Pediatric Diabetes[JOURNAL]
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200 papers
Awareness Campaigns to Prevent Diabetic Ketoacidosis at Diabetes Onset Are Successful When Constantly Maintained: From Local to Federal State Results.
Holder M, Weiler J, Holl RW … +1 more , Ehehalt S
Pediatr Diabetes · 2025 · PMID 40873755 · Full text
To expand the effective local Stuttgart childhood diabetic ketoacidosis (DKA) prevention campaign to the federal state of Baden-Württemberg (BW) in Germany. All public health departments (PHDs) in BW were invited to par...
To expand the effective local Stuttgart childhood diabetic ketoacidosis (DKA) prevention campaign to the federal state of Baden-Württemberg (BW) in Germany. All public health departments (PHDs) in BW were invited to participate. The DKA-incidence at diabetes onset was compared between participating and nonparticipating districts, prior (2015-2020) and during the campaign (2021-2023). A total of 3038 children and adolescents were newly diagnosed with type 1 diabetes in BW during the observation period. DKA was present in 990 children (32.6%), severe DKA in 346 (11.4%). In total 14 of 38 PHD (37%) participated. DKA rates increased both in participating (29.9%-36.3%) and in nonparticipating districts (27.0%-41.0%; < 0.0001 for time-trend). However, there was a significant interaction between time-interval and the groups of districts ( < 0.03) reflecting a significant treatment effect in the intervention group. The expansion of our local awareness campaign was possible and successful.
Diabetes, Celiac, and Thyroid-Related Autoantibodies in HLA Genotyped Ethiopian Children and Adolescents With Type 1 Diabetes: A Cross-Sectional Study.
Gudeta AN, Lind A, Girma A … +3 more , Lempainen J, Ilonen J, Agardh D
Pediatr Diabetes · 2025 · PMID 40860014 · Full text
Autoantibodies against β-cell components in the pancreatic islets of Langerhans are characteristic of type 1 diabetes (T1D). The genetic and autoimmune determinants of type 1 diabetes (T1D) in Ethiopians are not yet thor...
Autoantibodies against β-cell components in the pancreatic islets of Langerhans are characteristic of type 1 diabetes (T1D). The genetic and autoimmune determinants of type 1 diabetes (T1D) in Ethiopians are not yet thoroughly characterized, with studies indicating a lower occurrence of autoantibodies related to T1D compared to Caucasians. The study aimed to determine the occurrence of autoantibodies related to type 1 diabetes (T1D), celiac disease (CD), and autoimmune thyroid disease (AITD) in conjunction with Human Leukocyte Antigen (HLA) genotype in Ethiopian children and adolescents with T1D. This cross-sectional study included 206 children and adolescents with T1D (ranging from 1 to 18 years old) with a median disease duration of 6 years, alongside 200 age-matched control children (ranging from 1 to 6 years old). Participants were recruited from Adama, Asella, and Bishoftu Hospitals in Ethiopia. The study involved genotyping of HLA alleles, specifically HLA-DQA1, DQB1, and DRB1 04 (including DR4 subtypes). Additionally, autoantibodies targeting glutamic acid decarboxylase (GADA), insulinoma-associated protein (IA-2A), zinc transporter 8 (ZnT8A), tissue transglutaminase (tTGA), and thyroid peroxidase (TPOA) were analyzed using antibody detection by agglutination PCR (ADAP) assays. The most common haplotype found in participants with T1D was HLA-(DR3)-DQA1 05-DQB1 02 haplotype (36.4%) (OR = 5.0; < 0.000001). In addition, HLA-DRB1 0405-DQA1 03-DQB1 02 (19.3%, OR = 10.8; < 0.000001), HLA-DRB1 0405-DQA1 03-DQB1 0302 (9.2%, OR = 3.1; =0.001), and HLA-DRB1 0401-DQA1 03-DQB1 0302 (3.2%, OR = 20.0; =0.002) were significantly increased among T1D patients. Conversely, HLA-(DR15)-DQB1 0602, HLA-(DR13)-DQB1 0603, HLA-(DR1/10)-DQB1 0501, HLA-(DR13)-DQB1 0604, HLA-DRB1 0404-DQA1 03-DQB1 04, HLA-(DR7)-DQA1 0201-DQB1 02, HLA-(DR11/12/13)-DQA1 05-DQB1 0301, and HLA-DRB1 0403-DQA1 03-DQB1 0302 were noted as the most protective haplotypes with a significant value and, with ORs ranging from 0.05 to 0.5. The overall frequency of any islet autoantibodies in children and adolescents with T1D was 81.1% compared to 5.5% in the control group ( < 0.0001). While comparing antibody positivity between individuals with T1D and controls, GADA was found in 69% versus 2%, IA-2A in 24% versus 1.5%, ZnT8A in 32% versus 2%, tTGA in 14% versus 2%, and TPOA in 17% versus 5%, respectively ( < 0.0001). Individuals carrying DR4-DQ8 or DR3-DQ2 haplotypes exhibited a higher prevalence of IA-2A and tTGA ( ≤ 0.05). The HLA risk profile typical of sub-Saharan African population was observed in Ethiopians with T1D. Furthermore, they have a notably high prevalence of autoantibodies associated with T1D, CD, and AITD, which differs from earlier reports from the region but aligns with patterns observed in Caucasians.
