Glucose In Children Research Articles

Prevalence and clinical correlates of impaired fasting blood glucose in children and adolescents with depressive disorder and relationship with triglyceride and high-density lipoprotein ratio

Depressive disorder is a significant public health problem worldwide, which adversely affects children and adolescents’ health. Impaired fasting blood glucose (IFG) is more common in depressive disorder, which becomes a clinical problem that needs to be focused on. The study purposed to determine the prevalence and related factors of IFG in Chinese children and adolescents with depressive disorder and the relationship between triglyceride and high-density lipoprotein cholesterol (TG/HDL-C) ratio and IFG. This research encompassed 756 individuals aged 8 to 18 with major depressive disorders, all diagnosed under DSM-5 criteria at the Third People’s Hospital of Fuyang from January 2020 to December 2021. We detected fasting blood glucose (FBG) and lipid levels and assessed the suicidal behaviors and depressive symptoms severity of each participant. The sociodemographic and included study variables were collected and analyzed. Our study employed multiple logistic regression to discern independent factors affecting IFG in conjunction with depressive disorders among children and adolescents. The prevalence of IFG was 6.5% (49/756). IFG was positively correlated with FBG, BMI, TG, TG/HDL-C, and was negatively correlated with gender and the type of antidepressant drug taken. Binary logistic analysis showed that male (OR = 2.57, 95% CI: 1.43–4.63, P = 0.002) and higher levels of TG (OR = 1.63, 95% CI: 1.11–2.38, P = 0.013) were independently associated with IFG in children and adolescents with depressive disorder. The incidence of IFG in children and adolescents with depressive disorder was high and was positively related to the TG/HDL-C ratio. The evaluation and management of IFG in pediatric depression should extend beyond pharmacological interventions. Comprehensive strategies in both assessment and management of IFG are essential to address this condition effectively in young patients facing depressive disorders.

Obesity-Related Complications Including Dysglycemia Based on 1-h Post-Load Plasma Glucose in Children and Adolescents Screened before and after COVID-19 Pandemic.

Childhood obesity, with its metabolic complications, is a problem of public health. The International Diabetes Federation (IDF) has recommended glucose levels 1 h post oral glucose load (1h-PG) > 155-209 mg/dL as diagnostic for intermediate hyperglycemia (IH), while >209 mg/dL for type 2 diabetes (T2D). The aim of the study was to assess the occurrence of prediabetes, IH, and T2D in children and adolescents with simple obesity according to the criteria of American Diabetes Association (ADA) and of IDF, and the effect of COVID-19 pandemic on these disorders. Analysis included 263 children with simple obesity, screened either in prepandemic (PRE-113 cases) or post-pandemic period (POST-150 cases). All children underwent 2 h OGTT with measurements of glucose and insulin every 0.5 h, lipid profile, and other tests; indices if insulin resistance (IR): HOMA, QUICKI, Matsuda index, AUC (glu/ins) were calculated. The incidence of T2D, prediabetes, and IH was higher in POST with respect to PRE, with significant differences in the indices of IR, except for HOMA. Significant differences were observed in the assessed parameters of glucose metabolism among the groups with T2D, prediabetes, IH, and normal glucose tolerance (NGT), with some similarities between IH (based on 1h-PG) and prediabetes. Increased frequency of dysglycemia among children and adolescents with simple obesity is observed after COVID-19 pandemic. Metabolic profile of patients with IH at 1h-PG is "intermediate" between NGT and prediabetes.

Physical activity modified association of urinary metals mixture and fasting blood glucose in children: From two panel studies

