Try a new search

Format these results:

Searched for:

keyword:diabetes

department:pediatrics

recent-years:5

school:SOM

Total Results:

90


Epidemiologic Assessment of Pediatric Inflammatory Bowel Disease Presentation in NYC During COVID-19

Rosenbaum, Janet E; Ochoa, Kenny Castro; Hasan, Faria; Goldfarb, Alexa; Tang, Vivian; Tomer, Gitit; Wallach, Thomas
Inflammatory bowel disease (IBD) pathogenesis is thought to be induced by a mix of genetic susceptibility, microbial populations, and immune triggers such as infections. Severe acute respiratory syndrome coronavirus 2 (SARS-nCoV2) may have increased capacity to generate autoimmune disease as evidenced by known spikes in diseases such as type 1 diabetes mellitus. Public health interventions like masking and closures additionally created remarkable drops in typical viral infections, with remarkable shifts in influenza-like illness reporting in 2020. This study aims to evaluate the impact of SARS-nCoV2 and associated interventions on pediatric IBD presentation in New York City using records of new diagnoses at a consortium of 4 institutions between 2016 and June 2022. We fit time series model (autoregressive integrated moving average model) to monthly and quarterly number of cases of each disease for January 2016-March 2020 and forecast the period between April 2020 and June 2022. We note no decrease in ulcerative colitis (UC) or Crohn disease (CD) in the aftermath of historic low levels of overall viral illness, and statistically significant increases in CD diagnoses and elevation in UC diagnoses creating a trend suggesting overall increase in IBD diagnoses exceeding the baseline rate of increase. These data suggest a possible linkage between SARS-nCoV2 infection rates and subsequent pediatric IBD presentation.
PMCID:10097471
PMID: 36805627
ISSN: 1536-4801
CID: 5462232

Glucagon-like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth

Berman, Casey; Vidmar, Alaina P; Chao, Lily C
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have gained traction for the management of type 2 diabetes and obesity. Unlike several classes of antidiabetic medications that contribute to weight gain, GLP-1RAs not only reduce haemoglobin A1c, but also promote weight loss. While there is a large body of evidence supporting its safety and efficacy in adults, paediatric clinical trial data have only emerged in recent years. This review will discuss the limited treatment options for paediatric type 2 diabetes and the mechanism of action of GLP-1RAs as it pertains to physiological pathways relevant for type 2 diabetes, obesity and their related comorbidities. The outcomes of paediatric trials evaluating liraglutide, exenatide, semaglutide and dulaglutide in paediatric type 2 diabetes and obesity will be closely examined, including differences compared with adult studies. Finally, potential barriers and strategies to expanding GLP-1RA access in adolescents will be discussed. Future studies are needed to determine if the cardio-and renal-protective benefits of GLP-1RAs apply to youth-onset type 2 diabetes.
PMCID:10258616
PMID: 37313232
ISSN: 2752-5457
CID: 5534182

