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Batdorf HM, de Luna Lawes L, Cassagne GA, Fontenot MS, Harvey IC, Richardson JT, Burk DH, Dupuy SD, Karlstad MD, Salbaum JM, Staszkiewicz J, Beyl R, Ghosh S, Burke SJ, Collier JJ. Accelerated onset of diabetes in non-obese diabetic mice fed a refined high-fat diet. Diabetes Obes Metab 2024; 26:2158-2166. [PMID: 38433703 PMCID: PMC11078605 DOI: 10.1111/dom.15522] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
AIM Type 1 diabetes results from autoimmune events influenced by environmental variables, including changes in diet. This study investigated how feeding refined versus unrefined (aka 'chow') diets affects the onset and progression of hyperglycaemia in non-obese diabetic (NOD) mice. METHODS Female NOD mice were fed either unrefined diets or matched refined low- and high-fat diets. The onset of hyperglycaemia, glucose tolerance, food intake, energy expenditure, circulating insulin, liver gene expression and microbiome changes were measured for each dietary group. RESULTS NOD mice consuming unrefined (chow) diets developed hyperglycaemia at similar frequencies. By contrast, mice consuming the defined high-fat diet had an accelerated onset of hyperglycaemia compared to the matched low-fat diet. There was no change in food intake, energy expenditure, or physical activity within each respective dietary group. Microbiome changes were driven by diet type, with chow diets clustering similarly, while refined low- and high-fat bacterial diversity also grouped closely. In the defined dietary cohort, liver gene expression changes in high-fat-fed mice were consistent with a greater frequency of hyperglycaemia and impaired glucose tolerance. CONCLUSION Glucose intolerance is associated with an enhanced frequency of hyperglycaemia in female NOD mice fed a defined high-fat diet. Using an appropriate matched control diet is an essential experimental variable when studying changes in microbiome composition and diet as a modifier of disease risk.
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Affiliation(s)
- Heidi M. Batdorf
- Pennington Biomedical Research Center, Baton Rouge, LA 70808
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803
| | | | | | | | | | | | - David H. Burk
- Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - Samuel D. Dupuy
- Department of Surgery, University of Tennessee Health Science Center, Graduate School of Medicine, Knoxville, TN 37920
| | - Michael D. Karlstad
- Department of Surgery, University of Tennessee Health Science Center, Graduate School of Medicine, Knoxville, TN 37920
| | | | | | - Robbie Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - Sujoy Ghosh
- Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - Susan J. Burke
- Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - J. Jason Collier
- Pennington Biomedical Research Center, Baton Rouge, LA 70808
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803
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Balgobin S, Basak S, Teoh CW, Noone D. Hypertension in diabetes. Pediatr Nephrol 2024; 39:1739-1758. [PMID: 37831122 DOI: 10.1007/s00467-023-06163-x] [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: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023]
Abstract
Diabetes mellitus, a disease that affects hundreds of millions of people worldwide, is increasing in prevalence in all age groups, including children and adolescents. Much of the morbidity and mortality associated with diabetes is closely related to hypertension, often coincident with diabetes. Comorbid hypertension and diabetes often worsen the outcomes of each other, likely rooted in some overlapping pathogenic mechanisms. In this educational review, we will discuss the shared pathophysiology of diabetes and hypertension, particularly in regard to inflammation and oxidative stress, the sympathetic nervous system, vascular remodeling, and the renin-angiotensin-aldosterone system (RAAS). We will also review current hypertension diagnosis and management guidelines from many international jurisdictions for both adult and paediatric populations in the setting of diabetes. Many of these guidelines highlight the use and utility of RAAS blockers in this clinical scenario; however, on review of the evidence for their use, several meta-analyses and systematic reviews fail to demonstrate superiority of RAAS blockers over other anti-hypertensive medications. Finally, we discuss several new anti-hypertensive medications, review their mechanisms of action, and highlight some of the evidence for their use in the setting of hypertension and diabetes.
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Affiliation(s)
- Steve Balgobin
- Division of Paediatric Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Sanjukta Basak
- Pediatric Endocrinologist, BC Children's Hospital, Vancouver, BC, Canada
- Division of Endocrinology & Metabolism, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chia Wei Teoh
- Division of Paediatric Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Damien Noone
- Division of Paediatric Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada.
- Department of Paediatrics, University of Toronto, Toronto, Canada.
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3
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Sanchez N, Chen M, Ho S, Spinner H, Vagadori J, Neiser A, Padilla K, Bristol M, Winfield E, Thorstad I, Gulley LD, Lucas-Thompson RG, Pyle L, Thompson T, Estrada DE, Basch M, Tanofsky-Kraff M, Kelsey MM, Mackey ER, Shomaker LB. Mindfulness-based intervention for depression and insulin resistance in adolescents: Protocol for BREATHE, a multisite, pilot and feasibility randomized controlled trial. Contemp Clin Trials 2024; 141:107522. [PMID: 38580104 DOI: 10.1016/j.cct.2024.107522] [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] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/18/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Elevated depression symptoms have been associated with higher insulin resistance in adolescents, and consequently, greater risk for type 2 diabetes (T2D). Mindfulness-based intervention (MBI) may be suited for adolescents at risk for T2D given its potential to decrease depression and improve stress-related behavior/physiology underpinning insulin resistance. To prepare for a future multisite efficacy randomized controlled trial, a rigorous, multisite, pilot and feasibility study is needed to test this approach. The current paper describes the design and protocol for a multisite, pilot and feasibility randomized controlled trial of six-week MBI, cognitive-behavioral therapy (CBT), and health education (HealthEd) group interventions, to assess multisite fidelity, feasibility, and acceptability. METHODS Participants are N = 120 adolescents ages 12-17, with body mass index (BMI) ≥85th percentile, elevated depression symptoms (20-item Center for Epidemiologic Studies-Depression Scale total score > 20), and family history of diabetes. Enrollment occurs across four United States (US) sites, two in Colorado, one in Washington, D·C., and one in Maryland. Group interventions are delivered virtually by trained psychologists and co-facilitators. Assessments occur at baseline, six-week follow-up, and one-year follow-up. RESULTS Primary outcomes are intervention implementation fidelity, based upon expert ratings of audio-recorded sessions (≥80% adherence/competence), and recruitment feasibility, based upon percentage enrollment of eligible youth (≥80%). Secondary outcomes are intervention training fidelity/feasibility/acceptability, recruitment timeframe, and retention/assessment feasibility. CONCLUSION Findings will inform optimization of training, recruitment, intervention delivery, retention, and assessment protocols for a multisite, efficacy randomized controlled trial evaluating MBI for decreasing depression and improving insulin resistance in adolescents at risk for developing T2D.
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Affiliation(s)
- Natalia Sanchez
- Department of Human Development and Family Studies, Colorado State University, USA.
| | - Michele Chen
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Sally Ho
- Center for Translational Research, Children's National Hospital, USA
| | - Holly Spinner
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, USA
| | - Jack Vagadori
- Center for Translational Research, Children's National Hospital, USA
| | - Abigail Neiser
- Department of Human Development and Family Studies, Colorado State University, USA
| | - Kimberly Padilla
- Department of Human Development and Family Studies, Colorado State University, USA
| | - Madison Bristol
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Elijah Winfield
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Isabel Thorstad
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, USA
| | - Lauren D Gulley
- Department of Human Development and Family Studies, Colorado State University, USA; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Rachel G Lucas-Thompson
- Department of Human Development and Family Studies, Colorado State University, USA; Colorado School of Public Health, Fort Collins, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Talia Thompson
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Doris E Estrada
- Center for Translational Research, Children's National Hospital, USA; Department of Pediatrics, Division of Diabetes and Endocrinology, Children's National Hospital, USA
| | - Molly Basch
- Center for Translational Research, Children's National Hospital, USA
| | - Marian Tanofsky-Kraff
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, USA; Department of Medical and Clinical Psychology, Uniformed Services University, USA
| | - Megan M Kelsey
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Hospital, USA
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, USA; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA; Colorado School of Public Health, Fort Collins, Colorado, USA
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Zeitler P, Galindo RJ, Davies MJ, Bergman BK, Thieu VT, Nicolay C, Allen S, Heine RJ, Lee CJ. Early-Onset Type 2 Diabetes and Tirzepatide Treatment: A Post Hoc Analysis From the SURPASS Clinical Trial Program. Diabetes Care 2024; 47:1056-1064. [PMID: 38639997 DOI: 10.2337/dc23-2356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE We evaluated baseline characteristics of participants with early-onset type 2 diabetes (T2D) from the SURPASS program and tirzepatide's effects on glycemic control, body weight (BW), and cardiometabolic markers. RESEARCH DESIGN AND METHODS This post hoc analysis compared baseline characteristics and changes in mean HbA1c, BW, waist circumference (WC), lipids, and blood pressure (BP) in 3,792 participants with early-onset versus later-onset T2D at week 40 (A Study of Tirzepatide [LY3298176] in Participants With Type 2 Diabetes Not Controlled With Diet and Exercise Alone [SURPASS-1] and A Study of Tirzepatide [LY3298176] Versus Semaglutide Once Weekly as Add-on Therapy to Metformin in Participants With Type 2 Diabetes [SURPASS-2]) or week 52 (A Study of Tirzepatide [LY3298176] Versus Insulin Degludec in Participants With Type 2 Diabetes [SURPASS-3]). Analyses were performed by study on data from participants while on assigned treatment without rescue medication in case of persistent hyperglycemia. RESULTS At baseline in SURPASS-2, participants with early-onset versus later-onset T2D were younger with longer diabetes duration (9 vs. 7 years, P < 0.001) higher glycemic levels (8.5% vs. 8.2%, P < 0.001), higher BW (97 vs. 93 kg, P < 0.001) and BMI (35 vs. 34 kg/m2, P < 0.001), and a similarly abnormal lipid profile (e.g., triglycerides 167 vs. 156 mg/dL). At week 40, similar improvements in HbA1c (-2.6% vs. -2.4%), BW (-14 vs. -13 kg), WC (-10 vs. -10 cm), triglycerides (-26% vs. -24%), HDL (7% vs. 7%), and systolic BP (-6 vs. -7 mmHg) were observed in both subgroups with tirzepatide. CONCLUSIONS Despite younger age, participants with early-onset T2D from the SURPASS program had higher glycemic levels and worse overall metabolic health at baseline versus those with later-onset T2D. In this post hoc analysis, similar improvements in HbA1c, BW, and cardiometabolic markers were observed with tirzepatide, irrespective of age at T2D diagnosis. Future studies are needed to determine long-term outcomes of tirzepatide in early-onset T2D.
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Affiliation(s)
- Philip Zeitler
- Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, U.K
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Javidi H, Mariam A, Alkhaled L, Pantalone KM, Rotroff DM. An interpretable predictive deep learning platform for pediatric metabolic diseases. J Am Med Inform Assoc 2024; 31:1227-1238. [PMID: 38497983 PMCID: PMC11105121 DOI: 10.1093/jamia/ocae049] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES Metabolic disease in children is increasing worldwide and predisposes a wide array of chronic comorbid conditions with severe impacts on quality of life. Tools for early detection are needed to promptly intervene to prevent or slow the development of these long-term complications. MATERIALS AND METHODS No clinically available tools are currently in widespread use that can predict the onset of metabolic diseases in pediatric patients. Here, we use interpretable deep learning, leveraging longitudinal clinical measurements, demographical data, and diagnosis codes from electronic health record data from a large integrated health system to predict the onset of prediabetes, type 2 diabetes (T2D), and metabolic syndrome in pediatric cohorts. RESULTS The cohort included 49 517 children with overweight or obesity aged 2-18 (54.9% male, 73% Caucasian), with a median follow-up time of 7.5 years and mean body mass index (BMI) percentile of 88.6%. Our model demonstrated area under receiver operating characteristic curve (AUC) accuracies up to 0.87, 0.79, and 0.79 for predicting T2D, metabolic syndrome, and prediabetes, respectively. Whereas most risk calculators use only recently available data, incorporating longitudinal data improved AUCs by 13.04%, 11.48%, and 11.67% for T2D, syndrome, and prediabetes, respectively, versus models using the most recent BMI (P < 2.2 × 10-16). DISCUSSION Despite most risk calculators using only the most recent data, incorporating longitudinal data improved the model accuracies because utilizing trajectories provides a more comprehensive characterization of the patient's health history. Our interpretable model indicated that BMI trajectories were consistently identified as one of the most influential features for prediction, highlighting the advantages of incorporating longitudinal data when available.
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Affiliation(s)
- Hamed Javidi
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States
- Department of Electrical Engineering and Computer Science, Cleveland State University, Cleveland, OH 44115, United States
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Arshiya Mariam
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Lina Alkhaled
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Kevin M Pantalone
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Daniel M Rotroff
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States
- Department of Electrical Engineering and Computer Science, Cleveland State University, Cleveland, OH 44115, United States
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, United States
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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La Grasta Sabolic L, Marusic S, Cigrovski Berkovic M. Challenges and pitfalls of youth-onset type 2 diabetes. World J Diabetes 2024; 15:876-885. [PMID: 38766423 PMCID: PMC11099376 DOI: 10.4239/wjd.v15.i5.876] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/04/2024] [Accepted: 04/01/2024] [Indexed: 05/10/2024] Open
Abstract
The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) are increasing. The rise in frequency and severity of childhood obesity, inclination to sedentary lifestyle, and epigenetic risks related to prenatal hyperglycemia exposure are important drivers of the youth-onset T2DM epidemic and might as well be responsible for the early onset of diabetes complications. Indeed, youth-onset T2DM has a more extreme metabolic phenotype than adult-onset T2DM, with greater insulin resistance and more rapid deterioration of beta cell function. Therefore, intermediate complications such as microalbuminuria develop in late childhood or early adulthood, while end-stage complications develop in mid-life. Due to the lack of efficacy and safety data, several drugs available for the treatment of adults with T2DM have not been approved in youth, reducing the pharmacological treatment options. In this mini review, we will try to address the present challenges and pitfalls related to youth-onset T2DM and summarize the available interventions to mitigate the risk of microvascular and macrovascular complications.
