1,721,008 research outputs found
Prevalenza, modalità di identificazione e indicatori di progressione a insulino dipendenza del LADA nella realtà italiana: l'esperienza dello studio NIRAD
No full textCorrection to: "H" for heterogeneity in the algorithm for type 2 diabetes management
Full text linkThe original version of this article unfortunately contained a mistake in the authorgroup section. The authors' given and family names were inadvertently interchanged
Type 2 diabetes in children and adolescents: Challenges for treatment and potential solutions
No full text: Historically perceived as a disease mainly affecting adults, the prevalence of type 2 diabetes mellitus (T2DM) among children and adolescents has been rising, mirroring the increasing rates of childhood obesity. Currently, youth-onset T2DM poses a significant public health challenge globally. Treating youth-onset T2DM poses numerous critical challenges, namely limited and inadequate therapeutic options, and difficulties with conducting therapeutic studies. As a result, current treatment guidelines are based on adult studies and expert consensus. Few prominent guidelines on the treatment of youth-onset T2DM have been published recently, i.e., by the American Diabetes Association (ADA) 2024, National Institute for Healthcare and Excellence United Kingdom (NICE UK) 2023, International Society Paediatric and Adolescents Diabetes (ISPAD) 2022, Australasian Paediatric Endocrine Group (APEG) 2020 and Diabetes Canada 2018. This review first explores the unique aspects of youth-onset T2DM. It then summarises the different treatment guidelines, discusses the different treatment modalities based on available evidence and identifies any gaps. The review also explores challenges in the treatment of youth-onset T2DM with potential solutions and discusses recent trials on the treatment of youth-onset T2DM. Continued research aims to optimise treatment, improve outcomes, and alleviate the burden of T2DM on youths
Adult-onset autoimmune diabetes: current knowledge and implications for management
No full textAdult-onset autoimmune diabetes is a heterogeneous disease that is characterized by a reduced genetic load, a less intensive autoimmune process and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus (T1DM). The majority of patients with adult-onset autoimmune diabetes do not require insulin treatment for at least 6 months after diagnosis. Such patients are defined as having latent autoimmune diabetes in adults (LADA), which is distinct from classic adult-onset T1DM. The extensive heterogeneity of adult-onset autoimmune diabetes is apparent beyond the distinction between classic adult-onset T1DM and LADA. LADA is characterized by genetic, phenotypic and humoral heterogeneity, encompassing different degrees of insulin resistance and autoimmunity; this heterogeneity is probably a result of different pathological mechanisms, which have implications for treatment. The existence of heterogeneous phenotypes in LADA makes it difficult to establish an a priori treatment algorithm, and therefore, a personalized medicine approach is required. In this Review, we discuss the current understanding and gaps in knowledge regarding the pathophysiology and clinical features of adult-onset autoimmune diabetes and highlight the similarities and differences with classic T1DM and type 2 diabetes mellitus
Impact of obesity on the increasing incidence of type 1 diabetes
Full text linkPublished estimates of the incidence of type 1 diabetes (T1D) in children in the last decade varies between 2% and 4% per annum. If this trend continued, the disease incidence would double in the next 20 years. The risk of developing T1D is determined by a complex interaction between multiple genes (mainly human leukocyte antigens) and environmental factors. Notwithstanding that genetic susceptibility represents a relevant element in T1D risk, genetics alone cannot explain the increase in incidence. Various environmental factors have been suggested as potential triggers for T1D, including several viruses and the hygiene hypothesis; however, none of these seems to explain the large increase in T1D incidence observed over the last decades. Several studies have demonstrated that the prevalence of childhood/adolescence overweight and obesity has risen during the past 30 years in T1D. Currently, at diagnosis, the majority of patients with T1D have normal or elevated body weight and ~50% of patients with longstanding T1D are either overweight or obese. The growing prevalence of obesity in childhood and adolescence offers a plausible explanation for the increase in T1D incidence observed in recent decades. Possible mechanisms of the enhancement of β-cell autoimmunity by obesity include: a) insulin resistance-induced β-cell secretory demand triggering autoimmunity through cytokine release, neo-epitope antigen formation and increase in β-cell apoptosis, and b) obesity-induced low-grade inflammation with pro-inflammatory cytokines secreted by locally infiltrating macrophages, which contribute to the presentation by islet cells of autoantigens generally not accessible to T cells. Further studies are needed to clarify whether the control of body weight can prevent or delay the current and continuing rise in T1D incidence
OCA2 gene polymorphisms are associated with specific eye colour and skin phenotype in type 1 diabetes
No full text
L'HOMA-IR e la circonferenza del polso correlano con i principali parametri ecografici di rischio cardiovascolare in bambini obesi.
