Diabetes Type 2 in Neurologically Impaired Children and Adolescents Without Obesity: A New Emerging Entity?

Abstract

Background: Insulin resistance (IR) plays a key role in the pathogenesis of type 2 diabetes (T2D). In neurologically impaired (NI) children unfavorable cardio-metabolic risk profile with high prevalence of IR has been reported. We evaluated the prevalence of T2D in NI children and adolescents, in order to define if a dedicated glucose monitoring may be recommended in these subjects. Methods: We retrospectively evaluated 63 patients (11.4 ± 4.0 years) with severe disabilities. Auxological parameters were recorded. Metabolic blood assays included fasting blood glucose (FBG), fasting insulin, triglycerides (TG). IR was detected with the homeostasis model assessment for insulin resistance (HOMA-IR > 97.5th percentile for age and sex) and triglyceride-glucose index (TyG index > 7.88). Elevated FBG was defined with values >100 mg/dl. T2D was defined according to American Diabetes Association criteria. Results: Impaired insulin sensitivity, pathological TyG index and elevated FBG were observed, respectively, in 41.3, 63.5, and 11.1% patients. T2D was diagnosed in 3.2% asymptomatic patients. The prevalence of diabetes was higher in pre-pubertal compared to pubertal subjects ( p = 0.03). Conclusions: T2D in NI children and adolescents without obesity could represent a new emerging entity. IR and/or surrogate markers of IR index may be useful for the primary screening of this at-risk disabled population so as to prevent diabetes.

Clinical characteristics of children with severe neurologic impairment: A scoping review

“…Gastroesophageal reflux and feeding tubes ( n = 57, 56%) was the most common topic, with subtopics of gastroesophageal reflux ( n = 7), 7,42–44,102–104 gastrostomy tube outcomes ( n = 24), 9,39,45,46,56–65,81–84,105–110 and antireflux procedures ( n = 26) 8,47–55,66–71,85,86,111–118 . Other topics included aspiration and respiratory issues ( n = 13, 13%) 72,73,87–93,119–122 ; symptoms, palliative care, and quality of life ( n = 12, 12%) 38,41,74–77,94–97,123,124 ; growth and endocrinology ( n = 10, 10%) 78,98,99,125–131 ; caregivers and care burden ( n = 7, 7%) 10,37,40,79,80,100,132 ; other ( n = 2, 2%) 101,133 ; and musculoskeletal ( n = 1, 1%) 134 . Most studies ( n = 54, 53%) were retrospective cohorts or case series (Supporting Information: eFigure ), with a median sample size of 48 patients (range 20–240).…”

A Multivariate Pattern Analysis of Metabolic Profile in Neurologically Impaired Children and Adolescents

“…Recently, an increased prevalence of MetS (more than 10%) has also been described in children and adolescents with neurological impairments [ 12 , 15 , 20 , 21 , 31 ]. In this population, IR was reported in 50% of patients, and the alteration in their metabolic profile was not related to ponderal excess.…”

“…On the contrary, MetS seems to be relevant in malnourished patients [ 15 ]. In these patients, several factors including the physiologic adaptive mechanism for human survival [ 15 , 17 , 18 , 19 , 20 , 21 ], restricted physical activity, chronic stress, altered body composition, and long-term therapy may alter the anabolic/catabolic hormonal balance, leading to glucose, lipid, and insulin signaling interference [ 15 , 17 , 18 , 19 , 20 , 21 ].…”

“…The data in non-obese subjects with disabilities, who are considered to have MetS if they meet more than three pathological metabolic parameters, such as glucose metabolic disorders and/or dyslipidemia, and/or hypertension [ 15 ], suggest the crucial role that body composition plays, particularly loss of lean mass, in the risk of developing MetS [ 15 , 16 ]. In these subjects, multifactorial pathogenesis of MetS has been proposed, including malnutrition, the assumption of drugs, chronic inflammation, oxidative stress, high cumulative biological dysregulation, and restricted physical activity [ 16 , 17 , 18 , 19 , 20 , 21 ].…”

Screening Questionnaire for Vitamin D Insufficiency in Children with Obesity

“…In all participants, height (Ht), weight, pubertal stage and waist circumference were measured, and WC/Ht and BMI were calculated. Anthropometric measurements were performed as previously reported [ 20 , 21 ]. Pubertal stages were classified as follows: Tanner 1 = pre-pubertal stage 1; Tanner 2–3 = middle puberty stage 2; Tanner 4–5 = late puberty stage 3 [ 22 , 23 ].…”