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Affiliation(s)
- Lavinia La Grasta Sabolic
- Department of Pediatric Endocrinology and Diabetology, University Hospital Centre Sestre Milosrdnice, Zagreb 10000, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb 10000, Croatia
| | - Sanda Marusic
- Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology , Zagreb 10000, Croatia
| | - Maja Cigrovski Berkovic
- Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology , Zagreb 10000, Croatia
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Zhang C, Zhang H, Zhang B. Prevalence trends and racial-ethnic disparities of diabetes and prediabetes among children and adolescents in the United States from 2019 to 2021. Prev Med Rep 2024; 41:102688. [PMID: 38533394 PMCID: PMC10963308 DOI: 10.1016/j.pmedr.2024.102688] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
Objective This study investigated disparities in diabetes and prediabetes prevalence among US children and adolescents using 2019-2021 National Health Interview Survey (NHIS) data. With rising trends in diabetes, understanding prevalence rates and associated disparities is crucial for targeted interventions. Methods Analyzing a cross-sectional sample of 19,490 participants aged 3-17, we employed NHIS data to calculate prevalence rates. Stratification by sociodemographic factors, race/ethnicity, and family income allowed for in-depth analyses. Results Between 2019 and 2021, overall diabetes prevalence was 1.18%, comprising 0.87% prediabetes and 0.46% diabetes rates. Disparities were evident, with higher prediabetes rates in non-Hispanic black and Hispanic children and elevated diabetes rates in non-Hispanic white and Hispanic children. Subgroup analyses revealed associations within age, gender, education, and income strata. Conclusions The study highlighted potential increases in diabetes prevalence from 2017 to 2021 and persistent racial/ethnic disparities. The 12-17 age subgroup exhibited significant disparities, emphasizing the need for early intervention. Targeted strategies were imperative to mitigate diabetes and prediabetes prevalence in vulnerable populations, particularly non-Hispanic black and Hispanic children. This study underscored the urgency of addressing health disparities for improved overall well-being and healthcare outcomes.
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Affiliation(s)
- Cancan Zhang
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hui Zhang
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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8
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Lee SL, Wu LM, Lin SY, Chen TH, Lin WT. Cross-cultural translation and validation of the Chinese version Distress Tolerance Scale for adolescents with chronic physical disease. Child Care Health Dev 2024; 50:e13270. [PMID: 38706405 DOI: 10.1111/cch.13270] [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: 11/23/2023] [Revised: 03/18/2024] [Accepted: 03/31/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Chronic physical disease (CPD) makes life filled with many negative events in adolescents, but not all adolescents experiencing negative life events proceed to develop emotional distress, only those with low emotional distress tolerance (EDT). A valid and reliable scale to measure EDT in CPD adolescents is important for caring for their emotional distress. Therefore, the purpose of this study is to translate the 15-item English version Distress Tolerance Scale (DTS) into a Chinese version and then validate the scale for measuring EDT of adolescents with CPD. METHODS The 15-item English version DTS was translated into a Chinese version using the translation guidelines for cross-cultural research. Two cohorts of adolescents with CPD were recruited from four hospitals in southern Taiwan, with the first cohort including 124 adolescents with CPD employed to conduct exploratory factor analysis, corrected item-total correlation and reliability testing, while the second cohort, consisting of 238 adolescents with CPD, was utilized to examine confirmatory factor analysis and concurrent validity. RESULTS The two-factor nine-item Chinese version DTS for Adolescents with CPD (C-DTS-A) was developed. Lower scores of the C-DTS-A were significantly associated with higher diabetes distress, poorer self-management, and worse glycaemic control; their correlation coefficients sequentially were -.40, .17 and -.23. Cronbach's α and the test-retest reliability of the two-factor C-DTS-A ranged from .81 to .87 and from .79 to .89, respectively. CONCLUSION The two-factor nine-item C-DTS-A with good cross-cultural translation quality was a reliable and valid scale to assess EDT for adolescents with CPD.
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Affiliation(s)
- Shu-Li Lee
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Yuan Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Han Chen
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neonatal Intensive Care Unit, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Ting Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Wang X, Ma X, Song J, Liu B, Wang J. Analysis aqueous humor lipid profile of neovascular glaucoma secondary to diabetic retinopathy and lipidomic alteration response to anti-VEGF treatment. Exp Eye Res 2024; 242:109878. [PMID: 38554799 DOI: 10.1016/j.exer.2024.109878] [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] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/05/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
The objective of this study was to examine the lipid spectrum of aqueous humor (AH) in patients with neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy and to investigate the lipid alteration response to anti-vascular endothelial growth factor (anti-VEGF) treatment. Lipidomic analysis using ultra-high performance liquid chromatography-tandem mass spectrometry was conducted to compare the lipid profiles of the AH in NVG patients with those of a control group. Lipid changes in the AH of NVG patients before and after intravitreal conbercept injections were also evaluated. The identification of lipids showing differential expression was accomplished through both multivariate and univariate analyses. This study included 13 NVG patients and 20 control subjects. Based on LipidSearch software, 639 lipid species across 33 lipid classes were detected in the participants' AH. The combination of univariate and multivariate statistical analyses yielded 53 differentially expressed lipids (VIP >1 and P < 0.05). In addition, 9 lipids were found to be differentially expressed before and after the intravitreal conbercept injections in the NVG patients. Significant alterations in the metabolic pathways of glycerophospholipid and glycerolipid exhibited notable changes. Our results highlighted the lipid changes in patients' AH in relation to the progression of NVG, and indicated that the modified lipids could potentially be utilized as therapeutic targets for NVG.
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Affiliation(s)
- Xiaoyun Wang
- Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaohua Ma
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jingyao Song
- Department of Ophthalmology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bing Liu
- Department of Ophthalmology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Jiawei Wang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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McDonough C, Li YC, Vangeepuram N, Liu B, Pandey G. A comprehensive youth diabetes epidemiological dataset and web portal: Resource Development and Case Studies. JMIR Public Health Surveill 2024. [PMID: 38666756 DOI: 10.2196/53330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The prevalence of Type 2 diabetes (DM) and prediabetes (preDM) has been increasing among youth in recent decades in the United States, prompting an urgent need for understanding and identifying their associated risk factors. Such efforts, however, have been hindered by the lack of easily accessible youth preDM/DM data. OBJECTIVE We aimed to first build a high quality, comprehensive epidemiological dataset focused on youth preDM/DM. Subsequently, we aimed to make this data accessible by creating a user-friendly web portal to share it and corresponding codes. Through this, we hope to address this significant gap and facilitate youth preDM/DM research. METHODS Building on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we cleaned and harmonized hundreds of variables relevant to preDM/DM (fasting plasma glucose level ≥100 mg/dL and/or HbA1C ≥5.7%) for youth aged 12-19 years (n=15,149). We identified individual factors associated with preDM/DM risk using bivariate statistical analyses and predicted preDM/DM status using our Ensemble Integration (EI) framework for multi-domain machine learning. We then developed a user-friendly web portal named Prediabetes/diabetes in youth ONline Dashboard (POND) to share the data and codes. RESULTS We extracted 95 variables potentially relevant to preDM/DM risk organized into 4 domains (sociodemographic, health status, diet, and other lifestyle behaviors). The bivariate analyses identified 27 significant correlates of preDM/DM (P ≤0.0005, Bonferroni adjusted), including race/ethnicity, health insurance, BMI, added sugar intake, and screen time. Sixteen of these factors were also identified based on the EI methodology (Fisher's P of overlap=7.06x10^-6). In addition to those, the EI approach identified 11 additional predictive variables, including some known (e.g., meat and fruit intake and family income) and less recognized factors (e.g., number of rooms in homes). The factors identified in both analyses spanned over all 4 of the domains mentioned. These data and results, as well as other exploratory tools, can be accessed on POND (https://rstudio-connect.hpc.mssm.edu/POND/). CONCLUSIONS Using NHANES data, we built one of the largest public epidemiological datasets for studying youth preDM/DM and identified potential risk factors using complementary analytical approaches. Our results align with the multifactorial nature of preDM/DM with correlates across several domains. Also, our data-sharing platform, POND, facilitates a wide range of applications to inform future youth preDM/DM studies. CLINICALTRIAL
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Affiliation(s)
- Catherine McDonough
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, US
| | - Yan Chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl,, New York, US
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, US
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, US
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, US
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, US
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11
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Stein D, Ovadia D, Katz S, Brar PC. Association of hepatokines with markers of endothelial dysfunction and vascular reactivity in obese adolescents. J Pediatr Endocrinol Metab 2024; 37:309-316. [PMID: 38404032 DOI: 10.1515/jpem-2023-0339] [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: 07/20/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Obesity-induced insulin resistance (IR) is known to influence hepatic cytokines (hepatokines), including fibroblast growth factor (FGF-21), fetuin-A, and chemerin. This study aimed to investigate the association between hepatokines and markers of endothelial dysfunction and vascular reactivity in obese adolescents. METHODS A total of 45 obese adolescents were categorized into three groups based on glucose tolerance: normal glucose tolerance (NGT), prediabetes (PD), and type 2 diabetes (T2D). We examined the relationships between FGF-21, fetuin-A, and chemerin with endothelial markers (plasminogen activator inhibitor-1 [PAI-1], intercellular adhesion molecule-1 [ICAM-1], and vascular cell adhesion marker-1 [VCAM-1]) and vascular surrogates (brachial artery reactivity testing [BART] and peak reactive hyperemia [PRH]). RESULTS Obese adolescents (age 16.2±1.2 years; 62 % female, 65 % Hispanic) with NGT (n=20), PD (n=14), and T2D (n=11) had significant differences between groups in BMI; waist-hip ratio (p=0.05), systolic BP (p=0.008), LDL-C (p=0.02), PAI-1 (p<0.001). FGF-21 pg/mL (mean±SD: NGT vs. PD vs. T2D 54±42; 266±286; 160±126 p=0.006) and fetuin-A ng/mL (266±80; 253±66; 313±50 p=0.018), were significantly different while chemerin ng/mL (26±5; 31±10; 28±2) did not significantly differ between the groups. Positive correlations were found between chemerin and both PAI-1 (r=0.6; p=0.05) and ICAM-1 (r=0.6; p=0.05), FGF-21 and PAI-1 (r=0.6; p<0.001), and fetuin-A with TNFα (r=-0.4; p=0.05). Negative correlations were found between chemerin and PRH (r= -0.5; p=0.017) and fetuin-A and PRH (r=-0.4; p=0.05). CONCLUSIONS In our cohort, IR predicted higher FGF-21 levels suggesting a linear relationship may exist between the two parameters. Hepatokines can augment alterations in the microvascular milieu in obese adolescents as demonstrated by their associations with the markers PAI-1, ICAM-1, and PRH.
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Affiliation(s)
- David Stein
- Faculty of Medicine, 26745 Tel Aviv University , Tel Aviv, Israel
| | | | - Stuart Katz
- NYU Grossman School of Medicine Department, 5894 NYU Langone Health , New York, NY, USA
| | - Preneet Cheema Brar
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, 5894 New York University Grossman School of Medicine , New York, NY, USA
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12
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Yugar LBT, Sedenho-Prado LG, da Silva Ferreira IMC, Silva CAM, Sposito AC, Cercato C. The efficacy and safety of GLP-1 receptor agonists in youth with type 2 diabetes: a meta-analysis. Diabetol Metab Syndr 2024; 16:92. [PMID: 38659064 PMCID: PMC11044464 DOI: 10.1186/s13098-024-01337-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Glucagon-like peptide 1 receptor agonists have been proven to be effective in adults with diabetes and children with obesity. However, children with type 2 diabetes constitute an underrepresented subpopulation with limited treatment options. This meta-analysis aimed to determine more precise estimates of the efficacy and safety of glucagon-like peptide-1 agonists in pediatric type 2 diabetes mellitus. METHODS Three databases were searched (PubMed, Embase, and Cochrane Central Register of Controlled Trials) for trials published until the end of March 2024. The search indexing terms included 3 categories: [1] type 2 diabetes mellitus [2], youth, and [3] glucagon-like peptide-1 receptor agonist (GLP-1 RA). Randomized controlled trials in youth with type 2 diabetes (age ≤ 18 years) that assessed anthropometric and metabolic parameters were included. A total of 1119 nonduplicate studies were retrieved, and 137 full-text articles were screened. The data were analyzed using mean differences (MDs) with 95% CIs and odds ratios (ORs) with 95% CIs. For outcomes with low heterogeneity, a fixed-effects model was used. Otherwise, we applied a random effects model. Our outcomes were Hb1Ac, fasting blood glucose (FBG), blood pressure, weight, and side effects. RESULTS Five studies comprehending 415 children and adolescents were included. On average, GLP-1 RA reduced HbA1c levels (-1.01%; 95% CI, -1.26 to -0.76), fasting blood glucose levels (-1.88 mmol/L; 95% CI, -2.51 to -1.26), and body weight (-1.6 kg; 95% CI, -2.83 to -0.36). No significant reductions in systolic blood pressure (MD -0.19 mmHg; 95% CI, -3.9 to 3.52 mmHg) or diastolic blood pressure (MD 0.3 mmHg; 95% CI, -2.33 to 2.93 mmHg) were observed. Despite a higher incidence of side effects, withdrawal rates from the studies remained low. CONCLUSIONS Within this specific population, GLP-1 RAs exhibit a notable association with substantial reductions in HbA1c, FBG, and body weight. The administration of these medications is concurrent with an elevated incidence of side effects, which are predominantly gastrointestinal and tolerable. TRIAL REGISTRATION PROSPERO identifier: CRD42023393020.