There is unclear evidence available on the associations between multiple metals and fasting blood glucose (FBG) in children, and whether they could be beneficial from physical activity. We included 283 children aged 4–12 years from two panel studies with 4–consecutive morning urinary 13 essential metals and 10 non-essential metals repeated across 3 seasons. We employed multiple informant model, linear mixed-effect model, and quantile g–computation to evaluate associations of single metal and their mixture with FBG and interactions with extra-school activity. The results showed that positive relations of multiple essential metals (aluminum, chromium, copper, iron, molybdenum (Mo), nickel, selenium (Se), strontium, zinc) and non-essential metals (arsenic (As), cadmium (Cd), rubidium, titanium (Ti), thallium) with FBG were the strongest at lag 0 (the health examination day), especially in overweight & obesity children (FDR <0.05). The strongest effect presented 1-fold increment in As was related to FBG increased 1.66% (95%CI: 0.84%, 2.48%) in overweight & obesity children. Notably, modification of extra-school activity showed significant, and the effects of multiple metals on FBG were attenuated in children taking total extra-school activity ≥1 h/day, and only one type of which, low or moderate & high intensity extra-school activity reached 20 min/day (Pint <0.05). For instance, each 1-fold increased As was associated with 1.41% increased FBG in overall children taking total extra-school activity <1 h/day, while that of 0.13% in those ≥1 h/day. Meanwhile, mixture of all, essential and non-essential metals were associated with increased FBG, a trend that decreased and became nonsignificant in children having certain extra-school activity, which were dominated by Mo, Se, Ti, Cd. And such relations were substantially beneficial from extra-school activity in overweight & obesity children. Accordingly, multiple essential and non-essential metals, both individual and in mixture, were positively related to FBG in children, which might be attenuated by regular physical activity.

Altered Glucagon and GLP-1 Responses to Oral Glucose in Children and Adolescents With Obesity and Insulin Resistance.

Pediatric obesity is characterized by insulin resistance, yet it remains unclear whether insulin resistance contributes to abnormalities in glucagon and incretin secretion. To examine whether fasting and stimulated glucagon, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) concentrations differ between children and adolescents with obesity and insulin resistance (OIR), obesity and normal insulin sensitivity (OIS), and controls with normal weight (NW). 80 (34 boys) children and adolescents, aged 7-17 years with OIR (n = 22), OIS (n = 22), and NW (n = 36) underwent an oral glucose tolerance test with measurements of serum insulin, plasma glucose, glucagon, total GLP-1, and total GIP. Homeostatic model assessment of insulin resistance (HOMA-IR), single point insulin sensitivity estimator (SPISE), Matsuda index, insulinogenic index (IGI), and oral disposition index (ODI) were calculated. Fasting concentrations of glucagon and GLP-1 were higher in the OIR group, with no significant differences for GIP. The OIR group had higher glucagon total area under the curve (tAUC0-120) and lower GLP-1 incremental AUC (iAUC0-120), with no significant differences in GIP iAUC0-120. Higher fasting glucagon was associated with higher HOMA-IR, lower Matsuda index, lower SPISE, higher IGI, and higher plasma alanine transaminase, whereas higher fasting GLP-1 was associated with higher HOMA-IR, lower Matsuda index, and lower ODI. Higher glucagon tAUC0-120 was associated lower SPISE and lower Matsuda index, whereas lower GLP-1 iAUC0-120 was associated with a higher HOMA-IR, lower Matsuda index, and lower ODI. Children and adolescents with OIR have elevated fasting concentrations of glucagon and GLP-1, higher glucagon and lower GLP-1 responses during an OGTT compared to those with OIS and NW. In contrast, individuals with OIS have similar hormone responses to those with NW.

Investigation of The Effect of Combined Exercises on Glycemic Control in Individuals with Type 1 Diabetes

The aim of the present study was to investigate the effect of the combined physical exercise protocols on the blood glucose (BG) of children with T1D. The study was conducted over four weeks using self-controlled clinical trials. The first two weeks were control period and the last two weeks were the experimental period. A total of 6 exercise sessions were performed 3 days a week during the experimental period. The exercise program consisted of aerobic, stretching, and resistance exercises. Each exercise session was performed for 40 minutes. A total of 15 children with T1D, whose mean age was 13.3±SD, were included in the study. The blood glucose and insulin dose data of the participants were recorded in both periods through the continuous glucose measurement system and the registry. It was determined that aerobic exercises provided a significant decrease in blood glucose (p &lt; .05). There was no statistically significant difference between the mean BG values in the control (211.7±37.3) and experimental (208.7±40.4) periods (p &gt;0.05). On the other hand, a statistically significant decrease was found in the total daily insulin doses used by participants during the experimental (31.6±20.8 Unit) period (p &lt; 0.001). Physical exercises had an acute positive effect on blood glucose in children with T1D. However, the effect of exercise alone is not sufficient for chronic glycemic control in T1D. For chronic glycemic control, first of all, the injected insulin doses should be carefully regulated according to carbohydrates and exercise.

