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Objectives: To examine the relationship between urinary pH and metabolic syndrome risk factors along with insulin resistance in obese adolescents, and to evaluate the relationship between other urinary stone-forming and -inhibiting markers and metabolic syndrome. Study design: A total of 46 obese adolescents were enrolled. Twenty-four hour and randomly obtained urine samples were analyzed for urinary pH, promoters of stone formation (ie, uric acid, oxalate, and relative saturation ratio of calcium oxalate [RSR-CaOx]), and inhibitors of stone formation (ie, citrate and osteopontin). Other data collected included height, weight, blood pressure, and fasting lipid, insulin, and glucose levels. Results: The subjects had a mean age of 14.6±2.0 years and a mean body mass index of 36±6.3 kg/m2. Random urine pH and the number of risk factors for metabolic syndrome were negatively correlated (r =−0.34; P =.02). RSR-CaOx was correlated with both homeostasis model assessment of insulin resistance score (r =0.38; P <.01) and number of risk factors for metabolic syndrome (r =0.47; P =.001) Conclusion: Decreased urinary pH and increased RSR-CaOx are associated with risk factors for metabolic syndrome in obese adolescents. [ABSTRACT FROM AUTHOR]

Type 1 Diabetes Mellitus (T1DM) is a chronic disease caused by the autoimmune destruction of insulin producing cells of the pancreas and is treated by the subcutaneous administration of insulin. We have observed that many families do not adjust doses or contact the diabetes care team between visits despite high sugar readings. We hypothesized that phone contact between our office and families was associated with improved inter-visit control as measured by hemoglobin A1c (A1C). Subjects were T1DM patients of a moderately-sized pediatric endocrinology practice who have had diabetes for at least 1 year, excluding those in the honeymoon period. Pairs of office visits (n=1078) over I year were queried from a clinical database and the presence of phone contact between the two visits was determined. The sample of visits was then analyzed both as an entire group and sub-divided based on the A1C at the prior visit of each pair. Control-based groups were defined as follows: Excellent (A1C<7), Good (7.1-7.9), Fair (8.0-8.9), and Poor (>=9.0). Demographics were tabulated as well as the mean A1C at each visit of the pair along with the percentage of patients on insulin pumps, change in A1C, time between visits, and change in A1C over time (A1CδPM). Data was analyzed using a two-sided independent sample T-test and Levene's test for the equality of variances. Overall, phone contact was associated with a significant improvement in A1CδPM (-0.06±0.49 vs +0.01 ± 0.38, p=0.015). When groups were considered, significant improvement in the A1CδPM only occurred in the Poor group, (-0.34 ± 0.68 vs -0.15 ± 0.67, p = 0.042). Among all groups and in the overall group, patients who called were significantly younger and closer to time of diagnosis. Among diabetic visit pairs as a whole and among poorly controlled diabetics as a group, phone contact was associated with improved A1CδPM. This highlights the importance of emphasizing inter-visit contact in poorly controlled patients who may not be at the point where they can effectively adjust insulin doses by themselves. Among patients with A1Cs below 9, phone contact in itself was not associated with improved inter-visit A1C outcomes. Perhaps in these patients it is more important to teach the families to self-adjust insulin doses. This study shows the importance of inter-visit contact in the poorly controlled diabetic patient. Studies to further characterize inter-visit behavior of diabetic children and their families would server to further direct interventions to produce improved glycemic control. [ABSTRACT FROM AUTHOR]

