|
1
|
Xu M, Li B, Li C, Chai P, Qiu Q, Zheng Z, Chen Q, Luo D, Xu X, Zhou C. Is longer axial length protective of vision-threatening diabetic retinopathy across different ages? A multicenter cohort of 736 patients. Int J Retina Vitreous 2024; 10:74. [PMID: 39390534 PMCID: PMC11465653 DOI: 10.1186/s40942-024-00593-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 10/02/2024] [Indexed: 10/12/2024] Open
Abstract
PURPOSE Vision-threatening diabetic retinopathy (VTDR) included severe non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR) and clinically significant diabetic macular edema (DME). To compare the axial length (AL) and assess its influence on VTDR across different ages. METHODS A retrospective cohort study. Medical chart review was performed in 736 consecutive patients with VTDR. The patients were divided into young (≤ 45 years) and elderly group (> 45 years) based on their age at the diagnosis of VTDR. After at least one year of standardized treatments, all eligible patients were followed up. The main outcome measures included the presence of tractional retinal detachment (TRD) involving foveal, final best-corrected visual acuity (BCVA), the development of neovascular glaucoma (NVG), and recurrent vitreous hemorrhage (VH) post-vitrectomy. ALs were compared between two age groups. The impact of AL on clinical outcomes was determined by logistic analyses after controlling for systemic parameters. RESULTS The study included 144 patients ≤ 45 years and 592 patients > 45 years. Young patients had significantly longer AL than elderly participants (23.9 mm vs 23.0 mm, p < 0.001). Over a median follow-up of 25.9 months, a larger proportion of young patients developed TRD (34.7% vs 16.2%, p < 0.001) and recurrent VH (18.6% vs 10.3%, p = 0.040) than elderly patients. In elderly group, longer AL is an independent protective factor in preventing TRD (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.4-0.7; P < 0.001). However, this beneficial effect was not observed in young patients. CONCLUSIONS Young patients with VTDR exhibited significantly longer AL but more aggressive clinical signs with compromised prognosis. In elderly group, a longer AL independently reduced the risk of TRD, while this protective effect did not exist for young patients.
Collapse
Affiliation(s)
- Mingpeng Xu
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Li
- Department of Ophthalmology, The Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Chenxin Li
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Peiwei Chai
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qinghua Qiu
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, China
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China
| | - Qian Chen
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, China.
| | - Dawei Luo
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, 200080, China.
| | - Xiaofang Xu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Chuandi Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.
| |
Collapse
|
|
2
|
Pramanik S, Mondal S, Palui R, Ray S. Type 2 diabetes in children and adolescents: Exploring the disease heterogeneity and research gaps to optimum management. World J Clin Pediatr 2024; 13:91587. [PMID: 38947996 PMCID: PMC11212753 DOI: 10.5409/wjcp.v13.i2.91587] [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: 12/31/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 06/07/2024] Open
Abstract
Over the past 20 years, the incidence and prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents have increased, particularly in racial and ethnic minorities. Despite the rise in T2DM in children and adolescents, the pathophysiology and progression of disease in this population are not clearly understood. Youth-onset T2DM has a more adverse clinical course than is seen in those who develop T2DM in adulthood or those with T1DM. Furthermore, the available therapeutic options are more limited for children and adolescents with T2DM compared to adult patients, mostly due to the challenges of implementing clinical trials. A better understanding of the mechanisms underlying the de-velopment and aggressive disease phenotype of T2DM in youth is important to finding effective prevention and management strategies. This review highlights the key evidence about T2DM in children and adolescents and its current burden and challenges both in clinical care and research activities.
Collapse
Affiliation(s)
- Subhodip Pramanik
- Department of Endocrinology, Neotia Getwel Multi-specialty hospital, Siliguri 734010, West Bengal, India
| | - Sunetra Mondal
- Department of Endocrinology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
| | - Rajan Palui
- Department of Endocrinology, The Mission Hospital, Durgapur 713212, West Bengal, India
| | - Sayantan Ray
- Department of Endocrinology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, Odisha, India
| |
Collapse
|
|
3
|
Wang Q, Cheng H, Jiang S, Zhang L, Liu X, Chen P, Liu J, Li Y, Liu X, Wang L, Li Z, Cai G, Chen X, Dong Z. The relationship between diabetic retinopathy and diabetic nephropathy in type 2 diabetes. Front Endocrinol (Lausanne) 2024; 15:1292412. [PMID: 38344659 PMCID: PMC10853456 DOI: 10.3389/fendo.2024.1292412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Context Diabetic retinopathy (DR) and diabetic nephropathy (DN), are major microvascular complications of diabetes. DR is an important predictor of DN, but the relationship between the severity of DR and the pathological severity of diabetic glomerulopathy remains unclear. Objective To investigate the relationship between severity of diabetic retinopathy (DR) and histological changes and clinical indicators of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Methods Patients with T2DM (n=272) who underwent a renal biopsy were eligible. Severity of DR was classified as non-diabetic retinopathy, non-proliferative retinopathy, and proliferative retinopathy (PDR). Relationship between DN and DR and the diagnostic efficacy of DR for DN were explored. Results DN had a higher prevalence of DR (86.4%) and DR was more severe. The sensitivity and specificity of DR in DN were 86.4% and 78.8%, while PDR was 26.4% and 98.5%, respectively. In DN patients, the severity of glomerular lesions (p=0.001) and prevalence of KW nodules (p<0.001) significantly increased with increasing severity of DR. The presence of KW nodules, lower hemoglobin levels, and younger age were independent risk factors associated with more severe DR in patients with DN. Conclusion DR was a good predictor of DN. In DN patients, the severity of DR was associated with glomerular injury, and presence of KW nodules, lower hemoglobin levels and younger age were independent risk factors associated with more severe DR. Trial registration ClinicalTrails.gov, NCT03865914.
Collapse
Affiliation(s)
- Qian Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Haimei Cheng
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Shuangshuang Jiang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Li Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiaomin Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Pu Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Jiaona Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Ying Li
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Xiaocui Liu
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Liqiang Wang
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Zhaohui Li
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Zheyi Dong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| |
Collapse
|
|
4
|
Dong W, Zhang S, Yan S, Zhao Z, Zhang Z, Gu W. Clinical characteristics of patients with early-onset diabetes mellitus: a single-center retrospective study. BMC Endocr Disord 2023; 23:216. [PMID: 37814295 PMCID: PMC10563342 DOI: 10.1186/s12902-023-01468-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The prevalence of diabetes mellitus (DM) is dramatically increasing around the world, and patients are getting younger with changes in living standards and lifestyle. This study summarized and analyzed the clinical characteristics of different types of newly diagnosed diabetes mellitus patients with an onset age between 18 and 40 years to provide clinical evidence for the early diagnosis and treatment of diabetes, reduce short-term and long-term complications and offer scientific and personalized management strategies. METHODS A total of 655 patients newly diagnosed with early-onset diabetes mellitus in the Department of Endocrinology, the First Medical Center of PLA General Hospital from January 2012 to December 2022 were retrospectively enrolled in this study, with an onset age of 18-40 years. Their clinical data were collected and investigated. All patients were divided into two groups according to whether they presented with diabetic microangiopathy. Similarly, patients with early-onset type-2 diabetes were grouped in accordance with whether they had ketosis at the time of diagnosis. Binary logistic regression analysis was performed to analyze risk factors, and receiver-operating characteristic (ROC) analysis was used to explore the predictive value of significant risk factors. RESULTS The findings were as follows: (1) Of 655 enrolled patients, 477 (72.8%) were male and 178 (27.1%) were female, with a mean age of onset of was 29.73 years ± 0.24 SD. (2) The prevalence of early-onset diabetes was gradually increasing. Type-2 diabetes was the most common type of early-onset diabetes (491, 75.0%). The ages of onset of early-onset type-1 diabetes, type-2 diabetes and LADA were mainly 18-24 years, 25-40 years and 33-40 years, respectively. (3) Initial clinical manifestations of early-onset diabetes were classic diabetes symptoms (361, 55.1%), followed by elevated blood glucose detected through medical examination (207, 31.6%). (4) Binary logistic regression analysis suggested that high serum uric acid (UA), a high urinary albumin-to-creatinine ratio (UACR) and diabetic peripheral neuropathy (DPN) were risk factors for microangiopathy in early-onset diabetes patients (P < 0.05). The area under the curve (AUC) on ROC analysis of the combination of UA, UACR and DPN was 0.848, 95% CI was 0.818 ~ 0.875, sensitivity was 73.8% and specificity was 85.9%, which had higher predictive value than those of UA, UACR and DPN separately. (5) Weight loss, high glycosylated hemoglobin (HbA1c) and young onset age were risk factors for ketosis in patients with early-onset type-2 diabetes (P < 0.05). CONCLUSION (1) Men were more likely to have early-onset diabetes than women. (2) Early-onset diabetes patients with high serum uric acid levels, high UACRs and peripheral neuropathy were prone to microangiopathy. Comprehensive evaluation of these risk factors could have higher predictive value in the prediction, diagnosis and treatment of microvascular lesions. (3) Patients with weight loss at onset, high HbA1c and young onset age were more likely to develop ketosis. Attention should be given to the metabolic disorders of these patients.
Collapse
Affiliation(s)
- Wenjing Dong
- Chinese PLA Medical College, Beijing, 100039, China
- Department of Endocrinology, The first medical center of Chinese PLA General Hospital, Beijing, 100853, China
- Department of Gerontology, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China
| | - Saichun Zhang
- Department of Endocrinology, The first medical center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Shiju Yan
- Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China
| | - Zhizhuang Zhao
- Department of Gerontology, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China
| | - Zengqiang Zhang
- Department of Gerontology, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China
| | - Weijun Gu
- Department of Endocrinology, The first medical center of Chinese PLA General Hospital, Beijing, 100853, China.
