Esteatosis hepática, resistencia a la insulina y adiponectina en una población con obesidad / Fatty liver disease, insulin resistance and adiponectin in an obese pediatric population

Introducción: Estudiar la prevalencia de esteatosis hepática no alcohólica (EHNA) en una población pediátrica obesa y su relación con parámetros clinicoanalíticos de resistencia a la insulina (RI) y con niveles de adiponectina. Pacientes y métodos: Se estudió a 290 niños (4–18 años) con obesidad. Se analizó el índice de masa corporal (IMC) y la desviación estándar (DE), la acantosis nigricans, la presión arterial, el perfil lipídico, las aminotransferasas y la adiponectina. Se realizó un test de sobrecarga oral de glucosa y se definió la RI mediante el homeostasis model assessment (HOMA) y la esteatosis hepática por ecografía. Definimos el síndrome metabólico (SM) como la presencia de 3 o más de los siguientes criterios: obesidad, hipertensión, hipertrigliceridemia, colesterol ligado a lipoproteínas de alta densidad (cHDL) bajo y alteración hidrocarbonada. Resultados: Cincuenta y dos (18%) pacientes presentaban EHNA en la ecografía, 22 (8%) pacientes tenían elevación de alanin-aminotransferasa (ALT) (≥40U/l). Los pacientes con EHNA fueron significativamente mayores (12,2±2,4 frente a 11,1±2,9 años), más obesos (IMC±DE: 4,5±1,5 frente a 3,8±1,3), y presentaron niveles más elevados de HOMA (3,7±1,5 frente a 2,4±1,4) que los pacientes con ecografía normal. No se encontró diferencia significativa en sexo, raza y estadio puberal. La prevalencia del SM y la acantosis nigricans fue significativamente mayor en los niños con EHNA. Encontramos una correlación inversa entre los niveles séricos de adiponectina y edad, HOMA, ALT y ácido úrico, y encontramos una correlación directa con cHDL. En el análisis de regresión múltiple, las variables que se asociaron de forma independiente con la EHNA fueron IMC±DE, HOMA y adiponectina (odds ratio: 1,4 [1,1-1,9]; 1,3 [1,1-1,6] y 0,9 [0,8-0,9], respectivamente). Conclusiones: La obesidad y la RI son factores de riesgo de la EHNA en niños y adolescentes. Los niveles bajos de adiponectina están fuertemente asociados al desarrollo de EHNA en dichos pacientes (AU)

Introduction: To study the clinical and laboratory relationships of fatty liver disease in a group of obese children and to investigate whether circulating adiponectin is related to fatty liver disease. Patients and methods: Two hundred-ninety obese patients (age 4–18 years) were studied. Baseline body mass index-standard deviation score (BMI-SDS), acanthosis nigricans, blood pressure, plasma lipids, uric acid, alanine aminotransferase (ALT) and adiponectin were assessed, and a standard oral glucose tolerance test was performed. Insulin resistance (RI) was estimated by the homeostasis model assessment (HOMA) and liver steatosis was assessed by ultrasound (US). Children were classified as having metabolic syndrome if they met three or more of the following criteria: obesity, hypertension, hypertriglyceridemia, low HDL-cholesterol and impaired glucose metabolism. Results: Fifty-two subjects (18%) had fatty liver by US and 22 (8%) had elevated ALT levels (≥40U/L). Subjects with steatosis were significantly older (12.2±2.4 frente a 11.1±2.9yr), heavier (BMI-SDS: 4.5±1.5 frente a 3.8±1.3), and more RI (HOMA: 3.7±1.5 frente a 2.4±1.4), but were comparable in gender, pubertal status and racial distribution to those with normal US. The prevalence of metabolic syndrome and acanthosis nigricans were also higher in the steatosis frente a the normal US group. Serum adiponectin concentration was inversely correlated with age, HOMA, ALT and uric acid and directly correlated with HDL-cholesterol. In a multiple logistic regression analysis, BMI-SDS, HOMA and serum adiponectin, but not age, uric acid or triglycerides, were the covariates independently associated with the presence of steatosis (odds ratio 1.4 [1.1-1.9]; 1.3 [1.1-1.6] and 0.9 [0.8-0.9], respectively). Conclusions: Obesity and RI are risk factors for liver steatosis in children and adolescents. Decreased serum adiponectin is closely and independently associated with steatosis (AU)

[Fatty liver disease, insulin resistance and adiponectin in an obese pediatric population]. / Esteatosis hepática, resistencia a la insulina y adiponectina en una población con obesidad.

