and high WC increased in T2D participants. CONCLUSION The increase in number of CVD risk factors including large WC among youth with T2D suggests a need for early intervention to address these CVD risk factors. Further study is needed to examine longitudinal associations between diabetes and CVD.
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Affiliation(s)
- Grace Kim
- Department of Pediatrics, University of Washington, Seattle
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nora F. Fino
- Department of Biostatistical Sciences, Oregon Health and Science University, Portland, Oregon
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern CA, Pasadena, California
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern CA, Pasadena, California
| | - Ronny A. Bell
- Department of Public Health, East Carolina University, Greenville, North Carolina
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tessa Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Lenna Liu
- Department of Pediatrics, University of Washington, Seattle
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Kahkoska AR, Isom S, Divers J, Mayer-Davis EJ, Dolan L, Shah AS, Afkarian M, Pettitt DJ, Lawrence JM, Marcovina S, Saydah SH, Dabelea D, Maahs DM, Mottl AK. The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes. J Diabetes Complications 2018; 32:1160-1168. [PMID: 30316542 PMCID: PMC6289668 DOI: 10.1016/j.jdiacomp.2018.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 12/14/2022]
Abstract
AIMS To determine among adolescents and young adults with youth-onset type 1 diabetes and type 2 diabetes the rates and risk factors for albuminuria regression and progression. METHODS Data from SEARCH, a longitudinal observational study of youth-onset type 1 diabetes (N = 1316) and type 2 diabetes (N = 143) were analyzed. Urine albumin:creatinine ratio (UACR) was measured from random urine specimens at baseline and follow-up visits (mean 7 years later). Albuminuria regression was defined as halving of baseline UACR when baseline UACR was ≥30 μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30 μg/mg, respectively. Multivariable regression assessed risk factors associated with low-risk albuminuria category (combined persistently-low albuminuria and regression) versus moderate-risk albuminuria category (combined persistently-high albuminuria and progression). RESULTS Albuminuria progression was more common in type 2 diabetes versus type 1 diabetes (15.4% versus 6.0%, p<0.001). Moderate-risk albuminuria was associated with increasing HbA1c (adjusted OR (aOR) = 1.3, 95% CI 1.1-1.6) and lack of private health insurance (aOR = 2.7, 95%CI 1.1-6.5) in type 1 diabetes; and African American race (OR = 4.6, 95% CI 1.2-14.2), lower estimated insulin sensitivity score (aOR = 2.1, 95% CI 1.4-3.3), baseline UACR (aOR = 3.2, 95% CI 1.7-5.8), and follow-up estimated glomerular filtration rate (eGFR) (10-unit increase aOR = 1.3, 95% CI 1.0, 1.5) in type 2 diabetes. CONCLUSIONS In the first decade of diabetes duration, kidney complications in type 2 diabetes are significantly more aggressive than in type 1 diabetes and may be associated with less modifiable risk factors including race, insulin sensitivity, and eGFR. Early interventions may help reduce long-term kidney complications.
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Affiliation(s)
- Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Scott Isom
- Dept. of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Jasmin Divers
- Dept. of Biostatistical Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Elizabeth J Mayer-Davis
- Department of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia St, Chapel Hill, NC 27516, USA
| | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Amy S Shah
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Maryam Afkarian
- Division of Nephrology, Department of Medicine, University of California, Davis, 4610 X St, Sacramento, CA 95817, USA
| | | | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, USA
| | - Santica Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, Dept. of Medicine, University of Washington, 401 Queen Anne Avenue North, UW Mailbox 359119, Seattle, WA 98109, USA
| | - Sharon H Saydah
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, National Center for Health Statistics, 3311 Toledo Rd, Hyattsville, MD 20782, USA
| | - Dana Dabelea
- Department of Epidemiology, School of Public Health, University of Colorado Denver, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Amy K Mottl
- University of North Carolina Kidney Center, UNC School of Medicine, 101 Manning Dr, Chapel Hill, NC 27514, USA
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Costacou T, Crandell J, Kahkoska AR, Liese AD, Dabelea D, Lawrence JM, Pettitt DJ, Reynolds K, Mayer-Davis EJ, Mottl AK. Dietary Patterns Over Time and Microalbuminuria in Youth and Young Adults With Type 1 Diabetes: The SEARCH Nutrition Ancillary Study. Diabetes Care 2018; 41:1615-1622. [PMID: 29903846 PMCID: PMC6054499 DOI: 10.2337/dc18-0319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/14/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assessed the association between diet quality and microalbuminuria in youth-onset type 1 diabetes using three indices: a modified Mediterranean diet score for children and adolescents (mKIDMED), the Dietary Approaches to Stop Hypertension (DASH), and the Healthy Eating Index-2010 (HEI). RESEARCH DESIGN AND METHODS Youth and young adults from the SEARCH (SEARCH for Diabetes in Youth) Nutrition Ancillary Study (SNAS) diagnosed with type 1 diabetes in 2002-2008, who had repeated dietary assessments at baseline and follow-up visits and urine albumin-to-creatinine ratio (UACR) measured at the outcome visit (2012-2015) (n = 461), were selected for study. Regression models estimated the association between each longitudinally assessed diet score and UACR and microalbuminuria (UACR ≥30 μg/mg). RESULTS The cohort was 43% female, and at follow-up, mean age was 20 years, disease duration was 108 months, and 7% had microalbuminuria. Adherence to a higher-quality diet was low for the mKIDMED (mean 3.7 of a possible range of -3 to 12) and the DASH (mean 42 of 80) and better, for the HEI (mean 56.3 of 100). A borderline inverse association was observed between the HEI score and microalbuminuria after adjustment for caloric and protein intake and demographic and disease factors (odds ratio [OR]HEI 0.83, P = 0.07), which lost significance with further adjustment for HbA1c and systolic blood pressure (ORHEI 0.86, P = 0.19). Results were similar for continuous UACR. No significant associations were observed for diet quality characterized by the mKIDMED or DASH indices. CONCLUSIONS Greater adherence to the HEI may be beneficial for kidney health in youth and young adults with type 1 diabetes. Low adherence to the mKIDMED and DASH diets may explain the lack of association with microalbuminuria.
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Affiliation(s)
- Tina Costacou
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Jamie Crandell
- Department of Biostatistics, University of North Carolina Chapel Hill School of Nursing, Chapel Hill, NC
| | - Anna R Kahkoska
- Department of Biostatistics, University of North Carolina Chapel Hill School of Nursing, Chapel Hill, NC
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Dana Dabelea
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Santa Barbara, CA
| | - David J Pettitt
- Department of Research & Evaluation, Kaiser Permanente Southern California, Santa Barbara, CA
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Santa Barbara, CA
| | - Elizabeth J Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Amy K Mottl
- UNC Kidney Center, Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC
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Jaiswal M, Divers J, Urbina EM, Dabelea D, Bell RA, Pettitt DJ, Imperatore G, Pihoker C, Dolan LM, Liese AD, Marcovina S, Linder B, Feldman EL, Pop-Busui R. Cardiovascular autonomic neuropathy in adolescents and young adults with type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth Cohort Study. Pediatr Diabetes 2018; 19:680-689. [PMID: 29292558 PMCID: PMC5938122 DOI: 10.1111/pedi.12633] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/26/2017] [Accepted: 12/07/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of and risk factors for cardiovascular autonomic neuropathy (CAN) in adolescents and young adults with type 1 and type 2 diabetes enrolled in the SEARCH for Diabetes in Youth Study. METHODS The study included 1646 subjects with type 1 diabetes (age 18 ± 4 years, diabetes duration 8 ± 2 years, HbA1c 9.1 ± 1.9%, 76% non-Hispanic Whites) and 252 with type 2 diabetes (age 22 ± 4 years, diabetes duration 8 ± 2 years, HbA1c 9.2 ± 3.0%, 45% non-Hispanic Blacks). Cross-sectional and longitudinal risk factors were assessed at baseline and follow-up visits. Area under the curve (AUC) was used to assess the longitudinal glycemic exposure and cardiovascular risk factors. CAN was assessed by time and frequency domain indices of heart rate variability (HRV). CAN was defined as the presence of ≥3 of 5 abnormal HRV indices. RESULTS The prevalence of CAN was 12% in adolescents and young adults with type 1 diabetes and 17% in those with type 2 diabetes. Poor long-term glycemic control (AUC HbA1c), high blood pressure, and elevated triglyceride levels were correlates of CAN in subjects with type 1 diabetes. In those with type 2 diabetes, CAN was associated with elevated triglycerides and increased urinary albumin excretion. CONCLUSIONS The prevalence of CAN in this multiethnic cohort of adolescents and young adults with type 1 and type 2 diabetes are comparable to those reported in adults with diabetes. Suboptimal glycemic control and elevated triglycerides were the modifiable risk factors associated with CAN.
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Affiliation(s)
- Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elaine M. Urbina
- Preventive Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Ronny A. Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers of Disease Control and Prevention, Atlanta, Georgia
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle Washington
| | - Lawrence M. Dolan
- Division of Endocrinology, Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, South Carolina
| | - Santica Marcovina
- Northwest Lipid Research Laboratory, University of Washington, Seattle, Washington
| | - Barbara Linder
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Eva L. Feldman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Jaiswal M, Divers J, Dabelea D, Isom S, Bell RA, Martin CL, Pettitt DJ, Saydah S, Pihoker C, Standiford DA, Dolan LM, Marcovina S, Linder B, Liese AD, Pop-Busui R, Feldman EL. Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care 2017; 40:1226-1232. [PMID: 28674076 PMCID: PMC5566278 DOI: 10.2337/dc17-0179] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/02/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assessed the prevalence of and risk factors for diabetic peripheral neuropathy (DPN) in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) enrolled in the SEARCH for Diabetes in Youth (SEARCH) study. RESEARCH DESIGN AND METHODS The Michigan Neuropathy Screening Instrument (MNSI) was used to assess DPN in 1,734 youth with T1D (mean ± SD age 18 ± 4 years, T1D duration 7.2 ± 1.2 years, and HbA1c 9.1 ± 1.9%) and 258 youth with T2D (age 22 ± 3.5 years, T2D duration 7.9 ± 2 years, and HbA1c 9.4 ± 2.3%) who were enrolled in the SEARCH study and had ≥5 years of diabetes duration. DPN was defined as an MNSI exam score of >2. Glycemic control over time was estimated as area under the curve for HbA1c. RESULTS The prevalence of DPN was 7% in youth with T1D and 22% in youth with T2D. Risk factors for DPN in youth with T1D were older age, longer diabetes duration, smoking, increased diastolic blood pressure, obesity, increased LDL cholesterol and triglycerides, and lower HDL cholesterol (HDL-c). In youth with T2D, risk factors were older age, male sex, longer diabetes duration, smoking, and lower HDL-c. Glycemic control over time was worse among those with DPN compared with those without for youth with T1D (odds ratio 1.53 [95% CI 1.24; 1.88]) but not for youth with T2D (1.05 [0.7; 1.56]). CONCLUSIONS The high rates of DPN among youth with diabetes are a cause of concern and suggest a need for early screening and better risk factor management. Interventions in youth that address poor glycemic control and dyslipidemia may prevent or delay debilitating neuropathic complications.
