1
|
Steiman De Visser H, Fast I, Brunton N, Arevalo E, Askin N, Rabbani R, Abou-Setta AM, McGavock J. Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes: A Systemic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e240235. [PMID: 38393727 PMCID: PMC10891480 DOI: 10.1001/jamanetworkopen.2024.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/22/2023] [Indexed: 02/25/2024] Open
Abstract
Importance It is unclear whether cardiorespiratory fitness (CRF) and physical activity are lower among youths with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with youths without diabetes. Objective To describe the magnitude, precision, and constancy of the differences in CRF and physical activity among youths with and without diabetes. Data Sources MEDLINE, Embase, CINAHL, and SPORTDiscus were searched from January 1, 2000, to May 1, 2022, for eligible studies. Study Selection Observational studies with measures of CRF and physical activity in children and adolescents aged 18 years or younger with T1D or T2D and a control group were included. Data Extraction and Synthesis Data extraction was completed by 2 independent reviewers. A random-effects meta-analysis model was used to estimate differences in main outcomes. The pooled effect estimate was measured as standardized mean differences (SMDs) with 95% CIs. The Preferred Reporting Items for Systematic Review and Meta-Analyses guideline was followed. Main Outcomes and Measures The main outcomes were objectively measured CRF obtained from a graded maximal exercise test and subjective or objective measures of physical activity. Subgroup analyses were performed for weight status and measurement type for outcome measures. Results Of 7857 unique citations retrieved, 9 studies (755 participants) with measures of CRF and 9 studies (1233 participants) with measures of physical activity for youths with T2D were included; for youths with T1D, 23 studies with measures of CRF (2082 participants) and 36 studies with measures of PA (12 196 participants) were included. Random-effects models revealed that directly measured CRF was lower in youths with T2D (SMD, -1.06; 95% CI, -1.57 to -0.56; I2 = 84%; 9 studies; 755 participants) and in youths with T1D (SMD, -0.39; 95% CI, -0.70 to -0.09; I2 = 89%; 22 studies; 2082 participants) compared with controls. Random-effects models revealed that daily physical activity was marginally lower in youths with T1D (SMD, -0.29; 95% CI, -0.46 to -0.11; I2 = 89%; 31 studies; 12 196 participants) but not different among youths with T2D (SMD, -0.56; 95% CI, -1.28 to 0.16; I2 = 91%; 9 studies; 1233 participants) compared with controls. When analyses were restricted to studies with objective measures, physical activity was significantly lower in youths with T2D (SMD, -0.71; 95% CI, -1.36 to -0.05; I2 = 23%; 3 studies; 332 participants) and T1D (SMD, -0.67; 95% CI, -1.17 to -0.17; I2 = 93%; 12 studies; 1357 participants) compared with controls. Conclusions and Relevance These findings suggest that deficits in CRF may be larger and more consistent in youths with T2D compared with youths with T1D, suggesting an increased risk for cardiovascular disease-related morbidity in adolescents with diabetes, particularly among those with T2D. The findings reinforce calls for novel interventions to empower youths living with diabetes to engage in regular physical activity and increase their CRF.
Collapse
Affiliation(s)
| | - Isaak Fast
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Brunton
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward Arevalo
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John MacLean Library, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M. Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, Manitoba, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Gong Y, Liu Z, Zhang Y, Zhang J, Zheng Y, Wu Z. AGER1 deficiency-triggered ferroptosis drives fibrosis progression in nonalcoholic steatohepatitis with type 2 diabetes mellitus. Cell Death Discov 2023; 9:178. [PMID: 37280194 DOI: 10.1038/s41420-023-01477-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
Hyperglycemia is an independent risk factor for the rapid progression of nonalcoholic steatohepatitis (NASH) to liver fibrosis with an incompletely defined mechanism. Ferroptosis is a novel form of programmed cell death that has been identified as a pathogenic mechanism in various diseases. However, the role of ferroptosis in the development of liver fibrosis in NASH with type 2 diabetes mellitus (T2DM) is unclear. Here, we observed the histopathological features of the progression of NASH to liver fibrosis as well as hepatocyte epithelial-mesenchymal transition (EMT) in a mouse model of NASH with T2DM and high-glucose-cultured steatotic human normal liver (LO2) cells. The distinctive features of ferroptosis, including iron overload, decreased antioxidant capacity, the accumulation of reactive oxygen species, and elevated lipid peroxidation products, were confirmed in vivo and in vitro. Liver fibrosis and hepatocyte EMT were markedly alleviated after treatment with the ferroptosis inhibitor ferrostatin-1. Furthermore, a decrease in the gene and protein levels of AGE receptor 1 (AGER1) was detected in the transition from NASH to liver fibrosis. Overexpression of AGER1 dramatically reversed hepatocyte EMT in high-glucose-cultured steatotic LO2 cells, whereas the knockdown of AGER1 had the opposite effect. The mechanisms underlying the phenotype appear to be associated with the inhibitory effects of AGER1 on ferroptosis, which is dependent on the regulation of sirtuin 4. Finally, in vivo adeno-associated virus-mediated AGER1 overexpression effectively relieved liver fibrosis in a murine model. Collectively, these findings suggest that ferroptosis participates in the pathogenesis of liver fibrosis in NASH with T2DM by promoting hepatocyte EMT. AGER1 could reverse hepatocyte EMT to ameliorate liver fibrosis by inhibiting ferroptosis. The results also suggest that AGER1 may be a potential therapeutic target for the treatment of liver fibrosis in patients with NASH with T2DM. Chronic hyperglycemia is associated with increased advanced glycation end products, resulting in the downregulation of AGER1. AGER1 deficiency downregulates Sirt4, which disturbs key regulators of ferroptosis (TFR-1, FTH, GPX4, and SLC7A11). These lead to increased iron uptake, decreasing the antioxidative capacity and enhanced lipid ROS production, ultimately leading to ferroptosis, which further promotes hepatocyte epithelial-mesenchymal transition and fibrosis progression in NASH with T2DM.
Collapse
Affiliation(s)
- Yihui Gong
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Zijun Liu
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Yuanyuan Zhang
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Jun Zhang
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Yin Zheng
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, 250021, China.
| | - Zhongming Wu
- NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China.
- Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China.
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, 250021, China.
| |
Collapse
|
3
|
Shah AS, Zeitler PS, Wong J, Pena AS, Wicklow B, Arslanian S, Chang N, Fu J, Dabadghao P, Pinhas-Hamiel O, Urakami T, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes 2022; 23:872-902. [PMID: 36161685 DOI: 10.1111/pedi.13409] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Since the 2018 ISPAD guidelines on this topic, follow-up of large cohorts from around the globe have continued informing the current incidence and prevalence of co-morbidities and complications in young adults with youth-onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youth-onset T2D, the initial and subsequent management of youth-onset T2D, and management of co-morbidities and complications. We include key updates from the observational phase of the multi-center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head-to-head comparison of youth onset vs adult-onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth-onset T2D, social determinants of health, and settings of care given COVID-19 pandemic.
Collapse
Affiliation(s)
- Amy S Shah
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio, USA
| | - Philip S Zeitler
- Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital and Central Clinical School, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alexia S Pena
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Brandy Wicklow
- Division of Endocrinology, Winnipeg Children's Hospital and University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy Chang
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Junfen Fu
- Division of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Sackler School of Medicine, Tel-Aviv, Israel
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Maria E Craig
- The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Pediatrics & Child Health, School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Huang L, Wu P, Zhang Y, Lin Y, Shen X, Zhao F, Yan S. Relationship between onset age of type 2 diabetes mellitus and vascular complications based on Propensity score matching analysis. J Diabetes Investig 2022; 13:1062-1072. [PMID: 35119212 PMCID: PMC9153842 DOI: 10.1111/jdi.13763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 12/20/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022] Open
Abstract
Aims/Introduction To assess the relationship between type 2 diabetes mellitus onset age and vascular complications in China. Materials and Methods A retrospective review of 3,568 patients with type 2 diabetes mellitus using a propensity score‐matched (PSM) cohort analysis was carried out in two different age of onset groups (age 40 and 60 years). These groups were then subdivided into two groups, early‐onset diabetes (EOD40 and EOD60; the onset age before 40 and 60 years, respectively) and late‐onset diabetes (LOD40 and LOD60: the onset age after 40 and 60 years, respectively). Macrovascular and microvascular complications were analyzed before and after PSM. Results Patients categorized in both the early‐onset disease (EOD) groups had a higher risk of developing macro‐ and microvascular complications before PSM. After PSM, no differences existed between the EOD and late‐onset disease groups in the risk of macrovascular complications. Compared with the late‐onset disease group, the odds ratio of having a microvascular complication of diabetic retinopathy, chronic kidney disease and diabetic peripheral neuropathy in the 40‐year‐old EOD group increased to 2.906, 1.967 and 1.672 (P < 0.05), respectively. The odds ratio of diabetic retinopathy and diabetic peripheral neuropathy in the 60‐year‐old EOD group was 1.763 and 1.675 (P < 0.05), respectively. Conclusions The earlier the onset of type 2 diabetes mellitus, the higher risk of microvascular, but not necessarily macrovascular, complications. It is not too late to prevent diabetes at any age. Pre‐emptive microvascular treatment or preventative measures in EOD patients who do not yet show symptoms, might be beneficial.
Collapse
Affiliation(s)
- Lingning Huang
- Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Metabolic Diseases Research Institute, the First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China
| | - Peiwen Wu
- Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Metabolic Diseases Research Institute, the First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China
| | - Yongze Zhang
- Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Metabolic Diseases Research Institute, the First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China
| | - Yanxian Lin
- Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Graduate student of Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province; Fuzhou 350005, Fujian, China, now working at The Affiliated Hospital of Putian University, Putian, Fujian, 351100, China
| | - Ximei Shen
- Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Metabolic Diseases Research Institute, the First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China
| | - Fengying Zhao
- Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China
| | - Sunjie Yan
- Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Diabetes Research Institute of Fujian Province, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Metabolic Diseases Research Institute, the First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China.,Fujian Province Clinical Research Center for Metabolic Diseases, 20 Cha Zhong Road, Fuzhou, Fujian, 350005, China
| |
Collapse
|
5
|
Jun JE, Jeong IK, Ahn KJ, Chung HY, Hwang YC. Statin use for primary prevention in patients with type 2 diabetes: Can it benefit all ages? - A nationwide propensity-matched cohort study. Diabetes Res Clin Pract 2021; 180:109044. [PMID: 34508736 DOI: 10.1016/j.diabres.2021.109044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
AIMS This study aims to investigate whether statin use is associated with a reduction in CVD and mortality in patients with type 2 diabetes without pre-existing CVD. METHODS A propensity score-matched cohort analysis using retrospective data was created. Statin users received at least a 90-day prescription, and never used statin before initiation of the study. Statin non-users never received statin throughout the study. Primary outcome was a composite of myocardial infarction (MI), stroke, and all-cause death, and secondary outcome was an individual event. RESULTS The propensity score matched cohort included 168,045 statin users and 168,045 non-users (mean age 57 years; median follow-up 5.0 years). Compared to statin non-users, the hazard ratio (HR) was 0.72 (95% confidence interval [CI] 0.70-0.73; P < 0.001) for composite outcomes, 0.80 (0.76-0.84; P < 0.001) for MI, 0.74 (0.71-0.76; P < 0.001) for stroke, and 0.68 (0.66-0.70; P < 0.001) for all-cause death in statin users. The risk reduction was most prominent in subjects aged 40-74 years, attenuated but significant in those aged ≥75 years, and not significant in those aged <40 years. CONCLUSIONS Statin showed a protective effect against CVD and all-cause death in type 2 diabetes; this effect was reduced beyond the age of 75 years and disappeared in young patients aged <40 years.
