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Ciężki S, Odyjewska E, Bossowski A, Głowińska-Olszewska B. Not Only Metabolic Complications of Childhood Obesity. Nutrients 2024; 16:539. [PMID: 38398863 PMCID: PMC10892374 DOI: 10.3390/nu16040539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
The increasing incidence of obesity in the pediatric population requires attention to its serious complications. It turns out that in addition to typical, well-known metabolic complications, obesity as a systemic disease carries the risk of equally serious, although less obvious, non-metabolic complications, such as cardiovascular diseases, polycystic ovary syndrome, chronic kidney disease, asthma, thyroid dysfunction, immunologic and dermatologic conditions, and mental health problems. They can affect almost all systems of the young body and also leave their mark in adulthood. In addition, obesity also contributes to the exacerbation of existing childhood diseases. As a result, children suffering from obesity may have a reduced quality of life, both physically and mentally, and their life expectancy may be shortened. It also turns out that, in the case of obese pregnant girls, the complications of obesity may also affect their unborn children. Therefore, it is extremely important to take all necessary actions to prevent the growing epidemic of obesity in the pediatric population, as well as to treat existing complications of obesity and detect them at an early stage. In summary, physicians treating a child with a systemic disease such as obesity must adopt a holistic approach to treatment.
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Affiliation(s)
- Sebastian Ciężki
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, 15-274 Białystok, Poland
| | - Emilia Odyjewska
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, 15-274 Białystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, 15-274 Białystok, Poland
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, 15-274 Białystok, Poland
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S258-S281. [PMID: 38078582 PMCID: PMC10725814 DOI: 10.2337/dc24-s014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Ismail HM, Perera D, Mandal R, DiMeglio LA, Evans-Molina C, Hannon T, Petrosino J, Javornick CreGreen S, Schmidt NW. Gut microbial changes associated with obesity in youth with type 1 diabetes. medRxiv 2023:2023.12.01.23299251. [PMID: 38076970 PMCID: PMC10705628 DOI: 10.1101/2023.12.01.23299251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Obesity is increasingly prevalent in type 1 diabetes (T1D) and is associated with management problems and higher risk for diabetes complications. Gut microbiome changes have been described separately in each of T1D and obesity, however, it is unknown to what extent gut microbiome changes are seen when obesity and T1D concomitantly occur. OBJECTIVE To describe the gut microbiome and microbial metabolite changes associated with obesity in T1D. We hypothesized significant gut microbial and metabolite differences between T1D youth who are lean (BMI: 5-<85%) vs. those with obesity (BMI: ≥95%). METHODS We analyzed stool samples for gut microbial (using metagenomic shotgun sequencing) and short-chain fatty acid (SCFA) metabolite differences in lean (n=27) and obese (n=21) T1D youth. The mean±SD age was 15.3±2.2yrs, A1c 7.8±1.3%, diabetes duration 5.1±4.4yrs, 42.0% females, and 94.0% were White. Linear discriminant analysis (LDA) effect size (LEfSe) was used to identify taxa that best discriminated between the BMI groups. RESULTS Bacterial community composition showed differences in species type (β-diversity) by BMI group (p=0.013). At the genus level, there was a higher ratio of Prevotella to Bacteroides in the obese group (p=0.0058). LEfSe analysis showed a differential distribution of significantly abundant taxa in either the lean or obese groups, including increased relative abundance of Prevotella copri , among other taxa in the obese group. Functional profiling showed that pathways associated with decreased insulin sensitivity were upregulated in the obese group. Stool SCFAs (acetate, propionate and butyrate) were higher in the obese compared to the lean group (p<0.05 for all). CONCLUSIONS Our findings identify gut microbiome, microbial metabolite and functional pathways differences associated with obesity in T1D. These findings could be helpful in identifying gut microbiome targeted therapies to manage obesity in T1D.
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Drozd I, Weiskorn J, Lange K, Biester T, Datz N, Kapitzke K, Reschke F, von dem Berge T, Weidemann J, Danne TPA, Kordonouri O. Prevalence of LDL-hypercholesterolemia and other cardiovascular risk factors in young people with type 1 diabetes. J Clin Lipidol 2023; 17:483-490. [PMID: 37258406 DOI: 10.1016/j.jacl.2023.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Mortality and morbidity in people with Type 1 diabetes (T1D) is mainly caused by cardiovascular disease (CVD). Early treatment of cardiovascular risk factors (CVRFs) is of great importance. OBJECTIVE To analyze the prevalence of LDL-hypercholesterolemia and other CVRFs in youth with T1D. METHODS Clinical and laboratory parameters, and vascular thickness measurement were obtained in youth with T1D (age 6-18 years, T1D duration >1 year) attending a diabetes clinic. LDL-hypercholesterolemia, microalbuminuria and arterial hypertension were defined as CVRFs. RESULTS A total of 333 youth (48% girls; age: 13.3 years [10.3-15.5], median [interquartile range]) participated in the study. The T1D duration was 5.9 years [3.5-9.4] with HbA1c of 7.4% [6.8-8.0]. Intima media thickness (N=223) was 538.0 µm [470.0-618.0]). LDL-hypercholesterolemia was present in 30 participants (9%; 18 girls; age: 14.3 years [11.2-15.7]). None of the participants had persistent microalbuminuria, although 59 (18.3%) had elevated albumin excretion in a random urine specimen. LDL-hypercholesterolemia was associated with increased blood pressure (p<0.05), insulin requirement (p<0.05), HbA1c (p<0.05), triglyceride (p<0.001) and total cholesterol (p<0.001), and a family history of premature CVD (p<0.001), but negatively correlated with HDL cholesterol levels (p<0.05). Sex, pubertal status, duration of diabetes, type of therapy, and physical activity did not differ between participants with and without LDL- hypercholesterolemia. Arterial hypertension was present in 11 participants (3.3%; 4 girls; age: 14.1 years [11.1-16.1]). CONCLUSION LDL-hypercholesterolemia affected 9% of youth with T1D in this cohort and was associated with other CVRFs. A holistic therapeutic concept for these young people is essential.
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Affiliation(s)
- Irena Drozd
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany; Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Jantje Weiskorn
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Karin Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Torben Biester
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Nicolin Datz
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Kerstin Kapitzke
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Felix Reschke
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Thekla von dem Berge
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | - Jürgen Weidemann
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany
| | | | - Olga Kordonouri
- Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, Hannover 30173, Germany.
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Bishop FK, Addala A, Corbin KD, Muntis FR, Pratley RE, Riddell MC, Mayer-Davis EJ, Maahs DM, Zaharieva DP. An Overview of Diet and Physical Activity for Healthy Weight in Adolescents and Young Adults with Type 1 Diabetes: Lessons Learned from the ACT1ON Consortium. Nutrients 2023; 15:nu15112500. [PMID: 37299463 DOI: 10.3390/nu15112500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
The prevalence of overweight and obesity in young people with type 1 diabetes (T1D) now parallels that of the general population. Excess adiposity increases the risk of cardiovascular disease, which is already elevated up to 10-fold in T1D, underscoring a compelling need to address weight management as part of routine T1D care. Sustainable weight management requires both diet and physical activity (PA). Diet and PA approaches must be optimized towards the underlying metabolic and behavioral challenges unique to T1D to support glycemic control throughout the day. Diet strategies for people with T1D need to take into consideration glycemic management, metabolic status, clinical goals, personal preferences, and sociocultural considerations. A major barrier to weight management in this high-risk population is the challenge of integrating regular PA with day-to-day management of T1D. Specifically, exercise poses a substantial challenge due to the increased risk of hypoglycemia and/or hyperglycemia. Indeed, about two-thirds of individuals with T1D do not engage in the recommended amount of PA. Hypoglycemia presents a serious health risk, yet prevention and treatment often necessitates the consumption of additional calories, which may prohibit weight loss over time. Exercising safely is a concern and challenge with weight management and maintaining cardiometabolic health for individuals living with T1D and many healthcare professionals. Thus, a tremendous opportunity exists to improve exercise participation and cardiometabolic outcomes in this population. This article will review dietary strategies, the role of combined PA and diet for weight management, current resources for PA and glucose management, barriers to PA adherence in adults with T1D, as well as findings and lessons learned from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON).
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Affiliation(s)
- Franziska K Bishop
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA
| | - Karen D Corbin
- AdventHealth, Translational Research Institute, Orlando, FL 32804, USA
| | - Franklin R Muntis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Richard E Pratley
- AdventHealth, Translational Research Institute, Orlando, FL 32804, USA
| | - Michael C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA
- Stanford Diabetes Research Center, Stanford, CA 94305, USA
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA
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Ferreira M, Neves JS, Neves C, Carvalho D. Physical exercise and glycemic management in patients with type 1 diabetes on insulin pump therapy-a cross-sectional study. Acta Diabetol 2023; 60:881-889. [PMID: 36964201 DOI: 10.1007/s00592-023-02070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 03/02/2023] [Indexed: 03/26/2023]
Abstract
AIMS Exercise is an important practice for control in type 1 diabetes (T1D). This study aims to assess de association between exercise and glycemic management in people with T1D and to identify the main barriers to exercise in T1D. METHODS We evaluated 95 people with T1D treated with insulin pump therapy. Participants answered a questionnaire about 1) exercise habits, 2) usual adjustments in insulin and food intake with exercise and 3) main barriers to exercise. Continuous glucose monitoring (CGM) was used to evaluate time in range (TIR), time below range (TBR) and time above range (TAR) during the last 60 days before the evaluation. CGM data during, before (2 h before) and after (24 h after) the last bout of exercise was also evaluated. RESULTS The mean age was 30.1 ± 12.1 years, and 51.6% were women. Participants that reported practicing exercise (55.8%) had a higher TIR (59.6 ± 16.3 vs. 48.7 ± 15.7, p = 0.012) and a lower TAR (32.6 ± 15.8 vs. 45.4 ± 17.7, p = 0.006). Comparing with the 60 days CGM data, the TBR was lower in the 2 h before exercise (- 1.8 ± 3.8, p = 0.0454) and TAR was lower during (- 16.9 ± 33.6, p = 0.0320) and in the 24 h after (- 8.7 ± 17.2, p = 0.032) the last bout of exercise. The absence of adjustments on insulin and food intake was associated with higher TBR after the exercise (13.44 ± 3.5, p < 0.05). Eating before the exercise and turning off the pump during the exercise were associated with lower TBR after exercise (food booster: - 7.56 ± 3.49, p < 0.05; turning off insulin pump - 8.87 ± 3.52, p < 0.05). The main barriers reported for exercise practicing were fear of hypoglycemia, lack of free time and work schedule. CONCLUSION Exercise was associated with better glycemic management in people with T1D. Addressing common barriers may allow a higher adherence to exercise in T1D.