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Affiliation(s)
| | | | | | | | - Andrei C Sposito
- Atherosclerosis and Vascular Biology Laboratory (Atherolab), State University of Campinas, Campinas, Brazil
| | - Cintia Cercato
- Obesity Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, São Paulo, Brazil
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13
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Fang M, Wang D, Selvin E. Prevalence of Type 1 Diabetes Among US Children and Adults by Age, Sex, Race, and Ethnicity. JAMA 2024; 331:1411-1413. [PMID: 38573653 PMCID: PMC11040401 DOI: 10.1001/jama.2024.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/08/2024] [Indexed: 04/05/2024]
Abstract
This study uses data from the 2019 to 2022 cycles of the National Health Interview Survey to estimate the prevalence of type 1 diabetes among US youths and adults.
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Affiliation(s)
- Michael Fang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dan Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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14
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Krnic N, Sesa V, Mrzljak A, Berkovic MC. Are treatment options used for adult-onset type 2 diabetes mellitus (equally) available and effective for children and adolescents? World J Diabetes 2024; 15:623-628. [PMID: 38680687 PMCID: PMC11045425 DOI: 10.4239/wjd.v15.i4.623] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
Youth-onset type 2 diabetes mellitus (T2DM), influenced by an increase in obesity, is a rising problem worldwide. Pathophysiological mechanisms of this early-onset T2DM include both peripheral and hepatic insulin resistance, along with increased hepatic fasting glucose production accompanied by inadequate first and second-phase insulin secretion. Moreover, the incretin effect is reduced. The initial presentation of type 2 diabetes can be dramatic and symptoms may overlap with those of type 1 diabetes mellitus. Therefore, immediate therapy should address hyperglycemia and associated metabolic derangements irrespective of ultimate diabetes type, while further therapy adjustments are prone to patients' phenotype. New agents with proven glycemic and beyond glycemia benefits, such as Glucagon-like polypeptide 1 receptor agonists and Sodium-glucose cotransporter-2 inhibitors, used in the adult population of T2DM patients, might become increasingly important in the treatment armamentarium. Moreover, metabolic surgery is an option for markedly obese (body mass index > 35 kg/m2) children and adolescents suffering from T2DM who have uncontrolled glycemia and/or serious comorbidities when lifestyle and pharmacologic interventions fail. In this mini-review, we will discuss the potential of treatment options considering new data available from randomized control trials, including individuals with adult-onset type diabetes mellitus.
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Affiliation(s)
- Nevena Krnic
- Clinics for Pediatrics, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Vibor Sesa
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- University of Zagreb School of Medicine, Zagreb 10000, Croatia
| | - Maja Cigrovski Berkovic
- Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology, Zagreb 10000, Croatia
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15
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Carosi Arcangeli I, Celia G, Girelli L, Fioretti C, Cozzolino M. A Study on the Sense of Parental Competence, Health Locus of Control and Levels of Anxiety, Depression and Somatization in Parents of Children with Type 1 Diabetes: Evidence on a Possible Relationship. J Clin Med 2024; 13:2259. [PMID: 38673532 PMCID: PMC11050957 DOI: 10.3390/jcm13082259] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Parents of children with chronic conditions face challenges that go beyond basic care and parenting responsibilities. Parents' experiences can be influenced by perceived stress, emotional experiences, feelings of helplessness, low sense of self-efficacy, anxiety and depression, reducing their quality of life. It is therefore not surprising that parents of children with chronic illnesses are more likely to experience stress, anxiety and depression than parents of healthy children. A prevalent chronic condition is type 1 diabetes. Methods: Parents (31 with children with type 1 diabetes diagnosis and 71 with children without chronic illness) were recruited to complete the measures of the Brief Symptom Inventory-18 (BSI-18), the Parent Health Locus of Control (PHLOC) and Parenting Sense of Competence (PSOC). Results: Significant differences in depression and internal locus of control were found; there was a positive correlation between internal LOC and efficacy in both samples; furthermore, there was a negative correlation between somatization and satisfaction in the experimental group. Conclusions: The ongoing experiences and challenges faced daily make parents perceive themselves as capable. Active involvement in supporting and managing the needs of child with type 1 diabetes could be a source of empowerment for the parent, contributing to the maintenance of their sense of competence. It is important, therefore, to consider the well-being and perception of the parent at a personal level, regardless of the child's situation.
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Affiliation(s)
- Ivonne Carosi Arcangeli
- Department of Humanities, Philosophy and Education, University of Salerno, 84084 Fisciano, Italy; (L.G.); (C.F.); (M.C.)
| | - Giovanna Celia
- Scupsis—Scuola di Psicoterapia Strategica Integrata Seraphicum, 00142 Rome, Italy;
| | - Laura Girelli
- Department of Humanities, Philosophy and Education, University of Salerno, 84084 Fisciano, Italy; (L.G.); (C.F.); (M.C.)
| | - Chiara Fioretti
- Department of Humanities, Philosophy and Education, University of Salerno, 84084 Fisciano, Italy; (L.G.); (C.F.); (M.C.)
| | - Mauro Cozzolino
- Department of Humanities, Philosophy and Education, University of Salerno, 84084 Fisciano, Italy; (L.G.); (C.F.); (M.C.)
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16
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Kumar S, King E, Binns HJ, Christison A, Cuda SE, Yee JK, Joseph M, Kirk S. Diabetes screening outcomes in youth presenting for paediatric weight management: A report of the Paediatric Obesity Weight Evaluation Registry. Pediatr Obes 2024; 19:e13102. [PMID: 38296252 DOI: 10.1111/ijpo.13102] [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: 09/16/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Rising prevalence of obesity has led to increased rates of prediabetes and diabetes mellitus (DM) in children. This study compares rates of prediabetes and diabetes using two recommended screening tests (fasting plasma glucose [FPG] and haemoglobin A1c [HbA1c]). STUDY DESIGN Data were collected prospectively from 37 multi-component paediatric weight management programs in POWER (Paediatric Obesity Weight Evaluation Registry). RESULTS For this study, 3962 children with obesity without a known diagnosis of DM at presentation and for whom concurrent measurement of FPG and HbA1c were available were evaluated (median age 12.0 years [interquartile range, IQR 9.8, 14.6]; 48% males; median body mass index 95th percentile [%BMIp95] 134% [IQR 120, 151]). Notably, 10.7% had prediabetes based on FPG criteria (100-125 mg/dL), 18.6% had prediabetes based on HbA1c criteria (5.7%-6.4%), 0.9% had DM by FPG abnormality (≥126 mg/dL) and 1.1% had DM by HbA1c abnormality (≥6.5%). Discordance between the tests was observed for youth in both age groups (10-18 years [n = 2915] and age 2-9 years [n = 1047]). CONCLUSION There is discordance between FPG and HbA1c for the diagnosis of prediabetes and DM in youth with obesity. Further studies are needed to understand the predictive capability of these tests for development of DM (in those diagnosed with prediabetes) and cardiometabolic risk.
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Affiliation(s)
- Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Helen J Binns
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Christison
- Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Suzanne E Cuda
- Alamo City Healthy Kids and Families, San Antonio, Texas, USA
| | - Jennifer K Yee
- Division of Pediatric Endocrinology, Harbor-UCLA Medical Center and The Lundquist Institute of Biomedical Innovation at Harbor-UCLA, Torrance, California, USA
| | - Madeline Joseph
- College of Medicine, University of Florida, Jacksonville, Florida, United States
| | - Shelley Kirk
- Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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17
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Mohammadi V, Maleki AJ, Nazari M, Siahmansouri A, Moradi A, Elahi R, Esmaeilzadeh A. Chimeric Antigen Receptor (CAR)-Based Cell Therapy for Type 1 Diabetes Mellitus (T1DM); Current Progress and Future Approaches. Stem Cell Rev Rep 2024; 20:585-600. [PMID: 38153634 DOI: 10.1007/s12015-023-10668-1] [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] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 12/29/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is an autoimmune disease that destroys insulin-producing pancreatic β-cells. Insulin replacement therapy is currently the mainstay of treatment for T1DM; however, treatment with insulin does not ameliorate disease progression, as dysregulated immune response and inflammation continue to cause further pancreatic β-cell degradation. Therefore, shifting therapeutic strategies toward immunomodulating approaches could be effective to prevent and reverse disease progression. Different immune-modulatory therapies could be used, e.g., monoclonal-based immunotherapy, mesenchymal stem cell, and immune cell therapy. Since immune-modulatory approaches could have a systemic effect on the immune system and cause toxicity, more specific treatment options should target the immune response against pancreatic β-cells. In this regard, chimeric antigen receptor (CAR)-based immunotherapy could be a promising candidate for modulation of dysregulated immune function in T1DM. CAR-based therapy has previously been approved for a number of hematologic malignancies. Nevertheless, there is renewed interest in CAR T cells' " off-the-shelf " treatment for T1DM. Several pre-clinical studies demonstrated that redirecting antigen-specific CAR T cells, especially regulatory CAR T cells (CAR Tregs), toward the pancreatic β-cells, could prevent diabetes onset and progression in diabetic mice models. Here, we aim to review the current progress of CAR-based immune-cell therapy for T1DM and the corresponding challenges, with a special focus on designing CAR-based immunomodulatory strategies to improve its efficacy in the treatment of T1DM.
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Affiliation(s)
- Vahid Mohammadi
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Mahdis Nazari
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amir Siahmansouri
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amirhosein Moradi
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Reza Elahi
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Abdolreza Esmaeilzadeh
- Department of Immunology, Zanjan University of Medical Sciences, Zanjan, Iran.
- Cancer Gene Therapy Research Center, Zanjan University of Medical Sciences, Zanjan, Iran.
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Rasbach L, Purrington G, Adkins D, Benjamin R. Innovations: Using telemedicine to improve care of predominantly non-white youth with suboptimal insulin dependent diabetes control. Diabetes Res Clin Pract 2024; 210:111613. [PMID: 38484984 DOI: 10.1016/j.diabres.2024.111613] [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: 11/16/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
AIM Despite advances in diabetes treatments, youth commonly fail to meet glucose targets. Telehealth support may help youth meet diabetes related goals. The objective of the project was to assess whether intensive telehealth support in a group of poorly controlled youth with diabetes would help improve glycated hemoglobin (HbA1c) levels and decrease hospitalization rates over a 12-month time frame. METHODS This quality improvement project included youth aged 8-18 with suboptimal insulin dependent diabetes control and Medicaid insurance, who were willing to use continuous glucose monitoring (CGM). Participants received weekly contact (phone or video) with a certified diabetes educator and monthly video visits with a nurse practitioner. RESULTS Youth (N = 27, 63 % female, 89 % Non-Hispanic Black), diabetes duration 6.2 ± 4.3 years, had baseline mean HbA1c 12.4 ± 1.8 % (112 mmol/mol); 22 % were on pump therapy (majority were non-automated insulin delivery systems). There was a sustained improvement between baseline HbA1c (mean 12.4 %±1.8) (112 mmol/mol) and 3 months (mean 11.5 %±2.8) (102 mmol/mol) (p = 0.03), 6 months (mean 11.1 %±2.1) (98 mmol/mol) (p = 0.01), 9 months (mean 11.4 %±2.3) (101 mmol/mol) (p = 0.04) and 12 months (mean 10.8 %±2.2) (95 mmol/mol) (p = 0.02). CONCLUSION This intensive telehealth intervention provided interim glycemic improvement in a high-risk patient cohort. Further efforts to increase connection in vulnerable pediatric patient groups could help long-term diabetes management.
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Affiliation(s)
- Lisa Rasbach
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC, USA.
| | - Ginna Purrington
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC, USA
| | - Deanna Adkins
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC, USA
| | - Robert Benjamin
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC, USA
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Mottl AK, Tryggestad JB, Isom S, Gubitosi-Klug RA, Henkin L, White NH, D'Agostino R, Hughan KS, Dolan LM, Drews KL. Major adverse events in youth-onset type 1 and type 2 diabetes: The SEARCH and TODAY studies. Diabetes Res Clin Pract 2024; 210:111606. [PMID: 38493952 PMCID: PMC11103672 DOI: 10.1016/j.diabres.2024.111606] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
AIMS To determine contemporary incidence rates and risk factors for major adverse events in youth-onset T1D and T2D. METHODS Participant interviews were conducted once during in-person visits from 2018 to 2019 in SEARCH (T1D: N = 564; T2D: N = 149) and semi-annually from 2014 to 2020 in TODAY (T2D: N = 495). Outcomes were adjudicated using harmonized, predetermined, standardized criteria. RESULTS Incidence rates (events per 10,000 person-years) among T1D participants were: 10.9 ophthalmologic; 0 kidney; 11.1 nerve, 3.1 cardiac; 3.1 peripheral vascular; 1.6 cerebrovascular; and 15.6 gastrointestinal events. Among T2D participants, rates were: 40.0 ophthalmologic; 6.2 kidney; 21.2 nerve; 21.2 cardiac; 10.0 peripheral vascular; 5.0 cerebrovascular and 42.8 gastrointestinal events. Despite similar mean diabetes duration, complications were higher in youth with T2D than T1D: 2.5-fold higher for microvascular, 4.0-fold higher for macrovascular, and 2.7-fold higher for gastrointestinal disease. Univariate logistic regression analyses in T1D associated age at diagnosis, female sex, HbA1c and mean arterial pressure (MAP) with microvascular events. In youth-onset T2D, composite microvascular events associated positively with MAP and negatively with BMI, however composite macrovascular events associated solely with MAP. CONCLUSIONS In youth-onset diabetes, end-organ events were infrequent but did occur before 15 years diabetes duration. Rates were higher and had different risk factors in T2D versus T1D.
