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Previous research has linked the manifestation of multiple chronic diseases that are frequently due to health behaviors to adverse childhood experiences (ACEs). Despite this, the link between ACEs and the age of type 2 diabetes mellitus (T2DM) diagnosis is scarce. As such, our primary objective was to evaluate and describe the impact of ACEs on the age at diagnosis utilizing the data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS). Our secondary objective was to analyze the relationship between various demographic factors and the age of T2DM diagnosis. We conducted a cross-sectional analysis of data from the 2021 cycle of the BRFSS. Applying sampling weights, provided by BRFSS, we assessed the prevalence rates of ACEs across sociodemographic variables and utilized binary and multivariable regressions to determine associations between sociodemographic factors and ACE scores on age of T2DM diagnosis. Among the 437,708 respondents, 57,616 (12.6 %) individuals reported having diabetes, with 6901 including responses for age of T2DM diagnosis and ACEs. We found a relationship between ACEs and earlier age of diabetes diagnosis - with individuals experiencing 1-3 ACEs being diagnosed 2.15 years earlier (standard error [SE]=0.48, p<0.001) than those with 0 ACEs, and 6.37 years earlier for individuals experiencing 4+ ACEs (SE=0.61, p<0.001). Significant differences in ACEs and age of diagnosis were also found between ethnoracial groups - compared to White, non-Hispanic individuals with 0 ACEs, the mean age of diagnosis was more than 12 years earlier among those who experienced 4+ ACEs and were either Asian, American Indian/Alaskan Native (AI/AN), or Hispanic. This observational analysis of one-year of BRFSS data found earlier diagnosis of T2DM among adults reporting ACEs compared to those without ACEs, but this varied by racial and ethnic identities. Although early diagnosis is critical in long-term T2DM management, appropriate identification of childhood adversity may be a key component to the development of the disease. This may be achieved through comprehensive child and family resources that target mental health and behavioral factors already known to be associated with T2DM.

Gestational diabetes mellitus is the most common complication of pregnancy and contributes to increased risk for type 2 diabetes in both the mother and offspring. We developed and evaluated a gestational diabetes risk reduction and preconception counseling program, Stopping GDM (SGDM), for American Indian females. The purpose of this study is to examine the experiences of American Indian mother-daughter dyad participants and the site coordinators who facilitated the SGDM randomized controlled trial to inform program revisions. We engaged mother-daughter dyads (n = 22 dyads) and site coordinators (n = 6) in focus group interviews. Four themes emerged: (1) SGDM sparked valuable quality conversation for dyads; (2) gestational diabetes risk factors and risk reduction was new information for most dyads; (3) all trial sites experienced challenges to recruitment and engagement; and (4) study-improvement recommendations. These findings will be used to enhance SGDM to decrease adverse intergenerational health impacts of gestational diabetes in American Indian communities.

Context: Neonatal diabetes mellitus, a rare condition occurring in approximately 1 in 500 000 live births, is defined as insulin-requiring hyperglycemia presenting in the first months of life. Neonatal diabetes can be transient or permanent, with studies characterizing the condition as a monogenic disorder. Case Report: We describe a case of a 9-week-old infant with neonatal diabetes who presented in diabetic ketoacidosis due to a mutation affecting the ABCC8 gene that encodes the SUR1 subunit of the potassium ATP channel. Conclusion: This genetic diagnosis has therapeutic implications regarding the initiation of sulfonylurea administration as 85% of patients with neonatal diabetes due to ABCC8 gene mutations can be successfully treated with oral sulfonylurea treatment.

Abstract Context Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by endocrine and neuropsychiatric problems including hyperphagia, anxiousness, and distress. Intranasal carbetocin, an oxytocin analog, was investigated as a selective oxytocin replacement therapy. Objective To evaluate safety and efficacy of intranasal carbetocin in PWS. Design Randomized, double-blind, placebo-controlled phase 3 trial with long-term follow-up. Setting Twenty-four ambulatory clinics at academic medical centers. Participants A total of 130 participants with PWS aged 7 to 18 years. Interventions Participants were randomized to 9.6 mg/dose carbetocin, 3.2 mg/dose carbetocin, or placebo 3 times daily during an 8-week placebo-controlled period (PCP). During a subsequent 56-week long-term follow-up period, placebo participants were randomly assigned to 9.6 mg or 3.2 mg carbetocin, with carbetocin participants continuing at their previous dose. Main outcome measures Primary endpoints assessed change in hyperphagia (Hyperphagia Questionnaire for Clinical Trials [HQ-CT]) and obsessive-compulsive symptoms (Children's Yale-Brown Obsessive-Compulsive Scale [CY-BOCS]) during the PCP for 9.6 mg vs placebo, and the first secondary endpoints assessed these same outcomes for 3.2 mg vs placebo. Additional secondary endpoints included assessments of anxiousness and distress behaviors (PWS Anxiousness and Distress Behaviors Questionnaire [PADQ]) and clinical global impression of change (CGI-C). Results Because of onset of the COVID-19 pandemic, enrollment was stopped prematurely. The primary endpoints showed numeric improvements in both HQ-CT and CY-BOCS which were not statistically significant; however, the 3.2-mg arm showed nominally significant improvements in HQ-CT, PADQ, and CGI-C scores vs placebo. Improvements were sustained in the long-term follow-up period. The most common adverse event during the PCP was mild to moderate flushing. Conclusions Carbetocin was well tolerated, and the 3.2-mg dose was associated with clinically meaningful improvements in hyperphagia and anxiousness and distress behaviors in participants with PWS. Clinical Trials Registration Number NCT03649477

Nonalcoholic fatty liver disease (NAFLD) is probably the most common form of chronic liver disease in children in the USA and may continue to rise with the increasing prevalence of childhood obesity and metabolic syndrome. Although the exact pathophysiology of NAFLD is not well understood, insulin resistance, oxidative stress and the release of proinflammatory cytokines are suggested factors in the cascade of reactions resulting in NAFLD. The best diagnostic workup and treatment for NAFLD and nonalcoholic steatohepatitis are still being debated; however, early intervention to halt further progression and/or to reverse the disease process is recommended. Further studies are needed to better understand the demographics, pathogenesis, treatment, natural history and long-term prognosis of pediatric NAFLD. This review discusses current concepts regarding these issues in pediatric patients with NAFLD.

Background American Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented. Methods We conducted focus groups and individual interviews with multiple AI/AN stakeholders ( n  = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews. Results Four key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals. Conclusion Findings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies.

Context: Neonatal diabetes mellitus, a rare condition occurring in approximately 1 in 500 000 live births, is defined as insulin-requiring hyperglycemia presenting in the first months of life. Neonatal diabetes can be transient or permanent, with studies characterizing the condition as a monogenic disorder. Case Report: We describe a case of a 9-week-old infant with neonatal diabetes who presented in diabetic ketoacidosis due to a mutation affecting the ABCC8 gene that encodes the SUR1 subunit of the potassium ATP channel. Conclusion: This genetic diagnosis has therapeutic implications regarding the initiation of sulfonylurea administration as 85% of patients with neonatal diabetes due to ABCC8 gene mutations can be successfully treated with oral sulfonylurea treatment.