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Affiliation(s)
- Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Catherine L Martin
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI
| | | | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Debra A Standiford
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lawrence M Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Santica Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, Department of Medicine, University of Washington, Seattle, WA
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Angela D Liese
- Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI
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12
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Mayer-Davis EJ, Lawrence JM, Dabelea D, Divers J, Isom S, Dolan L, Imperatore G, Linder B, Marcovina S, Pettitt DJ, Pihoker C, Saydah S, Wagenknecht L. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002-2012. N Engl J Med 2017; 376:1419-1429. [PMID: 28402773 PMCID: PMC5592722 DOI: 10.1056/nejmoa1610187] [Citation(s) in RCA: 930] [Impact Index Per Article: 132.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diagnoses of type 1 and type 2 diabetes in youths present a substantial clinical and public health burden. The prevalence of these diseases increased in the 2001-2009 period, but data on recent incidence trends are lacking. METHODS We ascertained cases of type 1 and type 2 diabetes mellitus at five study centers in the United States. Denominators (4.9 million youths annually) were obtained from the U.S. Census or health-plan member counts. After the calculation of annual incidence rates for the 2002-2012 period, we analyzed trends using generalized autoregressive moving-average models with 2-year moving averages. RESULTS A total of 11,245 youths with type 1 diabetes (0 to 19 years of age) and 2846 with type 2 diabetes (10 to 19 years of age) were identified. Overall unadjusted estimated incidence rates of type 1 diabetes increased by 1.4% annually (from 19.5 cases per 100,000 youths per year in 2002-2003 to 21.7 cases per 100,000 youths per year in 2011-2012, P=0.03). In adjusted pairwise comparisons, the annual rate of increase was greater among Hispanics than among non-Hispanic whites (4.2% vs. 1.2%, P<0.001). Overall unadjusted incidence rates of type 2 diabetes increased by 7.1% annually (from 9.0 cases per 100,000 youths per year in 2002-2003 to 12.5 cases per 100,000 youths per year in 2011-2012, P<0.001 for trend across race or ethnic group, sex, and age subgroups). Adjusted pairwise comparisons showed that the relative annual increase in the incidence of type 2 diabetes among non-Hispanic whites (0.6%) was lower than that among non-Hispanic blacks, Asians or Pacific Islanders, and Native Americans (P<0.05 for all comparisons) and that the annual rate of increase among Hispanics differed significantly from that among Native Americans (3.1% vs. 8.9%, P=0.01). After adjustment for age, sex, and race or ethnic group, the relative annual increase in the incidence of type 1 diabetes was 1.8% (P<0.001) and that of type 2 diabetes was 4.8% (P<0.001). CONCLUSIONS The incidences of both type 1 and type 2 diabetes among youths increased significantly in the 2002-2012 period, particularly among youths of minority racial and ethnic groups. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Elizabeth J Mayer-Davis
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Jean M Lawrence
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Dana Dabelea
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Jasmin Divers
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Scott Isom
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Lawrence Dolan
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Giuseppina Imperatore
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Barbara Linder
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Santica Marcovina
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - David J Pettitt
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Catherine Pihoker
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Sharon Saydah
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Lynne Wagenknecht
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
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Liu LL, Kahn HS, Pettitt DJ, Fino NF, Morgan T, Maahs DM, Crimmins NA, Lamichhane AP, Liese AD, D’Agostino RB, Bell RA. Comparing Two Waist-to-Height Ratio Measurements with Cardiometabolic Risk Factors among Youth with Diabetes. Int J Child Health Nutr 2016; 5:87-94. [PMID: 28232855 PMCID: PMC5319429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Waist circumference (WC) is commonly measured by either the World Health Organization (WHO) or National Health and Nutrition Examination Survey (NHANES) protocol. OBJECTIVE Compare the associations of WHO vs. NHANES WC-to-height ratio (WHtR) protocols with cardiometabolic risk factors (CMRFs) in a sample of youth with diabetes. METHODS For youth (10-19 years old with type 1 [N=3082] or type 2 [N=533] diabetes) in the SEARCH for Diabetes in Youth Study, measurements were obtained of WC (by two protocols), weight, height, fasting lipids (total cholesterol, triglycerides, HDL cholesterol, Non-HDL cholesterol) and blood pressures. Associations of CMRFs with WHO and NHANES WHtR were modeled stratified by body mass index (BMI) percentiles for age/sex: lower BMI (<85th BMI percentile; N=2071) vs. higher BMI (≥85th percentile; N=1594). RESULTS Among lower-BMI participants, both NHANES and WHO WHtR were associated (p<0.005) with all CMRFs except blood pressure. Among higher-BMI participants, both NHANES and WHO WHtR were associated (p<0.05) with all CMRFs. WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides, non-HDL cholesterol, and systolic blood pressure in lower-BMI participants. Among high-BMI participants, WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides and systolic blood pressure. CONCLUSION Among youth with diabetes, WHtR calculated from either WC protocol captures cardiometabolic risk. The WHO WC protocol may be preferable to NHANES WC.
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Affiliation(s)
- Lenna L. Liu
- University of Washington and Seattle Children’s Hospital, Seattle, WA 98122, USA
| | - Henry S. Kahn
- Centers for Disease Control and Prevention, Mail Stop K-10, 4770 Buford Highway, NE Atlanta, GA 30341-3717, USA
| | | | - Nora F. Fino
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Tim Morgan
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - David M. Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, P. O. Box 6511, Mail Stop A140, Aurora, CO 80045, USA
| | - Nancy A. Crimmins
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Mail Location 7012, Cincinnati, OH 45229, USA
| | - Archana P. Lamichhane
- Department of Nutrition, University of North Carolina at Chapel Hill, 2211 McGavran Greenberg, CB 7461, Chapel Hill, NC 27599-7461, USA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA
| | - Ralph B. D’Agostino
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Ronny A. Bell
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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14
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Thaware PK, McKenna S, Patterson CC, Hadden DR, Pettitt DJ, McCance DR. Untreated Mild Hyperglycemia During Pregnancy and Anthropometric Measures of Obesity in Offspring at Age 5-7 Years. Diabetes Care 2015; 38:1701-6. [PMID: 26092862 PMCID: PMC4542272 DOI: 10.2337/dc14-2797] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/29/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Obesity in the offspring of women with hyperglycemia during pregnancy has been reported, but the results are conflicting. This study examined the association of hyperglycemia during pregnancy and anthropometry in 5- to 7-year-old offspring whose mothers participated in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study at the Belfast Centre. RESEARCH DESIGN AND METHODS Women in the HAPO study underwent a 75-g oral glucose tolerance test (OGTT) at approximately 28 weeks of gestation. Mothers and caregivers remained blinded to the results unless the fasting plasma glucose (FPG) concentration was >5.8 mmol/L or the 2-h plasma glucose (2hPG) concentration was >11.1 mmol/L. Offspring weight, height, and skinfold thicknesses (triceps, subscapular, and suprailiac) were measured at age 5-7 years. Overweight, obesity, and extreme obesity were defined as a BMI z score ≥85th, ≥95th, and ≥99th percentile, respectively, based on the 1990 British Growth Standard. RESULTS Belfast HAPO offspring (n = 1,320, 82%) aged 5-7 years attended for follow-up. With use of multiple regression, maternal FPG, 1h PG, and 2hPG did not show any relation to offspring BMI z score or offspring skinfold sum independent of maternal BMI at OGTT and offspring birth weight z score. This lack of association with maternal glycemia persisted with the offspring BMI z score expressed as ≥85th, ≥95th, or 99th percentile and the sum of skinfolds expressed as ≥90th percentile specific for sex. The initially significant relation between FPG and all offspring adiposity measures was explained by maternal BMI at the OGTT. CONCLUSIONS After adjustment for maternal BMI at the OGTT, higher maternal FPG concentration during pregnancy (short of diabetes) is no longer a risk factor for obesity, as reflected by BMI and the sum of skinfolds in offspring aged 5-7 years.
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Affiliation(s)
- Parag K Thaware
- Royal Victoria Hospital, Belfast, U.K. Queen's University Belfast, Belfast, U.K
| | | | | | - David R Hadden
- Queen's University Belfast, Belfast, U.K. Royal Jubilee Maternity Hospital, Belfast, U.K
| | | | - David R McCance
- Royal Victoria Hospital, Belfast, U.K. Queen's University Belfast, Belfast, U.K. Royal Jubilee Maternity Hospital, Belfast, U.K.
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Li C, Beech B, Crume T, D’Agostino RB, Dabelea D, Kaar JL, Liese AD, Mayer-Davis EJ, Pate R, Pettitt DJ, Taplin C, Rodriguez B, Merchant AT. Longitudinal association between television watching and computer use and risk markers in diabetes in the SEARCH for Diabetes in Youth Study. Pediatr Diabetes 2015; 16:382-91. [PMID: 25041407 PMCID: PMC4291304 DOI: 10.1111/pedi.12163] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/05/2014] [Accepted: 05/19/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The study provides evidence of the longitudinal association between screen time with hemoglobin A1c (HbA1c) and cardiovascular risk markers among youth with type 1 diabetes (T1D) and type 2 diabetes (T2D). OBJECTIVE To examine the longitudinal relationship of screen time with HbA1c and serum lipids among youth with diabetes. SUBJECTS Youth with T1D and T2D. METHODS We followed up 1049 youth (≥10 yr old) with recently diagnosed T1D and T2D participating in the SEARCH for Diabetes in Youth Study. RESULTS Increased television watching on weekdays and during the week over time was associated with larger increases in HbA1c among youth with T1D and T2D (p-value <0.05). Among youth with T1D, significant longitudinal associations were observed between television watching and TG (p-value <0.05) (week days and whole week), and low-density lipoprotein cholesterol (LDL-c, p-value <0.05) (whole week). For example, for youth who watched 1 h of television per weekday at the outset and 3 h per weekday 5 yr later, the longitudinal model predicted greater absolute increases in HbA1c (2.19% for T1D and 2.16% for T2D); whereas for youth who watched television 3 h per weekday at the outset and 1 h per weekday 5 yr later, the model predicted lesser absolute increases in HbA1c (2.08% for T1D and 1.06% for T2D). CONCLUSIONS Youth with T2D who increased their television watching over time vs. those who decreased it had larger increases in HbA1c over 5 yr. Youth with T1D who increased their television watching over time had increases in LDL-c, TG, and to a lesser extent HbA1c.
