Diabetic Children Research Articles

PREDICTIVE FACTORS OF GOOD METABOLIC CONTROL IN CHILDREN WITH TYPE I DIABETES

Introduction: The management of children with type 1 diabetes has been revolutionized first by the discovery of insulin and then by the development of new technologies. Nevertheless, the majority of patients still do not reach their glycemic target. The main objective of this study is to determine the predictive factors of good metabolic control in children with type I diabetes, in order to develop tailored approaches to improve the quality of management and prevent disease-related complications. Materials and Methods : Prospective analytical and descriptive study spread over 6 years from January 2015 to January 2021 including type 1 diabetic children diagnosed between 2015 and 2019 and followed up at the House Of The Young Diabeticin collaboration with the diabetes department of the childrens hospital (P2). Clinical and epidemiological data were obtained from patients medical records and the Free diab database. Results :The number of patients meeting the inclusion criteria was 542. A mean A1C in the target range was associated in bivariate analysis with patient age (p=0.003), parental socioeconomic and academic level (p=0.001), adhesion to health coverage (p=0.001), initial HbA1C value (p=0.001), number of self-monitoring of blood glucose (p=0.001), and treatment regimen (p=0.001). In multivariate analysis, the association was statistically significant for 5 parameters: socioeconomic level ( ß 0.10 95%CI 0.10-0.26 p 0.03), parents academic level (ß 0.15 95%CI 0.24-0. 5 p=0.002), adhesion to health coverage (ß 0.12 95%CI 0.18-0.46 p=0.001), initial A1C level (ß 0.16 95%CI 0.15-0.38 p<0.001) and number of self-monitoring of blood glucose (ß 0.46 95%CI 0.21-0.3 p<0.001). Conlusion: Our study demonstrates parameters related to good glycemic control that need to be taken into account to develop new management strategies for children with type 1 diabetes.

Analysis of dental status in children with type I diabetes mellitus: a literature review

Relevance. Diabetes mellitus is one of the most complex metabolic chronic diseases. Severe forms of type I diabetes mellitus are more common in children and adolescents, and its prevalence is increasing in many countries. Type I diabetes mellitus in children and adolescents remains an essential health issue in many countries despite the achieved scientific and practical results and progress in diabetology. Therefore, its early detection in children is still relevant and is associated with the early diagnosis of endocrinolog ical pathologies.Materials and methods. The study searched the publications in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), Medline (www.elibrary.ru, www.ncbi.nlm.nih.gov/pubmed) by the specific keywords.Results. In children with diabetes mellitus, vascular changes in periodontal tissues appear earlier than in other organs. On oral examination of children with diabetes mellitus, 50% of cases reveal periodontal lesions, and the lesions are often in the areas of the lower molars. If not treated, the following perio-dontitis signs are present in diabetic children: bleeding of the gingival papillae and the bright red colour of the gingival margin. There may be bulging of granulations from pathological gingival pockets. In most patients with type I diabetes mellitus, cytology of the periodontal pockets and gingival sulci demonstrated inflammatory cytologic responses, changes in the stratified squamous epithelium, and mixed bacterial microflora with leukocytes and erythrocytes.Conclusion. The study of type I diabetes mellitus impact on pathological changes in the oral cavity of children and the development of therapeutic and preventive measures is a relevant issue in pediatric dentistry, which justifies the need to continue research in this area.

Is there a characteristic pattern of ambulatory blood pressure profile in type 1 diabetic children and adolescents?

To examine the characteristics of ambulatory blood pressure (ABP) including blood pressure variability (BPV) and its association with albuminuria in type 1 diabetic (T1D) children and to identify potential predictors of high-normal albuminuria and microalbuminuria. ABP monitoring was performed in 201 T1D children and adolescents (mean age, 14.7±3.8 years) with T1D duration over 1 year. The level of albuminuria was assessed as the albumin/creatinine ratio (ACR) and patients were further classified as low-normal, high-normal or microalbuminuria. Fifteen T1D children (7.5%) were hypertensive using office blood pressure (BP) and 10 (5%) according to ABP. T1D subjects had elevated 24-hour systolic BP (SBP) and diastolic BP (DBP) (+0.2 and + 0.3 standard deviation score [SDS]) and nighttime SBP and DBP (+0.6 and +0.8 SDS) compared to reference values. Patients with microalbuminuria had significantly higher 24-hour, daytime and nighttime DBP compared to normoalbuminuric subjects. There was a high percentage of nondippers (74.1%). Nighttime diastolic BPV was significantly higher in subjects with high-normal compared to low-normal albuminuria (p=0.01). A weak correlation was found between ACR and daytime DBP SDS (r=0.29, p<0.001 and nighttime DBP SDS (r=0.21, p=0.003). Age and nighttime diastolic BPV were predictors of high-normal albuminuria while nighttime DBP was a strong predictor for microalbuminuria. T1D children have impaired BP regulation although most of them do not fulfill the criteria for sustained hypertension. There is an association between diastolic ABP and diastolic BPV with rising levels of albuminuria pointing to a clear connection between BP and incipient diabetic nephropathy.

