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1.
Pediatr Diabetes ; 20232023.
Artículo en Inglés | MEDLINE | ID: mdl-38590442

RESUMEN

Metformin is the first-line treatment for type 2 diabetes (T2D) in youth but with limited sustained glycemic response. To identify common variants associated with metformin response, we used a genome-wide approach in 506 youth from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study and examined the relationship between T2D partitioned polygenic scores (pPS), glycemic traits, and metformin response in these youth. Several variants met a suggestive threshold (P < 1 × 10-6), though none including published adult variants reached genome-wide significance. We pursued replication of top nine variants in three cohorts, and rs76195229 in ATRNL1 was associated with worse metformin response in the Metformin Genetics Consortium (n = 7,812), though statistically not being significant after Bonferroni correction (P = 0.06). A higher ß-cell pPS was associated with a lower insulinogenic index (P = 0.02) and C-peptide (P = 0.047) at baseline and higher pPS related to two insulin resistance processes were associated with increased C-peptide at baseline (P = 0.04,0.02). Although pPS were not associated with changes in glycemic traits or metformin response, our results indicate a trend in the association of the ß-cell pPS with reduced ß-cell function over time. Our data show initial evidence for genetic variation associated with metformin response in youth with T2D.


Asunto(s)
Diabetes Mellitus Tipo 2 , Metformina , Adulto , Humanos , Adolescente , Metformina/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/complicaciones , Péptido C , Insuficiencia del Tratamiento , Variación Genética , Glucemia , Hipoglucemiantes/uso terapéutico
2.
J Pediatr ; 251: 51-59.e2, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35985535

RESUMEN

OBJECTIVES: To evaluate the frequency and severity of new cases of youth-onset type 2 diabetes in the US during the first year of the pandemic compared with the mean of the previous 2 years. STUDY DESIGN: Multicenter (n = 24 centers), hospital-based, retrospective chart review. Youth aged ≤21 years with newly diagnosed type 2 diabetes between March 2018 and February 2021, body mass index ≥85th percentile, and negative pancreatic autoantibodies were included. Demographic and clinical data, including case numbers and frequency of metabolic decompensation, were compared between groups. RESULTS: A total of 3113 youth (mean [SD] 14.4 [2.4] years, 50.5% female, 40.4% Hispanic, 32.7% Black, 14.5% non-Hispanic White) were assessed. New cases of type 2 diabetes increased by 77.2% in the year during the pandemic (n = 1463) compared with the mean of the previous 2 years, 2019 (n = 886) and 2018 (n = 765). The likelihood of presenting with metabolic decompensation and severe diabetic ketoacidosis also increased significantly during the pandemic. CONCLUSIONS: The burden of newly diagnosed youth-onset type 2 diabetes increased significantly during the coronavirus disease 2019 pandemic, resulting in enormous strain on pediatric diabetes health care providers, patients, and families. Whether the increase was caused by coronavirus disease 2019 infection, or just associated with environmental changes and stressors during the pandemic is unclear. Further studies are needed to determine whether this rise is limited to the US and whether it will persist over time.


Asunto(s)
COVID-19 , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Cetoacidosis Diabética , Niño , Adolescente , Humanos , Femenino , Masculino , Pandemias , COVID-19/epidemiología , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Estudios Retrospectivos , Cetoacidosis Diabética/complicaciones
3.
Diabetologia ; 64(8): 1709-1716, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34075436

RESUMEN

Globally, the proportion of new diagnoses of youth-onset diabetes represented by type 2 diabetes is increasing, and youth with type 2 diabetes commonly have complications and comorbidities, as well as a higher rate of mortality. In this review, we summarise what is known about the natural progression of youth-onset type 2 diabetes from published clinical trials and large-scale prospective epidemiological studies. It is important to note that the robust pathophysiological and treatment data specifically related to individuals with a diabetes onset at ≤20 years of age largely hails from the USA. Youth-onset type 2 diabetes is characterised by pathophysiological heterogeneity and inadequate glycaemic control, highlighting the need for new treatment approaches and innovative study designs in populations of varied genetic and cultural backgrounds.


