Physicians and other health care professionals should consider screening youth with diabetes for depressed mood in clinical settings, particularly youth with poor glycemic control, those with a history of frequent ED visits, males with type 2 diabetes, and females with comorbidities.

Objective: To examine the associations between demographic and diabetes management variables and the health-related quality of life (HRQOL) of youths with type 1 or type 2 diabetes mellitus (DM).Design: Cross-sectional study.

OBJECTIVE -The "accelerator hypothesis" predicts that fatness is associated with an earlier age at onset of type 1 diabetes. We tested the hypothesis using data from the SEARCH for Diabetes in Youth study.RESEARCH DESIGN AND METHODS -Subjects were 449 youth aged Ͻ20 years at diagnosis who had positive results for diabetes antibodies measured 3-12 months after diagnosis (mean 7.6 months). The relationships between age at diagnosis and fatness were examined using BMI as measured at the SEARCH visit and reported birth weight, both expressed as SD scores (SDSs).RESULTS -Univariately, BMI SDS was not related to age at diagnosis. In multiple linear regression, adjusted for potential confounders, a significant interaction was found between BMI SDS and fasting C-peptide (FCP) on onset age (P Ͻ 0.0001). This interaction remained unchanged after additionally controlling for number and titers of diabetes antibodies. An inverse association between BMI and age at diagnosis was present only among subjects with FCP levels below the median (Ͻ0.5 ng/ml) (regression coefficient Ϫ7.9, P ϭ 0.003). A decrease of 1 SDS in birth weight (639 g) was also associated with an ϳ5-month earlier age at diagnosis (P ϭ 0.008), independent of sex, race/ethnicity, current BMI, FCP, and number of diabetes antibodies.CONCLUSIONS -Increasing BMI is associated with younger age at diagnosis of type 1 diabetes only among those U.S. youth with reduced ␤-cell function. The intrauterine environment may also be an important determinant of age at onset of type 1 diabetes. Diabetes Care 29:290 -294, 2006T he "accelerator hypothesis" postulates that obesity-associated insulin resistance accelerates the disease process of type 1 diabetes. The marker is an earlier age at onset of type 1 diabetes associated with increased BMI (1).In contemporary societies, increasing childhood obesity may account for the increasing incidence and younger age at onset of type 1 diabetes (2) and for the difficulty in distinguishing between type 1 and type 2 diabetes (3,4). The accelerator hypothesis suggests that the increased incidence of type 1 diabetes may be caused by an accelerated progression rather than by an increase in the absolute lifetime risk (1). In support of accelerated progression, the incidence of type 1 diabetes rose in children (0 -14 years) but fell later in life (15-34 or 39 years) in Sweden (5,6) and Belgium (7). Obesity-induced insulin resistance may upregulate the ␤-cells, which become susceptible to an autoimmune attack (8). If this is correct, we can hypothesize that the association between BMI and onset age, if present, may be mediated through an intensified autoimmune response.Studies have linked in utero growth restriction with an increased risk for future chronic diseases, including obesity and insulin resistance. The association between birth weight and age at onset of type 1 diabetes has not been systematically studied.We aimed to test aspects of the accelerator hypothesis using data from the SEARCH for Diabetes in Youth (9). We hypothesized that hig...

Clinicians should examine risk of rehospitalization before discharge, especially for younger patients and those with depression. Future research must focus on methods of intervention for this high-risk group.

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Objective: To identify differences in amount and distribution of fat and lean soft tissue in a cross-sectional study of subjects with and without type 2 diabetes and to determine whether any differences are affected by race/ethnicity or sex. Design and methods: Overweight and obese (body mass index, BMIX25 kg m À2 ) Black, White and Hispanic men (490) and women (825) with type 2 diabetes ((mean±s.d.) age 58.5±6.6; BMI 35.3±5.3) who had a baseline dual energy X-ray absorptiometry whole-body scan at the time of enrollment in the Look AHEAD clinical trial, and 242 healthy controls, 91 males and 151 females (age 55.3±8.6 years, BMI 30.7±4.2 kg m À2 ) who were participating in unrelated research and were scanned on the same densitometers. Results: Adjusted for gender, age, race, clinical site and body size, total fat mass was smaller in persons with type 2 diabetes than in controls (À1.4 ± 0.3 (s.e.); 34.5 vs 35.8 kg, Po0.001) while trunk fat was larger (1.3 ± 0.2 (s.e.); 19.9 vs 18.6 kg, Po0.001) and leg fat was smaller (À1.5±0.2 (s.e.); 10.7 vs 12.3 kg, Po0.001). The arms of subjects with type 2 diabetes did not have significantly less fat compared to controls. Adjusted trunk lean mass was larger in type 2 diabetes by 0.6 kg (28.4 vs 27.8 kg, Po0.001) while leg lean was smaller by 0.5 kg (18.1 vs 18.6 kg, Po0.001). Conclusions: Type 2 diabetes is associated with less total fat, leg fat and leg lean mass and more truncal fat and lean mass than controls. The physiological processes producing these deviations in tissue distribution and their metabolic significance warrant further investigation.

