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This Month in Archives of Pediatrics and Adolescent Medicine
February 2010

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2010;164(2):114. doi:10.1001/archpediatrics.2009.276
Fasting Plasma Glucose Levels in Childhood Predict Prediabetes and Type 2 Diabetes in Adulthood

While 19 million people have type 2 diabetes mellitus, 54 million individuals show impaired fasting glucose as adults, which may represent a prediabetic state. This study examined the prediction of normal fasting plasma glucose (FPG) levels for the development of type 2 diabetes during a 21-year period beginning in childhood. The results show a significantly increased risk (>2-fold) for developing adult prediabetes and type 2 diabetes in children with an FPG of 86 to 99 mg/dL (to convert to millimoles per liter, multiply by 0.0555) compared with those with an FPG of less than 86 mg/dL, even after controlling for other traditional cardiometabolic risk factors. This observation suggests that elevated FPG within the currently accepted normal range in childhood may portend a diabetic status (prediabetes and diabetes) in young adulthood.

Prevalence of adult diabetes status by quartiles of childhood fasting plasma glucose levels within the normoglycemic range. Levels of fasting plasma glucose according to the quartiles were less than 80 mg/dL for quartile 1; 80 to 85 mg/dL, quartile 2; 86 to 90 mg/dL, quartile 3; and 91 to 99 mg/dL, quartile 4.

Prevalence of adult diabetes status by quartiles of childhood fasting plasma glucose levels within the normoglycemic range. Levels of fasting plasma glucose according to the quartiles were less than 80 mg/dL for quartile 1; 80 to 85 mg/dL, quartile 2; 86 to 90 mg/dL, quartile 3; and 91 to 99 mg/dL, quartile 4.

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A Randomized Controlled Trial of Metformin XR Treatment of Adolescent Obesity

While metformin is commonly used as a primary or adjunctive treatment in obese, nondiabetic adolescents, there are limited short-term data to support this therapy. This 48-week randomized, double-blind, placebo-controlled trial of extended-release (XR) metformin therapy in nondiabetic obese adolescents was conducted in 5 clinical sites in the United States. Metformin XR had a small, but statistically significant, impact on body mass index during the initial 52 weeks of the study; this difference disappeared by 24 weeks after cessation of the drug. There were no significant effects on central adiposity, insulin indices, or lipids during metformin therapy. Longer-term studies will be needed to define the effects of metformin treatment on obesity-related disease risk in this population.

Adjusted change in body mass index (BMI [calculated as the mean weight in kilograms divided by the mean height in meters squared]) from baseline. Data are plotted as the mean and 1 SE. The vertical line separates the study drug treatment and post–study drug treatment monitoring periods.

Adjusted change in body mass index (BMI [calculated as the mean weight in kilograms divided by the mean height in meters squared]) from baseline. Data are plotted as the mean and 1 SE. The vertical line separates the study drug treatment and post–study drug treatment monitoring periods.

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A Randomized Controlled Trial of a Theory-Based Abstinence-Only Intervention Over 24 Months

Despite the widespread implementation of abstinence interventions for prevention of sexual risk behaviors in adolescents and the controversy regarding their appropriateness, few randomized controlled trials have tested their efficacy. In this study, African American sixth- and seventh-grade students were randomly assigned to an 8-hour abstinence-only intervention, an 8-hour safer sex–only intervention, an 8- or 12-hour combined abstinence and safer-sex intervention, or an 8-hour health-promotion control group. The probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the health-promotion control group; the safer-sex and comprehensive interventions did not differ from the control group in sexual initiation. None of the interventions had significant effects on consistent condom use or unprotected intercourse. Selective use of theory-based abstinence-only interventions might contribute to the overall goal of curbing the spread of sexually transmitted infections in both the United States and other countries.

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ADHD Outcomes for Children Treated in Community-Based Pediatric Settings

A considerable body of research has established the efficacy of stimulant medication for reducing attention-deficit/hyperactivity disorder (ADHD) symptomatology in patients with ADHD when administered according to detailed medication protocols. This study reports on the outcomes of 785 children with ADHD treated in 47 practices (158 physicians) participating in the ADHD Collaborative quality-improvement project. Children who received ADHD care in community-based primary care practices participating in the ADHD Collaborative experienced significant reductions in ADHD symptoms over time. Symptom improvement occurred mainly within the first 3 months of treatment and remained relatively stable thereafter. These results suggest that community-based physicians can achieve gains in ADHD symptom improvement comparable with carefully controlled, university-based clinical trials.

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