RESUMO
OBJECTIVES: To review the magnitude, characteristics, and public health importance of type 2 diabetes in North American youth. RESULTS: Among 15- to 19-year-old North American Indians, prevalence of type 2 diabetes per 1000 was 50.9 for Pima Indians, 4.5 for all US American Indians, and 2.3 for Canadian Cree and Ojibway Indians in Manitoba. From 1967-1976 to 1987-1996, prevalence increased 6-fold for Pima Indian adolescents. Among African Americans and whites aged 10 to 19 years in Ohio, type 2 diabetes accounted for 33% of all cases of diabetes. Youth with type 2 diabetes were generally 10 to 19 years old, were obese and had a family history of type 2 diabetes, had acanthosis nigricans, belonged to minority populations, and were more likely to be girls than boys. At follow-up, glucose control was often poor, and diabetic complications could occur early. CONCLUSIONS: Type 2 diabetes is an important problem among American Indian and First Nation youth. Other populations have not been well studied, but cases are now occurring in all population groups, especially in ethnic minorities. Type 2 diabetes among youth is an emerging public health problem, for which there is a great potential to improve primary and secondary prevention.
Assuntos
Diabetes Mellitus Tipo 2/etnologia , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Criança , Feminino , Humanos , Indígenas Norte-Americanos/estatística & dados numéricos , Masculino , Manitoba/epidemiologia , Saúde Pública , Sistema de Registros/estatística & dados numéricos , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
Type 2 diabetes mellitus is a disease of adults and has been considered rare in the pediatric population. Over the last decade, however, there has been a disturbing trend of increasing cases of type 2 diabetes in children, particularly adolescents, and with a greater proportion of minority children being affected. This article reviews the clinical characteristics of youth with type 2 diabetes, presents the risk factors associated with insulin resistance and type 2 diabetes, discusses treatment options, and projects future directions in research. The ultimate goal is to raise awareness of this challenging entity among healthcare professionals.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Grupos Minoritários , Adolescente , Criança , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Feminino , Hispânico ou Latino , Humanos , Indígenas Norte-Americanos , Masculino , México/etnologiaRESUMO
La clasificación actual y los criterios diagnósticos para la diabetes mellitus fueron hechos por el Grupo Nacional de Datos de Estados Unidos (United States National Data Group) en 1979 y aprobados por la Organización Mundial de la Salud en 1980, con modificaciones en 1985 y 1994. Los criterios, elegidos para reflejar el riesgo de las complicaciones, fueron la síntesis del debate y la experiencia, representando un consenso útil por igual para todas las personas relacionadas con la diabetes- el médico clínico, el investigador y el epidemiólogo. Es bien sabido que la prueba de tolerancia oral a la glucosa (PTOG) esincómoda, variable y no fisiológica. A pesar de estas limitaciones, la glucosa plasmática de 2 hs. postcarga sigue siendo el estándar contra el cual se evalúan el resto de las pruebas. En este artículo se hace una revisión sobre la justificación original de la PTOG y a la luz de investigaciones epidemiológicas más recientes, se busca colocar los actuales criterios diagnósticos para diabetes dentrode una perspectiva fisiopatológica, diagnóstica y pronóstica (AU)
Assuntos
Humanos , Diabetes Mellitus/diagnóstico , Teste de Tolerância a Glucose , Hemoglobinas Glicadas , Retinopatia Diabética , Nefropatias Diabéticas/complicaçõesRESUMO
La clasificación actual y los criterios diagnósticos para la diabetes mellitus fueron hechos por el Grupo Nacional de Datos de Estados Unidos (United States National Data Group) en 1979 y aprobados por la Organización Mundial de la Salud en 1980, con modificaciones en 1985 y 1994. Los criterios, elegidos para reflejar el riesgo de las complicaciones, fueron la síntesis del debate y la experiencia, representando un consenso útil por igual para todas las personas relacionadas con la diabetes- el médico clínico, el investigador y el epidemiólogo. Es bien sabido que la prueba de tolerancia oral a la glucosa (PTOG) esincómoda, variable y no fisiológica. A pesar de estas limitaciones, la glucosa plasmática de 2 hs. postcarga sigue siendo el estándar contra el cual se evalúan el resto de las pruebas. En este artículo se hace una revisión sobre la justificación original de la PTOG y a la luz de investigaciones epidemiológicas más recientes, se busca colocar los actuales criterios diagnósticos para diabetes dentrode una perspectiva fisiopatológica, diagnóstica y pronóstica
Assuntos
Humanos , Diabetes Mellitus/diagnóstico , Retinopatia Diabética , Teste de Tolerância a Glucose , Hemoglobinas Glicadas , Nefropatias Diabéticas/complicaçõesRESUMO
Complementary genetic and demographic analyses estimate the total proportion of European-American admixture in the Gila River Indian Community and trace its mode of entry. Among the 9,616 residents in the sample, 2,015 persons claim only partial Native American heritage. A procedure employing 23 alleles or haplotypes at eight loci was used to estimate the proportion of European-American admixture, m(a), for the entire sample and within six categories of Caucasian admixture calculated from demographic data, md. The genetic analysis gave an estimate of total European-American admixture in the community of 0.054 (95% confidence interval [CI] .044-.063), while an estimate from demographic records was similar, .059. Regression of m(a) on md yielded a fitted line m(a) = .922md, r = .959 (P = .0001). When total European-American admixture is partitioned between the contributing populations, Mexican-Americans have provided .671, European-Americans .305, and African-Americans .023. These results are discussed within the context of the ethnic composition of the Gila River Indian Community, the assumptions underlying the methods, and the potential that demographic data have for enriching genetic measurements of human admixture. It is concluded that, despite the severe assumptions of the mathematical methods, accurate, reliable estimates of genetic admixture are possible from allele and haplotype frequencies, even when there is little demographic information for the population.