Characteristics of 98 Children and Adolescents Diagnosed With Type 2 Diabetes by Their Health Care Provider at Initial Presentation

Abstract

A lthough the number of children and youth with type 2 diabetes is increasing, a clear case definition that describes children with type 2 diabetes at presentation remains elusive. Most initial diagnoses are decided on the clinical picture at presentation (1). Characteristics and risk factors have been outlined in several review and clinical articles (2-4). The purpose of this study was to describe the characteristics of youth presenting for an initial visit to the outpatient clinic of a large tertiary children's care center and diagnosed with type 2 diabetes.For this retrospective study, data were abstracted from a consecutive sample of 98 patients' medical records at Texas Children's Hospital starting 1 January 1998 and ending 31 October 2001. The sample's mean age at diagnosis was 13.6 years (SD 2.33; range 8.7-18.4 years). Fifty-one percent of the children were female and 49% were male (female: male ratio 1:1). For 43% race/ethnicity was not specified; the remaining participants were 28.6% African American, 22.4% Hispanic, 3.1% non-Hispanic white, and 3.1% Asian. Of those for whom data were available, a maternal history of type 2 diabetes was reported by 32.7% (18/55) and an unspecified type of diabetes by 12.7% (7/55). Twenty-seven percent (13/47) reported a father with type 2 diabetes and 21% (10/47) an unspecified type of diabetes.Mean BMI was 34.67 kg/m 2 (SD 6.91). Ninety-three percent had a BMI Ն95th percentile. All but three of the individuals had BMIs Ն85th percentile. Of those for whom data were recorded, acanthosis nigricans was identified in 94% (48/51). A Tanner stage of 3, 4, or 5 was identified in 73.2% (49/67).Blood pressure readings indicated that 49.4% (41/83) had a systolic (SBP) and 10.8% (9/83) a diastolic (DBP) Ն95th percentile for age, sex, and height (n ϭ 83). Fifty-five percent (46/83) had SBP and 19.3% (16/83) DBP readings Ն90th percentile for blood pressure. Of 72 pulse rates recorded, 2.6% were Ն95th percentile for age. Average HbA 1c was 10.38 (SD 3.52) (n ϭ 95).Of those who had symptoms documented in the medical record, 83.6% (56/ 67) reported polyuria, 83.9% (52/62) polydipsia , and 61% (36/59) polyphagia. Seventy-five percent reported both polyuria and polydipsia (46/61). Of the cases available, 46.2% (24/52) reported all three of the polys at initial presentation, 46.8% (29/62) had weight loss, and 62.5% (30/48) had ketones. Of those for whom islet cell antibody data were recorded (50/98), 49 had JDF units Ͻ5. Fifty-three percent were started on insulin, 46.3% on oral agents, and 13.7% on both insulin and oral agent (n ϭ 96). Initial mean insulin dose was 0.6 units/kg.Our sample is similar to those described in previous reports except for a more even ratio of female to male subjects, a greater percent with elevated SBP and/or DBP, and more individuals reporting weight loss. We are the first to report blood pressure by the 95th and 90th percentiles and the first to report pulse rate. These data contribute to the growing body of clinical evidence defining the characteristics of ...

Thiazide-Type Diuretics and β-Adrenergic Blockers as First-Line Drug Treatments for Hypertension

“…With few exceptions, these trials, especially those with high statistical power and thiazide-based regimens, showed benefit for CVD outcomes. [3][4][5][6][7][8] This evidence, which provided a basis for recommending thiazides or ␤-blockers as first-step drugs in most editions of US guidelines through 1997, 9 needs to continue to be given due weight in practice and practice guidelines.…”

“…This remained the situation through the 1990s, despite publication of results from the BMRC trial of treatment of hypertension in older adults, the ␤-blocker arm of which showed no significant reduction in either stroke or CHD events compared with placebo. 7 In keeping with practice trends, a cardioselective ␤-blocker, atenolol, was selected in this trial; in this arm, systolic BP was less well controlled for the first year than in the hydrochlorothiazide arm.…”

“…6 Conversely, hypertension is exceedingly common in patients with type 2 diabetes, even in children and adolescents. Upchurch et al 7 reported that 55% of young people had systolic blood pressures Ͼ90 percentile at the time of diagnosis of type 2 diabetes. In fact, hypertension at diagnosis was as much as 8 times more common in adolescents with type 2 diabetes compared with those with type 1 diabetes.…”

“…With few exceptions, these trials, especially those with high statistical power and thiazide-based regimens, showed benefit for CVD outcomes. [3][4][5][6][7][8] This evidence, which provided a basis for recommending thiazides or ␤-blockers as first-step drugs in most editions of US guidelines through 1997, 9 needs to continue to be given due weight in practice and practice guidelines.The largest and most consistent benefits from the earlier trials were for stroke and (where reported) heart failure. Benefits for coronary heart disease (CHD) were less clear, and commentators frequently speculated that potentially adverse metabolic effects-on potassium (for diuretics), lipids, and glucose-of thiazides and ␤-blockers were related to this shortfall in reducing CHD outcomes.…”

“…This remained the situation through the 1990s, despite publication of results from the BMRC trial of treatment of hypertension in older adults, the ␤-blocker arm of which showed no significant reduction in either stroke or CHD events compared with placebo. 7 In keeping with practice trends, a cardioselective ␤-blocker, atenolol, was selected in this trial; in this arm, systolic BP was less well controlled for the first year than in the hydrochlorothiazide arm.Although 1 observer began questioning the role of the class for first-line treatment, 50 during the era of direct comparison trials, the arm representing traditional classes of drugs most often offered participating clinicians a choice of thiazides or ␤-blockers or selected a ␤-blocker (most commonly, atenolol) as the comparator. Generally, before 2005 there were few differences for major cardiovascular event rates in individual trials between such regimens and those based on newer classes; an exception was the Losartan Intervention For End point reduction in hypertension (LIFE) trial, in which a composite of stroke, MI, and cardiovascular death was 13% (Pϭ0.02) less frequent in the losartan-based than in the atenolol-based group, owing mostly to an advantage for stroke.…”