Diagnosis Of T1D Research Articles

New technologies in psychological intervention for adolescents with type I diabetes: a systematic review

Type I diabetes mellitus (T1D) is a condition typically diagnosed during adolescence. The diagnosis of T1D, combined with the typical changes that occur during this developmental period, can have an impact on the psychopathology of adolescents. The aim of this study is to evaluate the effectiveness of a psychological intervention incorporating new technologies in managing psychopathological aspects among adolescents with T1D. A systematic search was carried out using the PRISMA method in the ProQuest and Web of Science databases, resulting in the screening of 209 studies, of which nine were included. Two evaluators independently and blindly selected and assessed the studies, demonstrating an excellent level of agreement. The age range of participants in the included studies varied from 12 to 21, with the common factor being a T1D diagnosis. The studies examined various variables, such as adherence to treatment, quality of life, and symptoms of depression and anxiety. Many of the studies indicated improvements in these aspects. However, it is crucial to note that the overall quality of the studies was low. Consequently, there is a need for further research on psychological interventions incorporating new technologies, and there is room for improvement in the design quality of such studies. While acknowledging the current limitations, the future of interventions for T1D is intricately linked to advancements in the development and integration of new technologies.

Glycemic Control and Metabolic Parameters in Children and Adolescents With Type 1 Diabetes.

The association between glycemic control and metabolic status is poorly defined in children and adolescents with T1D, besides being biologically plausible. We aimed to evaluate the association between glycemic control and body mass index (BMI), blood pressure (BP), and lipid profile in children and adolescents with T1D. Observational cross-sectional study including children and adolescents (5-18 years old) followed in our outpatient clinic with the diagnosis of T1D for at least a year. We used linear regression models (unadjusted and adjusted to sex and age) to evaluate the association between glycated hemoglobin (A1c) and time in range (TIR), several prespecified metabolic parameters, and prespecified demographic and clinical characteristics. We considered a p-value of <0.05 to be statistically significant. A total of 144 patients were included, 51% of whom were female. The population had a mean age of 12.7±3.4 years old. We report a positive association between A1c and BMI, systolic and diastolic BP, total- and LDL-cholesterol and triglycerides. Females and patients diagnosed at a younger age presented with higher A1c values. There is a tendency for a negative association between TIR and the former parameters. Higher A1c levels and lower TIR were associated with higher glycemic variability and were treated with a higher basal insulin per Kg dose. Our results support an important association between worse glycemic control and an unhealthier metabolic profile in children and adolescents with T1D. We can hypothesize that a good glycemic profile is needed to achieve good metabolic control at a young age.

Cardiovascular Risk Factors in Adolescents with Type 1 Diabetes: Prevalence and Gender Differences

Cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in patients with type 1 diabetes (T1D). Children with T1D have a similar or higher prevalence of being overweight (OW) or obese (Ob) compared to healthy peers. The aim of this study was to determine the prevalence of CVD risk factors in children and adolescents with T1D and the impact of obesity and sex differences on these factors. Data of patients aged 10-21 years and who had been using intensive insulin therapy with a diagnosis of T1D for at least three years were evaluated. Patients were divided into normal weight (NW), OW and Ob groups based on body mass index percentiles. Risk factors for CVD (obesity, dyslipidemia, hypertension) were compared between groups, and impact of gender was also analyzed. Data of 365 patients (200 girls, 54.8%), were evaluated. Prevalence of OW/Ob was 25.9% and was significantly higher in girls (30.6% vs 20.1%, p<0.001). Rate of hypertension was highest in OW/Ob girls followed by OW/Ob boys, and similar in NW girls and boys (p=0.003). Mean low density lipoprotein cholesterol (LDL-c) and triglyceride (TG) levels were highest in OW/Ob girls, followed by OW/Ob boys, NW girls and NW boys, respectively (p<0.001 and p<0.001, respectively). Mean high density lipoprotein-cholesterol (HDL-c) levels were similar among groups. Rates of high LDL-c and TG were similar between OW/Ob girls and boys and higher than NW girls, followed by NW boys (p<0.001 and p<0.001, respectively). The rate of low HDL-c was similar in OW/Ob girls and boys, and higher than NW girls, followed by NW boys (p<0.001). Overall, girls were 1.9 times more likely than boys to have two or more risk factors for CVD. Factors associated with risk for CVD in multiple logistic regression analyses were being a girl, followed by higher daily insulin dose, higher hemoglobin A1c, and longer duration of diabetes (r=0.856; p<0.001). In spite of the increased prevalence for obesity in both sexes, the trend for CVD risk factors was greater in Ob girls, followed by Ob boys and NW girls. Girls with T1D are more likely to be OW/Ob and to have CVD risk than boys, highlighting the need for early intervention and additional studies to elucidate the causes.

