Pediatric Diabetes[JOURNAL]
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200 papers
Elevated Serum IgA at Onset of Type 1 Diabetes in Children.
Thakkar A, Huang X, Wang J … +5 more , Hwu K, Chinn IK, Minard C, Hajjar J, Redondo MJ
Pediatr Diabetes · 2024 · PMID 40302948 · Full text
BACKGROUND: Elevated serum IgA levels have been observed in various autoimmune conditions, including type 1 diabetes (T1D). However, whether children with T1D and elevated serum IgA have unique features has not been stud...
BACKGROUND: Elevated serum IgA levels have been observed in various autoimmune conditions, including type 1 diabetes (T1D). However, whether children with T1D and elevated serum IgA have unique features has not been studied. We aimed to evaluate the prevalence and characteristics associated with elevated serum IgA at the onset of pediatric T1D. MATERIALS AND METHODS: We analyzed demographic, clinical, and laboratory data retrospectively collected from 631 racially diverse children (6 months-18 years of age) with T1D who had serum IgA levels measured within 90 days of T1D diagnosis. Univariable and multivariable logistic regression models were used to identify characteristics that were significantly associated with elevated versus normal IgA. RESULTS: Elevated serum IgA was present in 20.3% (128/631) of the children with newly diagnosed T1D. After adjusting for other variables, A1c level (=0.029), positive insulin autoantibodies (IAA) (=0.041), negative glutamic acid decarboxylase autoantibodies (GADA) (=0.005) and Hispanic ethnicity ( < 0.001) were significantly associated with elevated serum IgA. After adjustment for confounders, the odds of elevated serum IgA were significantly increased with positive IAA (OR 1.653, 95% CI 1.019-2.679), higher HbA1c (OR 1.132, 95% CI 1.014-1.268) and Hispanic ethnicity (OR 3.279, 95% CI 2.003-5.359) but decreased with GADA positivity (OR 0.474, 95% CI 0.281-0.805). CONCLUSIONS: Elevated serum IgA is present in 20.3% of the children at T1D onset and is associated with specific demographic and clinical characteristics, suggesting a unique pathogenesis in a subset of individuals. Further studies are warranted to investigate the IgA response, its role in T1D pathogenesis, and whether these associations persist over time.
The Prevalence and Associated Factors of Impaired Fasting Glucose among Children and Adolescents in Urban China: A Large-Scale Cross-Sectional Study.
Huang F, Lin Z, Lu Y … +4 more , Zhou Y, Zhu L, Wang X, Zhu Y
Pediatr Diabetes · 2024 · PMID 40302960 · Full text
This study aimed to investigate the level of fasting plasma glucose (FPG), the prevalence of impaired fasting glucose (IFG), and the associated factors among children and adolescents in urban China. Based on a cross-sect...
This study aimed to investigate the level of fasting plasma glucose (FPG), the prevalence of impaired fasting glucose (IFG), and the associated factors among children and adolescents in urban China. Based on a cross-sectional study conducted in three Chinese metropolises during 2013-2014, this analysis included 7,143 participants aged 7-18 years. Information on demographics, family environment, diet, and physical activity was collected by questionnaires. Anthropometric parameters and blood biochemical indicators were measured. Logistic regression models were applied to assess risk factors of glucose level. Results revealed that the average FPG level was 4.81 ± 0.53 mmol/L, and the prevalence of IFG was 3.3%. Trends of these two variables varied significantly with age increasing (all < 0.001), reaching double peaks at 10-12 and 15-17 years. IFG was positively associated with the male sex, age increasing, obesity, higher triglyceride (TG) levels, and living in northern China. When stratified by sex, family history of diabetes, elevated total cholesterol levels, and higher intake of sugar-sweetened beverages were positively associated with IFG only in females, suggesting these parameters were female-specific risk factors of IFG. We concluded that the prevalence of IFG among children and adolescents aged 7-18 years in urban China was higher than that reported in previous regional studies and was associated with obesity and higher levels of TG. Therefore, sex-specific lifestyle interventions should be provided to promote healthy weight and lipids and stem the upward trend of IFG.
Detection of Islet Autoantibodies in Whole Blood by Antibody Detection by Agglutination-PCR (ADAP) Technology Is Sensitive and Suitable for General Population Screening Programs.
Oron T, Cortez FJ, Shtaif B … +7 more , Robinson PV, Yackobovitch-Gavan M, Tandel D, Seftel D, Phillip M, Tsai CT, Gat-Yablonski G
Pediatr Diabetes · 2024 · PMID 40302965 · Full text
BACKGROUND: Detection of type 1 diabetes (T1D) at the preclinical stage is possible by detecting islet autoantibodies (IAs) years before the appearance of symptomatic diabetes. The Antibody Detection Israeli Research is...
