Diabetes In Youth Research Articles

Screening for Cystic Fibrosis–Related Diabetes and Prediabetes—Evaluating 1,5-Anhydroglucitol, Fructosamine, Glycated Albumin, and Hemoglobin A1c

Dysglycemia in the cystic fibrosis (CF) population is widespread and screening via oral glucose tolerance tests (OGTT) can be burdensome. Our primary aim was to investigate 1,5-anhydroglucitol (1,5AG), fructosamine (FA), glycated albumin (%GA), and hemoglobin A1c (HbA1c) as screening tests for cystic fibrosis-related prediabetes (CFPD) and cystic fibrosis-related diabetes (CFRD) in youth with CF as defined by the OGTT 2-hour glucose (2hG). Our secondary aim was to determine if alternate screening tests can identify those with better or worse lung function (forced expiratory volume in 1 second, FEV1%; forced vital capacity, FVC%). Youth 10-18 years with CF had 1,5AG, FA, %GA, HbA1c, and a 2 hour OGTT collected during a single study visit. Pearson’s correlation coefficient determined the correlation between all 4 glycemic estimates and 2hG. Receiver Operative Characteristic (ROC) curves were generated. The Youden Index determined optimal cut points for predicting CFPD (2hG≥140-200 mg/dL) and CFRD (2hG≥200 mg/dL). Lung function measures above and below these cutpoints were compared. Fifty-eight youth with CF participated (2hG<140, n=31; CFPD, n=17; CFRD, n=10; mean age 14±3.5 years, 43% male, BMI z-score 0.0±0.8, FEV1% 90±15.0, FVC% 99±14.1). FA, %GA, and HbA1c correlated with 2hG (p-<0.05). ROC area under the curves (ROC-AUCs) for all 4 alternate markers were low for both CFPD (0.53-0.67) and CFRD (0.56-0.66). HbA1c had the highest ROC-AUC of 0.66 (95% CI: 0.47-0.84) for identifying CFRD and 0.67 (95% CI: 0.53-0.8) for CFPD. When lung function was compared stratifying above and below the Youden cutpoint for CFRD, only HbA1c identified significant differences in FVC% (105% vs. 96%, p=0.02); FEV1% was not statistically significant (96% vs. 88%, p=0.06). All 4 alternate markers had poor diagnostic accuracy for identifying CFRD by 2hG, although HbA1c may be useful in detecting CFPD and in stratifying individuals with CF by lung function. Disclosure K.L. Tommerdahl: None. J.T. Brinton: None. T.B. Vigers: None. K.J. Nadeau: None. P. Zeitler: Consultant; Self; Daiichi Sankyo Company, Limited, Merck & Co., Inc., Eli Lilly and Company, Takeda Development Center Americas, Inc., Boehringer Ingelheim GmbH. C.L. Chan: None.

Vitamin D Levels Are Associated with Risk Factors for Type 2 Diabetes and Metabolic Syndrome in Chinese Youths

Evidence regarding association between vitamin D deficiency and metabolic syndrome (MS) remains controversial and relatively sparse among youth. We aimed to explore the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and risk factors for type 2 diabetes and MS in Chinese adolescents and young adults. A total of 559 subjects aged 14-28 years with high risk of MS were recruited from the Beijing Child and Adolescent Metabolic Syndrome Study cohort in 2012. All subjects underwent a 2h-oral glucose tolerance test. The concentrations of 25(OH)D, glucose, insulin and lipids were determined. MS was defined by the 2009 harmonized definition. The prevalence of vitamin D deficiency (< 20 ng/ml) was 78.3%. After adjusting for age, gender and visiting season, 25(OH)D levels were negatively correlated with percent body fat, LDL-C, fasting and 2h-glucose levels (all p < 0.05). 25(OH)D levels were significantly lower in subjects with obesity, high TG, type 2 diabetes, or MS, compared to their counterparts, respectively (all p < 0.05). After adjustment for potential confounders including body mass index, subjects in the lowest vs. highest tertile of 25(OH)D levels was 2.5 times more likely to have MS (Odds 95% CI: 1.13-5.45, p < 0.05). Vitamin D deficiency was very common in this young Chinese population with risk for MS. Given the negative association between vitamin D level and cardiometabolic risk factors, effective sun exposure and vitamin D supplementation should be encouraged in youths, particular in those with high MS risk. Disclosure S. Gao: None. L. Han: None. J. Fu: None. G. Li: None. M. Li: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim GmbH. Other Relationship; Self; Caladrius Biosciences, Inc.. Consultant; Self; GlaxoSmithKline plc., JAEB Center For Health Research.