1795-PUB: Teaming Up for T1D with Telehealth—An Initial Look at Youth and Family Coping following a New T1D Diagnosis

Purpose: A diagnosis of T1D is often associated with increased youth and parental distress as families learn to manage complex daily diabetes tasks and navigate glycemic fluctuations. This study sought to capture the early experiences of families following initial diagnosis, specifically focusing on its psychosocial impact. Method: Eight children (8-12; M=9.0; SD=1.3), 12 teenagers (13-17; M=14.7; SD=1.9) with T1D and 31 parents of youth ages 3-17 diagnosed with T1D were surveyed two weeks following diagnosis as part of a larger pilot of a prevention intervention to support families during the first-year post diagnosis. Additionally, electronic medical records were reviewed 3 months post diagnosis to evaluate health care utilization and medical outcomes. Results: Two weeks post T1D diagnosis, some parents (38.7%) and youth (18.8%) reported elevated symptoms of depression. Similarly, 36.7% of parents and 12.5% of youth reported elevated symptoms of anxiety. Fewer youth (11.8%) and parents (11.1%) endorsed elevated diabetes distress at two weeks post-diagnosis. At 3 months, mean A1c was 7.5% (SD = 1.4) and mean time in range was 67% (SD = 21.8). No baseline variables were correlated with A1c at 3 months post-diagnosis; however, youth report of family conflict was negatively correlated with time in range (r = -.761; p &amp;lt;.01). At 3 months following diagnosis, nearly all (92.6%) youth were using CGM, while few (7.7%) were using insulin pumps. Discussion: This study examined the experiences of youth and their parents following a T1D diagnosis, along with 3-month post diagnosis clinical outcomes. Many parents experience elevated symptoms of depression and anxiety two weeks following diagnosis. Few baseline variables correlated with clinical outcomes at three months following diagnosis. Future studies should examine family experiences in the first year following diagnosis, as well as interventions that promote positive coping among youth and their parents. Disclosure K.R.Howard: Stock/Shareholder; Abbott, AbbVie Inc. N.W.Smith: None. K.P.Garza: None. J.Weissberg-benchell: Advisory Panel; Beta Bionics, Inc., Research Support; Beta Bionics, Inc. M.Feldman: None. Funding JDRF (2-SRA-2020-985-S-B)

Complete remission in children and adolescents with type 1 diabetes mellitus—prevalence and factors

Little is known about complete remission in Type 1 diabetes mellitus (T1D) with the discontinuance of insulin treatment for a period of time. In this retrospective study we analysed the frequency and factors of onset and duration of 1. remission and 2. complete remission in children and adolescents with T1D from the Children Diabetes Centre in Bratislava, Slovakia. A total of 529 individuals with T1D, aged < 19 years (8.5 ± 4.3 years) at diabetes onset were included in the study. Remission was defined by HbA1c < 7.0% (53 mmol/mol) and an insulin daily dose < 0.5 IU/kg (and 0 IU/kg for complete remission). Remission occurred in 210 (39.7%) participants, and 15 of them had complete remission (2.8% from all participants). We have identified a new independent factor of complete remission onset (higher C-peptide). Complete remitters had a longer duration of remission compared with other remitters and also differed in lower HbA1c levels. No association was seen with autoantibodies or genetic risk score for T1D. Thus, not only partial but also complete remission is influenced by factors pointing toward an early diagnosis of T1D, which is important for better patient outcome.

Is β-Cell Dysfunction Present in Adult Autoantibody Negative Relatives of Individuals with Type 1 Diabetes Mellitus?

