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Sherr J.,Yale University | Xing D.,Jaeb Center for Health Research | Ruedy K.J.,Jaeb Center for Health Research | Beck R.W.,Jaeb Center for Health Research | And 8 more authors.
Diabetes Care | Year: 2013

OBJECTIVE - To examine the loss of glucagon response to hypoglycemia and its relationship with residual β-cell function early in the course of type 1 diabetes (T1D) in youth. RESEARCH DESIGN AND METHODS - Twenty-one youth with T1D duration <1 year (ages 8-18 years, T1D duration 6-52 weeks) underwent mixed-meal tolerance tests (MMTTs) to assess residual β-cell function and hypoglycemic clamps to assess glucagon responses to hypoglycemia. Glucagon responses to hypoglycemia in T1D subjects were compared with those in 12 nondiabetic young adults (ages 19-25 years). RESULTS - Peak MMTT-stimulated C-peptide levels (range 0.12-1.43) were ≥0.2 nmol/L in all but one T1D subject. As expected, the median of glucagon responses to hypoglycemia in the T1D subjects (18 pg/mL [interquartile range 7-32]) was significantly reduced compared with the responses in nondiabetic control subjects (38 pg/mL [19-66], P = 0.02). However, there was no correlation between the incremental increase in plasma glucagon during the hypoglycemic clamp and the incremental increase and peak plasma C-peptide level during the MMTT. Similarly, the seven T1D subjects who failed to achieve an increase in glucagon ≥12 pg/mL (i.e., 3 SD above baseline values) had C-peptide response ≥0.2 nmol/L (0.54- 1.12), and the one T1D subject with peak stimulated <0.2 nmol/L had a 14 pg/mL increase in plasma glucagon in response to hypoglycemia. CONCLUSIONS - Impaired plasma glucagon responses to hypoglycemia are evident in youth with T1D during the first year of the disease. Moreover, defective and absent glucagon responses to hypoglycemia were observed in patients who retained clinically important residual endogenous β-cell function. © 2013 by the American Diabetes Association.

Marzelli M.J.,The Interdisciplinary Center | Marzelli M.J.,Stanford University | Mazaika P.K.,The Interdisciplinary Center | Barnea-Goraly N.,The Interdisciplinary Center | And 12 more authors.
Diabetes | Year: 2014

Studies of brain structure in type 1 diabetes (T1D) describe widespread neuroanatomical differences related to exposure to glycemic dysregulation in adults and adolescents. In this study, we investigate the neuroanatomical correlates of dysglycemia in very young children with early-onset T1D. Structural magnetic resonance images of the brain were acquired in 142 children with T1D and 68 age-matched control subjects (mean age 7.0 ± 1.7 years) on six identical scanners. Whole-brain volumetric analyses were conducted using voxelbased morphometry to detect regional differences between groups and to investigate correlations between regional brain volumes and measures of glycemic exposure (including data from continuous glucose monitoring). Relative to control subjects, the T1D group displayed decreased gray matter volume (GMV) in bilateral occipital and cerebellar regions (P < 0.001) and increased GMV in the left inferior prefrontal, insula, and temporal pole regions (P = 0.002). Within the T1D group, hyperglycemic exposure was associated with decreased GMV in medial frontal and temporaloccipital regions and increased GMV in lateral prefrontal regions. Cognitive correlations of intelligence quotient to GMV were found in cerebellar-occipital regions and medial prefrontal cortex for control subjects, as expected, but not for the T1D group. Thus, early-onset T1D affects regions of the brain that are associated with typical cognitive development. © 2014 by the American Diabetes Association.

