Kerri Wachter

PHILADELPHIA – Children are likely to be diagnosed with autism spectrum disorders at a younger age if there is a shorter period between referral and evaluation, Dr. Ginger Janow said.

Early diagnosis of autism spectrum disorders can make a big difference in outcomes.

“The one thing that's been shown consistently [to] affect outcomes is early intensive behavioral intervention,” said Dr. Janow of the Children's Hospital at Montefiore, New York, at the annual meeting of the Eastern Pediatric Research Society. The effectiveness of these interventions depends on the age at which they are started.

The researchers performed a retrospective chart review of 116 children diagnosed with autism spectrum disorder (ASD) at the Seaver and New York Autism Center of Excellence at the Mount Sinai School of Medicine, New York, between 1995 and 2005. Specialists at the center conduct initial evaluations for ASD.

Supplementary evaluations are performed when additional assessment is warranted. The average age of diagnosis at the center was 27 months, and the average time between referral and evaluation was 2 months.

An analysis showed that earlier age of diagnosis was correlated with diagnosis at the primary evaluation (rather than at a supplemental evaluation), decreased time between referral and evaluation, and increased fine-motor and adaptive delays.

Early diagnosis was not correlated with insurance status, estimated income, or language delays.

PHILADELPHIA – Children are likely to be diagnosed with autism spectrum disorders at a younger age if there is a shorter period between referral and evaluation, Dr. Ginger Janow said.

Early diagnosis of autism spectrum disorders can make a big difference in outcomes.

“The one thing that's been shown consistently [to] affect outcomes is early intensive behavioral intervention,” said Dr. Janow of the Children's Hospital at Montefiore, New York, at the annual meeting of the Eastern Pediatric Research Society. The effectiveness of these interventions depends on the age at which they are started.

The researchers performed a retrospective chart review of 116 children diagnosed with autism spectrum disorder (ASD) at the Seaver and New York Autism Center of Excellence at the Mount Sinai School of Medicine, New York, between 1995 and 2005. Specialists at the center conduct initial evaluations for ASD.

Supplementary evaluations are performed when additional assessment is warranted. The average age of diagnosis at the center was 27 months, and the average time between referral and evaluation was 2 months.

An analysis showed that earlier age of diagnosis was correlated with diagnosis at the primary evaluation (rather than at a supplemental evaluation), decreased time between referral and evaluation, and increased fine-motor and adaptive delays.

Early diagnosis was not correlated with insurance status, estimated income, or language delays.

PHILADELPHIA – Children are likely to be diagnosed with autism spectrum disorders at a younger age if there is a shorter period between referral and evaluation, Dr. Ginger Janow said.

Early diagnosis of autism spectrum disorders can make a big difference in outcomes.

“The one thing that's been shown consistently [to] affect outcomes is early intensive behavioral intervention,” said Dr. Janow of the Children's Hospital at Montefiore, New York, at the annual meeting of the Eastern Pediatric Research Society. The effectiveness of these interventions depends on the age at which they are started.

The researchers performed a retrospective chart review of 116 children diagnosed with autism spectrum disorder (ASD) at the Seaver and New York Autism Center of Excellence at the Mount Sinai School of Medicine, New York, between 1995 and 2005. Specialists at the center conduct initial evaluations for ASD.

Supplementary evaluations are performed when additional assessment is warranted. The average age of diagnosis at the center was 27 months, and the average time between referral and evaluation was 2 months.

An analysis showed that earlier age of diagnosis was correlated with diagnosis at the primary evaluation (rather than at a supplemental evaluation), decreased time between referral and evaluation, and increased fine-motor and adaptive delays.

Early diagnosis was not correlated with insurance status, estimated income, or language delays.

WASHINGTON – Total social competence and externalizing behavior may play a role in how well children and adolescents control their diabetes, according the results of a study involving 78 patients.

“Lower total psychosocial competence is a strong predictor of poor metabolic control in diabetic youth,” Dr. Ivana Balic, a general psychiatry resident, and Dr. Burleson W. Daviss, a child psychiatrist, both of the University of Texas Health Sciences Center at San Antonio, wrote in a poster. Externalizing psychopathology was a lesser predictor.

The researchers recruited 78 children and adolescents (mean age 12 years) from a clinic or a diabetes camp for this study, presented at the annual meeting of the American Psychiatric Association. Using the Child Behavior Checklist, they assessed total social competence and externalizing symptoms. Along with sociodemographics, the researchers assessed these factors as predictors of poor metabolic control 3 months later. Poor metabolic control was defined as an HbA_1c level of 10 mg/dL or greater. In all, 56% of the youth had poor metabolic control. On univariate analysis, age and living with a single parent were significant predictors of poor metabolic control, along with lower total social competence, family conflict, dietary noncompliance, and externalizing symptoms. Interestingly, internalizing symptoms did not significantly predict poor metabolic control.

All of the significant predictors from univariate analysis were incorporated into the backward stepwise logistic regression. The final predictive model included age, living with a single parent, lower total social competence, dietary noncompliance, and family conflict. This model correctly classified 74% of the youth with poor metabolic control.

Total competence, as tested by the Child Behavioral Checklist, describes children's capability in school activities, social activities, and other areas of competence. “Children who do a good job at the things that total competence is measuring also are more likely to do a better job at handling their diabetes,” said Dr. Balic in an interview. Children who have trouble in these areas might have more trouble managing diabetes.

Age and living with a single parent also were significant predictors of poor metabolic control. DR. DAVISS

WASHINGTON – Total social competence and externalizing behavior may play a role in how well children and adolescents control their diabetes, according the results of a study involving 78 patients.

“Lower total psychosocial competence is a strong predictor of poor metabolic control in diabetic youth,” Dr. Ivana Balic, a general psychiatry resident, and Dr. Burleson W. Daviss, a child psychiatrist, both of the University of Texas Health Sciences Center at San Antonio, wrote in a poster. Externalizing psychopathology was a lesser predictor.

The researchers recruited 78 children and adolescents (mean age 12 years) from a clinic or a diabetes camp for this study, presented at the annual meeting of the American Psychiatric Association. Using the Child Behavior Checklist, they assessed total social competence and externalizing symptoms. Along with sociodemographics, the researchers assessed these factors as predictors of poor metabolic control 3 months later. Poor metabolic control was defined as an HbA_1c level of 10 mg/dL or greater. In all, 56% of the youth had poor metabolic control. On univariate analysis, age and living with a single parent were significant predictors of poor metabolic control, along with lower total social competence, family conflict, dietary noncompliance, and externalizing symptoms. Interestingly, internalizing symptoms did not significantly predict poor metabolic control.

All of the significant predictors from univariate analysis were incorporated into the backward stepwise logistic regression. The final predictive model included age, living with a single parent, lower total social competence, dietary noncompliance, and family conflict. This model correctly classified 74% of the youth with poor metabolic control.

Total competence, as tested by the Child Behavioral Checklist, describes children's capability in school activities, social activities, and other areas of competence. “Children who do a good job at the things that total competence is measuring also are more likely to do a better job at handling their diabetes,” said Dr. Balic in an interview. Children who have trouble in these areas might have more trouble managing diabetes.

