Type 2 diabetes in children and adolescents

Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32608, USA.
Pediatric Diabetes (Impact Factor: 2.57). 09/2009; 10 Suppl 12(12):17-32. DOI: 10.1111/j.1399-5448.2009.00584.x
Source: PubMed

ABSTRACT Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith, G Type 2 diabetes in the child and adolescent.

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Available from: AL Rosenbloom Rosenbloom, Aug 12, 2014
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    • "The goals of therapy are to maintain LDL below 2.6 mmol/L, triglycerides below 1.7 mmol/L, and HDL above 0.9 mmol/L [30, 33, 72, 73]. Statins are the first line of therapy in these patients [33]. "
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    ABSTRACT: Type 2 diabetes (T2D) was an adult disease until recently, but the rising rates of obesity around the world have resulted in a younger age at presentation. Children who have T2D have several comorbidities and complications reminiscent of adult diabetes, but these are appearing in teens instead of midlife. In this review, we discuss the clinical presentation and management options for youth with T2D. We discuss the elements of lifestyle intervention programs and allude to pharmacotherapeutic options used in the treatment of T2D youth. We also discuss comorbidities and complications seen in T2D in children and adolescents.
    International Journal of Pediatrics 10/2013; 2013:972034. DOI:10.1155/2013/972034
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    • "The optimal pharmacological treatment for PWS with DM remains controversial. Generally, metformin is recommended as a first-line pharmacological treatment for T2DM in children and adolescents (17). Since increased insulin resistance is observed in some PWS patients with DM (18), some experts advocate the use of metformin for these patients (19). "
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    ABSTRACT: Prader-Willi syndrome (PWS) is frequently associated with marked obesity and diabetes mellitus (DM). Although the overall frequency of DM in PWS ranges from 7-20%, there is only limited data available on Japanese patients. This study evaluated five factors associated with DM in PWS: 1) frequency, 2) age of onset, 3) risk factors, 4) long-term complications and 5) treatment. Sixty-five patients, ranging in age from 10 to 53 yr, were studied retrospectively. The frequency of DM in patients over 10 yr of age was 26.2% (17/65 patients). The age of DM onset ranged from 10 to 29 yr with a median age of 15 yr. The body mass index (BMI) was significantly higher in the DM group in comparison with the non-DM group. The number of patients using growth hormone (GH) in the DM group was significantly lower than the number that did not. Proteinuria (urinary excretion of albumin/creatinine at spot collection: U-Alb/Cr ≥300 mg/gCr) was observed in 1/17 patients (5.9%), microalbuminuria (U-Alb/Cr 30-300 mg/gCr) was observed in 4/17 patients (23.5%) and nonproliferative retinopathy was observed in 2/17 patients (11.8%). Among oral hypoglycemic agents, alpha-glucosidase inhibitors (α-GI) were most often used in our patients (10/17, 58.8%). Eleven out of 17 patients (64.7%) had been treated with insulin.
    Clinical Pediatric Endocrinology 04/2011; 20(2):33-8. DOI:10.1297/cpe.20.33
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    ABSTRACT: Background: Although research suggests that obese children and adolescents are stigmatised, experience victimisation, have poor body image, body dissatisfaction, depression and low self-esteem, these findings have been inconsistent. There is increasing evidence to suggest that body perception rather than actual body size leads to negative psychosocial outcomes with many obese people miss-rating themselves as being ‘normal’ weight; body perception is also the strongest predictor of weight change attempts. The majority of studies in this area have been quantitative; the few previous qualitative studies have either not fully utilised qualitative methods or not focused on adolescents. This study uses qualitative methods, and a unique sampling strategy, to improve understanding of obesity related experiences and reasons for weight change behaviours and success in adolescence. Methods: 35 semi-structured interviews were conducted between November 2007 and April 2008. Young adult (aged approximately 24) males (17) and females (18) were purposively sub-sampled from The West of Scotland 11 to 16/16+ Study cohort based on measured adolescent obese status (SDS > 1.65 at one or more of the 11 to 16/16+ study age 11, 13 or 15 measurement points). A picture task was used to stimulate discussion about perceptions of health and weight and the interviews continued with discussion of adolescent experiences, weight related behaviours (diet and exercise) and any weight change attempts. Framework analysis was used to organise data and facilitate analysis. Findings: Initial quantitative secondary analysis of the 11 to 16/16+ data demonstrated that the majority of participants had been worried about both their weight and putting on weight in the future, although this did not translate into slimming behaviour for all. This study found that body size awareness and related ‘botheredness’ varied greatly and were inconsistently related to each other or to weight. While none of the most obese were among the least aware, some were among the least bothered and vice versa. Botheredness related to body concerns, comparisons with others, clothing, romantic relationships, and for approximately half the sample, victimisation. Although the majority of participants reported using changes in diet or exercise behaviours in order to try to lose weight at some time, botheredness did not always translate into effective weight change attempts. Participants were categorised as effective slimmers (active and successful weight change attempt), failed slimmers (active but unsuccessful weight change attempt), passive slimmers (weight loss without active weight change attempt), and passive maintainers (had made no attempts to change weight and had no weight loss). As young adults, 14 were non obese, 14 were obese and 5 were morbidly obese. Those who made successful long lasting weight changes described determination, a greater degree of behaviour change and continued behaviour monitoring. There appeared to be no real pattern to when or why effective changes were made. Age related transitions were often described as being tipping points as well as ‘just being ready’ to change. Those who described sudden unplanned changes were among those who showed the most sustained improvement in weight Conclusions: Not all those who are obese as adolescents are aware or bothered. Most adolescents are aware of how to lose weight. Being bothered is not enough of a motivator to make long lasting changes – obese individuals need to be ‘ready’ to change regardless of knowledge of health behaviours. More needs to be done to assist individuals in being ready to change, this might include raising; body awareness through periodic body measurements at transition points. Further study of ‘tipping points’ in obese adolescents may aid intervention targeting and design.
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