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Aims Household food insecurity (FI), i.e., limited availability of nutritionally adequate foods, is associated with poor glycemic control among adults with type 2 diabetes. We evaluated the association of FI among youth and young adults (YYA) with type 1 diabetes to inform recent clinical recommendations from the American Diabetes Association for providers to screen all patients with diabetes for FI. Methods Using data from the Washington and South Carolina SEARCH for Diabetes in Youth Study sites, we conducted an observational, cross-sectional evaluation of associations between FI and glycemic control, hospitalizations, and emergency department (ED) visits among YYA with type 1 diabetes. FI was assessed using the Household Food Security Survey Module, which queries conditions and behaviors typical of households unable to meet basic food needs. Participants’ HbA1c were measured from blood drawn at the research visit; socio-demographics and medical history were collected by survey. Results The prevalence of FI was 19.5%. In adjusted logistic regression analysis, YYAs from food-insecure households had 2.37 higher odds (95% CI: 1.10, 5.09) of high risk glycemic control, i.e., HbA1c >9.0%, vs. peers from food-secure households. In adjusted binomial regression analysis for ED visits, YYAs from food-insecure households had an adjusted prevalence rate that was 2.95 times (95% CI [1.17, 7.45]) as great as those from food secure households. Conclusions FI was associated with high risk glycemic control and more ED visits. Targeted efforts should be developed and tested to alleviate FI among YYA with type 1 diabetes.

Prospective patient registries have been successfully utilized in several disease states with a goal of improving treatment approaches through multi-institutional collaboration. The prevalence of youth with severe obesity is at a historic high in the United States, yet evidence to guide effective weight management is limited. The Pediatric Obesity Weight Evaluation Registry (POWER) was established in 2013 to identify and promote effective intervention strategies for pediatric obesity.Sites in POWER provide multicomponent pediatric weight management (PWM) care for youth with obesity and collect a defined set of demographic and clinical parameters, which they regularly submit to the POWER Data Coordinating Center. A program profile survey was completed by sites to describe characteristics of the respective PWM programs.From January 2014 through December 2015, 26 US sites were enrolled in POWER and had submitted data on 3643 youth with obesity. Ninety-five percent were 6-18 years of age, 54% female, 32% nonwhite, 32% Hispanic, and 59% publicly insured. Over two-thirds had severe obesity. All sites included a medical provider and used weight status in their referral criteria. Other program characteristics varied widely between sites.POWER is an established national registry representing a diverse sample of youth with obesity participating in multicomponent PWM programs across the United States. Using high-quality data collection and a collaborative research infrastructure, POWER aims to contribute to the development of evidence-based guidelines for multicomponent PWM programs.

Findings regarding type 1 diabetes mellitus (T1DM) and neighborhood-level characteristics are mixed, with few US studies examining the influence of race/ethnicity. We conducted an ecologic study using SEARCH for Diabetes in Youth Study data to explore the association of neighborhood characteristics and T1DM incidence. 2002–2003 incident cases among youth at four SEARCH centers were included. Residential addresses were geocoded to US Census Tract. Standardized incidence ratios tended to increase with increasing education and median household income. Results from Poisson regression mixed models were similar and stable across race/ethnic groups and population density. Our study suggests a relationship of T1DM incidence with neighborhood-level socioeconomic status, independent of individual-level race/ethnic differences.

The Asian American (AA) population is currently the fastest growing population in the U.S., having expanded six times faster than the general population in the 1990s (1). In addition, diabetes prevalence continues to rise in this population, as observed for other populations around the world. However, given the diverse natures, cultures, and physiologies among the AA, Native Hawaiian (NH), and Pacific Islander (PI) (AANHPI) populations, and in particular the distinct diabetes profiles, an understanding of these factors can provide important clues to understand the genesis, pathophysiology, and treatment response of diabetes, as well as characterize community outreach programs needed for the wider net of diverse communities throughout the U.S. In this regard, a meeting, whose theme was “Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action,” was held in Honolulu, Hawaii, in September 2011 by a coalition of health care organizations and scientists with strong interests in the topic and in the health of AANHPI populations. There was consensus that there is a great need to understand the prevalence and pathophysiology and discuss potential intervention strategies regarding diabetes in AANHPI populations given the unique characteristics of this population. This information may help health care providers understand and improve diabetes prevention, treatment outcomes, and complications in AANHPI populations. In this review, we examine diabetes prevalence in different AANHPI populations to highlight the similarities and differences. The various groups that comprise AANHPI populations are hugely diverse geographically, culturally, and genetically. The U.S. census defines AAs as persons who have origins in the East, Southeast, or South Asia. NHs and PIs are people who have origins in Hawaii, Samoa, or any other Pacific island (2,3). Diversity within each of these groups is also large. For example, although grouped as AAs, the language, culture, and genetics of someone …