Age and living with a single parent also were significant predictors of poor metabolic control. DR. DAVISS

WASHINGTON – Total social competence and externalizing behavior may play a role in how well children and adolescents control their diabetes, according the results of a study involving 78 patients.

“Lower total psychosocial competence is a strong predictor of poor metabolic control in diabetic youth,” Dr. Ivana Balic, a general psychiatry resident, and Dr. Burleson W. Daviss, a child psychiatrist, both of the University of Texas Health Sciences Center at San Antonio, wrote in a poster. Externalizing psychopathology was a lesser predictor.

The researchers recruited 78 children and adolescents (mean age 12 years) from a clinic or a diabetes camp for this study, presented at the annual meeting of the American Psychiatric Association. Using the Child Behavior Checklist, they assessed total social competence and externalizing symptoms. Along with sociodemographics, the researchers assessed these factors as predictors of poor metabolic control 3 months later. Poor metabolic control was defined as an HbA_1c level of 10 mg/dL or greater. In all, 56% of the youth had poor metabolic control. On univariate analysis, age and living with a single parent were significant predictors of poor metabolic control, along with lower total social competence, family conflict, dietary noncompliance, and externalizing symptoms. Interestingly, internalizing symptoms did not significantly predict poor metabolic control.

All of the significant predictors from univariate analysis were incorporated into the backward stepwise logistic regression. The final predictive model included age, living with a single parent, lower total social competence, dietary noncompliance, and family conflict. This model correctly classified 74% of the youth with poor metabolic control.

Total competence, as tested by the Child Behavioral Checklist, describes children's capability in school activities, social activities, and other areas of competence. “Children who do a good job at the things that total competence is measuring also are more likely to do a better job at handling their diabetes,” said Dr. Balic in an interview. Children who have trouble in these areas might have more trouble managing diabetes.

Age and living with a single parent also were significant predictors of poor metabolic control. DR. DAVISS

BALTIMORE – Genes appear to play a role not only in a child's vulnerability to weight gain but also in behaviors that can lead to weight gain, data presented at the annual meeting of the American Psychosomatic Society show.

Jane Wardle, Ph.D., director of the health behavior research center at University College London, and her colleagues analyzed data on 5,435 pairs of twins aged 8–11 years who are part of the Twins Early Development Study (TEDS). Parents rated each twin on satiety sensitivity and food cue responsiveness.

Using genetic model fitting, the researchers estimated that genes account for 63% of satiety sensitivity. Shared environment and nonshared environmental factors accounted for 21% and 16% of satiety sensitivity. The researchers also estimated that genes account for 75% of food cue responsiveness. Shared environment and nonshared environmental factors accounted for 10% and 15% of food cue responsiveness, respectively, she said.

The researchers also used genetic model fitting to estimate the influence of genes, shared environment, and nonshared environment on body mass index and waist circumference.

Genes account for roughly three-quarters of the variability in BMI and waist circumference in these children, shared environment accounts for about 10%, and nonshared environment accounts for roughly 15%.

BALTIMORE – Genes appear to play a role not only in a child's vulnerability to weight gain but also in behaviors that can lead to weight gain, data presented at the annual meeting of the American Psychosomatic Society show.

Jane Wardle, Ph.D., director of the health behavior research center at University College London, and her colleagues analyzed data on 5,435 pairs of twins aged 8–11 years who are part of the Twins Early Development Study (TEDS). Parents rated each twin on satiety sensitivity and food cue responsiveness.

Using genetic model fitting, the researchers estimated that genes account for 63% of satiety sensitivity. Shared environment and nonshared environmental factors accounted for 21% and 16% of satiety sensitivity. The researchers also estimated that genes account for 75% of food cue responsiveness. Shared environment and nonshared environmental factors accounted for 10% and 15% of food cue responsiveness, respectively, she said.

The researchers also used genetic model fitting to estimate the influence of genes, shared environment, and nonshared environment on body mass index and waist circumference.

Genes account for roughly three-quarters of the variability in BMI and waist circumference in these children, shared environment accounts for about 10%, and nonshared environment accounts for roughly 15%.

BALTIMORE – Genes appear to play a role not only in a child's vulnerability to weight gain but also in behaviors that can lead to weight gain, data presented at the annual meeting of the American Psychosomatic Society show.

Jane Wardle, Ph.D., director of the health behavior research center at University College London, and her colleagues analyzed data on 5,435 pairs of twins aged 8–11 years who are part of the Twins Early Development Study (TEDS). Parents rated each twin on satiety sensitivity and food cue responsiveness.

Using genetic model fitting, the researchers estimated that genes account for 63% of satiety sensitivity. Shared environment and nonshared environmental factors accounted for 21% and 16% of satiety sensitivity. The researchers also estimated that genes account for 75% of food cue responsiveness. Shared environment and nonshared environmental factors accounted for 10% and 15% of food cue responsiveness, respectively, she said.

The researchers also used genetic model fitting to estimate the influence of genes, shared environment, and nonshared environment on body mass index and waist circumference.

Genes account for roughly three-quarters of the variability in BMI and waist circumference in these children, shared environment accounts for about 10%, and nonshared environment accounts for roughly 15%.

BALTIMORE – Children with greater food intake in the absence of hunger might have abnormal cortisol levels after stressful situations–a finding that could have implications for the development of obesity–data presented at the annual meeting of the American Psychosomatic Society show.

Lori A. Francis, Ph.D., of Pennsylvania State University, Hershey, and her colleagues looked for associations between cortisol levels in response to stress and evidence of dysregulated eating in 43 children aged 5–9 years.

They found that children with dysregulated eating (eating in the absence of hunger) had increased cortisol levels immediately after the stress test and increasing cortisol levels during a recovery period.

“We think there's some sort of blunted stress response there,” Dr. Francis said.

For the study, the children had baseline saliva measurements 15 minutes and 35 minutes after arrival. An hour after arrival, they were submitted to a stress test. A saliva sample was collected after the stress test, and two more samples were collected during the recovery period. Two hours after arrival, the children were given a meal, and 30 minutes later the eating in the absence of hunger protocol was started.

The researchers used a stress test that mainly consists of public speaking and arithmetic tasks. The children were told that they must give a 4-minute speech that would be judged against the speeches of all of the other children.

The speech task was followed by either an arithmetic challenge (children aged 8–9 years) or a block design challenge (aged 5–7 years) for 4 minutes.

During the recovery period, the children completed questionnaires and participated in a craft project. After the recovery period, the children were given a standard meal and told to eat as much as they wanted.

The children were then given a small taste of each of 10 palatable snack foods. The children were then allowed free access to the snack foods and to a box of toys. Foods were weighed pre- and post access and caloric intake was calculated.

Two patterns of cortisol response were identified. Low reactors had cortisol levels that started out high but continued to decline. The high reactors started the stress period with lower cortisol levels that peaked right after the stress test and returned to baseline during the recovery period.

Dr. Francis said that in future studies, she and her colleagues hope to find that stress reactivity is an important marker in terms of the mechanism for developing overweight or obesity.