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Affiliation(s)
- Chao Li
- Department of Epidemiology and Biostatistics, University of South Carolina, SC
| | | | - Tessa Crume
- Department of Epidemiology, University of Colorado at Denver, CO
| | | | - Dana Dabelea
- Department of Epidemiology, University of Colorado at Denver, CO
| | - Jill L Kaar
- Department of Epidemiology, University of Colorado at Denver, CO
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, SC
| | | | - Russell Pate
- Department of Epidemiology and Biostatistics, University of South Carolina, SC
| | | | - Craig Taplin
- Division of Endocrinology and Diabetes, Seattle Children’s Hospital, University of Washington, WA
| | - Beatriz Rodriguez
- John A. Burns School of Medicine, University of Hawaii at Manoa and Instituto Tecnologico de Monterrey, Mexico
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, SC
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Law JR, Stafford JM, D'Agostino RB, Badaru A, Crume TL, Dabelea D, Dolan LM, Lawrence JM, Pettitt DJ, Mayer-Davis EJ. Association of parental history of diabetes with cardiovascular disease risk factors in children with type 2 diabetes. J Diabetes Complications 2015; 29:534-9. [PMID: 25784087 PMCID: PMC4414789 DOI: 10.1016/j.jdiacomp.2015.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 12/01/2022]
Abstract
AIMS Determine if parental diabetes (DM) is associated with unhealthier cardiovascular disease (CVD) risk profiles in youth with type 2 diabetes (T2D), and whether associations differed by race/ethnicity. METHODS Family history was available for 382 youth with T2D from 2001 prevalent and 2002-2005 incident SEARCH for Diabetes in Youth cohorts. Parental DM was evaluated in two ways: two-category-any parent vs. no parent DM (evaluated overall and stratified by race/ethnicity); and four-category-both parents, mother only, father only, or no parent DM (evaluated overall only). Associations with hemoglobin A1c (HbA1c), fasting lipids, blood pressure (BP), and urine albumin:creatinine ratio (ACR) were examined using regression models. RESULTS Overall, sample characteristics included: 35.9% male, 19.1% non-Hispanic white (NHW), mean T2D duration 26.6±22.2months, mean HbA1c 7.9%±2.5% (62.6±27.8mmol/mol). Unadjusted two-category comparisons showed that youth with parental DM had higher HbA1c, higher DBP, and higher frequency of elevated ACR. Adjusted two-category comparisons showed associations remaining in non-stratified analysis for ACR [OR (95% CI)=2.3 (1.1, 5.0)] and in NHW youth for HbA1c [6.8%±0.4 vs. 8.0±0.4 (51.1±4.8 vs. 63.9±4.2mmol/mol), p=.015], DBP (67.7%±4.5 vs. 76.9±4.4mm Hg, p=.014) and lnTG (4.7±0.3 vs. 5.3±0.3, p=.008). There were no significant findings in the adjusted four-category evaluation. CONCLUSIONS Parental history of diabetes may be associated with unhealthier CVD risk factors in youth with T2D.
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Affiliation(s)
- Jennifer R Law
- Department of Pediatrics and Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jeanette M Stafford
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Angela Badaru
- Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, CA, USA
| | - Tessa L Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Lawrence M Dolan
- Division of Endocrinology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Elizabeth J Mayer-Davis
- Department of Pediatrics and Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lawrence JM, Imperatore G, Dabelea D, Mayer-Davis EJ, Linder B, Saydah S, Klingensmith GJ, Dolan L, Standiford DA, Pihoker C, Pettitt DJ, Talton JW, Thomas J, Bell RA, D'Agostino RB. Trends in incidence of type 1 diabetes among non-Hispanic white youth in the U.S., 2002-2009. Diabetes 2014; 63:3938-45. [PMID: 24898146 PMCID: PMC4207387 DOI: 10.2337/db13-1891] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The SEARCH for Diabetes in Youth Study prospectively identified youth aged <20 years with physician-diagnosed diabetes. Annual type 1 diabetes (T1D) incidence per 100,000 person-years (95% CI) overall, by age-group, and by sex were calculated for at-risk non-Hispanic white (NHW) youth from 2002 through 2009. Joinpoint and Poisson regression models were used to test for temporal trends. The age- and sex-adjusted incidence of T1D increased from 24.4/100,000 (95% CI 23.9-24.8) in 2002 to 27.4/100,000 (26.9-27.9) in 2009 (P for trend = 0.0008). The relative annual increase in T1D incidence was 2.72% (1.18-4.28) per year; 2.84% (1.12-4.58) per year for males and 2.57% (0.68-4.51) per year for females. After adjustment for sex, significant increases were found for youth aged 5-9 years (P = 0.0023), 10-14 years (P = 0.0008), and 15-19 years (P = 0.004) but not among 0-4-year-olds (P = 0.1862). Mean age at diagnosis did not change. The SEARCH study demonstrated a significant increase in the incidence of T1D among NHW youth from 2002 through 2009 overall and in all but the youngest age-group. Continued surveillance of T1D in U.S. youth to identify future trends in T1D incidence and to plan for health care delivery is warranted.
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Affiliation(s)
- Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Hyattsville, MD
| | | | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Debra A Standiford
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Jennifer W Talton
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joan Thomas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Pettitt DJ, Talton J, Dabelea D, Divers J, Imperatore G, Lawrence JM, Liese AD, Linder B, Mayer-Davis EJ, Pihoker C, Saydah SH, Standiford DA, Hamman RF. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes in youth study. Diabetes Care 2014; 37:402-8. [PMID: 24041677 PMCID: PMC3898760 DOI: 10.2337/dc13-1838] [Citation(s) in RCA: 302] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of diabetes in U.S. youth aged <20 years in 2009 and to estimate the total number of youth with diabetes in the U.S. by age, race/ethnicity, and diabetes type. RESEARCH DESIGN AND METHODS To address one of its primary aims, the SEARCH for Diabetes in Youth Study identified youth aged <20 years on 31 December 2009 with physician-diagnosed diabetes in selected areas of Colorado, Ohio, South Carolina, and Washington, among health plan members of Kaiser Permanente Southern California and among American Indians living on reservations in Arizona and New Mexico. Diabetes was classified as type 1, type 2, or other. Race/ethnicity was by self-report. RESULTS From a population of 3,458,974 youth aged <20 years, 7,695 youth with diabetes were identified (2.22/1,000): 6,668 with type 1 diabetes (1.93/1,000), 837 with type 2 diabetes (0.24/1,000), and 190 (0.05/1,000) with other diabetes types. Prevalence increased with age, was slightly higher in females than males, and was most prevalent in non-Hispanic White and least prevalent in Asian/Pacific Islanders, with Native American and black youth having the highest prevalence of type 2 diabetes. An estimated 191,986 U.S. youth aged <20 years have diabetes; 166,984 type 1 diabetes, 20,262 type 2 diabetes, and 4,740 other types. CONCLUSIONS Diabetes, one of the leading chronic diseases in childhood, affects >190,000 (1 of 433) youth aged <20 years in the U.S., with racial and ethnic disparities seen in diabetes prevalence, overall and by diabetes type.
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Jaiswal M, Lauer A, Martin CL, Bell RA, Divers J, Dabelea D, Pettitt DJ, Saydah S, Pihoker C, Standiford DA, Rodriguez BL, Pop-Busui R, Feldman EL. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes Care 2013; 36:3903-8. [PMID: 24144652 PMCID: PMC3836139 DOI: 10.2337/dc13-1213] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of and risk factors for diabetic peripheral neuropathy (DPN) in a pilot study among youth participating in the SEARCH for Diabetes in Youth study. RESEARCH DESIGN AND METHODS DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI) (examination for foot abnormalities, distal vibration perception, and ankle reflexes). An MNSI exam (MNSIE) score >2 is diagnostic for DPN. RESULTS The MNSIE was completed in 399 subjects, including 329 youth with type 1 diabetes (mean age 15.7 ± 4.3 years, duration 6.2 ± 0.9 years) and 70 with type 2 diabetes (mean age 21.6 ± 4.1 years, duration 7.6 ± 1.8 years). Glycated hemoglobin (A1C) was similar in both groups (8.8 ± 1.8% for type 1 vs. 8.5 ± 2.9% for type 2). The prevalence of DPN was significantly higher in youth with type 2 compared with those with type 1 diabetes (25.7 vs. 8.2%; P < 0.0001). In unadjusted analyses, diabetes type, older age, longer duration of diabetes, increased waist circumference, elevated blood pressure, lower HDL cholesterol, and presence of microalbuminuria (urinary albumin-to-creatinine ratio >30 mg/g) were associated with DPN. The association between diabetes type and DPN remained significant after adjustment for age and sex (odds ratio 2.29 [95% CI 1.05-5.02], P = 0.03). CONCLUSIONS DPN prevalence among youth with type 2 diabetes approached rates reported in adult populations with diabetes. Our findings suggest not only that youth with diabetes are at risk for DPN but also that many already show measurable signs of DPN.
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Crume TL, Andrews JS, D'Agostino RB, Pettitt DJ, Mayer-Davis EJ, Law JR, Dolan L, Lawrence JM, Saydah S, Greenbaum C, Rodriguez BL, Dabelea D. The influence of exposure to maternal diabetes in utero on the rate of decline in β-cell function among youth with diabetes. J Pediatr Endocrinol Metab 2013; 26:721-7. [PMID: 23645121 PMCID: PMC4074015 DOI: 10.1515/jpem-2012-0385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/24/2013] [Indexed: 01/12/2023]
Abstract
Abstract We explored the influence of exposure to maternal diabetes in utero on β cell decline measured by fasting C-peptide (FCP) among 1079 youth <20 years with diabetes, including 941 with type 1 and 138 with type 2 diabetes. Youths exposed to maternal diabetes had FCP levels that were 17% lower among youth with type 2 diabetes [95% confidence interval (CI): -34%, +6%] and 15% higher among youth with type 1 diabetes (95%CI: -14%, +55%) than their unexposed counterparts, although differences were not statistically significant (p=0.13 and p=0.35, respectively). Exposure to maternal diabetes was not associated with FCP decline in youth with type 2 (p=0.16) or type 1 diabetes (p=0.90); nor was the effect of in utero exposure on FCP modified by diabetes type. Findings suggest that exposure to maternal diabetes in utero may not be an important determinant of short-term β-cell function decline in youth with type 1 or type 2 diabetes.
