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Review paper final Review paper final Document Transcript

  • Effects of Early Onset Diabetes in Children By Omar Padilla VélezABSTRACT Diabetes is one of the main causes of child death, but it is ignored. New and currentresearch has shown that early onset diabetes is harmful for anyone. Type1 and Type 2 diabetesare both hereditary diseases. Experiments with diabetic patients who have diabetic parents showthat diabetes is inherited, especially via paternal lineage. Even though diabetes is a hereditarydisease it is preventable by keeping a healthy lifestyle. Diabetes in children has beendemonstrated to develop serious health problems. Studies have concluded that diabetic childrenunder 15 have more chances of developing microalbuminaria. This is high levels of protein in theurine, which can lead to kidney failure. As this disease progresses new treatments are beingdeveloped. The current method for diabetic children consists of multiple daily insulin injections.This treatment causes a great amount of stress in the children and decreasing their quality of life.The insulin pump therapy is being introduced as a new method for children. The pump regulatesthe glucose levels automatically, releasing the worries and stress of the children and theirparents.INTRODUCTION The human body functions using the energy that is consumed daily. In every activity thatis performed, energy is essential. Even when a person sleeps, they still need energy for theproper function of the body’s systems and processes. The main way that the body gets energy isby eating. Food is digested in the stomach for the extraction of nutrients which carry energy forgrowth and development. Most of the energy comes from glucose, which is a form of sugar inthe blood. This glucose is the main source of fuel for the body. Glucose comes into thebloodstream and spreads throughout the whole body. The body’s cells use hormones to complete several processes. To take in the glucosefrom the blood into the cells, the body uses insulin. A specific amount of insulin is produced bythe pancreas when food is eaten to move the glucose into the cells. This way, sugar levels in thebloodstream are lowered and the body gets the energy it needs to work properly. A healthypancreas is able to can adjust the amount of insulin needed based on the glucose levels in theblood. A person with diabetes has a condition in which the levels of glucose in the blood are toohigh. This is an effect of the body cells not responding to the insulin the pancreas produces, notproducing enough insulin or any amount of insulin. Without insulin the glucose does not enterthe cells and no energy for growth and development will be available. This is why diabetes inconsidered a metabolism disorder. There are two main types of diabetes, type 1 and type 2.People who suffer Type 1 diabetes are completely unable to produce insulin. People with Type 2diabetes can produce insulin, but their cells do not respond to it. In either case, the glucosecannot move into the cells causing high glucose levels in the blood. Over time, these high
  • glucose levels can cause serious complications in the body like: high blood pressure, highcholesterol, loss of sight, kidney disease and even nerve damage.Type 2 diabetes as a hereditary disease It is believed that people who have offspring. They selected three groups offamily members that have been diagnosed individuals: 1) offspring of fathers withwith type 2 diabetes have a great risk of early onset of diabetes, 2) offspring ofdeveloping it themselves. It is not mothers with early onset of diabetes, and 3)guaranteed, but a person’s family history offspring, in which neither parent developedand lifestyle plays an important part in diabetes. Body composition (percentage ofdetermining they have diabetes. Researchers body fat [%BF]), insulin action (M), andhave tested whether or not paternal and acute insulin response (AIR) were comparedmaternal type 2 diabetes may occur in their to formulate conclusions.offspring and tried to identify it for a betterdiagnosis. They specifically examined the Body composition was measured bymetabolic phenotype in three different dual energy X-ray absorptiometry using agroups of offspring to see distinct paternal total body scanner (DPX-L; Lunar,versus maternal effects. The offspring Madison, WI). Insulin action was assessed atphenotype may vary depending on which physiological insulin concentrations duringparent is affected and whether the offspring the hyperinsulinemic-euglycemic clampwas exposed to diabetes in utero. technique. Blood samples were taken at specific time to determine the insulin action Low birth weight (LBW), was by comparing and calculating the glucosethought to result from in utero maternal infusion with the plasma activity in theundernutrition. It is one of the phenotypic