BALTIMORE – Children with greater food intake in the absence of hunger might have abnormal cortisol levels after stressful situations–a finding that could have implications for the development of obesity–data presented at the annual meeting of the American Psychosomatic Society show.

Lori A. Francis, Ph.D., of Pennsylvania State University, Hershey, and her colleagues looked for associations between cortisol levels in response to stress and evidence of dysregulated eating in 43 children aged 5–9 years.

They found that children with dysregulated eating (eating in the absence of hunger) had increased cortisol levels immediately after the stress test and increasing cortisol levels during a recovery period.

“We think there's some sort of blunted stress response there,” Dr. Francis said.

For the study, the children had baseline saliva measurements 15 minutes and 35 minutes after arrival. An hour after arrival, they were submitted to a stress test. A saliva sample was collected after the stress test, and two more samples were collected during the recovery period. Two hours after arrival, the children were given a meal, and 30 minutes later the eating in the absence of hunger protocol was started.

The researchers used a stress test that mainly consists of public speaking and arithmetic tasks. The children were told that they must give a 4-minute speech that would be judged against the speeches of all of the other children.

The speech task was followed by either an arithmetic challenge (children aged 8–9 years) or a block design challenge (aged 5–7 years) for 4 minutes.

During the recovery period, the children completed questionnaires and participated in a craft project. After the recovery period, the children were given a standard meal and told to eat as much as they wanted.

The children were then given a small taste of each of 10 palatable snack foods. The children were then allowed free access to the snack foods and to a box of toys. Foods were weighed pre- and post access and caloric intake was calculated.

Two patterns of cortisol response were identified. Low reactors had cortisol levels that started out high but continued to decline. The high reactors started the stress period with lower cortisol levels that peaked right after the stress test and returned to baseline during the recovery period.

Dr. Francis said that in future studies, she and her colleagues hope to find that stress reactivity is an important marker in terms of the mechanism for developing overweight or obesity.

BALTIMORE – Children with greater food intake in the absence of hunger might have abnormal cortisol levels after stressful situations–a finding that could have implications for the development of obesity–data presented at the annual meeting of the American Psychosomatic Society show.

Lori A. Francis, Ph.D., of Pennsylvania State University, Hershey, and her colleagues looked for associations between cortisol levels in response to stress and evidence of dysregulated eating in 43 children aged 5–9 years.

They found that children with dysregulated eating (eating in the absence of hunger) had increased cortisol levels immediately after the stress test and increasing cortisol levels during a recovery period.

“We think there's some sort of blunted stress response there,” Dr. Francis said.

For the study, the children had baseline saliva measurements 15 minutes and 35 minutes after arrival. An hour after arrival, they were submitted to a stress test. A saliva sample was collected after the stress test, and two more samples were collected during the recovery period. Two hours after arrival, the children were given a meal, and 30 minutes later the eating in the absence of hunger protocol was started.

The researchers used a stress test that mainly consists of public speaking and arithmetic tasks. The children were told that they must give a 4-minute speech that would be judged against the speeches of all of the other children.

The speech task was followed by either an arithmetic challenge (children aged 8–9 years) or a block design challenge (aged 5–7 years) for 4 minutes.

During the recovery period, the children completed questionnaires and participated in a craft project. After the recovery period, the children were given a standard meal and told to eat as much as they wanted.

The children were then given a small taste of each of 10 palatable snack foods. The children were then allowed free access to the snack foods and to a box of toys. Foods were weighed pre- and post access and caloric intake was calculated.

Two patterns of cortisol response were identified. Low reactors had cortisol levels that started out high but continued to decline. The high reactors started the stress period with lower cortisol levels that peaked right after the stress test and returned to baseline during the recovery period.

Dr. Francis said that in future studies, she and her colleagues hope to find that stress reactivity is an important marker in terms of the mechanism for developing overweight or obesity.

PHILADELPHIA – Children with attention-deficit/hyperactivity disorder performed worse than children without the disorder on tests of working memory–an important factor in learning and academic success, according to the results of a case-controlled study of 64 children aged 7–12 years.

In the study, 35 children with ADHD (24 males and 11 females) and 29 healthy controls (6 males and 23 females) were asked to perform the Digit Span test, which assesses working memory. Working memory allows a person to receive, store, and retrieve information on a temporary basis, said Dr. Kanchana Roychoudhury, a pediatrician at Flushing (N.Y.) Hospital Medical Center.

The Digit Span test comprises digit span forward (DSF) and digit span backward (DSB) tasks. In DSF, a list of random numbers is read aloud and, at the end of a sequence, the child is asked to recall the items in order. The test begins with two or three numbers, increasing until the child commits an error. In DSB, the child must recall the list of digits in reverse order. DSF relies on simple short-term auditory memory with sequencing and verbal expression; DSB requires more attentional demands.

On the Digit Span total score, the control group performed significantly better than the ADHD group. Likewise, the control group performed significantly better on the DSB. There was no difference between the groups on the DSF, said Dr. Roychoudhury, who presented the findings at the annual meeting of the Eastern Society for Pediatric Research.

The results indicate that with ADHD, “working memory is low and children have difficulty in remembering material, especially pertaining to dates in social studies and sequencing information appropriately in science and social studies. In mathematics, they have significant problems in procedures since they have to remember in a stepwise fashion how to do the calculation,” Dr. Roychoudhury said in an interview.

PHILADELPHIA – Children with attention-deficit/hyperactivity disorder performed worse than children without the disorder on tests of working memory–an important factor in learning and academic success, according to the results of a case-controlled study of 64 children aged 7–12 years.

In the study, 35 children with ADHD (24 males and 11 females) and 29 healthy controls (6 males and 23 females) were asked to perform the Digit Span test, which assesses working memory. Working memory allows a person to receive, store, and retrieve information on a temporary basis, said Dr. Kanchana Roychoudhury, a pediatrician at Flushing (N.Y.) Hospital Medical Center.

The Digit Span test comprises digit span forward (DSF) and digit span backward (DSB) tasks. In DSF, a list of random numbers is read aloud and, at the end of a sequence, the child is asked to recall the items in order. The test begins with two or three numbers, increasing until the child commits an error. In DSB, the child must recall the list of digits in reverse order. DSF relies on simple short-term auditory memory with sequencing and verbal expression; DSB requires more attentional demands.

On the Digit Span total score, the control group performed significantly better than the ADHD group. Likewise, the control group performed significantly better on the DSB. There was no difference between the groups on the DSF, said Dr. Roychoudhury, who presented the findings at the annual meeting of the Eastern Society for Pediatric Research.

The results indicate that with ADHD, “working memory is low and children have difficulty in remembering material, especially pertaining to dates in social studies and sequencing information appropriately in science and social studies. In mathematics, they have significant problems in procedures since they have to remember in a stepwise fashion how to do the calculation,” Dr. Roychoudhury said in an interview.

PHILADELPHIA – Children with attention-deficit/hyperactivity disorder performed worse than children without the disorder on tests of working memory–an important factor in learning and academic success, according to the results of a case-controlled study of 64 children aged 7–12 years.

