Pediatric Diabetes[JOURNAL]
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200 papers
Efficacy and Safety of SGLT2 Inhibitors in Pediatric Patients and Young Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Dos Santos Borges R, Conegundes AF, Haikal de Paula L … +5 more , Lara Santos R, Alves SN, Machado RA, Bussolaro Viana I, Simões E Silva AC
Pediatr Diabetes · 2024 · PMID 40302966 · Full text
In recent decades, an increase in the incidence of type 2 diabetes mellitus (T2DM) in children and adolescents has been observed. Pediatric-onset T2DM differs from the adult-onset form, particularly regarding the durabil...
In recent decades, an increase in the incidence of type 2 diabetes mellitus (T2DM) in children and adolescents has been observed. Pediatric-onset T2DM differs from the adult-onset form, particularly regarding the durability of glycemic control and earlier appearance of complications. However, the scarcity of approved treatments and comprehensive studies on T2DM management in youth persists. Ongoing clinical trials seek to ascertain the efficacy and safety of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients aged between 10 and 24 years with T2DM. Therefore, we aimed to perform a meta-analysis exploring the efficacy and safety of SGLT2i in pediatric patients and young adults with T2DM. We searched PubMed, Embase, Cochrane, and Web of Science for randomized controlled clinical trials on the efficacy and safety of SGLT2i in children, adolescents, and young adults with T2DM compared with placebo. Statistical analysis was performed using RevMan 5.4 and R statistical software 4.2.1. Heterogeneity was assessed with statistics. We included three studies totaling 334 patients followed for 37.79 weeks. Reduction in HbAC (MD = -0.93; 95% CI = -1.36 to -0.49; < 0.0001; = 0%) was significantly higher in SGLT2i group compared with placebo. The proportion of patients requiring rescue or discontinuation of study medication due to lack of efficacy was statistically lower in SGLT2i group compared with placebo (RR = 0.64; 95% CI = 0.43-0.94; = 0.02; = 0%). SGLT2i and placebo were similar in terms of any adverse event (RR = 1.10; 95% CI = 0.96-1.27; = 0.17; = 0%), serious side effects (RR = 1.06; 95% CI = 0.44-2.57; =0.90; = 0%), and individual adverse effects. In children, adolescents, and young adults with T2DM, SGLT2i appears to be effective and safe for glycemic control.
Rates, Risk Factors, and Progression of Diabetic Retinopathy in Children with Type 1 Diabetes: A 15-Year Retrospective Study from a Regional Center in New Zealand.
Winter T, Derraik JGB, Jefferies CA … +4 more , Hofman PL, Shand JAD, Braatvedt GD, Misra SL
Pediatr Diabetes · 2024 · PMID 40302963 · Full text
AIMS: Diabetic retinopathy (DR) is the primary microvascular complication associated with diabetes. Evidence on DR prevalence among children in New Zealand is scarce. We examined DR rates and associated risk factors in y...
AIMS: Diabetic retinopathy (DR) is the primary microvascular complication associated with diabetes. Evidence on DR prevalence among children in New Zealand is scarce. We examined DR rates and associated risk factors in youth with type 1 diabetes (T1D) aged <16 years receiving care from a regional diabetes service in January 2006-December 2020. MATERIALS AND METHODS: DR diagnosis followed the International Society for Pediatric and Adolescent Diabetes guidelines. The study included 646 participants; mean age (±SD) at T1D diagnosis was 7.4 ± 3.6 years, 47% were female, and 69% identified as NZ Europeans. RESULTS: The initial DR screening occurred at a mean age of 12.6 ± 2.4 years and 5.2 ± 2.2 years after T1D diagnosis. At the first DR screen, 23.5% of participants (152/646) were diagnosed with DR: 69.1% (105/152) with minimal, 30.3% (46/152) with mild, and one moderate case (0.7%). Older age at diagnosis (=0.029) and longer diabetes duration (=0.015) were predictors of DR at first screen. Patients with at least one positive DR screen had a higher average HbA1c at their first screen (+2.6 mmol/mol; =0.042). Overall, 55.6% (359/646) of patients had a positive DR screen, whose worst grade was mostly either minimal (58.2%) or mild (40.7%) DR, with only three moderate cases (0.8%) and one severe (0.3%). Children diagnosed with T1D before age 10 were 72% more likely to have DR than older children ( < 0.0001), and DR risk was 32% and 41% higher among Pacific children than NZ European (=0.008) and Māori (=0.014) children. Lastly, the only predictor of DR at discharge from paediatric services was HbA1c at the first screen ( < 0.0001). CONCLUSIONS: In this regional cohort of children with T1D, there was a high rate of low-grade DR overall and at first retinal screen, with an increasing rate until transfer to adult services. Our findings underscore the importance of ongoing DR screening, reducing glycaemic levels, and supporting vulnerable high-risk groups.
Development of a Multivariable Risk Prediction Tool to Predict Adverse Outcomes among Children with Type 1 Diabetes: A Pilot Study.
Lieu F, Martin WN, Birt S … +2 more , Mattes J, McGee RG
Pediatr Diabetes · 2024 · PMID 40302962 · Full text
BACKGROUND: Children and adolescents with type 1 diabetes mellitus (T1DM) are frequently hospitalised for severe hypoglycaemia, hyperglycaemia, and diabetic ketoacidosis (DKA). While several risk factors have been recogn...