Barnea-Goraly N.,The Interdisciplinary Center | Raman M.,The Interdisciplinary Center | Mazaika P.,The Interdisciplinary Center | Marzelli M.,The Interdisciplinary Center | And 14 more authors.
Diabetes Care | Year: 2014

OBJECTIVE To investigate whether type 1 diabetes affects white matter (WM) structure in a large sample of young children. RESEARCH DESIGN AND METHODS Children (ages 4 to <10 years) with type 1 diabetes (n = 127) and age-matched nondiabetic control subjects (n = 67) had diffusion weighted magnetic resonance imaging scans in this multisite neuroimaging study. Participants with type 1 diabetes were assessed for HbA1c history and lifetime adverse events, and glucose levels were monitored using a continuous glucose monitor (CGM) device and standardized measures of cognition. RESULTS Between-group analysis showed that children with type 1 diabetes had significantly reduced axial diffusivity (AD) in widespread brain regions compared with control subjects. Within the type 1 diabetes group, earlier onset of diabetes was associated with increased radial diffusivity (RD) and longer duration was associated with reduced AD, reduced RD, and increased fractional anisotropy (FA). In addition, HbA1c values were significantly negatively associated with FA values and were positively associated with RD values in widespread brain regions. Significant associations of AD, RD, and FA were found for CGM measures of hyperglycemia and glucose variability but not for hypoglycemia. Finally,we observed a significant association between WM structure and cognitive ability in children with type 1 diabetes but not in control subjects. CONCLUSIONS These results suggest vulnerability of the developing brain in young children to effects of type 1 diabetes associated with chronic hyperglycemia and glucose variability. © 2014 by the American Diabetes Association.