Asunto(s)
Ensayos Clínicos como Asunto , Diabetes Mellitus Tipo 2/epidemiología , Ciencia Traslacional Biomédica , Adolescente , Niño , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Control Glucémico , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Estilo de Vida , Masculino , Metformina/uso terapéutico , Estudios Prospectivos , Rosiglitazona/uso terapéutico , Adulto Joven
4.
Diabetologia ; 64(10): 2237-2246, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34272965

RESUMEN

AIMS/HYPOTHESIS: Our aim was to explore metabolic pathways linking overnutrition in utero to development of adiposity in normal-weight children. METHODS: We included 312 normal-weight youth exposed or unexposed to overnutrition in utero (maternal BMI ≥25 kg/m2 or gestational diabetes). Fasting insulin, glucose and body composition were measured at age ~10 years (baseline) and ~16 years (follow-up). We examined associations of overnutrition in utero with baseline fasting insulin, followed by associations of baseline fasting insulin with adiposity (BMI z score [BMIZ], subcutaneous adipose tissue [SAT], visceral adipose tissue [VAT]), insulin resistance (HOMA-IR) and fasting glucose during follow-up. RESULTS: >All participants were normal weight at baseline (BMIZ -0.32 ± 0.88), with no difference in BMIZ for exposed vs unexposed youth (p = 0.14). Of the study population, 47.8% were female sex and 47.4% were of white ethnicity. Overnutrition in utero corresponded with 14% higher baseline fasting insulin (geometric mean ratio 1.14 [95% CI 1.01, 1.29]), even after controlling for VAT/SAT ratio. Higher baseline fasting insulin corresponded with higher BMIZ (0.41 [95% CI 0.26, 0.55]), SAT (13.9 [95% CI 2.4, 25.4] mm2), VAT (2.0 [95% CI 0.1, 3.8] mm2), HOMA-IR (0.87 [95% CI 0.68, 1.07]) and fasting glucose (0.23 [95% CI 0.09, 0.38] SD). CONCLUSIONS/INTERPRETATION: Overnutrition in utero may result in hyperinsulinaemia during childhood, preceding development of adiposity. However, our study started at age 10 years, so earlier metabolic changes in response to overnutrition were not taken into account. Longitudinal studies in normal-weight youth starting earlier in life, and with repeated measurements of body weight, fat distribution, insulin sensitivity, beta cell function and blood glucose levels, are needed to clarify the sequence of metabolic changes linking early-life exposures to adiposity and dysglycaemia.


Asunto(s)
Adiposidad/fisiología , Diabetes Mellitus Tipo 2/fisiopatología , Hiperinsulinismo/fisiopatología , Hipernutrición/fisiopatología , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Adolescente , Glucemia/metabolismo , Composición Corporal , Índice de Masa Corporal , Niño , Femenino , Estudios de Seguimiento , Humanos , Insulina/sangre , Resistencia a la Insulina/fisiología , Grasa Intraabdominal/metabolismo , Masculino , Embarazo
5.
J Pediatr ; 230: 244-247, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33300876

RESUMEN

Our objective was to explore the longitudinal trajectory of hemoglobin A1c (HbA1c) in well-characterized youth (n = 84) with normal weight and obesity during puberty. HbA1c rose from early puberty to Tanner stage 5, even in healthy, normal weight youth, revealing important implications for defining normal glycemia and prediabetes in adolescents.


Asunto(s)
Peso Corporal , Hemoglobina Glucada/análisis , Obesidad Infantil/epidemiología , Pubertad/sangre , Adolescente , Niño , Femenino , Humanos , Masculino , Valores de Referencia
6.
Pediatr Diabetes ; 22(5): 699-706, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-33870630

RESUMEN

OBJECTIVE: Adult women with polycystic ovary syndrome (PCOS) and obesity have an 8-fold increased risk of developing type 2 diabetes (T2D). Our goal was to determine the incidence and risk factors for T2D in adolescents with PCOS and obesity. RESEARCH DESIGN AND METHODS: Retrospective chart review of girls aged 11-21 years with confirmed PCOS (oligomenorrhea and hyperandrogenism) diagnosis between July 2013 and Aug 2018 and at least one follow-up visit and BMI >85%ile. T2D incidence, defined with an HbA1c ≥6.5%, was calculated. A nested case-control study with 1:3 matching by race, ethnicity, and BMI was performed to determine predictors of T2D diagnosis. RESULTS: Four hundred ninety-three patients with PCOS (age 15.6 ± 1.9 years, BMI 36.2 ± 6.3 kg/m2 ) were identified with a follow-up of 1018 person-years. Twenty-three developed T2D (incidence 22.6/1000 person-years) with diagnosis a median of 1.8 years (2 months-5.5 years) after PCOS diagnosis. T2D risk was higher in girls with a prediabetes HbA1c (5.7%-6.4%) (HR 14.6 [4.8-44.5]) and among Hispanic girls with an elevated HbA1c and alanine aminotransferase (HR 19.0 [3.7-97.2]) at the time of PCOS diagnosis. In the 1:3 matched cohort, T2D risk was 18.7 times higher (OR 18.66 [2.27-153.24]) for every 0.1% increase in HbA1c at the time of PCOS diagnoses. CONCLUSIONS: Girls with PCOS and obesity have an 18-fold increase in T2D incidence compared to published rates in non-PCOS youth. Hispanic girls with elevated HbA1c and ALT are at particular risk. Due to the morbidity associated with youth onset T2D, these findings argue for better screening and prevention approaches in this population.


