scholarly journals New-Onset Diabetes in Obese Adolescents ? Type 1 or Type 2 Diabetes? Comparative Cases Report

2012 ◽  
Author(s):  
Anna M. Gertig Elżbieta Niechciał ◽  
Bogda Skowrońska Piotr Fichna
Keyword(s):  
Type 2 Diabetes ◽  
Obese Adolescents ◽  
Onset Diabetes ◽  
New Onset

scholarly journals Type 2 Diabetes in Youth

2020 ◽  
Vol 7 ◽  
pp. 2333794X2098134
Author(s):  
Goutham Rao ◽  
Elizabeth T. Jensen
Keyword(s):  
Type 2 Diabetes ◽  
The United States ◽  
Second Line Therapy ◽  
Educational Value ◽  
Line Therapy ◽  
Potential Impact ◽  
Diabetes In Youth ◽  
New Onset

The incidence of type 2 diabetes in children and adolescents in the United States rose at an annual rate of 4.8% between 2002-2003 and 2014-2015. Type 2 diabetes progresses more aggressively to complications than type 1 diabetes. For example, in one large epidemiological study, proliferative retinopathy affected 5.6% and 9.1% of children with type 1 and type 2 diabetes, respectively. Screening begins at age 10 or at onset of puberty, and is recommended among children with a BMI% ≥85 with risk factors such as a family history and belonging to a high risk racial or ethnic or racial group. HbA1C% is preferred for screening as it does not require fasting. As distinguishing between type 1 and type 2 diabetes is not straightforward, all children with new onset disease should undergo autoantibody testing. Results of lifestyle interventions for control of type 2 diabetes have been disappointing, but are still recommended for their educational value and the potential impact upon some participants. There is limited evidence for the benefit of newer mediations. Liraglutide, a GLP-1 agonist, however, has been shown to significantly reduce HbA1C% in one study and is now approved for children. Liraglutide should be considered as second line therapy.

Maturity onset diabetes of youth (MODY) in Turkish children: sequence analysis of 11 causative genes by next generation sequencing

2016 ◽  
Vol 29 (4) ◽  
Author(s):  
Sebahat Yılmaz Ağladıoğlu ◽  
Zehra Aycan ◽  
Semra Çetinkaya ◽  
Veysel Nijat Baş ◽  
Aşan Önder ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Next Generation Sequencing ◽  
Point Mutations ◽  
Maturity Onset Diabetes ◽  
Turkish Children ◽  
Onset Diabetes ◽  
Molecular Studies ◽  
Generation Sequencing

AbstractMaturity-onset diabetes of the youth (MODY), is a genetically and clinically heterogeneous group of diseasesand is often misdiagnosed as type 1 or type 2 diabetes. The aim of this study is to investigate both novel and proven mutations of 11A panel of 11We identified 28 (65%) point mutations among 43 patients. Eighteen patients haveThis is the first study including molecular studies of 11

scholarly journals Improving clinical utility of GAD65 autoantibodies by electrochemiluminescence assay and clinical phenotype when identifying autoimmune adult-onset diabetes

Diabetologia ◽  
2021 ◽  
Author(s):  
Yong Gu ◽  
Xiaofan Jia ◽  
Tanwi Vartak ◽  
Dongmei Miao ◽  
Fran Dong ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Clinical Utility ◽  
Insulin Treatment ◽  
Clinical Phenotype ◽  
Adult Onset ◽  
Onset Diabetes ◽  
Adult Onset Diabetes

