Diabetic Children Research Articles

Quantitative Analysis and Visualization of the Interaction Between Intestinal Microbiota and Type 1 Diabetes in Children Based on Multi-Databases.

Background: As an important autoimmune disease, type 1 diabetes (T1D) is often diagnosed in children, but due to the complexity of the etiology of diabetes and many other factors, the disease pathogenesis of diabetes is still unclear. The intestinal microbiota has been proved to have close relationships with T1D in recent years, which is one of the most important molecular bases of pathogenesis and prognosis factors for T1D. Using the multi-omics and multicenter sample analysis method, a number of intestinal microbiota in T1D have been discovered and explained, which has provided comprehensive and rich information. However, how to find more useful information and get an intuitive understanding that people need conveniently in the huge data sea has become the focus of attention. Therefore, quantitative analysis and visualization of the interaction between intestinal microbiota and T1D in children are urgently needed.Methods: We retrieved the detailed original data from the National Center for Biotechnology Information, GMREPO, and gutMEGA databases and other authoritative multiple projects with related research; the ranking of intestinal microbiota abundance from healthy people, overall T1D patients, and T1D in children (0–18 years old) were detailed analyzed, classified, and visualized.Results: A total of 515 bacterial species and 161 related genera were fully analyzed. Also, Prevotella copri was led by 21.25% average abundance, followed by Clostridium tertium of 10.39% in all-cross T1D patients. For children with T1D, Bacteroides vulgatus has high abundance in all age periods, whereas the abundance of each intestinal microbiota was more uniform in female samples, with the ranking from high to low as Bacteroides dorei 9.56%, P. copri 9.53%, Streptococcus pasteurianus 8.15%, and C. tertium 7.53%, whereas in male samples, P. copri was accounted for the largest by 22.72%. The interaction between intestinal microbiota and comparison between healthy people and children with T1D was also detailed analyzed.Conclusions: This study provides a new method and comprehensive perspectives for the evaluation of the interaction between intestinal microbiota and T1D in children. A set of useful information of intestinal microbiota with its internal interaction and connections has been presented, which could be a compact, immediate, and practical scientific reference for further molecular biological and clinical translational research of T1D in children.

Clinical Significance of the Fetuin-A-to-Adiponectin Ratio in Obese Children and Adolescents with Diabetes Mellitus.

Fetuin-A and adiponectin are inflammatory cytokines associated with obesity and insulin resistance. This study aimed to examine the fetuin-A-to-adiponectin ratio (FAR) in diabetic children and to determine the role of FAR. A total of 54 children and adolescents with diabetes mellitus (DM) and 44 controls aged 9–16 years were included in this study. Clinical characteristics, including plasma fetuin-A and adiponectin levels, were compared with respect to body mass index (BMI) and diabetes type. Of 98 children, 54.1% were obese, whereas 18.4% were obese and diabetic. FAR was higher in obese children with DM than in non-obese children and also in type 2 DM children than in type 1. FAR showed a stronger association with BMI than with fetuin-A and adiponectin individually, and its association was more prominent in diabetic children than in controls. BMI was a risk factor for increased FAR. Plasma fetuin-A was elevated in obese children, and its association with insulin resistance and β cell function seemed more prominent in diabetic children after adjustment for adiponectin. Thus, FAR could be a useful surrogate for the early detection of childhood metabolic complications in diabetic children, particularly those who are obese.

Risk Factors for Diabetic Ketoacidosis among Type 1 Diabetic Children Registered at “Heraa Diabetes Center” in Makkah Al-Mokarramah City, Saudi Arabia

