Affected brother as the highest risk factor of type 1 diabetes development in children and adolescents: One center data before implementing type 1 diabetes national screening

BACKGROUND

There is an increased risk for childhood type 1 diabetes (T1D) when T1D and type 2 diabetes (T2D) are reported in relatives.

OBJECTIVES

Our objective was to evaluate current family risk factors for T1D development before implementing a national screening program for T1D.

MATERIAL AND METHODS

A population of 879 Caucasian children and adolescents with T1D and 286 healthy controls were enrolled in the study. All participants completed the same questionnaire, which collected information about family history of diabetes over 3 generations. In statistical analyses, frequency tables and χ2 tests evaluated possible multicollinearity among risk factors that were significantly associated with the outcomes.

RESULTS

Family history of diabetes was more frequent in controls (n = 75, 26.2%) than in patients with T1D (n = 146, 16.6%, odds ratio (OR) = 1.785, 95% confidence interval (95% CI): 1.299-2.452, degrees of freedom (df) = 12.976, p = 0.004), especially with a family history of T2D (n = 62, 21.7% compared to n = 79, 9.0%, respectively, OR = 2.803, 95% CI: 1.948-4.034, df = 32.669, p < 0.001). Also, there was a tendency for the nuclear family of T1D patients to be more frequently affected by T1D (n = 74, 8.4%) than the controls (n = 15, 5.2%, OR = 1.605, 95% CI: 0.937-2.751, df = 3.081, p = 0.079). The risk of T1D was associated with the closest family members being affected and accelerated over generations. Indeed, it was highest in siblings, especially brothers (OR = 12.985, 95% CI: 0.782-215.743, Fisher's test: p < 0.001). A positive family history of T2D burden among second-degree relatives was 2.728 times more frequent in the control group than in the T1D group (OR = 2.728; 95% Cl: 1.880-3.962, p < 0.001). Furthermore, a positive family history of T1D among first-degree relatives was less frequent in the controls than in the T1D group (OR = 0.124; 95% Cl: 0.030-0.516, p = 0.004).

CONCLUSIONS

A family history of T1D, but not T2D, is a significant risk factor for T1D development. Indeed, the priority in screening for T1D should be given to first-degree relatives of T1D patients, starting from siblings.

Assessing Individuals Attending the Family Medicine Clinic for Periodic Health Examinations in Screening of Diabetes Mellitus

PURPOSE

This study aims to evaluate the presence and risk of diabetes mellitus (DM) and the factors affecting the risk in those who visited the family medicine outpatient clinic.

METHODS

The present study included adult patients who presented to the outpatient clinic for periodic health examination between February 4, 2022, and April 4, 2022, and who had no known history of DM and were eligible for screening. Anthropometric measurements of the participants were made and their clinical and familial histories were taken in relation to DM. HbA1c and fasting blood glucose (FBG) tests were conducted for each participant.

RESULTS

A total of 125 participants, 87 (69.6%) women and 38 (30.4%) men, were included in the study, and five (4%) participants had diabetes. The analysis of the independent risk factors associated with diabetes by multivariate logistic regression analysis revealed that the presence of DM in the family increased the risk of having HbA1c ≥ 5.7% (OR: 3.441; 95% CI: 1.381-8,574; p=0.008). Among women, the waist circumference being > 95 cm was determined as a discriminating factor for HbA1c ≥ 5.7% (sensitivity: 61.54% and specificity: 68.85%).

CONCLUSION

Accurate patient-centered risk assessments by family physicians can lead to positive lifestyle modifications in patients. For this purpose, family physicians should evaluate the patients for diabetes and its associated risk factors and encourage them to take measures in order to prevent diabetes.