| |
Collapse
|
|
5
|
Perais J, Agarwal R, Evans JR, Loveman E, Colquitt JL, Owens D, Hogg RE, Lawrenson JG, Takwoingi Y, Lois N. Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy. Cochrane Database Syst Rev 2023; 2:CD013775. [PMID: 36815723 PMCID: PMC9943918 DOI: 10.1002/14651858.cd013775.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Diabetic retinopathy (DR) is characterised by neurovascular degeneration as a result of chronic hyperglycaemia. Proliferative diabetic retinopathy (PDR) is the most serious complication of DR and can lead to total (central and peripheral) visual loss. PDR is characterised by the presence of abnormal new blood vessels, so-called "new vessels," at the optic disc (NVD) or elsewhere in the retina (NVE). PDR can progress to high-risk characteristics (HRC) PDR (HRC-PDR), which is defined by the presence of NVD more than one-fourth to one-third disc area in size plus vitreous haemorrhage or pre-retinal haemorrhage, or vitreous haemorrhage or pre-retinal haemorrhage obscuring more than one disc area. In severe cases, fibrovascular membranes grow over the retinal surface and tractional retinal detachment with sight loss can occur, despite treatment. Although most, if not all, individuals with diabetes will develop DR if they live long enough, only some progress to the sight-threatening PDR stage. OBJECTIVES: To determine risk factors for the development of PDR and HRC-PDR in people with diabetes and DR. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5), Ovid MEDLINE, and Ovid Embase. The date of the search was 27 May 2022. Additionally, the search was supplemented by screening reference lists of eligible articles. There were no restrictions to language or year of publication. SELECTION CRITERIA: We included prospective or retrospective cohort studies and case-control longitudinal studies evaluating prognostic factors for the development and progression of PDR, in people who have not had previous treatment for DR. The target population consisted of adults (≥18 years of age) of any gender, sexual orientation, ethnicity, socioeconomic status, and geographical location, with non-proliferative diabetic retinopathy (NPDR) or PDR with less than HRC-PDR, diagnosed as per standard clinical practice. Two review authors independently screened titles and abstracts, and full-text articles, to determine eligibility; discrepancies were resolved through discussion. We considered prognostic factors measured at baseline and any other time points during the study and in any clinical setting. Outcomes were evaluated at three and eight years (± two years) or lifelong. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from included studies using a data extraction form that we developed and piloted prior to the data collection stage. We resolved any discrepancies through discussion. We used the Quality in Prognosis Studies (QUIPS) tool to assess risk of bias. We conducted meta-analyses in clinically relevant groups using a random-effects approach. We reported hazard ratios (HR), odds ratios (OR), and risk ratios (RR) separately for each available prognostic factor and outcome, stratified by different time points. Where possible, we meta-analysed adjusted prognostic factors. We evaluated the certainty of the evidence with an adapted version of the GRADE framework. MAIN RESULTS: We screened 6391 records. From these, we identified 59 studies (87 articles) as eligible for inclusion. Thirty-five were prospective cohort studies, 22 were retrospective studies, 18 of which were cohort and six were based on data from electronic registers, and two were retrospective case-control studies. Twenty-three studies evaluated participants with type 1 diabetes (T1D), 19 with type 2 diabetes (T2D), and 17 included mixed populations (T1D and T2D). Studies on T1D included between 39 and 3250 participants at baseline, followed up for one to 45 years. Studies on T2D included between 100 and 71,817 participants at baseline, followed up for one to 20 years. The studies on mixed populations of T1D and T2D ranged from 76 to 32,553 participants at baseline, followed up for four to 25 years. We found evidence indicating that higher glycated haemoglobin (haemoglobin A1c (HbA1c)) levels (adjusted OR ranged from 1.11 (95% confidence interval (CI) 0.93 to 1.32) to 2.10 (95% CI 1.64 to 2.69) and more advanced stages of retinopathy (adjusted OR ranged from 1.38 (95% CI 1.29 to 1.48) to 12.40 (95% CI 5.31 to 28.98) are independent risk factors for the development of PDR in people with T1D and T2D. We rated the evidence for these factors as of moderate certainty because of moderate to high risk of bias in the studies. There was also some evidence suggesting several markers for renal disease (for example, nephropathy (adjusted OR ranged from 1.58 (95% CI not reported) to 2.68 (2.09 to 3.42), and creatinine (adjusted meta-analysis HR 1.61 (95% CI 0.77 to 3.36)), and, in people with T1D, age at diagnosis of diabetes (< 12 years of age) (standardised regression estimate 1.62, 95% CI 1.06 to 2.48), increased triglyceride levels (adjusted RR 1.55, 95% CI 1.06 to 1.95), and larger retinal venular diameters (RR 4.28, 95% CI 1.50 to 12.19) may increase the risk of progression to PDR. The certainty of evidence for these factors, however, was low to very low, due to risk of bias in the included studies, inconsistency (lack of studies preventing the grading of consistency or variable outcomes), and imprecision (wide CIs). There was no substantial and consistent evidence to support duration of diabetes, systolic or diastolic blood pressure, total cholesterol, low- (LDL) and high- (HDL) density lipoproteins, gender, ethnicity, body mass index (BMI), socioeconomic status, or tobacco and alcohol consumption as being associated with incidence of PDR. There was insufficient evidence to evaluate prognostic factors associated with progression of PDR to HRC-PDR. AUTHORS' CONCLUSIONS: Increased HbA1c is likely to be associated with progression to PDR; therefore, maintaining adequate glucose control throughout life, irrespective of stage of DR severity, may help to prevent progression to PDR and risk of its sight-threatening complications. Renal impairment in people with T1D or T2D, as well as younger age at diagnosis of diabetes mellitus (DM), increased triglyceride levels, and increased retinal venular diameters in people with T1D may also be associated with increased risk of progression to PDR. Given that more advanced DR severity is associated with higher risk of progression to PDR, the earlier the disease is identified, and the above systemic risk factors are controlled, the greater the chance of reducing the risk of PDR and saving sight.
Collapse
Affiliation(s)
- Jennifer Perais
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Ridhi Agarwal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jennifer R Evans
- Cochrane Eyes and Vision, Queen's University Belfast, Belfast, UK
| | | | | | | | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - John G Lawrenson
- Centre for Applied Vision Research, School of Health Sciences, City University of London, London, UK
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| |
Collapse
|
|
6
|
The Distribution of Autoantibodies by Age Group in Children with Type 1 Diabetes versus Type 2 Diabetes in Southern Vietnam. J Clin Med 2023; 12:jcm12041420. [PMID: 36835954 PMCID: PMC9961333 DOI: 10.3390/jcm12041420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Asian children are increasingly being diagnosed with type 1 diabetes (T1D) or type 2 diabetes (T2D), and the presence of coexisting islet autoimmune antibodies complicate diagnosis. Here, we aimed to determine the prevalence of islet cell autoantibodies (ICAs) and glutamic acid decarboxylase 65 autoantibodies (GADAs) in children with T1D versus T2D living in Vietnam. This cross-sectional study included 145 pediatric patients aged 10.3 ± 3.6 years, with 53.1% and 46.9% having T1D and T2D, respectively. ICAs were reported in only 3.9% of pediatric T1Ds, which was not significantly different from the 1.5% of those with T2D. Older children with T1D were positive for either ICAs, or ICAs and GADAs (5-9 and 10-15 years), whereas only a small proportion of children aged 0-4 years were positive for GADAs (18%). Notably, 27.9% of children with T2D aged 10-15 were positive for GADAs, and all were classified as overweight (n = 9) or obese (n = 10). GADAs were more commonly observed in T1D patients younger than four years than ICAs, which were more prevalent in older children (5-15 years). Even though few children with T2D carried ICAs and GADAs, finding a better biomarker or an appropriate time to confirm diabetes type may require further investigation.
Collapse
|
|
7
|
Nien CW, Lee CY, Chen HC, Chao SC, Hsu HJ, Tzeng SH, Yang SJ, Huang JY, Yang SF, Lin HY. The elevated risk of sight-threatening cataract in diabetes with retinopathy: a retrospective population-based cohort study. BMC Ophthalmol 2021; 21:349. [PMID: 34587923 PMCID: PMC8480064 DOI: 10.1186/s12886-021-02114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background The effect of diabetic retinopathy (DR) on the development of sight-threatening cataracts was assessed using the National Health Insurance Research Database of Taiwan. Methods Patients diagnosed with diabetes mellitus (DM) and DR were enrolled in the study group. Age- and sex-matched DM individuals without DR and patients without DM served as the DM control group and non-DM control group, respectively, both with 1:4 ratios. The outcome was set as the performance of cataract surgery. Cox proportional hazard regression was used to calculate the adjusted hazard ratio (aHR) of DR considering multiple factors underlying cataract formation. Results A total of 3297 DR patients, 13,188 DM control patients and 13,188 non-DM control subjects were enrolled. The study group included 919 events of sight-threatening cataracts (27.87%), the DM control group included 1108 events (8.40%), and the non-DM control group included 957 events (7.26%). A multivariable analysis indicated that the study group presented a higher aHR of cataract surgery (2.93, 95% CI: 2.60–3.30) and a higher cumulative probability of cataract surgery than both the DM control and non-DM control groups (both log rank P < 0.001). In addition, both the proliferative DR (3.90, 95% CI: 3.42–4.45) and nonproliferative DR (2.35, 95% CI: 2.08–2.65) subgroups showed a higher aHR of cataract surgery than the DM control group. Conclusion The presence of DR increases the risk of sight-threatening cataracts that warrant surgery, and the effect is prominent among patients with both proliferative DR and nonproliferative DR.
Collapse
Affiliation(s)
- Chan-Wei Nien
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan.,Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Chun Chao
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Hung-Jui Hsu
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan.,Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Shih-Hao Tzeng
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shang-Jung Yang
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University and School of Medicine, Zhonghe, Taiwan.,College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan. .,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Hung-Yu Lin
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan. .,Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan. .,Department of Optometry, Chung Shan Medical University, Taichung, Taiwan. .,College of Medicine, National Chung Hsing University, Taichung, Taiwan.
| |
Collapse
|
|
8
|
Kidney failure risk in type 1 vs. type 2 childhood-onset diabetes mellitus. Pediatr Nephrol 2021; 36:333-340. [PMID: 32761484 DOI: 10.1007/s00467-020-04631-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/29/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diabetic kidney disease (DKD) is becoming increasingly common among children. We aimed to estimate the risk of end-stage renal disease (ESKD) and mortality among adolescents with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and normal renal function compared with non-diabetics. We hypothesized that childhood onset T1DM vs. T2DM would be associated with a different risk profile for developing ESKD and its complications. METHODS A nationwide, population-based, retrospective cohort study, including 1,500,522 adolescents examined for military service between 1967 and 1997, which were classified according to the presence and type of diabetes. Data were linked to the Israeli ESKD registry. Cox proportional-hazards models were used to estimate the hazard ratio (HR) for ESKD. RESULTS At study enrolment, 1183 adolescents had T1DM and 196 had T2DM. ESKD developed in 2386 non-diabetic individuals (0.2%) compared with 72 individuals (6.1%) with T1DM and 8 individuals (4.1%) with T2DM. Participants with T1DM were younger at ESKD onset than participants with T2DM (median age, 36.0 vs. 40.5 years, P < 0.05). In a multivariate model adjusted for age, sex, paternal origin, enrollment year, BMI, and blood pressure, T1DM and T2DM were associated with HR of 36.4 (95% CI 28.3-46.9) and 19.3 (95% CI 9.6-38.8) for ESKD, respectively. Stratification according to sex, ethnicity, immigration, and socioeconomic status did not materially change the HR. During the follow-up period, mortality rates were higher in T2DM as compared with T1DM and controls (8.7 %, 2.2%, and 2.7% respectively). CONCLUSIONS T1DM and T2DM in adolescents with normal renal function confer a significantly increased risk for ESKD. T1DM is associated with younger age at ESKD onset while T2DM is associated with higher mortality rate.