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Pettitt DJ, Talton JW, Liese AD, Liu LL, Crimmins N, West NA, D’Agostino RB, Kahn HS. Comparison of two waist circumference measurement protocols: the SEARCH for diabetes in youth study. Pediatr Obes 2012; 7:e81-5. [PMID: 22991230 PMCID: PMC3494800 DOI: 10.1111/j.2047-6310.2012.00088.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reports comparing waist circumference (WC) measurements from young populations are scarce. OBJECTIVES We compared two protocols for measuring waist circumference in a sample of youth with diabetes. METHODS Participants were enrolled in the SEARCH for Diabetes in Youth Study (SEARCH). WC was measured at least twice by the National Health and Nutrition Examination Survey (NHANES) protocol and twice by the World Health Organization (WHO) protocol. Method-specific averages were used in these analyses. RESULTS Among 6248 participants, the mean NHANES WC (76.3 cm) was greater than the mean WHO WC (71.9 cm). Discrepancies between protocols were greater for females than males, among older participants, and in those with higher body mass index (BMI). In both sexes and four age strata, the WCs using either method were highly correlated with BMI z-score. The within-method differences between the first and second measurements were similar for the two methods. CONCLUSIONS These analyses do not provide evidence that one of these two methods is more reproducible or is a better indicator of obesity as defined by BMI z-scores.
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Affiliation(s)
| | | | - Angela D. Liese
- Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Lenna L. Liu
- Seattle Children’s Hospital, Seattle, Washington
| | - Nancy Crimmins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Nancy A. West
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
| | | | - Henry S. Kahn
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
OBJECTIVE No guidelines for A1C measurement exist for women with gestational diabetes mellitus (GDM). The aim of this study was to document the rate of A1C decline in women with GDM. RESEARCH DESIGN AND METHODS Women with GDM in the Santa Barbara County Endocrine Clinic are managed with a carbohydrate-restricted diet and self-monitored blood glucose before and 1-h postprandial. Insulin is started if the preprandial glucose concentration is ≥90 mg/dl and/or a 1-h postprandial glucose concentration is ≥120 mg/dl. Capillary A1C was tested weekly using the DCA2000+ analyzer. RESULTS Twenty-four women with GDM (aged 29.0 ± 7.3 years) with initial A1C ≥7.0% were recruited. Baseline A1C was 8.8 ± 1.8%. Mean A1C decline was 0.47% per week (range 0.10-1.15%); the maximum was 4.3% in 4 weeks. CONCLUSIONS This study documents rapid decline in A1C during pregnancy and the utility of weekly A1C to guide therapy.
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Affiliation(s)
- Lois Jovanovic
- Sansum Diabetes Research Institute, Santa Barbara, California, USA.
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Abstract
The impact of gestational diabetes on maternal and fetal health has been increasingly recognized. However, universal consensus on the diagnostic methods and thresholds has long been lacking. Published guidelines from major societies differ considerably from one another, ranging in recommendations from aggressive screening to no routine screening at all. As a result, real-world practice is equally varied. The recently published Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, and two randomized controlled trials evaluating treatment of mild maternal hyperglycemia, have served to confirm the findings of smaller, nonrandomized studies solidifying the link between maternal hyperglycemia and adverse perinatal outcomes. In response to these studies, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) has formulated new guidelines for screening and diagnosis of diabetes in pregnancy. Key components of the IADPSG guidelines include the recommendation to screen high-risk women at the first encounter for pre-gestational diabetes, to screen universally at 24-28 weeks' gestation, and to screen with use of the 75-g oral glucose tolerance test interpreting abnormal fasting, 1-h, and 2-h plasma glucose concentrations as individually sufficient for the diagnosis of gestational diabetes. Furthermore, to translate the continuous association between maternal glucose and adverse outcomes demonstrated in the HAPO cohort, they recommend thresholds for positive screening tests at which the odds of elevated birth weight, cord C-peptide, and fetal percent body fat are 1.75 relative to odds of those outcomes at mean glucose values. Opponents to the IADPSG recommendations will likely be those who favor risk-based screening in addition to those who endorse the 50-g glucose challenge test followed by the 100-g oral glucose tolerance test as a more cost-effective, familiar, and possibly, well-validated screening tool. Others may argue that the diagnostic thresholds chosen by the IADPSG are arbitrary and will continue to miss many cases of abnormal glucose metabolism and therefore leave open the possibility of adverse perinatal outcomes due to untreated gestational diabetes. Finally, the potential economic impact of the IADPSG guidelines are unknown, and with minimal long-term data yet available on the offspring of the HAPO cohort, a true cost-effectiveness analysis will be difficult to perform accurately. Given these potential points of contention, the responses of professional and international groups to the IADPSG guidelines are difficult to gauge. Regardless, these guidelines serve to advance the discussion on appropriate screening and diagnosis of diabetes in pregnancy.
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Affiliation(s)
- Joyce Leary
- UC Davis Medical Center, Department of Internal Medicine, Sacramento, CA 95817, USA.
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Pettitt DJ, McKenna S, McLaughlin C, Patterson CC, Hadden DR, McCance DR. Maternal glucose at 28 weeks of gestation is not associated with obesity in 2-year-old offspring: the Belfast Hyperglycemia and Adverse Pregnancy Outcome (HAPO) family study. Diabetes Care 2010; 33:1219-23. [PMID: 20215449 PMCID: PMC2875426 DOI: 10.2337/dc09-2384] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes during pregnancy is a strong risk factor for obesity in the offspring, but the age at which this association becomes apparent is unknown. The purpose of this study was to examine the relation of glycemia during pregnancy with anthropometry in offspring of nondiabetic pregnant women from the Belfast U.K. center of the multinational Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. RESEARCH DESIGN AND METHODS Women from the HAPO Study were invited to participate in follow-up of their offspring aged 2 years. Measurements included height, weight, and thickness of triceps, subscapular, and suprailiac skinfolds. RESULTS A total of 1,165 offspring (73% of eligible children; 598 boys and 567 girls) were seen from ages 22-30 completed months. The only association that reached statistical significance was between categories of maternal 1-h glucose and BMI Z score >or=85th percentile at 2 years (P = 0.017). Overall the correlations between maternal glucose during pregnancy and BMI Z score at age 2 years were weak (fasting glucose r = 0.05, P = 0.08; 1-h glucose r = 0.04, P = 0.22; 2-h glucose r = 0.03, P = 0.36; and area under the curve for glucose r = 0.04, P = 0.18). CONCLUSIONS This study found little association between maternal glucose during pregnancy and obesity in the offspring at this young age. These findings are not unexpected given that study results for young offspring whose mothers had diabetes during pregnancy were indistinguishable from those for normal offspring at this age. It will be interesting to see whether, as these children age, maternal glucose during pregnancy in the ranges included in the HAPO Study will be associated with obesity in their children.
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Affiliation(s)
- David J Pettitt
- Sansum Diabetes Research Institute, Santa Barbara, California, USA.
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25
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Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C, Dabelea D, Hamman R, Waitzfelder B, Kahn HS. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes 2010; 11:4-11. [PMID: 19473302 DOI: 10.1111/j.1399-5448.2009.00519.x] [Citation(s) in RCA: 254] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Obesity's association with type 2 diabetes (T2DM) is well established, but is less clear with type 1 diabetes (T1DM). We calculated the prevalence of overweight and obesity among diabetic youth in the USA from a six-center, population-based study of racially and ethnically diverse youth with diabetes, and we compared these rates with estimates among nondiabetic youth. DESIGN/SETTING Diabetic participants were examined in 2001-2004 for the SEARCH for Diabetes in Youth study (SEARCH) and nondiabetic participants were examined during the same years of the National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS 3953 diabetic youth and 7666 nondiabetic youth aged 3-19 yr. MAIN OUTCOME MEASURES Overweight was defined as body mass index (BMI) from the 85th to <95th percentile for age and sex and obesity defined as > or = 95th percentile. Diabetes type was categorized as T1DM or T2DM based on physician diagnosis. RESULTS Among youth with T2DM, the prevalence of overweight was 10.4% and obesity was 79.4%. Among youth with T1DM, 22.1% were overweight. The prevalence of overweight among youth with T1DM was higher than among those without diabetes overall (22.1% vs. 16.1%) (P <.05). The obesity rate for T1DM was 12.6% overall (range Non-Hispanic White 10.7%-African-American 20.1%). CONCLUSIONS As expected, most of the youth with T2DM were obese. Youth with T1DM had a higher prevalence of overweight, but not of obesity, than nondiabetic youth. Future studies of obesity among youth with diabetes of all types will further our understanding of the impact of obesity on diabetes both as a risk factor and a comorbidity.
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Affiliation(s)
- Lenna L Liu
- Center for Child Health, Behavior, and Development, Seattle Children's Hospital Research Institute, Seattle, WA 98101, USA.
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Mayer-Davis EJ, Ma B, Lawson A, D'Agostino RB, Liese AD, Bell RA, Dabelea D, Dolan L, Pettitt DJ, Rodriguez BL, Williams D. Cardiovascular disease risk factors in youth with type 1 and type 2 diabetes: implications of a factor analysis of clustering. Metab Syndr Relat Disord 2009; 7:89-95. [PMID: 18847385 DOI: 10.1089/met.2008.0046] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The extent to which cardiovascular disease (CVD) risk factors cluster in youth with a diagnosis of type 1 (T1DM) or type 2 diabetes mellitus (T2DM) is unclear. Therefore, we aimed to evaluate potential clustering of traditional CVD risk factors that may reflect an unmeasured but unifying single pathology that may explain the phenomenon of the metabolic syndrome in these youths. METHODS Youths who participated in the SEARCH for Diabetes in Youth study with diabetes diagnosed <20 years, with current age >10 years (maximum current age, 22 years) were included. Confirmatory factor analysis (CFA) was performed to determine statistical associations among CVD risk factors, including obesity, blood pressure, triglycerides, and high-density lipoprotein cholesterol (HDL-C). Diabetes type was defined by diabetes autoantibodies (DAA) and fasting C-peptide (FCP); type 1 (T1DM, DAA positive, and FCP <0.8 ng/mL, n = 1198) and type 2 (T2DM, DAA negative, and FCP >2.9 ng/mL, n = 95). For T1DM, the sample was split randomly and analyses were conducted separately in each split sample. RESULTS Among five prespecified data structures ranging from a single underlying factor to a hierarchical structure of factors, the worst-fitting model for both of the T1DM split samples was the single-factor structure and the best-fitting model was a three-correlated-factor structure. The three correlated factors identified were obesity, lipids, and blood pressure. Results were very similar for youths with T2DM. CONCLUSION There is little evidence that a single factor underlies the CVD risk factor pattern in youths with diabetes. The concept of the metabolic syndrome provides a useful description of clinical characteristics but does not efficiently capture a single target for etiologic research among youths with diabetes.