Diabetes, Edentulism, and Cognitive Decline: A 12-Year Prospective Analysis

Wu, B; Luo, H; Tan, C; Qi, X; Sloan, F A; Kamer, A R; Schwartz, M D; Martinez, M; Plassman, B L
Diabetes mellitus (DM) is a recognized risk factor for dementia, and increasing evidence shows that tooth loss is associated with cognitive impairment and dementia. However, the effect of the co-occurrence of DM and edentulism on cognitive decline is understudied. This 12-y cohort study aimed to assess the effect of the co-occurrence of DM and edentulism on cognitive decline and examine whether the effect differs by age group. Data were drawn from the 2006 to 2018 Health and Retirement Study. The study sample included 5,440 older adults aged 65 to 74 y, 3,300 aged 75 to 84 y, and 1,208 aged 85 y or older. Linear mixed-effect regression was employed to model the rates of cognitive decline stratified by age cohorts. Compared with their counterparts with neither DM nor edentulism at baseline, older adults aged 65 to 74 y (β = -1.12; 95% confidence interval [CI], -1.56 to -0.65; P < 0.001) and those aged 75 to 84 y with both conditions (β = -1.35; 95% CI, -2.09 to -0.61; P < 0.001) had a worse cognitive function. For the rate of cognitive decline, compared to those with neither condition from the same age cohort, older adults aged 65 to 74 y with both conditions declined at a higher rate (β = -0.15; 95% CI, -0.20 to -0.10; P < 0.001). Having DM alone led to an accelerated cognitive decline in older adults aged 65 to 74 y (β = -0.09; 95% CI, -0.13 to -0.05; P < 0.001); having edentulism alone led to an accelerated decline in older adults aged 65 to 74 y (β = -0.13; 95% CI, -0.17 to -0.08; P < 0.001) and older adults aged 75 to 84 (β = -0.10; 95% CI, -0.17 to -0.03; P < 0.01). Our study finds the co-occurrence of DM and edentulism led to a worse cognitive function and a faster cognitive decline in older adults aged 65 to 74 y.
PMID: 36908186
ISSN: 1544-0591
CID: 5495532

Analysis of Pregnancy Complications and Epigenetic Gestational Age of Newborns

Ladd-Acosta, Christine; Vang, Elizabeth; Barrett, Emily S; Bulka, Catherine M; Bush, Nicole R; Cardenas, Andres; Dabelea, Dana; Dunlop, Anne L; Fry, Rebecca C; Gao, Xingyu; Goodrich, Jaclyn M; Herbstman, Julie; Hivert, Marie-France; Kahn, Linda G; Karagas, Margaret R; Kennedy, Elizabeth M; Knight, Anna K; Mohazzab-Hosseinian, Sahra; Morin, Andréanne; Niu, Zhongzheng; O'Shea, T Michael; Palmore, Meredith; Ruden, Douglas; Schmidt, Rebecca J; Smith, Alicia K; Song, Ashley; Spindel, Eliot R; Trasande, Leonardo; Volk, Heather; Weisenberger, Daniel J; Breton, Carrie V
IMPORTANCE:Preeclampsia, gestational hypertension, and gestational diabetes, the most common pregnancy complications, are associated with substantial morbidity and mortality in mothers and children. Little is known about the biological processes that link the occurrence of these pregnancy complications with adverse child outcomes; altered biological aging of the growing fetus up to birth is one molecular pathway of increasing interest. OBJECTIVE:To evaluate whether exposure to each of these 3 pregnancy complications (gestational diabetes, gestational hypertension, and preeclampsia) is associated with accelerated or decelerated gestational biological age in children at birth. DESIGN, SETTING, AND PARTICIPANTS:Children included in these analyses were born between 1998 and 2018 and spanned multiple geographic areas of the US. Pregnancy complication information was obtained from maternal self-report and/or medical record data. DNA methylation measures were obtained from blood biospecimens collected from offspring at birth. The study used data from the national Environmental Influences on Child Health Outcomes (ECHO) multisite cohort study collected and recorded as of the August 31, 2021, data lock date. Data analysis was performed from September 2021 to December 2022. EXPOSURES:Three pregnancy conditions were examined: gestational hypertension, preeclampsia, and gestational diabetes. MAIN OUTCOMES AND MEASURES:Accelerated or decelerated biological gestational age at birth, estimated using existing epigenetic gestational age clock algorithms. RESULTS:A total of 1801 child participants (880 male [48.9%]; median [range] chronological gestational age at birth, 39 [30-43] weeks) from 12 ECHO cohorts met the analytic inclusion criteria. Reported races included Asian (49 participants [2.7%]), Black (390 participants [21.7%]), White (1026 participants [57.0%]), and other races (92 participants [5.1%]) (ie, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, multiple races, and other race not specified). In total, 524 participants (29.0%) reported Hispanic ethnicity. Maternal ages ranged from 16 to 45 years of age with a median of 29 in the analytic sample. A range of maternal education levels, from less than high school (260 participants [14.4%]) to Bachelor's degree and above (629 participants [34.9%]), were reported. In adjusted regression models, prenatal exposure to maternal gestational diabetes (β, -0.423; 95% CI, -0.709 to -0.138) and preeclampsia (β, -0.513; 95% CI, -0.857 to -0.170), but not gestational hypertension (β, 0.003; 95% CI, -0.338 to 0.344), were associated with decelerated epigenetic aging among exposed neonates vs those who were unexposed. Modification of these associations, by sex, was observed with exposure to preeclampsia (β, -0.700; 95% CI, -1.189 to -0.210) and gestational diabetes (β, -0.636; 95% CI, -1.070 to -0.200), with associations observed among female but not male participants. CONCLUSIONS AND RELEVANCE:This US cohort study of neonate biological changes related to exposure to maternal pregnancy conditions found evidence that preeclampsia and gestational diabetes delay biological maturity, especially in female offspring.
PMCID:9958528
PMID: 36826815
ISSN: 2574-3805
CID: 5448302

