Diabetic Adolescents Research Articles

Dapagliflozin or Saxagliptin in Pediatric Type 2 Diabetes

BackgroundIncidence of type 2 diabetes (T2D) in children and adolescents is increasing, but treatment options are limited.MethodsThis was a 26-week, phase 3 trial with a 26-week extension among patients (10 to 17 years of age) with uncontrolled T2D (A1C 6.5 to 10.5%) receiving metformin, insulin, or both. Participants were randomly assigned 1:1:1 to 5 mg of dapagliflozin (N=81), 2.5 mg of saxagliptin (N=88), or placebo (N=76). Patients in active treatment groups with A1C ≥7% at week 12 were further randomly assigned 1:1 at week 14 to continue the dose or up-titrate to a higher dose (10 mg of dapagliflozin or 5 mg of saxagliptin). The primary end point was change in A1C at week 26. Safety was assessed over 52 weeks.ResultsAt week 26, the difference versus placebo in adjusted mean change in A1C was −1.03 percentage points (95% confidence interval [CI], −1.57 to −0.49; P<0.001) for dapagliflozin and −0.44 percentage points (95% CI, −0.93 to 0.05; P=0.078) for saxagliptin. Adverse events (AEs) and serious AEs occurred in 72.8% and 8.6% of patients receiving dapagliflozin, 69.3% and 8.0% of patients receiving saxagliptin, and 71.1% and 6.6% of patients receiving placebo. Severe hypoglycemia occurred in 4.9%, 4.5%, and 7.9% of patients in each group, respectively. Over 52 weeks, the most common AE was headache (dapagliflozin 14.8%; placebo 5.3%). Most events were mild and none was considered serious or resulted in discontinuation.ConclusionsDapagliflozin, but not saxagliptin, showed significant improvement in A1C compared with placebo. Nonserious headaches were more common in participants treated with dapagliflozin than in those receiving placebo. (Funded by AstraZeneca; ClinicalTrials.gov number, NCT03199053.)

Improving self-management and diabetes indicators in adolescents with type 1 diabetes through self-care education

ABSTRACT Introduction: The frequency of type 1 diabetes (T1D) as one of the most prevalent endocrine disease in adolescents is increasing globally. This type of diabetes is a progressive degeneration β cells of the islets of Langerhans, which decreases insulin production and causes permanent dependence on insulin injection. It is essential to control diabetes in adolescents and increase awareness about the effective factors (self-care) on the health of adolescents with diabetes. Therefore, this study aimed to evaluate the effect of self-care training intervention on self-management subscales and some diabetes indicators (glycosylated hemoglobin level and fasting blood sugar) in adolescents with T1D. Materials and Methods: This study was conducted on 50 adolescents with T1D, who were referred to the Diabetes Clinic of Golestan Hospital, aged 12 to 18 and selected for this semi-experimental intervention and case–control study by the census. Six one-hour self-help sessions were held for adolescents and their parents. The data collection tools were the Adolescent Self-Care Questionnaire and the Diabetes Index Form for T1D (SMOD-A), used before and three months after the intervention. Chi-square, t-pair tests, and SPSS software version 23 were utilized for statistical data analysis. Results: There was no significant difference between the case and control group regarding gender, age, race, course of the disease, education level, and family history of diabetes (P = 0.771, 0.551, 0.074, and 0.111, respectively). Three months after the intervention, a significant increase was observed in all subscales of self-management and total self-management (P &lt; 001), and a significant decrease was seen in fasting blood sugar (P = 0.001) and glycosylated hemoglobin changes (P = 0.001). Conclusion: Based on the results, training adolescents through a T1D self-care program effectively improved their overall and subscale self-management and reduced fasting glucose and HbA1c levels.