Collapse
Affiliation(s)
- Ji Eun Jun
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - In-Kyung Jeong
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Ho Yeon Chung
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - You-Cheol Hwang
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
6
|
Grøndahl MFG, Johannesen J, Kristensen K, Knop FK. Treatment of type 2 diabetes in children: what are the specific considerations? Expert Opin Pharmacother 2021; 22:2127-2141. [PMID: 34420454 DOI: 10.1080/14656566.2021.1954160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: The number of individuals under 18 years of age with type 2 diabetes is increasing at an alarming rate worldwide. These patients are often characterized by obesity and they often experience a more rapid disease progression than adults with type 2 diabetes. Thus, focus on prevention and management of complications and comorbidities is imperative. With emphasis on weight loss and optimal glycemic control, treatment includes lifestyle changes and pharmacotherapy, which in this patient group is limited to metformin, liraglutide and insulin. In selected cases, bariatric surgery is indicated.Areas covered: This perspective article provides an overview of the literature covering pathophysiology, diagnosis, characteristics and treatment of pediatric type 2 diabetes, and outlines the gaps in our knowledge where further research is needed. The paper draws on both mechanistic studies, large scale intervention trials, epidemiological studies and international consensus statements.Expert opinion: Type 2 diabetes in pediatric patients is an increasing health care problem, and the current treatment strategies do not successfully meet the many challenges and obstacles in this patient group. Treatments must be early, intensive, multifaceted and durable. Also, prevention of obesity and type 2 diabetes in at-risk children should be addressed and prioritized on all levels.
Collapse
Affiliation(s)
- Magnus F G Grøndahl
- Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Johannesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatrics, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Kurt Kristensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Steno Diabetes Center Aarhus - Children and Adolescence, Aarhus University, Aarhus, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Novo Nordisk Foundation for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Lin Y, Zhong X, Xiong Z, Zhang S, Liu M, Fan Y, Huang Y, Sun X, Zhou H, Xu X, Guo Y, Li Y, Yang D, Ye X, Zhuang X, Liao X. Intensity of Glycemic Exposure in Early Adulthood and Target Organ Damage in Middle Age: The CARDIA Study. Front Physiol 2021; 12:614532. [PMID: 34248653 PMCID: PMC8260980 DOI: 10.3389/fphys.2021.614532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
AIM To determine whether long-term intensity of glycemic exposure (IGE) during young adulthood is associated with multiple target organs function at midlife independent of single fasting glucose (FG) measurement. METHODS We included 2,859 participants, aged 18-30 years at Y0, in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. IGE was calculated as the sum of (average FG of two consecutive examinations × years between the examinations) over 25 years. Target organs function was indicated by cardiac structure, left ventricular (LV) systolic function, LV diastolic function, coronary artery calcium (CAC), and urine albumin-to-creatinine ratio (UACR) at Y25. We evaluated the associations between IGE with target organs function using linear regression models and estimated the associations between IGE with numbers of organs involved (0, 1, or ≥ 2 organs) using multinomial logistic regression models. RESULTS A 1-SD increment of IGE was significantly associated with worse target organs function after multivariable adjustment: left ventricular mass (β [SE], 5.468 [1.175]); global longitudinal strain (β [SE], 0.161 [0.071]); E/e' ratio (β[SE], 0.192 [0.071]); CAC score (β [SE], 27.948 [6.116]); and log UACR (β [SE], 0.076 [0.010]). Besides, IGE was independently associated with having ≥ 2 organs involved in both overall population (OR [95% CI], 1.48 [1.23, 1.41], P < 0.001) and subgroups stratified by diabetes at Y25. CONCLUSION Higher intensity of glycemic exposure during young adulthood was independently associated with subclinical alterations of target organs function at midlife. Our findings highlight the importance of early screening and management of IGE in youth.
Collapse
Affiliation(s)
- Yifen Lin
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiangbin Zhong
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhenyu Xiong
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Shaozhao Zhang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yongqiang Fan
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yiquan Huang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiuting Sun
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Huimin Zhou
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xingfeng Xu
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yue Guo
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yuqi Li
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Daya Yang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiaomin Ye
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiaodong Zhuang
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xinxue Liao
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
8
|
Wolf RM, Jaffe AE, Rodriguez S, Lei X, Sarver DC, Straub AT, Wong GW, Magge SN. Altered adipokines in obese adolescents: a cross-sectional and longitudinal analysis across the spectrum of glycemia. Am J Physiol Endocrinol Metab 2021; 320:E1044-E1052. [PMID: 33900848 PMCID: PMC8285597 DOI: 10.1152/ajpendo.00626.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obesity and type 2 diabetes are rapidly increasing in the adolescent population. We sought to determine whether adipokines, specifically leptin, C1q/TNF-related proteins 1 (CTRP1) and CTRP9, and the hepatokine fibroblast growth factor 21 (FGF21), are associated with obesity and hyperglycemia in a cohort of lean and obese adolescents, across the spectrum of glycemia. In an observational, longitudinal study of lean and obese adolescents, we measured fasting laboratory tests, oral glucose tolerance tests, and adipokines including leptin, CTRP1, CTRP9, and FGF21. Participants completed baseline and 2-year follow-up study visits and were categorized as lean (LC, lean control; n = 30), obese normoglycemic (ONG; n = 61), and obese hyperglycemic (OHG; n = 31) adolescents at baseline and lean (n = 8), ONG (n = 18), and OHG (n = 4) at follow-up. Groups were compared using ANOVA and regression analysis, and linear mixed effects modeling was used to test for differences in adipokine levels across baseline and follow-up visits. Results showed that at baseline, leptin was higher in all obese groups (P < 0.001) compared with LC. FGF21 was higher in OHG participants compared with LC (P < 0.001) and ONG (P < 0.001) and positively associated with fasting glucose (P < 0.001), fasting insulin (P < 0.001), Homeostasis Model Assessment-Insulin Resistance Index (HOMA-IR; P < 0.001), and hemoglobin A1c (HbA1c; P = 0.01). CTRP1 was higher in OHG compared with ONG (P = 0.03). CTRP9 was not associated with obesity or hyperglycemia in this pediatric cohort. At 2 years, leptin decreased in ONG (P = 0.003) and FGF21 increased in OHG (P = 0.02), relative to lean controls. Altered adipokine levels are associated with the inflammatory milieu in obese youth with and without hyperglycemia. In adolescence, the novel adipokine CTRP1 was elevated with hyperglycemia, whereas CTRP9 was unchanged in this cohort.NEW & NOTEWORTHY Leptin is higher in obese adolescents and FGF21 is higher in obese hyperglycemic adolescents. The novel adipokine CTRP1 is higher in obese hyperglycemic adolescents, whereas CTRP9 was unchanged in this adolescent cohort.
Collapse
Affiliation(s)
- Risa M Wolf
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew E Jaffe
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Human Genetics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susana Rodriguez
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xia Lei
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Biochemistry, Oklahoma State University, Stillwater, Oklahoma
- Department of Molecular Biology, Oklahoma State University, Stillwater, Oklahoma
| | - Dylan C Sarver
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander T Straub
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- University of Maryland, College Park, Maryland
| | - G William Wong
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Center for Metabolism and Obesity Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheela N Magge
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Cardiovascular (CV) disease is a major cause of mortality in type 2 diabetes mellitus (T2D). Dyslipidemia is prevalent in children with T2D and is a known risk factor for CVD. In this review, we critically examine the epidemiology, pathophysiology, and recommendations for dyslipidemia management in pediatric T2D. RECENT FINDINGS Dyslipidemia is multifactorial and related to poor glycemic control, insulin resistance, inflammation, and genetic susceptibility. Current guidelines recommend lipid screening after achieving glycemic control and annually thereafter. The desired lipid goals are low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, high-density lipoprotein cholesterol (HDL-C) > 35 mg/dL, and triglycerides (TG) < 150 mg/dL. If LDL-C remains > 130 mg/dL after 6 months, statins are recommended with a treatment goal of < 100 mg/dL. If fasting TG are > 400 mg/dL or non-fasting TG are > 1000 mg/dL, fibrates are recommended. Although abnormal levels of atherogenic TG-rich lipoproteins, apolipoprotein B, and non-HDL-C are commonly present in pediatric T2D, their measurement is not currently considered in risk assessment or management.
Collapse
Affiliation(s)
- Bhuvana Sunil
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Alabama at Birmingham, CPPII M30, 1601 4th Ave S, Birmingham, AL, 35233, USA
| | - Ambika P Ashraf
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Alabama at Birmingham, CPPII M30, 1601 4th Ave S, Birmingham, AL, 35233, USA.
| |
Collapse
|
10
|
Barrett T, Jalaludin MY, Turan S, Hafez M, Shehadeh N. Rapid progression of type 2 diabetes and related complications in children and young people-A literature review. Pediatr Diabetes 2020; 21:158-172. [PMID: 31804738 PMCID: PMC7028065 DOI: 10.1111/pedi.12953] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/25/2019] [Accepted: 12/02/2019] [Indexed: 01/05/2023] Open
Abstract
Type 2 diabetes (T2D) is suggested to progress faster in children and young people vs type 1 diabetes (T1D) in the same age group and T2D in adults. We reviewed the evidence base for this. A literature search was performed of PubMed-indexed publications between 2000 and 2018, for the terms "pediatric" and "T2D." Results were combined and filtered for those relating to "progression." Searches of abstract books from Latin American and Asian congresses were performed to include these populations. Pediatric populations were defined as <25 completed years of age. Of the articles and congress abstracts found, 30 were deemed relevant. Dividing the studies into categories based on how T2D progresses, we found the following: (a) yearly beta-cell function deterioration was shown to be 20% to 35% in children with T2D compared with 7% to 11% in adults with T2D, despite similar disease durations; (b) retinopathy progression was likely dependent on diabetes duration rather than diabetes type; however, nephropathy, neuropathy and probably hypertension progressed faster in youth-onset T2D vs T1D. Nephropathy progression was similar to adults with T2D, allowing for disease duration. Youth with T2D had a worse cardiovascular (CV) risk profile than youth with T1D, and a faster progression to CV death. (c) Progression to treatment failure was faster in youth-onset T2D vs adult-onset T2D. Substantial evidence exists for faster progression of T2D in pediatric patients vs T1D or adult-onset T2D. New treatments targeting the pathology are needed urgently to address this issue.
