Neonatal diabetes: current trends in diagnosis and management.

The purpose of this article is to describe diabetes diagnosed during the first 6 months of life. Neonatal diabetes, also known as congenital diabetes, presents a unique set of challenges for the pediatric healthcare provider. Neonatal diabetes is not type 1 diabetes. While the etiology of type 1 diabetes is multifactorial and includes genetic and environmental factors, neonatal diabetes is strictly a genetic condition. Management of children with neonatal diabetes, treatment of the disease, psychosocial considerations for the family, and nursing care required for this population are all included in this article. Unique issues related to the diagnosis of a genetic mutation resulting in a defect in the potassium channel are also discussed.

Neuropsychiatric disorders at the presentation of type 2 diabetes mellitus in children.

OBJECTIVES: To estimate the frequency of neuropsychiatric disease (NPD) in an urban pediatric type 2 diabetes mellitus (T2DM) population, to compare demographic characteristics of affected patients with those unaffected with NPD, and to determine the frequency of psychotropic medication treatment. STUDY DESIGN: Retrospective chart review of patients with T2DM at the Children's Hospital of Philadelphia. RESULTS: Of 237 patients with T2DM, 46 (19.4%) were found to have NPD at the presentation of diabetes. Diagnoses by report included depression, attention-deficit hyperactivity disorder (ADHD), neurodevelopmental disorders, schizophrenia, and bipolar disorder. Those affected were 63% females and 37% males, with a mean age of 14.6 yr and body mass index (BMI) of 34.3 kg/m(2) at diagnosis of T2DM. Patients were 79% African American, 13% Caucasian, 4.3% Hispanic, and 4.3% Asian. There were no statistically significant differences in demographic characteristics or BMI between those affected and unaffected with NPD. Twenty-nine patients (63%) were on psychotropic medication and were prescribed 58 medications, most commonly mood stabilizers (n = 20) and atypical antipsychotics (n = 17). CONCLUSIONS: Our data reveal a high frequency of NPD among pediatric patients with T2DM at presentation to a tertiary care, urban medical center. Many affected patients are receiving psychotropic medication. These data have implications for screening regimens for pediatric populations at high risk for T2DM and for therapeutic interventions, including lifestyle measures.

Effect of educational preparation on the accuracy of linear growth measurement in pediatric primary care practices: results of a multicenter nursing study.

Consistently monitoring a child's linear growth is one of the least invasive, most sensitive tools to identify normal physiologic functioning and a healthy lifestyle. However, studies, mostly from the United Kingdom, indicate that children are frequently measured incorrectly. Inaccurate linear measurements may result in some children having undetected growth disorders whereas others with normal growth being referred for costly, unwarranted specialty evaluations. This study presents the secondary analysis of a primary study that used a randomized control study design to demonstrate that a didactic educational intervention resulted in significantly more children being measured accurately within eight pediatric practices. The secondary analysis explored the influence of the measurer's educational level on the outcome of accurate linear measurement. Results indicated that RNs were twice as likely as non-RNs to measure children accurately.

The care of children and adolescents with type 2 diabetes.

The prevalence of Type 2 diabetes has dramatically increased in children and adolescents over the past 10 years. Type 2 diabetes is characterized by insulin resistance and high insulin levels. Reasons cited for the rise of this condition in children and adolescents are speculated to stem from obesity because of a rise in sedentary behavior, nonnutritious food choices, and genetic predisposition. A high recurrence rate in families shows that therapy for children and adolescents must involve the entire family to be successful. Treatment recommendations vary depending on severity but include nutrition, exercise, and medication. Assessment of the patient's and family's willingness to change their current lifestyle behaviors is an integral part of treatment. Nutrition and exercise goals should be made on an individual basis to meet the needs of the patient. Success of therapy is difficult to measure because this is a chronic condition being diagnosed in young people. As in any chronic condition, success of therapy is difficult to measure.