Adolescent Diabetic Patients Research Articles

Psychological Impact of COVID-19 Pandemic on Pediatric and Adolescent Patients with Type 1 Diabetes Mellitus

Background The COVID-19 pandemic and quarantine measures had actually affected the quality of life of general population. Pediatric and adolescent diabetic patients are vulnerable group with increased susceptibility to infections and increased morbidity and mortality. They are exposed to increase levels of stress, anxiety and depression during the COVID-19 pandemic. Aim of the Work This study aims to assess the psychological impact of COVID -19 pandemic among children and adolescents with type 1 diabetes. Subjects and Methods This study is observational cross-sectional study based on analysis of 100 patients with type 1 diabetes, aged 7-18 years old from Pediatrics Hospital, Faculty of Medicine, Ain Shams University. Patients were subjected to full history taking, physical examination, laboratory investigations and psychological assessment by assessing quality of life by PedsQLTM 3.0 Diabetes Module Arabic version which is a multidimensional diabetes-specific instrument assessing the broad age range of 2 - 18 years with both child and parent proxy-reports. Results The results showed that PedsQL (parents report) total score ranged from 40 – 92 with mean of 66.27 ± 12.48 and PedsQL (children report) total score range from 44-93 with mean of 68.41 ± 12.78. Both PedsQL (parents report) total score and PedsQL (children report) total score negatively correlated with age, weight, number of DKA, HbA1c post lockdown. There is a negative relation between PedsQL (parents report) total score and tanner stage, no. of sibling, hospital admission during pandemic and insulin regimen, so any increase in those parameters will lead to decrease in PedsQL (parents report) total score. There is a negative relation between PedsQL (children report) total score and no. of sibling. Conclusion There was a mutual relationship between the pandemic and lock down and HbA1c and quality of life in pediatrics and adolescences with T1DM in Egypt. Low quality of life during the COVID-19 pandemic negatively impacted glycemic control.

HDAC4 mutations cause diabetes and induce β-cell FoxO1 nuclear exclusion.

BackgroundStudying patients with rare Mendelian diabetes has uncovered molecular mechanisms regulating β‐cell pathophysiology. Previous studies have shown that Class IIa histone deacetylases (HDAC4, 5, 7, and 9) modulate mammalian pancreatic endocrine cell function and glucose homeostasis.MethodsWe performed exome sequencing in one adolescent nonautoimmune diabetic patient and detected one de novo predicted disease‐causing HDAC4 variant (p.His227Arg). We screened our pediatric diabetes cohort with unknown etiology using Sanger sequencing. In mouse pancreatic β‐cell lines (Min6 and SJ cells), we performed insulin secretion assay and quantitative RT‐PCR to measure the β‐cell function transfected with the detected HDAC4 variants and wild type. We carried out immunostaining and Western blot to investigate if the detected HDAC4 variants affect the cellular translocation and acetylation status of Forkhead box protein O1 (FoxO1) in the pancreatic β‐cells.ResultsWe discovered three HDAC4 mutations (p.His227Arg, p.Asp234Asn, and p.Glu374Lys) in unrelated individuals who had nonautoimmune diabetes with various degrees of β‐cell loss. In mouse pancreatic β‐cell lines, we found that these three HDAC4 mutations decrease insulin secretion, down‐regulate β‐cell‐specific transcriptional factors, and cause nuclear exclusion of acetylated FoxO1.ConclusionMutations in HDAC4 disrupt the deacetylation of FoxO1, subsequently decrease the β‐cell function including insulin secretion, resulting in diabetes.

Altered level of inflammatory markers in relation to glycemic status associated with adolescent diabetic patients

Altered level of inflammatory markers in relation to glycemic status associated with adolescent diabetic patients

Interrelation between Acute Phase Response with Altered Level of Serum Orosomucoid and Glycemic status in Newly Developed Adult as Well as Adolescent Diabetic Patients

Interrelation between Acute Phase Response with Altered Level of Serum Orosomucoid and Glycemic status in Newly Developed Adult as Well as Adolescent Diabetic Patients

The burden of common infections in children and adolescents with diabetes mellitus: A Pediatric Health Information System study.