BACKGROUND: Detection of type 1 diabetes (T1D) at the preclinical stage is possible by detecting islet autoantibodies (IAs) years before the appearance of symptomatic diabetes. The Antibody Detection Israeli Research is a general population screening program searching for children with multiple IAs who are at risk of developing T1D. IAs are measured in capillary or venous whole blood (WB) samples using the novel ultrasensitive antibody detection by agglutination-PCR (ADAP) technology. OBJECTIVE: To assess the accuracy and reliability of the ADAP assay in venous and capillary WB. MATERIALS AND METHODS: In total, 50 children with T1D and 50 healthy controls participated in the study. Venous and capillary blood samples were drawn from participants with T1D, while only venous blood was drawn from the controls. The ADAP assay in venous and capillary blood was compared to the currently used assays in their ability to detect glutamic acid decarboxylase (GADA), islet antigen-2 (IA-2A), and insulin autoantibodies (IAAs). RESULTS: The area under the curve using the receiver operating characteristic curves was comparable between the ADAP assay in WB and standard enzyme-linked immunosorbent assay (ELISA)/radioimmunoassay (RIA) for all three IAs GADA 0.946 (95% CI: 0.900-0.991) vs. 0.949 (0.906-0.992), =0.873; IA-2A 0.747 (0.649-0.844) vs. 0.666 (0.587-0.744), =0.106; IAA 1.000 (1.000-1.000) vs. 1.000 (1.000-1.000), =1.000. The correlation between the levels of IA in venous and capillary WB using ADAP was = 0.958 ( < 0.01), = 0.943 ( < 0.01), and = 0.711 ( < 0.01) for GADA, IA-2A, and IAA, respectively. IA levels in venous and capillary WB using ADAP were comparable without a proportional bias in Bland-Altman's plots of agreement, suggesting the two methods may be used interchangeably. CONCLUSIONS: The ADAP assay is reliable in detecting IA in venous and capillary WB samples with comparable performance to standard RIA and ELISA. These findings open avenues for widespread use of the ADAP assay in future general population screening programs to detect children at risk of developing T1D.
A Late Meal Timing Pattern Is Associated with Insulin Resistance in European Children and Adolescents.
Intemann T, Bogl LH, Hunsberger M … +8 more , Lauria F, De Henauw S, Molnár D, Moreno LA, Tornaritis M, Veidebaum T, Ahrens W, Hebestreit A
Pediatr Diabetes · 2024 · PMID 40302964 · Full text
Meal timing has been associated with metabolic markers in adults, but not in children or adolescents. The aim of this study was to investigate associations of meal timing patterns (MTPs) with insulin resistance (IR) and...
Meal timing has been associated with metabolic markers in adults, but not in children or adolescents. The aim of this study was to investigate associations of meal timing patterns (MTPs) with insulin resistance (IR) and triglyceride levels in children and adolescents. In this cross-sectional study, we included 2,195 participants aged 8-15 years from the European I.Family study (2013/14). Habitual diet exposures were derived using 24-hr dietary recalls and HOMA-IR, HbA1c, and triglycerides were used as metabolic outcome variables. We applied -means cluster analysis on five dietary exposures (energy proportion in the morning and evening, eating window, pre-sleep fasting and eating frequency), which revealed the following three MTPs: "early-often", "late-long" and "late-infrequent-short". We used linear mixed models to estimate the associations between MTPs and the -scores of the metabolic outcome variables. The association analysis revealed differences between MTPs in HOMA-IR but not in HbA1c or triglyceride -scores. The "late-infrequent-short" pattern was associated with a 0.19 (95%-CI: (0.01, 0.36)) higher HOMA-IR -score compared to the "early-often" pattern in the model adjusted for age, BMI -score, education, sex, country, and family membership. These findings suggest that the timing of meals may influence IR already in childhood and adolescence. Therefore, the time of meals should be considered in future nutrition research and dietary advice for children and adolescents.
Type 1 Diabetes and Other Autoimmune Disorders in Children.
Grasso EA, Chiarelli F
Pediatr Diabetes · 2024 · PMID 40302955 · Full text
The incidence of autoimmune disorders (AIDs) has been dramatically increasing in both children and adults over the past few years, and type 1 diabetes (T1D) is one of the diseases that has seen the highest growth. It is...
The incidence of autoimmune disorders (AIDs) has been dramatically increasing in both children and adults over the past few years, and type 1 diabetes (T1D) is one of the diseases that has seen the highest growth. It is well-known that the dysimmune process may spread to other systems, leading to the onset of one or more AIDs in the same individual; however, the relationship between AIDs is not often recognized. The most frequently diagnosed AIDs in children and adolescents with T1D are thyroid diseases and celiac disease, but it is also important to consider the onset of the other conditions, such as juvenile idiopathic arthritis, multiple sclerosis, atrophic gastritis, inflammatory bowel diseases, and skin disorders such as vitiligo and psoriasis. This review aims to explore the overlap of T1D and other AIDs, focusing on the less common and lesser-known diseases. A better knowledge of these comorbidities may facilitate the identification of patients at risk to treat them in the preclinical period, before the onset of complications.
Developing a General Population Screening Programme for Paediatric Type 1 Diabetes: Evidence from a Qualitative Study of the Perspectives and Attitudes of Parents.
Quinn LM, Narendran P, Bhavra K … +4 more , Boardman F, Greenfield SM, Randell MJ, Litchfield I
Pediatr Diabetes · 2024 · PMID 40302975 · Full text
INTRODUCTION: With reliable tests and preventative treatments now available the United Kingdom has introduced a prototype population-based paediatric (ages 3-13) screening programme for type 1 diabetes (T1D). To aid its...
