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Diabetes Journal

Prevalence of Diabetes and Diabetic Nephropathy in a Large U.S. Commercially Insured Pediatric Population, 2002–2013

Diabetic Nephropathy – A Complication of Diabetes

Imagine your kidneys are like a sophisticated waste management system. Now, diabetic nephropathy is like a wrench thrown into this system, causing significant damage. It’s a kidney disease that occurs as a complication of diabetes, with potentially severe consequences if left unaddressed.

Original article written by Lin Li, Susan Jick, Stefanie Breitenstein, and Alexander Michel for The Diabetes Journal on August 3, 2015. Click here to read the original article.


DiabetesJournalOBJECTIVE To estimate the prevalence of diabetes and diabetic nephropathy in a large population of U.S. commercially insured patients aged <18 years from 2002 to 2013.


RESEARCH DESIGN AND METHODS Using the U.S. MarketScan commercial claims database, we identified 96,171 pediatric patients with diabetes and 3,161 pediatric patients with diabetic nephropathy (DN) during 2002–2013. We estimated prevalence of pediatric diabetes overall; by diabetes type, age, and sex; and prevalence of pediatric DN overall; by age, sex, and diabetes type.


RESULTS The annual prevalence of diabetes in the whole pediatric population increased from 1.86 to 2.82 per 1,000 during 2002–2013: 1.48 to 2.32 per 1,000 for type 1 diabetes and 0.38 to 0.67 per 1,000 for type 2 diabetes in 2002–2006 and then 0.56 to 0.49 per 1,000 thereafter. The annual prevalence of diabetic nephropathy in pediatric patients with diabetes increased from 1.16 to 3.44% for all cases and 0.83 to 2.32% for probable cases only in 2002–2013. Prevalence of diabetes and diabetic nephropathy was highest in patients aged 12 to <18 years. While prevalence of type 1 diabetes was higher in male than in female youth, prevalence of type 2 diabetes and diabetic nephropathy was higher in female than in male youth. There was no difference in prevalence of diabetic nephropathy by diabetes type.


CONCLUSIONS The prevalence of diabetes and diabetic nephropathy increased in the U.S. MarketScan commercially insured pediatric population from 2002 to 2013. The prevalence of diabetes and DN markedly increased starting at age 12 years.

Have you ever considered how prevalent diabetes and its complications, like diabetic nephropathy, are among children? Well, buckle up! We’re about to take a deep dive into the state of these conditions in the U.S. pediatric population.

Brief Overview of Diabetes and DN

Diabetes in the Pediatric Population

Diabetes, as many of you know, is a chronic condition that occurs when the body can’t regulate blood sugar effectively. It can strike anyone, regardless of age. When it comes to the pediatric population, it’s like a thief in the night, robbing them of their carefree childhood and forcing them to deal with health issues that most adults find challenging.

Survey Methodology

Data Collection

In the study period from 2002 to 2013, data was collected from a broad cross-section of commercially insured children across the United States. Like piecing together a complex puzzle, this vast data was carefully collated and analyzed.

Cohort Selection

To ensure the study’s integrity, stringent selection criteria were used to identify children with diabetes and DN. It was like picking the right team for a critical mission – only those fitting the bill were included.


Prevalence of Diabetes

An alarming rise in the prevalence of diabetes among the pediatric population was observed during this period. It’s as if we were watching a tsunami approach from afar, powerless to stop it.

Prevalence of DN

Further darkening the landscape, the data showed a significant increase in diabetic nephropathy cases among the children with diabetes. The numbers painted a grim picture, much like

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New Type 4 Diabetes Not Linked To Obesity

The Salk Institute’s Ron Evans explains how immune cell dysfunction can lead to diabetes. -Salk Institute

Original article written by Bradley J. Fikes for The San Diego Union Tribune on November 18, 2015. Click here to read the original article.

A new type of diabetes that’s not associated with insulin deficiency or obesity has been discovered — in mice.

In a study published Wednesday, researchers led by Salk Institute scientists found that in a mouse model of the disease regarded as predictive of human diabetes, some develop an unusual type that affects old, lean mice.

This disease is caused by overactivity of a certain kind of immune system cell. The researchers call this new form Type 4 diabetes.

The study was published in the journal Nature. Go to j.mp/type4diabetes for the study.

If the study is confirmed in people — a big if — the public health implications would be profound. Diabetes can lead to blindness, kidney and heart disease, and poor blood circulation that can lead to amputation. Diabetes is usually associated with obesity, and a form that is not may escape detection because doctors aren’t looking for it.

The study was led by the Salk’s Ronald Evans and Ye Zheng. Evans said it’s possible that millions of Americans have this type of diabetes.

“Oftentimes people think that if they’re lean, they’re protected from diabetes, and most physicians would think that,” Evans said.

The researchers envision a potential treatment by developing an antibody drug to reduce levels of these overactive immune cells. That will take at least a few years, Evans said.

Evans estimates that about 20 percent of diabetics over 65 have this newly identified version, and may not be getting the proper care. More than 9.4 million diabetic Americans are over 65 as of 2012, according to the Kaiser Family Foundation. And that number doesn’t count those who haven’t been diagnosed.

So the total number of Americans with this new type of diabetes could reach about 2 million, if Evans’ estimate is accurate.

Evans said treatment of lean, elderly diabetics is less effective, because it’s largely focused on reducing consumption of fat or losing weight, which isn’t a factor for these people. Some of the regular diabetes drugs, such as the standby metformin, show some effectiveness, Evans said. Metformin is a good choice because it’s safe.

But even with the many drugs on the market, more are needed.

“Diabetes in general is not a well-managed disease,” Evans said.