People with diabetes mellitus (DM) have increased infection risk. The healthcare utilization of pediatric and adolescent diabetic patients with infection is not well defined. This study evaluates the number of pediatric and adolescent patients with DM that seek medical treatment for infection management and assesses its socioeconomic impact. A retrospective analysis was performed using the Pediatric Health Information System (PHIS) database on children and adolescents with DM who presented to the Emergency Department (ED) or were hospitalized for infection management from 2008 to 2014. The PHIS database collects admission, demographic, and economic data from 44 freestanding children's hospitals across the United States. In total, 123 599 diabetic patient encounters were identified (77% type 1 DM, 23% type 2 DM). ED visits and hospitalizations for type 1 DM and type 2 DM increased throughout the study period. Total charges for these encounters were greater than $250 million dollars per year and increased each year. Infection encounters make up more than 30% of that cost while accounting for only 14% of the visits. Respiratory infections were the most common type of infection followed by skin and soft tissue infections for both ED care and inpatient hospitalizations. Patients with infections had longer hospital length of stay and higher cost per day than those without infections. Children and adolescents with type 1 and type 2 DM commonly present to the ED and require hospitalization for infection evaluation and management. Encounters with infection make up a large proportion of a growing economic burden on the United States' healthcare system. As the prevalence of DM grows, this burden can be expected to become even more significant. Cost-effective strategies for the prevention of infection in pediatric patients with DM are needed.

PDB45 - Info-Diabetic Approach from Cellular Phone Text Massaging can Minimize the Complexities in Diabetic Patient Care

‘Info-Diabetics’ is becoming an imperative approach in E-health to stipulate the diabetic patient care and management. In this study we tried to get an overview for application of cellular phone text messaging over adolescent diabetic patients (ADPs). The major objective of this study was to test whether adding cellular application for patient care compared with control cases would reduce Glycated Hemoglobin (HbA1c). Eleven ADPs (study cases, n=11) were selected for mobile phone coaching through text messaging, to consultants. ADPs of the control site (n=09) were continued with their standard diabetes health care from consultants. Primarily ADPs were enquired for demographic and social characteristics, frequency of cellular phone use, general health information and diagnosis of type 2 diabetes. Further the level of Hb1Ac, in both the groups, was measured in a regular interval of 45 days. After 225 days, percentage of mean improvement in Hb1Ac level was compared between cellular users and control cases. More than 3% improvement in Hb1Ac was observed among the patients having mobile phone and they made regular interaction with consultant. The differences were very small but a trend of positive improvement was observed among ADPs using cellular phone’s text messaging. Result indicated that info-diabetic approach may contribute to minimize complexities in medical care and the cautious use of cellular phone technology in the form of text messaging would be an asset for self care management in ADPs.

