1
|
Giraudo F, Salinas A, Merino PM, Iñiguez G, López P, Castro A, Lardone MC, Cavada G, Cassorla F, Codner E. Subdermal Progestin Implant and an Oral Combined Hormonal Contraceptive in Youth with Type 1 Diabetes. J Pediatr Adolesc Gynecol 2024; 37:177-183. [PMID: 38012981 DOI: 10.1016/j.jpag.2023.11.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
STUDY OBJECTIVE To determine the metabolic effects of the subcutaneous etonogestrel implant compared with an oral contraceptive in adolescents and young adults (AYAs) with type 1 diabetes (T1D) on body weight, body composition, glucose, lipids, and C-reactive protein levels. METHODS This was a non-randomized, interventional, prospective study. Thirty-nine AYAs with T1D participated; 20 used the implant (Implant-T1D), and 19 used an oral combined contraceptive (OC-T1D). Body composition, HbA1c, intermittent continuous glucose monitoring, lipids, and high-sensitivity C-reactive protein (hsCRP) levels were evaluated. RESULTS All participants were followed for at least 12 months, and 26 completed the 24-month follow-up. No women discontinued the intervention due to adverse effects. Body weight increased by 0.8 ± 3.5 and 1 ± 2.9 kg in the OC-T1D and the Implant-T1D group at 12 months and by 2.6 ± 3.9 and 3.3 ± 3.6 kg at 24 months, respectively. OC-T1D and Implant-T1D had similar HbA1c, mean interstitial glucose levels, and time in range throughout the study; no significant difference over time was observed. hsCRP levels increased in both groups and were associated with BMI and HbA1c (P < .001 for both variables). Women in the OC-T1D group had higher total cholesterol, HDL-C, and triglyceride levels compared with the Implant-T1D. CONCLUSION Glucose levels were similar in youth using the subdermal progestin implant and an OC. However, both AYA groups showed increased BMI, fat mass, and subclinical inflammation. Changes in lipid levels were associated with the OC method. These data highlight the importance of weight gain prevention in young women with T1D using hormonal contraception.
Collapse
Affiliation(s)
- Franco Giraudo
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Abril Salinas
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Chilean Institute of Reproductive Medicine (ICMER), Santiago, Chile, 8320165
| | - Paulina M Merino
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Germán Iñiguez
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Patricia López
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Andrea Castro
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - María Cecilia Lardone
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Gabriel Cavada
- Public Health, School of Medicine, University of Chile, Santiago, Chile, 8380453
| | - Fernando Cassorla
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160.
| |
Collapse
|
2
|
de Bock M, Codner E, Craig ME, Huynh T, Maahs DM, Mahmud FH, Marcovecchio L, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatr Diabetes 2022; 23:1270-1276. [PMID: 36537523 PMCID: PMC10107615 DOI: 10.1111/pedi.13455] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, Universidad de Chile, Santiago, Chile
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.,Discipline of Paediatrics & Child Health, School of Clinical Medicine, University of New South Wales Medicine & Health, Sydney, Australia
| | - Tony Huynh
- Department of Endocrinology & Diabetes, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Department of Chemical Pathology, Mater Pathology, South Brisbane, Queensland, Australia.,School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David M Maahs
- Department of Pediatrics, Division of Endocrinology, Lucile Salter Packard Children's Hospital, Stanford University, Stanford, California, USA.,Stanford Diabetes Research Center, Stanford University, Stanford, California, USA.,Department of Epidemiology, Stanford University, Stanford, California, USA
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Linda A DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
3
|
Greeley SAW, Polak M, Njølstad PR, Barbetti F, Williams R, Castano L, Raile K, Chi DV, Habeb A, Hattersley AT, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: The diagnosis and management of monogenic diabetes in children and adolescents. Pediatr Diabetes 2022; 23:1188-1211. [PMID: 36537518 PMCID: PMC10107883 DOI: 10.1111/pedi.13426] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Siri Atma W. Greeley
- Section of Pediatric and Adult Endocrinology, Diabetes and Metabolism, Kovler Diabetes Center and Comer Children's HospitalUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Michel Polak
- Hôpital Universitaire Necker‐Enfants MaladesUniversité de Paris Cité, INSERM U1016, Institut IMAGINEParisFrance
| | - Pål R. Njølstad
- Department of Clinical ScienceUniversity of Bergen, and Children and Youth Clinic, Hauk eland University HospitalBergenNorway
| | - Fabrizio Barbetti
- Clinical Laboratory UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Rachel Williams
- National Severe Insulin Resistance ServiceCambridge University Hospitals NHS TrustCambridgeUK
| | - Luis Castano
- Endocrinology and Diabetes Research Group, Biocruces Bizkaia Health Research InstituteCruces University Hospital, CIBERDEM, CIBERER, Endo‐ERN, UPV/EHUBarakaldoSpain
| | - Klemens Raile
- Department of Paediatric Endocrinology and DiabetologyCharité – UniversitätsmedizinBerlinGermany
| | - Dung Vu Chi
- Center for Endocrinology, Metabolism, Genetics and Molecular Therapy, Departement of Pediatric Endocrinology and DiabetesVietnam National Children's HospitalHanoiVietnam
- Department of Pediatrics and Department of Biology and Medical GeneticsHanoi Medical UniversityHanoiVietnam
| | - Abdelhadi Habeb
- Department of PediatricsPrince Mohamed bin Abdulaziz Hopsital, National Guard Health AffairsMadinahSaudi Arabia
| | - Andrew T. Hattersley
- Institute of Biomedical and Clinical SciencesUniversity of Exeter Medical SchoolExeterUK
| | - Ethel Codner
- Institute of Maternal and Child ResearchSchool of Medicine, University of ChileSantiagoChile
| |
Collapse
|
4
|
Craig ME, Codner E, Mahmud FH, Marcovecchio ML, DiMeglio LA, Priyambada L, Wolfsdorf JI. ISPAD Clinical Practice Consensus Guidelines 2022: Editorial. Pediatr Diabetes 2022; 23:1157-1159. [PMID: 36537535 PMCID: PMC10107778 DOI: 10.1111/pedi.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.,Discipline of Paediatrics & Child Health, School of Clinical Medicine, University of New South Wales Medicine & Health, Sydney, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, Universidad de Chile, Santiago, Chile
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | | | - Linda A DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leena Priyambada
- Division of Pediatric Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, USA.,Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Cengiz E, Danne T, Ahmad T, Ayyavoo A, Beran D, Ehtisham S, Fairchild J, Jarosz-Chobot P, Ng SM, Paterson M, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1277-1296. [PMID: 36537533 DOI: 10.1111/pedi.13442] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Eda Cengiz
- University of California San Francisco (UCSF) Pediatric Diabetes Program, UCSF School of Medicine, San Francisco, California, USA
| | - Thomas Danne
- Auf Der Bult, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Tariq Ahmad
- Pediatric Endocrinology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Ahila Ayyavoo
- Department of Pediatrics, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine University of Geneva and Geneva University Hospitals, Faculty of Medicine Diabetes Centre, Geneva, Switzerland
| | - Sarah Ehtisham
- Division of Pediatric Endocrinology, Mediclinic City Hospital, Dubai, UAE
| | - Jan Fairchild
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, Australia
| | | | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Southport, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Megan Paterson
- John Hunter Children's Hospital, HRMC, New South Wales, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
6
|
Phelan H, Hanas R, Hofer SE, James S, Landry A, Lee W, Wood JR, Codner E. Sick day management in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:912-925. [PMID: 36093857 DOI: 10.1111/pedi.13415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Helen Phelan
- Pediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla Hospital, Uddevalla, and Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Alanna Landry
- Department of Paediatrics, Oak Valley Health, Markham, Ontario, Canada
| | - Warren Lee
- Dr. Warren Lee's Paediatrics, Growth & Diabetes Centre, and KK Hospital, Singapore, Singapore
| | - Jamie R Wood
- University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
7
|
Gregory JW, Cameron FJ, Joshi K, Eiswirth M, Garrett C, Garvey K, Agarwal S, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence. Pediatr Diabetes 2022; 23:857-871. [PMID: 36250644 PMCID: PMC9828225 DOI: 10.1111/pedi.13408] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- John W. Gregory
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Fergus J. Cameron
- Royal Children's HospitalMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia,Department of PaediatricsUniversity of MelbourneMelbourneAustralia
| | - Kriti Joshi
- Department of Endocrinology & DiabetesQueensland Children's HospitalSouth BrisbaneAustralia
| | - Mirjam Eiswirth
- Department of Anglophone StudiesUniversität Duisburg EssenEssenGermany
| | - Christopher Garrett
- Institute of Psychiatry, Psychology and NeuroscienceBart's Health and East London Foundation TrustLondonUK
| | - Katharine Garvey
- Division of EndocrinologyBoston Children's HospitalBostonMassachusettsUSA
| | - Shivani Agarwal
- Department of Medicine (Endocrinology), Albert Einstein College of MedicineMontefiore Medical CenterBronxNew YorkUSA
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de MedicinaUniversity of ChileSantiagoChile
| |
Collapse
|
8
|
Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 2022; 23:835-856. [PMID: 36250645 DOI: 10.1111/pedi.13406] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Nicole Glaser
- Department of Pediatrics, Section of Endocrinology, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Maria Fritsch
- Department of Pediatric and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Austria Medical University of Graz, Graz, Austria
| | - Leena Priyambada
- Division of Pediatric Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Arleta Rewers
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Sylvia Estrada
- Department of Pediatrics, Division of Endocrinology and Metabolism, University of the Philippines, College of Medicine, Manila, Philippines
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
9
|
Peña AS, Codner E, Witchel S. Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12081931. [PMID: 36010282 PMCID: PMC9406411 DOI: 10.3390/diagnostics12081931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/11/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions in women. PCOS may be more challenging to diagnose during adolescence due to an overlap with the physiological events of puberty, which are part of the diagnostic criteria in adult women. This review focuses on the evidence available in relation to PCOS diagnostic criteria for adolescents. Adolescent PCOS should be diagnosed using two main criteria irregular -menstrual cycles (relative to number of years post-menarche) and hyperandrogenism (clinical and/or biochemical); after excluding other conditions that mimic PCOS. Accurate definitions of the two main criteria will decrease challenges/controversies with the diagnosis and provide timely diagnosis during adolescence to establish early management. Despite the attempts to create accurate diagnostic criteria and definitions, this review highlights the limited research in this area, especially in the follow up of adolescents presenting with one diagnostic feature that are called “at risk of PCOS”. Studies in adolescents continue to use the Rotterdam diagnostic criteria that uses pelvic ultrasound. This is inappropriate, because previous and emerging data that show many healthy adolescents have polycystic ovarian morphology in the early years post-menarche. In the future, anti-Müllerian hormone levels might help support PCOS diagnosis if adolescents meet two main criteria.