BACKGROUND: Children and adolescents with type 1 diabetes mellitus (T1DM) are frequently hospitalised for severe hypoglycaemia, hyperglycaemia, and diabetic ketoacidosis (DKA). While several risk factors have been recognised, clinically identifying these children at high risk of acute decompensation remains challenging. OBJECTIVE: To develop a risk prediction model to accurately estimate the risk of acute healthcare utilisation due to severe hypoglycaemia, hyperglycaemia, and DKA in children and adolescents with T1DM. MATERIALS AND METHODS: Using a retrospective dataset, baseline demographic and clinical data were collected from patients (<18 years) seen at a regional paediatric diabetes clinic from 1 January 2018 to 1 January 2020. The outcome was the number of emergency department presentations or hospital admissions for severe hypoglycaemia, hyperglycaemia, and DKA across the study period. Variables that were significant in univariate analysis were entered into a multivariable model. Receiver operator characteristic (ROC) curves assessed the model's discrimination and generated cut-offs for risk group stratification (low, medium, and high). Kaplan-Meier survival analysis measured time to acute healthcare utilisation across the risk groups. RESULTS: Our multivariable risk prediction model consisted of five predictors (continuous glucose monitoring device, previous acute healthcare utilisation, missed appointments, and child welfare services involvement and socioeconomic status). The model exhibited good discrimination (area under the ROC = 0.81), accurately stratified children into low-, medium-, and high-risk groups, and demonstrated significant differences between median time to healthcare utilisation. CONCLUSION: Our model identified patients at an increased risk of acute healthcare utilisation due to severe hypoglycaemia, hyperglycaemia, and DKA.
The Journey to Adulthood: A Systematic Review of Interventions in Type 1 Diabetes Paediatric to Adult Transition Care.
Aljohani N, Donetto S, Due-Christensen M … +1 more , Forbes A
Pediatr Diabetes · 2024 · PMID 40302961 · Full text
Young people with type 1 diabetes mellitus (T1DM) transition from paediatric to adult services when they reach late adolescence. This can be a risky period for young people, and it has been associated with a deterioratio...
Young people with type 1 diabetes mellitus (T1DM) transition from paediatric to adult services when they reach late adolescence. This can be a risky period for young people, and it has been associated with a deterioration in glycaemic control and disengagement from diabetes services. This review aimed to identify current interventions addressing the following questions: What adolescents with T1DM healthcare transition interventions have been evaluated? What are the underlying theories and components of these interventions? What outcomes have been considered in these evaluations? Databases, trial registries and other sources were searched using the population and intervention keywords. Studies were included if they explicitly reported a transition intervention targeting young people aged 10-25 years. Studies were critically apprised, and data were extracted. Both tabular and narrative data synthesis were used. The review included 22 studies. Most interventions were service-oriented, with little use of theory. The interventions included transition planning, service coordination, pre-transition education, transition clinics, prompting strategies and other less frequent components. Most studies reported metabolic outcomes, with limited data on psychological outcomes such as diabetes adaptation, acceptance and self-management activation. It is inconsistent how each outcome was defined, measured or reported. Consequently, effective theory-based interventional transition models are yet to be identified.
Associations of Area-Level and Parental Individual-Level Social Deprivation with Glycemic Control over Time among Children with Type 1 Diabetes in France: A Longitudinal Cohort Study.
Morard I, Barat P, Bailhache M
Pediatr Diabetes · 2024 · PMID 40302959 · Full text
BACKGROUND: Poor glycemic control in patients with type 1 diabetes (T1D) is associated with greater social deprivation. However, the evidence is inconsistent in terms of the type of social deprivation (individual-level o...
BACKGROUND: Poor glycemic control in patients with type 1 diabetes (T1D) is associated with greater social deprivation. However, the evidence is inconsistent in terms of the type of social deprivation (individual-level or area-level) and whether glycemic control changes over time. Here, we investigated the impacts of individual-level and area-level social deprivation on the glycated hemoglobin (HbA1c) trajectory from the time of T1D diagnosis. MATERIALS AND METHODS: We retrospectively analyzed a cohort of children who were diagnosed with T1D between 2017 and 2020 at Bordeaux University Hospital. Social deprivation was assessed using both parental individual indicator (EPICES score) and ecological indicator (European Deprivation Index (EDI) score). Piecewise linear mixed-effects models were used to estimate the effects of social deprivation on HbA1c trajectory. RESULTS: We included 168 patients. The most-deprived group included 29% and 22% of all patients, as revealed by the respective EPICES and EDI scores. The two indicators were poorly correlated. The short-term decrease in HbA1c level tended to be smaller in the most-deprived patients over the first 4 months after diagnosis than in other patients (slope difference of 2.68% per year compared with the slope among the least-deprived patients, = 0.056). The long-term trajectory was influenced by area-level deprivation (EDI score); the least-deprived patients (quintile 1) exhibited more stable mean HbA1c levels. CONCLUSIONS: Social deprivation may partially explain poor glycemic control in some patients; both short-term individual deprivation and long-term area-level deprivation may be involved. Further research is needed to determine how to integrate this information into a therapeutic strategy.
Capillary Glycated Hemoglobin A1c Percentiles and the Risk Factors Associated with Abnormal HbA1c among Chinese Children Aged 3-12 Years.
Ren L, Yang J, Wu L … +7 more , Gao Y, Zhou Z, Li P, Shen Z, Wu J, Li J, Zhang L
Pediatr Diabetes · 2024 · PMID 40302958 · Full text
OBJECTIVE: Capillary glycated hemoglobin (HbA1c) may enhance screening for childhood prediabetes and diabetes, but variations in this parameter remain unclear. We aimed to develop percentiles of HbA1c and explore the inf...