Oral Therapy in a Diabetic Patient With History of Infantile Hyperinsulinism

Dear editor, Hyperinsulinism is the most common cause of persistent hypoglycemia in early infancy (1). Loss of function mutation in HNF4A gene is an unusual cause of this disease (2). HNF4A protein is a homodimer nuclear transcription factor with 474 amino acids which plays a role in 22 identified pathways. Mutations in this gene cause deficiency in regulation of beta-cell development and nuclear receptors transcription pathways, associated with maturity onset diabetes of Young (MODY) and HNF4A-related hyperinsulinism (3, 4). Association of hyperinsulinemia in infancy and diabetes in adolescence has been reported only in patients with HNF4A mutations (4). We present a patient with hyperinsulinmia in infancy and diabetes in adolescence without HNF4A mutation and with good response to oral hypoglycemic agents. In infancy, this patient presented with persistent hyperinsulinemic hypoglycemia. He was on oral diazoxide until 3 years of age when this drug was tapered and discontinued. Genetic study was not performed at that time due to limitation of facilities. After that time, his blood sugar was normal until 15 years of age when he presented with diabetes mellitus. Starting HbA1c was 9.5%. In addition, fasting triglyceride level and cholesterol level was 66 mg/dL and 168 mg/dL, respectively. Other routine laboratory studies were within the normal range. Pancreas anatomy was also normal in ultrasonography. At the time of manifestation of diabetes, he was 162 cm tall (about 25th percentile for sex and age) and 51 kg (about 25th percentile for sex and age). He did not have any family history of diabetes. Insulin therapy associated with oral sylfonylurea (Glibenclamid) was started with impression of monogenic diabetes. As he responded, insulin dose was gradually tapered and discontinued, and an α-glucodisase inhibitor (Acarbose) was started to improve his mild postprandial hyperglycemia. The treatment was continued with 0.1 mg/kg/day Glibenclamid and 50 mg Acarbose before each meal. Self-monitoring of blood glucose by the patient and most of the measurements were in the target range (70-130 mg/dL). After 4 months of treatment, HbA1c was 6.7%. He tolerated the medications well without any side effect. According to previous history of the patient, the most probable diagnosis was HNF4ɑ mutation. However, the results of HNF4ɑ gene study by DNA sequencing method revealed no mutation and only a previously reported variant rs745975 C > T determined in nucleotide 5 of intron 1 (5). This variant was associated with Stearoyl-CoA desaturase 1 activity (6) and with type 2 diabetes mellitus (7). History of hyperinsulinism in infancy, diabetes mellitus in adolescence, low plasma triglyceride level, and good response to oral hypoglycemic agents has been reported in previous cases of MODY type 1 with HNF4A mutation (8). Mutation in HNF4A was not found in the presented case and due to shortage of facilities, more genetic study was not performed, however, his clinical course is in favor of a type of monogenic diabetes. This case showed that some adolescent diabetic patients, even without family history of diabetes, and without clinical characteristics of type 2 diabetes may have good response to oral hypoglycemic agents. Further studies are needed to find more cases of monogenic diabetes in adolescents, and to determine which diabetic adolescent can be treated with oral agents. Also, it is recommended that in every patient whose diabetes commences in adolescence, a precise history about hypoglycemia of infancy should be obtained.

Abstract #262: Clinical Profile and Outcome of Diabetic Ketoacidosis among Saudi Adolescent Diabetic Patients in a Saudi Tertiary Center

Abstract #262: Clinical Profile and Outcome of Diabetic Ketoacidosis among Saudi Adolescent Diabetic Patients in a Saudi Tertiary Center

Diabetic Ketoacidosis in an Obese Adolescent Diabetic Patient with Acanthosis Nigricans and without Autoantibodies. Is It Type 1.5 Diabetes?

Over the years, adolescents have been diagnosed to be diabetic, the type of which do not fit into the classical types of diabetes - type 1 and type 2. These cases have been reported round the globe. They share features of both types of diabetes like obesity, acanathosis nigricans along with insulin resistance and can even have complications like Diabetic ketoacidosis. The present case study is about a newly diagnosed obese adolescent diabetic patient with acanthosis nigricans presenting with diabetic ketoacidosis who responded to standard treatment of Diabetic ketoacidosis. Subsequently, he was found to have low levels of C-peptide without insulin autoantibodies. Such cases have been variously referred as Double diabetes or 1.5 diabetes in literature and may constitute a subvariant of Diabetes.

Ambulatory care of paediatric and adolescent diabetic patients in the Western Cape

Ambulatory care of paediatric and adolescent diabetic patients in the Western Cape

Altered Sleep Patterns in Adolescents With Type 1 Diabetes: Implications for Insulin Regimen

Changes in sleep duration and pattern are well described in adolescence. Only 20% of adolescents meet recommendations for hours of sleep during the week (9–9.25 h) (1), and adolescents frequently overcompensate on weekends with delayed awakening times (2). Limited data exist describing sleep patterns in type 1 diabetic patients. This is directly relevant to determining optimal insulin treatment regimens and achieving target metabolic control. We describe sleeping times in adolescent diabetic patients in relation to age-matched peers with attention to the influence of insulin regimens. Seventy-five adolescent patients with diabetes and 54 healthy individuals aged 12–18 years were assessed. Sleep timings on typical weekends and weekdays were collected as part of a larger, institutional …

Treatment of Danish adolescent diabetic patients with CSII - a matched study to MDI