In the study, 35 children with ADHD (24 males and 11 females) and 29 healthy controls (6 males and 23 females) were asked to perform the Digit Span test, which assesses working memory. Working memory allows a person to receive, store, and retrieve information on a temporary basis, said Dr. Kanchana Roychoudhury, a pediatrician at Flushing (N.Y.) Hospital Medical Center.

The Digit Span test comprises digit span forward (DSF) and digit span backward (DSB) tasks. In DSF, a list of random numbers is read aloud and, at the end of a sequence, the child is asked to recall the items in order. The test begins with two or three numbers, increasing until the child commits an error. In DSB, the child must recall the list of digits in reverse order. DSF relies on simple short-term auditory memory with sequencing and verbal expression; DSB requires more attentional demands.

On the Digit Span total score, the control group performed significantly better than the ADHD group. Likewise, the control group performed significantly better on the DSB. There was no difference between the groups on the DSF, said Dr. Roychoudhury, who presented the findings at the annual meeting of the Eastern Society for Pediatric Research.

The results indicate that with ADHD, “working memory is low and children have difficulty in remembering material, especially pertaining to dates in social studies and sequencing information appropriately in science and social studies. In mathematics, they have significant problems in procedures since they have to remember in a stepwise fashion how to do the calculation,” Dr. Roychoudhury said in an interview.

The presence of infection at the time of magnetic resonance imaging using gadolinium contrast may predispose patients with renal failure to nephrogenic systemic fibrosis, according to a hospital analysis.

The estimated NSF development rate for infected patients with renal failure was 6.7%, compared with 0.3% for uninfected patients with renal failure—a 33-fold difference that was highly significant.

“If the presence of infection indeed proves to be a risk factor for the development of NSF, then some renal failure patients presently judged to be acceptable risks for MR contrast administration on the basis of the degree of renal failure might be reconsidered as high-risk patients,” wrote Dr. Lauren Goldberg of Moses H. Cone Memorial Hospital, Greensboro, N.C., and Dr. James Provenzale, a radiologist at Duke University, Durham, N.C. (Am. J. Roentgenol. 2008;190:1069–75).

Eight patients with symptoms consistent with NSF between 2002 and 2006 were prospectively identified by the nephrology group. Seven biopsy-proven cases were identified, along with another case involving strong clinical signs and symptoms of NSF without biopsy confirmation.

Seven patients had MRI contrast with gadodiamide (Omniscan, GE Healthcare), at a dose from 0.1 mmol/kg to 0.3 mmol/kg. NSF symptoms began 2 days to 5 months after contrast administration. The sole patient not exposed to gadolinium contrast had end-stage renal disease, breast carcinoma, and calciphylaxis.

All eight patients with NSF noted stiffening and thickening of the hands and lower extremities—often described as woody changes of the skin. Five patients had severe chronic pain, the authors reported.

No single medication was common to all patients with NSF. None had vascular thrombosis. Only one patient had undergone major surgery. Five of the patients had documented infection, including catheter infection, urinary tract infection, bacteremia, pneumonia, cellulitis, and osteomyelitis. Two patients who received gadolinium contrast did not have proinflammatory conditions. The one patient who did not receive gadolinium contrast was also considered not to have a proinflammatory condition.

The researchers estimated that 750 renal-failure patients without documented infection and 75 renal-failure patients with documented infection underwent contrast-enhanced MRI between 2002 and 2006.

“All six patients who were hemodialysis dependent at the time of contrast-enhanced MRI were dialyzed 1 day after gadodiamide administration, suggesting that prompt hemodialysis may not be protective against the development of NSF,” the authors wrote.

The investigators disclosed no conflicts of interest.

The presence of infection at the time of magnetic resonance imaging using gadolinium contrast may predispose patients with renal failure to nephrogenic systemic fibrosis, according to a hospital analysis.

The estimated NSF development rate for infected patients with renal failure was 6.7%, compared with 0.3% for uninfected patients with renal failure—a 33-fold difference that was highly significant.

“If the presence of infection indeed proves to be a risk factor for the development of NSF, then some renal failure patients presently judged to be acceptable risks for MR contrast administration on the basis of the degree of renal failure might be reconsidered as high-risk patients,” wrote Dr. Lauren Goldberg of Moses H. Cone Memorial Hospital, Greensboro, N.C., and Dr. James Provenzale, a radiologist at Duke University, Durham, N.C. (Am. J. Roentgenol. 2008;190:1069–75).

Eight patients with symptoms consistent with NSF between 2002 and 2006 were prospectively identified by the nephrology group. Seven biopsy-proven cases were identified, along with another case involving strong clinical signs and symptoms of NSF without biopsy confirmation.

Seven patients had MRI contrast with gadodiamide (Omniscan, GE Healthcare), at a dose from 0.1 mmol/kg to 0.3 mmol/kg. NSF symptoms began 2 days to 5 months after contrast administration. The sole patient not exposed to gadolinium contrast had end-stage renal disease, breast carcinoma, and calciphylaxis.

All eight patients with NSF noted stiffening and thickening of the hands and lower extremities—often described as woody changes of the skin. Five patients had severe chronic pain, the authors reported.

No single medication was common to all patients with NSF. None had vascular thrombosis. Only one patient had undergone major surgery. Five of the patients had documented infection, including catheter infection, urinary tract infection, bacteremia, pneumonia, cellulitis, and osteomyelitis. Two patients who received gadolinium contrast did not have proinflammatory conditions. The one patient who did not receive gadolinium contrast was also considered not to have a proinflammatory condition.

The researchers estimated that 750 renal-failure patients without documented infection and 75 renal-failure patients with documented infection underwent contrast-enhanced MRI between 2002 and 2006.

“All six patients who were hemodialysis dependent at the time of contrast-enhanced MRI were dialyzed 1 day after gadodiamide administration, suggesting that prompt hemodialysis may not be protective against the development of NSF,” the authors wrote.

The investigators disclosed no conflicts of interest.

The presence of infection at the time of magnetic resonance imaging using gadolinium contrast may predispose patients with renal failure to nephrogenic systemic fibrosis, according to a hospital analysis.

The estimated NSF development rate for infected patients with renal failure was 6.7%, compared with 0.3% for uninfected patients with renal failure—a 33-fold difference that was highly significant.

“If the presence of infection indeed proves to be a risk factor for the development of NSF, then some renal failure patients presently judged to be acceptable risks for MR contrast administration on the basis of the degree of renal failure might be reconsidered as high-risk patients,” wrote Dr. Lauren Goldberg of Moses H. Cone Memorial Hospital, Greensboro, N.C., and Dr. James Provenzale, a radiologist at Duke University, Durham, N.C. (Am. J. Roentgenol. 2008;190:1069–75).

Eight patients with symptoms consistent with NSF between 2002 and 2006 were prospectively identified by the nephrology group. Seven biopsy-proven cases were identified, along with another case involving strong clinical signs and symptoms of NSF without biopsy confirmation.

