ISPAD Clinical Practice Consensus Guidelines 2018: Type 2 diabetes mellitus in youth

Zeitler, Philip; Arslanian, Silva; Fu, Junfen; Pinhas‐Hamiel, Orit; Reinehr, Thomas; Tandon, Nikhil; Urakami, Tatsuhiko; Wong, Jencia; Maahs, David M.

doi:10.1111/pedi.12719

Cited by 214 publications

(294 citation statements)

References 186 publications

(308 reference statements)

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“…There is also increasing evidence to suggest that glucose fluctuations, above and beyond average glycemia, play an important role in the increased risk for microvascular and macrovascular complications in diabetes . Although the availability of data on the relevance of these alternate markers in adults is growing, there are limited data on their utility in obese, dysglycemic youth, a high‐risk group who may have a more aggressive disease than adults …”

Section: Introductionmentioning

confidence: 99%

Alternate glycemic markers reflect glycemic variability in continuous glucose monitoring in youth with prediabetes and type 2 diabetes

et al. 2016

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Objective To determine whether the alternate glycemic markers, fructosamine (FA), glycated albumin (GA), and 1,5-anhydroglucitol (1,5AG), predict glycemic variability captured by continuous glucose monitoring (CGM) in obese youth with prediabetes and type 2 diabetes (T2D). Study Design Youth with BMI ≥85th%ile, 10-18 years, had collection of fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), FA, GA, and 1,5AG and 72 hours of CGM. Participants with HbA1c ≥5.7% were included. Relationships between glycemic markers and CGM variables were determined with Spearman correlation coefficients. Linear models were used to examine the association between alternate markers and CGM measures of glycemic variability – standard deviation (SD) and mean amplitude of glycemic excursions (MAGE) – after controlling for HbA1c. Results Total n=56; Median (25th%ile,75th%ile) age=14.3 yrs (12.5, 15.9), 32% male, 64% Hispanic, 20% black, 13% white, HbA1c=5.9% (5.8, 6.3), FA=211mmol/L (200, 226), GA=12% (11%, 12%), and 1,5AG=22mcg/ml (19,26). HbA1c correlated with average sensor glucose, AUC, SD, MAGE, and %time>140mg/dl. FA and GA correlated with average and peak sensor glucose, %time>140mg/dl and >200mg/dl, and MAGE. GA also correlated with SD and AUC180. 1,5AG correlated with peak glucose, AUC180, SD, and MAGE. After adjusting for HbA1c, all 3 markers independently predicted MAGE; FA and GA independently predicted SD. Conclusions Alternate glycemic markers predict glycemic variability as measured by CGM in youth with prediabetes and T2D. After adjusting for HbA1c, these alternate markers continued to predict components of glycemic variability detected by CGM.

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Section: Introductionmentioning

confidence: 99%

Alternate glycemic markers reflect glycemic variability in continuous glucose monitoring in youth with prediabetes and type 2 diabetes

et al. 2016

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“…Similarly, using a non‐invasive magnetic resonance imaging (MRI) obese white adolescents are reported to have substantially higher liver fat content (17.5%) compared with undetectable liver fat in obese black adolescents despite having similar total body fat . Given that black obese adolescents have greater diabetogenic risk profiles (eg, lower insulin sensitivity and hyperinsulinemia) than their white peers, it is unclear why black adolescents are less prone to NAFLD than their white peers.…”

Section: Introductionmentioning

confidence: 59%

Visceral fat is associated with the racial differences in liver fat between black and white adolescent boys with obesity

Lee

Kuk

2017

Pediatr Diabetes

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Objective We examined whether racial differences in liver fat is associated with the differences in abdominal fat distribution or cardiorespiratory fitness (CRF). Methods Participants included 57 black and white obese boys (12–18 yrs). Total and abdominal fat was measured by DEXA and MRI, respectively. CRF was measured using a maximal graded treadmill test with the use of standard open-circuit spirometry techniques until volitional fatigue. Liver fat was measured using a 3T proton magnetic resonance spectroscopy. Fatty liver was defined as having liver fat ≥5%. Results In the sample, 16.1% of black boys and 30.8% of white boys had fatty liver. Liver fat was associated (P≤0.05) with BMI percentile (r=0.28), total fat (r=0.31), waist circumference (r=0.38), visceral fat (r=0.62), ASAT (r=0.30), and CRF (r= −0.27) adjusting for age and race. White boys had greater liver fat than black boys with adjustment for age and differences in BMI percentile or CRF, but not with waist circumference or visceral fat (P>0.05). In a model with age, ethnicity, total body fat, fat free mass, visceral fat, abdominal subcutaneous fat and CRF, visceral fat was the only factor to be independently associated with increased odds of having fatty liver (OR= 1.12, 95% CI: 1.04–1.21, P=0.003). Conclusion The racial disparities in liver fat between obese black versus white adolescents are explained, in part, by differences in visceral fat.

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“…T2DM was considered to be the most likely diagnosis based on presentation and clinical course, including negative pre‐type 1 diabetes autoantibodies (glutamic acid decarboxylase and insulinoma‐associated protein 2 antibodies), negative monogenic genetic diabetes testing (if performed) plus two or more risk factors for T2DM (obesity defined as body mass index (BMI) >95th centile, family history of T2DM, race/ethnicity and signs or conditions associated with insulin resistance – acanthosis nigricans, polycystic ovarian syndrome, dyslipidaemia and hypertension). Patients were further classified as symptomatic if they had one or more of polydipsia, polyuria, weight loss or ketoacidosis at presentation, as per our previous publication …”

Section: Methodsmentioning

confidence: 99%

Increasing incidence of type 2 diabetes in New Zealand children <15 years of age in a regional‐based diabetes service, Auckland, New Zealand

Sjardin

Reed

Albert

et al. 2018

J Paediatrics Child Health

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ISPAD Clinical Practice Consensus Guidelines 2018: Type 2 diabetes mellitus in youth

Cited by 214 publications

References 186 publications

Alternate glycemic markers reflect glycemic variability in continuous glucose monitoring in youth with prediabetes and type 2 diabetes

Alternate glycemic markers reflect glycemic variability in continuous glucose monitoring in youth with prediabetes and type 2 diabetes

Visceral fat is associated with the racial differences in liver fat between black and white adolescent boys with obesity

Increasing incidence of type 2 diabetes in New Zealand children <15 years of age in a regional‐based diabetes service, Auckland, New Zealand

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