INTRODUCTION: To study the clinical and laboratory relationships of fatty liver disease in a group of obese children and to investigate whether circulating adiponectin is related to fatty liver disease. PATIENTS AND METHODS: Two hundred-ninety obese patients (age 4-18 years) were studied. Baseline body mass index-standard deviation score (BMI-SDS), acanthosis nigricans, blood pressure, plasma lipids, uric acid, alanine aminotransferase (ALT) and adiponectin were assessed, and a standard oral glucose tolerance test was performed. Insulin resistance (RI) was estimated by the homeostasis model assessment (HOMA) and liver steatosis was assessed by ultrasound (US). Children were classified as having metabolic syndrome if they met three or more of the following criteria: obesity, hypertension, hypertriglyceridemia, low HDL-cholesterol and impaired glucose metabolism. RESULTS: Fifty-two subjects (18%) had fatty liver by US and 22 (8%) had elevated ALT levels (> or =40 U/L). Subjects with steatosis were significantly older (12.2+/-2.4 frente a 11.1+/-2.9 yr), heavier (BMI-SDS: 4.5+/-1.5 frente a 3.8+/-1.3), and more RI (HOMA: 3.7+/-1.5 frente a 2.4+/-1.4), but were comparable in gender, pubertal status and racial distribution to those with normal US. The prevalence of metabolic syndrome and acanthosis nigricans were also higher in the steatosis frente a the normal US group. Serum adiponectin concentration was inversely correlated with age, HOMA, ALT and uric acid and directly correlated with HDL-cholesterol. In a multiple logistic regression analysis, BMI-SDS, HOMA and serum adiponectin, but not age, uric acid or triglycerides, were the covariates independently associated with the presence of steatosis (odds ratio 1.4 [1.1-1.9]; 1.3 [1.1-1.6] and 0.9 [0.8-0.9], respectively). CONCLUSIONS: Obesity and RI are risk factors for liver steatosis in children and adolescents. Decreased serum adiponectin is closely and independently associated with steatosis.

Obesidad infantil y alteraciones del metabolismo hidrocarbonado / Children obesity and carbohydrate metabolism alterations

La obesidad infanto-juvenil constituye un importante problema de salud en todo el mundo, con importantes complicaciones, como la diabetes tipo 2, que pueden aparecer a edades más precoces. Durante las últimas décadas, la prevalencia de obesidad y diabetes en la edad pediátrica ha aumentado. La frecuencia de alteraciones glucémicas encontradas en niños obesos oscila entre el 4,5 y el 41%, según la población estudiada. La presencia de resistencia a la insulina es un marcador de riesgo para el desarrollo de alteraciones del metabolismo hidrocarbonado y otros componentes del síndrome metabólico. Por ello, es importante evaluar las alteraciones del metabolismo hidrocarbonado y la resistencia a la insulina en niños y adolescentes con obesidad, en especial en aquellos con antecedentes familiares de síndrome metabólico u otros factores de riesgo (AU)

Pediatric obesity is an important health problem worldwide and has significant adverse health consequences, like type 2 diabetes, also in early ages. In the last few decades, the prevalence of obesity and diabetes in pediatric age has increased. The frequency of carbohydrate metabolism alterations found in obese children ranges from 4.5% to 41% in different populations. Insulin resistance increase risk of carbohydrate metabolism alterations and others components of metabolic syndrome. It is important to evaluate abnormal glucose homeostasis and insulin resistance in obese children, especially, in those with a familiar history of metabolic syndrome and other risk factors (AU)

[Impact of diagnosis of celiac disease on metabolic control of type 1 diabetes]. / Impacto del diagnóstico de la enfermedad celíaca en el control metabólico de la diabetes tipo 1.