News Article | February 17, 2017

BILLERICA, Mass.--(BUSINESS WIRE)--Insulet Corporation (NASDAQ: PODD) (Insulet or the Company), the leader in tubeless insulin pump technology with its Omnipod® Insulin Management System (Omnipod System), today announced positive results from the first feasibility study of the Omnipod Horizon™ hybrid closed-loop system. The study demonstrated that the Omnipod automated glucose control algorithm performed well, was safe during the day and night for adults with type 1 diabetes, and was very effective at night with minimal hypoglycemia and excellent fasting glucose. These data were presented today at the 10th International Conference on Advanced Technologies & Treatments for Diabetes (ATTD) in Paris, France. Additional studies are underway to further validate the performance in adult and pediatric populations. Study participants included 24 adults with type 1 diabetes. The 36-hour study1 included a modified version of Insulet’s Omnipod, a Dexcom® continuous glucose sensor, and Insulet’s personalized model predictive control algorithm. Results showed use of the Company’s hybrid closed-loop system was associated with significantly less time spent in hypoglycemic blood glucose range compared to ranges prior to the study. Key findings included patients achieving and remaining in the target blood glucose control range 69% of the time over the course of the study and maintaining target blood glucose control 90% of the time during the overnight period. “ These very positive results, particularly in the overnight period, demonstrate the potential for the Omnipod Horizon System to improve clinical outcomes in patients with type 1 diabetes,” said Dr. Bruce Buckingham, Professor of Pediatric Endocrinology at the Lucille Salter Packard Children’s Hospital, Stanford University, and Principal Investigator of the study. “ This is a safe system providing significant reductions in hypoglycemia both during the day and night, and the system made significant improvements in overnight glucose control, decreasing glucose variability and bringing fasting glucose values into range. These are very positive early findings and I think I speak for the entire team when I say I am excited to see how the Horizon system continues to perform in future clinical studies.” “ We are incredibly excited by the early results of this trial, which demonstrated excellent glucose control and tremendous promise to make a significant impact for patients,” said Shacey Petrovic, President and Chief Operating Officer. “ Omnipod allows our users to feel more confident, and to experience improved quality of life and outcomes, and we are thrilled our Omnipod Horizon System is already demonstrating the ability to continue to make a significant impact on improving the lives of people with diabetes.” 1 Buckingham BA, Pinsker JE, Christiansen, MP, Schneider J, Peyser TA, Dassau E, Bok Lee J, O’Connor J, Layne JE, Ly TT. Feasibility of Omnipod Hybrid Closed-loop Control in Adults with Type 1 Diabetes Using an Enhanced Personalized Model Predictive Control Algorithm. Presented at the 10th International Conference on Advanced Technologies & Treatments for Diabetes, February 17, 2017. The Omnipod® Insulin Management System is an innovative continuous insulin delivery system that provides all the proven benefits of continuous subcutaneous insulin infusion (CSII) therapy in a way no conventional insulin pump can. The Omnipod System's innovative design and features allows people living with diabetes to live their life—and manage their diabetes—with unprecedented freedom, comfort, convenience, and ease. The Omnipod System consists of two components: (i) a Pod that stores and delivers insulin; and (ii) a Personal Diabetes Manager (PDM) that wirelessly programs the user's personalized insulin delivery, calculates suggested doses and insulin on board, and has a convenient, built-in blood glucose meter. The small, light-weight Pod can be worn in multiple locations, including the abdomen, hip, back of upper arm, upper thigh or lower back and, because it is waterproof (IPX8), there is no need to remove when showering, swimming or performing other activities. This means that Omnipod can provide up to three days of non-stop insulin delivery, without the need to disconnect a tube set or manually inject insulin. The Pod and PDM communicate wirelessly to offer precise, personalized and continuous insulin delivery with customizable basal and bolus delivery options, as well as important safety checks. The Pod's auto-cannula insertion is quick, simple, and virtually pain-free. Users never have to handle a needle. The user simply pushes a button on the PDM and the Pod's automated insertion system inserts the cannula beneath the skin and begins delivering insulin according to the user's programmed basal rate. The Omnipod System is the world's first commercially available tubeless insulin delivery system that allows users to live untethered by tubing and without the stress and anxiety of multiple daily injections. By breaking down the barriers to insulin pump therapy, the Omnipod System offers freedom for users to live life on their own terms and with the ease of use they deserve. Insulet Corporation (NASDAQ: PODD) is an innovative medical device company dedicated to making the lives of people with diabetes easier. Through its Omnipod Insulin Management System, Insulet seeks to expand the use of insulin pump therapy among people with insulin-dependent diabetes. The Omnipod is a revolutionary and easy-to-use tubeless insulin pump that features just two parts and a fully-automated cannula insertion. Insulet's Delivery Systems business also partners with global pharmaceutical and biotechnology companies to tailor the Omnipod technology platform for the delivery of subcutaneous drugs across multiple therapeutic areas. Founded in 2000, Insulet Corporation is based in Billerica, Massachusetts. For more information, please visit: This press release may contain forward-looking statements concerning Insulet's expectations, anticipations, intentions, beliefs or strategies regarding the future. These forward-looking statements are based on its current expectations and beliefs concerning future developments and their potential effects on Insulet. There can be no assurance that future developments affecting Insulet will be those that it has anticipated. These forward-looking statements involve a number of risks, uncertainties (some of which are beyond its control) or other assumptions that may cause actual results or performance to be materially different from those expressed or implied by these forward-looking statements, and other risks and uncertainties described in its Annual Report on Form 10-K, which was filed with the Securities and Exchange Commission on February 29, 2016 in the section entitled "Risk Factors," and in its other filings from time to time with the Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should any of its assumptions prove incorrect, actual results may vary in material respects from those projected in these forward-looking statements. Insulet undertakes no obligation to publicly update or revise any forward-looking statements. © 2017 Insulet Corporation. Omnipod, the Omnipod logo, Horizon, and the Horizon logo are trademarks or registered trademarks of Insulet Corporation. Dexcom and Dexcom G4 are registered trademarks of Dexcom, Inc. and used with permission. All rights reserved.