Assessment of the Risk of Type 2 Diabetes Mellitus Among a Rural Population in South India Using the Indian Diabetic Risk Score

Objective The objective of our study was to assess the risk for diabetes using the Indian Diabetic Risk Score (IDRS) questionnaire and compare the components of IDRS between the risk groups. Methods It was a cross-sectional study involving 270 male and female attendees who visited Melmaruvathur Adhiparasakthi Institute of Medical Sciences (MAPIMS) from December 2019 to May 2020. The diabetes risk was assessed using the IDRS questionnaire. Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY) was used for statistical analysis. P < 0.05 was considered statistically significant. Results IDRS categorization showed 12.6%, 73.7%, and 13.7% in the low-risk, moderate-risk, and high-risk groups, respectively. Age, waist circumference, and body mass index (BMI) were significantly (P < 0.05) higher in the high-risk group when compared with the low-risk group. Subjects with a positive family history of diabetes and no/mild physical activity were higher in the moderate and high-risk group but there is no significant association present between them. Conclusion The current study estimates the effectiveness of IDRS in identifying people at high risk for diabetes in the community. This study also emphasizes the need for early identification of high-risk individuals and planning for the appropriate intervention to prevent, or delay, the onset of diabetes and thus reduces the burden of diabetes in India.

Men With Both Diabetes and a Family History of Diabetes Were Associated With Depressed Mood in Korean Adults

Diabetes mellitus (DM) is strongly associated with depression, especially in women. This study was designed to investigate the gender-specific association between DM and depressive mood by family history of diabetes. Data from the Korea National Health and Nutrition Examination Survey, a population-based cross-sectional survey in 2020, were used. Of 6,133 participants aged 19 years or older, 4,259 participants were included after excluding participants without data of laboratory or physical examination, medical or family history of diseases, or depression scores of Patient Health Questionnaire-9. We examined associations of glucose and insulin metabolism, and DM with depressed mood by sex and family history of diabetes using logistic regression analyses with three stepwise models. In men, fasting glucose and HbA1c (odds ratio [OR]: 1.25, 95% confidence interval [CI]: [1.10, 1.42]) levels were significantly associated with depressed mood. Men with DM and a family history of diabetes were also significantly associated with depressed mood (OR: 1.84, 95% CI: [1.12, 3.05]), whereas DM without a family history showed no association. In women, glucose and insulin metabolism had no associations with depressed mood, and DM was also not associated with depressed mood regardless of a family history of diabetes. In Korean adults, DM with a family history of diabetes and glucose metabolism showed significant associations with depressed mood in men, but not in women. Our results suggest that men with both DM and a family history of diabetes should be paid more attention to depressed moods, considering ethnic characteristics.

Screening Model for Estimating Undiagnosed Diabetes among People with a Family History of Diabetes Mellitus: A KNHANES-Based Study

A screening model for estimating undiagnosed diabetes mellitus (UDM) is important for early medical care. There is minimal research and a serious lack of screening models for people with a family history of diabetes (FHD), especially one which incorporates gender characteristics. Therefore, the primary objective of our study was to develop a screening model for estimating UDM among people with FHD and enable its validation. We used data from the Korean National Health and Nutrition Examination Survey (KNHANES). KNAHNES (2010-2016) was used as a developmental cohort (n = 5939) and was then evaluated in a validation cohort (n = 1047) KNHANES (2017). We developed the screening model for UDM in male (SMM), female (SMF), and male and female combined (SMP) with FHD using backward stepwise logistic regression analysis. The SMM and SMF showed an appropriate performance (area under curve (AUC) = 76.2% and 77.9%) compared with SMP (AUC = 72.9%) in the validation cohort. Consequently, simple screening models were developed and validated, for the estimation of UDM among patients in the FHD group, which is expected to reduce the burden on the national health care system.

[Family diabetes and main noncommunicable diseases: The described and potential effect of metformin (remembering Vladimir Dilman).]

The work discusses the two biomedical problems: family diabetes (bearing in mind the presence of cases of type 2 diabetes mellitus in the family, including its different generations) and the features of relationship of family diabetes with major non-communicable human diseases (NCDs). The paper is timed to the anniversary of the famous - in our country and abroad - expert in the field of gerontology and endocrinology, Professor V.M.Dilman. The widely recognized works of V.M.Dilman, based on original ideas and giving rise to important practical consequences (including the use of antidiabetic biguanides in areas not studied before him, the need to eliminate metabolic immunodepression, to take into account the changes with age at the level of the hypothalamic threshold in various homeostatic systems and a whole number of other essential proposals), which for a long time, as it seems, will stimulate the further scientific search of his followers and specialists, who have yet to get acquainted with the area that attracted Prof. Dilman and interested him for many years.

