Anne Fagot-Campagna

TYPE 2 DIABETES IN CHILDREN

Type 2 diabetes mellitus in children is an emotionally charged issue and an emerging public health problem. 1 2 Until recently most children with diabetes mellitus had type 1, one of the most common3 and increasingly prevalent4 chronic diseases in children. Increasingly, however, type 2 diabetes is being reported in children from the United States, Canada, Japan, Hong Kong, Australia, New Zealand, Libya, and Bangladesh.5 The prevalence of type 2 diabetes in children ranges from 4.1 per 1000 12-19 year olds in the US to 50.9 per 1000 15-19 year old Pima Indians of Arizona. 1 2 Between 8% and 45% of recently diagnosed cases of diabetes among children and adolescents in the United States is type 2, and the magnitude of this disease may be underestimated. 1 2 The prevalence of the disease is on the rise in North America, and its incidence almost doubled in Japan between 1976-80 and 1991-5—from 7.3 to 13.9 per 100 000 junior high school children.5 These trends coincide with the rising prevalence of overweight and physical …

Family and genetic studies of indices of insulin sensitivity and insulin secretion in Pima Indians

The present analyses were conducted to examine the extent to which insulin sensitivity and insulin secretion, assessed using simple indices derived from an oral glucose tolerance test, are influenced by genetic factors, and to assess whether these genetic factors overlap with those influencing susceptibility to type 2 diabetes in Pima Indians.

Plasma lipoproteins and incidence of non-insulin-dependent diabetes mellitus in Pima Indians: protective effect of HDL cholesterol in women.

The role of plasma lipoproteins in the development of non-insulin-dependent diabetes mellitus (NIDDM) was studied in 787 non-diabetic (2-h glucose < 11.1 mmol/l) Pima Indians (265 men and 522 women). Subjects were followed for a mean of 9.8 (range: 1.8-16.4) years, during which 261 (76 men and 185 women) developed NIDDM. In men and women, very-low-density lipoprotein (VLDL) cholesterol, VLDL triglyceride, low-density lipoprotein triglyceride and total triglyceride, controlled for age, predicted NIDDM (P < 0.01 for each). These effects diminished when controlled for age, sex, body mass index, systolic blood pressure and 2-h glucose. However, high-density lipoprotein (HDL) cholesterol, controlled for age, body mass index, systolic blood pressure and 2-h glucose, was a significant protective factor for NIDDM in women (hazard rate ratio (HRR) = 0.35, 95% CI (0.23-0.54), P < 0.001, 90th compared with 10th percentile) but not in men (HRR = 1.04, 95% CI (0.53-2.05), P = 0.915). This association remained significant in women when controlled for fasting or 2-h plasma insulin concentrations, other estimates of insulin resistance or alcohol consumption. The protective effect of HDL cholesterol was similar among women with normal (2-h glucose < 7.8 mmol/1) or impaired (7.8 mmol/l < or = 2-h glucose < 11.1 mmol/l) glucose tolerance at baseline. These results indicate that lipoprotein disorders are an early accompaniment of the abnormalities that lead to NIDDM.

Serum Cholesterol and Mortality Rates in a Native American Population With Low Cholesterol Concentrations: A U-Shaped Association

BACKGROUND Low serum cholesterol concentrations are associated with high death rates from cancer, trauma, and infectious diseases, but the meaning of these associations remains controversial. The present report evaluates whether low cholesterol is likely to be a causal factor for mortality from all causes or from specific causes. METHODS AND RESULTS Among 4553 Pima Indians > or =20 years old, a population with low serum cholesterol (median, 4.50 mmol/L), 1077 deaths occurred during a mean follow-up of 12.8 years. Trauma was the most common cause. The relationship between serum cholesterol measured at 2-year intervals and age- and sex-standardized mortality rates was U-shaped. Cholesterol was related positively to mortality from cardiovascular diseases and diabetes (including nephropathy) and negatively to mortality from cancer and alcohol-related diseases. The relationship was U-shaped for mortality from infectious diseases, and cholesterol was not related to mortality from trauma. Change in cholesterol from one examination to the next was positively related to mortality from diabetes. In proportional-hazards models adjusted for potential confounders, the relationship between baseline cholesterol and mortality was U-shaped for all causes and diabetes and positive for cardiovascular diseases. Other relationships were nonsignificant. Among 3358 subjects followed > or =5 years, the relationship was significant and positive only for mortality from cardiovascular diseases. CONCLUSIONS Despite a high exposure risk for Pima Indians, if low cholesterol level is a causal factor, the relationships between low serum cholesterol and high mortality rates probably result from diseases lowering cholesterol rather than from a low cholesterol causing the diseases.

Diabetes, impaired fasting glucose, and elevated HbA1c in U.S. adolescents: The third National Health and Nutrition Examination Survey

OBJECTIVE Using population-based data, we estimated the prevalence of diabetes, impaired fasting glucose, and elevated HbA1c (>6%) levels in U.S. adolescents. RESEARCH DESIGN AND METHODS The Third National Health and Nutrition Examination Survey (1988-1994) examined a representative sample of the U.S. population, which included 2,867 adolescents aged 12-19 years who had serum glucose measured. RESULTS A total of 13 adolescents in the sample were considered to have diabetes; 9 reported using insulin, 2 reported using oral agents only, and 2 did not report any treatment but had high glucose levels (> or = 11.1 mmol/l regardless of length of fast or > or = 7.0 mmol/l after an 8-h fast). Four of these cases (31% of the sample with diabetes) were considered to have type 2 diabetes. The estimated prevalence of diabetes (all types) per 100 adolescents ages 12-19 years was 0.41% (95% confidence interval 0-0.86). The prevalence of impaired fasting glucose (> or = 6.1 mmol/l) among adolescents without diabetes who had fasted for at least 8 h was 1.76% (0.02-3.50). The prevalence of elevated HbA1c (>6%) was 0.39% (0.04-0.74). CONCLUSIONS National data reflect the presence of type 2 diabetes in U.S. adolescents, but the survey sample size was not large enough to obtain precise prevalence estimates because of the relatively low prevalence.