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Affiliation(s)
- Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina School of Public Health, Chapel Hill, North Carolina, USA
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Lawrence JM, Mayer-Davis EJ, Reynolds K, Beyer J, Pettitt DJ, D'Agostino RB, Marcovina SM, Imperatore G, Hamman RF. Diabetes in Hispanic American youth: prevalence, incidence, demographics, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009; 32 Suppl 2:S123-32. [PMID: 19246577 PMCID: PMC2647689 DOI: 10.2337/dc09-s204] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report the 2001 prevalence and 2002-2005 incidence of type 1 and type 2 diabetes in Hispanic American youth and to describe the demographic, clinical, and behavioral characteristics of these youth. RESEARCH DESIGN AND METHODS Data from the SEARCH for Diabetes in Youth Study, a population-based multicenter observational study of youth aged 0-19 years with physician-diagnosed diabetes, were used to estimate the prevalence and incidence of type 1 and type 2 diabetes. Information obtained by questionnaire, physical examination, and blood and urine collection was analyzed to describe the characteristics of youth who completed a study visit. RESULTS Among Hispanic American youth, type 1 diabetes was more prevalent than type 2 diabetes, including in youth aged 10-19 years. There were no significant sex differences in type 1 or type 2 diabetes prevalence. The incidence of type 2 diabetes for female subjects aged 10-14 years was twice that of male subjects (P < 0.005), while among youth aged 15-19 years the incidence of type 2 diabetes exceeded that of type 1 diabetes for female subjects (P < 0.05) but not for male subjects. Poor glycemic control, defined as A1C >or=9.5%, as well as high LDL cholesterol and triglycerides were common among youth aged >or=15 years with either type of diabetes. Forty-four percent of youth with type 1 diabetes were overweight or obese. CONCLUSIONS Factors such as poor glycemic control, elevated lipids, and a high prevalence of overweight and obesity may put Hispanic youth with type 1 and type 2 diabetes at risk for future diabetes-related complications.
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Affiliation(s)
- Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
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Pedula KL, Hillier TA, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Ethnic differences in gestational oral glucose screening in a large US population. Ethn Dis 2009; 19:414-419. [PMID: 20073142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To estimate gestational diabetes mellitus (GDM) prevalence and hyperglycemia in a large multi-ethnic population and evaluate the differences in glucose measures by age and ethnicity. PARTICIPANTS AND SETTING All singleton births in Kaiser Permanente Hawaii (KPH) during 1995-2003. MEASUREMENTS Ethnicity classifications from birth certificate data were linked to KPH's electronic medical records that included laboratory-screening results. GDM screening was performed using the 50-g, 1-hour oral glucose challenge test (CCT) and the 100-g, 3-hour oral glucose tolerance test (OCTT). GDM was ascertained by both the National Diabetes Data Group (NDDG) and the Carpenter and Coustan (C&C) thresholds. RESULTS 21,130 (96%) of all pregnant women were screened for GDM using the 1-hour GCT: 21% had glucose levels exceeding the threshold of 140 mg/dL, with the highest rates in Filipinos and Chinese. African American and Caucasian groups had the lowest elevated glucose. Of those with elevated glucose, 1.3% had levels >200 mg/dL, were considered to have GDM, and not tested further; 88% underwent the 3-hour OGTT. Age-adjusted GDM prevalence was 4.4% (NDDG) and 6.6% (C&C). Koreans (6.2%) and Filipinos (6.1%) had the highest age-adjusted NDDGC GDM. African Americans (1.5%), Caucasians (2.5%), and Vietnamese (2.8%) had the lowest. CONCLUSIONS This is the first population-based study to report GDM prevalence in a large group of ethnicities represented in Hawaii. We found very diverse rates of GDM prevalence and elevated glucose among these groups. These findings point to the need for further research along several avenues, such as maternal-child outcome differences and perhaps ethnic-specific guidelines for GDM diagnosis.
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Affiliation(s)
- Kathryn L Pedula
- Science Programs Department, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 97227, USA.
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Pettitt DJ, Lawrence JM, Beyer J, Hillier TA, Liese AD, Mayer-Davis B, Loots B, Imperatore G, Liu L, Dolan LM, Linder B, Dabelea D. Association between maternal diabetes in utero and age at offspring's diagnosis of type 2 diabetes. Diabetes Care 2008; 31:2126-30. [PMID: 18694977 PMCID: PMC2571061 DOI: 10.2337/dc08-0769] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to examine age of diabetes diagnosis in youth who have a parent with diabetes by diabetes type and whether the parent's diabetes was diagnosed before or after the youth's birth. RESEARCH DESIGN AND METHODS The cohort comprised SEARCH for Diabetes in Youth Study participants (diabetes diagnosis 2001-2005) with a diabetic parent. SEARCH is a multicenter survey of youth with diabetes diagnosed before age 20 years. RESULTS Youth with type 2 diabetes were more likely to have a parent with either type 1 or type 2 diabetes (mother 39.3%; father 21.2%) than youth with type 1 diabetes (5.3 and 6.7%, respectively, P < 0.001 for each). Type 2 diabetes was diagnosed 1.68 years earlier among those exposed to diabetes in utero (n = 174) than among those whose mothers' diabetes was diagnosed later (P = 0.018, controlled for maternal diagnosis age, paternal diabetes, sex, and race/ethnicity). Age at diagnosis of type 1 diabetes for 269 youth with and without in utero exposure did not differ significantly (difference 0.96 year, P = 0.403 after adjustment). Controlled for the father's age of diagnosis, father's diabetes before the child's birth was not associated with age at diagnosis (P = 0.078 for type 1 diabetes; P = 0.140 for type 2 diabetes). CONCLUSIONS Type 2 diabetes was diagnosed at younger ages among those exposed to hyperglycemia in utero. Among youth with type 1 diabetes, the effect of the intrauterine exposure was not significant when controlled for mother's age of diagnosis. This study helps explain why other studies have found higher age-specific rates of type 2 diabetes among offspring of women with diabetes.
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Affiliation(s)
- David J Pettitt
- Sansum Diabetes Research Institute, Santa Barbara, California, USA.
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Hillier TA, Vesco KK, Pedula KL, Beil TL, Whitlock EP, Pettitt DJ. Screening for gestational diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008; 148:766-75. [PMID: 18490689 DOI: 10.7326/0003-4819-148-10-200805200-00009] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In 2003, the U.S. Preventive Services Task Force concluded that evidence was insufficient to advise for or against routinely screening all pregnant women for gestational diabetes mellitus. PURPOSE To review evidence about the benefits and harms of screening for gestational diabetes. DATA SOURCES Databases (MEDLINE, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, National Institute for Health and Clinical Effectiveness, and Cochrane Library) were searched for reports published from January 2000 to 15 November 2007 (and from 1966 to 1999 for additional studies on screening at less than 24 weeks' gestation), citations in the 2003 evidence report, and studies identified through consultation of experts and searches of bibliographies. STUDY SELECTION English-language studies that used standard 1- or 2-step testing for gestational diabetes and that evaluated at least 1 of the following outcomes: neonatal mortality; brachial plexus injury; clavicular fracture; admission to a neonatal intensive care unit for hypoglycemia, hyperbilirubinemia, or the respiratory distress syndrome; maternal mortality; and preeclampsia or pregnancy-induced hypertension. DATA EXTRACTION 2 reviewers evaluated 1607 abstracts, critically appraised 288 articles, and qualitatively synthesized 13 studies. DATA SYNTHESIS No randomized, controlled trials that directly evaluated the risks and benefits of gestational diabetes screening were found. One good-quality randomized, controlled trial of treatment of mild gestational diabetes in a screening-detected population supported a reduction in serious neonatal complications and showed that gestational diabetes treatment also reduced the risk for gestational hypertension. Very limited evidence was found to evaluate early screening for gestational diabetes (before 24 weeks' gestation). Limited evidence suggests that serious maternal hypoglycemia is rare with treatment and that overall quality of life is not worse among women receiving gestational diabetes treatment compared with women not receiving treatment. LIMITATION The literature is limited by lack of a consistent standard for screening or diagnosis of gestational diabetes. CONCLUSION Limited evidence suggests that gestational diabetes treatment after 24 weeks improves some maternal and neonatal outcomes. Evidence is even more sparse for screening before 24 weeks' gestation.
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Maahs DM, Snively BM, Bell RA, Dolan L, Hirsch I, Imperatore G, Linder B, Marcovina SM, Mayer-Davis EJ, Pettitt DJ, Rodriguez BL, Dabelea D. Higher prevalence of elevated albumin excretion in youth with type 2 than type 1 diabetes: the SEARCH for Diabetes in Youth study. Diabetes Care 2007; 30:2593-8. [PMID: 17630264 DOI: 10.2337/dc07-0450] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of an elevated albumin-to-creatinine ratio (ACR) (> or = 30 microg/mg) among youth with type 1 or type 2 diabetes and to identify factors associated with elevated ACR and their effect on the relationship between elevated ACR and type of diabetes. RESEARCH DESIGN AND METHODS Cross-sectional data were analyzed from 3,259 participants with onset of diabetes at < 20 years of age in the SEARCH for Diabetes in Youth, a multicenter observational study of diabetes in youth. Multiple logistic regression was used to explore determinants of elevated ACR and factors accounting for differences in this prevalence between type 2 and type 1 diabetes. RESULTS The prevalence of elevated ACR was 9.2% in type 1 and 22.2% in type 2 diabetes (prevalence ratio 2.4 [95% CI 1.9-3.0]; P < 0.0001). In multiple logistic regression analysis, female sex, A1C and triglyceride values, hypertension, and type of diabetes (type 2 versus type 1) were significantly associated with elevated ACR. Adjustment for variables related to insulin resistance (obesity, hypertension, dyslipidemia, and inflammation) attenuated, but did not completely explain, the association of diabetes type with elevated ACR. CONCLUSIONS Youth with type 2 diabetes have a higher prevalence of elevated ACR than youth with type 1 diabetes, in an association that apparently does not completely depend on age, duration of diabetes, race/ethnicity, sex, level of glycemic control, or features of insulin resistance.