Asunto(s)
Diabetes Mellitus Tipo 2/etiología , Obesidad/complicaciones , Síndrome del Ovario Poliquístico/complicaciones , Adolescente , Índice de Masa Corporal , Estudios de Casos y Controles , Estudios de Cohortes , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/patología , Femenino , Humanos , Incidencia , Obesidad/epidemiología , Obesidad/patología , Síndrome del Ovario Poliquístico/epidemiología , Síndrome del Ovario Poliquístico/patología , Estado Prediabético/complicaciones , Estado Prediabético/epidemiología , Estado Prediabético/patología , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología
7.
Am J Med Genet C Semin Med Genet ; 184(2): 327-333, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32542985

RESUMEN

Klinefelter syndrome (KS) occurs in 1:600 males and is associated with high morbidity and mortality due to diabetes and cardiovascular disease. Up to 50% of men with KS have metabolic syndrome, a cluster of features conferring increased risk for diabetes and cardiovascular disease. These cardiometabolic (CM) risk features have not been studied in adolescents with KS. The objective of this cohort study was to compare CM risk features in adolescents with KS to controls matched for sex, age, and BMI z score. Fifty males with KS (age 10-17 years) were well-matched to male controls (n = 50) for age (14.0 ± 1.7 vs. 14.0 ± 1.5 years) and BMI z score (0.3 ± 1.3 vs. 0.4 ± 1.2). Three CM risk features were present in 30% of adolescents with KS compared to 12% of controls (RR 2.5, 95% CI 1.1-5.9, p = .048). The KS group had significantly lower HDL cholesterol (p = .006), higher triglycerides (p < .001), and greater waist circumference percentile (p < .001). Despite a normal BMI, the prevalence of CM risk features was very high in adolescents with KS, particularly for central adiposity and dyslipidemia. The pathophysiology of this metabolic profile independent of obesity needs further investigation to facilitate prevention of the high morbidity of cardiovascular disease and diabetes in this population. ClinicalTrials.gov identifiers: NCT01585831 and NCT02723305.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Síndrome de Klinefelter/epidemiología , Obesidad/epidemiología , Adolescente , Índice de Masa Corporal , Factores de Riesgo Cardiometabólico , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/patología , Estudios de Casos y Controles , Niño , Estudios de Cohortes , Diabetes Mellitus/sangre , Diabetes Mellitus/patología , Femenino , Humanos , Síndrome de Klinefelter/sangre , Síndrome de Klinefelter/patología , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/epidemiología , Síndrome Metabólico/patología , Obesidad/sangre , Obesidad/patología , Testosterona/sangre , Triglicéridos/sangre , Circunferencia de la Cintura
8.
J Pediatr ; 216: 232-235, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31405525

RESUMEN

American Diabetes Association adult criteria are used to screen youth for diabetes, but little is known about normal glycemia in youth. In the HEALTHY Study (total n = 8814), hemoglobin A1c was ≥5.7% in 2% of normal weight youth. This suggests need for cautious interpretation of prediabetes hemoglobin A1s in youth.