Polycystic ovary syndrome and risk factors for gestational diabetes

OBJECTIVE

To study the roles of self-reported symptoms and/or prior diagnosis of polycystic ovary syndrome (PCOS) and other potential risk factors for gestational diabetes mellitus (GDM) and to clarify whether the screening of GDM in early pregnancy is beneficial for all women with PCOS.

DESIGN

The FinnGeDi multicentre case-control study including 1146 women with singleton pregnancies diagnosed with GDM and 1066 non-diabetic pregnant women. There were 174 women with PCOS (symptoms and/or diagnosis self-reported by a questionnaire) and 1767 women without PCOS (data missing for 271).

METHODS

The study population (N = 1941) was divided into four subgroups: GDM + PCOS (N = 105), GDM + non-PCOS (N = 909), non-GDM + PCOS (N = 69), and controls (N = 858). The participants' characteristics and their parents' medical histories were compared.

RESULTS

The prevalence of PCOS was 10.4% among GDM women and 7.4% among non-diabetics (odds ratios (OR) 1.44, 95% CI: 1.05-1.97), but PCOS was not an independent risk for GDM after adjustments for participants' age and pre-pregnancy BMI (OR 1.07, 95% CI: 0.74-1.54). In a multivariate logistic regression analysis, the most significant parameters associated with GDM were overweight, obesity, age ≥35 years, participant's mother's history of GDM, either parent's history of type 2 diabetes (T2D) and participant's own preterm birth.

CONCLUSIONS

The increased risk of GDM in women with PCOS was related to obesity and increased maternal age rather than to PCOS itself, suggesting that routine early screening of GDM in PCOS women without other risk factors should be reconsidered. Instead, family history of GDM/T2D and own preterm birth were independent risk factors for GDM.

Type 2 diabetes as a disease of ectopic fat?

BACKGROUND

Although obesity and diabetes commonly co-exist, the evidence base to support obesity as the major driver of type 2 diabetes mellitus (T2DM), and the mechanisms by which this occurs, are now better appreciated.

DISCUSSION

This review briefly examines several sources of evidence - epidemiological, genetic, molecular, and clinical trial - to support obesity being a causal risk factor for T2DM. It also summarises the ectopic fat hypothesis for this condition, and lists several pieces of evidence to support this concept, extending from rare conditions and drug effects to sex- and ethnicity-related differences in T2DM prevalence. Ectopic liver fat is the best-studied example of ectopic fat, but more research on pancreatic fat as a potential cause of β-cell dysfunction seems warranted. This ectopic fat concept, in turn, broadly fits with the observation that individuals of similar ages can develop diabetes at markedly different body mass indexes (BMIs). Those with risk factors leading to more rapid ectopic fat gain - for example, men (compared with women), certain ethnicities, and potentially those with a family history of diabetes, as well as others with genes linked to a reduced subcutaneous adiposity - are more likely to develop diabetes at a younger age and/or lower BMI than those without.

SUMMARY

Obesity is the major risk factor for T2DM and appears to drive tissue insulin resistance in part via gain of ectopic fat, with the best-studied organ being the liver. However, ectopic fat in the pancreas may contribute to β-cell dysfunction. In line with this observation, rapid resolution of diabetes linked to a preferential and rapid reduction in liver fat has been noted with significant caloric reduction. Whether these observations can help develop better cost-effective and sustainable lifestyle /medical interventions in patients with T2DM requires further study.

Joint effect of family history of diabetes with obesity on prevalence of type 2 diabetes mellitus among Chinese and Finnish men and women

OBJECTIVE

To study joint effect of family history of diabetes (FHD) with obesity on prevalence of type 2 diabetes mellitus in the Chinese and in the Finns.

METHODS

A total of 1091 Chinese men and 1706 women, 1472 Finnish men and 1694 women, 45-74 years of age were studied. The probability and odds ratio (OR) of having diabetes were estimated using logistic regression analysis. The synergy index (SI) and relative excess risk due to interaction (RERI) of FHD with body mass index (BMI) or waist circumference (WC) was calculated.