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Affiliation(s)
- David M Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, P.O. Box 6511, Mail Stop A140, Aurora, CO 80045, USA.
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Pettitt DJ, Ospina P, Howard C, Zisser H, Jovanovic L. Efficacy, safety and lack of immunogenicity of insulin aspart compared with regular human insulin for women with gestational diabetes mellitus. Diabet Med 2007; 24:1129-35. [PMID: 17888133 PMCID: PMC2121124 DOI: 10.1111/j.1464-5491.2007.02247.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2007] [Indexed: 01/14/2023]
Abstract
AIM The efficacy and safety of insulin aspart (IAsp), a rapid-acting human insulin analogue, were compared with regular human insulin (HI) as the bolus component of basal-bolus therapy for subjects with gestational diabetes mellitus (GDM). METHODS In a randomized, parallel-group, open-labelled trial, 27 women with GDM (age 30.7 +/- 6.3 years, HbA(1c) < 7%) were randomized to receive IAsp (5 min before meal) or HI (30 min before meal). The trial period extended from diagnosis of GDM (18-28 weeks) to 6 weeks postpartum. RESULTS Both treatment groups maintained good overall glycaemic control during the study (beginning and end of study HbA(1c)< or = 6%). During the meal test, mean glucose at week 6 (IAsp 4.2 +/- 0.57 mmol/l, HI 4.8 +/- 0.86 mmol/l) was slightly lower than at week 0 (IAsp 4.9 +/- 0.59 mmol/l, HI 5.1 +/- 0.36 mmol/l). However, change from baseline values for average glucose (IAsp -1.09 +/- 0.54 mmol/l, HI -0.54 +/- 0.74 mmol/l; P = 0.003) and C-peptide (IAsp -0.50 +/- 0.67 nmol/l, HI -0.30 +/- 0.70 nmol/l; P = 0.027) were significantly lower after IAsp treatment than HI treatment. No major hypoglycaemic events were reported during the study. Cross-reacting insulin antibody binding increased slightly from baseline in both treatments groups (end of study: IAsp 2.1 +/- 5.4%, HI 6.4 +/- 13.9%), whereas antibodies specific to IAsp or HI remained relatively low (< 1% binding). CONCLUSION IAsp was more effective than HI in decreasing postprandial glucose concentrations. Duration of IAsp injection 5 min before a meal rather than 30 min prior to meals offers a more convenient therapy for subjects with GDM. Overall safety and effectiveness of IAsp were comparable to HI in pregnant women with GDM.
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Affiliation(s)
- D J Pettitt
- Sansum Diabetes Research Institute, Santa Barbara, CA 93105, USA
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Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 2007; 30:2287-92. [PMID: 17519427 DOI: 10.2337/dc06-2361] [Citation(s) in RCA: 441] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine how the range of measured maternal glycemia in pregnancy relates to risk of obesity in childhood. RESEARCH DESIGN AND METHODS Universal gestational diabetes mellitus (GDM) screening (a 50-g glucose challenge test [GCT]) was performed in two regions (Northwest and Hawaii) of a large diverse HMO during 1995-2000, and GDM was diagnosed/treated using a 3-h 100-g oral glucose tolerance test (OGTT) and National Diabetes Data Group (NDDG) criteria. Measured weight in offspring (n = 9,439) was ascertained 5-7 years later to calculate sex-specific weight-for-age percentiles using U.S. norms (1963-1994 standard) and then classified by maternal positive GCT (1 h >or= 7.8 mmol/l) and OGTT results (1 or >or=2 of the 4 time points abnormal: fasting, 1 h, 2 h, or 3 h by Carpenter and Coustan and NDDG criteria). RESULTS There was a positive trend for increasing childhood obesity at age 5-7 years (P < 0.0001; 85th and 95th percentiles) across the range of increasing maternal glucose screen values, which remained after adjustment for potential confounders including maternal weight gain, maternal age, parity, ethnicity, and birth weight. The risk of childhood obesity in offspring of mothers with GDM by NDDG criteria (treated) was attenuated compared with the risks for the groups with lesser degrees of hyperglycemia (untreated). The relationships were similar among Caucasians and non-Caucasians. Stratification by birth weight also revealed these effects in children of normal birth weight (<or=4,000 g). CONCLUSIONS Our results in a multiethnic U.S. population suggest that increasing hyperglycemia in pregnancy is associated with an increased risk of childhood obesity. More research is needed to determine whether treatment of GDM may be a modifiable risk factor for childhood obesity.
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Affiliation(s)
- Teresa A Hillier
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 97227, USA.
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Abstract
The offspring of women with diabetes during pregnancy are at high risk of developing diabetes before they reach childbearing age, resulting in a vicious cycle of diabetes and pregnancy. New cases of diabetes enter the cycle as a result of the effects of the increasing obesity among our youth. Solutions need to be found to break this cycle by preventing diabetes or delaying its onset until later in life and by normalizing glucose regulation during pregnancy.
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Affiliation(s)
- David J Pettitt
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105, USA.
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Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, Hod M, Kitzmiller JL, Kjos SL, Oats JN, Pettitt DJ, Sacks DA, Zoupas C. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007; 30 Suppl 2:S251-60. [PMID: 17596481 DOI: 10.2337/dc07-s225] [Citation(s) in RCA: 792] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Boyd E Metzger
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Pettitt DJ, Jovanovic L. Low birth weight as a risk factor for gestational diabetes, diabetes, and impaired glucose tolerance during pregnancy. Diabetes Care 2007; 30 Suppl 2:S147-9. [PMID: 17596463 DOI: 10.2337/dc07-s207] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- David J Pettitt
- Sansum Diabetes Research Institute, 2219 Bath St., Santa Barbara, CA 93105, USA.
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Affiliation(s)
- Lois Jovanovic
- Sansum Diabetes Research Institute, Santa Barbara, California 93105, USA.
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Dabelea D, Bell RA, D'Agostino RB, Imperatore G, Johansen JM, Linder B, Liu LL, Loots B, Marcovina S, Mayer-Davis EJ, Pettitt DJ, Waitzfelder B. Incidence of diabetes in youth in the United States. JAMA 2007; 297:2716-24. [PMID: 17595272 DOI: 10.1001/jama.297.24.2716] [Citation(s) in RCA: 652] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Data on the incidence of diabetes mellitus (DM) among US youth according to racial/ethnic background and DM type are limited. OBJECTIVE To estimate DM incidence in youth aged younger than 20 years according to race/ethnicity and DM type. DESIGN, SETTING, AND PARTICIPANTS A multiethnic, population-based study (The SEARCH for Diabetes in Youth Study) of 2435 youth with newly diagnosed, nonsecondary DM in 2002 and 2003, ascertained at 10 study locations in the United States, covering a population of more than 10 million person-years. MAIN OUTCOME MEASURE Incidence rates by age group, sex, race/ethnicity, and DM type were calculated per 100,000 person-years at risk. Diabetes mellitus type (type 1/type 2) was based on health care professional assignment and, in a subset, further characterized with glutamic acid decarboxylase (GAD65) autoantibody and fasting C peptide measures. RESULTS The incidence of DM (per 100,000 person-years) was 24.3 (95% confidence interval [CI], 23.3-25.3). Among children younger than 10 years, most had type 1 DM, regardless of race/ethnicity. The highest rates of type 1 DM were observed in non-Hispanic white youth (18.6, 28.1, and 32.9 for age groups 0-4, 5-9, and 10-14 years, respectively). Even among older youth (> or =10 years), type 1 DM was frequent among non-Hispanic white, Hispanic, and African American adolescents. Overall, type 2 DM was still relatively infrequent, but the highest rates (17.0 to 49.4 per 100,000 person-years) were documented among 15- to 19-year-old minority groups. CONCLUSIONS Our data document the incidence rates of type 1 DM among youth of all racial/ethnic groups, with the highest rates in non-Hispanic white youth. Overall, type 2 DM is still relatively infrequent; however, the highest rates were observed among adolescent minority populations.
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Petitti DB, Imperatore G, Palla SL, Daniels SR, Dolan LM, Kershnar AK, Marcovina S, Pettitt DJ, Pihoker C. Serum lipids and glucose control: the SEARCH for Diabetes in Youth study. ACTA ACUST UNITED AC 2007; 161:159-65. [PMID: 17283301 DOI: 10.1001/archpedi.161.2.159] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the relationship of serum lipid concentrations with glucose control in youth with diabetes mellitus. DESIGN Cross-sectional analyses of data from the SEARCH for Diabetes in Youth study. SETTING Multicenter study of youth with diabetes onset at younger than 20 years. PATIENTS/ PARTICIPANTS: Nineteen hundred seventy-three SEARCH participants aged 10 years or older with hemoglobin A(1c) and fasting total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride measured at the SEARCH study examination. MAIN EXPOSURE Hemoglobin A(1c). OUTCOME MEASURE Lipid concentrations. RESULTS There were significant trends of higher levels of TC, LDL-C, triglyceride, and non-HDL-C (but not HDL-C) with higher hemoglobin A(1c) concentrations for both diabetes types. The slopes of TC increase were 7.8 mg/dL (0.20 mmol/L) per unit increase in hemoglobin A(1c) for type 1 and 8.1 mg/dL (0.21 mmol/L) for type 2. Levels of TC, LDL-C, triglyceride, and non-HDL-C were all significantly higher (all P values <.001) in type 2 than in type 1 diabetes (mean differences in milligrams per deciliter [millimoles per liter], +13.6 [+0.35] for TC; +8.3 [+0.22] for LDL-C; +66.3 [+0.75] for triglyceride; +25.5 [+0.66] for non-HDL-C). Levels of HDL-C were lower in youth with type 2 diabetes (mean difference, -11.9 mg/dL [-0.31 mmol/L]). Among those with type 1 diabetes in poor glycemic control, 35%, 27%, and 12% had high concentrations of TC (>or=200 mg/dL [5.17 mmol/L]), LDL-C (>or=130 mg/dL [3.36 mmol/L]), and triglyceride (>or=200 mg/dL [2.26 mmol/L]), respectively. In youth with type 2 diabetes in poor glycemic control, percentages with high levels of TC, LDL-C, and triglycerides were 65%, 43%, and 40%, respectively. CONCLUSIONS Glycemic control and lipid levels are independently associated in youth with both type 1 and type 2 diabetes.