Abstract Aims/hypothesis It is important to differentiate the two major phenotypes of adult-onset diabetes, autoimmune type 1 diabetes and non-autoimmune type 2 diabetes, especially as type 1 diabetes presents in adulthood. Serum GAD65 autoantibodies (GADA) are the most sensitive biomarker for adult-onset autoimmune type 1 diabetes, but the clinical value of GADA by current standard radiobinding assays (RBA) remains questionable. The present study focused on the clinical utility of GADA differentiated by a new electrochemiluminescence (ECL) assay in patients with adult-onset diabetes. Methods Two cohorts were analysed including 771 diabetic participants, 30–70 years old, from the Action LADA study (n = 6156), and 2063 diabetic participants, 20–45 years old, from the Diabetes in Young Adults (DiYA) study. Clinical characteristics of participants, including requirement of early insulin treatment, BMI and development of multiple islet autoantibodies, were analysed according to the status of RBA-GADA and ECL-GADA, respectively, and compared between these two assays. Results GADA was the most prevalent and predominant autoantibody, >90% in both cohorts. GADA positivity by either RBA or ECL assay significantly discriminated clinical type 1 from type 2 diabetes. However, in both cohorts, participants with ECL-GADA positivity were more likely to require early insulin treatment, have multiple islet autoantibodies, and be less overweight (for all p < 0.0001). However, clinical phenotype, age at diagnosis and BMI independently improved positive predictive value (PPV) for the requirement of insulin treatment, even augmenting ECL-GADA. Participants with GADA detectable by RBA, but not confirmed by ECL, had a phenotype more similar to type 2 diabetes. These RBA-GADA positive individuals had lower affinity GADA compared with participants in which GADA was confirmed by ECL assay. Conclusions/interpretation Detection of GADA by ECL assay, given technical advantages over RBA-GADA, identified adult-onset diabetes patients at higher risk of requiring early insulin treatment, as did clinical phenotype, together allowing for more accurate clinical diagnosis and management. Graphical abstract

scholarly journals Immune checkpoint inhibitors: an emerging cause of insulin-dependent diabetes

2019 ◽  
Vol 7 (1) ◽  
pp. e000591 ◽  
Author(s):  
Anupam Kotwal ◽  
Candace Haddox ◽  
Matthew Block ◽  
Yogish C Kudva
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Immune Checkpoint ◽  
Insulin Dependent Diabetes ◽  
Insulin Deficiency ◽  
Immune Mediated ◽  
Insulin Dependent ◽  
New Onset

ObjectiveInsulin-dependent diabetes can occur with immune checkpoint inhibitor (ICI) therapy. We aimed to characterize the frequency, natural history and potential predictors of ICI-induced diabetes.Research design and methodsWe reviewed 1444 patients treated with ICIs over 6 years at our cancer center, and from the 1163 patients who received programmed cell death protein 1 (PD-1) inhibitors, we identified 21 such cases, 12 of which developed new-onset insulin-dependent diabetes and 9 experienced worsening of pre-existing type 2 diabetes.ResultsICI-induced diabetes occurred most frequently with pembrolizumab (2.2%) compared with nivolumab (1%) and ipilimumab (0%). The median age was 61 years, and body mass index was 31 kg/m2, which are both higher than expected for spontaneous type 1 diabetes. Other immune-related adverse events occurred in 62%, the most common being immune mediated thyroid disease. New-onset insulin-dependent diabetes developed after a median of four cycles or 5 months; 67% presented with diabetic ketoacidosis and 83% with low or undetectable C-peptide. Autoantibodies were elevated in 5/7 (71%) at the time of new-onset diabetes. Diabetes did not resolve during a median follow-up of 1 year.ConclusionsPD-1 inhibitors can lead to insulin deficiency presenting as new-onset diabetes or worsening of pre-existing type 2 diabetes, with a frequency of 1.8 %. The underlying mechanism appears similar to spontaneous type 1 diabetes but there is a faster progression to severe insulin deficiency. Better characterization of ICI-induced diabetes will improve patient care and enhance our understanding of immune-mediated diabetes.

scholarly journals Incidence of diabetes in children and adolescents in Dhaka, Bangladesh

2021 ◽  
Vol 34 (4) ◽  
pp. 509-515
Author(s):  
Bedowra Zabeen ◽  
Jayanthi Maniam ◽  
Ana Margarida Morrão Balsa ◽  
Samin Tayyeb ◽  
Kamrul Huda ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Age Group ◽  
Limited Information ◽  
Pancreatic Diabetes ◽  
Clinical Records ◽  
New Onset

