Diabetic Children Research Articles

174-LB: Autoantibodies against PTM-IA2 Extracellular Domain Are Only Associated with Late Progression of Type 1 Diabetes

Background: Autoantibodies directed against the extracellular domain of IA2 (IA2ecA) with post-translationally modified (PTM) (deamidated) epitopes have been identified in new-onset T1D patients. The prevalence and timing of appearance of PTM-IA2ecA in pre-T1D individuals is evaluated in the current study. Methods: A PTM-IA2ec protein antigen probe containing four T-cell responsive deamidated Q>E peptides (aa 198-216, aa 467-482, aa 523-536 and aa 545-562) was produced. The study subjects included 269 children and 260 adults with new-onset T1D, 271 adults with LADA, 274 children with new-onset diabetes but negative for all islet autoantibodies (IAbs) (IAA, GADA, IA-2A and ZnT8A), and 222 pre-T1D children who were longitudinally followed from birth to stage 1-3 T1D. The longitudinal follow-up serum samples included samples prior to seroconversion, samples at the first appearance on an IAb and the last follow-up samples. All serum samples were tested for PTM-IA2ecA and the wide type (WT-IA2ecA) with a radio binding assay. Results: In new-onset T1D, positivity for PTM-IA2ecA and WT-IA2ecA were 60.6% (163/269) and 19.3% (52/269), respectively in children, while significantly less in adults, 14.2% (37/260, P<0.0001) and 8.8% (23/260, P=0.0007), respectively. The positivity for PTM-IA2ecA and WT-IA2ecA were only 4.1% (11/271) and 1.5% (4/271) in LADA patients, 1.5% (4/274) and 1.1% (3/274) in diabetic children who were otherwise IAb negative. In 222 longitudinally followed children with pre-T1D, only 13 were tested positive for PTM-IA2ecA and 8 positives for WT-IA2ecA, with most detected at diagnosis of stage 3 T1D. Conclusion: Autoantibodies against either WT-IA2ec or PTM-IA2ec were not frequently seen in pre-T1D as shown in new onset T1D. These autoantibodies develop in the late stage of T1D progression with overt clinical disease. Disclosure X. Jia: None. J. M. Wenzlau: None. M. Rewers: Research Support; Provention Bio, Juvenile Diabetes Research Foundation (JDRF), Hemsley Charitable Trust, Dexcom, Inc., Janssen Research & Development, LLC. A. W. Michels: Stock/Shareholder; Immnomolecular Therapeutics. L. Yu: None. Funding National Institute of Allergy and Infectious Diseases (AI53665); National Institute of Diabetes and Digestive and Kidney Diseases (DK032083)

Optical Coherence Tomography Angiography in Early Detection of Microvascular Changes in Type I Diabetic Children: A Systematic Review and Meta-Analysis

Optical Coherence Tomography Angiography in Early Detection of Microvascular Changes in Type I Diabetic Children: A Systematic Review and Meta-Analysis

Assessment Self Care Practice among Diabetic Children

Assessment Self Care Practice among Diabetic Children

G Protein-Coupled Receptors and the Rise of Type 2 Diabetes in Children

The human genome counts hundreds of GPCRs specialized to sense thousands of different extracellular cues, including light, odorants and nutrients in addition to hormones. Primordial GPCRs were likely glucose transporters that became sensors to monitor the abundance of nutrients and direct the cell to switch from aerobic metabolism to fermentation. Human β cells express multiple GPCRs that contribute to regulate glucose homeostasis, cooperating with many others expressed by a variety of cell types and tissues. These GPCRs are intensely studied as pharmacological targets to treat type 2 diabetes in adults. The dramatic rise of type 2 diabetes incidence in pediatric age is likely correlated to the rapidly evolving lifestyle of children and adolescents of the new century. Current pharmacological treatments are based on therapies designed for adults, while youth and puberty are characterized by a different hormonal balance related to glucose metabolism. This review focuses on GPCRs functional traits that are relevant for β cells function, with an emphasis on aspects that could help to differentiate new treatments specifically addressed to young type 2 diabetes patients.

The Importance of Extended High Frequencies in Hearing Evaluation of Pediatric Patients with Type 1 Diabetes.