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Affiliation(s)
- Diana B Petitti
- Department of Research and Evaluation, Kaiser Permanente Southern California, 393 E Walnut St, Pasadena, CA 91188, USA.
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Ferrara A, Weiss NS, Hedderson MM, Quesenberry CP, Selby JV, Ergas IJ, Peng T, Escobar GJ, Pettitt DJ, Sacks DA. Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below the National Diabetes Data Group thresholds for gestational diabetes mellitus, are related to the risk of neonatal macrosomia, hypoglycaemia and hyperbilirubinaemia. Diabetologia 2007; 50:298-306. [PMID: 17103140 DOI: 10.1007/s00125-006-0517-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 10/02/2006] [Indexed: 12/20/2022]
Abstract
AIMS/HYPOTHESIS Gestational diabetes mellitus (GDM) is a risk factor for perinatal complications. In several countries, the criteria for the diagnosis of GDM have been in flux, the American Diabetes Association (ADA) thresholds recommended in 2000 being lower than those of the National Diabetes Data Group (NDDG) that have been in use since 1979. We sought to determine the extent to which infants of women meeting only the ADA criteria for GDM are at increased risk of neonatal complications. MATERIALS AND METHODS In a multiethnic cohort of 45,245 women who did not meet the NDDG criteria and were not treated for GDM, we conducted nested case-control studies of three complications of GDM that occurred in their infants: macrosomia (birthweight >4,500 g, n = 494); hypoglycaemia (plasma glucose <2.2 mmo/l, n = 488); and hyperbilirubinaemia (serum bilirubin > or =342 micromol/l (20 mg/dl), n = 578). We compared prenatal glucose levels of the mothers of these infants and mothers of 884 control infants. RESULTS Women with GDM by ADA criteria only (two or more glucose values exceeding the threshold) had an increased risk of having an infant with macrosomia (odds ratio OR = 3.40, 95% CI = 1.55-7.43), hypoglycaemia (OR = 2.61, 95% CI = 0.99-6.92) or hyperbilirubinaemia (OR = 2.22, 95% CI = 0.98-5.04). Glucose levels 1 h after the 100-g glucose challenge that exceeded the ADA threshold were particularly strongly associated with each complication. CONCLUSIONS/INTERPRETATION These results lend support to the ADA recommendations and highlight the importance of the 1-h glucose measurement in a diagnostic test for GDM.
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Affiliation(s)
- A Ferrara
- Division of Research, Kaiser Permanente Medical Care Program of Northern California, 2000 Broadway, Oakland, CA 94612, USA.
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Hedderson MM, Weiss NS, Sacks DA, Pettitt DJ, Selby JV, Quesenberry CP, Ferrara A. Pregnancy weight gain and risk of neonatal complications: macrosomia, hypoglycemia, and hyperbilirubinemia. Obstet Gynecol 2006; 108:1153-61. [PMID: 17077237 DOI: 10.1097/01.aog.0000242568.75785.68] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether pregnancy weight gains outside the Institute of Medicine (IOM) recommendations and rates of maternal weight gain are associated with neonatal complications. METHODS In a cohort of 45,245 women who delivered singletons at Kaiser Permanente Medical Care Program Northern California in 1996-1998 and who did not have gestational diabetes as of 24-28 weeks of gestation, we conducted a nested case-control study with three case groups: macrosomia (birth weight more than 4,500 g, n=391), neonatal hypoglycemia (plasma glucose less than 40 mg/dL, n=328), and hyperbilirubinemia (serum bilirubin 20 mg/dL or more, n=432) and one control group (n=652). Medical records were reviewed to ascertain the woman's prepregnancy and predelivery weight. RESULTS Adjusting for age, race-ethnicity, parity, plasma glucose screening value, and difference in weeks between delivery and time when last weight was measured, women who gained more than recommended by the IOM were three times more likely to have an infant with macrosomia (odds ratio [OR] 3.05, 95% confidence interval [CI] 2.19-4.26), and nearly 1.5 times as likely to have an infant with hypoglycemia (OR 1.38, 95% CI 1.01-1.89), or hyperbilirubinemia (OR 1.43, 95% CI 1.06-1.93) than women whose weight gain was in the recommended range. Women who gained less than the IOM recommendations were less likely than women in the recommended range to have an infant with macrosomia (OR 0.38, 95% CI 0.20-0.70), but equally likely to have an infant with hypoglycemia or hyperbilirubinemia. Similar results were obtained using other means of categorizing weight gain during pregnancy. CONCLUSION Maternal weight gain above the IOM recommendations was associated with an increased risk of the outcomes studied. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Monique M Hedderson
- Division of Research, Kaiser Permanente Medical Care Program of Northern California, Oakland, California 94612, USA.
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Kershnar AK, Daniels SR, Imperatore G, Palla SL, Petitti DB, Pettitt DJ, Marcovina S, Dolan LM, Hamman RF, Liese AD, Pihoker C, Rodriguez BL. Lipid abnormalities are prevalent in youth with type 1 and type 2 diabetes: the SEARCH for Diabetes in Youth Study. J Pediatr 2006; 149:314-9. [PMID: 16939739 DOI: 10.1016/j.jpeds.2006.04.065] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 02/24/2006] [Accepted: 04/24/2006] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Assessment of the prevalence of serum lipid abnormalities in US youth with type 1 or type 2 diabetes. STUDY DESIGN The SEARCH for Diabetes in Youth Study was a cross-sectional, population-based study, conducted in six centers. Subjects were 2448 youth with diabetes who had a study examination. Outcome measures were fasting measures of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and non-HDL-C. Analysis was descriptive. RESULTS The overall prevalence of high TC concentration (>240 mg/dL) was 5%; the overall prevalence of high LDL-C (>160 mg/dL) was 3%, and the overall prevalence of high triglyceride (>400 mg/dL) was 2%. About half of the participants (48%) had an LDL-C concentration above the optimal level of 100 mg/dL. Among youth ages 10+, the prevalence of abnormal lipids was higher in type 2 (n = 283) than in type 1 diabetes (n = 1963): 33% versus 19% had TC concentration >200 mg/dL; 24% versus 15% had LDL-C concentration >130 mg/dL; 29% versus 10% had triglyceride concentration >150 mg/dL; 44% versus 12% had HDL-C concentration <40 mg/dL. Only 1% of youth were receiving pharmacologic therapy for dyslipidemia. CONCLUSIONS A substantial proportion of young patients with diabetes have abnormal serum lipids.
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Affiliation(s)
- Ann K Kershnar
- Research and Evaluation, Kaiser Permanente Southern California, 9449 East Imperial Highway, Downey, CA 90242, USA.
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Pettitt DJ, Jovanovic L. Do we know how to find gestational diabetes mellitus? Clin Chem 2006; 52:1633-4. [PMID: 16940459 DOI: 10.1373/clinchem.2006.071704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dabelea D, D'Agostino RB, Mayer-Davis EJ, Pettitt DJ, Imperatore G, Dolan LM, Pihoker C, Hillier TA, Marcovina SM, Linder B, Ruggiero AM, Hamman RF. Testing the accelerator hypothesis: body size, beta-cell function, and age at onset of type 1 (autoimmune) diabetes. Diabetes Care 2006; 29:290-4. [PMID: 16443875 DOI: 10.2337/diacare.29.02.06.dc05-1339] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The "accelerator hypothesis" predicts that fatness is associated with an earlier age at onset of type 1 diabetes. We tested the hypothesis using data from the SEARCH for Diabetes in Youth study. RESEARCH DESIGN AND METHODS Subjects were 449 youth aged <20 years at diagnosis who had positive results for diabetes antibodies measured 3-12 months after diagnosis (mean 7.6 months). The relationships between age at diagnosis and fatness were examined using BMI as measured at the SEARCH visit and reported birth weight, both expressed as SD scores (SDSs). RESULTS Univariately, BMI SDS was not related to age at diagnosis. In multiple linear regression, adjusted for potential confounders, a significant interaction was found between BMI SDS and fasting C-peptide (FCP) on onset age (P < 0.0001). This interaction remained unchanged after additionally controlling for number and titers of diabetes antibodies. An inverse association between BMI and age at diagnosis was present only among subjects with FCP levels below the median (<0.5 ng/ml) (regression coefficient -7.9, P = 0.003). A decrease of 1 SDS in birth weight (639 g) was also associated with an approximately 5-month earlier age at diagnosis (P = 0.008), independent of sex, race/ethnicity, current BMI, FCP, and number of diabetes antibodies. CONCLUSIONS Increasing BMI is associated with younger age at diagnosis of type 1 diabetes only among those U.S. youth with reduced beta-cell function. The intrauterine environment may also be an important determinant of age at onset of type 1 diabetes.
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Affiliation(s)
- Dana Dabelea
- University of Colorado Health Sciences Center, Denver, Colorado, USA.
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Pettitt DJ, Okada Wollitzer A, Jovanovic L, He G, Ipp E. Decreasing the risk of diabetic retinopathy in a study of case management: the California Medi-Cal Type 2 Diabetes Study. Diabetes Care 2005; 28:2819-22. [PMID: 16306539 DOI: 10.2337/diacare.28.12.2819] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetic retinopathy affects >60% of people with type 2 diabetes during the first 2 decades of the disease and is ameliorated by good glycemic control. This study tested whether intensive diabetes case management could prevent or delay diabetic retinopathy in patients with established type 2 diabetes. RESEARCH DESIGN AND METHODS This study was part of a randomized, controlled clinical trial of diabetes case management in type 2 diabetes in southern California counties serving low income ethnic minority populations. Subjects were randomized to intervention (diabetes case management) or control (traditional treatment) groups. Subjects with at least two retinal photographs (n = 149) were included in this analysis to assess the effect of intervention on development or progression of diabetic retinopathy. RESULTS Progression of retinopathy in the intervention group was not significantly less than in the control group (P = 0.226). However, those in the intervention group with no evidence of retinopathy at baseline were less likely to develop diabetic retinal changes (5/48) during a mean follow-up of 23.1 months than those in the control group (10/34, chi(2) = 4.805, P = 0.028). This difference remained significant in a logistic regression model that controlled for potential confounders (odds ratio 5.35 [95% CI 1.14-25.12]). CONCLUSIONS This study shows that a relatively short duration of case management instituted before the onset of clinically identifiable retinopathy significantly diminished the risk of developing retinopathy in patients with type 2 diabetes. The findings also emphasized the retinal disease burden in this population, with development and progression of retinopathy occurring in <2 years.
