RESUMEN
OBJECTIVE: To determine the prevalence and the clinical features associated with persistent albuminuria in Canadian children aged <18 years with type 2 diabetes. STUDY DESIGN: This national prospective surveillance study involved a network of pediatricians and pediatric endocrinologists. Cases of persistent albuminuria in children with type 2 diabetes were reported during a 24-month period from 2010 to 2012. Persistent albuminuria was defined as an elevated albumin-to-creatinine ratio in a minimum of 2 out of 3 urine samples obtained at least 1 month apart over 3-6 months and confirmed with a first morning sample. Descriptive statistics were used to illustrate demographic and clinical features of the population. The prevalence of persistent albumuria was estimated using data from a previous national surveillence study of type 2 diabetes in children. RESULTS: Fifty cases were reported over the 24-month study period. The estimated prevalence of persistent albuminuria in children with type 2 diabetes in Canada was 5.1%. The median duration of diabetes at the time of diagnosis of albuminuria was 21 days (IQR, 0-241 days). Almost two-thirds (64%) were female, 80% were of Canadian First Nations heritage, and 76% were from Manitoba. Exposure to gestational or pregestational diabetes in utero occurred in 65%, and 48% had a family history of diabetes-related renal disease. Structural anomalies of the kidney were found in 37%. CONCLUSION: Persistent albuminuria occurs in youths with type 2 diabetes in the first year after diagnosis, demonstrates regional variation, and is associated with First Nations heritage and exposure to maternal diabetes during pregnancy.
Asunto(s)
Albuminuria/epidemiología , Albuminuria/etiología , Diabetes Mellitus Tipo 2/complicaciones , Adolescente , Albuminuria/diagnóstico , Canadá/epidemiología , Niño , Femenino , Humanos , Masculino , Vigilancia de la Población , Prevalencia , Estudios ProspectivosRESUMEN
OBJECTIVE: To compare the prevalence of risk factors in children aged <18 years diagnosed with medication-induced diabetes mellitus versus those diagnosed with type 2 diabetes. STUDY DESIGN: This retrospective observational study used data from a Canadian prospective surveillance study in which clinical features of new cases of type 2 diabetes (n = 225) and medication-induced diabetes (n = 58) were reported over a 2-year period. The presence of risk factors for type 2 diabetes (eg, obesity, family history of type 2 diabetes, ethnicity, acanthosis nigricans, hypertension, polycystic ovarian syndrome) was compared in the 2 groups using descriptive statistics and logistic regression. RESULTS: Compared with the children with type 2 diabetes, the children with medication-induced diabetes were more likely to be Caucasian (P < .0001) and less likely to be obese (P < .0001), to have a positive family history of type 2 diabetes (P = .0001), to have acanthosis nigricans (P < .0001) on clinical examination, and to have an obesity-related comorbidity, such as polycystic ovarian syndrome (P = .04), dyslipidemia (P = .02), hypertension (P = .04), or an elevated alanine aminotransferase level (P = .05). CONCLUSIONS: Evaluating for the typical risk factors for type 2 diabetes is not sufficient to identify all children at risk for developing medication-induced diabetes. Further studies are needed to help inform guidelines on screening for and prevention of medication-induced diabetes in children.
Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Glucocorticoides/efectos adversos , Inmunosupresores/efectos adversos , Medición de Riesgo/métodos , Acantosis Nigricans/tratamiento farmacológico , Acantosis Nigricans/epidemiología , Adolescente , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Canadá/epidemiología , Niño , Comorbilidad , Diabetes Mellitus Tipo 2/inducido químicamente , Diabetes Mellitus Tipo 2/diagnóstico , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Femenino , Glucocorticoides/uso terapéutico , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Inmunosupresores/uso terapéutico , Incidencia , Masculino , Obesidad/tratamiento farmacológico , Obesidad/epidemiología , Vigilancia de la Población , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To describe the prevalence and clinical characteristics of the metabolic syndrome (MetS) in a cohort of Australian Aboriginal children. STUDY DESIGN: Body mass index (BMI), waist circumference, skin fold thickness, body fat percentage, insulin resistance, and the prevalence of MetS were evaluated in 486 children age 9 to 14 years from the Darwin Health Region, Northern Territory, Australia. RESULTS: Using an age- and sex- specific definition, 14% of the children in the cohort had MetS, 6.4% were overweight, 4.9% were obese, and 26.2% had an elevated waist circumference. The mean percentage of body fat was 30.2%. The children with MetS had higher BMI and waist z-scores, percent body fat, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score, and skin fold thickness compared with those without MetS (P < .001); however, >50% of those with MetS were neither overweight nor obese. Waist circumference was significantly associated with insulin resistance as measured by the HOMA-IR (P < .001). CONCLUSIONS: MetS is common in our cohort despite low rates of overweight and obesity. A tendency for central adiposity is already evident in these young children. Measurement of waist circumference may help identify Aboriginal children at high risk for MetS.
Asunto(s)
Índice de Masa Corporal , Tamaño Corporal , Síndrome Metabólico/epidemiología , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Australia/epidemiología , Composición Corporal , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Síndrome Metabólico/diagnóstico , Prevalencia , Grosor de los Pliegues CutáneosRESUMEN
OBJECTIVE: To obtain objective information on the relationship between adult height (AH), glucocorticoid (GC) dose, and degree of hormonal suppression in a population of patients with 21-hydroxylase deficiency congenital adrenal hyperplasia (21-OHD CAH) to optimize treatment regimes. STUDY DESIGN: Multicenter retrospective chart review of patients with salt wasting 21-OHD CAH diagnosed in the first 6 months of life, and who had reached AH (n = 54). The data were compiled into a single database. RESULTS: Mean adult height standard deviation score - midparental height standard deviation score was -1.1 for both sexes. Growth velocity was normal during childhood but compromised during infancy and puberty. Onset and tempo of puberty were normal-to-delayed. Bone age was closely correlated with chronologic age (r = 0.93). AH was negatively correlated with androstenedione in infancy (r -0.68; P =.03) and childhood (-0.66; P <.01) and with testosterone in childhood (r -0.44; P =.01), but not with dehydroepiandrosterone or 17-hydroxyprogesterone. GC dose was not associated with AH. CONCLUSIONS: Mean AH was in the lower range of genetic potential in this group of persons with 21-OHD CAH. Androgen levels should be used in conjunction with growth velocity measurements to optimize GC dosing in persons with 21-OHD CAH.