Collapse
Affiliation(s)
- Alexia S. Peña
- Discipline of Paediatrics, The University of Adelaide Robinson Research Institute, 72 King William Road, Adelaide, SA 5006, Australia
- Endocrinology and Diabetes Department, Women’s and Children’s Hospital, 72 King William Road, Adelaide, SA 5006, Australia
- Correspondence: ; Tel.: +61-881618134
| | - Ethel Codner
- Institute of Child and Maternal Research, School of Medicine, University of Chile, Santiago 836-0160, Chile
| | - Selma Witchel
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA
| |
Collapse
|
10
|
Harnois-Leblanc S, Hernandez MI, Codner E, Cassorla F, Oberfield SE, Leibel NI, Mathew RP, Ten S, Magoffin DA, Lane CJ, Goran MI, Azziz R, Baillargeon JP, Geller DH. Profile of Daughters and Sisters of Women With Polycystic Ovary Syndrome: The Role of Proband's Glucose Tolerance. J Clin Endocrinol Metab 2022; 107:e912-e923. [PMID: 34752621 PMCID: PMC8851929 DOI: 10.1210/clinem/dgab812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/21/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT First-degree relatives of women with polycystic ovary syndrome (PCOS) present hormonal and metabolic alterations compared to girls unrelated to PCOS. It is unknown whether glucose intolerance in the PCOS proband confers a more severe metabolic predisposition on their first-degree relatives. OBJECTIVE To determine whether glucose tolerance status in women with PCOS is associated with worsened glucose metabolism and sex hormone levels in their peripubertal daughters or sisters. DESIGN Cross-sectional study. SETTING Seven academic centers in North America, South America, and Europe. PATIENTS Sixty-four pairs of women with PCOS and their daughters or younger sisters aged between 8 and 14 years were recruited. Twenty-five mothers or older sisters with PCOS were glucose intolerant (GI) and 39 were normal glucose tolerant (NGT). MAIN OUTCOME MEASURES Beta-cell function estimated by the insulin secretion-sensitivity index-2 (ISSI-2) during an oral glucose tolerance test and by the disposition index during a frequently sampled IV glucose tolerance test. Free testosterone and 17-hydroxyprogesterone (17-OHP) levels. RESULTS Being related to a GI PCOS proband was associated with a lower ISSI-2 (P-value = 0.032) after adjusting for ethnicity, body mass index z-score, and pubertal stage. They also had higher free testosterone (P-value = 0.011) and 17-OHP levels compared to girls with an NGT proband, the latter becoming significant after adjusting for confounders (P-value = 0.040). CONCLUSIONS Compared to first-degree female relatives of women with PCOS and NGT, first-degree relatives of women with PCOS and GI display lower beta-cell function and hyperandrogenemia, putting them at higher risk of GI and PCOS development.
Collapse
Affiliation(s)
- Soren Harnois-Leblanc
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Preventive and Social Medicine, School of Public Health, Université de Montréal, Montréal, QC, H3T 1J4, Canada
- Current Affiliation: The current affiliation of S. H-L is the Department of Preventive and Social Medicine, School of Public Health, Université de Montréal, Montréal, QC, H3T 1J4, Canada
| | - Maria Isabel Hernandez
- Department of Preventive and Social Medicine, School of Public Health, Université de Montréal, Montréal, QC, H3T 1J4, Canada
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, School of Medicine, University of Chile, Santiago, Chile
| | - Fernando Cassorla
- Instituto de Investigaciones Materno Infantil, School of Medicine, University of Chile, Santiago, Chile
| | - Sharon E Oberfield
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Natasha I Leibel
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Revi P Mathew
- Division of Pediatric Endocrinology, School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Svetlana Ten
- Richmond University Medical Center, Staten Island, NY, USA
| | - Denis A Magoffin
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christianne J Lane
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael I Goran
- Center for Endocrinology, Diabetes and Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ricardo Azziz
- Departments of Obstetrics and Gynecology, and Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, ALUSA
- Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, SUNY, Rensselaer, NYUSA
| | - Jean-Patrice Baillargeon
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Correspondence: Jean-Patrice Baillargeon, Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
| | - David H Geller
- Center for Endocrinology, Diabetes and Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
- David H. Geller, Children’s Hospital Los Angeles, CA 90027, USA.
| |
Collapse
|
11
|
Merino PM, Codner E. Contraception for Adolescents and Young Women with Type 2 Diabetes-Specific Considerations. Curr Diab Rep 2022; 22:77-84. [PMID: 35150410 DOI: 10.1007/s11892-022-01448-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This article reviews how to address contraception in young women with type 2 diabetes (T2D). The presence of obesity and comorbidities associated with insulin resistance increases the risk of thromboembolic disease and adverse cardiovascular outcomes. RECENT FINDINGS Recent studies have shown that adolescents with T2D are at high risk of unintended pregnancy with poor outcomes for the mother and offspring. Adolescents with T2D without severe obesity, micro- or macrovascular disease, or other cardiovascular risk factors can use any contraceptive method. However, only nonhormonal or progestin-only methods may be used when morbid obesity, severe hypertension, micro- or macrovascular disease, or multiple cardiovascular risk factors are present. The medical team must provide preconceptional counseling and contraception to reduce adolescent pregnancies in young women with T2D. Progestin-only or nonhormonal long-acting reversible contraception (LARC) should be recommended for women with T2D with compliance issues or adverse cardiovascular risk profiles.
Collapse
Affiliation(s)
- Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santa Rosa 1234, 8360160, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santa Rosa 1234, 8360160, Santiago, Chile.
| |
Collapse
|
12
|
Giraudo F, Lalanne I, Valdés I, Gajardo A, Charron-Prochownik D, Codner E. Risky sexual behaviors in adolescents and young adult women with type 1 diabetes: An overlooked problem. Pediatr Diabetes 2021; 22:1092-1098. [PMID: 34192395 DOI: 10.1111/pedi.13245] [Citation(s) in RCA: 4] [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: 06/07/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022] Open
Abstract
The presence of unprotected sex activity in women living with type 1 diabetes (T1D) who have insufficient glycemic control should be considered as a specific risky behavior. To evaluate risky behaviors, including unprotected sexual activity, sources of information and knowledge related to reproductive health in adolescents and young adult women with T1D (PwT1D) compared to a group of adolescents and young adult women without diabetes (Comparison group). PwT1D and the Comparison group completed a questionnaire with validated measures that assessed reproductive health. PwT1D (n = 115, age = 17.7 ± 3.2 years) and Comparison group (n = 386, age = 18.3 ± 2.9) were recruited. The proportion of women reporting having sex without any contraceptive was similar in both groups (57.1% and 50%, in PwT1D and Comparison group, respectively). The use of non-effective contraceptive was reported in 63.2% and 63.6% of the PwT1D and Comparison group, respectively. Among PwT1D, parents, formal sex education, and friends were the primary source of information on reproductive health. Low levels of knowledge about diabetes and pregnancy were observed in PwT1D. HbA1c level was associated with having at least one sexual activity without any contraception (OR = 1.63, p = 0.039). PwT1D have similar rates of risky behaviors compared to a Comparison group. Sexual risky behaviors should be especially considered in PwT1D with glycemic control above the optimal level. Parents are an important source of reproductive health information for PwT1D. Use of effective contraception should be reinforced in sexually active PwT1D.
Collapse
Affiliation(s)
- Franco Giraudo
- Institute Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile (FDJ), Santiago, Chile
| | - Ignacio Lalanne
- Institute Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile (FDJ), Santiago, Chile
| | - Ismael Valdés
- Institute Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile (FDJ), Santiago, Chile
| | - Abraham Gajardo
- Department of Medicine, University of Chile Clinical Hospital, Santiago, Chile.,Laboratory of Oxidative Stress, ICBM, University of Chile, Santiago, Chile
| | - Denise Charron-Prochownik
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ethel Codner
- Institute Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
13
|
Affiliation(s)
- Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
14
|
Priyambada L, Wolfsdorf JI, Brink SJ, Fritsch M, Codner E, Donaghue KC, Craig ME. ISPAD Clinical Practice Consensus Guideline: Diabetic ketoacidosis in the time of COVID-19 and resource-limited settings-role of subcutaneous insulin. Pediatr Diabetes 2020; 21:1394-1402. [PMID: 32935435 DOI: 10.1111/pedi.13118] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 05/10/2020] [Revised: 07/19/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
The International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guideline 2018 for management of diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state provide comprehensive guidance for management of DKA in young people. Intravenous (IV) infusion of insulin remains the treatment of choice for treating DKA; however, the policy of many hospitals around the world requires admission to an intensive care unit (ICU) for IV insulin infusion. During the coronavirus 2019 (COVID-19) pandemic or other settings where intensive care resources are limited, ICU services may need to be prioritized or may not be appropriate due to risk of transmission of infection to young people with type 1 or type 2 diabetes. The aim of this guideline, which should be used in conjunction with the ISPAD 2018 guidelines, is to ensure that young individuals with DKA receive management according to best evidence in the context of limited ICU resources. Specifically, this guideline summarizes evidence for the role of subcutaneous insulin in treatment of uncomplicated mild to moderate DKA in young people and may be implemented if administration of IV insulin is not an option.