Aim of Study: To assess risk factors associated with DKA among T1DM children registered at “Heraa Diabetes Center”, Makkah Al-Mokarramah City, Saudi Arabia. Patients and Methods: A retrospective hospital-based, case-control research design was followed and included 375 diabetic patients aged less than 15 years. The “Study Group” included 125 children who had a past history of diabetic ketoacidosis (DKA Group), while the “Control Group” comprised 250 diabetic children who did not have past history of DKA. A data collection sheet was designed by the researchers. Results: There was significantly more positive family history in the DKA group than the control group (78.4% and 68%, respectively, p=0.036). The mothers were the main person who injects the child. Differences between both study groups according to the person who injects the child was statistically significant (p=0.029). DKA occurred more than once in 59.2% of diabetic children, and in 46.4% of children with over-activity. The main presenting symptoms of DKA were polyuria, thirst and vomiting. The main causes and triggering factors were eating too many sweets (65.6%), missing blood sugar monitoring (57.6%), omitting the insulin dose (22.4%), or infection (12.8%). Children in the control group were significantly more compliant than those in the DKA group regarding daily measurement of blood sugar (82.8% and 71.2%, respectively, p=0.009), timely receiving treatment (96% and 82.4%, respectively, p<0.001), following a healthy diet (79.6% and 65.6%, respectively, p=0.003), and receiving health education (95.2% and 88%, respectively, p=0.011). Conclusions: Risk factors for DKA include positive family history of diabetes, and less educated or employed mothers, but its incidence is lower among children of parents with health-related jobs. It can be triggered by over-activity. It is caused by eating too many sweets, missing blood sugar monitoring, omitting the insulin dose, or infection. Noncompliance is associated with higher incidence of DKA. Recommendations: All parents of diabetic children should receive health education and be trained about management of diabetes, compliance to diabetes management, continuous monitoring of glucose levels, and early manifestations of DKA. Key Words: Diabetic ketoacidosis, Type 1 diabetes, Children, Risk factors, Compliance, Saudi Arabia.

AACE2021-A-1011: Recurrent Diabetic Ketoacidosis: Can We Prevent It?

Diabetic ketoacidosis begets another attack. It's often a challenge in treating diabetic children. Factors associated with recurrent diabetic ketoacidosis include psychological disturbance, depression, antidepressant use, abnormal eating pattern, social deprivation, female sex especially in teen age, and uncontrolled diabetes. Recurrent diabetic ketoacidosis is an independent predictor of short term mortality at 2-6 years. This retrospective study included review of medical records of 32 type 1 diabetic patients, 19 females and 13 males who were admitted with diabetic ketoacidosis to King Fahad hospital, Madina, Saudi Arabia. They aged 14 to 32 years. Data included for each patient included age, sex, number of attacks of diabetic ketoacidosis in last 2 years (from August 2018 to August 2020), HbA1c, and use of insulin pump or antidepressants. All cases presented with metabolic ketoacidosis and ketonuria. The largest number of attacks was 4 admissions per year in a female who was on antidepressant and has HbA1c 10.4% in her last admission. The mean HbA1c in females was 9.45% and in males 9.59%. 4 female patients are on insulin pump and 2 female patients have end stage renal disease. Adverse effects of recurrent diabetic ketoacidosis admissions include social burden, economic cost and patient morbidity/mortality. Suggested strategy for prevention of recurrent diabetic ketoacidosis include education of patient and care givers, multidisciplinary team composed of endocrinologist/diabetologist, dietician, psychiatrist, psychologist, social worker and diabetic educator. Continuous glucose monitors can also prevent or reduce recurrence of diabetic ketoacidosis.

Role of motivational interviewing in type 1 diabetes mellitus with sub optimal glycemic control.

Objective: To determine the role of motivational interviewing in better management of diabetes mellitus in children. Study Design: Observational Cross Sectional Study. Setting: Children Hospital & Institute of Child Health Multan. Period: November 2019 to May 2020. Material & Methods: Fifty-six poorly controlled follow up diabetic children of 8 to 15 years of both sexes, with HBA1c more than 10 %were included. Their social status, educational status whether studying or not was noted. All patients were advised subcutaneous Insulin according to weight. All children were counselled and motivated for self-care, problem identification and solution, and proper diabetic management by a team consisting of an endocrinologist, a dietitian, a psychologist and a nurse. Glycemic control was assessed using HbA1c, at 1st visit, 3rd and 6th month. A decline in HbA1c by ≥1% was considered for good control of DM, while ≤1% decrease was taken as poor control of DM. Data was analyzed by using SPSS version 20. Result: Out of 56 patients. 50%(n=28) were females and ,50%(n=28) were males.42.9 % (n=24) patients were age ranges between 8 to 11.5 years while 57.1%(n=32) more than 11.5 to 15 years, with mean age of 11.8±1.97 years 28.6% diabetic children belonged to lower, 57.1% middle while 14.3% upper socioeconomic status. 69.4%children were going to school while 27.6% were not studying. Good glycemic control was observed in 85.7% diabetic children which is statistically significant (p-value <0.001). Conclusion: Motivational interview proved to be a good tool for the better outcome of diabetic children, who need both knowledge and practical communication for their management regarding behavioral changes, lifestyle issues and self-management. It must be a part of diabetic management programs.