Seven patients had MRI contrast with gadodiamide (Omniscan, GE Healthcare), at a dose from 0.1 mmol/kg to 0.3 mmol/kg. NSF symptoms began 2 days to 5 months after contrast administration. The sole patient not exposed to gadolinium contrast had end-stage renal disease, breast carcinoma, and calciphylaxis.

All eight patients with NSF noted stiffening and thickening of the hands and lower extremities—often described as woody changes of the skin. Five patients had severe chronic pain, the authors reported.

No single medication was common to all patients with NSF. None had vascular thrombosis. Only one patient had undergone major surgery. Five of the patients had documented infection, including catheter infection, urinary tract infection, bacteremia, pneumonia, cellulitis, and osteomyelitis. Two patients who received gadolinium contrast did not have proinflammatory conditions. The one patient who did not receive gadolinium contrast was also considered not to have a proinflammatory condition.

The researchers estimated that 750 renal-failure patients without documented infection and 75 renal-failure patients with documented infection underwent contrast-enhanced MRI between 2002 and 2006.

“All six patients who were hemodialysis dependent at the time of contrast-enhanced MRI were dialyzed 1 day after gadodiamide administration, suggesting that prompt hemodialysis may not be protective against the development of NSF,” the authors wrote.

The investigators disclosed no conflicts of interest.

BALTIMORE — The anticonvulsant lamotrigine shows promise for reducing pain and improving mood symptoms associated with chronic pelvic pain, particularly in women with the vulvovaginal subtype.

In a study of 43 women with chronic pelvic pain, researchers at the University of North Carolina found that treatment with lamotrigine resulted in significant reductions in total pain, overall pain intensity, and depressive symptoms at 8 weeks, compared with baseline.

There were slightly greater reductions in those measures at 12 weeks that achieved significance. The study, which was presented as a poster at the annual meeting of the American Psychosomatic Society, was funded by GlaxoSmithKline Inc., maker of Lamictal (lamotrigine).

Dr. Samantha Meltzer-Brody of the department of psychiatry at the University of North Carolina, Chapel Hill, and her colleagues recruited women from a tertiary care clinic. Participants had to have pelvic pain for at least 6 months. Women were excluded if they had active systemic disease or substance abuse, pelvic surgery in the previous 6 months, or initiation/change in psychiatric medications in the previous month.

After baseline assessments, the women were titrated up to a therapeutic dosage of 400 mg/day lamotrigine over 8 weeks. This dosage was continued for weeks 8–12. Patients then were slowly discontinued from the drug over a 2-week period. A total of 31 women completed the 8-week titration phase and 21 completed all 12 weeks of treatment. Patients completed the McGill Pain Scale at each visit. Patients were also administered the Hamilton Depression Rating Scale.

The women completing 8 weeks of treatment were aged 41 years on average and were predominantly white (95%). The average dosage in that period was 340 mg/day. Most of the women had the vulvodynia/vulvar vestibulitis syndrome subtype (17). The remaining women were evenly split between diffuse abdominal pain (7) and neuropathic pain (7).

The researchers also analyzed the data by chronic pelvic pain subtype. Those with the vulvovaginal pain subtype (VVS) had significant reductions in McGill total pain and visual analog scale overall pain intensity scores at weeks 8 and 12. They also had a significant reduction in Hamilton Depression Rating Scale scores at 12 weeks. However, the investigators noted in the poster that “VVS patients have better mental health and decreased rates of sexual and/or physical abuse history compared to women with other chronic pelvic pain subtypes.”

BALTIMORE — The anticonvulsant lamotrigine shows promise for reducing pain and improving mood symptoms associated with chronic pelvic pain, particularly in women with the vulvovaginal subtype.

In a study of 43 women with chronic pelvic pain, researchers at the University of North Carolina found that treatment with lamotrigine resulted in significant reductions in total pain, overall pain intensity, and depressive symptoms at 8 weeks, compared with baseline.

There were slightly greater reductions in those measures at 12 weeks that achieved significance. The study, which was presented as a poster at the annual meeting of the American Psychosomatic Society, was funded by GlaxoSmithKline Inc., maker of Lamictal (lamotrigine).

Dr. Samantha Meltzer-Brody of the department of psychiatry at the University of North Carolina, Chapel Hill, and her colleagues recruited women from a tertiary care clinic. Participants had to have pelvic pain for at least 6 months. Women were excluded if they had active systemic disease or substance abuse, pelvic surgery in the previous 6 months, or initiation/change in psychiatric medications in the previous month.

After baseline assessments, the women were titrated up to a therapeutic dosage of 400 mg/day lamotrigine over 8 weeks. This dosage was continued for weeks 8–12. Patients then were slowly discontinued from the drug over a 2-week period. A total of 31 women completed the 8-week titration phase and 21 completed all 12 weeks of treatment. Patients completed the McGill Pain Scale at each visit. Patients were also administered the Hamilton Depression Rating Scale.

The women completing 8 weeks of treatment were aged 41 years on average and were predominantly white (95%). The average dosage in that period was 340 mg/day. Most of the women had the vulvodynia/vulvar vestibulitis syndrome subtype (17). The remaining women were evenly split between diffuse abdominal pain (7) and neuropathic pain (7).

The researchers also analyzed the data by chronic pelvic pain subtype. Those with the vulvovaginal pain subtype (VVS) had significant reductions in McGill total pain and visual analog scale overall pain intensity scores at weeks 8 and 12. They also had a significant reduction in Hamilton Depression Rating Scale scores at 12 weeks. However, the investigators noted in the poster that “VVS patients have better mental health and decreased rates of sexual and/or physical abuse history compared to women with other chronic pelvic pain subtypes.”

BALTIMORE — The anticonvulsant lamotrigine shows promise for reducing pain and improving mood symptoms associated with chronic pelvic pain, particularly in women with the vulvovaginal subtype.

In a study of 43 women with chronic pelvic pain, researchers at the University of North Carolina found that treatment with lamotrigine resulted in significant reductions in total pain, overall pain intensity, and depressive symptoms at 8 weeks, compared with baseline.

There were slightly greater reductions in those measures at 12 weeks that achieved significance. The study, which was presented as a poster at the annual meeting of the American Psychosomatic Society, was funded by GlaxoSmithKline Inc., maker of Lamictal (lamotrigine).

Dr. Samantha Meltzer-Brody of the department of psychiatry at the University of North Carolina, Chapel Hill, and her colleagues recruited women from a tertiary care clinic. Participants had to have pelvic pain for at least 6 months. Women were excluded if they had active systemic disease or substance abuse, pelvic surgery in the previous 6 months, or initiation/change in psychiatric medications in the previous month.

After baseline assessments, the women were titrated up to a therapeutic dosage of 400 mg/day lamotrigine over 8 weeks. This dosage was continued for weeks 8–12. Patients then were slowly discontinued from the drug over a 2-week period. A total of 31 women completed the 8-week titration phase and 21 completed all 12 weeks of treatment. Patients completed the McGill Pain Scale at each visit. Patients were also administered the Hamilton Depression Rating Scale.

