20 research outputs found
Pre-diabetes in overweight youth and early atherogenic risk
Get PDFPURPOSE: To compare atherogenic lipoprotein particles and vascular smooth muscle biomarkers in overweight youth with pre-diabetes (PD) vs. normal glucose tolerance (NGT).
METHODS: 144 adolescents (60 black, 84 white; 102 female; PD=45, NGT=99) aged 10-19 years underwent a fasting blood draw and 2-h OGTT. Lipoprotein particle size and subclass concentration and vascular smooth muscle biomarkers (ICAM-1, VCAM-1 and E-selectin) were compared between youth with PD and NGT.
RESULTS: Compared with NGT, PD adolescents had smaller LDL (mean±SE: 20.5±0.1 vs. 21.0±0.1 nm; P=0.002) and HDL (8.62±0.05 vs. 8.85±0.04 nm; P=0.013) size and elevated medium small (159.2±10.3 vs. 123.8±6.4 nmol/L; P=0.037) and very small (626.3±45.4 vs. 458.5±26.4 nmol/L; P=0.032) LDL particle concentrations, after adjustment for race and BMI. Further adjusting for fasting insulin or visceral adiposity obviated these differences between the groups except for LDL size. ICAM-1 and E-selectin did not differ in youth with PD but correlated with LDL and HDL size, and small LDL particle concentrations.
CONCLUSIONS: Overweight adolescents with PD have an atherogenic lipoprotein profile of small LDL and HDL size and increased concentrations of small LDL, moderated by insulin resistance and visceral adiposity, but independently driven by dysglycemia for LDL size. Associations between smooth muscle biomarkers and lipoproteins could be an early signal heralding the atherogenic process. It remains to be determined if correction of dysglycemia and associated lipoprotein abnormalities in obese youth could prove effective in halting this process
Experiences and Health Outcomes of Emerging Adults with Type 1 Diabetes: A Mixed Methods Study
Get PDFBackground Emerging adults with type 1 diabetes are at risk of poorer diabetes-related health outcomes than other age groups. Several factors affecting the health and experiences of the emerging adults are culture and healthcare specific.Objectives The aim of this study was to explore the experience of emerging adults living with type 1 diabetes in Lebanon, describe their diabetes self-care and diabetes-related health outcomes (HbA1c and diabetes distress), and identify the predictors of these outcomes.Methods A convergent mixed methods design was used with 90 participants aged 18-29 years. Sociodemographic, clinical data, and measures of diabetes distress, social support, and self-care were collected. Fifteen emerging adults participated in individual semi-structured interviews. Multiple linear regression was used to determine predictors of diabetes outcomes. Thematic analysis was used to analyze qualitative data. Data integration was used to present the mixed methods findings.Results The study sample had a mean HbA1c of 7.7% (SD = 1.36) and 81.1 % reported moderate to severe diabetes distress levels. The participants had good levels of diabetes self-care and high levels of social support. HbA1c was predicted by insulin treatment type, age at diagnosis, and diabetes self-care; while diabetes distress was predicted by diabetes knowledge, blood glucose monitoring approach, and diabetes self-care. âLiving with type 1 diabetes during emerging adulthood: the complex balance of a chemical reactionâ was the overarching theme of the qualitative data, with three underlying themes: âBreaking of bonds: changes and taking ownership of their diabetesâ, âThe reactants: factors affecting the diabetes experienceâ, and âAiming for equilibriumâ. The integrated mixed methods results revealed one divergence between the qualitative and quantitative findings related to the complexity of the effect of received social support.Discussion The suboptimal health of the emerging adults despite good self-care highlights the importance of addressing cultural and healthcare specific factors such as diabetes knowledge and public awareness, social support, and availability of technology to improve diabetes health. Findings of this study can guide future research, practice, and policy development
Arslanian S: Pathophysiology of type 2 diabetes mellitus in children and adolescents: treatment implications. Treat Endocrinol 1:359â371
No full textABSTRACT Type 2 diabetes mellitus (T2DM) in children and adolescents is an important Public Health problem against the backdrop of the epidemic of childhood obesity. The clinical presentation of T2DM in youth is heterogeneous from minimal symptomatology to diabetic ketoacidosis. The increasing rates of youth T2DM have paralleled the escalating rates of obesity, which is the major risk factor impacting insulin sensitivity. Additional risk factors include minority race, family history of diabetes mellitus, maternal diabetes during pregnancy, pubertal age group and conditions associated with insulin resistance (IR) -such as polycystic ovary syndrome (PCOS). The pathophysiology of T2DM has been studied extensively in adults, and it is widely accepted that IR together with beta-cell failure are necessary for the development of clinical diabetes mellitus in adulthood. However, pathophysiologic studies in youth are limited and in some cases conflicting. Similar to adults, IR is a prerequisite, but beta-cell failure is necessary for progression from normal glucose tolerance to prediabetes and frank diabetes in youth. Even though rates of T2DM in youth are increasing, the overall prevalence