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Affiliation(s)
- Margarida Ferreira
- Faculty of Medicine of Medicine of the University of Porto, Porto, Portugal.
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Celestino Neves
- Faculty of Medicine of Medicine of the University of Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, University of Porto, Porto, Portugal
| | - Davide Carvalho
- Faculty of Medicine of Medicine of the University of Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, University of Porto, Porto, Portugal
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Skinner AC, Staiano AE, Armstrong SC, Barkin SL, Hassink SG, Moore JE, Savage JS, Vilme H, Weedn AE, Liebhart J, Lindros J, Reilly EM. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities. Pediatrics 2023; 151:190446. [PMID: 36622098 DOI: 10.1542/peds.2022-060643] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.
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Affiliation(s)
- Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shari L Barkin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Jennifer E Moore
- Institute for Medicaid Innovation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Helene Vilme
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Oza C, Khadilkar A, Mondkar SA, Gondhalekar K, Khadilkar V. Longitudinal trends in lipid profile in indian children and youth with type-1 diabetes: a 5-year follow up from a single centre. Endocrine 2023; 79:313-322. [PMID: 36414859 DOI: 10.1007/s12020-022-03259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION High prevalence of dyslipidaemia in children and adolescents with type-1 diabetes (T1D) places them at increased risk of developing atherosclerosis leading to mortality caused by cardiovascular disease(CVD). Thus, screening for fasting blood lipids when diabetes is stabilized in children aged 11 years and above is routinely recommended with follow-up every 5 years. OBJECTIVES (1) To characterize the lipid profile of children and adolescents with respect to diabetes duration. (2) To describe longitudinal changes in lipid profile over a 5-year period in patients with T1D. METHODS This longitudinal 5-year follow-up study included 112 patients with T1D aged 3-18 years. Demographic data, anthropometry and laboratory measurements were performed using standard protocols at baseline and endline. P value < 0.05 was considered significant. RESULTS The prevalence of dyslipidaemia in our study was 49.5% with abnormal LDL as the most frequently deranged parameter. Duration of illness played a major role in deterioration of lipid profile mediated by triglyceride and VLDL. Duration of illness and fibre intake in diet significantly predicted the change in lipid profile which were driven by triglycerides and VLDL. Glycemic control, insulin sensitivity and serum TSH also significantly altered components of lipid profile with no impact on overall dyslipidaemia. A total of 6.5% subjects had LDL concentrations >130 mg/dl and the same proportion had non-HDL cholesterol concentrations >145 mg/dl at baseline while at endline, 11.9% subjects had LDL concentrations >130 mg/dl and 15.6% subjects had non-HDL cholesterol concentrations >145 mg/dl. 28.6% subjects with LDL > 130 mg/dl and non-HDL cholesterol >145 mg/dl at baseline had persistently elevated concentrations while 10.3% and 14.4% additional subjects developed elevated LDL and non-HDL cholesterol concentrations respectively during the study period. CONCLUSIONS The deterioration of lipid profile in T1D, due to increase in disease duration was chiefly mediated by increase in serum triglyceride and VLDL concentrations which may be prevented by improving glycaemic control, insulin sensitivity and fibre intake in diet.
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Affiliation(s)
- Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Senior Paediatric Endocrinologist, Jehangir Hospital, Pune and Bombay Hospital, Pune, India.
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
| | - Shruti A Mondkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | | | - Vaman Khadilkar
- Senior Paediatric Endocrinologist, Jehangir Hospital, Pune and Bombay Hospital, Pune, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S230-S253. [PMID: 36507640 PMCID: PMC9810473 DOI: 10.2337/dc23-s014] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Fröhlich-Reiterer E, Elbarbary NS, Simmons K, Buckingham B, Humayun KN, Johannsen J, Holl RW, Betz S, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1451-1467. [PMID: 36537532 DOI: 10.1111/pedi.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado, USA
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - Khadija N Humayun
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jesper Johannsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Shana Betz
- Parent/Advocate for people with diabetes, Markham, Canada
| | - Farid H Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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11
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Ismail HM, Evans-Molina C. Does the Gut Microbiome Play a Role in Obesity in Type 1 Diabetes? Unanswered Questions and Review of the Literature. Front Cell Infect Microbiol 2022; 12:892291. [PMID: 35873174 PMCID: PMC9304930 DOI: 10.3389/fcimb.2022.892291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022] Open
Abstract
Evidence suggests that type 1 diabetes (T1D) risk and progression are associated with gut bacterial imbalances. Children with either T1D or islet antibody positivity exhibit gut dysbiosis (microbial imbalance) characterized by lower gram-positive to gram-negative gut bacterial ratios compared to healthy individuals, leading to a pro-inflammatory milieu. In addition, specific gut microbiome changes, including increased virulence factors, elevated phage, prophage, and motility genes, and higher amplitude stress responses, have been identified in individuals who have or are progressing towards T1D. Additionally, gut microbiome differences are associated with and thought to contribute to obesity, a comorbidity that is increasingly prevalent among persons with T1D. Obesity in T1D is problematic because individuals with obesity progress faster to T1D, have reduced insulin sensitivity compared to their lean counterparts, and have higher risk of complications. Animal and human studies suggest higher relative abundance of bacterial taxa associated with changes in bile acid and short chain fatty acid biosynthesis in obesity. However, it is unknown to what extent the gut microbiome plays a role in obesity in T1D and these worse outcomes. In this review, we aim to evaluate potential gut microbiome changes and associations in individuals with T1D who are obese, highlighting the specific gut microbiome changes associated with obesity and with T1D development. We will identify commonalities and differences in microbiome changes and examine potential microbiota-host interactions and the metabolic pathways involved. Finally, we will explore interventions that may be of benefit to this population, in order to modify disease and improve outcomes.
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Affiliation(s)
- Heba M. Ismail
- Department of Pediatrics and the Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Heba M. Ismail, ; Carmella Evans-Molina,
| | - Carmella Evans-Molina
- Department of Pediatrics and the Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, United States
- Richard L. Roudebush Veterans Affairs (VA) Medical Center, Indiana University School of Informatics and Computing, Indianapolis, IN, United States
- *Correspondence: Heba M. Ismail, ; Carmella Evans-Molina,
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12
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Lin H, Chen X, Pan J, Ke J, Zhang A, Liu Y, Wang C, Chang ACY, Gu J. Secretion of miRNA-326-3p by senescent adipose exacerbates myocardial metabolism in diabetic mice. Lab Invest 2022; 20:278. [PMID: 35729559 PMCID: PMC9210699 DOI: 10.1186/s12967-022-03484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
Background Adipose tissue homeostasis is at the heart of many metabolic syndromes such as diabetes. Previously it has been demonstrated that adipose tissues from diabetic patients are senescent but whether this contributes to diabetic cardiomyopathy (DCM) remains to be elucidated. Methods The streptozotocin (STZ) type 1 diabetic mice were established as animal model, and adult mouse ventricular myocytes (AMVMs) isolated by langendorff perfusion as well as neonatal mouse ventricular myocytes (NMVMs) were used as cell models. Senescent associated β galactosidase (SA-β-gal) staining and RT-qPCR were used to identify the presence of adipose senescence in diabetic adipose tissue. Senescent adipose were removed either by surgery or by senolytic treatment. Large extracellular vesicles (LEVs) derived from adipose tissue and circulation were separated by ultracentrifugation. Cardiac systolic and diastolic function was evaluated through cardiac ultrasound. Cardiomyocytes contraction function was evaluated by the Ionoptix HTS system and live cell imaging, mitochondrial morphology and functions were evaluated by transmission electron microscope, live cell fluorescent probe and seahorse analysis. RNA-seq for AMVMs and miRNA-seq for LEVs were performed, and bioinformatic analysis combined with RT-qPCR and Western blot were used to elucidate underlying mechanism that senescent adipose derives LEVs exacerbates myocardial metabolism. Results SA-β-gal staining and RT-qPCR identified the presence of adipose tissue senescence in STZ mice. Through surgical as well as pharmacological means we show that senescent adipose tissue participates in the pathogenesis of DCM in STZ mice by exacerbates myocardial metabolism through secretion of LEVs. Specifically, expression of miRNA-326-3p was up-regulated in LEVs isolated from senescent adipose tissue, circulation, and cardiomyocytes of STZ mice. Up-regulation of miRNA-326-3p coincided with myocardial transcriptomic changes in metabolism. Functionally, we demonstrate that miRNA-326-3p inhibited the expression of Rictor and resulted in impaired mitochondrial and contractile function in cardiomyocytes. Conclusion We demonstrate for the first time that senescent adipose derived LEVs exacerbates myocardial metabolism through up-regulated miRNA-326-3p which inhibits Rictor in cardiomyocytes. Furthermore, reducing senescence burden in adipose tissue is capable of relieving myocardial metabolism disorder in diabetes mellitus. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03484-7.
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Affiliation(s)
- Hao Lin
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaonan Chen
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jianan Pan
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jiahan Ke
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Alian Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yangyang Liu
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Changqian Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Alex Chia Yu Chang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. .,Shanghai Institute of Precision Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Jun Gu
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Alshahrani AS, Alibrahim AR, Alanazi MM, Omair A, Alsadhan MA, Alattiah TM, Kanadily FA, Alattiah SM, Mahzari MM. A Pattern of Lipid Profile Among Saudi Adults With Type 1 Diabetes Mellitus in a Tertiary Hospital: A Retrospective Study. Cureus 2022; 14:e25622. [PMID: 35784993 PMCID: PMC9249038 DOI: 10.7759/cureus.25622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/21/2022] Open
Abstract
Objective: Dyslipidemia is prevalent in adults living with type 1 diabetes, and it can worsen the presentation of microvascular complications such as retinopathy. This study aims to identify the pattern coupled with the frequency of dyslipidemia in diabetic adults who followed up at different clinics in King Abdulaziz Medical City, Riyadh, and evaluate the associations with demographic and clinical characteristics. Methods: A cross-sectional, retrospective chart review study of 514 adults with type 1 diabetes was conducted in a tertiary health care facility in the central region of Saudi Arabia. Demographics were retrieved by using the implemented electronic medical records. Fasting lipid profile, glycated hemoglobin (HbA1c), and thyroid-stimulating hormone (TSH) levels were checked for all subjects. Results: Five hundred and fourteen (514) subjects aged 18-65 years were studied (mean age: 26.1 ± 7.1 years). There were 318 (62%) females in the sample, and their mean age was significantly different from the mean age of males (p = 0.01). The mean duration of having diabetes was 12.8 ± 6.9 years. The prevalence of lipid abnormalities included abnormal low-density lipoprotein (LDL) (70%), hypercholesterolemia (23%), abnormal high-density lipoprotein (HDL) (8%), and hypertriglyceridemia (5%). Abnormal HDL was significantly higher in males than in females (p=<0.001). There were no statistically significant differences in the prevalence of other lipid abnormalities between the two genders and the age group < or ≥ 25 years. There was no statistically significant difference in the mean of the tested lipids levels between the two genders. One hundred and forty-three (143) (27.8%) patients had more than one abnormal lipid condition. A statistically significant difference was observed in the mean HbA1c between males and females (p=0.001). Otherwise, there was no significant association of lipid abnormalities with gender, age, diabetes duration, and weight. Conclusion: The most prevalent lipid abnormality was high LDL cholesterol. Nearly a third of the tested individuals had more than one lipid abnormality. Furthermore, poor glycemic control was linked to abnormal lipid profiles. Consequently, local programs must aim to screen and intervene early to delay and prevent future severe vascular complications related to non-treated dyslipidemia.