The women completing 8 weeks of treatment were aged 41 years on average and were predominantly white (95%). The average dosage in that period was 340 mg/day. Most of the women had the vulvodynia/vulvar vestibulitis syndrome subtype (17). The remaining women were evenly split between diffuse abdominal pain (7) and neuropathic pain (7).

The researchers also analyzed the data by chronic pelvic pain subtype. Those with the vulvovaginal pain subtype (VVS) had significant reductions in McGill total pain and visual analog scale overall pain intensity scores at weeks 8 and 12. They also had a significant reduction in Hamilton Depression Rating Scale scores at 12 weeks. However, the investigators noted in the poster that “VVS patients have better mental health and decreased rates of sexual and/or physical abuse history compared to women with other chronic pelvic pain subtypes.”

SAVANNAH, GA. — Urinary incontinence symptoms do not appear to be more prevalent or more severe in women with bacteriuria, based on a study of 530 urogynecology patients seen at one institution.

Dr. Mary P. Fitzgerald, of the obstetrics and gynecology department at Loyola University in Chicago, and her colleagues conducted a chart review of all new urogynecology patients seen from March to December 2004. Scores from the Urogenital Distress Inventory (UDI6) and Medical, Epidemiological, and Social Aspects of Aging (MESA) incontinence questionnaires were available. Urine cultures had been obtained by catheterization. Significant infection was considered to be present if at least 10,000 colonies of uropathogen were present.

Of the 530 patients, 62 (12%) had positive cultures, Dr. Fitzgerald reported in a poster session at the annual meeting of the Society of Gynecologic Surgeons. UDI6 and MESA scores were compared between women with and without positive cultures. Uropathogen antibiotic sensitivities were compared with those of the general hospital population at that time.

Uropathogens included Escherichia coli (43), Klebsiella pneumoniae (13), Proteus mirabilis (4), Group B Streptococcus (1), and Citrobacter freundii complex (4). Antibiotic resistance profiles of the uropathogens were similar to those found in the general hospital population.

“We suggest that incontinence may not be a reliable symptom of bacteriuria in women attending a female urology/urogynecology clinic,” the researchers wrote.

Dr. Fitzgerald reported that she had no relevant financial relationships.

SAVANNAH, GA. — Urinary incontinence symptoms do not appear to be more prevalent or more severe in women with bacteriuria, based on a study of 530 urogynecology patients seen at one institution.

Dr. Mary P. Fitzgerald, of the obstetrics and gynecology department at Loyola University in Chicago, and her colleagues conducted a chart review of all new urogynecology patients seen from March to December 2004. Scores from the Urogenital Distress Inventory (UDI6) and Medical, Epidemiological, and Social Aspects of Aging (MESA) incontinence questionnaires were available. Urine cultures had been obtained by catheterization. Significant infection was considered to be present if at least 10,000 colonies of uropathogen were present.

Of the 530 patients, 62 (12%) had positive cultures, Dr. Fitzgerald reported in a poster session at the annual meeting of the Society of Gynecologic Surgeons. UDI6 and MESA scores were compared between women with and without positive cultures. Uropathogen antibiotic sensitivities were compared with those of the general hospital population at that time.

Uropathogens included Escherichia coli (43), Klebsiella pneumoniae (13), Proteus mirabilis (4), Group B Streptococcus (1), and Citrobacter freundii complex (4). Antibiotic resistance profiles of the uropathogens were similar to those found in the general hospital population.

“We suggest that incontinence may not be a reliable symptom of bacteriuria in women attending a female urology/urogynecology clinic,” the researchers wrote.

Dr. Fitzgerald reported that she had no relevant financial relationships.

SAVANNAH, GA. — Urinary incontinence symptoms do not appear to be more prevalent or more severe in women with bacteriuria, based on a study of 530 urogynecology patients seen at one institution.

Dr. Mary P. Fitzgerald, of the obstetrics and gynecology department at Loyola University in Chicago, and her colleagues conducted a chart review of all new urogynecology patients seen from March to December 2004. Scores from the Urogenital Distress Inventory (UDI6) and Medical, Epidemiological, and Social Aspects of Aging (MESA) incontinence questionnaires were available. Urine cultures had been obtained by catheterization. Significant infection was considered to be present if at least 10,000 colonies of uropathogen were present.

Of the 530 patients, 62 (12%) had positive cultures, Dr. Fitzgerald reported in a poster session at the annual meeting of the Society of Gynecologic Surgeons. UDI6 and MESA scores were compared between women with and without positive cultures. Uropathogen antibiotic sensitivities were compared with those of the general hospital population at that time.

Uropathogens included Escherichia coli (43), Klebsiella pneumoniae (13), Proteus mirabilis (4), Group B Streptococcus (1), and Citrobacter freundii complex (4). Antibiotic resistance profiles of the uropathogens were similar to those found in the general hospital population.

“We suggest that incontinence may not be a reliable symptom of bacteriuria in women attending a female urology/urogynecology clinic,” the researchers wrote.

Dr. Fitzgerald reported that she had no relevant financial relationships.

PHILADELPHIA — Testing for hemoglobin A_1c could be an effective means of screening children not only for type 2 diabetes but also for impaired glucose tolerance, according to the results of a study of 74 children.

“Type 2 diabetes was effectively excluded by hemoglobin A_1c [HbA_1c] below 6.0%,” said Dr. Alisa Schiffman of Children's Hospital of Philadelphia. Using this cutoff, HbA_1c was 100% sensitive and 80% specific in identifying children with type 2 diabetes.

In its 2008 position statement on the standards of medical care in diabetes, the American Diabetes Association stated that the fasting plasma glucose test is the preferred means to diagnose diabetes in children and in nonpregnant adults. The use of the Hb A_1c level for the diagnosis of diabetes is not recommended at this time (Diabetes Care 2008;31:S12–54).

However, “oral glucose tolerance tests and fasting plasma glucose have logistical challenges in children” because of the overnight fasting requirement and multiple blood draws, Dr. Schiffman said at the annual meeting of the Eastern Society for Pediatric Research.

HbA_1c testing can be performed with just a finger stick at any time of day regardless of fasting status.

The researchers performed a retrospective chart review of 74 children (mean age 12 years) who were referred for the evaluation of type 2 diabetes. The children were assigned to one of three groups based on their fasting plasma glucose level and 2-hour plasma glucose level.

There was a significant trend for increasing HbA_1c along the continuum from normal glucose tolerance to type 2 diabetes. Mean HbA_1c was 5.4% for those with normal glucose tolerance, 6.1% for those with impaired glucose tolerance, and 6.8% for those with type 2 diabetes.

A threshold HbA_1c of 5.7% was 91% sensitive and 80% specific in identifying children with abnormal glucose tolerance.

“Hemoglobin A_1c can be used to screen for type 2 diabetes and even impaired glucose tolerance [in children],” said Dr. Schiffman.

Likewise, there was a significant trend for decreasing mean β-cell function along the continuum from normal glucose tolerance to impaired glucose tolerance to type 2 diabetes.