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Affiliation(s)
- Amy K Mottl
- University of North Carolina Kidney Center, UNC School of Medicine, Chapel Hill, NC, United States.
| | - Jeanie B Tryggestad
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Rose A Gubitosi-Klug
- Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Leora Henkin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Neil H White
- Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ralph D'Agostino
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Kara S Hughan
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Lawrence M Dolan
- University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kimberly L Drews
- The Biostatistics Center, George Washington University, Rockville, MD, United States
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Noyd DH, Bailey A, Janitz A, Razzaghi T, Bouvette S, Beasley W, Baker A, Chen S, Bard D. Rurality, Cardiovascular Risk Factors, and Early Cardiovascular Disease among Childhood, Adolescent, and Young Adult Cancer Survivors. Res Sq 2024:rs.3.rs-4139837. [PMID: 38645102 PMCID: PMC11030544 DOI: 10.21203/rs.3.rs-4139837/v1] [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] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background and Aims Cardiovascular risk factors (CVRFs) later in life potentiate risk for late cardiovascular disease (CVD) from cardiotoxic treatment among survivors. This study evaluated the association of baseline CVRFs and CVD in the early survivorship period. Methods This analysis included patients ages 0-29 at initial diagnosis and reported in the institutional cancer registry between 2010 and 2017 (n = 1228). Patients who died within five years (n = 168), those not seen in the oncology clinic (n = 312), and those with CVD within one year of diagnosis (n = 17) were excluded. CVRFs (hypertension, diabetes, dyslipidemia, and obesity) within one year of initial diagnosis, were constructed and extracted from the electronic health record based on discrete observations, ICD9/10 codes, and RxNorm codes for antihypertensives. Results Among survivors (n = 731), 10 incident cases (1.4%) of CVD were observed between one year and five years after the initial diagnosis. Public health insurance (p = 0.04) and late effects risk strata (p = 0.01) were positively associated with CVD. Among survivors with public insurance(n = 495), two additional cases of CVD were identified from claims data with an incidence of 2.4%. Survivors from rural areas had a 4.1 times greater risk of CVD compared with survivors from urban areas (95% CI: 1.1-15.3), despite adjustment for late effects risk strata. Conclusions Clinically computable phenotypes for CVRFs among survivors through informatics methods were feasible. Although CVRFs were not associated with CVD in the early survivorship period, survivors from rural areas were more likely to develop CVD. Implications for Survivors Survivors from non-urban areas and those with public insurance may be particularly vulnerable to CVD.
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Affiliation(s)
- David H Noyd
- Seattle Children's Hospital/University of Washington Department of Pediatrics
| | - Anna Bailey
- The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology
| | - Amanda Janitz
- The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology
| | - Talayeh Razzaghi
- The University of Oklahoma, School of Industrial and Systems Engineering
| | - Sharon Bouvette
- The University of Oklahoma Health Sciences Center, College of Medicine
| | - William Beasley
- The University of Oklahoma Health Sciences Center, College of Medicine
| | - Ashley Baker
- The University of Oklahoma Health Sciences Center, College of Medicine
| | - Sixia Chen
- The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology
| | - David Bard
- The University of Oklahoma Health Sciences Center, College of Medicine
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Hölgyesi Á, Luczay A, Tóth-Heyn P, Muzslay E, Világos E, Szabó AJ, Baji P, Kovács L, Gulácsi L, Zrubka Z, Péntek M. The Impact of Parental Electronic Health Literacy on Disease Management and Outcomes in Pediatric Type 1 Diabetes Mellitus: Cross-Sectional Clinical Study. JMIR Pediatr Parent 2024; 7:e54807. [PMID: 38506893 PMCID: PMC10993131 DOI: 10.2196/54807] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents' skills to deal with electronic health information sources. OBJECTIVE We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children's outcomes. METHODS A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents' electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children's treatment, HbA1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA1c. RESULTS Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents' average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children's treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=-0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children's HbA1c (r=-0.143; P=.08), PedsQL Diab (r=-0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=-0.13; P=.12). Regression analysis revealed significant associations of the child's HbA1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=-0.66; P=.03; pump + sensor: β=-0.93; P=.007), and parents' self-efficacy (PSESDM; β=-0.08; P=.001). CONCLUSIONS Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents' diabetes management attitude but not with the child's glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged.
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Affiliation(s)
- Áron Hölgyesi
- Doctoral School, Semmelweis University, Budapest, Hungary
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Andrea Luczay
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | | | - Eszter Muzslay
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Eszter Világos
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Attila J Szabó
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Petra Baji
- Musculoskeletal Research Unit, University of Bristol, Bristol, United Kingdom
| | - Levente Kovács
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
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22
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Yang X, Chai M, Lin M. Proportion of vitamin D deficiency in children/adolescents with type 1 diabetes: a systematic review and meta-analysis. BMC Pediatr 2024; 24:192. [PMID: 38493103 PMCID: PMC10943883 DOI: 10.1186/s12887-024-04683-5] [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: 12/30/2022] [Accepted: 03/01/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The impact of vitamin D on type 1 diabetes has been a controversial topic in public health. Furthermore, significant differences in the proportion of vitamin D have been noted. The purpose of this systematic review was to determine the overall proportion of vitamin D deficiency in children/adolescents with type 1 diabetes (T1D). METHODS Based on six electronic databases (PubMed, Web of Science, Embase, Ovid Medline, ProQuest, and Cochrane Library), eligible studies since the databases' inception up to April 2022 were searched. Reference lists were also manually searched to identify additional studies. Overall, studies with statistical information on vitamin D deficiency in children and adolescents with T1D were included, and a random effects model was applied for the meta-analysis. In addition, subgroup and sensitivity analyses were carried out to evaluate heterogeneity, and publication bias was evaluated by using Egger's test. RESULTS A total of 45 studies involving 6,995 participants met the inclusion criteria; these included 25 countries covering Africa, Oceania, Europe, North America and Asia. The proportion of vitamin D deficiency in children/adolescents with T1D was 45% (95% confidence interval [CI] 37-54%, I2 = 97.94%). Subgroup analysis further revealed that the publication year, study design, vitamin D classification, season and geographical region significantly contributed to the variation in the reported incidence of vitamin D deficiency. CONCLUSIONS The results of the meta-analysis showed that the proportion of vitamin D deficiency among T1D children/adolescents was 45%. In addition, the proportion remains higher, which has important implications for adapting health and social care systems.
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Affiliation(s)
- Xin Yang
- Department of Pediatric Genetics, Metabolism and Endocrinology Nursing, West China Second University Hospital, Sichuan University, No. 1416, Section 1, Chenglong Avenue, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 1416, Section 1, Chenglong Avenue, Chengdu, Sichuan, China
| | - Min Chai
- Department of Pediatric Genetics, Metabolism and Endocrinology Nursing, West China Second University Hospital, Sichuan University, No. 1416, Section 1, Chenglong Avenue, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 1416, Section 1, Chenglong Avenue, Chengdu, Sichuan, China
| | - Meng Lin
- Department of Pediatric Genetics, Metabolism and Endocrinology Nursing, West China Second University Hospital, Sichuan University, No. 1416, Section 1, Chenglong Avenue, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 1416, Section 1, Chenglong Avenue, Chengdu, Sichuan, China.
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23
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Zhang D, Yang Y, Xu L, Zou H, Wu X, Yang L, Zhou B, Xu Q. Association between tri-ponderal mass index and glucose metabolism disorder in children with obesity in China: A case-control study. Medicine (Baltimore) 2024; 103:e37364. [PMID: 38457571 PMCID: PMC10919466 DOI: 10.1097/md.0000000000037364] [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: 09/26/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024] Open
Abstract
Obesity is a risk factor for glucose metabolism disorder. This study explored the association between the tri-ponderal mass index (TMI) and indicators of glucose metabolism disorder in children with obesity in China. This retrospective case-control study included children aged 3 to 18 years old diagnosed with obesity at Jiangxi Provincial Children's Hospital (China) between January 2020 and April 2022. Demographic and clinical characteristics were obtained from the medical records. Factors associated with glucose metabolism disorder were explored by logistic regression analysis. Pearson correlations were calculated to evaluate the relationships between TMI and indicators of glucose metabolism disorder. The analysis included 781 children. The prevalence of glucose metabolism disorder was 22.0% (172/781). The glucose metabolism disorder group had an older age (11.13 ± 2.19 vs 10.45 ± 2.33 years old, P = .001), comprised more females (76.8% vs 66.9%, P = .008), had a higher Tanner index (P = .001), and had a larger waist circumference (89.00 [82.00-95.00] vs 86.00 [79.00-93.75] cm, P = .025) than the non-glucose metabolism disorder group. There were no significant differences between the glucose metabolism disorder and non-glucose metabolism disorder groups in other clinical parameters, including body mass index (26.99 [24.71-30.58] vs 26.57 [24.55-29.41] kg/m2) and TMI (18.38 [17.11-19.88] vs 18.37 [17.11-19.88] kg/m3). Multivariable logistic regression did not identify any factors associated with glucose metabolism disorder. Furthermore, TMI was only very weakly or negligibly correlated with indicators related to glucose metabolism disorder. TMI may not be a useful indicator to screen for glucose metabolism disorder in children with obesity in China.
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Affiliation(s)
- Dongguang Zhang
- Department of Endocrinology, Metabolism and Genetics, Jiangxi Provincial Children’s Hospital (The Affiliated Children’s Hospital of Nanchang Medical College), Jiangxi Provincial Children’s Genetic and Metabolic Disease Clinical Medicine Research Center, Nanchang, China
| | - Yu Yang
- Department of Endocrinology, Metabolism and Genetics, Jiangxi Provincial Children’s Hospital (The Affiliated Children’s Hospital of Nanchang Medical College), Jiangxi Provincial Children’s Genetic and Metabolic Disease Clinical Medicine Research Center, Nanchang, China
| | - Lei Xu
- Department of Endocrinology, Metabolism and Genetics, Jiangxi Provincial Children’s Hospital (The Affiliated Children’s Hospital of Nanchang Medical College), Jiangxi Provincial Children’s Genetic and Metabolic Disease Clinical Medicine Research Center, Nanchang, China
| | - Haiying Zou
- Department of Endocrinology, Metabolism and Genetics, Jiangxi Provincial Children’s Hospital (The Affiliated Children’s Hospital of Nanchang Medical College), Jiangxi Provincial Children’s Genetic and Metabolic Disease Clinical Medicine Research Center, Nanchang, China
| | - Xian Wu
- Department of Endocrinology, Metabolism and Genetics, Jiangxi Provincial Children’s Hospital (The Affiliated Children’s Hospital of Nanchang Medical College), Jiangxi Provincial Children’s Genetic and Metabolic Disease Clinical Medicine Research Center, Nanchang, China
| | - Li Yang
- Department of Endocrinology, Metabolism and Genetics, Jiangxi Provincial Children’s Hospital (The Affiliated Children’s Hospital of Nanchang Medical College), Jiangxi Provincial Children’s Genetic and Metabolic Disease Clinical Medicine Research Center, Nanchang, China
| | - Bin Zhou
- Department of Endocrinology, Metabolism and Genetics, Jiangxi Provincial Children’s Hospital (The Affiliated Children’s Hospital of Nanchang Medical College), Jiangxi Provincial Children’s Genetic and Metabolic Disease Clinical Medicine Research Center, Nanchang, China
| | - Qingbo Xu
- Department of Endocrinology, Metabolism and Genetics, Jiangxi Provincial Children’s Hospital (The Affiliated Children’s Hospital of Nanchang Medical College), Jiangxi Provincial Children’s Genetic and Metabolic Disease Clinical Medicine Research Center, Nanchang, China
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Manji J, Pipella J, Brawerman G, Thompson PJ. Exploring Transcriptional Regulation of Beta Cell SASP by Brd4-Associated Proteins and Cell Cycle Control Protein p21. Epigenomes 2024; 8:10. [PMID: 38534794 DOI: 10.3390/epigenomes8010010] [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] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Type 1 diabetes (T1D) is a metabolic disease resulting from progressive autoimmune destruction of insulin-producing pancreatic beta cells. Although the majority of beta cells are lost in T1D, a small subset undergoes senescence, a stress response involving growth arrest, DNA damage response, and activation of a senescence-associated secretory phenotype (SASP). SASP in beta cells of the nonobese diabetic (NOD) mouse model of T1D and primary human islets is regulated at the level of transcription by bromodomain extra-terminal (BET) proteins, but the mechanisms remain unclear. To explore how SASP is transcriptionally regulated in beta cells, we used the NOD beta cell line NIT-1 to model beta cell SASP and identified binding partners of BET protein Brd4 and explored the role of the cyclin-dependent kinase inhibitor p21. Brd4 interacted with a variety of proteins in senescent NIT-1 cells including subunits of the Ino80 chromatin remodeling complex, which was expressed in beta cells during T1D progression in NOD mice and in human beta cells of control, autoantibody-positive, and T1D donors as determined from single-cell RNA-seq data. RNAi knockdown of p21 during senescence in NIT-1 cells did not significantly impact viability or SASP. Taken together, these results suggest that Brd4 interacts with several protein partners during senescence in NIT-1 cells, some of which may play roles in SASP gene activation and that p21 is dispensable for the SASP in this beta cell model.
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Affiliation(s)
- Jasmine Manji
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Physiology & Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Jasmine Pipella
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Physiology & Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Gabriel Brawerman
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Physiology & Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Peter J Thompson
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Physiology & Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
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Gong B, Yang W, Xing Y, Lai Y, Shan Z. Global, regional, and national burden of type 1 diabetes in adolescents and young adults. Pediatr Res 2024:10.1038/s41390-024-03107-5. [PMID: 38443523 DOI: 10.1038/s41390-024-03107-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Type 1 diabetes (T1D) incidence in adolescents varies widely, but has increased globally in recent years. This study reports T1D burden among adolescents and young adults aged 10-24-year-old age group at global, regional, and national levels. METHODS Based on the Global Burden of Disease Study 2019, we described the burden of T1D in the 10-24-year-old age group. We further analyzed these trends by age, sex, and the Social Development Index. Joinpoint regression analysis was used to assess temporal trends. RESULTS T1D incidence among adolescents and young adults increased from 7·78 per 100,000 population (95% UI, 5·27-10·60) in 1990 to 11·07 per 100,000 population (95% UI, 7·42-15·34) in 2019. T1D mortality increased from 5701·19 (95% UI, 4642·70-6444·08) in 1990 to 6,123·04 (95% UI, 5321·82-6887·08) in 2019, representing a 7·40% increase in mortality. The European region had the highest T1D incidence in 2019. Middle-SDI countries exhibited the largest increase in T1D incidence between 1990 and 2019. CONCLUSION T1D is a growing health concern globally, and T1D burden more heavily affects countries with low SDI. Specific measures and effective collaboration among countries with different SDIs are required to improve diabetes care in adolescents. IMPACT We assessed trends in T1D incidence and burden among youth in the 10-24-year-old age group by evaluating data from the Global Burden of Disease Study 2019. Our results demonstrated that global T1D incidence in this age group increased over the past 30 years, with the European region having the highest T1D incidence. Specific measures and effective collaboration among countries with different SDIs are required to improve diabetes care in adolescents.
