Diabetes Mellitus In Children Research Articles

Type 2 diabetes mellitus in children and young people: a single uk paediatric diabetes centre experience

Type 2 diabetes mellitus in children and young people: a single uk paediatric diabetes centre experience

Basic principles of treatment and follow-up of children with acute odontogenic infection and insulin-dependent diabetes mellitus

The purpose of the study is to substantiate the basic principles of treatment and clinical dental observation of children with acute odontogenic inflammatory disease and insulin-dependent diabetes mellitus as an accompanying disease. Material and methods. A medical examination was conducted for 213 children who were treated at the St. Petersburg city children’s hospital of K.A. Raukhus of. The dental status of children with insulin-dependent diabetes mellitus and children of the control group without concomitant diseases was assessed using the Fedorov-Volodkina index, the KPU index and analysis of the caries intensity according to the T.F. Vinogradova table, periodontal conditions according to the PMA index (papillary-marginal-alveolar). The state of microhemocirculation of periodontal tissues was also assessed using Doppler ultrasound and the use of a reflex cold test. In children diagnosed with “Acute odontogenic osteomyelitis of the jaws,” laboratory blood parameters, the composition of the microbial flora of wound discharge, and the length of hospitalization were studied. Results. Based on the data obtained, an algorithm for treatment and dispensary dental observation of children with diabetes was presented. The detection of diabetes mellitus in children of any age should be accompanied by increased attention to the dental health of these patients. If teeth affected by caries are identified during a preventive examination, immediate treatment is required. It is necessary to ensure constant follow-up of the child by an endocrinologist. Doppler examination of the microhemocirculatory bed vessels of the mucosa of the alveolar process of the jaw revealed that an adequate response to a reflex cold test was detected only in the control group patients, those who do not have insulin-dependent diabetes mellitus. With the development of acute odontogenic osteomyelitis of the jaw in children suffering from insulin-dependent diabetes mellitus, hospitalization is necessary when the first clinical symptoms of the inflammatory process appear. Immediately after hospitalization and immediate surgical sanitation of a purulent focus of infection in the oral cavity, drug therapy should be started: antibacterial, infusion, symptomatic, as well as insulin therapy. The results of this study are especially relevant in the treatment of children with a duration of insulin-dependent diabetes mellitus of more than 5 years and a decompensated course of endocrine disease. Conclusions. The results of the study allowed us to expand our understanding of the impact of diabetes on the oral health of children, to establish risk factors for the development of acute odontogenic osteomyelitis of the jaws in children of different age categories with insulin-dependent diabetes mellitus, as well as the characteristics of the course of odontogenic osteomyelitis of the jaws in each of the cases. Based on the identified features, the principles of diagnosis and treatment of acute odontogenic osteomyelitis of the jaws in children with insulin-dependent diabetes mellitus have been formulated.

Systematic Literature Review: Analisis Faktor Risiko Diabetes Melitus Tipe 1 pada Anak dan Remaja di Negara Maju Wilayah Eropa Barat

The incidence of type 1 diabetes mellitus mostly occurs in children and adolescents has increased significantly every year, especially in developed countries in Western Europe which continue to experience the highest increase. The purpose of this study was to analyze the risk factors for type 1 diabetes in children and adolescents in developed countries in Western Europe. This type of research is a systematic literature review. The literature search strategy as a source of information was carried out by accessing electronic databases online, namely Science Direct, PubMed, and Google Scholar. Article quality assessment using Critical Appraisal Skill Programme (CASP). The results showed that out of 10 (2014-2024), conducted in the United Kingdom (n=1), Sweden (n=1), Germany (n=1), England (n=2), Denmark (n=3), Norway (n=1) and conducted in Norway and Denmark (n=1). Of the 10 articles, 5 out of 10 articles examined BMI on the development of type 1 diabetes in children and adolescents. The results of this systematic review found that age, gender, race, family history of diabetes, socioeconomic, BMI, nutritional intake in mothers and children, physical activity, infection and smoking will increase the risk of type 1 diabetes mellitus in children and adolescents in developed countries in Western Europe.