Objective To evaluate the response to recombinant GH treatment and adverse events in children with Prader–Willi syndrome (PWS) from KIGS, the Pfizer International Growth Database. Patients A total of 328 children (274 prepubertal, median age 6·0 years; 54 pubertal, median age 12·7 years) were treated for 1 year and 161 children were treated for 2 years with GH. Results Height standard deviation score (SDS) increased significantly during treatment; the response was greater in prepubertal (−0·7 vs.−1·8 pretreatment) compared with pubertal children (−1·5 vs.−1·8). Predictors of first-year height velocity in multiple regression analysis were GH dose, body weight (positively correlated), height SDS minus mid-parental height SDS and chronological age (negatively correlated), together accounting for 39% of the variation in response to GH. Body mass index (BMI) SDS did not change significantly during 2 years of treatment. Of all the 675 GH-treated PWS patients in KIGS, there were five cases of sudden death (age range 3–15 years). Three were obese (weight for height > 200%) and causes of death included bronchopneumonia, respiratory insufficiency and sleep apnoea. Scoliosis was the most commonly reported adverse event ( n = 24), four children developed hyperglycaemia and six had presumptive diabetes (type 2 in five, and one case of type 1). Conclusions Short-term growth improved in response to conventional doses of GH in children with PWS. Prior to commencement of GH, examination of the upper airways and sleep studies should be performed in PWS patients. GH should be used with caution in those with extreme obesity or disordered breathing and all patients should be closely monitored for adverse events. [ABSTRACT FROM AUTHOR]

Heptulla RA, Allen HF, Gross TM, Reiter EO. Continuous glucose monitoring in children with type 1 diabetes: before and after insulin pump therapy. The aim of continuous subcutaneous insulin infusion (CSII) therapy in patients with type 1 diabetes mellitus (T1DM) is to mimic as closely as possible the normal physiologic pattern seen in individuals without diabetes. This study was undertaken to determine the specific areas of improved glycemic control in subjects after initiation of insulin pump therapy and times where further improvement is needed. Eight patients with T1DM (age 7.5–17 yr) wore the Continuous Glucose Monitoring System (CGMS) (Medtronic MiniMed, Northridge, CA, USA) for 3 d before and 3 months after initiation of insulin pump therapy. The CGMS, which measures inter- stitial glucose concentrations every 5 min for a 72-h period, was used to evaluate glucose profiles. Patients entered 4–5 fingerstick blood glucose measurements daily into the sensor for calibration. Detailed logs of food intake, exercise, and hypoglycemic symptoms were also recorded. Hemoglobin A1c (HbA1C) was reduced (p < 0.007) following 3 months of insulin pump therapy. Post-CSII continuous glucose profiles demonstrated an overall improvement in hourly mean glucose over a 24-h period (p < 0.001) as well as a reduction in the area under the curve for glucose (27 ± 4 prepump vs. 8.6 ± 1.4 mg/dL/d postpump, p < 0.004). This improvement was a result of an attenuation of the maximal postprandial glycemic excursions. Postbreakfast 349 ± 24 vs. 267 ± 16 mg/dL, p < 0.003; lunch 340 ± 16 vs. 217 ± 20 mg/dL, p < 0.003. Postdinner average similarly decreased after 3 months of CSII by 22%, p < 0.04. Pump therapy specifically improved the postprandial glucose excursions in children. [ABSTRACT FROM AUTHOR]

Background: People have long been fascinated with the size and growth of living things, from the giants of classic mythology and art to the little people who also have appeared in classical art, as well as the courts of European monarchs, and were exploited in "shows." Serious medical evaluation began in the late 19th century with the description of acromegaly and its association with pituitary tumors. In the early 20th century, multiple investigators attempted to extract a growth-promoting factor from the anterior pituitary and then, over the decades, to purify it and distinguish it from other anterior pituitary hormones. With relatively pure growth hormone (GH), its biological activity in growth promotion and as a metabolic hormone were studied, and species specificity became apparent: primate GH was the only GH active in man. Human GH was prepared from cadaveric pituitaries and distributed by the NIH to treat children with GH deficiency, but there was never enough pituitary hGH for all of the children who required it. When Creutzfeldt-Jakob disease was found in some patients who received pituitary GH, the production and FDA approval of biosynthetic hGH dramatically accelerated. With a large supply, one could treat those who were GH deficient and test its efficacy in other causes of short stature; longer acting versions of hGH have now been developed, tested, and in a few instances received FDA approval., Summary: It has been a long journey from the description of over- and underproduction of GH in animals to the production and clinical use of the biosynthetic hormones., Key Messages: The efforts of basic scientists led to the extraction and purification of GH. Clinical scientists have expanded the appropriate use of hGH for short children with conditions in addition to GH deficiency., (© 2022 S. Karger AG, Basel.)