OBJECTIVE—Given limited reports on diabetes among U.S. Asian and Pacific Islander youth, we describe the clinical characteristics, incidence, and prevalence of diabetes among Asian, Pacific Islander, and mixed Asian–Pacific Islander youth. RESEARCH DESIGN AND METHODS—Data were collected from 245 Asian, Pacific Islander, and Asian–Pacific Islander participants in the SEARCH for Diabetes in Youth Study, a population-based study of diabetes in youth (aged RESULTS—Most participants with type 2 diabetes were obese (range Asian 71% to Pacific Islander 100%) with mean BMI >33 kg/m2. In those with type 1 diabetes, Pacific Islanders were more likely to be obese, with a mean BMI of 26 vs. 20 kg/m2 for Asian and Asian–Pacific Islander youth (P < 0.0001). The incidence of type 1 diabetes for youth aged 0–9 years was 6.4 per 100,000 person-years and 7.4 per 100,000 person-years for youth aged 10–19 years. The incidence of type 2 diabetes was 12.1 per 100,000 person-years for youth aged 10–19 years. CONCLUSIONS—While Asian and Asian–Pacific Islanders with type 1 and type 2 diabetes had lower mean BMIs than Pacific Islanders, all Asian, Pacific Islander, and Asian–Pacific Islanders with type 2 diabetes had mean BMIs above adult ethnicity-specific definitions of obesity. While the majority of Asian, Pacific Islander, and Asian–Pacific Islander youth had type 1 diabetes, older Asian, Pacific Islander, and Asian–Pacific Islander youth (aged 10–19 years) have an incidence of type 2 diabetes almost double that of type 1 diabetes. Public health efforts to prevent type 2 diabetes and obesity in Asian, Pacific Islander, and Asian–Pacific Islander adolescents are needed.

r s a t e e a l D a p t b c Amid reports identifying obesity as one of the ost significant public health problems in the nited States comes the comprehensive review f type 2 diabetes in youth in this month’s Current roblems in Pediatrics. The authors, Dr. Lenna iu and colleagues, point out that for most peditricians, we last received training on type 2 iabetes in medical school. Thus, for many of us, heir article serves as a primer on the disease. he review of the epidemiology and pathophysilogy of type 2 diabetes provides the necessary nderpinning for understanding the recommenations for, and controversies surrounding, creening at-risk youth. Parenthetically, it is clear hat those of us who care for children need to alculate and review BMI with the same rigor that e now apply to analyzing growth charts. Cliniians caring for children and adolescents with ype 2 diabetes will find the review, by Dr. Liu et

Background— We have shown that adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is related to blood pressure in youth with type 1 and type 2 diabetes mellitus. We explored the impact of the DASH diet on other cardiovascular disease risk factors. Methods and Results— Between 2001 and 2005, data on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein particle density, apolipoprotein B, body mass index, waist circumference, and adipocytokines were ascertained in 2130 youth aged 10 to 22 years with physician-diagnosed diabetes mellitus. Dietary intake was assessed by food frequency questionnaire, categorized into the DASH food groups, and assigned an adherence score. Among youth with type 1 diabetes mellitus, higher adherence to the DASH diet was significantly and inversely associated with low-density lipoprotein/high-density lipoprotein ratio and A 1c in multivariable-adjusted models. Youth in the highest adherence tertile had an estimated 0.07 lower low-density lipoprotein/high-density lipoprotein ratio and 0.2 lower A 1c levels than those in the lowest tertile adjusted for confounders. No significant associations were observed with triglycerides, low-density lipoprotein particle density, adipocytokines, apolipoprotein B, body mass index Z score, or waist circumference. Among youth with type 2 diabetes mellitus, associations were observed with low-density lipoprotein particle density and body mass index Z score. Conclusions— The DASH dietary pattern may be beneficial in the prevention and management of cardiovascular disease risk in youth with diabetes mellitus.

