OBJECTIVE -The incidence of pediatric type 2 diabetes has recently seen an alarming increase. To improve our understanding of pediatric type 2 diabetes and identify markers that discriminate these subjects from those with type 1 diabetes, we performed a multivariant analysis associating serum adiponectin and leptin levels with anthropometrical parameters and disease state.RESEARCH DESIGN AND METHODS -Samples from children and adolescents with type 1 diabetes (n ϭ 41) and type 2 diabetes (n ϭ 17) and from nondiabetic individuals of similar age from the general population (n ϭ 43) were investigated. An analysis included the parameters of matching for BMI and Tanner stage. Receiver-operator characteristic (ROC) curves were established to assess these analytes' association with disease.RESULTS -Contrary to studies of adult type 1 diabetes, adiponectin levels in our pediatric type 1 diabetic subjects (10.2 g/ml [95% CI 8.6 -11.7]) did not differ from those of healthy control subjects (10.6 g/ml [9.2-12.0]; P ϭ NS). Children with type 2 diabetes (5.5 g/ml [4.8 -6.2]) had significantly lower adiponectin levels than both of those groups. Conversely, type 2 diabetic subjects showed marked elevations in serum leptin concentrations (24.3 ng/ml [17.1-31.5]) compared with healthy control subjects (2.7 ng/ml [1.3-4.1]; P Ͻ 0.001) and type 1 diabetic subjects (5.1 ng/ml [3.5-6.7]; P Ͻ 0.001). Importantly, each of the properties ascribed to pediatric type 2 diabetes was present when the comparison was restricted to healthy children or type 1 diabetic patients whose BMI was Ͼ85th percentile or who had Tanner stage 4 and 5. The evaluation of adiponectin-to-leptin ratios revealed a striking difference between children with type 1 diabetes (6.3 [3.8 -8.8]) and type 2 diabetes (0.3 [0.2-0.5]; P Ͻ 0.001).CONCLUSIONS -In pediatric diabetes, where diagnosis of disease is often difficult, these studies suggest that the adiponectin-to-leptin ratio may provide additional help in the discrimination between type 1 and type 2 diabetes.
Diabetes Care 27:2010 -2014, 2004A worldwide epidemic exists with respect to type 2 diabetes, primarily because of increased rates of obesity (1,2). Recent studies have established adipose tissue as an endocrine organ capable of hormone and cytokine secretion (3).One such secreted molecule, adiponectin, is an anti-inflammatory and antiatherogenic hormone exclusively synthesized in adipose tissue (4,5). Serum adiponectin levels are decreased in obese adults, including those with type 2 diabetes, and increase during weight loss or treatment with thiazolidinediones (6). Indeed, adiponectin has been proposed to independently protect against type 2 diabetes (7). Conversely, increased plasma levels of adiponectin were observed in adult Japanese type 1 diabetic patients compared with BMI-matched healthy control subjects (8). Adiponectin appears to increase insulin sensitivity by regulating glucose and lipid metabolism. Indeed, a major effect of adiponectin involves the enhancement of insulin action in liver and, henc...
Initiation of insulin pump therapy at diagnosis improved glycemic control, was well tolerated, and contributed to improved patient satisfaction with treatment. This study also suggests that earlier use of pump therapy might help to preserve residual β-cell function, although a larger clinical trial would be required to confirm this.
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