INTRODUCTION: With reliable tests and preventative treatments now available the United Kingdom has introduced a prototype population-based paediatric (ages 3-13) screening programme for type 1 diabetes (T1D). To aid its ethical and sustainable implementation this work explores parental views around the concept of this programme to determine how their involvement might be encouraged and supported. . Qualitative interviews were undertaken with 38 parents and the data were analysed using a purposely developed "Burden of Screening" framework, which presented the data within three domains describing the various elements of screening participation; pre-screening tasks designated to participants; factors influencing engagement with screening; and consequences of screening partici. RESULTS: Regarding , the importance of clear communication about the condition were apparent with parents expressing uncertainty of the benefits of screening against the potential anxiety engendered. In participants described their preference for less invasive testing techniques, the reassurance of structured support from healthcare professionals inherent within the programme, and the potential benefit of peer support. Regarding the parents described how a positive result might lead to overly protective behaviours, and anxiety from watching and waiting for the onset of symptomatic T1D. CONCLUSIONS: The benefits of T1D screening need to be clearly communicated to facilitate uptake. To this end the use of decision-support tools and better targeted educational materials should be explored. Post-testing, parents expressed preferences for peer support and access to psychological counselling.
Incidence, Phenotypes, and Genotypes of Neonatal Diabetes: A 16-Year Experience. The Rare Genetic Etiologies of Neonatal Diabetes Are Common in Sudan.
Hassan SS, Musa SA, De Franco E … +6 more , Donis Frew R, Babiker OO, Mohamadsalih GF, Ibrahim AA, Abu Samra S, Abdullah MA
Pediatr Diabetes · 2024 · PMID 40302952 · Full text
Neonatal diabetes (ND) is a rare subtype of diabetes occurring in the first 6 months of life. High incidence has been reported among populations with high rates of consanguineous marriage. However, there is paucity of re...
Neonatal diabetes (ND) is a rare subtype of diabetes occurring in the first 6 months of life. High incidence has been reported among populations with high rates of consanguineous marriage. However, there is paucity of reported data from sub-Saharan African countries. We report the incidence, genotype, and phenotype of ND in a large cohort from Sudan and compare these findings to regional and international data. All infants with onset of diabetes in the first 6 months of life, attending one of the only two tertiary pediatric diabetes centers in Sudan, Gaafar Ibn Auf Pediatric Tertiary Hospital and Sudan Childhood Diabetes Center, during the period of January 2006 to December 2022 were included. Medical records were reviewed for demographic and clinical information. Genetic testing was performed for 48 patients by the Exeter Genomics laboratory in the UK and for one patient by the University of Cambridge, Metabolic Research Laboratories, UK. The estimated incidence was 4.8 per 100,000 live births. Forty-nine ND patients from 45 unrelated families were identified, and a genetic diagnosis was confirmed in 37 patients (75.5%) from 33 unrelated families. Consanguinity was reported in 34 families (75.6%). The commonest genetic cause for permanent neonatal diabetes was recessive variants causing Wolcott-Rallison syndrome (18.92%). Pathogenic variants in two recently identified genes, and , were found in three patients each (8.11%). Activating variants in and were identified in four (10.81%) and two (5.41%) patients, respectively. Apart from hyperglycemia, the commonest clinical presentations included dehydration, failure to thrive, and diabetic ketoacidosis. ND in Sudan has a different pattern of etiologies compared to Western and Asian populations yet similar to some Arab countries with mutations being the commonest cause. Pathogenic variants in recently identified genes reflect the impact of genome sequencing on increasing the rate of genetic diagnosis.
The Impact of Expanding Diabetes Services on the Trend of Glycemic Control in Children and Adolescents with Type 1 Diabetes.
Alissa N, Alhumaidi S, Alzaid S … +3 more , Aldibasi O, Alfaraidi H, Almutair A
Pediatr Diabetes · 2024 · PMID 40302971 · Full text
OBJECTIVES: Our aim is to evaluate the impact of initiating a specialized children's hospital and expanding the diabetes service for children with type 1 diabetes (T1D) on their glycemic control and on acute-diabetes-rel...
OBJECTIVES: Our aim is to evaluate the impact of initiating a specialized children's hospital and expanding the diabetes service for children with type 1 diabetes (T1D) on their glycemic control and on acute-diabetes-related complications over a 4-year follow-up period. METHODS: This was a retrospective cohort study that included children aged 1-16 years with T1D, diagnosed for at least 1 year, and treated with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). The study period extended from January 1, 2016 to December 31, 2019. Outcomes included the trend of glycemic control measured by HgbA1c and acute-diabetes-related complications, such as hypoglycemia, hyperglycemia, and diabetic ketoacidosis (DKA), reflected by the number of emergency room (ER) visits. Additionally, the number of visits per patient per year was captured over the 4-year study period. RESULTS: Four hundred ninety-nine patients with T1D were included in the study (48.9% female). The mean age was 13.4 years (±2.0) in the CSII group and 12.4 years (±2.2) in the MDI group. Three thousand nine hundred and six visits were reviewed, with 618 in the CSII group and 3,288 in the MDI group. The mean hemoglobin A1c (HgbA1c) for the whole cohort was 10.56% at the start of the study period in 2016 and dropped by 0.67% to a mean of 9.89% in 2019 (-value = 0.025). There was a 0.67% decline in the HgbA1c of the MDI group and a 0.47% decrease in the CSII group (=<0.001). The average number of clinic visits per patient per year increased from 2.6 in 2016 to 2.8 in 2019. ER visits slightly decreased throughout the 4-year period (-value = 0.46). CONCLUSION: Increased accessibility of the diabetes care team to children and adolescents with T1D and their families, with more frequent contact with team members, contributes significantly to the improvement of glycemic control.