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Affiliation(s)
- Boshen Gong
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, P. R. China
| | - Wanyu Yang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, P. R. China
| | - Yumin Xing
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, P. R. China
| | - Yaxin Lai
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, P. R. China.
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, P. R. China.
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Sabapaty A, Salimi-Jazi F, Abrajano C, Yousefi R, Garza D, Dalusag KS, Hui T, Su W, Mueller C, Fuchs J, Chiu B. Comorbidities are not associated with pain symptom or recurrence in patients with pilonidal disease. Pediatr Surg Int 2024; 40:66. [PMID: 38436736 DOI: 10.1007/s00383-024-05644-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Comorbidities can potentially impact the presentation or outcome of patients with pilonidal disease (PD) due to poor wound healing or increased inflammatory response. We hypothesized that certain comorbidities could lead to worse pain or higher recurrence rate. METHODS A retrospective study was performed on all PD patients treated with standardized minimally invasive protocol at our clinic 2019-2022. Patients' demographics, comorbidities, initial/follow-up pain score, pain duration, and recurrence were recorded. Data were analyzed by t test and Chi-square test. RESULTS Of 207 total PD patients (108 male, 99 female), 61 had comorbidities. Mean age was 18.2 years. The recurrence rate was 7%, and patients with recurrence were significantly younger. Associated comorbidities included mood/psychiatric disorders (31%), asthma/respiratory illness (30%), obesity-related illness (15%), gastrointestinal disorders (13%), diabetes (10%), thyroid disease (8%), cardiac disease (8%), musculoskeletal/connective tissue disorders (7%), immunologic disease (7%), inflammatory bowel disease (5%), and chest wall disorders (3%). The presence of comorbidities was not associated with PD recurrence. By dividing patients into adolescents (< 18 years) and adults (≥ 18 years), we found no association between comorbidity and recurrence in either group. 55% of patients had pain as an initial symptom. The initial pain score, pain duration, and pain score at follow-up were not associated with comorbidities. The comorbidities and recurrence were not associated with patient age or sex. CONCLUSIONS Having comorbidities was not associated with pain symptoms or recurrence in PD patients. Even though patients with recurrence were younger, there was no association between comorbidity and recurrence in either adolescents or adults.
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Affiliation(s)
- Akanksha Sabapaty
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Fereshteh Salimi-Jazi
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Claire Abrajano
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Razie Yousefi
- Department of Biochemistry and Molecular Biology, 301 University Boulevard Galveston, University of Texas Medical Branch, 108 Basic Science Building, Galveston, TX, 77555, USA
| | - Deanna Garza
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Kyla Santos Dalusag
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Thomas Hui
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Wendy Su
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Claudia Mueller
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Julie Fuchs
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Bill Chiu
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
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Belay B, Kraus EM, Porter R, Pierce SL, Kompaniyets L, Lundeen EA, Imperatore G, Blanck HM, Goodman AB. Examination of Prediabetes and Diabetes Testing Among US Pediatric Patients With Overweight or Obesity Using an Electronic Health Record. Child Obes 2024; 20:96-106. [PMID: 36930745 PMCID: PMC10505239 DOI: 10.1089/chi.2022.0209] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Background: Youth with excess weight are at risk of developing type 2 diabetes (T2DM). Guidelines recommend screening for prediabetes and/or T2DM after 10 years of age or after puberty in youth with excess weight who have ≥1 risk factor(s) for T2DM. Electronic health records (EHRs) offer an opportunity to study the use of tests to detect diabetes in youth. Methods: We examined the frequency of (1) diabetes testing and (2) elevated test results among youth aged 10-19 years with at least one BMI measurement in an EHR from 2019 to 2021. We examined the presence of hemoglobin A1C (A1C), fasting plasma glucose (FPG), or oral glucose tolerance test (2-hour plasma glucose [2-hrPG]) results and, among those tested, the frequency of elevated values (A1C ≥6.5%, FPG ≥126 mg/dL, or 2-hrPG ≥200 mg/dL). Patients with pre-existing diabetes (n = 6793) were excluded. Results: Among 1,024,743 patients, 17% had overweight, 21% had obesity, including 8% with severe obesity. Among patients with excess weight, 10% had ≥1 glucose test result. Among those tested, elevated values were more common in patients with severe obesity (27%) and obesity (22%) than in those with healthy weight (8%), and among Black youth (30%) than White youth (13%). Among patients with excess weight, >80% of elevated values fell in the prediabetes range. Conclusions: In youth with excess weight, the use of laboratory tests for prediabetes and T2DM was infrequent. Among youth with test results, elevated FPG, 2hrPG, or A1C levels were most common in those with severe obesity and Black youth.
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Affiliation(s)
- Brook Belay
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily M. Kraus
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Public Health Informatics Institute, Atlanta, GA, USA
| | - Renee Porter
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
- McKing Consulting Corporation, Atlanta, GA, USA
| | - Samantha Lange Pierce
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lyudmyla Kompaniyets
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth A. Lundeen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heidi M. Blanck
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alyson B. Goodman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
- United States Public Health Service, Atlanta, GA, USA
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Tilden DR, French B, Datye KA, Jaser SS. Disparities in Continuous Glucose Monitor Use Between Children With Type 1 Diabetes Living in Urban and Rural Areas. Diabetes Care 2024; 47:346-352. [PMID: 37906202 PMCID: PMC10909681 DOI: 10.2337/dc23-1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Despite evidence that continuous glucose monitoring (CGM) use is associated with lower HbA1c among children with type 1 diabetes, uptake of this technology remains lower among those with difficulty accessing health care, including those from lower socioeconomic status backgrounds and racial and ethnic minorities. In this study, we sought to explore the impact of rural location in use of CGM technology to guide patient and provider decision making. RESEARCH DESIGN AND METHODS In this retrospective study of electronic health record demographic and visits data from a single diabetes program from 1 January 2018 through 31 December 2021, we compared the odds of completing a visit with (+) and without (-) CGM interpretation between rural-urban commuting area (RUCA) designations. RESULTS Among the 13,645 visits completed by 2,008 patients with type 1 diabetes younger than age 18 years, we found children living in small rural towns had 31% lower odds (6.3% of CGM+ visits, 8.6% of CGM- visits; adjusted odds ratio [aOR] 0.69, 95% CI 0.51-0.94) and those living in isolated rural towns had 49% lower odds (2.0% of CGM+ visits, 3.4% of CGM- visits; aOR 0.51, 95% CI 0.28-0.92) of completing a CGM-billed clinic visit compared with those living in urban areas (70.0% of CGM+ visits, 67.2% of CGM- visits). We also found significant differences in CGM-billed visits by neighborhood deprivation as well as race/ethnicity and insurance payor. CONCLUSIONS Geographic location presents a meaningful barrier to access to care for patients living with type 1 diabetes. Further work is needed to identify and address the needs of children and families living in rural areas to improve the care of these patients.
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Affiliation(s)
- Daniel R. Tilden
- Division of Endocrinology, Diabetes & Clinical Genetics, Department of Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Karishma A. Datye
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S. Jaser
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Redondo MJ, Harrall KK, Glueck DH, Tosur M, Uysal S, Muir A, Atkinson EG, Shapiro MR, Yu L, Winter WE, Weedon M, Brusko TM, Oram R, Vehik K, Hagopian W, Atkinson MA, Dabelea D. Diabetes Study of Children of Diverse Ethnicity and Race: Study design. Diabetes Metab Res Rev 2024; 40:e3744. [PMID: 37888801 PMCID: PMC10939959 DOI: 10.1002/dmrr.3744] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/16/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023]
Abstract
AIMS Determining diabetes type in children has become increasingly difficult due to an overlap in typical characteristics between type 1 diabetes (T1D) and type 2 diabetes (T2D). The Diabetes Study in Children of Diverse Ethnicity and Race (DISCOVER) programme is a National Institutes of Health (NIH)-supported multicenter, prospective, observational study that enrols children and adolescents with non-secondary diabetes. The primary aim of the study was to develop improved models to differentiate between T1D and T2D in diverse youth. MATERIALS AND METHODS The proposed models will evaluate the utility of three existing T1D genetic risk scores in combination with data on islet autoantibodies and other parameters typically available at the time of diabetes onset. Low non-fasting serum C-peptide (<0.6 nmol/L) between 3 and 10 years after diabetes diagnosis will be considered a biomarker for T1D as it reflects the loss of insulin secretion ability. Participating centres are enrolling youth (<19 years old) either with established diabetes (duration 3-10 years) for a cross-sectional evaluation or with recent onset diabetes (duration 3 weeks-15 months) for the longitudinal observation with annual visits for 3 years. Cross-sectional data will be used to develop models. Longitudinal data will be used to externally validate the best-fitting model. RESULTS The results are expected to improve the ability to classify diabetes type in a large and growing subset of children who have an unclear form of diabetes at diagnosis. CONCLUSIONS Accurate and timely classification of diabetes type will help establish the correct clinical management early in the course of the disease.
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Affiliation(s)
- Maria J. Redondo
- Diabetes and Endocrinology Division, Department of Pediatrics. Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Kylie K. Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Deborah H. Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mustafa Tosur
- Diabetes and Endocrinology Division, Department of Pediatrics. Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
- Children’s Nutrition Research Center, USDA/ARS, Houston, TX, USA
| | - Serife Uysal
- Diabetes and Endocrinology Division, Department of Pediatrics. Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Andrew Muir
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Elizabeth G. Atkinson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Melanie R. Shapiro
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL, USA
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine; Aurora, CO, USA
| | - William E. Winter
- Departments of Pathology and Pediatrics, University of Florida, Gainesville, FL, USA
| | - Michael Weedon
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Todd M. Brusko
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL, USA
| | - Richard Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Mark A. Atkinson
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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30
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Andreae SJ, Reeves H, Casey T, Lindberg A, Pickett KA. A systematic review of diabetes prevention programs adapted to include family members. Prev Med Rep 2024; 39:102655. [PMID: 38390312 PMCID: PMC10882182 DOI: 10.1016/j.pmedr.2024.102655] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024] Open
Abstract
Objectives Family-based programs may be a strategy to prevent health conditions with hereditary risk such as diabetes. This review examined the state of the science regarding interventions that adapted the Diabetes Prevention Program (DPP) lifestyle change curriculum to include family members. Methods CINAHL, Cochrane Central, PsycINFO, PubMed, and Scopus were searched for reports that were peer reviewed, written in English, evaluated interventions that adapted the DPP lifestyle change curriculum to be family-based, reported diabetes risk related outcomes, and published between 2002 and August 2023. Records were reviewed, data extracted, and quality assessed by two researchers working independently. A narrative synthesis was completed. Meta-analysis was not completed due to the small number of studies and the heterogeneity of the study characteristics. Results 2177 records were identified with four meeting inclusion criteria. Primary participants for three studies were adults and one study focused on youth. Family participants were adult family members, children of the primary participant, or caregivers of the enrolled youth. For primary participants, two studies found significant intervention effects on weight-related outcomes. Of the studies with no intervention effects, one was a pilot feasibility study that was not powered to detect changes in weight outcomes. Three studies assessed outcomes in family participants with one finding significant intervention effects on weight. Conclusions While DPP interventions adapted to include family showed promising or similar results as individual-based DPP interventions, additional studies are needed to better understand the mechanisms of action and the most effective methods to engage family members in the programs.
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Affiliation(s)
- Susan J Andreae
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
| | - Hailey Reeves
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
| | - Thomas Casey
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna Lindberg
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
| | - Kristen A Pickett
- Kinesiology Department, University of Wisconsin-Madison, Madison, WI, United States
- Program in Occupational Therapy, University of Wisconsin-Madison, Madison, WI, United States
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Li Y, Tian J, Hou T, Gu K, Yan Q, Sun S, Zhang J, Sun J, Liu L, Sheng CS, Pang Y, Cheng M, Wu C, Harris K, Shi Y, Bloomgarden ZT, Chalmers J, Fu C, Ning G. Association Between Age at Diabetes Diagnosis and Subsequent Incidence of Cancer: A Longitudinal Population-Based Cohort. Diabetes Care 2024; 47:353-361. [PMID: 38237119 PMCID: PMC10909688 DOI: 10.2337/dc23-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 11/02/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Diabetes presenting at a younger age has a more aggressive nature. We aimed to explore the association of age at type 2 diabetes mellitus (T2DM) diagnosis with subsequent cancer incidence in a large Chinese population. RESEARCH DESIGN AND METHODS The prospective population-based longitudinal cohort included 428,568 newly diagnosed T2DM patients from 2011 to 2018. Participants were divided into six groups according to their age at diagnosis: 20-54, 55-59, 60-64, 65-69, 70-74, and ≥75 years. The incidence of overall and 14 site-specific cancers was compared with the Shanghai general population including 100,649,346 person-years. RESULTS A total of 18,853 and 582,643 overall cancer cases were recorded in the T2DM cohort and the general population. The age-standardized rate of overall cancer in T2DM patients was 501 (95% CI: 491, 511) per 100,000 person-years, and the standardized incidence ratio (SIR) was 1.10 (1.09, 1.12). Younger age at T2DM diagnosis was associated with higher incidence of overall and site-specific cancers. SIRs for overall cancer with T2DM diagnosis at ages 20-54, 55-59, 60-64, 65-69, 70-74, and ≥75 years were 1.48 (1.41, 1.54), 1.30 (1.25, 1.35), 1.19 (1.15, 1.23), 1.16 (1.12, 1.20), 1.06 (1.02, 1.10), and 0.86 (0.84, 0.89), respectively. Similar trends were observed for site-specific cancers, including respiratory, colorectum, stomach, liver, pancreatic, bladder, central nervous system, kidney, and gallbladder cancer and lymphoma among both males and females. CONCLUSIONS Our findings highlight the necessity of stratifying management for T2DM according to age of diagnosis. As with a range of vascular outcomes, age-standardized cancer risks are greater in earlier compared with later onset T2DM.