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Silva C, Zhang Q, Bone JN, Amed S. Anthropometric Measurements and Laboratory Investigations in Children and Youth With Type 1 Diabetes Before and During the COVID-19 Pandemic. Can J Diabetes 2022; 46:S1499-2671(22)00087-9. [PMID: 35987748 PMCID: PMC9009070 DOI: 10.1016/j.jcjd.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our aim in this study was to compare rates of anthropometric, blood pressure (BP) and glycated hemoglobin (A1C) measurements and laboratory screening for hypothyroidism, nephropathy and dyslipidemia in children and youth with type 1 diabetes (T1D), 1 year before and after the onset of COVID-19. METHODS Clinical data were analyzed from a voluntary registry of children and youth with T1D followed at the BC Children's Hospital between March 2019 and 2021. Logistic and Poisson mixed-effect models were used. RESULTS Four hundred forty patients, with median (interquartile range) age and time since diagnosis 12.7 (9.5 to 15.4) and 4.7 (2.6 to 7.9) years, respectively, were included. Clinic visits were all in-person before March 2020, and 99% via telemedicine afterward. The number of visits per patient was 2 (2 to 3), with a 6% increase during the pandemic (relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.10). There was a substantial decrease in height, weight and BP measurements (RR, 0.32; 95% CI, 0.28 to 0.36; RR, 0.34, 95% CI, 0.31 to 0.38; RR, 0.005, 95% CI, 0.002 to 0.014, respectively); only 49% of patients had anthropometric and 1% BP data during the pandemic year, compared with >97% before the pandemic. A1C measurements dropped from 3 (2 to 4) to 1 (1 to 2) per patient per year (RR, 0.53; 95% CI, 0.48 to 0.57). Rates of screening investigations were suboptimal before the pandemic, and these rates continued to decline. CONCLUSIONS Shifting to telemedicine allowed ongoing care during the pandemic, but the frequency of anthropometric, BP and A1C measurements decreased dramatically. A combined telemedicine/in-person model may be needed to ensure adequate care for this population.
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Affiliation(s)
- Carolina Silva
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Qian Zhang
- Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Ashour D, AlSubaihin A, Lim YY, Legault L. Overweight and obese youth with type 1 or type 2 diabetes share similar elevation in triglycerides during middle and late adolescence. Obes Res Clin Pract 2022; 16:138-43. [PMID: 35430167 DOI: 10.1016/j.orcp.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 03/13/2022] [Accepted: 03/20/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Overweight and obesity have been observed in children with type 1 diabetes (T1D). This further increases their future risk of Cardiovascular Disease (CVD) as well as the development of other risk factors, such as dyslipidemia. AIMS To compare lipid profiles in children and adolescents with Type 1 diabetes and lean mass (T1L), Type 1 diabetes and overweight or obese (T1OW/OB), and type 2 diabetes (T2D). METHODS This was a cross-sectional study of 669 patients with T1D or T2D aged 2-19 years using retrospective data collected from 2003 to 2014. Included patients were categorized into lean (BMI < 85th ile and overweight or Obese (BMI ≥ 85th ile). Patients were subcategorized into three age groups: < 10 years, 10-14 years, and 15-19 years. RESULTS 7.6% of patients had T2D. Of the patients with T1D, 58.9% were lean, 26.4% were overweight, and 14.7% were obese. Total Cholesterol (TC), Low-density lipoprotein cholesterol (LDL-C) and Non-HDL-C levels were similar across groups. In the 15-19 years group, Triglycerides (TG) levels were significantly higher in T1OW/OB and similar to T2D. High-density lipoprotein Cholesterol (HDL-C) was significantly lower in T2D. Weight status significantly correlated with TG and HDL-C levels in T1D and T2D groups. CONCLUSIONS T1OW/OB constitutes a significant proportion of the T1D population. Patients with obesity and T1D, especially if in their late adolescence, have an adverse lipid profile pattern that is comparable to adolescents with T2D. Based on these findings, risk for future CVD in T1OW/OB and T2D may be equivalent.
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Ciężki S, Kurpiewska E, Bossowski A, Głowińska-Olszewska B. Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children - From Disease Pathogenesis to Complications. Front Endocrinol (Lausanne) 2022; 13:890833. [PMID: 35784568 PMCID: PMC9243381 DOI: 10.3389/fendo.2022.890833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children's population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.
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Genua I, Franch-Nadal J, Navas E, Mata-Cases M, Giménez-Pérez G, Vlacho B, Mauricio D, Goday A. Obesity and related comorbidities in a large population-based cohort of subjects with type 1 diabetes in Catalonia. Front Endocrinol (Lausanne) 2022; 13:1015614. [PMID: 36531459 PMCID: PMC9756841 DOI: 10.3389/fendo.2022.1015614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Obesity, an increasing global health problem, can affect people with other disease conditions. The prevalence of obesity in people with type 1 diabetes (T1D) is not well known. The aim of this study was to describe extensively the characteristics and prevalence of different classes of obesity according to BMI (body mass index) categories in a large cohort of patients with T1D. MATERIAL AND METHODS This was a retrospective, cross-sectional study in Catalonia. We reviewed all patients with T1D diagnosis, ≥ 18 years old and with BMI data from the SIDIAP database. Sociodemographic and clinical data, cardiovascular risk factors, laboratory parameters and concomitant medications were collected. RESULTS A total of 6,068 patients with T1D were analyzed. The prevalence of obesity in the total sample was 18% (13.8% with class 1 obesity [BMI 30-34.9 kg/m2]). Patients with obesity had a higher prevalence of other cardiovascular risk factors (i.e. hypertension was 61.4% vs. 37.5%; dyslipidemia 63.6% vs 44%, and chronic kidney disease 38.4% vs. 24.4%; p<0.001 in all cases) and poorer control of them. The higher prevalence was regardless of sex, age and duration of diabetes. The increase in these comorbidities was noticeable from a BMI > 25 kg/m2. Patients with obesity did not have poorer glycemic control. CONCLUSION The presence of obesity in people with T1D is frequent and cardiovascular risk factors are more common and more poorly controlled in T1D patients with obesity.
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Affiliation(s)
- Idoia Genua
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Josep Franch-Nadal
- Diabetis en Atenció Primaria-Catalunya (DAP-Cat) group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Elena Navas
- Unitat de Suport a la Recerca|, Barcelona, Spain
| | - Manel Mata-Cases
- Diabetis en Atenció Primaria-Catalunya (DAP-Cat) group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Gabriel Giménez-Pérez
- Endocrinology Section, Department of Medicine, Hospital General de Granollers, Granollers, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Bogdan Vlacho
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Diabetis en Atenció Primaria-Catalunya (DAP-Cat) group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Didac Mauricio
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Diabetis en Atenció Primaria-Catalunya (DAP-Cat) group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Medicine, Universitat de Vic - Universitat Central de Catalunya, Barcelona, Spain
- *Correspondence: Didac Mauricio,
| | - Albert Goday
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Deparment of Endocrinology & Nutrition, Hospital del Mar, IMIM Institut Mar d’Investigacions Mediques. Parc de Salut Mar, Barcelona, Spain
- CIBERobn, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Franco L, Bozzetto L, Angelis RD, Calabrese I, Cavagnuolo L, Gasparro T, Riccardi G, Rivellese AA, Annuzzi G. Beneficial effects on body weight of group vs individual care in adults with type 1 diabetes on advanced technologies. Health Sci Rep 2021; 4:e385. [PMID: 34622019 PMCID: PMC8485624 DOI: 10.1002/hsr2.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 11/08/2022] Open
Abstract
RATIONALE AND AIMS Outpatient group visits in diabetes care have several potential advantages and can be simplified by the new technologies. The aim of this study was to assess feasibility and effectiveness of group visits vs individual visits in adults with type 1 diabetes on insulin pump therapy (continuous subcutaneous insulin infusion, CSII) and continuous glucose monitoring (CGM). METHODS Outpatient setting for group visits (2-hour duration, quarterly, 6-8 patients) was the projection on giant screen of each patient's CGM and insulin pump data, with interactive discussion moderated by a diabetologist. Anthropometric measures and glycemic control (HbA1c) were assessed before and after a mean observation period of 4.4 ± 1.2 years (mean ± standard deviation, M ± SD) in CSII patients followed by group visits (GROUP) or individual visits (INDIVIDUAL) between 2013 and 2019. RESULTS At the beginning of the observation, GROUP and INDIVIDUAL cohorts were strictly matched for gender (M/F = 37/35 and 37/35), age, diabetes duration, body mass index (BMI), CSII duration, and HbA1c level. HbA1c levels did not change significantly between beginning and end of observation in either cohort (GROUP 7.54 ± 0.80% and 7.60 ± 0.79%, P = .585; INDIVIDUAL 7.73 ± 1.27% and 7.60 ± 1.08%, P = .281) (time*visit effect P = .232, two-way repeated measures analysis of variance [ANOVA]). Body weight remained unchanged in the GROUP cohort (73.2 ± 14.0 vs 73.8 ± 14.8 kg, P = .361), while it increased in the INDIVIDUAL cohort (70.3 ± 13.5 vs 73.0 ± 13.7 kg, P < 0.001) (time*visit effect P = .009). CONCLUSIONS Group care is feasible in adult patients with type 1 diabetes using new technologies. Group visits can be beneficial in inducing lifestyle changes, as indicated by the favorable effects observed on body weight trend.