Serum Uromodulin (SUMOD) Inversely Correlates with Aortic Stiffness in Type 1 Diabetes (T1D) Youth

Lower SUMOD correlates with decreasing kidney function and atherosclerosis in adults with T1D, but its relationship with markers of arterial stiffness in youth with T1D is unknown. We sought to evaluate the relationship between SUMOD and central arterial stiffness in youth with T1D. Participants (n=49, 12-21 years old, 51% female, BMI 25.2±4.6 kg/m2, mean HbA1c8.6±1.4) were enrolled in EMERALD, a randomized controlled trial of metformin in youth with T1D. Post-hoc SUMOD was measured using Euroimmun ELISA kits from serum from the baseline visit. Ascending (AA) and descending aortic (DA) stiffness (pulse wave velocity [PWV] and strain) were determined by MRI at baseline and 3 months of follow-up. SUMOD positively correlated with AA strain (r: 0.37, p=0.04) and negatively with AA PWV (r: -0.41, p=0.03). According to SUMOD tertiles, participants in the lower tertile had higher AA PWV vs. the middle and high tertiles (Figure). Lower baseline SUMOD also predicted worsening in AA PWV over 3 months (β±SE: -0.04±0.01, p=0.03) adjusting for age, sex, baseline AA PWV, treatment group (metformin vs. placebo) and estimated glomerular filtration rate. In T1D youth, decreased SUMOD is associated with increased aortic stiffness. Further research is needed in T1D youth to understand the pathogenesis of SUMOD in cardiovascular disease. Disclosure P. Wiromrat: None. P. Bjornstad: Consultant; Self; Boehringer Ingelheim GmbH. C. Roncal-Jimenez: None. M. Schäfer: None. A. Baumgartner: None. L. Pyle: None. M. Cree-Green: None. Y. Garcia Reyes: None. L. Browne: None. R. Johnson: Board Member; Self; XORT Therapeutics. Stock/Shareholder; Self; Colorado Research Partners LLC. Consultant; Self; Danone Research Foundation. K.J. Nadeau: None.

Adipocyte Insulin Resistance Index in Youth along the Span of Glycemia from Normal Glucose Tolerance (NGT) to Impaired Glucose Tolerance (IGT) to Type 2 Diabetes (T2D)