To compare two intensified insulin therapy regimens - continuous subcutaneous insulin infusion (CSII) against multiple daily insulin injection (MDI) - in Danish adolescents examined in a prospective, matched controlled study design. Thirty type 1 diabetic adolescents at CSII and 26 matched MDI controls were included in this open intention-to-treat study. Actrapid was used in both groups. Before study entry, all participants followed a brush-up course in order to minimize study effect. At each visit, the following parameters were recorded: hemoglobin A1c (HbA1c), insulin dose, weight, number of hypoglycemic and diabetic ketoacidosis (DKA) events, and the time resources used. At entry and exit of the study, diet registration and validated quality-of-life (QoL) questionnaires were filled by the participants. A non-significant decline in HbA1c was seen in both groups (p = 0.468); HbA1c decreased from 9.5 to 8.9% and from 9.7 to 9.5% in the CSII and MDI group, respectively. The insulin dose and the number of severe hypoglycemic events per patient were lower (non-significant) in the CSII group. Both groups showed increased body mass index - highest in the CSII group - and mild to moderate DKA episodes were only seen among CSII users. No differences could be demonstrated within the QoL or diet registrations. CSII treatment is beneficial as an intensified insulin therapy for selected type 1 diabetic patients and both MDI and CSII can be offered by the professional diabetes team to better tailor therapy. In future, there is a strong need to identify the characteristics of responders to CSII treatment in order to increase the efficacy and safety of CSII treatment.

Changes in oxidant-antioxidant status in young diabetic patients from clinical onset onwards.

Oxidative stress has been implicated as a mechanism underlying hyperglycaemia-associated cellular damage and could play a role in the development of diabetes-related complications. This study aimed to evaluate the significance of changes in oxidant–antioxidant status in 176 child and adolescent diabetic patients at clinical onset, during disease progression and when early microvascular complications appeared. Indicative lipid and protein oxidation markers and antioxidant defence activity were measured in plasma and correlated with clinical data, diabetes duration, long-term glycometabolic control and serum lipids. Compared with their respective age-matched controls, diabetic patients had greater oxidative damage to lipids and proteins, demonstrated through the analysis of hydroperoxides, lipoperoxides and oxidation protein products, all of which were significantly raised at onset, decreased during the first 1.5 years of evolution and rose progressively thereafter. Plasma levels of oxidizable lipids were significantly associated with lipid and protein oxidation products. Overall, plasma antioxidant capacity was significantly and consistently lower from clinical onset onwards. These results suggest that insulin therapy in the first year improved metabolic and oxidant homeostasis and consequently hyperglycaemia-derived biomolecular oxidative damage. Diabetes-associated hyperlipidaemia is related to lipid and protein oxidation processes, which supports the concept of glucose toxicity and lipotoxicity being interrelated. The greatest increase in lipid and protein oxidative damage biomarkers in young diabetic patients with premature microangiopathy points to oxidative stress as a possible contributing mechanism of microvascular dysfunction. Consequently, tight lipid and glycometabolic control may have therapeutic potential by diminishing oxidative tissue-damaging effects of hyperglycaemia.

Renal functional changes in relation to hemodynamic parameters during exercise test in normoalbuminuric insulin‐dependent children

To examine the relationship between filtration fraction and systemic vasculopathy, in normoalbuminuric insulin-dependent diabetic adolescents. We calculated filtration fraction from measured glomerular filtration rate and renal plasma flow during a hypotonic saline perfusion test in 30 normotensive adolescent diabetic patients (9-19 years), with a mean duration of diabetes of 7.4 years. Blood pressure and heart rate were measured in basal conditions, during a 24-h ambulatory monitoring and during a dynamic exercise test on a cycle ergometer and peripheral vascular resistance was calculated. Filtration fraction was increased in the diabetic children compared with controls (30+/-6% vs. 22+/-4%, p<0.001), while renal plasma flow was significantly lower (453+/-133 mL/min/1.73 m2 vs. 593+/-155 mL/min/1.73 m2, p<0.001). Peripheral vascular resistance was significantly higher at peak exercise in diabetic children compared to controls (16.3+/-1.3 mmHg/L min m2 vs. 11.4+/-0.5 mmHg/L min m2, p<0.01). These results indicate that in young patients with IDDM, without apparent nephropathy or apparent systemic vasculopathy, filtration fraction is increased, suggesting an increased intraglomerular pressure. The associated reduced decrease of peripheral vascular resistance (increased diastolic blood pressure during exercise) suggests that renal functional abnormalities may be partly explained by a systemic vasculopathy, also present in the kidney.