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Affiliation(s)
- Luca Franco
- Department of Clinical Medicine and Surgery Federico II University Naples Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery Federico II University Naples Italy
| | - Raffaele De Angelis
- Department of Clinical Medicine and Surgery Federico II University Naples Italy
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery Federico II University Naples Italy
| | - Luisa Cavagnuolo
- Department of Clinical Medicine and Surgery Federico II University Naples Italy
| | - Tiziana Gasparro
- Department of Clinical Medicine and Surgery Federico II University Naples Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery Federico II University Naples Italy
| | | | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery Federico II University Naples Italy
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Van der Schueren B, Ellis D, Faradji RN, Al-Ozairi E, Rosen J, Mathieu C. Obesity in people living with type 1 diabetes. Lancet Diabetes Endocrinol 2021; 9:776-785. [PMID: 34600607 DOI: 10.1016/s2213-8587(21)00246-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023]
Abstract
Although type 1 diabetes is traditionally considered a disease of lean people, overweight and obesity are becoming increasingly more common in individuals with type 1 diabetes. Non-physiological insulin replacement that causes peripheral hyperinsulinaemia, insulin profiles that do not match basal and mealtime insulin needs, defensive snacking to avoid hypoglycaemia, or a combination of these, are believed to affect body composition and drive excessive accumulation of body fat in people with type 1 diabetes. The consequences of overweight or obesity in people with type 1 diabetes are of particular concern, as they increase the risk of both diabetes-related and obesity-related complications, including cardiovascular disease, stroke, and various types of cancer. In this Review, we summarise the current understanding of the aetiology and consequences of excessive bodyweight in people with type 1 diabetes and highlight the need to optimise future prevention and treatment strategies in this population.
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Affiliation(s)
- Bart Van der Schueren
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Clinical and Experimental Endocrinology, University of Leuven, Leuven, Belgium.
| | - Darcy Ellis
- Laboratory of Clinical and Experimental Endocrinology, University of Leuven, Leuven, Belgium
| | - Raquel N Faradji
- Endocrinology and Diabetes, Clinica EnDi, Mexico City, Mexico; Centro Medico ABC, Mexico City, Mexico
| | - Eeba Al-Ozairi
- Department of Clinical Research and Clinical Trials, Dasman Diabetes Institute, Dasman, Kuwait
| | | | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Clinical and Experimental Endocrinology, University of Leuven, Leuven, Belgium
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Smigoc Schweiger D, Battelino T, Groselj U. Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes. Int J Mol Sci 2021; 22:ijms221910192. [PMID: 34638531 PMCID: PMC8508122 DOI: 10.3390/ijms221910192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.
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Affiliation(s)
- Darja Smigoc Schweiger
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Urh Groselj
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
- Department of Cardiovascular Medicine, School of Medicine, Stanford University, 870 Quarry Road, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +386-1-522-9235; Fax: +386-1-232-0190
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22
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Lee YJ, Yoo S, Yi S, Kim S, Lee C, Cho J, Ahn S, Choi S, Hwang H, Lee YA, Shin CH, Yoon HJ, Kim K, Song E, Choi JH, Yoo HW, Kim YH, Oh JS, Kang EA, Baek GK, Kim JH. Trajectories in glycated hemoglobin and body mass index in children and adolescents with diabetes using the common data model. Sci Rep 2021; 11:14614. [PMID: 34272437 PMCID: PMC8285411 DOI: 10.1038/s41598-021-94194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/07/2021] [Indexed: 01/17/2023] Open
Abstract
We evaluated trajectories of glycated hemoglobin (HbA1c) levels and body mass index z-scores (BMIz) for 5 years after diagnosis among Korean children and adolescents with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the common data model. From the de-identified database of three hospitals, 889 patients < 15 years of age diagnosed with T1D or T2D (393 boys, 664 T1D patients) were enrolled. Diagnosis was defined as first exposure to antidiabetic drug at each center. Compared with T2D patients, T1D patients had lower BMIz at diagnosis (- 0.4 ± 1.2 vs. 1.5 ± 1.4, p < 0.001) and 3 months (- 0.1 ± 1.0 vs. 1.5 ± 1.5, p < 0.001), and higher HbA1c levels at diagnosis (10.0 ± 2.6% vs. 9.5 ± 2.7%, p < 0.01). After 3 months, HbA1c levels reached a nadir of 7.6% and 6.5% in T1D and T2D patients, respectively, followed by progressive increases; only 10.4% of T1D and 29.7% of T2D patients achieved the recommended HbA1c target (< 7.0%) at 60 months. T1D patients showed consistent increases in BMIz; T2D patients showed no significant change in BMIz during follow-up. Peri-pubertal girls with T1D had higher HbA1c and BMIz values. Achieving optimal glycemic control and preventing obesity should be emphasized in pediatric diabetes care.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Soyoung Yi
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Seok Kim
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Chunggak Lee
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Jihoon Cho
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Sunkyu Choi
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.,Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Jin Yoon
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Korea.,Department of Data Science Research, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Eunhye Song
- Department of Data Science Research, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jin Ho Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Wook Yoo
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hak Kim
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Health Innovation Big Data Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ji Seon Oh
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Ae Kang
- Health Innovation Big Data Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ga Kyoung Baek
- Health Innovation Big Data Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. .,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.
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23
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Tommerdahl KL, Baumgartner K, Schäfer M, Bjornstad P, Melena I, Hegemann S, Baumgartner AD, Pyle L, Cree-Green M, Truong U, Browne L, Regensteiner JG, Reusch JEB, Nadeau KJ. Impact of Obesity on Measures of Cardiovascular and Kidney Health in Youth With Type 1 Diabetes as Compared With Youth With Type 2 Diabetes. Diabetes Care 2021; 44:795-803. [PMID: 33402367 PMCID: PMC7896261 DOI: 10.2337/dc20-1879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin resistance and obesity are independently associated with type 1 diabetes (T1D) and are known risk factors for cardiovascular and kidney diseases, the leading causes of death in T1D. We evaluated the effect of BMI on cardiovascular and kidney outcomes in youth with T1D versus control youth with normal weight or obesity and youth with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Pubertal youth (n = 284) aged 12-21 years underwent assessments of resting heart rate (RHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), leptin, hs-CRP, adiponectin, ratio of urine albumin to creatinine, and estimated glomerular filtration rate. Participants with T1D underwent bicycle ergometry for VO2peak, monitoring for peripheral brachial artery distensibility (BAD), endothelial function testing for reactive hyperemic index, and aortic MRI for central arterial stiffness or shear. RESULTS In adolescents with T1D, RHR, SBP, DBP, mean arterial pressure, leptin, hs-CRP, and hypertension prevalence were significantly higher, and BAD, descending aorta pulse wave velocity, and VO2peak lower with an obese versus normal BMI. Although hypertension prevalence and RHR were highest in obese adolescents with T1D and adiponectin lowest in youth with T2D, other measures were similar between obese adolescents with T1D and those with T2D. CONCLUSIONS Obesity, now increasingly prevalent in people with T1D, correlates with a less favorable cardiovascular and kidney risk profile, nearly approximating the phenotype of youth with T2D. Focused lifestyle management in youth-onset T1D is critically needed to reduce cardiovascular risk.
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Affiliation(s)
- Kalie L Tommerdahl
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO.,Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Karl Baumgartner
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Michal Schäfer
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Pediatrics, Section of Cardiology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Petter Bjornstad
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Isabella Melena
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shannon Hegemann
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy D Baumgartner
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Melanie Cree-Green
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Uyen Truong
- Department of Pediatrics, Section of Cardiology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Pediatrics, Section of Cardiology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Lorna Browne
- Department of Pediatrics, Section of Radiology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Judith G Regensteiner
- Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Divisions of General Internal Medicine and Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jane E B Reusch
- Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.,Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO
| | - Kristen J Nadeau
- Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO .,Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
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24
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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25
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March CA, Becker DJ, Libman IM. Nutrition and Obesity in the Pathogenesis of Youth-Onset Type 1 Diabetes and Its Complications. Front Endocrinol (Lausanne) 2021; 12:622901. [PMID: 33828529 PMCID: PMC8021094 DOI: 10.3389/fendo.2021.622901] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Abstract
Since the 1980s, there has been a dramatic rise in the prevalence of overweight and obesity in pediatric populations, in large part driven by sedentary lifestyles and changing dietary patterns with more processed foods. In parallel with the rise in pediatric obesity in the general population, the prevalence of overweight and obesity has increased among children and adolescents with type 1 diabetes. Adiposity has been implicated in a variety of mechanisms both potentiating the risk for type 1 diabetes as well as exacerbating long-term complications, particularly cardiovascular disease. Treatment options targeting the unique needs of obese pediatric patients, both before and after diagnosis of type 1 diabetes, are limited. In this review, we discuss the history of the epidemiology of the obesity epidemic in the context of pediatric type 1 diabetes, highlight the possible role of obesity in type 1 diabetes pathogenesis and review the concept of "double diabetes". The impact of obesity at and after diagnosis will be discussed, including noted differences in clinical and biochemical markers, lipid abnormalities, and long-term cardiovascular complications. Finally, we will review the existing literature on pharmacologic and nutritional interventions as potential treatment strategies for youth with coexisting type 1 diabetes and obesity.
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26
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Siller AF, Tosur M, Relan S, Astudillo M, McKay S, Dabelea D, Redondo MJ. Challenges in the diagnosis of diabetes type in pediatrics. Pediatr Diabetes 2020; 21:1064-1073. [PMID: 32562358 DOI: 10.1111/pedi.13070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/07/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
The incidence of diabetes, both type 1 and type 2, is increasing. Health outcomes in pediatric diabetes are currently poor, with trends indicating that they are worsening. Minority racial/ethnic groups are disproportionately affected by suboptimal glucose control and have a higher risk of acute and chronic complications of diabetes. Correct clinical management starts with timely and accurate classification of diabetes, but in children this is becoming increasingly challenging due to high prevalence of obesity and shifting demographic composition. The growing obesity epidemic complicates classification by obesity's effects on diabetes. Since the prevalence and clinical characteristics of diabetes vary among racial/ethnic groups, migration between countries leads to changes in the distribution of diabetes types in a certain geographical area, challenging the clinician's ability to classify diabetes. These challenges must be addressed to correctly classify diabetes and establish an appropriate treatment strategy early in the course of disease for all. This may be the first step in improving diabetes outcomes across racial/ethnic groups. This review will discuss the pitfalls in the current diabetes classification scheme that is leading to increasing overlap between diabetes types and heterogeneity within each type. It will also present proposed alternative classification schemes and approaches to understanding diabetes type that may improve the timely and accurate classification of pediatric diabetes type.
