Type 2 Diabetes in Youth
Download
1 / 43

Prevalence of Diabetes and IFG in US Adolescents - PowerPoint PPT Presentation


  • 625 Views
  • Updated On :

Type 2 Diabetes in Youth. Francine Ratner Kaufman, M.D. Distinguished Professor of Pediatrics The Keck School of Medicine of USC Head, Center for Diabetes and Endocrinology Childrens Hospital Los Angeles. Question . What Do We Know About Type 2 Diabetes in Youth?.

Related searches for Prevalence of Diabetes and IFG in US Adolescents

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Prevalence of Diabetes and IFG in US Adolescents ' - Olivia


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide1 l.jpg

Type 2 Diabetes in Youth

Francine Ratner Kaufman, M.D.

Distinguished Professor of Pediatrics

The Keck School of Medicine of USC

Head, Center for Diabetes and Endocrinology

Childrens Hospital Los Angeles


Slide2 l.jpg

Question

What Do We Know About Type 2 Diabetes in Youth?


Prevalence of diabetes and ifg in us adolescents nhanes 1999 2002 l.jpg
Prevalence of Diabetes and IFG in US Adolescents – NHANES 1999-2002

  • Type 2 Diabetes

    • 0.5% of adolescents have diabetes

    • 71% type 1 and 29% type 2

      • Determined by insulin use vs no insulin use

    • 39,005 US teens with T2D

  • Impaired Fasting Glucose

    • 11% had IFG

    • 2,769,736 teens with IFG

  • Diabetes Increased 41% from 4.9 to 6.9/1000 from 1997 to 2003 - adults

    Duncan, Arch Pediatr Adolesc Med 2006;160:523; Geiss, Am J Prevent Med 2006;30:371


Is it an epidemic l.jpg
Is it an epidemic? 1999-2002

  • The incidence is increasing and probably underestimated

    • Population based estimates indicate an ~10-fold increase in incident cases over the past 10-15 years

    • 8% to 43% of all new cases of diabetes in the United States depending on ethnicity

    • The SEARCH Trial

    • What about prevalence??

      Bloomgarden ZT. Diabetes Care. 2004;27:998-1010 Centers for Disease Control. Diabetes Fact Sheet. 2005


Controversies as to the nature of this epidemic l.jpg
Controversies as to the Nature of this Epidemic 1999-2002

  • Difficult to recruit for the TODAY trial

    • 13 centers across the country

    • Presence of antibodies

  • The SEARCH Trial

    • 19,000 new patients with T1D

    • 4,100 new patients with T2D


  • Slide6 l.jpg

    Diabetes Trends Among Adults in the US 1999-2002 BRFSS 1990, 1995 and 2001


    Slide7 l.jpg

    Is Type 2 Diabetes An Epidemic? 1999-2002

    Little Rock, Cincinnati, San Antonio

    35

    30

    25

    20

    % with type 2

    15

    10

    5

    0

    87

    88

    89

    90

    91

    92

    93

    94

    95

    96

    • Ten-fold increase 0.7 vs 7.2/100000

    • 8% to 43% of all new cases of diabetes in youth in US depending on ethnicity

    J Pediatr 136:664-672, 2000


    Slide8 l.jpg

    Question 1999-2002

    Is the Presentation the Same as in Adults?

    • Does not appear to be preceded by long asymptomatic period

      • Do not find undiagnosed cases on screening


    Natural history of type 2 diabetes l.jpg
    Natural History of Type 2 Diabetes 1999-2002

    Complications

    Geneticsusceptibility

    Environmentalfactors

    Onset ofdiabetes

    Disability

    PRE

    Ongoing hyperglycemia

    Obesity Insulin resistance

    Death

    Risk for

    Disease

    Metabolic

    Syndrome

    BlindnessRenal failureCHDAmputation

    RetinopathyNephropathyNeuropathy

    AtherosclerosisHyperglycemiaHypertension



    Ogtt feasibility study pre diabetes and diabetes by ada cut offs l.jpg
    OGTT Feasibility Study 1999-2002Pre-diabetes and Diabetes by ADA Cut-offs


    Slide14 l.jpg

    Prevention and Early Treatment 1999-2002

    Type 2 Diabetes

    Progressive Pancreatic B-cell Failure

    UKPDS Data

    B-cell Function (%)

    ? Curve for Youth

    Years from Clinical Diagnosis


    Slide15 l.jpg

    Question 1999-2002

    Is the Pathophysiology the Same as in Adults?

