He Went Wee, Wee, Wee All Night Long

2020 ◽  
pp. 159-168
Author(s):  
Ajay K. Puri ◽  
Melissa A. McGuire
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mortality Rate ◽  
Laboratory Testing ◽  
Pediatric Population ◽  
Unique Challenge ◽  
Hyperosmolar Hyperglycemic Syndrome ◽  
High Degree

Hyperosmolar hyperglycemic syndrome is a condition occurring with increasing frequency in the pediatric population that carries a high mortality rate. Obese males of African American descent are most at risk. Diagnosis requires a high degree of suspicion as patients often present with nonspecific symptoms. A fingerstick glucose sample and laboratory testing are primary identifiers of type 2 diabetes mellitus. The hallmark of management of these patients involves aggressive fluid resuscitation and close management of their electrolytes. Patients may present with features of diabetic ketoacidosis, which presents a unique challenge to treatment. Complications such as rhabdomyolysis, malignant hyperthermia, and cerebral edema need to be identified early and managed promptly.

scholarly journals Serum Irisin Levels, Endothelial Dysfunction, and Inflammation in Pediatric Patients with Type 2 Diabetes Mellitus and Metabolic Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-16
Author(s):  
Anna S. Huerta-Delgado ◽  
Daniel N. Roffe-Vazquez ◽  
Adrian M. Gonzalez-Gil ◽  
José R. Villarreal-Calderón ◽  
Oscar Tamez-Rivera ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Metabolic Syndrome ◽  
Type 2 Diabetes Mellitus ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Compensatory Mechanism ◽  
Endothelial Cell Apoptosis ◽  
Soluble Cell

The prevalence of type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) has increased in the pediatric population. Irisin, an adipomyokine, is involved in white adipose tissue browning, energy expenditure, insulin sensitivity, and anti-inflammatory pathways. Data on the associations among circulating irisin levels, soluble cell adhesion molecules (sCAMs), and inflammatory cytokines is scarce in children and adolescents with MetS and T2DM. Subjects aged 6-16 years were grouped into T2DM, MetS, and healthy controls. Serum irisin levels were significantly lower in the MetS (6.6 [2.8-18.0] ng/mL) and T2DM (6.8 [2.2-23.2] ng/mL) groups compared with controls (30.3 [24.6-57.1] ng/mL). Negative correlations between irisin and the BMI percentile (R=−0.358), WC percentile (R=−0.308), and triglycerides (R=−0.284) were identified, while positive associations with TC (R=0.287), HDL-c (R=0.488), and LDL-c (R=0.414) were observed. Significant negative correlations were found between irisin and sNCAM (R=−0.382), sICAM-2 (R=−0.300), sVCAM-1 (R=−0.292), MCP-1 (R=−0.308), and IFN-α2 (R=−0.406). Of note, lower concentrations of most sCAMs (sICAM-1, sPSGL-1, sP-selectin, sEpCAM, sICAM-2, sALCAM, sPECAM-1, sCD44, sVCAM-1, sICAM-3, sL-selectin, and sNCAM) were shown in T2DM subjects compared with MetS patients. Lower irisin levels induce a lack of inhibition of oxidative stress and inflammation. In T2DM, higher ROS, AGEs, glucotoxicity, and inflammation trigger endothelial cell apoptosis, which downregulates the sCAM expression as a compensatory mechanism to prevent further vascular damage. In opposition, in subjects with MetS that have not yet developed T2DM and its accompanying stressors, the upregulation of the sCAM expression is ensued.

scholarly journals Outcomes of Uncomplicated Type B Intramural Hematoma Patients with Type 2 Diabetes Mellitus

2020 ◽  
Author(s):  
Zhonggui Shan ◽  
Qu Chen ◽  
Dandan Jiang ◽  
Feng Kuang ◽  
Fan Yang
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mortality Rate ◽  
Acute Phase ◽  
Intramural Hematoma ◽  
Elevated Risk ◽  
Type B ◽  
Related Mortality

