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Treat the patient as a whole, including obesity, insulin resistance, dyslipidemia, hypertension, and psychosocial disorders all conditions frequently present in youth who have T2DM. Finally, as we gain more experience both clinical and research our approaches to some of these problems and recommendations may change over time. In addition to research, public health measures to increase activities of children and youth, along with public education campaigns for healthy eating may have a profound...

Type Diabetes Mellitus in Youth The Complete Picture to Date

Neslihan Gungor, MD, Tamara Hannon, MD, Ingrid Libman, MD, PhD, Fida Bacha, MD, Silva Arslanian, MD Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA Type 2 diabetes mellitus T2DM historically was considered a disease of adults, with autoimmune type 1 diabetes mellitus T1DM accounting for almost all cases of pediatric diabetes. T2DM was recognized as a disease of the pediatric age group by the...

Etiology

Over the past 30 years, the ability to predict the development of T1D has improved dramatically with the combined use of genetic, autoantibody, and metabolic markers. The most often cited model of the natural history of T1D suggests that genetically susceptible individuals with a fixed number of beta cells are exposed to a putative environmental trigger that induces beta cell autoimmunity 11 . The development of islet reactive autoantibodies is a marker of ongoing autoimmune disease, but it is...

Risk factors of youth type diabetes mellitus

The risk factors for youth T2DM are discussed under the following four broad categories 1 genetics, 2 environment, 3 ethnicity, and 4 insulin resistance phenotype. Genetics family history of type 2 diabetes mellitus The cause of T2DM is heterogeneous, including social, behavioral, and environmental risk factors in addition to a strong hereditary component 42,56 . Although few susceptibility genes have been identified thus far 57 , the genetic component of T2DM is evidenced by the strong...

Ilb

Absolute risk for type 1 diabetes mellitus according to DR DQ genotypes DR 3 4, DQ 0201 0302 DR 4 4, DQ 0300 0302 DR 3 3, DQ 0201 0201 As indicated, non-HLA genes are also associated with T1D. For example, the IDDM2 locus has been mapped to a variable number of tandem repeats located upstream of the insulin gene. Disease association studies in case control and family cohorts show that the number of tandem repeats is associated with T1D risk, with shorter repeats conferring higher risk and...

The interaction of insulin resistance and Bcell function

Having presented the major aspects of insulin secretion and IR, some examples of DM and its related disorders according to their main determinant are now discussed predominantly insulin deficiency, predominantly IR, or resulting from relative insulin deficiency in the context of IR. Diabetes with predominantly insulin deficiency Type 1 diabetes is the form of the disease caused primarily by -cell destruction. This condition is characterized by severe insulin deficiency and dependence on...

Uwaifo Gi Fallon Em Diabetes Care 2002 25 2081-7

1 Bergman RN, Ader M, Huecking K, et al. Accurate assessment of beta-cell function the hyperbolic correction. Diabetes 2002 51 Suppl 1 S212-20. 2 Bruning JC, Michael MD, Winnay JN, et al. A muscle-specific insulin receptor knockout exhibits features of the metabolic syndrome of NIDDM without altering glucose tolerance. Mol Cell 1998 2 559-69. 3 Bruning JC, Winnay J, Bonner-Weir S, et al. Development of a novel polygenic model of NIDDM in mice heterozygous for IR and IRS-1 null alleles. Cell...

Nicole Glaser MD

Department of Pediatrics, University of California Davis, School of Medicine, 2516 Stockton Boulevard, Sacramento, CA 95817, USA Diabetic ketoacidosis DKA is an important complication of childhood diabetes mellitus and the most frequent diabetes-related cause of death in children 1,2 . In various population-based studies, reported rates of DKA at presentation of type 1 diabetes have ranged from as low as 15 to as high as 83 3-7 , with most North American and European studies reporting rates of...

References

1 Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents an epidemiologic review and a public health perspective. J Pediatr 2000 136 5 664-72. 2 Centers for Disease Control and Prevention. Diabetes projects. Available at http www.cdc. gov diabetes projects cda2.htm. Accessed August 15, 2005. 3 Karvonen M, Viik-Kajander M, Moltchanova E, et al. Incidence of childhood type 1 diabetes worldwide Diabetes Mondiale DiaMond Project Group....

Epidemiology incidence and prevalence

T1D is one of the most common chronic diseases of childhood. Even with the recent epidemic of type 2 diabetes, T1D accounts for approximately two thirds of E-mail address schatda peds.ufl.edu D. Schatz . 0031-3955 05 - see front matter 2005 Elsevier Inc. All rights reserved. all cases of diabetes in children 1 . In the United States, more than 150,000 children younger than 18 years old have T1D 2 . The prevalence of T1D in US children is 1.7 to 2.5 cases per 1000 individuals, and the incidence...

Presentations classic silent and diabetic ketoacidosis

Sympathomimetics Classification Table

The presentation of new-onset T1D is distributed among three typical patterns classic new onset, silent diabetes, and diabetic ketoacidosis DKA . Although most children present with classic new-onset diabetes, in many locations, DKA still accounts for 20 to 40 of all new diagnoses 78 . Silent diabetes, which is less commonly seen at diagnosis, is typically seen in children either involved in diabetes research studies or picked up by families in which one member already has the disease. Children...

Meranda Nakhla MD Constantin Polychronakos MD

Department of Pediatrics, Division of Pediatric Endocrinology, McGill University Health Center, Montreal Children S Hospital, 2300 Tupper, Suite C-244, Montreal, Quebec H3H1P3, Canada The latest version of the American Diabetes Association practice guidelines 1 distinguishes no fewer than 59 causes of diabetes mellitus. This array of etiologies can be dazzling even to the specialist but can be made manageable by putting it in statistical perspective and reducing it to the two basic physiologic...