Pediatric Diabetes[JOURNAL]
Sun
200 papers
Remission Period in Children With Newly Diagnosed Type 1 Diabetes During the COVID-19 Pandemic-Results From the DPV Registry.
Lahn V, Tittel SR, Ohlenschläger U … +7 more , Kamrath C, Hammersen J, Gellai R, Mönkemöller K, Dost A, Bartelt H, Holl RW
Pediatr Diabetes · 2025 · PMID 40406224 · Full text
To investigate whether the remission period in type 1 diabetes, as measured by insulin-dose adjusted A1c (IDAA1C), was affected by the COVID-19 pandemic. Data from 7603 children and adolescents with type 1 diabetes from...
To investigate whether the remission period in type 1 diabetes, as measured by insulin-dose adjusted A1c (IDAA1C), was affected by the COVID-19 pandemic. Data from 7603 children and adolescents with type 1 diabetes from the prospective diabetes follow-up (DPV) registry were available. We compared two time periods of diabetes onset, 2020/2021 vs. 2018/2019. IDAA1C and remission prevalence (IDAA1c < 9%) were analyzed using logistic and linear regression models adjusted for age groups (0.5-<6, 6-<12, and 12-<18 years), sex, diabetic ketoacidosis (DKA) at onset, use of continuous glucose monitoring (CGM) systems, insulin pumps, sensor-augmented pumps (SAPs) or automated insulin delivery (AID) systems, BMI categories (<90. percentile of BMI, 90. -<97. percentile of BMI, 97. -<99.5 percentile of BMI, > = 99.5 percentile of BMI) and immigrant background. Data from three time periods were analyzed: 3-5 months, 6-10 months, and 11-13 months after diagnosis of type 1 diabetes. Compared to the prepandemic period, during the COVID-19 pandemic adjusted IDAA1C was significantly higher at 3-5 months after diagnosis (mean estimated differences 0.26 [95% confidence interval 0.17; 0.35], < 0.001), but not at 6-10 months and 11-13 months after diagnosis (mean estimated difference 0.08 [-0.01; 0.17], =0.07; and -0.03 [-0.12; 0.07], =0.60), reflecting a lower percentage of patients in remission at 3-5 months. Reasons may be changes in autoimmune progression during the pandemic, lack of physical activities, increased stress or psychological burden, or altered access to care with delayed diagnosis of diabetes. Underlying causes need to be evaluated in future studies.
Trends in Prevalence of Insulin Resistance Among Nondiabetic/Nonprediabetic Adolescents, 1999-2020.
Zhao D, Wang L, Jiao X … +4 more , Shi C, Luo Z, Chen Y, Zhang Y
Pediatr Diabetes · 2025 · PMID 40365140 · Full text
Insulin resistance (IR)/hyperinsulinemia in young individuals is associated with the subsequent development of diabetes and cardiovascular disease. To assess trends in the prevalence of IR/hyperinsulinemia among nondiabe...
Insulin resistance (IR)/hyperinsulinemia in young individuals is associated with the subsequent development of diabetes and cardiovascular disease. To assess trends in the prevalence of IR/hyperinsulinemia among nondiabetic/nonprediabetic adolescents in the US from 1999 to 2020. A total of 6111 adolescents without diabetes and prediabetes were included from ten cycles of National Health and Nutrition Examination Survey (NHANES) between 1999-2000 and 2017-2020. Hyperinsulinemia or IR was defined as fasting insulin or homeostasis model assessment of insulin resistance [HOMA-IR] above the 75th percentile in all participants who underwent blood tests on fasting insulin, glucose, and hemoglobin A1c. Trends in prevalence rates were estimated using joinpoint regressions with heteroscedastic and uncorrelated errors. The overall weighted median fasting insulin level, prevalence of hyperinsulinemia, and IR were 9.9 μU/ml [95% confidence interval (CI): 9.6, 10.1], 17.2% (95% CI: 15.7, 18.6), and 16.4% (95% CI: 15.2, 17.9), respectively. The estimated prevalence of hyperinsulinemia and HOMA-IR increased significantly from 15.2% (95% CI: 12.1, 18.9) and 14.0% (95% CI: 11.1, 17.8) in 1999-2000% to 21.5% (95% CI: 17.1, 26.3) and 20.4% (95% CI: 16.4, 25.6) in 2017-2020, respectively, with a 3.35% (95% CI: 1.74, 4.99) and 3.41% (95% CI: 1.72, 5.12) relative increase per 2-year survey cycle, respectively ( for trend <0.05). Substantial increases were observed in the subgroups of girls, Hispanic, non-Hispanic white, and overweight adolescents. The prevalence of hyperinsulinemia/IR increased substantially among US nondiabetic/nonprediabetic adolescents over the last two decades. Early detection and effective interventions are in dire need to reverse the rising tide.
Patient Characteristics Associated With Annual Nutrition Visits in Children With Type 1 Diabetes.
Azova S, Lennerz BS, Petty CR … +5 more , Gordon E, Michelson H, Schmidt A, Garvey K, Rhodes ET
Pediatr Diabetes · 2025 · PMID 40322222 · Full text
OBJECTIVE: Diabetes organizations recommend nutrition education by a registered dietitian (RD) at least annually following type 1 diabetes (T1D) diagnosis in children. The study objectives were to describe differences ov...