Atypical diabetic presentation in Saudi Arabian adolescents

Background: The prevalence of diabetes mellitus is increasing worldwide. Adolescents in Saudi Arabia frequently presentwith the disease, some with clinical features which differ from those expected in youth from other countries. This newpattern is reported in the following study of newly diagnosed young diabetic patients from Eastern Saudi Arabia. Patientsand Method: Patients aged 14-20 diagnosed with diabetes over a five year period (1998-2003) in a private health centre werestudied. The presenting clinical features are described and compared with those of diabetic children from the samepopulation base. Results: Most newly diagnosed adolescent diabetic patients presented with the classical clinical features ofpolyuria, polydipsia and weight loss, rather than diabetic keto-acidosis. About one third of them (30%) behaved clinicallylike patients with type 2 diabetes (Type2 DM), with subsequent reasonable glycaemic control on diet and oral hypoglycaemicagents (OHAs), while only about a quarter (23%) presented with diabetic keto-acidosis (DKA) which was relatively mild.Conclusion: Only about a quarter of patients with adolescent onset diabetes mellitus in the Hasa area of Saudi Arabiapresented with DKA. The majority presented with the classical features of polydipsia, polyuria and weight loss with about athird behaving clinically like patients with Type 2 DM. (Int J Diabetes Metab 15: 4-8, 2007)

Low Birth Weight and Insulin Resistance Associated with Lean Body Adiposity in an Adolescent Onset Diabetic Patient

We describe a patient characterized by reduced fetal growth, no history of rapid "catch-up" growth in prepubertal childhood, and adolescent onset diabetes. High doses of insulin were required for glycemic control. Pioglitazone treatment was followed by a deterioration of glycemic control and hepatic steatosis, while metformin treatment was followed by a partial response. Leptin and adiponectin levels were reduced, but a significant increase in leptin and adiponectin levels occurred concomitantly with an increase in weight and adiposity. This case suggests that some fetal genetic factors determining insulin sensitivity might be linked to a reduction in fetal growth as well as the later development of diabetes.

Oxidative protein damage in early stage Type 1 diabetic patients

To examine the influence of oxidative stress on oxidative protein damage, we studied 51 young Type 1 diabetic patients clinically free of complications and 48 healthy normolipidaemic age-matched controls. We determined: (1) plasma carbonyl (PCO), plasma total thiol (T-SH), and nitrotyrosine (NT) levels as markers of oxidative protein damage; (2) plasma lipid hydroperoxide (LHP), and nitric oxide (NO) levels as markers of oxidative stress; (3) plasma total antioxidant capacity (TAO), ceruloplasmin (Cp), transferrin (TRF), unsaturated iron binding capacity (UIBC), erythrocyte glutathione (GSH), and erythrocyte superoxide dismutase (SOD) as markers of free radical scavengers. There were no significant differences in the levels of these markers between prepubertal diabetic patients and the controls. The levels of both of PCO and LHP were increased in adolescent and young adult Type 1 diabetic patients with respect to their controls. In the adolescent group, patient versus control values for PCO were 1.04±0.067 versus 0.67±0.0274 nmol/mg and for LHP they were 2.10±1.09 versus 1.00±0.4 nmol/mg. In the young adult group, patient versus control values for PCO were 0.99±0.054 versus 0.66±0.02 nmol/mg and for LHP they were 1.96±0.78 versus 1.15±0.4 nmol/mg. TAO levels were significantly decreased in adolescent diabetic patients compared to their controls (0.92±0.27 vs. 1.86±0.37) and in young adult diabetic patients compared to their controls (0.80±0.27 vs. 2.11±0.54 nmol/mg). T-SH was not different between diabetic patients and the controls. Serum NT, NO, and erythrocyte SOD levels were not different either between three groups of diabetic patients or between the patients and their controls. We attribute this lack of difference to limited disease duration. Changes in markers of oxidative stress other than NT, NO, and SOD observed in adolescent and young adult early stage Type 1 diabetic patients contribute to the imbalance in the redox status of the plasma. We attribute this imbalance to metal-catalyzed protein oxidation in both groups of Type 1 diabetic patients clinically free from complications.