    • Associated with significant ß-cell failure as well as insulin resistance

      • Occurs at the time of intense insulin resistance due to puberty


    Slide16 l.jpg

    Type 2 Diabetes 1999-2002

    Prediabetes

    Beta Cell Defect

    Beta Cell Defect

    Age

    Puberty

    Obesity

    BP,

    Lipids

    InsulinResistance

    Genetics

    Ethnicity

    Sedentary Lifestyle

    Gender – Girls

    Polycystic ovary syndrome


    Slide17 l.jpg

    Type 2 Diabetes 1999-2002

    Prediabetes

    Beta Cell Defect

    Autoimmunity

    Genetic Defect

    Beta Cell Defect

    Fat cell

    toxicity

    Intrauterine

    IUGR, DM

    Glucose

    toxicity

    InsulinResistance


    Slide18 l.jpg

    Question 1999-2002

    What distinguishes type 1 from type 2 diabetes in youth?


    Slide19 l.jpg

    Type 1 Versus type 2 Diabetes in youth? 1999-2002

    Kaufman,Endocrinol Meta Clinics N Am, 34;659-676: 2005


    Differentiation between type 1 and 2 l.jpg
    Differentiation Between Type 1 and 2 1999-2002

    • 48 with type 2 vs 39 with type 1

    • Type 2

      • Ethnicity, 1st degree relative, BMI>24, +C-peptide, acanthosis

    • Hathout et al Pediatrics 107e102,June,2001


    Slide21 l.jpg

    Question 1999-2002

    How Does Type 2 Present in Youth?

    Is it asymptomatic or symptomatic in youth?


    Diagnosis with type 2 fagot campagna et al j pediatr 2000 l.jpg
    Diagnosis with Type 2 1999-2002Fagot-Campagna et al J Pediatr 2000

    • Mean Age 12-14 years

    • Girls > Boys 1.7:1

    • Obese BMI >85th %

    • Minority Groups 94%

    • Strong Family History 74-100%

    • Acanthosis Nigricans 56-92%

    • Diagnosis made by Symptoms, not Screening

    • HbA1c 10-13%

    • Weight loss 19-62%

    • Glucose in urine 95%

    • Ketosis 16-79%

    • DKA 5-10%


    Slide23 l.jpg

    Question 1999-2002

    What Are Treatment Targets in Youth with Type 2 Diabetes?

    Are they the same as in adults?


    Treatment goals l.jpg
    TREATMENT GOALS 1999-2002

    • Glucose control, HbA1c <7%

      • Eliminate symptoms of hyperglycemia

    • Maintenance of reasonable body weight

    • Improve cardiovascular risk factors

    • Reduce microvascular complications

    • Improvement in physical and emotional well-being


    Slide25 l.jpg

    Question 1999-2002

    What are the Treatment Regimens for Youth?


    Slide26 l.jpg

    GLP 1999-2002


    Slide27 l.jpg

    Diagnosis 1999-2002

    BG 250 mg/dL or 12 mmol/L

    Asymptomatic

    Start with insulin and diet, exercise

    Diet and exercise

    <7%

    <7%

    Monthly review, A1C q3mo

    Add metformin

    Attempt to

    wean insulin

    >7%

    Add metformin

    >7%

    Add insulin, TZD, sulfonylurea

    >7%

    Add 3rd agent

    TZD = thiazolidinedione

    Silverstein JH, Rosenbloom AL.

    J Pediatr Endcrinol Metab. 2000;13 Suppl 6:1406-1409.


    Lwpes survey 130 clinical practices l.jpg
    LWPES Survey 1999-2002130 Clinical Practices

    • 48% treated with insulin alone

      • 2 injections

    • 44% with oral agents

      • 71% metformin

      • 46% sulfonylurea

      • 9% TZD

      • 4% meglitinide

    • 8% lifestyle


    Slide29 l.jpg

    A1c at CHLA 2005 1999-2002


    Intensive therapy for diabetes reduction in incidence of complications l.jpg
    Intensive Therapy for Diabetes: 1999-2002Reduction in Incidence of Complications

    T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus.

