OBJECTIVE -Since the Diabetes Control and Complications Trial, diabetes management goals have changed. The aims of the present study were to assess complication rates, including nerve abnormalities, in adolescents from 1990 to 2002 and to investigate associated risk factors. RESEARCH DESIGN AND METHODS-Cross-sectional analysis of complications was assessed in three study periods (1990 -1994 [T1], 1995-1998 [T2], and 1999 -2002 [T3]) in adolescents matched for age and diabetes duration (n ϭ 878, median age 14.6 years, median duration 7.5 years). Retinopathy was assessed by seven-field stereoscopic fundal photography, albumin excretion rate (AER) from three consecutive timed overnight urine collections, peripheral nerve function by thermal and vibration thresholds, and autonomic nerve function by cardiovascular reflexes.RESULTS -Retinopathy declined significantly (T1, 49%; T2, 31%; and T3, 24%; P Ͻ 0.0001), early elevation of AER (Ն7.5 g/min) declined (38, 30, and 25%, respectively, P ϭ 0.022), and microalbuminuria (AER Ն20 g/min) declined (7, 3, and 3%, respectively; P ϭ 0.017, T1 vs. T2 and T3). Autonomic nerve abnormalities were unchanged (18, 21, and 18%, respectively; P ϭ 0.60), but peripheral nerve abnormalities increased (12, 19, and 24%, respectively; P ϭ 0.0017). More patients were treated with three or more injections per day (12, 46, and 67%, respectively; P Ͻ 0.0001) and insulin dose increased (1.08, 1.17, and 1.22 units ⅐ kg Ϫ1 ⅐ day Ϫ1 , respectively; P Ͻ 0.0001), but median HbA 1c (A1C) was unchanged (8.5, 8.5, and 8.4%, respectively). BMI and height SD score increased: BMI 0.46, 0.67, and 0.79, respectively (P Ͻ 0.0001), and height Ϫ0.09, 0.05, and 0.27, respectively (P Ͻ 0.0001).CONCLUSIONS -Retinopathy and microalbuminuria declined over time in this cohort, but the increased rate of peripheral nerve abnormalities is of concern. Despite intensified management (higher insulin dose and more injections), A1C has not changed and remains well above the recommended targets for adolescents. Recognition that screening is important to identify individuals who will benefit from interventions has led to screening programs for adolescents (2,3). Prevention of long-term chronic complications has now become one of the main goals of modern type 1 diabetes treatment in children and adolescents.In Australia, we initially reported a retinopathy rate of 42% in adolescents (4) and microalbuminuria has been found in 4 -20% of children, mostly after the age of 12-15 years (5-7). Although symptomatic neuropathy is uncommon in children with diabetes, previous studies have found a high prevalence of subclinical neurological abnormalities: nerve conduction abnormalities in 51% (8), cardiac autonomic abnormalities in 31% (9), and reduced sensory sensibility in 16% (10). A decline in the cumulative incidence of nephropathy was reported in Linkoping, Sweden, in 1994 in individuals diagnosed as children during 1961-1980 (11). This finding was considered by some to apply to only that geographical area because a similar study in...
Purpose of Review This review will examine the unique susceptibility of premature infants to oxidative stress, the role of reactive oxygen species (ROS) in the pathogenesis of common disorders of the preterm infant, and potential for therapeutic interventions using enzymatic and/or non-enzymatic antioxidants. Recent Findings Oxidative stress is caused by an imbalance between the production of ROS and the ability to detoxify them with the help of antioxidants. The premature infant is especially susceptible to ROS-induced damage because of inadequate antioxidant stores at birth, as well as impaired upregulation in response to oxidant stress. Thus, the premature infant is at increased risk for the development of ROS-induced diseases of the newborn, such as bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and periventricular leukomalacia. Summary Potential therapies for ROS-induced disease include both enzymatic and non-enzymatic antioxidant preparations. More research is required to determine the beneficial effects of supplemental antioxidant therapy.
Background/Aim: In adults, studies have shown that obesity is a chronic low-grade inflammatory state characterized by altered levels of cytokines. Studies in children have mainly focused on C-reactive protein and adiponectin, and there is limited data for other inflammatory markers in healthy weight and overweight children. The aim of this study was to measure IL-6, IL-8 and IL-10 levels in healthy normal weight and overweight children at 8 and 15 years. Methods: 118 normal weight and overweight children (59 boys) from the Nepean longitudinal study were recruited at age 8 years and followed up at 15 years. Serum IL-6, IL-8 and IL-10 levels were measured at both time-points. Results: At 8 years, we found no significant differences in cytokine levels between normal weight and overweight (owt)/obese (ob) groups. However, at 15 years, owt/ob girls (n = 23) had higher levels of IL-6 (p = 0.04), IL-8 (p = 0.04) and IL-10 (p = 0.03) compared to normal weight girls (n = 36), even after adjustment for puberty; no differences were seen in boys. Conclusion:The effects of obesity on IL-6, IL-8 and IL-10 levels vary with age and sex, with owt/ob girls at 15 years showing raised IL-6, IL-8 and IL-10 levels compared to healthy weight girls.
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