Terri H. Lipman

Disordered Eating Behaviors in Youth With Type 1 Diabetes

Eating disorders are a significant health problem for many adolescents and are described as occurring along a spectrum of symptoms including disordered eating behaviors and clinical eating disorders. Poor self-esteem and body image, intense fear of gaining weight or refusal to maintain weight, and purging unwanted calories are clinical features of some eating disorders. Type 1 diabetes is a chronic illness with marked insulin deficiency. Chronic hyperglycemia creates a state of glucosuria with subsequent weight loss. Diabetes treatment focuses on intensive daily management of blood glucose by balancing insulin, food intake, and physical activity. Insulin omission offers an easy method for the purging of unwanted calories. The combination of these 2 illnesses is potentially deadly and also leads to an increased risk of poor diabetes outcomes. This includes poor metabolic control (measured by elevated hemoglobin A1C), increased risk of diabetic ketoacidosis, and microvascular complications such as retinopathy and nephropathy. Diabetes clinicians should be aware of the potential warning signs in an adolescent with diabetes as well as assessment and treatment options for eating disorders with concomitant type 1 diabetes. This article reviews the available data on the prevalence, screening tools, assessment guidelines, and treatment options for eating disorders in youth with type 1 diabetes.

A multicentre randomised controlled trial of an intervention to improve the accuracy of linear growth measurement

Aims: To evaluate linear growth assessment and the effect of an intervention on measurement accuracy in primary care practices (PCP) within eight US geographical areas. Methods: In this multicentre randomised controlled intervention study, paediatric endocrine nurses as site coordinators (SC) visited 55 randomly assigned PCP to evaluate growth assessment of staff performing linear measurements. SC observed 127 measurers assessing a total of 878 children: 307 (baseline), 282 (3 months), and 289 (6 months). Accuracy was determined by SC re-measuring each child with correct technique and equipment. State of the art equipment and a standardised growth training session were provided to the intervention group (IG) following the baseline visit. SC repeated data collection at all PCP at 3 and 6 months. Results: There were no baseline differences between IG and CG equipment, technique, or accuracy; only 30% of measurements were accurate (⩽0.5 cm from SC). Post-intervention, significantly more IG measurements were accurate: IG  =  55%, CG  =  37% at 3 months; IG  =  70%, CG  =  34% at 6 months. Odds ratio of accuracy for IG versus CG was 2.1 at 3 months and 4.5 at 6 months. At 6 months, mean difference from the SC measurements was 0.5 cm in IG and 1.1 cm in CG. Conclusions: In PCP, children are measured inaccurately. Our intervention significantly improved measurement accuracy. Improved accuracy could yield more rapid detection and diagnosis of paediatric growth disorders.

Fasting c‐peptide and insulin‐like growth factor‐binding protein‐1 levels help to distinguish childhood type 1 and type 2 diabetes at diagnosis

Background:  Children with new onset diabetes (n = 175) were evaluated over 12‐months. Patients were presumptively diagnosed with type 2 diabetes mellitus (T2DM) (n = 26) based on obesity, a relative with T2DM, the ability to wean from insulin, and absence of glutamic acid decarboxylase‐65 (GAD‐65) antibodies. We hypothesized that markers of insulinization at diagnosis, including fasting C‐peptide and insulin‐like growth factor‐binding protein (IGFBP)‐1, in addition to initial CO2 levels and urine ketones, would help in distinguishing type 1 diabetes mellitus (T1DM) from T2DM.

Incidence of Type 1 Diabetes in Philadelphia Is Higher in Black Than White Children From 1995 to 1999 Epidemic or misclassification

OBJECTIVE—To determine the epidemiology of type 1 diabetes in children in Philadelphia, Pennsylvania, from 1995 through 1999 and compare these data with previous cohorts. RESEARCH DESIGN AND METHODS—This is a report of a retrospective population-based registry maintained since 1985. Hospital records meeting the following criteria were reviewed: newly diagnosed type 1 diabetes, age 0–14 years, residing in Philadelphia at the time of diagnosis, and diagnosed from 1 January 1995 to 31 December 1999. The secondary source of validation was the School District of Philadelphia. Incidence rates by race and age were compared with 1985–1989 and 1990–1994 cohorts. RESULTS—A total of 234 case subjects were identified, and the registry was determined to be 96% complete. The overall age-adjusted incidence rate in Philadelphia was 14.8 per 100,000/year. Incidence rates in Hispanic children (15.5 per 100,000/year) and white children (12.8 per 100,000/year) have been relatively stable over 15 years. The incidence in black children (15.2 per 100,000/year), however, has increased dramatically, rising 64% in children 5–9 years of age (14.9 per 100,000/year) and 37% in the 10- to 14-year age-group (26.9 per 100,000/year). CONCLUSIONS—The overall incidence of type 1 diabetes in Philadelphia is increasing and is similar to other U.S. registries. These are the first data reporting a higher incidence in black children in a registry of children 0–14 years of age. The etiology of the marked increase in incidence in the black population is unknown and underscores the need to establish type 1 diabetes as a reportable disease, so that environmental risk factors may be thoroughly investigated.