Impact of consanguinity marriage on developing type 1 diabetes of beta thalassemia children

Objective: To find impact of consanguinity marriage on developing diabetes in a group of thalassemia children.
 Methodology: A cross sectional study carried out from October 2016 to June 2017at thalassemia centers of Lahore city. One hundred and fifty beta thalassemia major children with age range 4 to 8 years receiving regular blood transfusion were recruited by purposive sampling. Structured questionnaires were filled by the consented parents of children.
 Results: Among total number of thalassemia patients, the frequency of male was100 and of female was 50. The frequency of male and female diabetic thalassemia children was 25 (25 %) and 25 (50%) respectively. Frequency of general consanguinity was 148(98.66%). Weak correlation of fasting blood sugar with consanguinity in diabetic thalassemia children was observed. 
 Conclusion: Consanguinity marriages may have a role on developing diabetes in thalassemia children.

Mortality amongst children and adolescents with type 1 diabetes in sub-Saharan Africa: The case study of the Changing Diabetes in Children program in Cameroon.

Type 1 diabetes in Africa has been associated with high mortality attributed mainly to poor insulin access. Free insulin provision programs for people with type 1 diabetes have been introduced across Africa recently. We aimed to determine the mortality rate and associated factors in a cohort of children and adolescents with type 1 diabetes who receive free insulin treatment in sub-Saharan Africa. We conducted a retrospective analysis using the Changing Diabetes in Children (CDiC) medical records in Cameroon between 2011 and 2015. The overall mortality rate was 33.0 per 1000 person-years (95% CI 25.2-43.2). Most deaths (71.7%) occurred outside of the hospital setting, and the cause of death was known only in 13/53 (24.5%). Mortality was substantially higher in CDiC participants followed up in regional clinics compared to the main urban CDiC clinic in Yaounde; 41 per 1000 years (95% CI 30.8-56.0) versus 17.5 per 1000 years (95% CI 9.4-32.5), and in those with no formal education compared to those who had some level of education; 68.0 per 1000 years (95% CI 45.1-102.2) versus 23.6 per 1000 years (95% CI 16.5-33.8). In Cox proportional multivariable analysis, urban place of care (HR=0.23, 95% CI 0.09-0.57; p= 0.002) and formal education (HR=0.42, 95% CI 0.22-0.79; p= 0.007) were independently associated with mortality. Despite free insulin provision, mortality remains high in children and adolescents with type 1 diabetes in Cameroon and is substantially higher in rural settings and those with no formal education.

Homozygosity of the Z-2 polymorphic variant in the aldose reductase gene promoter confers increased risk for neuropathy in children and adolescents with Type 1 diabetes.

Diabetic neuropathy (DN) is the least recognized complication of diabetes mellitus and may start early in the course of the disease. Aldose reductase (AKR1B1) gene promoter Z-2/Z-2 polymorphism increases the expression of AKR1B1 enzyme and may contribute to DN. We evaluated 108 Type 1 diabetes (T1D) children and adolescents (mean ± SD age: 13.5 ± 3.46 years, disease duration: 5.3 ± 3.4 years) and 150 healthy controls (age: 11.9 ± 2.7 years). In both groups, pupillary dilation (PD) in darkness, postural blood pressure test (PBPT), and vibration sensation thresholds (VST) in upper and lower limbs were estimated as indices of autonomic and peripheral neuropathy, respectively. Nerve conduction studies (NCS) were performed in patients as peripheral neuropathy index. The polymorphisms of AKR1B1 gene were evaluated using microsatellite (AC)n sequence Z. PBPT, PD, and VST impairments were more frequent in patient group compared with controls, while 38.6% of patients exhibited NCS abnormality. Gender, age, pubertal status, height, body mass index, diabetes duration, HbA1c, and anti-GAD titers were associated with neuropathy indices in patients. There was a strong correlation between PD and NCS in patients, while homozygous patients for Z-2 AKR1B1 gene polymorphism had higher prevalence of abnormal NCS (83.3% vs. 34.6%), PD (62.5% vs. 31.5%), and PBPT values compared with heterozygous or negative patients. Homozygous AKR1B1 status predicted PD, NCS, and PBPT variance, while PD, VST, NCS, and PBPT parameters accurately discriminated homozygous AKR1B1 patients. Impaired indices of peripheral and autonomic DN were present in a significant proportion of young T1D patients. PD, VST, NCS, and PBPT parameters were simultaneously associated with homozygous state of AKR1B1 Z-2 gene polymorphism, implicating polyol metabolism with both autonomic and peripheral neuropathies.