Asunto(s)
Hemoglobina Glucada/análisis , Estado Prediabético/sangre , Estado Prediabético/diagnóstico , Adolescente , Adulto , Factores de Edad , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Valores de Referencia
9.
Pediatr Diabetes ; 21(2): 224-232, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31886931

RESUMEN

BACKGROUND: Individual health behaviors (ie, eating habits and sedentary lifestyle) are associated with type 2 diabetes (T2D). Health behavior profiles specific to adolescents with T2D have not been described. OBJECTIVE: To identify health behavior profiles in adolescents with T2D and examine how these profiles change over time. METHODS: Diet (via food frequency questionnaire) and activity behaviors (via 3-day physical activity recall) examined at baseline, 6 months, and 24 months from participants in the the Treatment Options for T2D in Adolescents and Youth (TODAY) study were used for this analysis. Latent profile analysis identified profiles of health behaviors within three time points, and latent transition probabilities were estimated to examine the change from baseline to 6 months (n = 450) and baseline to 24 months (n = 415). Multinomial logistic regressions were used to examine if the assigned TODAY treatment group (Metformin [Met], Met + Rosiglitazone [Rosi], or Met + Lifestyle) predicted change in health behavior profiles. RESULTS: Three profiles emerged: "most sedentary," "healthy eaters," and "active and eat most." At 6 months, 50% of males and 29% of females in the Met + Lifestyle treatment group improved in their health behavior profile. Among males only, the Met + Lifestyle treatment group were more likely to improve their profiles from baseline to 6 months (P = .01). CONCLUSIONS: Three health behavior profiles emerged and shifted over time. A high quality, lifestyle intervention had little effect on improving health behavior profiles. Optimizing outcomes in youth with T2D might require more robust and multifaceted interventions beyond family-level lifestyle, including more extensive psychosocial intervention, novel medication regimen, or bariatric surgery.


Asunto(s)
Conducta del Adolescente , Diabetes Mellitus Tipo 2/psicología , Conductas Relacionadas con la Salud , Adolescente , Niño , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 2/terapia , Femenino , Humanos , Masculino , Conducta de Reducción del Riesgo
10.
Curr Diab Rep ; 17(7): 49, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28526994

RESUMEN

PURPOSE OF REVIEW: One-third of US adolescents are obese, and related comorbidities exist in this population. Preventing early indicators of these diseases, such as insulin resistance (IR), may impact future morbidity and mortality. Interventions to date have only focused on diet or exercise. Additional targets to prevent disease are needed. This paper reviews the evidence in adolescents examining multiple health behaviors that have been associated with IR. RECENT FINDINGS: Health behaviors (i.e., diet, activity, sleep) have been individually examined as possible contributors to disease, but an understanding of the complex interplay between these behaviors is lacking. A better understanding of how multiple health behaviors contribute to IR in adolescents is needed. Future studies using both advanced statistical methodology and robust measures of each health behavior may facilitate better understanding of the impact of lifestyle factors on IR and guide intervention strategies to reduce the risk of disease.


Asunto(s)
Conducta del Adolescente , Conductas Relacionadas con la Salud , Resistencia a la Insulina , Adolescente , Dieta , Ejercicio Físico , Humanos , Riesgo , Sueño
12.
Pediatr Diabetes ; 18(7): 629-636, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27873436

RESUMEN

OBJECTIVE: To determine whether the alternate glycemic markers, fructosamine (FA), glycated albumin (GA), and 1,5-anhydroglucitol (1,5AG), predict glycemic variability captured by continuous glucose monitoring (CGM) in obese youth with prediabetes and type 2 diabetes (T2D). STUDY DESIGN: Youth with BMI ≥85th%ile, 10-18 years, had collection of fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), FA, GA, and 1,5AG and 72 hours of CGM. Participants with HbA1c ≥5.7% were included. Relationships between glycemic markers and CGM variables were determined with Spearman correlation coefficients. Linear models were used to examine the association between alternate markers and CGM measures of glycemic variability-standard deviation (SD) and mean amplitude of glycemic excursions (MAGE)-after controlling for HbA1c. RESULTS: Total n = 56; Median (25th%ile, 75th%ile) age = 14.3 years (12.5, 15.9), 32% male, 64% Hispanic, 20% black, 13% white, HbA1c = 5.9% (5.8, 6.3), FA=211 mmol/L (200, 226), GA= 12% (11%, 12%), and 1,5AG = 22mcg/mL (19, 26). HbA1c correlated with average sensor glucose, AUC, SD, MAGE, and %time > 140 mg/dL. FA and GA correlated with average and peak sensor glucose, %time >140 and >200 mg/dL, and MAGE. GA also correlated with SD and AUC180. 1,5AG correlated with peak glucose, AUC180, SD, and MAGE. After adjusting for HbA1c, all 3 markers independently predicted MAGE; FA and GA independently predicted SD. CONCLUSIONS: Alternate glycemic markers predict glycemic variability as measured by CGM in youth with prediabetes and T2D. After adjusting for HbA1c, these alternate markers continued to predict components of glycemic variability detected by CGM.