One of the pathophysiological components of T2D is adipocyte insulin resistance. We demonstrated diminished insulin suppression of lipolysis, using the hyperinsulinemic-euglycemic clamp combined with [2H5]glycerol tracer, in obese IGT vs. NGT youth (Diabetes 66: 2017). Herein we examined a surrogate index of adipose tissue insulin resistance (AT-IR= fasting insulin x FFA) to test the hypothesis that AT-IR increases from normal weight (NW) to obese NGT to IGT to T2D. A total of 2youth (70 M/135 F; Tanner IV-V) had body composition, visceral adipose tissue (VAT), fasting glucose, insulin and free fatty acids (FFA), and AT-IR evaluated. Despite hyperinsulinemia in obese IGT youth, fasting FFA was higher compared with NW and obese NGT peers (Table). AT-IR was 2.2 fold higher in obese NGT, 4.3 fold higher in IGT and 4.6 fold higher in T2D compared with NW before and after adjusting for sex, Tanner stage, BMI and VAT. In conclusion, the surrogate index of AT-IR reflects pathophysiological alterations in adipose tissue insulin sensitivity showing progressive increase in AT-IR in youth from normal weight to obese, and from NGT to IGT to T2D. This AT-IR, derived from fasting blood samples, could be used in epidemiological, observational and/or interventional studies investigating changes in adipocyte insulin sensitivity in obese youth with IGT and T2D. Variables, mean ± SEMNW (n=49)Obese-NGT (n=89)Obese-IGT (n=38)Obese-T2D (n=29)P, ANCOVAAge (years)14.4 ± 0.314.6 ± 0.214.9 ± 0.415.2 ± 0.3NSBMI (kg/m2)20.6 ± 0.333.9 ± 0.736.8 ± 1.036.8 ± 1.0<0.0001Visceral adipose tissue (cm2)24.4 ± 2.260.8 ± 4.185.1 ± 5.183.6 ± 7.7<0.0001Fasting glucose (mg/dL)95.1 ± 0.895.4 ± 0.696.8 ± 1.2121.5 ± 4.8<0.0001Fasting insulin (µU/mL)16.2 ± 0.831.3 ± 1.550.4 ± 4.957.6 ± 9.6<0.0001Fasting FFA (mmol/L)0.25 ± 0.020.28 ± 0.010.35 ± 0.020.32 ± 0.020.001AT-IR (µU/mL x mmol/L)4.± 0.388.98 ± 0.6917.51 ± 1.9918.59 ± 3.00<0.0001 Disclosure J. Kim: None. F. Bacha: Research Support; Self; AstraZeneca, JAEB Center For Health Research, National Institutes of Health, Pediatric Diabetes Consortium. H. Tfayli: None. S. Michaliszyn: None. S.A. Arslanian: None.

Racial Ethnic Disparities in Diabetes Youth Participating in Diabetes Summer Camps

Background: Diabetes camps are beneficial for campers, including increases in diabetes knowledge, glycemic control and psychological functioning. Racial/ethnic minority youth are likely to have poorer disease management and glycemic control, more complications, and are often managed with less intensive, less technologically advanced regimens. We hypothesized that racial/ethnic minority youth with type 1 diabetes (T1D) would have reduced participation in diabetes summer camps. Methods: We reviewed de-identified data from 5033 campers with T1D who participated in a network of 46 ADA-affiliated summer camps during the 2017 season. We performed t-tests and chi-square analysis to analyze the demographic characteristics of white vs. non-white campers. Results: Campers with T1D came from all over the U.S. (49 states), 68.4% were return campers, 55% were female, ages ranging from 4-18 (m =11.7 ±2.8). Of campers, 73.2% were on insulin pump regimens. Camps cost $0 to $1400 (Day Camps M=$158.83 ± $103.69, Residential Camps M=$622.73 ± $274.26). Campers identified as caucasian (83.9%), black (4.8%), Hispanic (3.9%), Asian/Pacific Islander (2.7%), and Multiracial (3.9%). We compared ethnicity data to the 2009 SEARCH data from children and adolescents where T1D prevalence was 72% in caucasians, 9% black, 15% Hispanic and 2% Asian/Pacific Islander. Camper demographics were significantly different than the general population of children with T1D (p<0.001). Racial/ethnic minority status was associated with type of camp attended (day vs. residential), and minority campers were less likely to be on insulin pump therapy. Conclusions: Children of ethnic minorities with diabetes are underrepresented in diabetes camps nationwide compared to the prevalence of diabetes in each minority group as described by the SEARCH study. This highlights the need to assess barriers to camp attendance in these communities and to design outreach programs to increase minority youth participation in the diabetes camp experience. Disclosure J.M. Valenzuela: None. M.T. Martin: None. S. Records: None. K. O'NEal: None. K. Mueller: None. R.M. Wolf: None.

Engaging Native American Caregivers in Youth-Focused Diabetes Prevention and Management.

Native American youth aged 10 to 19 years are disproportionately affected by type 2 diabetes. Intergenerational programs may improve health in tribal communities. We evaluated Together on Diabetes, a diabetes prevention and management program, among 257 participating Native American youths with or at risk for type 2 diabetes and their adult caregivers. Feasibility, acceptability, and demographic data were collected from 226 adult caregivers. Data on physical measurements (weight, height, waist circumference) were collected from 37 of the caregivers. Results indicated that engaging adult caregivers was feasible, acceptable, and effective. Furthermore, a subset of adult caregivers reduced their body mass index (weight in kilograms divided by height in m2) significantly from the start to the end of the program, a 12 month period (P = .02). Findings suggest the feasibility of engaging adult caregivers in youth diabetes prevention programs.