Diabetes knowledge and associated factors in adolescents and young adults with type 1 diabetes in Ouagadougou (Burkina Faso)

BackgroundType 1 diabetes (T1D) in youth is becoming a public health problem in Sub-Saharan Africa, including Burkina Faso. However, little is known about the level of knowledge of these patients on T1D. This study aimed to evaluate the knowledge of diabetes in adolescents and young adults about the disease, and identify the factors associated in Burkina Faso.MethodsA cross-sectional survey was conducted from April to June 2020 among youth with T1D, aged 10 to 30 years, and regularly followed in the internal medicine department of Yalgado Ouedraogo University Hospital of Ouagadougou, Burkina Faso. Data were collected using the French AJD (Aide aux Jeunes Diabétiques) validated diabetes knowledge and skills (DKS) questionnaire designed to test participants’ accuracy in knowledge about six different themes of T1D, as generalities of diabetes, hypoglycemia and hyperglycemia, management of insulin treatment, and self-monitoring blood glucose (SMBG). DKS level was determined by calculating the scores, and univariate and multivariate logistic regression were used to explore factors influencing DKS scores. This level was classified as insufficient or low ≤ 25/50, regular 26–39/50, and adequate or good ≥ 40/50.ResultsSixty-three participants with a mean age of 19.05 years and a sex ratio (W/M) of 1.17 were included in our study. The mean HbA1c level was 9.79%, and 43 (68.23%) patients had an insufficient DKS level. The mean global DKS score of correct answers was 23.63/50. The percentage of correct answers was respectively 50% for the item “generalities of diabetes”, 32.4% for the item “hypoglycemia and hyperglycemia”, 67.72% for the item “diet”, 37.34% for the item “management of insulin treatment” and 44.97% for the item “SMBG”. In univariate analysis, a better patient DKS level was associated with university education and long duration of diabetes care follow-up (> 10 years, p < 0.05). Only increasing age remain associated with a better knowledge score (p < 0.05) in multivariate analysis.ConclusionThis study is an important first step in identifying areas for intervention efforts about therapeutic education for youth with type I diabetes in Burkina Faso.

Association between eating habits during adolescence and gestational diabetes: data from the Japan environment and children's study.

It is difficult to change pre-pregnancy eating habits, yet establishing healthy eating habits before pregnancy is important for preventing gestational diabetes mellitus (GDM). This study aimed to examine whether the weight-loss behavior of avoiding between-meal and midnight snacking in teenagers is associated with a reduction in the risk of subsequent GDM. We used a dataset (jecs-an-20,180,131) from a nationwide, prospective birth cohort study, the Japan Environment and Children's Study (JECS). We included 89,227 (85.7% of the total) mother-infant pairs with live births. Participants in their second or third trimester were asked to report their weight-loss behavior during their teenage years. The prevalence of GDM was investigated. Differences in maternal characteristics were examined using chi-square tests. Crude and adjusted logistic regression models were constructed to assess the associations of various maternal characteristics with the weight-loss behavior of avoiding between-meal and midnight snacking during teenage years. A total of 2,066 (2.3%) participants had GDM. Weight-loss behavior in teenagers was associated with a decreased risk of GDM. Among participants with normal weight or overweight prior to pregnancy, the adjusted odds ratios were 0.79 (95% confidence interval, 0.70-0.89) and 0.82 (95% confidence interval, 0.69-0.98), respectively. The results suggest that teenage weight-loss behaviors, such as avoiding between-meal and midnight snacking, are associated with a decreased risk of developing GDM. The online version contains supplementary material available at 10.1007/s40200-023-01294-2.

Epidemiological and Evolutionary Aspects of Diabetes Mellitus in Children and Adolescents in Pointe Noire

Diabetes in children and adolescents is considered rare in Africa due to a lack of data. We conducted a retrospective analytical study for 12 years, based on patient records between 2010 and 2022, and analyzed the epidemiological and evolutionary aspects of patients. A total of 236 patients were enrolled, including 121 (51.48%) men and 114 (48.51%) women. The average age at the discovery of the disease was 16.29±5.39 years, ranging from 1 year to 19 years. The most represented age group was 10-20 years. The incidence rate was 2.43/10,000 inhabitants/year. The prevalence of childhood diabetes mellitus in Pointe-Noire was 0.20%. We observed 98.29% cases of T1D, 0.85% of secondary diabetes, 0.42% of T2D, and 0.42% cases of MODY. Diabetic ketoacidosis was the most common cause of hospitalization (51.89%). Follow-up was regular for 43.82% of patients but marked by patients lost to follow-up (14.46%) and a significant number of deaths (18.72%). Better biological monitoring of our patients will prevent complications and improve care.

The burden of type 2 diabetes in adolescents and young adults in Mexico: analysis from the Global Burden of Disease Study, 1990 to 2019.

