Menarche delay and menstrual irregularities persist in adolescents with type 1 diabetes

<p>Abstract</p> <p>Background</p> <p>Menarche delay has been reported in adolescent females with type 1 diabetes (T1DM), perhaps due to poor glycemic control. We sought to compare age at menarche between adolescent females with T1DM and national data, and to identify factors associated with delayed menarche and menstrual irregularity in T1DM.</p> <p>Methods</p> <p>This was a cross-sectional study and females ages 12- 24 years (n = 228) with at least one menstrual period were recruited during their outpatient diabetes clinic appointment. The National Health and Nutrition Examination Survey (NHANES) 2001-2006 data (n = 3690) for females 12-24 years were used as a control group.</p> <p>Results</p> <p>Age at menarche was later in adolescent females with T1DM diagnosed prior to menarche (12.81 +/- 0.09 years) (mean+/- SE) (n = 185) than for adolescent females diagnosed after menarche (12.17 0.19 years, <it>p = </it>0.0015) (n = 43). Average age of menarche in NHANES was 12.27 +/- 0.038 years, which was significantly earlier than adolescent females with T1DM prior to menarche (<it>p </it>< 0.0001) and similar to adolescent females diagnosed after menarche (<it>p </it>= 0.77). Older age at menarche was negatively correlated with BMI z-score (r = -0.23 <it>p = </it>0.0029) but not hemoglobin A1c (A1c) at menarche (r = 0.01, <it>p </it>= 0.91). Among 181 adolescent females who were at least 2 years post menarche, 63 (35%) reported usually or always irregular cycles.</p> <p>Conclusion</p> <p>Adolescent females with T1DM had a later onset of menarche than both adolescent females who developed T1DM after menarche and NHANES data. Menarche age was negatively associated with BMI z-score, but not A1c. Despite improved treatment in recent decades, menarche delay and high prevalence of menstrual irregularity is still observed among adolescent females with T1DM.</p

Pediatric diabetes consortium T1D New Onset ( NeOn ) study: clinical outcomes during the first year following diagnosis

Objective There have been few prospective, multicenter studies investigating the natural history of type 1 diabetes ( T1D ) from the time of diagnosis. The objective of this report from the Pediatric Diabetes Consortium ( PDC ) T1D New Onset ( NeOn ) study was to assess the natural history and clinical outcomes in children during the first year after diagnosis of T1D . Research design and methods: Clinical measures from the first year following diagnosis were analyzed for 857 participants (mean age 9.1 yr, 51% female, 66% non‐Hispanic White) not participating in an intervention study who had a HbA1c result at 12 months. Results Mean HbA1c ± SD was 102 ± 25 mmol/mol (11.4 ± 2.3%) at diagnosis, 55 ± 12 mmol/mol (7.2 ± 1.1%) at 3 months, 56 ± 15 mmol/mol (7.3 ± 1.3%) at 6 months and 62 ± 16 mmol/mol (7.8 ± 1.5%) at 12 months from diagnosis. A severe hypoglycemic ( SH ) event occurred in 31 (4%) participants (44 events, 5.2 events per 100 person‐years). Diabetic ketoacidosis ( DKA ) not including diagnosis occurred in 10 (1%) participants (13 events, 1.5 events per 100 person‐years). Conclusions After onset of T1D , mean HbA1c reaches its nadir at 3–6 months with a gradual increase through 12 months. SH and DKA are uncommon but still occur during the first year with T1D . Data from large cohorts, such as the PDC T1D NeOn study, provide important insights into the course of T1D during the first year following diagnosis, which will help to inform the development of models to target future interventions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107374/1/pedi12068.pd

Randomized Nutrition Education Intervention to Improve Carbohydrate Counting in Adolescents with Type 1 Diabetes Study: Is More Intensive Education Needed?

Youth with type 1 diabetes do not count carbohydrates (CHOs) accurately, yet it is an important strategy in blood glucose control. The study objective was to determine whether a nutrition education intervention would improve CHO counting accuracy and glycemic control

Clinical outcomes in youth beyond the first year of type 1 diabetes: Results of the Pediatric Diabetes Consortium (PDC) type 1 diabetes new onset (NeOn) study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138914/1/pedi12459.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138914/2/pedi12459_am.pd

Predictors of Lost to Follow-Up among Children with Type 2 Diabetes

Background/Aims: Youth with type 2 diabetes (T2D) have poor compliance with medical care. This study aimed to determine which demographic and clinical factors differ between youth with T2D who receive care in a pediatric diabetes center versus youth lost to follow-up for >18 months. Methods: Data were analyzed from 496 subjects in the Pe­diatric Diabetes Consortium registry. Enrollment variables were selected a priori and analyzed with univariable and multivariable logistic regression models. Results: After a median of 1.3 years from enrollment, 55% of patients were lost to follow-up. The final model included age, race/ethnicity, parent education, and estimated distance to study site. The odds ratio (99% confidence interval) of loss to follow-up was 2.87 (1.34, 6.16) for those aged 15 to <18 years versus those aged 10 to <13 years and 6.57 (2.67, 16.15) for those aged ≥18 years versus those aged 10 to <13 years. Among patients living more than 50 miles from the clinic, the odds ra tio of loss to follow-up was 3.11 (1.14, 8.49) versus those living within 5 miles of the site. Conclusion: Older adolescents with T2D are more likely to be lost to follow-up, but other socioeconomic factors were not significant predictors of clinic follow-up