OBJECTIVE: Capillary glycated hemoglobin (HbA1c) may enhance screening for childhood prediabetes and diabetes, but variations in this parameter remain unclear. We aimed to develop percentiles of HbA1c and explore the influence of various variables on HbA1c level among Chinese children. . The data were derived from the Shanghai Children's Health and Nutrition Community-based Epidemiologic Survey (CHANCE). A total of 4,615 children aged 3-12 years were included. The capillary HbA1c level was measured using point-of-care (POC) testing analyzers. Abnormal HbA1c level was identified as HbA1c (%) value equal to or above the 95th percentile of the nomograms. RESULTS: The mean HbA1c value was 5.30% (SD = 0.50%). The age-specific 95th percentile thresholds of HbA1c (%) ranged from 5.9 to 6.2 among all children. In the whole participants, body mass index (BMI), total cholesterol (TC), outdoor activity frequency, and daily sleep duration were positively associated with high HbA1c. Among preschool-aged children, TC and sleep duration ≥10 hr per day were associated with increased risk of being in the higher HbA1c (both < 0.05). Among the school-aged group, positive associations with HbA1c levels were identified for TC, living with grandparents, frequency of outdoor activity, and sleep duration (all < 0.05). CONCLUSIONS: The present study established capillary HbA1c percentiles based on a large sample of Chinese children among aged 3-12 years. Daily sleep duration and frequency of outdoor activity, BMI, and TC were found to be associated with high HbA1c. Actions of successful public strategies that focus on promoting a healthy lifestyle, including regular physical exercise to reduce weight among children, are needed. . We used POC testing for capillary HbA1c with a finger-stick sample which may offer an opportunity to enhance screening and early diagnosis for childhood and adolescent diabetes, which was suggested as an essential premise to determine the subject's glycemic status by the American Diabetes Association (ADA). Capillary HbA1c levels fluctuate during childhood, while there has been no population-based study on HbA1c reference values in Chinese youths.
Psychosocial-Spiritual Experiences and Outcomes in Parents of Children with Type 1 Diabetes Mellitus from the Middle East and North Africa Region: A Systematic Review.
Asaad M, Abu Ghazaleh H, Tzouvara V … +2 more , Zhao X, Sturt J
Pediatr Diabetes · 2024 · PMID 40302957 · Full text
BACKGROUND: Type 1 diabetes mellitus (T1DM) is prevalent in the Middle East and North Africa (MENA). Parents of children or young people (CYP) with T1D experience shock, devastation, guilt, and societal blame, which impa...
BACKGROUND: Type 1 diabetes mellitus (T1DM) is prevalent in the Middle East and North Africa (MENA). Parents of children or young people (CYP) with T1D experience shock, devastation, guilt, and societal blame, which impact both physical and psychosocial-spiritual aspects of their lives. However, our knowledge of the breadth of these psychosocial-spiritual experiences and how they are assessed is limited. AIM: (1) To examine the diabetes-specific psychosocial experiences of parents of CYP with T1D in the MENA region; (2) to assess the person-reported outcome measures (PROMs) that measure the psychosocial-spiritual outcomes in this population; and (3) to assess their reliability and validity. MATERIALS AND METHODS: A systematic review methodology was implemented using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Ovid MEDLINE, Embase, APA PsycINFO, CINAHL, and Global Health databases were searched for relevant articles. A narrative synthesis approach was used for data analysis. RESULTS: Twenty-three studies were included. We identified four categories: (1) spiritual functioning, parents' ability to accept and cope with their CYP's condition, (2) psychological functioning, parents' emotional distress due to insufficient diabetes-related knowledge and skills, (3) social functioning, describing financial challenges, social support experiences, and cultural concerns faced by parents, and (4) physical functioning, parents' struggle with sleep deprivation. Our results revealed methodological and conceptual limitations of the current tools measuring these experiences. Some of the limitations of this review are (1) heterogeneity in the tools captured perhaps some but not all domains of the parents' psychosocial experiences, (2) only English studies were included, as no Arabic studies were found. CONCLUSION: Our studied population experiences psychosocial-spiritual distress by managing the condition of their CYP and needs culturally specific psychosocial-spiritual support. Further studies are needed to develop a new measure to specifically assess the psychosocial-spiritual outcomes of this population.
Supporting Adolescents and Young Adults through Digitally Mediated Type 1 Diabetes Transition Care: A Qualitative Descriptive Study.
El-Dassouki N, Taylor M, Pfisterer KJ … +10 more , Saragadam A, Nakhla M, Greenberg M, Landry A, Mukerji G, Mok E, Brazeau AS, Kichler JC, Cafazzo JA, Shulman R
Pediatr Diabetes · 2024 · PMID 40302956 · Full text
OBJECTIVE: The time during which adolescents and young adults (AYAs) living with Type 1 Diabetes (T1D) transition from pediatric to adult care is associated with blood sugar levels outside of target ranges, care gaps, an...