Objectives We aimed to summarize the clinical presentations, therapeutic approaches, and outcomes of type B intramural hematoma (IMHB) patients with and without type 2 diabetes mellitus (DM). Methods Patients with uncomplicated IMHBs were included between January 2016 and January 2018 and divided into two groups according to whether or not they had DM. Cox proportional hazard analysis was utilized to investigate the risk factors for aortic-related mortality. Kaplan-Meier survival analysis was used to estimate cumulative mortality and aortic-related mortality. Results A total of 149 patients were included and were divided into the two groups (DM group [n=60] and non-DM group [n=89]). Patients in the non-DM group underwent thoracic endovascular aortic repair treatment more frequently (12% vs 2%, P=0.028) and had a higher reintervention rate during the follow-up (9 in 81 patients, 11% vs 2%, P=0.043). There were significant differences between the two groups regarding the aorta-related mortality rate during the acute phase (9% vs 0%, P=0.042) and the all-cause mortality rate (22% vs 7%, P=0.011). Ulcer-like projection (ULP) development (during the acute phase) (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01-1.31, P=0.008), C-reactive protein (CRP) levels (HR, 1.92; 95% CI, 1.51-2.49, P<0.001) and MMP-9 levels (HR, 16.82; 95% CI, 7.52-28.71, P<0.001) were associated with an elevated risk for aorta-related mortality. Conclusions IMHBs without DM are not benign and have a considerably high aortic-related mortality rate. ULP development (during the acute phase), CRP levels and maximum MMP-9 levels are associated with an elevated risk for aorta-related mortality.

scholarly journals Risk of total and cardiovascular mortality, major cardiovascular events in patients with type 2 diabetes mellitus, depending on therapy choice upon making a diagnosis

2013 ◽  
Vol 17 (1 (65)) ◽  
pp. 80-84
Author(s):  
V. I. Pan’kiv ◽  
L. A. Khutorska
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mortality Rate ◽  
Cardiovascular Mortality ◽  
Risk Of Death ◽  
Major Cardiovascular Events ◽  
Type 2 Dm ◽  
Therapy Choice

The purpose of this research is studying the risk of the total and cardiovascular mortality rate as well as the risk of the development of myocardial infarction (MI) and acute disturbances of the cerebral circulation (ADCC) in patients with type 2 diabetes mellitus (DM), depending on the choice of a peroral sugar-reducting agent (PSRA) after making a diagnosis. A retrospective cohort study was undertaken on the basis of operative lists of type 2 DM patients, being on a dispensary registration at medical treatment – preventive facilities of the Transcarpathian region. The patients with type 2 DM were subdivided into cohorts, depending on the type of obtained therapy: with metformin, glyclazide, glibenclamide and glimepiride. Higher risks of the total and cardiovascular mortality rate, the risk of the development of ADCC and the risk of death from ADCC as well as the risk of the development of MI as compared to the starting metformin treatment were detected in patients with type 2 DM who received sulfonylurea drugs as staring therapy in 5 years after establishing the diagnosis. A relative risk (RR) of ADCC was higher with glyclazide, glibenclamide and glimepiride compared with metformin, however, a RR of fatal ADCC is considerably higher only with glibenclamide and with glimepiride. A reliable decrease of the risk of fatal ADCC was marked with glyclazide compared to glibenclamide.

Body mass index and the all-cause mortality rate in patients with type 2 diabetes mellitus

2018 ◽  
Vol 55 (6) ◽  
pp. 569-577 ◽  
Author(s):  
Rezvan Salehidoost ◽  
Asieh Mansouri ◽  
Massoud Amini ◽  
Sima Aminorroaya Yamini ◽  
Ashraf Aminorroaya
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Type 2 Diabetes Mellitus ◽  
Mortality Rate ◽  
Body Mass ◽  
All Cause Mortality

scholarly journals Off-Label Use of Liraglutide in the Management of a Pediatric Patient with Type 2 Diabetes Mellitus