Evaluation and risk factors of microalbuminuria in children with type 1 diabetes in Aswan University Hospital

Background Diabetic nephropathy is the major complication of diabetes and is one of the leading causes of end-stage renal disease. Early identification of nephropathy is crucial to slow down this process. Assessment of albuminuria is used as an early clinical marker for impaired kidney function. The aim of this study is to evaluate the magnitude of microalbuminuria (MA) in children with type 1 diabetes and determine the factors correlated to it. Patients and methods A cohort study that was carried out on diabetic children attained the endocrinology clinic in our hospital from August 2019 to October 2020. Children aged 6–18 years old with a history of 2 years of diabetes were subjected to history, examination, and investigation, including urea, creatinine, lipid profile, hemoglobin A1c, and 24-h urinary albumin were done twice. Statistical analysis used χ 2, Fisher exact, and independent Wilcoxon t test for comparison between groups. Spearman and Pearson's for correlations. Results The median (interquartile range) of MA in the first visit was 10 mg/24 h (6.15–20 mg/24 h) in the first visit versus 9.5 mg/24 h (4.9–23.55 mg/24 h) in the second visit, with an insignificant P value. The abnormal numbers of hemoglobin A1c in the first visit were 85.7 and 79.3% in the second visit; P value is 0.350. Children with abnormal MA were 13.2% in the first visit versus 20% in the second visit with only four patients having persistent MA. MA was positively correlated to the Tanner stage in the first visit to blood pressure, serum triglyceride, and Tanner stage in the second visit, and negatively correlated to high-density lipoprotein. Conclusion Most of our patients had uncontrolled diabetes with an increasing prevalence of MA over time.

Association between Pediatric Adenovirus Infection and Type 1 Diabetes.

Background: Viruses are among the inducers of type 1 diabetes (T1D) as they are implicated in the initiation of β-cell destruction. This study aimed to explore the link between adenoviruses’ infection, inflammatory biomarkers, and the development of T1D. Methods: The study population included 80 children with T1D and 40 healthy controls (2–16 years old). The T1D group was further clustered into two groups according to time of T1D diagnosis: a group of children who were diagnosed during the first year of life and a second group who were diagnosed after the first year of life. Adenovirus DNA, anti-adenovirus IgG, cytokines, and lipid profiles were screened in the different groups. The results were statistically assessed using one-way analysis of variance (ANOVA) and LSD t-test. Results: Positive adenovirus PCR was detected in 2.5% and 20% of normal and T1D children, respectively. Moreover, the positive PCR results for adenovirus were found significantly higher in the T1D group, who were diagnosed during the first year of life (33.4%), in comparison to those diagnosed after the first year of life (12%). Anti-adenoviruses IgG was found in 12.5% and 40% of healthy controls and diabetic children, respectively. Seropositive results were found to be higher in newly diagnosed children (46.7%) in comparison to those previously diagnosed with T1D (36%). Body mass index (BMI), IFN-γ, IL-15, adiponectin, lipid profile, and microalbuminuria were significantly increased in T1D adenoviruses-positive children compared to children who were negative for adenoviruses. Conclusions: Adenovirus infection could be among the contributing risk factors and may play a role in the induction of T1D in children.

Diabetic Ketoacidosis and its Severity Predictors in Type 1 Diabetic Children; A 10-year Experience of A Teaching Hospital in Saudi Arabia.