Type 1 diabetes (T1D), one of the most common childhood diseases worldwide, can cause hearing loss through its systemic effects. Diabetes-induced hearing loss is considered a progressive sensorineural hearing loss with a gradual onset typically occurring at high frequencies. We investigated extended high-frequency (EHF) hearing sensitivity in children with T1D who did not complain of hearing loss as an early marker for hearing loss at the standard/conventional frequency range of hearing. We evaluated 42 children (21 with T1D and 21 healthy controls) in a case-control design. Conventional and EHF (14,000, 16,000, and 18,000 Hz) audiometry were performed. The diabetes group underwent routine blood biochemistry and glycated hemoglobin (HbA1c) measurements. The data were analyzed by the Student t-test, Mann-Whitney U test, chi-square test, and logistic regression analysis. The mean hearing thresholds were significantly higher (p < 0.05) in the diabetes group than in controls at 500, 2,000, 4,000, and 8,000 Hz (all < 15 decibel hearing level [dB HL]). The number of ears with thresholds > 15 dB HL at 14,000-18,000 Hz but ≤ 15 dB HL at 500-4,000 Hz was significantly higher in the diabetes group than in the control group (p = 0.049). Children with diabetes showed normal hearing thresholds within the conventional audiometric frequency range; however, they presented higher hearing thresholds during EHF audiometry when they were compared with controls. Audiometry in these children should be performed using frequencies above 8,000 Hz combined with the conventional frequency range. EHF audiometry could be an effective method for identifying subclinical hearing loss in children with diabetes. Thus, diabetic children with an EHF mean hearing threshold above 15 dB HL should be monitored more closely in terms of blood glucose regulation to prevent diabetes-related hearing loss at the conventional frequency range.

Prevention of Type 1 Diabetes in Children: A Worthy Challenge?

Nowadays, the development of new immuno-therapeutic drugs has made it possible to alter the course of many autoimmune diseases. Type 1 diabetes is a chronic disease with a progressive dependence on exogenous insulin administration. The ability to intercept individuals at high risk of developing type 1 diabetes is the first step toward the development of therapies that can delay the process of β-cell destruction, thus permitting a better glycemic control and reducing the incidence of ketoacidosis. The knowledge of the main pathogenetic mechanisms underlying the three stages of the disease may be helpful to identify the best immune therapeutic approach. In this review, we aim to give an overview of the most important clinical trials conducted during the primary, secondary and tertiary phases of prevention.

The Psychological Burden of Families with Diabetic Children: A Literature Review Focusing on Quality of Life and Stress.

Chronic diseases, such as childhood diabetes mellitus (DM), are a complex and continuous struggle as well as a great challenge both for the children who face the disease and for their parents. DM is characterized by the complex management of therapeutic treatments, thus causing physical and psychological complications infamily members. There are many families who, upon hearing the diagnosis of their child with DM, stand still in front of these new facts as their lives change. All these unprecedented conditions cause parents intense stress and discomfort, leading them to a mental burden, as the only thing that concerns them upon diagnosis is how the family will survive in the face of the current conditions they are experiencing as well as the future of the sick child. The purpose of this brief literature review is to present the research findings related to the psychological burden of families withchildren with DM, focusing on the quality of life and stress.

Psychological Characteristics of Families of Children with Diabetes Mellitus

Chronic diseases, such as childhood diabetes mellitus (DM), are a challenge for sick children and their families. Paediatric DM is characterized by a complex therapeutic management treatment, which has a physical and psychological effect on the whole family and entails multiple losses for the parents. Investigators point out that parents of children with DS react to the diagnosis with anger, denial, frustration, and depression and that mothers differ in their reactions from fathers. The teenager goes through a very intense period of his life, full of emotional tensions and outbursts, anger, sorrow, fear, and shame for his desires, thoughts, and himself. Thus, a disease in the period of adolescence is very likely to harm the adolescent’s self-image and negatively affect body image and perception of strength and ability. For this reason, the investigations carried out in the context of this field are necessary to focus not only on the needs of the children but also on those of their parents, as this is how it can be achieved better control. Despite all the difficulties in the management of the chronic disease of their child, it seems that the families of diabetic children adequately respond to the demands of intensive care and probably manage satisfactorily the psychological, social, and physical levels of their child’s chronic illness.