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Affiliation(s)
- Alejandro F Siller
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Mustafa Tosur
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Shilpi Relan
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Marcela Astudillo
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Siripoom McKay
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maria J Redondo
- Diabetes and Endocrinology Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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27
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Redondo MJ, Siller AF, Gu X, Tosur M, Bondy M, Devaraj S, Sisley S. Sex differences in circulating leptin as a marker of adiposity in obese or overweight adolescents with type 1 diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001683. [PMID: 33087341 PMCID: PMC7580039 DOI: 10.1136/bmjdrc-2020-001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION We aimed to test whether the serum adipokines leptin and adiponectin are more strongly associated with body fat percentage (BF%) than body mass index (BMI) in adolescents with type 1 diabetes (T1D) and overweight/obesity. RESEARCH DESIGN AND METHODS We studied all participants in the T1D Exchange Metformin Study (n=122, median age 12.9 years, range 12-19.5; 32% males; 77% non-Hispanic whites, 100% overweight or obesity; median diabetes duration 6.7 years, range 1.4-15) with a baseline serum sample where we measured leptin and adiponectin concentrations. Anthropometric, clinical, laboratory and dual-energy X-ray absorptiometry (DEXA) scan measurements were analyzed. We compared correlation coefficients between variables of interest. RESULTS BF% by DEXA was significantly correlated with BMI Z-score (r=0.38, p<0.0001), BMI per cent of the 95th percentile (BMI%95) (r=0.45, p<0.0001), waist circumference (r=0.46, p<0.0001), leptin (r=0.58, p<0.00001) and leptin/adiponectin ratio (r=0.36, p<0.0001), while it was not significantly correlated with absolute body weight, adiponectin or insulin dose (total or basal). BF% was significantly more strongly correlated with leptin than with BMI Z-score in the overall group (p=0.022). However, there were sex-based differences. Among the significant correlations in the overall group, BF% was most strongly associated with leptin (r=0.75) in boys (n=39) but with waist circumference (r=0.58) in girls (n=83) (all p<0.0001). CONCLUSIONS Serum leptin could be used as a surrogate convenient marker of adiposity in overweight/obese adolescent boys with T1D, equivalent to BMI Z-score or BMI%95. In girls, waist circumference was the best performing marker overall, and was also strongly correlated with %BF in boys.
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Affiliation(s)
- Maria J Redondo
- Texas Children's Hospital, Diabetes and Endocrinology Section, Baylor College of Medicine, Houston, Texas, USA
| | - Alejandro F Siller
- Texas Children's Hospital, Diabetes and Endocrinology Section, Baylor College of Medicine, Houston, Texas, USA
| | - Xiangjun Gu
- Epidemiology and Population Science Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mustafa Tosur
- Texas Children's Hospital, Diabetes and Endocrinology Section, Baylor College of Medicine, Houston, Texas, USA
| | - Melissa Bondy
- Epidemiology and Population Health, Stanford Cancer Institute, Stanford, California, USA
| | - Sridevi Devaraj
- Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Stephanie Sisley
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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28
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Nwosu BU, Yeasmin S, Ayyoub S, Rupendu S, Villalobos-Ortiz TR, Jasmin G, Parajuli S, Zahedi B, Zitek-Morrison E, Alonso LC, Barton BA. Continuous glucose monitoring reduces pubertal hyperglycemia of type 1 diabetes. J Pediatr Endocrinol Metab 2020; 33:865-872. [PMID: 32634109 PMCID: PMC9064487 DOI: 10.1515/jpem-2020-0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/08/2020] [Indexed: 11/15/2022]
Abstract
Background Physiologic hyperglycemia of puberty is a major contributor to poor glycemic control in youth with type 1 diabetes (T1D). This study's aim was to determine the effectiveness of continuous glucose monitoring (CGM) to improve glycemic control in pubertal youth with T1D compared to a non-CGM cohort after controlling for age, sex, BMI, duration, and insulin delivery methodology. The hypothesis is that consistent CGM use in puberty improves compliance with diabetes management, leading to increased percentage (%) time in range (TIR70-180 mg/dL) of glycemia, and lowering of HbA1c. Methods A longitudinal, retrospective, case-controlled study of 105 subjects consisting of 51 T1D controls (60.8% male) age 11.5 ± 3.8 y; and 54 T1D subjects (48.1% male) age 11.1 ± 5.0 y with confirmed CGM use for 12 months. Pubertal status was determined by Tanner staging. Results were adjusted for baseline HbA1c and diabetes duration. Results HbA1c was similar between the controls and the CGM group at baseline: 8.2 ± 1.1% vs 8.3 ± 1.2%, p=0.48 respectively; but was significantly lower in the CGM group 12 months later, 8.2 ± 1.1% vs. 8.7 ± 1.4%, p=0.035. Longitudinal change in HbA1c was similar in the prepubertal cohort between the control- and CGM groups: -0.17 ± 0.98% vs. 0.38 ± 1.5%, p=0.17. In contrast, HbA1c increased with advancing age and pubertal status in the pubertal controls but not in the pubertal CGM group: 0.55 ± 1.4 vs -0.22 ± 1.1%, p=0.020. Percent TIR was inversely related to HbA1c in the CGM group, r=-0.6, p=0.0004, for both prepubertal and pubertal subjects. Conclusions CGM use significantly improved glycemic control in pubertal youth with T1D compared to non-CGM users.
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Affiliation(s)
- Benjamin Udoka Nwosu
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shamima Yeasmin
- Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sanaa Ayyoub
- Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shwetha Rupendu
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tony R Villalobos-Ortiz
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gabrielle Jasmin
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sadichchha Parajuli
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bita Zahedi
- Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Emily Zitek-Morrison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Laura C Alonso
- Weill Cornell Division of Endocrinology, Diabetes and Metabolism, New York, NY USA
| | - Bruce A Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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29
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Kim G, DeSalvo D, Guffey D, Minard CG, Cephus C, Moodie D, Lyons S. Dyslipidemia in adolescents and young adults with type 1 and type 2 diabetes: a retrospective analysis. Int J Pediatr Endocrinol 2020; 2020:11. [PMID: 32536946 PMCID: PMC7288506 DOI: 10.1186/s13633-020-00081-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022]
Abstract
Background Youth onset type 1 diabetes (T1D) and type 2 diabetes (T2D) is increasing and associated with earlier vascular complications and mortality. Dyslipidemia is an important modifiable cardiovascular (CVD) risk factor that is under-recognized and undertreated in youth with T1D and T2D. Given this, we evaluated the prevalence and associations between lipid concentrations and clinical CVD risk factors in youth with T1D compared to T2D at our large ethnically diverse diabetes center. Methods A retrospective chart review was performed, evaluating patients with T1D or T2D seen at least once in clinic from 2015 to 2017, age 10–22 years of age, duration of diabetes at least 6 months on the date of most recent LDL-cholesterol (LDL-C) concentration, and not on statin therapy. We performed independent and multivariable linear regressions of LDL-C and HDL-cholesterol (HDL-C) concentrations. Results There were 32.7% with T1D (n = 1701) and 47.7% with T2D (n = 298) with LDL-C above recommend goal (> 100 mg/dL/2.6 mmol/L). Furthermore, there were 9% with T1D and 16.4% with T2D with LDL > 130 mg/dL (> 3.4 mmol/L), who likely met criteria for starting statin therapy. Higher LDL-C and/or lower HDL-C were associated with increased age, diabetes duration, higher HbA1C, female sex, Hispanic ethnicity, obesity, and T2D. After adjusting for these risk factors in a multivariable linear regression model, the association of higher LDL-C and lower HDL-C was higher with T2D than T1D. Conclusions This highlights the need for more aggressive dyslipidemia screening and treatment in youth with diabetes, especially T2D. At our institution we have created and instituted quality improvement algorithms to try to address this need.
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Affiliation(s)
- Grace Kim
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
| | - Daniel DeSalvo
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030 USA
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030 USA
| | - Constance Cephus
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
| | - Douglas Moodie
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
| | - Sarah Lyons
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030 USA
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30
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Phelan H, Foster NC, Schwandt A, Couper JJ, Willi S, Kroschwald P, Jones TW, Wu M, Steigleder-Schweiger C, Craig ME, Maahs DM, Prinz N. Longitudinal trajectories of BMI z-score: an international comparison of 11,513 Australian, American and German/Austrian/Luxembourgian youth with type 1 diabetes. Pediatr Obes 2020; 15:e12582. [PMID: 31691541 DOI: 10.1111/ijpo.12582] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND BMI fluctuations during puberty are common. Data on individual change in BMI from childhood to young adulthood are limited in youth with type 1 diabetes. OBJECTIVES To compare longitudinal trajectories of body mass index z score (BMIz) from childhood to adolescence across three registries spanning five countries. METHODS Data sources: T1DX (USA), DPV (Germany/Austria/Luxembourg) and ADDN (Australia). The analysis included 11,513 youth with type 1 diabetes, duration >1 year, at least one BMI measure at baseline (age 8-10 years) and >5 aggregated BMI measures by year of age during follow-up until age 17 years. BMIz was calculated based on WHO charts. Latent class growth modelling was used to identify subgroups following a similar trajectory of BMIz over time. RESULTS Five distinct trajectories of BMIz were present in the T1DX and ADDN cohorts, while six trajectories were identified in the DPV cohort. Boys followed more often a low/near-normal pattern while elevated BMIz curves were more likely in girls (ADDN; DPV). For T1DX cohort, no sex differences were observed. Comparing the reference group (BMIz ~0) with the other groups during puberty, higher BMIz was significantly associated with older age at T1D onset, racial/ethnic minority and elevated HbA1c (all p<0.05). CONCLUSION This multinational study presents unique BMIz trajectories in youth with T1D across three continents. The prevalence of overweight and the longitudinal persistence of overweight support the need for close monitoring of weight and nutrition in this population. The international and individual differences likely result from diverse genetic, environmental and therapeutic factors.
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Affiliation(s)
- Helen Phelan
- John Hunter Children's Hospital, Newcastle, Australia.,University of Sydney, Sydney, Australia
| | | | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-, Neuherberg, Germany
| | - Jennifer J Couper
- Women's and Children's Hospital, Adelaide, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Steven Willi
- Diabetes Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter Kroschwald
- Department of Pediatrics and Adolescent Medicine, Ruppiner Clinics, Neuruppin, Germany
| | - Timothy W Jones
- Department of Diabetes and Endocrinology, Princess Margaret Hospital and Telethon Kids Institute, Perth, Australia
| | - Mengdi Wu
- JAEB Centre for Health Research, Tampa, Florida, USA
| | | | - Maria E Craig
- Children's Hospital at Westmead, Sydney, Australia.,University of New South Wales, Sydney, Australia.,Charles Perkins Centre Westmead, University of Sydney, Australia
| | - David M Maahs
- Lucile Salter Packard Children's Hospital and Stanford University Medical Center, Palo Alto, California, USA.,Stanford University, Stanford, California, USA
| | - Nicole Prinz
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-, Neuherberg, Germany
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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32
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Abstract
Diabetes mellitus is becoming more prevalent and even with new advancements which improve glycaemic control, complications of diabetes are common. Vascular complications of diabetes include the microvascular complications: retinopathy, nephropathy, and peripheral and autonomic neuropathy. Macrovascular complications are also common in patients with diabetes and arguably more concerning as they confer a high mortality risk yet are sometimes under-treated. Risk factors for diabetes complications start to occur in childhood and adolescents and some youths may be diagnosed with complications before transition to adult care. This article discusses the prevalence, risk factors, screening, and treatment recommendations for vascular complications in children and adolescents with diabetes.