Prevalence and Risk Factors for Bladder and Bowel Dysfunction in Children With Type 1 Diabetes.
Favel K, Kelly MS, Lam STT … +6 more , Bone JN, Morgan KE, Stephany HA, Thomas S, Afshar K, Panagiotopoulos C
Pediatr Diabetes · 2025 · PMID 40860013 · Full text
Urologic complications, including urinary incontinence and urinary tract infections are commonly observed in the adult population with type 1 diabetes (T1D); however, there remains a paucity of data on the prevalence, as...
Urologic complications, including urinary incontinence and urinary tract infections are commonly observed in the adult population with type 1 diabetes (T1D); however, there remains a paucity of data on the prevalence, associated risk factors and impact of bowel and bladder dysfunction (BBD) in the pediatric T1D population. This study aims to examine the prevalence of BBD in children with T1D compared to healthy pediatric controls and to explore clinical factors associated with childhood BBD. This cross-sectional, noninterventional, multicenter survey study involved children with TID and healthy controls aged 5-16 years across North America. Participants and their caregivers completed the Vancouver Symptom Score (VSS) to assess bowel and bladder symptoms. BBD was defined as a total VSS score of 11 or greater. Logistic regression was used to identify potential factors associated with BBD and bother with symptoms. In a group of 242 participants with T1D and 86 controls, 46% were male, and the median age was 11.0 years. The prevalence of BBD was found to be higher in participants with T1D at 21.5%, compared to 10.5% in controls. While irritative symptoms were most commonly reported in the T1D group with BBD, urinary incontinence caused the most bother. In the T1D group, poorer glycemic control was linked to a greater likelihood of BBD, while male sex and more severe symptomatology (such as urinary incontinence) were associated with greater bother related to these symptoms. There is a high prevalence of BBD in children with T1D compared to healthy controls. These data highlight the need for early identification and intervention for BBD in T1D. Proactive measures, such as routine screening and comprehensive T1D management with strict attention to glycemic control, are crucial to address the significant burden of BBD and improve overall health outcomes for children with T1D and their families.
Physiologically-Based Pharmacokinetics and Empirical Pharmacodynamic Modeling for Pediatric Henagliflozin Dosing: Clinical Insights for Chinese Patients.
Zhang X, Xue H, Xu J … +8 more , Ren K, Qian F, Zhang Y, Dou J, Shen K, Zhu X, Xiang X, He Q
Pediatr Diabetes · 2025 · PMID 40822299 · Full text
This study aimed to present a quantitative modeling and simulation approach for oral henagliflozin, a selective sodium-glucose cotransporter 2 (SGLT2) inhibitor primarily metabolized by uridine diphosphate-glucuronosyltr...
This study aimed to present a quantitative modeling and simulation approach for oral henagliflozin, a selective sodium-glucose cotransporter 2 (SGLT2) inhibitor primarily metabolized by uridine diphosphate-glucuronosyltransferase (UGT) enzymes. A physiologically-based pharmacokinetic (PBPK) model for henagliflozin was developed using in vitro metabolism and clinical pharmacokinetic (PK) data, with validation across multiple contexts, including healthy adults, and hepatic impairment populations. Additionally, empirical pharmacodynamic (PD) modeling was employed to optimize pediatric dosing based on exposure-response relationships for urinary glucose excretion (UGE). Predicting henagliflozin exposure in pediatric patients poses challenges due to UGT enzyme ontogeny and the scarcity of clinical PK data in younger age groups. Using twofold acceptance criteria, model-predicted and observed drug exposures and PK parameters (area under the curve and peak concentration) were compared in diverse scenarios, including monotherapy in healthy adults (single/multiple doses), hepatic impairment, and extrapolation to pediatric age groups. The PBPK model accurately captured observed exposures within a twofold range in both adults and adolescents, supporting the model's predictive utility. The verified PBPK and empirical PD models informed dosing recommendations in pediatric populations aged 1 month to 18 years, achieving henagliflozin exposures comparable to those in adult patients receiving a 5-10 mg dose. This study shows that PBPK and PD modeling effectively guide pediatric dosing of henagliflozin, reducing trial reliance and supporting real-world validation.
Celiac Disease in Children With Type 1 Diabetes: The Usefulness of Screening- 25 years of Experience in a Single Center.
Schweizer R, Bung JI, Majer D … +4 more , Liebrich F, Herrlich S, Neu A, Ziegler J
Pediatr Diabetes · 2025 · PMID 40786596 · Full text
Children with type 1 diabetes (T1D) have an increased risk of developing additional autoimmune diseases. The risk of developing celiac disease (CD) is 3-4 times higher in children with T1D. Guidelines recommend regular s...