Collapse
|
|
9
|
Liao M, Wang X, Yu J, Meng X, Liu Y, Dong X, Li J, Brant R, Huang B, Yan H. Characteristics and outcomes of vitrectomy for proliferative diabetic retinopathy in young versus senior patients. BMC Ophthalmol 2020; 20:416. [PMID: 33076873 PMCID: PMC7574415 DOI: 10.1186/s12886-020-01688-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/08/2020] [Indexed: 01/06/2023] Open
Abstract
Background Proliferative diabetic retinopathy (PDR) is one of the most common cause of vision loss in diabetic patients, and the incidence age of PDR patients gradually gets younger. This study aims to compare the characteristics of PDR and outcomes following vitrectomy in young and senior patients. Methods This is a retrospective case series study. Data of 116 eyes of 92 patients who underwent vitrectomy for PDR from February 2012 to February 2017 were reviewed, which were divided into young and senior patient groups. All patients were followed up for 24 months at least. Results There were 62.1% of eyes with tractional retinal detachment secondary to PDR in the young patient group, while only 12.1% of eyes in the senior patient group with this surgery indication. (P < 0.001) The best corrected visual acuity increased in 41 eyes (70.7%), stable in 9 eyes (15.5%), and decreased in 8 eyes (13.8%) in young patients at the final follow-up. And it increased in 47 eyes (81.0%), stable in 2 eyes (3.4%), and decreased in 9 eyes (15.5%) in senior patients.(P = 0.085) Postoperative complications mainly included recurrent vitreous hemorrhage (24.1%), retinal detachment (3.4%), neovascular glaucoma (NVG) (27.6%) and nuclear sclerosis (53.4%) in young patients, and it was 19.0, 0.0, 1.7 and 3.4% in senior patients respectively. Conclusion PDR of young patients is more severe than that of senior patients, and vitrectomy is an effective and safe method for PDR treatment. NVG is a main and severe complication besides nuclear sclerosis in young patients, and the incidence of NVG is higher compared to that in senior patients.
Collapse
Affiliation(s)
- Mengyu Liao
- Department of Ophthalmology, Tianjin Medical University General Hospital, No.154 Anshan Road, Tianjin, 300052, China
| | - Xiaohong Wang
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, No.154 Anshan Road, Tianjin, 300052, China
| | - Xiangda Meng
- Department of Ophthalmology, Tianjin Medical University General Hospital, No.154 Anshan Road, Tianjin, 300052, China
| | - Yuanyuan Liu
- Department of Ophthalmology, Tianjin Medical University General Hospital, No.154 Anshan Road, Tianjin, 300052, China
| | - Xue Dong
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Jianan Li
- Department of Ophthalmology, Tianjin Medical University General Hospital, No.154 Anshan Road, Tianjin, 300052, China
| | - Rodrigo Brant
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Bo Huang
- Department of Ophthalmology, University of Mississippi Medical Center, Jackson, USA
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, No.154 Anshan Road, Tianjin, 300052, China.
| |
Collapse
|
|
10
|
Lv X, Ran X, Chen X, Luo T, Hu J, Wang Y, Liu Z, Zhen Q, Liu X, Zheng L, Tang Y, Zhao Q, Han S, Zhou Y, Luo W, Yang L, Li Q, Wang Z. Early-onset type 2 diabetes: A high-risk factor for proliferative diabetic retinopathy (PDR) in patients with microalbuminuria. Medicine (Baltimore) 2020; 99:e20189. [PMID: 32384512 PMCID: PMC7220424 DOI: 10.1097/md.0000000000020189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We aim to explore the relationship between early-onset diabetes and proliferative diabetic retinopathy (PDR) in type 2 diabetes mellitus (T2DM) patients with microalbuminuria.A total of 461 T2DM patients with microalbuminuria were enrolled. Subjects were defined as early-onset or late-onset based on the age at which they were diagnosed with diabetes (<40 and ≥40 years, respectively). Medical history, anthropometry, and laboratory indicators were documented. PDR was defined as the presence of any of the following changes on fundus photography: neovascularization, vitreous hemorrhage, or preretinal hemorrhage.The prevalence of PDR was 6-fold higher in patients with early-onset than late-onset T2DM [(6.1% vs 1.0%), P = .004]. Univariate correlation analysis showed that early-onset diabetes, use of oral hypoglycemic drugs, and insulin therapy were risk factors for PDR. In multivariate logistic analysis, patients with early-onset diabetes exhibited a 7.00-fold [(95% confidence interval 1.40-38.26), P = .019] higher risk of PDR than subjects with late-onset diabetes after adjusting for sex; T2DM duration; systolic blood pressure; total triglyceride; glycated hemoglobin; insulin therapy; and the use of oral hypoglycemic drugs, antihypertensive drugs, and lipid-lowering drugs.In T2DM patients with microalbuminuria, early-onset diabetes is an independent risk factor for the development of PDR.
Collapse
Affiliation(s)
- Xinlu Lv
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Xi Ran
- Department of Endocrinology, The Affiliated Yanan Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiangjun Chen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Ting Luo
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Yue Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Zhiping Liu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Qianna Zhen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Xiurong Liu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Li Zheng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Ying Tang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Qinying Zhao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Shichao Han
- Statistics and Computer Science, University of California, Berkeley, CA
| | - Yangmei Zhou
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Wenjin Luo
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Lina Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Zhihong Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| |
Collapse
|
|
11
|
Phan DH, Do VV, Khuong LQ, Nguyen HT, Minh HV. Prevalence of Diabetes and Prediabetes among Children Aged 11-14 Years Old in Vietnam. J Diabetes Res 2020; 2020:7573491. [PMID: 32190701 PMCID: PMC7071796 DOI: 10.1155/2020/7573491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/19/2020] [Accepted: 02/18/2020] [Indexed: 01/01/2023] Open
Abstract
AIM Diabetes in children is becoming more prevalent in some countries. However, in most countries, little is known about the epidemiology of this disease. This study is aimed at estimating the prevalence of type 1 and type 2 diabetes and prediabetes among children in Vietnam and examining factors associated with the conditions. METHODS A total of 2880 students aged 11-14 years old were recruited for the survey, using a school-based and nationally representative sampling frame. Capillary blood samples of participants were collected to measure fasting glucose level, using glucose meter OneTouch Verio Pro+. Diabetes and impaired fasting plasma glucose were initially diagnosed based on the cut-off points of the American Diabetes Association criteria. Diabetes status and type of diabetes of participants were confirmed at a hospital. Additionally, anthropometric and blood pressure measurements were conducted following a standardized procedure. Multivariate logistic regression was used to examine the association between outcome and independent variables. RESULTS The overall prevalence of diabetes among the participants was 1.04‰ (three cases), with 2 cases (0.75‰) diagnosed with type 1 diabetes (one known and one newly diagnosed) and 1 case newly diagnosed with type 2 diabetes (0.35‰). The prevalence of impaired fasting glucose was 6.1%. Body mass index, place of residence, and age were found to be significantly associated with the impaired fasting glucose condition in participants. CONCLUSION The prevalence of type 1 and type 2 diabetes in children in Vietnam is lower than that in some other countries reported recently. However, there is a high prevalence in impaired fasting glucose, requiring attention from policymakers to take action to prevent the occurrence of the epidemic of type 2 diabetes in children in the future.
Collapse
Affiliation(s)
| | - Vuong V. Do
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Long Q. Khuong
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Hoang V. Minh
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| |
Collapse
|
|
12
|
Mora-Ortiz M, Nuñez Ramos P, Oregioni A, Claus SP. NMR metabolomics identifies over 60 biomarkers associated with Type II Diabetes impairment in db/db mice. Metabolomics 2019; 15:89. [PMID: 31179513 PMCID: PMC6556514 DOI: 10.1007/s11306-019-1548-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/24/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The rapid expansion of Type 2 Diabetes (T2D), that currently affects 90% of people suffering from diabetes, urges us to develop a better understanding of the metabolic processes involved in the disease process in order to develop better therapies. The most commonly used model for T2D research is the db/db (BKS.Cg-Dock7 < m > +/+ Lepr < db >/J) mouse model. Yet, a systematic 1H NMR based metabolomics characterisation of most tissues in this animal model has not been published. Here, we provide a systematic organ-specific metabolomics analysis of this widely employed model using NMR spectroscopy. OBJECTIVES The aim of this study was to characterise the metabolic modulations associated with T2D in db/db mice in 18 relevant biological matrices. METHODS High-resolution 1H-NMR and 2D-NMR spectroscopy were applied to 18 biological matrices of 12 db/db mice (WT control n = 6, db/db = 6) aged 22 weeks, when diabetes is fully established. RESULTS 61 metabolites associated with T2D were identified. Kidney, spleen, eye and plasma were the biological matrices carrying the largest metabolomics modulations observed in established T2D, based on the total number of metabolites that showed a statistical difference between the diabetic and control group in each tissue (16 in each case) and the strength of the O-PLS DA model for each tissue. Glucose and glutamate were the most commonly associated metabolites found significantly increased in nine biological matrices. Investigated sections where no increase of glucose was associated with T2D include all intestinal segments (i.e. duodenum, jejunum, ileum and colon). Microbial co-metabolites such as acetate and butyrate, used as carbon sources by the host, were identified in excess in the colonic tissues of diabetic individuals. CONCLUSIONS The metabolic biomarkers identified using 1H NMR-based metabolomics will represent a useful resource to explore metabolic pathways involved in T2D in the db/db mouse model.
Collapse
Affiliation(s)
- Marina Mora-Ortiz
- Department of Food and Nutritional Sciences, The University of Reading, Whiteknights Campus, P.O. Box 226, Reading, RG6 6AP, UK.
- Department of Twin Research, Kings' College London, St Thomas' Hospital Campus, Westminster Bridge Road, London, SE1 7EW, UK.
| | - Patricia Nuñez Ramos
- Facultad de Medicina, Universidad de Extremadura, Campus de Badajoz, C.P. 06006, Badajoz, Spain
| | - Alain Oregioni
- MRC Biomedical NMR Centre, The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
| | - Sandrine P Claus
- Department of Food and Nutritional Sciences, The University of Reading, Whiteknights Campus, P.O. Box 226, Reading, RG6 6AP, UK.
| |
Collapse
|
|
13
|
Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association. Diabetes Care 2018; 41:2648-2668. [PMID: 30425094 PMCID: PMC7732108 DOI: 10.2337/dci18-0052] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, PA
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Fida Bacha
- Children's Nutrition Research Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Margaret Grey
- Yale School of Nursing, New Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | - Neil H White
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Philip Zeitler
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
|
14
|
Panagiotopoulos C, Hadjiyannakis S, Henderson M. Type 2 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42 Suppl 1:S247-S254. [DOI: 10.1016/j.jcjd.2017.10.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
|
15
|
Bjornstad P, Cherney DZ. Renal Hyperfiltration in Adolescents with Type 2 Diabetes: Physiology, Sex Differences, and Implications for Diabetic Kidney Disease. Curr Diab Rep 2018; 18:22. [PMID: 29557063 PMCID: PMC6344350 DOI: 10.1007/s11892-018-0996-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Compared to adult-onset type 2 diabetes (T2D), youth with T2D have a more aggressive phenotype with greater insulin resistance (IR), more rapid β cell decline, and higher prevalence of diabetic kidney disease (DKD). RECENT FINDINGS Hyperfiltration is common in youth with T2D and predicts progressive DKD. Hyperfiltration is a consequence of early changes in intrarenal hemodynamic function, including increased renal plasma flow (RPF) and glomerular pressure. Girls with T2D are disproportionally affected by DKD, with a 3-fold greater risk of developing hyperfiltration over 5 years compared to boys. Despite the high prevalence and gravity of DKD in youth-onset T2D, widely effective therapeutic options are lacking. In this review, we focus on pathophysiology underlying early DKD in T2D and sex differences and summarize promising novel medical therapies and bariatric surgery.