Collapse
Affiliation(s)
- Leena Priyambada
- Division of Pediatric Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stuart J Brink
- New England Diabetes and Endocrinology Center, Waltham, Massachusetts, USA
| | - Maria Fritsch
- Department of Pediatric and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Kim C Donaghue
- Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maria E Craig
- Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
15
|
Salinas A, Merino PM, Giraudo F, Codner E. Long-acting contraception in adolescents and young women with type 1 and type 2 diabetes. Pediatr Diabetes 2020; 21:1074-1082. [PMID: 32562346 DOI: 10.1111/pedi.13069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/09/2020] [Revised: 05/28/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
Adolescent pregnancy is a major public health problem worldwide. Adolescents living with diabetes are not aware of the risks of unplanned pregnancy and the high rate of fetal and maternal complications when gestation occurs in women with significant hyperglycemia. These data highlight the significance of pregnancy prevention in young women with diabetes. Long-acting reversible contraceptives (LARCs), which include subdermal progestin implants and hormonal and nonhormonal intrauterine devices (IUDs), have been recommended by the American College of Obstetricians Gynecologists and the American Academy of Pediatrics as a first-line contraceptive option for adolescents and young women. This article reviews LARC options for adolescents and young women with type 1 (T1D) and type 2 (T2D) diabetes as well as the possible complications and side effects.
Collapse
Affiliation(s)
- Abril Salinas
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Chilean Institute of Reproductive Medicine ICMER, Santiago, Chile
| | - Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Franco Giraudo
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile FDJ, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
16
|
Codner E. Metabolic Problems in the Offspring of Women with Gestational Diabetes and Obesity: An Opportunity for Prevention. J Clin Endocrinol Metab 2020; 105:5846187. [PMID: 32453829 DOI: 10.1210/clinem/dgaa307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
17
|
Abstract
Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present - 'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event. Without optimal treatment, DKA remains a condition with appreciable, although largely preventable, morbidity and mortality. In this Primer, we discuss the epidemiology, pathogenesis, risk factors and diagnosis of DKA and provide practical recommendations for the management of DKA in adults and children.
Collapse
Affiliation(s)
- Ketan K Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, UK.,Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Nicole S Glaser
- Department of Pediatrics, University of California Davis, School of Medicine, Sacramento, CA, USA
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | | |
Collapse
|
18
|
Thong EP, Codner E, Laven JSE, Teede H. Diabetes: a metabolic and reproductive disorder in women. Lancet Diabetes Endocrinol 2020; 8:134-149. [PMID: 31635966 DOI: 10.1016/s2213-8587(19)30345-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [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: 06/17/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023]
Abstract
Reproductive dysfunction is a common but little studied complication of diabetes. The spectrum of reproductive health problems in diabetes is broad, and encompasses delayed puberty and menarche, menstrual cycle abnormalities, subfertility, adverse pregnancy outcomes, and potentially early menopause. Depending on the age at diagnosis of diabetes, reproductive problems can manifest early on in puberty, emerge later when fertility is desired, or occur during the climacteric period. Historically, women with type 1 diabetes have frequently had amenorrhoea and infertility, due to central hypogonadism. With the intensification of insulin therapy and improved metabolic control, these problems have declined, but do persist. Additional reproductive implications of contemporary diabetes management are now emerging, including polycystic ovary syndrome and hyperandrogenism, which are underpinned by insulin action on the ovary. The sharp rise in type 2 diabetes incidence in youth suggests that more women of reproductive age will encounter diabetes-related reproductive problems in their lifetimes. With an ever increasing number of young women living with diabetes, clinicians need to be aware of and equipped for the challenges of navigating reproductive health concerns across the lifespan.
Collapse
Affiliation(s)
- Eleanor P Thong
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia.
| |
Collapse
|
19
|
Merino PM, Lopez P, Salinas A, Pastene C, Muñoz A, Cassorla F, Codner E. Ovarian Function in Adolescents Conceived Using Assisted Reproductive Technologies. J Pediatr Adolesc Gynecol 2019; 32:117-121. [PMID: 30502496 DOI: 10.1016/j.jpag.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/20/2018] [Revised: 10/04/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare ovarian function between adolescents conceived using assisted reproductive technology (AcART) and adolescents who were conceived spontaneously (AcSP). DESIGN Multicenter study of ovarian function in AcART because of male or tubal infertility. SETTING University Hospital. PARTICIPANTS We evaluated 22 AcART and 53 AcSP at 1-2 years after menarche. The participants were born at term (≥37 weeks of gestation) with normal birth weights (≥2500 g) from singleton pregnancies. INTERVENTIONS None. MAIN OUTCOME MEASURES Differences in ovulation, reproductive hormones, and ovarian morphology. RESULTS AcART had an older age of menarche than that of AcSP, even after adjusting for maternal age at menarche, gestational age, and birth weight (P = .027). AcART had lower incidence of ovulation (P = .021) and higher luteinizing hormone serum levels (P = .01) than those of AcSP. The incidence of oligomenorrhea and the cycle length were similar between AcART and AcSP. AcART had levels of anti-Müllerian hormone, inhibin B, follicle-stimulating hormone, estradiol, and androgens similar to those of AcSP. The ovarian morphology, ovarian volume, and follicle counts were similar in both groups. CONCLUSION AcART had later menarche, lower ovulation rates, and higher luteinizing hormone levels than those of AcSP. Future studies should investigate whether these findings are indicative of a risk of ovarian dysfunction later in life for AcART.
Collapse
Affiliation(s)
- Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.
| | - Patricia Lopez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile; Cytogenetics Laboratory, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Abril Salinas
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Carolina Pastene
- Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
| | - Alex Muñoz
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile; Cytogenetics Laboratory, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
20
|
Gaete X, Vivanco M, Lopez P, Rocha A, Sepúlveda C, Codner E. Earlier puberty in boys with type 1 diabetes mellitus compared to a simultaneously recruited group of control adolescents. Pediatr Diabetes 2019; 20:197-201. [PMID: 30575242 DOI: 10.1111/pedi.12811] [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: 10/11/2018] [Revised: 12/02/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Recent studies have suggested that there is an earlier age of onset of puberty in healthy boys. However, no study has determined the age of pubertal development in boys with type 1 diabetes (T1D) and compared the results with a simultaneously recruited group of healthy children. OBJECTIVE The aim of this study was to evaluate the age of pubertal events in boys with TD1 and determine whether the duration of diabetes, metabolic control or insulin dose are associated with the age of puberty in boys with T1D. METHODS Boys aged 7 to 19 years with T1D (n = 148, age 12.9 ± 3.0 years) and healthy boys recruited from schools (n = 388 controls, age 12.8 ± 2.2 years) were studied. A pediatric endocrinologist evaluated pubertal development. RESULTS Boys at genital Tanner stage 2 and the final stages of puberty (genital Tanner 4 and 5) were younger than the control group (P = 0.005, P = 0.003, and P = 0.015, respectively). Both groups of boys had a similar age of pubic Tanner stage development. There were no cases of pubertal delay observed in the T1D cohort. There was no association observed between metabolic control with pubertal timing. T1D adolescents had lower height-SDS than the C group at the final stages of puberty. CONCLUSIONS Boys with T1D who are treated with modern insulin therapy appear to have an earlier age of onset and an earlier age of final pubertal events than a simultaneously studied group of healthy children. These data suggest that pubertal delay is not a frequent problem for male T1D patients.
Collapse
Affiliation(s)
- Ximena Gaete
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Department of Hospital Clínico San Borja Arriarán, Santiago, Chile.,Departamento de Pediatría, Clínica Alemana, Santiago, Chile
| | | | - Patricia Lopez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Department of Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Ana Rocha
- Hospital Exequiel González Cortes, Santiago, Chile
| | | | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
21
|
Crisosto N, Ladrón de Guevara A, Echiburú B, Maliqueo M, Cavada G, Codner E, Paez F, Sir-Petermann T. Higher luteinizing hormone levels associated with antimüllerian hormone in postmenarchal daughters of women with polycystic ovary syndrome. Fertil Steril 2018; 111:381-388. [PMID: 30527840 DOI: 10.1016/j.fertnstert.2018.10.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To study the reproductive and metabolic differences between daughters of women with polycystic ovary syndrome (PCOSd) and control women (Cd) after menarche. DESIGN Case-control study. SETTING Clinical endocrinology unit. PATIENT(S) We studied 43 PCOSd and 28 Cd 1.5-6 years after menarche. INTERVENTION(S) Determination of anthropometry, pubertal development, hirsutism, oral glucose tolerance test, and GnRH analogue test. MAIN OUTCOME MEASURE(S) Ferriman score, sex steroids, gonadotropins, antimüllerian hormone (AMH), ovarian volumes, and glucose and insulin levels. RESULT(S) The groups were similar in chronologic, gynecologic, and menarchal ages and anthropometric variables. Ferriman score, ovarian volumes, and AMH were higher in PCOSd. Propensity score analysis showed that there were significant differences in LH, LH-FSH ratio, T and free androgen index, post-stimulated LH and LH-FSH ratio, and 2-hour insulin that could be attributed only to the fact of being a PCOS daughter. The generalized linear model showed that higher LH levels were positively associated with AMH and T levels. CONCLUSION(S) We found that higher LH, androgen, and insulin levels are present in PCOSd during the postmenarchal period, which may establish the basis for the development of PCOS during adulthood. Moreover, LH levels were associated with AMH levels, which supports that the neuroendocrine feedback proposed for AMH and LH is present in humans and that this feature is probably programed in utero, as recently shown in mice.