1117-P: Variability in Glycemia Measured by CGM in Children and Young Adults with Acute Recurrent or Chronic Pancreatitis

Post pancreatitis diabetes mellitus is an underrecognized disorder. Children with pancreatitis are at elevated risk for development of diabetes (DM) in the near term (approximately 9%), and lifetime risk of DM approaches 50%. Unfortunately, there is limited data regarding pathophysiology and disease course. This pilot study was undertaken to investigate glycemic physiology in the free-living state in children with acute recurrent (ARP) or chronic pancreatitis (CP). Methods: Children (&amp;lt;21 years of age) with an established diagnosis of CP or ARP, and participants of INSPPIRE-2 (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE) were invited to participate. Pancreatitis type, demographics and growth parameters were extracted from the INSPPIRE-2 database. HbA1c was collected. A continuous glucose monitor was placed (CGM, Dexcom Pro). Glycemic variability metrics were calculated at the participant level using EasyGV software. The relationship between HbA1c and CGM variables was evaluated via multiple linear regression. Results: 12 children were enrolled, age 10-20.8 years (mean 17.2; 66% female). One subject had known DM prior to enrollment. Participants had normal mean height (0.19+/- 0.72 SD), weight (1.1 +/- 0.98SD) and BMI (0.98 +/- 0.81 SD) z-scores. Mean A1c was 5.73% (range 5.0-8.9) with the known diabetic and 5.42% (5.0-6.1) without. Mean CGM glucose was 121.8 mg/dl +/- 21.4. Of the 11 subjects without DM, 2 had CGM glucose &amp;gt;180 mg/dl &amp;gt; 10% time and 1 had CGM glucose &amp;lt;55 mg/dl &amp;gt; 1% time. HbA1c correlated with mean CGM glucose in univariate analysis and when controlled for age and BMI (p = 0.02, r2 = 0.47). Conclusions: In this small study, A1c correlated well with average CGM glucose in children with ARP and CP, and some had abnormal glycemic excursions on CGM. More research is needed on the use of CGM in children with CP and ARP. Disclosure M.G.Parra villasmil: None. M.Bellin: Consultant; Insulet Corporation, Vertex Pharmaceuticals Incorporated, Research Support; Dexcom, Inc., ViaCyte, Inc. C.Pinnaro: None. K.L.Ode: None.

Temporal Trends of Blood Glucose in Children with Cerebral Malaria.

Hypoglycemia, defined as a blood glucose < 2.2 mmol/L, is associated with death in pediatric cerebral malaria (CM). The optimal duration of glucose monitoring in CM is unknown. We collected data from 1,674 hospitalized Malawian children with CM to evaluate the association between hypoglycemia and death or neurologic disability in survivors. We assessed the optimal duration of routine periodic measurements of blood glucose. Children with hypoglycemia at admission had a 2.87-fold higher odds (95% CI: 1.35-6.09) of death and, if they survived, a 3.21-fold greater odds (95% CI: 1.51-6.86) of sequelae at hospital discharge. If hypoglycemia was detected at 6 hours but not at admission, there was a 7.27-fold higher odds of death (95% CI: 1.85-8.56). The presence of newly developed hypoglycemia after admission was not independently associated with neurological sequelae in CM survivors. Among all new episodes of blood sugar below a treatment threshold of 3.0 mmol/L, 94.7% occurred within 24 hours of admission. In those with blood sugar below 3.0 mmol/L in the first 24 hours, low blood sugar persisted or recurred for up to 42 hours. Hypoglycemia at admission or 6 hours afterward is strongly associated with mortality in CM. Children with CM should have 24 hours of post-admission blood glucose measurements. If a blood glucose less than the treatment threshold of 3.0 mmol/L is not detected, routine assessments may cease. Children who have blood sugar values below the treatment threshold detected within the first 24 hours should continue to have periodic glucose measurements for 48 hours post-admission.

Associations among permissive parenting, family mealtime behaviors, nutrition, and blood glucose in children with type 1 diabetes

ABSTRACT We examined relations among permissive parenting, mealtime behaviors, nutrition, and HbA1c in pediatric type 1 diabetes (T1D). Sixty-three children (Mage = 10.3, SD = 1.9) with T1D and caregivers completed surveys. Permissive parenting significantly negatively correlated with vegetable consumption (r=-0.27, p = .03). It was positively correlated with child resistance to eating (r = 0.48, p < .01), parent aversion to mealtime (r = 0.51, p < .01) and mealtime disturbance (r = 0.48, p < .01). Child resistance to eating did not mediate the relation between permissive parenting and HbA1c or permissive parenting and vegetable consumption. Because permissive parenting relates to eating behaviors, parent-child interventions promoting healthy eating and more effective parenting in T1D should be explored.