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Affiliation(s)
- Yanyun Li
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jingyan Tian
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianzhichao Hou
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Gu
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qinghua Yan
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Siming Sun
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Jiange Zhang
- The Research Center of Chiral Drugs, Innovation Research Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiao Sun
- Department of Endocrinology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Lili Liu
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chang-Sheng Sheng
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Pang
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Minna Cheng
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chunxiao Wu
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yan Shi
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Clinical Research Center for Aging and Medicine, Shanghai, China
| | - Zachary T. Bloomgarden
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Chen Fu
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- Shanghai Clinical Research Center for Aging and Medicine, Shanghai, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Casanovas‐Marsal J, Civitani Monzón E, Ferrer Duce MP, González de la Cuesta D, Yelmo Valverde R, Pérez Repiso V, Goicoechea Manterola I, de Arriba Muñoz A. Study protocol of translation into Spanish and cross-cultural adaptation and validation of the problem areas in diabetes-Pediatric version (PAID-Peds) survey. Nurs Open 2024; 11:e2128. [PMID: 38429883 PMCID: PMC10907615 DOI: 10.1002/nop2.2128] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024] Open
Abstract
AIM The metabolic and psychological management of paediatric type 1 diabetes mellitus (T1DM) can be challenging over time given that T1DM may cause a negative emotional burden and, consequently, result in poor metabolic control of the disease. The objectives of this study are to translate the Problem Area in Diabetes Survey-Pediatric version (PAID-Peds) into Spanish, adapt it culturally and validate it. DESIGN Multicenter cross sectional study. METHODS 636 patients aged 8-17 years, diagnosed with T1DM, under treatment with insulin and follow-up at the Miguel Servet University Hospital in Zaragoza (Aragón, Spain), the Ramón y Cajal University Clinical Hospital in Madrid (Spain) and at the Sant Joan de Déu Hospital in Barcelona (Catalonia, Spain) between 1 January 2023 and 31 December 2024 will be included. This study will consist of two phases: (1) Translation and cultural adaptation of the original PAID-Peds® survey into Spanish following eight steps; (2) Validation of the Spanish version of the PAIS-Peds® survey. The statistical analysis will be performed using Jamovi® 2.1.23. The reliability or internal consistency will be calculated using Cronbach's alpha index (considering an index higher than 0.8 to be good) and the test-retest will be evaluated using the intraclass correlation coefficient. For validity, confirmatory factor analysis will be calculated. This study has been approved by the ethics and research committees at each centre. RESULTS The translation and validation into Spanish language of the Problem Area in Diabetes Survey-Pediatric version will be feasible, valid and reliable to detecting the youth-perceived burden of T1DM. Therapeutic education in diabetes-recommended by the WHO and the Diabetes Education Study Group-has shown encouraging results in glycaemia and psychosocial and behavioural factors in T1DM.
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Affiliation(s)
- Josep‐Oriol Casanovas‐Marsal
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
| | - Elisa Civitani Monzón
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
| | - María Pilar Ferrer Duce
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
| | - Delia González de la Cuesta
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
| | | | | | | | - Antonio de Arriba Muñoz
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
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Abadula F, Garretson S, Okonkwo N, LeStourgeon LM, Jaser SS. Detangling Associations Between Maternal Depressive Symptoms and Diabetes Relationship Distress With Adolescents' HbA1c. J Pediatr Psychol 2024; 49:89-94. [PMID: 37794836 PMCID: PMC10874213 DOI: 10.1093/jpepsy/jsad070] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Previous research in families of children with type 1 diabetes demonstrates that maternal depressive symptoms are a known risk factor for poor diabetes outcomes. We sought to examine whether maternal diabetes relationship distress or maternal depressive symptoms were more strongly associated with adolescent glycemic outcomes. METHODS Analyses were conducted using data from mothers who consented to screen for a behavioral intervention. The screener included the Patient Health Questionnaire and the Parent Diabetes Distress Scale, Parent/Teen Relationship Distress subscale. Hemoglobin A1c (HbA1c) was extracted from adolescents' medical records. RESULTS Our sample consisted of 390 maternal caregivers of adolescents with type 1 diabetes aged 11-17. Screening data revealed that 35% of mothers reported clinically significant diabetes distress related to their relationship with their adolescents, and 14% of mothers reported clinically significant depressive symptoms. The adolescents of mothers who reported diabetes relationship distress had significantly higher mean HbA1c levels (9.7 ± 2.2%) compared to those whose mothers were not distressed (8.2 ± 1.8%, d = .72). Similarly, adolescents whose mothers reported clinically significant depressive symptoms had higher mean HbA1c levels (9.6 ± 2.4%) than those whose mothers were not depressed (8.6 ± 2.0%, d = .48). After adjusting for clinical and demographic factors, mothers' reports of diabetes relationship distress were more strongly associated with adolescents' HbA1c than maternal depressive symptoms. CONCLUSIONS Our findings suggest that screening for maternal distress-particularly distress related to the caregiver-adolescent relationship-could match families with psychosocial support or other resources to improve both psychosocial and glycemic outcomes.
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Affiliation(s)
- Fayo Abadula
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | - Sydney Garretson
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | - Nkemjika Okonkwo
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | | | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, USA
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Minniakhmetov I, Yalaev B, Khusainova R, Bondarenko E, Melnichenko G, Dedov I, Mokrysheva N. Genetic and Epigenetic Aspects of Type 1 Diabetes Mellitus: Modern View on the Problem. Biomedicines 2024; 12:399. [PMID: 38398001 PMCID: PMC10886892 DOI: 10.3390/biomedicines12020399] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Omics technologies accumulated an enormous amount of data that advanced knowledge about the molecular pathogenesis of type 1 diabetes mellitus and identified a number of fundamental problems focused on the transition to personalized diabetology in the future. Among them, the most significant are the following: (1) clinical and genetic heterogeneity of type 1 diabetes mellitus; (2) the prognostic significance of DNA markers beyond the HLA genes; (3) assessment of the contribution of a large number of DNA markers to the polygenic risk of disease progress; (4) the existence of ethnic population differences in the distribution of frequencies of risk alleles and genotypes; (5) the infancy of epigenetic research into type 1 diabetes mellitus. Disclosure of these issues is one of the priorities of fundamental diabetology and practical healthcare. The purpose of this review is the systemization of the results of modern molecular genetic, transcriptomic, and epigenetic investigations of type 1 diabetes mellitus in general, as well as its individual forms. The paper summarizes data on the role of risk HLA haplotypes and a number of other candidate genes and loci, identified through genome-wide association studies, in the development of this disease and in alterations in T cell signaling. In addition, this review assesses the contribution of differential DNA methylation and the role of microRNAs in the formation of the molecular pathogenesis of type 1 diabetes mellitus, as well as discusses the most currently central trends in the context of early diagnosis of type 1 diabetes mellitus.
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Affiliation(s)
- Ildar Minniakhmetov
- Endocrinology Research Centre, Dmitry Ulyanov Street, 11, 117292 Moscow, Russia; (R.K.); (E.B.); (G.M.); (I.D.); (N.M.)
| | - Bulat Yalaev
- Endocrinology Research Centre, Dmitry Ulyanov Street, 11, 117292 Moscow, Russia; (R.K.); (E.B.); (G.M.); (I.D.); (N.M.)
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Orr CJ, Leslie LK, Schaechter J, Williams XJ, Montez KG, Deen JF, Evans YN, Russell CJ, Webb J, Gaona AR, Mendoza FS. Diversity, Equity, and Inclusion, Child Health, and the Pediatric Subspecialty Workforce. Pediatrics 2024; 153:e2023063678S. [PMID: 38300010 PMCID: PMC10852199 DOI: 10.1542/peds.2023-063678s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Using multiple metrics, the diversity of the pediatric population in the United States is increasing. However, recent data suggest significant disparities in both the prevalence and management of child health conditions cared for by pediatric subspecialists. These inequities occur across multiple dimensions of diversity, including race and ethnicity, country of origin, socioeconomic status, sex and gender, and disability. Research also suggests that attending to diversity, equity, and inclusion in the medical workforce may positively affect health outcomes. High-quality pediatric subspecialty care thus requires knowledge of these data, attention to the effects of social drivers, including racism and discrimination, on health and wellbeing, and interventions to improve pediatric health equity through educational, practice, policy, and research innovations. In this article, we review data on the diversity of the pediatric population and pediatric subspecialty workforce, suggest potential strengths, weaknesses, opportunities, and threats of current diversity, equity, and inclusion initiatives in academic pediatrics, and provide recommendations across 4 domains: education and training, practice, policy, and future research. The ultimate goal of pediatrics is to improve health equity for all infants, children, adolescents, and young adults cared for in the United States by pediatric subspecialists.
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Affiliation(s)
- Colin J. Orr
- Department of Pediatrics
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Kimberly G. Montez
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jason F. Deen
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Yolanda N. Evans
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | - Jonathan Webb
- American Board of Pediatrics, Chapel Hill, North Carolina
- Association of Women’s Health Obstetric and Neonatal Nurses, Washington, District of Columbia
| | | | - Fernando S. Mendoza
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, California
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Lazarev A, Nath S, Nguyen CQ, Demian AM, Bertasi RAO, Bertasi TGO, Pujalte GGA. Sports and Weight Control in Children. Cureus 2024; 16:e53731. [PMID: 38455821 PMCID: PMC10919905 DOI: 10.7759/cureus.53731] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Pediatric obesity is a global concern with distressing comorbid conditions, including mood disturbance, cardiovascular changes, endocrine imbalance, liver disease, sleep apnea, and orthopedic conditions. The primary treatment of this condition includes physical activity. Participating in organized sports has been shown to reduce weight and the complications of pediatric obesity more effectively than individual exercise.
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Affiliation(s)
- Artemii Lazarev
- Internal Medicine, Mount Sinai Hospital Chicago, Chicago, USA
| | - Sahil Nath
- Family Medicine, Mayo Clinic, Jacksonville, USA
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Abstract
PURPOSE OF REVIEW Poor diet and food insecurity contribute to the dramatic rise in diet-related chronic disease and increasing cost of healthcare. The Food as Medicine (FAM) framework describes food-based interventions designed to prevent, manage, and treat diet-related diseases. However, FAM interventions have not been widely implemented or evaluated in pediatric populations, so critical questions remain about their optimal delivery and design, efficacy, and funding opportunities. We have reviewed the recent literature and offer insights into potential funding and implementation strategies for pediatric healthcare providers. RECENT FINDINGS Data from adult and population-level interventions provide evidence that FAM interventions positively impact diet quality, food security, health outcomes, and healthcare utilization and cost in adults and households with children. Evidence from recent pediatric-based FAM interventions and population data from recent changes to federal nutrition programs support the use of food-based interventions to improve child diet quality, food insecurity, and potentially impact long-term health and healthcare utilization and cost. SUMMARY Applying the entire spectrum of evidence-based FAM interventions in pediatric settings from prenatal to adolescent stages will offer the greatest opportunity to ensure all children have access to enough healthful food so they can achieve their highest potential in life.
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Affiliation(s)
- Laura Fischer
- Children's National Hospital, General and Community Pediatrics, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Hemen Muleta
- Children's Hospital at Montefiore, Pediatric Hospital Medicine
- Albert Einstein College of Medicine, Department of Pediatrics, Bronx, New York
| | - Kofi Essel
- Children's National Hospital, General and Community Pediatrics, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
- Elevance Health, Indianapolis, Indiana, USA
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Zhang E, Zhu H, Song B, Shi Y, Cao Z. Recent advances in oral insulin delivery technologies. J Control Release 2024; 366:221-230. [PMID: 38161033 DOI: 10.1016/j.jconrel.2023.12.045] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
With the rise in diabetes mellitus cases worldwide, oral delivery of insulin is preferred over subcutaneous insulin administration due to its good patient compliance and non-invasiveness, simplicity, and versatility. However, oral insulin delivery is hampered by various gastrointestinal barriers that result in low drug bioavailability and insufficient therapeutic efficiency. Numerous strategies have been developed to overcome these barriers and increase the bioavailability of oral insulin. Yet, no commercial oral insulin product is available to address all clinical hurdles because of various substantial obstacles related to the structural organization and physiological function of the gastrointestinal tract. Herein, we discussed the significant physiological barriers (including chemical, enzymatic, and physical barriers) that hinder the transportation and absorption of orally delivered insulin. Then, we showcased recent significant and innovative advances in oral insulin delivery technologies. Finally, we concluded the review with remarks on future perspectives on oral insulin delivery technologies and potential challenges for forthcoming clinical translation of oral insulin delivery technologies.
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Affiliation(s)
- Ershuai Zhang
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Hui Zhu
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Boyi Song
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Yuanjie Shi
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Zhiqiang Cao
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA.