Children with type 1 diabetes (T1D) have an increased risk of developing additional autoimmune diseases. The risk of developing celiac disease (CD) is 3-4 times higher in children with T1D. Guidelines recommend regular screening for transglutaminase antibodies (TgAbs) in T1D children. CD could be an additional burden for T1D children as both diseases affect food intake. We describe the screening practice for CD during the last 25 years in our outpatient clinic in children with T1D. We retrospectively analyzed the development of CD-specific antibodies in our children with T1D (diabetes onset since 1998). We did not routinely recommend endoscopy when CD-specific antibodies (TgAb, endomysium [EAb], and gliadin) were positive and patients had no CD-specific symptoms. We analyzed 304 patients. In total 122 had CD-specific antibodies. In 98 of them, they disappeared after a short time or had been only slightly elevated. The diagnosis of CD was confirmed in 12. All 12 showed CD-specific symptoms, such as failure to thrive, anemia, hypoglycemia, or gastrointestinal problems. In six patients, even severely elevated EAb and/or TgAb disappeared on average after 7.1 years (range 4.9-13.5 years) on gluten-containing diet. The remaining six had antibodies without CD-specific symptoms by the end of the observation period. In this group the duration of antibody-positivity was 4 years (range 1.8-11.6 years). We conclude that even highly elevated CD-specific antibodies can disappear in children with T1D and that screening for CD-specific antibodies is therefore only useful in symptomatic children with T1D.
Topology of Variants Linked With Islet Function and Higher Risk of Urological Symptoms in -Associated Disease.
Zhang JJ, Dai TT, Wang JQ … +10 more , Yin MY, Yang YY, Jiang L, Xia BJ, Cui ZZ, Lu WL, Hu RG, Li CY, Dong ZY, Xiao Y
Pediatr Diabetes · 2025 · PMID 40777921 · Full text
Wolfram syndrome type 1 gene (), which encodes a transmembrane (TM) structural protein (wolframin), is essential for several biological processes. Mutations of , autosomal dominant or recessive inherited, are related to...
Wolfram syndrome type 1 gene (), which encodes a transmembrane (TM) structural protein (wolframin), is essential for several biological processes. Mutations of , autosomal dominant or recessive inherited, are related to a broad clinical spectrum. Molecular genetic tests were performed, and clinical phenotypes of three WFS1-associated cases were evaluated. The expression of , viability, and endoplasmic reticulum (ER) stress of the MIN6 cell and structural analysis of the variant WFS1 protein were revealed. Furthermore, a total of 75 pathogenic variants from ClinVar were included to analyze variant-phenotype association. Genetic testing revealed 3 mutations with unclear pathogenicity in of the 3 patients with early-onset diabetes, including c.613G >A (p.G205S), c.2053C >T (p.R685C), and c.169G >A (p.A57T). Decreased expression, reduced β-cell viability and enhanced ER stress were found in all variants. Protein stability and structural analysis showed increased protein stability and molecule flexibility of variants p.R685C in the ER-lumenal domain and p.A57T in the ATP6VIA-interaction region, while destabilized protein and rigidificated structure by p.G205S variant in the EF-hand domain at the cytoplasm region. Remarkably, topology was found an independent risk factor with urological symptoms (USs) (=0.007, odds ratio [OR] 4.768 [95% confidence interval (CI): 1.531-14.854]). Surprisingly, variants in the cytoplasm had the highest risk with US than ones in the ER-lumenal domain (=0.008, OR 22.013 [95% CI: 2.270-213.428]). The functional analysis of the three variants of uncertain significance in indicated a quantitative and qualitative damage to wolframin with proven pathogenicity. The topology of the WFS1 protein may play an important role in the pathogenesis of β-cell and urological defects in -associated disease.
Changes in the Prevalence of Diabetes Ketoacidosis at the Onset of Type 1 Diabetes in Polish Children: A Comparative Analysis Between Two 9-Year Periods-2006-2014 and 2015-2023.
Niechciał E, Bielecki M, Geppert A … +7 more , Kokociński S, Kopa K, Wiącek P, Witkowska O, Dwulit L, Mejer O, Kędzia A
Pediatr Diabetes · 2025 · PMID 40741228 · Full text
Having been facing a progressive increase in the prevalence of type 1 diabetes (T1D), there might be a growing risk of the development of diabetic ketoacidosis (DKA) at disease onset. The prevalence of DKA varies widely...
Having been facing a progressive increase in the prevalence of type 1 diabetes (T1D), there might be a growing risk of the development of diabetic ketoacidosis (DKA) at disease onset. The prevalence of DKA varies widely by geographic region, ranging from approximately 13% in Sweden to 80% in the United Arab Emirates. This study aimed to compare the prevalence of DKA in childhood-onset T1D from Greater Poland (Poland) in two 9-year periods. We assessed the prevalence of DKA in children aged <18 years with newly diagnosed T1D in Greater Poland (Poland) in two 9-year periods, 2006-2014 and 2015-2023, in a retrospective review of a complete regional cohort. DKA and its severity were classified according to International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Over the 18 years, 2432 children below 18 years of age with newly diagnosed T1D were recorded. The overall prevalence of DKA was 51.3% ( = 1248), and it rose significantly in two nine-year periods, from 47.7% in 2006-2014 to 53.4% in 2015-2023 (=0.007). There was a significant shift toward more severe presentations of DKA. While the prevalence of mild DKA decreased slightly from 51.3% to 47.0% (=0.145), and moderate DKA had a notable decline from 33.1% to 25.2% (=0.003), the proportion of severe DKA cases rose sharply from 15.5% to 27.7% ( < 0.001). Despite the increasing incidence of T1D in Poland, healthcare, and parental awareness of T1D symptoms remain low, which results in delayed T1D recognition. The escalating prevalence of DKA at T1D onset in children is a concerning public health issue that necessitates a multifaceted approach to education, prevention, and early intervention. Addressing these challenges might help reduce the prevalence of DKA and improve clinical outcomes for children with T1D.