Methods for Measuring Risk for Type 2 Diabetes in Youth: the Oral Glucose Tolerance Test (OGTT).

The oral glucose tolerance test (OGTT) is used both in clinical practice and research to assess glucose tolerance. In addition, the OGTT is utilized for surrogate measures of insulin sensitivity and the insulin response to enteral glucose and has been widely applied in the evaluation of β-cell dysfunction in obesity, prediabetes, and type 2 diabetes. Here we review the use of the OGTT and the OGTT-derived indices for measurement of risk markers for type 2 diabetes in youth. Advantages of using the OGTT for measures of diabetes risk include its accessibility and the incorporation of physiological contributions of the gut-pancreas axis in the measures of insulin response to glucose. Mathematical modeling expands the potential gains from the OGTT in physiology and clinical research. Disadvantages include individual differences in the rate of glucose absorption that modify insulin responses, imperfect control of the glycemic stimulus, and poor intraindividual reproducibility. Available research suggests the OGTT provides valuable information about the development of impaired glycemic control and β-cell function in obese youth along the spectrum of glucose tolerance.

Dietary Patterns Over Time and Microalbuminuria in Youth and Young Adults With Type 1 Diabetes: The SEARCH Nutrition Ancillary Study.

We assessed the association between diet quality and microalbuminuria in youth-onset type 1 diabetes using three indices: a modified Mediterranean diet score for children and adolescents (mKIDMED), the Dietary Approaches to Stop Hypertension (DASH), and the Healthy Eating Index-2010 (HEI). Youth and young adults from the SEARCH (SEARCH for Diabetes in Youth) Nutrition Ancillary Study (SNAS) diagnosed with type 1 diabetes in 2002-2008, who had repeated dietary assessments at baseline and follow-up visits and urine albumin-to-creatinine ratio (UACR) measured at the outcome visit (2012-2015) (n = 461), were selected for study. Regression models estimated the association between each longitudinally assessed diet score and UACR and microalbuminuria (UACR ≥30 μg/mg). The cohort was 43% female, and at follow-up, mean age was 20 years, disease duration was 108 months, and 7% had microalbuminuria. Adherence to a higher-quality diet was low for the mKIDMED (mean 3.7 of a possible range of -3 to 12) and the DASH (mean 42 of 80) and better, for the HEI (mean 56.3 of 100). A borderline inverse association was observed between the HEI score and microalbuminuria after adjustment for caloric and protein intake and demographic and disease factors (odds ratio [OR]HEI 0.83, P = 0.07), which lost significance with further adjustment for HbA1c and systolic blood pressure (ORHEI 0.86, P = 0.19). Results were similar for continuous UACR. No significant associations were observed for diet quality characterized by the mKIDMED or DASH indices. Greater adherence to the HEI may be beneficial for kidney health in youth and young adults with type 1 diabetes. Low adherence to the mKIDMED and DASH diets may explain the lack of association with microalbuminuria.

Identifying Prediabetes and Type 2 Diabetes in Asymptomatic Youth: Should HbA1c Be Used as a Diagnostic Approach?

