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Janet Silverstein

Publications and source records attributed to Janet Silverstein.

16 recordsLinked to original sources
PubMed2005

Short-term effects of growth hormone on sleep abnormalities in Prader-Willi syndrome.

CONTEXT: GH was approved for Prader-Willi Syndrome (PWS) in 2000. Fatalities in individuals with PWS soon after beginning GH treatment prompted concern about GH worsening sleep apnea. OBJECTIVE: We sought to determine whether GH affects sleep apnea in individuals with PWS. DESIGN: Twenty-five patients with PWS had overnight polysomnography (PSA) at baseline and 6 wk after starting GH. SETTING: The study was conducted in a sleep lab using a standardized procedure. PATIENTS: The patients studied had genetically confirmed PWS. MAIN OUTCOME MEASURES: PSA results were analyzed for frequency and severity of central and obstructive apnea/hypopnea events and total apnea/hypopnea index. RESULTS: As a group, GH improved apnea/hypopnea index by a mean of 1.2 events per hour (P = 0.02) and central events by a median of 1.7 events per hour (P < 0.001). Fourteen patients had improvement in obstructive events by a mean of 1.7 events per hour. Six patients had worsening of obstructive events on GH. Four of these patients had upper respiratory tract infections at the time of the second PSA and had tonsil/adenoid hypertrophy on otorhinolaryngological evaluation. Two patients with high serum IGF-I levels had increased obstructive events. CONCLUSIONS: Most of our PWS patients had improvement after short-term GH treatment, but 32% had worsening of sleep disturbance. A subset of PWS patients are at risk during this window of vulnerability shortly after initiation of GH. Because it is difficult to predict who will worsen with GH, patients with PWS should have PSA before and after starting GH and should be monitored for sleep apnea with upper respiratory tract infections. Otorhinolaryngological evaluation is warranted if sleep apnea worsens on GH. IGF-I levels should be monitored, with the goal being physiological levels.

Adolescent↗
PubMed2005

Screening for retinopathy in the pediatric patient with type 1 diabetes mellitus.

Diabetic retinopathy (DR) is the leading cause of blindness in young adults in the United States. Early identification and treatment of DR can decrease the risk of vision loss in affected patients. This clinical report reviews the risk factors for the development of DR and screening guidance for pediatric patients with type 1 diabetes mellitus.

Child↗
PubMed2004

Preservation of C-peptide secretion in subjects at high risk of developing type 1 diabetes mellitus--a new surrogate measure of non-progression?

Individuals at high risk of developing type 1 diabetes mellitus can be identified using immunologic, genetic, and metabolic parameters. In the Diabetes Prevention Trial-1 (DPT-1), annual intravenous infusions of low doses of regular insulin, together with daily subcutaneous injection of a single low dose of Ultralente insulin at nighttime, failed to prevent or delay the onset of type 1 diabetes in high-risk non-diabetic relatives. In our study, we attempted to achieve beta-cell rest by administering higher doses of neutral protamine Hagedorn (NPH) insulin twice daily to high-risk non-diabetic subjects in an effort to prevent or delay the onset of the disease. The maximum tolerable dose was given with the dose reduced for any hypoglycemia (mean dose 0.33 +/- 0.15; range 0.09-0.66 units/kg/d). We treated 26 subjects who were confirmed to have islet cell antibodies (ICAs) and a low first-phase insulin response (FPIR) to intravenous glucose. Fourteen had normal glucose tolerance and 12 impaired glucose tolerance (IGT). The median duration of follow-up was 5.5 yr. Diabetes occurred in 10 of 12 subjects with IGT and five of 14 subjects with normal glucose tolerance. The cumulative incidence of diabetes was the same as with that seen in a matched, observation group (subjects followed prospectively as part of the University of Florida natural history studies) (age, sex, ICA, insulin autoantibodies, duration of ICA prior to enrollment, FPIR, and glucose intolerance; p = 0.39), as was the rate of progression (p = 0.79). There was a higher rate of progression to diabetes in the group with abnormal glucose tolerance at baseline than in those with normal baseline glucose tolerance (p = 0.003). Interestingly, in non-progressors, as opposed to progressors, there was no fall in C-peptide (peak and area under the curve) production regardless of the type of tolerance testing (mixed meal, oral or intravenous) over time (p < 0.001). In this study, in the dose and regimen of NPH insulin used, insulin did not delay or prevent the development of type 1 diabetes. However, preservation of C-peptide production in the prediabetic period appears to indicate non-progression to clinical disease and may serve as a new surrogate for determining response to preventative efforts.