Eighteen-Year Incidence, Health Outcomes and Costs Associated With Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children in NSW, Australia.
Bell KJ, Lain SJ, Stevens L … +3 more , Craig ME, Donaghue KC, Nassar N
Pediatr Diabetes · 2025 · PMID 40726969 · Full text
Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). We determined the incidence, trends, cost and characteristics of children with and without DKA at T1D diagnosis and association wit...
Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). We determined the incidence, trends, cost and characteristics of children with and without DKA at T1D diagnosis and association with DKA readmissions. Children aged <16 years with T1D and residing in New South Wales, Australia, were identified from population-based hospital records (Admitted Patient Data Collection; APDC) for 2002-2019. Diagnoses of T1D and DKA were identified using ICD10 codes. Costs were determined using the 'Australian Refined-Diagnosis Related Group' (AR-DRG) code multiplied by the cost weight and National Efficient Price for the admission year. Associations were assessed using Chi-squared analyses and multivariate regression. A total of 5832 children with T1D were identified, and 36% had DKA at diagnosis. The proportion with DKA at diagnosis was 34.4% in 2002-2003 and 41.0% in 2018-2019, with limited evidence to support a meaningful change over time (Cochrane-Armitage test-for-trend, =0.062). DKA at diagnosis was associated with age <2 years, lower socio-economic status (SES) and rural/regional areas. DKA at diagnosis was also associated with an increased risk of readmission(s) for DKA (odds ratio [OR]: 1.35 [95% confidence interval [CI] 1.23, 1.49]). DKA doubled the costs/person, considering all available follow-up ($20,571 [interquartile range: $10,825, $37,845] vs. $9743 [$4980, $18,287]). DKA at diagnosis of T1D is a common and expensive health issue in Australia, with the rate of DKA at diagnosis not improving over the last two decades. Effective strategies are needed to improve health outcomes and reduce the economic burden.
Effect of Gluten-Free Diet on Metabolic Control and Growth Parameters Among Children and Adolescents With Type 1 Diabetes During the First Year After Diagnosis of Celiac Disease: A Retrospective Case-Control Study.
Hegab AM, Abou-Taleb A
Pediatr Diabetes · 2025 · PMID 40655315 · Full text
Assessment of celiac disease and gluten-free diet (GFD) associations with metabolic control and growth parameters in children and adolescents with type 1 diabetes mellitus (T1DM) during the first year after diagnosis of...
Assessment of celiac disease and gluten-free diet (GFD) associations with metabolic control and growth parameters in children and adolescents with type 1 diabetes mellitus (T1DM) during the first year after diagnosis of celiac disease. This was a retrospective case-control study that included 47 children and adolescents with T1DM aged <18 years who attended the pediatric diabetes clinic at Sohag University Hospital, Egypt, and had a biopsy-proven diagnosis of celiac disease between January 2017 and December 2021. Each case had two age-, sex-, and duration of diabetes-matched control participants with T1DM who had persistently negative celiac screening tests. Clinical characteristics, growth parameters, insulin doses, celiac autoantibody titers, and HbA1c levels throughout the first year after diagnosis of celiac disease were obtained from the medical records. Children and adolescents with celiac disease had significantly lower insulin doses at diagnosis (=0.002) compared to their matched controls. There were no significant differences between both groups regarding the HbA1c levels at diagnosis of celiac disease or after 1 year (=0.27 and 0.81, respectively). Patients with celiac disease had significantly lower weight, height, and body mass index (BMI) standard deviation scores (SDSs) at diagnosis and after 1 year. There were no significant differences between both groups regarding the fasting lipid profiles at diagnosis or after 1 year. Patients with villous atrophy at diagnosis had significantly higher HbA1c levels after 1 year (=0.04). There were no significant improvements in weight, height, and BMI SDS after 1 year even in patients with normalized celiac autoantibodies. Children and adolescents with T1DM had lower insulin requirements and growth parameters at diagnosis of celiac disease. Villous atrophy at diagnostic small bowel biopsies was associated with worsening glycemic control after 1 year. Longer follow-up periods are required to detect significant improvements in growth parameters.
Hypertriglyceridemia in New-Onset Type 1 Pediatric Diabetes.
Macke CA, Al-Gadi I, Bansal N … +2 more , Lyons SK, Nella AA
Pediatr Diabetes · 2025 · PMID 40612706 · Full text
Hypertriglyceridemia (HTG) in the setting of newly diagnosed diabetes is common in both adult and pediatric populations, as insulin deficiency promotes lipolysis and impairs triglyceride (TG) clearance. Severe HTG (defin...
Hypertriglyceridemia (HTG) in the setting of newly diagnosed diabetes is common in both adult and pediatric populations, as insulin deficiency promotes lipolysis and impairs triglyceride (TG) clearance. Severe HTG (defined as TG levels above 1000 mg/dL) in pediatric patients with new-onset type 1 diabetes mellitus (T1D) is rare; the true incidence and sequela of this phenomenon have not been well characterized. We present a single-center experience on severe HTG in pediatric patients with new-onset T1D between 2013 and 2022 and summarize the cases previously reported in the literature. Our cases display variability in their presentation and in their association with high-risk complications, such as acute pancreatitis. We discuss suggestions of early screening for HTG and pancreatitis in patients with protracted abdominal pain, and close monitoring of those identified to have significant HTG.