Collapse
Affiliation(s)
- Nicolás Crisosto
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Santiago, Chile; Endocrinology Unit, Clinica Las Condes, Santiago, Chile.
| | - Amanda Ladrón de Guevara
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Santiago, Chile
| | - Bárbara Echiburú
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Santiago, Chile
| | - Manuel Maliqueo
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Santiago, Chile
| | - Gabriel Cavada
- Public Health Department, University of Chile and University Finis Terrae, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| | - Francisco Paez
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Santiago, Chile
| | - Teresa Sir-Petermann
- Endocrinology and Metabolism Laboratory, West Division, School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
22
|
Merino PM, Villarroel C, Jesam C, López P, Codner E. New Diagnostic Criteria of Polycystic Ovarian Morphology for Adolescents: Impact on Prevalence and Hormonal Profile. Horm Res Paediatr 2018; 88:401-407. [PMID: 29049986 DOI: 10.1159/000481532] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The ultrasonographic criteria used to identify polycystic ovarian morphology (PCOM) during adolescence have changed over time. Recently, a Worldwide Pediatric Consensus (PedC) defined PCOM using stricter criteria than the previous recommendations of the Rotterdam Consensus (RC) and Androgen Excess-Polycystic Ovarian Syndrome Society (AES/PCOS) criteria. The aim of this study was to determine the prevalence of PCOM in healthy adolescents according to the 3 reported diagnostic criteria and compare the hormonal profile in females with and without PCOM based on the PedC criteria. METHODS Nonobese adolescents (n = 102) with regular menstrual cycles were studied. Transabdominal ultrasound and hormonal profiles were assessed during the follicular phase. PCOM was defined on the basis of the 3 published criteria. RESULTS On the basis of the PedC, RC, and AES/PCOS criteria, PCOM was diagnosed in 13, 34, and 24% of adolescents, respectively. Adolescents with and without PCOM according to the PedC criteria had similar androgen levels. Serum anti-Müllerian hormone (AMH) levels were elevated in adolescents with PCOM, irrespective of the criteria used. CONCLUSIONS Use of the new PedC diagnostic criteria for PCOM results in a lower prevalence of this ultrasonographic pattern in adolescents, but this condition is not associated with hyperandrogenism. Elevated AMH is associated with PCOM in adolescents regardless of the criteria used to determine the ultrasonographic pattern.
Collapse
Affiliation(s)
- Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Claudio Villarroel
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Cristián Jesam
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Patricia López
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Hospital Clínico San Borja Arriarán, Servicio de Salud Metropolitano Centro, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
23
|
Ibáñez L, Oberfield SE, Witchel S, Auchus RJ, Chang RJ, Codner E, Dabadghao P, Darendeliler F, Elbarbary NS, Gambineri A, Garcia Rudaz C, Hoeger KM, López-Bermejo A, Ong K, Peña AS, Reinehr T, Santoro N, Tena-Sempere M, Tao R, Yildiz BO, Alkhayyat H, Deeb A, Joel D, Horikawa R, de Zegher F, Lee PA. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Horm Res Paediatr 2018; 88:371-395. [PMID: 29156452 DOI: 10.1159/000479371] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [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: 05/22/2017] [Accepted: 07/10/2017] [Indexed: 12/11/2022] Open
Abstract
This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)1. The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents.
Collapse
Affiliation(s)
- Lourdes Ibáñez
- Endocrinology, Hospital Sant Joan de Deu, Esplugues, Barcelona, Spain.,CIBERDEM, ISCIII, Madrid, Spain
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, CUMC, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Selma Witchel
- Division of Pediatric Endocrinology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | | | - R Jeffrey Chang
- Department of Reproductive Medicine, UCSD School of Medicine, La Jolla, California, USA
| | - Ethel Codner
- Institute of Maternal and Child Research, University of Chile, School of Medicine, Santiago, Chile
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | - Alessandra Gambineri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Cecilia Garcia Rudaz
- Division of Women, Youth and Children, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kathleen M Hoeger
- Department of OBGYN, University of Rochester Medical Center, Rochester, New York, USA
| | - Abel López-Bermejo
- Pediatric Endocrinology, Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | - Ken Ong
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Alexia S Peña
- The University of Adelaide and Robinson Research Institute, Adelaide, South Australia, Australia
| | - Thomas Reinehr
- University of Witten/Herdecke, Vestische Kinder- und Jugendklinik, Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Datteln, Germany
| | - Nicola Santoro
- Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Rachel Tao
- Division of Pediatric Endocrinology, CUMC, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Bulent O Yildiz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - Haya Alkhayyat
- Medical University of Bahrain, BDF Hospital, Riffa, Bahrein
| | - Asma Deeb
- Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Dipesalema Joel
- Department of Paediatrics and Adolescent Health, University of Botswana Teaching Hospital, Gaborone, Botswana
| | - Reiko Horikawa
- Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Francis de Zegher
- Department Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Peter A Lee
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
24
|
Codner E, Acerini CL, Craig ME, Hofer SE, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: What is new in diabetes care? Pediatr Diabetes 2018; 19 Suppl 27:5-6. [PMID: 30276976 DOI: 10.1111/pedi.12759] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/28/2018] [Indexed: 01/18/2023] Open
Affiliation(s)
- Ethel Codner
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Maria E Craig
- School of Women's and Children's Health, The University of New South Wales, Kensington, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
25
|
Codner E, Acerini CL, Craig ME, Hofer SE, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Limited Care Guidance Appendix. Pediatr Diabetes 2018; 19 Suppl 27:328-338. [PMID: 30276975 DOI: 10.1111/pedi.12767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
26
|
Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, Sperling MA, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018; 19 Suppl 27:155-177. [PMID: 29900641 DOI: 10.1111/pedi.12701] [Citation(s) in RCA: 344] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Nicole Glaser
- Department of Pediatrics, Section of Endocrinology, University of California, Davis School of Medicine, Sacramento, California
| | - Michael Agus
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts.,Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Maria Fritsch
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla and Sahlgrenska Academy, Gothenburg University, Uddevalla, Sweden
| | - Arleta Rewers
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | - Mark A Sperling
- Division of Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| |
Collapse
|
27
|
Codner E, Acerini C, Craig ME, Hofer S, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Introduction to the Limited Care guidance appendix. Pediatr Diabetes 2018; 19 Suppl 27:326-327. [PMID: 30175550 DOI: 10.1111/pedi.12765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/28/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Carlo Acerini
- Department of Pediatrics, University of Cambridge, Cambridge, UK
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Westmead, New South Wales, Australia
| | - Sabine Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
| |
Collapse
|
28
|
Cameron FJ, Garvey K, Hood KK, Acerini CL, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence. Pediatr Diabetes 2018; 19 Suppl 27:250-261. [PMID: 29900653 DOI: 10.1111/pedi.12702] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/28/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fergus J Cameron
- Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de Medicina, University of Chile, Santiago, Chile
| |
Collapse
|
29
|
Danne T, Phillip M, Buckingham BA, Jarosz-Chobot P, Saboo B, Urakami T, Battelino T, Hanas R, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:115-135. [PMID: 29999222 DOI: 10.1111/pedi.12718] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/01/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Thomas Danne
- Kinder- und Jugendkrankenhaus AUF DER BULT, Diabetes-Zentrum für Kinder und Judendliche, Hannover, Germany
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Bruce A Buckingham
- Department of Pediatric Endocrinology, Stanford University, Stanford, California
| | | | - Banshi Saboo
- Department of Endocrinology, DiaCare - Advance Diabetes Care Center, Ahmedabad, India
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Tadej Battelino
- Department Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, University de Chile, Santiago, Chile
| |
Collapse
|
30
|
DiMeglio LA, Acerini CL, Codner E, Craig ME, Hofer SE, Pillay K, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:105-114. [PMID: 30058221 DOI: 10.1111/pedi.12737] [Citation(s) in RCA: 360] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology and Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, Universidad de Chile, Santiago, Chile
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, Australia
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
| |
Collapse
|
31
|
Garcia-Diaz DF, Camacho-Guillén P, Codner E, Pérez-Bravo F. miR15a and miR16 in Chilean type 1 diabetes patients: possible association with apoptosis, inflammatory, or autoimmunity markers. J Endocrinol Invest 2018; 41:1083-1088. [PMID: 29383679 DOI: 10.1007/s40618-018-0837-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 12/22/2017] [Indexed: 11/25/2022]
Abstract
AIM Type 1 diabetes mellitus (T1D) is an autoimmune disease characterized by the progressive destruction of β cells, mediated by the interaction between T cells and several cytokines. The pathogenesis of T1D has established its possible relationship with miRNAs. In this study, we analyze the expression profile of miR-15a and miR-16 in peripheral blood mononuclear cells (PBMCs) and their possible association with apoptosis, inflammation, or autoimmunity markers. PATIENTS AND METHODOLOGY 38 T1D patients and 41 control subjects were recruited. mRNAs were analyzed by means of qPCR and TaqMan probes. PBMCs were treated with different concentrations of glucose (baseline, 11 and 25 mM) with or without an inflammatory stimulus as TNF-α (10 ng/ml). RESULTS A decrease in the levels of the miR-15a expression in basal conditions is observed in T1D patients compared to healthy control subjects (relative units 0.5 vs. 1.8, p < 0.05). This change in miR-15a and miR-16 is not affected by the addition of TNF-α. No association is observed with inflammatory markers (IL-6, TNF-α, vCAM) or apoptosis (bcl2 expression). The relationship with immunological markers shows an interaction effect between miR16 and IA-2 (p < 0.03). CONCLUSION TNF-α does not affect the expression profile of miR-15a and miR16 in PBMCs. A weak correlation is observed between miR-16 and with the autoimmunity profile (IA-2 autoantibody).
