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Cerdeña J, Plaisime MV, Belcher HME, Wright JL. A PLAN for Race-Conscious Medicine in Pediatrics. Pediatrics 2024; 153:e2023061893. [PMID: 38425225 DOI: 10.1542/peds.2023-061893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 03/02/2024] Open
Affiliation(s)
- Jessica Cerdeña
- Department of Family Medicine, Middlesex Health, Middletown, Connecticut
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP)
- Department of Anthropology, University of Connecticut, Storrs, Connecticut
| | - Marie V Plaisime
- FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Penn Program on Race, Science & Society Center for Africana Studies (PRSS), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harolyn M E Belcher
- Kennedy Krieger Institute, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph L Wright
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland
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Baboun D, Solano N, Del Toro V, Alvarez-Salvat R, Granados A, Carrillo-Iregui A. Technology use and clinical outcomes in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab 2023; 36:1128-1132. [PMID: 37852007 DOI: 10.1515/jpem-2023-0334] [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: 07/16/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Technology use has been shown to improve diabetes control, but minority youths tend to have low rates of technology use and exhibit suboptimal glycemic control. We examined the impact of continuous glucose monitors (CGM) and continuous subcutaneous insulin infusion (CSII) on glycemic control in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes (T1D). METHODS A cross-sectional study was conducted among 140 pediatric T1D patients seen at a multidisciplinary clinic. From January to November 2022, data on demographics and glycated hemoglobin (HbA1c) levels were collected. Patients were categorized as technology (CGM, CSII, or both) or non-technology users (finger stick meter (FS) and multiple daily injections (MDI)). RESULTS The majority identified as Hispanic (79 %) and had public health insurance (71 %). Sixty-nine percent used technology. Compared with non-technology users, technology users had significantly lower mean HbA1c levels (9.60 vs. 8.40 %, respectively) (p=0.0024), though no group (CGM + CSII, CGM + MDI, FS + CSII, and FS + MDI) achieved a mean HbA1c level of <7.0 %. Regarding minority status, no significant differences in mean HbA1c levels existed between Hispanics and Blacks in the CGM + MDI and FS + CSII groups (p=0.2232 and p=0.9224, respectively). However, there was a significant difference in mean HbA1c levels between Hispanic and Black non-technology users (9.19 vs. 11.26 %, respectively) (p=0.0385). CONCLUSIONS Technology users demonstrated better glycemic control than non-technology users. Further research is needed to investigate factors affecting glycemic control in minority youths with T1D.
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Affiliation(s)
- Daniela Baboun
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Natalia Solano
- University of Chicago, Chicago, USA
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Victoria Del Toro
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
- Vanderbilt University, Nashville, USA
| | | | - Andrea Granados
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Adriana Carrillo-Iregui
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
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Hassan S, Gujral UP, Quarells RC, Rhodes EC, Shah MK, Obi J, Lee WH, Shamambo L, Weber MB, Narayan KMV. Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. Lancet Diabetes Endocrinol 2023; 11:509-524. [PMID: 37356445 PMCID: PMC11070656 DOI: 10.1016/s2213-8587(23)00129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/27/2023]
Abstract
Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA.
| | - Unjali P Gujral
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Rakale C Quarells
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Jane Obi
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Wei-Hsuan Lee
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Luwi Shamambo
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Beth Weber
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - K M Venkat Narayan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
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Alkhatib EH, Dauber A, Estrada DE, Majidi S. Weekly Growth Hormone (Lonapegsomatropin) Causes Severe Transient Hyperglycemia in a Child with Obesity. Horm Res Paediatr 2023; 96:542-546. [PMID: 37015214 DOI: 10.1159/000530522] [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: 02/02/2023] [Accepted: 03/28/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION A 12-year-and-9-month-old non-Hispanic black male with a history of growth hormone deficiency, pituitary hypoplasia, prediabetes, obesity, hypertension, and hyperlipidemia was initiated on weekly growth hormone (lonapegsomatropin-tcgd) and then transiently developed symptomatic hyperglycemia to 500 mg/dL. We aimed to describe this medication's effect. CASE PRESENTATION He was born full term and appropriate for gestational age. He was referred to endocrinology at 3.5 years of age for short stature with a height SDS of -2.48. IGF-1 51.1 ng/mL and IGFBP-3 1.2 ng/mL were low. GH stimulation test noted baseline and peak GH of 0.1 ng/mL. MRI brain showed hypoplastic adenohypophysis, aplastic pituitary stalk, and ectopic neurohypophysis. There had been difficulty with adherence to daily GH over the following 9 years. BMI trajectory rose above 180% of the 95th percentile. By age 12, A1c was 6.6%. Metformin was started and increased to 1,000 mg twice daily. Subsequent A1c was 6.0%. Due to poor compliance with daily GH, at 12 years and 9 months, he was initiated on 22 mg (0.25 mg/kg/week) of weekly lonapegsomatropin-tcgd to improve compliance. The day after his first injection, he developed non-bloody, non-bilious emesis. He denied headaches and endorsed polyuria. Due to concern for increased intracranial pressure, he was sent to the emergency department; however, ophthalmologic exam was negative. Initial serum glucose was 500 mg/dL, then 336 mg/dL after 1-L normal saline. Hemoglobin A1c was 5.7%, urine glucose 3+ mg/dL, and urine ketones 2+ mg/dL. Venous pH of 7.379 and bicarbonate of 20.6 mmol/L ruled out diabetic ketoacidosis. Metformin was held during the hospitalization. Hyperglycemia rapidly improved with transient insulin administration. He received one dose of glargine 20 units. He was initiated on lispro carb ratio of 1:8 and correction factor 1:15 for target glucose 150 mg/dL. By day four, glucoses were below 100 mg/dL; lispro was discontinued, and he was discharged home. Weekly GH was discontinued with plans to resume daily GH therapy in several months. CONCLUSION Lonapegsomatropin-tcgd offers the convenience of weekly rather than daily GH treatment; however, this patient developed a rapid increase in insulin resistance and hyperglycemia requiring insulin. The discrepancy between the glucose of 500 mg/dL and A1c of 5.7%, along with the rapid resolution of hyperglycemia, is further consistent with a medication side effect. Close glucose monitoring of patients initiated on weekly growth hormone is crucial, particularly in those with a history of prediabetes.
