Type 1 Diabetes Management in the Hospital Setting.

The incidence of diabetes in children and adolescents has increased during the past decades, with a 1.9% increase per year in type 1 diabetes mellitus (T1DM). Patients with diabetes have a greater risk of hospitalizations compared with those without diabetes. Clear evidence has emerged in the past decade that supports appropriate glycemic control in the hospital setting to improve clinical outcomes and reduce the risk of hospital complications and mortality. Determining the appropriate insulin regimen in patients with T1DM in the hospital depends on the clinical status, type of outpatient insulin regimen (multiple daily injections versus pump therapy), glycemic control before admission, nutritional status, procedures, and enteral versus parenteral nutrition. Due to the complexity of the inpatient management of diabetes, institutions should have an inpatient diabetes management team that includes dietitians, diabetes educators, nurses, pharmacists, social workers, and endocrinologists. The use of inpatient diabetes teams has been demonstrated to be beneficial in the management of patients with T1DM.

Technology use and clinical outcomes in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes.

OBJECTIVES: Technology use has been shown to improve diabetes control, but minority youths tend to have low rates of technology use and exhibit suboptimal glycemic control. We examined the impact of continuous glucose monitors (CGM) and continuous subcutaneous insulin infusion (CSII) on glycemic control in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes (T1D). METHODS: A cross-sectional study was conducted among 140 pediatric T1D patients seen at a multidisciplinary clinic. From January to November 2022, data on demographics and glycated hemoglobin (HbA1c) levels were collected. Patients were categorized as technology (CGM, CSII, or both) or non-technology users (finger stick meter (FS) and multiple daily injections (MDI)). RESULTS: The majority identified as Hispanic (79 %) and had public health insurance (71 %). Sixty-nine percent used technology. Compared with non-technology users, technology users had significantly lower mean HbA1c levels (9.60 vs. 8.40 %, respectively) (p=0.0024), though no group (CGM + CSII, CGM + MDI, FS + CSII, and FS + MDI) achieved a mean HbA1c level of <7.0 %. Regarding minority status, no significant differences in mean HbA1c levels existed between Hispanics and Blacks in the CGM + MDI and FS + CSII groups (p=0.2232 and p=0.9224, respectively). However, there was a significant difference in mean HbA1c levels between Hispanic and Black non-technology users (9.19 vs. 11.26 %, respectively) (p=0.0385). CONCLUSIONS: Technology users demonstrated better glycemic control than non-technology users. Further research is needed to investigate factors affecting glycemic control in minority youths with T1D.

Inter- and intra-ethnic group comparison of metabolic syndrome components among morbidly obese adolescents.

This study explored inter- (between) and intra- (within) ethnic group differences in metabolic syndrome components among a clinical sample of morbidly obese (body mass index [BMI] > or =97th percentile for age and sex) 12- to 18-year-olds originating from Latin America and the Caribbean Basin and a matched (age/ethnicity/sex/BMI percentile) national sample (N=208, both samples) of Mexican American and non-Hispanic blacks from the 1999 to 2006 National Health and Nutrition Examination Survey (NHANES). Mexican American and non-Hispanic black boys from the NHANES/national sample had significantly higher mean fasting glucose levels compared with Latin and Caribbean blacks (98.50 vs 85.42 mg/dL, 97.34 vs 86.44 mg/dL, respectively, (P< .001 for both comparisons). Conversely, both diastolic/systolic blood pressure was consistently higher among Latin/Caribbean adolescents vs Mexican American and non-Hispanic blacks for all age/sex/ethnic groups. These results indicate that morbidly obese adolescents from both major ethnic groups and subgroups within these groups show health-related comorbidities in both clinic- and population-based settings.

Relationship between aminotransferases levels and components of the metabolic syndrome among multiethnic adolescents.