OBJECTIVE -Intentional weight loss is recommended for those with type 2 diabetes, but the strategies patients attempt and their effectiveness for weight management are unknown. In this investigation we describe intentional weight loss strategies used and those related to BMI in a diverse sample of overweight participants with type 2 diabetes at enrollment in the Look AHEAD (Action for Health in Diabetes) clinical trial. RESEARCH DESIGN AND METHODS-This was a cross-sectional study of baseline weight loss strategies, including self-weighing frequency, eating patterns, and weight control practices, reported in 3,063 women and 2,082 men aged 45-74 years with BMI Ն25 kg/m 2 .RESULTS -Less than half (41.4%) of participants self-weighed Ն1/week. Participants ate breakfast 6.0 Ϯ 1.8 days/week, ate 5.0 Ϯ 3.1 meals/snacks per day, and ate 1.9 Ϯ 2.7 fast food meals/week. The three most common weight control practices (increasing fruits and vegetables, cutting out sweets, and eating less high-carbohydrate foods) were reported by ϳ60% of participants for Ն20 weeks over the previous year. Adjusted models showed that self-weighing less than once per week (B ϭ 0.83), more fast food meals consumed per week (B ϭ 0.14), and fewer breakfast meals consumed per week (B ϭ Ϫ0.19) were associated (P Ͻ 0.05) with a higher BMI (R 2 ϭ 0.24).CONCLUSIONS -Regular self-weighing and breakfast consumption, along with infrequent consumption of fast food, were related to lower BMI in the Look AHEAD study population.

Elevated mean corpuscular volume (MCV) is common in persons with hemochromatosis associated with HFE C282Y homozygosity. We evaluated data from the subset of non-Hispanic white participants in the Hemochromatosis and Iron Overload Screening Study to determine if elevated MCV in C282Y homozygotes is related to this genotype or to serum iron measures. Regression analysis was used to model MCV and Hb from transferrin saturation (TfSat), serum ferritin (SF), mean corpuscular hemoglobin concentration, red blood cell count, age, HFE genotype, Field Center, and presence of liver-related abnormalities in C282Y homozygotes and control subjects without HFE mutations (wt/wt genotype). Mean MCV was higher in C282Y homozygotes than in HFE wt/wt controls (94.4 vs. 89.7 fL in women; 95.3 vs. 91.2 fL in men; P < 0.0001 for both). These differences were largely associated with increased mean TfSat and SF in C282Y homozygotes. Adjusted mean MCV was 92.0 fL (95% confidence interval, 91.1, 92.9) in female C282Y homozygotes and 90.9 fL (90.3, 91.5) in controls. Among women with SF in the reference range 20-200 lg/L, adjusted mean MCV was 92.9 fL, (91.7, 94.2) in C282Y homozygotes, 1.8 fL higher than in controls (P 5 0.013). The adjusted mean MCV of male C282Y homozygotes and controls was similar (P 5 0.30). Adjusted mean Hb was 0.2 g/dL higher in women with C282Y/C282Y than in controls. Greater mean MCV in C282Y homozygosity reflects increased mean TfSat and mean SF in men and women; an additional effect of genotype on MCV and Hb was detected in women. Am. J. Hematol. 82:898-905, 2007. V V C 2007 Wiley-Liss, Inc. IntroductionElevated values of mean corpuscular volume (MCV) are common in persons with hemochromatosis. In early series of hemochromatosis cases, this was attributed to hepatic cirrhosis [1], a then-current diagnostic criterion of hemochromatosis and a common sequel of severe iron overload [1,2]. In Alabama hemochromatosis probands diagnosed in medical care, mean MCV and hemoglobin concentration (Hb) were significantly greater in HFE C282Y homozygotes than in probands with other HFE genotypes or in control subjects, and 44% of all probands had prephlebotomy values of MCV greater than the upper reference limit [3]. Further, there was a significant positive association of MCV in HFE C282Y homozygotes with serum transferrin saturation (TfSat) at diagnosis and with quantities of iron removed by phlebotomy to achieve iron depletion, but not with the presence of human leukocyte antigen-A*03 [3]. In a southern California hemochromatosis screening program that evaluated persons who attended a health appraisal clinic, mean TfSat, mean serum ferritin concentration (SF), mean MCV, and mean Hb were higher than the corresponding measures in participants without common HFE mutations [4].