The Need for Peer Support and Codesigned Services: A Qualitative Study to Understand Diabetes Education Program Needs of Adolescents With Type 1 Diabetes.
Ng AH, Peng W, Murfet G … +3 more , Payk M, Barlow S, Lin S
Pediatr Diabetes · 2025 · PMID 40599715 · Full text
Developmental challenges of adolescence, such as puberty and social pressures, exacerbate the complexity of managing type 1 diabetes (T1D) as they transition from pediatric to adult care. However, there is a paucity of c...
Developmental challenges of adolescence, such as puberty and social pressures, exacerbate the complexity of managing type 1 diabetes (T1D) as they transition from pediatric to adult care. However, there is a paucity of codesigned, evidence-based diabetes education and support programs and services to guide adolescents through this transition. This study aimed to explore the experiences, perspectives, facilitators, and barriers faced by adolescents with T1D in diabetes education and program services and to identify feasible approaches to support them as they transition from pediatric to adult care. Semistructured interviews were conducted with 13 adolescents aged 13-19 years with T1D. Thematic analysis was used to understand participants' past experiences, facilitators, barriers, and preferences regarding diabetes education programs and services. Participants highly valued the opportunity to meet with peers living with T1D and the emotional support from those interactions. Participants also highlighted the need for age-appropriate content and interactive learning experiences. Suggested gamification features were well-received, with participants emphasizing the importance of interactivity. While there was not a strong preference between virtual or in-person game formats, it was suggested that online options offered flexibility and inclusiveness regardless of physical abilities. Participants were not as enthusiastic for a one-on-one live chat compared to an online community chat, again, for the opportunity for peer support. The study highlights the value that adolescents with T1D place on peer support that arises from opportunities to meet others through in-person events. It was evident that codesigning diabetes education programs and services with adolescents with T1D is key to develop tailored offerings for this population.
Prevalence and Presentation of Lower Limb Neurovascular Complications in Children With Diabetes: A Systematic Review With Proportion Meta-Analysis.
Irwandy ISF, Hawke F, Coda A … +3 more , McGee RG, Birt S, Fellas A
Pediatr Diabetes · 2025 · PMID 40589586 · Full text
Disorders of the lower limb are common in people with diabetes and may result in significant long-term complications. Currently, most evidence for lower limb complications in children with diabetes relies on infrequent c...
Disorders of the lower limb are common in people with diabetes and may result in significant long-term complications. Currently, most evidence for lower limb complications in children with diabetes relies on infrequent clinical observations and occasionally invasive assessments that can cause discomfort. Clinical guidelines do not provide explicit guidance on frequency of neurovascular assessments for children with diabetes. To systematically review the prevalence and presentation of clinical neuropathy and vasculopathy in children with diabetes. A systematic search of the literature was conducted in March 2024 using the EMBASE, Cochrane, PubMed (including MEDLINE) and CINAHL databases. At least two authors independently screened studies for inclusion and assessed methodological quality for each paper using the downs and black quality appraisal checklist. Extracted data was summarised and tabulated. Meta-analysis was also performed. Eighteen studies with 3533 participants were included. Participants were aged 3.5-18 years, and 95% had type 1 diabetes, while 5% had type 2 diabetes. These studies used a range of assessments, including monofilament, vibrioception, sharp-blunt discrimination, temperature perception, reflexes, muscle strength and tone, joint perception, pedal pulses, and ankle brachial index (ABI). Prevalence of clinical neuropathy ranged from 0% to 57.1% with a prospective cohort study reporting a 2.6-fold increase in 5 years, while prevalence of vascular complications ranged from 0% to 37.8%. The meta-analysis reported 0%-7% of children could report abnormality on assessments for neuropathy. The broad range may be due to heterogeneous methodological designs and diagnostic assessments, and potentially inadequate reporting. There is emerging evidence that children with diabetes may develop complications before age 18, which provides impetus for clinical caution. Higher quality evidence, particularly from longitudinal studies, is required to guide clinical screening for lower limb vascular and neurological complications in this vulnerable and growing paediatric population.
Parents of Children With Type 1 Diabetes Experienced More Parent-Specific Distress Than Parents of Adolescents in China.
Zhao H, Chen Y, Gao Y … +4 more , Zhong J, Luo J, Xie Y, Guo J
Pediatr Diabetes · 2025 · PMID 40585060 · Full text
Distress is one of the most common negative emotions in parents of children and adolescents diagnosed with type 1 diabetes (T1D). Because of the differences in the developmental stages between children and adolescents wi...
