The changing spectrum of diabetes in Mexican American youth

Liver Biomarkers and Lipid Profiles in Mexican and Mexican-American 10- to 14-Year-Old Adolescents at Risk for Type 2 Diabetes

Liver enzymes alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) are markers for type 2 diabetes mellitus (T2DM); alkaline phosphatase is a marker of liver disease. Mexican-American adolescents are disproportionately affected by T2DM, while in Mexico its prevalence is emerging. We assessed liver biomarkers and lipid profiles among Mexican and Mexican-American adolescents 10-14 years old with high/low risk of T2DM through a cross-sectional, descriptive study (Texas n = 144; Mexico n = 149). We included family medical histories, anthropometry, and blood pressure. Obesity was present in one-third of subjects in both sites. ALT (UL) was higher (p < 0.001) in high-risk adolescents (23.5 ± 19.5 versus 17.2 ± 13.4 for males, 19.7 ± 11.6 versus 15.1 ± 5.5 for females), in Toluca and in Texas (26.0 ± 14.7 versus 20.0 ± 13.2 for males, 18.2 ± 13.4 versus 14.6 ± 10.1 for females), as well as GGT (UL) (p < 0.001) (18.7 ± 11.1 versus 12.4 ± 2.3 for males, 13.6 ± 5.8 versus 11.5 ± 3.9 for Mexican females; 21.0 ± 6.8 versus 15.4 ± 5.5 for males, 14.3 ± 5.0 versus 13.8 ± 5.3 for females in Texas). We found no differences by sex or BMI. Total cholesterol and HDL were higher among Mexican-Americans (p < 0.001). In conclusion, multiple risk factors were present in the sample. We found differences by gender and between high and low risk for T2DM adolescents in all liver enzymes in both sites.

Youth-onset type 2 diabetes mellitus: lessons learned from the TODAY study

Type 2 diabetes mellitus is increasingly diagnosed in obese children and adolescents. Evidence suggests that this disease commonly progresses more rapidly in youth compared with adults and is associated with high rates of early microalbuminuria, hypertension, and dyslipidemia. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study was the first multiethnic, multicenter randomized trial in the United States to compare 3 treatment approaches in obese youth with new-onset type 2 diabetes (n=699; ages 10-17 years): monotherapy with metformin, metformin with rosiglitazone, and metformin with an intensive lifestyle intervention. The primary outcome was glycemic control. Diabetes-related complications and cardiovascular risk factors were also examined. Approximately half of the participants could not maintain glycemic control by using metformin alone. Combination therapy with metformin and rosiglitazone resulted in better durability of glycemic control, and metformin plus intensive lifestyle intervention was intermediate but not superior to metformin alone. Deterioration in glycemic control was associated with rapid loss of beta cell function, not worsened insulin sensitivity, and could not be explained by differences in adherence or body mass index. After 3.9 years, 236 (33.8%) of participants had hypertension and 116 participants (16.6%) had microalbuminuria. Only 55.9% of participants had a low-density lipoprotein cholesterol level less than 100 mg/dL (to convert to mmol/L, multiply by 0.0259) after 3 years, and 71 of 517 participants (13.7%) had retinopathy. The significance of the findings from this important trial for the management of youth and young adults with youth-onset type 2 diabetes and its complications is discussed. An aggressive multifaceted approach is needed to prevent or forestall premature microvascular and macrovascular complications in youth-onset type 2 diabetes.

Socioeconomic factors in the development of childhood obesity and diabetes

Pediatric obesity has reached critical proportions. Although this pandemic touches individuals from all socioeconomic, racial, and ethnic backgrounds, the trend is more prevalent among children from families of lower-socioeconomic classes. The causes of this separation in obesity rates by socioeconomic background are multifold but include differences in the availability of healthier foods in homes and schools, as well as the availability of safe environments for physical activity. Equally concerning are increases in the diagnosis of type 2 diabetes among certain ethnic groups and discrepancies in health care availability to children of lower-socioeconomic backgrounds. As our society attempts to improve the lifestyle of our children and decrease rates of obesity, it will be important to give focus to children of lower socioeconomic backgrounds in planning these potential interventions.

Diabetes in Hispanic American youth: prevalence, incidence, demographics, and clinical characteristics: the SEARCH for Diabetes in Youth Study

OBJECTIVE

To report the 2001 prevalence and 2002-2005 incidence of type 1 and type 2 diabetes in Hispanic American youth and to describe the demographic, clinical, and behavioral characteristics of these youth.

RESEARCH DESIGN AND METHODS

Data from the SEARCH for Diabetes in Youth Study, a population-based multicenter observational study of youth aged 0-19 years with physician-diagnosed diabetes, were used to estimate the prevalence and incidence of type 1 and type 2 diabetes. Information obtained by questionnaire, physical examination, and blood and urine collection was analyzed to describe the characteristics of youth who completed a study visit.

RESULTS

Among Hispanic American youth, type 1 diabetes was more prevalent than type 2 diabetes, including in youth aged 10-19 years. There were no significant sex differences in type 1 or type 2 diabetes prevalence. The incidence of type 2 diabetes for female subjects aged 10-14 years was twice that of male subjects (P < 0.005), while among youth aged 15-19 years the incidence of type 2 diabetes exceeded that of type 1 diabetes for female subjects (P < 0.05) but not for male subjects. Poor glycemic control, defined as A1C >or=9.5%, as well as high LDL cholesterol and triglycerides were common among youth aged >or=15 years with either type of diabetes. Forty-four percent of youth with type 1 diabetes were overweight or obese.

CONCLUSIONS

Factors such as poor glycemic control, elevated lipids, and a high prevalence of overweight and obesity may put Hispanic youth with type 1 and type 2 diabetes at risk for future diabetes-related complications.