DIFFERENCES IN DIABETES TECHNOLOGY USE ONLY PARTIALLY EXPLAIN DISPARITIES IN TYPE 1 DIABETES OUTCOMES AMONG MINORITY YOUTH [Meeting Abstract]

Namkoong, L; Stein, C; Ilkowitz, J; Gonzalez, J; Joseph, V; Gallagher, M P
Background and Aims: Diabetes technology (DT) use is associated with lower HbA1c in type 1 diabetes (T1D). Non- Hispanic Black and Hispanic populations are more likely to have lower DT use and higher HbA1c compared to non-Hispanic White populations. We examined the extent to which differential DT use explains outcome disparities at an outpatient pediatric diabetes center in NYC.
Method(s): Patients identifying as non-White, Hispanic, or non-English language preference were grouped (minority race/ language; MRL) and compared to non-Hispanic White, Englishpreferred patients. HbA1c >9% was categorized as high. T-test and chi-square statistics compared patient characteristics by HbA1c category. Binomial regression with generalized estimating equations estimated associations (risk ratios, RR; 95% confidence intervals, CI) between MRL and high HbA1c. First, models were adjusted for insurance type and Child Opportunity Index (COI), then additionally for CGM and pump use.
Result(s): Patients (n = 331) aged 2-25 years with T1D >= 3 months attended 709 visits (mean 2.2, SD 1.2) from 2020-2021; 32% identified as MRL. At the most recent visit, 16% had HbA1c>9% (MRL 29%, non-MRL 10%), 87% used CGMs (MRL 77%, non-MRL 92%), and 78% used pumps (MRL 72%, non-MRL 81%). MRL youth were 2.5 (95% CI 1.6-4.0) times more likely to have HbA1c>9% as compared to non-MRL youth, adjusted for insurance and COI. After adjusting for DT use, MRL youth remained twice as likely to have HbA1c>9% (RR 2.0, 95% CI 1.2-3.3).
Conclusion(s): While the disparity in HbA1c between MRL and non-MRL youth can be partially attributed to DT use, disparity persists even after accounting for DT use
EMBASE:640506971
ISSN: 1557-8593
CID: 5512052

Association Between Self-Reported Polycystic Ovary Syndrome with Chronic Diseases Among Emiratis: A Cross-Sectional Analysis from the UAE Healthy Future Study

