Glycemic Control In Children Research Articles

A comparative study of the gut microbiome in Indian children with type 1 diabetes and healthy controls.

Type 1 diabetes mellitus (T1DM) occurs in genetically susceptible individuals due to certain environmental triggers causing destruction of insulin secreting beta cells. One of the environmental triggers studied recently in the pathogenesis and progression of T1DM is the role of gut microbiome. (1) To compare the gut microbiome profile of T1DM children with healthy age, gender, and body mass index (BMI) matched controls. (2) To assess the relationship of abundance of genera with glycemic control in children with T1DM. Cross-sectional, case-control study. Sixty-eight children with T1DM and 61 age-, gender-, and BMI-matched healthy controls were enrolled. QIAamp Fast DNA Stool Mini kit protocol and reagents were used for DNA isolation and Miseq sequencing platform for targeted gene sequencing. Alpha and beta diversity analysis showed no significant differences in the abundance of microbes between the groups. At phylum level, Firmicutes was the dominant phylum followed by Actinobacteria and Bacteroidota in both groups. Analysis of microbiome at the genera level showed that percentage abundance for Parasutterella was higher in children with T1DM as compared to the healthy group (p < .05). A linear regression analysis showed that increase in abundance of Haemophilus (adjusted R2 = -1.481 p < .007) was associated with a significant decrease in glycated hemoglobin (HbA1c) concentrations (p < .05). Our comparative study of gut microbiome profile showed significant differences in the taxonomial composition between Indian children with T1DM and healthy controls. Short chain fatty acid producers may play an important role in glycemic control.

Glycemia Risk Index as a novel metric to evaluate the safety of glycemic control in children and adolescents with Type 1 Diabetes: an observational, multicenter, real-life cohort study.

Glycemia Risk Index (GRI) is a novel composite metric for the evaluation of the safety of glycemic management and control. The aim of this study was to evaluate GRI and its correlations with continuous glucose monitoring (CGM) metrics by analysing real-life CGM data in 1067 children/adolescents with type 1 Diabetes (T1D) using four different treatment strategies (intermittently scanned CGM [isCGM]-Multiple daily injections [MDI]; real time CGM [rtCGM]-MDI; rt-CGM-insulin pump [IP]; Hybrid Closed-Loop [HCL] therapy). GRI was positively correlated with High Blood Glucose Index (HBGI), Low Blood Glucose Index (LBGI), mean glycemia, its standard deviation, coefficient of variation and HbA1c. The four treatment strategies groups showed significantly different GRI with the lowest value in the HCL group (30.8) and the highest in the isCGM-MDI group (68.4). These findings support the use of GRI for the assessment of the glycemic risk and the safety of specific treatment in paediatric subjects with T1D.

Impact of Parental Food Choices on Nutritional and Metabolic Status of Children with Type 1 Diabetes.

Parents play a key role in what their children eat. The Food Choice Questionnaire (FCQ) has been used elsewhere to assess the dietary motivations of parents of healthy children, but not for parents of children with chronic diseases such as type 1 diabetes (T1D). The aim of our research was to evaluate the associations between parental food choice motivations and the nutritional status and glycemic control of children with T1D. A cross-sectional observational study of children aged 5 to 16 years with T1D attending the Pediatric Endocrinology Unit of Puerta del Mar University Hospital in Cádiz (Spain) was performed. Demographic, anthropometric and clinical data, including glycated hemoglobin, were collected. The FCQ in Spanish was conducted to assess the eating behaviors of the main caregivers of children with T1D. Significance was established at the level of p-value < 0.05. In total, 85 children with T1D (female 56.5%, age 12.07 ± 2.93 years, HbA1c 7.29 ± 0.77%) were recruited. Of these children, 31.3% showed HbA1c levels of <7.0% and 44.9% had a TIR >70%. A significant positive correlation was found between Hb1Ac and "familiarity" (R: +0.233). Anthropometric measures (weight, BMI, skinfolds and body circumferences) showed significant positive correlations with "sensory appeal" and "price". Parents' eating behaviors influence the nutritional status of their children with T1D and their glycemic control of the disease.

Sleep quality and glycemic control in children and adolescents with type 1 diabetes mellitus.