Vitamin D status in children and adolescents with type 1 diabetes in a specialized diabetes care centre in Bangladesh.

ObjectivesHigh prevalence of vitamin D deficiency (VDD) in children and adolescents with type 1 diabetes (T1D) was found in several epidemiological studies. The current study aimed to assess the Vitamin D status in children and adolescents with T1D and to examine the influence of the disease characteristics on vitamin D status in a specialized care centre in a tertiary hospital in Bangladesh.MethodsParticipants were enrolled in the cross‐sectional study at the time of a regularly scheduled visit to the CDiC Paediatric Diabetes Center in BIRDEM 2(Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders), a tertiary care hospital in Bangladesh. The demographic and clinical data were collected through medical records with a structured questionnaire.ResultsAmong sixty study participants, most had inadequate levels of vitamin D: deficiency 31 (51.7%), insufficiency 14 (23.3%) and sufficiency 15 (25.0%). Participants with vitamin D deficiency (VDD) were significantly older compared to the sufficient and insufficient group (p = .029), and were residing in urban areas (p = .036) and from higher socioeconomic status (p = .014). BMI was significantly higher in VDD compared to the sufficient group (p = .040). Although we observed higher median values of daily insulin requirements and HbA1c values in patients with VDD compared to patients with vitamin D insufficiency or vitamin D sufficiency, these differences did not reach statistical significance.ConclusionsThe present study revealed that the prevalence of vitamin D deficiency and insufficiency among T1 diabetes children was very high. Future studies in large sample are required to assess hypovitaminosis D in youth with T1D and also the possible relating factors of vitamin D deficiency.

Does low-glycaemic index diet affect glycaemic control, diet adherence and life quality of type 1 diabetic children and young people?

Does low-glycaemic index diet affect glycaemic control, diet adherence and life quality of type 1 diabetic children and young people?

Dental Treatment Effect on Blood Glucose Level Fluctuation in Type 1 Unbalanced Diabetic Children.

Diabetic patients struggle to maintain their blood glucose near normal levels to avoid the occurrence of hypo- or hyperglycemia discomfort. Dental practitioners must foresee such complications as they can also take place during dental treatment.Aim and objectiveThis study aims to evaluate the impact of the type and duration of dental treatment on the blood glucose level (BGL) fluctuation in type 1 unbalanced diabetic children [hemoglobin A1c (HbA1c) >7].Material and methodsA cross-sectional approach was conducted on 83 type 1 unbalanced diabetic children (HbA1c) > 7%, aged between 7 years and 12 years, divided into 40 females and 43 males in the Department of Pediatric Dentistry at the Lebanese University in Beirut. For dental treatments, diabetic children were scheduled for morning sessions 60–90 minutes after breakfast intake and a habitual insulin shot. Only patients with a BGL between 70 mg/dL and 300 mg/dL underwent dental treatments. The type, the duration of the dental session, and the BGL at the baseline (T0), and at the end of the session (T1) were recorded. The dental acts were classified into simple (without local anesthesia) and unpleasant with a solution of 2% lignocaine with 1:200,000 epinephrine. Statistical analyses were performed.ResultsFifty of 83 showed a decrease in their BGLs after dental treatments, 20 an increase, and 13 no change. For both genders, in simple acts, a statistical significance was noted (p = 0.0002) for the female and (p = 0.0014) for the males.ConclusionTreatment unbalanced diabetic children can be safely done by taking some precautions and measures to avoid a hypo- or hyperglycemia episode.How to cite this articleNoueiri B, Nassif N. Dental Treatment Effect on Blood Glucose Level Fluctuation in Type 1 Unbalanced Diabetic Children. Int J Clin Pediatr Dent 2021;14(4):497–501.