Background/Objective: Individuals with a family history of type 1 diabetes mellitus (T1D) are at increased genetic risk for T1D. Previous studies identified the presence of β-cell dysfunction before clinical onset and diagnosis of T1D. However, it is unclear if β-cell dysfunction predates islet autoimmunity in individuals at high genetic risk. Our objective was to test β-cell function in islet antibody negative adults who have a first-degree relative with T1D. We hypothesized that individuals at genetic risk for T1D would exhibit β-cell dysfunction even without detectable islet autoimmunity.Methods: We used ordinary one-way and Brown-Forsythe ANOVA to compare the repeated mixed meal tolerance test (MMTT) and hyperglycemic clamp glucose-stimulated β-cell response and function measures between three groups of individuals: normoglycemic adults without T1D family history age, sex, and BMI-matched islet antibody negative first-degree relatives of individuals with T1D, and islet antibody positive first-degree relatives of individuals with T1D.Results: Neither the MMTT first-phase insulin secretion measures (c-peptide0-15 minutes, c-peptide0-30 minutes, insulin0-15 minutes, insulin0-30 minutes), nor second-phase measures (c-peptide0-120 minutes, insulin0-120 minutes, and glucose0-120 minutes) showed a statistically significant difference between groups. The clamp acute c-peptide response to glucose, insulin sensitivity, c-peptide steady state, first-phase β-cell function, and second-phase β-cell function were similar between subject groups in both visits. Fasting proinsulin:c-peptide ratios, a biomarker of β-cell stress, were also similar between participant groups.Conclusion and Impact: Our data suggest that genetically at-risk autoantibody negative adult relatives of individuals with T1D do not demonstrate β-cell dysfunction compared to controls. Studies show that β-cell ER dysfunction preceding T1D onset is more striking in younger children. Thus, our findings may reflect the use of an adult study population. Alternatively, β-cell dysfunction in T1D may require initial autoimmune activation. This study will contribute to the growing understanding of risk factors contributing to T1D development.This project was funded, in part, with support from the Research Training Program in Diabetes and Obesity funded, in part by grant 3T32DK064466 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding also provided by JDRF grant 2-SRA-2017-498-M-B.

Epidemiological trends in the presentation of diabetic ketoacidosis in children newly diagnosed with type 1 diabetes from 2011 to 2017 in Kuwait.

Monitoring the trends in the presentation of T1D over decades cannot be underestimated as it provides a rich source of information on diabetes-related complications like DKA. DKA represents a medical emergency, with potentially fatal outcome, and thus the prevention of DKA is a priority in diabetes care. The aim of this study is to report on trends in the presentation of DKA in children newly diagnosed with T1D in Kuwait. This study is based on a retrospective review of children newly diagnosed with T1D aged 14 years or less at three Governmental Hospitals representing three health sectors out of the total six health sectors in the country during the period 2011-2017. A total of 799 children (376 males and 423 females) were newly diagnosed with T1D. 287 children presented with DKA (35.9%) with only 73 children (9.1%) classified as severe. During the years 2011 to 2017, we note that the percentage of children older than 6 years of age presenting with severe DKA has decreased significantly (p=0.022). Unfortunately, this has not been replicated in children younger than 6 years. This study highlights the importance of continued monitoring of clinical characteristics of children at diagnosis of T1D specifically presenting with DKA to enable diabetes care professionals to appreciate the multifaceted aspects of T1D, in particular the importance of raising awareness of the early signs of the onset of T1D with special attention to DKA and its severe consequences.

The role of specific pancreatic antibodies in the differential diagnosis of complete clinical and laboratory remission of type 1 diabetes mellitus and MODY in children