Asunto(s)
Desoxiglucosa/sangre , Diabetes Mellitus Tipo 2/sangre , Fructosamina/sangre , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Estado Prediabético/sangre , Albúmina Sérica/análisis , Adolescente , Área Bajo la Curva , Biomarcadores/sangre , Glucemia/análisis , Niño , Estudios de Cohortes , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Hemoglobina Glucada/análisis , Productos Finales de Glicación Avanzada , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Masculino , Monitoreo Ambulatorio , Reproducibilidad de los Resultados , Albúmina Sérica Glicada
14.
Curr Diab Rep ; 16(7): 64, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27179965

RESUMEN

Puberty is a time of considerable metabolic and hormonal change. Notably, puberty is associated with a marked decrease in insulin sensitivity, on par with that seen during pregnancy. In otherwise healthy youth, there is a nadir in insulin sensitivity in mid-puberty, and then it recovers at puberty completion. However, there is evidence that insulin resistance (IR) does not resolve in youth who are obese going into puberty and may result in increased cardiometabolic risk. Little is known about the underlying pathophysiology of IR in puberty, and how it might contribute to increased disease risk (e.g., type 2 diabetes). In this review, we have outlined what is known about the IR in puberty in terms of pattern, potential underlying mechanisms and other mediating factors. We also outline other potentially related metabolic changes that occur during puberty, and effects of underlying insulin resistant states (e.g., obesity) on pubertal changes in insulin sensitivity.


Asunto(s)
Diabetes Mellitus Tipo 2/inmunología , Resistencia a la Insulina , Pubertad , Adolescente , Animales , Enfermedades Cardiovasculares/etiología , Niño , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Insulina/inmunología , Factores de Riesgo
15.
Pediatr Diabetes ; 17(3): 184-90, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-25611822

RESUMEN

OBJECTIVE: Reduced testosterone, a recognized comorbidity of reduced insulin sensitivity (IS) and type 2 diabetes (T2D), has also been reported in adult males with type 1 diabetes (T1D). However, there are limited data on how early reduced testosterone occurs, and whether it is related to the reduced IS in T1D. Leptin, a modulator of the HPG-axis, may also influence testosterone in T1D. We hypothesized that IS and leptin would be associated with total testosterone (TT), and free androgen index (FAI) in adolescent males with T1D. METHODS: T1D (n = 35), T2D (n = 13), lean (n = 13) and obese (n = 9) adolescent males had IS measured by hyperinsulinemic-euglycemic clamps (glucose infusion rate [GIR]), in addition to leptin, sex hormone binding globulin (SHBG), TT, and FAI. The cohort was stratified into those with T1D (n = 35) and those without (n = 35). RESULTS: TT and SHBG were lower in T2D boys vs. lean controls, and GIR and leptin correlated with FAI and TT in non-T1D participants. However, despite being insulin resistant, adolescent males with T1D had normal TT and FAI, unrelated to GIR. In T1D, leptin was inversely associated with TT (p = 0.005) and FAI (p = 0.01), independent of puberty, hemoglobin A1c (HbA1c), diabetes duration, body mass index (BMI) z-score and GIR. CONCLUSION: Leptin accounted for a significant proportion of the variability of testosterone in T1D. However, despite reduced IS, there was no association between IS and testosterone in T1D adolescents. These observations suggest that the mechanisms affecting testosterone may differ between adolescent males with and without T1D.


Asunto(s)
Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 2/sangre , Resistencia a la Insulina , Leptina/sangre , Testosterona/sangre , Adolescente , Niño , Estudios de Cohortes , Técnica de Clampeo de la Glucosa , Humanos , Masculino , Obesidad/sangre , Obesidad/complicaciones
16.
Pediatr Diabetes ; 17(3): 212-21, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-25690268