OBJECTIVE: To asses the prevalence of celiac disease and to evaluate the clinical effects of a gluten-free diet on metabolic control and growth in children and adolescents with type 1 diabetes mellitus (DM1). PATIENTS AND METHODS: We performed a retrospective study of 261 patients with DM1. Diagnosis of celiac disease was based on the presence of endomysium and tissue transglutaminase antibodies in serum and was confirmed by intestinal biopsy. The impact of a gluten-free diet on metabolic control (mean annual HbAlc values), growth (height and annual growth velocity) and nutritional status (body mass index) was evaluated. Patients diagnosed with DM1 and subsequently with celiac disease were compared with a control group of patients with DM1 only. RESULTS: Twenty-one (8%) of the 261 diabetic patients were diagnosed with celiac disease and 19% also had another associated autoimmune disease. No significant differences were found in growth or metabolic control after withdrawal of gluten from the diet. CONCLUSIONS: We found a high prevalence of celiac disease in our type 1 diabetes population. A gluten-free diet had no effects on metabolic control of diabetes or on height or weight. Nevertheless, given the high prevalence of celiac disease and the possible development of long-term complications, such as lymphoma and osteoporosis, we recommend systematic screening in all diabetic patients, especially in the first 5 years after diagnosis of DM1.

Impacto del diagnóstico de la enfermedad celíaca en el control metabólico de la diabetes tipo 1 / Impact of diagnosis of celiac disease on metabolic contro l of type 1diabetes

Objetivo. Determinar la prevalencia de enfermedad celíaca (EC) en pacientes pediátricos con diabetes tipo 1 (DM-1) y evaluar la repercusión de la retirada del gluten de la dieta en el crecimiento y el control metabólico. Pacientes y métodos. Estudio retrospectivo de 261 pacientes pediátricos con DM-1. El diagnóstico de EC se basó en la presencia de anticuerpos antiendomisio y transglutaminasa junto con la confirmación mediante biopsia intestinal. Valoramos el impacto de la retirada del gluten sobre el control metabólico (medias anuales de hemoglobina glucosilada [HbA1c]), el crecimiento (talla y velocidad de crecimiento anual) y el estado nutritivo (índice de masa corporal [IMC]). Comparamos los pacientes diagnosticados de DM y EC después del diagnóstico de la diabetes con un grupo control de pacientes afectados exclusivamente de DM-1. Resultados. Un total de 21 de los 261 pacientes (8 %) presentaban EC. El 19 % de ellos tenían otro tipo de autoinmunidad asociada. No evidenciamos diferencias significativas en cuanto al crecimiento y al grado de control metabólico de la diabetes tras la retirada del gluten. Conclusiones. Encontramos una alta incidencia de EC en nuestra población con DM-1. El cribado de EC no repercute en el control metabólico de la diabetes ni en el desarrollo pondero-estatural. A pesar de ello, y debido a la alta incidencia de EC en España y a la posibilidad de aparición de complicaciones a largo plazo, como la osteoporosis y los linfomas, recomendamos realizar cribado sistemático en todos los pacientes diagnosticados de DM-1, fundamentalmente, en los primeros 5 años tras el diagnóstico

Objective. To asses the prevalence of celiac disease and to evaluate the clinical effects of a gluten-free diet on metabolic control and growth in children and adolescents with type 1 diabetes mellitus (DM1). Patients and methods. We performed a retrospective study of 261 patients with DM1. Diagnosis of celiac disease was based on the presence of endomysium and tissue transglutaminase antibodies in serum and was confirmed by intestinal biopsy. The impact of a gluten-free diet on metabolic control (mean annual HbAlc values), growth (height and annual growth velocity) and nutritional status (body mass index) was evaluated. Patients diagnosed with DM1 and subsequently with celiac disease were compared with a control group of patients with DM1 only. Results. Twenty-one (8 %) of the 261 diabetic patients were diagnosed with celiac disease and 19 % also had another associated autoimmune disease. No significant differences were found in growth or metabolic control after withdrawal of gluten from the diet. Conclusions. We found a high prevalence of celiac disease in our type 1 diabetes population. A gluten-free diet had no effects on metabolic control of diabetes or on height or weight. Nevertheless, given the high prevalence of celiac disease and the possible development of long-term complications, such as lymphoma and osteoporosis, we recommend systematic screening in all diabetic patients, especially in the first 5 years after diagnosis of DM1

[Continuous subcutaneous insulin infusion in pediatric patients with type 1 diabetes mellitus]. / Tratamiento con infusión subcutánea continua de insulina en pacientes pediátricos con diabetes mellitus tipo 1.