OBJECTIVE: Diabetes organizations recommend nutrition education by a registered dietitian (RD) at least annually following type 1 diabetes (T1D) diagnosis in children. The study objectives were to describe differences over time in annual RD follow-up in children with T1D and to identify patient characteristics associated with RD engagement. RESEARCH DESIGN AND METHODS: Data based on 6034 completed diabetes medical visits among 1982 patients aged <18 years with T1D for ≥1 year followed at a pediatric, tertiary care, academic medical center over a 5-year period (2018-2022) were analyzed. Generalized estimating equations models assessed for differences over time in the rates of RD visit completion in the year preceding the last diabetes medical encounter and identified sociodemographic, diabetes care-related, and clinical patient characteristics associated with RD follow-up. Models were fit for the whole sample and groups subset by race and ethnicity. RESULTS: Observed annual RD follow-up rate over the 5-year period was 20.8%, with the lowest adjusted percentage in 2021 compared to 2018. In multivariable analysis, for each year increase in age ( = 0.004) and diabetes duration (<0.001), there was a 3% and 15% reduction in the odds of RD follow-up, respectively. RD follow-up was associated with lower hemoglobin A1c within the subsequent year in adjusted analysis ( = 0.029), with the greatest improvement among Hispanic patients. CONCLUSIONS: Annual RD visit frequency among children with T1D is suboptimal. Study findings provide insights for targeted intervention to improve RD engagement. RD follow-up may be associated with improved glycemic outcomes.
Sociocultural Attitudes Toward Appearance and Attitudes Toward Eating in Adolescents With Type 1 Diabetes: The Importance of Perfectionism.
Ruiz-Aranda D, Luque A, Russo F … +1 more , Fenollar-Cortés J
Pediatr Diabetes · 2025 · PMID 40303945 · Full text
Adolescents managing type 1 diabetes (T1D) are at increased risk of experiencing eating disorders (EDs). Identifying risk factors is essential to develop preventive strategies. This study examines the potential mediation...
Adolescents managing type 1 diabetes (T1D) are at increased risk of experiencing eating disorders (EDs). Identifying risk factors is essential to develop preventive strategies. This study examines the potential mediation value of self-esteem and the perfectionism associated with EDs in the relationship between sociocultural attitudes toward appearance and eating attitudes related to EDs in a sample of adolescents with T1D. Forty-six adolescents aged 12-17 years diagnosed with T1D participated in the current study. Sociocultural attitudes toward appearance, perfectionism associated with EDs, and self-esteem were measured. Multiple and simple mediator analyses using the bootstrapping method with bias-corrected confidence estimates were conducted. Our results show that perfectionism associated with eating problems is not only related to sociocultural attitudes toward appearance and eating attitudes, but rather the relationship between these last two variables would be fully mediated by perfectionism. A high degree of perfectionism could be a risk variable when developing potential eating problems in T1D adolescents. Perfectionism and its self-management would be a prominent factor that may help to design interventions developed for adolescents with diabetes who show behaviors that potentially conflict with eating. The clinical implications are discussed.
Focusing on Rare Variants Related to Maturity-Onset Diabetes of the Young in Children.
Ding Y, Zhang Q, Gao S … +11 more , Li J, Chang G, Wang Y, Wang L, Li X, Chen Y, Yao RE, Yu T, Li N, Lou D, Wang X
Pediatr Diabetes · 2025 · PMID 40303944 · Full text
In this study, we analysed the clinical and genetic characteristics and follow-up data of patients with maturity-onset diabetes of the young (MODY). From January 2015 to December 2022, patients with persistent hyperglyc...
In this study, we analysed the clinical and genetic characteristics and follow-up data of patients with maturity-onset diabetes of the young (MODY). From January 2015 to December 2022, patients with persistent hyperglycaemia suspected of having monogenic diabetes or diabetes syndrome were recruited, and next-generation sequencing (NGS) was performed at the Shanghai Children's Medical Center. Patients' clinical and laboratory findings were recorded preceding follow-ups. Candidate variants were verified using Sanger sequencing. Variant pathogenicity was evaluated according to the American College of Medical Genetics and Genomics (ACMG) guidelines. Genetic testing was performed in 175 children. MODY-related pathogenic or likely pathogenic gene variants were identified in 30 patients from different families. Of these, 11 were diagnosed with -MODY (36.7%), six with -MODY (20%), five with -MODY (16.7%), five with -MODY (16.7%), two with -MODY (6.7%) and one with -MODY (3.3%). There was one shift variant and seven splice-site variants, and the rest were missense variants. We discovered six novel variants. Of the 30 patients, 63.3% had a family history of diabetes, 13.3% had diabetic ketoacidosis (DKA), and 16.7% had positive diabetes-associated autoantibodies. The diabetes phenotype of patients with the variant was similar to that of patients with type 1 diabetes. All patients, including those having positive autoantibodies, required long-term insulin therapy during follow-ups. Four patients with the variant were unable to switch to oral sulfonylurea therapy and continued insulin therapy. Genetic testing is helpful for the precise diagnosis and treatment of patients with MODY, including those with DKA history and positive diabetes autoantibody. -MODY is the most common type of MODY, and patients with variant account for a relatively large proportion of MODY cases in our cohort.