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Affiliation(s)
- David J Pettitt
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105, USA
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46
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Reboussin DM, Goff DC, Lipkin EW, Herrington DM, Summerson J, Steffes M, Crouse RJ, Jovanovic L, Feinglos MN, Probstfield JL, Banerji MA, Pettitt DJ, Williamson J. The combination oral and nutritional treatment of late-onset diabetes mellitus (CONTROL DM) trial results. Diabet Med 2004; 21:1082-9. [PMID: 15384954 DOI: 10.1111/j.1464-5491.2004.01289.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the effect of short-term improvements in glycaemic control on brachial artery endothelial function as a marker of cardiovascular health. METHODS Persons with Type 2 diabetes who were poorly controlled on oral therapy were randomly assigned to monotherapy with repaglinide or combination therapy with repaglinide plus metformin. Brachial artery flow-mediated vasodilation was assessed by ultrasonography at randomization and following 16 weeks of therapy. The primary outcome was change in brachial artery endothelial function from baseline. Comparison of randomized groups was a secondary aim. RESULTS Eighty-six participants were randomized, and 83 were followed to study completion. Post occlusion brachial artery vasodilation was 3.74% at baseline and 3.82% following 16 weeks of therapy (P = 0.77). The treatment effect was 0.08% (95% CI: -0.48%, 0.64%). No difference was seen between treatment groups (P = 0.69). Overall, A1C was reduced from 8.3% to 7.0%, with a greater reduction in the combination therapy group (from 8.4% to 6.7%) than in the monotherapy group (from 8.3% to 7.3%, p for difference between groups = 0.01). Statistically significant reductions were observed in fasting glucose, and plasminogen activator inhibitor-1. Statistically significant increases were observed for fasting insulin, uric acid, weight and BMI. CONCLUSIONS Brachial artery endothelial function was not influenced by short-term improvements in glycaemic control. The CONTROL DM group was successful in lowering A1C. Future research should explore more intensive and longer-lasting improvements in glycaemic control on endothelial function. Some data previously published in abstract form (Diabetes 2001; 50 (Suppl. 2): A217).
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Affiliation(s)
- D M Reboussin
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Jovanovic L, Giammattei J, Acquistapace M, Bornstein K, Sommermann E, Pettitt DJ. Efficacy Comparison between preprandial and postprandial insulin aspart administration with dose adjustment for unpredictable meal size. Clin Ther 2004; 26:1492-7. [PMID: 15531011 DOI: 10.1016/j.clinthera.2004.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with type 1 diabetes mellitus (DM) may encounter situations in which meal size and content is unpredictable. In theory, postprandial injection of rapid-acting insulin analogues could prove more effective in achieving glucose control at such times because this treatment strategy could allow adjustment of insulin dose for the actual size of the meal consumed rather than being based on an estimate of what will be consumed. OBJECTIVE This study compared the postprandial glycemic control achieved with meal-related insulin aspart injected immediately before a meal with that injected immediately after a meal. METHODS This randomized, crossover study was conducted at Sansum Diabetes Research Institute, Santa Barbara, California. Adult patients with type 1 DM were enrolled. At study visit 1, patients were randomly assigned to inject insulin aspart 0 to 5 minutes before the start of the meal or immediately after the meal. The timing of injection relative to the meal was reversed at study visit 2. The meal-related dose was calculated based on the anticipated caloric and carbohydrate intake (preprandial injection) or actual calories and carbohydrates ingested (postprandial injection). Postprandial blood glucose concentrations were evaluated as markers of efficacy of postprandial aspart administration. RESULTS Twenty patients were enrolled in the study (mean [SE] duration of DM, 22.5 [3.2] years; mean [SE] body mass index, 26.2 [1.0] kg/M2; age range, 22-82 years); 19 completed it. Total glucose AUC during the meal test was 22% less when insulin aspart was injected immediately before the study meal (mean [SE], 23,014 [1832] mg/dL.min) than when injected immediately after the meal (mean [SE], 29,535 [2243] mg/dL.min) (P < 0.001), but baseline-adjusted AUC was similar. Maximum mean (SD) glucose concentrations in the postprandial period were <180 mg/dL, the current DM treatment goals specified by the American Diabetes Association (149.0 [9.9] mg/dL and 102.0 [9.2] mg/dL, following postprandial insulin aspart injection and preprandial injection, respectively; P < 0.001). There was variation in the number of calories consumed, but patients consumed a similar number of calories in the 2 treatment regimens. The frequency of postprandial hypoglycemia was comparable. Adjustment of postprandial insulin aspart dose for the actual meal size consumed maintained postprandial glucose concentrations within currently recommended treatment guidelines. CONCLUSIONS Preprandial insulin aspart injection produced a better glucose profile and is preferred when conditions permit. However, both preprandial and postprandial insulin aspart administration achieved postprandial glucose concentrations within currently recommended treatment guidelines.
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Affiliation(s)
- Lois Jovanovic
- Sansum Diabetes Research Institute, Santa Barbara, California 93105, USA.
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Pettitt DJ, Giammattei J, Wollitzer AO, Jovanovic L. Glycohemoglobin (A1C) distribution in school children: results from a school-based screening program. Diabetes Res Clin Pract 2004; 65:45-9. [PMID: 15163477 DOI: 10.1016/j.diabres.2003.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2002] [Accepted: 11/24/2003] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To establish the normal distribution for glycohemoglobin (A1C) in sixth and seventh grade children and to assess the practicality of a school-based fingerstick screening program. RESEARCH DESIGN AND METHODS Fingerstick capillary whole blood was collected from 400 children aged 11 to 13 years and the percent A1C was determined on-site. RESULTS Among the boys, the A1C was significantly higher among the minorities (4.88+/-0.37%, mean+/-S.D.) than among the non-hispanic whites (4.73+/-0.41%, P<0.01), but was similar in the two groups of girls (4.74+/-0.41 and 4.75+/-0.34, respectively, P=0.88). None of the students had abnormal glucose tolerance by the standards published for adults. CONCLUSIONS A1C in boys was higher among minorities than among the non-hispanic whites, even at this young age of 11-13 years. This may be an early sign of predisposition to type 2 diabetes among the groups known to be at higher risk for type 2 diabetes. However, this difference was not seen among girls. Reasons for the discrepancy between boys and girls is unexplained. A school-based fingerstick screening program proved to be practical. As the risk of obesity-related diseases, such as type 2 diabetes mellitus, increases among youth, the classroom may become an important location for screening.
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Affiliation(s)
- David J Pettitt
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105, USA.
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Giammattei J, Blix G, Marshak HH, Wollitzer AO, Pettitt DJ. Television watching and soft drink consumption: associations with obesity in 11- to 13-year-old schoolchildren. Arch Pediatr Adolesc Med 2003; 157:882-6. [PMID: 12963593 DOI: 10.1001/archpedi.157.9.882] [Citation(s) in RCA: 235] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To determine the prevalence of obesity among sixth- and seventh-grade students in a school-based setting, and to identify lifestyle parameters associated with obesity. METHODS Sixth- and seventh-grade students (n = 385, 186 boys and 199 girls) from 3 schools participated in a school-based screening study, and 319 completed a short questionnaire. Height and weight were measured, and body fat as a percentage of body weight was obtained using a Tanita bioelectrical impedance scale. RESULTS Overall, 35.3% of students had a body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) at or above the 85th percentile, and half these students (17.4%) had a BMI at or above the 95th percentile. Rates were higher among Latino and lower among Asian than non-Hispanic white students. Significant associations were found between BMI and hours of television watched per evening and daily soft drink consumption. The mean (SE) BMI z score for those watching less than 2 hours per night (0.34 [0.09]) was lower than for those watching 2 or more hours per night (0.82 [0.08]; P<.001). The mean (SE) BMI z score for those consuming less than 3 soft drinks per day (0.51 [0.07]) was lower than for those consuming 3 or more soft drinks per day (1.02 [0.13]; P =.003). Latino students watched more television (2.4 hours per night) than did non-Hispanic white or Asian students (1.3 hours per night; P<.001 for each) and consumed more soft drinks (1.6 per day) than non-Hispanic white students (1.1 per day; P =.004) or Asian students (0.7 per day; P<.001). CONCLUSIONS Time spent watching television and the number of soft drinks consumed were significantly associated with obesity. Latinos spent more time watching television and consumed more soft drinks than did non-Hispanic white or Asian students. These findings will be beneficial in developing preventive measures for these children.
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Affiliation(s)
- Joyce Giammattei
- Department of Health Promotion and Education, School of Public Health, Loma Linda University, Loma Linda, CA, USA
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50
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Pettitt DJ, Ospina P, Kolaczynski JW, Jovanovic L. Comparison of an insulin analog, insulin aspart, and regular human insulin with no insulin in gestational diabetes mellitus. Diabetes Care 2003; 26:183-6. [PMID: 12502678 DOI: 10.2337/diacare.26.1.183] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the short-term efficacy of insulin aspart in comparison with regular human insulin in women with gestational diabetes mellitus (GDM) during standardized meal tests. RESEARCH DESIGN AND METHODS The study included 15 women with GDM who had inadequate diabetes control with diet alone. On 3 consecutive days, breakfast meal tests were performed-the first with no exogenous insulin and the other two after the injection of either regular insulin or insulin aspart. RESULTS The peak insulin concentration was higher and the peak glucose and C-peptide concentrations were lower with both insulin preparations than with no exogenous insulin. Glucose areas under the curve above baseline were significantly lower with insulin aspart (180-min area, 7.1 mg. h. dl(-1); P = 0.018), but not with regular insulin (30.2 mg. h. dl(-1); P = 0.997), than with no insulin (29.4 mg. h. dl(-1)). CONCLUSIONS This study demonstrates that effective postprandial glycemic control in women with GDM who required insulin was brought about by insulin aspart through higher insulin peak and lower demand on endogenous insulin secretion.
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Affiliation(s)
- David J Pettitt
- Sansum Medical Research Institute, Santa Barbara, California. Novo Nordisk Pharmaceuticals, Inc., Princeton, New Jersey, USA.
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