OBJECTIVE: The time during which adolescents and young adults (AYAs) living with Type 1 Diabetes (T1D) transition from pediatric to adult care is associated with blood sugar levels outside of target ranges, care gaps, and an increased risk of acute diabetes complications. The aim of this study was to understand (1) the perspectives of AYAs and providers about the strengths, challenges, and opportunities of transition care and (2) the role of digital technologies in supporting the transition to adult care. . We conducted a qualitative descriptive study that involved 43 semistructured interviews in French or English with AYA living with T1D (aged 16-25; = 22) and pediatric or adult diabetes health care providers (HCPs) ( = 21). RESULTS: We identified three themes. First, transition care is not standardized and varies widely, and there is a lack of awareness of transition guidelines. Second, virtual care can simultaneously hinder and help relationship-building between providers and AYA. Third, AYAs value a holistic approach to care; both HCPs and AYA highlighted the opportunity to better support overall mental wellbeing. CONCLUSIONS: The design of digital technologies to support T1D transition care should consider methods for standardizing holistic care delivery and integrating hybrid diabetes care visits to support access to transition care. These findings can inform future transition intervention development that leverages existing transition guidelines, targets holistic care model integration, and considers quantitative diabetes metrics in conjunction with broader life experiences of AYA when providing transition care.
Insulin Resistance in Pediatric Obesity: From Mechanisms to Treatment Strategies.
Luo Y, Luo D, Li M … +1 more , Tang B
Pediatr Diabetes · 2024 · PMID 40302954 · Full text
Insulin resistance, an increasingly prevalent characteristic among children and adolescents with obesity, is now recognized as a significant contributor to the development of type 2 diabetes mellitus (T2DM) and other met...
Insulin resistance, an increasingly prevalent characteristic among children and adolescents with obesity, is now recognized as a significant contributor to the development of type 2 diabetes mellitus (T2DM) and other metabolic diseases in individuals with obesity. Insulin resistance refers to a decrease in the sensitivity of peripheral tissues (primarily skeletal muscle, adipose tissue, and liver) to insulin, which is mainly characterized by impaired glucose uptake and utilization. Although the mechanisms underlying insulin resistance in children with obesity remain incompletely elucidated, several risk factors including lipid metabolism disorders, oxidative stress (OS), mitochondrial dysfunction, inflammation, and genetic factors have been identified as pivotal contributors to the pathogenesis of obesity-related insulin resistance. In this review, we comprehensively analyze relevant literature and studies to elucidate the underlying mechanisms of insulin resistance in childhood obesity. Additionally, we discuss treatment strategies for pediatric obesity from a perspective centered on improving insulin sensitivity, aiming to provide valuable insights for the prevention and management of pediatric obesity.
Real-World Accuracy of a Continuous Glucose Monitoring System after Radiologic Exposure.
Tellez S, Hornung L, Smith E … +6 more , Trout A, Brady S, Lowe C, Courter J, Abu-El-Haija M, Elder D
Pediatr Diabetes · 2024 · PMID 40302953 · Full text
BACKGROUND: The increasing use of continuous glucose monitor (CGM) necessitates a review of variables that impact accuracy and interrupt use. Manufacturer recommendations include removing CGMs before diagnostic imaging,...
BACKGROUND: The increasing use of continuous glucose monitor (CGM) necessitates a review of variables that impact accuracy and interrupt use. Manufacturer recommendations include removing CGMs before diagnostic imaging, such as X-ray and computed tomography (CT). Early removal and replacement of CGM components present financial, clinical, and psychosocial burdens to the wearer and interrupt optimal management of diabetes for pediatric patients who receive a total pancreatectomy with islet autotransplantation (TPIAT). The study's aim was to evaluate the effect of scatter dose exposure during X-ray or CT if the CGM remained intact but outside the field of view (FoV). MATERIALS AND METHODS: Participants were followed through the first 3 months after TPIAT surgery, managed diabetes with an insulin pump and CGM, and were routinely exposed to diagnostic imaging. Participants' CGMs were unshielded by a protective apron during any X-ray or CT procedures for the duration of the study period, and the transmitter was collected after expiration or removal. Glucometer data was collected from hospital records and home glucometer downloads. Mixed models were used to analyze absolute differences between matched CGM and glucometer values, and Clarke error grid analyses (EGA) were performed. Scatter dose exposure was derived using anthropomorphic phantoms and calculated retrospectively. RESULTS: A total of 14 patients (median 12.2 years, 64% female) received a median of five diagnostic imaging procedures with a median cumulative scatter dose of 559 Gy. The absolute difference between the CGM and glucometer values was not significantly associated with the cumulative scatter dose (=0.17) or time from TPIAT (=0.24) when analyzed in a mixed model. Regardless of scatter dose exposure, time from TPIAT, or glucometer, ≥98% of glucose values fell within zones A and B on EGA. CONCLUSION: Scatter dose exposure from diagnostic imaging did not affect the clinical accuracy of CGM values for the duration of transmitter use. Leaving CGM components in place when not in the FoV during diagnostic imaging successfully mitigated interruptions to use and undue burden or cost to participants.
Clinical Characteristics and Remission Monitoring of 6q24-Related Transient Neonatal Diabetes.
McCullough ME, Letourneau-Freiberg LR, Bowden TL … +7 more , Kandasamy B, Ray A, Wroblewski K, Del Gaudio D, Mackay DJG, Philipson LH, Greeley SAW
Pediatr Diabetes · 2024 · PMID 40302951 · Full text
Transient neonatal diabetes mellitus (TNDM) is a heterogeneous subtype of neonatal diabetes that usually presents within the first days or weeks of life, spontaneously remits in infancy, but can recur in childhood or ado...
