Clinical and Metabolic Characteristics among Mexican Children with Different Types of Diabetes Mellitus

Abstract

BackgroundCurrent classification of diabetes mellitus (DM) is based on etiology and includes type 1 (T1DM), type 2 (T2DM), gestational, and other. Clinical and pathophysiological characteristics of T1DM and T2DM in the same patient have been designated as type 1.5 DM (T1.5DM).ObjectivesThe aim of this study was to classify pediatric patients with DM based on pancreatic autoimmunity and the presence or absence of overweight/obesity, and to compare the clinical, anthropometric, and biochemical characteristics between children in the different classes of DM.MethodsA sample of 185 patients, recruited (March 2008-April 2015) as part of the Cohort of Mexican Children with DM (CMC-DM); ClinicalTrials.gov, identifier: NCT02722655. The DM classification was made considering pancreatic autoimmunity (via antibodies GAD-65, IAA, and AICA) and the presence or absence of overweight/obesity. Clinical, anthropometric and biochemical variables, grouped by type of DM were compared (Kruskal-Wallis or chi-squared test).ResultsThe final analysis included 140 children; 18.57% T1ADM, 46.43% T1BDM, 12.14% T1.5DM, and 22.86% T2DM. Fasting C-Peptide (FCP), and hs-CRP levels were higher in T1.5DM and T2DM, and the greatest levels were observed in T1.5DM (p<0.001 and 0.024 respectively).ConclusionsWe clearly identified that the etiologic mechanisms of T1DM and T2DM are not mutually exclusive, and we detailed why FCP levels are not critical for the classification system of DM in children. The findings of this study suggest that T1.5DM should be considered during the classification of pediatric DM and might facilitate more tailored approaches to treatment, clinical care and follow-up.

Associations of diabesity with all‐cause and cardiovascular disease mortality: Findings from the Mexico City Prospective Study

“…Since 2006, there have been increases in the prevalence of diabetes, hypertension and dyslipidaemia in Mexico, probably associated with the rise in obesity, poor‐quality diet consumption and population aging 31 . The ENSANUTs do not report the prevalence of diabetes and other non‐communicable diseases in individuals under 18 years; however, a Mexican study on schoolchildren and adolescents indicated the onset of diabetes at the early age of 11.17 years 32 . This scenario, which was characterized by high prevalences of overweight and obesity, is distressing in terms of quality of life, healthy life years, early mortality, impairment of the productive activity of the economically active population affected by illness, as well as the costs incurred by health care systems in the country 33 …”

“…31 The ENSANUTs do not report the prevalence of diabetes and other non-communicable diseases in individuals under 18 years; however, a Mexican study on schoolchildren and adolescents indicated the onset of diabetes at the early age of 11.17 years. 32 This scenario, which was characterized by high prevalences of overweight and obesity, is distressing in terms of quality of life, healthy life years, early mortality, impairment of the productive activity of the economically active population affected by illness, as well as the costs incurred by health care systems in the country. 33 Our research question was investigated in a single, large, and well-characterized general population cohort.…”

Clinical characteristics and cardiovascular risk profile in children and adolescents with latent autoimmune diabetes: Results from the German/Austrian prospective diabetes follow‐up registry

“…The term “LADY‐like” (latent autoimmune diabetes of the young) was first coined in 2000 by Lohmann and colleagues, who described two 8‐year‐old girls with clinical and immunologic characteristics of LADA 15 . Further studies confirmed islet autoimmunity in a high percentage of children clinically classified as type 2 diabetes (10%–74%, depending on ethnicity) 16–22 . In the Diabetes‐Patienten‐Verlaufsdokumentation (DPV) registry, islet autoantibodies were detected in 32% of adolescents with type 2 diabetes phenotype not requiring insulin within 1 year after diagnosis 23 .…”

“…15 Further studies confirmed islet autoimmunity in a high percentage of children clinically classified as type 2 diabetes (10%-74%, depending on ethnicity). [16][17][18][19][20][21][22] In the Diabetes-Patienten-Verlaufsdokumentation (DPV) registry, islet autoantibodies were detected in 32% of adolescents with type 2 diabetes phenotype not requiring insulin within 1 year after diagnosis. 23 Clinically, antibody-positive adolescents with type 2 diabetes cannot be distinguished from antibody-negative individuals with type 2 diabetes, 17,18,20,23,24 nor does the oral glucose tolerance test sufficiently discriminates between these two groups.…”