Confirmation needed

Announcing a new form of diabetes is a bit premature, said UC San Diego diabetes researcher Alan Saltiel, who was not involved in the study. Confirmation in humans still needs to be done. That means finding evidence in old, lean people of overactivity of these immune cells, called T regulatory cells, Saltiel said. These “Treg” cells suppress inflammation and tamp down the immune response.

Saltiel, who co-authored an accompanying commentary in Nature, said that despite his caution, the study is significant. It indicates that the story of diabetes is much more complicated than previously thought. Suppressing inflammation was supposed to be a good thing, but this study indicates it’s not always the case.

“It’s very surprising,” Saltiel said. “We didn’t expect these Treg cells to play this role. It’s been assumed that diabetes is kind of an inflammatory disease, that obesity begets inflammation, and then inflammation plays a big role in the generation of diabetes.”

While no animal model equals evidence from humans, Saltiel said the mouse model tested in the study is the best one around. But while it’s accurate in imitating many aspects of human diabetes, he cautioned that it’s not perfect in mimicking what diabetes does in people.

Another expert, Scripps Health clinical endocrinologist Athena Philis-Tsimikas, said the findings make sense.

“Clinically we see a wide variety of patient ‘types’ and body habitus that all have similar rises in blood sugar,” she said by email. “The variation is found in individuals that are older, younger, lean, overweight and different racial/ethnic mix. So the findings in this article are definitely interesting and it would seem logical that with so many clinical pictures that there must be different underlying mechanisms such as those described in this article.”

“One exciting outcome of studies like these are that with so many new therapies in diabetes that the discovery of new mechanisms may allow us to tailor a more unique therapeutic regimen for our individual patients,” Philis-Tsimikas said. “I find this kind of work very exciting and look forward to seeing further work in humans.”

Balancing act

All forms of diabetes involve abnormally high levels of blood sugar. This is mainly regulated by two hormones. Insulin lowers blood sugar levels, and glucagon raises them. With this brake and accelerator system, blood sugar levels can be controlled within a narrow range.

Type 1 diabetes is caused by a lack of insulin, and eventually is fatal unless insulin is provided. It’s caused by an autoimmune reaction that destroys the insulin-producing islet cells in the pancreas. Inflammation is believed to be part of the autoimmune response.

Type 2 diabetes, by far the most common, is caused by resistance to insulin. This requires production of larger amounts of insulin to overcome the resistance and drive down blood sugar levels. It’s related to being overweight and obese. Inflammation produced by other immune cells called macrophages drives obesity-associated insulin resistance, which may be a sign of pre-diabetes.

More tentatively, a third type of diabetes has recently been proposed. It’s called Type 3 diabetes and is associated with Alzheimer’s. It’s thought to be caused by the effects of diabetes on the brain.

A fourth type of diabetes, caused by suppressing inflammation, would add another layer of complexity, Saltiel said.

“People have looked at Tregs in obesity, and the idea was that they were protective, that they were lost in the obese state,” Saltiel said. “What this paper is saying that surprisingly, they’re going up in aging, and aging is another condition associated with resistance to insulin.”

More tentatively, a third type of diabetes has recently been proposed. It’s called type 3 diabetes and is associated with Alzheimer’s. It’s thought to be caused by the effects of diabetes on the brain.

A fourth type of diabetes would add another layer of complexity, Saltiel said.

“People have looked at Tregs in obesity, and the idea was that they were protective, that they were lost in the obese state,” Saltiel said. “What this paper is saying that surprisingly, they’re going up in aging, and aging is another condition associated with resistance to insulin.”

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Crowdfunding Website Aims To Give Young Diabetes Researchers A Leg Up

Crowdfunding Website Aims To Give Young Diabetes Researchers A Leg UpOriginal article written by Kenny Goldberg, Health Reporter, for KPBS on December 21, 2015. Click here to read the original article.

It can be tough for young scientists to get their research projects off the ground.

A group of San Diegans have launched a website called the Diabetes Research Connection aimed at making things a little easier.

The crowd-funding website provides grants of up to $50,000 to scientists who are pursuing novel approaches to finding a cure for type 1 diabetes.

Connection co-founder David Winkler said it’s important to give young researchers a financial shot in the arm.

“Some of the greatest innovations in science have come from those who were in their 20s and early 30s who have not yet been so influenced by traditional thought and theories,” Winkler said.

There are no strings attached to the grants, except that all recipients are required to publish their research on the website.

Winkler said he believes, in general, all scientific data and any conclusions drawn from it should be published.

“Even though it may not appear to be successful, it adds to the body of knowledge,” he said.

According to the American Diabetes Association, approximately 1.25 million American adults and children have type 1 diabetes.

Listen to the audio clip of David Winkler’s interview HERE.

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See our approved research projects and campaigns.

Role of the integrated stress response in type 1 diabetes pathogenesis
In individuals with type 1 diabetes (T1D), the insulin-producing beta cells are spontaneously destroyed by their own immune system. The trigger that provokes the immune system to destroy the beta cells is unknown. However, accumulating evidence suggest that signals are perhaps first sent out by the stressed beta cells that eventually attracts the immune cells. Stressed cells adapt different stress mitigation systems as an adaptive response. However, when these adaptive responses go awry, it results in cell death. One of the stress response mechanisms, namely the integrated stress response (ISR) is activated under a variety of stressful stimuli to promote cell survival. However, when ISR is chronically activated, it can be damaging to the cells and can lead to cell death. The role of the ISR in the context of T1D is unknown. Therefore, in this DRC funded study, we propose to study the ISR in the beta cells to determine its role in propagating T1D.
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