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Sara J. Micale ◽  
Michael P. Kane ◽  
Eileen Hogan
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Pediatric Population ◽  
Off Label Use ◽  
Off Label ◽  
Glucose Levels ◽  
Glucagon Like Peptide 1 ◽  
Label Use

Liraglutide is a glucagon-like peptide 1 (GLP-1) analog indicated for the treatment of type 2 diabetes mellitus as an adjunct to diet and exercise in adults. Liraglutide lowers blood glucose levels by stimulating insulin secretion and decreasing glucagon release in glucose-dependent manners, increases satiety, and delays gastric emptying. Liraglutide, unlike metformin and insulin, is not approved for use in the pediatric population. We report the successful off-label use of liraglutide in an obese, 16 year old Caucasian female with type 2 diabetes mellitus.

scholarly journals Impact of type 2 diabetes mellitus on clinical outcomes in patients with COVID-19 and cardiovascular disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K G Lobanova ◽  
T Y U Demidova ◽  
V M Plakhotnyaya
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Mortality Rate ◽  
Clinical Outcomes ◽  
Antihypertensive Therapy ◽  
Ace Inhibitors ◽  
Beta Blockers

Abstract Introduction Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are independent risk factors for the severe course of COVID-19. Thus, all patients with COVID-19, T2DM and CVD should be constant medical control and receive adequate therapy for concomitant diseases. Purpose To study the effect of T2DM on the clinical outcomes of patients with COVID-19 and CVD. Methods Retrospective analysis of clinical outcomes of 1665 patients with a confirmed diagnosis of COVID-19, depending on the presence of CVD, T2DM and received therapy. Results The study included 866 men and 799 women; 299 patients (17.96%) had T2DM. The average age of the patients was 57.56±15.04 years. We noted a high prevalence of CVD: 747 patients (44.9%) had hypertension, 362 patients (21.7%) – coronary heart disease (CHD): 109 (6.5%) – myocardial infarction, 23 (1.4%) – exertional angina, 106 (6.4%) – atrial fibrillation, 98 (5.9%) – chronic heart failure. The patients with T2DM had hypertension in 80% of cases and CHD in 42%. Overall, 65.2% of patients had at least 1 concomitant CVD. Mortality of patients with COVID-19 without concomitant pathology was 0.5%, and in the patients with CHD – 20.7%, with hypertension – 12.9%. Mortality in the patients without T2DM was 7.4%, in the patients with T2DM – 14.0%. Hyperglycemia was associated with a higher mortality rate: the median of glycemia was 5.7 mmol/L in discharged patients and 7.2 mmol/L in deceased patients, regardless of the presence of T2DM (p&lt;0.001). The deceased patients had a higher level of HbA1c compared to those discharged (7.8% vs 8.1%). 24.6% of patients received antihypertensive therapy: 15.5% of patients received ACE inhibitors or ARBs, 11.9% – beta-blockers, 7.1% – thiazide and thiazide-like diuretics, 3.1% – calcium channel blockers. Statins were received by 2.4% of patients, antiplatelet drugs – 2.1%. The mortality rate of patients with COVID-19 and hypertension who received antihypertensive therapy was comparable to the mortality rate of the patients without hypertension: 8.8% and 9.0%, respectively. A significant decrease in mortality was observed during therapy with ACE inhibitors/ARBs (OR 0.39, 95% CI 0.21–0.72, p&lt;0.05), beta-blockers (OR 0.53, 95% CI 0.28–1, p&lt;0.05). This decrease was more significant among patients with T2DM compared with patients without T2DM: a 2.27-fold decrease in mortality due to ACE inhibitors/ARBs in the group without T2DM (OR 0.44, 95% CI 0.2–0.96, p&lt;0.05), in the T2DM group – 4.76 times (OR 0.21, 95% CI 0.07–0.6, p&lt;0.05); decrease in mortality against the background of beta-AB in the group without T2DM – by 1.72 times (OR 0.58, 95% CI 0.26–1.37), in the group with T2DM – by 3 times (OR 0.33, 95% CI 0.12–0.97, p&lt;0.05). Conclusion The presence of CVD and T2DM in the patients with COVID-19 worsens the prognosis of COVID-19. But the adequate therapy for concomitant diseases can have a positive effect on this group of patients. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Association between Irisin, hs-CRP, and Metabolic Status in Children and Adolescents with Type 2 Diabetes Mellitus