Short stature caused by pituitary stalk interruption syndrome in a type 1 diabetic child: a case report

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Vitamin D status and biomarkers of bone health in diabetic adolescents and children in a multi-ethnic cohort

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

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

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

Assessment of perceived fear of coronavirus disease 2019 and its relationship to health-related quality of life among type one diabetic children and adolescents during the pandemic in Ismailia City

Background Coronavirus disease 2019 (COVID-19) pandemic affected the world especially those with chronic diseases. Diabetes mellitus (DM) is considered one of the most prevalent noncommunicable diseases. Type 1 diabetes (T1D) is one of the most common endocrine metabolic disorders around the world. This study aimed to assess the perceived fear of COVID-19 and its relationship to HRQoL among children and adolescents with T1D during the pandemic in Ismailia City. Methods This is a retrospective study carried out on T1D children and adolescents during pandemic in Ismailia City and conducted at Suez Canal University endocrinology outpatient clinic, Ismailia City, Egypt from June 30, 2021, to December 31, 2021. All participants were interviewed using a semi-structured demographic and clinical checklist, fear of COVID-19 Scale, and the short form 36 (SF-36) health survey. Blood samples were taken to analyze HbA1c for all patients. Results This study analyzed data from 68 children and adolescents with T1D with age ranged from 10 to 14 years, 58.8% were females and 55.9% had preparatory school education. 38% had BMI more than 30, 38.2% had DM for more than 5 years. HbA1C was more than 8 among 41.2%. 59% had low FCV-19 and 41% had high FCV-19. Mean PCS was 39.1±9.6 and 82% had poor PCS. MCS was ranging from 19 to 36 with a median of 28. Older age, preparatory educated, and larger BMI children had higher fears of COVID-19. Poor DM control, and poor adherence to glucose and diet showed higher FCV-19 scores. Higher PCS was associated with higher FCV-19 score. Using univariate logistic regression, age, HbA1C, type of insulin regimen, family history of DM, and FCV-19 score are predictors for PCS. While age, grade, BMI, HbA1C, adherence to glucose testing, type of insulin regimen, adherence to diet control, and PCS are predictors for FCV-19. Conclusion This study suggested that children and adolescents with T1D showed above-average levels of fear of COVID-19, and it may be associated with lower quality of life, especially physical aspects.

Associations between endocrine disruptor contamination and thyroid hormone homeostasis in Belgian type 1 diabetic children.

Humans are daily exposed to many environmental pollutants, some of which being suspected to be thyroid disruptors. Some populations could be particularly susceptible to thyroid disruption, such like diabetics due to the well-known relation between the thyroid function and the control of carbohydrate homeostasis by pancreas. Therefore, the aim of this study was to investigate the associations between the exposure to several persistent and non-persistent chemicals and thyroid hormones levels in children with type 1 diabetes. Blood and urine sample were collected from 54 children diagnosed for type 1 diabetes mellitus. The concentrations of 7 phthalate metabolites, 4 parabens, 7 bisphenols, benzophenone 3 and triclosan were measured in urine, while 15 organochlorine pesticides, 4 polychlorinated biphenyls (PCBs) and 7 perfluoroalkyl substances were analyzed in serum samples. In the same time, the blood levels of free thyroxine (fT4), thyroid stimulating hormone (TSH) and glycated hemoglobin (Hb1Ac) were determined. We highlighted positive associations between serum perfluorohexane sulfonate and urinary monoethylphthalate levels, and TSH level in blood. We also found that PCB 138 was positively associated to fT4 while urinary levels of bisphenol F were negatively correlated to this hormone. Finally, we observed positive associations between Hb1Ac levels and the contamination by PCB 153 and two urinary phthalate metabolites: mono-2-ethyl-5-hydroxyhexyl phthalate and mono-2-ethyl-5-oxoxyhexyl phthalate. Our results showed that our small cohort of children with type 1 diabetes mellitus is potentially susceptible to thyroid disruptions by some pollutants. Moreover, for these children, both di-(2-ethylhexyl) phthalate metabolites would potentially hamper the glucose homeostasis. Nevertheless, additional studies are mandatory to further explore these findings.