BACKGROUND: T1D is characterized by autoimmune destruction of pancreatic β-cells, which develops due to genetic and environmental risk factors. Shortly after initiating the treatment with insulin, 80% of children with T1D may require smaller doses of insulin and develop clinical and laboratory remission of the disease so called «honeymoon». The issue of whether there is a need of differential diagnosis between autoimmune DM and non-immune forms of DM raises in cases of preclinical diagnosis of T1D and laboratory remission for more than 6 months.AIM: To study the clinical, immunological, genetic characteristics of T1D remission phase and MODY in children, to determine the diagnostic criteria for T1D and MODY in children.MATERIALS AND METHODS: A single-centre, cross sectional noncontrolled comparative study of two independent cohorts. Data of 150 children examined in the Endocrinology Research Center (January 2016–June 2021). First cohort included patients with complete clinical and laboratory remission of T1D (n=36), second cohort included patients with MODY, confirmed by genetic study (n=114).RESULTS: The median age of diabetes manifestation was significantly higher in patients with T1D — 11.25 years [8.33; 13.78] than in patients with MODY — 7.5 years [4.6; 12.2] (p=0.004). In patients with T1D remission the level of glycated hemoglobin was 6.0% [5.6; 6.4], in group with MODY — 6.5% [6.2; 6.7] (p&lt;0.001). Patients with monogenic diabetes had impaired fasting glucose — 6.27 mmol/l [5.38; 6.72], while patients with remission phase had normoglycemia — 5.12 mmol/l [4.17; 5.87]. The oral glucose tolerance test was perform to all patients, two-hour glucose level did not significantly differ in two groups (p=0.08). A strong family history of diabetes in patients with MODY registered more often (93% vs. 66.7%). A positive autoantibody titer detected more often in patients with remission of T1D (77.8%) than in patients with MODY (11.4%). In addition, no more than 1 type of autoantibodies was detected in patients with MODY.CONCLUSION: Antibodies ZnT8 and IA2 showed the greatest significance for the differential diagnosis of T1D and MODY in cases with long absents of insulin requirement in children with diabetes mellitus. Genetic test is recommended in seronegative cases. If only one type of AT is detected, specialist should decide on the need to do diagnostic genetic test based on a comprehensive analysis of the patient’s clinic characteristics, including family history, manifestation and blood glucose levels.

ODP206 High Burden of Chronic Kidney Disease in Young Adults with Type 1 Diabetes

Abstract Background Type 1 diabetes (T1D) increases the risk of chronic kidney disease (CKD). We sought to assess the burden of CKD and albuminuria, and risk factors contributing to CKD development. Methods This retrospective cohort study (1996-2020) involved Canadian adults diagnosed with T1D before 30 years of age, followed in a sub-speciality clinic in British Columbia. CKD was defined as an estimated GFR &amp;lt;60 ml/min/1.73 m 2 and persistent albuminuria was defined as a urine albumin-to-creatinine ratio (ACR) ≥2 mg/mmol (≥2 measurements over 6 months). Logistic regression was used to describe the relationship between CKD and diabetes-related risk factors. Results Of the 268 adults followed in the clinic, 63.4% were male, and the median age at diagnosis of T1D was 13.7 years (IQR 11.9 years). Over a median duration of T1D of 27.1 years (IQR 21.2 years), 8.2% of the adults developed CKD and 32.5% developed albuminuria (19.8% ACR 2-20 mg/mmol, 12.7%≥20 mg/mmol). Five adults went on to develop end-stage renal disease within the follow-up period. A longer duration of T1D (≥30 years) was associated with 4-fold increase in the odds of developing CKD (odds ratio 4. 09, 95% CI 1.37-15.10). History of medical and psychiatric comorbidities, A1C≥7%, systolic blood pressure ≥130 mmHg, and ACR ≥2 mg/mmol were also associated with greater odds of developing CKD. Conclusion In this contemporary Canadian cohort of young adults with T1D, CKD and albuminuria are common. Contributing risk factors include comorbid medical and psychiatric conditions, suboptimal glycemic control, systolic hypertension, and albuminuria. Presentation: No date and time listed

A Co-diagnosis of Crohn Disease and Autoimmune Diabetes in an Adolescent Patient.

Inflammatory bowel disease (IBD) is a lifelong, immune-mediated disorder that often occurs in childhood and is becoming increasingly common worldwide. Diagnosis of IBD in children remains difficult due to the spectrum of symptoms, including gastrointestinal and extraintestinal manifestations. Type 1 diabetes mellitus (T1D) is one of the most common autoimmune diseases in children and adolescents. Classic manifestations of T1D in young people include polyuria, polydipsia, abdominal pain, weight loss, and ketoacidosis. However, children with autoimmunity of pancreatic β-cells may remain euglycemic and asymptomatic for many years. An accurate and prompt diagnosis of IBD and T1D is particularly important in children because they can negatively affect growth, psychosocial function and overall well-being. We present a case in which a previously healthy child was co-diagnosed with Crohn disease and T1D during a routine pediatric evaluation in the outpatient clinic of a peripheral secondary hospital.