Juber, Nirmin F.; Abdulle, Abdishakur; Aljunaibi, Abdulla; Alnaeemi, Abdulla; Ahmad, Amar; Leinberger-Jabari, Andrea; Al Dhaheri, Ayesha S.; Alzaabi, Eiman; Al-Maskari, Fatma; Alanouti, Fatme; Alsafar, Habiba; Alkaabi, Juma; Wareth, Laila Abdel; Aljaber, Mai; Kazim, Marina; Weitzman, Michael; Al-Houqani, Mohammad; Hag-Ali, Mohammed; Oumeziane, Naima; Sherman, Scott; Shah, Syed M.; Almahmeed, Wael; Idaghdour, Youssef; Loney, Tom; El-Shahawy, Omar; Ali, Raghib
Purpose: This study aimed to assess the prevalence of self-reported polycystic ovary syndrome (PCOS) among Emiratis and examine bi-directional associations of PCOS with self-reported chronic diseases, namely: diabetes, asthma, high cholesterol, and high blood pressure. Patients and Methods: A cross-sectional analysis was performed using the UAE Healthy Future Study (UAEHFS) data collected from February 2016 to April 2022 involving 1040 Emirati women aged 25"“67 years from recruitment centers in the United Arab Emirates (UAE). The bi-directional associations between self-reported PCOS and self-reported chronic diseases were evaluated by establishing temporality based on reported age-at-diagnoses. Firstly, the associations between PCOS (diagnosed at ≥25 years) and chronic diseases (diagnosed at <25 years) were examined, followed by PCOS (diagnosed at <25 years) and chronic diseases (diagnosed at ≥25 years). Finally, a Poisson regression under unadjusted and age-and-body mass index (BMI) adjusted models was performed to obtain the risk ratio (RR) and its 95% confidence interval (CI). Results: The prevalence of PCOS in this study was 25.9%. Those with asthma and high cholesterol diagnosed at <25 years had increased risks of PCOS diagnosed at ≥25 years (RR = 1.79, 95% CI: 1.17"“2.76 for asthma; and RR = 1.61, 95% CI: 1.01"“2.59 for high cholesterol), compared to those respective healthier counterparts, after adjusting for age and BMI. No significant association was observed between PCOS diagnosed at <25 years and respective chronic diseases diagnosed at ≥25 years. Conclusion: PCOS prevalence among Emirati women was high. Asthma and high cholesterol in earlier life were associated with PCOS in later life. Understanding how chronic disease conditions and PCOS are associated in bi-directional ways may improve the surveillance of chronic disease conditions among women with PCOS and may also contribute to more targeted PCOS prevention strategies.
SCOPUS:85148649993
ISSN: 1179-1411
CID: 5445752

Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative

Marks, Brynn E.; Mungmode, Ann; Neyman, Anna; Levin, Laura; Rioles, Nicole; Eng, Donna; Lee, Joyce M.; Basina, Marina; Hawah-Jones, Nana; Mann, Elizabeth; O"™Malley, Grenye; Wilkes, Meredith; Steenkamp, Devin; Aleppo, Grazia; Accacha, Siham; Ebekozien, Osagie
This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes.
SCOPUS:85150042490
ISSN: 0891-8929
CID: 5447032

DANTROLENE: EMPIRIC USE TO INCREASE SURVIVAL IN MALIGNANT HYPERTHERMIALIKE SYNDROME [Meeting Abstract]