Collapse
Affiliation(s)
- Timothy Barrett
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | | | - Serap Turan
- Department of Pediatrics, Subdivision of Endocrinology and DiabetesMarmara University, School of MedicineIstanbulTurkey
| | - Mona Hafez
- Diabetes and Endocrinology Unit, Department of PediatricsCairo UniversityCairoEgypt
| | - Naim Shehadeh
- Endocrinology, Diabetes & Metabolism InstituteRambam Health Care CampusHaifaIsrael
| | | |
Collapse
|
11
|
Yuan Y, Xie H, Sun L, Wang B, Zhang L, Han H, Yao R, Sun Y, Fu L. A Novel Indicator of Children's Lipid Accumulation Product Associated with Impaired Fasting Glucose in Chinese Children and Adolescents. Diabetes Metab Syndr Obes 2020; 13:1653-1660. [PMID: 32523365 PMCID: PMC7234967 DOI: 10.2147/dmso.s238224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diabetes is one of the most prevalent noncommunicable diseases worldwide. Children's lipid accumulation product (CLAP) is a novel indicator to show children's lipid accumulation and is effectively associated with metabolic syndrome among children and adolescents. The aim of the present study was to explore an association between CLAP and impaired fasting glucose (IFG) in Chinese children and adolescents. METHODS A total of 683 children and adolescents aged 8-15 years were recruited using the stratified cluster sampling method in this cross-sectional study and were measured for body height, weight, waist circumference (WC), abdominal skinfold thickness (AST), triglycerides (TG), fasting plasma glucose, dietary behaviors and physical activities. A logistic regression model and receiver operating characteristic (ROC) curve were used to compare the effects of CLAP for predicting IFG. RESULTS The prevalence of IFG in children and adolescents was 13.8%: 16.9% in boys and 10.1% in girls (P<0.05). The CLAP, height, weight, WC, AST, waist-to-height ratio (WHtR), and TG among boys with IFG were significantly higher than those among boys without IFG (P<0.05). The area under the ROC curve of CLAP for predicting IFG (0.637 (0.562-0.712)) was higher than those of WC, WHtR, AST, and TG. The cutoff point of P 75 CLAP was the optimal value to predict IFG among boys, and the OR (95% CI) was 2.48 (1.40-4.42) and area under the ROC curve was 0.595 (0.513-0.676). CONCLUSION The CLAP was a novel indicator associated with IFG in Chinese boys, and it performed better than WC, WHtR, AST and TG.
Collapse
Affiliation(s)
- Yongting Yuan
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Hong Xie
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Anhui, People’s Republic of China
| | - Lili Sun
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Bangxuan Wang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Li Zhang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Hui Han
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Rongying Yao
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Anhui, People’s Republic of China
- Yehuan Sun Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Meishan Road, Hefei230032, Anhui, People’s Republic of China Email
| | - Lianguo Fu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, People’s Republic of China
- Correspondence: Lianguo Fu Department of Child and Adolescents Health, School of Public Health, Bengbu Medical College, 2600 East Sea Avenue, Bengbu233030, Anhui, People’s Republic of ChinaTel +8613195529639Fax +86-5523175215 Email
| |
Collapse
|
12
|
Spreghini N, Cianfarani S, Spreghini MR, Brufani C, Morino GS, Inzaghi E, Convertino A, Fintini D, Manco M. Oral glucose effectiveness and metabolic risk in obese children and adolescents. Acta Diabetol 2019; 56:955-962. [PMID: 30868315 DOI: 10.1007/s00592-019-01303-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 12/22/2022]
Abstract
AIM To investigate whether GE is affected in children/adolescents with obesity and abnormalities of the metabolic syndrome (MetS). METHODS Cross-sectional study of oral GE (oGE), insulin sensitivity and secretion (calculated on 5 time-points oral glucose tolerance test) and metabolic abnormalities in 1012 patients with overweight/obesity (aged 6.0-17.9 years old). A MetS risk score was calculated on the basis of distribution of fasting glucose, triglycerides, HDL-cholesterol, total cholesterol, systolic and diastolic blood pressure. Non-alcoholic fatty liver disease (NAFLD) was suspected based on thresholds of alanine aminotransferases. RESULTS Four-hundred and eighty patients (47.73%) had low-MetS risk score, 488 medium (48.22% with 1-2 risk factors) and 41 (4.05% with ≥ 3 factors) high risk. oGE was significantly lower in subjects with obesity [3.81 (1.46) mg/dl/min- 1] than in those with overweight [4.98 (1.66) mg/dl/min- 1; p value < 0.001]. oGE was negatively correlated with BMI (ρ = - 0.79; p < 0.001) and BMI z score (ρ = - 0.56; p < 0.001) and decreased significantly among MetS risk classes (p = 0.001). The median difference of oGE from low to medium risk was estimated to be as - 4.9%, from medium to high as - 13.38% and from low to high as - 17.62%. oGE was not statistically different between NAFLD+ and NAFLD- cases. CONCLUSIONS In children and adolescents with obesity oGE decreases. Noteworthy, it decreases as the Met score increases. Therefore, reduced oGE may contribute to the higher risk of these individuals to develop type 2 diabetes.
Collapse
Affiliation(s)
- Nicola Spreghini
- Research Unit for Multifactorial Diseases, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Cianfarani
- Dipartimento Pediatrico Universitario Ospedaliero, BambinoGesù Children's Hospital, Tor Vergata University, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Maria Rita Spreghini
- Research Unit for Multifactorial Diseases, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Elena Inzaghi
- Dipartimento Pediatrico Universitario Ospedaliero, BambinoGesù Children's Hospital, Tor Vergata University, Rome, Italy
| | - Alessio Convertino
- Dipartimento Pediatrico Universitario Ospedaliero, BambinoGesù Children's Hospital, Tor Vergata University, Rome, Italy
| | - Danilo Fintini
- Dipartimento Pediatrico Universitario Ospedaliero, BambinoGesù Children's Hospital, Tor Vergata University, Rome, Italy
| | - Melania Manco
- Research Unit for Multifactorial Diseases, Bambino Gesù Children's Hospital, Rome, Italy.
| |
Collapse
|
13
|
Reinehr T. Inflammatory markers in children and adolescents with type 2 diabetes mellitus. Clin Chim Acta 2019; 496:100-107. [PMID: 31276632 DOI: 10.1016/j.cca.2019.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
This review examines the potential relationship between serum inflammation markers and type 2 diabetes mellitus (T2DM). Inflammation markers have been proposed as prognostic markers for the development of T2DM and its complications. Furthermore, modulation of the inflammatory process may offer future treatment strategies for T2DM. This review focuses on children and adolescents because there is usually little, if any, complications associated with other disease processes, use of medications, or active tobacco smoking. Furthermore, β-cell failure in young age cannot be solely explained by aging and exhaustion of β-cells due to insulin resistance. Pediatric studies have demonstrated that pro-inflammatory cytokines TNF-α, IL-6, IL-1β, IFNγ, PEDF, and fetuin A were increased in insulin resistance, while the anti-inflammatory cytokines adiponectin and omentin were decreased. Furthermore, TNF-α, fetuin A, FGF-21 were altered in obese children with T2DM suggesting a direct involvement in β-cell failure. Future studies focusing on children and adolescents may facilitate our understanding of T2DM as an inflammatory disease process.
Collapse
Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Dr. F. Steiner Str. 5, D-45711 Datteln, Germany.
| |
Collapse
|
14
|
Telo GH, Cureau FV, Szklo M, Bloch KV, Schaan BD. Prevalence of type 2 diabetes among adolescents in Brazil: Findings from Study of Cardiovascular Risk in Adolescents (ERICA). Pediatr Diabetes 2019; 20:389-396. [PMID: 30737879 DOI: 10.1111/pedi.12828] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/13/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) in adolescents represents a clinical challenge related to lifestyle and obesity; however, only a few data are available in developing countries. Therefore, our aim was to investigate the prevalence of T2DM and prediabetes among Brazilian adolescents, as well as to describe the cardio-metabolic profile according to the diagnosis. METHODS This is a cross-sectional school-based multicenter study including youth aged 12 to 17 years from cities with more than 100 000 inhabitants in Brazil (n = 37 854 students). Fasting glucose, hemoglobin A1c (HbA1c) and other cardio-metabolic risk factors were measured. Prediabetes was defined by glucose levels 100 to 125 mg/dL or HbA1c 5.7% to 6.4%. T2DM was defined by self-report, glucose ≥126 mg/dL or HbA1c ≥ 6.5%. Multinomial logistic regression was used to estimate the odds ratio (OR) of prediabetes or T2DM according to covariates. RESULTS Prevalences of prediabetes and T2DM were 22.0% (95% confidence interval [CI] 20.6%-23.4%) and 3.3% (95% CI 2.9%-3.7%), respectively. This estimates represented 213 830 adolescents living with T2DM and 1.46 million adolescents with prediabetes in Brazil. Prevalences of cardio-metabolic risk factors were higher in adolescents with prediabetes and T2DM. In the multinomial logistic model, obesity (OR 1.59, 95% CI 1.20-2.11), high waist circumference (OR 1.51, 95% CI 1.13-2.01), and skipping breakfast (OR 1.48, 95% CI 1.21-1.81) were associated with an increased OR for T2DM, while studying at rural area (OR 0.56, 95% CI 0.41-0.78) was associated with a decreased OR for T2DM. CONCLUSIONS The prevalence of T2DM and prediabetes was high among Brazilian adolescents, which highlights that this disease became a public health challenge not only among adults in Brazil.
