Elisa Nishimura-Meguro

Emotional dysfunction associated with diabetes in Mexican adolescents and young adults with type-1 diabetes

OBJECTIVE To assess the emotional dysfunction associated with diabetes in Mexican young individuals with type-1 diabetes. MATERIAL AND METHODS A cross-sectional survey was conducted to perform a complete clinical and psychosocial evaluation of 93 consecutive type-1 diabetes patients, and 14 to 30 years. RESULTS Adolescents had higher scores of emotional dysfunction related to diabetes and a diminished knowledge in diabetes-related areas. A multivariate logistic regression model showed that an inadequate emotional response to diabetes (high problem areas in diabetes or PAID scores) was mainly associated with a poor glycemic control (OR = 2.9, 95% CI 0.9-9.7, p = 0.09). Apprehension about the future and the possibility of serious complications had the highest mean PAID score in all age groups. CONCLUSIONS New strategies should be developed to improve the routine care and support of young individuals with type-1 diabetes.

Glycemic control and high‐density lipoprotein characteristics in adolescents with type 1 diabetes

Recent evidence suggests that high‐density lipoprotein (HDL) physicochemical characteristics and functional capacity may be more important that HDL‐C levels in predicting coronary heart disease. There is little data regarding HDL subclasses distribution in youth with type 1 diabetes.

Resistin levels are not associated with obesity in central precocious puberty

Objective: To compare serum resistin concentrations between prepubertal girls with a BMI > 85th percentile and girls with precocious puberty (CPP) who have and have not undergone GnRH analog treatment. Patients and methods: This is a cross‐sectional study in girls with a BMI > 85th percentile and a median age of 8 years. We included 31 girls with CPP who did not receive treatment (CPPoT), 23 girls with CPP who were treated with leuprolide (CPPT), 22 prepubertal girls and 24 pubertal girls. Anthropometric data and the fasting plasma concentrations of lipids, glucose, insulin, and resistin were measured. Results: The z‐BMI scores were similar among the groups (p = 0.344), and body fat percentage (BF%) was similar among CPPT, CPPoT and prepubertal girls (p = 0.151). Resistin and insulin levels were lower in girls with CPP (CPPT and CPPoT) than in prepubertal and pubertal girls (median resistin level: CPPT 11.8 pg/ml vs CPPoT 11 pg/ml vs prepubertal 16 pg/ml vs pubertal 16 pg/ml, p = 0.001; median insulin level: CPPT 10.7 &mgr;UI/mL vs CPPoT 10.2 &mgr;UI/mL vs prepubertal 14.4 &mgr;UI/mL vs pubertal 32 &mgr;UI/mL p = 0.02). ANCOVA analysis, after adjustments for pubertal stage, BF% and z‐BMI, showed that CPP modifies resistin levels (F = 31.4; p = 0.0001) independently of these parameters (p < 0.05). Conclusions: In the group of girls with overweight or obesity, the resistin level was lower in girls with CPP than in prepubertal and pubertal girls. More studies are needed to understand the role of resistin in CPP patients. HIGHLIGHTSThis study is the first to determine resistin levels in patients with CPP.CPP patients have lower concentrations of resistin than prepubertal and pubertal girls with overweight or obesity without CPP.Resistin levels were not found to be related to z‐BMI, body fat percentage or CPP treatment status.

Asociación de leptina con factores cardiometabólicos en escolares y adolescentes con hiperplasia suprarrenal congénita