Silber, Y; Groves, K
INTRODUCTION: The distinct clinical entity known as Hyperosmolar Diabetic Ketoacidosis (H-DKA) is increasing in incidence without simultaneous advances in treatment. There are limited reports of an associated fatal syndrome characterized by a Malignant Hyperthermia-like (MH-L) picture with persistent fever, rhabdomyolysis and cardiac compromise. Evidence supports the use of empiric treatment with Dantrolene to decrease mortality in these cases. This report highlights a case of patient survival with early, empiric Dantrolene administration. DESCRIPTION: A 15-year-old male with ADHD and obesity presented to the hospital after being found unresponsive at home. He was intubated with succinylcholine and started on an insulin drip and maintenance fluids. He was admitted with fluid-refractory, hypovolemic shock secondary to H-DKA and new onset Type II Diabetes Mellitus. He was afebrile at presentation, but developed high fevers within hours of insulin initiation which persisted, despite use of scheduled acetaminophen and cooling blankets. He then developed rhabdomyolysis (CK: 9,680 U/L), pancreatitis (lipase: 2,103 U/L) and severe AKI (Creatinine: 5.4 mg/dL). High fevers persisted, blood and urine cultures remained negative, thus given concern for MH-L picture, Dantrolene 2.5mg/kg (240mg) was administered and he defervesced to 37 degreeC. He then developed significant cardiac dysfunction with ST elevations on ECG, high troponin levels (Troponin: 21,534 ng/L), and depressed LV function (EF: 35%), thought to be secondary to Myopericarditis given normal cardiac catheterization. Ultimately, fevers persisted without an identified source, but inflammatory markers downtrended and cultures remained negative. DISCUSSION: H-DKA with associated rhabdomyolysis, cardiac dysfunction, and MH-L picture is rarely reported and associated with significant mortality. This case demonstrates the effective use of Dantrolene administration with transient improvement in the patient's fever curve and patient survival. Evolving evidence supports the entity referred to as "awake- MH" in which there is no triggering anesthetic agent, but a possible underlying genetic cause due to a variant in the RYR1 gene. Genetic testing may be considered in patients with H-DKA, rhabdomyolysis and persistent fever without a source
EMBASE:640006955
ISSN: 1530-0293
CID: 5513682

Exercise and cardiovascular health: A state-of-the-art review

Isath, Ameesh; Koziol, Klaudia J; Martinez, Matthew W; Garber, Carol Ewing; Martinez, Matthew N; Emery, Michael S; Baggish, Aaron L; Naidu, Srihari S; Lavie, Carl J; Arena, Ross; Krittanawong, Chayakrit
Cardiovascular (CV) disease (CVD) is the leading cause of global morbidity and mortality, and low levels of physical activity (PA) is a leading independent predictor of poor CV health and associated with an increased prevalence of risk factors that predispose to CVD development. In this review, we evaluate the benefits of exercise on CV health. We discuss the CV adaptations to exercise, focusing on the physiological changes in the heart and vasculature. We review the impact and benefits of exercise on specific CV prevention, including type II diabetes, hypertension, hyperlipidemia, coronary artery disease, and heart failure, in addition to CVD-related and all-cause mortality. Lastly, we evaluate the current PA guidelines and various modes of exercise, assessing the current literature for the effective regimens of PA that improve CVD outcomes.
PMID: 37120119
ISSN: 1873-1740
CID: 5465772

Association of Gestational Diabetes Mellitus and Perinatal Maternal Depression with Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study

Shuffrey, Lauren C; Morales, Santiago; Jacobson, Melanie H; Bosquet Enlow, Michelle; Ghassabian, Akhgar; Margolis, Amy E; Lucchini, Maristella; Carroll, Kecia N; Crum, Rosa M; Dabelea, Dana; Deutsch, Arielle; Fifer, William P; Goldson, Brandon; Hockett, Christine W; Mason, W Alex; Jacobson, Lisette T; O'Connor, Thomas G; Pini, Nicolò; Rayport, Yael; Sania, Ayesha; Trasande, Leonardo; Wright, Rosalind J; Lee, Seonjoo; Monk, Catherine
This study examined the association of gestational diabetes mellitus (GDM), prenatal, and postnatal maternal depressive symptoms with externalizing, internalizing, and autism spectrum problems on the Preschool Child Behavior Checklist in 2379 children aged 4.12 ± 0.60 (48% female; 47% White, 32% Black, 15% Mixed Race, 4% Asian, <2% American Indian/Alaskan Native, <2% Native Hawaiian; 23% Hispanic). Data were collected from the NIH Environmental influences on Child Health Outcomes (ECHO) Program from 2009-2021. GDM, prenatal, and postnatal maternal depressive symptoms were each associated with increased child externalizing and internalizing problems. GDM was associated with increased autism behaviors only among children exposed to perinatal maternal depressive symptoms above the median level. Stratified analyses revealed a relation between GDM and child outcomes in males only.
PMID: 37132048
ISSN: 1467-8624
CID: 5544842