Vitamin D status in youth with type 1 and type 2 diabetes enrolled in the Pediatric Diabetes Consortium (PDC) is not worse than in youth without diabetes

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134500/1/pedi12340.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134500/2/pedi12340_am.pd

A cross‐sectional view of the current state of treatment of youth with type 2 diabetes in the USA: enrollment data from the Pediatric Diabetes Consortium Type 2 Diabetes Registry

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136377/1/pedi12377_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136377/2/pedi12377.pd

Demographic and Clinical Correlates of Diabetes-Related Quality of Life among Youth with Type 1 Diabetes

To evaluate the reliability and cluster structure of the Pediatric Quality of Life Inventory Type 1 Diabetes Module 3.0 (PedsQL-T1DM) and associated subscales and to explore the associations between PedsQL-T1DM total score and demographic and clinical characteristics and clinical indicators among a large racially/ethnically diverse cohort of youth with type 1 diabetes

Correlates of Treatment Patterns Among Youth With Type 2 Diabetes

OBJECTIVETo describe treatment regimens in youth with type 2 diabetes and examine associations between regimens, demographic and clinical characteristics, and glycemic control.RESEARCH DESIGN AND METHODSThis report includes 474 youth with a clinical diagnosis of type 2 diabetes who completed a SEARCH for Diabetes in Youth study visit. Diabetes treatment regimen was categorized as lifestyle alone, metformin monotherapy, any oral hypoglycemic agent (OHA) other than metformin or two or more OHAs, insulin monotherapy, and insulin plus any OHA(s). Association of treatment with demographic and clinical characteristics (fasting C-peptide [FCP], diabetes duration, and self-monitoring of blood glucose [SMBG]), and A1C was assessed by χ2 and ANOVA. Multiple linear regression models were used to evaluate independent associations of treatment regimens and A1C, adjusting for demographics, diabetes duration, FCP, and SMBG.RESULTSOver 50% of participants reported treatment with metformin alone or lifestyle. Of the autoantibody-negative youth, 40% were on metformin alone, while 33% were on insulin-containing regimens. Participants on metformin alone had a lower A1C (7.0 ± 2.0%, 53 ± 22 mmol/mol) than those on insulin alone (9.2 ± 2.7%, 77 ± 30 mmol/mol) or insulin plus OHA (8.6 ± 2.6%, 70 ± 28 mmol/mol) (P < 0.001). These differences remained significant after adjustment (7.5 ± 0.3%, 58 ± 3 mmol/mol; 9.1 ± 0.4%, 76 ± 4 mmol/mol; and 8.6 ± 0.4%, 70 ± 4 mmol/mol) (P < 0.001) and were more striking in those with diabetes for ≥2 years (7.9 ± 2.8, 9.9 ± 2.8, and 9.8 ± 2.6%). Over one-half of those on insulin-containing therapies still experience treatment failure (A1C ≥8%, 64 mmol/mol).CONCLUSIONSApproximately half of youth with type 2 diabetes were managed with lifestyle or metformin alone and had better glycemic control than individuals using other therapies. Those with longer diabetes duration in particular commonly experienced treatment failures, and more effective management strategies are needed

Trends in Incidence of Type 1 Diabetes Among Non-Hispanic White Youth in the U.S., 2002–2009

The SEARCH for Diabetes in Youth Study prospectively identified youth aged <20 years with physician-diagnosed diabetes. Annual type 1 diabetes (T1D) incidence per 100,000 person-years (95% CI) overall, by age-group, and by sex were calculated for at-risk non-Hispanic white (NHW) youth from 2002 through 2009. Joinpoint and Poisson regression models were used to test for temporal trends. The age- and sex-adjusted incidence of T1D increased from 24.4/100,000 (95% CI 23.9–24.8) in 2002 to 27.4/100,000 (26.9–27.9) in 2009 (P for trend = 0.0008). The relative annual increase in T1D incidence was 2.72% (1.18–4.28) per year; 2.84% (1.12–4.58) per year for males and 2.57% (0.68–4.51) per year for females. After adjustment for sex, significant increases were found for youth aged 5–9 years (P = 0.0023), 10–14 years (P = 0.0008), and 15–19 years (P = 0.004) but not among 0–4-year-olds (P = 0.1862). Mean age at diagnosis did not change. The SEARCH study demonstrated a significant increase in the incidence of T1D among NHW youth from 2002 through 2009 overall and in all but the youngest age-group. Continued surveillance of T1D in U.S. youth to identify future trends in T1D incidence and to plan for health care delivery is warranted