remains low if compared with type 1 diabetes mellitus (T1DM). However, as youth with T1DM are becoming obese, the clinical distinction between T2DM and obese T1DM has become difficult, because of the overlapping clinical picture with evidence of islet cell autoimmunity in a significant proportion of clinically diagnosed youth with T2DM. The latter are most likely obese children with autoimmune T1DM who carry a misdiagnosis of T2DM. Further research is needed to probe the pathophysiological, immunological, and metabolic differences between these two groups in the hopes of assigning appropriate therapeutic regimens. These challenges combined with the evolving picture of youth T2DM and its future complications provide unending opportunities for acquisition of new knowledge in the field of childhood diabetes. Arq Bras Endocrinol Metab. 2009;53(2):165-174. Keywords Policystic ovarian syndrome; obesity; diabetic physiopathology RESUMO Em um cenĂĄrio de uma epidemia de obesidade, o diabetes melito tipo 2 (DM2) em crianças e adolescentes Ă© um importante problema de SaĂșde PĂșblica. As manifestaçÔes clĂnicas do DM2 na juventude sĂŁo heterogĂȘneas e vĂŁo desde sintomas leves atĂ© a cetoacidose diabĂ©tica. As taxas crescentes de DM2 no jovem seguem em paralelo ao aumento da obesidade, a qual constitui o mais importante fator de risco para a redução da sensibilidade Ă insulina. Outras condiçÔes de risco para o DM2 sĂŁo: minorias Ă©tnicas, histĂłria familiar de DM2, diabetes materno durante a gestação, idade puberal e situaçÔes associadas Ă resistĂȘncia Ă insulina (RI) -como a sĂndrome dos ovĂĄrios policĂsticos (SOP). A fisiopatologia do DM2 tem sido muito estudada em adultos, sendo aceita como condiçÔes necessĂĄrias Ă RI em conjunto com a disfunção da cĂ©lula beta. Estudos da fisiopatologia em jovens sĂŁo escassos e conflitantes. Semelhante ao que se passa com os adultos, a RI Ă© um prĂ©-requisito, mas a falĂȘncia da cĂ©lula beta Ă© necessĂĄria para que haja progressĂŁo da tolerĂąncia normal Ă glicose para o prĂ©-diabetes e DM2. Mesmo com o aumento da incidĂȘncia de DM2 no jovem, a prevalĂȘncia permanece baixa em comparação com o diabetes mellitus tipo 1 (DM1). Se uma criança com DM1 Ă© obesa, a distinção clĂ-nica entre o DM2 e DM1 Ă© dificultada, pois existem semelhanças clĂnicas e evidĂȘncias da presença de autoimunidade contra a cĂ©lula beta em uma significativa proporção de jovens diagnosticados com DM2. Esta condição normalmente representa uma criança obesa com autoimunidade para DM1 com o diagnĂłstico equivocado de DM2. Novas pesquisas sĂŁo necessĂĄrias para caracterizar os diferentes mecanismos fisiopatolĂłgicos, imunolĂłgicos e metabĂłlicos entre estes dois grupos, na esperança de que sejam alcançados regimes terapĂȘuticos apropriados. Esses desafios e o quadro em mutação do diabetes na criança e no adolescente nos fornecem oportunidades infindĂĄveis para a aquisição de novos conhecimentos no campo da diabetologia. Arq Bras Endocrinol Metab. 2009;53(2):165-174. Descritores SĂndrome do ovĂĄrio policĂstico; obesidade; fisiopatologia diabĂ©tic
Pre-diabetes in overweight youth and early atherogenic risk
No full textPURPOSE: To compare atherogenic lipoprotein particles and vascular smooth muscle biomarkers in overweight youth with pre-diabetes (PD) vs. normal glucose tolerance (NGT).
METHODS: 144 adolescents (60 black, 84 white; 102 female; PD=45, NGT=99) aged 10-19 years underwent a fasting blood draw and 2-h OGTT. Lipoprotein particle size and subclass concentration and vascular smooth muscle biomarkers (ICAM-1, VCAM-1 and E-selectin) were compared between youth with PD and NGT.
RESULTS: Compared with NGT, PD adolescents had smaller LDL (mean±SE: 20.5±0.1 vs. 21.0±0.1 nm; P=0.002) and HDL (8.62±0.05 vs. 8.85±0.04 nm; P=0.013) size and elevated medium small (159.2±10.3 vs. 123.8±6.4 nmol/L; P=0.037) and very small (626.3±45.4 vs. 458.5±26.4 nmol/L; P=0.032) LDL particle concentrations, after adjustment for race and BMI. Further adjusting for fasting insulin or visceral adiposity obviated these differences between the groups except for LDL size. ICAM-1 and E-selectin did not differ in youth with PD but correlated with LDL and HDL size, and small LDL particle concentrations.
CONCLUSIONS: Overweight adolescents with PD have an atherogenic lipoprotein profile of small LDL and HDL size and increased concentrations of small LDL, moderated by insulin resistance and visceral adiposity, but independently driven by dysglycemia for LDL size. Associations between smooth muscle biomarkers and lipoproteins could be an early signal heralding the atherogenic process. It remains to be determined if correction of dysglycemia and associated lipoprotein abnormalities in obese youth could prove effective in halting this process
Coronary Artery Calcification in Obese Youth: What Are the Phenotypic and Metabolic Determinants?
No full textDeclining ÎČ-Cell Function Relative to Insulin Sensitivity With Escalating OGTT 2-h Glucose Concentrations in the Nondiabetic Through the Diabetic Range in Overweight Youth
No full textÎČ-Cell Function, Incretin Effect, and Incretin Hormones in Obese Youth Along the Span of Glucose Tolerance From Normal to Prediabetes to Type 2 Diabetes
No full textAdipose Tissue Insulin Resistance in Youth on the Spectrum From Normal Weight to Obese and From Normal Glucose Tolerance to Impaired Glucose Tolerance to Type 2 Diabetes
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