blood.features and has been shown to predict thedevelopment of type 2 diabetes. Recent From all the experimentation theystudies with mice demonstrated that concluded that offspring of fathers withalthough a LBW phenotype, first generated early-onset diabetes are leaner and haveusing maternal undernutrition, confers lower early insulin secretion compared toimpaired glucose tolerance via both individuals who both parents remainedsubsequent parental lines, the LBW without diabetes up to 50 years of age.phenotype is passed on via paternal Insulin action was very similar in all threeinheritance only. As these mice reach groups of offspring. These results indicatematurity, paternal offspring continue to have an important role of paternal heritability inlower body weight but similar degrees of body composition. Paternal transmissionimpairment in glucose tolerance and patterns for susceptibility to diabetesimpaired insulin secretion. indicate that epigenetic mechanisms are involved in the predisposition to diabetes. With this data the researchers made (Penesova et. al 2010).an experiment to separate parental effects in
  • Health risks on children with diabetes Type 1 diabetes is the most common screening program, the North Walestype of diabetes in children today. Usually Diabetic Retinopathy Screening Program,children under the age of 16 are being hospital departments of chemical pathology,revealed with the disease. Type 1 diabetes in and general practitioners (GPs). Urinechildren is known as an autoimmune disease samples were asked for and patients who didbecause the body’s immune system will not attend hospital clinics send their samplesattack one of the body’s own tissues or by postal request. A nephropathy score wasorgans. It is believed that the younger the set for each age group from renal outcomepatient suffering Type 1 diabetes the worse and were ranked as: normal, 1;the outcome. Studies have shown that young macroalbuminuria, 2; established diabeticonset Type 1 diabetes is associated with an nephropathy, 3; progressive renal failure, 4;increased incidence of macroalbuminuria, or end-stage renal failure (ESRF), 5.20 - 200 µg/min albumin proteins in theurine, and increased incidence of The study resulted that comparedbackground retinopathy. The aim of this with adult-onset controls, the nephropathystudy was to quantify the influence of age at outcome was worse in childhood-onsetonset on long-term renal and retinal outcome diabetes. The risk of developingof childhood onset Type 1 diabetes by macroalbuminuria was greater in childhoodcomparing the rates at which renal and onset diabetes. The number of patientsretinal pathology occur. developing background retinopathy did not differ with age at onset but younger onset patients were more likely to need laser An ethical committee approval was treatment. Patients with onset of Type 1obtained for the study. The data was diabetes before age 15 had worse renalprovided by three hospital units and all 74 outcome and require more treatment thangeneral practices serving the area. The adult-onset patients. Differences betweenpatients were 98% Type 1 diabetic patients those with onset before age 5, onset at 5–9with onset before age 15. They divided and 10–14 years are small compared withpatients who developed Type 1 diabetes in the difference between childhood onset andgroups by age: before age 5 (group 1), from adult onset. Kidney disease and diabetes willage 5 to 9 (group 2) and from age 10 to 14 progress and the child will not be able to getyears (group 3), and a reference group rid of the waste that is their blood. Thiscomprising all patients diagnosed with Type waste will build up and become toxic to the1 diabetes between ages 21 and 25 years body turning into uremia. Developing(group 4). diabetes in the teenage years appears to have a major effect on the risk of developing The data on these patients was long-term micro vascular complications.obtained from the diabetes register, patients’ (Harvey and Allagoa 2003).case notes, the local microalbuminuriaInsulin pump therapy
  • As technology is developed in quality of life and it decreases parental stressmedicine, it is important that new treatments because the glucose levels are maintainedare efficient and harmful for the patients. In and the children do not argue that much. Athe U.S., 186,300 children have been research was conducted using sixty-twodiagnosed with type 1 diabetes and each middle and high school children (ages 12–year 15,000 more are diagnosed. Type 1 17) with type 1 diabetes, and the parents indiabetes can result and develop in serious charge of them. Twenty-six (42%) of thelike cardiovascular disease, blindness, nerve children were using the pumps at the time ofdamage and kidney damage. Researchers are the study and 36 (58%) were using MDI. Afocusing on establishing effective methods written