There is currently a lack of valid instruments to measure adolescent diabetes numeracy. The Diabetes Numeracy Test (DNT) was adapted for type 1 diabetes and administered to two samples of adolescents. Sample 1 was administered the 39-item version of the DNT (DNT-39) with measures of self-management, responsibility, reading, and glycemic control (A1C). Sample 2 was administered the 14-item version of the DNT (DNT-14) with measures of self-management, responsibility, problem solving, and A1C. Both versions of the DNT showed adequate internal reliability. In sample 1, the DNT-39 and DNT-14 were related (r=.87, p=.001), and both DNT versions were related to parent education (DNT-14 r=.31, p=.02; DNT-39 r=.29, p=.03) and reading (DNT-14 r=.36, p=.005; DNT-39 r=.40, p=.001). In sample 2, the DNT-14 was related to A1C (r=−.29, p=.001), reading skills (r=.36, p=.005), diabetes problem solving (r=.27, p=.02), adolescent age (r=.19, p=.03), and parent education (r=.31, p=.02). In combined analyses, 75% of items were answered correctly on the DNT-14 (Range 7-100), and performance was associated with age (r=.19, p=.03), pump use (r=.33 p=.001), and A1C (r=−.29, p=.001). The DNT-14 is a feasible, reliable, and valid numeracy assessment that indicated adolescents with T1D have numeracy deficits that may impact their glycemic control.

Retinoids and rexinoids are prescribed for conditions ranging from acne vulgaris to hyperkeratosis to cutaneous T cell lymphoma. Dyslipidemia is a frequent consequence of the use of these drugs, with more than one-third of patients manifesting aberrations in triglyceride (TG) levels. The efficacy of retinoic acid derivatives is linked to their influence on lipid metabolism in the skin, which can impair systemic lipid trafficking and metabolism in some patients. Thus, baseline screening for preexisting dyslipidemia and regular follow-up lipid panels are mandated, especially when powerful agents such as bexarotene are used. Dietary modification, increased physical activity, and weight management are the cornerstones of initial management for mild hypertriglyceridemia, which is a contributor to cardiovascular risk. More severe impairments (fasting TG > 500 mg/dL) warrant pharmacologic interventions early on to reduce the risk of pancreatitis. Retinoic acid derivative action, lipid metabolism, and treatment of incident dyslipidemias are reviewed to empower prescribers in management of adverse lipid effects.

Thyroglossal duct cysts can contain ectopic thyroid tissue, and in some cases this tissue may be the only functional thyroid gland. We present a 6-year-old girl with delayed diagnosis of iatrogenic hypothyroidism that developed following excision of a thyroglossal duct cyst.

BackgroundPlasma lipid levels are highly heritable traits, but known genetic loci can only explain a small portion of their heritability.Methods and ResultsIn this study, we analyzed the role of parental levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs) in explaining the values of the corresponding traits in adult offspring. We also evaluated the contribution of nongenetic factors that influence lipid traits (age, body mass index, smoking, medications, and menopause) alone and in combination with variability at the genetic loci known to associate with TC, LDL-C, HDL-C, and TG levels. We performed comparisons among different sex-specific regression models in 416 families from the Framingham Heart Study and 304 from the SardiNIA cohort. Models including parental lipid levels explain significantly more of the trait variation than models without these measures, explaining up to ≈39% of the total trait variation. Of this variation, the parent-of-origin effect explains as much as ≈15% and it does so in a sex-specific way. This observation is not owing to shared environment, given that spouse-pair correlations were negligible (<1.5% explained variation in all cases) and is distinct from previous genetic and acquired factors that are known to influence serum lipid levels.ConclusionsThese findings support the concept that unknown genetic and epigenetic contributors are responsible for most of the heritable component of the plasma lipid phenotype, and that, at present, the clinical utility of knowing age-matched parental lipid levels in assessing risk of dyslipidemia supersedes individual locus effects. Our results support the clinical utility of knowing parental lipid levels in assessing future risk of dyslipidemia.

NK: Cellular immunity to a determinant common to glutamate decarboxylase and coxsackie virus in insulin-dependent diabetes.