Distress is one of the most common negative emotions in parents of children and adolescents diagnosed with type 1 diabetes (T1D). Because of the differences in the developmental stages between children and adolescents with T1D and their subsequent diabetes management needs, their parents may experience different levels of distress. This study aimed to compare diabetes-specific distress between parents of children with T1D and parents of adolescents with T1D in China and explore the associated factors. A cross-sectional design was used. Parents of children (aged 8-12 years) and adolescents (aged 13-18 years) diagnosed with T1D for >6 months were recruited online via social media. Using established online questionnaires, data were collected on sociodemographic and T1D-related characteristics, diabetes-specific distress, anxiety symptoms, perceived stress, depressive symptoms, and parent-child conflict. Hierarchical linear regression was conducted to explore the potential factors associated with parental diabetes-specific distress. The final sample included 365 parents of children with T1D and 268 parents of adolescents with T1D. Notably, the parents of children with T1D exhibited a higher level of diabetes-specific distress compared to the parents of adolescents with T1D ( < 0.001). Among the parents of children with T1D, higher parental diabetes-specific distress was associated with fathers with 9 years or less of education, higher annual family income (≥US$2857), higher levels of parental anxiety symptoms and perceived stress, and children's episodes of frequent hypoglycemia in the past 6 months ( = 8.497, < 0.001, = 0.433, adjusted = 0.382). Among the parents of adolescents with T1D, higher parental diabetes-specific distress was associated with fathers with 9 years or less of education and higher levels of parental anxiety symptoms and perceived stress ( = 4.955, < 0.001, = 0.385, adjusted = 0.308). The parents of children with T1D experienced higher levels of diabetes-specific distress than the parents of adolescents with T1D in China. Fathers with 9 years or less of education and parents with more anxiety and perceived stress were particularly affected in both groups; thus, interventions are warranted.
The Relationship Between Social Media Use Purposes, Healthy Lifestyle Behaviors, and Metabolic Parameters in Adolescents With Type 1 Diabetes.
Avan H, Barna N
Pediatr Diabetes · 2025 · PMID 40556970 · Full text
This study aims to determine the relationship between social media use, healthy lifestyle behaviors, and metabolic parameters in adolescents with Type 1 diabetes (T1D). The study was conducted with descriptive and cross...
This study aims to determine the relationship between social media use, healthy lifestyle behaviors, and metabolic parameters in adolescents with Type 1 diabetes (T1D). The study was conducted with descriptive and cross-sectional design, andwas carried out on 108 adolescents, aged 11-18, who were diagnosed with T1D mellitus (T1DM) via Google Form. An adolescent descriptive information form, the Scale of Social Media Use Purposes (SSMUP), the Social Media Addiction Scale (SMAS), and the Adolescent Lifestyle Profile (ALP) were used in the study. The data were analyzed using descriptive statistics such as number, percentage, mean and standard deviation (SD), and statistical methods such as -tests and Pearson correlation analysis. The results of the study indicated that social media addiction is significantly related to adolescents' interpersonal relationships and metabolic parameters, while the purposes of social media use are positively associated with physical activity, healthy eating, and interpersonal relationships. Nurses should closely maintain vigilant oversight of social media use and interpersonal communication among adolescents with chronic diseases, create social media content appropriate for diabetes management, and organize trainings on the effects of social media use.
Burden of Treatment in Children and Adolescents With Type 1 Diabetes Evaluated by Focus Groups.
Le Fur S, Gueorguieva I, Perge K … +12 more , Guémazi F, Frament N, Bouhours-Nouet N, Razafimahefa B, Trioche-Eberschweiler P, Nicolescu R, Pigeon-Kherchiche P, Dalla Vale F, Rodet C, Bonin A, Bourvis N, Bougnères P
Pediatr Diabetes · 2025 · PMID 40539033 · Full text
Taking into account the burden of treatment (BOT) should favor psychological fulfillment and adherence of young patients to treatment, which largely determines the quality of type 1 diabetes (T1D) control. To identify BO...
Taking into account the burden of treatment (BOT) should favor psychological fulfillment and adherence of young patients to treatment, which largely determines the quality of type 1 diabetes (T1D) control. To identify BOT components, the Ariane study carried out a focus group survey among 84 children and adolescents with T1D aged 12.6 ± 3.7 years. Focus groups were organized in 10 pediatric diabetes centers, a qualitative research method that brings together a small group of patients to express their perception of treatment and answer questions in a moderated nonmedical setting. A total of 3640 verbatim voicing children's concerns were recorded, transcribed, and analyzed by five working groups composed of pediatric diabetologists, specialized nurses, adults with childhood-onset T1D, and two groups from the civil society. Each group studied the verbatim separately to extract 24 main concerns summarizing BOT. These concerns fell into two distinct categories: concerns about physical, material, and care organization ( = 15) or psychological concerns ( = 9). A BOT score summed the number of concerns of each patient. The mean BOT score was 7.4 ± 3.3 (range 1-18). Gender had a prominent influence on concerns (=0.002). The identification of common concerns expressed through focus groups provides a new tool for estimation of BOT in childhood T1D.
Evaluation of Taste Perception and Olfactory Function in Adolescents in Relation to the Duration of Type 1 Diabetes.
Sobek G, Jagielski P, Dąbrowski M … +1 more , Mazur A
Pediatr Diabetes · 2025 · PMID 40503246 · Full text
Olfactory dysfunction may be one of the clinical symptoms of neuropathy in diabetics. It is also known that taste and smell disorders in diabetes may impact dietary adherence and, consequently, good glycemic control. The...