This study aimed to investigate the frequency of sleep disorders, and the relationship between glycemic control and sleep characteristics in diabetic children and adolescents. Sixty-one patients followed for at least one year for type 1 diabetes mellitus (T1DM) aged 6-16 years old, and eighty-three group-matched healthy controls were included in the study. Time in range (TIR) and hypoglycemia episode numbers were recorded using the freestyle libre sensor data. The sleep characteristics were evaluated using the Sleep Disturbance Scale for Children (SDSC) validated survey. The diabetic patients were trichotomized according to SDSC scores, as low, medium, and high score groups. Sleep duration, SDSC total score, and subgroup scores except for sleep hyperhidrosis (3.11±1.53 vs. 2.16±0.85, p<0.001, respectively) were similar (p>0.05) between the diabetic and control group. According to the survey, 1.6% of diabetic cases and 6.1% of the control group had clinically significant sleep disturbances (p>0.05). Duration of diabetes (DD) was lower (p=0.01), and the level of HbA1C was higher (p=0.02) in the high-score group than the others. Regression analysis revealed that TIR was the only independent determinant for the SDSC score (β=-1.27, t=-1.90; p=0.012). Sleep habits and problems should be routinely evaluated in diabetic children and adolescents.

Effect on Glycemic Control of an Early Intensive Dietary Structured Education Program for Newly Diagnosed Children with Type 1 Diabetes in Jordan

Background and Aim. Early diabetes education for persons with type 1 diabetes (T1D) is important to achieve early glycemic control. We had developed a dietary structured education program (SEP) to provide patients with the required skills for optimal diabetes management. Our aim was to study the effect of our program and factors that might affect its outcomes. Methods. This is a retrospective medical chart review study at Jordan University Hospital. The glycemic control of children who were diagnosed with T1D and included in the SEP between June 2017 and December 2019, was compared with those who were exposed to the conventional diabetes education, between January 2014 and December 2016. Various factors were assessed for the possible effects on the SEP outcomes. Results. The average age at diagnosis for the 112 persons with diabetes (PwD) included in the dietary SEP was 8.30 ± 3.87 years. Glycated hemoglobin was lower in children in the SEP group at 6 months ( P value = 0.001) and 12 months ( P = 0.032 ) but not at 24 months ( P = 0.290 ). SEP had better effect on patients older than 5 years. The possible predictors of glycemic control for the SEP group at 12 months included the mother’s educational level and the number of hospital admissions due to DKA and hyperglycemia during the first year after diagnosis. Conclusion. Our dietary SEP was associated with better glycemic control than conventional diabetes education, at 6 and 12 months after diagnosis. It had a positive effect, mainly in PwD patients who are older than 5 years and had higher maternal educational level.

Glycemic Fluctuations of Children and Adolescence Type 1 Diabetes Mellitus and the Impressive Aspects of SARS-CoV-2 Since the Onset of Pandemic Lockdown: A Review Paper

Background: The COVID-19 pandemic limited the daily activities of children and adolescents with type 1 diabetes mellitus, and several factors are impacting ongoing care. The role of pandemics on glycemic control is unknown. We plan to assess the glycemic status and the factors that influence it during the pandemic. Objectives: Our goal was to examine the impact of COVID-19 quarantine on the glycemic control of children and adolescents with type 1 diabetes mellitus. Methods: Databases including PubMed, Scopus, Web of Science, and Science Direct, with English-type articles extracted from December 31, 2019, to March 3, 2022, were searched. The article review was based on factors influencing glycemic control in type 1 diabetes mellitus cases younger than 18 years of age during the pandemic period such as psychological factors, telemedicine role, lifestyle changes, various diabetes technology (cost, availability…), caregivers’ role, and socioeconomic factors. Results: We scanned 573 articles as an initial search for titles/abstracts and full-text reviews, and 54 articles remained after title/abstract screening for full-text assessment among which 14 articles (cohort studies) were included. Most studies reported glycemic improvement based on blood glucose metrics while some studies reported stable glycemic control. Although the pre-pandemic glucose profile is important, factors such as telemedicine, diabetes technology, and lifestyle play a more tangible role in improving glycemic control during the pandemic. Conclusions: Overall, the studies did not contain strong evidence that glycemic control worsened in children and adolescents with type 1 diabetes mellitus during the pandemic. Although the assessment was conducted over a short period, long-term multicenter studies would be useful for a more precise assessment of the mentioned potential factors.