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Affiliation(s)
- Lara E. Graves
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
- *Correspondence: Lara E. Graves
| | - Kim C. Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, Children's Hospital at Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
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33
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Abstract
The purpose of this study was twofold: to examine predictors of disordered eating behaviours and body image dissatisfaction, including social networking, among type 1 diabetes population, and to qualitatively explore the relationship between type 1 diabetes management and body image. A convenience sample of 121 type 1 diabetes patients (F = 106; Mage = 36 ± 6.5) was collected via online questionnaires, of which 98 patients responded to two open-ended questions. Young age and negative body image explained 58.8 per cent of disordered eating variance, while body weight and social networking negatively contributed to poor body image (29.9%). Qualitative analysis revealed three themes: no control over body weight, limitation in clothing options and discomfort towards medical equipment.
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Affiliation(s)
- Irini L Verbist
- University of Nottingham, UK.,Greater Manchester Mental Health NHS Foundation Trust, UK
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34
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Marlow AL, Rowe CW, Anderson D, Wynne K, King BR, Howley P, Smart CE. Young children, adolescent girls and women with type 1 diabetes are more overweight and obese than reference populations, and this is associated with increased cardiovascular risk factors. Diabet Med 2019; 36:1487-1493. [PMID: 31505060 DOI: 10.1111/dme.14133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
Abstract
AIM Overweight and obesity are frequently reported in young persons with type 1 diabetes, however its relative magnitude in comparison to the general population is not well understood. This study compared the prevalence of overweight and obesity in young persons with type 1 diabetes to a reference population and explored possible associated factors, including gender, age, HbA1c , insulin regimen, age at diagnosis, diabetes duration, socio-economic status and cardiovascular disease risk factors. METHODS A cross-sectional review was undertaken of data collected from youth (3-17 years) in 2016 and young adults (18-30 years) in 2015 with a diagnosis of type 1 diabetes for > 3 months attending diabetes centres in Newcastle, Australia. Rates of overweight and obesity were compared with matched population survey results. RESULTS Data from 308 youth and 283 young adults were included. In girls, significantly higher prevalence of overweight and obesity were seen in the 5-8 (43% vs. 18%), 13-16 (41% vs. 27%), 18-24 (46% vs. 34%) and 25-30 (60% vs. 43%) years age groups; whereas in boys increased prevalence was observed in the 5-8 years age group only (41% vs. 18%). Rates of overweight and obesity increased with age across sexes. In youth, BMI standard deviation score was correlated with socio-economic status, insulin regimen, blood pressure and blood lipids (P < 0.05). In adults, BMI was positively associated with blood pressure, and longer diabetes duration (P < 0.02). CONCLUSIONS Overweight and obesity are over-represented in young persons with type 1 diabetes, particularly girls. As overweight is associated with other cardiovascular disease markers early intervention is paramount.
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Affiliation(s)
- A L Marlow
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - C W Rowe
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Department of Diabetes and Endocrinology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - D Anderson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
| | - K Wynne
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Department of Diabetes and Endocrinology, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - B R King
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
| | - P Howley
- School of Mathematics and Physical Sciences/Statistics, University of Newcastle, Callaghan, Australia
| | - C E Smart
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
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35
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Alderisio A, Bozzetto L, Franco L, Riccardi G, Rivellese AA, Annuzzi G. Long-term body weight trajectories and metabolic control in type 1 diabetes patients on insulin pump or multiple daily injections: A 10-year retrospective controlled study. Nutr Metab Cardiovasc Dis 2019; 29:1110-1117. [PMID: 31371264 DOI: 10.1016/j.numecd.2019.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Overweight/obesity is a clinical concern also in patients with Type 1 diabetes (T1DM). These patients' body weight may vary depending on whether treatment consists in continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI), as these treatments lead to different blood glucose control, insulin doses, and eating behaviors. We compared long-term body weight trajectories in persons with diabetes on CSII or MDI regimens. METHODS AND RESULTS Annual changes in body weight, HbA1c, and daily insulin doses over 6-10 years were retrospectively analyzed in T1DM adult patients on CSII (n = 90) or MDI (n = 90), strictly matched for sex, age, BMI, and diabetes duration. Mean follow-up was 9.1 ± 1.4 years. Body weight increased linearly (∼0.5 kg per year) throughout the observation period (p = 0.001, repeated measures ANOVA) with no significant difference between the CSII and MDI cohorts (p = 0.74), in either normal-weight or overweight/obese patients. HbA1c over follow-up was lower with CSII than with MDI (p = 0.037), maintaining the initial reduction after starting pump therapy. Insulin doses over follow-up were stably lower than baseline (∼20%) with CSII, while linearly increasing (∼20% from baseline to the end of observation) with MDI (p = 0.002). Mean annual weight changes correlated directly with total insulin dose changes (r = 0.191; p = 0.011) and baseline HbA1c level (r = 0.267; p = 0.001), and inversely with HbA1c changes (-0.173; p = 0.021) and baseline age (r = -0.254; p = 0.001). CONCLUSION T1DM patients on CSII or MDI showed comparable body weight gain over a 10-year follow-up, despite improved glycemic control and decreased insulin doses with CSII.
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Affiliation(s)
- Antonio Alderisio
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luca Franco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
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36
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Kosteria I, Schwandt A, Davis E, Jali S, Prieto M, Rottembourg D. Lipid profile is associated with treatment regimen in a large cohort of children and adolescents with Type 1 diabetes mellitus: a study from the international SWEET database. Diabet Med 2019; 36:1294-1303. [PMID: 30972800 DOI: 10.1111/dme.13963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
AIMS To examine the effect of pump vs injection therapy on the lipid profile of children with Type 1 diabetes mellitus. METHODS A cross-sectional analysis of the lipid profile of children aged ≤ 18 years with Type 1 diabetes mellitus from SWEET, an international diabetes registry, was conducted with a focus on the effect of treatment regimen. Dyslipidaemia was defined as LDL cholesterol ≥2.6 mmol/l or non-HDL cholesterol ≥3.1 mmol/l. LDL and non-HDL cholesterol values among 14 290 children (52% boys, 51% receiving pump therapy) from 60 SWEET centres were analysed by linear and logistic regression analysis adjusted for sex, age, diabetes duration, HbA1c and BMI-standard deviation score group, region, and common interactions between age, sex, HbA1c and BMI. RESULTS This study confirmed the established associations of increased lipids with female sex, age, diabetes duration, HbA1c and BMI. LDL and non-HDL cholesterol levels were lower in the pump therapy group compared to the injection therapy group [LDL cholesterol: injection therapy 2.44 mmol/l (95% CI 2.42 to 2.46) vs pump therapy 2.39 mmol/l (95% CI 2.37-2.41), P<0.001; non-HDL cholesterol: injection therapy 2.88 mmol/l (95% CI 2.86 to 2.90) vs pump therapy 2.80 mmol/l (95% CI 2.78-2.82), both P<0.0001]. Similarly, the odds ratios for LDL cholesterol ≥2.6 mmol/l [0.89 (95% CI 0.82-0.97)] and non-HDL cholesterol ≥3.1 mmol/l [0.85 (0.78 to 0.93)] were significantly lower in the pump therapy group, even after all adjustments. CONCLUSIONS Our results indicate that pump therapy is associated with a better lipid profile.
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Affiliation(s)
- I Kosteria
- Diabetes Centre, Division of Endocrinology, Diabetes and Metabolism, First Department of Paediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - A Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | - E Davis
- Centre for Child Health Research, Telethon Kids Institute, University of Western, Perth, Australia
| | - S Jali
- J. N. Medical College (KAHER) and the KLE Diabetes Centre, KLES Dr Prabhakar Kore Hospital, Belgaum, India
| | - M Prieto
- Hospital de Pediatria Garrahan, Buenos Aires, Argentina
| | - D Rottembourg
- Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
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37
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Sevaliev N, Strich D, Avnon-Ziv C, Levy-Khademi F. The metabolic consequences of overweight in a cohort of children with type 1 diabetes. J Pediatr Endocrinol Metab 2019; 32:715-719. [PMID: 31150359 DOI: 10.1515/jpem-2018-0483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/14/2019] [Indexed: 02/03/2023]
Abstract
Objective To estimate the prevalence of overweight and obesity among a cohort of children with type 1 diabetes mellitus (T1DM) and its metabolic consequences. Methods This was a cross-sectional study conducted in the Pediatric Diabetic Clinic at Shaare Zedek Medical Center and Clalit Health Care Services. Background information was taken from the patients' files. Anthropometric measures, blood pressure, waist and hip circumference (WC and HC), hemoglobin A1c (HbA1c) and lipid profile were recorded. The prevalence of metabolic derangements was compared between normal and overweight children. Results The study included 96 patients with type 1 diabetes, mean age 14.1 ± 3.7 years, mean diabetes duration 3.9 ± 3 and mean HbA1c level 8.1 ± 1.4% (65 mmol/mol). Thirty-seven percent of the study population were overweight and of them 11.5% were obese. In the overweight group, the high-density lipoprotein (HDL) levels were significantly lower and systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were higher compared with normal weight participants. Multivariate analysis showed that BMI and age at study affected SBP and HDL levels, while age at study and HbA1c levels affected DBP. Female patients were significantly overweight compared to males and had higher low-density lipoprotein (LDL) and cholesterol levels. Waist-to-hip ratio, an indicator of central obesity, was abnormally high among overweight males and females. Conclusions In our cohort of children with type 1 diabetes, there were a significant number of overweight children, with a higher prevalence in females. Components of metabolic syndrome were more prevalent among overweight and obese diabetic individuals.
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Affiliation(s)
| | - David Strich
- Diabetes Clinic at Clalit Health Organization, Jerusalem, Israel
| | - Carmit Avnon-Ziv
- Division of Pediatric Endocrinology, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem Israel
| | - Floris Levy-Khademi
- Division of Pediatric Endocrinology, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem Israel
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38
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Pettus JH, Kushner JA, Valentine V, Wood R, Pang C, Paranjape S, Berria R, Deluzio A, Edelman SE. Adjunct Therapy in Type 1 Diabetes: A Survey to Uncover Unmet Needs and Patient Preferences Beyond HbA1c Measures. Diabetes Technol Ther 2019; 21:336-343. [PMID: 31095422 PMCID: PMC6551969 DOI: 10.1089/dia.2019.0027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Adjunct therapy can help patients with type 1 diabetes achieve glycemic goals while potentially mitigating some of the side effects of insulin. In this study, we used a patient survey to identify the unmet needs in type 1 diabetes therapy, patient views of treatment benefit-risk trade-offs, and patient preferences for the use of an adjunct therapy. Methods: A quantitative survey was sent to 2084 adults with type 1 diabetes in November 2017. "Jobs-to-be-done" and conjoint analyses were performed on survey responses to identify unmet needs and the importance of treatment-associated benefits and risks to patients. A 5-point Likert scale measured the importance and satisfaction with patients' current therapy, and with gaps relating to unmet needs. In the conjoint analysis, patients were asked to choose between "packages" of attributes of two doses of adjunct therapy (200 and 400 mg) and placebo, based on established benefits and side effects. Results: A total of 1313 patients (63%) responded. The greatest unmet needs identified were simplifying treatment, lowering/maintaining glycated hemoglobin (HbA1c), reducing mental effort, and increasing time in range (TIR). Conjoint analysis showed that reductions in body weight and TIR had the highest attribute importance (25% and 18%, respectively). The majority (93%) of patients had a preference for the adjunct therapy (either dose) over placebo. Conclusions: This survey highlights the importance of measures beyond HbA1c, such as treatment simplification and TIR, and patient preference for adjunct therapies that help address unmet needs in type 1 diabetes treatment.