INTRODUCTION: To determine the efficacy and safety of continuous subcutaneous insulin infusion therapy in a group of children and adolescents with type 1 diabetes mellitus. PATIENTS AND METHODS: Data from 17 patients were collected during the first year of continuous subcutaneous insulin infusion treatment. All patients were followed-up at our diabetic pediatric clinic. HbA1c, body mass index, insulin dose, severe hypoglycemic episodes, and diabetic ketoacidosis events before and after initiation of pump therapy were compared. RESULTS: The mean age was 14.02 +/- 3.70 years and the mean diabetes duration was 5.81 +/- 3.31 years. HbA1c decreased from 8.12 +/- 1.46 to 7.52 +/- 0.87 % after 2 months of therapy and this decrease was maintained throughout the first year of continuous subcutaneous insulin infusion treatment. Insulin dose decreased from 0.99 +/- 0.24 to 0.84 +/- 0.18 U/kg/day after 1 year of treatment. Body mass index remained unchanged. There were fewer severe hypoglycemic events after the start of insulin pump therapy (0.47 +/- 1.23 events/patient in the 6 months before continuous insulin infusion, 0.29 +/- 1.20 episodes in the first 6 months of insulin pump therapy and 0.06 +/- 0.24 in the period from 6 to 12 months of the treatment). There were 3 ketoacidosis episodes, all in the same patient. CONCLUSIONS: Continuous subcutaneous insulin infusion is a safe and effective alternative in the treatment of children and adolescents with type 1 diabetes mellitus. It improves metabolic control and decreases the number of severe hypoglycemic episodes.

Tratamiento con infusión subcutánea continua de insulina en pacientes pediátricos con diabetes mellitus tipo 1 / Continuous subcutaneous insulin infusion in pediatric patients with type 1 diabetes mellitus

Introducción El propósito del estudio es determinar la eficacia y la seguridad del tratamiento con bombas de infusión subcutánea continua de insulina en un grupo de niños y adolescentes con diabetes mellitus tipo 1. Pacientes y métodos Se analizan los datos de 17 pacientes diabéticos tratados en nuestra Unidad de Diabetes Pediátrica durante el primer año de terapia con bomba de infusión subcutánea continua de insulina. Comparamos la HbA1c, índice de masa corporal, dosis de insulina, episodios de hipoglucemia grave y episodios de cetoacidosis antes y después del inicio de la terapia con bomba de insulina. Resultados La media de edad fue de 14,02 ± 3,70 años y el tiempo medio de evolución de la diabetes de 5,81 ± 3,31 años. Se objetiva una disminución de HbA1c de 8,12 ± 1,46 a 7,52 ± 0,87 % a los 2 meses de tratamiento que se mantiene en estas concentraciones durante todo el año. La dosis de insulina disminuye de 0,99 ± 0,24 a 0,84 ± 0,18 U/kg/día al año de tratamiento. El índice de masa corporal permanece estable. También se observa una disminución del número de episodios de hipoglucemia grave (0,47 ± 1,23 episodios/paciente en los 6 meses previos al inicio del tratamiento con bomba, 0,29 ± 1,20 durante los primeros 6 meses de la nueva terapia y 0,06 ± 0,24 de los 6 a 12 meses). Hubo tres episodios de cetoacidosis, todos ellos en el mismo paciente. Conclusiones La terapia con bomba de infusión subcutánea continua de insulina es una alternativa eficaz y segura para tratar niños y adolescentes con diabetes mellitus tipo 1, ya que permite mejorar el control metabólico con disminución del riesgo de hipoglucemia grave