Adolescent↗
PubMed2004

An initial evaluation of the design of pediatric psychology consultation service with children with diabetes.

The objective of this study was to review the process of psychology consultation with an outpatient pediatric diabetes service, and provide data regarding assessment and outcome. The purpose was to demonstrate that the inclusion of psychology in the care of the child would enhance the effectiveness of treatment delivery. Over a one-year period, 91 psychological consultations were reviewed for information related to reasons for referral, diagnosis, and treatment. Processes of assessment and collaboration are described. Nearly half of all the participants that were referred for a consultation met the criteria for a psychiatric disorder, including Attention-Deficit Hyperactivity Disorder, mood disorder or anxiety. Paired t-tests revealed significant improvement in metabolic control from referral to the next clinic appointment. Psychological consultation appears to have a positive impact on selected health outcomes. Given the large number of children with psychiatric disorder, psychological intervention may facilitate adherence and reduce complications associated with poor metabolic control.

Adolescent↗
PubMed2004

Adiponectin and leptin concentrations may aid in discriminating disease forms in children and adolescents with type 1 and type 2 diabetes.

OBJECTIVE: The incidence of pediatric type 2 diabetes has recently seen an alarming increase. To improve our understanding of pediatric type 2 diabetes and identify markers that discriminate these subjects from those with type 1 diabetes, we performed a multivariant analysis associating serum adiponectin and leptin levels with anthropometrical parameters and disease state. RESEARCH DESIGN AND METHODS: Samples from children and adolescents with type 1 diabetes (n = 41) and type 2 diabetes (n = 17) and from nondiabetic individuals of similar age from the general population (n = 43) were investigated. An analysis included the parameters of matching for BMI and Tanner stage. Receiver-operator characteristic (ROC) curves were established to assess these analytes' association with disease. RESULTS: Contrary to studies of adult type 1 diabetes, adiponectin levels in our pediatric type 1 diabetic subjects (10.2 microg/ml [95% CI 8.6-11.7]) did not differ from those of healthy control subjects (10.6 microg/ml [9.2-12.0]; P = NS). Children with type 2 diabetes (5.5 microg/ml [4.8-6.2]) had significantly lower adiponectin levels than both of those groups. Conversely, type 2 diabetic subjects showed marked elevations in serum leptin concentrations (24.3 ng/ml [17.1-31.5]) compared with healthy control subjects (2.7 ng/ml [1.3-4.1]; P < 0.001) and type 1 diabetic subjects (5.1 ng/ml [3.5-6.7]; P < 0.001). Importantly, each of the properties ascribed to pediatric type 2 diabetes was present when the comparison was restricted to healthy children or type 1 diabetic patients whose BMI was >85th percentile or who had Tanner stage 4 and 5. The evaluation of adiponectin-to-leptin ratios revealed a striking difference between children with type 1 diabetes (6.3 [3.8-8.8]) and type 2 diabetes (0.3 [0.2-0.5]; P < 0.001). CONCLUSIONS: In pediatric diabetes, where diagnosis of disease is often difficult, these studies suggest that the adiponectin-to-leptin ratio may provide additional help in the discrimination between type 1 and type 2 diabetes.

Adiponectin↗
PubMed2003

Prevention and treatment of type 2 diabetes mellitus in children, with special emphasis on American Indian and Alaska Native children. American Academy of Pediatrics Committee on Native American Child Health.

The emergence of type 2 diabetes mellitus in the American Indian/Alaska Native pediatric population presents a new challenge for pediatricians and other health care professionals. This chronic disease requires preventive efforts, early diagnosis, and collaborative care of the patient and family within the context of a medical home.

Adolescent↗
PubMed1986

Assessing daily management in childhood diabetes.

One hundred sixty-eight patients with childhood diabetes (6 to 19 years of age) and their parents participated in 24-hr recall interviews concerning daily diabetes management behavior. Each patient and parent was interviewed independently on three separate occasions. The information obtained was used to construct measures of 13 different adherence behaviors. Parent-patient agreement was good to excellent for most of the 13 behaviors. Agreement was influenced by the patient's age, with the most consistently high parent-child agreement found in the 10- to 15-year-old age group. Factor analysis of the 13 adherence behaviors resulted in a five-factor solution accounting for 70.6% of the variance. Adherence in childhood diabetes appears to be a complex construct, consisting of at least five different components unrelated to each other. Teenagers in this sample were less adherent than their younger counterparts on most of the adherence measures studied.