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Affiliation(s)
- Jeremy H. Pettus
- University of California San Diego, La Jolla, California
- Address correspondence to: Jeremy H. Pettus, MD, University of California San Diego, 9500 Gilman Drive #9111-G, La Jolla, CA 92093
| | | | | | - Richard Wood
- dQ&A–The Diabetes Research Company, San Francisco, California
| | | | | | | | | | - Steven E. Edelman
- Veterans Affairs Medical Center, University of California San Diego, San Diego, California
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39
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Stankute I, Dobrovolskiene R, Danyte E, Razanskaite-Virbickiene D, Jasinskiene E, Mockeviciene G, Marciulionyte D, Schwitzgebel VM, Verkauskiene R. Factors Affecting Cardiovascular Risk in Children, Adolescents, and Young Adults with Type 1 Diabetes. J Diabetes Res 2019; 2019:9134280. [PMID: 31223626 PMCID: PMC6541948 DOI: 10.1155/2019/9134280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 03/25/2019] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular risk and obesity are becoming major health issues among individuals with type 1 diabetes (T1D). The aim of this study was to evaluate cardiovascular risk factors and obesity in youth with T1D in Lithuania. Methods. 883 patients under 25 years of age with T1D for at least 6 months were investigated. Anthropometric parameters, blood pressure, and microvascular complications were evaluated, and the lipid profile and HbA1c were determined for all patients. Results. Study subjects' mean HbA1c was 8.5 ± 2%; 19.5% were overweight and 3.6% obese. Hypertension and dyslipidemia were diagnosed in 29.8% and 62.6% of participants, respectively. HbA1c concentration was directly related to levels of total cholesterol (r = 0.274, p < 0.001), LDL (r = 0.271, p < 0.001), and triglycerides (r = 0.407, p < 0.001) and inversely associated with levels of HDL (r = 0.117, p = 0.001). Prevalence of dyslipidemia increased with duration of diabetes (p < 0.05). Hypertension was more prevalent in overweight and obese compared to normal-weight patients (40.6 and 65.6 vs. 25.6%, respectively, p < 0.001). Frequency of microvascular complications was higher among patients with dyslipidemia (27.2 vs. 18.8%, p = 0.005) and among those with hypertension (25.9 vs. 23.2%, p < 0.001). Conclusion. The frequency of cardiovascular risk factors is high in youth with T1D and associated with diabetes duration, obesity, and metabolic control.
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Affiliation(s)
- Ingrida Stankute
- Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Evalda Danyte
- Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Edita Jasinskiene
- Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Giedre Mockeviciene
- Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Marciulionyte
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Valerie M. Schwitzgebel
- Pediatric Endocrine and Diabetes Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, 1211 Geneva, Switzerland
- Diabetes Center of the Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Rasa Verkauskiene
- Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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40
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Jaja T, Yarhere I. Dyslipidaemia in Nigerian Children and Adolescents with Diabetes Mellitus: Prevalence and Associated Risk Factors. Dubai Diabetes Endocrinol J 2019. [DOI: 10.1159/000499713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
<b><i>Background:</i></b> Dyslipidaemia is prevalent in children and adolescents with type 1 diabetes and can worsen the presentation of chronic complications such as nephropathy, retinopathy, and neuropathy. The aim of this study is to determine the frequency of dyslipidaemia in children living with diabetes followed up at a paediatric endocrine clinic in southern Nigeria and to identify associations with demographic and clinical characteristics. <b><i>Methods:</i></b> The study is a cross-sectional, descriptive study of 22 children with diabetes followed up in a tertiary health care facility in southern Nigeria. Demographic data were retrieved from case files, and fasting lipid profile and HbA<sub>1c</sub> levels were determined for all subjects. Lipid abnormalities were defined based on the Expert Panel on Integrated Guidelines for Cardiovascular Health Risk Reduction in Children and Adolescents. <b><i>Results:</i></b> Twenty-two subjects aged 7–18 years were studied (mean age: 14.94 ± 3.59 years). There were 12 (54.5%) females. Both genders were comparable regarding age (<i>p</i> = 0.95). Mean duration of diabetes was 3.37 ± 2.38 years. Prevalence of lipid abnormalities include: hypertriglyceridaemia (86.4%), hypercholesterolemia (22.7%), abnormal HDL-C (36.4%), high LDL-C (13.6%), and non-HDL-C (22.7%). Hypercholesterolaemia was significantly higher in females (<i>p</i> = 0.02), and prevalence of hypertriglyceridaemia was higher in subjects ≥12 years (<i>p</i> = 0.019). There was no statistically significant difference in mean levels of various lipids between males and females. Six (27.3%) subjects had more than one lipid abnormality. There was no statistically significant association of lipid abnormalities with age, sex, weight category, and HbA<sub>1c</sub> level. <b><i>Conclusion:</i></b> The commonest lipid abnormality was hypertriglyceridaemia. About a quarter of the subjects had more than 1 lipid abnormality. Programs should therefore be targeted at improved control of glycemia and lipid levels to delay and prevent chronic complications.
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41
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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42
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Birkebaek NH, Kahlert J, Bjarnason R, Drivvoll AK, Johansen A, Konradsdottir E, Pundziute-Lyckå A, Samuelsson U, Skrivarhaug T, Svensson J. Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA 1c and other predictors of increasing BMISDS. Pediatr Diabetes 2018; 19:1198-1205. [PMID: 29781227 DOI: 10.1111/pedi.12693] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/30/2018] [Accepted: 04/30/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Intensified insulin therapy may increase body weight and cause obesity. This study compared body mass index standard deviation score (BMISDS) and obesity rate in children with type 1 diabetes (T1D) in Denmark, Iceland, Norway and Sweden, and uncovered predictors for increasing BMISDS. METHODS Data registered in the Nordic national childhood diabetes databases during the period 2008-2012 on children below 15 years with T1D for more than 3 months were compiled, including information on gender, age, diabetes duration, hemoglobin A1c (HbA1c ), insulin dose, severe hypoglycemia (SH), treatment modality, height and weight. The Swedish reference chart for BMI was used for calculating BMISDS. RESULTS Totally, 11 025 children (48% females) (30 994 registrations) were included. Medians by the last recorded examination were: age, 13.5 years; diabetes duration, 4.3 years; HbA1c , 7.9% (63 mmol/mol); insulin dose, 0.8 IU/kg/d and BMISDS, 0.70. Obesity rate was 18.5%. Adjusted mean BMISDS (BMISDS adj) was inversely related to HbA1c and directly to diabetes duration. Higher BMISDS adj was found in those with an insulin dose above 0.6 IU/kg/d, and in girls above 10 years. Pump users had higher BMISDS adj than pen users, and patients with registered SH had higher BMISDS adj than patients without SH (both P < .001). CONCLUSION Obesity rate in children with T1D in the Nordic countries is high, however, with country differences. Low HbA1c , long diabetes duration, higher insulin dose, pump treatment and experiencing a SH predicted higher BMISDS. Diabetes caregivers should balance the risk of obesity and the benefit of a very low HbA1c.
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Affiliation(s)
- N H Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - J Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - R Bjarnason
- Landspitali University Hospital, and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - A K Drivvoll
- Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - A Johansen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - E Konradsdottir
- Landspitali University Hospital, and School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - U Samuelsson
- Department of Pediatrics, Linköbing University Hospital, Linköping, Sweden
| | - T Skrivarhaug
- Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - J Svensson
- Department of Paediatrics, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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43
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Addala A, Maahs DM. Can Real World Evidence on Body Mass Index Trajectories Inform Clinical Practice? J Pediatr 2018; 201:10-1. [PMID: 30025670 DOI: 10.1016/j.jpeds.2018.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/27/2018] [Indexed: 11/20/2022]
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44
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Mahmud FH, Elbarbary NS, Fröhlich-Reiterer E, Holl RW, Kordonouri O, Knip M, Simmons K, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19 Suppl 27:275-286. [PMID: 30066458 PMCID: PMC6748835 DOI: 10.1111/pedi.12740] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Farid H. Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | | | - Mikael Knip
- Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado
| | - Maria E. Craig
- The Children’s Hospital at Westmead, Westmead, NSW, Australia,Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia,School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
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Cho YH, Craig ME, Jopling T, Chan A, Donaghue KC. Higher body mass index predicts cardiac autonomic dysfunction: A longitudinal study in adolescent type 1 diabetes. Pediatr Diabetes 2018; 19:794-800. [PMID: 29383813 DOI: 10.1111/pedi.12642] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/04/2017] [Accepted: 12/25/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obesity is associated with an increased risk of cardiovascular morbidity in adults with diabetes. OBJECTIVE To examine the predictive role of body mass index (BMI) and adiposity on cardiac autonomic function in childhood onset type 1 diabetes. SUBJECTS Two hundred and fifty-three participants with type 1 diabetes (aged 8-30 years) were assessed for diabetes complications at a tertiary hospital, and followed over 7 years (total 922 visits). METHODS Heart rate variability (HRV) measures assessed by 10-minute electrocardiography recording using LabChart Pro were standard deviation of RR intervals, time between consecutive QRS complexes, [SDNN], root mean squared difference of successive RR intervals (RMSSD), triangular index (TI), and low to high frequency ratio [LF:HF]. Multivariable generalized estimating equations were used to model the longitudinal associations between HRV measures and clinical variables (BMI standard deviation scores [SDS], waist:height ratio, total daily insulin dose/kg (TDD) and hemoglobin A1c [HbA1c]). RESULTS At baseline, mean age was 14.4 ± 2.7 years, diabetes duration 7.1 ± 3.7 years, HbA1c 8.3% ± 1.5% (67 ± 16 mmol/mol), and 33% were overweight/obese (BMI ≥85th percentile). At final visit, mean age was 18.5 ± 2.7 years, duration 11.3 ± 3.9 years, HbA1c 9.0% ± 1.8% (75 ± 20 mmol/mol), and 40% were overweight/obese. Adiposity (higher BMI SDS or waist: height ratio) was a significant predictor of worse HRV (lower SDNN, RMSSD; P < .05), while higher HbA1c and TDD predicted all adverse HRV measures (lower SDNN, RMSSD, TI; P < .05) and abnormal sympathovagal balance (higher LF:HF ratio; P < .05). CONCLUSIONS Higher BMI and central adiposity are associated with cardiac autonomic dysfunction in childhood onset type 1 diabetes, after adjusting for HbA1c. Interventions targeting overweight/obesity during adolescence may optimize long-term vascular health in type 1 diabetes.
