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Adolfsson P, Taplin CE, Zaharieva DP, Pemberton J, Davis EA, Riddell MC, McGavock J, Moser O, Szadkowska A, Lopez P, Santiprabhob J, Frattolin E, Griffiths G, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1341-1372. [PMID: 36537529 PMCID: PMC10107219 DOI: 10.1111/pedi.13452] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of PediatricsKungsbacka HospitalKungsbackaSweden
- Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Craig E. Taplin
- Department of Endocrinology and DiabetesPerth Children's HospitalNedlandsWestern AustraliaAustralia
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Dessi P. Zaharieva
- Division of Endocrinology, Department of PediatricsSchool of Medicine, Stanford UniversityStanfordCaliforniaUSA
| | - John Pemberton
- Department of Endocrinology and DiabetesBirmingham Women's and Children's HospitalBirminghamUK
| | - Elizabeth A. Davis
- Department of Endocrinology and DiabetesPerth Children's HospitalNedlandsWestern AustraliaAustralia
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Jonathan McGavock
- Faculty of Kinesiology and Recreation ManagementUniversity of ManitobaWinnipegManitobaCanada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) ThemeChildren's Hospital Research Institute of ManitobaWinnipegManitobaCanada
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegManitobaCanada
- Diabetes Action Canada SPOR NetworkTorontoOntarioCanada
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport ScienceUniversity of BayreuthBayreuthGermany
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology & NephrologyMedical University of LodzLodzPoland
| | - Prudence Lopez
- Department of PaediatricsJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
- University of NewcastleNewcastleNew South WalesAustralia
| | - Jeerunda Santiprabhob
- Siriraj Diabetes CenterFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
- Division of Endocrinology and Metabolism, Department of PediatricsFaculty of Medicine Siriraj Hospital, Mahidol UniversityBangkokThailand
| | | | | | - Linda A. DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and DiabetologyIndiana University School of Medicine, Riley Hospital for ChildrenIndianapolisIndianaUSA
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2
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Zuckerman Levin N, Cohen M, Phillip M, Tenenbaum A, Koren I, Tenenbaum-Rakover Y, Admoni O, Hershkovitz E, Haim A, Mazor Aronovitch K, Zangen D, Strich D, Brener A, Yeshayahu Y, Schon Y, Rachmiel M, Ben-Ari T, Levy-Khademi F, Tibi R, Weiss R, Lebenthal Y, Pinhas-Hamiel O, Shehadeh N. Youth-onset type 2 diabetes in Israel: A national cohort. Pediatr Diabetes 2022; 23:649-659. [PMID: 35521999 DOI: 10.1111/pedi.13351] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Prevalence of youth-onset type 2 diabetes (T2D) has increased worldwide, paralleling the rise in pediatric obesity. Occurrence and clinical manifestations vary regionally and demographically. OBJECTIVES We assessed the incidence, and clinical and demographic manifestations of youth-onset T2D in Israel. METHODS In a national observational study, demographic, clinical, and laboratory data were collected from the medical records of children and adolescents, aged 10-18 years, diagnosed with T2D between the years 2008 and 2019. RESULTS The incidence of youth-onset T2D in Israel increased significantly from 0.63/100,000 in 2008 to 3.41/100,000 in 2019. The study cohort comprised 379 individuals (228 girls [59.7%], 221 Jews [58.3%], mean age 14.7 ± 1.9 years); 73.1% had a positive family history of T2D. Mean body mass index (BMI) z-score was 1.96 ± 0.7, higher in Jews than Arabs. High systolic (≥ 130 mmHg) and diastolic blood pressure (≥ 85 mmHg) were observed in 33.7% and 7.8% of patients, respectively; mean glycosylated hemoglobin (A1c) level at diagnosis was 8.8 ± 2.5%. Dyslipidemia, with high triglyceride (>150 mg/dl) and low HDL-c (<40 mg/dl) levels, was found in 45.6% and 56.5%, respectively. Microalbuminuria and retinopathy were documented at diagnosis, 15.2% and 1.9%, respectively) and increased (36.7% and 4.6%, respectively) at follow-up of 2.9 ± 2.1 years. Criteria of metabolic syndrome were met by 224 (62.2%) patients, and fatty liver documented in 65%, mainly Jews. Psychosocial comorbidity was found in 31%. Treatment with metformin (45.6%), insulin (20.6%), and lifestyle modification (18%) improved glycemic control. CONCLUSION Youth-onset T2D in Israel has increased significantly and presents a unique profile.