Characterization of the Oral Microbiome Among Children With Type 1 Diabetes Compared With Healthy Children.

Aim: Current microbiome profiling of type 1 diabetes mellitus (T1D) patients is mostly limited to gut microbiome. We characterized the oral microbiome associated with T1D in children after the onset of the disease and explored its relationship with oral physiological factors and dental status.Methods: This cohort study comprised 37 children aged 5–15 years with T1D and 29 healthy children matched in age and gender. Unstimulated whole saliva was collected from diabetic and non-diabetic children, in the morning after brushing their teeth and a fasting period of at least 1 h before sampling. 16S rRNA gene-based analysis was performed by Powersoil Pro kit by Qiagen and Phusion High-Fidelity PCR Master Mix. Oral physiological and dental parameters studied included decayed, missing, and filled teeth index, salivary flow rate, and salivary pH, glucose, calcium, phosphate, and urea levels.Results: Of the identified 105 different genera and 211 different species, the most abundant genera were Streptococcus, Prevotella, Veillonella, Haemophilus, and Neisseria. Streptococcus was more abundant in T1D children. The diabetes group had 22 taxa at the genus level and 33 taxa at the species level that were not present in the control group and the control group exhibited 6 taxa at the genus level and 9 taxa at the species level that did not exist in the diabetes group. In addition, Catonella, Fusobacterium, and Mogibacterium differed between healthy and T1D subjects. Eight species and eight subspecies were significantly more abundant among healthy children than in T1D children. Porphyromonas and Mogibacterium genera were significantly correlated with salivary parameters. We found similarities between taxa revealed in the present study and those found in gut microbiome in type 1 diabetes mellitus according to gutMDisorder database.Conclusions: Salivary microbiome analysis revealed unique microbial taxa that differed between T1D children and healthy subjects. Several genera found in the saliva of T1D children were associated with gut microbiome in T1D individuals.

A Cloud-based Robot System for Long-term Interaction: Principles, Implementation, Lessons Learned

Making the transition to long-term interaction with social-robot systems has been identified as one of the main challenges in human-robot interaction. This article identifies four design principles to address this challenge and applies them in a real-world implementation: cloud-based robot control, a modular design, one common knowledge base for all applications, and hybrid artificial intelligence for decision making and reasoning. The control architecture for this robot includes a common Knowledge-base (ontologies), Data-base, “Hybrid Artificial Brain” (dialogue manager, action selection and explainable AI), Activities Centre (Timeline, Quiz, Break and Sort, Memory, Tip of the Day, \( \ldots \) ), Embodied Conversational Agent (ECA, i.e., robot and avatar), and Dashboards (for authoring and monitoring the interaction). Further, the ECA is integrated with an expandable set of (mobile) health applications. The resulting system is a Personal Assistant for a healthy Lifestyle (PAL), which supports diabetic children with self-management and educates them on health-related issues (48 children, aged 6–14, recruited via hospitals in the Netherlands and in Italy). It is capable of autonomous interaction “in the wild” for prolonged periods of time without the need for a “Wizard-of-Oz” (up until 6 months online). PAL is an exemplary system that provides personalised, stable and diverse, long-term human-robot interaction.

Evaluation of early retinal vascular changes by optical coherence tomography angiography in children with type 1 diabetes mellitus without diabetic retinopathy.

To evaluate macular and peripapillary vascular changes by optical coherence tomography angiography (OCTA) in children with type 1 diabetes mellitus (T1DM) without diabetic retinopathy (DR). This study included 46 patients with T1DM and 46 age-sex matched healthy subjects. All participants were evaluated in terms of macular and optic disk parameters by using AngioVue. Foveal avascular zone (FAZ) area, macular and optic disk vessel density (VD) were analyzed. The correlation of these parameters with metabolic factors such as disease duration, mean hemoglobin A1c (HbA1c), insulin-like growth factor 1 (IGF-1) standard deviation score (SDS), homocysteine (Hcy) level, body mass index (BMI) SDS and daily insulin dose was also investigated in T1DM group. No significant difference was found in FAZ area and optic disk radial peripapillary capillary (RPC) VD comparing diabetic and control groups. In all macular regions, VD was significantly lower in T1DM versus control group both in superficial capillary plexus (SCP) and deep capillary plexus (DCP). None of the metabolic parameters was correlated with FAZ area and optic disk RPC-VD. Vascular density in SCP was negatively correlated with mean HbA1c and positively correlated with IGF-1 SDS. Homocysteine level was negatively correlated with DCP-VD in all areas. In children with T1DM without clinically apparent DR, VD in SCP and DCP was decreased and OCTA is a valuable imaging technique for detecting early vascular changes. The metabolic parameters such as mean HbA1c, IGF-1 SDS and Hcy affect the macular VD in diabetic children. 2011-KAEK-2, 2021/4, Trial registration date: 02.04.2021.

