Twenty years of pediatric diabetes surveillance: what do we know and why it matters

Dabelea, Dana; Sauder, Katherine A.; Jensen, Elizabeth T.; Mottl, Amy K.; Huang, Alyssa; Pihoker, Catherine; Hamman, Richard F.; Lawrence, Jean M.; Dolan, Lawrence M.; Agostino, Ralph B. D'; Wagenknecht, Lynne E.; Mayer‐Davis, Elizabeth J.; Marcovina, Santica M.

doi:10.1111/nyas.14573

Cited by 25 publications

(20 citation statements)

References 146 publications

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“…Given the burden of diabetes and associated nephropathy, any potential opportunities to prevent onset or reduce complications need to be pursued aggressively. Our study needs validation by other longitudinal studies to evaluate the impact of renal size on risk of chronic kidney disease, but if a correlation exists, this would suggest that future prevention strategies may include formal use of fetal ultrasound followed by targeted health-promotion strategies in early childhood [ 35 , 36 ].…”

Section: Discussionmentioning

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

International Journal of Nephrology

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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.

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Section: Discussionmentioning

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

International Journal of Nephrology

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“…Information gleaned from several large cohort studies suggest that the risk factors associated with youth‐onset T2D are similar to those associated with later onset T2D, but key differences exist as discussed below 16–19 . These risk factors and the clinical correlates of youth‐onset T2D underlie the currently recommended risk‐based screening approaches.…”

Section: Pathophysiology and Risk Factorsmentioning

confidence: 99%

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

et al. 2022

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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.

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“…38 Demographic characteristics may include race, ethnic/cultural background, sex, age, geographic location, technology access, levels of formal education, literacy level, health literacy, and numeracy. [39][40][41] The populations' perception of risk associated with diabetes, related complications, and co-occurring conditions 28,42,43 are also key characteristics to consider. This information is available from a variety of sources, including but not limited to community needs assessments by local or state health departments, health system/organizations specific to the populations, and DSMES data.…”

Section: The Dsmes Service Will Evaluate Their Chosen Target Population To Determine Develop and Enhance The Resources Design And Delivermentioning

confidence: 99%

2022 National Standards for Diabetes Self-Management Education and Support

Davis

Fischl

Beck

et al. 2022

The Science of Diabetes Self-Management and Care

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Purpose: The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings. Conclusion: The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.

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Twenty years of pediatric diabetes surveillance: what do we know and why it matters

Cited by 25 publications

References 146 publications

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

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

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

2022 National Standards for Diabetes Self-Management Education and Support

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