OBJECTIVE: Our objective was to determine the trend and precipitating factors of the severity of diabetic ketoacidosis (DKA) in the population admitted to the Pediatric Intensive Care Unit (PICU) in a large teaching hospital in the Eastern region of Saudi Arabia. METHODS: We conducted a retrospective, analytical study at King Fahad Hospital, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia. We retrieved the complete medical records of 2234 children who were admitted to the PICU during the 10-year period of 2010 through 2019. The children included those with polydipsia, polyurea, abdominal pain, vomiting, dehydration, and weight loss, as well as breathing disturbances due to acidosis and CNS issues such as lethargy or coma and elevated blood glucose level, > 200 mg/dL [> 11.1 mmol/L], venous pH 7.3, serum total CO2 15 mmol/L, and blood- hydroxybutyrate concentration 3 mmol/L or moderate or severe ketonuria. RESULTS: Out of 2234 PICU admissions, 211 (9.4%) were diagnosed with DKA. A persistent increase in the rate of DKA ended up at 14.1% in 2019 (p = .005). The incidence of DKA was 88/2234 (3.93%). The severity of DKA was as follows: 130 (61.6%) had severe and 81 (38.4%) had moderate DKA. Excessive sweet intake without adding insulin in 83 (39.3%) patients and unhealthy lifestyles (35.1%) were the best predictors of severe DKA (p = .001). CONCLUSION: Over a 10-year period, the DKA pattern was persistently rising and slightly falling, which ended up at the significantly highest rate of 14.1% in 2019. URTI, pneumonia, unhealthy lifestyle, and excess sweet intake were significant precipitating factors associated with severe DKA.

The COVID-19 Pandemic Affects Seasonality, With Increasing Cases of New-Onset Type 1 Diabetes in Children, From the Worldwide SWEET Registry.

To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. We analyzed data on 17,280 cases of T1D diagnosed during 2018-2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1-12.2) in 2018 to 21.7 (20.6-22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2-14.0) in 2018 to 26.7 (25.7-27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5-12.9) to 24.7 (24.0-25.5) for adolescents ages 12-18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018-2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic. The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.

Assessment of nutritional status, dietary intake and adherence to dietary recommendations in type 1 diabetic children and adolescents.

Currently, T1D is one of the most common chronic diseases in children and adolescents. The International Diabetes Federation (IDF) estimates that more than 1.1 million children and adolescents are living with (T1D). A few studies have evaluated the relationship between dietary intake and glycemic control (GC) in people with T1D, and in particular, children and adolescents. The aim of this study was to evaluate the relationship between anthropometric characteristics, lipid profile, inflammation, dietary intake and GC in comparison with international guidelines. The study included a sample of 240 children, aged 15 years old or less with T1D. A structured questionnaire was used to collect information on the socio-demographic status, disease characteristics, and diet of the participants. Weight, height, and WC were measured and WHtR and BMI were calculated. Biochemical measurements were determined. Dietary intake was assessed using three 24-hour recalls. Saturated fat intake was five times higher than recommended. Only 8.3% of participants reached the recommended level of fiber. Overweight, obesity, TC, TG, HDL and CRP were significantly higher in children with poor GC to those with good GC. In addition, participants with poor GC had significantly low intakes of calories, carbohydrates, fiber, MUFAs, and PUFAs and high intakes of fat and SFAs. The use of Bivariate correlation analyses showed that calorie, protein, fat and fiber intake were positively correlated with weight, height, WC, and GO, whereas carbohydrate intake was negatively associated with these parameters. On the contrary, CO showed a negative correlation with calorie, protein, fat and fiber intake and a positive correlation with carbohydrate intake. The results revealed that the dietary quality was poor and adherence to dietary recommendations was low with insufficient fiber intake and excess SFA. These results suggest that GC can be improved by a healthy, balanced diet by increasing fiber intake and limiting SFA intake. Liczba pobrań: 2.