Real-World Insights Into Hypoglycemia Risk While Driving in Teens and Young Adults With Type 1 Diabetes.
Pamidimukkala K, Ferm ML, Erraguntla M … +7 more , Haridas B, Byju A, Lawley M, Menon S, Villegas C, McKay S, DeSalvo DJ
Pediatr Diabetes · 2025 · PMID 40303943 · Full text
Clinical guidelines on driving for people with diabetes exist, but there are limited studies analyzing glucose data and hypoglycemia risk while driving. No published studies have analyzed teenage or emerging adult driver...
Clinical guidelines on driving for people with diabetes exist, but there are limited studies analyzing glucose data and hypoglycemia risk while driving. No published studies have analyzed teenage or emerging adult drivers with type 1 diabetes (T1D). The primary aim of our pilot study was to explore the glycemic patterns of young drivers with T1D as they relate to clinical guidelines and identify trends that could be used to improve road safety. In this pilot study, we collected continuous glucose monitoring (CGM) data from five drivers with T1D (median age 19, range 17-21 years) over a 1-month period. The driving trips were divided into two categories: (1) (<60 min) and (2) (≥60 min). Hypoglycemia was defined as <70 mg/dL as recorded by CGM for at least four consecutive readings. Trips <10 min were excluded from the analysis. Data on 284 total trips with associated CGM readings were recorded. The average number of trips taken by drivers during the study was 56.8 trips (range 9-82). For short trips ( = 276), no episodes of hypoglycemia occurred when starting glucose was >90 mg/dL ( = 227). For short trips with starting glucose of 70-90 mg/dL ( = 32), each hypoglycemic event ( = 5) had a drop in the first CGM glucose value while driving. Seventeen (5.7%) of short trips started with a glucose <70 mg/dL. A total of eight long trips (>60 min) were recorded, all had a starting CGM value of >90 mg/dL, and none had hypoglycemia events. These real-world findings from a small sample of teenage and young adult drivers with T1D support the American Diabetes Association (ADA) recommendation for starting glucose of >90 mg/dL when driving. Larger studies would be helpful in clearly identifying and improving road safety concerns in young drivers with T1D.
Executive Functioning, Diabetes Distress, and Diabetes Management Among Adolescents With Type 1 Diabetes: Youth and Parent Perspectives.
Choe A, Fredericks EM, Albright D … +6 more , Lee JM, Sturza JM, Riley HO, Kaciroti N, Bauer KW, Miller AL
Pediatr Diabetes · 2025 · PMID 40303942 · Full text
Most adolescents with Type 1 Diabetes (T1D) do not achieve recommended glycemic targets, placing them at risk for long-term complications. Executive functioning (EF), or the cognitive processes that support goal-directed...
Most adolescents with Type 1 Diabetes (T1D) do not achieve recommended glycemic targets, placing them at risk for long-term complications. Executive functioning (EF), or the cognitive processes that support goal-directed action and management of behavior, emotion, and cognition, is proposed to support effective T1D management and contribute to glycemic stability. We sought to examine associations of EF with T1D management behaviors and diabetes-related distress in adolescents with T1D. Participants were 13-17-year-olds ( = 15.44, = 1.38 years) from a randomized controlled trial ( = 88). We conducted secondary analyses of preintervention data. Youth and their parents each reported on youth EF (Behavior Rating Inventory of Executive Functioning; BRIEF) and T1D management behaviors (Self-Care Inventory-Revised; SCI-R), parents reported on responsibility for T1D management (Diabetes Family Responsibility Questionnaire; DFRQ), and youth reported on their diabetes-related distress (Problem Areas In Diabetes-Teen; PAID-T). Youth also completed performance-based measures of EF. Questionnaire-based and performance-based EF measures were generally unrelated. Regression analysis showed that youth self-reported EF predicted youth-reported T1D management (SCI-R) and diabetes distress (PAID-T) outcomes, and parent-reported youth EF predicted parent-reported T1D management behaviors, such that greater EF difficulties predicted suboptimal management and greater diabetes-related distress (youth PAID-T : 0.41, < 0.01; youth SCI-R : -0.40, < 0.01; parent SCI-R -0.33, < 0.01). Older child age and poorer performance-based EF also predicted greater youth responsibility for T1D management (age : 0.43, < 0.01; EF reaction time : 0.23, < 0.05; EF accuracy : -0.23, < 0.05). Youth EF may shape which adolescents are at increased risk for suboptimal T1D management as well as diabetes distress; understanding EF challenges may help guide T1D family management across this developmental period. Implications for EF measurement approaches in youth are also discussed. ClinicalTrials.gov identifier: NCT03688919.
Transition of Adolescents With Diabetes Mellitus to Adult Care at the Ho Teaching Hospital in Ghana.
Nukpezah RN, Tsigbe CC
Pediatr Diabetes · 2025 · PMID 40303941 · Full text
Transitioning adolescents with diabetes from pediatric to adult care poses significant challenges, especially in low-resource settings like Ghana. Poorly coordinated transitions can disrupt care continuity and adversely...