Modifying Factors of the Incidence of Type 1 Diabetes Mellitus in Children under 18 Years of Age in Northern Spain in the Last 3 Decades

Introduction: Type 1 Diabetes Mellitus is a chronic disease of autoimmune etiology that is highly prevalent in childhood. In the last decade, the possibility of the influence of the Bacillus Calmette-Guérin vaccine, different autoimmune diseases, modification of the immune response, and COVID19 itself of a simple population change due to immigration. Objectives: The objective of this work is to study the incidence of Type 1 Diabetes Mellitus in a cohort of children from Euskadi, north of Spain in the last 15 years. Methods: For the epidemiological study in Euskadi, a comparison of accumulated incidences between vaccinated and unvaccinated population groups was made. Results: The results of our study were not conclusive, but we believe that it is necessary to continue with long-term studies to eliminate bias.

Association of the apoptotic markers Apo1/Fas and cCK-18 and the adhesion molecule ICAM-1 with Type 1 diabetes mellitus in children and adolescents

BackgroundType 1 diabetes mellitus (T1DM) is characterized by immune and metabolic dysregulation. Apo1/Fas is implicated in maintaining homeostasis of the immune system. Cytokeratin-18 (cCK-18) is a predictive marker of liver disorders in T2DM. Intercellular adhesion molecule-1 (ICAM-1) is considered to increase susceptibility to diabetes mellitus. All three markers are associated with endothelial function, apoptosis and diabetes-related complications. The possible role of Apo1/Fas, cCK-18 and ICAM-1 was investigated in children and adolescents with T1DM.MethodForty-nine (49) children and adolescents with T1DM and 49 controls were included in the study. Somatometric measurements were obtained and the Body Mass Index (BMI) of the participants was calculated. Biochemical parameters were measured by standard laboratory methods and Apo1/Fas, cCK-18 and ICAM-1 were measured using appropriate ELISA kits. The statistical analysis was performed using the IBM SPSS Statistics 23 program.ResultsApo1/Fas (p = 0.001), cCK-18 (p < 0.001) and ICAM-1 (p < 0.001) were higher in patients with T1DM compared to the controls. Apo1Fas was negatively correlated with glucose (p = 0.042), uric acid (p = 0.026), creatinine (p = 0.022), total cholesterol (p = 0.023) and LDL (p = 0.005) in the controls. In children and adolescents with T1DM, Apo1/Fas was positively correlated with total cholesterol (p = 0.013) and LDL (p = 0.003). ICAM-1 was negatively correlated with creatinine (p = 0.019) in the controls, whereas in patients with T1DM it was negatively correlated with HbA1c (p = 0.05).ConclusionsApo1/Fas, cCK-18 and ICAM-1 may be useful as serological markers for immune and metabolic dysregulation in children and adolescents with T1DM. Also, Apo1/Fas may have a protective role against metabolic complications in healthy children.

Physical development of adolescents with type 1 diabetes mellitus and the impact of the war in Ukraine on its impairment