Transient neonatal diabetes mellitus (TNDM) is a heterogeneous subtype of neonatal diabetes that usually presents within the first days or weeks of life, spontaneously remits in infancy, but can recur in childhood or adolescence as a permanent form of diabetes. Approximately 70% of TNDM cases are due to overexpression of genes at chromosome 6q24 (6q24-TNDM) caused by one of three potential mechanisms: paternal uniparental disomy (pUPD6), paternal duplication, or hypomethylation of the maternal allele. Our aim was to further elucidate the clinical characteristics of a relatively large group of individuals with this rare condition. Participants with a genetically confirmed diagnosis of 6q24-TNDM were identified through the University of Chicago Monogenic Diabetes Registry. Some participants had testing done on a clinical basis, with the remainder having received research-based genetic testing. Clinical information was extracted from survey responses and medical records. There were 33 participants with 6q24-TNDM (58% were male). Eight (24%) had hypomethylation of the maternal allele, seven (21%) had paternal duplication, 17 (52%) had pUPD6, and one individual had 6q24 hypomethylation of unknown etiology. The median age of initial diabetes presentation was 2 days ( = 33). Remission occurred at a median age of 3 months ( = 28). The median age of relapse was 14 years (range 12-31 years, = 9). The majority (71%) of participants were born small for gestational age and 32% of participants were born before 37 weeks gestation. The most common extra-pancreatic features were umbilical hernia (22%, = 6/27), macroglossia (56%, = 15/27), and speech pathologies (36%, = 10/28). No significant differences in clinical characteristics were identified across the three genetic etiologies (pUPD6, paternal duplication, maternal hypomethylation). Clinical characteristics were not different across underlying genetic mechanism groups, suggesting that genetic testing is required to definitively determine the mechanism and diagnosis of 6q24-TNDM. Clarification of the specific underlying mechanism is strongly encouraged to clarify recurrence risk, but whether these subcategories may have other clinically relevant differences remains to be elucidated. Early assessment for speech therapy should be considered for this patient population. We recommend that patients in remission be equipped to check blood glucose levels as needed, such as during illness, and should continue seeing a diabetes provider at least occasionally, especially around the time of puberty and thereafter.
Complications during Adolescence Predict Mortality in Young Adults with Childhood Onset Type 1 Diabetes.
Poon MS, Chan AKF, Cusumano JM … +2 more , Craig ME, Donaghue KC
Pediatr Diabetes · 2024 · PMID 40302950 · Full text
OBJECTIVE: Microvascular complications increase the risk of cardiovascular disease and premature death in adults with type 1 diabetes. We examined the association between microvascular complications during adolescence, i...
OBJECTIVE: Microvascular complications increase the risk of cardiovascular disease and premature death in adults with type 1 diabetes. We examined the association between microvascular complications during adolescence, including cardiac autonomic nerve dysfunction and subsequent mortality. . We undertook data linkage with the Australian National Death Index in a cohort of 409 adolescents (diagnosed between 1973 and 1993), 48% male, median age at final complications assessment 17.4 years (interquartile range: 16.0-18.9), followed longitudinally for median 22.3 years (21.0-23.4) from diagnosis. Generalized estimating equations (GEE) were used to examine associations between mortality and adolescent complications. Mortality risk was calculated as standardized mortality ratio (SMR). RESULTS: At final adolescent visit, 20% had CAN abnormality, 30% abnormal pupillary response, 20% albuminuria, 40% early elevation of albumin excretion rate (AER) and 45% retinopathy. Data linkage 8-13 years later showed 14 were deceased (3% of cohort), 57% male, median age 28.3 years (24.8-32.9). Acute or chronic diabetes complications accounted for 25% of deaths. In multivariable GEE, elevated AER (OR 4.54, 1.23-16.80, =0.030), pupillary abnormality (OR 4.27, 1.20-15.22, =0.023), systolic blood pressure SDS (OR 2.17, 1.26-3.74, =0.005) and CAN (OR 4.65, 1.03-21.0, =0.045) predicted mortality. HbA1c was not significant. SMR was 2.5 (1.4-4.2) and was higher in females (SMR 3.5, 1.3-7.8) but not in males (SMR 2.1, 0.9-4.0). CONCLUSION: Mortality in young adults with type 1 diabetes is predicted by subclinical markers of autonomic neuropathy and elevated AER during adolescence, but not glycemia. Mortality was over twice that of the background population in females but not in males.
Adolescent-Initiated Retrospective Glucose Data Review is Associated With Improved Glycemia in Type 1 Diabetes Mellitus.
Chenoweth DJ, Palmer BA, Norris AW … +2 more , Tansey MJ, Pinnaro CT
Pediatr Diabetes · 2024 · PMID 40302947 · Full text
Regular retrospective review of glucose data is an important aspect of type 1 diabetes (T1D) management. Continuous glucose monitors (CGMs) facilitate retrospective review by capturing glucose data and generating standar...
Regular retrospective review of glucose data is an important aspect of type 1 diabetes (T1D) management. Continuous glucose monitors (CGMs) facilitate retrospective review by capturing glucose data and generating standardized reports. However, only a minority of adults with T1D retrospectively review their glucose data, and adolescents are understudied. The objectives of this study were to determine the prevalence of self-reported retrospective glucose data review by adolescents with T1D, determine factors associated with self-reported retrospective glucose data review, and assess whether self-reported retrospective glucose data review was associated with improved glycemia. We conducted a cross-sectional survey of adolescents aged 12-18 years with T1D in conjunction with review of the associated electronic medical record, which included age, sex, date of diagnosis, clinic hemoglobin A1c (HbA1c), type of insurance, and CGM data. The survey included the Hypoglycemia Fear Survey (HFS) and questions regarding habits and attitudes associated with retrospective review. 112 out of 218 eligible individuals completed the survey (51%). Fifty-three percent of adolescents who completed the survey reported that they had engaged in retrospective glucose data review. Of these, 88% of individuals reported that they reviewed data regularly. Age, sex, race, type of insurance, and CGM use were not associated with retrospective review status. Self-report of retrospective glucose data review was associated with improved glycemia as measured by HbA1c and time in range (TIR) compared to adolescents who indicated they do not review glucose data (=0.006 and =0.04, respectively). There was no difference in HFS scores between reviewers and nonreviewers including the behavioral subscale, worry subscale, and total score. Self-report of retrospective glucose data review was associated with improved glycemia as measured by HbA1c and TIR. Adolescent-initiated glucose data self-review does not appear to be driven by fear of hypoglycemia (FoH).