No full textVariabilità intra e interoperatore nelle misure della circonferenza del polso in bambini e adolescenti sovrappeso e obesi.
No full textWrist circumference is associated with systolic blood pressure in a population of overweight/obese children and adolescents.
No full textWrist circumference is associated with systolic blood pressure in a population of overweight/obese children and adolescents
G. Campagna1, S. Zampetti1, F. Lucantoni1, M. Capizzi1, L. Marandola1, C. Chiesa2, L. Pacifico3, A. Vania4, R. Buzzetti1; 1Experimental Medicine, Sapienza, University of Rome, 2National Research Counci, Institute of Translational Pharmacology, 3Policlinico Umberto I Hospital, Sapienza, University of Rome, 4Pediatric, Sapienza, University of Rome, Rome, Italy.
Background and aims: Insulin resistance, according to many pathophysiological models is one of the most important cardiovascular (CV) risk factors. In a previous study, we demonstrated that the wrist circumference is a clinical marker for insulin-resistance in overweight/obese children and adolescents. Hypertension is another relevant cardiovascular risk factor and obesity is one of its major determinants in children. Various indexes of obesity, such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio and neck circumference, are associated with a high risk of hypertension. The aim of the present study was to investigate a possible association between the wrist circumference and systolic (S) and diastolic (D) blood pressure (BP) in a population of overweight/obese children and adolescents. Materials and methods: N=1133 overweight/obese children and adolescents (580 boys and 553 girls) were consecutively enrolled. In all children and adolescents, body weight, height, SBP, DBP,wrist circumference, SDS-BMI, fasting glucose, fasting insulin levels, and lipid profiles were evaluated at entry. Insulin resistance was estimated according to the homeostasis model assessment of insulin resistance (HOMA-IR). Subjects were evaluated by a doctor for the pubertal stages. Shapiro-Wilk test was used to verify the normality of distribution of continuous variables. The dependent variables for this study were SBP and diastolic DBP; independent variables were SDS-BMI and wrist circumference adjusted for Tanner stage. Multivariate linear regression analyses were used to investigate the influence of independent variables on the variance of blood pressure. All analyses were performed using Statistical Analysis Software (SAS v.9.3). Results: The frequency of hypertension was 22.6% in males and 28.2% in females (p=0.048). Results of the multivariate regression analysis performed in the 1133 children and adolescents stratified according to gender, using wrist circumference and SDS-BMI as independent variable and blood pressure as the dependent variables showed that SBP was significantly associated with wrist circumference and SDS-BMI both in males and females (p≤0.04 for both comparison). We found no association between DBP and wrist circumference in both gender. Wrist circumference and SDS-BMI together explained 21% of the variance of SBP in males and 18% in females. To evaluate the contribution of wrist circumference and SDS-BMI, respectively, to explained variance (R2) of SBP index, we used the backward method. The total variance of SBP was explained by wrist circumference for 17% and by SDS-BMI for 2.7% in males; and by wrist circumference for 14% and SDS-BMI 1% in females. Conclusion: The wrist circumference in overweight/obese children and adolescents is correlated with SBP, confirming that this bone anthropometric marker could be useful for the prediction of cardiovascular risk being correlated with insulin resistance and its deleterious effects.
Disclosure: G. Campagna: None
- …