Collapse
Affiliation(s)
- D F Garcia-Diaz
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - P Camacho-Guillén
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - E Codner
- Instituto de Investigaciones Materno Infantil (IDIMI), Hospital San Borja Arriarán, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - F Pérez-Bravo
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| |
Collapse
|
32
|
Bowman P, Sulen Å, Barbetti F, Beltrand J, Svalastoga P, Codner E, Tessmann EH, Juliusson PB, Skrivarhaug T, Pearson ER, Flanagan SE, Babiker T, Thomas NJ, Shepherd MH, Ellard S, Klimes I, Szopa M, Polak M, Iafusco D, Hattersley AT, Njølstad PR. Effectiveness and safety of long-term treatment with sulfonylureas in patients with neonatal diabetes due to KCNJ11 mutations: an international cohort study. Lancet Diabetes Endocrinol 2018; 6:637-646. [PMID: 29880308 PMCID: PMC6058077 DOI: 10.1016/s2213-8587(18)30106-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [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] [Received: 09/29/2017] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND KCNJ11 mutations cause permanent neonatal diabetes through pancreatic ATP-sensitive potassium channel activation. 90% of patients successfully transfer from insulin to oral sulfonylureas with excellent initial glycaemic control; however, whether this control is maintained in the long term is unclear. Sulfonylurea failure is seen in about 44% of people with type 2 diabetes after 5 years of treatment. Therefore, we did a 10-year multicentre follow-up study of a large international cohort of patients with KCNJ11 permanent neonatal diabetes to address the key questions relating to long-term efficacy and safety of sulfonylureas in these patients. METHODS In this multicentre, international cohort study, all patients diagnosed with KCNJ11 permanent neonatal diabetes at five laboratories in Exeter (UK), Rome (Italy), Bergen (Norway), Paris (France), and Krakow (Poland), who transferred from insulin to oral sulfonylureas before Nov 30, 2006, were eligible for inclusion. Clinicians collected clinical characteristics and annual data relating to glycaemic control, sulfonylurea dose, severe hypoglycaemia, side-effects, diabetes complications, and growth. The main outcomes of interest were sulfonylurea failure, defined as permanent reintroduction of daily insulin, and metabolic control, specifically HbA1c and sulfonylurea dose. Neurological features associated with KCNJ11 permanent neonatal diabetes were also assessed. This study is registered with ClinicalTrials.gov, number NCT02624817. FINDINGS 90 patients were identified as being eligible for inclusion and 81 were enrolled in the study and provided long-term (>5·5 years cut-off) outcome data. Median follow-up duration for the whole cohort was 10·2 years (IQR 9·3-10·8). At most recent follow-up (between Dec 1, 2012, and Oct 4, 2016), 75 (93%) of 81 participants remained on sulfonylurea therapy alone. Excellent glycaemic control was maintained for patients for whom we had paired data on HbA1c and sulfonylurea at all time points (ie, pre-transfer [for HbA1c], year 1, and most recent follow-up; n=64)-median HbA1c was 8·1% (IQR 7·2-9·2; 65·0 mmol/mol [55·2-77·1]) before transfer to sulfonylureas, 5·9% (5·4-6·5; 41·0 mmol/mol [35·5-47·5]; p<0·0001 vs pre-transfer) at 1 year, and 6·4% (5·9-7·3; 46·4 mmol/mol [41·0-56·3]; p<0·0001 vs year 1) at most recent follow-up (median 10·3 years [IQR 9·2-10·9]). In the same patients, median sulfonylurea dose at 1 year was 0·30 mg/kg per day (0·14-0·53) and at most recent follow-up visit was 0·23 mg/kg per day (0·12-0·41; p=0·03). No reports of severe hypoglycaemia were recorded in 809 patient-years of follow-up for the whole cohort (n=81). 11 (14%) patients reported mild, transient side-effects, but did not need to stop sulfonylurea therapy. Seven (9%) patients had microvascular complications; these patients had been taking insulin longer than those without complications (median age at transfer to sulfonylureas 20·5 years [IQR 10·5-24·0] vs 4·1 years [1·3-10·2]; p=0·0005). Initial improvement was noted following transfer to sulfonylureas in 18 (47%) of 38 patients with CNS features. After long-term therapy with sulfonylureas, CNS features were seen in 52 (64%) of 81 patients. INTERPRETATION High-dose sulfonylurea therapy is an appropriate treatment for patients with KCNJ11 permanent neonatal diabetes from diagnosis. This therapy is safe and highly effective, maintaining excellent glycaemic control for at least 10 years. FUNDING Wellcome Trust, Diabetes UK, Royal Society, European Research Council, Norwegian Research Council, Kristian Gerhard Jebsen Foundation, Western Norway Regional Health Authority, Southern and Eastern Norway Regional Health Authority, Italian Ministry of Health, Aide aux Jeunes Diabetiques, Societe Francophone du Diabete, Ipsen, Slovak Research and Development Agency, and Research and Development Operational Programme funded by the European Regional Development Fund.
Collapse
Affiliation(s)
| | - Åsta Sulen
- KG Jebsen Centre for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescents, Haukeland University Hospital, Bergen, Norway
| | | | - Jacques Beltrand
- Service Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Universitaire Necker Enfants Malades Paris, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Descartes-Université Sorbonne Paris Cité, Inserm U1016, Institut Imagine, Paris, France
| | - Pernille Svalastoga
- KG Jebsen Centre for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescents, Haukeland University Hospital, Bergen, Norway
| | - Ethel Codner
- Institute for Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | | | - Petur B Juliusson
- KG Jebsen Centre for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescents, Haukeland University Hospital, Bergen, Norway
| | | | - Ewan R Pearson
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | | | | | - Maggie H Shepherd
- University of Exeter Medical School, Exeter, UK; Exeter NIHR Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sian Ellard
- University of Exeter Medical School, Exeter, UK
| | - Iwar Klimes
- Biomedical Research Centre, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Magdalena Szopa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Michel Polak
- Service Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Universitaire Necker Enfants Malades Paris, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Descartes-Université Sorbonne Paris Cité, Inserm U1016, Institut Imagine, Paris, France
| | - Dario Iafusco
- Department of Paediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Pål R Njølstad
- KG Jebsen Centre for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescents, Haukeland University Hospital, Bergen, Norway
| | | |
Collapse
|
33
|
García-Díaz DF, Pizarro C, Camacho-Guillén P, Codner E, Soto N, Pérez-Bravo F. Expression of miR-155, miR-146a, and miR-326 in T1D patients from Chile: relationship with autoimmunity and inflammatory markers. Arch Endocrinol Metab 2018; 62:34-40. [PMID: 29694627 PMCID: PMC10118688 DOI: 10.20945/2359-3997000000006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/31/2017] [Indexed: 11/23/2022]
Abstract
Objective The aim of this research was to analyze the expression profile of miR-155, miR-146a, and miR-326 in peripheral blood mononuclear cells (PBMC) of 47 patients with type 1 diabetes mellitus (T1D) and 39 control subjects, as well as the possible association with autoimmune or inflammatory markers. Subjects and methods Expression profile of miRs by means of qPCR using TaqMan probes. Autoantibodies and inflammatory markers by ELISA. Statistical analysis using bivariate correlation. Results The analysis of the results shows an increase in the expression of miR-155 in T1D patients in basal conditions compared to the controls (p < 0.001) and a decreased expression level of miR-326 (p < 0.01) and miR-146a (p < 0.05) compared T1D patients to the controls. miR-155 was the only miRs associated with autoinmmunity (ZnT8) and inflammatory status (vCAM). Conclusion Our data show a possible role of miR-155 related to autoimmunity and inflammation in Chilean patients with T1D.
Collapse
Affiliation(s)
- Diego F García-Díaz
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Chile
| | - Carolina Pizarro
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Chile
| | - Patricia Camacho-Guillén
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Chile
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil (IDIMI), Hospital San Borja Arriarán, Facultad de Medicina, Universidad de Chile, Chile
| | - Néstor Soto
- Instituto de Investigaciones Materno Infantil (IDIMI), Hospital San Borja Arriarán, Facultad de Medicina, Universidad de Chile, Chile
| | - Francisco Pérez-Bravo
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Chile
| |
Collapse
|
34
|
Villarroel C, Salinas A, López P, Kohen P, Rencoret G, Devoto L, Codner E. Anti-Müllerian hormone in type 2 and gestational diabetes during the second half of pregnancy: relationship with sexual steroid levels and metabolic parameters. Gynecol Endocrinol 2018; 34:120-124. [PMID: 28758808 DOI: 10.1080/09513590.2017.1359824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hyperandrogenemia and hyperinsulinemia are observed in women with diabetes during pregnancy. The effect of diabetes on anti-Müllerian hormone (AMH) levels during pregnancy is unclear. The aim of this study was to determine the AMH levels in women with type 2 diabetes (T2D) and gestational diabetes (GD) compared to healthy (C) pregnant women during the second half of gestation. A prospective study of 69 pregnant women with T2D (N: 21), GD (N: 24) and C (N: 24) were followed up during the second half of pregnancy. Clinical assessments and blood samples were collected at 26.7 (25-27.8); 34 (32-34.9) and 37.5 (37-40) weeks of gestation. AMH, sexual steroids, insulin, homeostatic model assessment of insulin resistance, HbA1c levels were measured. AMH levels were similar between T2D, GD and C (p = .07). A decline of AMH levels during the second half of gestation was observed in the three groups (p < .0001). AMH levels were negatively associated with age (p < .001). A positive association between AMH and testosterone (p < .05) was found in all groups. A progressive decline of AMH levels is observed in diabetic and healthy women during the second half of pregnancy. Testosterone levels are an independent factor that influences AMH levels during pregnancy. However, AMH levels are not affected by the presence of diabetes during gestation.