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Affiliation(s)
- Yoon H Cho
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia.,University of Sydney, Discipline of Child and Adolescent Health, Camperdown, Australia
| | - Maria E Craig
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia.,University of Sydney, Discipline of Child and Adolescent Health, Camperdown, Australia.,University of New South Wales, School of Women's and Children's Health, Randwick, Australia
| | - Tracey Jopling
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia
| | - Albert Chan
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia
| | - Kim C Donaghue
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, Australia.,University of Sydney, Discipline of Child and Adolescent Health, Camperdown, Australia
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Macedoni M, Hovnik T, Plesnik E, Kotnik P, Bratina N, Battelino T, Groselj U. Metabolic control, ApoE genotypes, and dyslipidemia in children, adolescents and young adults with type 1 diabetes. Atherosclerosis 2018; 273:53-58. [DOI: 10.1016/j.atherosclerosis.2018.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/08/2018] [Accepted: 04/11/2018] [Indexed: 11/27/2022]
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Bjornstad P, Lovshin JA, Lytvyn Y, Boulet G, Lovblom LE, Alhuzaim ON, Farooqi MA, Lai V, Tse J, Cham L, Orszag A, Scarr D, Weisman A, Keenan HA, Brent MH, Paul N, Bril V, Perkins BA, Cherney DZI. Adiposity Impacts Intrarenal Hemodynamic Function in Adults With Long-standing Type 1 Diabetes With and Without Diabetic Nephropathy: Results From the Canadian Study of Longevity in Type 1 Diabetes. Diabetes Care 2018; 41:831-839. [PMID: 29437821 PMCID: PMC5860840 DOI: 10.2337/dc17-2475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/09/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Central adiposity is considered to be an important cardiorenal risk factor in the general population and in type 1 diabetes. We sought to determine the relationship between central adiposity and intrarenal hemodynamic function in adults with long-standing type 1 diabetes with and without diabetic nephropathy (DN). RESEARCH DESIGN AND METHODS Patients with type 1 diabetes (n = 66, duration ≥50 years) and age-/sex-matched control subjects (n = 73) were studied. The cohort was stratified into 44 DN Resistors (estimated glomerular filtration rate [eGFR] >60 mL/min/1.73 m2 and <30 mg/day urine albumin) and 22 patients with DN (eGFR ≤60 mL/min/1.73 m2 or ≥30 mg/day urine albumin). Intrarenal hemodynamic function (glomerular filtration rate for inulin [GFRINULIN], effective renal plasma flow for p-aminohippuric acid [ERPFPAH]) was measured. Afferent arteriolar resistance, efferent arteriolar resistance, renal blood flow, renal vascular resistance [RVR], filtration fraction, and glomerular pressure were derived from the Gomez equations. Fat and lean mass were quantified by DXA. RESULTS Whereas measures of adiposity did not associate with GFRINULIN or ERPFPAH in healthy control subjects, trunk fat mass inversely correlated with GFRINULIN (r = -0.46, P < 0.0001) and ERPFPAH (r = -0.31, P = 0.01) and positively correlated with RVR (r = 0.53, P = 0.0003) in type 1 diabetes. In analyses stratified by DN status, greater central adiposity related to lower GFRINULIN values in DN and DN Resistors, but the relationships between central adiposity and ERPFPAH and RVR were attenuated and/or reversed in patients with DN compared with DN Resistors. CONCLUSIONS The adiposity-intrarenal hemodynamic function relationship may be modified by the presence of type 1 diabetes and DN, requiring further study of the mechanisms by which adiposity influences renal hemodynamic function.
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Affiliation(s)
- Petter Bjornstad
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada .,Division of Endocrinology, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Julie A Lovshin
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yuliya Lytvyn
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Genevieve Boulet
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Leif E Lovblom
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Omar N Alhuzaim
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mohammed A Farooqi
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Vesta Lai
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Josephine Tse
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Cham
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrej Orszag
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daniel Scarr
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Alanna Weisman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Michael H Brent
- Department of Ophthalmology and Vision Sciences and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Narinder Paul
- Division of Cardiothoracic Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Vera Bril
- The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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Lipsky LM, Gee B, Liu A, Nansel TR. Body mass index and adiposity indicators associated with cardiovascular biomarkers in youth with type 1 diabetes followed prospectively. Pediatr Obes 2017; 12:468-476. [PMID: 27417272 PMCID: PMC8211376 DOI: 10.1111/ijpo.12167] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/27/2016] [Accepted: 05/30/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The impact of excess weight on cardiovascular disease risk in type 1 diabetes patients is unclear. OBJECTIVE This study examined associations of BMI and body composition with cardiovascular risk factors in youth followed prospectively for 18 months. METHODS The sample includes youth with type 1 diabetes (N = 136, baseline age = 12.3 ± 2.5y, glycated hemoglobin = 8.1 ± 1.1%) participating in an 18-month behavioral nutrition intervention trial. BMI, body composition (by dual energy x-ray absorptiometry), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C); triglycerides (TG), c-reactive protein (CRP), 8-iso-prostaglandin-F2alpha (8-iso-PGF2α), adiponectin and systolic and diastolic blood pressure (SBP and DBP, respectively) were assessed at clinic visits every 6 months. Random effects regression models for repeated measures estimated associations of time-varying BMI and body composition with time-varying cardiovascular risk factors, adjusted for treatment assignment and covariates. RESULTS There was no intervention effect on cardiovascular risk factors. Percent body fat was positively associated with TG, LDL-C, CRP, SBP and DBP, while trunk fat mass and trunk %fat were associated positively with TG, LDL-C, CRP, SBP and DBP, and inversely with HDL-C. Higher BMI was associated with greater TG, CRP, SBP and DBP and lower HDL-C. BMI and body composition indicators were unrelated to 8-iso-PGF2α and adiponectin. CONCLUSIONS Excess adiposity is associated with increased cardiovascular risk factors in this sample of youth with type 1 diabetes. Non-significant associations with adiponectin and 8-iso-PGF2α suggest potential differences from the general population in the role of adiposity in cardiovascular health.
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Affiliation(s)
- LM Lipsky
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, North Bethesda, MD, USA
| | - B Gee
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, North Bethesda, MD, USA
| | - A Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - TR Nansel
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, North Bethesda, MD, USA
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Abstract
AIM To compare demographic and clinical characteristics among children from ethnic minorities and non-Hispanic white children with new-onset autoimmune Type 1 diabetes. METHODS We analysed a single-centre series of 712 children with new-onset autoimmune Type 1 diabetes between January 2008 and March 2011. The median (range) age was 9.7 (0.3-18.1) years, the mean (sd) BMI percentile was 69.7 (25.4) and 48.3% of the cohort were girls. The cohort comprised 57.3% non-Hispanic white, 20.5% Hispanic and 14.8% African-American children, and 7.4% were of other, mixed or unknown race. RESULTS The Hispanic subgroup, compared with non-Hispanic white subgroup, had a higher mean (sd) C-peptide level [0.82 (1.62) vs 0.55 (0.47) ng/ml; P=0.004), and a greater proportion of children with elevated BMI (overweight or obesity; 49.6% vs 32.5%; P<0.001) and diabetic ketoacidosis (51.8% vs 38.2%; P=0.006). The African-American group had a higher mean (sd) glucose level [24.4 (12.8) vs 21.4 (10.7) mmol/l; P=0.017], a greater proportion of children with ketoacidosis (56.7% vs 38.2%; P=0.001), a greater proportion with elevated BMI (52.9% vs 32.5%; P<0.001), and a lower proportion of children at pre-pubertal stage (49.0% vs 61.6%; P=0.01), and tended to have higher C-peptide levels [0.65 (0.59) vs 0.55 [0.47] ng/ml; P=0.079) compared with the non-Hispanic white children. The differences in C-peptide levels compared with non-Hispanic white children persisted for Hispanic (P=0.01) but not African-American children (P=0.29) after adjustment for age, sex, BMI, ketoacidosis, glucose, Tanner stage and autoantibody number. CONCLUSION At the onset of paediatric autoimmune Type 1 diabetes, Hispanic, but not African-American children had higher C-peptide levels, after adjustment for potential confounders, compared with non-Hispanic white children. These findings suggest that ethnicity may contribute to the heterogeneity of Type 1 diabetes pathogenesis, with possible implications for intervention.
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Affiliation(s)
- K Gandhi
- Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - M Tosur
- Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - R Schaub
- Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - M W Haymond
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - M J Redondo
- Section of Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
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Driscoll KA, Corbin KD, Maahs DM, Pratley R, Bishop FK, Kahkoska A, Hood KK, Mayer-Davis E. Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps. Curr Diab Rep 2017; 17:58. [PMID: 28660565 PMCID: PMC6053070 DOI: 10.1007/s11892-017-0892-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This review aims to summarize the type 1 diabetes (T1D) and weight literature with an emphasis on barriers associated with weight management, the unique T1D-specific factors that impact weight loss success, maladaptive and adaptive strategies for weight loss, and interventions to promote weight loss. RECENT FINDINGS Weight gain is associated with intensive insulin therapy. Overweight and obese weight status in individuals with T1D is higher than the general population and prevalence is rising. A variety of demographic (e.g., female sex), clinical (e.g., greater insulin needs), environmental (e.g., skipping meals), and psychosocial (e.g., depression, stress) factors are associated with overweight/obese weight status in T1D. Fear of hypoglycemia is a significant barrier to engagement in physical activity. Studies evaluating adaptive weight loss strategies in people with T1D are limited. There is a growing literature highlighting the prevalence and seriousness of overweight and obesity among both youth and adults with T1D. There is an urgent need to develop evidence-based weight management guidelines and interventions that address the unique concerns of individuals with T1D and that concurrently address glycemic control.
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Affiliation(s)
- Kimberly A Driscoll
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO, 80045, USA.
| | - Karen D Corbin
- Florida Hospital Translational Research Institute for Metabolism and Diabetes, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Richard Pratley
- Florida Hospital Translational Research Institute for Metabolism and Diabetes, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Franziska K Bishop
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO, 80045, USA
| | - Anna Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Korey K Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Elizabeth Mayer-Davis
- Department of Nutrition, The University of North Carolina Chapel Hill, Chapel Hill, NC, 27599-7461, USA
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