Adverse Social Determinants of Health in Children with Newly Diagnosed Type 1 Diabetes: A Potential Role for Community Health Workers.
Lai CW, Craven M, Hershey JA … +2 more , Lipman TH, Hawkes CP
Pediatr Diabetes · 2024 · PMID 40302949 · Full text
OBJECTIVE: There are significant socioeconomic and racial disparities in glycemic control among children with type 1 diabetes (T1D). Community health workers (CHWs) have been shown to improve outcomes in marginalized, hi...
OBJECTIVE: There are significant socioeconomic and racial disparities in glycemic control among children with type 1 diabetes (T1D). Community health workers (CHWs) have been shown to improve outcomes in marginalized, high-risk populations. The purpose of this qualitative study was to describe the prevalence and the impact of adverse social determinants of health (SDOH) on diabetes care soon after a diagnosis of pediatric T1D, and investigate the potential supportive role of a CHW. . Caregivers of youth <17-year old, with new onset T1D, and government insurance at the time of diagnosis were enrolled. Baseline demographic and SDOH questionnaires were administered at the time of enrollment. Semistructured interviews were performed at 3 months after diagnosis to explore the effect of SDOH on diabetes care and the impact of a CHW. RESULTS: Seventeen caregivers were enrolled, 10 were randomly assigned to a CHW. Two-thirds of caregivers identified at least one SDOH need at enrollment; 35% of caregivers identified two SDOH needs. Interviews revealed that the two major themes identified as barriers to diabetes care were caregivers' employment and financial issues. Social support was identified as a facilitator. The transition from hospital to home after the diagnosis of T1D was improved for families working with a CHW, and the CHW was identified as a strong source of support. CONCLUSIONS: There is a high prevalence of adverse SDOH in families from lower socioeconomic status at the time of diagnosis of pediatric T1D. These SDOH have a significant impact on families' abilities to care for their children. Preliminary data suggest that CHWs can be a facilitator to the diabetes care. This trial is registered with NCT04238949.
Assessing Risk Classification in Medication-Induced Diabetes during Induction Therapy in Pediatric Acute Lymphoblastic Leukemia.
Ross K, Kulkarni K, MacDonald T … +1 more , Pinto T
Pediatr Diabetes · 2023 · PMID 40303251 · Full text
Medication-induced diabetes (MID) is common during induction therapy for pediatric acute lymphoblastic leukemia (ALL) and has potentially significant negative consequences. Reported risk factors for MID are variable with...
Medication-induced diabetes (MID) is common during induction therapy for pediatric acute lymphoblastic leukemia (ALL) and has potentially significant negative consequences. Reported risk factors for MID are variable with limited data comparing patients treated with standard-risk (SR) vs. high-risk (HR) regimens. This study aims to evaluate the incidence and risk factors for MID during induction in patients with ALL from the Maritimes over a 20-year period. We performed a retrospective single-center study of 262 patients (142 males, 120 females) diagnosed with ALL at IWK Health in Halifax, Nova Scotia, Canada, from 2000 to 2019. Older age, higher body mass index, greater central nervous system status, Trisomy 21, and prednisone steroid type were risk factors associated with MID in our cohort. HR patients developed significantly more complications than SR patients including MID and infection. Screening for MID should be routine during ALL induction treatment, particularly in those with HR disease.
Extremely Early Appearance of Islet Autoantibodies in Genetically Susceptible Children.
Kyrönniemi A, Valtanen T, Koskenniemi J … +6 more , Vähäsalo P, Härkönen T, Ilonen J, Toppari J, Knip M, Veijola R
Pediatr Diabetes · 2023 · PMID 40303239 · Full text
OBJECTIVE: We studied the characteristics of children who developed islet autoantibodies by the age of 0.50 years and hypothesized that the appearance of extremely early islet autoimmunity differs between four birth coho...