Time to first optimal glycemic control and its predictors among type 1 diabetic children in Bahir Dar city public referral hospitals, North West Ethiopia: a retrospective follow up study

BackgroundRecognizing the level of glycemic control of a client is an important measure/tool to prevent acquiring complications and risk of death from diabetes. However, the other most important variable, which is the time that the patient stayed in that poor glycemic level before reaching optimal glycemic control, has not been studied so far. Therefore, this study aim to estimate time to first optimal glycemic control and identify predictors among type 1 diabetic children in Bahir Dar city public referral hospitals, Northwest, Ethiopia, 2021.MethodsA Retrospective cohort study was conducted at Bahir Dar city public referral hospitals among a randomly selected sample of 385 patients with type 1 diabetes who were on follow up from January 1, 2016 to February30, 2021.Data were collected by using a data abstraction tool and then entered into Epi-data version 4.6 and exported into STATA 14.0 statistical software. Descriptive statistics, Kaplan Meier plots and median survival times, Log-rank test and Cox-proportional hazard regression were used for reporting the findings of this study. After performing Cox-proportional hazard regression, model goodness-of-fit and assumptions were checked. Finally, the association between independent variables and time to first optimal glycemic control in months was assessed using the multivariable Cox Proportional Hazard model and variables with a p-value < 0.05 were considered as statistically significant.ResultsMedian survival time to first optimal glycemic control among type 1 diabetic clients was 8 months (95%CI: 6.9–8.9). The first optimal glycemic achievement rate was 8.2 (95%CI: 7.2–9.2) per 100 person/month observation. Factors that affect time to first optimal glycemic control were age > 10–14 years (AHR = 0.32;95%CI = 0.19–0.55), increased weight (AHR = 0.96;95%CI = 0.94–0.99), having primary care giver (AHR = 2.09;95%CI = 1.39–3.13), insulin dose (AHR = 1.05;95%CI = 1.03–1.08), duration of diabetes ≥4 years (AHR = 0.64;95%CI = 0.44–0.94), adherence to diabetic care (AHR = 9.72;95%CI = 6.09–15.51), carbohydrate counting (AHR = 2.43;95%CI = 1.12–5.26), and comorbidity (AHR = 0.72;95%CI = 0.53–0.98).ConclusionThe median survival time to first optimal glycemic control in this study was long. Age, weight, primary care giver, insulin dose, duration of diabetes, adherence, and carbohydrate counting, including history of comorbidity were determinant factors. Giving attention for overweight and comorbid illness prevention, increasing either the dose or frequency of insulin during initial treatment; counseling parent (for both the mother and father) about adherence to diabetic care focusing on insulin drugs and how to audit their children’s diet as prescription helps to reduce the length of glycemic control.

Glycemic control among type 1 diabetes children pre and during COVID-19 pandemic

The impact of the COVID-19 pandemic on glycemic control in Type 1 Diabetes Mellitus (T1DM) patients is still evolving. This study aims to assess the negative effect of the COVID-19 pandemic on mean glucose and glycated hemoglobin (HbA1c) in patients with T1DM. This meta-analysis study using the PRISMA framework method with the search strategy according to the population, intervention, control, and outcome (PICO) model. Relevant articles were searched in 4 databases. The results identified the HbA1c and mean glucose. The COVID-19 pandemic caused an increase in the HbA1c levels (%) compared to the pre-COVID group with a mean difference of -1.06 (95% CI: -1.44, -0.69; p&lt;0.00001). Meanwhile, the mean glucose (mg/dL) decreased during-COVID-19 pandemic with a mean difference of -2.32 (95% CI: -4.40, -0.23; p=0.03). Ten studies with a total of 1615 subjects contributed for HbA1c analysis (during-COVID-19, n = 615; pre-COVID, n = 1000). A total of 1164 patients from six studies with a mean glucose analysis were included (during-COVID-19, n = 418; pre-COVID, n = 746). This study found that the COVID-19 pandemic significantly increased the levels of HbA1c and decreased mean glucose in patients with T1DM, but further studies need to be evaluated.

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

Brief Summary: Despite provision of free insulin by the Changing Diabetes in Children (CDiC) program, mortality remains high in children and adolescents with type 1 diabetes (T1D) in Cameroon, in particular in rural settings and in families with no formal education.

Do type 1 diabetic children have echocardiographic signs of subclinical cardiac dysfunction?