The aim was to analyze the findings from the 2019 Global Burden of Disease (GBD-2019) study on type-2 diabetes in Mexico's adolescents and young adults, at a national and subnational scale from 1990 to 2019, and to assess its association with the socio-demographic, and the healthcare access and quality indices. Following the GBD-2019 study, young-onset type 2 diabetes mortality, premature mortality, years lived with disability and disability-adjusted life-years (DALYs) are reported. A significant increase in the overall number of deaths attributed to young-onset T2D was found. There was a non-significant decrease in mortality rates for both sexes across most age groups. DALYs in men were greater than that in women, with almost half attributed to premature death in males, while disability accounted for two thirds of DALYs in females. The DALY rate increased significantly in most states. Premature mortality decreased, while disability increased across all age-groups, and in all states for both sexes. The surge in disability corresponded to the upsurge in obesity and overweight rates in Mexico among the younger population. This happened despite improvements in socio-economic status and healthcare access in Mexico which underscores the need for diabetes education in the public health sector.

Size for Gestational Age Affects the Risk for Type 1 Diabetes in Children and Adolescents: A Swedish National Case - Control Study

Size for Gestational Age Affects the Risk for Type 1 Diabetes in Children and Adolescents: A Swedish National Case - Control Study

Developing Self-Management of Type 1 Diabetes in the Australian School Setting: Perspectives of Adolescent Involvement in Sharing Responsibility for Diabetes Management

The International Society for Pediatric and Adolescent Diabetes has identified school as a critical context for adolescents with type 1 diabetes (T1D) who typically hold a fluctuating, though growing, amount of responsibility for diabetes self-management across this time. When parents use frequent autonomy-supportive communication to maintain a mutually agreeable sharing of responsibility for diabetes management with their adolescent, better outcomes are achieved. There is, however, a dearth of research examining the way adolescent responsibility is managed at school. This cross-sectional study investigated adolescents’ perspectives of sharing responsibility for T1D management at school and the extent to which these were concordant with parent perceptions. Sixty adolescents (10–19 years) and fifty-five parents completed questionnaires measuring the perceived impact of diabetes on adolescents’ school activities and respective involvement in the management of responsibility for school-based diabetes care. Adolescent questionnaires also measured perceptions of autonomy supportiveness (Health Care Climate Questionnaire) and communication quality (frequency, mode, autonomy), in relation to diabetes management. Differences by age and inter-rater agreement between parent and adolescent dyads were examined. Results showed that parents and adolescents did not agree about their relative involvement in setting up diabetes management strategies or the impact of diabetes on school activities. There was no difference in the involvement of older adolescents relative to younger students. Adolescents predominantly communicated about school diabetes care in person, though some reported no communication with school staff (25%) or healthcare workers (36%). Only thirty nine (65%) reported having a diabetes school plan. Nineteen (32%) perceived little or no involvement in setting up diabetes care strategies for the year and most had not attended a school-related meeting. These results suggest more explicit inclusion of adolescents in formal school support strategies may better represent their unique perceptions of responsibility, enabling the consensual sharing of responsibility that is associated with better outcomes.

Dimensionality and psychometric properties of the Parent Diabetes Distress Scale-Greek (PDDS-Gr).

Type 1 diabetes (T1D) is a chronic disease characterised by insulin deficiency due to autoimmune destruction of beta-pancreatic cells. T1D, formerly known as juvenile diabetes, is the most common form of diabetes in children and adolescents. On diagnosis, parents of children with TID experience considerable stress, because they need to care for a child in a challenging and life-threatening situation that requires adherence to an intensive medical regimen, constant monitoring of, and coping with their child's condition. T1D is a complex condition that affects both children and their parents in many aspects of their daily lives. This study presents the psychometric properties of the Greek translation of the Parent Diabetes Distress Scale (PDDS), which assesses diabetes distress in parents of children with T1D. A sample of 95 parents, mainly mothers (88.4%), with a mean age of their children 12.2 years (± 3.6) and a diabetes duration of 4.7 years (± 3.4), completed the Greek translation of the PDDS. Exploratory factor analysis (EFA) revealed a five-factor model: 'Parent/child relationship distress', 'Personal distress', 'Child diabetes management distress', 'Future distress', and 'Healthcare team distress'. Confirmation Factor Analysis (CFA) confirmed the construct validity of the scale. The internal consistency indices (Cronbach alpha) for the subscales ranged from 0.69 to 0.89, while the unidimensional structure had an alpha of 0.90. Furthermore, convergent validity was shown with moderate positive correlations between the PDDS-Gr and the subscales of the DASS-21 (depression, anxiety, and stress), the child's age (in years), and the HbA1c value. Finally, parents of children with inadequate glycemic control (HbA1c ≥ 7%) presented higher scores on both the unidimensional structure and the subscales 'Parent/child relationship distress' and 'Healthcare team distress' of the PDDS-Gr. The PDDS-Gr is a valid and reliable tool for assessing diabetes distress in parents of children with T1D and can be used in both clinical and research settings.