RESUMEN

OBJECTIVE: The objectives were to (i) describe the characteristics of a large ethnically/racially and geographically diverse population of adolescents with recent-onset type 2 diabetes (T2D), and (ii) assess the effects of short-term diabetes education and treatment with metformin on clinical and biochemical parameters in this cohort. RESEARCH DESIGN AND METHODS: Descriptive characteristics were determined for subjects screened for Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) who met criteria for diagnosis of T2D (n = 1092). Changes in clinical and biochemical parameters were determined for those who completed at least 8 wk of the run-in phase of the trial, which included standardized diabetes education and treatment with metformin. Further analysis determined whether these changes differed according to the treatment at screening. MAIN OUTCOME MEASURES: Demographic, biochemical measurements, and anthropometrics at screening and changes over 8 wk of run-in were the outcome measures. RESULTS: Subjects screened for TODAY had a median age of 14 yr and median hemoglobin A1c (HbA1c) of 6.9% (52 mM/M), 2/3 were female, and ethnic/racial minorities were overrepresented. Dyslipidemia and hypertension were common comorbidities. During run-in, HbA1c, body mass index, low-density lipoprotein cholesterol, triglycerides, and blood pressure significantly improved. Nearly all participants on insulin therapy at screening were able to attain target HbA1c following insulin discontinuation. CONCLUSIONS: Treatment with metformin and diabetes education provided short-term improvements in glycemic control and cardiometabolic risk factors in a large adolescent T2D cohort. Nearly all insulin-treated youth could be successfully weaned off insulin with continued improvement in glycemic control.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Adolescente , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Masculino , Educación del Paciente como Asunto , Resultado del Tratamiento , Estados Unidos/epidemiología
17.
Acta Neuropathol ; 128(1): 111-22, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24839956

RESUMEN

Individuals harboring germ-line DICER1 mutations are predisposed to a rare cancer syndrome, the DICER1 Syndrome or pleuropulmonary blastoma-familial tumor and dysplasia syndrome [online Mendelian inheritance in man (OMIM) #601200]. In addition, specific somatic mutations in the DICER1 RNase III catalytic domain have been identified in several DICER1-associated tumor types. Pituitary blastoma (PitB) was identified as a distinct entity in 2008, and is a very rare, potentially lethal early childhood tumor of the pituitary gland. Since the discovery by our team of an inherited mutation in DICER1 in a child with PitB in 2011, we have identified 12 additional PitB cases. We aimed to determine the contribution of germ-line and somatic DICER1 mutations to PitB. We hypothesized that PitB is a pathognomonic feature of a germ-line DICER1 mutation and that each PitB will harbor a second somatic mutation in DICER1. Lymphocyte or saliva DNA samples ascertained from ten infants with PitB were screened and nine were found to harbor a heterozygous germ-line DICER1 mutation. We identified additional DICER1 mutations in nine of ten tested PitB tumor samples, eight of which were confirmed to be somatic in origin. Seven of these mutations occurred within the RNase IIIb catalytic domain, a domain essential to the generation of 5p miRNAs from the 5' arm of miRNA-precursors. Germ-line DICER1 mutations are a major contributor to PitB. Second somatic DICER1 "hits" occurring within the RNase IIIb domain also appear to be critical in PitB pathogenesis.


Asunto(s)
ARN Helicasas DEAD-box/genética , Mutación , Neoplasias Complejas y Mixtas/genética , Neoplasias Complejas y Mixtas/patología , Neoplasias Hipofisarias/genética , Neoplasias Hipofisarias/patología , Ribonucleasa III/genética , Preescolar , Análisis Mutacional de ADN , Resultado Fatal , Mutación de Línea Germinal , Humanos , Inmunohistoquímica , Lactante , Imagen por Resonancia Magnética , Neoplasias Complejas y Mixtas/cirugía , Linaje , Neoplasias Hipofisarias/cirugía , Radiografía Torácica , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
18.
Muscle Nerve ; 49(6): 887-94, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24037802

RESUMEN

INTRODUCTION: We compared fatigability and activation of elbow flexor muscles in children at 3 pubertal stages during a sustained submaximal contraction. METHODS: In 72 healthy children (39 boys) aged 11 ± 3 years (range, 8-14 years), differences in fatigability (time to task failure) and muscle activation were compared at 3 Tanner stages (T1-T3). RESULTS: Time to task failure and muscle activation were similar between boys and girls at prepubertal Tanner stage 1. Time to task failure was briefer for girls than boys at Tanner stages 2 and 3 and was predicted by the coactivation indices and percent body fat in girls. Muscle torque was the only predictor for the time to task failure in boys. CONCLUSIONS: Differences in fatigability and muscle coactivation were evident during the initial pubertal stages (T2 and T3), but not before the onset of puberty (T1).