RESULTS

Age-standardized prevalence of diabetes was higher in individuals with FHD than in those without in both the Chinese and Finns. Compared with individuals without FHD and with BMI <30 kg/m(2), ORs (95% confidence intervals [CI]) for diabetes were 2.7 (1.8, 4.0), 2.8 (1.9, 4.0), 9.1 (5.9, 13.9), respectively, in Finnish men with BMI ≥30 kg/m(2) alone, with FHD alone and with both (SI [95% CI] = 2.4 [1.4, 3.9], RERI = 4.6 [1.3, 8.0]); the corresponding figures were 1.7 (1.0, 2.9), 2.7 (1.8, 4.2) and 4.4 (1.9, 10.4) in Chinese men (SI = 1.4 [0.4, 4.9] RERI = 1.0 [-2.9, 5.0]). They were 3.5 (2.1, 5.8), 2.1 (1.3, 3.4) and 6.8 (4.1, 11.2) in Finnish women (SI = 1.6 [0.9, 2.8], RERI = 2.2 [-0.4, 4.9]), and 1.6 (1.1, 2.2), 2.1 (1.5, 3.0), 3.5 (1.9, 6.4) in Chinese women (SI = 1.5 [0.6, 3.8], RERI = 0.8 [-1.4, 3.0]). The pattern of synergistic effect of FHD with WC on diabetes was similar to that seen with BMI in the Finns but no effect was seen in the Chinese.

CONCLUSIONS

Both obesity and FHD are independent risk factors for diabetes, but their joint effect is significant only in Finnish men.

Joint impact of physical activity and family history on the development of diabetes among urban adults in Mainland China: a pooled analysis of community-based prospective cohort studies

To examine the joint influences of physical activity (PA) and family history (FH) of diabetes on subsequent type 2 diabetes (T2D), the authors pooled and analyzed data from 2 community-based urban adult prospective cohort studies in 2011 in Nanjing, China. Among 4550 urban participants, the 3-year cumulative incidence of T2D was 5.1%. After adjustment for potential confounders, compared with those with FH+ and insufficient PA, the adjusted odds ratio (95% confidence interval) of developing T2D was 0.42 (0.18, 0.98) for participants with sufficient PA and FH+, 0.32 (0.22, 0.46) for participants with insufficient PA and FH-, and 0.15 (0.08, 0.28) for participants with sufficient PA and FH-. Such significant graduated associations between PA/FH and risk of developing T2D were also identified in either men or women, separately. Sufficient PA and FH- may jointly reduce the risk of developing T2D in urban Chinese adults.

Metabolic dysfunction in women with bipolar disorder: the potential influence of family history of type 2 diabetes mellitus

OBJECTIVE

Overweight/obesity, insulin resistance (IR), and other types of metabolic dysfunction are common in patients with bipolar disorder (BD); however, the pathophysiological underpinnings of metabolic dysfunction in BD are not fully understood. Family history of type 2 diabetes mellitus (FamHxDM2), which has been shown to have deleterious effects on metabolic function in the general population, may play a role in the metabolic dysfunction observed in BD.

METHODS

Using multivariate analysis of variance, the effects of BD illness and/or FamHxDM2 were examined relative to metabolic biomarkers in 103 women with BD and 36 healthy, age-matched control women.

RESULTS

As a group, women with BD had higher levels of fasting plasma insulin (FPI) and fasting plasma glucose (FPG), higher homeostatic assessment of IR (HOMA-IR) scores, body mass index (BMI), waist circumference (WC), and hip circumference (HC) compared to control women. FamHxDM2 was associated with significantly worse metabolic biomarkers among women with BD but not among healthy control women. Among women with BD, there was a significant main effect of FamHxDM2 on FPI, HOMA-IR, BMI, WC, and HC, even after controlling for type of BD illness, duration of medication exposure, and depression severity. Metabolic biomarkers were not influenced by use of weight-liable psychotropic medication (WLM), even after controlling for type of BD illness, duration of medication exposure, and depression severity.

CONCLUSIONS

Women with BD have overall worse metabolic biomarkers than age-matched control women. The use of WLM, duration of medication use, type of BD illness, and depression severity did not appear to be associated with more pronounced metabolic dysfunction. FamHxDM2 may represent a risk factor for the development of IR in women with BD. Further, focused studies of the endocrine profiles of families of BD patients are needed.