Purpose: To determine the characteristics of physical development (PD) of adolescents with type 1 diabetes mellitus (T1DM) and the impact of the war in Ukraine on its nature. Material and methods: The nature of physical development (PD) was assessed in adolescents with T1DM aged 14–18 years, examined before the start of the war on 24.02.2022 (main group, n = 114) and after 01.10.2022 (comparison group, n=76). The study was conducted in accordance with the principles of the Declaration of Helsinki and accepted by the Committee on Bioethics and Deontology. The examination of patients was carried out in accordance with the standards of medical care “Diabetes mellitus in children”, approved by Order of the Ministry of Health No. 413 of February 28, 2023 (Order of the Ministry of Health of Ukraine, 2023) and protocol for providing medical care to children in the specialty “pediatric endocrinology” (Order of the Ministry of Health of Ukraine, 2013). Results: It was proven that 29,1% of modern adolescents 14-17 years old, patients with T1DM, had a disharmonic PD, the nature of which depended on gender and the state of glycemic control. Girls were more likely to have impaired growth (21,0%) and overweight (12,8%), while boys were diagnosed with tall stature (8,9%) and underweight (8,9%). More often, PD disturbances were observed in the case of stable decompensation of carbohydrate metabolism with a decrease in the time spent in the target range and high levels of glycemic variability during the day. Among adolescents with T1DM during the period of hostilities in Ukraine, the number of adolescents with disharmonious PD increased (36,7%, P&lt;0,05), which may be due to a deterioration in glycemic control. In boys, an increase in the percentage of patients with underweight (20,0%, P&lt;0,05) and with short stature (4,0%, P&lt;0,05) was recorded, and in girls - with overweight (29,9 %, P&lt;0,05). Conclusions: confirms the negative impact of T1DM on RF, especially when socio-economic conditions worsen during armed conflicts. The relationship between the nature of risk factors, gender, the state of glycemic control and unfavorable living conditions during the war in Ukraine was determined.

Possibilities of Skin Autofluorescence Reflecting the Characteristics of Diabetes Mellitus in Childhood

Objective: To measure skin autofluorescence in children and adolescents suffering from type 1 diabetes mellitus and evaluate its relationship with gender, age, experience and chronic complications of the disease. Materials and Methods: The study group included 47 children and adolescents with type 1 diabetes. Autofluorescence of the skin from the inner surface of the shoulder and nail of patients was measured using an original compact spectrofluorimeter based on the STS-VIS OCEAN OPTICS © USA microspectrometer with UVA excitation. Statistical analysis was carried out using StatsoftStatistica 12.0 software. The data is presented as a two-dimensional array. The UV LED signal was averaged and smoothed using the moving average method with a 10 nm window. Then the spectra were renormalized taking into account the found coefficients. The result of applying additional normalization is a decrease in the standard deviation. Results and Discussion: Significant differences were revealed in the skin fluorescence spectra of children of different ages. between age groups (5-7) and (8-12) is most significant in the region of the alpha band of oxyhemoglobin (540 nm) (p &lt;0.005). When using I-normalization, the NADH peak region (p &lt; 0.02) is significant with increasing disease duration. When studying the influence of gender factors on the level of skin autofluorescence, the most significant differences are found in the area of only the isosbestic points of deoxy and oxyhemoglobin 442 nm (p&lt;10-7) and 491 nm (p&lt;10-8). Significant differences in skin autofluorescence at the reference length were also obtained waves in the autofluorescence spectrum of 500 nm correspond to p&lt;10-14, depending on the presence of complications. Conclusion: In Russia, as well as throughout the world, there is an increase in the incidence of type 1 diabetes mellitus. For early diagnosis of changes in carbohydrate metabolism and complications of the disease, a simple, accessible, non-invasive research method is needed. Taking into account the results of our study, when creating non-invasive methods for monitoring the state of carbohydrate metabolism, it is necessary to take into account gender and age characteristics, experience and the presence of complications of type 1 diabetes mellitus.

Predictive factors of diabetic ketoacidosis in patients with newly onset type 1 diabetes: A single center study

