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Tang SS, Zhao XF, An XD, Sun WJ, Kang XM, Sun YT, Jiang LL, Gao Q, Li ZH, Ji HY, Lian FM. Classification and identification of risk factors for type 2 diabetes. World J Diabetes 2025; 16:100371. [PMID: 39959280 PMCID: PMC11718467 DOI: 10.4239/wjd.v16.i2.100371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 10/24/2024] [Accepted: 11/26/2024] [Indexed: 12/30/2024] Open
Abstract
The risk factors for type 2 diabetes mellitus (T2DM) have been increasingly researched, but the lack of systematic identification and categorization makes it difficult for clinicians to quickly and accurately access and understand all the risk factors, which are categorized in this paper into five categories: Social determinants, lifestyle, checkable/testable risk factors, history of illness and medication, and other factors, which are discussed in a narrative review. Meanwhile, this paper points out the problems of the current research, helps to improve the systematic categorisation and practicality of T2DM risk factors, and provides a professional research basis for clinical practice and industry decision-making.
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Affiliation(s)
- Shan-Shan Tang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130117, Jilin Province, China
| | - Xue-Fei Zhao
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
| | - Xue-Dong An
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
| | - Wen-Jie Sun
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
| | - Xiao-Min Kang
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
| | - Yu-Ting Sun
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
| | - Lin-Lin Jiang
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
| | - Qing Gao
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
| | - Ze-Hua Li
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
| | - Hang-Yu Ji
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
| | - Feng-Mei Lian
- Department of Endocrinology, Guang’anmen Hospital, Beijing 100053, China
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Shah AS, Barrientos-Pérez M, Chang N, Fu JF, Hannon TS, Kelsey M, Peña AS, Pinhas-Hamiel O, Urakami T, Wicklow B, Wong J, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2024: Type 2 Diabetes in Children and Adolescents. Horm Res Paediatr 2024; 97:555-583. [PMID: 39675348 PMCID: PMC11854986 DOI: 10.1159/000543033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 11/23/2024] [Indexed: 12/17/2024] Open
Abstract
Youth-onset type 2 diabetes (T2D) results from genetic, environmental, and metabolic causes that differ among individuals and populations. This chapter builds on the 2022 ISPAD guidelines and summarizes recent advances in the management of T2D in children and adolescents. Updates include diagnostic algorithm for youth with new onset T2D, algorithms and tables for treatment, management, and assessment of comorbidities and complications and recommendations on recently approved pharmacologic therapies for the treatment of youth-onset T2D and management strategies. Youth-onset type 2 diabetes (T2D) results from genetic, environmental, and metabolic causes that differ among individuals and populations. This chapter builds on the 2022 ISPAD guidelines and summarizes recent advances in the management of T2D in children and adolescents. Updates include diagnostic algorithm for youth with new onset T2D, algorithms and tables for treatment, management, and assessment of comorbidities and complications and recommendations on recently approved pharmacologic therapies for the treatment of youth-onset T2D and management strategies.