Long-Term Effects and Potential Impact of Early Nutrition with Breast Milk or Infant Formula on Glucose Homeostasis Control in Healthy Children at 6 Years Old: A Follow-Up from the COGNIS Study.

There is scarce evidence about early nutrition programming of dynamic aspects of glucose homeostasis. We analyzed the long-term effects of early nutrition on glycemic variability in healthy children. A total of 92 children participating in the COGNIS study were considered for this analysis, who were fed with: a standard infant formula (SF, n = 32), an experimental formula (EF, n = 32), supplemented with milk fat globule membrane (MFGM) components, long-chain polyunsaturated fatty acids (LC-PUFAs), and synbiotics, or were breastfed (BF, n = 28). At 6 years old, BF children had lower mean glucose levels and higher multiscale sample entropy (MSE) compared to those fed with SF. No differences in MSE were found between EF and BF groups. Normal and slow weight gain velocity during the first 6 months of life were associated with higher MSE at 6 years, suggesting an early programming effect against later metabolic disorders, thus similarly to what we observed in breastfed children. Conclusion: According to our results, BF and normal/slow weight gain velocity during early life seem to protect against glucose homeostasis dysregulation at 6 years old. EF shows functional similarities to BF regarding children's glucose variability. The detection of glucose dysregulation in healthy children would help to develop strategies to prevent the onset of metabolic disorders in adulthood.

Association of BMAL1 clock gene polymorphisms with fasting glucose in children

BackgroundThe brain and muscle Arnt-like protein-1 (BMAL1) gene is an important circadian clock gene and previous studies have found that certain polymorphisms are associated with type 2 diabetes in adults. However, it remains unknown if such polymorphisms can affect fasting glucose in children and if other factors modify the associations.MethodsA school-based cross-sectional study with 947 Chinese children was conducted. A multivariable linear regression model was used to analyze the association between BMAL1 gene polymorphisms and fasting glucose level.ResultsAfter adjusting for age, sex, body mass index (BMI), physical activity, and unhealthy diet, GG genotype carriers of BMAL1 rs3789327 had higher fasting glucose than AA/GA genotype carriers (b = 0.101, SE = 0.050, P = 0.045). Adjusting for the same confounders, rs3816358 was shown to be significantly associated with fasting glucose (b = 0.060, SE = 0.028, P = 0.032). Furthermore, a significant interaction between rs3789327 and nutritional status on fasting glucose was identified (Pinteraction = 0.009); rs3789327 was associated with fasting glucose in the overweight/obese subgroup (b = 0.353, SE = 0.126, P = 0.006), but not in non-overweight/non-obese children.ConclusionsBMAL1 polymorphisms were significantly associated with the fasting glucose level in children. Additionally, the observed interaction between nutritional status and BMAL1 supports promoting an optimal BMI in children genetically predisposed to higher glucose level.ImpactPolymorphisms in the essential circadian clock gene BMAL1 were associated with fasting blood glucose levels in children. Additionally, there was a significant interaction between nutritional status and BMAL1 affecting fasting glucose levels.BMAL1 rs3789327 was associated with fasting glucose only in overweight/obese children.This finding could bring novel insights into mechanisms by which nutritional status influences fasting glucose in children.

Obstructive sleep apnea (OSA) is associated with the impairment of beta-cell response to glucose in children and adolescents with obesity

