Type 1 diabetes mellitus(T1DM) is one of the most prevalent chronic conditions affecting individuals under the age of 18 years, with increasing incidence worldwide, especially among very young age groups, younger than...Type 1 diabetes mellitus(T1DM) is one of the most prevalent chronic conditions affecting individuals under the age of 18 years, with increasing incidence worldwide, especially among very young age groups, younger than 5. There is still no cure for the disease, and therapeutic goals and guidelines are a challenge. Currently, despite T1 DM intensive management and technological interventions in therapy, the majority of pediatric patients do not achieve glycemic control goals. This leads to a potential prognosis of long term diabetic complications, nephrological, cardiac, ophthalmological and neurological. Unfortunately, the neurological manifestations, including neurocognitive and behavioral complications, may present soon after disease onset, during childhood and adolescence. These manifestations may be prominent, but at times subtle, thus they are often not reported by patients or physicians as related to the diabetes. Furthermore, the metabolic mechanism for such manifestations has been inconsistent and difficult to interpret in practical clinical care, as reported in several reviews on the topic of brain and T1 DM. However, new technological methods for brain assessment, as well as the introduction of continuous glucose monitoring, provide new insights and information regarding brain related manifestations and glycemic variability and control parameters, which may impact the clinical care of children and youth with T1 DM. This paper provides a comprehensive review of the most recently reported behavioral, cognitive domains, sleep related, electrophysiological, and structural alterations in children and adolescences from a novel point of view. The review focuses on reported impairments based on duration of T1 DM, its timeline, and modifiable disease related risk parameters. These findings are not without controversy, and limitations of data are presented in addition to recommendations for future research direction.展开更多
BACKGROUND Diabetes mellitus type 2(T2DM)is a state of hyperglycemia due to a defect in the secretion and/or action of insulin,and it represents the most common form of diabetes worldwide.In Mexico,10.3%of the adult p...BACKGROUND Diabetes mellitus type 2(T2DM)is a state of hyperglycemia due to a defect in the secretion and/or action of insulin,and it represents the most common form of diabetes worldwide.In Mexico,10.3%of the adult population have been diagnosed with T2DM and it is expanding to the pediatric population.AIM To evaluate and compare the prevalence of T2DM in the pediatric population at the Children’s Hospital,“Hospital Infantil de México Federico Gómez(HIMFG)”,at two time periods:2013 vs 2018.METHODS A comparison of two cross-sectional studies was done(2013 and 2018).The study population was comprised of children and adolescents 8-17 years old,from the Diabetes Clinic at the aforementioned institution.A comprehensive interrogation regarding family history and perinatal antecedents was performed.Complete blood work after 12 h of fasting was obtained to determine serum levels of glucose,glycated hemoglobin,lipid profile,C-peptide,and insulin.The data were analysed using the statistical software package SPSS v.23.0.A P value of<0.05 was considered statistically significant.RESULTS A total of 151 patients were included:47 from 2013,and 104 from 2018.There were age differences noted between the two periods with younger patients presenting T2DM in 2013.Also,T2DM predominated in the male sex in 55.36%in 2013 vs 32.7%in 2018.An increased prevalence of T2DM was noted from 2013 to 2018(20.2%vs 33.0%,respectively),which was a statistically significant 12.8%increase(P<0.0001).The illness phenotype was more aggressive in the 2018 group with the presence of a higher proportion of obesity,insulin resistance,and adverse lipid profiles.CONCLUSION The prevalence of T2DM at the HIMFG institution from 2013 to 2018 increased by 12.8%(20.2%vs 33.0%,respectively).The study results demonstrate the need for vigilance in T2DM trends,and to strengthen programs of healthy nutrition and physical activity as well as early detection and risk factors for obesity,data on insulin resistance,and metabolic syndrome,with the aim of preventing the development of T2DM.展开更多
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 ado...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 development 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.展开更多