BACKGROUND: Data evaluating the frequency of elevated aminotransferases (as a surrogate for non-alcoholic fatty liver disease [NAFLD]) and metabolic syndrome (MS) components among overweight multiethnic children/adolescents originating predominantly from South/Central America and the Caribbean are limited. METHODS: A sample (N = 284) of multiethnic (75% Latino, 25% Afro Caribbean/non-Hispanic black) overweight children/ adolescents' (mean age 12.24 +/- 3.48) overnight fasting insulin and glucose, systolic/diastolic blood pressure, HDL/LDL/total cholesterol, triglyceride, aspartate aminotransferase (AST) and alanine aminostransferase (ALT) were analyzed. RESULTS: A total of 22% of the sample had elevated ALT (> or = 30 U/L; mean 25.94 U/L for Hispanics, 23.05 U/L for blacks) and 8% had elevated AST (> or = 35 U/L; mean 23.05 U/L for Hispanics, 24.68 U/L for blacks). AST and ALT were significantly correlated with triglycerides (r = 0.23, P < .01; r = 0.18, P < .05, respectively) for the overall sample. CONCLUSIONS: Among overweight adolescents, MS components are associated with NALFD in subgroups of major ethnic groups suggesting that AST and ALT as surrogate markers for NAFLD should be included in addition to the standard cardio metabolic tests.

How do different indices of obesity correlate with cardiometabolic disease risk factors in multiethnic youths?

OBJECTIVE: To investigate the relationship between cardiometabolic disease risk factors (CDRFs) among ethnic minorities and anthropometric factors including body mass index z score, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) in Hispanic and non-Hispanic black youths originating primarily from Central America, South America, and the Caribbean. METHODS: Clinical data of 167 young persons 2 to 19 years of age encountered in an outpatient pediatric endocrinology clinic were analyzed. The CDRFs included fasting insulin and glucose, homeostasis model assessment of insulin resistance (HOMA-IR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), high-density lipoprotein cholesterol, triglycerides, cardiac C-reactive protein (CRP), and apolipoproteins. RESULTS: For both the non-Hispanic black and the Hispanic youths, WC was significantly correlated with SBP (r = 0.63; P<.001 and r = 0.50; P<.001, respectively), DBP (r = 0.61; P<.001 and r = 0.47; P<.001, respectively), and cardiac CRP (r = 0.76; P<.001 and r = 0.26; P = .026, respectively). Similarly, WHTR was significantly correlated with SBP, DBP, and cardiac CRP for the non-Hispanic black study subjects, whereas SBP (r = 0.22; P = .01), DBP (r = 0.34; P<.001), fasting insulin (r = 0.43; P<.001), HOMA-IR (r = 0.38; P<.001), apolipoprotein A-I (r = 0.30; P = .01), and CRP (r = 0.44; P<.001) were significantly correlated for the Hispanic group. For both groups, body mass index z score was not consistently correlated with CDRFs, and waist-to-hip ratio was not significantly correlated with any CDRFs, except for apolipoprotein B in non-Hispanic black youths. CONCLUSION: Our study shows that WC and WHTR may be useful anthropometric factors for better identification of ethnic minority youths at risk for adult-onset cardiometabolic disease.

Prevalence of metabolic syndrome in US-born Latin and Caribbean youth.

BACKGROUND: Little is knows about the prevalence of the metabolic syndrome (MS) among overweight first or second generation United States immigrant children/adolescents from Central/South America and the Caribbean basin. METHODS: Analysis of anthropometric and laboratory data (N = 224) in overweight children ages 3-18 (64% Hispanic, 25% AfroCaribbean/black, 8% white, 3% multiracial) was conducted. The main outcome measure was the prevalence of individual parameters of MS and the MS (defined as > or =3 abnormal components). RESULTS: The prevalence of the MS was 29% for the overall sample; an additional 28% had two MS components. Boys were significantly more likely than girls to have abnormal systolic blood pressure (P < 0.05). Hispanics were significantly more likely than blacks to have abnormal triglyceride and HDL cholesterol (P < 0.01 for both comparisons). CONCLUSIONS: Our results indicate that both sub-groups of, and major ethnic groups (Mexican- and African American) are at equal risk for cardiometabolic disease. Early identification of MS in recent immigrant children may improve their future cardiometabolic health.