Diabetes mellitus in children and adolescents

CONTENTS......Page 2
FORTHCOMING ISSUES......Page 7
Diabetes Mellitus in Children......Page 8
The Classification of Diabetes Mellitus: A Conceptual Framework......Page 10
Physiology......Page 12
Biochemical and molecular aspects of insulin secretion......Page 15
Euglycemic hyperinsulinemic clamp......Page 18
Homeostatic model assessment......Page 20
The interaction of insulin resistance and beta-cell function......Page 21
Mitochondrial diabetes......Page 22
Metabolic syndrome......Page 23
Type 2 diabetes mellitus......Page 24
Summary......Page 25
References......Page 26
Epidemiology: incidence and prevalence......Page 30
Economics of health care......Page 31
Natural history of prediabetes......Page 32
Genetics......Page 33
Autoimmunity and autoantibodies......Page 35
Environment......Page 37
Presentations: classic, silent, and diabetic ketoacidosis......Page 40
Management in new-onset diabetes......Page 42
Ongoing diabetes management......Page 43
Subcutaneous insulin regimens: neutral protamine Hagedorn and rapid acting analogs......Page 44
Potential adjuncts to insulin therapy......Page 45
Medical nutritional therapy......Page 46
Hypoglycemia......Page 47
School issues......Page 48
Complications......Page 49
Future......Page 50
References......Page 52
Type 2 Diabetes Mellitus in Youth: The Complete Picture to Date......Page 56
Epidemiology......Page 57
Insulin resistance and insulin secretion in type 2 diabetes mellitus......Page 58
Natural history of youth type 2 diabetes mellitus......Page 62
Environment: behavior and lifestyle translate into a risk for obesity and altered body fat distribution......Page 63
Insulin resistance phenotype......Page 64
Acanthosis nigricans......Page 65
Criteria for the diagnosis of diabetes......Page 66
Screening of children and adolescents at risk for type 2 diabetes mellitus......Page 67
Pancreatic autoantibodies in youth type 2 diabetes mellitus......Page 69
Comorbidities and complications of youth type 2 diabetes mellitus......Page 71
Team approach and goals of treatment......Page 72
Insulin......Page 73
Other oral agents......Page 74
Acute complications......Page 75
Dyslipidemia......Page 76
Summary......Page 77
References......Page 78
Pediatric Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State......Page 87
Pathophysiologic abnormalities early in the development of diabetic ketoacidosis......Page 88
Pathophysiologic abnormalities later in the development of diabetic ketoacidosis......Page 89
Clinical manifestations of diabetic ketoacidosis......Page 91
Hyperglycemia......Page 93
Electrolyte abnormalities......Page 94
Other biochemical abnormalities......Page 95
Insulin and dextrose......Page 96
Electrolytes......Page 97
Bicarbonate......Page 99
Complications......Page 100
Differential diagnosis......Page 103
Hyperglycemic hyperosmolar state without ketosis......Page 104
Summary......Page 105
References......Page 106
Maturity-onset diabetes of the young......Page 112
Physiology of the beta-cell and the role of maturity-onset diabetes of the young genes......Page 113
Treatment......Page 115
Transient neonatal diabetes......Page 116
Permanent neonatal diabetes......Page 117
Wolfram syndrome......Page 118
Mitochondrial diabetes......Page 119
Cystic fibrosis-related diabetes......Page 120
Insulin receptor defects......Page 121
Congenital lipoatrophic diabetes......Page 122
References......Page 123
Insulin Analogues in Children and Teens with Type 1 Diabetes: Advantages and Caveats......Page 126
Development of insulin formulations......Page 127
Rapid-acting analogues: meal-related (bolus) insulin......Page 128
Basal insulins: (very) long-acting insulin analogues......Page 132
Safety of insulin analogues......Page 134
Insulin aspart in adults who have type 1 diabetes......Page 135
Rapid-acting analogues in children and adolescents who have type 1 diabetes......Page 136
Insulin glargine in adults who have type 1 diabetes......Page 138
Very long-acting insulin analogues in children and adolescents who have type 1 diabetes......Page 141
Continuous subcutaneous insulin infusion (pump therapy)......Page 142
Adjunctive therapies......Page 143
References......Page 145
Insulin Pump Treatment of Childhood Type 1 Diabetes......Page 151
Safety and efficacy of continuous subcutaneous insulin infusion in youth: clinical outcome studies......Page 153
Safety and efficacy of continuous subcutaneous insulin infusion in youth: results of randomized clinical trials......Page 156
Subjective and other benefits of continuous subcutaneous insulin infusion......Page 157
Toward a brighter future......Page 158
References......Page 160
Oral Agents in Managing Diabetes Mellitus in Children and Adolescents......Page 163
Type 2 diabetes mellitus......Page 164
Metformin......Page 165
Thiazolidinediones......Page 167
Glitinides......Page 169
Treatment plan for management of type 2 diabetes mellitus......Page 170
Summary......Page 174
References......Page 175
Hypoglycemia: A Complication of Diabetes Therapy in Children......Page 178
Defining hypoglycemia......Page 179
Prevalence of hypoglycemia......Page 180
Glucose counterregulation......Page 181
Glucose transporters......Page 182
Physiologic consequences......Page 183
Symptom detection......Page 185
Acute neurologic sequelae......Page 186
Transient cognitive deterioration......Page 187
Acute electroencephalographic changes......Page 189
Permanent cognitive sequelae of severe or recurrent hypoglycemia......Page 190
Chronic electroencephalographic abnormalities......Page 192
Risk factors for hypoglycemia......Page 193
Intervention strategies......Page 194
Treatment of acute episodes......Page 195
Summary......Page 196
References......Page 197
Pathogenesis......Page 207
The importance of glycemic control......Page 208
Diabetic retinopathy......Page 209
Interventions......Page 212
Diabetic nephropathy......Page 213
Interventions......Page 214
Peripheral neuropathy......Page 215
Interventions......Page 216
Associated autoimmune diseases......Page 217
Discussing complications......Page 218
References......Page 220
Interactions between psychologic adjustment and family management of type 1 diabetes in children and adolescents......Page 226
Family environment and parental involvement......Page 227
Psychologic and behavioral problems......Page 228
Peer relationships......Page 229
School issues......Page 230
Pediatric type 1 diabetes: psychologic interventions......Page 231
Treatment adherence......Page 232
Family communication and problem solving......Page 233
Anxiety and stress management......Page 234
Future research......Page 235
Differences in the psychologic contexts of type 1 versus type 2 diabetes mellitus......Page 236
Risk factors for developing type 2 diabetes mellitus......Page 237
Behavioral intervention and prevention efforts......Page 238
Summary: keys to intervention......Page 240
Prevent adjustment problems and promote family teamwork......Page 241
Refer for appropriate services and encourage engagement......Page 242
Seek continuing education regarding psychologic aspects of diabetes......Page 243
References......Page 244
Islet autoantibodies......Page 250
The role of major histocompatibility complex in type 1 diabetes mellitus prediction studies......Page 254
Proposed guidelines for screening......Page 256
Primary prevention......Page 257
Secondary prevention......Page 259
Parenteral and oral insulin: Diabetes Prevention Trial Type 1......Page 260
Tertiary prevention......Page 262
Anti-CD3 treatment......Page 263
Pancreas and islet transplantation......Page 266
Stem cell therapy, gene therapy, and other therapies......Page 267
References......Page 269