Diabetes Knowledge among Caregivers of Pediatric Diabetic Patients in Sudan, Khartoum State

Background: The global prevalence of type I diabetes has been rising, with the current estimated incidence in Sudan of 10.1 per 100,000. Type I diabetes often develops in children, and their caregivers’ knowledge about it is crucial in managing it and preventing complications. This study was conducted to assess Sudanese diabetic patients’ caregivers regarding their children's condition. Materials and Methods: This was a cross-sectional hospital-based study conducted among Sudanese caregivers of pediatrics with type 1 diabetes mellitus present to the outpatient of Jaafar Bin Auf Hospital, Ahmed Qasim Hospital, and Jabber AbuEla center from December 2021 to march 2022. Data was collected using a structured and tested questionnaire, then entered and analyzed using SPSS V 28. Results and Conclusion: Two hundred participants responded (response rate 83%), with females, predominating (n=144), Overall, the mean knowledge score of the participants was 57± 20 out of 100. More than half 52% (n=104) had fair knowledge about diabetes, nearly one-third 33.5% (n=67) had poor knowledge, and only 14.5% (n=29) had good knowledge about diabetes. Females had significantly higher knowledge scores than males (p-value 0.03), a significant difference between educational levels was found p-value 0.01), and a significant difference was found between those who received knowledge about diabetes and those who hadn’t; with those who attended courses had the highest mean score (84± 26) followed by those who obtained knowledge from doctors (61± 19) (p-value 0.001). In conclusion the study found that Sudanese caregivers of diabetic children had a fair knowledge of Type 1 diabetes. Some areas of knowledge defect include diabetes symptoms, follow-up, and complications. Females, education, and receiving knowledge from courses and doctors were associated with good knowledge. Conduction of diabetes awareness programs with more focused approaches is recommended.

Risk of Type 1 Diabetes in Children Is Not Increased After SARS-CoV-2 Infection: A Nationwide Prospective Study in Denmark.

It has been hypothesized that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children can increase risk of developing type 1 diabetes. We undertook a prospective, register-based analysis of children in Denmark by investigating the association between SARS-CoV-2 infection and subsequent risk of type 1 diabetes. During the pandemic, Denmark had one of the highest test rates per capita in the world, and 90% of all Danish children were tested. Compared with children with a history of only negative SARS-CoV-2 tests, we did not observe a higher risk of first-time diagnosis of type 1 diabetes in children 30 days or more after a positive SARS-CoV-2 test (hazard ratio 0.85; 95% CI 0.70-1.04). Our data do not support that SARS-CoV-2 infection is associated with type 1 diabetes or that type 1 diabetes should be a special focus after a SARS-CoV-2 infection in children.

Self-care management among children and adolescents with diabetes mellitus in Malaysia.

The study aimed to evaluate diabetes self-care among diabetic children and adolescents and compare with glycaemic control. Summary of Diabetes Self-Care Activities (SDSCA) questionnaire was distributed to patients aged 10-18years with types 1 and 2 diabetes mellitus (DM) at paediatric diabetes clinics in Malaysia. Haemoglobin A1c levels were measured after questionnaire completion. A total of 106 patients completed the questionnaire with a mean age of 13.91 (± SD 2.48) years. Mean haemoglobin A1c and SDSCA score were 9.78 (± SD 2.43)% and 19.09 (± SD 5.81), respectively. Type 1 DM patients had significantly higher haemoglobin A1c (10.11 95% CI [9.62, 10.59] vs 8.38 95% CI [7.13, 9.62]). Total score was higher in type 1 DM although not statistically significant (19.32 95% CI [18.21, 20.43] vs 18.08 95% CI [14.28, 21.87]). Blood glucose testing score was significantly higher in type 1 DM (5.24 95% CI [4.82, 5.66] vs 3.50 95% CI [2.23, 4.77]). There was statistically significant negative correlation between score in diet subcategory and haemoglobin A1c. In conclusion, self-care activities among diabetic children and adolescents are still suboptimal. Self-care activities on blood glucose testing are significantly better in type 1 DM. Diet section correlated well with glycaemic control necessitating further research.