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Affiliation(s)
- Einas H Alkhatib
- Division of Pediatric Endocrinology, Children's National Hospital, Washington, District of Columbia, USA
| | - Andrew Dauber
- Division of Pediatric Endocrinology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Doris Elizabeth Estrada
- Division of Pediatric Endocrinology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Shideh Majidi
- Division of Pediatric Endocrinology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Fan Y, Lau ESH, Wu H, Yang A, Chow E, So WY, Kong APS, Ma RCW, Chan JCN, Luk AOY. Incidence of long-term diabetes complications and mortality in youth-onset type 2 diabetes: A systematic review. Diabetes Res Clin Pract 2022; 191:110030. [PMID: 35934175 DOI: 10.1016/j.diabres.2022.110030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/17/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
AIMS This systematic review aims to assess the incidence of chronic kidney disease (CKD), cardiovascular disease (CVD) and mortality in people with type 2 diabetes diagnosed <20 years. METHODS We searched MEDLINE, Embase and Cochrane Library for longitudinal studies published between 1 January 2000 and 31 November 2021. RESULTS Seventeen studies (15 reporting CKD, 3 reporting CVD, 5 reporting mortality) from seven countries of sample size ranging between 96 and 4,141 were eligible. Most studies were conducted in North America and Europe (n = 14). Diabetes duration at enrolment varied from 0 to 8.3 years and follow-up duration from 1 to 12.6 years. The incidence rates (per 1,000 person-year) of albuminuria ranged between 12.4 and 114.8, macroalbuminuria or proteinuria between 10 and 35.0, end-stage kidney disease (ESKD) between 0.4 and 25.0, CVD between 3.7 and 19.5, and mortality between 1.0 and 18.6. The highest incidence rates of albuminuria, ESKD and mortality were recorded in Australian Aboriginal and Pima Indian populations. Youth-onset type 2 diabetes was associated with greater risk of developing CKD compared with type 1 diabetes in most studies. CONCLUSION Studies reporting CVD in youth-onset type 2 diabetes are scarce. Estimated incidence rates of CKD and mortality in youth-onset type 2 diabetes varied across different study populations, potentially higher in indigenous people. Youth with type 2 diabetes are at higher risk of adverse kidney outcomes than their type 1 counterparts. More studies are needed in regions outside of North America and Europe.
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Affiliation(s)
- Yingnan Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Wing-Yee So
- Hong Kong Hospital Authority, Kowloon, Hong Kong, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Modarelli R, Sarah S, Ramaker ME, Bolobiongo M, Benjamin R, Gumus Balikcioglu P. Pediatric Diabetes on the Rise: Trends in Incident Diabetes During the COVID-19 Pandemic. J Endocr Soc 2022; 6:bvac024. [PMID: 35265783 PMCID: PMC8900286 DOI: 10.1210/jendso/bvac024] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Context The effects of the coronavirus disease 2019 (COVID-19) pandemic on the incident cases of pediatric type 1 diabetes (T1D) and type 2 diabetes (T2D) are not clear. Objective To identify trends in incidence and presentation of pediatric new-onset T1D and T2D during the COVID-19 pandemic. Methods A retrospective chart review was conducted. Demographics, anthropometrics, and initial laboratory results from patients ages 0 through 21 years who presented with new-onset diabetes to a pediatric tertiary care center were recorded. Results During the pandemic, incident cases of pediatric T1D increased from 31 in each of the prior 2 years to 46; an increase of 48%. Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The number of incident cases of pediatric T2D increased significantly more than the number of incident cases of pediatric T1D (P = 0.009). Patients with T2D were more likely to present in diabetic ketoacidosis (DKA), though this was not statistically significant (P = 0.093). Severe DKA was higher compared with moderate DKA (P = 0.036) in incident cases of pediatric T2D. During the pandemic, for the first time, incident cases of T2D accounted for more than one-half of all newly diagnosed pediatric diabetes cases (53%). Conclusions There were more incident pediatric T1D and T2D cases as well as an increase in DKA severity in T2D at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the pediatric diabetes trends with profound individual and community health consequences.
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Affiliation(s)
- Rachel Modarelli
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
| | - Salma Sarah
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27705, USA
| | - Megan E Ramaker
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27701, USA
| | - Mboli Bolobiongo
- Duke School of Medicine, Master of Biomedical Sciences, Durham, NC 27710, USA
| | - Robert Benjamin
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27705, USA
| | - Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27705, USA
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27701, USA
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Ugwueze C, Ezeokpo B. The racial and ethnic differences in type 2 diabetes mellitus: A black race narrative review. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_127_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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