Collapse
Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA.
| | - David Z Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
|
16
|
Bjornstad P, Nehus E, El Ghormli L, Bacha F, Libman IM, McKay S, Willi SM, Laffel L, Arslanian S, Nadeau KJ. Insulin Sensitivity and Diabetic Kidney Disease in Children and Adolescents With Type 2 Diabetes: An Observational Analysis of Data From the TODAY Clinical Trial. Am J Kidney Dis 2017; 71:65-74. [PMID: 29157731 DOI: 10.1053/j.ajkd.2017.07.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetic kidney disease is a major cause of premature mortality in type 2 diabetes mellitus (T2DM). Worsening insulin sensitivity independent of glycemic control may contribute to the development of diabetic kidney disease. We investigated the longitudinal association of insulin sensitivity with hyperfiltration and increased albumin excretion in adolescents with T2DM. STUDY DESIGN Observational prospective cohort study. SETTING & PARTICIPANTS 532 TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) participants aged 12 to 17 years with T2DM duration less than 2 years at baseline. The TODAY Study was a multicenter randomized clinical trial that examined the efficacy of 3 treatment regimens (metformin monotherapy, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention program) to achieve durable glycemic control. PREDICTORS Natural log-transformed estimated insulin sensitivity (reciprocal of fasting insulin), hemoglobin A1c concentration, age, race-ethnicity, treatment group, body mass index, loss of glycemic control, and hypertension. OUTCOMES Hyperfiltration was defined as 99th percentile or higher of estimated glomerular filtration rate (≥140mL/min/1.73m2) when referenced to healthy adolescents (NHANES 1999-2002) and albumin-creatinine ratio ≥ 30μg/mg at 3 consecutive annual visits. RESULTS Hyperfiltration was observed in 7.0% of participants at baseline and in 13.3% by 5 years, with a cumulative incidence of 5.0% over 5 years. The prevalence of increased albumin excretion was 6% at baseline and 18% by 5 years, with a cumulative incidence of 13.4%. There was an 8% increase in risk for hyperfiltration per 10% lower estimated insulin sensitivity in unadjusted and adjusted models (P=0.01). Increased albumin excretion was associated with hemoglobin A1c concentration, but not estimated insulin sensitivity. LIMITATIONS Longer follow-up is needed to capture the transition from hyperfiltration to rapid glomerular filtration rate decline in youth-onset T2DM. CONCLUSIONS Lower estimated insulin sensitivity was associated with risk for hyperfiltration over time, whereas increased albumin excretion was associated with hyperglycemia in youth-onset T2DM.
Collapse
Affiliation(s)
- Petter Bjornstad
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Edward Nehus
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Laure El Ghormli
- George Washington University Biostatistics Center, Rockville, MD.
| | - Fida Bacha
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Ingrid M Libman
- Children's Hospital University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Steven M Willi
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Silva Arslanian
- Children's Hospital University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kristen J Nadeau
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | | |
Collapse
|
|
17
|
Vitrectomy for complications of proliferative diabetic retinopathy in young adults: clinical features and surgical outcomes. Graefes Arch Clin Exp Ophthalmol 2017; 255:863-871. [PMID: 28063082 DOI: 10.1007/s00417-016-3579-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/12/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To investigate the clinical manifestations and surgical results after vitrectomy for proliferative diabetic retinopathy (PDR) in young patients. METHODS Clinical features of patients between 18 to 40 years old who received vitrectomy for PDR between January 2009 and January 2015 were retrospectively reviewed. Those older than 40 years who received vitrectomy for PDR during the same period were retrospectively enrolled and compared as the control group. RESULTS There were 68 eyes (52 patients) in the study group and 77 eyes (61 patients) in the control group. The average age at operation was 33.15 ± 4.92 years and 56.67 ± 7.52 years, respectively (p < 0.001). At presentation, those in the study group had significantly higher proportions of active fibrovascular proliferation and traction retinal detachment, and with significantly higher-severity gradings than those in the control group. After operation, the recurrent detachment rates were 13.2% in the study group and 1.3% in the control group (p = 0.006), and the final anatomical success rates were 91.2% in the study group and 100% in the control group (p = 0.009). The most significant risk factor for poor visual outcome in the study group was neovascular glaucoma (NVG) (p = 0.001). Patients with Type 1 and Type 2 diabetes mellitus subgroups shared similar clinical features and visual outcome. CONCLUSIONS Younger patients who received vitrectomy for PDR presented with more severe anatomical features at the time of vitrectomy and had a higher rate of post-operative recurrent detachment. More than 90% achieved final anatomical success. NVG was associated with worse visual outcome.
Collapse
|
|
18
|
Satake E, Matsushita R, Kitsuda K, Ohtaka K, Nagata E, Yamaguchi R, Sano S, Fujisawa Y, Nakanishi T, Nakagawa Y, Ohzeki T. Urinary myo-inositol levels in Japanese schoolchildren with normal glucose tolerance. J Pediatr Endocrinol Metab 2016; 29:179-84. [PMID: 26360496 DOI: 10.1515/jpem-2015-0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/18/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Urinary myo-inositol (UMI) level is elevated in adult diabetic patients, and also increases after glucose loading. However, the relationship between UMI and plasma glucose levels in children is unknown. We aimed to assess whether UMI is a practical marker for glucose intolerance in children or not. METHODS In Study 1 (328 schoolchildren), fasting and postprandial UMI were measured, with ΔUMI defined as the difference between fasting and postprandial UMI levels. In Study 2, oral glucose tolerance tests and UMI measurements were conducted in 18 children with suspected having diabetes. RESULTS For Study 1, ΔUMI was observed [-0.65 (-3.9, 1.35) mg/g creatinine]. For Study 2, children with diabetes or impaired glucose tolerance had a significantly higher ΔUMI than children with normal glucose tolerance. CONCLUSIONS These studies demonstrated the normal range of UMI in children and possibility of a novel biomarker for early detection of glucose intolerance in children.
Collapse
|
|
19
|
Bjornstad P, Cherney DZ, Maahs DM, Nadeau KJ. Diabetic Kidney Disease in Adolescents With Type 2 Diabetes: New Insights and Potential Therapies. Curr Diab Rep 2016; 16:11. [PMID: 26803647 PMCID: PMC5841446 DOI: 10.1007/s11892-015-0708-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) and dialysis in the Western world. Early DKD, including microalbuminuria and renal hyperfiltration, is common in adolescents with type 2 diabetes (T2D). Furthermore, youth-onset T2D carries a higher risk of progressive DKD than adult-onset T2D of similar diabetes duration. DKD is characterized by a long clinically silent period without signs of disease. Therefore, a major challenge in preventing DKD is the difficulty in identifying high-risk T2D patients at an early stage. The Type 2 Diabetes in Adolescents and Youth (TODAY) study demonstrated a high initial prevalence that increased over time, irrespective of treatment arm. This key observation underscores the importance of discovering new therapeutic targets to supplement conventional management, in order to reduce DKD risk. In this review, we focus on early DKD in T2D and summarize potential novel biomarkers and therapeutic targets.
Collapse
Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA.
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA.
| | - David Z Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - David M Maahs
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
- Department of Medicine, Division of Nephrology, University of Colorado, Aurora, CO, USA
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
| |
Collapse
|
|
20
|
Piccoli GB, Grassi G, Cabiddu G, Nazha M, Roggero S, Capizzi I, De Pascale A, Priola AM, Di Vico C, Maxia S, Loi V, Asunis AM, Pani A, Veltri A. Diabetic Kidney Disease: A Syndrome Rather Than a Single Disease. Rev Diabet Stud 2015; 12:87-109. [PMID: 26676663 PMCID: PMC5397985 DOI: 10.1900/rds.2015.12.87] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/15/2015] [Accepted: 04/22/2015] [Indexed: 12/13/2022] Open
Abstract
The term "diabetic kidney" has recently been proposed to encompass the various lesions, involving all kidney structures that characterize protean kidney damage in patients with diabetes. While glomerular diseases may follow the stepwise progression that was described several decades ago, the tenet that proteinuria identifies diabetic nephropathy is disputed today and should be limited to glomerular lesions. Improvements in glycemic control may have contributed to a decrease in the prevalence of glomerular lesions, initially described as hallmarks of diabetic nephropathy, and revealed other types of renal damage, mainly related to vasculature and interstitium, and these types usually present with little or no proteinuria. Whilst glomerular damage is the hallmark of microvascular lesions, ischemic nephropathies, renal infarction, and cholesterol emboli syndrome are the result of macrovascular involvement, and the presence of underlying renal damage sets the stage for acute infections and drug-induced kidney injuries. Impairment of the phagocytic response can cause severe and unusual forms of acute and chronic pyelonephritis. It is thus concluded that screening for albuminuria, which is useful for detecting "glomerular diabetic nephropathy", does not identify all potential nephropathies in diabetes patients. As diabetes is a risk factor for all forms of kidney disease, diagnosis in diabetic patients should include the same combination of biochemical, clinical, and imaging tests as employed in non-diabetic subjects, but with the specific consideration that chronic kidney disease (CKD) may develop more rapidly and severely in diabetic patients.
Collapse
Affiliation(s)
- Giorgina B. Piccoli
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | - Giorgio Grassi
- SCDU Endocrinologia, Diabetologia e Metabolismo, Citta della Salute e della Scienza Torino, Italy
| | | | - Marta Nazha
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | - Simona Roggero
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | - Irene Capizzi
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | - Agostino De Pascale
- SCDU Radiologia, san Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Italy
| | - Adriano M. Priola
- SCDU Radiologia, san Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Italy
| | - Cristina Di Vico
- SS Nefrologia, SCDU Urologia, San Luigi Gonzaga Hospital, Department of Clinical and Biological Sciences, University of Torino, Italy
| | | | | | - Anna M. Asunis
- SCD Anatomia Patologica, Brotzu Hospital, Cagliari, Italy
| | | | - Andrea Veltri
- SCDU Radiologia, san Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Italy
| |
Collapse
|
|
21
|
Tajima N, Noda M, Origasa H, Noto H, Yabe D, Fujita Y, Goto A, Fujimoto K, Sakamoto M, Haneda M. Evidence-based practice guideline for the treatment for diabetes in Japan 2013. Diabetol Int 2015. [DOI: 10.1007/s13340-015-0206-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
|
22
|
Cost-effectiveness of obstructive sleep apnea screening for patients with diabetes or chronic kidney disease. Sleep Breath 2015; 19:1081-92. [DOI: 10.1007/s11325-015-1134-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/27/2014] [Accepted: 01/23/2015] [Indexed: 01/28/2023]
|
|
23
|
Wong J, Constantino M, Yue DK. Morbidity and mortality in young-onset type 2 diabetes in comparison to type 1 diabetes: where are we now? Curr Diab Rep 2015; 15:566. [PMID: 25398205 DOI: 10.1007/s11892-014-0566-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Increasingly, we recognise that type 2 diabetes in youth is a disease with an aggressive time course and a significant complication risk. On the other hand, outcomes for youth with type 1 diabetes appear generally to be improving. With increasing numbers of both types of diabetes in youth, it is timely that a comparative perspective is offered to help clinicians prognosticate more appropriately. Contemporary comparative studies add a new perspective to a consistent story, that for youth-onset type 2 diabetes, the development and progression of cardio-renal complications are increased and the survival prognosis is significantly worse than for type 1 diabetes. Here, we review this mounting evidence, highlight the importance of metabolic syndrome factors in the excess risk and underscore that there remains a significant mortality gap for youth with either type of diabetes, to be addressed as a matter of urgency.