Collapse
Affiliation(s)
- Gabriela H Telo
- Postraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe V Cureau
- Postraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Science and Technology for Health Technology Assessment, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins and Bloomberg School of Public Health, Baltimore, Maryland.,Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Katia V Bloch
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Beatriz D Schaan
- Postraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
15
|
Serbis A, Giapros V, Challa A, Chaliasos N, Siomou E. Elevated 1-hour post-load plasma glucose identifies obese youth with abnormal glucose metabolism and an unfavourable inflammatory profile. Clin Endocrinol (Oxf) 2018; 89:757-764. [PMID: 30229983 DOI: 10.1111/cen.13859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 01/01/2023]
Abstract
CONTEXT Adults with plasma glucose levels at one hour (1h-GL) ≥8.6 mmol/L during an oral glucose tolerance test (OGTT) are at increased risk for type 2 diabetes mellitus and present an unfavourable cardiometabolic and inflammatory profile, but relevant data on children are scarce. OBJECTIVE To investigate if elevated 1h-GL during OGTT in obese children and adolescents is associated with insulin resistance and specific pro-inflammatory biomarkers. RESEARCH DESIGN AND METHODS The study group comprised 88 obese children who attended the Outpatient Pediatric Clinic of our Hospital between January and December 2016. Children were divided into two groups according to 1h-GL during an OGTT: group 1 (n = 57) consisted of those with 1h-GL <8.6 mmol/L and group 2 (n = 31) of those with 1h-GL ≥8.6 mmol/L. Arterial blood pressure, body mass index (BMI) and waist circumference (WC) z-scores were measured in all participants. Specific insulin resistance (IR) indices, that is HOMA-IR, Matsuda index and Cederholm insulin sensitivity index (ISI) were calculated. Further, pro-inflammatory biomarkers that have been correlated with obesity complications, namely adiponectin, leptin, visfatin and interleukin (IL)-6 together with lipid levels were measured in all participants. Logistic regression analysis was used. RESULTS Children in group 2 had higher insulin (15.5 ± 6.4 vs 10.9 ± 4.8 μU/mL), HOMA-IR (3.41 ± 1.4 vs 2.34 ± 1.05) and lower Matsuda index [4.7 (3.1) vs 18.4 (17) median plus IQR] and Cederholm ISI (38 ± 6 vs 56 ± 11), than children in group 1 (all P < 0.001). They also had higher visfatin (15.4 ± 5.2 vs 10.1 ± 7 ng/mL), and IL-6 [12.5 (6.7) vs 4.8 (4.4) pg/mL], and lower adiponectin (5.9 ± 3.4 vs 11.8 ± 4.7 μg/mL) than children in group 1 (all P < 0.001). Logistic regression showed that these differences between the two groups were independent of age, sex, Tanner stage, BMI and WC z-scores. CONCLUSIONS In obese children, 1h-GL ≥8.6 mmol/L during an OGTT is correlated with worsened IR, and an unfavourable metabolic and inflammatory profile. Thus, 1h-GL could be used as an additional marker to identify obese children and adolescents at increased risk of developing obesity complications.
Collapse
Affiliation(s)
- Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece
| | - Anna Challa
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Chaliasos
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW Chronic inflammation, adipokines, and hepatokines have been identified as basis of insulin resistance and β cell failure in animal models. We present our current knowledge concerning the potential relationship between these cytokines, inflammation, metabolic syndrome (MetS), and type 2 diabetes mellitus (T2DM) in the pediatric population. RECENT FINDINGS Pro-inflammatory cytokines related to insulin resistance and MetS in children are tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-1β, interferon gamma, pigment epithelium-derived factor, chemerin, vaspin, and fetuin A. Anti-inflammatory cytokines associated with insulin resistance and MetS in children are leptin, adiponectin, omentin, fibroblast growth factor (FGF)-21, osteocalcin, and irisin. These anti-inflammatory cytokines are decreased (adiponectin, omentin, and osteocalcin) or increased (leptin, FGF-21, and irisin) in obesity suggesting a resistance state. TNF-α, fetuin A, and FGF-21 are altered in obese children with T2DM suggesting an involvement in β cell failure. These cytokines, adipokines, and hepatokines may be able to predict development of MetS and T2DM and have a potential therapeutic target ameliorating insulin resistance.
Collapse
Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Dr. F. Steiner Str. 5, D-45711, Datteln, Germany.
| | - Christian Ludwig Roth
- Center for Integrative Brain Research, Seattle Children's Research Institute, 1900 Ninth Avenue, Seattle, WA, 98101, USA
- Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle, WA, 98105, USA
| |
Collapse
|
17
|
Zeitler P, Arslanian S, Fu J, Pinhas-Hamiel O, Reinehr T, Tandon N, Urakami T, Wong J, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Type 2 diabetes mellitus in youth. Pediatr Diabetes 2018; 19 Suppl 27:28-46. [PMID: 29999228 DOI: 10.1111/pedi.12719] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/24/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Phillip Zeitler
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Silva Arslanian
- Children's Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Junfen Fu
- The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv, Israel
| | - Thomas Reinehr
- Vestische Children's Hospital, University of Witten/Herdecke, Witten, Germany
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Jencia Wong
- Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - David M Maahs
- Lucile Packard Children's Hospital, Stanford University, Stanford, California
| |
Collapse
|
18
|
Huo L, Magliano DJ, Rancière F, Harding JL, Nanayakkara N, Shaw JE, Carstensen B. Impact of age at diagnosis and duration of type 2 diabetes on mortality in Australia 1997-2011. Diabetologia 2018; 61:1055-1063. [PMID: 29473119 DOI: 10.1007/s00125-018-4544-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS Current evidence suggests that type 2 diabetes may have a greater impact on those with earlier diagnosis (longer duration of disease), but data are limited. We examined the effect of age at diagnosis of type 2 diabetes on the risk of all-cause and cause-specific mortality over 15 years. METHODS The data of 743,709 Australians with type 2 diabetes who were registered on the National Diabetes Services Scheme (NDSS) between 1997 and 2011 were examined. Mortality data were derived by linking the NDSS to the National Death Index. All-cause mortality and mortality due to cardiovascular disease (CVD), cancer and all other causes were identified. Poisson regression was used to model mortality rates by sex, current age, age at diagnosis, diabetes duration and calendar time. RESULTS The median age at registration on the NDSS was 60.2 years (interquartile range [IQR] 50.9-69.5) and the median follow-up was 7.2 years (IQR 3.4-11.3). The median age at diagnosis was 58.6 years (IQR 49.4-67.9). A total of 115,363 deaths occurred during 7.20 million person-years of follow-up. During the first 1.8 years after diabetes diagnosis, rates of all-cause and cancer mortality declined and CVD mortality was constant. All mortality rates increased exponentially with age. An earlier diagnosis of type 2 diabetes (longer duration of disease) was associated with a higher risk of all-cause mortality, primarily driven by CVD mortality. A 10 year earlier diagnosis (equivalent to 10 years' longer duration of diabetes) was associated with a 1.2-1.3 times increased risk of all-cause mortality and about 1.6 times increased risk of CVD mortality. The effects were similar in men and women. For mortality due to cancer (all cancers and colorectal and lung cancers), we found that earlier diagnosis of type 2 diabetes was associated with lower mortality compared with diagnosis at an older age. CONCLUSIONS/INTERPRETATION Our findings suggest that younger-onset type 2 diabetes increases mortality risk, and that this is mainly through earlier CVD mortality. Efforts to delay the onset of type 2 diabetes might, therefore, reduce mortality.
Collapse
Affiliation(s)
- Lili Huo
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Dianna J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Fanny Rancière
- Inserm, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre, Villejuif, France
- Paris Descartes University, Sorbonne Paris Cité, UMR1153, Paris, France
| | - Jessica L Harding
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Natalie Nanayakkara
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jonathan E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Level 4, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark.
| |
Collapse
|
19
|
Vijayakumar G, Sreehari GK, Vijayakumar A, Jaleel A. Distinct Predictors and Comorbidities in Early Onset Type 2 Diabetes Mellitus Among Asian Indians. Metab Syndr Relat Disord 2017; 15:458-464. [PMID: 28829247 DOI: 10.1089/met.2017.0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide, and the age of disease onset is falling. Although there is rising prevalence of early onset T2DM in India, little is known about their clinical characteristics and cardiovascular risks profiles. The aim of this study was to address this knowledge gap by comparing the characteristics of early onset T2DM and usual onset T2DM patients from our clinic population in India. METHODS We studied the clinical and biochemical parameters of 98 consecutive early onset T2DM patients of age <45 and <5 years of disease duration and compared those parameters with 86 consecutive usual onset T2DM patients of age >50 years and similar disease duration. RESULTS There was a strong component of family history of T2DM in early onset T2DM patients; however, no difference was observed in body mass index or waist circumference between the groups. When compared with usual onset group, the early onset T2DM patients were more hypertriglycedemic, with higher total cholesterol, higher total cholesterol/high-density lipoprotein (HDL) ratio, higher low-density lipoprotein levels, and lower HDL cholesterol. Early onset T2DM patients showed significantly worse glycemic control and rapid decline in insulin secretion compared with usual onset T2DM patients. CONCLUSIONS Our results demonstrate that early onset T2DM in Asian Indians appears to be a disease phenotype with adverse risk factors having poor glycemic control and longer disease duration demanding strategies for novel clinical management.
Collapse
Affiliation(s)
| | | | | | - Abdul Jaleel
- 2 Rajiv Gandhi Centre for Biotechnology , Thiruvananthapuram, India
| |
Collapse
|
20
|
Bjornstad P, Pyle L, Kinney GL, Rewers M, Johnson RJ, Maahs DM, Snell-Bergeon JK. Adiponectin is associated with early diabetic kidney disease in adults with type 1 diabetes: A Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study. J Diabetes Complications 2017; 31:369-374. [PMID: 27368123 PMCID: PMC5156602 DOI: 10.1016/j.jdiacomp.2016.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/01/2016] [Accepted: 06/10/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The associations between elevated adiponectin and end-stage renal disease are well recognized and thought to be at least partially explained by reduced renal clearance. Conversely, the relationship between adiponectin and early diabetic kidney disease (DKD) with preserved glomerular filtration rate (GFR), including rapid GFR decline and incident chronic kidney disease (CKD) is unclear. We hypothesized that elevated adiponectin would be associated with early DKD in adults with type 1 diabetes. METHODS Adults with type 1 diabetes (n=646 at baseline, n=525 at 6years) had adiponectin and renal function by estimated GFR (eGFR) by CKD-EPI creatinine and albumin-excretion rate (AER) evaluated at baseline and 6years. Linear and logistic models evaluated the associations of baseline adiponectin with AER, macroalbuminuria (AER ≥200μg/min), eGFR, CKD (<60mL/min/1.73m2) and rapid GFR decline (>3mL/min/1.73m2/year). Models adjusted for age, sex, duration, HbA1c, SBP, LDL-C and current smoking. RESULTS Compared to non-diabetics, adults with type 1 diabetes had significantly higher adiponectin, and the difference remained significant after adjusting for AER and/or eGFR (p<0.0001). Adiponectin at baseline was positively associated with rapid GFR decline (OR: 1.24, 95% CI 1.00-1.53), incident CKD (OR: 1.75, 1.14-2.70), and persistent macroalbuminuria and CKD (OR: 1.61, 1.10-2.36) over 6years in adjusted models. The associations also remained significant after further adjustments for CRP, estimated insulin sensitivity and ACEi/ARB therapy. CONCLUSIONS Adults with type 1 diabetes have higher adiponectin than their non-diabetic peers, and elevated adiponectin at baseline is independently associated with greater odds of developing early DKD over 6years.