Olfactory dysfunction may be one of the clinical symptoms of neuropathy in diabetics. It is also known that taste and smell disorders in diabetes may impact dietary adherence and, consequently, good glycemic control. The study aimed to investigate taste perception and olfactory function in adolescents with type 1 diabetes (T1D) compared to the control group. The study was conducted on patients aged 11-15 from south-eastern Poland with T1D in the diabetes clinic of the 2nd Department of Pediatrics, Endocrinology, and Diabetology of the Provincial Clinical Hospital No. 2 in Rzeszów. Taste strips (sweet, salty, sour, and bitter), -Sniff sticks (12 selected smells), and a filter paper strip impregnated with n-propylthiouracil (PROP) were used. No significant differences were observed between both the groups in the taste tests, except for the sweet taste test. The sweet taste test scores were higher for diabetes, for whom the median score was 4 (3.0-4.0), than for the control group, for whom the median score was 3.0 (3.0-4.0), (=0.0001). These results mean that diabetics were more sensitive to sweet taste. We also found no significant differences between T1D and the control group of the -Sniff test. However, significantly lower -Sniff test scores were seen in adolescents with diabetes of more than 10 years. Median -Sniff test scores for people with diabetes for 10 years were 11 (10.0-12.0) while in the control group median was 10.0 (9.0-12.0), (=0.0370). The analysis also showed that adolescents suffering from long-term T1D more often incorrectly identified bitter tastes than healthy adolescents. The duration of diabetes is important regarding changes in taste perception and olfactory function in adolescents with diabetes.
Equity of Continuous Glucose Monitoring in Children and Young People With Type 1 Diabetes: A Systematic Review.
Howard Dicks J, McCann LJ, Tolley A … +4 more , Barrell A, Johnson L, Kuhn I, Ford J
Pediatr Diabetes · 2025 · PMID 40496819 · Full text
Socioeconomic status (SES) and ethnic inequalities in type 1 diabetes (T1D) outcomes are well-established. There is concern that unequal access to technologies, including continuous glucose monitoring (CGM), may increase...
Socioeconomic status (SES) and ethnic inequalities in type 1 diabetes (T1D) outcomes are well-established. There is concern that unequal access to technologies, including continuous glucose monitoring (CGM), may increase disparities. This systematic review summarises the evidence for inequalities in the prevalence of CGM use for children and young people (CYP) and outcomes for CGM users. Medline, Embase and Web of Science were searched for observational studies published between January 2020 and July 2023 which report CGM use stratified by any PROGRESS-Plus criteria for T1D patients under 26. Reports based in low- or middle-income countries, ≤500 participants or only reporting hybrid closed-loop systems were excluded. Primary outcomes were the proportion of patients using CGM and HbA1c of CGM users. Quality assessment was performed using the Newcastle-Ottawa Scale. Unadjusted odds ratios were calculated from the extracted summary data, though heterogeneity precluded meta-analysis. The protocol was preregistered with PROSPERO (CRD42023438139). Of the 3369 unique studies identified, 27 met the inclusion criteria. Thirty-three percent were of 'good' or 'very good' quality. We found decreased CGM use and higher discontinuation for low SES, low education, publicly insured and minority ethnic, especially Black, CYP. These associations were generally robust to adjustment for other sociodemographic variables, suggesting an independent effect. Lower SES inequalities were seen in countries where CGM is reimbursed. Although low SES and minority ethnicity were associated with poorer outcomes in general, for CGM users there was no significant association between domains of disadvantage and higher HbA1c, excepting parental education. There are significant SES, ethnic and education inequalities in CGM use for CYP with T1D, particularly when reimbursement is limited. This inequity is contributing to inequalities in T1D outcomes. However, evidence suggests CYP benefit equally from CGM use, irrespective of ethnicity and SES. Increasing CGM funding and use is likely to reduce outcome inequalities.
Suicide Risk Screening in a Diverse Cohort of Youth With Type 1 and Type 2 Diabetes.
Fatima S, Prichett L, Campbell N … +3 more , Snyder MCN, Bifano M, Wolf RM
Pediatr Diabetes · 2025 · PMID 40496818 · Full text
Depression and suicide are more prevalent in adolescents with chronic illnesses such as diabetes. Psychosocial assessment is recommended in routine diabetes care. The goal of this study was to determine the prevalence of...
Depression and suicide are more prevalent in adolescents with chronic illnesses such as diabetes. Psychosocial assessment is recommended in routine diabetes care. The goal of this study was to determine the prevalence of suicide risk in youth with diabetes and to determine the utility of the Patient Health Questionnaire-9 (PHQ-9) Item 9 compared to the Ask Suicide-Screening Questions (ASQ). The PHQ-9 and ASQ were prospectively administered to patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), ages 11-24 years at routine diabetes visits at a pediatric diabetes center from January to December 2023. Depression and suicide risk were assessed using PHQ-9 Item 9 and ASQ. The sensitivity and specificity of PHQ-9 were determined using ASQ as the reference standard. Among the 309 patients included in this study, 237 (76.6%) had T1D and 72 (23.3%) had T2D. The mean age was 15.1 ± 2.6 years, 145 (46.9%) were female, and the mean HbA1c was 8.6% ± 2.3%. The prevalence of suicide risk using PHQ-9 Item 9 was 5.9% in T1D and 12.5% in T2D, and 8.4% in T1D and 19.4% in T2D, using ASQ. The sensitivity of the PHQ-9 Item 9 was 55.9% (95% CI: 37.9, 72.8%), specificity was 98.5% (95% CI: 96.3, 99.6%), PPV was 82.6% (95% CI: 61.2, 95%), and NPV was 94.8% (95% CI: 91.5, 97%) as compared to ASQ as reference standard. After a positive suicide risk screen, only 52.9% completed mental health follow-up at 1 month. The feasibility survey showed providers could identify high risk patients without workflow impact. Prevalence of suicide risk is higher in youth with T2D compared to T1D. PHQ-9 is less sensitive in identifying suicide risk in adolescents and young adults (AYA) compared to the ASQ. Diabetes care teams should consider using a specific suicide risk screener in routine diabetes care. Follow-up with mental health is suboptimal, and should be encouraged.