Background Diabetes mellitus is a major illness in which cardiac problems play a significant role in patient mortality. Objectives We aimed to evaluate whether children with diabetes mellitus type 1 have early echocardiographic signs of subclinical cardiac dysfunction and whether their sex, metabolic control, and duration of diabetes have an effect. Patients and methods A case–control study was performed from January 2022 to November 2022 that included 29 children and adolescents with type 1 diabetes aged from 4 to 15 years. A control group of 15 healthy children was also included. They were recruited from the pediatric endocrinology clinic, Al-Fayoum University Children’s Hospital, Al-Fayoum University, Egypt. Conventional echocardiographic study and tissue Doppler imaging measurements were done. Results With glycated hemoglobin levels less than 7%, the study group of diabetic children had inadequate glycemic control. There was a statistically significant low mean of fractional shortening and high mean of left ventricular septal wall thickness in diastole among diabetic children in comparison with controls, with P values of 0.04 and 0.038, respectively, but still within normal range. Conclusion Children with diabetes have poor glycemic control and scanty echocardiographic evidence of subclinical cardiac dysfunctions. According to the study, cardiac dysfunction in children with diabetes is uncommon. For the early identification of any potential cardiac dysfunctions, distant periodic cardiac examination using both conventional and tissue Doppler echocardiography is advised.

The Progression of Prediabetes to Type 2 Diabetes in Children and Adolescents in the United States: Current Challenges and Solutions

Prediabetes, the precursor of type 2 diabetes (T2D), is on the rise among children and adolescents in the United States. The natural history of prediabetes is poorly characterized in children compared to adults. The available data indicate a phenotype of an accelerated β-cell failure in youth with prediabetes. Data from randomized controlled trials showed no benefit on β-cell preservation or A1c in youth with prediabetes from therapeutic agents such as metformin and insulin. As a result, the American Diabetes Association recommends only lifestyle intervention, but not therapeutic agents, for the management of prediabetes in children and adolescents. These recommendations for lifestyle modification in youth, largely derived from data in adults, lack the precision necessary for efficacy in youth. However, a recent 4-year real-world study on youth reported that adherence to nutrition visits was associated with a 4-fold reduction in the likelihood of progressing from prediabetes to T2D. The finding that this reversal is associated with reduced insulin resistance (IR) and not with decreased body weight is novel and provides the foundation for trialing investigational products that may protect β-cells and reduce IR and/or body weight. This study provides the much-needed foundation for further exploration of the impact of lifestyle modification in conjunction with other approaches for the reversal of prediabetes in youth. The systematization of the protocol for medical nutrition therapy for the reversal of prediabetes in youth will ensure optimal and consistent results from adherent patients. This communication provides updates on the pathobiology of prediabetes in youth and a clear direction for efficacious studies in the field.

Immunoglobulin E-mediated allergies among children with type 1 diabetes mellitus

Background Type 1 diabetes mellitus (T1DM) and immunoglobulin E (IgE)-mediated allergy belong to the most common diseases in the pediatric population, in which they are caused by multifactorial causes. Growing evidence proposes that there is a change in Th1/Th2 balance, and subsequently their associated cytokine response, which is essential during the pathogenesis of autoimmune disorders such as T1DM. Aim To assess clinical characteristics and subsequently risk factors potentiating the IgE-mediated allergy among Egyptian children with T1DM and also to assess serum level of interleukin 5 (IL5) among them. Patients and methods An interviewer-administrated questionnaire was designed to take history of allergy in diabetic children who come to the outpatient clinic fulfilling inclusion criteria and used to collect data. The age range was 5–17 years, with at least 2 years duration of T1DM. Skin prick testing was performed for all diabetic children with history of allergy. Patients were divided into allergic diabetic group (45 patients) and nonallergic diabetic group (45 patients). Laboratory assessment of serum total IgE, IL5, and eosinophils% was carried out. Results Among the 45 allergic diabetic group, 82% were asthmatic cases, 40% of them have allergic rhinitis, and 30% of them have skin allergy. Skin test results showed that allergy to house dust mite showed the highest percentage among the diabetic allergic group (51.1%). The allergic diabetic group showed significantly higher levels of IL5, total IgE, and eosinophils than nonallergic diabetic group (Z=8.13, P&lt;0.001; Z=7.18, P&lt;0.001; and Z=8.02, P&lt;0.001). Conclusion Bronchial asthma is considered the most common type of IgE-mediated allergy that may occur in children with T1DM. Developing IgE allergy in T1DM is dependent on the increased levels of IL5. IL5 was an independent predictor of developing asthma, allergic rhinitis, and skin allergy among our studied cases.