Because the incidence of type 2 diabetes and prediabetes in children is rising, routine screening of those at risk is recommended. In 2010, the ADA made the recommendation to include hemoglobin A1c (HbA1c) as a diagnostic test for diabetes, in addition to the oral glucose tolerance test or fasting plasma glucose. Our objective was to assess the pediatric literature with regard to HbA1c test performance and discuss advantages and disadvantages of use of the test for diagnostic purposes. HbA1c has a number of advantages, including elimination of the need for fasting, lower variability, assay standardization, and long-term association with future development of diabetes. It also has many drawbacks. It can be affected by a number of non-glycemic factors, including red blood cell turnover, hemoglobinopathies, medications, race, and age. In particular, it performs differently in children compared with adults, generally with lower sensitivity for prediabetes (as low as 0-5% in children vs 23-27% in adults) and lower area under the receiver operating characteristic curve (AUC) (0.53 vs 0.73 for prediabetes), and it has lower efficacy at a higher cost, compared with other tests of glycemia. Finally, HbA1c may perform very differently across diverse populations according to race/ethnicity; in Chinese populations, the proportion of individuals classified with prediabetes based on HbA1c predominates compared with IFG (77% for HbA1c vs 27.7% for IFG), whereas in US populations, it is the opposite (24.8% for HbA1c vs 80.1% for FPG). HbA1c is controversial because although it is convenient, it is not a true measure of glycemia. The interpretation of HbA1c results requires a nuanced understanding that many primary care physicians who are ordering the test in greater numbers do not possess. Alternative markers of glycemia may hold promise for the future but are not yet endorsed for use in practice. Further studies are needed to determine appropriate thresholds for screening tests and the long-term impact of screening and identification.

Using financial incentives to promote physical activity in American Indian adolescents: A randomized controlled trial.

American Indians (AI) have high prevalence of diabetes in youth and may benefit from increasing physical activity as a strategy to improve metabolic health. We tested whether financial incentives would elicit greater frequency and/or duration of exercise in AI youth at high risk for developing diabetes. Overweight/obese AI boys and girls, 11–20 years old, were instructed to exercise on 3 days/week for 48 weeks at a tribal wellness center. The program was divided into three, 16-week-long phases to test different financial incentive strategies. Within each phase participants were randomly assigned to one of two groups that received different payments for exercise. Phase 1 was designed to test whether the size of the incentive would affect exercise frequency. In Phase 1, the number of exercise sessions did not differ between the group receiving a modest fixed-value payment per exercise session and the group receiving enhanced incentives to exercise more frequently (26 ± 3 versus 28 ± 2 sessions, respectively, p = 0.568). In Phase 2, the provision of an enhanced financial incentive to increase exercise duration resulted longer sessions, as the incentivized and standard payment groups exercised 38 ± 2 versus 29 ± 1 minutes per session (p = 0.002), respectively. In Phase 3, the effect of reducing the incentives on maintenance of exercise behaviors was inconclusive due to high participant withdrawal. Aerobic fitness increased 10% during Phase 1 but was unchanged thereafter. Insulin sensitivity and body composition were unchanged during the study. In conclusion, enhanced financial incentives increased the duration of exercise sessions, but had minimal effects on exercise participation. These results indicate that financial incentives hold promise in motivating previously sedentary, overweight/obese adolescents to exercise longer, but motivating them to sustain an exercise program remains the major challenge.Trial Registration: ClinicalTrials.gov NCT01848353.

P164 How can continuous glucose monitoring system impact on therapy of Cystic Fibrosis-Related Diabetes (CFRD) in youth

P164 How can continuous glucose monitoring system impact on therapy of Cystic Fibrosis-Related Diabetes (CFRD) in youth

Type 2 Diabetes in Youth: New Lessons from the SEARCH Study.

The purpose of this review is to provide an update on the recent body of evidence emerging for type 2 diabetes as identified through the SEARCH for Diabetes in Youth study. This body of evidence illustrates that type 2 diabetes continues to increase in incidence, although this increase may be partially attributable to increased surveillance. Disease management is influenced by the transition from adolescent to adult care and psychosocial factors may also contribute. This evidence also describes a high prevalence of disease-associated complications and comorbidities. Risk factors for cardiovascular disease are also highly prevalent. The SEARCH for Diabetes in Youth study continues to inform our understanding of the descriptive epidemiology and natural history of type 2 diabetes in youth. As the cohort matures, new opportunities emerge for building on our understanding of how youth-onset type 2 diabetes impacts future health.

Menstrual Dysfunction in Girls From the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study.