We evaluated geographic variation in type 1 and type 2 diabetes mellitus (T1DM, T2DM) in four regions of the United States. Data on 807 incident T1DM cases diabetes and 313 T2DM cases occurring in 2002-03 in South Carolina (SC) and Colorado (CO), 5 counties in Washington (WA), and an 8 county region around Cincinnati, Ohio (OH) among youth aged 10-19 years were obtained from the SEARCH for Diabetes in Youth Study. Geographic patterns were evaluated in a Bayesian framework. Incidence rates differed between the study regions, even within race/ethnic groups. Significant small-area variation within study region was observed for T1DM and T2DM. Evidence for joint spatial correlation between T1DM and T2DM was present at the county level for SC (r(SC)=0.31) and CO non-Hispanic Whites (r(CO)=0.40) and CO Hispanics (r(CO)=0.72). At the tract level, no evidence for meaningful joint spatial correlation was observed (r(SC)=-0.02; r(CO)=-0.02; r(OH)=0.03; and r(WA=)0.09). Our study provides evidence for the presence of both regional and small area, localized variation in type 1 and type 2 incidence among youth aged 10-19 years in the United States.

OBJECTIVE—To report the prevalence and incidence of type 1 and type 2 diabetes among African American youth and to describe demographic, clinical, and behavioral characteristics. RESEARCH DESIGN AND METHODS—Data from the SEARCH for Diabetes in Youth Study, a population-based, multicenter observational study of youth with clinically diagnosed diabetes aged 0–19 years, were used to estimate the prevalence for calendar year 2001 (692 cases) and incidence based on 748 African American case subjects diagnosed in 2002–2005. Characteristics of these youth were obtained during a research visit for 436 African American youth with type 1 diabetes and 212 African American youth with type 2 diabetes. RESULTS—Among African American youth aged 0–9 years, prevalence (per 1,000) of type 1 diabetes was 0.57 (95% CI 0.47–0.69) and for those aged 10–19 years 2.04 (1.85–2.26). Among African American youth aged 0–9 years, annual type 1 diabetes incidence (per 100,000) was 15.7 (13.7–17.9) and for those aged 10–19 years 15.7 (13.8–17.8). A1C was ≥9.5% among 50% of youth with type 1 diabetes aged ≥15 years. Across age-groups and sex, 44.7% of African American youth with type 1 diabetes were overweight or obese. Among African American youth aged 10–19 years, prevalence (per 1,000) of type 2 diabetes was 1.06 (0.93–1.22) and annual incidence (per 100,000) was 19.0 (16.9–21.3). About 60% of African American youth with type 2 diabetes had an annual household income of 90% were overweight or obese. CONCLUSIONS—Type 1 diabetes presents a serious burden among African American youth aged

OBJECTIVE—The purpose of this study was to describe the weight-loss practices and weight-related issues reported by youth with diabetes, according to sex and diabetes type. RESEARCH DESIGN AND METHODS—A total of 1,742 female and 1,615 male youth aged 10–21 years with type 1 or type 2 diabetes completed a SEARCH for Diabetes in Youth study visit during which height, weight, and A1C were measured. A survey assessed weight-related issues and weight-loss practices. RESULTS—Although more common in youth with type 2 diabetes, youth with type 1 diabetes also reported weight-related concerns and had elevated BMI. Among youth who had ever tried to lose weight (n = 1,646), healthy weight-loss practices (diet [76.5%] and exercise [94.8%]) were the most common, whereas unhealthy practices (fasting [8.6%], using diet aids [7.5%], vomiting or laxative use [2.3%], and skipping insulin doses [4.2%]) were less common. In sex-specific multivariable models including age, race/ethnicity, diabetes type, BMI category, and glycemic control, obese females and overweight/obese males were more likely to report ever practicing any unhealthy weight-loss practice than normal-weight youth. These practices were associated with poor glycemic control for female but not male subjects. All unhealthy weight-loss practices except fasting were more common in female than in male subjects. Dieting, fasting, and using diet aids were all more common in youth with type 2 diabetes than in those with type 1 diabetes. CONCLUSIONS—Given the prevalence of overweight and obesity among youth with type 1 or type 2 diabetes, health care professionals caring for youth with diabetes need to pay particular attention to identifying youth, particularly females, with unhealthy weight-loss practices.

The intracellular growth of Legionella micdadei was inhibited in mouse L cells treated with interferon (IFN). This IFN-mediated restriction was dose-dependent and required preincubation of the L cells with high doses of IFN (1,000 U/ml) for maximal inhibition. Incubation of L. micdadei with IFN alone had no detectable effect on growth of the bacteria. The IFN-mediated growth restriction was not dependent upon tryptophan concentration in the culture medium.