The Impact of COVID 19 on Glycemic Control in Children with Type 1 Diabetes on Insulin Pump Therapy: A Single Centre Study

Background Children with type 1 diabetes (T1DM) are at risk of glycemic deterioration during the COVID-19 pandemic due to several factors. However, some studies reported glycemic improvement in these children. Aim To assess the impact of COVID-19 on children with T1DM on insulin pump in terms of glycemic control and insulin therapy adjustments. Methodology Forty-two children with T1DM on insulin pump (Medtronic) for at least 3 months were recruited from the Pediatric and Adolescent Diabetes Unit (PADU), Ain-Shams University, Cairo, Egypt. They were assessed for insulin requirements, frequency of diabetic ketoacidosis and clinically significant hypoglycemia. Auxological parameters, HbA1c and lipid profile were assessed. Continuous glucose monitoring was performed using Medtronic i-pro device for 5 days for each patient. Data were compared to previous patients’ data obtained from their medical records. Study period was performed between 29/6/2020 until 29/12/2020. Results This study was carried out on 42 children with T1DM on insulin pump (15 males and 27 females with a male to female ratio of 1: 1.8) with a mean age of 11.31± 3.28 years, mean BMI of 18.80± 3.35 and mean disease duration of 4.40± 2.93 years. The mean insulin requirements of the studied children before the COVID- 19 pandemic was 0.83 ± 0.28 U/kg/d, range 0.5- 1.8 U/Kg/d with a mean basal percentage of 51.19 ± 3.46 %, range 45-60 % .As regards the laboratory data of the studied children with a mean HbA1c of 9.0±1.2%, range: 7-11.8%, mean fasting cholesterol of 184.88 ± 27.03 mg/dl, range: 142-233 mg/dl, mean fasting triglycerides of 89.81 ± 32.69 mg/dl, range: 43-148 mg/dl, mean LDL of 87.77±9.97 mg/dl, range: 68-98 mg/dl, mean HDL of 58.33± 12.28, range: 32-83 and median UACR was 13(10-21.9) mg/g, range: 7.0-94. There was a statistically significant increase in the total daily insulin units(P = 0.001), basal percentage (P = 0.011) and time in range (p = 0.009) with a significant decrease in the frequency of DKA (P = 0.001), hypoglycemia (P = 0.004), HbA1c (p = 0.001) and glycemic variability (p = 0.001) after the COVID-19 pandemic. Conclusion Glycemic control improved during the COVID-19 pandemic among children with T1DM on insulin pump therapy reflected by improvement in TIR and decrease in glycemic variability. Declarations Conflicts of interest disclosure The authors declare that they have no conflict of interest. Funding sources No funding sources

Evaluation of the Current International Registry Update for Children and Adolescents with Diabetes Mellitus Following Up in Diabetes Clinic, Pediatric Hospital, Ain Shams University