informed consent was obtained fromto control blood glucose levels. Currently, the parents. The data collected was:insulin levels are managed via multiple daily children’s age, date of diabetes diagnosis,injections (MDI), but an increasing number and most recent blood glucose levels. Also,of children are using insulin pumps. Insulin the parents completed a measure ofpumps deliver insulin 24 hours a day parenting stress and the children completedthrough a catheter. This allows more a measure of quality of life.flexibility nutrition choices and may lead tomore stable glucose levels. These insulin The outcome of the study indicatedpumps better mimic pancreatic insulin that children on insulin pump therapy aredelivery and provide a more predictable not very different from children receivinginsulin effect on blood glucose levels than MDI in terms of metabolic control, qualityinjections. of life and parenting stress. These results are similar to previous studies. The similar The insulin pumps have three results may be associated with advances inadvantages over MDI. The children achieve MDI therapy. (Yelena et al. 2010).better metabolic control, they have a higherCONCLUSION Studies have shown that diabetes is a hereditary disease. By following the condition’smetabolic phenotypes in offspring, researchers demonstrated that the disease is inherited fromparent to child. Symptoms and conditions that lead to diabetes such as low birth weight andinsulin secretion are seen in children with parents with who suffer the same conditions. Eventhough diabetes is hereditary, it is preventable. Children with diabetic family history and who do not keep a healthy life style are at greatrisk of developing the disease. Diabetes in children is very serious because it leads to big healthissues at an early age. A study with children under and over 15 year of age showed that childrenfewer than 15 diagnosed with diabetes have more renal problems. This is caused bymicroalbuminaria, high levels of protein in the urine. This can lead to kidney problems and evenkidney failure. It is important to develop an effective treatment for children because they are notcapable on understanding the risk of diabetes. Children care for having a good time, which iswhy the new insulin pump therapy is ideal for them. The pump regulates the glucose levels in the
  • blood automatically. This releases the kid’s worries and let’s them have a good quality of lifewhile at the same time having a better control over their condition.REFERENCES 1. Harvey J.N, Allagoa B. 2003. Urinary Nitrites and Nitrates And The long-term renal and retinal Doppler Sonography in Children outcome of childhood onset Type with Diabetes. Diabetes Care 1 diabetes. Diabetic Medicine Journal [Ienternet] Available at: [Internet]. [cited 2010 December] http://proquest.umi.com.uprcdb.c Available at: ayey.upr.edu:2048/pqdweb? http://onlinelibrary.wiley.com/do index=0&did=1184538281&Src i/10.1046/j.1464-5491.2003.0106 2.x/references hMode=1&sid=1&Fmt=4&VInst =PROD&VType=PQD&RQT=3 2. Nahata L. 2006. Insulin Therapy in 09&VName=PQD&TS=1292851 Pediatric with Type I Diabetes: 157&clientId=45093 Continuos Subcutaneous Insulin Infusion versus Multiple Daily 5. Sllers E, Blydt-Hansen T, Dean H, Injections. Clinical Pediatrics Gibson I, Birk P, Ogborn M. 2009. Journal [Internet] Available at: Macroalbuminaria and Renal http://proquest.umi.com.uprcdb.c Pathology in First Nation Youth ayey.upr.edu:2048/pqdweb? With Type 2 Diabetes. Diabetes RQT=511&sid=5&restriction=4 Care Journal [Internet] Available &TS=1292851289 at: http://proquest.umi.com.uprcdb.c 3. Penesova A, Bunt J, Bogardus C, ayey.upr.edu:2048/pqdweb? Krakoff J. 2010. Effect of index=0&did=1787504221&Src Paternal Diabetes on Pre- hMode=1&sid=10&Fmt=4&VIn Diabetic Phenotypes in Adult st=PROD&VType=PQD&RQT= Offspring. Diabetes Care Journal 309&VName=PQD&TS=129285 [Internet]. [cited 2010 December] 1918&clientId=45093 Available at: http://proquest.umi.com.uprcdb.c 6. Svensson M, Nytröm L, Schön S, ayey.upr.edu:2048/pqdweb? Dahlquist G. 2006. Age at Onset of index=4&did=2115752321&Src Childhood-Onset Type 1 Diabetes hMode=1&sid=2&Fmt=3&VInst and the Development of End-Stage =PROD&VType=PQD&RQT=3 Renal Disease. Diabetes Care 09&VName=PQD&TS=1286487 Journal [Internet]. Available at: 989&clientId=45093 http://proquest.umi.com.uprcdb.caye y.upr.edu:2048/pqdweb? 4. Savino A, Pelliccia P, Schiavone C, index=0&did=1005241031&SrchM Primavera A, Tumini S, Mohn A, ode=1&sid=1&Fmt=4&VInst=PRO Chiarelli F. 2006. Serum and D&VType=PQD&RQT=309&VNa
  • me=PQD&TS=1292811310&clientI d=450937. Yelena P, Montserrat M, Michael C, Adela C. 2010. Is insulin pump therapy better than injection for adolescents with diabetes? Elsevier Journal [Internet]. [cited 2010 December] Available at: http:// www.diabetesresearchclinicalpractic e.com/article/S0168-8227(10)00187 -7/abstract