Diabetes
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21757
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Browsing Diabetes by Subject "Diabetes"
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Item CLASSIFICATION OF CHILDREN WITH NEWLY DIAGNOSED DIABETES MELLITUS(2014-03) Prakash, Sameer; Leung-Pineda, Van; Suzuki, Sumihiro; Radack, Jill A.; Dallas, John; Thornton, Paul; Wilson, DonPurpose (a): Historically the diagnosis of Type 2 Diabetes Mellitus (T2DM) has relied on a well described clinical phenotype. The reliability of this clinical phenotype in classifying children with diabetes is, however, not clear. The ability of experienced clinicians to correctly classify the type of diabetes based upon the clinical phenotype has recently been challenged. According to the American Diabetes Association, the diagnosis of T2DM requires a fasting plasma glucose of 126 mg/dL or higher, a 2-hour glucose level of 200 mg/dl or higher during a 75-g oral glucose tolerance test, or a random plasma glucose of 200 mg/dL or higher in a patient with classic symptoms of hyperglycemia or hyperglycemia crisis. In addition, those with T2DM should demonstrate the absence of diabetes auto-antibodies. Since the appropriate classification of a child's diabetes has important implications with regard to treatment options, expected outcomes and genetic counseling, a systematic, cost-effective algorithm to assist in the initial classification of diabetes mellitus is needed. Methods (b): We propose a retrospective analysis of diabetes related autoantibody tests (GAD, IA-2, Tg, Gliadin Peptide IGA, Gliadin Peptide IGG) in children (< 18 yrs of age) seen for evaluation of newly diagnosed diabetes mellitus in the Pediatric Endocrine Clinic hospitalized at Cook Children’s Medical Center for Jan 2010-June 2012.Following IRB approval, children and adolescents. Results (c): Following IRB approval, we conducted a retrospective chart review of 348 children(178 males; 170 females) hospitalized at Cook’s Children’s Medical Center from Jan 2010 – Jun 2012 with new onset diabetes mellitus to determine the frequency of antibody positive vs. antibody negative diabetes mellitus. In addition the frequency and test results for other diabetes-associated conditions (i.e. thyroid and celiac disease) were summarized. As expected the majority of patients were positive for one or more diabetes related antibodies. A much smaller number of patients were also tested for diabetes-associated conditions. Conclusions (d): We conclude that the majority of children < 18 years of age with new onset diabetes are positive for diabetes antibodies at the time of presentation. Those that are antibody negative need further evaluation to 1) determine whether these patients may have T2DM, a genetic form of DM (i.e. MODY) or some other form of diabetes and 2) to provide appropriate therapeutic and genetic counseling. Given the complexity of diagnosing diabetes mellitus and the rising cost of healthcare, a systematic algorithm may be useful in providing a cost-effective means of classifying children with new onset diabetes mellitus.Item INCREASED POTENTIAL FOR GLUCOSE METABOLISM INTERFERENCE AND RETINAL ANEURYSMS FROM CARBON DISFULDIE EXPOSURE IN OIL AND NATURAL GAS WORKERS: A SYSTEMATIC REVIEW(2014-03) Patel, Jay T.; Rich, Alisa L.; Al-Angari, Samiah S.Exposure to chemicals in the air from manufacturing emissions may cause health impact to workers and the general public. A chemical historically found in rayon manufacturing emissions, carbon disulfide (CS2) is also present in emissions from oil and natural gas operations. This research identified how exposure to CS2 can affect blood glucose levels and can lead to damage to eyes. With the current trend in urban drilling, the general public may experience these health impacts from breathing CS2 in the air. Workers need to be tested regularly to prevent health complications. Purpose (a): This study examined the relationship of glucose metabolism interference and retinal microaneurysms from exposure to carbon disulfide (CS2) in natural gas workers. This study is the first to identify an increased potential for glucose metabolism interference, resulting in diabetogenic effect and subsequent retinal microaneurysms in natural gas occupational workers exposed to CS2. Methods (b): The review of literature was conducted as an evaluative assessment rather than an annotated bibliography and focused on the potential diabetogenic effects from CS2 exposure. The search criteria were inclusive to all papers on occupational health effects related to CS2 exposure. Relevant articles were identified by a systematic search of Medline, TOXLINE, Scopus, and PubMed databases. Due to the lack of current literature, all study designs were included. Results (c): The literature review found a strong association in viscose rayon occupational workers exposed to CS2 and an increased potential for alteration of normal glucose metabolism and retinal microaneurysms. CS2 wasalso found to be present in emissions from extraction and processing of oil and natural gas. The mechanism of action of CS2 on a biochemical level proved similar in viscose rayon and oil and natural gas workers. Conclusions (d): Natural gas occupational workers exposed to CS2 may experience an increased potential for glucose metabolism interference, which has been an indicator for diabetogenic effect and increased incidence for retinal disease. The recommendation is for regular monitoring of blood glucose levels in CS2-exposed workers preventing diabetogenic effect and ensuing retinopathy.Item PARENT'S PERCEPTIONS OF NEIGHBORHOOD SAFETY AND RISK OF TYPE 2 DIABETES IN MEXICAN AMERICAN CHILDREN AND ADOLESCENTS(2014-03) Ramirez, Roberto C.; Fulda, Kimberly; Lee, Michelle; Proffitt Leyva, Randi; Franks, Susan; Espinoza, AnnaWe conducted a study with Mexican American children and their parents and found that having playgrounds in the child's neighborhood lowers the risk of having type 2 diabetes. Purpose (a): The number of people suffering from type 2 diabetes (2 DM) has increased drastically over the last 30 years, especially in children under the age of 18. Specifically, Mexican American children have been diagnosed at alarming rates. Inactivity in children has contributed to these high rates of diabetes, but there is not sufficient information on factors that contribute to this inactivity. The purpose of this study was to explore parent’s perceptions of the features in their neighborhoods and its safety as it relates to their child being at risk of developing 2 DM. Methods (b): 144 Mexican American participants, ages 10-14 were enrolled in this study which included one visit that lasted approximately two hours. The primary caregiver was asked via a survey to assess the features and safety of the neighborhood in which the child participant lives. A set of measurements and family history were taken on each participant. “High-risk” status was assigned if participants had ≥3 of the following risk factors: BMI ≥95 percentile, high blood glucose, presence of Acanthosis Nigricans, family history of 2 DM in a 1st or 2nd degree relative, and history of hypertension or blood pressure ≥95th percentile. Simple and multiple logistic regressions were performed with high risk status for 2 DM as the outcome variable and neighborhood safety, presence of sidewalks and playgrounds in neighborhoods as the primary predictors. The adjusted model controlled for child’s age, gender, highest education level of household and household income. Results (c): Adjusted analyses illustrate that the presence of playgrounds in the respondent’s neighborhoods presented a 76% decreased odds of being at risk for 2 DM [OR: 0.24; 95% CI (0.06-0.86)]. The parent’s perceptions of neighborhood safety and the presence of sidewalks were not significant findings. In secondary findings, participants who responded that Spanish was the primary language spoken in the home had 79% decreased odds of being at risk for 2 DM [OR: 0.21; 95% CI (0.11-1.35)]. Conclusions (d): Potential policy implications resulting from the analysis of the study point to an increase in potential support for the establishment of playgrounds in areas that are deprived of such elements.