Collapse
Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Laura Pyle
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Gregory L Kinney
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States; Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Marian Rewers
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
| | - Richard J Johnson
- Department of Medicine, Division of Nephrology, University of Colorado School of Medicine, Aurora, CO, United States
| | - David M Maahs
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States; Department of Medicine, Division of Nephrology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Janet K Snell-Bergeon
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
| |
Collapse
|
21
|
Huan-Sheng C, Yeong-Chang C, Ming-Hsing H, Fan-Lieh T, Chu-Cheng L, Tsai-Kun W, Hung-Ping C, Sze-Hung H, Hsien-Chang C, Chia-Chen L, Chun-Cheng H, Chun-Ting C, Hung-Hsiang L, Chun-Ju L, Paik-Seong L. Application of bioimpedance spectroscopy in Asian dialysis patients (ABISAD-III): a randomized controlled trial for clinical outcomes. Int Urol Nephrol 2016; 48:1897-1909. [PMID: 27620902 DOI: 10.1007/s11255-016-1415-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 09/01/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE Fluid management with body composition monitor based on bioimpedance spectroscopy (BCM-BIS) has been found to be beneficial for dialysis patients. We conducted a study to provide an algorithm for the determination of post-dialysis target weight (PDTW) and to evaluate whether this approach could improve clinical outcomes compared to patients who had PDTW decided clinically. METHODS Two hundred and ninety-eight dialysis patients participated in this 1-year randomized controlled trial. The outcomes were all-cause hospitalization rate, AFO or CV-related events, hypertension and intra-dialysis morbidities. RESULTS 80 % of post-dialysis weight reached the target set with current algorithm. All-cause hospitalization rate was not different. Incidence of acute fluid overload (AFO) or CV-related events was lower in study group. Longitudinal data showed decreased incidence of hypertension, intra-dialysis morbidities and intra-dialysis hypotension. CONCLUSIONS Assessment of PDTW by BCM-BIS with an explicit algorithm decreased AFO or CV-related events, hypertension and intra-dialysis morbidities. Further studies were required to demonstrate possible benefits of hospitalization rate.
Collapse
Affiliation(s)
| | | | | | | | - Lin Chu-Cheng
- Dialysis Center, Yuan Lin Ho's Hospital, Changhua, Taiwan
| | - Wu Tsai-Kun
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec.1, Chungchi Rd., Wuchi Dist., Taichung City, 43503, Taiwan
| | - Chen Hung-Ping
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec.1, Chungchi Rd., Wuchi Dist., Taichung City, 43503, Taiwan
| | - Hung Sze-Hung
- Dialysis Center, Tseng Han Chi Hospital, Nantou, Taiwan
| | | | | | - Hou Chun-Cheng
- Department of Nephrology, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Cheng Chun-Ting
- Department of Nephrology, Saint Paul's Hospital, Taoyuan, Taiwan
| | | | - Lin Chun-Ju
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Lim Paik-Seong
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec.1, Chungchi Rd., Wuchi Dist., Taichung City, 43503, Taiwan.
| |
Collapse
|
22
|
Zabeen B, Nahar J, Tayyeb S, Mohsin F, Nahar N, Azad K. Characteristics of children and adolescents at onset of type 2 diabetes in a Tertiary Hospital in Bangladesh. Indian J Endocrinol Metab 2016; 20:638-642. [PMID: 27730073 PMCID: PMC5040043 DOI: 10.4103/2230-8210.190544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Recent data show that the prevalence of diabetes among children and adolescents is increasing in some ethnic groups. The worldwide epidemic of childhood obesity has been accompanied by an increase in the incidence of type 2 diabetes (T2D) in youth. METHODS The aim of this study was to describe the baseline characteristics of children and adolescents diagnosed ≤18 years who had features of T2D and presented at Changing Diabetes in Children, Paediatric Diabetes Clinic at Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine, and Metabolic Disorders. All patients who were newly diagnosed and came to the clinic from March 2011 to March 2015 were included. RESULTS Among 939 newly registered patients, 77 (8%) had a diagnosis of T2D. The age at diagnosis was 9-10 years in 11 patients (14%), 11-14 years in 46 (60%) and 15-17 years in other 20 patients (26%). Majority of the children had a positive family history of T2D (94%) and 58% were obese. Median fasting insulin (27.9 [17.3-99.3]) was high in 76% patients. Insulin was started initially along with metformin in 40 patients and could be stopped in six patients in 3 months. CONCLUSION Our study reflects that T2D is emerging as a problem in children and adolescents in Bangladesh.
Collapse
Affiliation(s)
- Bedowra Zabeen
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Jebun Nahar
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Samin Tayyeb
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Fauzia Mohsin
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Nazmun Nahar
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Kishwar Azad
- Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
- Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| |
Collapse
|
23
|
Reinehr T, Woelfle J, Wiegand S, Karges B, Meissner T, Nagl K, Holl RW. Leptin but not adiponectin is related to type 2 diabetes mellitus in obese adolescents. Pediatr Diabetes 2016; 17:281-8. [PMID: 25882767 DOI: 10.1111/pedi.12276] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/16/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adipokines have been suggested to be involved in the development of type 2 diabetes mellitus (T2DM). However, studies in humans are controversial and analyzes at the onset of disease are scarce. METHODS We compared adiponectin and leptin levels between 74 predominately Caucasian adolescents with T2DM and 74 body mass index (BMI)-, age-, and gender-matched controls without T2DM. Adiponectin and leptin were correlated to age, BMI, hemoglobin A1c (HbA1c), blood pressure, and lipids. RESULTS Adolescents with T2DM showed significant lower leptin levels as compared with controls (18 ± 12 vs. 37 ± 23 ng/mL, p < 0.001), whereas the adiponectin levels did not differ between the adolescents with and without T2DM (5.0 ± 2.5 vs. 4.9 ± 2.5 µg/mL, p = 0.833). The associations between adiponectin and high-density lipoprotein (HDL) cholesterol (r = 0.42), systolic (r = -0.15), and diastolic blood pressure (r = -0.20) were stronger as the associations of leptin to these parameters (all r < 0.07). In multiple linear regression analysis, leptin was significantly and positively associated with BMI [β-coefficient: 1.3 (95% confidence interval (95% CI): ±0.5), p < 0.001] and female sex [β-coefficient: 9.7 (95% CI: ±6.7), p = 0.005], and negatively with age [β-coefficient: -2.3 (95% CI: ±2.1), p < 0.001] and HbA1c [β-coefficient -3.1 (95% CI: ±2.1), p = 0.011]. Adiponectin was not significantly associated with BMI, HbA1c, age, or gender in multiple linear regression analysis. CONCLUSIONS Because adiponectin levels did not differ between obese adolescents with and without T2DM, hypoadiponectinemia as observed in obesity seems not to be involved in the genesis of T2DM. The relative hypoleptinemia in obese adolescents with T2DM as compared with obese adolescents without T2DM may contribute to the development of T2DM. Future longitudinal studies in humans are necessary to prove this hypothesis.
Collapse
Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
| | - Joachim Woelfle
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetes, Charité Childrens' Hospital Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, German Center for Diabetes Research (DZD), RWTH Aachen University, Aachen, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Duesseldorf, Germany
| | - Katrin Nagl
- Department for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| |
Collapse
|
24
|
Reinehr T, Karges B, Meissner T, Wiegand S, Stoffel-Wagner B, Holl RW, Woelfle J. Inflammatory Markers in Obese Adolescents with Type 2 Diabetes and Their Relationship to Hepatokines and Adipokines. J Pediatr 2016; 173:131-5. [PMID: 26996723 DOI: 10.1016/j.jpeds.2016.02.055] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/15/2016] [Accepted: 02/22/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To analyze inflammatory markers, adipokines, and hepatokines in obese adolescents with and without type 2 diabetes mellitus (T2DM). STUDY DESIGN We studied high sensitivity C-reactive protein (hsCRP), tumor necrosis factor (TNF)-α, interleukin-1β, and interferon-γ, the hepatokines (fetuin-A and fibroblast growth factor [FGF]-21), and the adipokines (adiponectin and leptin) in a cross-sectional study of 74 predominately Caucasian adolescents with T2DM aged 12-18 years and in 74 body mass index (BMI)-, age-, and sex-matched controls. RESULTS Adolescents with T2DM had significantly higher concentrations of hsCRP, TNF-α, and interleukin-1β compared with obese controls without T2DM. Interferon-γ was not detectable in obese adolescents with or without T2DM. In multiple linear regression analysis, hsCRP was significantly associated with FGF-21 and BMI, but not with hemoglobin A1c, adiponectin, leptin, fetuin-A, sex, or age. TNF-α was significantly related negatively to leptin, positively to BMI, but not to hemoglobin A1c, adiponectin, fetuin-A, FGF-21 sex, or age in multiple linear regression analysis. CONCLUSIONS Increased inflammatory markers are associated with T2DM in adolescents. Because hsCRP was related to FGF-21 and TNF-α was associated with leptin, these findings suggest a link between increased levels of these adipokines and hepatokines and chronic inflammation. Future longitudinal studies in humans are necessary to confirm these hypotheses.
Collapse
Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Germany.
| | - Beate Karges
- Medical Faculty, Division of Endocrinology and Diabetes, German Center for Diabetes Research (DZD), Rheinisch-Westfälische Technische Hochschule Aachen University, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, German Center for Diabetes Research (DZD), University Children's Hospital Düsseldorf, Germany
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetes, Charité Children's Hospital Universitätsmedizin Berlin, Germany
| | - Birgit Stoffel-Wagner
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital of Bonn, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Zentralinstitut für Biomedizinische Technik, German Center for Diabetes Research (DZD), University of Ulm, Germany
| | - Joachim Woelfle
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Germany
| |
Collapse
|
25
|
Zeitler P. Considerations Regarding the Diagnosis and Treatment of Childhood Type 2 Diabetes. Postgrad Med 2015; 122:89-97. [DOI: 10.3810/pgm.2010.05.2146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
26
|
Wong J, Constantino M, Yue DK. Morbidity and mortality in young-onset type 2 diabetes in comparison to type 1 diabetes: where are we now? Curr Diab Rep 2015; 15:566. [PMID: 25398205 DOI: 10.1007/s11892-014-0566-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Increasingly, we recognise that type 2 diabetes in youth is a disease with an aggressive time course and a significant complication risk. On the other hand, outcomes for youth with type 1 diabetes appear generally to be improving. With increasing numbers of both types of diabetes in youth, it is timely that a comparative perspective is offered to help clinicians prognosticate more appropriately. Contemporary comparative studies add a new perspective to a consistent story, that for youth-onset type 2 diabetes, the development and progression of cardio-renal complications are increased and the survival prognosis is significantly worse than for type 1 diabetes. Here, we review this mounting evidence, highlight the importance of metabolic syndrome factors in the excess risk and underscore that there remains a significant mortality gap for youth with either type of diabetes, to be addressed as a matter of urgency.