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Affiliation(s)
- Nehama Zuckerman Levin
- Pediatric Diabetes Clinic, Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Meidan Cohen
- Pediatric Diabetes Clinic, Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ariel Tenenbaum
- The Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ilana Koren
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Endocrine and Diabetes Unit, Carmel Medical Center, Haifa, Israel
| | - Yardena Tenenbaum-Rakover
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Endocrine Institute, Ha'Emek Medical Center, Afula, Israel
| | - Osnat Admoni
- Pediatric Endocrine Institute, Ha'Emek Medical Center, Afula, Israel
| | - Eli Hershkovitz
- Pediatric Endocrinology and Diabetes Unit, Soroka Medical Center, Beer Sheva, Israel.,The Faculty of Health Sciences, Goldman School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alon Haim
- Pediatric Endocrinology and Diabetes Unit, Soroka Medical Center, Beer Sheva, Israel.,The Faculty of Health Sciences, Goldman School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Kineret Mazor Aronovitch
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
| | - David Zangen
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Strich
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Specialist Clinic, Clalit Health Services, Jerusalem, Israel.,Pediatric Endocrinology and Diabetes Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Avivit Brener
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yonatan Yeshayahu
- The Faculty of Health Sciences, Goldman School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Endocrine Unit, Department of Pediatrics, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Yossi Schon
- Pediatric Endocrinology Institute, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Marianna Rachmiel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology Institute, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Tal Ben-Ari
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Edith Wolfson Medical Center, Holon, Israel
| | - Floris Levy-Khademi
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Endocrinology and Diabetes Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Rami Tibi
- Pediatric Diabetes Clinic, Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ram Weiss
- Pediatric Diabetes Clinic, Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yael Lebenthal
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
| | - Naim Shehadeh
- Pediatric Diabetes Clinic, Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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3
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Zeitler P, El Ghormli L, Arslanian S, Caprio S, Isganaitis E, Kelsey MK, Weinstock RS, White NH, Drews K. Deterioration of Glycemic Control in Youth-Onset Type 2 Diabetes: What Are the Early and Late Predictors? J Clin Endocrinol Metab 2022; 107:e3384-e3394. [PMID: 35486388 PMCID: PMC9653021 DOI: 10.1210/clinem/dgac254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We examined predictors of early and late loss of glycemic control in individuals with youth-onset type 2 diabetes, as well as predictors of short-term deterioration in youth from the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. METHODS Demographic, physical, and biochemical measures at baseline and 48 months, and change over time, were examined in 584 participants separated into those with loss of glycemic control (sustained HbA1c ≥ 8%) before 48 months or at 48 months or later, and those who remained in control until the end of the study (median 6.8 years). Univariate and multivariate models, and receiver operating characteristic curve analyses were performed. RESULTS Approximately 45% of youth remained in control at 48 months; of these, 30% subsequently lost glycemic control prior to the end of follow-up. Predictors of early loss of glycemic control included baseline HbA1c, C-peptide index, oral disposition index, proinsulin, and proinsulin to insulin ratio. Predictors of late loss included baseline measures of insulin secretion and change in HbA1c and insulin processing at 48 months. A baseline HbA1c cutoff of ≥ 6.2% was optimally predictive of loss of glycemic control at any time, while an absolute rise in HbA1c > 0.5% related to loss of glycemic control within 3 to 6 months. CONCLUSION This analysis demonstrates that youth with type 2 diabetes at risk for loss of glycemic control, including impending rapid deterioration, can be identified using available clinical measures, allowing for closer monitoring of at-risk youth, and facilitating the design of research on better therapeutic options.