Collapse
Affiliation(s)
- Claudio Villarroel
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
| | - Abril Salinas
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
| | - Patricia López
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
- b Servicio de Salud Centro, Ministerio de Salud , Hospital Clínico San Borja Arriarán , Santiago , Chile
| | - Paulina Kohen
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
| | - Gustavo Rencoret
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
- c School of Medicine , University of Chile , Santiago , Chile
| | - Luigi Devoto
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
| | - Ethel Codner
- a Institute for Mother and Child Research , University of Chile , Santiago , Chile
| |
Collapse
|
35
|
Garcia-Diaz DF, Camacho-Guillén P, Codner E, Pérez-Bravo F. miR15a and miR16 in Chilean type 1 diabetes patients: possible association with apoptosis, inflammatory, or autoimmunity markers. J Endocrinol Invest 2018:10.1007/s40618-017-0814-8. [PMID: 29388053 DOI: 10.1007/s40618-017-0814-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 12/22/2017] [Indexed: 11/27/2022]
Abstract
AIM Type 1 diabetes mellitus (T1D) is an autoimmune disease characterized by the progressive destruction of β cells, mediated by the interaction between T cells and several cytokines. The pathogenesis of T1D has established its possible relationship with miRNAs. In this study, we analyze the expression profile of miR-15a and miR-16 in peripheral blood mononuclear cells (PBMCs) and their possible association with apoptosis, inflammation, or autoimmunity markers. PATIENTS AND METHODOLOGY 38 T1D patients and 41 control subjects were recruited. mRNAs were analyzed by means of qPCR and TaqMan probes. PBMCs were treated with different concentrations of glucose (baseline, 11 and 25 mM) with or without an inflammatory stimulus as TNF-α (10 ng/ml). RESULTS A decrease in the levels of the miR-15a expression in basal conditions is observed in T1D patients compared to healthy control subjects (relative units 0.5 vs. 1.8, p < 0.05). This change in miR-15a and miR-16 is not affected by the addition of TNF-α. No association is observed with inflammatory markers (IL-6, TNF-α, vCAM) or apoptosis (bcl2 expression). The relationship with immunological markers shows an interaction effect between miR16 and IA-2 (p < 0.03). CONCLUSION TNF-α does not affect the expression profile of miR-15a and miR16 in PBMCs. A weak correlation is observed between miR-16 and with the autoimmunity profile (IA-2 autoantibody).
Collapse
Affiliation(s)
- D F Garcia-Diaz
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - P Camacho-Guillén
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - E Codner
- Instituto de Investigaciones Materno Infantil (IDIMI), Hospital San Borja Arriarán, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - F Pérez-Bravo
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| |
Collapse
|
36
|
Apablaza P, Soto N, Codner E. De la bomba de insulina y el monitoreo continuo de glucosa al páncreas artificial. Rev Med Chil 2017; 145:630-640. [DOI: 10.4067/s0034-98872017000500011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/09/2017] [Indexed: 11/17/2022]
|
37
|
Villarroel C, Salinas A, López P, Kohen P, Rencoret G, Devoto L, Codner E. Pregestational type 2 diabetes and gestational diabetes exhibit different sexual steroid profiles during pregnancy. Gynecol Endocrinol 2017; 33:212-217. [PMID: 27898283 DOI: 10.1080/09513590.2016.1248933] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Higher androgen levels are observed in non-pregnant women with diabetes. Whether this hormonal profile is found during pregnancy is unknown. The aim of this study was to determine the sexual steroids levels in pregnant women with pregestational type 2 (T2D) and gestational diabetes (GD) compared to healthy control (C) pregnant women during the second half of pregnancy. A prospective study of 69 pregnant women with T2D (n = 21), GD (n = 24) and control (C, n = 24) was followed up during the second half of gestation. Clinical assessments and blood samples were collected at 26.7 (25-27.8); 34 (32-34.9) and 37.5 (37-40) weeks of gestation. Androgens, sex hormone-binding globulin (SHBG), estrogens, estradiol/testosterone (E/T) ratio, insulin, glucose, HOMA-IR, were measured. Testosterone, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) levels were higher in T2D compared with C at each sampling point during pregnancy, even after adjusting for BMI and age. Estrogens levels and estradiol/testosterone ratio were lower in T2D and GD compared with C. Hyperandrogenemia, and higher insulin resistance is observed in T2D, but not in GD during pregnancy. Decreased estrogen and E/T ratio found in T2D and GD suggests a diminished aromatase activity during gestation. T2D and GD are associated with specific changes in sexual steroids and insulin resistance levels during pregnancy.
Collapse
Affiliation(s)
- Claudio Villarroel
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
| | - Abril Salinas
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
| | - Patricia López
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
- b Hospital Clínico San Borja Arriarán, Servicio de Salud Centro, Ministerio de Salud , Santa Rosa 1234, Santiago , Chile , and
| | - Paulina Kohen
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
| | - Gustavo Rencoret
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
- c School of Medicine, University of Chile , Independencia 1027, Santiago , Chile
| | - Luigi Devoto
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
| | - Ethel Codner
- a Institute for Mother and Child Research (IDIMI), University of Chile , Santa Rosa 1234, Santiago , Chile
| |
Collapse
|
38
|
Rubio-Cabezas O, Gómez JL, Gleisner A, Hattersley AT, Codner E. Hypogonadotropic Hypogonadism and Short Stature in Patients with Diabetes Due to Neurogenin 3 Deficiency. J Clin Endocrinol Metab 2016; 101:3555-3558. [PMID: 27533310 PMCID: PMC5052352 DOI: 10.1210/jc.2016-2319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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
CONTEXT Biallelic mutations in NEUROG3 are known to cause early-onset malabsorptive diarrhea due to congenital anendocrinosis and diabetes mellitus at a variable age. No other endocrine disorders have been described so far. We report four patients with homozygous NEUROG3 mutations who presented with short stature and failed to show any signs of pubertal development. CASE DESCRIPTION Four patients (two males, two females) were diagnosed with homozygous mutations in NEUROG3 on the basis of congenital malabsorptive diarrhea and diabetes. All four had severe short stature and failed to develop secondary sexual characteristics at an appropriate age, despite some having normal body mass index. The absence of gonadal function persisted into the third decade in one patient. Upon testing, both basal and stimulated LH and FSH levels were low, with the remaining pituitary hormones within the normal range. Magnetic resonance imaging scans of the hypothalamic-pituitary axis did not reveal structural abnormalities. A diagnosis of hypogonadotropic hypogonadism was made, and replacement therapy with sex hormones was started. CONCLUSIONS The high reproducibility of this novel phenotype suggests that central hypogonadism and short stature are common findings in patients with mutations in NEUROG3. Growth rate needs to be carefully monitored in these patients, who also should be routinely screened for hypogonadism when they reach the appropriate age. NEUROG3 mutations expand on the growing number of genetic causes of acquired hypogonadotropic hypogonadism.
Collapse
Affiliation(s)
- Oscar Rubio-Cabezas
- Department of Pediatric Endocrinology (O.R.-C.), Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, 28007 Madrid, Spain; Department of Pediatrics (J.L.G.), Complejo Hospitalario Torrecárdenas, 04009 Almería, Spain; Department of Pediatrics (A.G.), University of Concepcion, School of Medicine, 4070038 Concepción, Chile; Institute for Biomedical and Clinical Science (A.T.H.), University of Exeter Medical School, Exeter EX2 5DW, United Kingdom; and Institute of Maternal and Child Research (E.C.), School of Medicine, University of Chile, 8360160 Santiago, Chile
| | - José Luis Gómez
- Department of Pediatric Endocrinology (O.R.-C.), Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, 28007 Madrid, Spain; Department of Pediatrics (J.L.G.), Complejo Hospitalario Torrecárdenas, 04009 Almería, Spain; Department of Pediatrics (A.G.), University of Concepcion, School of Medicine, 4070038 Concepción, Chile; Institute for Biomedical and Clinical Science (A.T.H.), University of Exeter Medical School, Exeter EX2 5DW, United Kingdom; and Institute of Maternal and Child Research (E.C.), School of Medicine, University of Chile, 8360160 Santiago, Chile
| | - Andrea Gleisner
- Department of Pediatric Endocrinology (O.R.-C.), Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, 28007 Madrid, Spain; Department of Pediatrics (J.L.G.), Complejo Hospitalario Torrecárdenas, 04009 Almería, Spain; Department of Pediatrics (A.G.), University of Concepcion, School of Medicine, 4070038 Concepción, Chile; Institute for Biomedical and Clinical Science (A.T.H.), University of Exeter Medical School, Exeter EX2 5DW, United Kingdom; and Institute of Maternal and Child Research (E.C.), School of Medicine, University of Chile, 8360160 Santiago, Chile
| | - Andrew T Hattersley
- Department of Pediatric Endocrinology (O.R.-C.), Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, 28007 Madrid, Spain; Department of Pediatrics (J.L.G.), Complejo Hospitalario Torrecárdenas, 04009 Almería, Spain; Department of Pediatrics (A.G.), University of Concepcion, School of Medicine, 4070038 Concepción, Chile; Institute for Biomedical and Clinical Science (A.T.H.), University of Exeter Medical School, Exeter EX2 5DW, United Kingdom; and Institute of Maternal and Child Research (E.C.), School of Medicine, University of Chile, 8360160 Santiago, Chile
| | - Ethel Codner
- Department of Pediatric Endocrinology (O.R.-C.), Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, 28007 Madrid, Spain; Department of Pediatrics (J.L.G.), Complejo Hospitalario Torrecárdenas, 04009 Almería, Spain; Department of Pediatrics (A.G.), University of Concepcion, School of Medicine, 4070038 Concepción, Chile; Institute for Biomedical and Clinical Science (A.T.H.), University of Exeter Medical School, Exeter EX2 5DW, United Kingdom; and Institute of Maternal and Child Research (E.C.), School of Medicine, University of Chile, 8360160 Santiago, Chile
| |
Collapse
|
39
|
Martínez D, Castro A, Merino PM, López P, Lardone MC, Iñiguez G, Cassorla F, Codner E. Oestrogen activity of the serum in adolescents with Type 1 diabetes. Diabet Med 2016; 33:1366-73. [PMID: 26802741 DOI: 10.1111/dme.13078] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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] [Accepted: 01/19/2016] [Indexed: 01/01/2023]
Abstract
AIMS To assess serum oestrogen levels and oestrogenic activity in adolescents with Type 1 diabetes compared with a healthy control group. METHODS We conducted a cross-sectional study that evaluated adolescents with Type 1 diabetes (n = 38) and healthy adolescents (control group; n = 32). Serum oestrogens, urinary oestrogen metabolites and serum oestrogenic activity were assessed. Oestrogenic activity was evaluated in an in vitro cell proliferation assay using a modified E-screen assay with MCF-7/BUS cells. RESULTS Adolescents with Type 1 diabetes had lower oestrogenic activity levels in both phases of the menstrual cycle compared with the control group (follicular phase: 76 vs 94%; luteal phase: 97 vs 131%; P < 0.01), even after adjusting for BMI, oestradiol and oestrone levels. Postmenarcheal adolescents with Type 1 diabetes had lower oestradiol levels compared with control subjects in the follicular phase (63.3 pmol/l vs 89.4 pmol/l; P < 0.01) and higher oestrone levels compared with controls in the luteal phase (196 vs 151.9 pmol/l; P < 0.05). CONCLUSIONS Adolescents with Type 1 diabetes had lower levels of serum oestrogenic activity, and these were lower than expected based on their serum oestradiol levels. We postulate that changes in the serum milieu of oestrogens in patients with Type 1 diabetes may explain their decreased oestrogenic activity and may play a role in their adverse metabolic profile.