BackgroundThe main purpose of the study is to assess the association between obstructive sleep apnea (OSA) and insulin secretion in children with obesity.MethodsWe enrolled children and adolescents who attended our pediatric clinic because of obesity and OSA. Glucose homeostasis was assessed through standard 2-h oral glucose tolerance test (OGTT). Nocturnal cardio-respiratory polygraphy was performed for OSA diagnosis. Twenty-two patients underwent a 3-h OGTT to investigate insulin secretion and sensitivity through the oral-minimal model.Resultsseventy-seven children and adolescents were included in the study. Based on OSA severity, the cohort was divided into three groups (29 mild, 29 moderate, and 19 severe OSA). The group with mild OSA showed lower levels of 30-min glucose (p = 0.01) and 60-min glucose (p = 0.03), and lower prevalence of elevated 1-h glucose (10.4% versus 44.8% in moderate and 31.6% in severe OSA, p = 0.01). The odds for elevated 1-h plasma glucose was 6.2-fold (95%CI 1.6–23.4) higher in subjects with moderate and severe OSA compared to mild OSA (p = 0.007) independent of confounders. Spearman correlation test revealed a positive correlation between 30-min plasma glucose and apnea-hypopnea index (AHI, r = 0.31, p = 0.01), oxygen desaturation index (ODI, r = 0.31, p = 0.009), and mean desaturation (r = 0.25, p = 0.04). The 3-h OGTT study included 22 participants (7 mild, 9 moderate, and 6 severe OSA). The group with mild OSA showed a higher dynamic, static, and total insulin secretion compared to those with moderate and severe OSA (p < 0.0001, p = 0.007, p = 0.007, respectively). AHI was significantly correlated to dynamic insulin secretion (r = −0.48, p = 0.02).ConclusionsOSA might impair beta-cell function reducing the pool of promptly releasable insulin in children and adolescents with obesity, in the absence of an effect on insulin sensitivity.

999-P: Associations between Perceived Stress and Morning Serum Cortisol with Glycemic Measures in Minority Youth with Overweight or Obesity

Background: In youth, higher morning serum cortisol has been associated with fasting glucose, however the direct role of psychosocial stress as risk factor type 2 diabetes has not been well established; therefore, in this study, we examined the associations between perceived stress and fasting serum cortisol with fasting and 2-hour post glucose challenge and hemoglobin A1c. Methods: In this cross-sectional study among Latino and African American youth with overweight or obesity (n=195, age=14.6±2.8yrs) we measured psychosocial stress with the 14-item Perceived Stress Scale for children and glucose concentrations at fasting and 2-hour post glucose challenge (1.75g oral glucose solution/kg body weight to a maximum 75g) . Hemoglobin A1c (HbA1c) and morning serum cortisol were measured from the fasting blood draw. Linear regression models assessed the relationships between perceived stress and morning cortisol with fasting glucose, 2-hour glucose, and HbA1c. With logistic regression models, we tested if perceived stress and morning serum cortisol associated with impaired fasting glucose, impaired glucose tolerance, or impaired HbA1c status. A priori covariates included age, sex, and ethnicity. Results: Perceived stress scores were not associated with any glycemic measures (all p&amp;gt;0.05) . Morning serum cortisol was positively associated with HbA1c (β=0.016; 95%CI=0.002,0.030) and impaired HbA1c status (OR=1.090; 95%CI=1.006,1.181) in unadjusted models and results were largely unchanged in adjusted models. Conclusion: Perceived stress, a common way to measure psychosocial stress, was not associated with any glycemic measures. Morning fasting cortisol was not associated with glucose levels, but was associated with HbA1c, a novel finding in this population of minority children. This finding adds to previous literature which showed that fasting serum cortisol associates with fasting glucose in children with overweight and obesity. Disclosure K.Felix: None. M.Weigensberg: None. C.M.Toledo-corral: None. Funding National Institutes of Health (P60 MD00254) National Institutes of Health (UL1GM118976) National Institutes of Health (RLGM118975) National Institutes of Health (TL4GM118977)

Parents' views about healthcare professionals having real‐time remote access to their young child's diabetes data: Qualitative study

ObjectivesWe explored parents' views about healthcare professionals having remote access to their young child's insulin and glucose data during a clinical trial to inform use of data sharing in routine pediatric diabetes care.Research Design and MethodsInterviews with 33 parents of 30 children (aged 1–7 years) with type 1 diabetes participating in a randomized trial (KidsAP02) comparing hybrid closed‐loop system use with sensor‐augmented pump therapy. Data were analyzed using a qualitative descriptive approach.ResultsParents reported multiple benefits to healthcare professionals being able to remotely access their child's glucose and insulin data during the trial, despite some initial concerns regarding the insights offered into everyday family life. Key benefits included: less work uploading/sharing data; improved consultations; and, better clinical input and support from healthcare professionals between consultations. Parents noted how healthcare professionals' real‐time data access facilitated remote delivery of consultations during the COVID‐19 pandemic, and how these were more suitable for young children than face‐to‐face appointments. Parents endorsed use of real‐time data sharing in routine clinical care, subject to caveats regarding data access, security, and privacy. They also proposed that, if data sharing were used, consultations for closed‐loop system users in routine clinical care could be replaced with needs‐driven, ad‐hoc contact.ConclusionsReal‐time data sharing can offer clinical, logistical, and quality‐of‐life benefits and enhance opportunities for remote consultations, which may be more appropriate for young children. Wider rollout would require consideration of ethical and cybersecurity issues and, given the heightened intrusion on families' privacy, a non‐judgmental, collaborative approach by healthcare professionals.