Background Diabetes team should have the access for receiving continuous feedback for the health care service to help successful improvement. Health professionals need to continuously work to improve the quality of pediatric diabetes care to reduce the risk of acute and chronic complications. Objective: To evaluate the current international SWEET registry update for the children and adolescents following regularly at Pediatric and Adolescents Diabetes Unit (PADU) during a period of six months and updating the existing electronic medical record (Database) in (PADU) to provide measures to improve patients outcome regarding both acute and chronic complications. Patients and Methods The present study is a prospective follow up study performed on 385 patients with diabetes mellitus type1, with a mean age 11.79 ± 4.16 years. All patient with diabetes mellitus type1 visiting diabetes clinic (PADU) were included in the study after obtaining an informed consent. Results Patients with longer diabetes duration have significant higher insulin dose, more attacks of DKA and less attacks of hypoglycemia comparing to those with shorter duration. Patients with poor glycemic control have more attacks of DKA (62 patients vs 58 patients), (p-value=0.046), and less attacks of hypoglycemia (25 patients vs 65 patients), compared to properly controlled patients (p-value=0.000). Patients on insulin pump show significant improvement of them HbA1c (11% vs 7.3%) (p –value=0.000), cholesterol (173 mg/dl vs 139.8 mg/dl) (p- value= 0.006) and SMBG (2.7 times vs 4.6 times) (p-value= 0.000), compared to patients on multiple daily injections (MDIs). Conclusion Diabetes care is the cornerstone for proper glycemic control and prevention of long term complications. This study showed the value of a registry system to enable monitoring of patients over many years. The study could be an important step in the development of a national registry system for diabetes in Egypt.

Ongoing Increase in Incidence of Diabetes in Austrian Children and Adolescents (1989–2021): Results from a Nationwide Registry

Introduction. Since there is no uniform global diabetes trend in childhood and adolescence, regional epidemiological surveys of diabetes incidences are important. In Austria, the incidences of type 1 diabetes (T1D), type 2 diabetes (T2D), and other forms of diabetes have been recorded for decades. Methods. To analyze recent developments of diabetes incidence within the decades long-standing Austrian nationwide prospective population-based incidence study for diabetes in children aged &lt;15 years. We estimated time trends of age-standardized rates from 1989 to 2021 for T1D and T2D by joinpoint analysis. Annual percent changes (APCs) were calculated. Case ascertainment was 97%. Results. We observed an unusual increase of T1D incidence in the year 2021, reaching a peak of 28.7/100,000/PY (person years). From 2011 to 2020, there had been a constant plateau phase in the total cohort (APC 0.78, 95% CI [−0.99, 2.58], p = 0.379 ), which had followed a steep increase of T1D incidence (APC 4.6, 95% CI [3.94, 5.19], p &lt; 0.001 ) from 1989 to 2011. Age-specific differences in T1D incidence development were observed. For the first time, we observed a statistically significant constant increase in T2D during the observation period (APC 3.47, 95% CI [0.76, 6.26], p = 0.014 ). Other forms of diabetes are two times more common than T2D in this age group. Conclusion. The incidence of T1D in Austrian children &lt;15 years is still increasing and showed a peak in 2021. For the first time, a significant increase in pediatric T2D was observed in Austria.

Impact of youth onset type 2 diabetes during pregnancy on microvascular and cardiac outcomes

AimsTo examine the impact of pregnancy on microvascular and cardiovascular measures in women with youth-onset T2D. MethodsMicrovascular and cardiovascular measures were compared in in a cohort of 116 women who experienced a pregnancy of ≥ 20 weeks gestation and 291 women who did not among women in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. ResultsCox regression models adjusted for participant characteristics at baseline including age, race/ethnicity, household income, diabetes duration, HbA1c (>6%), and BMI, demonstrated those who experienced pregnancy had 2.76 (1.38–5.49; p = 0.004) fold increased risk of hyperfiltration (eGFR ≥ 135 ml/min/1.73 m2), compared to those without a pregnancy. No differences were observed in rates of retinopathy (48.9% vs. 41.1%) or neuropathy (23.3% vs. 16.3%) in women who experienced pregnancy vs. women who did not, respectively. In fully adjusted models, pregnancy did not impact changes in echocardiographic or arterial stiffness compared to changes in women who were never pregnant. ConclusionsThese results indicate that pregnancy increases the risk of hyperfiltration in women with youth-onset T2D, but not other micro or macrovascular complications. The rates of vascular complications are very high in youth-onset T2D potentially obscuring micro- and macrovascular changes attributable to pregnancy.Clinical Trial Information: ClinicalTrials.gov numbers,NCT01364350andNCT02310724.