News Article | February 15, 2017

BOSTON & SYDNEY--(BUSINESS WIRE)--GI Dynamics, Inc. (ASX:GID), a medical device company that has commercialized EndoBarrier in Europe for patients with type 2 diabetes and obesity, today announced that enrollment is complete in the first clinical trial evaluating EndoBarrier in adolescents. The study was conducted at the University Children’s Hospital (UCH) in Ljubljana, Slovenia. This investigator-initiated prospective single-arm study was led by Tadej Battelino, MD, PhD, Professor of Pediatrics at UCH, and was designed to determine the efficacy and safety of the EndoBarrier treatment for up to one year in morbidly obese adolescents. Preliminary data show that patients who received the treatment saw an average of 10 percent decrease in body mass index (BMI), metabolic improvements and no serious adverse effects. “The preliminary data show that treatment with EndoBarrier has the potential to treat prediabetic, severely obese adolescents, especially those with metabolic complications,” said Dr. Battelino. “In this study, relevant weight loss was achieved in most of the subjects, with clinically relevant improvements in metabolic stabilization in prediabetic patients. Our cohort also saw an acceptable safety profile with no serious adverse events.” EndoBarrier demonstrated therapeutic benefit in treating prediabetes, as blood sugar levels (HbA1c) were reduced by 6 percent and BMI was reduced by an average of 10 percent in study subjects. Most notable was the 49% improvement in HOMA-IR (Homeostatic Model Assessment), a critical measure of insulin resistance and beta-cell function. In addition, the study noted clinically significant reductions in triglycerides (43 percent) and systolic blood pressure (6 percent). EndoBarrier demonstrated an acceptable safety profile, with all study subjects completing treatment to the intended twelve-month implant duration. No devices were removed due to adverse events; there were no serious device-related adverse effects. Some patients reported abdominal discomfort, mild pain, nausea and gastrointestinal issues. This new data confirms and adds to the preliminary analysis of study subjects at six and twelve months that was previously presented at the European Society for Pediatric Endocrinology (ESPE) conference in Paris. Obesity and its complications have a significant effect on morbidity and mortality for adolescents. Standard treatment-based diets and cognitive therapy have limited effects. Surgical bariatric procedures are nonreversible and permanently alter certain metabolic functions. The long-term consequences of those alterations in the corporal development of adolescents are not well known but are a source of great concern. “Obesity in adolescents has risen to epidemic levels globally with serious individual and public health consequences, and long-term implications that we only have just begun to understand,” said Scott Schorer, GI Dynamics president and CEO. “This study, in conjunction with many additional investigator-initiated studies around the world, is completing a picture of clinical evidence that further reinforces the broader safety and efficacy profile of EndoBarrier.” GI Dynamics, Inc. (ASX:GID), is the developer of EndoBarrier, the first endoscopically-delivered device therapy approved for the treatment of type 2 diabetes and obesity. EndoBarrier is approved and commercially available in multiple countries outside the United States. EndoBarrier is not approved for sale in the United States and is limited by federal law to investigational use only in the United States. Founded in 2003, GI Dynamics is headquartered in Boston, Massachusetts. For more information, please visit This announcement contains forward-looking statements concerning our development and commercialization plans, potential revenues and revenue growth, costs, excess inventory, profitability and financial performance, ability to obtain reimbursement for our products, clinical trials and associated regulatory submissions and approvals, the number and location of commercial centers offering the EndoBarrier, and our intellectual property position. These forward-looking statements are based on GI Dynamics’ management’s current estimates and expectations of future events as of the date of this announcement. Furthermore, the estimates are subject to several risks and uncertainties that could cause actual results to differ materially and adversely from those indicated in or implied by such forward-looking statements. These risks and uncertainties include but are not limited to, risks associated with the consequences of terminating the ENDO trial and the possibility that future clinical trials will not be successful or confirm earlier results. Further risks are associated with obtaining funding from third parties; the timing and costs of clinical trials; the timing of regulatory submissions; and the timing, receipt and maintenance of regulatory approvals. The timing and amount of other expenses and the timing and extent of third-party reimbursement risks associated with commercial product sales, including product performance, competition, risks related to market acceptance of products, intellectual-property risk; risks related to excess inventory; and risks related to assumptions regarding the size of the available market, the benefits of our products, product pricing, timing of product launches, future financial results and other factors, including those described in our filings with the U.S. Securities and Exchange Commission. Given these uncertainties, one should not place undue reliance on these forward-looking statements. We do not assume any obligation to publicly update or revise any forward-looking statements, whether as a result of new information or future events or otherwise, unless we are required to do so by law.