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Affiliation(s)
- Amy S. Shah
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
| | | | - Nancy Chang
- Center for Endocrinology, Diabetes and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Jun-Fen Fu
- Department of Endocrinology, Children’s Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Tamara S. Hannon
- Division of Endocrinology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Megan Kelsey
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Alexia S. Peña
- Robinson Research Institute and Women’s and Children’s Hospital, The University of Adelaide, North Adelaide, SA, Australia
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Brandy Wicklow
- Division of Endocrinology, Children’s Hospital Research Institute of Manitoba, Winnipeg Children’s Hospital and University of Manitoba, Winnipeg, MB, Canada
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Farid H. Mahmud
- Division of Endocrinology, Hospital for Sick Children, Sick Kids Research Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Kakko K, Keskinen P, Pihlakoski L, Salmelin R, Puura K. In search of measures to improve the detection of increased cardiometabolic risk in children using second-generation antipsychotic medications. Nord J Psychiatry 2022; 76:316-322. [PMID: 34431750 DOI: 10.1080/08039488.2021.1968489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Second-generation antipsychotic medications (SGAs) are widely used in child psychiatry. SGA-induced metabolic disturbances are common in children, but monitoring practices need systematisation. The study's aims were to test an SGA-monitoring protocol, examine the distributions of metabolic measurements compared to reference values in child psychiatry patients, and determine whether using a homeostasis model for the assessment of insulin resistance (HOMA-IR) and triglyceride/high-density lipoprotein (TG/HDL) ratio could improve the detection of increased cardiometabolic risk. MATERIALS AND METHODS A systematic monitoring protocol was implemented. Weight and height, blood pressure, fasting glucose, insulin, HDL, and TG were measured at baseline and four times during follow-up. HOMA-IR, TG/HDL ratio and zBMI were calculated. Age-, gender- and BMI-specific percentile curves for HOMA-IR were used to define elevated cardiometabolic risk. RESULTS The study patients (n = 55, mean age 9.9 years) were followed for a median of 9 months. A disadvantageous, statistically significant shift, often appearing within the reference range, was seen in zBMI, TG, HDL, glucose, insulin, HOMA-IR, and TG/HDL ratio. The increase in HOMA-IR appeared earlier than individual laboratory values and was more evident than the TG/HDL ratio increase. An HOMA-IR cut point of 1.98 resulted in a sensitivity and specificity of 83%. Compared to a previous study performed in the same location, the monitoring rates of metabolic parameters improved. CONCLUSION The monitoring protocol implementation improved the monitoring of metabolic parameters in child psychiatric patients using SGAs. Using HOMA-IR as part of systematic SGA monitoring could help detect metabolic adverse effects.
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Affiliation(s)
- Kirsi Kakko
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi Keskinen
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland.,Center for Child Health Research, Tampere University, Tampere, Finland
| | - Leena Pihlakoski
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Raili Salmelin
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences/Health Sciences, Tampere University, Tampere, Finland
| | - Kaija Puura
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Kosmalski M, Różycka-Kosmalska M, Sikora J, Pietras T. Diabetes mellitus in patients using psychotropic
medications: How does it work? POSTEP HIG MED DOSW 2021. [DOI: 10.5604/01.3001.0014.9330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diabetes mellitus (DM) is not a single disease, but a group of diseases that are characterized
by chronic hyperglycemia and risk of damage to tissues and organs. The mechanisms of its
development are different and due mainly to disorders of insulin secretion or its effects. For
this reason, 4 types of DM have been distinguished. One of them is a specific type of DM, determined,
inter alia, by the use of certain psychotropic medications. Chronic hyperglycemia
often occurs in association with some of these drugs, but in many cases it is categorized erroneously
as type 2 (T2DM) or 1 (T1DM). The relationship between DM and psychiatric disorders
is bi-directional, involving two mutually independent risk factors for the development
of the disease. However, not all patients with a mental illness develop carbohydrate metabolism
disorders, which is due to a varied diabetogenic potential and mechanisms of action
of psychotropic medications. In clinical practice, questions concerning the frequency of this
type of DM, risk factors of its development and hyperglycemic mechanism of psychotropic
medications arise. Therefore, the aim of this article is to attempt to answer these questions.
From a practical point of view, obtaining such information should allow for the development
of appropriate diagnostic and therapeutic procedures.