Efficacy and safety of closed-loop control system for type one diabetes in adolescents a meta analysis

This meta-analysis compares the efficacy and safety of Closed-Loop Control (CLC) to Sensor-Augmented Insulin Pump (SAP) for adolescent patients with Type 1 Diabetes Mellitus (T1DM). Eleven randomized-controlled trials were included with a total of 570 patients, from a total of 869 articles found adhering to PRISMA guidelines. The efficacy of the therapies were evaluated from the day, night and during physical activities monitoring of the of the mean blood glucose (BG), Time In Range (TIR), and Standard Deviation (SD) of the glucose variability. The safety measure of the therapies, was assessed from the day and night recording of the hypoglycemic and hyperglycemic events occurred. Pooled results of comparison of mean BG values for day, night and physical activities, − 4.33 [− 6.70, − 1.96] (P = 0.0003), − 16.61 [− 31.68, − 1.54] (P = 0.03) and − 8.27 [− 19.52, 2.99] (P = 0.15). The monitoring for day, night and physical activities for TIR − 13.18 [− 19.18, − 7.17] (P < 0.0001), − 15.36 [− 26.81, − 3.92] (P = 0.009) and − 7.39 [− 17.65, 2.87] (P = 0.16). The day and night results of SD of glucose variability was − 0.40 [− 0.79, − 0.00] (P = 0.05) and − 0.86 [− 2.67, 0.95] (P = 0.35). These values shows the superiority of CLC system in terms of efficacy. The safety evaluation, of the day, night and physical activities observations of average blood glucose goal hypoglycemic events − 0.54 [− 1.86, 0.79] (P = 0.43), 0.04 [− 0.20, 0.27] (P = 0.77) and 0.00 [− 0.25, 0.25] (P = 1.00) and hyperglycemic events − 0.04 [− 0.20, 0.27] (P = 0.77), − 7.11 [− 12.77, − 1.45] (P = 0.01) and − 0.00 [− 0.10, 0.10] (P = 0.97), highlights the commendable safety factor of CLC. The CLC systems can be considered as an ideal preference in the management of adolescents with type 1 diabetes to be used during a 24 h basis.

COMPARATIVE EFFECTIVENESS AND SAFETY OF METHODS OF INSULIN DELIVERY AND GLUCOSE MONITORING FOR DIABETES MELLITUS: A SYSTEMATIC REVIEW

Introduction: Achieving glycemic control remains difficult for patients with type 1 diabetes. We compared the efficacy of day-and-night hybrid closed-loop insulin delivery to sensor-augmented pump therapy in individuals 6 years and older with suboptimally controlled type 1 diabetes.&#x0D; The aim: This article compared effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus.&#x0D; Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done.&#x0D; Result: In the PubMed database, the results of our search brought up 166 articles, whereas the results of our search on SagePub brought up 143 articles. The results of the search conducted for the last year of 2013 yielded a total 116 articles for PubMed and 89 articles for SagePub. In the end, we compiled a total of 23 papers, 15 of which came from PubMed and eight of which came from SagePub. We included six research that met the criteria.&#x0D; Conclusion: The use of a hybrid closed-loop insulin delivery system in free-living conditions for a period of twelve weeks led to clinically relevant improvements in glycaemic control while simultaneously reducing the risk of hypoglycemia in suboptimally controlled type 1 diabetes in adults, adolescents, and children aged six years and older.

Basal and Bolus Insulin Distribution According to Treatment Modality: Data from SWEET Diabetes Registry

Background and Aims. The optimal basal and bolus insulin distribution in type 1 diabetes (T1D) is still controversial. Herein, we aimed to determine the variability of basal to total daily insulin dose according to treatment modality and diabetes technologies from the Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Methods. The study cohort was generated by using the SWEET database. Patients with T1D for at least 2 years, aged between 2.5 and 18 years, with at least one clinic visit between June 2010 and June 2021, were included in the study. Four groups were composed according to treatment modality as follows: multiple daily injections (MDI) without continuous glucose monitoring (CGM); MDI with CGM; subcutaneous insulin infusion (CSII) without CGM; and CSII with CGM. Data of the participants were analyzed and compared for each treatment modality separately. Results. A total of 38,956 children and adolescents were included in the study. Of the study sample, 48.6% were female, the median (range) age was 15.2 (11.9–17.2) years, and the median diabetes duration was 6.0 (3.8–9.0) years. The distribution of treatment modality was as follows: MDI without CGM, 32.9%; MDI with CGM, 18.0%; CSII without CGM, 11.7%; and CSII with CGM, 37.3%. In unadjusted data, regardless of treatment modality, all the analyses revealed a significant association between basal dose to total daily insulin dose (BD/TDD) with male gender, younger age group, and lower HbA1c, which were all related to a decreased ratio of BD/TDD (all p &lt; 0.05 ). There was no association between BD/TDD and different diabetes technologies after the age, gender, and diabetes duration were adjusted. Conclusions. Herein, we showed that there was an association between lower proportions of basal to total insulin and lower hemoglobin A1c in a large cross-sectional cohort of children who had T1D. There was also an association between lower BD/TDD and younger age. There was no significant difference between BD/TDD ratios under different diabetes technologies (CGM and/or CSII).

