Adolescent type 2 diabetes: Comparing the Pediatric Diabetes Consortium and Germany/Austria/Luxemburg Pediatric Diabetes Prospective registries

Klingensmith, Georgeanna J.; Lanzinger, Stefanie; Tamborlane, William V.; Hofer, Sabine E.; Cheng, Peiyao; Beaufort, Carine de; Gal, Robin L.; Reinehr, Thomas; Kollman, Craig; Holl, Reinhard W.

doi:10.1111/pedi.12712

Cited by 16 publications

(11 citation statements)

References 34 publications

(58 reference statements)

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“…Almost half of the children (46.5%) were started on insulin treatment at the time of diagnosis and 40.5% were started on metformin alone. The high rate of medical therapy was similar to the other paediatric cohorts in the USA and Europe (85 and 86%, respectively) . Fasting blood glucose and HbA 1C levels of children who were treated with insulin or a combination of insulin and metformin were significantly higher than those who were not treated with insulin, suggesting that physicians mostly follow International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines for the treatment of Type 2 diabetes.…”

Section: Discussionsupporting

confidence: 63%

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Characteristics of Turkish children with Type 2 diabetes at onset: a multicentre, cross‐sectional study

et al. 2019

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Aims To describe the baseline clinical and laboratory findings and treatment modalities of 367 children and adolescents diagnosed with Type 2 diabetes in various paediatric endocrinology centres in Turkey.Methods A standard questionnaire regarding clinical and laboratory characteristics at onset was uploaded to an online national database system. Data for 367 children (aged 6-18 years) newly diagnosed with Type 2 diabetes at 37 different paediatric endocrinology centres were analysed.Results After exclusion of the children with a BMI Z-score < 1 SD, those with genetic syndromes associated with Type 2 diabetes, and those whose C-peptide and/or insulin levels were not available, 227 cases were included in the study. Mean age was 13.8 AE 2.2 (range 6.5-17.8) years, with female preponderance (68%). Family history of Type 2 diabetes was positive in 86% of the children. The mean BMI was 31.3 AE 6.5 kg/m 2 (range 18.7-61) and BMI Z-score was 2.4 AE 0.8 (range 1-5). More than half (57%) of the children were identified by an opportunistic diabetes screening due to existing risk markers without typical symptoms of diabetes. Only 13% (n = 29) were treated solely by lifestyle modification, while 40.5% (n = 92) were treated with metformin, 13% (n = 30) were treated with insulin, and 33.5% (n = 76) were treated with a combination of insulin and metformin initially. Mean HbA 1C levels of the insulin and combination of insulin and metformin groups were 98 (11.1%) and 102 mmol/mol (11.5%), respectively, and also were significantly higher than the lifestyle modification only and metformin groups mean HbA 1C levels (70(8.6%) and 67 mmol/mol (8.3%), respectively).Conclusions An opportunistic screening of children who are at high risk of Type 2 diabetes is essential, as our data showed that > 50% of the children were asymptomatic at diagnosis. The other important result of our study was the high rate of exclusion from the initial registration (38%), suggesting that accurate diagnosis of Type 2 diabetes in youth is still problematic, even for paediatric endocrinologists.

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Section: Discussionsupporting

confidence: 63%

“…To date, a female preponderance has been shown in all paediatric Type 2 diabetes cohorts . The majority (68%) of children in the current study were also female.…”

Section: Discussionsupporting

confidence: 48%

Characteristics of Turkish children with Type 2 diabetes at onset: a multicentre, cross‐sectional study

et al. 2019

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“…In YDR and SEARCH, 30–43% of type 2 diabetes patients were treated with metformin only, and 33–39% required insulin treatment 28 . Similar to the SEARCH study, the Pediatric Diabetes Consortium, which included young type 2 diabetes patients from 19 centers in the USA, reported an average HbA 1c of 7.8%, whereas the Pediatric Diabetes Prospective registries in Germany, Austria and Luxemburg reported a lower mean HbA 1c of 6.5% 24 . In the present study, 50% of type 2 diabetes patients were treated with an oral antidiabetic agent only.…”

Section: Discussionmentioning

confidence: 94%

Young‐onset diabetes patients in Thailand: Data from Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN)