Serum Asprosin Concentrations in Children with Prader-Willi Syndrome: Correlations with Metabolic Parameters.

Children with Prader–Willi syndrome (PWS) are characterized by severe obesity. Asprosin is a newly discovered protein hormone produced by the white adipose tissue and is correlated with insulin resistance. The aim of our study was to describe the concentrations of serum asprosin in children with PWS compared to those with overweight/obesity and normal weight, and to explore the postprandial change in asprosin concentrations in participants with PWS and BMI-z matched controls. We enrolled 52 children, 23 with PWS, 8 with overweight/obesity, and 21 with normal weight. Fasting levels of asprosin, glucose, and insulin were collected in all children, and postprandial asprosin and fasting levels of acyl ghrelin (AG) and leptin were also determined in a subsample of participants. There were no significant differences among groups in fasting levels of asprosin, glucose, insulin, and HOMA-IR. Fasting serum asprosin and 1-h post-meal serum asprosin did not differ in children with PWS nor in BMI-z matched controls. Fasting asprosin showed an adjusted positive correlation with glucose in children with obesity (r = 0.93, p = 0.007) but not in children with PWS nor children with normal weight. Circulating asprosin might be a predictor of early alterations in glucose metabolism in children with obesity. More research is needed to further explain the association between asprosin, food intake, metabolism, and obesity in PWS.

Meal-Related Asprosin Serum Levels Are Affected by Insulin Resistance and Impaired Fasting Glucose in Children With Obesity.

Asprosin physiologically increases in fasting conditions and decreases with refeeding and has been implicated in glucose homeostasis. An alteration of meal-related circadian oscillation of asprosin has been suggested in adults affected by type 2 diabetes mellitus.Aims of this study were to test the hypothesis of an alteration in the meal-related variation of asprosin levels in non-diabetic children and adolescents with obesity and to assess which metabolic variables condition this variation in non-diabetic children and adolescents with obesity. This is a cross-sectional study which included 79 children and adolescents with obesity. Children underwent clinical and biochemical assessments, including oral glucose tolerance test (OGTT), and liver ultrasound evaluation. Asprosin serum levels were measured by an enzyme-linked immunosorbent assay at a fasting state and at the 120-minute OGTT timepoint (2h-postprandial asprosin). Fasting and 2h-postprandial asprosin serum levels did not significantly differ in the entire study population (374.28 ± 77.23 vs 375.27 ± 81.26;p=0.837). 55.7% of patients had a significant increase in 2h-postprandial asprosin compared with fasting levels. The asprosin level increase condition was significantly associated with HOMA-IR (OR,1.41; 95%CI,1.005-1.977; p=0.047), fasting glycaemia (OR,1.073; 95%CI,1.009-1.141;p=0.024) and HOMA-B (OR,0.99; 95%CI,0.984-0.999; p=0.035). Moreover, the IFG condition was associated with the increase in asprosin levels (OR, 3.040; 95%CI, 1.095-8.436; p=0.033), even after adjustment for HOMA-IR, BMI SDS, sex and pubertal stage. Insulin resistance and IFG influence meal-related changes of asprosin serum levels in our study population of obese, non-diabetic, children. Alteration of asprosin circadian secretion might be an early biomarker of impaired glucose regulation in obese children with insulin resistance.