Glawe J.D.,LSU Health Shreveport | Mijalis E.M.,LSU Health Shreveport | Davis W.C.,LSU Health Shreveport | Barlow S.C.,University of South Carolina | And 3 more authors.
Diabetologia | Year: 2013

Aims/hypothesis: We had previously reported that stromal cell-derived factor 1 (SDF-1) mediates chemorepulsion of diabetogenic T cell adhesion to islet microvascular endothelium through unknown mechanisms in NOD mice. Here we report that SDF-1-mediated chemorepulsion occurs through slit homologue (SLIT)2-roundabout, axon guidance receptor, homologue 1 (Drosophila) (ROBO1) interactions. Methods: C-X-C receptor (CXCR)4 and ROBO1 protein expression was measured in mouse and human T cells. Parallel plate flow chamber adhesion and detachment studies were performed to examine the molecular importance of ROBO1 and SLIT2 for SDF-1-mediated T cell chemorepulsion. Diabetogenic splenocyte transfer was performed in NOD/LtSz Rag1 -/- mice to examine the effect of the SDF-1 mimetic CTCE-0214 on adoptive transfer of diabetes. Results: CXCR4 and ROBO1 protein expression was elevated in diabetic NOD/ShiLtJ T cells over time and coincided with the onset of hyperglycaemia. CXCR4 and ROBO1 expression was also increased in human type 1 diabetic T cells, with ROBO1 expression maximal at less than 1 year post diagnosis. Cell detachment studies revealed that immunoneutralisation of ROBO1 prevented SDF-1-mediated chemorepulsion of NOD T cell firm adhesion to TNFα-stimulated islet endothelial cells. SDF-1 increased NOD T cell adhesion to recombinant adhesion molecules, a phenomenon that was reversed by recombinant SLIT2. Finally, we found that an SDF-1 peptide mimetic prevented NOD T cell adhesion in vitro and significantly delayed adoptive transfer of autoimmune diabetes in vivo. Conclusions/interpretation: These data reveal a novel molecular pathway, which regulates diabetogenic T cell recruitment and may be useful in modulating autoimmune diabetes. © 2013 Springer-Verlag Berlin Heidelberg.