Transitioning adolescents with diabetes from pediatric to adult care poses significant challenges, especially in low-resource settings like Ghana. Poorly coordinated transitions can disrupt care continuity and adversely impact health outcomes. This study explored how adolescents with diabetes mellitus (DM) transition from pediatric to adult care at Ho Teaching Hospital, Ghana. A qualitative exploratory-descriptive design was used. Semistructured interviews were conducted with 15 adolescents and their caregivers. Thematic analysis was applied to identify key themes and subthemes. Six key themes emerged: (1) inadequate education on DM management, with gaps in adolescents' and caregivers' understanding of the disease and emergency symptoms; (2) limited self-management skills, with caregivers performing most care tasks; (3) poor timing and uncoordinated transfer, with abrupt transitions at age 13; (4) overreliance on caregivers, as caregivers were hesitant to shift responsibilities to adolescents; (5) limited adolescent involvement in care decisions, with healthcare providers engaging more with caregivers; and (6) recommendations for transition improvement, including raising the transfer age, providing skills training, and establishing a transition clinic. The study underscores the need for a structured, developmentally appropriate transition process with targeted education, skills training, and adolescent participation to promote self-management and improve transition outcomes for adolescents with DM.
Positive Impact of a Specialized Summer Camp on the Correlation Between Improved Mental Health and Glycemic Control in Pediatric Type 1 Diabetic Patients.
McManus L, Vinson C, Patel D … +8 more , Faichtinger C, Yazdani Z, Ray R, Patel R, Stokell M, Birks B, Gardiner LA, Rocic P
Pediatr Diabetes · 2025 · PMID 40303940 · Full text
Type 1 diabetes mellitus (T1DM) is associated with an increased risk of mental illness. In recent years, specialized summer camps for children and adolescents with type 1 diabetes have emerged, aimed at normalizing life...
Type 1 diabetes mellitus (T1DM) is associated with an increased risk of mental illness. In recent years, specialized summer camps for children and adolescents with type 1 diabetes have emerged, aimed at normalizing life with diabetes and building skills needed for optimal management of the condition. This project analyzed the effects of one such camp, Camp Sweeney, on glycemic control, physical health, and psychosocial wellbeing of camp attendees (children 5-17, mean age 14.4 years old) and their parents/caregivers. The standard Pediatric Quality of Life Inventory (PedsQL) was modified by the addition of questions pertaining to self-assessment of diabetes management, and questionnaires were distributed to parents and campers to complete at the start of and 2 months after completion of the camp. A total of 14 completed surveys (7 child/camper-parent/caregiver pairs) were collected and analyzed. Self-reported glycemic control (DM management), perceived overall quality of life (wellness), physical wellness, and psychosocial wellness improved after attendance of Camp Sweeney as reported by both campers/children (17.86% DM management, 10.96% overall wellness, 16.25% psychosocial wellness) and their parents/caregivers (16.07% DM management, 14.54% overall wellness, 17.86% psychosocial wellness). Importantly, we established a significant positive correlation between glycemic control (DM management) and overall wellness, psychosocial wellness, and average quality of life (correlation coefficient = 0.92, 0.80, and 0.94, respectively). While previous studies do provide some evidence that these types of camps improve the mental wellbeing of participants, this is the first study to establish a direct correlation between improved mental and psychosocial wellbeing and diabetes management.
Diabetes Distress and Unmet Support Needs Hinder Optimal Care for Adolescents With Type 2 Diabetes: A Mixed Methods Study.
Spajic D, Curran J, Luu Y … +6 more , Shah MAE, Subramani G, James R, Oxlad M, Speight J, Peña AS
Pediatr Diabetes · 2025 · PMID 40303939 · Full text
Adolescents with type 2 diabetes (T2D) are more likely than those with type 1 diabetes (T1D) to develop complications soon after diagnosis. However, limited data exist about diabetes-specific distress (DD) and how diabet...
Adolescents with type 2 diabetes (T2D) are more likely than those with type 1 diabetes (T1D) to develop complications soon after diagnosis. However, limited data exist about diabetes-specific distress (DD) and how diabetes teams can better support adolescents with T2D. We aimed to assess DD and other aspects of emotional/mental health among adolescents with T2D and qualitatively explore their lived experience and support needs. This study used a cross-sectional mixed methods survey of adolescents with T2D, recruited via two tertiary diabetes clinics. Study outcomes included the Diabetes Distress Scale (DDS), World Health Organization-Five Well-being Index (WHO-5), Patient Health Questionnaire-2 (PHQ-2) and two free-text questions concerning what they wished their health professionals understood about living with T2D and diabetes support. Descriptive statistics and inductive thematic analysis were applied. Forty adolescents with T2D (22 females, predominantly from non-Indigenous background) completed all questionnaires. Nineteen were taking metformin, 18 were taking metformin plus injectables, and 3 were on lifestyle management. They had mean ± standard deviation (SD) age of 15.7 ± 2.1 years, median (interquartile range [IQR]) diabetes duration of 1.8 (0.8-2.6) years and median (IQR) glycated haemoglobin (HbA1c) of 6.9 (6.0-9.5)% (52 [42-80] mmol/mol). Twenty-one (53%) adolescents had moderate-to-severe DD, 16 (40%) had suboptimal emotional well-being, and 23 (58%) had depressive symptoms; 15 (38%) had both DD and depressive symptoms, while 11 (28%) had neither. Four themes described what adolescents wished their health professionals understood about living with diabetes: diabetes stigma, diabetes management burden, diabetes is challenging for young people and impact on mental health. Five themes described the support adolescents desired from their diabetes teams: show empathy and assist with motivation; mental health support; more frequent and convenient appointments; access to, and choice of, medications and management tools; and discussions about the future. Most adolescents with T2D experience significant DD, impaired general emotional well-being and/or depressive symptoms. They also have considerable unmet support needs relevant to optimising their well-being and diabetes self-management.
