Establishing Surveillance for Diabetes in American Indian Youth
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OBJECTIVE—To determine prevalence estimates in order to monitor diabetes, particularly type 2 diabetes, in American Indian youth. RESEARCH DESIGN AND METHODS—To explore the feasibility of developing a case definition using information from primary care records, all youth aged <20 years with an outpatient visit or hospitalization for diabetes were identified from the Billings Area Indian Health Service database in Montana and Wyoming from 1997 to 1999, and the medical records were reviewed. Classification for probable type 1 diabetes was based on age ≤5 years, weight per age ≤15th percentile at diagnosis, or positive results of islet cell antibody test. Classification for probable type 2 diabetes was based on weight per age ≥85th percentile or presence of acanthosis nigricans at diagnosis, elevated C-peptide or insulin, family history for type 2 diabetes, or use of oral hypoglycemic agents with or without insulin or absence of current treatment 1 year after diagnosis. RESULTS—A total of 52 case subjects with diabetes were identified, 3 of whom had diabetes secondary to other conditions. Of the remaining 49 case subjects, 25 (51%) were categorized as having probable type 2 diabetes, 14 (29%) as having probable type 1 diabetes, and 10 (20%) could not be categorized because of missing or negative information. Prevalence estimates for diabetes of all types, type 1 diabetes, and type 2 diabetes were 2.3, 0.6, and 1.1, respectively, per 1,000 youth aged <20 years. CONCLUSIONS—Our definitions may be useful for surveillance in primary care settings until further studies develop feasible case definitions for monitoring trends in diabetes among youth.Keywords:
Acanthosis Nigricans
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To the Editor:—
It is of the greatest importance to differentiate malignant acanthosis nigricans, which is one of the best external clues to internal adenocarcinoma, from benign and pseudo acanthosis nigricans, which do not threaten the patient's life. The paper by Winkelmann, Scheen, Jr., and Underdahl (The JournalOct. 29, 1960, p. 1145), however, does not decrease the difficulties of differentiating the various types. Winkelmannet al. apply to the benign type, which is present at birth or begins in childhood or at puberty, the term "congenital," which they do not use in its strict sense, meaning present at birth, but as "referring to the state [of acanthosis nigricans] having been present since infancy." What they call benign post-pubertal acanthosis nigricans is either malignant or pseudo acanthosis nigricans, since the benign type does not begin after puberty. It seems difficult to connect, as they do, acanthosis nigricans with so manyAcanthosis Nigricans
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A mother and daughter had benign familial acanthosis nigricans. Familial acanthosis nigricans begins in early childhood and may be accentuated at puberty. The eruption is not associated with underlying illness. Forms of acanthosis nigricans are associated with obesity, endocrinologic abnormalities, drug ingestion, and malignant neoplasms.
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Acanthosis Nigricans
Diabetic ketoacidosis
Hyperinsulinemia
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ABSTRACT Acanthosis nigricans is characterized by hyperpigmented velvety plaques of body folds and neck. Insulin could be a responsible factor in the pathogenesis of this condition and hyperinsulinemia: a consequence of insulin resistance stimulates the formation of these characteristic plaques. In this study, insulin resistance was compared in obese women with and without acanthosis nigricans. This was a cross‐sectional study. Sixty‐six obese women (32 patients with acanthosis nigricans and 34 patients without acanthosis nigricans) were selected randomly. Levels of fasting serum insulin and fasting blood glucose were measured in both groups and insulin resistance was determined using homeostasis model assessment. Glucose tolerance test also was performed for all of participants. Five (15.6%) patients with acanthosis nigricans and no (0%) patient without acanthosis nigricans had insulin resistance ( P < 0.05). Six (18.7%) patients with acanthosis nigricans and one (2.9%) patient without acanthosis nigricans had impaired glucose tolerance test ( P < 0.05). The mean levels of fasting serum insulin were 15.7 ± 8.7 and 12.2 ± 4.1 µm/mL ( P < 0.05) and the mean values of insulin resistance index were 3.5 ± 1.9 and 2.6 ± 0.9 µm/mL between patients with and without acanthosis nigricans, respectively ( P < 0.05). In Iranian obese women, acanthosis nigricans is a marker of insulin resistance.