BACKGROUND Type 1 diabetes(T1D)incidence varies substantially between countries/territories,with most studies indicating increasing incidence.In Western Pacific region(WPR),reported rates are much lower than European-...BACKGROUND Type 1 diabetes(T1D)incidence varies substantially between countries/territories,with most studies indicating increasing incidence.In Western Pacific region(WPR),reported rates are much lower than European-origin populations.In contrast,there are reports of substantial numbers of young people with type 2 diabetes(T2D).A deeper understanding of T1D and T2D in the WPR may illuminate factors important in pathogenesis of these conditions.Furthermore,with varying resources and funding for diabetes treatment in this region,there is a need to more clearly determine the current burden of disease and also any gaps in knowledge.AIM To compile and summarise published epidemiologic and phenotypic data on childhood diabetes in non-European populations in and from WPR.METHODS Research articles were systematically searched from PubMed(MEDLINE),Embase,Cochrane library,and gray literature.Primary outcome measures were incidence and prevalence,with secondary measures including phenotypic descriptions of diabetes,including diabetes type categorization,presence of diabetic ketoacidosis(DKA)at onset,autoantibody positivity,Cpeptide levels,and human leucocyte antigen phenotype.Extracted data were collected using a customized template.Three hundred and thirty relevant records were identified from 16 countries/territories,with analysis conducted on 265(80.3%)records published from the year 2000.RESULTS T1D incidence ranged from<1-7.3/100000 individuals/year,rates were highest in emigrant/mixed populations and lowest in South-East Asia,with most countries/territories(71.4%)having no data since 1999.Incidence was increasing in all six countries/territories with data(annual increases 0.5%-14.2%,highest in China).Peak age-of-onset was 10-14 years,with a female case excess.Rate of DKA at onset varied from 19.3%-70%.Pancreatic autoantibodies at diagnosis were similar to European-origin populations,with glutamic acid decarboxylase-65 autoantibody frequency of 44.1%-64.5%,insulinoma-associated 2 autoantibody 43.5%-70.7%,and zinc transporter-8 autoantibody frequency 54.3%(one study).Fulminant T1D also occurs.T2D was not uncommon,with incidence in Japan and one Chinese study exceeding T1D rates.Monogenic forms also occurred in a number of countries.CONCLUSION T1D is less common,but generally has a classic phenotype.Some countries/territories have rapidly increasing incidence.T2D is relatively common.Registries and studies are needed to fill many information gaps.展开更多
BACKGROUND The prevalence of diabetes as a catastrophic disease in childhood is growing in the world.The search for novel biomarkers ofβ-cell failure has been an elusive task because it requires several clinical and ...BACKGROUND The prevalence of diabetes as a catastrophic disease in childhood is growing in the world.The search for novel biomarkers ofβ-cell failure has been an elusive task because it requires several clinical and biochemical measurements in order to integrate the risk of metabolic syndrome.AIM To determine which biomarkers are currently used to identifyβ-cell failure among children and adolescents with high risk factors for diabetes mellitus.METHODS This systematic review was carried out using a modified version of the PICO protocol(Participants/Intervention/Comparison/Outcome).Once our research question was established,terms were individually researched on three different databases(PubMed,BIREME and Web of Science).The total articles obtained underwent a selection process from which the 78 most relevant articles were retrieved to undergo further analysis.They were assessed individually according to quality criteria.RESULTS First,we made the classification of theβ-cell-failure biomarkers by the target tissue and the evolution of the disease,separating the biomarkers in relation to the types of diabetes.Second,we demonstrated that most biomarkers currently used as early signs ofβ-cell failure are those that concern local or systemic inflammation processes and oxidative stress as well as those related to endothelial dysfunction processes.Third,we explored the novelties of diabetes as a protein conformational disease and the novel biomarker called real human islet amyloid polypeptide amyloid oligomers.Finally,we ended with a discussion about the best practice of validation and individual control of using different types of biomarkers in type 1 and type 2 diabetes in order to assess the role they play in the progress of diabetes in childhood.CONCLUSION This review makes widely evident that most biomarkers currently used as early signs ofβ-cell failure are those that concern local or systemic inflammation processes and oxidative stress as well as those related to endothelial dysfunction processes.Landing in the clinical practice we propose that real human islet amyloid polypeptide amyloid oligomers is good for identifying patients withβ-cell damage and potentially could substitute many biomarkers.展开更多