Collapse
Affiliation(s)
- Jencia Wong
- Royal Prince Alfred Hospital Diabetes Centre, Level 6 West, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, 2050, Australia,
| | | | | |
Collapse
|
|
24
|
Cai X, Han X, Zhang S, Luo Y, Chen Y, Ji L. Age at diagnosis and C-peptide level are associated with diabetic retinopathy in Chinese. PLoS One 2014; 9:e91174. [PMID: 24614131 PMCID: PMC3948781 DOI: 10.1371/journal.pone.0091174] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 02/10/2014] [Indexed: 02/04/2023] Open
Abstract
Objective To find the associations between diabetic retinopathy and age at diagnosis, C-peptide level and thyroid-stimulating hormone (TSH) level in Chinese type 2 diabetes mellitus. Methods 3100 hospitalized type 2 diabetic patients in Peking University People's Hospital were included in this retrospective study. Their medical history and the laboratory data were collected. All the patients received examination of diabetic retinopathy (DR) by professional ophthalmologist. Results Comparisons among patients with NDR, NPDR and PDR showed that with the progression of diabetic retinopathy, patients turned to have older age but younger age at diagnosis of diabetes, and have higher SBP, longer duration of diabetes, higher mean HbA1c but lower fasting and 2 hours postprandial C-peptide level. Moreover, with the progression of diabetic retinopathy, patients turned to have higher prevalence of primary hypertension, higher prevalence of peripheral vascular sclerosis, higher proportion with insulin treatment. TSH level was comparable among the three groups of patients. Association analysis showed that after adjusting for age, sex, duration of diabetes, body mass index, HbA1c, blood pressure and albuminurea creatinine ratio and insulin treatment, age at diagnosis (OR 0.888, 95%CI 0.870–0.907, p = 0.00) and postprandial C-peptide (OR 0.920, 95%CI 0.859–0.937, p = 0.00) are the independent associated factors of DR in Chinese type 2 diabetes. Conclusions According to the results, postprandial C-peptide level and age at diabetes may be two independent associated factors with DR in Chinese type 2 diabetes. The lower level of postprandial C-peptide, the younger age at diagnosis, may indicate the higher prevalence of DR.
Collapse
Affiliation(s)
- Xiaoling Cai
- Endocrinology & Metabolism Department, Peking University People's Hospital, Beijing, China
| | - Xueyao Han
- Endocrinology & Metabolism Department, Peking University People's Hospital, Beijing, China
| | - Simin Zhang
- Endocrinology & Metabolism Department, Peking University People's Hospital, Beijing, China
| | - Yingying Luo
- Endocrinology & Metabolism Department, Peking University People's Hospital, Beijing, China
| | - Yingli Chen
- Endocrinology & Metabolism Department, Peking University People's Hospital, Beijing, China
| | - Linong Ji
- Endocrinology & Metabolism Department, Peking University People's Hospital, Beijing, China
- * E-mail:
| |
Collapse
|
|
25
|
Ohsugi K, Sugawara H, Ebina K, Shiga K, Kikuchi N, Mori M, Yokota S. Comparison of brachial artery flow-mediated dilation in youth with type 1 and type 2 diabetes mellitus. J Diabetes Investig 2014; 5:615-20. [PMID: 25411631 PMCID: PMC4188121 DOI: 10.1111/jdi.12191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/03/2013] [Accepted: 11/17/2013] [Indexed: 02/04/2023] Open
Abstract
Aims/Introduction Brachial artery flow‐mediated dilation (FMD) is a method of evaluating the function of vascular endothelial cells and is utilized for early diagnosis of atherosclerotic diseases. Only a few studies evaluated the risks for major vascular complications in youth with type 1 and 2 diabetes mellitus from the aspect of the early development of atherosclerosis. We studied whether there is a difference in vascular endothelial cell function between youth with type 1 and 2 diabetes mellitus. Materials and Methods We assessed %FMD of 24 patients with type 1 diabetes mellitus and 27 patients with type 2 diabetes mellitus aged 12–20 years along with glycated hemoglobin, lipid metabolism markers such as triglycerides, and inflammatory biomarkers such as total adiponectin levels in adolescent patients with type 1 or 2 diabetes mellitus. The significance of the difference in each factor between the type 1 and type 2 diabetes groups was assessed using Student's t‐test. Results The %FMD was significantly lower in patients with type 2 diabetes. The body mass index and blood pressure were significantly higher, and total and high‐molecular‐weight adiponectin levels were significantly lower in patients with type 2 diabetes. %FMD significantly correlated with systolic blood pressure. Conclusions The results suggest that youth with type 2 diabetes have more advanced damage of the vascular endothelium and therefore are at higher risk for major vascular complications. Therefore, monitoring the progression of atherosclerosis would also be beneficial in youth with diabetes mellitus, and measurement of FMD could be further warranted.
Collapse
Affiliation(s)
- Koji Ohsugi
- Department of Pediatrics Yokohama City University Medical Center Yokohama Kanagawa Japan
| | - Hidenori Sugawara
- Department of Pediatrics Yokohama City University Medical Center Yokohama Kanagawa Japan
| | - Kanako Ebina
- Department of Pediatrics Yokohama City University Medical Center Yokohama Kanagawa Japan
| | - Kentaro Shiga
- Department of Pediatrics Yokohama City University Medical Center Yokohama Kanagawa Japan
| | - Nobuyuki Kikuchi
- Department of Pediatrics Yokohama City University Medical Center Yokohama Kanagawa Japan
| | - Masaaki Mori
- Department of Pediatrics Yokohama City University Medical Center Yokohama Kanagawa Japan
| | - Shumpei Yokota
- Department of Pediatrics Yokohama City University School of Medicine Yokohama Kanagawa Japan
| |
Collapse
|
|
26
|
Abstract
The occurrence and progression of nephropathy associated with early onset type 2 diabetes (T2D) is a consequence of the ongoing epidemic of childhood obesity. Minimal evidence regarding treatment effectiveness of renovascular comorbidities in youth with early onset T2D is available, due to the relatively recent emergence of T2D in youth and young adults. Extrapolation of adult therapy guidelines is not an ideal approach to making therapeutic decisions in this population. Evolving management and intervention strategies are based on accumulating longitudinal data from cohorts of well characterized youth and young adults with T2D. The degree of similarity in histologic findings and disease specific characteristics of kidney disease in patients with early onset T2D and albuminuria compared with affected adults is not well characterized. Early aggressive therapies to minimize the impact of nephropathy are indicated as the evidence for best therapies in youth with T2D are further explored.
Collapse
Affiliation(s)
- Carolina Solis-Herrera
- Resident, Internal Medicine, Texas Tech University Health Science Center at Permian Basin, 5075 East 52 St. #J305, Odessa, TX 79762, Phone: 210-619-3264
| | - Curtis L. Triplitt
- Texas Diabetes Institute, Clinical Assistant Professor, Department of Medicine, Div. of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, Phone:210-358-7228, Fax:210-358-7235
| | - Jane L. Lynch
- Professor of Pediatrics, University of Texas Health Science Center, 7703 Floyd Curl Dr. (MS 7806), San Antonio, TX 78229, Phone: 210-567-5213, Fax: 210-567-0492
| |
Collapse
|
|
27
|
Song SH, Hardisty CA. Early-onset Type 2 diabetes mellitus: an increasing phenomenon of elevated cardiovascular risk. Expert Rev Cardiovasc Ther 2014; 6:315-22. [DOI: 10.1586/14779072.6.3.315] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
|
28
|
Management of pediatric and adolescent type 2 diabetes. Int J Pediatr 2013; 2013:972034. [PMID: 24260037 PMCID: PMC3821947 DOI: 10.1155/2013/972034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/20/2013] [Indexed: 12/25/2022] Open
Abstract
Type 2 diabetes (T2D) was an adult disease until recently, but the rising rates of obesity around the world have resulted in a younger age at presentation. Children who have T2D have several comorbidities and complications reminiscent of adult diabetes, but these are appearing in teens instead of midlife. In this review, we discuss the clinical presentation and management options for youth with T2D. We discuss the elements of lifestyle intervention programs and allude to pharmacotherapeutic options used in the treatment of T2D youth. We also discuss comorbidities and complications seen in T2D in children and adolescents.
Collapse
|
|
29
|
Panagiotopoulos C, Riddell MC, Sellers EA. Le diabète de type 2 chez les enfants et les adolescents. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
30
|
|
|
31
|
Takenaka T, Okayama M, Kojima E, Nodaira Y, Arai J, Uchida K, Kikuta T, Sueyoshi K, Hoshi H, Watanabe Y, Takane H, Suzuki H. Aliskiren reduces morning blood pressure in hypertensive patients with diabetic nephropathy on hemodialysis. Clin Exp Hypertens 2013; 35:244-9. [PMID: 23534458 DOI: 10.3109/10641963.2013.780066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our previous study indicated that the exchange from an angiotensin receptor blocker (ARB) to aliskiren reduced morning blood pressure and albuminuria in hypertensive patients with diabetic nephropathy. We extended the above study and assessed the effects of exchanging from an ARB to aliskiren on home blood pressure in hypertensive patients with diabetic nephropathy on chronic hemodialysis. The patients who were persistently hypertensive despite antihypertensive therapy, including ARB, were considered as candidates for the exchange from the ARB to aliskiren. Patients' age and durations of diabetes and hemodialysis were averaged as 62 ± 9 years old, 15 ± 8 and 7 ± 3 years, respectively. Aliskiren decreased morning systolic blood pressure (149 ± 14 to 144 ± 13 mm Hg, n = 30, P < .01) and plasma renin activity (3.5 ± 1.1 to 1.2 ± 0.6 ng/mL/h, P < .01) without changes in serum potassium. Aliskiren also reduced interdialytic weight gain (2.7 ± 0.6 to 2.5 ± 0.5 kg/interval, P < .05) and attenuated the magnitude of intradialytic declines in systolic (-20 ± 11 to -17 ± 10 mm Hg, P < .05) and diastolic blood pressure (-9 ± 6 to -5 ± 5 mm Hg, P < .01). The exchange from an ARB to aliskiren is safe and useful to control home blood pressure in hypertensive hemodialysis patients with diabetic nephropathy. Aliskiren reduced both intradialytic blood pressure drops and interdialytic weight gain in patients with DN.