Physical activity during COVID-19 pandemic and its impact on glycemic control in children with type 1 diabetes mellitus

Background: Physical activity is one of the important factors affecting glycemic control in type 1 diabetes mellitus (T1DM). During COVID-19 pandemic the government imposed restrictions to prevent the spread of COVID and physical activity of children was curtailed. We assessed the physical activity during COVID-19 pandemic restrictions (from September 2020 to September 2021) and its association with their glycemic control. Methods: 48 children with T1DM receiving treatment in paediatric endocrinology outpatient department (OPD), AIIMS, New Delhi were enrolled. Socio-clinical data were collected using pre-validated and tested self-structured tool, physical activity was assessed using global physical activity questionnaire and glycemic control was assessed by glycated haemoglobin (HbA1C) and compared to baseline level before the onset of pandemic. Results: Among 48 children (11.2±3.7 years, 25 M: 23 F), 79.2% fulfilled the 60 minutes’ requirement of physical activity/day. Moderate negative correlation was found in recommended physical activity duration and HbA1c during COVID-19 pandemic. However, there was a significant increase in the HbA1C level from 7.6±1.5 to 8.5±1.8 during COVID-19 pandemic. Conclusions: There was a moderate negative correlation between duration of physical activity and HbA1c of children. In spite of restrictions imposed by the government, children who were physically active were able to maintain good glycemic control. Although there was significant increase in the mean HbA1c of children during COVID-19 pandemic but the percentage of hyperglycemic events was significantly lower among the children who had walked/rode bicycle for going from one place to another and who had more rooms to play at home had good glycemic control.

Comparison of regular with NPH insulin vs. premix insulin in children and adolescents with type 1 diabetes in a resources-limited setting: a retrospective data analysis

Few studies addressed the efficacy of human insulin regimens (mostly premix insulin) used in many low-and-middle income countries on glycemic control of children and adolescents with diabetes. The aim of this study was to assess the efficacy of the premix insulin on the glycated hemoglobin (HbA1c) in comparison to the regular with NPH insulin scheme. A retrospective study was carried out from January 2020 to September 2022 on patients with type 1 diabetes aged below 18years followed in Burkina Life For A Child program. They were categorized into three groups, on regular with NPH insulin (Group A), on premix insulin (Group B) and on regular with premix insulin (Group C). Outcome was analyzed based on HbA1c level. Sixty-eight patients with a mean age of 15.38±2.26years and the sex ratio (M/W) 0.94 were studied. There were 14 in Group A, 20 in Group B, and 34 patients in Group C. The mean HbA1c value in the corresponding insulin regimen was 12.8±1.39%, 9.87±2.18%, and 10.66±2.1%, respectively. Glycemic control was better in Groups B and C than Group A (p<0.05) but there was no difference between groups B and C. Our results indicate that the use of premix insulin gives a better glycemic control than NPH insulin. However, further prospective study of these insulin regimens with a strengthening education strategy and glycemic control by continuous glucose monitoring and HbA1c is required to corroborate these preliminary findings.

IDF2022-0387 Long-term impact of an advanced closed-loop system on glycaemic control in children and adults with type 1 diabetes

IDF2022-0387 Long-term impact of an advanced closed-loop system on glycaemic control in children and adults with type 1 diabetes

"One and a Half Years of Things We Could Have Done": Multi-Method Analysis of the Narratives of Adolescents with Type 1 Diabetes during the COVID-19 Pandemic.