Demographic and clinical characteristics of a Spanish population of people living with type 1 diabetes who practice nonprofessional sports: The DIABESPORT survey

AimTo determine the characteristics of people with type 1 diabetes mellitus (T1D) who practice sports, the support they receive, and the way in which they manage their disease during sports. MethodsAn observational cross-sectional study designed as a web-based survey released through social media was carried out, directed to physically active people with T1D. ResultsA total of 342 subjects completed the survey (16 children; 67.5% males). The duration of living with T1D was 18.6 ± 11.4 years. The mean glycosylated hemoglobin concentration (HbA1c) was 6.7 ± 0.8%, and the mean time in range (TIR) was 72.9 ± 15.8%. Only 27.2% started sports activity following the diagnosis of T1D. The most frequently used basal insulin was insulin degludec (38.6%). The usual treatment modification before doing sports consisted of bolus reduction (42.5%) or only the adjustment of nutritional supplements (19.7%). In cases of long-acting insulin users, the basal dose usually remained unchanged during sports. One-quarter of the participants were insulin pump users, and of these, 12.5% always disconnected the pump during physical activities. Severe hypoglycemia on the day of physical activity was experienced by 5% of the participants in the last 6 months. One-third reported a lack of support from their physician, and 61% had learned to manage glycemic control during sports by themselves. ConclusionsThis study highlights the adjustments made by people living with T1D during sports practice, and the lack of support received from healthcare professionals.

633-P: Families' Lived Experience Guides Intervention Development: Addressing the Psychosocial Needs of Families in the First Year after Diagnosis

A diagnosis of T1D can be overwhelming. Offering psychosocial support throughout the first year may facilitate family adjustment. To our knowledge, no interventions exist that promote psychosocial adjustment in families immediately following diagnosis. Family-based interventions are rarely developed with a focus on the experiences of the families who have lived through the diagnosis. This study offers a novel approach to developing a family-based intervention for youth with T1D, with content developed from the lived experiences of youth and their parents. The goal of Teaming up for T1D with Telehealth (Triple T) is to support families post-diagnosis, combining brief, targeted telehealth sessions and access to a video library depicting common family experiences during the first year. We conducted age specific focus groups to explore challenges, fears, successes, and advice of youth and their families, diagnosed within the past 2 years. Children (8-12 years; n= 10) ; teens (13-17 years; n= 11) ; their caregivers (n= 27) and parents of children 7 or younger (n= 12) participated. Main themes were sorted into topics to be addressed by telehealth visits or videos. These themes informed the development of 20 videos with age-specific themes. There were five main topics: Reassurance that they will be “Okay”; Strategies for getting to “Okay”; Managing activities; Handling disclosure and questions; and Family teamwork. Test videos were reviewed by the original focus group participants for additional stakeholder feedback. Final videos were filmed with professional actors to be used in conjunction with telehealth sessions during the intervention. Using stakeholder experience in addition to clinical experience and empirical research to inform interventions represents a novel approach to developing interventions that may directly address the needs of families and inform future interventions and education following a T1D diagnosis. Disclosure K.P.Garza: None. K.R.Howard: None. J.Weissberg-benchell: None. M.Feldman: None. Funding Juvenile Diabetes Research Foundation

1022-P: Youth from High-Poverty Neighborhoods Demonstrate Higher HbA1c within Year after Diagnosis of T1D

Background: T1D management and control in the year after diagnosis often establish long-term patterns for pediatric patients. Disparities in HbA1c based on race, ethnicity, and socioeconomic status (SES) are documented in the pediatric literature; yet there is limited description of the timeline in which these disparities appear. Study Design: We conducted a retrospective chart review of patients diagnosed with T1D at a tertiary children’s hospital between 1/1/16 and 2/20/20 who received follow-up care for at least 1 year. Using zip-code level geocoding, we obtained community-level SES data based on American Community Survey (ACS) measures and classified patients according to the percent of families in census tract living in poverty, defined as 200% of the federal poverty level (FPL) . Results: Of 758 patients, 15.6% (median, IQR 10.53, 24.01) of households were living in poverty; poor patients were defined as those in the upper quartile (&amp;gt;24.0% of households living below 200% of FPL) and rich patients in the lower quartile (&amp;lt;10.5%) . Patients from households in poor communities had higher HbA1c levels compared with their rich counterparts from baseline to 1-year post-diagnosis, although statistical differences emerged after 9 months between poor vs. rich groups: baseline 11.5% vs. 11.2%, p=0.10; 3 months 7.4% vs. 7.3%, p=0.62; 6 months 7.5% vs. 7.3%, p=0.24) ; 9 months 8.1% vs. 7.6%, p=0.01; and 1 year 8.2% vs. 7.8%, p=0.05. Discussion: These data highlight the early origin of disparities in glycemic control in pediatric patients with T1D based on community-level SES. Understanding the time course of these disparate outcomes helps to inform the need for early intervention, particularly in low-income groups, to provide support likely needed to optimize glycemic control and long-term health outcomes. Further research can assess the overlapping axes of disparities that include race, ethnicity, and education level. Disclosure E.S.Tremblay: None. E.Liu: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. Funding NIDDK (K12DK094721)