Adolescent↗
PubMedDate not supplied

Blood glucose estimations in adolescents with type 1 diabetes: predictors of accuracy and error.

OBJECTIVE: To examine predictors of blood glucose (BG) estimation accuracy and errors in adolescents with Type 1 diabetes. METHOD: Seventy-eight adolescents (ages 11-19) rated their physical symptoms and estimated their BG prior to conducting daily BG tests. BG estimation data were subject to an error grid analysis. Hierarchical regression was used to identify predictors of BG estimation accuracy and errors. RESULTS: The average participant made accurate BG estimations 37% of the time and clinically relevant BG estimation errors 24% of the time. Girls and older adolescents had higher BG estimation accuracy rates and lower BG estimation error rates than boys and younger adolescents. Higher BG variability was also associated with increased BG estimation errors. CONCLUSIONS: Although boys, younger adolescents, and those with higher BG variability showed higher BG estimation error rates, most participants showed low rates of BG estimation accuracy and high rates of BG estimation error. Health providers may underestimate the frequency of inappropriate self-treatment as a result of patient difficulty in estimating BG accurately.

Adolescent↗
PubMedDate not supplied

Type 2 diabetes mellitus among Florida children and adolescents, 1994 through 1998.

OBJECTIVES: This study was undertaken to examine the trends in the diagnosis of Type 2 diabetes mellitus among children and adolescents with new-onset diabetes seen from 1994 through 1998 at the three university-based diabetes centers in Florida. METHODS: Data were abstracted from medical records and patients were categorized as having Type 1 or Type 2 diabetes. RESULTS: There were 569 patients classified with Type 1 diabetes and 92 with Type 2 diabetes. The proportion of patients diagnosed with Type 2 diabetes increased over the five years from 9.4% in 1994 to 20.0% in 1998 (chi-square test for trend = 8.2; p=0.004). There was not an associated net increase in the total number of new diabetes patients referred over time (chi-square test for trend = 0.6, p=0.4). Those with Type 2 diabetes were more likely to have a body mass index in the 85th-94th percentile [odds ratio (OR) = 8.5; 95% confidence interval (CI) 2.5, 28.8], have a body mass index >or=95th percentile (OR = 6.8; 95% CI 2.6, 17.7), Hispanic ethnicity (OR = 6.2; 95% CI 2.2, 17.9), black race (OR = 2.8; 95% CI 1.3, 6.2), female gender (OR = 2.2; 95% CI 1.2, 4.3), and older age (OR = 1.4 for each one-year increment in age; 95% CI 1.3, 1.6), compared with those having Type 1 diabetes. CONCLUSIONS: From 1994 through 1998, there was a significant overall increase in the percentage of children referred with new-onset diabetes who were considered to have Type 2 diabetes. Factors associated with the diagnosis of Type 2 diabetes relative to Type 1 diabetes include body mass index >/=85th percentile, Hispanic ethnicity, black race, female gender, and older age.

Adolescent↗
PubMedDate not supplied

Clinical predictors of mucormycosis in children with type 1 diabetes mellitus.

BACKGROUND: Mucormycosis is an acute, often rapidly fatal fungal infection that is an important cause of death in young patients with diabetes mellitus (DM) who have poor glycemic control and acute ketosis. Despite the importance of this condition, the clinical predictors of mucor infection are not well defined. METHODS: A retrospective chart review was carried out for five patients, age 14-19 years, diagnosed with mucormycosis at the University of Florida between 1984 and 1999. For the three patients for whom adequate information was available, two randomly selected, age-matched case controls were selected and compared to affected patients for the following variables: average HbA1c concentrations, number of missed clinic appointments, and the number of hospital and Diabetes Project Unit (DPU) admissions. RESULTS: HbA1c levels were similar in affected patients and controls, indicating glycemic control is not the principal factor predisposing to mucor infection. African-American race and poor compliance, as evidenced by poor clinic attendance, risk-taking behaviors and high admission rate to the DPU, were predictors of increased susceptibility to infection with mucormycosis.

Adolescent↗