Role of Social Factors in Glycemic Control Among African American Children and Adolescents with Type 1 Diabetes.

Objective: With the rising incidence of Type 1 diabetes (T1DM), it is important to recognize deficiencies in care and areas of improvement to provide better access to resources and education for T1DM patients. The objective of this study was to recognize social factors and compliance barriers affecting glycated hemoglobin (A1c) level in T1D patients among the minority population.

Methods: A total of 84 T1DM patients, ages 3 to 21 years, 49% males, 87% African American participated in the study.

Presence of 21-Hydroxylase Antibodies in a Boy with X-Linked Adrenal Hypoplasia Congenita.

Background: X-linked adrenal hypoplasia congenita is a rare cause of primary adrenal insufficiency (PAI) in children due to mutations in NR0B1/DAX1 (nuclear receptor subfamily 0, group B, member 1/dosage-sensitive sex reversal-adrenal hypoplasia congenita at the critical region of the X chromosome, gene 1). Another rare cause of PAI in children is autoimmune adrenal disease (AAD) which could be either isolated or as part of autoimmune polyglandular syndrome. Antibody to major auto-antigen, 21-hydroxylase, is highly specific for AAD.

Celiac disease in African American children with type 1 diabetes mellitus in inner city Brooklyn.

Objective: There is a strong evidence for association between type 1 diabetes and Celiac Disease. Up to 8% of patients with type1 diabetes have characteristic features of CD on small intestinal biopsy. Type 1 diabetics who have HLA DQ2 or DQ8 are at risk for CD.

Study of glucose profiles with continuous glucose monitoring in adolescents with poorly controlled type 2 diabetes mellitus.

Aim: To evaluate glycemic excursions in adolescents with poorly controlled type 2 diabetes mellitus (DM2).

Methods: Seventeen adolescents (12 F/5 M) underwent glucose monitoring for 3 days using a continuous glucose monitoring system (CGMS). Glucose measurements were divided into periods of euglycemia, hyperglycemia, and hypoglycemia.

Mauriac syndrome in a 3-year-old boy.

Objective: To report a case of Mauriac syndrome in a young child with poorly controlled type 1 diabetes mellitus.

Methods: We describe the typical features of Mauriac syndrome and review the clinical, laboratory, and ultrasound findings and follow-up results in our current patient.

Results: Hepatomegaly, growth impairment, and cushingoid features characterize Mauriac syndrome.

Transient pituitary dysfunction, empty sella, pseudotumor cerebri in a morbidly obese adolescent.

We report a 16-year-old morbidly obese African-American female who developed pseudotumor cerebri, partially empty sella syndrome and transient central hypothyroidism. After reduction of the increased intracranial pressure by lumbar puncture, normalization of the thyroid function occurred. The mechanism of the transient pituitary dysfunction in relation to the pseudotumor cerebri and empty sella is discussed.

The prevalence of metabolic syndrome in inner city obese African-American youth.

Background: In children and adolescents, obesity increases the risk of metabolic syndrome (MS).

Objective: We examined the prevalence of MS among obese and morbidly obese children and adolescents referred to an obesity clinic in a university-based hospital center.

Design/methods: A total of 194 obese (BMI > 95%) children and adolescents were evaluated.

Management of metabolic syndrome in morbidly obese children and adolescents.

The main goal in managing metabolic syndrome (MS) in children and adolescents is to prevent Type 2 DM and reduce the risk of future cardiovascular disease. Although frustrating and challenging for both patients and healthcare providers, the best strategy for managing MS is preventing obesity through promotion of lifestyle modifications that include weight reduction, prevention of excessive weight gain and increase physical activity. Different therapeutic options and medications for MS are discussed including side effects of each drug.

Pancreatic beta-cell hyperactivity in morbidly obese adolescents.

beta-cell hyperactivity, with increased beta-cell mass in the pancreas, contributes to insulin oversecretion in response to insulin resistance. beta-cell mass expansion, also known as "endocrine pancreas plasticity", is an adaptation to variations in insulin demand, is generally observed in obese persons and in women during late pregnancy. In obese persons, increased free fatty acids contribute to beta-cell growth.

Type 2 diabetes mellitus in African-American adolescents: impaired beta-cell function in the face of severe insulin resistance.

We have previously demonstrated abnormalities in insulin secretion in adolescents with type 2 diabetes mellitus (DM2) in response to the mixed meal test and to glucagon. In order to further assess beta-cell function in DM2, we measured insulin and C-peptide responses to oral glucose in adolescents with DM2 in comparison to non-diabetic obese and lean adolescents. We studied 20 patients with DM2, 25 obese adolescents with matching body mass index (BMI) (33.

Plasminogen activator inhibitor-1 and tissue-plasminogen activator in minority adolescents with type 2 diabetes and obesity.

Increased plasminogen activator inhibitor-1 (PAI-1) and decreased tissue-plasminogen activator (t-PA) activities lead to impaired fibrinolysis, which is critical for cardiovascular disease. We studied these hemostatic factors at fasting state and after an oral fat load in 12 type 2 diabetic and 17 nondiabetic obese adolescents, matched for age, sex, body mass index, and sexual maturation. Plasma PAI-1, t-PA, and glucose as well as serum C-peptide, insulin, total cholesterol, triglyceride, and HDL and LDL cholesterol levels were measured at 0, 2, 4, and 6 h after the fat load.

Postprandial hyperlipidemia after a fat loading test in minority adolescents with type 2 diabetes mellitus and obesity.

The continuing increase in the incidence of type 2 diabetes mellitus (DM2) and obesity in children and adolescents is attributable to excessive caloric intake. Abnormal lipid metabolism in the postprandial state leads to long exposure of the vasculature to hyperlipidemia. Most children and adolescents with DM2 are obese, and many have fasting hypertriglyceridemia.

Management of hyperglycemia in minority children with type 2 diabetes mellitus.

This paper discusses management of hyperglycemia in minority children with type 2 diabetes mellitus (DM). Over the past several years the incidence of type 2 DM in minority children and adolescents has markedly increased. Intensive management of children with type 2 DM includes exercise, diet, insulin therapy, oral drug (metformin) therapy, and combination insulin-oral drug therapy.

Autoantibodies in children with type 2 diabetes mellitus.

To evaluate the frequency of autoantibodies to glutamic acid decarboxylase (GAD), protein tyrosine phosphatase-like protein (IA-2), and insulin (IAA) in children with type 2 diabetes mellitus (DM), we studied 37 children and adolescents whose type 2 DM was defined by fasting and 90-min standard liquid meal-stimulated serum C-peptide levels of >0.2 and >0.5 nmol/l (0.

Sponastrime dysplasia with abnormal urinary glycosaminoglycans and growth hormone unresponsiveness.

Sponastrime dysplasia is a rare skeletal dysplasia characterized by severe short stature, scoliosis, a saddle nose, frontal bossing, and increased upper/lower segment ratio. Etiology of this condition is unknown. Radiological findings include a concavity in the posterior two thirds of lumbar vertebral bodies, platyspondyly, thoracolumbar scoliosis, marginal irregularity and striations of metaphyses, and delayed bone age.

Beta-cell response to intravenous glucagon in African-American and Hispanic children with type 2 diabetes mellitus.

The incidence of type 2 diabetes mellitus (DM) in children and adolescents has substantially increased over the past decade. The present study was conducted to evaluate the beta-cell response to intravenous glucagon (a non-glucose secretagogue) in children with type 2 DM. Twenty pediatric patients with type 2 DM were compared to 15 control subjects matched for body mass index and sexual maturation.