350-OR: The Oral Disposition Index (ODI) Predicts Type 1 Diabetes (T1D) in Autoantibody-Positive (Ab+) Individuals

The ODI is a measure of β-cell function accounting for insulin sensitivity. ODI has primarily been studied in adults and shown to be inversely predictive of type 2 diabetes (T2D) ; however, little is known about ODI’s prediction of T1D. We thus used data from Ab+ Trialnet Pathway to Prevention (PTP) and Diabetes Prevention Trial Type 1 (DPT-1) cohorts (relatives of T1D patients) to study this. Data were analyzed from 33PTP participants: age (mean±SD) 15.8±12.1 yrs; BMI 21.1±13.1 kg/m2; 50.1% female, and 2from DPT-1: age 14.8±10.0 yrs; BMI 21.8±6.1 kg/m2; 51.2% female. Insulin measures at baseline included insulin sensitivity [ (1/Fasting Insulin) ; 1/FI) ], β-cell function [C-peptide index: (30 min C-pep-0 min C-pep) / (30 min glucose-0 min glucose) ], and ODI [ (1/FI) x (C-peptide Index) ]. Spearman correlations of C-peptide Index vs. 1/FI were r=-0.47 (p&amp;lt;0.001) in PTP, and r=-0.22 (p=0.001) in DPT-1. The figure shows cumulative incidence curves according to ODI quartiles (Q) for progression to T1D in both PTP and DPT-1. The diagnosis of T1D was inversely related to ODI, with Q4 vs. Q1 hazard ratios and 95% CIs of [0.13 (0.10, 0.16) , p=0.006] for PTP and of [0.13 (0.06, 0.29) , p=0.002] for DPT-1. In conclusion, ODI is inversely predictive of T1D among Ab+ individuals. Thus, as with predicting T2D, insulin sensitivity should be taken into account when β-cell function is used to predict T1D in Ab+ populations. Disclosure H.M.Ismail: n/a. D.D.Cuthbertson: None. M.J.Redondo: Advisory Panel; Provention Bio, Inc. L.M.Jacobsen: None. M.A.Atkinson: None. J.Sosenko: None. Diabetes prevention trial type 1: n/a. Type 1 diabetes trialnet: n/a. Funding NIH

Influence of emotional intelligence on glycemic control in adolescents with diabetes type 1.

Psychological factors can have a significant impact on diabetes control. We aimed to evaluate the correlation between emotional intelligence and glycemic control in type one diabetes (T1D) adolescents. This prospective study enrolled 97 consecutive children admitted to our department and aged 15 to 17 with T1D. The Emotional Intelligence Questionnaire INTE was used to measure emotional intelligence. The results were correlated with a glycemic control status, measured by current and mean (since the diagnosis of T1D, minimum four tests per year) and hemoglobin A1c (HbA1c). An additional questionnaire collected the demographic and social data. Our study found a significant, negative correlation between HbA1c level and the ability to utilize emotions to support thinking and actions (Factor I of the INTE questionnaire). There was no significant correlation between emotional intelligence General Score or Factor II (the ability to recognize emotions) and glycemic control. A higher ability to utilize emotions to support thinking and actions positively correlates with metabolic control in the adolescent population with T1D. The appropriate emotional intelligence training and better psychological care may improve the metabolic outcomes of children with T1D. This merits further study.