BackgroundDiabetic ketoacidosis is a severe metabolic emergency often associated with the onset of Type 1 Diabetes Mellitus, with significant morbidity and mortality. Its incidence as the initial presentation of Type 1 Diabetes Mellitus varies widely by country. In Morocco, there is a lack of comprehensive research on the prevalence and risk factors of diabetic ketoacidosis in children with newly diagnosed Type 1 Diabetes Mellitus, highlighting the need for this study. ObjectivesThe aim of our study was to analyze the predictive factors of diabetic ketoacidosis at the onset of Type 1 Diabetes Mellitus in children and adolescents at a single medical center in Morocco to develop prevention and management strategies. MethodsA retrospective, single-center study including 200 patients aged between 1 and 18 years at Type 1 Diabetes Mellitus onset, between September 2019 and September 2023. The population was divided into two groups according to the presence or absence of diabetic ketoacidosis. Medical records provided data for analysis with SPSS v21, employing Chi-square and Student's t-tests, followed by logistic regression to identify predictors of diabetic ketoacidosis. ResultsMultivariate regression identified several factors that were significantly associated with diabetic ketoacidosis at presentation, including age below 5 years (OR: 3.98; p = 0.021 compared to 6–10 years and OR: 5.07; P = 0.003 compared to 11–18 years), rural living (OR: 2.95; p = 0.032), low family income (OR: 9.22; p < 0.001), delayed diagnosis (OR: 21.27; p < 0.001), longer symptom duration before diagnosis (OR: 1.02; p = 0.010), preceding infections (OR: 2.72; p = 0.019), and lower vitamin D levels (OR: 0.90; p = 0.011). ConclusionOur findings underscore the critical need for increased awareness, education, use of point-of-care glucose testing, and targeted interventions in rural areas, in order to reduce the incidence of diabetic ketoacidosis. We also highlight the potential role of vitamin D in increasing the risk of diabetic ketoacidosis at the onset of Type 1 Diabetes Mellitus. This study provides important information on the present state of pediatric diabetes care in our country, and suggests target points for future interventions and research.

Features of the Liver Sonoelastography Findings in Patients with Type 1 Diabetes Mellitus in Childhood

Features of the Liver Sonoelastography Findings in Patients with Type 1 Diabetes Mellitus in Childhood

ANALYSIS OF REGULATORY AND LEGAL SUPPORT FOR THE PREVENTION OF DIABETES MELLITUS IN CHILDREN

Diabetes mellitus has become one of the most prevalent chronic diseases in childhood today. International forecasts suggest that the incidence of diabetes will continue to rise in the coming decades, leading to a lifelong burden for millions of children worldwide. Therefore, prediction, prevention, and optimal treatment of diabetes, as well as early prevention of serious long-term complications, remain essential. Providing highly qualified medical care to diabetic patients is a crucial step in preventing the development of complications. The purpose of this article is to review existing research on diabetes prevention strategies for children, considering the different levels of medical care support available. Materials and Methods. This study investigates the organization of preventive care for children with diabetes in Ukraine. Researchers employed three key methods: bibliosemantic analysis, content analysis focused on analyzing Ukraine relevant regulations and legal frameworks, and the method of systemic approach and analysis to gain a comprehensive understanding of how preventive care is currently organized for children with diabetes in Ukraine. Results. In Ukraine, preventive measures and the provision of medical care to pediatric patients with diabetes in the past years and today are regulated by a number of documents and orders of the Ministry of Health. As part of the Comprehensive Program “Diabetes Mellitus” (1999) and in accordance with the Order of the Ministry of Health of Ukraine “On Improving the Organization of Providing Endocrinological Care to the Population of Ukraine” (2006), the State Register of Patients with Diabetes Mellitus (SYNADIAB) was created. The next step was the approval of the State Target Program “Diabetes Mellitus”. Subsequently, the Project of the national program “Health 2020: Ukrainian Dimension” became an effective tool, which outlined the main principles of the program implementation in the “Endocrinology” section for 2013-2020. It defined measures at all stages of diabetes prevention, such as primary prevention, which consists of maintaining and strengthening the general state of health and preventing or delaying the development of diabetes; secondary prevention should improve early detection of diabetes mellitus; tertiary prevention, which ensures the effectiveness and safety of treatment of children with diabetes to prevent the development of long-term complications. Today, the guidelines for the management of children with diabetes mellitus have been continued in such documents as “Diabetes Mellitus in Children”, Evidence-Based Clinical Guidelines (2023) and Standards of Care (2023). Conclusion. Diabetes mellitus is a chronic disease that ranks third in prevalence after cardiovascular and cancerous diseases and second in the structure of endocrine diseases after thyroid gland pathology. Today, the prevalence of diabetes mellitus among children is constantly increasing and, therefore, solving the issues associated with this disease is one of the priority tasks for the national health care system. This is because diabetes mellitus is associated with a high risk of complications leading to loss of work capacity, disability, and mortality across various population groups. Organizing high-quality medical care and establishing an effective prevention system based on the latest medical technologies is crucial. Diabetes demands attention. Understanding the risks and prevention of the disease can significantly increase the chances of protection and a long, healthy life through timely treatment.