A Novel Follow-Up Model for Type 1 Diabetes in Children Leads to Higher Glycemic Control.
Vonasek J, Larsen IM, Nikontovic A … +1 more , Thorvig CM
Pediatr Diabetes · 2025 · PMID 40303938 · Full text
Poor glycemic control in type 1 diabetes (T1D) in children leads to a higher risk of diabetic complications. In the pediatric department at the North Denmark Regional Hospital, only one-third of all children with diabete...
Poor glycemic control in type 1 diabetes (T1D) in children leads to a higher risk of diabetic complications. In the pediatric department at the North Denmark Regional Hospital, only one-third of all children with diabetes were well-regulated, defined as HbA no more than 58 mmol/mol (7.5%), in 2016. Therefore, a novel follow-up model was developed to increase the proportion of children with well-regulated T1Ds. The aim of this study was to evaluate the effect of a standardized follow-up model for poorly regulated diabetes on mean HbA. All children aged 0-18 with T1Ds were included in this study. A novel standardized follow-up model was developed if HbA was greater than 58 mmol/mol (7.5%), in which children were followed more closely until improvement in glycemic control. In the reference year, only one-third of children with diabetes were well-regulated and 19% were poorly regulated (HbA greater than 75 mmol/mol (9.0%)). After fully implementing the model, two-thirds of the children had well-regulated diabetes, and only a few percent had poorly regulated diabetes. The mean HbA decreased by almost 10 mmol/mol (or 0.8%) from the reference year to the following years when the model was fully implemented. This follow-up model for poorly regulated diabetes increased the fraction of children with well-regulated diabetes in our clinic and significantly decreased mean HbA.
Assessment of Health-Related Quality of Life Among Palestinian Adolescents With Type 1 Diabetes: A Cross-Sectional Investigation.
Sadder F, Nemer M
Pediatr Diabetes · 2025 · PMID 40303937 · Full text
Type 1 diabetes (T1D) with its worldwide increasing incidence is one of the most serious chronic conditions of adolescence. This study aimed to assess the Palestinian adolescent diabetic patients' health-related quality...
Type 1 diabetes (T1D) with its worldwide increasing incidence is one of the most serious chronic conditions of adolescence. This study aimed to assess the Palestinian adolescent diabetic patients' health-related quality of life (HRQOL) and to identify specific factors that could predict poor quality of life. We also aimed to compare adolescents' reported HRQOL to proxy reports by their parents. A cross-sectional study was carried out between November 2022 and October 2023 in the six governorates of northern West Bank/Palestine: Jenin, Nablus, Qalqilya, Salfit, Tubas, and Tulkarm. Patients who were diagnosed with T1D for over 6 months from their recruitment, aged between 10 and 18 years, were recruited from diabetes clinics of the Ministry of Health (MOH) and the Palestine Diabetes Institute (PDI). One hundred seventy adolescents and 170 parents (or guardians) completed the Pediatric Quality of Life Inventory (Peds QL) 3.2 Diabetes Module for adolescents and parents, respectively. An acceptable mean of 70.6 for the total score was reported for the Peds QL 3.2 Diabetes Module. Better scores were reported for the diabetes management summary score compared to the diabetes symptom summary score. Worry and communication were the lowest and highest reported subscores, respectively. Parents reported significantly lower results than adolescents. Income, gender, and hemoglobin A1c (HbA1c) were the main predictors of HRQOL among adolescents with T1D in Palestine. Future national health strategies should consider income differences and try to overcome health gaps among adolescents with T1D coming from low-income families. Future research is needed to explore the political and cultural aspects and their effects on HRQOL among diabetic adolescents in Palestine.
Diabetes Complications among Inpatients with Childhood and Young Adult-Onset Type 1 and 2 Diabetes.
Hawke K, Ng SZ, Anderson J … +5 more , Dharmaputra R, Hogg P, Titmuss A, Sinha A, McLean A
Pediatr Diabetes · 2024 · PMID 40302977 · Full text
AIMS: To assess morbidity among young people with diabetes presenting to a regional hospital in Northern Australia and compare the risk of complications among those living with type 2 diabetes (T2D) versus type 1 diabete...
AIMS: To assess morbidity among young people with diabetes presenting to a regional hospital in Northern Australia and compare the risk of complications among those living with type 2 diabetes (T2D) versus type 1 diabetes (T1D). MATERIALS AND METHODS: A cross-sectional study of young people with T1D or T2D (diagnosed age 1-25 years) presenting to a regional Northern Australian hospital with any condition from 2015 to 2019. Demographics, cardiometabolic comorbidities, and diabetes-related complications were collected from individual medical records and compared between those with T1D and T2D. RESULTS: Among 357 young people (192 had T2D, 165 T1D), the mean age was 22 years, the mean duration of diabetes was 6.7 years, 52% were Aboriginal or Torres Strait Islander, and 28% lived remotely. Cardiometabolic comorbidities (obesity, hypertension, and dyslipidaemia) and diabetes-related complications (microalbuminuria, amputation, and elevated non-alcoholic fatty liver disease score) were more prevalent in those with T2D compared to T1D, despite shorter disease duration and lower median HbA1c. When adjusted for age, sex, and BMI, the odds ratio (95% CI) for microalbuminuria was 4.8 (1.83-12.8) with T2D compared to T1D. CONCLUSION: In a cohort of young people with diabetes in Northern Australia, the prevalence of diabetes-related complications was higher among those with T2D than T1D.