Collapse
Affiliation(s)
- Jencia Wong
- Royal Prince Alfred Hospital Diabetes Centre, Level 6 West, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, 2050, Australia,
| | | | | |
Collapse
|
27
|
Hamman RF, Bell RA, Dabelea D, D'Agostino RB, Dolan L, Imperatore G, Lawrence JM, Linder B, Marcovina SM, Mayer-Davis EJ, Pihoker C, Rodriguez BL, Saydah S. The SEARCH for Diabetes in Youth study: rationale, findings, and future directions. Diabetes Care 2014; 37:3336-44. [PMID: 25414389 PMCID: PMC4237981 DOI: 10.2337/dc14-0574] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/04/2014] [Indexed: 02/03/2023]
Abstract
The SEARCH for Diabetes in Youth (SEARCH) study was initiated in 2000, with funding from the Centers for Disease Control and Prevention and support from the National Institute of Diabetes and Digestive and Kidney Diseases, to address major knowledge gaps in the understanding of childhood diabetes. SEARCH is being conducted at five sites across the U.S. and represents the largest, most diverse study of diabetes among U.S. youth. An active registry of youth diagnosed with diabetes at age <20 years allows the assessment of prevalence (in 2001 and 2009), annual incidence (since 2002), and trends by age, race/ethnicity, sex, and diabetes type. Prevalence increased significantly from 2001 to 2009 for both type 1 and type 2 diabetes in most age, sex, and race/ethnic groups. SEARCH has also established a longitudinal cohort to assess the natural history and risk factors for acute and chronic diabetes-related complications as well as the quality of care and quality of life of persons with diabetes from diagnosis into young adulthood. Many youth with diabetes, particularly those from low-resourced racial/ethnic minority populations, are not meeting recommended guidelines for diabetes care. Markers of micro- and macrovascular complications are evident in youth with either diabetes type, highlighting the seriousness of diabetes in this contemporary cohort. This review summarizes the study methods, describes key registry and cohort findings and their clinical and public health implications, and discusses future directions.
Collapse
Affiliation(s)
- Richard F Hamman
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lawrence Dolan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Barbara Linder
- Childhood Diabetes Research Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina, Chapel Hill, NC Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Beatriz L Rodriguez
- John A. Burns School of Medicine, University of Hawaii, Kuakini Medical Center, Honolulu, HI Instituto Tecnologico de Monterrey, Monterrey, Mexico
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
28
|
Zeitler P, Fu J, Tandon N, Nadeau K, Urakami T, Barrett T, Maahs D. ISPAD Clinical Practice Consensus Guidelines 2014. Type 2 diabetes in the child and adolescent. Pediatr Diabetes 2014; 15 Suppl 20:26-46. [PMID: 25182306 DOI: 10.1111/pedi.12179] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Affiliation(s)
- Phil Zeitler
- The Children's Hospital Colorado, Aurora, CO, USA
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Maahs DM, Daniels SR, de Ferranti SD, Dichek HL, Flynn J, Goldstein BI, Kelly AS, Nadeau KJ, Martyn-Nemeth P, Osganian SK, Quinn L, Shah AS, Urbina E. Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the American Heart Association. Circulation 2014; 130:1532-58. [PMID: 25170098 DOI: 10.1161/cir.0000000000000094] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
30
|
Gu W, Huang Y, Zhang Y, Hong J, Liu Y, Zhan W, Ning G, Wang W. Adolescents and young adults with newly diagnosed Type 2 diabetes demonstrate greater carotid intima-media thickness than those with Type 1 diabetes. Diabet Med 2014; 31:84-91. [PMID: 24112039 DOI: 10.1111/dme.12335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 08/31/2013] [Accepted: 09/19/2013] [Indexed: 12/14/2022]
Abstract
AIM To compare the carotid intima-media thickness in patients with newly diagnosed Type 1 or Type 2 diabetes ranging from 14 to 30 years of age. METHODS Demographic, anthropometric and laboratory data were obtained from 404 adolescents and young adults (103 subjects with Type 1 diabetes, 94 with Type 2 diabetes, 153 obese subjects and 54 normal control subjects). Carotid intima-media thickness was assessed based on Doppler ultrasound examination and compared among the four groups. RESULTS Our data showed significant increases in carotid intima-media thickness in subjects with Type 1 diabetes, Type 2 diabetes and obese subjects compared with the control subjects, with those in the group with Type 2 diabetes demonstrating the greatest change (P < 0.001). Age, BMI, percentage of fat, waist-hip ratio and total triglycerides were significantly correlated with both common and internal carotid intima-media thickness segments. From a stepwise multiple linear regression model, the independent determinants of common carotid intima-media thickness were age, BMI, HbA1c and HDL cholesterol (adjusted R(2) = 0.152, P < 0.001). After adjustment for age, sex and HbA1c , the odds ratio for increased carotid intima-media thickness was 1.67 (95% CI 1.19-2.33, P = 0.003) for obese subjects, 2.38 (95% CI 1.59-9.47, P = 0.001) for subjects with Type 1 diabetes and 3.93 (95% CI 1.90-6.07, P = 0001) for subjects with Type 2 diabetes compared with the control subjects. CONCLUSIONS Compared with young control subjects, we found significant increases in carotid intima-media thickness in patients with newly diagnosed Type 1 diabetes and Type 2 diabetes, with patients with Type 2 diabetes showing greater carotid intima-media thickness. Traditional cardiovascular risk factors, such as obesity, dyslipidaemia, hypertension and hyperglycaemia, could cause vessel changes even in adolescents and young adults.
Collapse
Affiliation(s)
- W Gu
- Department of Endocrine and Metabolic diseases, Rui-jin Hospital, Shanghai Jiao-Tong University School of Medicine
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Umamahesh K, Vigneswari A, Surya Thejaswi G, Satyavani K, Viswanathan V. Incidence of cardiovascular diseases and associated risk factors among subjects with type 2 diabetes - an 11-year follow up study. Indian Heart J 2013; 66:5-10. [PMID: 24581089 PMCID: PMC3946454 DOI: 10.1016/j.ihj.2013.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 10/24/2013] [Accepted: 12/04/2013] [Indexed: 12/30/2022] Open
Abstract
Aims This study was planned to assess the development of cardiovascular disease (CVD) events over an 11-year period and to identify the associated risk factors that could predict the onset of CVD among subjects with type 2 diabetes. Methods Retrospective data of 249 patients (M:F 149:100) with type 2 diabetes, from a cohort of 7800 patients, attending a tertiary care center for diabetes from January 2000 to December 2011 were retrieved and analyzed for this study. Sociodemographic and habitual risk factors, baseline diabetes duration, HbA1c and time of onset of CVD and its risk factors were collected from case records. Person-years method was used to calculate incident rate of CVD. Binary logistic regression analyses were done to identify predictors associated with CVD and its risk factors. Results Incidence of CVD among subjects with diabetes was 5.6 cases/1000 person-years. Nearly 60% developed hypertension and dyslipidemia or both during the 11-year period. The most common complication was neuropathy (14.4%). Smoking [OR (95%CI)] [9.26 (1.6–54.9)] (p = 0.014) and heavy alcohol consumption [8.7 (1.1–69.8)] (p = 0.04) were significantly associated with CVD. Higher BMI was significantly associated with hypertension and dyslipidemia [2.4 (1.3–4.3)] (p = 0.003). Conclusions Smoking and heavy alcohol consumption were significantly associated with CVD, and increased BMI was significantly associated with hypertension and dyslipidemia among subjects with type 2 diabetes in this study population. These findings emphasize the need for early identification and modification of risk factors associated with CVD events in patients with diabetes.
Collapse
Affiliation(s)
- K Umamahesh
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], No. 4, Main Road, Royapuram, Chennai 600 013, Tamil Nadu, India
| | - A Vigneswari
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], No. 4, Main Road, Royapuram, Chennai 600 013, Tamil Nadu, India
| | - G Surya Thejaswi
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], No. 4, Main Road, Royapuram, Chennai 600 013, Tamil Nadu, India
| | - K Satyavani
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], No. 4, Main Road, Royapuram, Chennai 600 013, Tamil Nadu, India
| | - Vijay Viswanathan
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], No. 4, Main Road, Royapuram, Chennai 600 013, Tamil Nadu, India.
| |
Collapse
|
32
|
Yi P, Pang J, Alexander JS, Rivera C. The endotoxin/toll-like receptor-4 axis mediates gut microvascular dysfunction associated with post-prandial lipidemia. BMC PHYSIOLOGY 2013; 13:12. [PMID: 24219792 PMCID: PMC3833857 DOI: 10.1186/1472-6793-13-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/26/2013] [Indexed: 12/21/2022]
Abstract
Background Postprandial lipidemia is important in the development of coronary artery disease (CAD). Consumption of a meal high in monounsaturated fat was correlated with acute impairment of endothelial function. However, the mechanisms underlying impaired endothelial function in the postprandial state have not yet been elucidated. The effects of polyunsaturated fat (corn oil) and monounsaturated fat (olive oil) on vascular dysfunction in intestinal postcapillary venules and arterioles were examined in wild-type (WT) mice, mice genetically deficient in TLR4 (TLR4-/-) and mice pre-treated with antibiotics by intravital microscopy which was performed 1.0, 1.5, 2.0, 2.5 hours after oil administration. After intravital microscopy, samples of jejunum were therefore collected to test TLR4, pNF-kB p65 and SIRT1 protein expression by western blotting. Results Our findings showed that feeding mono-unsaturated olive oil or polyunsaturated corn oil promoted leukocyte and platelet trafficking in the gut microvasculature, and impaired endothelium-dependent arteriolar vasodilator responses during postprandial lipidemia. The expression of TLR4, pNF-kB p65 was significantly increased in mice gavaged with olive oil at 2 h and was significantly reduced in mice gavaged for 7 days with antibiotics and in TLR4 knockout (TLR4-/-) mice. At the same time, SIRT1 protein expression is diminished by feeding olive oil for 2 h, a phenomenon that is attenuated in mice pre-treated with antibiotics and in TLR4-/- mice. Corn oil treated mice exhibited a pattern of response similar to olive oil. Conclusions Dietary oils may be negative regulators of SIRT1 which activate the innate immune response through the endotoxin/TLR4 axis. Our findings establish a link between innate immunity (i.e. the endotoxin/TLR4 axis) and epigenetic controls mediated by SIRT1 in the genesis of diet associated vascular stress.