OBJECTIVE: We studied the characteristics of children who developed islet autoantibodies by the age of 0.50 years and hypothesized that the appearance of extremely early islet autoimmunity differs between four birth cohorts within 1994-2019 according to the change in the incidence of Type 1 diabetes (T1D) in Finland. METHODS: Data from Finnish children participating in the Type 1 Diabetes Prediction and Prevention (DIPP) study, or the Environmental Determinants of Diabetes in the Young (TEDDY) study were analyzed. These studies follow children with increased HLA-conferred risk for T1D with regular measurements of islet autoantibodies. Maternally transferred antibodies were excluded by comparing islet autoantibodies in cord serum, child's first follow-up serum and the maternal serum. RESULTS: Among 20,979 Finnish children at increased risk to T1D, 53 (0.25%) developed at least one islet autoantibody at the age of ≤0.50 years. During a mean follow-up of 8.1 years, 15.1% progressed to T1D (median age at diagnosis 2.0 years), 43.4% developed confirmed islet autoimmunity but no T1D, and 41.5% had only transient islet autoantibodies. IAA was the most common first-appearing autoantibody. Among progressors, age at diagnosis was 1.0-2.4 years in children with IAA-initiated autoimmunity and 4.5-16.1 years in ZnT8A-initiated autoimmunity. When comparing children developing autoantibodies either at the age of ≤0.50 years or 0.51-0.75 years, confirmed positivity during follow-up was more common in the older group (81.7% vs. 58.5%; =0.002). In four birth cohorts within 1994-2019 appearance of islet autoantibodies at the age of ≤0.50 years decreased towards the most recent birth cohorts (=0.016). CONCLUSION: Islet autoimmunity by the age of 0.50 years was rare in genetically susceptible children and was typically initiated with IAA. Confirmed positivity was less common in children with autoantibodies at age ≤0.50 than at slightly older age. The secular decrease of islet autoimmunity before age 0.50 years was observed. This trial is registered with NCT03269084 and NCT00279318.
Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic.
Azova S, Liu E, Wolfsdorf J
Pediatr Diabetes · 2023 · PMID 38050487 · Full text
The incidence of pediatric diabetic ketoacidosis (DKA) increased during the peak of the COVID-19 pandemic. The objective of this study was to investigate whether rates of hyperosmolar therapy administration for suspected...
The incidence of pediatric diabetic ketoacidosis (DKA) increased during the peak of the COVID-19 pandemic. The objective of this study was to investigate whether rates of hyperosmolar therapy administration for suspected clinically apparent brain injury (CABI) complicating DKA also increased during this period as compared to the three years immediately preceding the pandemic and to compare the characteristics of patients with suspected CABI before the pandemic, patients with suspected CABI during the peak of the pandemic, and those with DKA but without suspected CABI during the pandemic. Patients aged ≤18 years presenting with DKA before (March 11, 2017-March 10, 2020) and during the peak of the pandemic (March 11, 2020-March 10, 2021) were identified through a rigorous search of two databases. Predefined criteria were used to diagnose suspected CABI. Biochemical, clinical, and sociodemographic data were collected from a comprehensive review of the electronic medical record. The proportion of patients with DKA who received hyperosmolar therapy was significantly higher ( = 0.014) during the pandemic compared to the prepandemic period; however, this was only significant among patients with newly diagnosed diabetes. Both groups with suspected CABI had more severe acidosis, lower Glasgow Coma Scale scores, and longer hospital admissions (< 0.001 for all) than cases without suspected CABI. During the pandemic, the blood urea nitrogen concentration was significantly higher in patients with suspected CABI than those without suspected CABI, suggesting they were more severely dehydrated. The clinical, biochemical, and sociodemographic characteristics of patients with suspected CABI were indistinguishable before and during the pandemic. In conclusion, administration of hyperosmolar therapy for suspected CABI was more common during the peak of the COVID-19 pandemic, possibly a result of delayed presentation, highlighting the need for increased awareness and early recognition of the signs and symptoms of diabetes and DKA, especially during future surges of highly transmissible infections.
Macronutrient Intake in Children and Adolescents with Type 1 Diabetes and Its Association with Glycemic Outcomes.
Fisher EL, Weaver NA, Marlow AL … +2 more , King BR, Smart CE
Pediatr Diabetes · 2023 · PMID 40303278 · Full text
AIMS: This study aimed to identify the quantity and range of protein, fat, and carbohydrate consumed in meals and snacks in children with Type 1 diabetes (T1D), and to explore associations between the variability in fat...
AIMS: This study aimed to identify the quantity and range of protein, fat, and carbohydrate consumed in meals and snacks in children with Type 1 diabetes (T1D), and to explore associations between the variability in fat and protein intakes with the glycemic outcomes. METHODS: This was a cross-sectional dietary study of children 6-18 years attending pediatric diabetes service in Australia. Three-day weighed food records were analyzed for the macronutrient intake. Impacts of dietary intake on glycemic outcomes were explored. RESULTS: Forty-eight children (63% male) aged 11.7 ± 2.9 (mean ± SD) with HbA1c 6.7 ± 1.1% (mmol/mol), BMI -score 0.51 ± 0.83, and daily insulin dose 0.99 units/kg completed 3-day weighed food records. Mean intakes at breakfast were 47-g carbohydrate, 15-g protein, and 12-g fat. Lunch: 49-g carbohydrate, 19-g protein, and 19-g fat. Dinner: 57-g carbohydrate, 33-g protein, and 26-g fat. Fifty-five percent ( = 80) of the dinner meals met criteria for a high-fat, high-protein (HFHP) meal. In a subset ( = 16) of participants, exploratory analysis indicated a trend of reduced %TIR (58%) in the 8 hr following HFHP dinner, compared to %TIR (74%) following non-HFHP dinner (=0.05). Seventy-eight percent of the participants aged 12-18 years intake at dinner varied by more than 20-g fat or more than 25-g protein. There was no association between the variability in fat and protein intake at dinner with HbA1c. Saturated fat contributed to 14.7% (±3.0) of participants energy intake. CONCLUSIONS: Children with T1D frequently consume quantities of fat and protein at dinner that have been shown to cause delayed postprandial hyperglycemia. HFHP dinners were associated with the reduced %TIR over 8 hr, presenting an opportunity for insulin-dose adjustments. Future research that explores the meal dietary variability with postprandial glycemia in this population is needed. Excessive intake of the saturated fat highlights the need for dietary interventions to reduce CVD risk. This trial is registered with ACTRN12622000002785.