A comparison of FreeStyle Libre 2 to self-monitoring of blood glucose in children with type 1 diabetes and sub-optimal glycaemic control: a 12-week randomised controlled trial protocol

PurposeFrequent glucose monitoring is necessary for optimal glycaemic control. Second-generation intermittently scanned glucose monitoring (isCGM) systems inform users of out-of-target glucose levels and may reduce monitoring burden. We aim to compare FreeStyle Libre 2 (Abbott Diabetes Care, Witney, U.K.) to self-monitoring of blood glucose in children with type 1 diabetes and sub-optimal glycaemic control.MethodsThis open-label randomised controlled trial will enrol 100 children (4–13 years inclusive, diagnosis of type 1 diabetes ≥ 6 months, HbA1c 58–110 mmol/mol [7.5–12.2%]), from 5 New Zealand diabetes centres. Following 2 weeks of blinded sensor wear, children will be randomised 1:1 to control or intervention arms. The intervention (duration 12 weeks) includes second-generation isCGM (FreeStyle Libre 2) and education on using interstitial glucose data to manage diabetes. The control group will continue self-monitoring blood glucose. The primary outcome is the difference in glycaemic control (measured as HbA1c) between groups at 12 weeks. Pre-specified secondary outcomes include change in glucose monitoring frequency, glycaemic control metrics and psychosocial outcomes at 12 weeks as well as isCGM acceptability.DiscussionThis research will investigate the effectiveness of the second-generation isCGM to promote recommended glycaemic control. The results of this trial may have important implications for including this new technology in the management of children with type 1 diabetes.Trial registrationThis trial was prospectively registered with the Australian New Zealand Clinical Trials Registry on 19 February 2020 (ACTRN12620000190909p) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1237-0090).

Impact of overweight and obesity on the relationship between serum vitamin D and fasting blood glucose in children aged 6-17 years in Shandong Province

To study the relationship between serum vitamin D and fasting blood glucose in children and adolescents, and its influence on overweight and obesity. Using a multi-stage stratified cluster sampling method, 13 districts and counties in Shandong Province were selected as survey points, and a total of 26 elementary schools, 26 junior high schools and 13 high schools were selected. Questionnaire surveys and physical examination were conducted on children and adolescents aged 6-17.Serum vitamin D and fasting blood glucose were uniformly measured. The "BMI Classification Standard for Overweight and Obesity Screening for Chinese School-age Children and Adolescents" was used to determine overweight and obesity. Statistical method adopt t-test and generalized linear regression model for analysis. A total of 3562 children aged 6-17 years were investigated, 2666 were healthy, 446 were overweight, 450 were obese, including 131 peripheral obesity and 319 abdominal obesity. The fasting blood glucose level of the 13-17-year-old group was significantly higher than that of the 6-12-year-old group(t=-3.13, P=0.002), and the male was significantly higher than that of the female(t=7.87, P& lt; 0.001). In the healthy and obesity group, there was a negative correlation between serum vitamin D and fasting blood glucose(P& lt; 0.05). In overweight group, serum vitamin D was not significantly related to fasting blood glucose(P& gt; 0.05). Serum vitamin D and fasting blood glucose were negatively correlated with healthy bodies in female group and 13-17 years old group, and the abdominal obesity bodies in the 6-12 year old group(P& lt; 0.05). The fasting blood glucose of adolescents aged 13-17 is significantly higher than that of children aged 6-12, and the fasting blood glucose of men is significantly higher than that of women. Different gender, age, and overweight and obesity status have an impact on the relationship between serum vitamin D and fasting blood glucose.

Comparative analysis of different drug delivery methods of injectable hydrogel nanomaterials of insulin biomaterials via multiple daily injections and continuous subcutaneous insulin infusion in the treatment of type 1 diabetes mellitus in children

The aim of this study was to investigate the difference between multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) in blood glucose control during the treatment of type 1 diabetes mellitus (T1DM) in children. under the nano-hydrogel delivery carrier. In order to improve the efficiency and therapeutic effect of the experiment, this paper adopts injectable nanomaterial-polymer composite hydrogel as drug delivery system to cooperate with insulin injection to improve the effective utilization of drugs. Eighty children diagnosed with T1DM by the department of Endocrinology, Genetics, and Metabolism of INNER MONGOLIA BAOGANG Hospital from October 2018 to December 2019 were selected as research subjects for this study. The children were randomly divided into MDI group (treated with MDI) and CSII group (treated with CSII), with 40 children in each group. The basic data of the children were compared, and changes in hemoglobin A1c (HbA1c) at admission and 1, 2, and 3 months after treatment were detected. During the detection, the blood glucose level, therapeutic time of blood glucose normalization, and daily insulin dosage were recorded. The HbA1c and fasting blood glucose (FBG) were followed up three months after discharge, and incidences of hypoglycemia in the two groups were observed. The results showed that the mean value of HbA1c in the MDI group was higher than that in the CSII group (P &lt; 0.05). Each patient was assessed for the number of times their blood sugar was allowed to dip below normal levels; patients with less hypoglycemia had a higher rate of blood sugar control. The control rates of blood glucose in the MDI and CSII groups were 19.21% and 23.50%, respectively. The CSII group showed significantly higher blood glucose rates than the MDI group (P &lt; 0.05). The therapeutic time of blood glucose normalization in the MDI group was significantly longer than that in the CSII group (P &lt; 0.05). There was no significant difference in the average daily insulin dosage between the MDI and CSII groups (P &gt; 0.05), which indicated that CSII therapy had significant advantages in reducing blood glucose in children with T1DM.