Collapse
Affiliation(s)
- Tsuneo Takenaka
- Department of Nephrology, Saitama Medical University, Iruma, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
32
|
Springer SC, Silverstein J, Copeland K, Moore KR, Prazar GE, Raymer T, Shiffman RN, Thaker VV, Anderson M, Spann SJ, Flinn SK. Management of type 2 diabetes mellitus in children and adolescents. Pediatrics 2013; 131:e648-64. [PMID: 23359584 DOI: 10.1542/peds.2012-3496] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Over the last 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. This technical report describes, in detail, the procedures undertaken to develop the recommendations given in the accompanying clinical practice guideline, "Management of Type 2 Diabetes Mellitus in Children and Adolescents," and provides in-depth information about the rationale for the recommendations and the studies used to make the clinical practice guideline's recommendations. METHODS A primary literature search was conducted relating to the treatment of T2DM in children and adolescents, and a secondary literature search was conducted relating to the screening and treatment of T2DM's comorbidities in children and adolescents. Inclusion criteria were prospectively and unanimously agreed on by members of the committee. An article was eligible for inclusion if it addressed treatment (primary search) or 1 of 4 comorbidities (secondary search) of T2DM, was published in 1990 or later, was written in English, and included an abstract. Only primary research inquiries were considered; review articles were considered if they included primary data or opinion. The research population had to constitute children and/or adolescents with an existing diagnosis of T2DM; studies of adult patients were considered if at least 10% of the study population was younger than 35 years. All retrieved titles, abstracts, and articles were reviewed by the consulting epidemiologist. RESULTS Thousands of articles were retrieved and considered in both searches on the basis of the aforementioned criteria. From those, in the primary search, 199 abstracts were identified for possible inclusion, 58 of which were retained for systematic review. Five of these studies were classified as grade A studies, 1 as grade B, 20 as grade C, and 32 as grade D. Articles regarding treatment of T2DM selected for inclusion were divided into 4 major subcategories on the basis of type of treatment being discussed: (1) medical treatments (32 studies); (2) nonmedical treatments (9 studies); (3) provider behaviors (8 studies); and (4) social issues (9 studies). From the secondary search, an additional 336 abstracts relating to comorbidities were identified for possible inclusion, of which 26 were retained for systematic review. These articles included the following: 1 systematic review of literature regarding comorbidities of T2DM in adolescents; 5 expert opinions presenting global recommendations not based on evidence; 5 cohort studies reporting natural history of disease and comorbidities; 3 with specific attention to comorbidity patterns in specific ethnic groups (case-control, cohort, and clinical report using adult literature); 3 reporting an association between microalbuminuria and retinopathy (2 case-control, 1 cohort); 3 reporting the prevalence of nephropathy (cohort); 1 reporting peripheral vascular disease (case series); 2 discussing retinopathy (1 case-control, 1 position statement); and 3 addressing hyperlipidemia (American Heart Association position statement on cardiovascular risks; American Diabetes Association consensus statement; case series). A breakdown of grade of recommendation shows no grade A studies, 10 grade B studies, 6 grade C studies, and 10 grade D studies. With regard to screening and treatment recommendations for comorbidities, data in children are scarce, and the available literature is conflicting. Therapeutic recommendations for hypertension, dyslipidemia, retinopathy, microalbuminuria, and depression were summarized from expert guideline documents and are presented in detail in the guideline. The references are provided, but the committee did not independently assess the supporting evidence. Screening tools are provided in the Supplemental Information.
Collapse
|
|
33
|
Emerging Type 2 Diabetes in Young Adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 771:51-61. [DOI: 10.1007/978-1-4614-5441-0_7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
|
34
|
Okada K, Osuga JI, Kotani K, Yagyu H, Miyamoto M, Nagasaka S, Ishibashi S. Current smoking status may be associated with overt albuminuria in female patients with type 1 diabetes mellitus: a cross-sectional study. Tob Induc Dis 2012; 10:12. [PMID: 22883528 PMCID: PMC3476992 DOI: 10.1186/1617-9625-10-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 08/06/2012] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There are very few clinical reports that have compared the association between cigarette smoking and microangiopathy in Asian patients with type 1 diabetes mellitus (T1DM). The objective of this study was to assess the relationships between urinary protein concentrations and smoking and gender-based risk factors among patients with T1DM. METHODS A cross-sectional study of 259 patients with T1DM (men/women = 90/169; mean age, 50.7 years) who visited our hospital for more than 1 year between October 2010 and April 2011 was conducted. Participants completed a questionnaire about their smoking habits. Patient characteristics included gender, age, body mass index, blood pressure, hemoglobin A1c, lipid parameters, and microangiopathy. Diabetic nephropathy (DN) was categorized as normoalbuminuria (NA), microalbuminuria (MA), or overt albuminuria (OA) on the basis of the following urinary albumin/creatinine ratio (ACR) levels: NA, ACR levels less than 30 mg/g creatinine (Cr); MA, ACR levels between 30 and 299 mg/g Cr; and OA, ACR levels over 300 mg/g Cr. RESULTS The percentages of current nonsmokers and current smokers with T1DM were 73.0% (n = 189) and 27.0% (n = 70), respectively. In addition, the percentage of males was higher than that of females (52.2% versus 13.6%) in the current smoking population. The percentage of DN was 61.8% (n = 160) in patients with NA, 21.6% (n = 56) in patients with MA, and 16.6% (n = 43) in patients with OA. The percentage of males among OA patients was also higher than that of females (24.4% versus 12.4%). However, current smoking status was associated with OA in females with T1DM only [unadjusted odds ratio (OR), 4.13; 95% confidence interval (CI), 1.45-11.73, P < 0.01; multivariate-adjusted OR, 5.41; 95% CI, 1.69-17.30, P < 0.01]. CONCLUSIONS Based on our results in this cross-sectional study of Asian patients with T1DM, smoking might be a risk factor for OA among female patients. Further research is needed of these gender-specific results.
Collapse
Affiliation(s)
- Kenta Okada
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Tochigi 320-0498, Japan
| | - Jun-ichi Osuga
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Tochigi 320-0498, Japan
| | - Kazuhiko Kotani
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi 320-0498, Japan
| | - Hiroaki Yagyu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Tochigi 320-0498, Japan
| | - Michiaki Miyamoto
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Tochigi 320-0498, Japan
| | - Shoichiro Nagasaka
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Tochigi 320-0498, Japan
| | - Shun Ishibashi
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Jichi Medical University, Tochigi 320-0498, Japan
| |
Collapse
|
|
35
|
Dart AB, Sellers EA, Martens PJ, Rigatto C, Brownell MD, Dean HJ. High burden of kidney disease in youth-onset type 2 diabetes. Diabetes Care 2012; 35:1265-71. [PMID: 22432116 PMCID: PMC3357249 DOI: 10.2337/dc11-2312] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 02/09/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate renal outcomes and survival in youth with type 2 diabetes (T2DM) versus type 1 diabetes (T1DM) versus nondiabetic control subjects. RESEARCH DESIGN AND METHODS In total, 342 prevalent youth (aged 1-18 years) with T2DM, 1,011 youth with T1DM, and 1,710 control subjects identified from 1986 to 2007 were anonymously linked to health care records housed at the Manitoba Centre for Health Policy to assess long-term outcomes using ICD codes. RESULTS Youth with T2DM were found to have a fourfold increased risk of renal failure versus youth with T1DM. Risk factors associated with renal failure were renin angiotensin aldosterone system inhibitor use and albuminuria in adolescence. Compared with control subjects (age, sex, and postal code matched), youth with T2DM had a 23-fold increased risk of renal failure and a 39-fold increased risk of dialysis. Kaplan-Meier survival at 10 years was 91.4% in the type 2 diabetic group versus 99.5% in the type 1 diabetic group (P < 0.0001). Renal survival was 100% at 10 years in both groups. It decreased to 92.0% at 15 years and 55.0% at 20 years in the type 2 diabetic group but remained stable in the type 1 diabetic group (P < 0.0001). CONCLUSIONS Youth with T2DM are at high risk of adverse renal outcomes and death. Albuminuria and angiotensin aldosterone system inhibitor use, which may be a marker of severity of disease, are associated with poor outcomes in early adulthood.
Collapse
Affiliation(s)
- Allison B Dart
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | | | | | | | | |
Collapse
|
|
36
|
The initiation of insulin therapy in type 2 diabetic patients treated with oral anti-diabetic drugs: an observational study in multiple institutes across Japan (JDDM27). Diabetol Int 2012. [DOI: 10.1007/s13340-012-0073-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
37
|
Takenaka T, Nobe K, Okayama M, Kojima E, Nodaira Y, Sueyoshi K, Hoshi H, Watanabe Y, Takane H, Suzuki H. Aliskiren reduces morning blood pressure in hypertensive patients with diabetic nephropathy. Clin Exp Hypertens 2012; 34:243-8. [PMID: 22559034 DOI: 10.3109/10641963.2012.681080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetic nephropathy (DN) is a leading disease that requires renal replacement therapy. The progression of renal dysfunction in DN is faster than the other renal diseases. While antihypertensive therapy reduces albuminuria, a good indicator for the progression, hypertension in DN is treatment resistant. Among patients with DN who took angiotensin receptor blockers (ARBs), 27 patients who exhibited poor control of albuminuria were enrolled into the study. Angiotensin receptor blocker was exchanged to aliskiren (150-300 mg/d) and clinical parameters were followed for 6 months. Exchange to aliskiren decreased albuminuria (1.57 ± 0.68 to 0.89 ± 0.45 g/gCr, P < .01) without changes in estimated glomerular filtration rate and office blood pressure (BP). Body weight and hemoglobin A1c were not altered. Aliskiren also reduced plasma renin activity (2.0 ± 0.9 to 1.2 ± 0.6 ng/mL/h, P < .01). While evening BP was unchanged, morning systolic BP (139 ± 8 to 132 ± 7 mm Hg, P < .01) and diastolic BP (81 ± 7 to 76 ± 6 mm Hg, P < .05) were decreased significantly after 6 months. Our results indicated that aliskiren decreased BP, especially morning BP in hypertensive patients with DN. The present data suggest that aliskiren exerts renoprotective actions including reduction in albumin excretion for patients with DN.