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Rabson-Mendenhall syndrome (RMS) is an autosomal recessive disorder due to mutations in the insulin receptor gene (INSR) which is mapped to 19p13.2. RMS is characterized by acanthosis nigricans, generalized lanugo, tooth and nail dysplasia, high nasal bridge, and growth retardation. A 5-year-old female patient was referred due to acanthosis nigricans and generalized lanugo. On her physical examination, severe acanthosis nigricans of the neck, axillae, the external genitalia and antecubital regions, generalized lanugo, mildly decreased subcutaneous fat, dysmorphic facial features, and polydactyly on her left hand were noted. Insulin resistance and impaired glucose tolerance were found. Sequence analysis of the INSR in the patient revealed c.3529+5G>A mutation in homozygous state. RMS should be suspected in a patient with characteristic physical features and insulin resistance.
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Acanthosis nigricans is a skin symptom in obesity that helps to identify patients at high risk for dyslipidemia, hypertension, insulin resistance, and diabetes. It is the most important complication of obesity in metabolic syndrome. Studies investigating the relationship between acanthosis nigricans and metabolic syndrome in obese children are insufficient. In our study, the relationship of acanthosis nigricans and metabolic syndrome was evaluated in children.Obese children aged between 6 and 18 years old, who were examined in the pediatric endocrinology outpatient clinic, were included. The patients' anthropometric measurements and laboratory results were recorded. Modified IDF (International Diabetes Federation) criteria for children were used in metabolic syndrome classification.A hundred and forty-eight obese children were evaluated. The mean age of the cases was 11.91 ± 2.94 years old. Of the cases, 56.1% were female (n=83) 43.9% (n=65) were male. In 39.9% (n=59) of cases, acanthosis nigricans was determined. Acanthosis nigricans was mostly located in the axillary area (27.1%) and the neck (16.9%). In 55.9% of the cases, it was located in more than one area. The relation of regionally detected acanthosis nigricans and metabolic syndrome was not significant (p=0.291). Metabolic syndrome was detected in 14% of 136 patients according to IDF criteria. Acanthosis nigricans and metabolic syndrome combination was present in 27.7%; however, 6.7% of the metabolic syndrome patients did not have acanthosis nigricans. There was a strong relation between metabolic syndrome and the presence of acanthosis nigricans (p=0.003).In our study, a correlation between acanthosis nigricans and metabolic syndrome was detected. Acanthosis nigricans is a skin sign that can be easily detected by clinician. It is an important and easy-to-detect dermatosis that helps determine patients at risk of metabolic syndrome in obese children.
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To the Editor:—
My co-authors and I appreciate Dr. Curth's major contributions to the field of acanthosis nigricans, but we cannot agree entirely with her method of classification. Acanthosis nigricans is a cutaneous manifestation associated with many different conditions, and the prognosis is not associated with the acanthosis nigricans but with the associated disease or mode of inheritance. We do not use the term "pseudoacanthosis nigricans," for histologically and clinically it is in every way similar to acanthosis nigricans. It is not related to obesity, for many of our patients have lost weight without having their acanthosis nigricans involute, and acanthosis nigricans has developed in some patients without obesity. We find it difficult to separate the types II and IV in Dr. Curth's classification, seeing no difference between an inherited acanthosis nigricans which is not associated with congenital dysplasia and one which is associated with phenomena such as congenital lipodystrophy.Acanthosis Nigricans
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Abstract: Acanthosis nigricans in children is usually a benign condition most commonly associated with obesity. Generalized acanthosis nigricans is a very rare condition, especially in childhood. We report a 6‐year‐old boy with a 4‐year history of generalized hyperpigmentation and velvety thickening of the skin. Despite an extensive examination, no evidence for an underlying neoplastic or endocrinologic disease was found.
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Acanthosis
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Pigmentation disorder
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