Glomerular Filtration Rate Abnormalities in Children With Type 1 Diabetes

ObjectivesType 1 diabetes (T1D) increases the risk of chronic kidney disease (CKD) development. The primary objective of this study was to assess the prevalence of abnormalities in estimated glomerular filtration rate (eGFR) in children with T1D. As a secondary objective, we sought to explore the relationship between clinical characteristics and abnormalities in eGFR. MethodsThis cross-sectional study involved children ≤18 years of age with T1D followed in the diabetes clinic at a pediatric tertiary care centre. Data were collected from health records between 2016 and 2020. Using the Bedside Schwartz, Chronic Kidney Disease in Children Under 25 (CKiD U25) and European Kidney Function Consortium (EKFC) equations, eGFR was categorized as CKD (<60 mL/min/1.73 m2), mildly decreased (60 to <90 mL/min/1.73 m2), normal (90 to <158 mL/min/1.73 m2) and hyperfiltration (≥158 mL/min/1.73 m2). Linear regression analysis was used to describe the relationship between eGFR and clinical characteristics. ResultsOf the 420 participants, 225 were male (54%); the median age at diagnosis and duration of T1D were 6.1 and 4.8 years, respectively. The proportion of participants with mildly decreased eGFR was similar regardless of eGFR equation, with 11% to 14% of participants with an eGFR <90 mL/min/1.73 m2. When analyzed as a function of duration of T1D, eGFR was 1.4 mL/min/1.73 m2 lower per year duration of T1D. ConclusionsA notable proportion of children with T1D demonstrates eGFR abnormalities early in their T1D course. This finding along with evidence of lower eGFR in adolescence is concerning for long-term risk of CKD and warrants systematic serum creatinine monitoring at diagnosis and regular intervals thereafter in children with T1D.

DKA and new-onset type 1 diabetes in Brazilian children and adolescents during the COVID-19 pandemic.

We assess the severity and frequency of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes mellitus (T1D) patients and in patients with previous diagnosis of T1D in a referral Brazilian university hospital in the first five months of the COVID-19 pandemic. We also compare the data with data from pre-pandemic periods. Forty-three new-onset T1D patients were diagnosed between April and August of the years 2017, 2018, 2019, and 2020. During the COVID-19 pandemic, the number of new-onset T1D was over twice the number of new-onset T1D in the same period in the three previous years. All the 43 patients survived and are now on outpatient follow-up. We also compared the characteristics of the T1D patients hospitalized between April and August of the years 2017, 2018, and 2019 (32 hospitalizations) to the characteristics of the T1D patients hospitalized between April and August/2020 (35 hospitalizations; 1 patient was hospitalized twice in this period). Fourteen of the 34 patients admitted during the pandemic presented with COVID-19-related symptoms (any respiratory symptom, fever, nausea, vomiting, and diarrhea), but only one had positive SARS-CoV-2 RT-PCR test. Samples from 32 out of these 34 patients were assayed for SARS-CoV-2 antibodies, and four patients were positive for total antibodies (IgM and IgG). In agreement with recent reports from European countries, we observed increased frequency of DKA and severe DKA in new-onset and previously diagnosed T1D children and adolescents in a large referral public hospital in Brazil in the first five months of the COVID-19 pandemic. The reasons for this outcome might have been fear of SARS-CoV-2 infection in emergency settings, the more limited availability of primary healthcare, and the lack of school personnel's attention toward children's general well-being.

Trend in initial presenting features of type 1 diabetes mellitus over a 24 year period in Turkey: a retrospective analysis of 814 cases.

The study aim was to examine changes in trends of presenting features during the diagnosis of patients followed up with newly diagnosed Type 1 diabetes mellitus (T1DM) over the past 24 years. The study was retrospective. Patients with a diagnosis of T1D between the years of 1996-2019 were included. Patients diagnosed in the first half of the period comprised Period I, and those from the second half comprised Period II. Patient data were extracted from medical records and included gender distribution, year of diagnosis, age at diagnosis, duration of symptoms, type of admission, frequency of diabetic ketoacidosis (DKA) and biochemical parameters. Subsequently, temporal changes in trends of these parameters were sought. For the whole cohort the gender distribution was equal; 404 (49.6%) were girls and 410 (50.4%) were boys. Mean age at diagnosis was 8.5±4.2 years and age groupings at presentation were: 23.2% (n = 189) aged 0-4; 39.2% (n = 319) aged 5-9; 27.5% (n = 224) aged 10-13; 10.1% (n= 82) aged 14-18. At presentation 72 (12.7%) had hyperglycemia, 230 (40.6%) had diabetic ketosis, and 264 (46.6%) had DKA. In those with DKA, mild DKA was found in 103 (39.0%), moderate DKA in 81 (30.6%), and severe DKA in 80 (30.3%). While the frequency of DKA was 54.9% between 1996 and 2007 (Period I), this significantly decreased to 44.4% between 2008 and 2019 (Period II). Girls and boys had a similar rate of T1DM, and this did not change over time. Three peak ages of diagnosis were evident; 5-7, 8-10, 12-14 years of age. The frequency of DKA decreased and the frequency of admission with hyperglycemia and ketosis increased during the study period, which may have repercussions for mortality and morbidity rates and aid in improved treatment outcomes.