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Leticia Elizondo-Montemayor ◽  
Adrian M. Gonzalez-Gil ◽  
Oscar Tamez-Rivera ◽  
Carla Toledo-Salinas ◽  
Mariana Peschard-Franco ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Children And Adolescents ◽  
Pediatric Population ◽  
Surrogate Marker ◽  
Metabolic Effects ◽  
Mexican Children ◽  
Hs Crp

Proinflammatory cytokines and the novel myokine irisin, a cleavage product of FNDC5, have been found to play a role in obesity and type 2 diabetes mellitus (T2DM). Irisin has been shown to increase browning of adipose tissue, thermogenesis, energy expenditure, and insulin sensitivity, yet its association with inflammatory markers is still limited. Circulating irisin has been found to be increased in obesity, while in adult subjects with T2DM decreased levels have been found. However, data establishing the association of circulating irisin in children and adolescents with T2DM has not been described in the literature. The objective of this study was to determine irisin plasma concentration and its association with metabolic and adiposity markers and with hs-CRP, a surrogate marker of inflammation used in clinical practice, in a pediatric population with T2DM. A cross-sample of 40 Mexican children and adolescents aged 7-17 were recruited, 20 diagnosed with T2DM and 20 healthy controls. Plasma irisin levels were found to be lower in the T2DM group compared with controls, which could be attributed to a reduced PGC-1α activity in muscle tissue with a consequent decrease in FNDC5 and irisin expression. Irisin concentration was found to be positively correlated with HDL-c, LDL-c, and total cholesterol, while negatively correlated with BMI, waist circumference, and triglycerides. However, after multiple regression analysis, only HDL-c correlation remained significant. hs-CRP was higher in the T2DM group and positively associated with adiposity markers, unfavorable lipid profile, insulin levels, and HOMA-IR, but no association with irisin was found. Given the favorable metabolic effects attributed to irisin, the low plasma levels found in children and adolescents with T2DM could exacerbate the inflammatory and metabolic imbalances and the intrinsic cardiovascular risk of this disease. We propose an “irisin-proinflammatory/anti-inflammatory axis” to explain the role of irisin as a metabolic regulator in obesity and T2DM.

Glycated hemoglobin A1c as a screening test for detecting type 2 diabetes mellitus in obese children and adolescents

2018 ◽  
Vol 31 (5) ◽  
pp. 503-506 ◽  
Author(s):  
Jong Seo Yoon ◽  
Cheol Hwan So ◽  
Hae Sang Lee ◽  
Jin Soon Hwang
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Children And Adolescents ◽  
Glycated Hemoglobin ◽  
Pediatric Population ◽  
Oral Glucose ◽  
Lower Sensitivity ◽  
Obese Children

Abstract Background: The diagnostic cutoff points for indicators of type 2 diabetes mellitus (T2DM) in the pediatric population have not been defined thus far. Methods: A retrospective, single-center study was conducted from April 2003 to May 2016. We enrolled 236 overweight or obese children and adolescents aged 4–17 years. Thirty-nine (26.9%) of 145 patients had T2DM according to the oral glucose tolerance test results. Results: A glycated hemoglobin (HbA1c) level of 6.5% had a sensitivity and specificity of 87.2% and 98.5%, respectively, for detecting T2DM. The optimal HbA1c cutoff level for T2DM was >6.2% (94.7% sensitivity, 95.5% specificity). Conclusions: We observed that the use of an HbA1c level of 6.5% had a lower sensitivity for detecting T2DM than an HbA1c level of >6.2%.

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