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      Season, Terrestrial Ultraviolet Radiation, and Markers of Glucose Metabolism in Children Living in Perth, Western Australia

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          Abstract

          Seasonality in glucose metabolism has been observed in adult populations; however, little is known of the associations between season and glucose metabolism in children. In this study, we examined whether markers of glucose metabolism (fasting glucose, insulin and HbA1c) varied by season in a paediatric population (6–13 years of age) located in Perth (Western Australia, n = 262) with data categorised by weight. Linear regression was used to analyse the nature of the relationships between mean daily levels of terrestrial ultraviolet radiation (UVR) (prior to the day of the blood test) and measures of glucose metabolism. Fasting blood glucose was significantly lower in autumn compared to spring, for children in combined, normal and obese weight categories. Fasting insulin was significantly lower in autumn and summer compared to winter for individuals of normal weight. HbA1c was significantly higher in summer (compared with winter and spring) in overweight children, which was in the opposite direction to other published findings in adults. In children with obesity, a strong inverse relationship (r = −0.67, p = 0.002) was observed for fasting glucose, and daily terrestrial UVR levels measured in the previous 6 months. Increased safe sun exposure in winter therefore represents a plausible means of reducing fasting blood sugar in children with obesity. However, further studies, using larger paediatric cohorts are required to confirm these relationships.

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          Type 2 diabetes across generations: from pathophysiology to prevention and management.

          Type 2 diabetes is now a pandemic and shows no signs of abatement. In this Seminar we review the pathophysiology of this disorder, with particular attention to epidemiology, genetics, epigenetics, and molecular cell biology. Evidence is emerging that a substantial part of diabetes susceptibility is acquired early in life, probably owing to fetal or neonatal programming via epigenetic phenomena. Maternal and early childhood health might, therefore, be crucial to the development of effective prevention strategies. Diabetes develops because of inadequate islet β-cell and adipose-tissue responses to chronic fuel excess, which results in so-called nutrient spillover, insulin resistance, and metabolic stress. The latter damages multiple organs. Insulin resistance, while forcing β cells to work harder, might also have an important defensive role against nutrient-related toxic effects in tissues such as the heart. Reversal of overnutrition, healing of the β cells, and lessening of adipose tissue defects should be treatment priorities. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Insulin resistance in children: consensus, perspective, and future directions.

            Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points. The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants. An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children. The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement. Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases.
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              Early onset type 2 diabetes: risk factors, clinical impact and management.

              Early onset type 2 diabetes mellitus (T2DM) is increasingly prevalent with a significant impact on the individual, healthcare service delivery and planning. The individuals are likely to be obese, lead a sedentary lifestyle, have a strong family history of T2DM, be of black and minority ethnic (BME) origin and come from a less affluent socioeconomic group. They have a heightened risk of developing microvascular and macrovascular complications, often at an earlier stage and with greater frequency than seen in type 1 diabetes. As such, early and aggressive risk factor management is warranted. Early onset T2DM is complex and impacts on service delivery with a need for multidisciplinary care of complications and comorbidities', in addition to adequate educational and psychological support. This review on the impact of early onset T2DM provides the latest insights into this emerging epidemic.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                03 October 2019
                October 2019
                : 16
                : 19
                : 3734
                Affiliations
                [1 ]Telethon Kids Institute, University of Western Australia, Perth 6872, Australia; cathy.clarke@ 123456hotmail.com (C.L.C.); aris.siafarikasl@ 123456health.wa.gov.au (A.S.)
                [2 ]Department of Paediatric Endocrinology and Diabetes, Perth Children’s Hospital, Nedlands 6009, Australia; lana.bell@ 123456health.wa.gov.au
                [3 ]Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Yallambie 3085, Victoria, Australia; peter.gies@ 123456arpansa.gov.au (P.G.); stuart.henderson@ 123456arpansa.gov.au (S.H.)
                [4 ]Medical School, Division of Paediatrics, University of Western Australia, Crawley 6009, Australia
                [5 ]Institute for Health Research, University of Notre Dame, Fremantle 6160, Australia
                Author notes
                [* ]Correspondence: shelley.gorman@ 123456telethonkids.org.au ; Tel.: +61-8-6319-1747; Fax: +61-8-9489-7700
                Author information
                https://orcid.org/0000-0002-7111-6735
                Article
                ijerph-16-03734
                10.3390/ijerph16193734
                6801873
                31623384
                f77caf26-4f69-430a-a33b-a10b30c9b38f
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 30 August 2019
                : 24 September 2019
                Categories
                Article

                Public health
                season,sunlight,terrestrial ultraviolet radiation,paediatric,blood glucose,insulin,hba1c
                Public health
                season, sunlight, terrestrial ultraviolet radiation, paediatric, blood glucose, insulin, hba1c

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