BackgroundObese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes.MethodsParticipants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance.DiscussionThe proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth.Trial Registration NCT02615353, registered on June 8, 2016.

Background/aims: Prediabetes and diabetes disproportionately impact Latino youth, yet few diabetes prevention programs have prioritized inclusion of this underrepresented population. This report describes the recruitment process, yields, associated costs, and phenotypic characteristics of Latino youth with obesity and prediabetes enrolled in a randomized controlled diabetes prevention study in the USA. Methods: Recruitment efforts included referrals from clinics, community outlets, local media, and word of mouth with the goal of enrolling 120 Latino adolescents aged 12-16 with obesity (BMI > 95th percentile) and prediabetes. Prediabetes eligibility was determined by any of the following: HbA1c between 5.7 and 6.5%, fasting glucose between 100 and 125 mg/dL, or a 2-h glucose between 120 and 199 mg/dL following a 75-g oral glucose tolerance test (OGTT), but not meeting any of the diagnostic criteria for diabetes. Eligible participants were randomized 2:1 to either a 6-month community-based lifestyle intervention that included group nutrition and health education classes (1 day/week) and group exercise classes (2 days/week) or usual care control arm. Recruitment yields were determined by review of referral source in the study screening database. Recruitment costs were determined by an after-the-fact financial review of actual and in-kind costs. Participant phenotypic characteristics (i.e., demographics, anthropometrics, and biochemical data) were compared by recruitment strategy using a one-way ANOVA.

Objective: Inhaled corticosteroids (ICS) are exogenous glucocorticoids that typically have minimal systemic effects at standard doses. They are metabolized by the cytochrome P450 (CYP450) enzyme pathway in the liver; thus, they can cause unwanted side effects when used in conjunction with medications affecting this system. Here, we present a case of adrenal suppression (AS) secondary to combined usage of ICS and posaconazole, a known CYP450 inhibitor.Methods: Clinical and laboratory data were isolated and are presented.Results: A 9-year-old Caucasian female with history of hyper IgE syndrome. On chronic fluticasone and posaconazole for Aspergillus infection, she presented with fatigue and "facial puffiness" (cushingoid features). Low morning cortisol (0.3 μg/dL) prompted further evaluation. Low-dose (1 μg) adrenocorticotropic hormone (ACTH)stimulation test with peak cortisol level <1 μg/dL. Other causes of hypocortisolism were ruled out. Started on physiologic hydrocortisone (10 mg/m 2 /day) and fluticasone discontinued. After weaning hydrocortisone, repeat low-dose ACTH-stimulation test with peak cortisol of 21.8 μg/dL, consistent with resolution of AS. Conclusion:Cushingoid features, growth failure, and AS can all be side effects of exogenous corticosteroids. The risk of AS increases when ICS are paired with CYP450 inhibitors, such as triazoles. Patients on ICS are not routinely screened for hypocortisolism. AS should be considered in symptomatic patients on moderate-high doses of ICS for prolonged periods. AS is a high-risk condition; thus, providers must have high level of suspicion and be aware of this potentially life-threatening complication.

Background and Objective Epicardial adipose thickness (EAT) is increased in adults with type 1 diabetes (T1D) and is thought to contribute to cardiovascular disease (CVD) in this population. Given that CVD risk factors emerge early in life, the purpose of this study was to identify whether EAT is increased in pediatric patients with T1D compared with non‐diabetic controls. Methods Anthropometric data, blood pressure (BP), and EAT were evaluated in 20 youth with T1D and 20 age, sex, and body mass index (BMI) matched healthy controls between the ages of 5 and 18 years. Results EAT was 18.5% higher among youth with T1D compared to healthy controls (1.65 ± 0.44 mm vs 1.37 ± 0.27 mm, P = .02). In the entire cohort, EAT was correlated with age (r = 0.71, P < .001), BMI (r = .69, P < .001), waist circumference (r = 0.60, P < .001), systolic BP (r = .34, P = .03), and diastolic BP (r = 0.41, P = .009). Among youth with T1D, there were no significant correlations between EAT and HbA1c (r = −0.16, P = .50), insulin dose (r = .09, P = .71), or duration of disease (r = 0.06, P = .82). Conclusions Youth with T1D exhibited significantly higher EAT compared to controls. Increased EAT was associated with adiposity and BP, but not duration of disease, insulin dose, or glycemic control. Increased EAT may represent a pathophysiologic mechanism leading to premature CVD in pediatric patients with T1D.