News Article | February 15, 2017

One Million Solutions in Health and Choices & Patterns know that Type 1 Diabetes can be difficult to manage. Consequently, sharing this research about "Type 1 Diabetes – What Does it Take to be in Control of Blood Sugar?" via a webinar with Stephen Duck, MD, Director of Pediatric Endocrinology, NorthShore University HealthSystem and Gerene Schmidt, MA, BSPHN, RN, President/Co-Founder, Choices & Patterns, Inc. is important to help those individuals with this condition. Type 1 Diabetes: What Does it Take to be in Control of Blood Sugar? The key to a healthy life with Type 1 Diabetes is to be in control. Control of glucose levels in an individual with Type 1 Diabetes involves at least three distinct areas: 1. Insulin Replacement – This includes choosing the type of injectable insulin and the method of delivering the insulin. 2. Blood Glucose Monitoring – This area covers the method of measuring insulin levels and the intensity of measurements. 3. Pattern Management – The third and most critical part: pattern management. This has often been the domain of the health care team, which knows that current techniques are not ideal. The goal of this webinar is to empower people with diabetes. It is important to understand how to optimize blood glucose control. Dr. Stephen Duck outlines the issues and discusses current techniques that are essential for a patient with Type 1 Diabetes to succeed. Review the webinar here: "Type 1 Diabetes – What Does it Take to be in Control of Blood Sugar?". ABOUT ONE MILLION SOLUTIONS IN HEALTH: As a not-for-profit, the goal of One Million Solutions in Health™ is to shape health care by sharing solutions and, importantly, to accelerate the discovery, development and delivery ... of innovative cures, treatments and preventative measures for patients around the world. By facilitating efforts to ensure organizations can Connect, Learn + Share, Innovate and Collaborate, our vision is to improve health care delivery, accelerate life sciences research and share patient and consumer-focused ideas and solutions. By engaging scientists, entrepreneurs, investors, innovators, industry experts, health care professionals, and patients across various disciplines, and from around the world, we can utilize the power of the internet to disrupt things in a positive and transformative way to accelerate the movement of new solutions and scientific discoveries from the scientist to the patient. The Technology Evaluation Consortium (TEC) brings together life sciences and/or health care companies and technology providers, and other relevant partners (e.g., government and Universities) to evaluate and validate technologies or services in a collaborative environment. The model empowers technology providers and industry end users to collectively assess a number of technologies in a cost-effective manner, producing a depth and breadth of results that no company can achieve alone. We are on our way towards accelerating high-potential innovations, catalyzing investment and increasing awareness of, and support for, important ideas to improve health and save lives. We are thrilled to have you be a part of this transformative journey! IF YOU HAVE A TECHNOLOGY, SCIENTIFIC DISCOVERY OR MEDICAL SOLUTION YOU WOULD LIKE US TO HELP SHARE WITH THE WORLD, CONTACT US.

Bacha F.,Childrens Hospital of Pittsburgh | Bacha F.,Mellitus | Gungor N.,Pediatric Endocrinology | Lee S.,Childrens Hospital of Pittsburgh | And 3 more authors.
Pediatric Diabetes | Year: 2012

Objective: Non-diabetic African American (AA) youth have an upregulated insulin secretion relative to insulin sensitivity (IS) compared with their American White (AW) peers. We investigated if similar racial differences exist in youth with T2DM. Research Design and Methods: Fourteen AAs and 14 AWs T2DM adolescents underwent evaluation of IS and clearance (hyperinsulinemic-euglycemic clamp), first- and second-phase insulin and C-peptide secretion (hyperglycemic clamp); body composition (DEXA); and abdominal adiposity (CT). Results: AA and AW T2DM had similar HbA1c, diabetes duration, BMI, and % body fat, with lower visceral fat in AAs (p = 0.013). While insulin-stimulated glucose disposal was similar in AA and AW (7.5 ± 1.0 vs. 7.3 ± 0.9 mg/kg FFM/min), IS tended to be lower (2.5 ± 0.4 vs. 3.8 ± 0.6 mg/kg FFM/min per μU/mL, p = 0.081). First-phase insulin (175.7 ± 52.9 vs. 66.6 ± 10.8 μU/mL, p = 0.01) and second-phase insulin (236.2 ± 40.7 vs. 105.1 ± 17.9 μU/mL, p = 0.008), and first-phase C-peptide (8.2 ± 1.2 vs. 5.0 ± 0.3 ng/mL, p = 0.02) and second-phase C-peptide (10.8 ± 0.9 vs. 7.6 ± 0.6 ng/mL, p = 0.012) were higher in AA. β-Cell function relative to IS was higher in AA vs. AW (259.5 ± 35.3 vs. 168.8 ± 25.1 mg/kg FFM/min, p = 0.043). Conclusions: Racial differences in insulin secretion can be demonstrated with the clamp technique in obese adolescents with T2DM. Similar to non-diabetic youth, AA adolescents with T2DM compared with their AW counterparts have an upregulated β-cell function relative to IS, the reasons for which remain to be investigated. © 2011 John Wiley & Sons A/S.