Effectiveness of Educational and Psychoeducational Self-Management Interventions in Children and Adolescents With Type 1 Diabetes: A Systematic Review and Meta-Analysis.
Cockcroft EJ, Clarke R, Dias RP … +7 more , Lloyd J, Mann RH, Narendran P, Reburn C, Smith B, Smith JR, Andrews RC
Pediatr Diabetes · 2024 · PMID 40302946 · Full text
Type 1 diabetes (T1D) is one of the most common chronic conditions in children and adolescents. Approximately 1.5 million young people are currently living with T1D throughout the world. Despite recent improvement in ove...
Type 1 diabetes (T1D) is one of the most common chronic conditions in children and adolescents. Approximately 1.5 million young people are currently living with T1D throughout the world. Despite recent improvement in overall indices of metabolic control in children and adolescents with T1D, control remains suboptimal and additional approaches are needed. The aim of the study was to conduct a systematic review and meta-analysis of educational and psychoeducational self-management interventions, to help optimize future interventions including physical activity support. A systematic review and meta-analysis were conducted according to our registered protocol (PROSPERO CRD42022295932) and are reported in line with the PRISMA 2020 guidance. We searched five databases (MEDLINE, EMBASE, PsycINFO [via Ovid], CINAHL [via EBSCO], Cochrane Library) from 1994 up to May 2024. We included randomized controlled trials assessing the effectiveness of self-management interventions. Outcomes of interest included HbA1c and quality of life (QoL) as well as self-care behaviors, diabetes knowledge, and self-efficacy. Meta-analyses were conducted using a random effects model. In total, 46 papers were included, reporting on 30 interventions. Meta-analyses showed small short-term improvements in HbA1c (MD = -2.58 mmol/L, 95% CI -4.44 to -0.71, =0.007) and QoL (mean difference [MD] = 1.37, 95% CI 0.19-2.54, =0.02). Prespecified subgroup analyses suggested no significant difference in effectiveness of psychoeducational and education-only interventions. Quality of included studies was low with 27 having a high risk of bias. There is a lack of robust evidence that current self-management interventions result in clinically meaningful improvements in HbA1c and QoL. Future research should focus on redefining approaches to supporting and encouraging self-management.
Associations Between Arterial Stiffness and Metabolic Target in Children and Adolescents With Type 1 Diabetes Treated in a Modern Setting.
Damm JA, Dalgas-Madsen A, Bech AMK … +4 more , Pilgaard KA, Pociot F, Hansen TW, Johannesen J
Pediatr Diabetes · 2024 · PMID 40302945 · Full text
To investigate the prevalence of elevated arterial stiffness and associations to known and potentially novel risk factors in a modern European technology-based cohort of children and adolescents with type 1 diabetes. Cr...
To investigate the prevalence of elevated arterial stiffness and associations to known and potentially novel risk factors in a modern European technology-based cohort of children and adolescents with type 1 diabetes. Cross-sectional study, including 127 children recruited from Pediatric Diabetes Departments across Eastern Denmark between May 2022 and January 2024. Arterial stiffness was assessed as carotid-femoral pulse-wave-velocity (cfPWV) using the Sphygmocor XCEL system. Unadjusted and adjusted linear regression models explored associations between cfPWV and other risk factors. Adjustments included age, sex, diabetes duration, time-in-range, hemoglobin A1c (HbA1c), body mass index (BMI) -score, low-density lipoprotein (LDL)-cholesterol, and mean arterial pressure (MAP). Median (interquartile range [IQR]) age was 14.2 years (12.0, 16.4), diabetes duration was 4.7 years (2.7, 8.4), HbA1c level was 7.0% (6.5, 7.9), (53 mmol/l: 48-63), time-in-range was 63% (53-75), and 52% were male. The majority were treated with continuous-subcutaneous-insulin-infusion (82%), and all (except two) used continuous-glucose-monitors. The prevalence of elevated arterial stiffness (cfPWV -score over the 90th percentile) was 16%. Unadjusted analyses demonstrated higher cfPWV was associated with longer diabetes duration, higher age, HbA1c, MAP, and liver stiffness, and lower time-in-range and insulin sensitivity. Higher cfPWV remained associated with higher age (standardized (confidence interval (CI) 95%): 0.38 (0.27, 0.48); < 0.001) and lower time-in-range (-0.15 ((-0.26), (-0.03)); < 0.011) after adjustment. Despite modern treatment technology and better overall metabolic control, children and adolescents with type 1 diabetes present with a high prevalence of elevated arterial stiffness. Higher arterial stiffness was associated with higher age and lower time-in-range, independent of other risk factors, including HbA1c.
Adolescents and Young Adults with Type 1 Diabetes Present Changes in Arterial Compliance and Resistance and Increased Arterial Stiffness.