Collapse
Affiliation(s)
- D Martínez
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - A Castro
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - P M Merino
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - P López
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
- Hospital San Borja Arriarán, Servicio Salud Metropolitano Central, Santiago, Chile
| | - M C Lardone
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - G Iñiguez
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - F Cassorla
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile
| | - E Codner
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile.
| |
Collapse
|
40
|
Gaete X, López P, Unanue N, Codner E, Cavada G, Mericq V. Factors associated with post-menarcheal growth: results of a longitudinal study in Chilean girls from different socioeconomic statuses. J Pediatr Endocrinol Metab 2016; 29:1063-7. [PMID: 27544720 DOI: 10.1515/jpem-2016-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/18/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Menarche is the last stage of pubertal development, which coincides, with the completion of longitudinal growth. Our aim was to evaluate, post-menarcheal growth and clinical variables proposed to be associated with this growth. METHODS In a prospective fashion, 106 healthy girls attending five different socioeconomic status (SES) schools of Santiago were randomly recruited. A pediatric endocrinologist obtained anthropometrics and registration of date at menarche every 6 months. The evolution of the girls' heights was assessed through mixed models adjusted to the SESes, parental height and body mass index (BMI). RESULTS Sixty-three girls from a high socioeconomic status (HSS) and 50 from a low socioeconomic status (LSS) were followed. Four years post menarche, the girls reached a growth plateau and the average height gain was 5.2±2.5 cm. This gain was not associated with SES, BMI, nor with parental height (p=0.744). The only variable that modulated this gain was age at menarche (r=-0.1997, p=0.0332). There was an inverse correlation between height at the moment of menarche and the height reached after 4 years of follow-up adjusted to parental height (r=-0302, p=0.0011). CONCLUSIONS Post-menarcheal growth ends 4 years post-event and is inversely correlated with the age at menarche and with the height at the moment of menarche independent of BMI, parental height and SES.
Collapse
|
41
|
Estrella S, Garcia-Diaz DF, Codner E, Camacho-Guillén P, Pérez-Bravo F. [Expression of miR-22 and miR-150 in type 1 diabetes mellitus: Possible relationship with autoimmunity and clinical characteristics]. Med Clin (Barc) 2016; 147:245-7. [PMID: 27377214 DOI: 10.1016/j.medcli.2016.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 04/14/2016] [Accepted: 05/05/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Type 1 diabetes (T1D) is an autoimmune disease of complex aetiology. Several microRNAs (miR) have been linked to the pathogenesis of autoimmune diseases. To analyze the possible association of miR-22 and miR-150 with autoimmunity and clinical severity of T1D. PATIENTS AND METHODS The study was performed in peripheral blood mononuclear cells of 20 patients with T1D and 20 control subjects. The expression of miR-22 and miR-150 was performed in peripheral blood mononuclear cells using TaqMan probes to different glucose concentrations (baseline, 11mm, 25mm). RESULTS Our results suggest that the expression of miR-22 is increased in T1D patients compared to the controls. This effect was observed in baseline glucose conditions and decreased in 11 and 25mM of glucose. The expression of miR-150 was lower in T1D patients versus the controls. There was no correlation between the autoimmune profile and the two studied miRNAs. miR-22 (baseline condition) and miR-150 (11mM condition) or the ketoacidosis component. CONCLUSION miR-22 and 150 were not associated with the autoimmune component present in T1D patients.
Collapse
Affiliation(s)
- Santiago Estrella
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Diego F Garcia-Diaz
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil (IDIMI), Hospital San Borja Arriarán, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Patricia Camacho-Guillén
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Francisco Pérez-Bravo
- Laboratorio de Nutrigenómica, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| |
Collapse
|
42
|
Codner E, Merino PM, Martínez D, Lopez P, Godoy C, Iñiguez G, Cassorla F, Perez-Bravo F. C-Reactive protein and insulin growth factor 1 serum levels during the menstrual cycle in adolescents with Type 1 diabetes. Diabet Med 2016; 33:70-6. [PMID: 26043285 DOI: 10.1111/dme.12829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Accepted: 06/01/2015] [Indexed: 01/15/2023]
Abstract
AIMS To evaluate C-reactive protein, insulin growth factor 1 and lipid levels during the follicular and luteal phases in adolescents with Type 1 diabetes. METHODS Adolescents with Type 1 diabetes (N = 40) and healthy controls (C; N = 43) were studied during the follicular and luteal phases of their menstrual cycles. C-Reactive protein, insulin growth factor 1 and lipid levels were measured. RESULTS Adolescents with Type 1 diabetes exhibited higher C-reactive protein levels than the C group during the follicular (P < 0.0001) and luteal phases (P < 0.01). The elevation of C-reactive protein levels was more pronounced in overweight adolescents with Type 1 diabetes than in adolescents in the C group. More adolescents with Type 1 diabetes were classified as having an elevated risk of cardiovascular disease (C-reactive protein > 3 mg/l) in the luteal phase than in the follicular phase (37.5% and 17.5%, respectively); half of the overweight adolescents with Type 1 diabetes in the luteal phase reached this level. BMI was the only significant factor affecting follicular and luteal phase C-reactive protein levels in adolescents with Type 1 diabetes. Lower insulin growth factor 1 levels were observed during both phases of the menstrual cycle in adolescents with Type 1 diabetes compared with controls. An elevation in insulin growth factor 1 levels in the luteal phase relative to the follicular phase was observed in controls, but not in adolescents with Type 1 diabetes. Luteal insulin growth factor 1 and C-reactive protein exhibited an inverse correlation (r = -0.4, P = 0.01). CONCLUSIONS Adolescents with Type 1 diabetes have higher C-reactive protein levels and lower insulin growth factor 1 levels relative to controls, especially during the luteal phase. Type 1 diabetes diminishes the natural elevation in insulin growth factor 1 levels observed during the luteal phase in controls. Excess weight exacerbates the subclinical inflammatory state observed during both phases of the menstrual cycle in adolescents with Type 1 diabetes.
Collapse
Affiliation(s)
- E Codner
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - P M Merino
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - D Martínez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - P Lopez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
- Cytogenetics Laboratory, Hospital San Borja Arriarán, Santiago, Chile
| | - C Godoy
- Pediatric Endocrine Unit, Hospital Sótero del Rio, Santiago, Chile
| | - G Iñiguez
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - F Cassorla
- Institute of Maternal and Child Research, University of Chile, Santiago, Chile
| | - F Perez-Bravo
- Nutrigenomics Laboratory, Nutrition Department, University of Chile, Santiago, Chile
| |
Collapse
|
43
|
Pollak F, Araya V, Lanas A, Sapunar J, Arrese M, Aylwin CG, Bezanilla CG, Carrasco E, Carrasco F, Codner E, Díaz E, Durruty P, Galgani J, García H, Lahsen R, Liberman C, López G, Maíz A, Mujica V, Poniachik J, Sir T, Soto N, Valderas J, Villaseca P, Zavala C. [Second Consensus of the Chilean Society of Endocrinology and Diabetes about insulin resistance]. Rev Med Chil 2015. [PMID: 26203576 DOI: 10.4067/s0034-98872015000500012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Insulin resistance is a prevalent condition commonly associated with unhealthy lifestyles. It affects several metabolic pathways, increasing risk of abnormalities at different organ levels. Thus, diverse medical specialties should be involved in its diagnosis and treatment. With the purpose of unifying criteria about this condition, a scientific-based consensus was elaborated. A questionnaire including the most important topics such as cardio-metabolic risk, non-alcoholic fatty liver disease and polycystic ovary syndrome, was designed and sent to national experts. When no agreement among them was achieved, the Delphi methodology was applied. The main conclusions reached are that clinical findings are critical for the diagnosis of insulin resistance, not being necessary blood testing. Acquisition of a healthy lifestyle is the most important therapeutic tool. Insulin-sensitizing drugs should be prescribed to individuals at high risk of disease according to clinically validated outcomes. There are specific recommendations for pregnant women, children, adolescents and older people.