Beydoun M.A.,U.S. National Institute on Aging | Atilio Canas J.,Pediatric Endocrinology | Beydoun H.A.,Eastern Virginia Medical School | Chen X.,Johns Hopkins University | And 2 more authors.
Journal of Nutrition | Year: 2012

Specific micronutrients, including retinol, retinyl esters, carotenoids [α-carotene, β-carotene (cis+trans), β-cryptoxanthin, lutein+zeaxanthin, and total lycopene], vitamin E, and vitamin C have antiinflammatory and antioxidant effects, properties shown to reduce oxidative stress, a process that accompanies the pathogenesis of many chronic diseases. It is still largely unknown whether they are associated with the occurrence of metabolic syndrome (MetS) in the adolescent U.S. population. MetS was defined by the International Diabetes Federation (IDF) criteria. Other non-MetS outcomes relying on blood measurements were elevated HOMA-IR, C-reactive protein (CRP), and hyperuricemia. We tested associations between serum antioxidants and MetS outcomes among adolescents aged 12-19 y using cross-sectional data from NHANES 2001-2006 (n = 782-4285). IDF MetS prevalence was estimated at 7% among boys and 3% among girls. In adjusted models, adolescents with MetS had consistently lower carotenoid concentrations compared with their counterparts without MetS. Total carotenoids were also inversely related to HOMA-IR and CRP. Vitamin C was inversely related to uric acid level and MetS binary outcome. Retinol+retinyl esters exhibited an inverse relationship with CRP and a positive relationship with uric acid and HOMA-IR as well as MetS binary outcome. Vitamin E had no association with MetS, particularly after controlling for serum cholesterol and TG. In conclusion, among U.S. adolescents, serum carotenoid concentrations were inversely associated with MetS status, HOMA-IR, and CRP, whereas serum vitamin C was inversely related to MetS status and serum uric acid. Vitamin E had no consistent association with MetS, whereas retinol+retinyl esters had a positive relationship with HOMA-IR, uric acid, and MetS, while being inversely related to CRP. These associations need further study. © 2012 American Society for Nutrition.

Davies J.H.,Pediatric Endocrinology | Reed J.M.,Trauma and Orthopaedics | Blake E.,Biomedical Research Unit | Mrcpch M.P.,Pediatric Endocrinology | And 2 more authors.
Journal of Pediatric Orthopaedics | Year: 2011

BACKGROUND: Vitamin D deficiency may increase predisposition to a number of pediatric orthopaedic conditions and the prevalence of vitamin D deficiency is increasing in children in developed countries. The aim of this study was to determine the epidemiology of vitamin D deficiency and insufficiency in children presenting to a regional pediatric orthopaedic service. We also examined the relationships between vitamin D status, social deprivation, and ethnicity. METHODS: Individuals of age 18 years and younger presenting to the regional pediatric orthopaedic service at Southampton, UK from 2008 to 2010 were investigated. Deprivation index scores were calculated from indices of deprivation. RESULTS: A total of 187 children (97 male, 90 female, mean age 7.1 y) underwent serum 25-hydroxyvitamin D level measurement. Of them 82% were white British and 11% were of Asian ethnicity. The calculation of the total depravation index for the whole cohort showed 34 patients (18%) were in quartile 1 (most deprived), 54 (29%) in quartile 2, 49 (26%) in quartile 3, and 50 (27%) in quartile 4 (least deprived). Sixty patients (32%) had vitamin D insufficiency with 25-(OH) levels <50 nmol/L and 15 patients (8%) had vitamin D deficiency. No relationship was identified between vitamin D level and social deprivation score. CONCLUSIONS: There is a need for awareness of the prevalence of vitamin D deficiency in the pediatric orthopaedic population presenting with bone pain and lower limb deformity before commencing observation or orthopaedic surgical treatment. Copyright © 2011 by Lippincott Williams & Wilkins.

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