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Sellers EAC, McLeod L, Prior HJ, Dragan R, Wicklow BA, Ruth C. Incidence and prevalence of type 2 diabetes in Manitoba children 2009-10 to 2017-18: First Nation versus all other Manitobans. Diabetes Res Clin Pract 2024; 208:111097. [PMID: 38244781 DOI: 10.1016/j.diabres.2024.111097] [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: 09/22/2023] [Revised: 12/10/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024]
Abstract
AIM To describe the incidence and prevalence of type 2 diabetes in children in Manitoba over a ten-year period. METHODS Population-based, provincial databases were linked to calculate the incidence and prevalence of type 2 diabetes in children < 18 years of age in Manitoba from 2009-10 to 2017-18. First Nation and all other Manitoban children are described separately. RESULTS The incidence of type 2 diabetes increased from 16.0/100,000/year in 2009-10 to 31‧1/100,000/year in 2017-18 (p < 0.001). For First Nation children, the incidence increased from 73‧4 to 121‧2/100,000/year (p < 0.001). For all other Manitoban children, the incidence increased from 3‧3 to 10‧7/100,000/year (p < 0.001). The prevalence of type 2 diabetes rose from 66‧4 to 124‧2/100,000/year between 2009 -10 and 2017-18 (<0.001). The prevalence in First Nation children rose from 282‧8 to 517‧9/100,000/year (p < 0.001) and in all other Manitoban children from 18‧4 to 35.0/100,000/year (p < 0.001). CONCLUSIONS The incidence and prevalence of type 2 diabetes is increasing in Manitoban children. While the greatest increase is seen in all other Manitoban children, type 2 diabetes disproportionally affects First Nation children. Understanding the prevalence and incidence of type 2 diabetes in children is necessary for resource allocation and to inform program planning, aimed at both prevention and management.
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Affiliation(s)
- Elizabeth A C Sellers
- Dept. Pediatrics and Child Health, University of Manitoba, 840 Sherbrook St, Winnipeg, Manitoba R3A 1S1, Canada; Children's Hospital Research Institute of Manitoba, 715 McDermot Ave, Winnipeg, Manitoba R3E 3P4, Canada.
| | - Lorraine McLeod
- First Nations Health & Social Secretariat of Manitoba, Unit 74 - 630 Kernaghan Avenue, Winnipeg, Manitoba R2C 5G1, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, University of Manitoba, #404-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, #404-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
| | - Brandy A Wicklow
- Dept. Pediatrics and Child Health, University of Manitoba, 840 Sherbrook St, Winnipeg, Manitoba R3A 1S1, Canada; Children's Hospital Research Institute of Manitoba, 715 McDermot Ave, Winnipeg, Manitoba R3E 3P4, Canada
| | - Chelsea Ruth
- Dept. Pediatrics and Child Health, University of Manitoba, 840 Sherbrook St, Winnipeg, Manitoba R3A 1S1, Canada; Manitoba Centre for Health Policy, University of Manitoba, #404-727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada
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Kwak SH, Srinivasan S, Chen L, Todd J, Mercader JM, Jensen ET, Divers J, Mottl AK, Pihoker C, Gandica RG, Laffel LM, Isganaitis E, Haymond MW, Levitsky LL, Pollin TI, Florez JC, Flannick J. Genetic architecture and biology of youth-onset type 2 diabetes. Nat Metab 2024; 6:226-237. [PMID: 38278947 PMCID: PMC10896722 DOI: 10.1038/s42255-023-00970-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/20/2023] [Indexed: 01/28/2024]
Abstract
The prevalence of youth-onset type 2 diabetes (T2D) and childhood obesity has been rising steadily1, producing a growing public health concern1 that disproportionately affects minority groups2. The genetic basis of youth-onset T2D and its relationship to other forms of diabetes are unclear3. Here we report a detailed genetic characterization of youth-onset T2D by analysing exome sequences and common variant associations for 3,005 individuals with youth-onset T2D and 9,777 adult control participants matched for ancestry, including both males and females. We identify monogenic diabetes variants in 2.4% of individuals and three exome-wide significant (P < 2.6 × 10-6) gene-level associations (HNF1A, MC4R, ATXN2L). Furthermore, we report rare variant association enrichments within 25 gene sets related to obesity, monogenic diabetes and β-cell function. Many youth-onset T2D associations are shared with adult-onset T2D, but genetic risk factors of all frequencies-and rare variants in particular-are enriched within youth-onset T2D cases (5.0-fold increase in the rare variant and 3.4-fold increase in common variant genetic liability relative to adult-onset cases). The clinical presentation of participants with youth-onset T2D is influenced in part by the frequency of genetic risk factors within each individual. These findings portray youth-onset T2D as a heterogeneous disease situated on a spectrum between monogenic diabetes and adult-onset T2D.
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Affiliation(s)
- Soo Heon Kwak
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Shylaja Srinivasan
- Division of Pediatric Endocrinology, University of California at San Francisco, San Francisco, CA, USA
| | - Ling Chen
- Center for Genomic Medicine, and Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Todd
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Vermont, Burlington, VT, USA
| | - Josep M Mercader
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, and Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jasmin Divers
- Department of Foundations of Medicine, NYU Langone Health, New York, NY, USA
| | - Amy K Mottl
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Rachelle G Gandica
- Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | | | - Morey W Haymond
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Lynne L Levitsky
- Pediatric Endocrine Division, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA
| | - Toni I Pollin
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jose C Florez
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, and Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jason Flannick
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
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Qu G, Liu H, Ma S, Han T, Zhang H, Sun L, Qin Q, Chen M, Sun Y. Inflammatory burden of adolescents with childhood maltreatment: results from baseline data of a school cohort. Eur Child Adolesc Psychiatry 2024; 33:539-548. [PMID: 36877251 DOI: 10.1007/s00787-023-02181-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Increasing studies have investigated inflammatory burden of adults with childhood adversity, but less is known about how childhood maltreatment affects the inflammation level of adolescents. Baseline data of a school cohort of physical and mental health status and life experience survey on primary and secondary school students in Anhui Province, China was used. Childhood maltreatment of children and adolescents was assessed by Chinese version of Childhood Trauma Questionnaire-Short Form (CTQ-SF). Urine samples were collected to assess levels of soluble urokinase Plasminogen Activator Receptor (suPAR), C-reactive protein (CRP) and cytokines interleukin-6 (IL-6) by enzyme-linked immunosorbent assay (ELISA). Logistic regression was conducted to examine the association between childhood maltreatment exposure and risk of high inflammation burden. A total of 844 students were included with mean age 11.41 ± 1.57 years old. Adolescents with emotional abuse were significantly more likely to have high level of IL-6 (OR = 3.59, 95% CI 1.16-11.14). In addition, adolescents with emotional abuse were more likely to show high IL-6 and high suPAR combination (OR = 33.41, 95% CI 1.69-659.22), and high IL-6 and low CRP combination (OR = 4.34, 95% CI 1.29-14.55). Subgroup analyses showed that emotional abuse was associated with high IL-6 burden among boys or adolescents with depression. Childhood emotional abuse was positively associated with higher burden of IL-6. Early detection and prevention of emotional abuse for children and adolescents, especially for boys or adolescents with depression status, may be helpful for preventing elevated inflammatory burden and related health problems.
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Affiliation(s)
- Guangbo Qu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Haixia Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Shaodi Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tiantian Han
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Huimei Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Liang Sun
- Fuyang Center for Disease Control and Prevention, No.19, Zhongnan Avenue, Fuyang, 236000, Anhui, China
| | - Qirong Qin
- Ma'anshan Center for Disease Control and Prevention, No.849, Jiangdong Avenue, Ma'anshan, 243000, Anhui, China
| | - Mingchun Chen
- Changfeng Center for Disease Control and Prevention, Changfeng, Anhui, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Chaohu Hospital, Anhui Medical University, Hefei, 238000, Anhui, China.
- Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
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Aye T, Boney CM, Orr CJ, Leonard MB, Leslie LK, Allen DB. Child Health Needs and the Pediatric Endocrinology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678J. [PMID: 38300000 DOI: 10.1542/peds.2023-063678j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
The pediatric endocrinology (PE) workforce in the United States is struggling to sustain an adequate, let alone optimal, workforce capacity. This article, one of a series of articles in a supplement to Pediatrics, focuses on the pediatric subspecialty workforce and furthers previous evaluations of the US PE workforce to model the current and future clinical PE workforce and its geographic distribution. The article first discusses the children presenting to PE care teams, reviews the current state of the PE subspecialty workforce, and presents projected headcount and clinical workforce equivalents at the national, census region, and census division level on the basis of a subspecialty workforce supply model through 2040. It concludes by discussing the educational and training, clinical practice, policy, and future workforce research implications of the data presented. Data presented in this article are available from the American Board of Pediatrics, the National Resident Matching Program, and the subspecialty workforce supply model. Aging, part-time appointments, and unbalanced geographic distribution of providers diminish the PE workforce capacity. In addition, limited exposure, financial concerns, and lifestyle perceptions may impact trainees. Additional workforce challenges are the subspecialty's increasingly complex cases and breadth of conditions treated, reliance on international medical graduates to fill fellowship slots, and high relative proportion of research careers. The recent limitations on pediatric endocrinologists providing gender-affirming care may also impact the geographic distribution of the subspecialty's workforce. Deliberate actions need to be taken now to continue serving the needs of children.
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Affiliation(s)
- Tandy Aye
- Division of Pediatric Endocrinology
- Stanford University School of Medicine, Stanford, California
| | - Charlotte M Boney
- Division of Pediatric Endocrinology, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Colin J Orr
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mary B Leonard
- Stanford University School of Medicine, Stanford, California
| | | | - David B Allen
- Division of Pediatric Endocrinology and Diabetes, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Hosoda-Urban T, O'Donnell EH. Diabetes-Related Posttraumatic Stress Symptoms in Adolescents and Young Adults With Type 1 Diabetes: A Pilot Study. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00003-X. [PMID: 38302058 DOI: 10.1016/j.jaclp.2024.01.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/16/2023] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Posttraumatic stress symptoms (PTSS) may adversely affect glycemic control. Yet no studies have focused on trauma and PTSS induced by diabetes-related events in adolescents and young adults (AYA) with type 1 diabetes. OBJECTIVE This study explores PTSS arising from diabetes-related events (e.g., severe symptoms or emergency room visits due to complications) among AYA with type 1 diabetes. METHODS In this cross-sectional pilot study, self-reported measures (Posttraumatic Diagnostic Scale for DSM-5, Child Posttraumatic Stress Disorder Symptom Scale 5) were employed to assess trauma experiences and PTSS in AYA with type 1 diabetes at a pediatric diabetes clinic within a large hospital/academic medical center. RESULTS Fifty AYA with type 1 diabetes completed questionnaires assessing trauma and PTSS. Of the sample, 82% (n = 41) reported experiencing at least one form of general trauma (e.g., physical abuse, witnessing violence, or serious injuries). Among those who reported trauma, 22% (n = 9) indicated that the most distressing event was specifically diabetes-related. Over a quarter of participants exhibited clinically relevant levels of PTSS related to diabetes events. Females assigned at birth and those with a higher frequency of emergency room visits due to diabetes had an elevated risk of developing clinically relevant levels of diabetes-related PTSS. CONCLUSIONS Our results suggest that diabetes itself can serve as a traumatic stressor for some individuals. Therefore, interventions should be designed to prevent or mitigate PTSS starting from the time of diagnosis.
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Affiliation(s)
- Tamaki Hosoda-Urban
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Clinical Psychology, Graduate School of Medical Sciences, Tottori University, Yonago, Tottori, Japan.
| | - Ellen H O'Donnell
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Hammoud B, Nelson JB, May SC, Tersey SA, Mirmira RG. Discordant Effects of Polyamine Depletion by DENSpm and DFMO on β-cell Cytokine Stress and Diabetes Outcomes in Mice. Endocrinology 2024; 165:bqae001. [PMID: 38195178 PMCID: PMC10808000 DOI: 10.1210/endocr/bqae001] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 01/11/2024]
Abstract
Type 1 diabetes (T1D) is an autoimmune disease leading to dysfunction and loss of insulin-secreting β cells. In β cells, polyamines have been implicated in causing cellular stress and dysfunction. An inhibitor of polyamine biosynthesis, difluoromethylornithine (DFMO), has been shown to delay T1D in mouse models and preserve β-cell function in humans with recent-onset T1D. Another small molecule, N1,N11-diethylnorspermine (DENSpm), both inhibits polyamine biosynthesis and accelerates polyamine metabolism and is being tested for efficacy in cancer clinical trials. In this study, we show that DENSpm depletes intracellular polyamines as effectively as DFMO in mouse β cells. RNA-sequencing analysis, however, suggests that the cellular responses to DENSpm and DFMO differ, with both showing effects on cellular proliferation but the latter showing additional effects on mRNA translation and protein-folding pathways. In the low-dose streptozotocin-induced mouse model of T1D, DENSpm, unlike DFMO, did not prevent or delay diabetes outcomes but did result in improvements in glucose tolerance and reductions in islet oxidative stress. In nonobese diabetic (NOD) mice, short-term DENSpm administration resulted in a slight reduction in insulitis and proinflammatory Th1 cells in the pancreatic lymph nodes. Longer term treatment resulted in a dose-dependent increase in mortality. Notwithstanding the efficacy of both DFMO and DENSpm in reducing potentially toxic polyamine levels in β cells, our results highlight the discordant T1D outcomes that result from differing mechanisms of polyamine depletion and, more importantly, that toxic effects of DENSpm may limit its utility in T1D treatment.