Asunto(s)
Fatiga Muscular/fisiología , Músculo Esquelético/fisiología , Pubertad/fisiología , Factores Sexuales , Análisis y Desempeño de Tareas , Adolescente , Fenómenos Biomecánicos , Composición Corporal/fisiología , Niño , Estudios Transversales , Electromiografía , Femenino , Humanos , Masculino , Contracción Muscular/fisiología , Factores de Tiempo
19.
Gerontology ; 60(3): 222-8, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24434909

RESUMEN

The severity and frequency of childhood obesity has increased significantly over the past three to four decades. The health effects of increased body mass index as a child may significantly impact obese youth as they age. However, many of the long-term outcomes of childhood obesity have yet to be studied. This article examines the currently available longitudinal data evaluating the effects of childhood obesity on adult outcomes. Consequences of obesity include an increased risk of developing the metabolic syndrome, cardiovascular disease, type 2 diabetes and its associated retinal and renal complications, nonalcoholic fatty liver disease, obstructive sleep apnea, polycystic ovarian syndrome, infertility, asthma, orthopedic complications, psychiatric disease, and increased rates of cancer, among others. These disorders can start as early as childhood, and such early onset increases the likelihood of early morbidity and mortality. Being obese as a child also increases the likelihood of being obese as an adult, and obesity in adulthood also leads to obesity-related complications. This review outlines the evidence for childhood obesity as a predictor of adult obesity and obesity-related disorders, thereby emphasizing the importance of early intervention to prevent the onset of obesity in childhood.


Asunto(s)
Envejecimiento/patología , Envejecimiento/fisiología , Obesidad Infantil/complicaciones , Adolescente , Adulto , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , Niño , Diabetes Mellitus Tipo 2/etiología , Femenino , Interacción Gen-Ambiente , Humanos , Estudios Longitudinales , Masculino , Síndrome Metabólico/etiología , Neoplasias/etiología , Enfermedad del Hígado Graso no Alcohólico/etiología , Obesidad Infantil/patología , Obesidad Infantil/fisiopatología , Factores de Riesgo
20.
J Clin Transl Endocrinol ; 36: 100356, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38948245

RESUMEN

Background: 1.8% of youth identify as transgender; a growing proportion are transgender male (female sex, male gender identity). Many receive gonadotropin releasing hormone agonist (GnRHa) therapy to suppress endogenous puberty and/or will start testosterone to induce secondary sex characteristics that align with gender identity. Objectives: To determine the effects of 12 months of testosterone on cardiometabolic health among transgender youth, including insulin sensitivity, body composition, and bone mineral density and whether changes in outcomes differ based on prior GnRHa treatment. Methods: Participants (n = 19, baseline age 15.0 ± 1.0 years) were examined prior to and 12 months after testosterone therapy in a longitudinal observational study. Fasted morning blood draw, a 2-hour 75-gram oral glucose tolerance test, body composition and bone mineral density (dual-energy X-ray absorptiometry) were assessed at baseline and 12 months. Insulin sensitivity was estimated by HOMA-IR and Matsuda index. Changes were compared with mixed linear regression models evaluating time (baseline, 12 months), group (GnRHa treatment yes/no), and their interaction. Results: In the entire cohort, fasted insulin decreased (median [25,75 %ile]: -3 [-5, 0] mIU/L, p = 0.044) and 2-hour glucose increased (mean ± standard deviation): +18.5 ± 28.9 mg/dL, p = 0.013 from baseline after 12 months of testosterone therapy. There were no significant changes in HOMA-IR (p = 0.062) or Matsuda index (p = 0.096), nor by GnRHa status. Absolute (+6.2 [4.7, 7.5] kg, p = 0.016) and percent fat-free mass increased (+7.3 [5.4, 9.1] %, p = 0.003) and percent fat mass declined (-7.4 [-9.3, 5.3]%, p = 0.005) for the entire cohort. There were time*group interactions for absolute (p = 0.0007) and percent fat-free mass (p = 0.033). There were time*group interactions for bone mineral content (p = 0.006). Conclusions: Twelve months of testosterone in transgender adolescents resulted in changes in body composition and bone mineral density, with baseline differences between the +/-GnRHa group and convergence after 12 months. There were no changes in insulin sensitivity over time or between groups.

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