文摘Type 1 diabetes mellitus(T1DM) is one of the most prevalent chronic conditions affecting individuals under the age of 18 years, with increasing incidence worldwide, especially among very young age groups, younger than 5. There is still no cure for the disease, and therapeutic goals and guidelines are a challenge. Currently, despite T1 DM intensive management and technological interventions in therapy, the majority of pediatric patients do not achieve glycemic control goals. This leads to a potential prognosis of long term diabetic complications, nephrological, cardiac, ophthalmological and neurological. Unfortunately, the neurological manifestations, including neurocognitive and behavioral complications, may present soon after disease onset, during childhood and adolescence. These manifestations may be prominent, but at times subtle, thus they are often not reported by patients or physicians as related to the diabetes. Furthermore, the metabolic mechanism for such manifestations has been inconsistent and difficult to interpret in practical clinical care, as reported in several reviews on the topic of brain and T1 DM. However, new technological methods for brain assessment, as well as the introduction of continuous glucose monitoring, provide new insights and information regarding brain related manifestations and glycemic variability and control parameters, which may impact the clinical care of children and youth with T1 DM. This paper provides a comprehensive review of the most recently reported behavioral, cognitive domains, sleep related, electrophysiological, and structural alterations in children and adolescences from a novel point of view. The review focuses on reported impairments based on duration of T1 DM, its timeline, and modifiable disease related risk parameters. These findings are not without controversy, and limitations of data are presented in addition to recommendations for future research direction.
文摘BACKGROUND Diabetes mellitus type 2(T2DM)is a state of hyperglycemia due to a defect in the secretion and/or action of insulin,and it represents the most common form of diabetes worldwide.In Mexico,10.3%of the adult population have been diagnosed with T2DM and it is expanding to the pediatric population.AIM To evaluate and compare the prevalence of T2DM in the pediatric population at the Children’s Hospital,“Hospital Infantil de México Federico Gómez(HIMFG)”,at two time periods:2013 vs 2018.METHODS A comparison of two cross-sectional studies was done(2013 and 2018).The study population was comprised of children and adolescents 8-17 years old,from the Diabetes Clinic at the aforementioned institution.A comprehensive interrogation regarding family history and perinatal antecedents was performed.Complete blood work after 12 h of fasting was obtained to determine serum levels of glucose,glycated hemoglobin,lipid profile,C-peptide,and insulin.The data were analysed using the statistical software package SPSS v.23.0.A P value of<0.05 was considered statistically significant.RESULTS A total of 151 patients were included:47 from 2013,and 104 from 2018.There were age differences noted between the two periods with younger patients presenting T2DM in 2013.Also,T2DM predominated in the male sex in 55.36%in 2013 vs 32.7%in 2018.An increased prevalence of T2DM was noted from 2013 to 2018(20.2%vs 33.0%,respectively),which was a statistically significant 12.8%increase(P<0.0001).The illness phenotype was more aggressive in the 2018 group with the presence of a higher proportion of obesity,insulin resistance,and adverse lipid profiles.CONCLUSION The prevalence of T2DM at the HIMFG institution from 2013 to 2018 increased by 12.8%(20.2%vs 33.0%,respectively).The study results demonstrate the need for vigilance in T2DM trends,and to strengthen programs of healthy nutrition and physical activity as well as early detection and risk factors for obesity,data on insulin resistance,and metabolic syndrome,with the aim of preventing the development of T2DM.
文摘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 development 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.