Collapse
|
44
|
Witchel SF, Oberfield S, Rosenfield RL, Codner E, Bonny A, Ibáñez L, Pena A, Horikawa R, Gomez-Lobo V, Joel D, Tfayli H, Arslanian S, Dabadghao P, Garcia Rudaz C, Lee PA. The Diagnosis of Polycystic Ovary Syndrome during Adolescence. Horm Res Paediatr 2015; 83:000375530. [PMID: 25833060 DOI: 10.1159/000375530] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [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: 11/10/2014] [Accepted: 01/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The diagnostic criteria for polycystic ovary syndrome (PCOS) in adolescence are controversial, primarily because the diagnostic pathological features used in adult women may be normal pubertal physiological events. Hence, international pediatric and adolescent specialty societies have defined criteria that have sufficient evidence to be used for the diagnosis of PCOS in adolescents. METHODS The literature has been reviewed and evidence graded to address a series of questions regarding the diagnosis of PCOS during adolescence including the following: clinical and biochemical evidence of hyperandrogenism, criteria for oligo-anovulation and polycystic ovary morphology, diagnostic criteria to exclude other causes of hyperandrogenism and amenorrhea, role of insulin resistance, and intervention. RESULTS AND CONCLUSION Features of PCOS overlap normal pubertal development. Hence, caution should be taken before diagnosing PCOS without longitudinal evaluation. However, treatment may be indicated even in the absence of a definitive diagnosis. While obesity, insulin resistance, and hyperinsulinemia are common findings in adolescents with hyperandrogenism, these features should not be used to diagnose PCOS among adolescent girls. © 2015 S. Karger AG, Basel.
Collapse
Affiliation(s)
- Selma F Witchel
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pa., USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Merino PM, Martínez D, Iñiguez G, Lopez P, Cassorla F, Perez-Bravo F, Codner E. Elevation of C-reactive protein during the luteal phase in healthy adolescents. Gynecol Endocrinol 2015; 31:260-3. [PMID: 25392126 DOI: 10.3109/09513590.2014.982086] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Variations in inflammatory markers have been reported in adult women during the luteal phase, but whether these findings are observed during adolescence is unknown. We postulate that higher ultrasensitive C-reactive protein (usCRP) and lower 2-hydroxyestrone (2OHE) levels, an estrogen metabolite with cardioprotective actions, are present during the luteal phase in young women. AIM To evaluate usCRP levels during the menstrual cycle and to determine its association with 2OHE and 16α-hydroxyestrone (16OHE) in adolescents. METHODS Healthy postmenarcheal adolescents (N = 37) were studied during one menstrual cycle in follicular phase (FP) and luteal phase-like period (LP-L). RESULTS Elevations in usCRP levels in the LP-L were observed in the entire group and in anovulatory cycles (1.9 ± 1.1 mg/L in FP to 2.5 ± 1.8 mg/L in LP-L; p < 0.0001). Increases in estrone, estradiol, free and bioavailable estradiol, testosterone, usCRP and 2OHE levels were observed in LP-L compared with FP (p < 0.01), with a borderline elevation in IFG-I levels (p = 0.06). CONCLUSIONS We report an elevation of usCRP and 2OHE levels during the luteal phase in healthy adolescents. Elevations of this inflammatory marker in anovulatory adolescents without an increase in 2OHE may play a role in metabolic risks associated with chronic anovulation.
Collapse
Affiliation(s)
- Paulina M Merino
- Faculty of Medicine, Institute of Maternal and Child Research, University of Chile , Santiago , Chile
| | | | | | | | | | | | | |
Collapse
|
46
|
Gaete X, García R, Riquelme J, Codner E. La pubertad en niños chilenos muestra un adelantamiento en el inicio del crecimiento testicular. Rev Med Chil 2015; 143:297-303. [DOI: 10.4067/s0034-98872015000300003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 01/12/2015] [Indexed: 11/17/2022]
|
47
|
Villarroel C, López P, Merino PM, Iñiguez G, Sir-Petermann T, Codner E. Hirsutism and oligomenorrhea are appropriate screening criteria for polycystic ovary syndrome in adolescents. Gynecol Endocrinol 2015; 31:625-9. [PMID: 26190534 DOI: 10.3109/09513590.2015.1025380] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We evaluated the association of hirsutism and oligomenorrhea (persistent menstrual cycles > 45 days) as screening criteria for the detection of biochemical hyperandrogenism (BH) and polycystic ovaries (PCOM) during adolescence and determined which androgens, granulosa cell hormone, ultrasonographic parameters have the best association with polycystic ovary syndrome (PCOS). Hirsute girls with oligomenorrhea (N = 26 Hirs/Oligo group) and non-hirsute girls with regular cycles (N = 63, C group) were studied. Prevalence of BH and PCOM, diagnostic performance of androgens and ultrasound parameters for PCOS diagnosis were analyzed. BH and PCOM prevalence were higher in the Hirs/Oligo girls than in the C girls (76.9% versus 25.5%; 92.3% versus 33.3%, respectively; p < 0.0001). A complete PCOS phenotype (Hirs/Oligo with BH and PCOM) was observed in 73.1% of the Hirs/Oligo group. The presence of both BH and PCOM was observed in 7.9% of the C group. The parameters with the best diagnostic performance were free androgen index ≥6.1, testosterone ≥2.4 nmol/L, follicle number ≥12 and ovarian volume ≥10 ml anti-Müllerian hormone (AMH) exhibited a low diagnostic accuracy. Hirsutism and persistent menstrual cycle over 45 days are highly associated with BH and PCOM suggesting that the presences of both criteria are necessary for the diagnosis of PCOS during adolescence.
Collapse
Affiliation(s)
- Claudio Villarroel
- a Institute of Maternal and Child Research, School of Medicine, University of Chile , Santiago , Chile
| | - Patricia López
- a Institute of Maternal and Child Research, School of Medicine, University of Chile , Santiago , Chile
- b Hospital Clínico San Borja Arriarán, Servicio de Salud Metropolitano Centro , Santiago , Chile , and
| | - Paulina M Merino
- a Institute of Maternal and Child Research, School of Medicine, University of Chile , Santiago , Chile
| | - Germán Iñiguez
- a Institute of Maternal and Child Research, School of Medicine, University of Chile , Santiago , Chile
| | - Teresa Sir-Petermann
- c Laboratory of Endocrinology, Department of Medicine W. Division , School of Medicine, University of Chile , Santiago , Chile
| | - Ethel Codner
- a Institute of Maternal and Child Research, School of Medicine, University of Chile , Santiago , Chile
| |
Collapse
|
48
|
Pizarro C, García-Díaz DF, Codner E, Salas-Pérez F, Carrasco E, Pérez-Bravo F. PD-L1 gene polymorphisms and low serum level of PD-L1 protein are associated to type 1 diabetes in Chile. Diabetes Metab Res Rev 2014; 30:761-6. [PMID: 24816853 DOI: 10.1002/dmrr.2552] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/02/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Type 1 diabetes (T1D) has a complex etiology in which genetic and environmental factors are involved, whose interactions have not yet been completely clarified. In this context, the role in PD-1 pathway and its ligands 1 and 2 (PD-L1 and PD-L2) have been proposed as candidates in several autoimmune diseases. The aim of this work was to determine the allele and haplotype frequency of six gene polymorphisms of PD-ligands (PD-L1 and PD-L2) in Chilean T1D patients and their effect on serum levels of PD-L1 and autoantibody profile (GAD65 and IA2). METHODS This study cohort comprised 205 T1D patients and 205 normal children. We performed genotypic analysis of PD-L1 and PD-L2 genes by TaqMan method. Determination of anti-GAD65 and anti-IA-2 autoantibodies was performed by ELISA. The PD-L1 serum levels were measured. RESULTS The allelic distribution of PD-L1 variants (rs2297137 and rs4143815) showed differences between T1D patients and controls (p = 0.035 and p = 0.022, respectively). No differences were detected among the PD-L2 polymorphisms, and only the rs16923189 showed genetic variation. T1D patients showed decreased serum levels of PD-L1 compared to controls: 1.42 [0.23-7.45] ng/mL versus 3.35 [0.49-5.89] ng/mL (p < 0.025). In addition, the CGG haplotype in PD-L1 associated with T1D (constructed from rs822342, rs2297137 and rs4143815 polymorphisms) showed an OR = 1.44 [1.08 to 1.93]. Finally, no association of these genetic variants was observed with serum concentrations of PD ligands or auto-antibody profile, although a correlation between PD-L1 ligand serum concentration and the age at disease onset was detected. CONCLUSION Two polymorphism of PD-L1 are presented in different allelic variants between T1D and healthy subjects, also PDL-1 serum levels are significantly lowered in diabetics patients. Moreover, the age of onset of the disease determine differences between serum ligand levels in diabetics, being lower in younger. These results points to a possible establishment of PDL-1 as a genetic and biochemical marker for T1D onset, at least in Chilean population.
Collapse
Affiliation(s)
- Carolina Pizarro
- Laboratorio de Genómica Nutricional, Departamento de Nutrición, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | | | | | | | | | | |
Collapse
|
49
|
Rubio-Cabezas O, Codner E, Flanagan SE, Gómez JL, Ellard S, Hattersley AT. Neurogenin 3 is important but not essential for pancreatic islet development in humans. Diabetologia 2014; 57:2421-4. [PMID: 25120094 PMCID: PMC4181041 DOI: 10.1007/s00125-014-3349-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/22/2014] [Indexed: 12/03/2022]
Affiliation(s)
- Oscar Rubio-Cabezas
- Department of Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, Avda. Menéndez Pelayo 65, 28007 Madrid, Spain,
| | | | | | | | | | | |
Collapse
|
50
|
Cameron FJ, Amin R, de Beaufort C, Codner E, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetes in adolescence. Pediatr Diabetes 2014; 15 Suppl 20:245-56. [PMID: 25039664 DOI: 10.1111/pedi.12169] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/05/2014] [Indexed: 01/16/2023] Open
Affiliation(s)
- Fergus J Cameron
- Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | | | | | | | | | | |
Collapse
|