Protective Influence of Breastfeeding on Cardiovascular Risk Factors in Women With Previous Gestational Diabetes Mellitus and Their Children: A Systematic Review and Meta-Analysis.

There is evidence that breastfeeding may provide protection against cardiovascular risk factors in mothers with a history of gestational diabetes mellitus and their children who were exposed in utero. To perform a systematic review and meta-analysis of observational studies to ascertain the effects of breastfeeding on cardiovascular risk factors in women with previous gestational diabetes mellitus and their children exposed in utero. Studies assessing conventional cardiovascular risk factors in women with previous gestational diabetes mellitus and children exposed in utero stratified by breastfeeding/no breastfeeding or breastfed/not breastfed were included. Gestational diabetes mellitus was defined based on the International Association of Diabetes in Pregnancy Study Group definition or previous accepted definitions. Breastfeeding was defined as reported in each study. The literature search yielded 260 titles, of which 17 studies were selected to be in the review. Women with previous gestational diabetes mellitus who did not breastfeed had higher blood glucose (SMD: 0.32, 95% CI [0.12, 0.53]) and a greater risk of developing Type 2 diabetes mellitus (RR: 2.08 95% CI [1.44, 3.00]) compared to women with no history. There were not enough studies to conduct a meta-analysis on the effects of breastfeeding on risk factors for cardiovascular disease among children exposed to gestational diabetes mellitus in utero. Breastfeeding appears to be protective against cardiovascular risk factors among women who experience gestational diabetes mellitus.

Estimation of vitamin D level in type 1 diabetic children

Background and Aim Previous studies have shown the relationship between children with type 1 diabetes and vitamin D. To evaluate the level of vitamin D in children with type 1 diabetes and the effect of low vitamin D level on the long-term blood glucose controls reflected by glycated hemoglobin. Patients and methods The study included 20 children who had already been diagnosed as having type 1 diabetes mellitus with vitamin D deficiency and 20 normal nondiabetic children as a control group. Full history taking, clinical examinations, and investigations for all children, including serum 25-hydroxy vitamin D level, were done. Results Vitamin D deficiency was present in ∼85% of children with type 1 diabetes compared with nondiabetic control, who showed good vitamin D level. Conclusion Type 1 diabetic children are associated with low vitamin D level. Perhaps infants supplemented with vitamin D level might be a safe and effective plan for decreasing the risk of type 1 diabetes and also may decrease and improve levels of glucose and glycated hemoglobin levels in type 1 diabetes mellitus.

Psychological Assessment of a Sample of Egyptian Children and Adolescents with type 1 diabetes

Abstract Background Type 1 Diabetes Mellitus (T1DM) is the most common type of diabetes in children. Besides the damaging effects of diabetes on various organs, cognitive changes are also very common. Changes in memory, executive function, attention and academic performance are among the most important impairments seen in children with diabetes. Objectives The aim of this work is to do psychological assessment of children and adolescents with type 1 diabetes at Ain Shams University paediatrics hospital including Health Related Quality of life assessment and DSM-5 criteria for diagnosing ADHD. Patients and methods This study is cross sectional case-control study included 140 cases divided into two groups group (A) includes seventy diabetic children recruited from the Paediatric Diabetes Clinic, paediatric hospital, Ain Shams University 35 males (50%) and 35 females(50%) age ranges from 6 to 14 years old with Mean±SD (9.56±2.25), group (B) includes seventy normal children 32 males(45.7%) and 38 females(54.3%) age ranges from 5 to 15.5 years old with Mean±SD (10.32 ± 2.93). Both groups were subjected to full history taking, clinical examination including Anthropometric measures i.e. weight, height, Body Mass Index (BMI), laboratory investigations includes HbA1C, CBC, Metabolic Profile, psychometric assessment includes DSM-5 criteria for attention deficit hyperactivity disorder (ADHD), Conners rating scale, health related quality of life ( HRQL) questionnaire, Pediatric Check List (PCL). Results Cases fulfilling criteria of ADHD (predominantly hyperactive type, predominantly inattentive type, mixed type) more than control group and difference was statistically significant, HRQOL of diabetic children shows lower score than those of the control group and difference was statistically highly significant. Conclusion Diabetes has an important impact on the psychosocial development of the children as they grow up.