Children with normal glucose tolerance had a fasting plasma glucose level less than 100 mg/dL and a 2-hour plasma glucose less than 140 mg/dL. Children with impaired glucose tolerance had a fasting plasma glucose level between 100 mg/dL and 126 mg/dL and a 2-hour plasma glucose between 140 mg/dL and 200 mg/dL.

Children with type 2 diabetes had a fasting plasma glucose level of at least 126 mg/dL and a 2-hour plasma glucose greater than 200 mg/dL. In all, 51 children had normal glucose tolerance, 16 had impaired glucose tolerance, and 7 had type 2 diabetes.

PHILADELPHIA — Testing for hemoglobin A_1c could be an effective means of screening children not only for type 2 diabetes but also for impaired glucose tolerance, according to the results of a study of 74 children.

“Type 2 diabetes was effectively excluded by hemoglobin A_1c [HbA_1c] below 6.0%,” said Dr. Alisa Schiffman of Children's Hospital of Philadelphia. Using this cutoff, HbA_1c was 100% sensitive and 80% specific in identifying children with type 2 diabetes.

In its 2008 position statement on the standards of medical care in diabetes, the American Diabetes Association stated that the fasting plasma glucose test is the preferred means to diagnose diabetes in children and in nonpregnant adults. The use of the Hb A_1c level for the diagnosis of diabetes is not recommended at this time (Diabetes Care 2008;31:S12–54).

However, “oral glucose tolerance tests and fasting plasma glucose have logistical challenges in children” because of the overnight fasting requirement and multiple blood draws, Dr. Schiffman said at the annual meeting of the Eastern Society for Pediatric Research.

HbA_1c testing can be performed with just a finger stick at any time of day regardless of fasting status.

The researchers performed a retrospective chart review of 74 children (mean age 12 years) who were referred for the evaluation of type 2 diabetes. The children were assigned to one of three groups based on their fasting plasma glucose level and 2-hour plasma glucose level.

There was a significant trend for increasing HbA_1c along the continuum from normal glucose tolerance to type 2 diabetes. Mean HbA_1c was 5.4% for those with normal glucose tolerance, 6.1% for those with impaired glucose tolerance, and 6.8% for those with type 2 diabetes.

A threshold HbA_1c of 5.7% was 91% sensitive and 80% specific in identifying children with abnormal glucose tolerance.

“Hemoglobin A_1c can be used to screen for type 2 diabetes and even impaired glucose tolerance [in children],” said Dr. Schiffman.

Likewise, there was a significant trend for decreasing mean β-cell function along the continuum from normal glucose tolerance to impaired glucose tolerance to type 2 diabetes.

Children with normal glucose tolerance had a fasting plasma glucose level less than 100 mg/dL and a 2-hour plasma glucose less than 140 mg/dL. Children with impaired glucose tolerance had a fasting plasma glucose level between 100 mg/dL and 126 mg/dL and a 2-hour plasma glucose between 140 mg/dL and 200 mg/dL.

Children with type 2 diabetes had a fasting plasma glucose level of at least 126 mg/dL and a 2-hour plasma glucose greater than 200 mg/dL. In all, 51 children had normal glucose tolerance, 16 had impaired glucose tolerance, and 7 had type 2 diabetes.

PHILADELPHIA — Testing for hemoglobin A_1c could be an effective means of screening children not only for type 2 diabetes but also for impaired glucose tolerance, according to the results of a study of 74 children.

“Type 2 diabetes was effectively excluded by hemoglobin A_1c [HbA_1c] below 6.0%,” said Dr. Alisa Schiffman of Children's Hospital of Philadelphia. Using this cutoff, HbA_1c was 100% sensitive and 80% specific in identifying children with type 2 diabetes.

In its 2008 position statement on the standards of medical care in diabetes, the American Diabetes Association stated that the fasting plasma glucose test is the preferred means to diagnose diabetes in children and in nonpregnant adults. The use of the Hb A_1c level for the diagnosis of diabetes is not recommended at this time (Diabetes Care 2008;31:S12–54).

However, “oral glucose tolerance tests and fasting plasma glucose have logistical challenges in children” because of the overnight fasting requirement and multiple blood draws, Dr. Schiffman said at the annual meeting of the Eastern Society for Pediatric Research.

HbA_1c testing can be performed with just a finger stick at any time of day regardless of fasting status.

The researchers performed a retrospective chart review of 74 children (mean age 12 years) who were referred for the evaluation of type 2 diabetes. The children were assigned to one of three groups based on their fasting plasma glucose level and 2-hour plasma glucose level.

There was a significant trend for increasing HbA_1c along the continuum from normal glucose tolerance to type 2 diabetes. Mean HbA_1c was 5.4% for those with normal glucose tolerance, 6.1% for those with impaired glucose tolerance, and 6.8% for those with type 2 diabetes.

A threshold HbA_1c of 5.7% was 91% sensitive and 80% specific in identifying children with abnormal glucose tolerance.

“Hemoglobin A_1c can be used to screen for type 2 diabetes and even impaired glucose tolerance [in children],” said Dr. Schiffman.

Likewise, there was a significant trend for decreasing mean β-cell function along the continuum from normal glucose tolerance to impaired glucose tolerance to type 2 diabetes.

Children with normal glucose tolerance had a fasting plasma glucose level less than 100 mg/dL and a 2-hour plasma glucose less than 140 mg/dL. Children with impaired glucose tolerance had a fasting plasma glucose level between 100 mg/dL and 126 mg/dL and a 2-hour plasma glucose between 140 mg/dL and 200 mg/dL.

Children with type 2 diabetes had a fasting plasma glucose level of at least 126 mg/dL and a 2-hour plasma glucose greater than 200 mg/dL. In all, 51 children had normal glucose tolerance, 16 had impaired glucose tolerance, and 7 had type 2 diabetes.

PHILADELPHIA — Positive pancreatic antibodies and the presence of diabetic ketoacidosis appear to affect how insulin reserve changes over time in children with type 2 diabetes, based on the results of a natural history study of 66 children.

By studying the natural history of type 2 diabetes in children, the researchers hope to identify predictors of changes in insulin secretion that could lead to new treatments aimed at delaying β-cell failure.

Hemoglobin A_1c and insulin dose differed between children who were nonacidotic and antibody negative at presentation, those who had diabetic ketoacidosis but were antibody negative at presentation, and those who were nonacidotic but antibody positive at presentation. HbA_1c and insulin dose changed significantly over time in a complex curvilinear manner, said Marcia Hernandez, a third-year medical student at the Philadelphia College of Osteopathic Medicine, who presented the results at the annual meeting of the Eastern Society for Pediatric Research.

Ms. Hernandez, Dr. Lorraine E. Levitt Katz, and their colleagues at the Children's Hospital of Philadelphia recruited 66 children (55% girls, mean age 14 years) with type 2 diabetes between 1998 and 2002. The children were presumptively diagnosed with type 2 diabetes based on clinical features—obesity (body mass index greater than 85% for age and gender), acanthosis nigricans, and a family history of type 2 diabetes. Children were treated with metformin and/or insulin.

The researchers measured HbA_1c, insulinlike growth factor-binding protein-1 (IGFBP-1), C-peptide, and the dose of exogenous insulin. Measurements were taken at diagnosis and at follow-up assessments every 3–6 months for 4 years.