The Effect of COVID-19 on Type 1 Diabetes Occurrence among Children and Adolescents: A Multicenter Prospective Observational Cohort Study in Israel.
Gruber N, Brand L, Barhod E … +9 more , Hemi R, Lebenthal Y, Rachmiel M, Kedar T, Shatzman-Steuerman R, Sverdlove R, Lustig Y, Indenbaum V, Pinhas-Hamiel O
Pediatr Diabetes · 2023 · PMID 40303246 · Full text
AIM: The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the pediatric occurrence of type 1 diabetes (T1D) is inconclusive. We aimed to assess associations between seroprevalences of t...
AIM: The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the pediatric occurrence of type 1 diabetes (T1D) is inconclusive. We aimed to assess associations between seroprevalences of the distinct anti-SARS-CoV-2 antibodies and T1D occurrence in children and adolescents. METHODS: This multicenter prospective observational cohort comprised children diagnosed with T1D between October 2020 and July 2022 and unrelated children who performed endocrine tests (control group) in a 1 : 3 ratio. Anti-SARS-CoV-2 antibodies, including anti-S, anti-N, and neutralizing antibodies, were assessed in each group. RESULTS: The cohort included 51 children with T1D and 182 children in the control group. The median (interquartile range) age was 11.4 (8.2, 13.3) years, with 45% being female. Increases were not observed in the seroprevalence of any of the anti-SARS-CoV-2 antibodies among the children with new-onset T1D compared to the control group. Among the T1D group, anti-S seroprevalence was higher among those without diabetic ketoacidosis (DKA) than in those with DKA upon T1D diagnosis (72% vs. 42%, =0.035). After adjustment to vaccination status, this difference was not statistically significant. Additionally, anti-N antibodies and neutralizing antibodies did not differ between the DKA and the non-DKA groups. None of the anti-SARS-CoV-2 antibodies were associated with any of the glycemic parameters. CONCLUSIONS: This study is the first to assess several distinct anti-SARS-CoV-2 antibodies in new-onset T1D, and our findings do not support an association between SARS-CoV-2 infection and the occurrence of T1D in children and adolescents. Since autoimmunity may emerge years after a viral infection, we recommend conducting follow-up epidemiological studies to assess whether there is a change in the incidence of T1D following the SARS-CoV-2 pandemic.
Incidence Trends of Type 2 Diabetes Mellitus, Medication-Induced Diabetes, and Monogenic Diabetes in Canadian Children, Then (2006-2008) and Now (2017-2019).
Patel TJ, Ayub A, Bone JN … +8 more , Hadjiyannakis S, Henderson M, Nour MA, Pinto TE, Wicklow B, Hamilton JK, Sellers EAC, Amed S
Pediatr Diabetes · 2023 · PMID 40303241 · Full text
INTRODUCTION: The landscape of childhood diabetes has evolved and addressing the knowledge gaps in non-Type 1 diabetes mellitus are key to accurate diagnosis. OBJECTIVES: A national surveillance study was completed betwe...
INTRODUCTION: The landscape of childhood diabetes has evolved and addressing the knowledge gaps in non-Type 1 diabetes mellitus are key to accurate diagnosis. OBJECTIVES: A national surveillance study was completed between 2006 and 2008 and then repeated between 2017 and 2019 to describe Canadian incidence trends and clinical characteristics of non-Type 1 diabetes mellitus. METHODS: We prospectively tracked new cases of non-Type 1 diabetes mellitus in children <18 years of age between June 1, 2017 and May 31, 2019. For each reported new case, a detailed questionnaire was completed, and cases were classified as Type 2 diabetes mellitus, medication-induced diabetes (MID), monogenic diabetes, or "indeterminate." Minimum incidence rates and 10-year incidence trends of non-Type 1 diabetes mellitus and its subtypes were calculated. RESULTS: 441 cases of non-Type 1 diabetes mellitus were included (Type 2 diabetes mellitus = 332; MID = 52; monogenic diabetes = 30; indeterminate = 27). Compared to 10 years ago, the incidence of MID and monogenic diabetes remained stable, while Type 2 diabetes mellitus increased by 60% ( < 0.001) overall and by 37% (=0.005) and 50% (=0.001) in females and males, respectively. Type 2 diabetes mellitus incidence increased by 1.5 times in Indigenous ( < 0.001) and doubled in Asian (=0.003) children. CONCLUSIONS: Canadian incidence rates of childhood-onset Type 2 diabetes mellitus have significantly increased. Further research, policy, and prevention efforts are needed to curb rising rates of youth onset Type 2 diabetes mellitus.
School Nurse Confidence with Diabetes Devices in Relation to Diabetes Knowledge and Prior Training: A Study of Convergent Validity.