Carvalho-Ribeiro IA, Cunha LCF, Ribeiro LR … +6 more , Lima MN, Ferreira-Silva BA, S Rajão J, Bittencourt JC, F A Pinheiro J, Rodrigues-Machado MDG
Pediatr Diabetes · 2024 · PMID 40302944 · Full text
INTRODUCTION: Cardiovascular disease (CVD) is highly prevalent in patients with type 1 diabetes (T1DM) and is responsible for a significant reduction in life expectancy. OBJECTIVE: To compare the arterial stiffness indic...
INTRODUCTION: Cardiovascular disease (CVD) is highly prevalent in patients with type 1 diabetes (T1DM) and is responsible for a significant reduction in life expectancy. OBJECTIVE: To compare the arterial stiffness indices, arterial compliance and vascular resistance assessed centrally and peripherally between healthy adolescents and young adults (CTRL group) and those with T1DM. METHODS: This is an observational cross-sectional study involving 90 adolescents and young adults, with half of them being considered healthy ( = 45) and the other half with T1DM ( = 45), matched by age and sex. Cardiovascular parameters were evaluated using the oscillometric method of brachial artery pressure assessment for a noninvasive estimation of central arterial pressures. RESULTS: Weight and body mass index were significantly higher in the T1DM group. AIx@75 was significantly higher in the T1DM group (24.96% ± 8.88%) compared to the CTRL (20.16% ± 9.95%). Peripheral and central arterial compliance were significantly lower in the T1DM group (0.79 ± 0.21; 1.16 ± 0.27 ml/m/mmHg) compared to the CTRL (0.98 ± 0.32; 1.47 ± 0.61 ml/m/mmHg). Peripheral and central vascular resistance were significantly higher in the T1DM group (1.32 ± 0.32; 0.91 ± 0.21 mmHg/ml/m) compared to the CTRL (1.11 ± 0.30; 0.75 ± 0.22 mmHg/ml/m). CONCLUSION: Our data confirm premature aging of the vascular system in adolescents and young adults with T1DM and extend our knowledge by showing important changes in central and peripheral hemodynamics indices.
Preterm Labor and Hypertensive Disorders in Adolescent Pregnancies With Diabetes Between 2006 and 2019.
Everett E, Han CS, Richley M … +3 more , Copeland TP, Moin T, Wisk LE
Pediatr Diabetes · 2024 · PMID 39872023 · Full text
OBJECTIVE: We sought to evaluate the risk of preterm labor and hypertensive disorders in adolescent pregnancies with and without diabetes. METHODS: We evaluated 1,843,139 adolescents (≤20 years old) with labor and delive...
OBJECTIVE: We sought to evaluate the risk of preterm labor and hypertensive disorders in adolescent pregnancies with and without diabetes. METHODS: We evaluated 1,843,139 adolescents (≤20 years old) with labor and delivery admissions in the national Kids' Inpatient Database (KID) in years 2006, 2009, 2012, 2016, and 2019. International classification of disease codes was used to identify diabetes and medical factors affecting pregnancy. Weighted logistic regression was used to evaluate the association between diabetes and complications. RESULTS: Among admissions, 0.2% had type 1 diabetes (T1D), 0.2% had type 2 diabetes (T2D), and 0.7% had gestational diabetes (GDM); 10.1% of admissions were complicated by hypertensive disorders and 5.8% by preterm labor. Compared to adolescents without diabetes, those with diabetes had a higher prevalence of hypertensive disorders (T1D: 35.4%, T2D: 37.8%, GDM: 24.9%, None: 9.9%; <0:001) and preterm labor (T1D: 21.5%, T2D: 16.8%, GDM: 6.8%, none: 5.7%; <0:001). In adjusted models, odds of hypertensive disorders were higher in later study years (2019 vs. 2006 OR 1.85, 95% CI 1.77-1.94), among those with T1D (OR 4.32, 95% CI 3.94-4.74), with T2D (OR 4.18, 95% CI 3.79-4.61), and with GDM (OR 1.99, 95% CI 1.89-2.10). Adjusted odds of preterm labor were higher among those with T1D (OR 4.53, 95% CI 4.09-5.02), with T2D (OR 3.35, 95% CI 2.96-3.78), and with GDM (OR 1.18, 95% CI 1.08-1.28); disparities were seen by race/ethnicity, insurance, and income. CONCLUSIONS: Diabetes, which is increasing among adolescents, is a significant risk factor for preterm labor and hypertensive disorders. Though the absolute number of adolescent pregnancies is decreasing, rates of hypertensive disorders have increased. Appropriate interventions are needed to ensure healthy outcomes for adolescents who are pregnant.
The Reproducibility and Reliability of Insulin Sensitivity and Secretion Indices in Children and Adolescents.
Hani NS, Vajravelu ME, Meijer JL … +4 more , McCaffery H, Sturza J, Dhadphale E, Lee JM
Pediatr Diabetes · 2024 · PMID 39726936 · Full text
CONTEXT: Insulin sensitivity and secretion indices can be useful tools in understanding insulin homeostasis in children at risk for diabetes. There have been few studies examining the reproducibility of these measures in...