Public health interventions for COVID-19 forced families to adopt changes in daily routines that affected children's and adolescents' psychological well-being. In youth with type 1 diabetes (T1D), psychological symptoms may compromise glycemic control and outcomes; however, evidence of improved glycemic control in children and adolescents with T1D emerged early during the pandemic. This qualitative study aims to provide a more in-depth understanding of how the COVID-19 pandemic affected adolescents' with T1D routines, experiences, T1D management, and psychological well-being. 24 adolescents, aged 15-18 years, with T1D, joined focus-group discussions during the diabetes summer camp. Word frequency analysis and thematic analysis were conducted on adolescents' narratives. The average frequencies of use of words related to COVID-19 and to T1D were compared by t-test. Word frequency analysis identified "friends", "family", and "home" as the most recurrent terms. Seven themes were highlighted: (1) COVID-19 and T1D; (2) emotional reactions to the COVID-19 pandemic; (3) changes in daily life; (4) feelings of loss; (5) coping with the COVID-19 pandemic; (6) the COVID-19 pandemic as opportunity; (7) return to (new) normality. COVID-19 related words were on average more frequent than words referring to T1D. The COVID-19 pandemic may have represented a more stressful condition for adolescents with T1D, facing additional challenges compared to their healthy peers. Findings offer directions to the diabetes care team for customized interventions while the effects of the pandemic on adolescents' health continue.

Update information on type 1 diabetes in children/adolescents and adults.

Update information on type 1 diabetes in children/adolescents and adults.

Impacts of Educational Interventions on Glycemic Control in Children and Adolescents with Type 1 Diabetes Mellitus

Impacts of Educational Interventions on Glycemic Control in Children and Adolescents with Type 1 Diabetes Mellitus

Impact of lockdown during COVID-19 on glycaemic control in children with type 1 diabetes mellitus following at diabetes clinic, Omdurman, Sudan.

Corona Virus Disease-2019 (COVID-19) is a novel pandemic disease. There have been many challenges for diabetic patients, which might have resulted in an increased risk of complications and significant lifestyle changes, including physical inactivity and psychological distress. This study evaluated the effects of lockdown on paediatric patients with type 1 diabetic mellitus (T1DM) in terms of acute metabolic complications and psychological deterioration. A questionnaire-based cross-sectional study was conducted between November 2020 and February 2021 at Mohammed Alamin Hamid Diabetic Clinic, Omdurman, Sudan. Data was collected from direct interviews with patients and their caregivers. Out of 208 children with T1DM aged from 1-18 years, 48.1% had persistent hyperglycaemia, and 20.6% had hypoglycaemia. Insulin doses were missed in 20.2% of them, glucose monitoring was not done in 28.8%, and 20.6% reported decreased physical activity during the lockdown. Mean HbA1c levels were the same in pre and post-lockdown periods. There was an insignificant relationship between physical activity, dietary changes, and glycaemic control (p values = 0.519 and 0.146, respectively). On the other hand, there was a significant weak positive correlation between psychological and behavioural disorders such as aggression, anxiety, isolation, and glycaemic control (p-value = 0.032, 0.002, and <0.0001; r = 0.115, 0.135, and 0.169, respectively). The negative impact of the COVID-19 lockdown found on blood glucose measures and psychological status may correlate with glucose monitoring equipment shortage, lifestyle changes, and mood deterioration.

New-Onset Idiopathic Generalised Seizure in a Nigerian Teenager with Type 1 Diabetes Mellitus

We described a case of a 19-year-old female with a new onset Idiopathic Generalised seizure and Type 1 Diabetes mellitus(TIDM). Diagnosis of epilepsy is based on at least two unprovoked seizures. Anti-glutamic acid decarboxylase (Anti-GAD) antibodies positivity is a potential link between TIDM and epilepsy as seen in this case similar to other report. There is a need for careful glycaemic control in children with epilepsy and TIDM as hypoglycemia-induced seizure must be avoided using appropriate insulin dosage.

