ComorbidityDiabetes and Insulin Resistance in Pediatric Obesity
Section snippets
Epidemiology of diabetes and insulin resistance
Before the 1990s, type 2 diabetes mellitus (T2DM) was rarely diagnosed in children. In 1994, however, T2DM represented nearly 16% of new cases of diabetes in children in urban areas.1 By 1999, the percent of new cases of diabetes that are T2DM ranged from 8% to 45% and was disproportionately represented in minority populations.2, 3 Most overweight children have metabolic abnormalities associated with insulin resistance without T2DM.4 Metabolic syndrome represents a cluster of metabolic
Autoimmunity and diagnosis
The classification of diabetes is determined by the clinical presentation and course of the disease.7 Making the distinction between type 1 diabetes and T2DM is often difficult in overweight children and adolescents.5 Diabetes-associated autoantibodies are measured to aid in diagnosis (islet cell antibodies [ICAs], antibodies against insulin, glutamic acid decarboxylase [GAD], and insulinoma-associated protein 2 [IA-2] or islet cell antigen 512 [ICA512]). The SEARCH study is the first
Insulin Resistance and Insulin Secretion Defects
Glucose is the most important regulator of insulin release.9 Normally, there is a nonlinear dose-related effect of glucose on insulin secretion.9 The relationship between glucose and insulin secretion follows a sigmoidal curve.9 The threshold to secrete insulin corresponds to nonfasting glucose levels and the steepest portion corresponds to postprandial glucose levels.9 Data show that chronic exposure to hyperglycemia (glucotoxicity) reduces expression of genes important in β-cell function,
Management
Obesity has been connected to sedentary lifestyle and poor nutrition. Children are consuming more fast food and foods containing high fat and sugar. Physical activity has decreased among children and adolescents. Both lifestyle modification and drug therapies are recommended in the management of T2DM.
Lifestyle modification programs are geared to changing high-risk lifestyle behaviors.29 A multidisciplinary family-based approach is critical factor to success.29 These programs focus on dietary
Summary
Over the past 2 decades, the prevalence of obesity and T2DM in children and adolescents has risen to epidemic proportions and disproportionately affects racial and ethnic minorities, who are at greater risk. The pathophysiology of T2DM is complex and involves insulin resistance and pancreatic β-cell dysfunction as well as visceral adiposity. Children who have impaired fasting glucose or IGT display abnormal insulin secretion, which can lead to T2DM. Current treatments of T2DM are limited to
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Cited by (31)
The Role of Δ<sup>9</sup>-Tetrahydrocannabinol in Diabetes Mellitus
2017, Handbook of Cannabis and Related Pathologies: Biology, Pharmacology, Diagnosis, and TreatmentAddressing Childhood Obesity. Opportunities for Prevention.
2015, Pediatric Clinics of North AmericaCitation Excerpt :Intervening during childhood is important due to the persistence of obesity into adulthood with associated increased morbidity and mortality.3–6 Comorbidities often affect children before they reach adulthood, requiring increased diligence in evaluating and treating these conditions7–9 and leading to increased health care expenditures.10,11 The personal and emotional face of childhood obesity is also serious: daily quality of life can be significantly worsened by obesity.12
Cutaneous manifestations in children with diabetes mellitus and obesity
2014, Actas Dermo-SifiliograficasBiochemical and immunohistochemical changes in delta-9-tetrahydrocannabinol-treated type 2 diabetic rats
2014, Acta HistochemicaCitation Excerpt :The activation of cannabinoid receptors stimulates insulin secretion to maintain glucose homeostasis (Bermúdez-Silva et al., 2007; Li et al., 2011). Diabetes mellitus is frequently complicated by hyperlipidemia and hyperglycemia with an increase in blood glucose levels accompanied by an increase in blood levels of low-density lipoproteins (LDL), total cholesterol (TC) and triglycerides (TG) (Kim and Caprio, 2011; Ranasinghe et al., 2012). In recent years, the prevalence of type 2 diabetes mellitus (T2DM) has increased dramatically and it comprises approximately 90% of all cases of diabetes.
The chequered career of metformin: From darkness to light
2012, Medecine des Maladies Metaboliques