文摘BACKGROUND Type 1 diabetes(T1D)incidence varies substantially between countries/territories,with most studies indicating increasing incidence.In Western Pacific region(WPR),reported rates are much lower than European-origin populations.In contrast,there are reports of substantial numbers of young people with type 2 diabetes(T2D).A deeper understanding of T1D and T2D in the WPR may illuminate factors important in pathogenesis of these conditions.Furthermore,with varying resources and funding for diabetes treatment in this region,there is a need to more clearly determine the current burden of disease and also any gaps in knowledge.AIM To compile and summarise published epidemiologic and phenotypic data on childhood diabetes in non-European populations in and from WPR.METHODS Research articles were systematically searched from PubMed(MEDLINE),Embase,Cochrane library,and gray literature.Primary outcome measures were incidence and prevalence,with secondary measures including phenotypic descriptions of diabetes,including diabetes type categorization,presence of diabetic ketoacidosis(DKA)at onset,autoantibody positivity,Cpeptide levels,and human leucocyte antigen phenotype.Extracted data were collected using a customized template.Three hundred and thirty relevant records were identified from 16 countries/territories,with analysis conducted on 265(80.3%)records published from the year 2000.RESULTS T1D incidence ranged from<1-7.3/100000 individuals/year,rates were highest in emigrant/mixed populations and lowest in South-East Asia,with most countries/territories(71.4%)having no data since 1999.Incidence was increasing in all six countries/territories with data(annual increases 0.5%-14.2%,highest in China).Peak age-of-onset was 10-14 years,with a female case excess.Rate of DKA at onset varied from 19.3%-70%.Pancreatic autoantibodies at diagnosis were similar to European-origin populations,with glutamic acid decarboxylase-65 autoantibody frequency of 44.1%-64.5%,insulinoma-associated 2 autoantibody 43.5%-70.7%,and zinc transporter-8 autoantibody frequency 54.3%(one study).Fulminant T1D also occurs.T2D was not uncommon,with incidence in Japan and one Chinese study exceeding T1D rates.Monogenic forms also occurred in a number of countries.CONCLUSION T1D is less common,but generally has a classic phenotype.Some countries/territories have rapidly increasing incidence.T2D is relatively common.Registries and studies are needed to fill many information gaps.
基金Mexico’s National Council of Science and Technology (CONACYT),No. SALUD-2010-C02-151942Institute of Science and Technology of Mexico City.
文摘BACKGROUND The prevalence of diabetes as a catastrophic disease in childhood is growing in the world.The search for novel biomarkers ofβ-cell failure has been an elusive task because it requires several clinical and biochemical measurements in order to integrate the risk of metabolic syndrome.AIM To determine which biomarkers are currently used to identifyβ-cell failure among children and adolescents with high risk factors for diabetes mellitus.METHODS This systematic review was carried out using a modified version of the PICO protocol(Participants/Intervention/Comparison/Outcome).Once our research question was established,terms were individually researched on three different databases(PubMed,BIREME and Web of Science).The total articles obtained underwent a selection process from which the 78 most relevant articles were retrieved to undergo further analysis.They were assessed individually according to quality criteria.RESULTS First,we made the classification of theβ-cell-failure biomarkers by the target tissue and the evolution of the disease,separating the biomarkers in relation to the types of diabetes.Second,we demonstrated that most biomarkers currently used as early signs ofβ-cell failure are those that concern local or systemic inflammation processes and oxidative stress as well as those related to endothelial dysfunction processes.Third,we explored the novelties of diabetes as a protein conformational disease and the novel biomarker called real human islet amyloid polypeptide amyloid oligomers.Finally,we ended with a discussion about the best practice of validation and individual control of using different types of biomarkers in type 1 and type 2 diabetes in order to assess the role they play in the progress of diabetes in childhood.CONCLUSION This review makes widely evident that most biomarkers currently used as early signs ofβ-cell failure are those that concern local or systemic inflammation processes and oxidative stress as well as those related to endothelial dysfunction processes.Landing in the clinical practice we propose that real human islet amyloid polypeptide amyloid oligomers is good for identifying patients withβ-cell damage and potentially could substitute many biomarkers.