Etiologic Determinants and Characteristics of Diabetes in Haitian Youth (EDDHY Study).
Jean-Baptiste E, Larco P, Oettingen JEV … +9 more , Noble JA, Mack SJ, Song N, Martin HRN, Rozemuller E, Atkinson MA, Govender D, Larco NC, Ogle GD
Pediatr Diabetes · 2025 · PMID 40458319 · Full text
Published information on youth-onset diabetes in Haiti is scarce, with limited data available on diabetes autoimmunity and genetic susceptibility to the disease. We determined the anthropometric, metabolic, and immunolog...
Published information on youth-onset diabetes in Haiti is scarce, with limited data available on diabetes autoimmunity and genetic susceptibility to the disease. We determined the anthropometric, metabolic, and immunological characteristics and human leukocyte antigen (HLA)-associated risks in patients with youth-onset diabetes. One hundred and ten subjects with type 1 diabetes (T1D) aged <22 years and diagnosed for < 2 years were evaluated. Demographic and clinical information, as well as biochemical parameters, including blood glucose, hemoglobin A1c, fasting C-peptide (FCP), and T1D-associated autoantibodies, were assessed. DNA from 54 subjects and 66 controls was genotyped for classical HLA loci. Of the 110 patients, 54% were male. Onset age was 13.5 ± 4.2 years (range 2-21), and disease duration was 11.7 ± 8.1 months (range 0-24). Idiopathic T1D was found in 62 (56.4%) patients and was diagnosed at an older age than immune-mediated T1D (14.4 ± 3.5 years vs., 12.3 ± 4.8 years, =0.01), with a higher BMI z-score in patients aged <14 years than in those aged ≥14 years (-0.29 ± 1.52 vs., -1.15 ± 1.18, =0.01). No correlation was found between immune-mediated T1D and BMI z-score. Diabetic ketoacidosis was present at diagnosis in 18 (16.4%) patients. Zinc transporter 8 autoantibodies (ZnT8A) were marginally more common in younger patients. Low FCP levels were found in 71 (64.5%) patients. Thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (TG-Ab) were positive in 1.1% and 2.2% of the patients, respectively. The alleles , , , and showed a significant T1D risk, whereas , , and were protective. Three haplotypes were strongly associated with T1D: , , both predisposing, and , . Idiopathic T1D is common among youth in Haiti. A significant proportion of all patients had preserved C-peptide secretion. Overall, predisposing and protective HLA patterns were identified. Study results highlight the importance of distinguishing T1D endotypes within and between populations.
Markers of Early Liver Dysfunction Associate With Reduced Heart Rate Variability in Adolescents With Type 1 Diabetes.
Velayutham V, Benitez-Aguirre PZ, Liew G … +3 more , Jenkins AJ, Craig ME, Donaghue KC
Pediatr Diabetes · 2025 · PMID 40406225 · Full text
Data on the impact of metabolic dysfunction-associated fatty liver disease (MAFLD) on diabetes complications in youth with type 1 diabetes are lacking. However, MAFLD is well known to contribute to cardiovascular disease...
Data on the impact of metabolic dysfunction-associated fatty liver disease (MAFLD) on diabetes complications in youth with type 1 diabetes are lacking. However, MAFLD is well known to contribute to cardiovascular disease (CVD) in people with type 2 diabetes. We aimed to investigate markers of MAFLD in youth with type 1 diabetes and their relationship with chronic complications. A prospective study of 102 adolescents (mean age 14.7 ± 1.9 years) with type 1 diabetes underwent repeated annual diabetes complications assessments, including annual measures of liver enzymes. Early cardiac autonomic nerve dysfunction (CAN) was defined as ≥1 abnormality in seven heart rate variability parameters derived from a 10-min resting electrocardiogram. Multivariate generalized estimating equations explored predictors of CAN and other microvascular complications (retinopathy and early kidney dysfunction). After a median follow-up of 3.5 years (IQR 2.7-4.6), there were significant increases in the mean alanine transaminase level (ALT) and systolic blood pressure (SBP) percentiles. Upper ALT and gamma-glutamyl transferase (GGT) tertiles (T3 vs. T1-2: odds ratio [OR], 95% confidence interval [CI], 2.05 [1.20, 3.48], and 2.99 [1.61, 5.58], respectively) predicted CAN development (23%, = 24) independent of HbA1c and diabetes duration. They were not associated with retinopathy or early kidney dysfunction. Higher ALT and GGT associate with early CAN in adolescents with type 1 diabetes, suggesting hepatic inflammation may compound the impact of the diabetes milieu on systemic endothelial dysfunction.
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