Little is known about reproductive function in girls with youth-onset type 2 diabetes. To characterize girls with irregular menses and effects of glycemic treatments on menses and sex steroids in the Treatment Options for Type 2 Diabetes in Youth (TODAY) study. Differences in demographic, metabolic, and hormonal characteristics between regular- vs irregular-menses groups were tested; treatment group (metformin with or without rosiglitazone, metformin plus lifestyle) effect on menses and sex steroids over time in the study was assessed. This is a secondary analysis of TODAY data. Multicenter study in an academic setting. TODAY girls not receiving hormonal contraception and those at least 1-year postmenarche were included. Irregular menses was defined as three or fewer periods in the prior 6 months. Of eligible participants with serum measurement of sex steroids (n = 190; mean age, 14 years), 21% had irregular menses. Those with irregular vs regular menses had higher body mass index (BMI) (P = 0.001), aspartate aminotransferase (AST) (P = 0.001), free androgen index (P = 0.0003), and total testosterone (P = 0.01) and lower sex hormone-binding globulin (SHBG) (P = 0.004) and estradiol (P = 0.01). Differences remained after adjustment for BMI. There was no treatment group effect on menses or sex steroids at 12 or 24 months, and no association of sex steroids was seen with measures of insulin sensitivity or secretion. Menstrual dysfunction is common in girls with recently diagnosed type 2 diabetes and associated with alterations in sex steroids, SHBG, and AST but not with alteration in insulin sensitivity or β-cell function and did not improve with 2 years of antihyperglycemic treatment.

Metabolic control of type 1 diabetes in youth with autism spectrum disorder: A multicenter Diabetes-Patienten-Verlaufsdokumentation analysis based on 61 749 patients up to 20 years of age.

A paucity of reports in the literature exists concerning the co-existence between autism spectrum disorder (ASD) and type 1 diabetes (T1D). To compare clinical characteristics, diabetes management and metabolic control in youth with T1D and ASD (T1D-ASD) with youth without ASD (T1D-non ASD). Using the German/Austrian diabetes patient follow-up registry, this study analyzed aggregated data from the last available year of observation for each patient with T1D, ages 1-20 with consistent data on insulin regimen and glycated hemoglobin (A1C), between January, 2005 and March, 2017. From 61 749 patients, 150 (0.24%) were identified as T1D-ASD. Non-adjusted comparisons showed similar results for mean age at onset and duration of diabetes, but not for gender (male: T1D-ASD: 85.3%; T1D-non ASD: 52.8%; P < .001). Unadjusted comparisons showed no difference for severe hypoglycemia, diabetic ketoacidosis, insulin doses, insulin pump therapy, and body mass index. A statistical difference was observed for A1C (P-value .01) and in the number of blood glucose (SMBG) tests/day (median [interquartile range]: T1D-ASD 6.0 [4.4-7.0]; T1D-non ASD 5.0 [4.4-7.0]; P-value < .001). After adjusting for age, gender, duration of diabetes, and year of observation, only SMBG remained significant (P-value .003). T1D-ASD used psycho-stimulants (15.3% vs 2.2%; P-value < .001), antipsychotics (10.7% vs 0.6%; P-value < .001), and antidepressive medications (3.6% vs 0.7%; P-value < .001) more frequently. Metabolic control was similar in the T1D-ASD group compared to T1D-non ASD despite their comorbidity. Awareness of ASD remains important in T1D treatment, as both conditions require long-term multi-disciplinary medical follow-up for optimal outcomes.

Pediatric endocrine society survey of diabetes practices in the United States: What is the current state?

The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system.

Ambient and Traffic-Related Air Pollution Exposures as Novel Risk Factors for Metabolic Dysfunction and Type 2 Diabetes.

Diabetes mellitus is a top contributor to the global burden of mortality and disability in adults. There has also been a slow, but steady rise in prediabetes and type 2 diabetes in youth. The current review summarizes recent findings regarding the impact of increased exposure to air pollutants on the type 2 diabetes epidemic. Human and animal studies provide strong evidence that exposure to ambient and traffic-related air pollutants such as particulate matter (PM), nitrogen dioxide (NO2), and nitrogen oxides (NOx) play an important role in metabolic dysfunction and type 2 diabetes etiology. This work is supported by recent findings that have observed similar effect sizes for increased exposure to air pollutants on clinical measures of risk for type 2 diabetes in children and adults. Further, studies indicate that these effects may be more pronounced among individuals with existing risk factors, including obesity and prediabetes. Current epidemiological evidence suggests that increased air pollution exposure contributes to alterations in insulin signaling, glucose metabolism, and beta (β)-cell function. Future work is needed to identify the specific detrimental pollutants that alter glucose metabolism. Additionally, advanced tools and new areas of investigation present unique opportunities to study the underlying mechanisms, including intermediate pathways, that link increased air pollution exposure with type 2 diabetes onset.

