Pediatric Diabetes

BACKGROUND: Patient education is essential in management of type I diabetes. OBJECTIVE: To evaluate the short-term impact of patient education through WhatsApp on the knowledge of the disease and glycemic control of adolescents and young adults living with Type 1 diabetes in a resource-limited setting. METHODS: A double arm non-randomized clinical trial was carried out in two clinics for diabetes in Cameroon, over a period of two months. The intervention consisted in providing four sessions of patient education through WhatsApp to an intervention group compared to a control group with their classic follow up...

BACKGROUND AND OBJECTIVES: Indications for insulin pump therapy (IPT) in children with type 1 diabetes (T1D) are relatively non-specific and therefore subject to provider discretion. Health professionals' perceptions of which people will have difficulty with IPT, e.g., those with higher HbA1c , may not be correct. This study examined the effect of IPT on HbA1c , and the role of pre-pump HbA1c on this effect. METHODS: All children with T1D started on IPT at British Columbia Children's Hospital from January 2011 through June 2016 were included if they had HbA1c values available both before and after IPT (n=125)...

BACKGROUND: Frequent use of modern diabetes technologies increases the chance for optimal type 1 diabetes (T1D) control. Limited reimbursement influences the access of patients with T1D to these modalities and could worsen their prognosis. We aimed to describe the situation of reimbursement for insulins, glucometers, insulin pumps (CSII) and continuous glucose monitoring (CGM) for children with T1D in European countries participating in the SWEET Project and to compare data from EU countries with data from our previous study in 2009...

OBJECTIVE: Continuous intravenous (IV) insulin infusion therapy minimizes blood glucose (BG) fluctuations and prevents metabolic deterioration in pediatric patients with type 1 diabetes (T1D) during intercurrent illness and surgery. However, data on the adequate fluid and insulin substitution in this situation is rare. We evaluated the effectiveness and safety of IV insulin therapy according to our local protocol. RESEARCH DESIGN AND METHODS: Retrospective study of 124 cases of hospitalization with IV insulin therapy due to intercurrent illness (n=78) or minor surgery (n=46) in 62 patients with T1D (mean age: 9...

BACKGROUND: Standardized patient registries provide a unique basis to get insight into cystic fibrosis-related diabetes (CFRD), the most common comorbidity in cystic fibrosis. METHODS: 3,853 CFRD patients from the European CF Society Patient Registry (ECFSPR) and 752 from the German/Austrian diabetes prospective follow-up (DPV) were studied. To adjust for age and sex, multivariable regression was used (SAS 9.4). RESULTS: DPV subjects were younger (26...

BACKGROUND: Type 2 diabetes (T2DM) in adolescents represents a clinical challenge related to lifestyle and obesity; however, only a few data are available in developing countries. Therefore, our aim was to investigate the prevalence of T2DM and prediabetes among Brazilian adolescents, as well as to describe the cardio-metabolic profile according to the diagnosis. METHODS: This is a cross-sectional school-based multicenter study including youth aged 12-17 years from cities with more than 100,000 inhabitants in Brazil (n=37,854 students)...

OBJECTIVE: To evaluate primary care presentations during the prodrome (12 months prior to onset-Type 1 diabetes, with or without DKA), to identify opportunities for earlier diagnosis. METHODS: This was a case-control study, linking 16 years of data from children (≤15 years) registered at diagnosis of Type 1 diabetes, and routinely collected primary care records in Wales (UK). Controls (without Type 1 diabetes) were matched on a 3:1 ratio. Conditional logistic regression modelling was used to compare characteristics occurring in cases (children with Type 1 diabetes) and controls; and cases that presented with/without DKA...

BACKGROUND: Serological screening for celiac disease (CD) allows the identification of individuals genetically predisposed, as type 1 diabetes mellitus (T1DM). However, the diagnosis is confirmed by intestinal biopsy. The aim was to determine the prevalence of immunoglobulin-A anti-tissue transglutaminase antibodies (IgA-tTG) and CD in a large cohort of young T1DM patients. METHODS: Screening for CD was randomly conducted in 881 T1DM by IgA-tTG and total IgA. Individuals with positive antibodies were referred to endoscopy/duodenal biopsy...

BACKGROUND: ABCC8 gene mutations with different inheritance patterns have been well described to cause transient and permanent forms of neonatal diabetes with onset of hyperglycaemia commonly before the age of 6 months, and rare cases between 6 and 12 months. However, recent analyses have also demonstrated ABCC8 gene mutations in patients with monogenic diabetes (maturity onset diabetes of the young, MODY), with milder clinical phenotypes and later onset of hyperglycaemia. CLINICAL CASES: We report 2 siblings with diabetes mellitus due to a novel homozygous p...

BACKGROUND: Catestatin is a chromogranin A-derived peptide with a wide spectrum of biological activities, such as inhibiting catecholamine release, decreasing blood pressure, stimulating histamine release, reducing beta-adrenergic stimulation and regulating oxidative stress. OBJECTIVES: The aims of our study were to determine serum catestatin concentrations in obese children and adolescents in regard to presence or absence of MS and to evaluate the possible relations between catestatin levels and other cardiovascular risk factors...