Risk of New-onset Type 1 Diabetes in Danish Children and Adolescents After SARS-CoV-2 Infection: A Nationwide, Matched Cohort Study.

We investigated the association between SARS-CoV-2 infection and new-onset type 1 diabetes (T1D) in children and adolescents in a nationwide, matched cohort study. The hazard ratio of new-onset T1D within 6 months after SARS-CoV-2 infection was 1.22 (0.58-2.58). The risk of new-onset T1D in children and adolescents was not significantly increased after SARS-CoV-2 infection.

The Role of the Health Literacy Levels of Parents in the Management of Type 1 Diabetes in Children and Adolescents

The Role of the Health Literacy Levels of Parents in the Management of Type 1 Diabetes in Children and Adolescents

Pediatric Type 1 Diabetes: Mechanisms and Impact of Technologies on Comorbidities and Life Expectancy.

Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood, with a progressively increasing incidence. T1D management requires lifelong insulin treatment and ongoing health care support. The main goal of treatment is to maintain blood glucose levels as close to the physiological range as possible, particularly to avoid blood glucose fluctuations, which have been linked to morbidity and mortality in patients with T1D. Indeed, the guidelines of the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend a glycated hemoglobin (HbA1c) level < 53 mmol/mol (<7.0%) for young people with T1D to avoid comorbidities. Moreover, diabetic disease strongly influences the quality of life of young patients who must undergo continuous monitoring of glycemic values and the administration of subcutaneous insulin. In recent decades, the development of automated insulin delivery (AID) systems improved the metabolic control and the quality of life of T1D patients. Continuous subcutaneous insulin infusion (CSII) combined with continuous glucose monitoring (CGM) devices connected to smartphones represent a good therapeutic option, especially in young children. In this literature review, we revised the mechanisms of the currently available technologies for T1D in pediatric age and explored their effect on short- and long-term diabetes-related comorbidities, quality of life, and life expectation.

Trajectories of eGFR and risk of albuminuria in youth with type 2 diabetes: results from the TODAY cohort study.

We conducted exploratory analyses to identify distinct trajectories of estimated glomerular filtration rate (eGFR) and their relationship with hyperfiltration, subsequent rapid eGFR decline, and albuminuria in participants with youth-onset type 2 diabetes enrolled in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. Annual serum creatinine, cystatin C, urine albumin, and creatinine measurements were obtained from 377 participants followed for ≥ 10years. Albuminuria and eGFR were calculated. Hyperfiltration peak is the greatest eGFR inflection point during follow-up. Latent class modeling was applied to identify distinct eGFR trajectories. At baseline, participants' mean age was 14years, type 2 diabetes duration was 6months, mean HbA1c was 6%, and mean eGFR was 120ml/min/1.73m2. Five eGFR trajectories associated with different rates of albuminuria were identified, including a "progressive increasing eGFR" group (10%), three "stable eGFR" groups with varying starting mean eGFR, and an "eGFR steady decline" group (1%). Participants who exhibited the greatest peak eGFR also had the highest levels of elevated albuminuria at year 10. This group membership was characterized by a greater proportion of female and Hispanic participants. Distinct eGFR trajectories that associate with albuminuria risk were identified, with the eGFR trajectory characterized by increasing eGFR over time associating with the highest level of albuminuria. These descriptive data support the current recommendations to estimate GFR annually in young persons with type 2 diabetes and provide insight into eGFR-related factors which may contribute to predictive risk strategies for kidney disease therapies in youth with type 2 diabetes. ClinicalTrials.gov Identifier: NCT00081328, date registered 2002. A higher resolution version of the Graphical abstract is available as Supplementary information.