Development and Validation of the Pediatric Diabetes Routines Questionnaire for Adolescents.

This study describes the development and psychometric evaluation of an adolescent self-report version of the Pediatric Diabetes Routines Questionnaire (PDRQ:A), a measure of diabetes-specific routines for youth with type 1 diabetes, and further validation of the parent-version (PDRQ:P) in an adolescent sample. Participants included 120 parent-adolescent dyads (ages 12-17) and an additional 24 parents who completed measures of diabetes-specific adolescent routines, general adolescent routines, diabetes self-care, and family support of youth diabetes care. The PDRQ:P/A demonstrated good internal consistency, test-retest reliability, and parent-child agreement, and adequate validity coefficients. Confirmatory factor analysis supported a one-factor model. Promising results were obtained. The PDRQ:P/A is a clinically feasible parent- and self-report measure that can provide valuable information regarding how frequently adolescents engage in their diabetes management tasks in a consistent manner. Addition of an adolescent report format will enhance the utility of the measure for clinical and research use.

Type 1 Diabetes in Children and Adolescents.

Type 1 Diabetes in Children and Adolescents.

Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Obese Adolescents

Because of the substantial increase in the occurrence of type 2 diabetes in the pediatric population and the medical complications of this condition, therapies are urgently needed that will achieve better glycemic control than standard medical management. To compare glycemic control in cohorts of severely obese adolescents with type 2 diabetes undergoing medical and surgical interventions. A secondary analysis of data collected by the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) consortia was performed. Teen-LABS enrolled 242 adolescents (≤19 years of age) from March 1, 2007, through December 31, 2011. TODAY randomized 699 participants (aged 10-17 years) from July 24, 2004, through February 25, 2009. Data analysis was performed from July 6, 2015, to June 24, 2017. Anthropometric, clinical, and laboratory data from adolescents with severe obesity and type 2 diabetes who underwent treatment with metabolic or bariatric surgery in the Teen-LABS study or medical therapy in the TODAY study were compared. Teen-LABS participants underwent a primary bariatric surgical procedure; TODAY participants were randomized to receive metformin therapy alone or in combination with rosiglitazone or an intensive lifestyle intervention; insulin therapy was given in cases of progression of disease. Glycemic control, body mass index, prevalence of elevated blood pressure, dyslipidemia, abnormal kidney function, and clinical adverse events were measured. Data from 30 participants from Teen-LABS (mean [SD] age at baseline, 16.9 [1.3] years; 21 [70%] female; 18 [66%] white) and 63 from TODAY (mean [SD] age at baseline, 15.3 [1.3] years; 28 [44%] female; 45 [71%] white) were analyzed. During 2 years, mean hemoglobin A1c concentration decreased from 6.8% (95% CI, 6.4%-7.3%) to 5.5% (95% CI, 4.7% -6.3%) in Teen-LABS and increased from 6.4% (95% CI, 6.1%-6.7%) to 7.8% (95% CI, 7.2%-8.3%) in TODAY. Compared with baseline, the body mass index decreased by 29% (95% CI, 24%-34%) in Teen-LABS and increased by 3.7% (95% CI, 0.8%-6.7%) in TODAY. Twenty-three percent of Teen-LABS participants required a subsequent operation during the 2-year follow-up. Compared with medical therapy, surgical treatment of severely obese adolescents with type 2 diabetes was associated with better glycemic control, reduced weight, and improvement of other comorbidities. These data support the need for a well-designed, prospective controlled study to define the role of surgery for adolescents with type 2 diabetes, including health and surgical outcomes.

Prevalence of Diabetes and Statin Treatment in Youth

Prevalence of Diabetes and Statin Treatment in Youth