Comparative assessment of modern parameters of glycemic control in children with type 1 diabetes after switching to fast-acting insulin aspart using Flash Glucose Monitoring in real clinical practice

BACKGROUND: Postprandial hyperglycaemia contributes significantly to the lack of glycaemic control in patients with type 1 diabetes mellitus (DM1). At least a quarter of patients forget to inject insulin before meals once a week, and more than 40% of them inject bolus insulin immediately before meals, which does not correspond to the pharmacokinetic effects of ultrashort insulins and determines the need to use insulins with better imitations of physiological insulin secretion.AIM: To assess the effect of fast acting insulin aspart (FIAsp) on the current parameters of glycaemic control in children with DM1 after switching from insulin Asp (iAsp) using continuous glucose monitoring.MATERIALS AND METHODS: A multicenter observational 12-week prospective open-label uncontrolled comparative study was initiated. A group of insufficiently controlled patients were identified (n = 48) including a group on multiple insulin injections therapy (MII) (insulin degludec and IAsp) and a group on continuous subcutaneous insulin infusion (CSII) of iAsp. Three 14-day flash glucose monitoring (FMG) were performed: before transferring patients to FiAsp and after 2 and 12 weeks of the transfer. Key endpoints: HbA1c after 2 and 12 weeks on FiAsp relative to baseline, analysis of 5 FMG target glucose ranges, presented as an ambulatory glycemic profile. Additional indicators: dynamics of insulin daily dose, frequency of glucose self- monitoring, the number of severe hypoglycemia, adverse events that occurred during treatment.RESULTS: 2 weeks after the transfer from IAsp to FIAsp, TIR increased in the entire group of patients: from 53% [44.3; 66.5] to 57% [47.4; 71.0] (p-value = 0.010) and TAR decreased from 38% [24.8; 50.2] to 30.5% [22.0; 45, 0] (p-value = 0.0124). Maintaining and increase time spent in the target glucose ranges during a 12-week observation period, in parallel with a significant decrease in hypoglycemic episodes &lt;3.9 mmol / L per week, on FIAsp therapy naturally leads to an improvement in diabetes control: a decrease in HbA1c from 8.15% up to 7.75% (p-value = 0.0224), more pronounced in the group of patients on CSII — from 7.9% to 7.5% (p-value = 0.028).CONCLUSION: Switching from IAsp to BDIAsp in routine clinical practice in the MII and CSII regimen in children and adolescents with type 1 diabetes allows achieving better glycemic control compared to the previous generation prandial insulin analog Iasp. The better diabetes control is associated with an increase or a trend towards an increase in TIR and a decrease or a trend towards a decrease in TAR and TBR, as well as a significant decrease in episodes of hypoglycemia.

An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study.

The COVID-19 pandemic led to substantial shifts in pediatric diabetes care delivery to virtual and hybrid models. It is unclear if these changes in care delivery impacted short-term patient outcomes. We aimed to explore glycemic control and other diabetes-related outcomes in children living with Type 1 Diabetes Mellitus (T1DM) during the first year of the COVID-19 pandemic at a tertiary pediatric academic center in Canada. Patients <18 years of age with a confirmed diagnosis of T1DM for at least one year were included. This was a retrospective chart review. We compared data from two years pre-pandemic (March 15, 2018-March 14, 2020) to the first year of the pandemic (March 15, 2020-March 14, 2021). The data assessed included glycemic control [Hemoglobin A1c (HbA1c)], diabetic ketoacidosis (DKA), hospital attendance and hospitalizations, hypoglycemia, and hyperglycemia. The generalized estimating equation (GEE) analysis was used to model potential factors affecting the HbA1c and diabetes-related morbidities. Multiple imputations were conducted as a sensitivity analysis. There were 346 eligible patients included in the study. The HbA1c remained stable during the pandemic compared to the pre-pandemic phase (MD-0.14, 95% CI, -0.28, 0.01; p = 0.058). The pandemic saw an increase in the number of newly diagnosed patients (X2 = 16.52, p < 0.001) and a higher number of newly diagnosed patients presenting in DKA (X2 = 12.94, p < 0.001). In patients with established diabetes, there was an increase in hyperglycemia (OR1.38, 95% CI, 1.12,1.71; p = 0.003) and reduced DKA (OR 0.30, 95% CI, 0.12,0.73; p = 0.009) during the pandemic compared to the pre-pandemic phase. Stable rates of hospitalization (OR0.57, 95% CI, 0.31,1.04, p = 0.068) and hypoglycemia (OR1.11, 95% CI, 0.83,1.49; p = 0.484) were noted. These results were retained in the sensitivity analysis. Glycemic control in children with T1DM remained stable during the first year of the pandemic. There were more newly diagnosed patients during the pandemic compared to the pre-pandemic phase, and more of these new patients presented in DKA. The latter presentation was reduced in those with established diabetes during the same period.Further studies are needed to assess the ongoing impact of the COVID-19 pandemic on T1DM care pathways and outcomes to allow children, families, and diabetes teams to personalize choices of care models.