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Affiliation(s)
- Batoul Hammoud
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA
| | - Jennifer B Nelson
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Sarah C May
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Sarah A Tersey
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Raghavendra G Mirmira
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
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Chen J, Zhang WC, Tang XQ, Yin RH, Wang T, Wei XY, Pan CJ. Predictive value of bilirubin and serum γ-glutamyltranspeptidase levels in type-2 diabetes mellitus patients with acute coronary syndrome. World J Diabetes 2024; 15:34-42. [PMID: 38313856 PMCID: PMC10835495 DOI: 10.4239/wjd.v15.i1.34] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/13/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Cardiovascular disease is a major complication of diabetes mellitus (DM). Type-2 DM (T2DM) is associated with an increased risk of cardiovascular events and mortality, while serum biomarkers may facilitate the prediction of these outcomes. Early differential diagnosis of T2DM complicated with acute coronary syndrome (ACS) plays an important role in controlling disease progression and improving safety. AIM To investigate the correlation of serum bilirubin and γ-glutamyltranspeptidase (γ-GGT) with major adverse cardiovascular events (MACEs) in T2DM patients with ACS. METHODS The clinical data of inpatients from January 2022 to December 2022 were analyzed retrospectively. According to different conditions, they were divided into the T2DM complicated with ACS group (T2DM + ACS, n = 96), simple T2DM group (T2DM, n = 85), and simple ACS group (ACS, n = 90). The clinical data and laboratory indices were compared among the three groups, and the correlations of serum total bilirubin (TBIL) levels and serum γ-GGT levels with other indices were discussed. T2DM + ACS patients received a 90-day follow-up after discharge and were divided into event (n = 15) and nonevent (n = 81) groups according to the occurrence of MACEs; Univariate and multivariate analyses were further used to screen the independent influencing factors of MACEs in patients. RESULTS The T2DM + ACS group showed higher γ-GGT, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) and lower TBIL and high-density lipoprotein cholesterol levels than the T2DM and ACS groups (P < 0.05). Based on univariate analysis, the event and nonevent groups were significantly different in age (t = 3.3612, P = 0.0011), TBIL level (t = 3.0742, P = 0.0028), γ-GGT level (t = 2.6887, P = 0.0085), LDL-C level (t = 2.0816, P = 0.0401), HbA1c level (t = 2.7862, P = 0.0065) and left ventricular ejection fraction (LEVF) levels (t=3.2047, P = 0.0018). Multivariate logistic regression analysis further identified that TBIL level and LEVF level were protective factor for MACEs, and age and γ-GGT level were risk factors (P < 0.05). CONCLUSION Serum TBIL levels are decreased and γ-GGT levels are increased in T2DM + ACS patients, and the two indices are significantly negatively correlated. TBIL and γ-GGT are independent influencing factors for MACEs in such patients.
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Affiliation(s)
- Jie Chen
- Radiology Department, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu Province, China
| | - Wan-Chao Zhang
- Radiology Department, The People’s Hospital of WuQia County, Wuqia 845450, Xinjiang Uygur Autonomous Region, China
| | - Xiao-Qiang Tang
- Radiology Department, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu Province, China
| | - Ruo-Han Yin
- Radiology Department, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu Province, China
| | - Tao Wang
- Radiology Department, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu Province, China
| | - Xiao-Yu Wei
- Radiology Department, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu Province, China
| | - Chang-Jie Pan
- Radiology Department, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu Province, China
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Zhao Y, Quan E, Zeng T, Huang Z, Luo Y, Peng L, Li S, Liu J, Chong Y, Cao H. Type 1 diabetes, its complications, and non-ischemic cardiomyopathy: a mendelian randomization study of European ancestry. Cardiovasc Diabetol 2024; 23:31. [PMID: 38218861 PMCID: PMC10787423 DOI: 10.1186/s12933-023-02117-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is a significant risk factor for a range of cardiovascular diseases. Nonetheless, the causal relationship between T1D and non-ischemic cardiomyopathy (NICM) remains to be elucidated. Furthermore, the mechanisms responsible for the progression from T1D to NICM have not been definitively characterized. OBJECTIVE The aim of this study was to conduct a Mendelian randomization (MR) study to investigate the causal effects of T1D and its complications on the development of NICM. Additionally, this study aimed to conduct a mediation analysis to identify potential mediators within this correlation. METHODS Genetic variants were used as instrumental variables for T1D. The summary data for T1D were obtained from two genome-wide association study datasets. The summary data for T1D with complications and NICM were obtained from the Finnish database. Two-sample MR, multivariable MR and mediation MR were conducted in this study. RESULTS The study revealed a causal association between T1D, T1D with complications, and NICM (with odds ratios of 1.02, 95% CI 1.01-1.04, p = 1.17e-04 and 1.03, 95% CI 1.01-1.05, p = 3.15e-3). Even after adjusting for confounding factors such as body mass index and hypertension, T1D remained statistically significant (with odds ratio of 1.02, 95% CI 1.01-1.04, p = 1.35e-4). Mediation analysis indicated that monokine induced by gamma interferon may play a mediating role in the pathogenesis of T1D-NICM (mediation effect indicated by odds ratio of 1.005, 95% CI 1.001-1.01, p = 4.9e-2). CONCLUSION The study demonstrates a causal relationship between T1D, its complications, and NICM. Additionally, monokine induced by gamma interferon may act as a potential mediator in the pathogenesis of T1D-NICM.
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Affiliation(s)
- Yunyue Zhao
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Enxi Quan
- Department of Clinical Pharmacy, Guangzhou First People's Hospital, Guangzhou, 511457, China
| | - Tao Zeng
- Department of Infectious Diseases, Guangdong Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Zhuoshan Huang
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Yanting Luo
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Long Peng
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Suhua Li
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Jinlai Liu
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Yutian Chong
- Department of Infectious Diseases, Guangdong Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
| | - Hong Cao
- Department of Infectious Diseases, Guangdong Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
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47
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Hoe FM, Darbinian JA, Greenspan LC, Lo JC. Hemoglobin A1c and Type 2 Diabetes Incidence Among Adolescents With Overweight and Obesity. JAMA Netw Open 2024; 7:e2351322. [PMID: 38231515 PMCID: PMC10794942 DOI: 10.1001/jamanetworkopen.2023.51322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/17/2023] [Indexed: 01/18/2024] Open
Abstract
Importance With the increase in prediabetes among adolescents with overweight and obesity, identifying those at highest risk for type 2 diabetes (T2D) can support prevention strategies. Objective To assess T2D risk by hemoglobin A1c (HbA1c) levels among adolescents with overweight and obesity. Design, Setting, and Participants This retrospective cohort study was conducted using data for January 1, 2010, to December 31, 2019, from a large California health care system. The study population comprised adolescents aged 10 to 17 years who had a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) at or above the 85th percentile, had HbA1c measured during 2010 to 2018, and did not have preexisting diabetes. Data abstraction and analyses were conducted from January 1, 2020, to November 16, 2023. Exposures Baseline HbA1c, with covariates including BMI category (overweight: 85th to <95th percentile; moderate obesity: 100% to <120% of 95th percentile; or severe obesity: ≥120% of 95th percentile), age, sex, race and ethnicity, and Neighborhood Deprivation Index score. Main Outcomes and Measures The main outcome was incident T2D during follow-up through 2019, including cumulative incidence and multivariable hazard ratios (HRs) with 95% CIs using Cox proportional hazard regression analyses. Results This study included 74 552 adolescents with a mean (SD) age of 13.4 (2.3) years. More than half (50.6%) were female; 26.9% of individuals had overweight, 42.3% had moderate obesity, and 30.8% had severe obesity. Individuals identified as Asian or Pacific Islander (17.6%), Black (11.1%), Hispanic (43.6%), White (21.6%), and other or unknown race or ethnicity (6.1%). During follow-up, 698 adolescents (0.9%) developed diabetes, and 626 (89.7%) had T2D; 72 individuals (10.3%) who had type 1, secondary, or other diabetes were censored. The overall T2D incidence was 2.1 (95% CI, 1.9-2.3) per 1000 person-years, with a 5-year cumulative incidence of 1.0% (95% CI, 0.9%-1.1%). Higher baseline HbA1c (from <5.5% to 5.5%-5.6%, 5.7%-5.8%, 5.9%-6.0%, 6.1%-6.2%, and 6.3-6.4%) was associated with higher 5-year cumulative T2D incidence (from 0.3% [95% CI, 0.2%-0.4%] to 0.5% [0.4%-0.7%], 1.1% [0.8%-1.3%], 3.8% [3.2%-4.7%], 11.0% [8.9%-13.7%], and 28.5% [21.9%-36.5%], respectively). In addition, higher baseline HbA1c was associated with greater T2D risk (reference [HbA1c <5.5%]: HR, 1.7 [95% CI, 1.3-2.2], 2.8 [2.1-3.6], 9.3 [7.2-12.1], 23.3 [17.4-31.3], and 71.9 [51.1-101.1], respectively). Higher BMI category, older age, female sex, and Asian or Pacific Islander race (HR, 1.7 [95% CI, 1.3-2.2]), but not Black race or Hispanic ethnicity (compared with White race), were also independent indicators of T2D. In stratified analyses, incremental risk associated with higher HbA1c was greater for Asian or Pacific Islander and White adolescents than for Black and Hispanic adolescents. Conclusions and Relevance In this cohort study of adolescents with overweight and obesity, T2D risk increased substantially with baseline HbA1c above 6.0%. Risk varied by BMI, age, sex, and race and ethnicity. These findings suggest that diabetes surveillance in adolescents should be tailored to optimize identification among high-risk subgroups.
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Affiliation(s)
- Francis M. Hoe
- Department of Pediatric Specialties, Kaiser Permanente Roseville Medical Center, Roseville, California
- The Permanente Medical Group, Oakland, California
| | - Jeanne A. Darbinian
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Louise C. Greenspan
- The Permanente Medical Group, Oakland, California
- Department of Pediatrics, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Joan C. Lo
- The Permanente Medical Group, Oakland, California
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Dai J, Niu X, Bullock A, Manson SM, O’Connell J, Jiang L. Prevalence of Diagnosed Type 1 and Type 2 Diabetes Among American Indian and Alaska Native Peoples in 2012-2013. Diabetes Care 2024; 47:e1-e3. [PMID: 37953641 PMCID: PMC10733645 DOI: 10.2337/dc23-0930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/04/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Jiahui Dai
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, CA
| | - Xiaoyi Niu
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, CA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Joan O’Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, CA
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Xiang AH, Lin JC, Chow T, Martinez MP, Negriff S, Page KA, McConnell R, Carter SA. Types of diabetes during pregnancy and risk of depression and anxiety in offspring from childhood to young adulthood. Diabetes Obes Metab 2024; 26:224-232. [PMID: 37823225 PMCID: PMC10962903 DOI: 10.1111/dom.15308] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023]
Abstract
AIMS To assess maternal pre-existing type 1 diabetes (T1D), type 2 diabetes (T2D), gestational diabetes mellitus (GDM) during pregnancy and risk of depression and anxiety from childhood to young adulthood in offspring. MATERIALS AND METHODS This birth cohort included singletons born during 1995-2015, followed using electronic medical records through 2020. Cox regression was used to estimate hazard ratio (HR) of depression or anxiety diagnosis during follow-up associated with in-utero exposure to maternal diabetes. RESULTS Among 439 590 offspring, 29 891 (6.8%) had depression and 51 918 (11.8%) had anxiety. T1D, followed by T2D and GDM requiring antidiabetes medication were associated with risk of depression and anxiety in offspring. Compared with no diabetes during pregnancy, the adjusted HRs (95% confidence interval) of depression in offspring associated with T1D, T2D or GDM requiring medications were 1.44 (1.09-1.91), 1.30 (1.15-1.47) and 1.18 (1.11-1.26) respectively; conversely, HRs were 0.97 (0.82-1.15) for T2D and 0.99 (0.94-1.04) for GDM without medications. The associations with anxiety followed similar patterns. The significant associations were observed for offspring ages 5-12 and >12-18 years and attenuated for 18-25 years. CONCLUSION These data suggest that the severity of diabetes (T1D vs. T2D requiring medications vs. GDM requiring medications) during pregnancy may increase the vulnerability of offspring for depression or anxiety.
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Affiliation(s)
- Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jane C. Lin
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Mayra P. Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Sonya Negriff
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Kathleen A. Page
- Division of Endocrinology, Diabetes and Obesity Research Institute
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Sarah A. Carter
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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50
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Reid LA, Geraci M, Mendoza JA, Merchant AT, Reboussin BA, Pate RR, Dolan LM, Sauder KA, Lustigova E, Kim G, Liese AD. Household Food Insecurity Is Associated With Physical Activity in Youth and Young Adults With Diabetes: A Cross-Sectional Study. J Phys Act Health 2024; 21:77-84. [PMID: 37922896 DOI: 10.1123/jpah.2022-0338] [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] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2023] [Accepted: 09/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Physical activity (PA) is essential for optimal diabetes management. Household food insecurity (HFI) may negatively affect diabetes management behaviors. The purpose of this study was to cross-sectionally examine the association between HFI and PA in youth and young adults (YYA) with type 1 (N = 1998) and type 2 (N = 391) diabetes from the SEARCH for Diabetes in Youth Study. METHODS HFI was measured with the US Household Food Security Survey Module. PA was measured with the International Physical Activity Questionnaire Short Form. Walking, moderate-intensity PA (excluding walking), vigorous-intensity PA, moderate- to vigorous-intensity PA, and total PA were estimated as minutes per week, while time spent sitting was assessed in minutes per day. All were modeled with median regression. Meeting PA guidelines or not was modeled using logistic regression. RESULTS YYA with type 1 diabetes who experienced HFI spent more time walking than those who were food secure. YYA with type 2 diabetes who experienced HFI spent more time sitting than those who were food secure. CONCLUSIONS Future research should examine walking for leisure versus other domains of walking in relation to HFI and use objective PA measures to corroborate associations between HFI and PA in YYA with diabetes.
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Affiliation(s)
- Lauren A Reid
- South College, Atlanta, GA, USA
- University of South Carolina, Columbia, SC, USA
| | - Marco Geraci
- University of South Carolina, Columbia, SC, USA
- Sapienza University of Rome, Rome, Italy
| | - Jason A Mendoza
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | | | | | | | - Eva Lustigova
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Grace Kim
- University of Washington School of Medicine, Seattle, WA, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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