Dejkhamron

Santiprabhob

Likitmaskul

et al. 2022

J of Diabetes Invest

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Aims/Introduction There is a lack of current information regarding young‐onset diabetes in Thailand. Thus, the objectives of this study were to describe the types of diabetes, the clinical characteristics, the treatment regimens and achievement of glycemic control in Thai patients with young‐onset diabetes. Materials and Methods Data of 2,844 patients with diabetes onset before 30 years‐of‐age were retrospectively reviewed from a diabetes registry comprising 31 hospitals in Thailand. Gestational diabetes was excluded. Results Based on clinical criteria, type 1 diabetes was identified in 62.6% of patients, type 2 diabetes in 30.7%, neonatal diabetes in 0.8%, other monogenic diabetes in 1.7%, secondary diabetes in 3.0%, genetic syndromes associated with diabetes in 0.9% and other types of diabetes in 0.4%. Type 1 diabetes accounted for 72.3% of patients with age of onset <20 years. The proportion of type 2 diabetes was 61.0% of patients with age of onset from 20 to <30 years. Intensive insulin treatment was prescribed to 55.2% of type 1 diabetes patients. Oral antidiabetic agent alone was used in 50.8% of type 2 diabetes patients, whereas 44.1% received insulin treatment. Most monogenic diabetes, secondary diabetes and genetic syndromes associated with diabetes required insulin treatment. Achievement of glycemic control was identified in 12.4% of type 1 diabetes patients, 30% of type 2 diabetes patients, 36.4% of neonatal diabetes patients, 28.3% of other monogenic diabetes patients, 45.6% of secondary diabetes patients and 28% of genetic syndromes associated with diabetes patients. Conclusion In this registry, type 1 diabetes remains the most common type and the prevalence of type 2 diabetes increases with age. The majority of patients did not achieve the glycemic target, especially type 1 diabetes patients.

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“…The similar ages of onset between male and female Chinese patients further confirmed that the increased levels of insulin resistance during puberty only had a limited effect on the pathogenesis of T2DM. Furthermore, only 58% of patients with T2DM were obese in this study, and the obesity rate in China is significantly lower than that in Europe[ 32 ]. It was noticed that even little weight gain could cause insulin resistance and increased risk of diabetes among the Chinese population[ 15 ].…”

Section: Discussionmentioning

confidence: 96%

Association of β-cell function and insulin resistance with pediatric type 2 diabetes among Chinese children

Xu¹,

Du²,

Cui³

et al. 2021

WJD

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BACKGROUND In addition to insulin resistance, impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus (T2DM). Scarce clinical data exist for pediatric T2DM. AIM To investigate the association of β-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study. METHODS This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019. Children with normal glycemic levels ( n = 1935) were included as healthy control subjects. The homeostasis models (HOMAs) were used to assess the β-cell function (HOMA2-%B) and insulin resistance (HOMA2-IR) levels. The HOMA index was standardized by sex and age. We performed logistic regression analysis to obtain odds ratios (ORs) for T2DM risk using the standardized HOMA index, adjusted for confounding factors including sex, Tanner stage, T2DM family history, body mass index z-score, and lipid profile. RESULTS The male-female ratio of newly diagnosed T2DM patients was 1.37:1 (OR = 2.20, P = 0.011), and the mean ages of onset for boys and girls were 12.5 ± 1.9 years and 12.3 ± 1.7 years, respectively. The prevalence of related comorbidities including obesity, elevated blood pressure, and dyslipidemia was 58.2%, 53.2%, and 80.0%, respectively. The T2DM group had lower HOMA2-%B levels ( P < 0.001) and higher HOMA2-IR levels ( P < 0.001) than the control group. Both the decrease in HOMA2-%B z-score (OR = 8.40, 95%CI: 6.40–11.02, P < 0.001) and the increase in HOMA2-IR z-score (OR = 1.79, 95%CI: 1.60–2.02, P < 0.001) were associated with a higher risk of T2DM, and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors. CONCLUSION Besides insulin resistance, β-cell function impairment is also strongly associated with Chinese pediatric T2DM. Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.

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Adolescent type 2 diabetes: Comparing the Pediatric Diabetes Consortium and Germany/Austria/Luxemburg Pediatric Diabetes Prospective registries

Abstract: Both DPV and PDC youth have multiple risks for diabetes complications. Understanding reasons for persistently higher HbA1c in PDC youth requires further study.

Cited by 16 publications

References 34 publications

Characteristics of Turkish children with Type 2 diabetes at onset: a multicentre, cross‐sectional study

Characteristics of Turkish children with Type 2 diabetes at onset: a multicentre, cross‐sectional study

Young‐onset diabetes patients in Thailand: Data from Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN)

Association of β-cell function and insulin resistance with pediatric type 2 diabetes among Chinese children

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