Trends in CVD Risk Factors for Youth with Incident Diabetes: SEARCH for Diabetes in Youth.
Bell RA, Rigdon J, Bellatorre A … +14 more , Dabelea D, D'Agostino R, Divers J, Dolan LM, Jensen E, Liese AD, Lustigova E, Marcovina SM, Merjaneh L, Pettitt DJ, Pihoker C, Shah AS, South AM, Wagenknecht LE
Pediatr Diabetes · 2024 · PMID 40302976 · Full text
OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of death and disability among persons with diabetes. Early intervention on cardiovascular risk factors (CRFs) is important in reducing CVD burden. The SEARCH...
OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of death and disability among persons with diabetes. Early intervention on cardiovascular risk factors (CRFs) is important in reducing CVD burden. The SEARCH for Diabetes in Youth study assessed CRFs in incident cohorts of youth aged <20 years established from 2002 to 2016. . Regression models assessed trends over each incident year for lipids (total cholesterol (TC), HDL-c, LDL-c, triglycerides (TG), VLDL-c, and non-HDL-c), kidney function (albumin/creatinine ratio (ACR) ≥30 and ≥300, cystatin C, serum creatinine and estimated glomerular filtration rate (eGFR)), systolic and diastolic blood pressure (BP) -scores, BMI -score, waist circumference (WC), and an inflammatory marker (C-reactive protein (CRP)). Models were stratified by diabetes type (type 1 diabetes (T1D), = 4,600; type 2 diabetes (T2D), = 932) and adjusted for age at diagnosis, sex, race/ethnicity, and diabetes duration. An interaction analysis assessed differential time trends by type. RESULTS: For youth with T1D, all CRFs significantly improved over time, with the exception of ACR > 300, cystatin C, serum creatinine, eGFR, and CRP. For youth with T2D, TC, LDL-c, and non-HDL-c significantly improved, while eGFR, BMI -score, and CRP significantly worsened. Significant differences in trends over time by type were seen for TC, HDL-c, BMI -score, BP -scores, WC, and CRP. CONCLUSIONS: Overall, improvements in CRFs were more often observed in youth with T1D. Youth with T2D had worsening trends over time in BMI -score, CRP, and kidney function. Further research is needed to better understand these trends and their implications for long-term CVD risk.
Assessing the Feasibility and Acceptability of a Virtual Food Skills and Food Sustainability Program Designed for Children Living With Type 1 Diabetes.
Goldstein S, Chow O, Schwartz J … +3 more , Pais V, Wright S, Gucciardi E
Pediatr Diabetes · 2024 · PMID 40302974 · Full text
To assess the feasibility and acceptability of a virtual food skills program for children with type 1 diabetes. Forty-three patients, aged 6-14 years with type 1 diabetes, participated in an 8-week online programme, sum...
To assess the feasibility and acceptability of a virtual food skills program for children with type 1 diabetes. Forty-three patients, aged 6-14 years with type 1 diabetes, participated in an 8-week online programme, summerlunch+ At Home, that included weekly live cooking classes, asynchronous learning modules, and quizzes accessed through Google Classroom. Grocery delivery or gift cards were provided to all participants to support equitable access to participation. Descriptive results were summarized, and thematic analysis was performed on answers to a post-intervention questionnaire, parent/caregivers interview transcripts, and facilitators' field notes. Participants reported having a positive experience and would recommend the programme to others. Acceptable elements included the online format, the cooking class demonstrations, and the well-organized content. Families enjoyed the recipes, expressed an improvement in the families' cooking skills and nutrition knowledge, and noted the program as a way to improve family bonding and reduce participants' sense of social isolation given the opportunity of meeting peers with diabetes. The intervention also appears to increase participants' independence, confidence, and self-esteem. While grocery cards were easier to coordinate compared with meal kits, both were deemed acceptable by caregivers. Barriers to participation include a distracting home environment and not feeling comfortable on camera. Factors that negatively impacted satisfaction were the large age range of participants and the class timing and duration. Caregivers noted a desire for more diabetes education, enhanced peer-to-peer interaction, and incorporation of animal-based protein recipes in future programmes. The current study demonstrates the feasibility and acceptability of the virtual summerlunch+ At Home cooking and nutrition program that was adapted for children with diabetes. Similar food skills programmes may support the development of food skills imperative to diabetes self-management long-term. Further research can continue to assess food literacy skills, glycemic management, and the social benefits of such interventions.
Non-surgical Treatment May be Appropriate for Most Chinese Children With Monogenic Congenital Hyperinsulinism Based on a Retrospective Study of 121 Patients.