Racial and Ethnic Disparities in the Incidence, Treatment, and Outcomes of Youth with Type 1 Diabetes

Type 1 diabetes mellitus (T1DM) is the third most common chronic childhood disease in the United States. As more Hispanic and non-Hispanic black children are diagnosed with T1DM, racial and ethnic disparities in the treatment and outcomes of T1DM are increasing. This article reviews the increasing incidence and prevalence of T1DM in non-Hispanic white, non-Hispanic black, and Hispanic children. In addition, the racial and ethnic disparities in diabetes treatment, such as blood glucose monitoring, insulin therapy, and continuous glucose monitoring, and outcomes, including glycemic control, diabetic ketoacidosis, severe hypoglycemia, retinopathy, nephropathy, neuropathy, and diabetes-related mortality, are highlighted.

Insulin-like growth factor-I and insulin-like growth factor binding protein-1 are related to cardiovascular disease biomarkers in obese adolescents

Insulin‐like growth factor (IGF)‐I and IGF binding protein (IGFBP)‐1 have been linked to cardiovascular disease (CVD) risk and pathophysiology in adults, but there are limited data in youth.

Social jet lag, chronotype and body mass index in 14–17-year-old adolescents

ABSTRACT The relationship between sleep duration and obesity in adolescents is inconclusive. This may stem from a more complex relationship between sleep and obesity than previously considered. Shifts toward evening preferences, later sleep–wake times and irregular sleep–wake patterns are typical during adolescence but their relationship to body mass index (BMI) has been relatively unexplored. This cross-sectional study examined associations between sleep duration, midpoint of sleep and social jet lag (estimated from 7 days of continuous actigraphy monitoring), and morningness/eveningness with BMIs (BMI z-scores) and waist-to-height ratios in 14–17-year-old adolescents. Seventy participants were recruited from ninth and tenth grades at a public high school. Participants’ characteristics were as follows: 74% female, 75% post-pubertal, 36% Hispanic, 38% White, 22% Black, 4% Asian and 64% free/reduced lunch participants with a mean age of 15.5 (SD, 0.7). Forty-one percent of the participants were obese (BMI ≥ 95th percentile); 54% were abdominally obese (waist-to-height ratio ≥ 0.5). Multivariable general linear models were used to estimate the association between the independent variables (school night sleep duration, free night sleep duration, midpoint of sleep (corrected), social jet lag and morningness/eveningness) and the dependent variables (BMI z-scores and waist-to-height ratios). Social jet lag is positively associated with BMI z-scores (p < 0.01) and waist-to-height ratios (p = 0.01). Midpoint of sleep (corrected) is positively associated with waist-to-height ratios (p = 0.01). After adjusting for social jet lag, school night sleep duration was not associated with waist-to-height ratios or BMI z-scores. Morningness/eveningness did not moderate the association between sleep duration and BMI z-scores. Findings from this study suggest that chronobiological approaches to preventing and treating obesity may be important for accelerating progress in reducing obesity rates in adolescents.

Assessment of Growth and Immunologic Function in HIV-Infected and Exposed Children

Many children who are HIV infected grow poorly. An epidemiological framework guided a retrospective chart review assessing growth in three groups of children (n = 192): (a) children who were HIV infected secondary to maternal transmission (n = 77), (b) children who had been HIV-positive at birth but became seronegative and continue to be observed (seroreverters) (n = 84), and (c) HIV-infected children who had died (n = 31). Growth failure in the HIV-infected children was significantly greater than that expected in the general population. The seroreverters also demonstrated significantly more growth failure than that expected in the general population. Of the children who had linear growth failure, only 3 of 12 HIV-infected children and 2 of 11 seroreverters also had inadequate weight gain. However, 13 of 15 children with growth failure who subsequently died had poor weight gain. HIV classification was not significantly related to growth. These findings extend our understanding to a large, urban population of children in the United States including those who are older than children in other studies and who developed HIV through perinatal transmission. Nursing clinical practice and research implications are offered.