Clinical prediction model for MODY type diabetes mellitus in children

BACKGROUND: MODY (maturity-onset diabetes of the young) is a rare monogenic form of diabetes mellitus, the gold standard of diagnosis is mutations detection in the genes responsible for the development of this form diabetes. Genetic test is expensive and takes a lot of time. The diagnostic criteria for MODY are well known. The development of clinical decision support system (CDSS) which allows physicians based on clinical data to determine who should have molecular genetic testing is relevant.AIM: Provided a retrospective analysis of clinical data of the patients with T1DM and MODY, from 0 to 18 years old, regardless of the duration of the disease to develop the model. Based on clinical data, a feedforward neural network (NN) was implemented - a multilayer perceptron.MATERIALS AND METHODS: Development of the most effective algorithm for predicting MODY in children based on available clinical indicators of 1710 patients with diabetes under the age of 18 years using a multilayer feedforward neural network.RESULTS: The sample consisted of 1710 children under the age of 18 years with T1DM (78%) and MODY (22%) diabetes. For the final configuration of NS the following predictors were selected: gender, age at passport age, age at the diagnosis with DM, HbA1c, BMI SDS, family history of DM, treatment. The performance (quality) assessment of the NN was carried out on a test sample (the area under the ROC (receiver operating characteristics) curve reached 0.97). The positive predictive value of PCPR was achieved at a cut-off value of 0.40 (predicted probability of MODY diabetes 40%). At which the sensitivity was 98%, specificity 93%, PCR with prevalence correction was 78%, and PCR with prevalence correction was 99%, the overall accuracy of the model was 94%.Based on the NN model, a CDSS was developed to determine whether a patient has MODY diabetes, implemented as an application.CONCLUSION: The clinical prediction model MODY developed in this work based on the NN, uses the clinical characteristic available for each patient to determine the probability of the patient having MODY. The use of the developed model in clinical practice will assist in the selection of patients for diagnostic genetic testing for MODY, which will allow for the efficient allocation of healthcare resources, the selection of personalized treatment and patient monitoring.

Evaluation of the Presentation of Newly Diagnosed Type 1 Diabetes Mellitus in Children During and After the COVID-19 Pandemic

Background: The COVID-19 pandemic has been a global health problem with high morbidity and mortality. In this study, it was aimed to compare the clinical and laboratory findings of patients diagnosed with type 1 diabetes(T1D) during the pandemic and after the pandemic. Method: This is a 30-month, single-center, cross-sectional study. Between October 2020 and December 2021 was defined as the pandemic period, and between January 2022 and March 2023 as the post-pandemic period. The clinical and laboratory parameters of the newly diagnosed T1D patients who applied in these two time periods were compared. Results: While 87 patients were diagnosed during the pandemic period, 86 patients were diagnosed during the post-pandemic period. The rate of male patients diagnosed during the pandemic period was significantly higher (56%, 36%, respectively, p=0.007). Anti-islet Cell antibody (ICA) positivity was statistically significantly higher in those diagnosed during the pandemic period. (52.6%, 18.6%, respectively, p&amp;lt;0.001). There was no difference between the groups in terms of hemoglobin A1C, thyroid autoantibodies and tissue transglutaminase antibodies (p&amp;gt;0.05).C peptide levels were significantly lower in those diagnosed during the pandemic period (0.39±0.4, 0.63±0.6, respectively, p=0.021). Admissions with severe acidosis were more common during the pandemic than those admitted after the pandemic (29.9%, 16.3%, respectively, p=0.151). Conclusions: The numbers of children with T1D newly diagnosed in a secondary health center were similar during and after the pandemic. In the pandemic period, admissions with autoantibody positivity, low C-peptide and severe acidosis were more common.

Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50-year, single-center experience.

Global variations in epidemiology of type 1 diabetes mellitus (T1DM) exist. This study is designed to examine demographic and clinical features of T1DM over the past 3 decades as well as evolving trends in epidemiology over last 50 years. Clinical characteristics of 925 patients with T1DM over last 30 years (1990-2019) were evaluated and compared to previously published data of 477 patients diagnosed between 1969 and 1990 from one of the major referral centers for diabetes in Turkey. Mean age at diagnosis decreased from 9.5 ± 4.0 to 7.1 ± 3.6 years within the past 50 years (p < .001). Age at diagnosis peaked at 12-14 years between 1969 and 1990, then fell to 10-11.9 years between 1990 and 1999, and to 4-5.9 years between 2000-2009 and 2010-2019 (p = .005). Although the percentage of patients diagnosed <6 years of age is gradually increasing, the percentage between the ages of 6 and 11.9 years is decreasing, and the percentage diagnosed ≥12 years remained stable. A total of 47.5% of patients had ketoacidosis, 38.2% had ketosis, and 14.3% had only hyperglycemia. 23% of patients had severe diabetic ketoacidosis (DKA), whereas 42% had moderate. Over last 3 decades, there has been no change in frequency of ketoacidosis at presentation, but there has been significant decline in severity (p = .865, and p < .001, respectively). Although the frequency of patients with mild DKA increased over time, frequency of patients with moderate DKA decreased; however, no significant difference was observed among patients with severe ketoacidosis. DKA was more frequent and severe in patients <6 years of age (p = .005, and p < .001, respectively). Age at diagnosis shifted to younger ages in T1DM in the past 50 years. Half of patients had ketoacidosis at diagnosis and frequency of presentation with DKA did not decrease, but severity decreased slightly. Increase in prevalence of T1DM in the younger age group and the fact that half of patients present with DKA indicate that awareness should be increased in terms of early diagnosis and treatment.

Correlation between auto-immune diseases and type 1 diabetes mellitus in the pediatric age group in Erbil city

Background and objective: Type-1 diabetes mellitus is the most common chronic endocrine disorder of childhood and adolescence and is characterized by immune-mediated destruction of pancreatic cells, which has been proven to be correlated with and increase the risk of developing autoimmune thyroid disease, celiac disease, Addison’s disease, and further autoimmune diseases. The aim of this study is to evaluate the prevalence of autoimmune disease-related markers in type 1 diabetes mellitus in children and adolescents in Erbil city. Methods: One hundred children and adolescents with type 1 diabetes mellitus were enrolled in this cross-sectional study. Patients &lt;1 year old were excluded from the study. Autoimmune thyroid antibodies (anti-thyroid peroxidase and anti-thyroglobulin) along with tissue transglutaminase (IgA and IgG) antibodies were measured with further evaluation by thyroid function test and endoscopy with biopsy (for positive serological autoantibodies level). Results: Elevated anti-thyroglobulin, anti-thyroid peroxidase, and tissue transglutaminase IgA and IgG antibodies were determined in 24.0%, 26%, 10%, and 8%, respectively. 50.0% of cases with positive anti-thyroid peroxidase antibodies had overt hypothyroidism; on the flip side, 3.8% had subclinical hypothyroidism. As well, the high level of thyroid autoantibodies was significantly correlated to the prevalence of overt hypothyroidism (P &lt;0.001). Nine of the patients with positive tissue transglutaminase antibodies were verified to have biopsy-proven celiac disease. Conclusion: Children and adolescents with type 1 diabetes mellitus are at risk of developing positive antithyroid and celiac-related autoantibodies, so they are at risk of progressing to autoimmune thyroid and celiac diseases.

Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents.

Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents.

Ultrasound indicators of blood flow in the eyes and orbits at different durations of type 1 diabetes mellitus in childhood and adolescence

Diabetic retinopathy is a complication of type 1 diabetes mellitus with high social significance, especially in childhood and adolescence.Aim: To evaluate ultrasound indicators of retrobulbar blood flow at different durations of type 1 diabetes mellitus in childhood and adolescence.Material and Methods. Ultrasound examinations were performed in 70 patients with type 1 diabetes mellitus aged from 5 to 18 years, with disease duration of up to 5 years, from 5 to 10 years, and more than 10 years. The analysis included an assessment of the linear velocity of blood flow and the index of peripheral resistance in the ophthalmic arteries, central arteries and retinal veins, posterior short ciliary arteries, and ophthalmic veins at different times of the duration of type 1 diabetes mellitus.Results. The study revealed a decrease in blood flow velocity in the central retinal arteries, in the posterior short ciliary arteries with an increase in the duration of type1 diabetes mellitus. The greatest decrease in blood flow velocity was recorded in the group with duration of diabetes mellitus of more than 10 years.Conclusion. The obtained data on a decrease in blood flow velocity in the retrobulbar arteries can be used for the assessment and dynamic monitoring of early disorders of the blood supply to the eye and orbit in patients with type 1 diabetes mellitus in childhood and adolescence.

Growth and endocrinopathies among children with β-Thalassemia major treated at Dubai Thalassemia centre

Backgroundβ-Thalassemia major (BTM) is one of the most common hereditary anemias worldwide. Patients suffer from iron overload that results from repeated blood transfusion This in turn leads to multiple organ damage and endocrinopathies. This study aims to assess the prevalence of growth retardation, hypothyroidism, and diabetes mellitus in children and adolescents with BTM treated at Dubai Thalassemia Centre.MethodsA total of 105 children and adolescents were included in this retrospective observational study.Results39 children and 66 adolescents’ data were analyzed. Females composed 51.3% (n = 20) of children and 53.0% (n = 35) of adolescents. Pretransfusion hemoglobin below 9 gm/dl was observed in 10.8% (n = 4) and 10.6% (n = 7) in children and adolescents, respectively. The mean age of menarche was 13.5 years. Among all study participants, 22.6% (n = 14) had normal height velocity whereas 37.1% (n = 23) had reduced height velocity in one year and 40.3% (n = 25) had reduced height velocity in two consecutive years. The proportion of children and adolescents showing reduced height velocity was significantly higher in females compared to the males (90.6% versus 63.3%, respectively, Chi-square = 6.597, p-value = 0.010). Although none of the study participants had diabetes mellitus, 26.1% (n = 12/46) had pre-diabetes. Elevated TSH was observed in 14.7% (n = 5) children and 8.1% (n = 5) adolescents while low FT4 was reported in one child and one adolescent.ConclusionOf all endocrinopathies seen among children and adolescents with BTM, growth delay remains the main concern for this group of patients. Effective treatment is key to further reducing endocrinopathies. Although the sample size is limited, we postulate that the low percentage of endocrinopathies among children with BTM treated at Dubai thalassemia center and the low level of pretransfusion anemia reflect the effective transfusion and chelation at the center.

Risk factors causing Diabetes Mellitus in children and adolescent in Indonesia: A literature review

Diabetes mellitus in children and adolescents in Indonesia is becoming an increasingly significant health issue. Although the pediatric population reached 83 million in 2010, only a few were recorded as having TIDM according to data from the Indonesian Society of Pediatric Endocrinology (IPS). Prevalence in Indonesia has increased sevenfold in the last 10 years, reaching 28.19 per 100 million population in 2010. The main obstacles involve lack of awareness in the community and limited access to insulin. Hereditary factors also play a major role in pediatric cases. In the first stage after diagnosis, education is key in management, with emphasis on basic understanding. dietary management, insulin use, and handling medical emergencies. Insulin doses are administered empirically, with adjustments according to the phase of the disease. Collaboration with stakeholders and policy advocacy are needed to improve the quality of care for pediatric Diabetes Mellitus patients in Indonesia.