Cheng M, Su C, Wang D … +9 more , Song Y, Li Y, Zeng H, Yuan Z, Li X, Meng X, Ding Y, Cao B, Gong C
Pediatr Diabetes · 2024 · PMID 40302972 · Full text
There is a notable absence of extensive Chinese studies involving monogenic congenital hyperinsulinism (CHI). The purpose of this large retrospective Chinese cohort with monogenic CHI from a national children's medical c...
There is a notable absence of extensive Chinese studies involving monogenic congenital hyperinsulinism (CHI). The purpose of this large retrospective Chinese cohort with monogenic CHI from a national children's medical center was to analyze the genetic and clinical characteristics. We compared clinical characteristics grouped by genotypes based on CHI-targeted next-generation sequencing (tNGS) and performed subgroup analyses by onset time. Totally, 121 non-consanguineous patients were enrolled. Among them, 79 patients (65.3%) had variants in ATP-sensitive potassium channel () genes (62 heterozygotes and 17 compound heterozygotes), 35 (28.9%) in glutamate dehydrogenase 1 (), and 7 (5.8%) in rare genes (hydroxyacyl-CoA dehydrogenase [], glucokinase [], and hepatocyte nuclear factor 4 alpha []). Ten patients had ATP binding cassette subfamily C member 8 () variants (p.G111R), and 12 had variants (p.S498L), suggesting two potential founder variants. Three variants (p.G1478R, p.L580_S581insFASL, and p.S986 ) and two variants (p.R63W and p.V382I) were previously reported to be associated with diabetes. Non-surgical treatment was effective in 65.9% of patients with variants, while in 100% of those with non- variants. For the subgroup of variants, neonatal-onset patients tended to present with mild symptoms (67.9% versus 19.3%), had a higher proportion of surgical intervention (24.5% versus 3.8%), and displayed higher levels of serum insulin and C-peptide than non-neonatal onset ones ( < 0.001). The absence of homozygous variants in genes and a quite higher proportion of variants than previous cohorts, may explain a high response rate of non-surgical treatment in this study. Surgery might be considered for neonatal-onset children, especially when variants were discovered but not for those carried variants reported to cause diabetes in later life. While expanding the genotypic spectrum, we also highlight the clinical significance of genetic screening.
The Psychometric Properties of the Type 1 Diabetes Mellitus Screening Acceptability Assessment (DMSA) Scale among General Population.
Al-Gadi IS, Albalawi AD, Al Khalifah RA
Pediatr Diabetes · 2024 · PMID 40302970 · Full text
BACKGROUND: Type 1 diabetes mellitus (T1DM) screening facilitates access to early intervention and prevention of severe complications, such as diabetic ketoacidosis. Despite its significance, many countries lack a system...
BACKGROUND: Type 1 diabetes mellitus (T1DM) screening facilitates access to early intervention and prevention of severe complications, such as diabetic ketoacidosis. Despite its significance, many countries lack a systematic T1DM screening program. Understanding how the public perceives T1DM screening for children is essential for successfully implementing such programs but is currently an area with limited research. Our study aims to fill this gap by developing a standardized tool designed to assess the acceptability of T1DM screening programs for children, focusing on caregiver perspectives within the general population. MATERIALS AND METHODS: We developed the Type 1 Diabetes Mellitus Screening Acceptability (DMSA) scale based on the theoretical framework of acceptability and integrated components from the Pediatric Testing Attitudes Scale-Diabetes (P-TAS-D). It covers a broad spectrum of acceptability constructs. The DMSA scale underwent iterative modifications following expert feedback to refine clarity and content validity. We tested the scale in both Arabic and English with adults living in Saudi Arabia, regardless of their parental status, focusing on the potential of screening their children. The psychometric strengths of the scale were evaluated through reliability analyses and exploratory factor analysis. RESULTS: Of the 599 participants, the majority were female (89.2%), with a mean age of 35.9 ± 8.6 years. The final DMSA scale consists of 10 items, with two distinct factors: "individual acceptability" and "psychosocial acceptability." The mean total score was 42.9 ± 5.1 across a potential range of 10-50 points. The English and Arabic versions of the scale demonstrated strong reliability, with Cronbach's alpha values of 0.84 and 0.79, respectively. CONCLUSIONS: The DMSA scale emerges as a valid and reliable tool for gauging the acceptability of the general population of screening children for T1DM. It integrates key elements of the acceptability construct, pivotal for guiding the implementation of culturally sensitive T1DM screening initiatives. Future research should expand its application across various cultural settings and examine the correlation between scale scores and actual screening behaviors.
Effect of Oral Insulin on Early Combined Glucose and C-Peptide Endpoints in Individuals at High-Risk for Type 1 Diabetes.
Triolo TM, Jacobsen LM, Cuthbertson D … +10 more , Sims EK, Ismail HM, Redondo MJ, Lundgren M, DiMeglio LA, Gottlieb PA, Atkinson MA, Krischer JP, Schatz DA, Sosenko JM
Pediatr Diabetes · 2024 · PMID 40302969 · Full text
The TrialNet Oral Insulin (OI) prevention trial showed no overall treatment effect, using the diagnosis of type 1 diabetes as an endpoint. A significant delay in onset was only found in a high-risk stratum (termed second...