Relationship between Salivary Levels of Protein Carbonyl and Total Antioxidant Capacity and Prevalence of Dental Caries among Type 1 Diabetic Children

Introduction: We aimed to assess the possible relationship between dental caries prevalence and oxidative stress markers such as protein carbonyl (PC) and total antioxidant capacity (TAOC) of saliva among type 1 diabetic children. Methods: An analytical cross-sectional study was performed among 45 type 1 diabetic children and compared with 45 healthy control children aged 10 to 12 years old. Dental caries was diagnosed and recorded using the decayed, missing, and filling index (DMFS/dmfs). Unstimulated salivary specimens were collected for evaluation of TAOC and PC using an enzyme-linked immune-sorbent assay (ELISA). A linear regression model and one-way ANOVA test were employed for data analysis using the R 4.3.0. Results: Salivary levels of TAOC and PC, having diabetes, and diabetes status (controlled or uncontrolled) were not statistically significant (P &gt; 0.05) predicators regarding the prevalence of dental caries among type 1diabetic children. Conclusion: The diabetic status had a significant effect on salivary levels of TAOC and PC, but no significant effect on the prevalence of dental caries.

Serum Catestatin as a Novel Biomarker of Cardiometabolic Risk among Diabetic Children

Serum Catestatin as a Novel Biomarker of Cardiometabolic Risk among Diabetic Children

Vitamin D Status in Diabetic Moroccan Children And Adolescents: a Case-control Study

Background: Type 1 diabetes mellitus (T1DM) incidence is currently increasing worldwide, and different environmental players along with genetic predisposition, could be involved as powerful triggers of this disease onset. In this study, we aim to shed the light on the relationship between 25OHD deficiency and T1DM. Patients and methods: A case-control study was laid out to compare serum 25OHD level between T1DM patients and controls. A total of 147 T1DM patients aged under 19 years old were recruited from our Endocrinology-Diabetology and Nutrition department between October 2014 and December 2019. A total of 147 controls were randomly enlisted from clinical biochemistry laboratory of our center, and were carefully matched. The levels of 25OHD in the serum were determined in T1DM patients and nondiabetic controls. Results: Average serum 25OHD concentration was established in both groups; reaching 19,29 ±6,13 ng/ml in the control arm and 15,02 ± 6,48 ng/ml in the selected group with T1DM independently of the disease duration. However, the mean serum 25OHD concentration was not significantly different between the two T1DM subgroups according to diabetes duration below or above 5 years, and 25OHD concentration remained lower either in winter or summer months. A negative correlation was noticed between HbA1c and serum 25 OHD concentration in T1DM patients and was statistically significant (p<0,05). Conclusion: Key messages on the importance of vitamin D status, particularly in diabetic children and adolescents, should be spread widely in order to start a suitable vitamin supplementation, and establish guidelines regarding its timing at adequate recommended doses..

A Clinical and Biochemical Comparative Study Of Diabetic Ketoacidosis (DKA) in Newly Diagnosed Vs Known Cases of Type 1 Diabetic Children

Objectives: We aimed to study the characterizing clinical and biochemical profiles of Diabetic Ketoacidosis (DKA) in children with newly diagnosed Type 1 Diabetes Mellitus (Type 1DM) compared to children with established diagnosis of Type 1DM presenting with DKA admitted to the pediatric intensive care unit of a large university hospital in the eastern region of Saudi Arabia. Methods: We retrospectively reviewed the medical records of 211 patients who were admitted to the pediatric intensive care unit with diabetic ketoacidosis between 2010 and 2019. The diagnosis of diabetic ketoacidosis was based on symptoms of polydipsia, polyurea, weight loss, vomiting, dehydration, abdominal pain, breathing problems, lethargy or coma, biochemical hyperglycemia (blood glucose level of >200 mg/dL), venous pH of <7.3, serum bicarbonate level of ≤15 mEq/L, and ketonemia (blood β -hydroxybutyrate concentration of ≥3 mM) or moderate or severe ketonuria (diagnosed as newly acquired type 1 diabetes). Results: The rate of newly diagnosed Type 1 DM with DKA was 41.7%, out of them who got severe and moderate diabetic ketoacidosis were 61.6% and 38.4%, respectively. We observed significantly increased heart and respiratory rates in patients newly diagnosed with diabetic ketoacidosis and in those with severe diabetic ketoacidosis (p<0.001) compared to known cases with Type 1DM presenting with DKA. We also identified significantly increased biochemical indices including HbA1c, random blood sugar, serum osmolality, blood urea nitrogen, creatinine, chloride, lactate, and anion gap in relation to severe diabetic ketoacidosis and newly diagnosed type 1 diabetes (p ≤ 0.05). Conclusions: We found that the clinical and biochemical profiles of patients with newly diagnosed Type 1 DM children were significantly affected compared to children who were known Type 1DM presenting with DKA.