Children's Diabetic Ketoacidosis and COVID 19: Two Case Reports

Introduction: The current global pandemic due to SARS-CoV-2 has resulted in a large literature on associated comorbidities, including diabetes. COVID 19 infection in a diabetic child can be complicated by severe ketoacidosis. The aim of this study is to determine the effect of COVID-19 infection on a diabetic child. Observations: The first case involved a 12-year-old Congolese child from a diabetic mother who was hospitalized for febrile respiratory distress and a consciousness disorder. Biological examinations showed the first diabetic ketoacidosis. Chest radiography showed radiological images suggestive of COVID-19 involvement, which was confirmed by a PCR and a thoracic CT. The evolution was marked by the appearance of a left pleurisy of medium abundance, which regressed after treatment. Second, a 16-month-old infant with no prior history was admitted to the hospital for febrile dehydration with impaired consciousness. Biological tests were consistent with diabetic ketoacidosis. Multiplex PCRs were performed showing infection with SARS-CoV-2 and other viruses (adenovirus, rhinovirus and enterovirus). Chest radiography was normal. The evolution was favorable under treatment with insulin therapy, rehydration, and antibiotic therapy. Conclusion: After discussing the role of decompensation or the triggering of diabetes in children with SARS-CoV-2 infection, the authors insist on the polymorphism of the clinical presentation and the need to perform a PCR in a diabetic child with ketoacidosis.

Evaluation of serum vitamin D levels in diabetic children and the effect of vitamin D supplementation on glycemic control (Hba1C) in vitamin D deficient diabetic children

Background: It has been estimated that around 96,000 children under 15 years are found to develop type 1 diabetes annually all over the world. Vitamin D deficiency is more common in paediatric diabetic population and vitamin D supplementation is known to improve glycemic control in Diabetic children. The objectives of the study being, to compare serum vitamin D levels of diabetic children aged less than 18 years with non-diabetic children aged &lt;18 years and to study the effect of oral vitamin D supplementation on glycemic control in vitamin D deficient diabetic children.Methods: Present study was a cross sectional study conducted in Cheluvamba hospital, Mysuru. 60 diabetic children and 60 healthy (control) children were enrolled for the study. Serum 25(OH)D was assessed by ELISA in both groups. HbA1c levels were assessed by HPLC among vitamin D deficient diabetic children before and after supplementation of Vitamin D.Results: In current study, study group (diabetic children) mean vitamin D levels were found to be 21.667±7.9 ng/ml which were statistically significant compared to control group that is 25.90±10.06 ng/ml (p=0.012) but there was no clinical significance. Among diabetic children the mean HbA1c before and after supplementation of vitamin D among vitamin D insufficient children was 11.78±2.22% vs. 11.73±0.141% (p=0.141) respectively and in vitamin D deficient children was 11.74±1.18% vs 11.72±1.17% (p=0.662). Conclusions: Mean serum vitamin D levels were comparable among diabetic children and control group. The mean HbA1c levels were comparable before and after supplementation of vitamin D among vitamin D deficient diabetic children thus indicating that there is no role of vitamin D in glycemic control among diabetic children.

Serum Zinc Level in Children Suffering from Type 1 Diabetes Mellitus and Its Relationship with Glycemic Control: An Experience from A Tertiary Level Specialized Diabetic Hospital in Bangladesh

A cross-sectional study was conducted in the Department of Biochemistry and Molecular Biology of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh, between July 2016 and June 2017, to evaluate serum zinc level and its relationship with glycemic control in type 1 diabetic children. A total of 160 participants (all aged between 1 and 18 years) were selected from the outpatient department (OPD) of BIRDEM General Hospital-2, Dhaka – 80 type 1 diabetic children as cases and 80 apparently healthy children as controls. We measured anthropometric parameters all study subjects. Serum zinc level was assessed using colorimetric method. Fasting plasma glucose level was estimated using enzymatic glucose-oxidase method. Glycemic control was evaluated through estimation of HbA1c using a high-performance liquid chromatographic method. The mean serum zinc levels were significantly lower in patient with type 1 DM compared to control (72.5±16.5 vs. 82.4±13.3 μg/dl; P&lt;0.001). Lower levels of zinc were found in subjects with poor glycemic control compared to good glycemic control (62.8±14.6 vs. 78.8±14.6 μg/dl; P&lt;0.001). Moreover, serum zinc levels were significantly lower in patients who have duration of diabetes mellitus for 5 years or more (P&lt;0.05). To summarize, serum zinc level is lower in type 1 diabetic children in comparison to its healthy counterpart and this lower zinc level is strongly associated with poor glycemic control which may potentially contribute to the early development of diabetic complications in children.&#x0D; CBMJ 2022 July: vol. 11 no. 02 P: 80-85

Diabetic kidney disease in pediatric patients: A current review.