Diabetic Ketoacidosis at Manifestation of Type 1 Diabetes in Childhood and Adolescence—Incidence and Risk Factors.

Diabetic ketoacidosis (DKA) is a potentially life-threatening metabolic disorder that can occur with manifestation of type 1 diabetes mellitus (T1D). The aim of this study was to analyze the incidence of DKA at the time of the diagnosis of T1D in childhood and adolescence, the risk factors, and regional approaches to reduce the incidence of ketoacidosis. We investigated the proportion of patients under 18 years of age with DKA (defined as pH <7.3, severe DKA pH <7.1) at the manifestation of T1D in Germany in the period 2000-2019, based on data from the German-Austrian registry of diabetes (Diabetes-Patienten-Verlaufsdokumentation, DPV). The influence of the following factors was evaluated: year of manifestation, age, sex, family history of migration (MiH), and distance from the hospital. Moreover, data from the region with and the region without a pilot screening project from 2015 onwards were compared. Of the 41 189 patients with manifestation of T1D, 19.8% presented with DKA (n = 8154, slight increase [p <0.001] over the study period) and 6.1% (n = 2513) had severe DKA. Children under 6 years of age had DKA more often than adolescents (12-17 years) (21.7% versus 18.6%, OR 1.22 {95% CI: [1.14; 1.30]}). Girls had a higher rate of DKA than boys (20.5% versus 19.2%, OR 1.10 [1.03; 1.14]), and patients with MiH were more likely to have DKA than those without MiH (21.4% versus 18.2%, OR 1.40 [1.32; 1.48]). In the region with a pilot screening project, the DKA rate stayed the same, at 20.6%, while in the control region the rate was 22.7% with a decreasing tendency. The frequency of DKA at the time of diagnosis of T1D did not decrease between 2000 and 2019 and increased towards the end of the observation period. Children with MiH, children under 6, and girls were at a higher risk of DKA.

929-P: A Population-Based Study of Long-Term HbA1c Associated with Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Western Australian Children

Background: In addition to the acute illness associated with DKA at diagnosis of T1D in children, there is some evidence of its association with poor long-term glycaemic outcomes, increasing risk of complications. With growing global interest in screening for pre-diabetes in children, long-term outcomes are an important consideration in terms of economic viability but there is limited high quality data. This population-based study helps to address this gap. Methods: All children &amp;lt;16 years presenting to Perth Children’s Hospital with new onset T1D 2000-2019 were included and followed up for ≤ 14 years. Moderate-severe DKA at diagnosis was defined as serum pH &amp;lt;7.2 or bicarb &amp;lt;15mmol/l in the presence of hyperglycaemia and ketosis. HbA1c was recorded at each clinic visit, ~3 monthly from diagnosis. A linear mixed model, adjusted for sex, diagnosis age, socioeconomic status and metro/regional area of residence, was used to examine long-term HbA1c associated with DKA at diagnosis at each year of duration. Results: The population-based cohort included 2063 patients and median [IQR] follow-up time was 5.4 [3.0-8.4] years. The incidence of DKA at diagnosis was 25%. Patients presenting with DKA had a higher mean HbA1c at diagnosis as expected but from 2 to 7 years post-diagnosis there was no difference between the two groups. Mean HbA1c of patients presenting with DKA increased relative to the remainder from 7 years. The only comparable study, conducted in Colorado in 2017, reported an immediate and sustained relationship between DKA severity at onset and HbA1c over 15 years. Conclusion: The difference in findings for similar cohorts in Australia and the US raises questions regarding the variables that influence long-term glycaemic outcomes in children diagnosed with T1D. Further studies are required to explore the association between DKA at diagnosis and HbA1c over time and to understand the importance of sociodemographic, physiological and other factors. Disclosure H. Clapin: None. G. J. Smith: None. S. Vijayanand: None. T. Jones: None. E. A. Davis: None. A. Haynes: None.