Effectiveness of a standardized scenario in teaching the management of pediatric diabetic ketoacidosis (DKA) to residents: a simulation cross-sectional study

BackgroundDiabetic ketoacidosis (DKA) is a frequent manifestation at the onset of type 1 diabetes mellitus in children, possibly associated with a wide range of complications, often as a consequence of wrong or delayed treatment. Due to its complex and risky management, direct exposure to real situations alone is not sufficient to achieve adequate skills in pediatric DKA for residents. Simulation could be a valuable aid, allowing to practice a standardized scenario of a complex real-world situation. We aimed to test the effectiveness of a standardized scenario of pediatric DKA in teaching its recognition and treatment.MethodsWe develop a standardized scenario able to guide step-by-step the learners through the flowchart of DKA management and considering alternative evolutions in the case of possible deviations from guidelines. It was a real-life simulation with the use of a high-fidelity pediatric simulator. It was played by 78 pediatrics 20 and emergency medicine residents. At the end of the simulation, a validated questionnaire was administered to collect feedback from participants regarding the impact of the simulation on learning. All materials to reproduce the DKA scenario are provided.ResultsOverall, the scenario was rated as realistic (mean score 4.37 ± 0.68, from 1 to 5) and relevant to professional training (4.72 ± 0.47), useful in increasing confidence in interpreting laboratory tests (3.97 ± 0.65), group organization and communication strategies (3.49 ± 0.94), and managing the treatment of DKA (3.46 ± 0.92).ConclusionsThe use of a standardized scenario of pediatric DKA may be a valid tool to reinforce theoretical knowledge in residents, both in pediatrics and in emergency medicine, and to directly and safely practice pediatric DKA management.

The role of GaD65, ZNTS, IA-2, and IAA as predictive biomarkers for type 1 diabetes mellitus in children

Background Type 1 diabetes mellitus (T1DM) is a chronic disorder characterized by immune-mediated harm to the pancreatic β-cells that produce insulin. The four major autoantibodies implicated in the pathophysiology are insulin autoantibodies, glutamic acid decarboxylase antibodies, tyrosine phosphatase antibodies, and zinc transporter 8 antibodies. Objective We examined whether children with T1DM have particular antibodies related to T1DM and their association with clinical features. Materials and methods The study involved 60 Iraqi children who had been diagnosed with T1DM within the last 3 years, as well as a control group of 60 healthy individuals without diabetes or autoimmune diseases. Blood samples were collected from all participants to analyze the levels of serum autoantibodies, specifically insulin (IAA), glutamic acid decarboxylase (GADA), tyrosine phosphatase (IA-2A), and zinc transporter 8 (ZnT8A), using an enzyme-linked immunosorbent assay (Sandwich-ELISA). Results and conclusion The findings revealed that a significant number of patients with diabetes had elevated levels of antibodies against zinc transporter 8 (P&lt;0.001), tyrosine phosphatase (P&lt;0.001), insulin autoantibodies (P&lt;0.001), and glutamic acid decarboxylase (P&lt;0.001). Glutamic acid decarboxylase 65 antibodies were found to be the most prevalent. All four biomarkers showed remarkable effectiveness in distinguishing positive and negative cases. Logistic regression analysis revealed that glutamic acid decarboxylase 65 and insulin antibodies were significantly associated with the outcome, while tyrosine phosphatase and zinc transporter 8 did not show such a relationship. These findings indicate that measurements of anti-zinc transporter 8, tyrosine phosphatase, insulin autoantibodies, and glutamic acid decarboxylase could be important diagnostic markers for identifying patients with T1DM, aiding in early detection and understanding the disease process.