In addition, pancreatic autoantibodies were measured at diagnosis. In accordance with the standard of care at the time, glutamic acid decarboxylase-65(Gad-65) antibodies were the only pancreatic antibodies measured at the time of diagnosis of diabetes, until 2001. After 2001, islet cell autoantigen 512 and insulin antibodies were measured in addition to Gad-65.

IGFBP-1 is secreted by the liver and circulates in the blood. Secretion is acutely inhibited by insulin. Higher fasting levels of IGFBP-1 have been found in individuals with type 1 diabetes, compared with those with type 2 diabetes. C-peptide reflects the amount of insulin produced by the body.

The children were divided into three groups: those who were nonacidotic and antibody negative at presentation (46), those who had diabetic ketoacidosis but were antibody negative at presentation (13), and those who were nonacidotic but antibody positive at presentation (7).

Those who presented with antibodies were younger at presentation. At baseline, HbA_1c was strongly correlated to C-peptide and insulin dose. Insulin dose was strongly correlated to IGFBP-1 and C-peptide.

All of the groups had elevated HbA_1c levels at baseline; those who had diabetic ketoacidosis but were antibody negative had the highest levels. HbA_1c in all groups reached the lowest levels between 6 months and 1 year, and then began steadily rising.

ELSEVIER GLOBAL MEDICAL NEWS

PHILADELPHIA — Positive pancreatic antibodies and the presence of diabetic ketoacidosis appear to affect how insulin reserve changes over time in children with type 2 diabetes, based on the results of a natural history study of 66 children.

By studying the natural history of type 2 diabetes in children, the researchers hope to identify predictors of changes in insulin secretion that could lead to new treatments aimed at delaying β-cell failure.

Hemoglobin A_1c and insulin dose differed between children who were nonacidotic and antibody negative at presentation, those who had diabetic ketoacidosis but were antibody negative at presentation, and those who were nonacidotic but antibody positive at presentation. HbA_1c and insulin dose changed significantly over time in a complex curvilinear manner, said Marcia Hernandez, a third-year medical student at the Philadelphia College of Osteopathic Medicine, who presented the results at the annual meeting of the Eastern Society for Pediatric Research.

Ms. Hernandez, Dr. Lorraine E. Levitt Katz, and their colleagues at the Children's Hospital of Philadelphia recruited 66 children (55% girls, mean age 14 years) with type 2 diabetes between 1998 and 2002. The children were presumptively diagnosed with type 2 diabetes based on clinical features—obesity (body mass index greater than 85% for age and gender), acanthosis nigricans, and a family history of type 2 diabetes. Children were treated with metformin and/or insulin.

The researchers measured HbA_1c, insulinlike growth factor-binding protein-1 (IGFBP-1), C-peptide, and the dose of exogenous insulin. Measurements were taken at diagnosis and at follow-up assessments every 3–6 months for 4 years.

In addition, pancreatic autoantibodies were measured at diagnosis. In accordance with the standard of care at the time, glutamic acid decarboxylase-65(Gad-65) antibodies were the only pancreatic antibodies measured at the time of diagnosis of diabetes, until 2001. After 2001, islet cell autoantigen 512 and insulin antibodies were measured in addition to Gad-65.

IGFBP-1 is secreted by the liver and circulates in the blood. Secretion is acutely inhibited by insulin. Higher fasting levels of IGFBP-1 have been found in individuals with type 1 diabetes, compared with those with type 2 diabetes. C-peptide reflects the amount of insulin produced by the body.

The children were divided into three groups: those who were nonacidotic and antibody negative at presentation (46), those who had diabetic ketoacidosis but were antibody negative at presentation (13), and those who were nonacidotic but antibody positive at presentation (7).

Those who presented with antibodies were younger at presentation. At baseline, HbA_1c was strongly correlated to C-peptide and insulin dose. Insulin dose was strongly correlated to IGFBP-1 and C-peptide.

All of the groups had elevated HbA_1c levels at baseline; those who had diabetic ketoacidosis but were antibody negative had the highest levels. HbA_1c in all groups reached the lowest levels between 6 months and 1 year, and then began steadily rising.

ELSEVIER GLOBAL MEDICAL NEWS

PHILADELPHIA — Positive pancreatic antibodies and the presence of diabetic ketoacidosis appear to affect how insulin reserve changes over time in children with type 2 diabetes, based on the results of a natural history study of 66 children.

By studying the natural history of type 2 diabetes in children, the researchers hope to identify predictors of changes in insulin secretion that could lead to new treatments aimed at delaying β-cell failure.

Hemoglobin A_1c and insulin dose differed between children who were nonacidotic and antibody negative at presentation, those who had diabetic ketoacidosis but were antibody negative at presentation, and those who were nonacidotic but antibody positive at presentation. HbA_1c and insulin dose changed significantly over time in a complex curvilinear manner, said Marcia Hernandez, a third-year medical student at the Philadelphia College of Osteopathic Medicine, who presented the results at the annual meeting of the Eastern Society for Pediatric Research.

Ms. Hernandez, Dr. Lorraine E. Levitt Katz, and their colleagues at the Children's Hospital of Philadelphia recruited 66 children (55% girls, mean age 14 years) with type 2 diabetes between 1998 and 2002. The children were presumptively diagnosed with type 2 diabetes based on clinical features—obesity (body mass index greater than 85% for age and gender), acanthosis nigricans, and a family history of type 2 diabetes. Children were treated with metformin and/or insulin.

The researchers measured HbA_1c, insulinlike growth factor-binding protein-1 (IGFBP-1), C-peptide, and the dose of exogenous insulin. Measurements were taken at diagnosis and at follow-up assessments every 3–6 months for 4 years.

In addition, pancreatic autoantibodies were measured at diagnosis. In accordance with the standard of care at the time, glutamic acid decarboxylase-65(Gad-65) antibodies were the only pancreatic antibodies measured at the time of diagnosis of diabetes, until 2001. After 2001, islet cell autoantigen 512 and insulin antibodies were measured in addition to Gad-65.

IGFBP-1 is secreted by the liver and circulates in the blood. Secretion is acutely inhibited by insulin. Higher fasting levels of IGFBP-1 have been found in individuals with type 1 diabetes, compared with those with type 2 diabetes. C-peptide reflects the amount of insulin produced by the body.

The children were divided into three groups: those who were nonacidotic and antibody negative at presentation (46), those who had diabetic ketoacidosis but were antibody negative at presentation (13), and those who were nonacidotic but antibody positive at presentation (7).

Those who presented with antibodies were younger at presentation. At baseline, HbA_1c was strongly correlated to C-peptide and insulin dose. Insulin dose was strongly correlated to IGFBP-1 and C-peptide.

All of the groups had elevated HbA_1c levels at baseline; those who had diabetic ketoacidosis but were antibody negative had the highest levels. HbA_1c in all groups reached the lowest levels between 6 months and 1 year, and then began steadily rising.

ELSEVIER GLOBAL MEDICAL NEWS