    *Not statistically significant due to small number of events.

    †Showed statistical significance in subsequent epidemiologic analysis.

    DCCT Research Group. N Engl J Med. 1993;329:977-986; Ohkubo Y, et al. Diabetes Res Clin Pract. 1995;28:103-117; UKPDS 33: Lancet. 1998;352: 837-853; Stratton IM, et al. Brit Med J. 2000;321:405-412.


    Long term outcome l.jpg
    Long term outcome 1999-2002

    • Pima Indians - diagnosed < 20 years of age

      • 22% had microalbuminuria at diagnosis

      • Increased to 60% at 20-29 years of age

    • Indigenous Canadians- mean age 23 yrs, 9 yrs duration of diabetes

      • HbA1c 10.9%

        • 67% poor glycemic control

      • 45% hypertension requiring treatment

      • 35% microalbuminuria (6% required dialysis)

      • 38% pregnancy loss

      • 9% mortality

    Arslanian S. Hormone Res 2002; 57 Suppl 1: 19-28Dean., Diabetes 2002;51(Suppl 2):A24.


    Slide32 l.jpg

    Blindness 1999-2002

    Amputations

    Loss of Sensations

    Heart disease

    and strokes

    Uncontrolled diabetes

    can lead to…

    Death

    Kidney failure


    Slide33 l.jpg

    An Answer 1999-2002

    The Today Trial?


    Studies to treat or prevent pediatric type 2 diabetes stopp t2d l.jpg

    Studies to Treat Or Prevent Pediatric Type 2 Diabetes 1999-2002STOPP-T2D

    Funded by

    National Institute of Diabetes and Digestive

    and Kidney Diseases

    National Institutes of Health


    Stopp t2 treatment primary aim l.jpg
    STOPP-T2 TREATMENT 1999-2002PRIMARY AIM

    To compare the efficacy of 3 treatment regimens

    • Metformin

    • Metformin + lifestyle

    • Metformin + TZD

      On Time to Treatment Failure and on Glycemic Control

    TODAY


    Primary outcomes l.jpg
    Primary Outcomes 1999-2002

    • Treatment goal

      • HbA1c < 6% (glycemic control)

    • Treatment failure

      • HbA1c  8.0% over 6 consecutive months

        OR

      • Inability to wean from temporary insulin therapy due to metabolic decompensation


    Outcome measures l.jpg
    Outcome Measures 1999-2002

    • Glycemia

      • HbA1c, fasting and postprandial glucose by home monitoring

    • Insulin sensitivity and secretion

      • OGTT, HOMA, QUICKI, proinsulin, C-peptide

    • Body composition

      • BMI, DEXA, waist circumference, abdominal height

    • Fitness and physical activity

      • PDPAR, PWC 170, accelerometer


    Outcome measures continued l.jpg
    Outcome Measures (continued) 1999-2002

    • Nutrition

      • food frequency questionnaire

    • Cardiovascular disease risk

      • BP, lipids, inflammatory markers, coagulation factors

    • Microvascular complications

      • microalbuminuria, neuropathy

    • Quality of life

    • Cost


    Inclusion criteria l.jpg
    Inclusion Criteria 1999-2002

    • Age 10 to 17 years

    • Duration of diabetes < 2 years

    • BMI  85th percentile

    • Adult involved in the daily activities of the child agrees to participate in the intervention

    • Absence of pancreatic autoimmunity

    • Fasting C-peptide > 0.6 mmol/L

    • Fluency in English or Spanish


    National diabetes education program s tip sheets for kids with type 2 l.jpg
    National Diabetes Education Program’s Tip Sheets for Kids with Type 2

    • What is Diabetes?

    • Be Active

    • Stay at a Healthy Weight

    • Eat Healthy Foods



    Conclusion l.jpg
    Conclusion with Type 2

    • Increased incidence

    • Difficult to distinguish from type 1

    • Occurs at the time of intense insulin resistance due to puberty

    • Does not appear to be preceded by long asymptomatic period

    • More insulin deficiency and requirement for exogenous insulin early

    • Safety and efficacy of therapeutic agents

    • Rapid progression of co-morbidities and complications


    Thank you l.jpg

    Thank you with Type 2

    [email protected]


    ad