Introduction To determine the efficacy and safety of continuous subcutaneous insulin infusion therapy in a group of children and adolescents with type 1 diabetes mellitus. Patients and methods Data from 17 patients were collected during the first year of continuous subcutaneous insulin infusion treatment. All patients were followed-up at our diabetic pediatric clinic. HbA1c, body mass index, insulin dose, severe hypoglycemic episodes, and diabetic ketoacidosis events before and after initiation of pump therapy were compared. Results The mean age was 14.02 ± 3.70 years and the mean diabetes duration was 5.81 ± 3.31 years. HbA1c decreased from 8.12 ± 1.46 to 7.52 ± 0.87 % after 2 months of therapy and this decrease was maintained throughout the first year of continuous subcutaneous insulin infusion treatment. Insulin dose decreased from 0.99 ± 0.24 to 0.84 ± 0.18 U/kg/day after 1 year of treatment. Body mass index remained unchanged. There were fewer severe hypoglycemic events after the start of insulin pump therapy (0.47 ± 1.23 events/patient in the 6 months before continuous insulin infusion, 0.29 ± 1.20 episodes in the first 6 months of insulin pump therapy and 0.06 ± 0.24 in the period from 6 to 12 months of the treatment). There were 3 ketoacidosis episodes, all in the same patient. Conclusions Continuous subcutaneous insulin infusion is a safe and effective alternative in the treatment of children and adolescents with type 1 diabetes mellitus. It improves metabolic control and decreases the number of severe hypoglycemic episodes

Tratamiento con insulina glargina vs infusor continuo de insulina en niños y adolescentes con diabetes tipo 1 / Continuous subcutaneous insulin infusion vs multiple daily injections with glargine in children and adolescents with type 1 diabetes

Objetivo: Evaluar la eficacia y la seguridad de dos tipos de terapia intensiva: la infusión subcutánea continua de insulina (ISCI) y el tratamiento con múltiples dosis de insulina (MDI) utilizando análogos de acción rápida preprandiales e insulina glargina, en niños y adolescentes con diabetes mellitus tipo 1 (DM1). Pacientes y métodos: Cuarenta y dos pacientes con DM1 en tratamiento intensivo con MDI con NPH y análogos de acción rápida o insulina regular fueron trasferidos 21 a ISCI y 21 a MDI con insulina glargina. No había diferencias significativas entre los dos grupos ni en las características clínicas ni metabólicas al inicio. Se analizan: índice de masa corporal (IMC), dosis total de insulina al día, incidencia de hipoglucemias graves, descompensaciones cetoacidóticas, niveles de hemoglobina glicada (HbA1c) y grado de satisfacción al inicio y al año de la nueva terapia. Resultados: La HbA1c mejora en ambos grupos, más en el grupo tratado con ISCI [7,89 ± 1,46 a 7,51 ± 0,79%] vs glargina [7,80 ± 0,53 a 7,65 ± 0,62%]. El aporte de insulina disminuye un 17% en el grupo de ISCI [0,98 ± 0,24 a 0,81 ± 0,16u/kg/d] (p < 0,05) y un 10,6% en el de glargina [0,94 ± 0,27 a 0,84 ± 0,22u/kg/d] (p < 0,05). La frecuencia de hipoglucemias graves fue más baja en el grupo tratado con ISCI aunque disminuye en ambos grupos. El IMC no se modifica en el grupo de ISCI y disminuye en el de glargina. Solo evidenciamos cetoacidosis en un paciente con ISCI. El grado de aceptación de la terapia fue bueno en ambos grupos. Conclusiones: El tratamiento con ISCI o con MDI con glargina constituye una buena alternativa terapéutica en los pacientes pediátricos con DM1. Permiten mejorar el control metabólico sin aumentar la incidencia de complicaciones agudas