Discordance between physician and adolescent assessments of adherence to treatment: influence of HbA1c level. The PEDIAB Collaborative Group.

To compare the subjective assessments (perceptions) of physicians and adolescent diabetic patients on the adolescents' adherence to treatment and to test the hypothesis that the HbA1c level influences physicians' perceptions. In a multicenter cross-sectional survey, 143 adolescents with diabetes (mean age 14.6 years) auto-assessed, while their pediatricians independently assessed, the level of adherence to treatment on a four-point scale. Scores of adherence given by a validated scale and metabolic control (HbA1c) were compared according to those assessments. Agreement between the adherence perceptions from adolescents and physicians was low (kappa = 0.23), and adolescents scored significantly higher (P < 0.001). Mean adherence score to diabetes treatment was significantly higher when the adolescents' perception of their self-care behaviors was good than when it was poor (P = 0.01), but did not significantly differ according to physicians' perception. Mean HbA1c level was significantly lower when the self-care behavior perception was good than when it was poor, both for the adolescents (P = 0.02) and for the physicians (P < 0.001). Multivariate analyses showed that only the adherence scale score was significantly associated with the adolescents' perception (P = 0.015), whereas only HbA1c level was significantly associated with the physicians' perception (P = 0.0008). By identifying the possible discrepancy between their own assessment of adherence and that of adolescents, and by avoiding the systematic attribution of poor metabolic control to poor adherence, physicians could generate a more confident and collaborative relationship with diabetic adolescents and therefore facilitate adolescents' self-management.

Renal Disease in Adolescents With Type I Diabetes Mellitus: A Report of the Southwest Pediatric Nephrology Study Group

Although 30% to 40% of patients with type I diabetes mellitus develop diabetic nephropathy, the usual signs of clinical nephropathy are often thought to be delayed until adulthood. We studied 13 adolescents with type I diabetes mellitus for 5 to 14 years who had renal biopsies completed because of clinical problems, including proteinuria, hematuria, or hematuria plus proteinuria. Changes typical of diabetes were seen by light and immunofluorescence microscopy; evidence of other renal diseases was not noted. On electron microscopy evaluation, glomerular basement membrane width was increased in 11 patients. In seven patients, mesangial volume was elevated above the normal range. Peripheral capillary filtration surface density was diminished below the normal range in five patients. Thus, several of these adolescents had severe glomerular lesions that were indicative of overt diabetic nephropathy. Within 2 to 3 years after biopsy, at least two patients were dialysis dependent. Thus, the adolescent diabetic patient with a relatively short duration of diabetes may be developing progressive diabetic renal leSions, and the clinical signs and symptoms at presentation may not be those typically seen in diabetic nephropathy.

Permeability of the blood-ocular barrier in adolescent and adult diabetic patients.

The permeability of the blood-ocular barrier was examined by fluorophotometry in adolescent and adult diabetic patients before the onset of retinopathy. The adolescent group consisted of 52 eyes of 52 insulin dependent diabetic patients aged 11 to 19 years and a control group of 10 eyes of 10 normal adolescents. The adult group consisted of 74 eyes of 74 non-insulin dependent diabetics and a control group of 30 eyes of 30 normal adults. The increase in lens autofluorescence in the adolescent diabetic patients compared with the controls was striking and showed a significant positive correlation (r = 0.79, p < 0.0001) with the duration of diabetes. Anterior chamber (AQ) values, an index of the permeability of the blood-aqueous barrier (BAB), increased in the adolescent diabetic patients compared with the controls and showed a significant positive correlation with glycosylated haemoglobin levels. No significant differences from the controls were observed regarding the permeability of the blood-retinal barrier (BRB). In the adult group there was no significant difference in either the permeability of the BRB or the AQ values between the diabetic and the control groups. Our results suggest that adolescent diabetic patients differ from adults in that BAB permeability is increased before the onset of retinopathy, suggesting that this is the cause of the striking increase in lens autofluorescence.