CONTEXT: Insulin sensitivity and secretion indices can be useful tools in understanding insulin homeostasis in children at risk for diabetes. There have been few studies examining the reproducibility of these measures in pediatrics. OBJECTIVE: To determine whether fasting or oral glucose tolerance test (OGTT)-derived insulin measures would be more reproducible and whether there would be differences based on weight, sex, race, and pubertal status. DESIGN: Observational study. SETTING: Clinical research unit. PATIENTS OR OTHER PARTICIPANTS: Two hundred fifty-seven overweight/obese (BMI ≥ 85th%, = 186) and normal weight (BMI < 85th%, = 71) children without diabetes between ages of 8 and 17 were included in the study. METHODS: OGTT tests performed in study participants at two separate visits within a 3-week period. We performed two formal oral glucose tolerance tests within a 3-week period. The reproducibility of fasting measures was compared with OGTT-derived measures by weight categories and compared by weight, sex, race, and pubertal status. Comparisons were made between the correlation coefficients of fasting vs. OGTT-derived measures and between normal weight vs. obese/overweight participants, male vs. female, White vs. Black, and pre- vs. post-midpubertal. Intraclass correlation coefficients were calculated for each comparison as well. RESULTS: For insulin sensitivity, the OGTT-derived measure was more reproducible than the fasting measures. There were no significant differences in reproducibility in the overweight/obese population compared to the normal weight population nor by sex, race, or pubertal status. CONCLUSIONS: Nonfasting insulin sensitivity measures are more reproducible than fasting insulin sensitivity measures, regardless of weight category. Insulin secretion measures have poor reproducibility overall. Weight status, sex, race, and midpubertal stage do not impact the reproducibility of insulin sensitivity and secretion measures.
High Prevalence of Ketosis-Prone Diabetes in Children with Type 2 Diabetes and Diabetic Ketoacidosis at Diagnosis: Evidence from the Rare and Atypical Diabetes Network (RADIANT).
Kubota-Mishra E, Huang X, Minard CG … +11 more , Astudillo M, Refaey A, Montes G, Sisley S, Ram N, Winter WE, Naylor RN, Balasubramanyam A, Redondo MJ, Tosur M, RADIANT Study Group
Pediatr Diabetes · 2024 · PMID 38765897 · Full text
BACKGROUND: ketosis-prone diabetes (KPD) in adults is characterized by presentation with diabetic ketoacidosis (DKA), negative islet autoantibodies, and preserved -cell function in persons with a phenotype of obesity-as...
BACKGROUND: ketosis-prone diabetes (KPD) in adults is characterized by presentation with diabetic ketoacidosis (DKA), negative islet autoantibodies, and preserved -cell function in persons with a phenotype of obesity-associated type 2 diabetes (T2D). The prevalence of KPD has not been evaluated in children. We investigated children with DKA at "T2D" onset and determined the prevalence and characteristics of pediatric KPD within this cohort. METHODS: We reviewed the records of 716 children with T2D at a large academic hospital and compared clinical characteristics of those with and without DKA at onset. In the latter group, we identified patients with KPD using criteria of the Rare and Atypical Diabetes Network (RADIANT) and defined its prevalence and characteristics. RESULTS: Mean age at diagnosis was 13.7 ± 2.4 years: 63% female; 59% Hispanic, 29% African American, 9% non-Hispanic White, and 3% other. Fifty-six (7.8%) presented with DKA at diagnosis and lacked islet autoantibodies. Children presenting with DKA were older and had lower C-peptide and higher glucose concentrations than those without DKA. Twenty-five children with DKA (45%) met RADIANT KPD criteria. They were predominantly male (64%), African American or Hispanic (96%), with substantial C-peptide (1.3 ± 0.7 ng/mL) at presentation with DKA and excellent long-term glycemic control (HbA1c 6.6% ± 1.9% at follow-up (median 1.3 years postdiagnosis)). CONCLUSIONS: In children with a clinical phenotype of T2D and DKA at diagnosis, approximately half meet criteria for KPD. They manifest the key characteristics of obesity, preserved -cell function, male predominance, and potential to discontinue insulin therapy, similar to adults with KPD.
Excess Mortality in an Inception Cohort of Childhood Diabetes Diagnosed 1990-2010.
Lain SJ, Stevens L, Craig ME … +5 more , Jenkins AJ, Bell KJ, Pryke A, Donaghue KC, Nassar N
Pediatr Diabetes · 2024 · PMID 40302973 · Full text
OBJECTIVE: Evaluate the mortality risk of childhood-onset type 1 diabetes compared to the general population. . The study population, identified from the Australasian Paediatric Endocrinology Group diabetes register, was...
OBJECTIVE: Evaluate the mortality risk of childhood-onset type 1 diabetes compared to the general population. . The study population, identified from the Australasian Paediatric Endocrinology Group diabetes register, was diagnosed with type 1 diabetes at age < 16 in New South Wales (NSW), Australia, from 1990 to 2010. The register was linked to National Death Index registrations to ascertain timing and cause of death up to 31/12/2022. Risk factors for mortality were assessed using multivariable Cox regression models and observed mortality rate compared to "expected" rates in the Australian general population using indirect-standardized mortality ratios (SMR), overall and by sex and age at diagnosis. Diabetes-related cause of death categories were identified. RESULTS: Of 5,417 children diagnosed with type 1 diabetes, 157 subsequently died, with all-cause mortality of 1.37/1,000 person years. Increased mortality risk was associated with living in most disadvantaged areas (aHR 1.81 (1.05, 3.11)) but not living in a rural area. Overall SMR was 2.83 (95% CI 2.40, 3.33) with females having higher SMR than males (4.18 vs. 2.19). Most common causes of death recorded were acute diabetes complications (26%), including diabetes ketoacidosis, accident/misadventure (21%), and chronic diabetes complications (15%). Alcohol and/or drug use contributed to 17% of deaths. CONCLUSION: Compared to the general population, higher risk of mortality in people with type 1 diabetes was associated with female sex and living in area of socioeconomic disadvantage. Education about minimizing risk-taking behaviors should be communicated to young adults with type 1 diabetes.
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