Screening for Celiac Disease in Newly Diagnosed Children with Type I Diabetes

Abstract Background Type I diabetes (T1D) is an autoimmune disease caused by the immune-mediated destruction of insulin-producing pancreatic β cells.. Celiac disease is 5-7 percent more common in people with T1D than in the general population. Objectives The aim of this study was to detect the incidence of coeliac disease among newly diagnosed T1D children by assessment of Anti-tissue Transglutaminase Antibody (anti-tTG), IgA. Methods Fifty children with newly diagnosed T1D and another 15 age and sex –matched healthy individuals were subjected to screening for celiac disease by measuring total body IgA and antiTtg(IgA). Results the incidence of positive anti tTG(IgA) Ab among our T1D patients was found to be 12%. Upon comparing children with positive anti tTG(IgA) Ab with those with negative anti tTG(IgA) Ab we found that children with +ve anti tTG(IgA) Ab were significantly shorter than those with -ve anti tTG(IgA) Ab(p < 0.05). Also HbA1c among our diabetic children with +ve anti tTG(IgA) Ab was significantly higher than those with -ve anti tTG(IgA) (p < 0.05). Gastrointestinal manifestations were significantly higher among T1D patients with anti tTG (IgA)+ve than those with anti tTG(IgA)- ve.(p < 0.001). Conclusion Anti tTG(IgA) Ab levels are elevated in children and adolescents with type 1 diabetes compared with healthy controls with incidence rate of about 12%. Anti tTG(IgA) Ab test can be used as screening test for celiac disease among type1 DM.

Vitamin D Receptor Gene (Fok-I) Polymorphisms in Type 1 Diabetic Children; Case Study in Zagazig University Hospitals

Vitamin D Receptor Gene (Fok-I) Polymorphisms in Type 1 Diabetic Children; Case Study in Zagazig University Hospitals

Before-Visit Questionnaire: A Tool to Augment Communication and Decrease Provider Documentation Burden in Pediatric Diabetes.

To develop and evaluate an electronic tool that collects interval history and incorporates it into a provider summary note. A parent-facing online before-visit questionnaire (BVQ) collected information from parents and caregivers of pediatric diabetes patients prior to a clinic encounter. This information was related to interval history and perceived self-management barriers. The BVQ generated a summary note that providers could paste in their own documentation. Parents also completed postvisit experience questionnaires. We assessed the BVQs perceived usefulness to parents and providers and compared provider documentation content and length pre- and post-BVQ rollout. We interviewed providers regarding their experiences with the system-generated note. Seventy-three parents of diabetic children were recruited and completed the BVQ. A total of 79% of parents stated that the BVQ helped with visit preparation and 80% said it improved perceived quality of visits. All 16 participating providers reviewed BVQs prior to patient encounters and 100% considered the summary beneficial. Most providers (81%) desired summaries less than 1 week old. A total of 69% of providers preferred the prose version of the summary; however, 75% also viewed the bulleted version as preferable for provider review. Analysis of provider notes revealed that BVQs increased provider documentation of patients' adherence and barriers. We observed a 50% reduction in typing by providers to document interval histories. Providers not using summaries typed an average of 137 words (standard deviation [SD]: 74) to document interval history compared with 68 words [SD 47] typed with BVQ use. Providers and parents of children with diabetes appreciated the use of previsit, parent-completed BVQs that automatically produced provider documentation. Despite the BVQ redistributing work from providers to parents, its use was acceptable to both groups. Parent-completed questionnaires on the patient's behalf that generate provider documentation encourage communication between parents and providers regarding disease management and reduce provider workload.