Collapse
Affiliation(s)
- Tsuneo Takenaka
- Department of Nephrology, Saitama Medical University, Iruma, Saitama, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
38
|
Conway BN, May ME, Signorello LB, Blot WJ. Mortality experience of a low-income population with young-onset diabetes. Diabetes Care 2012; 35:542-8. [PMID: 22238277 PMCID: PMC3322678 DOI: 10.2337/dc11-1385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In young-onset diabetes, insulin therapy status is a rough marker of diabetes type. We describe the mortality experience of a low-income, predominantly minority population with diabetes diagnosed before age 30 years, stratified by insulin therapy. RESEARCH DESIGN AND METHODS A total of 1,098 adults aged 40-79 years (median 49) diagnosed with diabetes before age 30 years and 49,914 without diabetes were recruited from community health centers. Individuals with diabetes were categorized by insulin therapy at baseline: group A, insulin therapy only; group B, insulin therapy and an oral hypoglycemic agent; and group C, no insulin therapy. Cox models were used to compute hazard ratios (HRs) and 95% CI for cause-specific mortality based on both underlying and contributing causes of death from death certificates. RESULTS During follow-up (mean 3.9 years), 15.0, 12.5, and 7.3% of groups A, B, and C, respectively, and 4.6% without diabetes died. Compared with individuals without diabetes, HRs (CI) for all-cause mortality were 4.3 (3.4-5.6), 4.2 (2.8-6.3), and 2.0 (1.4-2.8) in groups A, B, and C, respectively. The leading cause of death was renal failure (end-stage renal disease [ESRD]) in group A, ESRD and coronary artery disease (CAD) in group B, and CAD in group C and individuals without diabetes. HRs for these conditions were at least twice as high as the HRs for all-cause mortality, reaching 17.3 (10.2-29.3), 17.9 (8.3-38.7), and 5.1 (2.3-11.7) in groups A, B, and C, respectively, for ESRD. CONCLUSIONS Excess mortality persists among people with young-onset diabetes of long duration, with ESRD and CAD as the leading contributors to mortality.
Collapse
Affiliation(s)
- Baqiyyah N Conway
- Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
| | | | | | | |
Collapse
|
|
39
|
Kidney disease and youth onset type 2 diabetes: considerations for the general practitioner. Int J Pediatr 2012; 2012:237360. [PMID: 22315622 PMCID: PMC3270413 DOI: 10.1155/2012/237360] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/11/2011] [Indexed: 12/15/2022] Open
Abstract
Youth onset type 2 diabetes (T2DM) continues to increase worldwide, concomitant with the rising obesity epidemic. There is evidence to suggest that youth with T2DM are affected by the same comorbidities and complications as adults diagnosed with T2DM. This review highlights specifically the kidney disease associated with youth onset T2DM, which is highly prevalent and associated with a high risk of end-stage kidney disease in early adulthood. A general understanding of this complex disease by primary care providers is critical, so that at-risk individuals are identified and managed early in the course of their disease, such that progression can be modified in this high-risk group of children and adolescents. A review of the pediatric literature will include a focus on the epidemiology, risk factors, pathology, screening, and treatment of kidney disease in youth onset T2DM.
Collapse
|
|
40
|
Song SH, Gray TA. Early-onset type 2 diabetes: high risk for premature diabetic retinopathy. Diabetes Res Clin Pract 2011; 94:207-11. [PMID: 21855159 DOI: 10.1016/j.diabres.2011.07.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/13/2011] [Accepted: 07/25/2011] [Indexed: 10/17/2022]
Abstract
AIM To examine the relationship between early-onset type 2 diabetes (T2D) and retinopathy in relation to the burden, severity, the extent of its premature development and associated predictive risk factors. METHODS A cross sectional study using the hospital diabetes register and eye screening database to identify T2D subjects and to ascertain retinopathy severity. Early and later-onset cohort were defined as age of diagnosis <40 and >40 years respectively. RESULTS 2516 subjects were identified of which 455 were diagnosed below 40 years. After 10 years of diagnosis, the prevalence of overall retinopathy was significantly higher in the early-onset cohort (p < 0.05). For significant retinopathy (SigDR), there was a non-significant trend of higher prevalence with increasing diabetes duration in the early-onset cohort. The rate of increase for SigDR was greater in the early-onset cohort who experienced similar burden of SigDR up to 20 years earlier than the later-onset cohort. Hypertension (p < 0.05), suboptimal glycaemic control (p < 0.05) and long diabetes duration (p < 0.05) were associated with risk of retinopathy whilst lower age of diagnosis and dyslipidaemia were not significant predictive factors. CONCLUSIONS Early-onset T2D subjects are at risk of developing premature retinopathy driven predominantly by hypertension and prolonged exposure to suboptimal diabetes control.
Collapse
Affiliation(s)
- Soon H Song
- Diabetes Centre, Northern General Hospital, Sheffield, UK.
| | | |
Collapse
|
|
41
|
Halpern A, Mancini MC, Magalhães MEC, Fisberg M, Radominski R, Bertolami MC, Bertolami A, de Melo ME, Zanella MT, Queiroz MS, Nery M. Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment. Diabetol Metab Syndr 2010; 2:55. [PMID: 20718958 PMCID: PMC2939537 DOI: 10.1186/1758-5996-2-55] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 08/18/2010] [Indexed: 02/06/2023] Open
Abstract
Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D. The earlier the appearance of the clustering of risk factors and the higher the time of exposure, the greater will be the chance of developing coronary disease with a more severe endpoint. The age when the event may occur seems to be related to the presence and aggregation of risk factors throughout life.The treatment in this age-group is non pharmacological and aims at promoting changes in lifestyle. However, pharmacological treatments are indicated in special situations.The major goals in dietary treatments are not only limited to weight loss, but also to an improvement in the quality of life. Modification of risk factors associated to comorbidities, personal satisfaction of the child or adolescent and trying to establish healthy life habits from an early age are also important. There is a continuous debate on the best possible exercise to do, for children or adolescents, in order to lose weight. The prescription of physical activity to children and adolescents requires extensive integrated work among multidisciplinary teams, patients and their families, in order to reach therapeutic success.The most important conclusion drawn from this symposium was that if the growing prevalence of overweight and obesity continues at this pace, the result will be a population of children and adolescents with metabolic syndrome. This would lead to high mortality rates in young adults, changing the current increasing trend of worldwide longevity. Government actions and a better understanding of the causes of this problem must be implemented worldwide, by aiming at the prevention of obesity in children and adolescents.
Collapse
Affiliation(s)
- Alfredo Halpern
- Group of Obesity and Metabolic Syndrome, Endocrinology and Metabolism Service, Hospital das Clínicas da Faculdade de Medicina, São Paulo University (HC-FMUSP). Av. Dr. Enéas de Carvalho Aguiar, 155 - 8º andar - bloco 3. São Paulo, Brazil
| | - Marcio C Mancini
- Group of Obesity and Metabolic Syndrome, Endocrinology and Metabolism Service, Hospital das Clínicas da Faculdade de Medicina, São Paulo University (HC-FMUSP). Av. Dr. Enéas de Carvalho Aguiar, 155 - 8º andar - bloco 3. São Paulo, Brazil
| | - Maria Eliane C Magalhães
- Arterial Hypertension and Lipids Sector of Hospital Universitário Pedro Ernesto - State University of Rio de Janeiro (UERJ). Rua São Francisco Xavier, 524. Rio de Janeiro, Brazil
| | - Mauro Fisberg
- Adolescent Center, Department of Pediatrics, Federal University of Sao Paulo (UNIFESP). Rua Pedro de Toledo, 650, 2o andar. São Paulo, Brazil
| | - Rosana Radominski
- Endocrinology and Metabolism Service of Hospital de Clínicas, Department of Nutrition, Federal University of Paraná (UFPR). Rua General Carneiro, 181. Curitiba, Brazil
| | - Marcelo C Bertolami
- Dante Pazzanese Institute of Cardiology of the São Paulo State Health Department. Av. Dr. Dante Pazzanese, 500. São Paulo, Brazil
| | - Adriana Bertolami
- Group of Diabetes, Endocrinology and Metabolism Service, Hospital das Clínicas da Faculdade de Medicina, São Paulo University (HC-FMUSP). Av. Dr. Enéas de Carvalho Aguiar, 155 - 8º andar - bloco 3. São Paulo, Brazil
| | - Maria Edna de Melo
- Group of Obesity and Metabolic Syndrome, Endocrinology and Metabolism Service, Hospital das Clínicas da Faculdade de Medicina, São Paulo University (HC-FMUSP). Av. Dr. Enéas de Carvalho Aguiar, 155 - 8º andar - bloco 3. São Paulo, Brazil
| | - Maria Teresa Zanella
- Service of Endocrinology, Department of Medicine, Federal University of São Paulo (UNIFESP). Rua Pedro de Toledo, 650, 2º andar. São Paulo, Brazil
| | - Marcia S Queiroz
- Group of Diabetes, Endocrinology and Metabolism Service, Hospital das Clínicas da Faculdade de Medicina, São Paulo University (HC-FMUSP). Av. Dr. Enéas de Carvalho Aguiar, 155 - 8º andar - bloco 3. São Paulo, Brazil
| | - Marcia Nery
- Group of Diabetes, Endocrinology and Metabolism Service, Hospital das Clínicas da Faculdade de Medicina, São Paulo University (HC-FMUSP). Av. Dr. Enéas de Carvalho Aguiar, 155 - 8º andar - bloco 3. São Paulo, Brazil
| |
Collapse
|
|
42
|
Bowen ME, Rothman RL. Multidisciplinary management of type 2 diabetes in children and adolescents. J Multidiscip Healthc 2010; 3:113-24. [PMID: 21197360 PMCID: PMC3004606 DOI: 10.2147/jmdh.s7840] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Indexed: 12/16/2022] Open
Abstract
Although once considered a disease of adults, the prevalence of type 2 diabetes in youth is increasing at a significant rate. Similar to adults, youth with type 2 diabetes are at increased risk for developing hypertension, lipid abnormalities, renal disease, and other diabetes-related complications. However, children and adolescents with type 2 diabetes also face many unique management challenges that are different from adults with type 2 diabetes or children with type 1 diabetes. To deliver safe, effective, high-quality, cost-effective health care to adolescents with type 2 diabetes, reorganization and redesign of health care systems are needed. Multidisciplinary health care teams, which allow individuals with specialized training to maximally utilize their skills within an organized diabetes treatment team, may increase efficiency and effectiveness and may improve outcomes in children with type 2 diabetes. This review article provides a brief review of type 2 diabetes in children and adolescents, provides an overview of multidisciplinary health care teams, and discusses the role of multidisciplinary health care management in youth with type 2 diabetes.