The TrialNet Oral Insulin (OI) prevention trial showed no overall treatment effect, using the diagnosis of type 1 diabetes as an endpoint. A significant delay in onset was only found in a high-risk stratum (termed secondary stratum 1) of participants with low first-phase insulin release (FPIR). Since trials with an endpoint of type 1 diabetes take years to complete, in this post hoc analysis, we assessed whether a novel combination of glucose and C-peptide markers could identify a therapeutic benefit after 1 year of follow-up (trial participants followed for a median 2.7 years). Participants were relatives with multiple islet autoantibodies and low FPIR ( = 40). Glucose rose, and C-peptide declined in the placebo group, whereas glucose rose minimally, and C-peptide increased in the OI group. When glucose and C-peptide were plotted on two-dimensional grids using 30-120-min oral glucose tolerance test (OGTT) time points, changes in ratios of their central points (centroid ratio) differed between groups (=0.037 adjusted for age, BMI, and baseline C-peptide and glucose). These findings support a favorable early effect of OI on combined glucose and C-peptide endpoints in high-risk individuals, indicating metabolic benefit. With further study, these measures may allow for shorter trials compared to the standard endpoint of type 1 diabetes diagnosis.
"I Think I Could Have Used It Better": Experiences of Youth with High HbA1c Commencing Advanced Hybrid Closed-Loop Therapy in a Clinical Trial Setting-A Qualitative Research.
Roberts A, Dart J, Lloyd S … +7 more , Bebbington K, Fairchild JM, Ambler GR, Cameron FJ, Davis EA, Jones TW, Abraham MB
Pediatr Diabetes · 2024 · PMID 40302968 · Full text
BACKGROUND: Advanced hybrid closed-loop (AHCL) therapy improves glycemia. However, it is not known if there is an improvement in overall outcomes with AHCL for youth with type 1 diabetes (T1D) at high risk of diabetes-re...
BACKGROUND: Advanced hybrid closed-loop (AHCL) therapy improves glycemia. However, it is not known if there is an improvement in overall outcomes with AHCL for youth with type 1 diabetes (T1D) at high risk of diabetes-related complications. The study aimed to capture the experiences of youth with suboptimal glycemic control when commencing AHCL therapy in a clinical trial setting. METHODS: This was a singlecenter substudy of a multicenter 6-month randomized clinical trial. Youth between 12 and 25 years of age on insulin pump therapy with HbA1c > 8.5% (> 69 mmol/mol) who commenced AHCL therapy with Medtronic MiniMed™ system were invited to participate in a semistructured interview after 6 months of AHCL. Open-ended questions were used to explore the participants' lived experience of AHCL in improving their glucose levels and its impact on diabetes management and well-being. The interviews were audiorecorded, transcribed, and analyzed using thematic analysis. RESULTS: Ten youth with T1D with a mean (SD) age of 17.4 (2.9) years, diabetes duration 10.7 (4.8) years, HbA1c 10.2 (0.8)%, or 87 (9.5) mmol/mol at enrollment participated in the interview. Three main themes were identified: (1) improved glycemia despite not using closed loop to its full potential; (2) persistent diabetes burden; and (3) a need for increased psychosocial and clinical support. Although improved glycemia was noted with AHCL therapy, participants reported ongoing motivation issues and used the system suboptimally. They continued to experience distress with overall diabetes management and acknowledged the need for ongoing support from family and health professionals. CONCLUSION: All participants reported overall satisfaction with improved glucose levels, however, the persistent diabetes burden impacted their ability to use AHCL optimally. The need for ongoing monitoring with support and interventions to enhance psychological care remains vital for youth with suboptimal diabetes management.
Trends in the Incidence of Type 1 Diabetes in European Children and Adolescents from 1994 to 2022: A Systematic Review and Meta-Analysis.
Ruiz-Grao MC, Díez-Fernández A, Mesas AE … +4 more , Martínez-Vizcaíno V, Sequí-Domínguez I, Sebastián-Valles F, Garrido-Miguel M
Pediatr Diabetes · 2024 · PMID 40302967 · Full text
AIM: To assess the incidence trends in type 1 diabetes among children and adolescents across Europe during the period from 1994 to 2022 using a systematic methodology. MATERIALS AND METHODS: Cross-sectional or follow-up...
AIM: To assess the incidence trends in type 1 diabetes among children and adolescents across Europe during the period from 1994 to 2022 using a systematic methodology. MATERIALS AND METHODS: Cross-sectional or follow-up studies reporting population-based incidence rates (IRs) of European children and adolescents diagnosed aged <15 years with type 1 diabetes were included. The Mantel‒Haenszel or DerSimonian and Laird random-effects method was used to compute the pooled IR estimates and their 95% confidence intervals (CIs). Subgroup analyses were conducted by study year, biological sex, age group (0-4, 5-9, and 10-14 years), country, and European regions. RESULTS: A total of 75 studies (219,331 children and adolescents aged 0-14 years) with data from 32 countries were included. Generally, a high overall rate of increase in type 1 diabetes incidence has been shown in most European countries from 1994 to 2022 in both sexes, with an overall increase from 10.85 (95% CI, 9.62-12.07) per 100,000 person-years from 1994 to 2003 to 20.96 (95% CI, 19.26-22.66) per 100,000 person-years from 2013 to 2022. CONCLUSIONS: There are substantial between-country differences in the current levels and trends of IR in type 1 diabetes in European children and adolescents. Our data suggest a worrying upward trend in most European countries.
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