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Affiliation(s)
- Philip Zeitler
- University of Colorado
Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Laure El Ghormli
- The Biostatistics Center, George Washington University, Rockville, MD 20852,USA
| | - Silva Arslanian
- University of Pittsburgh, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213,USA
| | | | | | - Megan K Kelsey
- University of Colorado
Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ruth S Weinstock
- State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | - Neil H White
- Washington University in St. Louis School of Medicine, St. Louis, MO 63110,USA
| | - Kimberly Drews
- The Biostatistics Center, George Washington University, Rockville, MD 20852,USA
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4
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Dejkhamron P, Santiprabhob J, Likitmaskul S, Deerochanawong C, Rawdaree P, Tharavanij T, Reutrakul S, Kongkanka C, Suprasongsin C, Numbenjapon N, Sahakitrungruang T, Lertwattanarak R, Engkakul P, Sriwijitkamol A, Korwutthikulrangsri M, Leelawattana R, Phimphilai M, Potisat S, Khananuraksa P, Kunsuikmengrai K, Nitiyanant W. Young-onset diabetes patients in Thailand: Data from Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN). J Diabetes Investig 2022; 13:796-809. [PMID: 34890117 PMCID: PMC9077742 DOI: 10.1111/jdi.13732] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION There is a lack of current information regarding young-onset diabetes in Thailand. Thus, the objectives of this study were to describe the types of diabetes, the clinical characteristics, the treatment regimens and achievement of glycemic control in Thai patients with young-onset diabetes. MATERIALS AND METHODS Data of 2,844 patients with diabetes onset before 30 years-of-age were retrospectively reviewed from a diabetes registry comprising 31 hospitals in Thailand. Gestational diabetes was excluded. RESULTS Based on clinical criteria, type 1 diabetes was identified in 62.6% of patients, type 2 diabetes in 30.7%, neonatal diabetes in 0.8%, other monogenic diabetes in 1.7%, secondary diabetes in 3.0%, genetic syndromes associated with diabetes in 0.9% and other types of diabetes in 0.4%. Type 1 diabetes accounted for 72.3% of patients with age of onset <20 years. The proportion of type 2 diabetes was 61.0% of patients with age of onset from 20 to <30 years. Intensive insulin treatment was prescribed to 55.2% of type 1 diabetes patients. Oral antidiabetic agent alone was used in 50.8% of type 2 diabetes patients, whereas 44.1% received insulin treatment. Most monogenic diabetes, secondary diabetes and genetic syndromes associated with diabetes required insulin treatment. Achievement of glycemic control was identified in 12.4% of type 1 diabetes patients, 30% of type 2 diabetes patients, 36.4% of neonatal diabetes patients, 28.3% of other monogenic diabetes patients, 45.6% of secondary diabetes patients and 28% of genetic syndromes associated with diabetes patients. CONCLUSION In this registry, type 1 diabetes remains the most common type and the prevalence of type 2 diabetes increases with age. The majority of patients did not achieve the glycemic target, especially type 1 diabetes patients.
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Affiliation(s)
- Prapai Dejkhamron
- Division of Endocrinology and MetabolismDepartment of PediatricsFaculty of MedicineChiang Mai UniversityChiang MaiThailand
- Northern Diabetes CenterFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Jeerunda Santiprabhob
- Siriraj Diabetes CenterFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Division of Endocrinology and MetabolismDepartment of PediatricsFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Supawadee Likitmaskul
- Siriraj Diabetes CenterFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Division of Endocrinology and MetabolismDepartment of PediatricsFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Chaicharn Deerochanawong
- Division of Endocrinology and MetabolismDepartment of MedicineCollege of MedicineRajavithi HospitalRangsit UniversityBangkokThailand
| | - Petch Rawdaree
- Division of Endocrinology and MetabolismDepartment of Internal MedicineFaculty of MedicineVajira HospitalNavamindradhiraj UniversityBangkokThailand
| | - Thipaporn Tharavanij
- Endocrine and Metabolism UnitDepartment of Internal MedicineFaculty of MedicineThammasat UniversityPathum ThaniThailand
- Center of Excellence in Applied EpidemiologyThammasat UniversityBangkokThailand
| | - Sirimon Reutrakul
- Division of Endocrinology and MetabolismDepartment of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Chawkaew Kongkanka
- Endocrinology and Metabolism UnitDepartment of PediatricsQueen Sirikit National Institute of Child HealthBangkokThailand
| | - Chittiwat Suprasongsin
- Research CenterFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Nawaporn Numbenjapon
- Division of Endocrinology, Diabetes, and MetabolismDepartment of PediatricsPhramongkutklao Hospital and College of MedicineBangkokThailand
| | - Taninee Sahakitrungruang
- Division of Pediatric EndocrinologyDepartment of PediatricsFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Raweewan Lertwattanarak
- Siriraj Diabetes CenterFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Division of Endocrinology and MetabolismDepartment of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Pontipa Engkakul
- Endocrinology and Metabolism UnitDepartment of PediatricsFaculty of MedicineThammasat UniversityPathum ThaniThailand
| | - Apiradee Sriwijitkamol
- Siriraj Diabetes CenterFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Division of Endocrinology and MetabolismDepartment of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Manassawee Korwutthikulrangsri
- Division of Endocrinology and MetabolismDepartment of PediatricsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Rattana Leelawattana
- Division of Endocrinology and MetabolismDepartment of MedicineFaculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Mattabhorn Phimphilai
- Northern Diabetes CenterFaculty of MedicineChiang Mai UniversityChiang MaiThailand
- Division of Endocrinology and MetabolismDepartment of MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Somkiat Potisat
- Department of Medical ServicesMinistry of Public HealthNonthaburiThailand
| | | | | | - Wannee Nitiyanant
- Siriraj Diabetes CenterFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Division of Endocrinology and MetabolismDepartment of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
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