AIM: The study aimed to analyze the frequency of partial remission (PR) and its association with chosen clinical and laboratory factors among pediatric patients with newly diagnosed type 1 diabetes (T1D). The long-term effect of PR on chosen parameters was also investigated. METHODS: In 194 patients (95 girls) aged 8.1±4.3 years we analyzed data at T1D onset: glycaemia, pH, C-peptide, antibodies, weight, concomitant autoimmune diseases. Anthropometric parameters, daily insulin requirement (DIR), and HbA1c 2 and 4 years after T1D diagnosis were also analyzed...

BACKGROUND: Results of genetic have led to off-label glibenclamide treatment in patients with neonatal diabetes due to potassium channel mutations. No pediatric form of glibenclamide was available. Glibenclamide was designated an orphan drug designation for neonatal diabetes and a suspension was developed. As a part of the pediatric plan investigation, we assessed its acceptability, efficiency and safety. METHODS: In this Phase II, prospective, non-randomized, single-center study, patient received glibenclamide tablets for 1 month then the suspension for 3 months...

OBJECTIVE: When diabetes is associated with congenital malformations, without autoimmune antibodies, a genetic cause is suspected. Here, we aimed to identify a defective gene that led to diabetes. RESEARCH DESIGN AND METHODS: We performed an exome analysis of an index case and his healthy parents. RESULTS: The child presented with childhood-onset diabetes, congenital hypopituitarism, cardiac malformation, and anal atresia. A DNA analysis revealed a heterozygous de novo pathogenic variant in the developmental transcription factor, forkhead box A2 (FOXA2)...

Affordability and geographic accessibility are key health care access characteristics. We used data from 481 youth and young adults (YYA) with diabetes (389 type 1, 92 type 2) to understand the association between health care access and glycemic control as measured by HbA1c values. In multivariate models, YYA with state or federal health insurance had HbA1c percentage values 0.68 higher (p=0.0025) than the privately insured, and those without insurance 1.34 higher (p<0.0001). Not having a routine diabetes care provider was associated with a 0...

BACKGROUND: Historically, data on the rate of hyperglycemia and ketosis have not been collected in clinical trials. However, it is clinically important to assess the rate of these events in children with type 1 diabetes (T1D). This question was addressed in two pediatric trials using insulin degludec (degludec). OBJECTIVE: To assess the rate of hyperglycemia and ketosis in two phase 3b trials investigating degludec (Study 1) and degludec with insulin aspart (IDegAsp [Study 2]) versus insulin detemir (IDet) SUBJECTS: Patients (aged 1-17 years inclusive) with T1D treated with insulin for ≥3 months...

AIM: To compare the efficacy of three strategies for real-time continuous glucose monitoring (RT-CGM) over 12 months in children and adolescents with type 1 diabetes. METHODS: A French multicenter trial (NCT00949221) with a randomized, controlled, prospective, open, parallel-group design was conducted. After three months of RT-CGM, patients were allocated to one of three groups: return to self-monitoring of blood glucose, continuous CGM (80% of the time), or discontinuous CGM (40% of the time)...

AIMS: Residual beta-cell secretion in type 1 diabetes is commonly assessed by area-under-curve of plasma C-peptide concentration (AUCCpep ) following mixed-meal tolerance test (MMTT). We aimed to investigate alternative measures of beta-cell responsiveness. METHODS: We analysed data from 32 youth (age 7 to 17years) undergoing MMTT within 6months of type 1 diabetes diagnosis. We related AUCCpep with (i) validated mechanistic index of postprandial beta-cell responsiveness MI accounting for glucose level during MMTT, and (ii) pragmatic marker calculated as baseline plasma C-peptide concentration corrected for baseline plasma glucose concentration...

Background and Objective Celiac Disease (CD), the most common genetically-based food intolerance, affects 3-16% of children with Type 1 Diabetes (T1D). Treatment involves lifelong adherence to a gluten-free diet (GFD). Individualized dietary education is resource-intensive. We, therefore, sought to develop and test the usability of an e-learning module aimed at educating patients and caregivers regarding implementation of the GFD in children with concurrent CD and T1D. METHODS: An interactive e-learning module was developed based on extensive review of CD, T1D, and educational literature...

BACKGROUND AND OBJECTIVE: Genetics play a very strong role in the development of pediatric-onset type 2 diabetes (T2D); however, little information exists about specific common single nucleotide polymorphisms (SNPs) associated with T2D in this age group. The aim of the study was to analyze the association and parental transmission of 64 obesity-related SNPs with pediatric-onset T2D in Mexican families. METHODS: A total of 57 pedigrees containing 171 probands with pediatric-onset T2D and 119 unrelated controls older than 18 years were included...

BACKGROUND: Approximately 90% of children and adolescents with type 1 diabetes in Sweden use continuous glucose monitoring (CGM), either as real-time CGM or intermittently scanned CGM to monitor their glucose levels. Time in target range (TIT) is an easily understandable metric for assessing glycemic control. OBJECTIVE: The aim of this study was to examine the relation between TIT and HbA1c. SUBJECTS AND METHODS: Subjects were recruited from 3 diabetes care centers in Sweden...