Type 2 Diabetes in the Young

Bloomgarden, Zachary T.

doi:10.2337/diacare.27.4.998

Cited by 214 publications

(137 citation statements)

References 140 publications

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“…In Table 1 we present 15 papers, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] all of which used different sets of variables, number of criteria and cutoff points to define the risk-factors associated with the MS. [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] The main differences concern the techniques used to estimate adiposity (body mass index (BMI) and/or waist circumference (WC)), and the variable(s) chosen to evaluate glucose metabolism (fasting glucose, …”

Section: Actual Featuresmentioning

confidence: 99%

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

et al. 2007

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Background: The diagnostic criteria of the metabolic syndrome (MS) have been applied in studies of obese adults to estimate the metabolic risk-associated with obesity, even though no general consensus exists concerning its definition and clinical value. We reviewed the current literature on the MS, focusing on those studies that used the MS diagnostic criteria to analyze children, and we observed extreme heterogeneity for the sets of variables and cutoff values chosen. Objectives: To discuss concerns regarding the use of the existing definition of the MS (as defined in adults) in children and adolescents, analyzing the scientific evidence needed to detect a clustering of cardiovascular risk-factors. Finally, we propose a new methodological approach for estimating metabolic risk-factor clustering in children and adolescents. Results: Major concerns were the lack of information on the background derived from a child's family and personal history; the lack of consensus on insulin levels, lipid parameters, markers of inflammation or steato-hepatitis; the lack of an additive relevant effect of the MS definition to obesity per se. We propose the adoption of 10 evidence-based items from which to quantify metabolic risk-factor clustering, collected in a multilevel Metabolic Individual Risk-factor And CLustering Estimation (MIRACLE) approach, and thus avoiding the use of the current MS term in children. Conclusion: Pediatricians should consider a novel and specific approach to assessing children/adolescents and should not simply derive or adapt definitions from adults. Evaluation of insulin and lipid levels should be included only when specific references for the relation of age, gender, pubertal status and ethnic origin to health risk become available. This new approach could be useful for improving the overall quality of patient evaluation and for optimizing the use of the limited resources available facing to the obesity epidemic.

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Section: Actual Featuresmentioning

confidence: 99%

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

et al. 2007

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“…A more recent trend has been the shift of type 2 diabetes to middle-aged and younger populations. The new epidemic of obesity and type 2 diabetes in young people is becoming a clinical and health economic priority [2].…”

Section: Introductionmentioning

confidence: 99%

Early-onset type 2 diabetes in obese white subjects is characterised by a marked defect in beta cell insulin secretion, severe insulin resistance and a lack of response to aerobic exercise training

et al. 2007

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Aims/hypothesis Early-onset type 2 diabetes is associated with marked visceral obesity and extreme insulin resistance, but its pathogenesis and response to treatment are not completely understood. We studied physical fitness, wholebody and hepatic glucose turnover, and insulin secretion in young obese Irish subjects before and after 3 months of aerobic exercise training. We hypothesised that exercise alone, with stable diet, should improve insulin sensitivity. Materials and methods Anthropometric parameters and maximum volume of oxygen utilisation (VO 2max ) were measured in 13 subjects with type 2 diabetes and 18 nondiabetic control subjects, matched for age and BMI. Insulin sensitivity and hepatic glucose turnover were measured using the hyperinsulinaemic-euglycaemic clamp. Insulin secretion was assessed from an OGTT and a modified intravenous glucose tolerance test. Some subjects (seven type 2 diabetic, 14 non-diabetic control subjects) then completed a 12-week supervised aerobic exercise programme. All measurements were repeated on completion of the exercise programme. Results Type 2 diabetic subjects had higher WHR, systolic blood pressure and triacylglycerols than non-diabetic control subjects. They were significantly more insulinresistant as measured both by the clamp and oral glucose insulin sensitivity. They also displayed marked defects in insulin secretion in response to oral and intravenous glucose challenges. Exercise intervention had no significant effect on whole-body or hepatic insulin sensitivity or insulin secretion. VO 2max increased significantly in the non-diabetic control subjects, but not in the type 2 diabetic subjects after exercise training. Conclusions/interpretation Young obese subjects with type 2 diabetes are severely insulin-resistant with marked loss of beta cell function compared with control subjects matched for age and obesity. Neither group responded metabolically to aerobic exercise intervention.

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“…True prevalence data exist mainly for the United States, and an overview of population-and clinic-based studies shows that prevalence rates of T2D and impaired glucose regulation are increasing and have already reached alarming dimensions. [1][2][3] The latest analysis from the crosssectional National Health and Nutrition Examination survey (NHANES 1999(NHANES -2002 found that 0.5% of 12-to 19-year-old adolescents reported to have diabetes (29% of them T2D) and that 11% of the non-diabetic adolescents had impaired fasting glucose (IFG). 4 Genetic and environmental factors are of importance for the development of obesity and T2D, as higher prevalences are found in certain ethnic groups and are associated with lower socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of impaired glucose regulation in German school-leaving students

et al. 2007

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The increase in prevalence of obesity in childhood and adolescence appears to be followed by a rise of type 2 diabetes (T2D) cases in youth. Studies from the United States indicated that more than 1 in 10 adolescents may have disturbed glucose metabolism and that ethnicity and socioeconomic status are major determinants of (pre) diabetes prevalence. Since data for European countries are rare, we conducted a cross-sectional survey in 721 school-leaving boys and girls (mean age 15.5 years) in Düsseldorf (Germany). In our population from a predominantly low socioeconomic background, a total of 2.5% had impaired fasting glucose, impaired glucose tolerance or T2D.

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Type 2 Diabetes in the Young

Cited by 214 publications

References 140 publications

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

Early-onset type 2 diabetes in obese white subjects is characterised by a marked defect in beta cell insulin secretion, severe insulin resistance and a lack of response to aerobic exercise training

Prevalence of impaired glucose regulation in German school-leaving students

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