Comparison of Clinical and Social Characteristics of Canadian Youth Living With Type 1 and Type 2 Diabetes

Castillo

Ann Pediatr Endocrinol Metab

et al. 2022

Purpose: Type 1 diabetes (T1D) is the most common type of diabetes in children, but the frequency of type 2 diabetes (T2D) is increasing rapidly. Classification of diabetes is based on a constellation of features that are typical of each type. We aimed to compare demographic, clinical and laboratory characteristics at diabetes diagnosis in pediatric T1D and T2D. Methods:We studied children who attended a large academic hospital in Houston, Texas (USA) with a new diagnosis of T2D (n=753) or T1D (n=758). We compared age, sex, race/ethnicity, presence of obesity, glucose, hemoglobin A1c, islet autoantibody positivity, C-peptide, and presence of diabetic ketoacidosis (DKA) at diabetes diagnosis.Results: At diagnosis of diabetes, children with T2D, compared with those with T1D, were older (13.6 vs 9.7 years old), more likely females (63.2% vs 47.8%), of racial/ethnic minority (91.1% versus 42.3%) and obese (90.9% vs 19.4%), and were less likely to have DKA (7.8% vs 35.0%) and diabetes autoantibodies (5.5% vs 95.4%). Children with T2D also had significantly less marked elevation of glucose and hemoglobin A1c, and lower C-peptide levels (all comparisons, p<0.0001). In multiple logistic regression analysis, older age, racial/ethnic minority, obesity, higher C-peptide and negative islet autoantibodies were independently associated with T2D (all, p<0.05) while sex, glucose, hemoglobin A1c and DKA were not (model p<0.0001).

Section: Discussionmentioning

confidence: 99%

Demographic and diagnostic markers in new onset pediatric type 1 and type 2 diabetes: differences and overlaps

Castillo

Ann Pediatr Endocrinol Metab

et al. 2022

International Journal of Nephrology

“…However, much of our current understanding of complications of childhood T2D and related end-organ sequelae is informed by knowledge of disease processes in adults and other comorbidities of obesity. There is particular concern that the earlier onset of disease in children could be linked to an earlier age of developing complications of diabetes including diabetic nephropathy [ 18 – 20 , 33 , 34 ]. Observed trends towards increasing severity of T2D with each successive generation affected have heightened the speculation about whether there may be factors beyond genetics and environment that are mediating this phenomenon [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our region also experiences high rates of youth-onset T2D and we anticipate trends towards earlier onset of comorbidities of diabetes including endstage renal failure requiring dialysis with earlier ages at diagnosis of T2D [18,19]. Risk of youth-onset diabetes is also independently correlated with childhood obesity [13,20]. It has been shown that renal tubule number is reduced in childhood-onset diabetes [21][22][23]; however, less is known about the relationship between fetal kidneys size or trajectory of renal volumes into childhood and other markers of diabetic nephropathy in these offspring.…”

Section: Introductionmentioning

confidence: 99%

The Significance of Exposure to Pregestational Type 2 Diabetes in Utero on Fetal Renal Size and Subcutaneous Fat Thickness

Pylypjuk

Day

ElSalakawy

et al. 2022

Objectives. To determine the relationship between exposure to pregestational type 2 diabetes (T2D) and renal size and subcutaneous fat thickness in fetuses during routine obstetrical ultrasound. Methods. This was a case-control study (January 1, 2019 to December 31, 2019). Routine obstetrical ultrasounds performed between 18 and 22 weeks’ gestation at a tertiary-care fetal assessment unit were reviewed. “Cases” comprised ultrasounds of fetuses exposed to pregestational T2D in utero. The control group was assembled from ultrasounds of healthy controls. Postprocessing measurements of fetal renal size and abdominal wall thickness from stored images were performed by two independent observers, and findings were compared between groups. Results. There were 54 cases and 428 ultrasounds of healthy controls. The mean maternal age of cases was 32.1 years (SD 6.2) compared to 33.2 years (SD 5.3) for healthy controls, and the majority of ultrasounds were performed in multiparous patients (83%). At the 18 to 22 week ultrasound, there was a significant reduction in renal size amongst fetuses exposed to maternal T2D in utero compared to controls; among cases, the mean renal width was 8.0 mm (95% CI 7.8–8.1) compared to 11.4 mm (95% CI 10.6–12.7) in controls ( p < 0.0001 ); the mean renal thickness among cases was 8.1 mm (95% CI 7.9–8.2) compared to 11.5 mm (95% CI 10.7–12.9) in controls ( p = 0.001 ). There was no obvious difference in estimated fetal weight between groups, yet fetuses exposed to maternal T2D had increased subcutaneous abdominal wall fat thickness at this early gestational age ( p = 0.008 ). Conclusions. Fetal renal size in cases exposed to pregestational T2D is significantly smaller compared to controls, and subcutaneous abdominal wall fat is significantly thicker. Given emerging evidence about the developmental origins of disease, further study is needed to correlate the association between fetal renal size and fat distribution in the fetus and the long-term risk of chronic renal disease and diabetes in these offspring.

“…Youth onset T2D disproportionately affects youth facing structural disadvantages, including living in poverty, 16,18,163,164,242 in food insecure households, and being a racialized minority. 243,244 In this context, mental health comorbidities including depression and anxiety are frequent among youth living with T2D.…”

Section: Psychosocial Healthmentioning

confidence: 99%

“…162 Using ambulatory BP monitoring HTN was present in 49.3% of Canadian youth with T2D. 163 The age adjusted prevalence of HTN in young adults with T2D in the SEARCH study was twofold higher (21.6%, 95% CI 17-1-26.9) compared to those with T1D (10.1%, 95% CI 8.6-11.9). 164 Higher rates of HTN in youth with T2D have been associated with male sex, higher BMI and older age.…”

Section: Benefits Barriersmentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents

et al. 2022

Self Cite

Since the 2018 ISPAD guidelines on this topic, follow-up of large cohorts from around the globe have continued informing the current incidence and prevalence of co-morbidities and complications in young adults with youth-onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youthonset T2D, the initial and subsequent management of youth-onset T2D, and management of co-morbidities and complications. We include key updates from the observational phase of the multi-center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head-to-head comparison of youth onset vs adult-onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth-onset T2D, social determinants of health, and settings of care given COVID-19 pandemic.