March CA, Hill A, Kazmerski TM … +4 more , Siminerio L, Switzer G, Miller E, Libman I
Pediatr Diabetes · 2023 · PMID 37929232 · Full text
OBJECTIVE: The Diabetes Device Confidence Scale (DDCS) is a new scale designed to evaluate school nurse confidence with diabetes devices. We hypothesized that DDCS score would be associated with related constructs of sch...
OBJECTIVE: The Diabetes Device Confidence Scale (DDCS) is a new scale designed to evaluate school nurse confidence with diabetes devices. We hypothesized that DDCS score would be associated with related constructs of school nurse diabetes knowledge, experience, and training. RESEARCH DESIGN AND METHODS: In a cross-sectional study, we co-administered the DDCS and Diabetes Knowledge Test 2 (DKT2) questionnaires to school nurses in Pennsylvania. We summarized DDCS scores (range 1-5) descriptively. We evaluated the relationship between DKT2 percent score and DDCS mean score with the Spearman correlation coefficient. Simple linear regression examined school nurse characteristics as predictors of DDCS score. RESULTS: A total of 271 completed surveys were received. Mean DDCS score was 3.16±0.94, indicating moderate confidence with devices overall. School nurses frequently reported low confidence in items representing specific skills, including suspending insulin delivery (40%), giving a manual bolus (42%), knowing when to calibrate a continuous glucose monitor (48%), changing an insulin pump site (54%), and setting a temporary basal rate (58%). Mean DKT2 score was 89.5±0.1%, which was weakly but not significantly correlated with DDCS score (r=0.12, p=0.06). Formal device training (p<0.001), assisting ≥5 students with diabetes devices in the past 5 years (p<0.01), and a student caseload between 1000-1500 students (p<0.001) were associated with higher mean DDCS score. CONCLUSIONS: DDCS score is related to prior training and experience, providing evidence for the scale's convergent validity. The DDCS may be a useful tool for assessing school nurse readiness to use devices and identify areas to enhance knowledge and practical skills.
Comparisons of school-day glycemia in different settings for children with type 1 diabetes using continuous glucose monitoring.
March CA, Nanni M, Lutz J … +6 more , Kavanaugh M, Jeong K, Siminerio LM, Rothenberger S, Miller E, Libman IM
Pediatr Diabetes · 2023 · PMID 37929231 · Full text
OBJECTIVE: Using continuous glucose monitoring (CGM), we examined patterns in glycemia during school hours for children with type 1 diabetes, exploring differences between school and non-school time. METHODS: We conducte...
OBJECTIVE: Using continuous glucose monitoring (CGM), we examined patterns in glycemia during school hours for children with type 1 diabetes, exploring differences between school and non-school time. METHODS: We conducted a retrospective analysis of CGM metrics in children 7-12 years (n=217, diabetes duration 3.5±2.5 years, hemoglobin A1c 7.5±0.8%). Metrics were obtained for weekday school hours (8 AM to 3 PM) during four weeks in fall 2019. Two comparison settings included weekend (fall 2019) and weekday (spring 2020) data when children had transitioned to virtual school due to COVID-19. We used multilevel mixed models to examine factors associated with time in range (TIR) and compare glycemia between in-school, weekends, and virtual school. RESULTS: Though CGM metrics were clinically similar across settings, TIR was statistically higher, and time above range (TAR), mean glucose, and standard deviation (SD) lower, for weekends and virtual school (p<0.001). Hour and setting exhibited a significant interaction for several metrics (p<0.001). TIR in-school improved from a mean of 40.9% at the start of the school day to 58.0% later in school, with a corresponding decrease in TAR. TIR decreased on weekends (60.8 to 50.7%) and virtual school (62.2 to 47.8%) during the same interval. Mean glucose exhibited a similar pattern, though there was little change in SD. Younger age (p=0.006), lower hemoglobin A1c (p<0.001), and insulin pump use (p=0.02) were associated with higher TIR in-school. CONCLUSION: Although TIR was higher for weekends and virtual school, glycemic metrics improve while in-school, possibly related to beneficial school day routines.
School-based diabetes care: A national survey of U.S. pediatric diabetes providers.
March CA, Siminerio LM, Kazmerski TM … +3 more , Albanese-O'Neill A, Miller E, Libman I
Pediatr Diabetes · 2023 · PMID 37929230 · Full text
OBJECTIVES: To understand the practices, attitudes, and beliefs of type 1 diabetes (T1D) providers towards school-based diabetes care (SBDC), including counseling families and communicating with schools, and explore the...
OBJECTIVES: To understand the practices, attitudes, and beliefs of type 1 diabetes (T1D) providers towards school-based diabetes care (SBDC), including counseling families and communicating with schools, and explore the barriers and facilitators which affect their support of SBDC. RESEARCH DESIGN AND METHODS: We conducted a national survey of pediatric T1D providers about their perceived support of SBDC, including family counseling and school communication. We used descriptive statistics to analyze results and explored differences by practice size (<500, 500-999, and ≥1000 patients) and environment (academic vs non-academic). RESULTS: A total of 149 providers completed the survey. Nearly all (95%) indicated SBDC was very important. Though most (63%) reported counseling families about SBDC multiple times per year, few (19%) spoke with school staff routinely, reporting that was a shared responsibility among different providers. Close to 90% agreed school feedback on T1D management plans would be helpful, yet only 31% routinely requested this input. Moderate to extremely significant barriers to SBDC communication included internal factors, such as staff resources (67%) and time (82%), and external factors, such as school nurse education needs (62%) and differing school district policies (70%). Individuals from large or academic practices reported more barriers in their knowledge of SBDC, including federal/state laws. Desired facilitators for SBDC included a designated school liaison (84%), electronic transmission for school forms (90%), and accessible school staff education (95%). CONCLUSIONS: Though providers universally agree that SBDC is important, there are multilevel internal (practice) and external (policy) barriers to facilitating a bidirectional relationship between schools and health teams.