Objective: To evaluate the efficacy and safety of two different forms of intensive therapy, continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) using premeal insulin rapid analogs and insulin glargine, in children and adolescents with type 1 diabetes mellitus (1DM). Patients and methods: Forty-two diabetic patients, previously treated with MDI using NPH and premeal rapid insulin or shortacting analogs, were changed to CSII (21 subjects) or MDI using glargine. There were not significant differences between both groups, neither in the clinical characteristics nor in the metabolic data at the beginning. Body mass index (BMI), total daily insulin dose, severe hypoglycemic episodes incidence, ketoacidosis events, glycosidase hemoglobin (HbA1c) levels, and quality of life at the beginning and after one year of treatment were analyzed. Results: HbA1c has improved in both groups. This improvement is more significant in the group treated with CSII [7,89 ± 1,46 to 7,51 ± 0,79%] than in the glargine group [7,80 ± 0,53 to 7,65 ± 0,62%]. Insulin dose has declined 17% in CSII patients [0,98 ± 0,24 to 0,81 ± 0,16u/kg/d] (p < 0,05) and 10,6% in glargine patients [0,94 ± 0,27 a 0,84 ± 0,22u/kg/d] (p < 0,05). The number of hypoglycaemic episodes was lower in the CSII group, although it has decreased in both groups. BMI did not change in the CSII patients and was reduced in the glargine patients. There was only one ketoacidosis episode in one patient treated with CSII. The new treatment was very well accepted in both groups. Conclusions: CSII and MDI using insulin glargine are good alternatives to control children and adolescents with type 1 diabetes mellitus. They improve metabolic control without increasing acute complications

[Graves' disease in preschool children]. / Enfermedad de Graves-Basedow en el niño preescolar.

Graves' disease, which is the main cause of hyperthyroidism in the pediatric age group, is very rare in pre-school children. We describe the cases of four girls, aged less than 6 years old, out of a total of 30 patients diagnosed with Graves' disease between 1985 and 2004. Investigations were motivated by tachycardia, chronic diarrhea, language development delay or thyroid nodules detected by cervical ultrasonography. In three of the four patients height and bone age were advanced. In all patients goiter was small or absent. None of the patients had ophthalmic disease. In all patients free T3 and T4 were elevated and thyroid-stimulating hormone was suppressed. Three patients were positive for thyroid-stimulating immunoglobulins (the method was not available for the oldest case). Two patients showed complete resolution after 5 years of treatment with carbimazole. The remaining two patients are still under treatment and no adverse effects have been documented.

Therapy with insulin glargine (Lantus) in toddlers, children and adolescents with type 1 diabetes.

OBJECTIVE: To determine the efficacy and safety of insulin glargine (IG) in children and adolescents with type 1 diabetes. In a prospective, 6-month study, 80 patients, aged 2-19 years, received IG once daily plus insulin regular or rapid analogue before meals. The data of body mass index, frequency of severe hypoglycaemia, daily mean blood glucose, fasting blood glucose, haemoglobin A1c and total daily insulin dosage before and after institution of glargine therapy were collected. RESULTS: After 6 months, the average HbA1c level in the entire cohort dropped from 7.63+/-0.81 to 7.14+/-0.70% (p<0.001). Fasting blood glucose decreased from 161+/-37 to 150+/-35 mg/dl (p<0.05) in the total group. Severe hypoglycaemic episodes were reduced from 0.18 events per patient in the 6 months before IG therapy to 0.11 events per patient in the 6 months after IG therapy. The total daily insulin dose was reduced in the entire group from 0.90+/-0.32 to 0.83+/-0.29 u/kg/day (p<0.05). Body mass index (BMI) remained unchanged. In the 14 preschooler children, the HbA1c dropped from 7.54+/-0.60 to 6.96+/-0.57% (p<0.05). CONCLUSIONS: Insulin glargine is an efficacious treatment to improve metabolic control in children and adolescents with type 1 diabetes. It also improved the metabolic control in preschool-age children, without increasing the number of hypoglycaemic events.

Tratamiento con infusión subcutánea continua de insulina en la edad pediátrica / Therapy with continous subcutaneous insulin infusion in the pediatric age

Children and adolescents with type 1 diabetes mellitus are usually treated with multiple daily insulin injections (MDI). Although continuous subcutaneous insulin infusion (CSII) has been used extensively for several years in adult diabetic patients, it has been used less frequent in children and adolescents. But in the recent years, CSII is used more often in the pediatric age, specially in several countries. CSII enables patients with type 1 diabetes to get closer to physiological insulin secretion over 24 hours. This system allows individualization of the insulin dose. Unacceptable glycemic control in spite of MDI has been usually an indication for switching to CSII. Several studies have suggested that CSII in children and adolescents could provides better glycemic control, reduces the risk of severe hypoglycemia and led to lesser weight gain than MDI. CSII therapy in the pediatric age has been proved to be safe, effective and well accepted by children and adolescents with type 1 diabetes and also by their families