Collapse
|
33
|
D'Adamo E, Santoro N, Caprio S. Metabolic syndrome in pediatrics: old concepts revised, new concepts discussed. Curr Probl Pediatr Adolesc Health Care 2013; 43:114-23. [PMID: 23582593 DOI: 10.1016/j.cppeds.2013.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ebe D'Adamo
- Department of Pediatrics, Yale University School of Medicine, PO Box 208064, New Haven, CT, USA
| | | | | |
Collapse
|
34
|
Song SH, Gray TA. Early-onset type 2 diabetes: higher burden of atherogenic apolipoprotein particles during statin treatment. QJM 2012; 105:973-80. [PMID: 22753665 DOI: 10.1093/qjmed/hcs113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To determine the burden of atherogenic apolipoprotein particles in early-onset type 2 diabetes (T2D) compared to those with later-onset disease during statin treatment. METHODS Early and later-onset T2D was defined as current age below and above 40 years respectively. Conventional lipid profile, LDL, non-HDL cholesterol, apolipoprotein B and A1 were determined in those without cardiovascular disease treated with simvastatin to achieve LDL cholesterol <2 mmol/l. RESULTS Fifty subjects were recruited (early-onset n=24 and later-onset n=26). The mean age was 34.5 and 59.6 years and mean age of diagnosis was 29.1 and 49.1 years for early and later-onset T2D respectively. Obesity, dyslipidaemia, microalbuminuria, glycaemic control and diabetes complication burden were similar in both cohorts. Early-onset subjects received non-significantly higher simvastatin dose (37.5 vs. 31.9 mg daily, p=NS). On-treatment LDL cholesterol was similar in both cohorts (early vs. later-onset; 2.12 vs. 1.97 mmol/l, p=NS). Fasting triglyceride, non-HDL, apo B and B/A1 ratio were significantly higher in early-onset cohort. There was no difference in apo A1, HDL and total cholesterol/HDL ratio. Apo B level remained significantly higher among early-onset subjects after adjustment for insulin treatment. Lower current age and age of diagnosis were significant predictors of higher apo B level. CONCLUSION The burden of atherogenic apolipoprotein particles was greater in early-onset T2D despite adequate statin treatment indicating an adverse phenotype for vascular disease.
Collapse
Affiliation(s)
- S H Song
- Diabetes Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
| | | |
Collapse
|
35
|
Rhodes ET, Prosser LA, Hoerger TJ, Lieu T, Ludwig DS, Laffel LM. Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus. Diabet Med 2012; 29:453-63. [PMID: 22150528 DOI: 10.1111/j.1464-5491.2011.03542.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS To estimate remaining life expectancy (RLE), quality-adjusted life expectancy (QALE), causes of death and lifetime cumulative incidence of microvascular/macrovascular complications of diabetes for youths diagnosed with Type 2 diabetes. METHODS A Markov-like computer model simulated the life course for a hypothetical cohort of adolescents/young adults in the USA, aged 15-24 years, newly diagnosed with Type 2 diabetes following either conventional or intensive treatment based on the UK Prospective Diabetes Study. Outcomes included RLE, discounted QALE in quality-adjusted life years (QALYs), cumulative incidence of microvascular/macrovascular complications and causes of death. RESULTS Compared with a mean RLE of 58.6 years for a 20-year-old in the USA without diabetes, conventional treatment produced an average RLE of 43.09 years and 22.44 discounted QALYs. Intensive treatment afforded an incremental 0.98 years and 0.44 discounted QALYs. Intensive treatment led to lower lifetime cumulative incidence of all microvascular complications and lower mortality from microvascular complications (e.g. end-stage renal disease (ESRD) death 19.4% vs. 25.2%). Approximately 5% with both treatments had ESRD within 25 years. Lifetime cumulative incidence of coronary heart disease (CHD) increased with longer RLE and greater severity of CHD risk factors. Incorporating disutility (loss in health-related quality of life) of intensive treatment resulted in net loss of QALYs. CONCLUSIONS Adolescents/young adults with Type 2 diabetes lose approximately 15 years from average RLE and may experience severe, chronic complications of Type 2 diabetes by their 40s. The net clinical benefit of intensive treatment may be sensitive to preferences for treatment. A comprehensive management plan that includes early and aggressive control of cardiovascular risk factors is likely needed to reduce lifetime risk of CHD.
Collapse
Affiliation(s)
- E T Rhodes
- Division of Endocrinology, Children's Hospital Boston, Boston, MA 02115, USA.
| | | | | | | | | | | |
Collapse
|
36
|
D'Adamo E, Santoro N, Caprio S. Metabolic syndrome in pediatrics: old concepts revised, new concepts discussed. Pediatr Clin North Am 2011; 58:1241-55, xi. [PMID: 21981958 DOI: 10.1016/j.pcl.2011.07.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The worldwide epidemic of childhood obesity in the last decades is responsible for the occurrence in pediatrics of disorders once mainly found in adults, such as the metabolic syndrome. A key factor in the pathogenesis of metabolic syndrome is insulin resistance, a phenomenon occurring mainly in obese subjects with a general resistance to the insulin effect only on carbohydrates metabolism. Given that the metabolic syndrome is driven by obesity, the prevalence of the latter will strongly influence the prevalence of metabolic syndrome. This article addresses the causes of metabolic syndrome and the relevance of obesity in the pediatric population.
Collapse
Affiliation(s)
- Ebe D'Adamo
- Department of Pediatrics, Yale University School of Medicine, PO Box 208064, New Haven, CT 6520, USA
| | | | | |
Collapse
|
37
|
Song SH, Gray TA. Early intensive cardiovascular risk management in young people with type 2 diabetes. Diabetes Res Clin Pract 2011; 92:e70-2. [PMID: 21420751 DOI: 10.1016/j.diabres.2011.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
Abstract
This study assessed the adequacy of cardiovascular risk management among recently diagnosed early-onset T2D. Despite the presence of adverse cardiovascular risk profile, intensive treatment to prevent cardiovascular disease remained suboptimal in these young subjects.
Collapse
Affiliation(s)
- Soon H Song
- Diabetes Centre, Northern General Hospital, Sheffield, UK.
| | | |
Collapse
|
38
|
Abu-Samak M, Yousef AM, Al-Jarie A, Al-Matubsi HY, Abu-Zaiton A, Al-Quraan M, Khuzaie R. Lipid and hematological parameters in hyperleptinemic healthy Arab male youth in Jordan. Pak J Biol Sci 2011; 14:344-350. [PMID: 21874826 DOI: 10.3923/pjbs.2011.344.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
To analyze the influence ofhyperleptinemia on fasting lipid and hematological parameters in healthy Arab male youth in Jordan, this cross-sectional study was carried out in April 2009 on a sample of 120 students aged 18-24 years. Subjects were stratified by fasting leptin into two groups (control, <12.7 ng mL(-1) vs. hyperleptenimic, e_< 12.7 ng mL(-1)) and BMI (normal weight, < 25 kgm(-2) vs. overweight/obese, BMI e_< 25 kg m(-2)). Fasting serum leptin, blood glucose, lipid profile and hematological parameters values were determined by standard kit methods. Mean serum leptin concentrations were more than five times as high in hyperleptenemic subjects than in control subjects (p < 0.001). Compared with control group, significant elevations (p < 0.01) were observed in the means total cholesterol, LDL cholesterol and triglyceride levels of hyperleptenemic group whereas no significant differences was detected in HDL-cholesterol. Except the changes of WBC count, MCH and slightly MCHC, there were no differences between both groups in any other term of hematological parameters. In conclusion, changes in lipid variables and some hematological parameters may increase plasma viscosity as a step during atherosclerosis pathogenesis in male youth at risk for dyslipidemia and cardiovascular diseases. Thus, hyperleptinemia could be a useful index in identifying healthy youth male subjects but this hypothesis needs further investigation.
Collapse
|
39
|
Abstract
The prevalence of both type 1 and type 2 diabetes among children and adolescents has been steadily increasing over the last few decades. However, as the general pediatric population becomes more obese and more ethnically diverse, reliance on phenotypic characteristics for distinguishing between these types of diabetes is becoming increasingly untenable. Yet, the recognition of differences in treatment strategies, associated disorders, and both short- and long-term diabetes and cardiovascular outcomes supports the importance of diagnostic efforts to make a distinction between diabetes types. An approach to determination of diabetes type is discussed, focused on the presence or absence of autoimmunity and assessment of β-cell function. At the time of diagnosis, it is generally not possible to be certain of diabetes type, and therefore, initial treatment decisions must be made based on aspects of the presenting physiology, with adjustments in treatment approach made as the individual's course proceeds and additional information becomes available. The apparent overlap between type 1 and type 2 diabetes that occurs in obese adolescents has resulted in some controversy regarding mixed forms of diabetes that are ultimately semantic, but this does raise interesting questions about the treatment of type 1 diabetes in the presence of an insulin-resistant phenotype. Finally, the lack of information about the efficacy of treatment of cardiovascular risk factors, such as dyslipidemia and hypertension, along with the well-documented challenges in adherence to chronic illness treatment in this population, creates substantial challenges.
Collapse
MESH Headings
- Accreditation/methods
- Adolescent
- Confidentiality
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/etiology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/therapy
- Diagnosis, Differential
- Humans
- Hypoglycemic Agents/therapeutic use
- Insulin/therapeutic use
- Male
- Minority Groups
- Obesity/complications
- Obesity/diagnosis
- Societies, Medical
Collapse
Affiliation(s)
- Philip Zeitler
- Department of Pediatrics, University of Colorado Denver, and The Children's Hospital, 13123 East 16th Avenue, Aurora, Colorado 80045, USA.
| |
Collapse
|
40
|
Dabelea D, Mayer-Davis EJ, Imperatore G. The value of national diabetes registries: SEARCH for Diabetes in Youth Study. Curr Diab Rep 2010; 10:362-9. [PMID: 20635171 DOI: 10.1007/s11892-010-0135-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Diabetes mellitus is one of the most common severe chronic diseases of childhood. Much of our knowledge of the epidemiology of diabetes in young people has been generated by large collaborative efforts based on standardized registry data, such as the DIAMOND Project worldwide and the EURODIAB study in Europe. These registries showed that although at the start of the 20th century childhood diabetes was rare, by the end of the century a steady increase in incidence had been reported in many parts of the world. However, epidemiologic data for temporal trends in pediatric diabetes are still lacking or are minimal for most of the global population of youth, including in the United States. In addition, the epidemiology of diabetes in youth is changing. As youth are becoming increasingly overweight, we are seeing more obese children with a clinical phenotype of type 2 diabetes or "adult-onset" diabetes. It is imperative that efforts directed at surveillance of diabetes in young people continue and expand, not only to understand its complex etiology, but also because of its increasing public health importance.