Social Determinant of Health Impact on Diabetes Device Use and Clinical Outcomes in Youth with Type 1 Diabetes.
Crain ER, Ramphul R, Butler AM … +4 more , Huang X, Minard CG, Redondo MJ, DeSalvo DJ
Pediatr Diabetes · 2023 · PMID 40303257 · Full text
BACKGROUND: Youth with Type 1 diabetes (T1D) who are Black, Hispanic, or lower socioeconomic status (SES) have lower rates of diabetes device use, higher hemoglobin A1c (HbA1c), and higher rates of diabetic ketoacidosis...
BACKGROUND: Youth with Type 1 diabetes (T1D) who are Black, Hispanic, or lower socioeconomic status (SES) have lower rates of diabetes device use, higher hemoglobin A1c (HbA1c), and higher rates of diabetic ketoacidosis (DKA). However, the associations of individual-level social determinants of health (SDoH) and neighborhood-level factors with device use and clinical outcomes are unknown. Area deprivation index (ADI) is a neighborhood level measure of SES reported in deciles (range 1-10 with 10 representing most deprived neighborhood). METHODS: We evaluated the association of ADI and other SDoH factors with pump/continuous glucose monitor (CGM) use, HbA1c, and DKA in 1,461 youth with T1D (50% female, age 12.8 ± 3.6 years, HbA1c 8.7 ± 2.1%, 52% pump, 70% CGM) seen between October 1, 2020 and September 30, 2021 at a large pediatric diabetes center. Multiple logistic regression and multiple linear regression analyses were used to determine statistically significant associations adjusting for potential confounders. RESULTS: Youth were less likely to use an insulin pump if they lived in a higher ADI neighborhood, were Black or Hispanic, had Medicaid or were uninsured, or received government assistance (e.g., Supplemental Security Income, Supplemental Nutritional Assistance Program). Youth were less likely to use a CGM if they lived in a higher ADI neighborhood, were Black or Hispanic, had Medicaid or were uninsured. Youth had higher risk of DKA event in the past year if they used government assistance, whereas pump and CGM use were associated with lower DKA risk. HbA1c (%) increased by 0.09 (95% CI: 0.05, 0.13) per unit increase in ADI. HbA1c was 0.62 lower (95% CI: -0.82, -0.42) in pump users vs. nonusers and 0.78 lower (95% CI: -0.99, -0.56) in CGM users vs. nonusers. CONCLUSIONS: Interventions that tailor care plans to address SDoH in families living in deprived neighborhoods may be needed to increase successful technology uptake, optimize HbA1c, and prevent DKA.
Splitting Mealtime Insulin Doses for Mixed Fat and Protein Meals in Children and Adolescents with Type 1 Diabetes Using Multiple Daily Injection Regimen: A Randomized Cross-Over Trial.
Hegab AM, Hasaballah SE, Mohamed MM
Pediatr Diabetes · 2023 · PMID 40303273 · Full text
AIMS: Assessment of the glycemic outcomes of increasing and splitting mealtime insulin doses for mixed fat and protein meals in pediatric patients with type 1 diabetes mellitus (T1DM) using multiple daily injection regim...
AIMS: Assessment of the glycemic outcomes of increasing and splitting mealtime insulin doses for mixed fat and protein meals in pediatric patients with type 1 diabetes mellitus (T1DM) using multiple daily injection regimen and comparing the effects of regular insulin and fast-acting insulin on glycemic outcomes following those meals. METHODS: This single-center, randomized, cross-over trial included 43 children and adolescents with T1DM randomly assigned to receive three interventional insulin doses for lunch meals over 3 consecutive days; Intervention A (100% insulin-to-carbohydrate ratio (ICR) dose given as premeal insulin lispro with an additional insulin sensitivity factor-calculated correction dose after 3 hr), Intervention B (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal insulin lispro after 30 min), and Intervention C (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal regular insulin after 30 min). The test meal consisted of two slices of pizza (weight: 150 g, carbohydrates: 40 g, fat: 15 g, protein: 20 g, and calories: 380 kcal). Postprandial blood glucose levels were monitored for 6 hr. RESULTS: There were no significant differences in postprandial blood glucose excursions following the three interventions. However, Intervention C had a significantly lower late (3-6 hr) blood glucose area under the curve (=0.01). Postprandial hypoglycemia developed in 12 participants (27.9%) following Interventions A and B and in 17 participants (39.5%) following Intervention C (=0.32). CONCLUSIONS: Using regular insulin as a postmeal portion of increased and split insulin doses provided better late postprandial glycemic outcomes following mixed fat and protein meals. However, the amount of additional insulin used needs optimization to reduce the frequency of postprandial hypoglycemia. This trial is registered with NCT04783376.
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