espanolIntroduccion: En la hiperplasia suprarrenal congenita (HSC), la obesidad, la hiperinsulinemia y los niveles de leptina se encuentran incrementados. Objetivo: Identificar la frecuencia de los factores de riesgo cardiometabolico (FRC) en ninos y adolescentes con HSC y explorar la relacion con los niveles de leptina. Metodo: Estudio transversal de 40 pacientes a quienes se realizo somatometria y evaluacion de glucosa, insulina, trigliceridos, 17-hidroxiprogesterona, leptina, colesterol HDL y LDL en ayuno. Los pacientes fueron clasificados por el numero de FRC y se analizaron los niveles de leptina con Kruskal-Wallis. Se aplico correlacion de Pearson entre la leptina, puntuacion Z del indice de masa corporal (zIMC) y porcentaje de grasa corporal. Resultados: 50 % de los pacientes presento obesidad y sobrepeso, 59 % hipertrigliceridemia, 40 % hipoalfalipoproteinemia, 27.5 % colesterol LDL alto y 22.5 % resistencia a la insulina. Hubo correlacion positiva entre leptina y porcentaje de grasa corporal (r = 0.64), el zIMC (r = 0.55) y el numero de FRC (r = 0.65). En el analisis multivariado ajustado por obesidad, los niveles de leptina se asociaron con el numero de FRC. Conclusion: La HSC tuvo alta frecuencia de FRC y al parecer la leptina se asocio con perfil cardiometabolico mas adverso en sujetos con obesidad y sobrepeso. EnglishIntroduction: In congenital adrenal hyperplasia (CAH), obesity, hyperinsulinemia and leptin levels are increased. Objective: To identify the frequency of cardiometabolic risk factors (CRF) in children and adolescents with CAH and to explore the relationship with leptin levels. Method: Cross-sectional study of 40 patients who underwent anthropometric measurements and had fasting glucose, insulin, triglycerides, 17-hidroxyprogesterone, leptin, HDL and LDL-cholesterol assessed. The patients were classified according to the number of CRFs, and leptin levels were analyzed with the Kruskal-Wallis test. Pearson’s correlation was applied between leptin, body mass index (BMI) z-score and body fat percentage. Results: Fifty percent of the patients had obesity and overweight, 59% had hypertriglyceridemia, 40%, hypoalphalipoproteinemia, 27.5%, high LDL-cholesterol and 22.5% insulin resistance. There was positive correlation between leptin and body fat percentage (r = 0.64), BMI z-score (r = 0.55) and the number of CRFs (r = 0.65). In the obesity-adjusted multivariate analysis, leptin levels were associated with the number of CRFs. Conclusion: CAH had a high frequency of CRFs and leptin appeared to be associated with a more adverse cardiometabolic profile in subjects with obesity and overweight.

Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus

Objectives In prepubertal type 1 diabetic patients (DM1), the availability of an informal primary caregiver (ICP) is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified.

Original articleInfluence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitusInfluência do cuidador familiar principal sobre o controle glicêmico entre pacientes pediátricos pré-púberes com diabetes mellitus tipo 1☆

Objectives In prepubertal type 1 diabetic patients (DM1), the availability of an informal primary caregiver (ICP) is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified.

RELATIONSHIP BETWEEN SERUM LEPTIN LEVELS AND WEIGHT GAIN IN GIRLS WITH CENTRAL PRECOCIOUS PUBERTY AT 1-YEAR FOLLOW-UP

OBJECTIVE Patients with central precocious puberty (CPP) may have increased serum leptin levels; however, it is not well known whether this increase differs between patients with and without obesity. Our objectives were to describe the changes in serum leptin in girls with CPP in the first 12 months after diagnosis based on body mass index (BMI) and to explore whether serum leptin level at CPP diagnosis is related to BMI z-score (BMIz) after a 1-year follow-up. METHODS A prospective cohort study was performed. We included 42 girls with idiopathic CPP in Tanner stages II and III. Anthropometric measurements were performed, and serum leptin was measured at study initiation and after 12 months. Patients were stratified according to BMI category (30 with a BMI in the <94th percentile and 12 with a BMI in the >95th percentile). Study variables were compared. Correlations among leptin, BMIz, and body fat were assessed. RESULTS Leptin increased gradually during the first year of treatment. In girls with a BMI in the <94th percentile at diagnosis, body fat percentage increased gradually during the first year of follow-up. CONCLUSION Girls with a BMI in the <94th percentile have a greater risk of weight increase. Leptin level >10.5 ng/dL at diagnosis is a risk factor for weight gain after 1 year. ABBREVIATIONS BMI = body mass index BMIz = BMI z-score CPP = central precocious puberty GnRHa = gonadotropin-releasing hormone analogue.