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Affiliation(s)
- Marcin Kosmalski
- Medical University of Lodz, Department of Clinical Pharmacology, Lodz, Poland
| | | | - Joanna Sikora
- Medical University of Lodz, Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry Drug Analysis and Radiopharmacy, Lodz, Poland
| | - Tadeusz Pietras
- Medical University of Lodz, Department of Clinical Pharmacology, Lodz, Poland
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Davis DW, Lohr WD, Feygin Y, Creel L, Jawad K, Jones VF, Williams PG, Le J, Trace M, Pasquenza N. High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid. BMC Psychiatry 2021; 21:303. [PMID: 34112146 PMCID: PMC8194140 DOI: 10.1186/s12888-021-03309-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of antipsychotic medication and psychotropic polypharmacy has increased in the United States over the last two decades especially for children from low-income families and those in foster care. Although attention has been paid to providing greater insight, prescribing patterns remain concerning since there is a lack of evidence related to safety and efficacy. High-level psychotropic polypharmacy has not been described. We aim to compare the use of HLPP for children receiving Medicaid services and those in foster care and identify factors associated with the duration of use of high-level psychotropic polypharmacy. Additionally, we will examine the frequency of laboratory metabolic screening and emergency department, inpatient, and outpatient visits. METHODS A cross-sectional, secondary analysis of statewide data describes trends in high-level psychotropic polypharmacy from 2012 to 2017 and the prevalence and predictors of high-level psychotropic polypharmacy duration and resource use in 2017 for all children on Medicaid and those in foster care. High-level psychotropic polypharmacy included concurrent use, at least four classes of medications including an antipsychotic, and at least 30 days duration. RESULTS High-level psychotropic polypharmacy increased from 2012 to 2014 for both groups but stabilized in 2015-2016. Children in foster care showed a slight increase compared to their peers in 2017. There was no association between duration and demographic characteristics or foster care status. Diagnoses predicted duration. Neither group received metabolic monitoring at an acceptable rate. CONCLUSIONS Concerning patterns of high-level psychotropic polypharmacy and metabolic monitoring were identified. Cautious use of high-level psychotropic polypharmacy and greater oversight to ensure that these children are receiving comprehensive services like behavioral health, primary care, and primary prevention.
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Affiliation(s)
- Deborah Winders Davis
- Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY, 40202, Louisville, USA.
| | - W. David Lohr
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Yana Feygin
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Liza Creel
- grid.266623.50000 0001 2113 1622Department of Health Management & System Sciences, University of Louisville School of Public Health and Information Science, 485 E. Gray Street, Louisville, KY 40202 USA
| | - Kahir Jawad
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - V. Faye Jones
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - P. Gail Williams
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Jennifer Le
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Marie Trace
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Natalie Pasquenza
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
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Jia K, Wu Y, Ju J, Wang L, Shi L, Wu H, Jiang K, Dong J. The identification of gene signature and critical pathway associated with childhood-onset type 2 diabetes. PeerJ 2019; 7:e6343. [PMID: 30755828 PMCID: PMC6368838 DOI: 10.7717/peerj.6343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/24/2018] [Indexed: 12/15/2022] Open
Abstract
In general, type 2 diabetes (T2D) usually occurs in middle-aged and elderly people. However, the incidence of childhood-onset T2D has increased all across the globe. Therefore, it is very important to determine the molecular and genetic mechanisms of childhood-onset T2D. In this study, the dataset GSE9006 was downloaded from the GEO (Gene Expression Omnibus database); it includes 24 healthy children, 43 children with newly diagnosed Type 1 diabetes (T1D), and 12 children with newly diagnosed T2D. These data were used for differentially expressed genes (DGEs) analysis and weighted co-expression network analysis (WGCNA). We identified 192 up-regulated genes and 329 down-regulated genes by performing DEGs analysis. By performing WGGNA, we found that blue module (539 genes) was highly correlated to cyan module (97 genes). Gene ontology (GO) and pathway enrichment analyses were performed to figure out the functions and related pathways of genes, which were identified in the results of DEGs and WGCNA. Genes with conspicuous logFC and in the high correlated modules were input into GeneMANIA, which is a plugin of Cytoscape application. Thus, we constructed the protein-protein interaction (PPI) network (92 nodes and 254 pairs). Eventually, we analyzed the transcription factors and references related to genes with conspicuous logFC or high-degree genes, which were present in both the modules of WGCNA and PPI network. Current research shows that EGR1 and NAMPT can be used as marker genes for childhood-onset T2D. Gestational diabetes and chronic inflammation are risk factors that lead to the development of childhood-onset T2D.
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Affiliation(s)
- Keren Jia
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Yingcheng Wu
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Jingyi Ju
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Liyang Wang
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Lili Shi
- Department of Medical Informatics, Medical School of Nantong University, Nantong, Jiangsu, China
| | - Huiqun Wu
- Department of Medical Informatics, Medical School of Nantong University, Nantong, Jiangsu, China
| | - Kui Jiang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, Jiangsu, China
| | - Jiancheng Dong
- Medical School of Nantong University, Nantong, Jiangsu, China
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