Parental monitoring for type 1 diabetes in genetically at-risk young children: The TEDDY study.

We examined parental diabetes monitoring behaviors in a cohort of children at increased genetic risk for type 1 diabetes. We hypothesized that being informed of a positive islet autoantibody (IA) would increase monitoring behaviors. The Environmental Determinants of Diabetes in the Young (TEDDY) study follows 8676 children with high-risk human leucocyte antigen-DQ genotypes from birth to age 15, including general population (GP) children and those with a first-degree relative (FDR) with diabetes. Data on parental monitoring behaviors were solicited yearly. Serum samples were tested for IA and parents were informed of child results. We examined parental monitoring behaviors during the first 7 years of TEDDY. In IA- children, the most common monitoring behavior was participating in TEDDY study tasks; up to 49.8% and 44.2% of mothers and fathers, respectively, reported this. Among FDRs, 7%-10% reported watching for diabetes symptoms and 7%-9% reported monitoring the child's glucose, for mothers and fathers, respectively. After IA+ notification, all monitoring behaviors significantly increased in GP parents; only glucose monitoring increased in FDR parents and these behaviors continued for up to 4 years. FDR status, accurate diabetes risk perception, and anxiety were associated with glucose monitoring in IA+ and IA- cohorts. Many parents view TEDDY participation as a way to monitor for type 1 diabetes, a benefit of enrollment in a longitudinal study with no prevention offered. IA+ notification increases short- and long-term monitoring behaviors. For IA- and IA+ children, FDR parents engage in glucose monitoring, even when not instructed to do so.

Fat Mass Accretion from Birth to 5 Years and Metabolic Homeostasis in Childhood: the Healthy Start Study.

It is unclear how fat mass accretion in early life is related to glucose-insulin homeostasis. Examine associations of fat and fat-free mass accretion from birth to early childhood with glucose-insulin homeostasis in early childhood in a multi-ethnic cohort. Observational Healthy Start study with data collection from 2010 to 2020. Air displacement plethysmography at birth and 4.8 (SD 0.7) years estimated fat mass percent (FMP, %), fat mass index (FMI, kg/m2), and fat-free mass index (FFMI, kg/m2). General population recruited from academic obstetrics clinics in Denver, Colorado, consisting of 419 mother/offspring dyads. The main outcome measures were fasting glucose, insulin, homeostasis model assessment-2 insulin resistance (HOMA2-IR), and beta-cell function (HOMA2-B) at 4.8 years. Greater fat mass accretion from birth to early childhood was associated with higher fasting glucose (ΔFMP β = 0.20 [95% CI 0.06-0.34], ΔFMI β = 0.90 [0.30-1.50]) in participants of Hispanic, Black, and Other races/ethnicities, while greater fat-free mass accretion was associated with higher fasting glucose in non-Hispanic White participants (ΔFFMI β = 0.76 [0.21-1.32]). Overall, greater fat, but not fat-free, mass accretion was also associated with higher insulin (ΔFMP β = 0.14 [0.09-0.18], ΔFMI 0.71 [0.51-0.92]), HOMA2-IR (FMP β = 0.02 [0.01-0.02], ΔFMI β = 0.09 [0.06-0.12]), and HOMA2-B (ΔFMP β = 0.92 [0.18-1.36], ΔFMI β = 4.76 [2.79-6.73]). Greater fat mass accretion in infancy and childhood is associated with shifts in fasting glucose in children of Hispanic, Black, and Other races/ethnicities at 5 years of age. Body composition beginning in early life is relevant for metabolic health, and precise assessments of adiposity in pediatric research are needed.