Adiponectin inversely correlated with IR, trended down in late puberty, and was lowest in adult males. H adults of both sexes had lower adiponectin than NHW adults, and H females followed a more "male pattern," lacking the rebound in adiponectin seen in NHW females after puberty. These data suggest that adiponectin, independent of body mass index, may relate to the greater cardiometabolic risk seen in H populations and in particular H females.
Focal dermal hypoplasia (FDH) is a rare genetic disorder caused by mutations in the PORCN gene located on the X chromosome. Short stature was previously noted to be a common finding in FDH, however the etiology of this is unclear. The present study sought to elucidate specific causes for short stature by assessing growth charts, determining bone ages and auxologic measurements, examining laboratory data for the common causes of growth failure, assessing dietary intake, and performing a growth hormone stimulation test. Sixteen patients with FDH between the ages of 3 and 18 years of age consented to the study. While 11 out of 16 patients had short stature based on height less than 2 standard deviations below mid-parental target height percentile and bone age not suggestive of likely catch-up growth, only four had a BMI less than the 5th percentile for age. Laboratory studies did not support a gastrointestinal, allergy or autoimmune cause of growth failure. Three patients had results suggestive of possible growth hormone deficiency. Although short stature is a common feature in FDH, our data suggests that severe undernutrition is not common in this group and that there may be underlying treatable causes for this short stature in some patients.
T here have been many recent advancements in available technology for management of type 1 diabetes (T1D) in the past few years. Notably, the recent commercial approval of the Medtronic 670G system has made the first artificial pancreas (AP) available for use in patients older than 14 years. 1 Additional clinical studies are underway to develop, refine, and test various devices from almost a dozen industry and academic research groups. [2][3][4] Relatively few studies, however, have looked at AP use and feasibility in toddlers and young children; a population with unique management challenges such as unpredictable dietary habits, increased insulin sensitivity, and rapid glucose fluctuations with meals and activity, 5-7 as well as cognitive and verbal immaturity, which make it challenging to identify and report hypoglycemia. 8,9 These challenges cause significant parental stress and decreased quality of life for both the patients and their families. 9,10 Specifically, the fear of hypoglycemia (and its potential detrimental effects on neurocognitive development) leads to worse glycemic control and suboptimal HbA1c levels in this age group. [11][12][13][14] Recent technological advancements with continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGMs) have led to decreased parental anxiety and improved quality of life in the T1D population. [15][16][17][18] Several small studies using AP in young children have shown reduced rates of hypoglycemia, although without significant improvements in glycemic control [19][20][21] as has been seen in older children and adults. [22][23][24][25] While these results are encouraging, widespread use of AP in young children may continue to be limited by parental fear of hypoglycemia. Specifically, fear regarding ability of the child to interact with increasingly complex devices and the risk of inadvertent delivery of inappropriate amounts of insulin, leading to either hypoglycemia or hyperglycemia. As the incidence of T1D in young children is on the rise, 13,26 optimal management options, including the use of AP technology, are of great importance.In this issue of Diabetes Technology and Therapeutics, DeBoer et al. present results of a small, randomized, crossover trial assessing the safety, feasibility, and efficacy of an AP system in young children with T1D (age 5-8 years) compared to their usual home regimen of sensor-augmented pump (SAP) therapy. 27 Unique to this study was the use of altered Diabetes Assistant control-platform software, which included child-resistant (password-protected) lock-out screens for pump settings and carbohydrate ingestion; an addition meant specifically to address the potential safety issue of accidental or intentional tampering with the control settings of an AP system. The authors report significantly improved glycemic control with increased time of blood glucose inrange (70-180 mg/dL) within the AP period versus the SAP period (73% vs. 47%; P < 0.001) and increased percent time of blood glucose in tight control ...
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