Abstract Objectives Bangladesh has limited information regarding incidence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in young people. The objective of this study was to measure minimum incidence of T1D and T2D, and record other types of new-onset diabetes in children and adolescents <20 years (y), in Dhaka District, Bangladesh, from 2011–2018. Methods Retrospective study using clinical records from Diabetic Association of Bangladesh clinics. Cases were classified by clinical evaluation. Results 725 cases were diagnosed. 482 (66.5%) had T1D, 205 (28.3%) T2D, 14 (1.9%) fibrocalculous pancreatic diabetes, and 24 (3.3%) other types. Male:female ratios for T1D/T2D were 1:1.6 (p<0.0001) (T1D) and 1:1.4 (p<0.01) respectively. T1D cases by age-group were 7.3% (0–4 y), 19.9% (5–9 y), 43.6% (10–14 y) and 29.3% (15–19 y). Mean ± SD ages of onset were 12.3 ± 4.2 y (T1D) and 13.1 ± 2.4 y (T2D). Annual T1D mean incidences/100,000 were 1.22 [95%CI: 0.85–1.58] (<15 y) and 1.25 [0.94–1.57] (<20 y), and for T2D 0.52 [0.33–0.73] (<20 y). T1D incidence <15 y was 1.04 [0.69–1.39] in 2011 and 1.42 [1.04–1.80] in 2018 (p=0.08). T2D incidence rose from 0.22 [0.80–0.36] (2011) to 0.57 [0.36–0.77] (2018), an annualized increase of 12% [8–22%] (p=0.001). Ascertainment was estimated as 95%. Conclusions T1D was most common, but T2D, FCPD and other forms also occur. T2D incidence increased during the study period.

The predictive value of endothelin-1 and type 2 diabetes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Youssri ◽  
M Ohlsson ◽  
V Hamrefors ◽  
O Mellander
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Predictive Value ◽  
Fasting Glucose ◽  
Hazard Ratio ◽  
Funding Source ◽  
Onset Diabetes ◽  
New Onset

Abstract Introduction Endothelin 1 is a potent vasoconstrictor released from mainly vascular endothelial cells and to a lesser extent adipose, muscle and renal tissues. Its involvement in cardiovascular disease is well documented, with increasing ET-1 levels correlated to cardiovascular events. Less is however, known about its role in insulin resistance and type 2 diabetes. Purpose To test if ET-1 plasma levels predict the risk of developing type 2 diabetes independently of known risk factors. Method The Malmo Preventive project is a prospective single centre population-based study which recruited 33 346 inhabitants in Malmo, Sweden between 1974–1992. A follow up study was conducted between 2002 and 2006 on willing participants of which 18 240 accepted. Cardiovascular risk factors were documented along with blood plasma samples frozen to −80°C available for further analysis among approximately 5000 subjects. Record linkage with national and regional diagnoses and drug prescription registries was performed to identify all new onset type 2 diabetes cases in this cohort during a mean follow-up period of nine years. C-terminal proendothelin-1 (proET-1), a stable precursor to ET-1, levels were analysed by a double sandwich immunoassay (ThermoFisher) among 4536 individuals with complete data and without diabetes at baseline. The subjects were divided into quartiles based on proET-1 levels and hazard ratios (HR) for new onset diabetes were calculated by Cox Proportional Hazards Model adjusting for age, gender, smoking, hypertension, body mass index (BMI) and fasting glucose. Results There was a positive relationship between increasing proET-1 quartiles and age (p&lt;0.001), hypertension (p&lt;0.001), BMI (p&lt;0.001) and smoking (p&lt;0.001). There was no significant relationship between ET-1 quartiles and fasting glucose (p=0.08) and gender (p=0.21). In models adjusted for age, gender, smoking, hypertension, fasting glucose and BMI among non-diabetic subjects each 1 standard deviation increment of proET-1 conferred a hazard ratio (95% confidence interval) for new onset diabetes during follow up period of 1.12 (1.00–1.26) (p=0.05). The hazard ratio for incident diabetes in quartile 4 (Q4) vs quartile 1 (Q1) was 1.40 (1.03–1.92) (p=0.03). Of note, the predictive value of proET-1 was markedly higher among individuals without pre-diabetes (fasting glucose &lt;6.1) with a hazard ratio of 1.27 per standard deviation proET-1 (CI 1.09–1.49, p=0.02) and 2.18 (CI 1.41–3.36, p&lt;0.001) when comparing proET-1 Q4 vs Q1. There was no significant relationship between the risk of new onset diabetes and proET-1 levels among pre-diabetic individuals. Conclusion Raised proET-1 levels among non-diabetic individuals independently predict risk of new onset type 2 diabetes. The predictive value is driven by the part of the population without prediabetes, suggesting that proET-1 might identify individuals at “hidden high risk”, i.e. indivduals who do not get medical attention by having prediabetes. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Knut & Alice Wallenberg Foundation Clinical Scholars and Göran Gustafsson Foundation

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