Children and adolescents with type 1 diabetes mellitus are usually treated with multiple daily insulin injections (MDI). Although continuous subcutaneous insulin infusion (CSII) has been used extensively for several years in adult diabetic patients, it has been used less frequent in children and adolescents. But in the recent years, CSII is used more often in the pediatric age, specially in sev-eral contries. CSII enables patients with type 1 diabetes to get closer to physiological insulin secretion over 24 hours. This system allows individualization of the insulin dose. Unacceptable glycemic control in spite of MDI has been usually an indication for switching to CSII. Several studies have suggested that CSII in children and adolescents could provides better glycemic control, reduces the risk of severe hypoglycemia and led to lesser weight gain than MDI. CSII therapy in the pediatric age has been proved to be safe, effec-tive and well accepted by children and adolescents with type 1 diabetes and also by their families

[Type 2 diabetes mellitus in the pediatric age group]. / Diabetes mellitus tipo 2 en la edad pediátrica.

In the past two decades, type 2 diabetes mellitus has increased in children and adolescents, especially within certain ethnic groups. This increase has been parallel to the rising prevalence of obesity. Because of the overlap between some clinical characteristics, the differential diagnosis between type 1 and 2 diabetes is difficult. Of 300 diabetic patients in our diabetes section, only three (1 %) had type 2 diabetes. Two patients were obese adolescents with a positive family history of type 2 diabetes mellitus; the third patient was a prepubertal, overweight girl with no family history of this disorder. The diagnosis was incidental in two patients and one patient presented with ketoacidosis. The differences between the three patients reveal the great clinical variability of this disorder and suggest that various underlying factors are involved in the pathophysiology of type 2 diabetes.

Obesidad y síndrome metabólico en la infancia / Obesity and metabolic syndrome in childhood

La obesidad está aumentando de manera ostensible en el niño y en el adolescente en la última década en todos los países. En estos pacientes, sobre todo los de ciertas etnias, se han comenzado a encontrar alteraciones del metabolismo hidrocarbonado y se ha llegado incluso a presentar diabetes tipo 2. También muestran signos precoces de insulinorresistencia y factores de riesgo cardiovascular. La presencia de diferentes factores de riesgo tiene un efecto aditivo (AU)

In the last decade, overweight and obesity have increased in children and adolescents in all countries. These patients, especially those from certain ethnic groups, are now being diagnosed with impaired glucose tolerance and even type 2 diabetes. Early signs of insulin resistance syndrome and cardiovascular risk are also present. These risk factors appear to act in an additive fashion (AU)

Factores predisponentes al desarrollo de diabetes tipo 2 y riesgo cardiovascular en la infancia. Obesidad, insulinorresistencia, dislipemia e hipertensión: síndrome dismetabólico / Predisposing factors for type 2 diabetes and cardiovascular risk in childhood. Obesity, insulin resistance, dyslipidemia and hypertension: dysmetabolic syndrome

La dislipemia, hipertensión, insulinorresistencia, alteración hidrocarbonada y obesidad son potentes factores de riesgo de la enfermedad cardiovascular en el adulto. Esta constelación de situaciones patológicas se conoce como síndrome dismetabólico. La obesidad tiene un papel central en este síndrome. Aunque el impacto de la enfermedad cardiovascular y la muerte se ve en el adulto, el proceso patológico y los factores de riesgo asociados comienzan durante la infancia. Se han encontrado componentes del síndrome dismetabólico en el niño y en el adolescente. La obesidad en estas edades también se asocia con insulinorresistencia, junto a anomalías lipídicas y alteración de la presión arterial en el adulto joven. La diabetes tipo 2 se ha vuelto muy prevalente entre los adolescentes obesos, y el mejor predictor de la alteración de la tolerancia a la glucosa es la evidencia de insulinorresistencia. Debido al gran incremento de la incidencia de obesidad en la edad pediátrica, sobre todo en algunos países y en ciertas etnias, tiene una gran importancia conocer y controlar estos factores de riesgo en las edades tempranas de la vida. Hay que prevenir e intervenir precozmente en los niños y adolescentes con sobrepeso y obesidad, sobre todo en los que pertenecen a los grupos de riesgo (AU)