Combination therapy with lansoprazole and cholecalciferol is associated with a slower decline in residual beta-cell function and lower insulin requirements in children with recent onset type 1 diabetes: results of a pilot study.

To investigate the effects of combination therapy with cholecalciferol and lansoprazole on residual β-cell function and glycemic control in children with new-onset type 1 diabetes. Children aged 6-12 years with type 1 diabetes were allocated to receive cholecalciferol and lansoprazole (Group 1) or no treatment (Group 2). Children were maintained on their respective insulin regimens and kept records of blood sugar and insulin doses taken. Children were followed at three-month intervals for six months. Changes in mean fasting C-peptide and HbA1c levels, daily insulin doses, fasting blood glucose and mean blood glucose levels from baseline to end of the study were analyzed. Twenty-eight children (14 per group) met the eligibility criteria. Fasting C-peptide levels decreased significantly from baseline to study end in both groups (mean decrease -0.19±0.09ng/mL and -0.28±0.08ng/mL, p=0.04 and p=0.001; Group 1 and Group 2 respectively). However, fasting C-peptide level drop was significantly smaller in Group 1 compared to Group 2 (30.6% and 47.5% respectively; p=0.001). Likewise, daily insulin doses decreased significantly in both groups (-0.59±0.14units/kg and -0.37±0.24units/kg respectively; p=0.001). All patients recruited completed the study. No adverse events were reported. Combined therapy with cholecalciferol and lansoprazole for six months was associated with smaller decline in residual β-cell function and lower insulin requirements in children with new-onset type 1 diabetes. Preliminary findings of this small-scale study need to be confirmed by larger studies. (www.ctri.nic.in) under number REF/2021/03/041415 N.

Interrelationships Between Sleep, Obesity, and Glycemic Control in Children.

Interrelationships Between Sleep, Obesity, and Glycemic Control in Children.

Evaluating Health Disparities in a Pediatric Population With Type 1 Diabetes

We sought to determine the association between SES and glycemic control in children with type 1 diabetes (T1D) followed at the Montreal Children’s Hospital (MCH), and whether insulin pump use, processes of care and depression modified the association. Using MCH’s Pediatric Diabetes Database, we conducted a retrospective cohort study of children ages 0 to 18 years diagnosed with T1D for at least a year with a visit between November 2019 and October 2020. Our outcome was mean glycated hemoglobin (HbA1c) in the following year.

Poor glycemic control and associated factors among pediatric diabetes mellitus patients in northwest Ethiopia, 2020: facility-based cross sectional retrospective study design

Diabetes mellitus is a global public health problem. Glycemic control is a major public health problem. Diabetes results from elevated levels of glycaemia such as increased glucose and glycated hemoglobin, and controlling glycaemia is an integral component of the management of diabetes. Glycemic control in children is particularly difficult to achieve. Identifying determinants of poor glycemic control is important for early modification of diabetic related end organ damages. This study was aimed to assess the status of glycemic control and associated factors among pediatric diabetes mellitus patients in northwest Ethiopia. Facility-based cross sectional retrospective cohort study design was used and this study was conducted from September, 2015 to February, 2018. Simple random sampling was used to select 389 samples. Data were collected using an extraction checklist. Data were entered into Epi-data − 4.6, and analyzed using Stata-16. Finally, multivariable binary logistic regression was done. Poor glycemic control was more common among pediatric patients 39.3% (95% CI 34.6, 44.3). Treatment discontinuation (AOR 2.42, 95% CI 1.25, 4.69), age (AOR 1.15, 95% CI 1.03, 1.28) and treatment dose (AOR 0.96, 95 CI 0.92, 0.99) were significantly associated with poor glycemic control. Prevalence of poor glycemic control was high. Patient’s age, history of treatment discontinuation and dose of treatment were the significant contributing factors to poor glycemic control. These need to be addressed to attain the objective of adequate glycemic control.