Collapse
Affiliation(s)
- Dana Dabelea
- Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Avenue, Aurora, CO 80045, USA.
| | | | | |
Collapse
|
41
|
Theilade J, Winkel BG, Holst AG, Tfelt-Hansen J, Svendsen JH, Haunsø S. A nationwide, retrospective analysis of symptoms, comorbidities, medical care and autopsy findings in cases of fatal pulmonary embolism in younger patients. J Thromb Haemost 2010; 8:1723-9. [PMID: 20492468 DOI: 10.1111/j.1538-7836.2010.03922.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our objective was to provide a comprehensive description of fatal pulmonary embolism (PE) in younger persons. Specifically, we recorded information on symptoms, comorbidity, medical contact, if this had been required, and subsequent autopsy findings. METHODS We reviewed all death certificates from persons aged 0-35 years who had died between 1 January 2000 and 31 December 2006, and retrospectively identified all cases of fatal PE. Additional information was retrieved from the National Patient Registry, autopsy reports, and clinical charts. RESULTS Sixty-one cases of fatal PE were included; 38% of these were in males. The median age was 29 years. The predominant symptoms were dyspnea, syncope, leg pains, and chest pains. Sixty-three per cent of patients reportedly experienced symptoms for days, weeks, or months. More than half of the patients had sought medical care, and at the time of medical evaluation the majority of the patients were not hemodynamically compromised. In 21% cases, the correct diagnosis was reached before death; however, in only 5% of cases was this accomplished before clinical deterioration. Furthermore, clinical history and subsequent postmortem examinations showed that approximately half of younger persons dying from PE were otherwise healthy, and in no case was occult cancer diagnosed. CONCLUSIONS Our data show that a substantial proportion of younger victims of fatal PE had experienced symptoms for an extended period of time. Furthermore, the correct diagnosis remained elusive in the majority of cases, even though approximately half of the subjects had sought medical evaluation for symptoms that, in retrospect, were most likely caused by a venothrombotic event.
Collapse
Affiliation(s)
- J Theilade
- The Danish National Research Foundation Centre for Cardiac Arrhythmia, DARC, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | | | | | | | | |
Collapse
|
42
|
Rivera CA, Gaskin L, Allman M, Pang J, Brady K, Adegboyega P, Pruitt K. Toll-like receptor-2 deficiency enhances non-alcoholic steatohepatitis. BMC Gastroenterol 2010; 10:52. [PMID: 20509914 PMCID: PMC2891617 DOI: 10.1186/1471-230x-10-52] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 05/28/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Previously we reported that mice deficient in toll-like receptor 4 (TLR-4) signalling were protected from diet-induced non-alcoholic steatohepatitis (NASH). Another member of the toll-like receptor family, TLR-2, has been shown to play a role in lipid trafficking via uptake of diacylated lipoproteins. However, a role for TLR-2 in NASH has not been elucidated. The objectives of the current study were to examine the influence of dietary fat quality and TLR-2 on NASH pathogenesis. METHODS Steatohepatitis was induced in male Db, C57BL/6 and TLR-2(-/-) mice by feeding an L-amino acid-defined diet that was deficient in methionine and choline (MCDD). Mice fed the base diet supplemented with methionine and choline (control diet; CD) were used as controls. To determine the role of fat quality, MCDD was enriched with polyunsaturated corn oil (PUFA) or coconut oil that is comprised mostly of saturated fat (SAFA); the total amount of each fat was 112.9 g/kg of diet. After 8 weeks of feeding CD or MCDD, hepatic steatosis, inflammation and necrosis were evaluated in histological sections. Total RNA was extracted from frozen liver samples and mRNA expression of TNFalpha, collagen alpha1, IL-10, peroxisome proliferator-activated receptor-gamma (PPAR-gamma), TLR-4, and CD14, was analyzed via real-time PCR. Protein levels of TLR-2 were analyzed by western blot. RESULTS Panlobular macrovessicular steatosis and diffuse leukocyte infiltration were noted in PUFA-fed Db mice. Histological scores demonstrated significantly less steatosis, inflammation and necrosis in SAFA-fed mice of all mouse strains. However, compared to wild type mice, hepatocellular damage was notably more severe in TLR-2(-/-) mice. Consistent with histological findings, mRNA expression of TNFalpha was elevated by approximately 3-fold in TLR-2(-/-) mice; PPAR-gamma expression was blunted in this strain compared to wild type. Expression of the matrix protein collagen alphaI was also significantly higher in TLR-2(-/-) mice, indicating a pro-fibrogenic state. Sensitivity to steatohepatitis due to dietary fat or TLR-2 deficiency correlated significantly with alterations in the expression of TLR-4 as well as the co-receptor CD-14. CONCLUSIONS Our findings suggest that dietary saturated fat plays a protective role against MCDD-induced steatohepatitis, whereas TLR-2 deficiency exacerbated NASH. The mechanism underlying the response to dietary fat and TLR-2 likely involves altered signalling via the TLR-4 pathway.
Collapse
Affiliation(s)
- Chantal A Rivera
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
| | | | | | | | | | | | | |
Collapse
|
43
|
Spezia Faulkner M, Fritschi C, Quinn L, Hepworth JT. Cardiovascular Risks in Adolescents With Diabetes From Vulnerable Populations. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2010. [DOI: 10.1177/1084822309343944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Limited data exist on the predisposition for an early trajectory of cardiovascular (CV) disease in adolescents with diabetes. We explored the effects of types of diabetes and sociodemographic factors (i.e., race, gender, income level, family structure) on the following CV risks: glucose control (A1c), blood pressure (BP), and lipid profile. Adolescents with type 1 DM (T1DM) or type 2 DM (T2DM) participated: 109 with T1DM and 42 with T2DM. The general linear model was used to examine the influence of type of DM, sociodemographic factors, and the interaction of type of DM and the sociodemographic factors on CV risks. Systolic and diastolic BP were increased in youth with T2DM versus T1DM. Non-Hispanic Blacks had a higher A1c and resting diastolic BP than non-Hispanic Whites. Lower income was also associated with higher resting diastolic BP. Males with T1DM had higher A1c, whereas females with T2DM had higher A1c. With low income, individuals with T1DM had higher A1c values than those with T2DM; those with high income and T2DM had higher A1c than those with T1DM. Adolescents with T1DM from single, divorced, or separated families had higher average A1c values. In comparison, those with T2DM from married families had higher A1c values. Triglycerides were increased for those with T2DM, with the greatest amount for Hispanics as compared with non-Hispanic Blacks. In summary, minority status, lower income, and family structure may have a greater impact on vulnerability for poor outcomes in adolescents with DM, regardless of the type of the disease.
Collapse
Affiliation(s)
| | | | - Lauretta Quinn
- College of Nursing, University of Illinois at Chicago, IL, USA
| | | |
Collapse
|
44
|
Fleischman A, Rhodes ET. Management of obesity, insulin resistance and type 2 diabetes in children: consensus and controversy. Diabetes Metab Syndr Obes 2009; 2:185-202. [PMID: 21437133 PMCID: PMC3048003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Childhood obesity has become a national and international epidemic. The prevalence and incidence of type 2 diabetes in youth have been increasing, and type 2 diabetes is one of the most challenging complications of obesity in childhood. Comprehensive lifestyle interventions that include attention to dietary change, increased physical activity and behavior change appear to be required for the successful treatment of pediatric obesity. In particular, aspects of behavioral interventions that have been identified as contributing to effectiveness have included intensity, parent/family participation, addressing healthy dietary change, promoting physical activity, and involving behavioral management principles such as goal setting. A multidisciplinary team approach is required for successful management of type 2 diabetes in youth as well. As with many therapies in pediatrics, clinical trials and support for treatments of obesity and type 2 diabetes in youth lag behind adult data. Pediatric recommendations may be extrapolated from adult data and are often based on consensus guidelines. Type 2 diabetes in children is most commonly managed with lifestyle modification and medications, metformin and/or insulin, the only medications currently approved for use in children. However, many opportunities exist for ongoing research to clarify optimal management for obesity and type 2 diabetes in youth.
Collapse
Affiliation(s)
| | - Erinn T Rhodes
- Correspondence: Erinn T Rhodes, Division of Endocrinology, Children’s, Hospital Boston, 333 Longwood Ave., 6th Floor, Boston, MA, 02115, USA, Tel + 617-355-3209, Fax + 617-730-0183, Email
| |
Collapse
|
45
|
D'Adamo E, Santoro N, Caprio S. Metabolic syndrome in pediatrics: old concepts revised, new concepts discussed. Endocrinol Metab Clin North Am 2009; 38:549-63. [PMID: 19717004 DOI: 10.1016/j.ecl.2009.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The worldwide epidemic of childhood obesity in the last decades is responsible for the occurrence in pediatrics of disorders once mainly found in adults, such as the metabolic syndrome. A key factor in the pathogenesis of metabolic syndrome is insulin resistance, a phenomenon occurring mainly in obese subjects with a general resistance to the insulin effect only on carbohydrates metabolism. Given that the metabolic syndrome is driven by obesity, the prevalence of the latter will strongly influence the prevalence of metabolic syndrome. This article addresses the causes of metabolic syndrome and the relevance of obesity in the pediatric population.
Collapse
Affiliation(s)
- Ebe D'Adamo
- Department of Pediatrics, Yale University School of Medicine, PO Box 208064, New Haven, CT 6520, USA
| | | | | |
Collapse
|
46
|
Abstract
Over the last two decades, nonautoimmune-mediated type 2 diabetes mellitus (T2DM) has become a clinical entity of increasing importance among adolescents. Yet, research specific to adolescent T2DM is in its infancy. Our understanding of the epidemiology of T2DM among adolescents is complicated by variability in definition, incomplete knowledge of novel autoimmune epitopes, the presence of individuals with phenotypic overlap between type 1 and type 2 diabetes, and inadequate understanding of the contribution of common single-gene defects. Furthermore, a higher ratio of diagnosed to undiagnosed cases and a strong relationship with the onset of puberty suggest unique aspects of the pathophysiology in adolescents. Investigators have begun to address these areas while also identifying important relationships with the intrauterine development. Well-designed clinical studies are currently examining the adolescent-specific challenges in prevention and treatment of T2DM, whereas a number of associations struggle to provide screening and treatment guidelines to practitioners based on limited understanding of the phenomenon. Finally, there is growing understanding of medium- and long-term morbidity and mortality in early adulthood. Given the likelihood that early-onset T2DM will have important implications for future public health, continued attention to all aspects of this complex social, economic, and physiological disorder is critical.
Collapse
Affiliation(s)
- Philip Zeitler
- University of Colorado Denver, Aurora, Colorado 80045, USA.
| |
Collapse
|