Collapse
Affiliation(s)
- Michael E Bowen
- Veterans Affairs Quality Scholars Fellowship Program, Tennessee Valley Healthcare System, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN, USA
| | | |
Collapse
|
|
43
|
Nakamura N, Sasaki N, Kida K, Matsuura N. Health-related and diabetes-related quality of life in Japanese children and adolescents with type 1 and type 2 diabetes. Pediatr Int 2010; 52:224-9. [PMID: 20500475 DOI: 10.1111/j.1442-200x.2009.002918.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study was to assess (i) the health-related quality of life (HR-QOL) of primary, junior and high school children with type 1 and type 2 diabetes and to compare it with that of healthy school children; and (ii) to compare the diabetes-related QOL (DR-QOL) and the QOL of parents of children with diabetes, between type 1 and type 2 diabetes in Japan. METHODS Overall, 471 patients aged 9-18 years (368 with type 1 and 103 with type 2 diabetes) and their parents were involved. QOL was assessed using a self-administered questionnaire. RESULTS The total score for HR-QOL of primary and junior school children with type 1 diabetes was significantly higher than that of those with type 2 diabetes and healthy controls. However, there were no significant differences in high school children. Some subscales regarding HR-QOL were significantly lower for children with type 2 diabetes than for children with type 1 diabetes or healthy controls. The DR-QOL of children with type 1 and type 2 diabetes did not significantly differ. The Family Burden and Family Involvement were significantly greater in parents of children with type 1 diabetes. There were significantly positive correlations between HR-QOL and DR-QOL in both groups. In type 1 diabetes only, there were significant negative correlations between glycated hemoglobin and some subscales of the HR-QOL and QOL of parents of children with diabetes, and weak positive correlation between glycated hemoglobin and Family Burden. CONCLUSIONS The HR-QOL of school children with type 1 diabetes was higher than that of those with type 2 diabetes and healthy school children. The QOL of school children with type 1 diabetes was not impaired.
Collapse
Affiliation(s)
- Nobue Nakamura
- Department of Child Nursing, School of Nursing, Chiba University, Chiba, Japan
| | | | | | | | | |
Collapse
|
|
44
|
Panagiotopoulos C, Ronsley R, Davidson J. Increased prevalence of obesity and glucose intolerance in youth treated with second-generation antipsychotic medications. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:743-9. [PMID: 19961662 DOI: 10.1177/070674370905401104] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the rates of obesity, impaired fasting glucose (IFG), and type 2 diabetes between second-generation antipsychotic (SGA)-treated and -naive youth. METHODS A retrospective chart review was conducted for all child and adolescent psychiatry emergency admissions over 2.5 years. Data collected included age, sex, psychiatric diagnosis, medications, height, weight, fasting glucose, and lipid profile. Body mass index (BMI) was standardized for age and sex and converted to a z score. Overweight was defined as a BMI between the 85th and 95th percentile and obese as a BMI at the 95th percentile or greater for age and sex. The 2007 American Diabetes Association criteria for IFG and type 2 diabetes were used. RESULTS Among the 432 admissions, 167 (39%) had both height and weight measured, and 145 (34%) had fasting glucose measured. The mean zBMI was higher in the SGA-treated (n = 68), compared with the SGA-naive group (n = 99) (mean difference 0.81; 95% CI 0.46 to 1.16). In the SGA-treated group, 31% were obese and 26% were overweight, compared with 15% and 8%, respectively, in the SGA-naive group (P < 0.01). In the SGA-treated group (n = 65), 21.5% had IFG or type 2 diabetes, compared with 7.5% in the SGA-naive group (n = 80) (P = 0.01). CONCLUSIONS Youth treated with SGAs have significantly higher rates of obesity and glucose intolerance than SGA-naive youth. These data emphasize the need for consistent metabolic monitoring of youth with psychiatric disorders who are prescribed SGAs.
Collapse
|
|
45
|
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) is a risk factor for macrovascular complications in adults. Recently young-onset type 2 DM has increased worldwide and the increase of macrovascular complications in the young is worrisome. METHODS Plasma values for plasminogen activator inhibitor-1 (PAI-1) as a marker for promotion, and adiponectin as a marker for inhibition of atherosclerosis, were compared in 33 patients with type 1 DM (16 boys, 17 girls; age 14.9 +/- 3.7 years, mean +/- standard deviation) with those of 43 patients with type 2 DM (15 boys, 28 girls; age 16.5 +/- 3.5 years). RESULTS The PAI-1 level was significantly higher (19.3 +/- 8.1 vs 32.9 +/- 17.2 ng/ml; P < 0.001) and the adiponectin level was significantly lower (10.1 +/- 3.8 vs 7.4 +/- 3.7 microg/ml; P < 0.005) in the type 2 DM group. In obese patients, the PAI-1 level was significantly higher (P < 0.005) and the adiponectin level was lower (P= 0.15) in the type 2 DM group. Also, in the non-obese subjects, the PAI-1 level was significantly higher (P < 0.05) and the adiponectin level was lower (P= 0.11) in the type 2 DM group. CONCLUSIONS Even in young patients, type 2 DM is a risk factor for macrovascular complications compared with type 1 DM.
Collapse
Affiliation(s)
- Kentaro Shiga
- Department of Pediatrics, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan.
| | | |
Collapse
|
|
46
|
Whalley GA, Gusso S, Hofman P, Cutfield W, Poppe KK, Doughty RN, Baldi JC. Structural and functional cardiac abnormalities in adolescent girls with poorly controlled type 2 diabetes. Diabetes Care 2009; 32:883-8. [PMID: 19196881 PMCID: PMC2671111 DOI: 10.2337/dc08-2005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 01/26/2009] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes is associated with left ventricular hypertrophy (LVH) and diastolic dysfunction, which may eventually lead to clinical heart failure. We sought to determine the cardiovascular effects of adolescent-onset type 2 diabetes. RESEARCH DESIGN AND METHODS We recruited diabetic girls (8 with type 2 and 11 with type 1 diabetes) from a hospital diabetes service and nondiabetic control subjects (9 lean and 11 overweight) from the schools of the diabetic subjects. Echocardiography and measurements were performed by a single observer, blinded to subject group allocation, and included M-mode left ventricular dimensions, two-dimensional left ventricular mass, Doppler diastolic flows, estimation of left ventricular filling pressure, and systolic longitudinal motion. Left ventricular mass was indexed to height and fat-free body mass. ANOVA was used to compare the groups. RESULTS The groups were similar in age and height, but significant differences in body composition were observed. Subjects with type 2 diabetes had larger left ventricular dimensions and left ventricular mass, which persisted when indexed to height. Diastolic filling was impaired in both diabetic groups, and systolic longitudinal function was lower in the type 2 diabetic group. Half of the group with type 2 diabetes met the published criteria for LVH and left ventricular dilatation; 25% had evidence of elevated left ventricular filling pressure in association with structural abnormalities. CONCLUSIONS This study has demonstrated preclinical abnormalities of cardiac structure and function in adolescent girls with type 2 diabetes, despite the short duration of diabetes and highlights the potential high cardiovascular risk occurring in adolescent type 2 diabetes.
Collapse
Affiliation(s)
- Gillian A Whalley
- Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | | | | | | | | | | | | |
Collapse
|
|
47
|
Uchigata Y, Otani T, Takaike H, Miura J, Osawa M, Tukahara S, Kasahara T, Iwamoto Y. Time-course changes in clinical features of early-onset Japanese type 1 and type 2 diabetes: TWMU hospital-based study. Diabetes Res Clin Pract 2008; 82:80-6. [PMID: 18707790 DOI: 10.1016/j.diabres.2008.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 06/23/2008] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
Abstract
Using a database of patients with type 1 (n=1675) and type 2 (n=2259) diabetes diagnosed before the age of 30 years at the Diabetes Center, Tokyo Women's Medical University (TWMU), in which such Japanese patients have been registered at the time of first visit since the 1960s, we performed a hospital-based study over the last 40 years to clarify time-course changes in clinical features of type 1 and type 2 diabetes diagnosed before the age of 30 years. Type 2 diabetes had a male dominancy, while there has been a female dominancy in patients with type 1 diabetes as in previous reports of Japanese childhood-onset type 1 diabetes. Such dominances had been continued over the last 40 years. The number of patients with type 2 diabetes and with a past history of obesity increased with time. The age at which type 2 diabetes was diagnosed was suggested to have been getting lower with time, whereas that of type 1 diabetes has been higher with time. There was no marked difference in family history of diabetes in the first-degree relatives of patients with type 2 diabetes, regardless of the presence or absence of a past history of obesity. More female patients with type 2 diabetes diagnosed before the age of 15 years had mothers with type 2 diabetes compared to corresponding male patients.
Collapse
Affiliation(s)
- Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | | | | | | | | | | | | | | |
Collapse
|
|
48
|
Bogdanović R. Diabetic nephropathy in children and adolescents. Pediatr Nephrol 2008; 23:507-25. [PMID: 17940807 DOI: 10.1007/s00467-007-0583-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Revised: 07/09/2007] [Accepted: 07/12/2007] [Indexed: 12/12/2022]
Abstract
Type 1 diabetes mellitus (T1DM) commonly occurs in childhood or adolescence, although the rising prevalence of type 2 diabetes mellitus (T2DM) in these age groups is now being seen worldwide. Diabetic nephropathy (DN) develops in 15-20% of subjects with T1DM and in similar or higher percentage of T2DM patients, causing increased morbidity and premature mortality. Although overt DN or kidney failure caused by either type of diabetes are very uncommon during childhood or adolescence, diabetic kidney disease in susceptible patients almost certainly begins soon after disease onset and may accelerate during adolescence, leading to microalbuminuria or incipient DN. Therefore, all diabetics warrant ongoing assessment of kidney function and screening for the earliest manifestations of renal injury. Pediatric health care professionals ought to understand about risk factors, strategy for prevention, method for screening, and treatment of early DN. This review considers each form of diabetes separately, including natural history, risk factors for development, screening for early manifestations, and strategy recommended for prevention and treatment of DN in children and adolescents.
Collapse
Affiliation(s)
- Radovan Bogdanović
- The Institute of Mother and Child Healthcare of Serbia Dr Vukan Cupic, Belgrade, Serbia.
| |
Collapse
|
|
49
|
Song SH. Review: Early-onset type 2 diabetes mellitus: a condition with elevated cardiovascular risk? ACTA ACUST UNITED AC 2008. [DOI: 10.1177/14746514080080020201] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The age of onset of type 2 diabetes mellitus is falling and this condition has become increasingly common among those aged under 30 years including children and adolescents. Early-onset type 2 diabetes has been reported in various countries from different ethnic and cultural backgrounds reflecting the effects of sedentary lifestyle as part of globalisation and industrialisation affecting all societies. The pathophysiological features of early-onset type 2 diabetes is similar to the later-onset cohort characterised by β-cell failure and obesity-induced insulin resistance but the decline in β-cell function appears to be more rapid. Early-onset type 2 diabetes may be a more aggressive disease phenotype to develop cardiovascular complications than later-onset cohort, reflected by more adverse cardiovascular risk profile and higher relative risk for myocardial infarction. Given the paucity of clinical trial evidence in this population, clinical judgement is required to initiate treatments to prevent cardiovascular complications guided by assessment of global cardiovascular risk. Future research strategies should include exploration of cardiovascular risk factors. its natural history, development of complications and outcome studies pertaining to the treatment of cardiovascular risk factors.
Collapse
Affiliation(s)
- Soon H Song
- Diabetes Centre, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK,
| |
Collapse
|
|
50
|
Nichol H, Retallack J, Panagiotopoulos C. Cooking For Your Life! A Family-Centred, Community-Based Nutrition Education Program for Youth With Type 2 Diabetes or Impaired Glucose Tolerance. Can J Diabetes 2008. [DOI: 10.1016/s1499-2671(08)21008-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|