In the last decades, a significant increase in the incidence of diabetic kidney disease (DKD) was observed concomitant with rising diabetes mellitus (DM) incidence. Kidney disease associated with DM in children and adolescents is represented by persistent albuminuria, arterial hypertension, progressive decline in estimated glomerular filtration rate to end-stage renal disease and increased cardiovascular and all-cause morbidity and mortality of these conditions. In medical practice, the common and still the “gold standard” marker for prediction and detection of diabetic kidney involvement in pediatric diabetes is represented by microalbuminuria screening even if it has low specificity to detect early stages of DKD. There are some known limitations in albuminuria value as a predictor biomarker for DKD, as not all diabetic children with microalbuminuria or macroalbuminuria will develop end-stage renal disease. As tubular damage occurs before the glomerular injury, tubular biomarkers are superior to the glomerular ones. Therefore, they may serve for early detection of DKD in both type 1 DM and type 2 DM. Conventional and new biomarkers to identify diabetic children and adolescents at risk of renal complications at an early stage as well as renoprotective strategies are necessary to delay the progression of kidney disease to end-stage kidney disease. New biomarkers and therapeutic strategies are discussed as timely diagnosis and therapy are critical in the pediatric diabetic population.

Evaluation of Auditor Functions in Diabetic patients in a tertiary care center, central India

Background: sensorineural hearing loss (SNHL) is the common entity among uncontrolled diabetes patients, mainly in long term hyperglycemia. SNHL is mild to severe in nature. Aims and Objectives: The aims of this study were to evaluate sensory neural hearing loss in patients with diabetes mellitus (DM). Materials and Methods: We undertook that this prospective observational study which includes patients presented with DM to the department of ENT in Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, was planned for hearing evaluation during period of June 2020-November 2021, total 42 patients of age group 25-65 years were taken for the study. Results: On hearing assessment 29 (69.04%) cases were having SNHL and 13 (30.95%) cases were having normal hearing. Only 10 (23.80%) control were having SNHL and 32 (76.19%) control were having normal hearing. There was statistically significant association found between diabetes and SNHL. SNHL was found in less number of young cases and it was found in most of old age patients. Conclusion: The severity and prevalence of hearing loss are more if duration of hyperglycemia is more and if delay in starting treatment in diabetic child. SNHL is bilateral and mostly mild in the early stage.

BURDEN OF NON-COMMUNICABLE DISEASES AMONG CHILDREN IN MOROCCO

Noncommunicable diseases remain important public health problems worldwide, accounting for significant mortality and morbidity. Noncommunicable diseases (NCDs) are the leading causes of death and disability worldwide. According to WHO (2018), Non-communicable diseases (NCDs) kill 41 million people each year, accounting for 71% of deaths worldwide. It predicts that the rapid growth of NCDs will impede poverty reduction initiatives in low-income countries, particularly due to rising out-of-pocket health expenditures.In Morocco, the situation is also problematic. The epidemiological and demographic transition is reflected in an increase in the burden of disease and mortality of NCDs in children 0- 18 years, particularly cancers, diabetes, cardiovascular diseases, chronic respiratory diseases and chronic renal failure. At the level of the Marrakech-Safi Region, the total number of diabetic children reached 1519 cases in 2019 of which 162 new cases and 1357 old cases, with a predominance (55%) at the level of the city of Marrakech. For children with hypertension, they represent 749 cases in 2019 including 25 new cases and 724 old cases. As for respiratory infections, the number of cases of acute viral bronchiolitis declared at the level of the region during the autumn-winter period 2019-2020 has reached 8404 cases. Finally, for children suffering from chronic renal failure a total number of 35 children are currently under care at the level of public hemodialysis centers, including 21 children hemodialysis, 12 under peritoneal dialysis and 02 kidney transplanted. The objective of this article is to describe the burden of morbidity and mortality related to non-communicable diseases in the Marrakech-Safi region.