RESUMO
OBJECTIVE: To compare the prevalence of risk factors in children aged <18 years diagnosed with medication-induced diabetes mellitus versus those diagnosed with type 2 diabetes. STUDY DESIGN: This retrospective observational study used data from a Canadian prospective surveillance study in which clinical features of new cases of type 2 diabetes (n = 225) and medication-induced diabetes (n = 58) were reported over a 2-year period. The presence of risk factors for type 2 diabetes (eg, obesity, family history of type 2 diabetes, ethnicity, acanthosis nigricans, hypertension, polycystic ovarian syndrome) was compared in the 2 groups using descriptive statistics and logistic regression. RESULTS: Compared with the children with type 2 diabetes, the children with medication-induced diabetes were more likely to be Caucasian (P < .0001) and less likely to be obese (P < .0001), to have a positive family history of type 2 diabetes (P = .0001), to have acanthosis nigricans (P < .0001) on clinical examination, and to have an obesity-related comorbidity, such as polycystic ovarian syndrome (P = .04), dyslipidemia (P = .02), hypertension (P = .04), or an elevated alanine aminotransferase level (P = .05). CONCLUSIONS: Evaluating for the typical risk factors for type 2 diabetes is not sufficient to identify all children at risk for developing medication-induced diabetes. Further studies are needed to help inform guidelines on screening for and prevention of medication-induced diabetes in children.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Glucocorticoides/efeitos adversos , Imunossupressores/efeitos adversos , Medição de Risco/métodos , Acantose Nigricans/tratamento farmacológico , Acantose Nigricans/epidemiologia , Adolescente , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Canadá/epidemiologia , Criança , Comorbidade , Diabetes Mellitus Tipo 2/induzido quimicamente , Diabetes Mellitus Tipo 2/diagnóstico , Dislipidemias/tratamento farmacológico , Dislipidemias/epidemiologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Imunossupressores/uso terapêutico , Incidência , Masculino , Obesidade/tratamento farmacológico , Obesidade/epidemiologia , Vigilância da População , Estudos Retrospectivos , Fatores de RiscoRESUMO
Data from the menu ordering system was used to calculate servings/child/day of food groups ordered by pediatric inpatients. The children ordered a mean of 5.0 +/- 0.56 servings of fruits and vegetables/day, which decreased to 3.5 +/- 0.27 servings when juice was removed. "Foods-to-limit" were ordered 3.8 +/- 0.31 times/day. Interventions to improve healthier choices are warranted.
Assuntos
Inquéritos sobre Dietas , Ingestão de Alimentos/psicologia , Comportamento Alimentar/fisiologia , Alimentos/estatística & dados numéricos , Pacientes Internados , Seguimentos , Humanos , Lactente , Política Nutricional , Ontário , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To determine whether the addition of the thiazoladinedione, pioglitazone, to standard therapy improves metabolic control in adolescents with type 1 diabetes (T1D) and clinical evidence of insulin resistance. STUDY DESIGN: Randomized, placebo-controlled 6-month 2-site trial of pioglitazone therapy in 35 adolescents with T1D, high insulin requirements (>0.9 U/kg/d), and suboptimal metabolic control (A1c 7.5%-11%), with the primary outcome of change in A1c. Secondary outcomes include change in insulin dose, body mass index (BMI), lipids, and waist and hip circumference. RESULTS: Metabolic control (A1c) was improved at 6 months in all subjects (P = .02). There was no significant difference between the pioglitazone and placebo treatment groups at 6 months in either change in A1c (-0.4% +/- 0.9% and -0.5% +/- 1.2%, respectively) or insulin dose. BMI SDS increased by 0.3 +/- 0.3 (kg/m(2)) in the pioglitazone group and remained unchanged in the placebo group (P = .01). There was no significant difference in change in any lipid parameters between the pioglitazone and placebo groups at 6 months. CONCLUSIONS: Adjunctive pioglitazone therapy was not effective in improving glycemic control in adolescents with T1D. Pioglitazone was associated with increased BMI.