Pediatric Diabetes最新文献

Background: Managing severe insulin resistance (IR) is challenging, necessitating a multifaceted approach, including dietary restriction, exercise, and pharmacotherapy. This paper will detail our utilization of dapagliflozin in a series of cases involving patients with severe IR of various etiology and inadequate glycemic control.

Case studies: We describe six cases of extreme IR with distinct clinical diagnoses: four with Rabson-Mendenhall syndrome (RMS), one with IR type 1A, and a patient with type 1 diabetes mellitus (T1DM) and severe subcutaneous (SC) IR. These cases exhibit the observable characteristics of IR, characterized by an inability to effectively manage blood glucose (BG) with a standard treatment plan. Every case had a remarkable response to dapagliflozin. Subsequent assessment demonstrated improved HgbA1C, fasting glucose, insulin, and C-peptide concentrations. Furthermore, several cases demonstrated improvement in the clinical manifestations of IR following the administration of dapagliflozin, while others showed a reduction in the frequency of diabetic ketoacidosis (DKA). There were no documented adverse reactions with the use of dapagliflozin for a duration of 2-4 years in these patients.

Conclusion: Dapagliflozin appeared both safe and effective as a standalone treatment or when used alongside other antidiabetes medications such as insulin in a case series of children with T1DM and severe IR or IR syndromes (IRS).

Objective: Adolescents with type 1 diabetes (T1D) face unique barriers to physical activity (PA), and most do not meet recommended targets despite its recognised health benefits. To address the lack of tailored, evidence-based support for this group, this study explores how adolescents manage PA and how it is influenced by the wider support system, including parents, carers, and healthcare professionals (HCPs).

Research design and methods: Semi-structured interviews were conducted with adolescents with T1D (n = 11), parents/carers (n = 15), and HCPs (n = 11). Adolescents were aged between 12 and 18 (64% female). HCPs were dieticians (n = 7), nurses (n = 2), a doctor (n = 1) and a health and wellbeing practitioner (n = 1). Interviews explored practical, emotional, and contextual factors influencing PA. Data were analysed using thematic analysis.

Results: Participants described cognitive, emotional, and practical demands of managing T1D during PA. Thematic analysis identified three overarching themes: (1) the mental effort required to manage diabetes with PA, including parental anxiety, desire for normality, and unpredictability of glucose responses; (2) practical and organisational challenges, such as access to supportive environments, technology, and activity-specific logistics; and (3) adaptive management strategies, including trial and error, parental involvement, peer learning, and variable clinical support. Current support was often generic, leading families to rely on self-devised strategies and informal networks to support their individual needs.

Conclusion: Enhanced, youth-friendly, and activity-specific guidance is needed for adolescents with T1D. This should include training for healthcare professionals, teachers, and coaches. Future work should prioritise the co-design of resources and interventions with young people and families, integrating structured peer support.

Objective: Studies showing increased diabetes incidence in pediatric patients after COVID-19 are from data early in the pandemic, and some studies found conflicting results. Our objective was to evaluate trends in pediatric diabetes incidence and whether COVID-19 was associated with increased risk across viral variant periods.

Research design and methods: We conducted a retrospective cohort study using National COVID-19 Cohort Collaborative data to evaluate incident diabetes risk among COVID-19-positive pediatric patients compared to COVID-19-negative patients or controls with acute respiratory illness. Cohorts were weighted on demographics, data site, and body mass index percentile. The primary outcome was the cumulative incidence ratio (CIR) of incident diabetes for each viral variant era.

Results: There was no difference in the risk of incident diabetes in pediatric patients after COVID-19 compared to patients in COVID-19 negative or ARI control groups during any of the viral variant periods (e.g., ancestral period CIR 1.03, 95% CI 0.65-1.41). The predominant subtype of incident diabetes was T2D. Incidence rates over time followed a U-shaped curve, with the highest incidence in the ancestral variant period.

Conclusions: COVID-19 was not associated with an increased risk of diabetes in pediatric patients. Incidence rates were highest early in the pandemic, and mirrored patterns of pandemic-era healthcare utilization. The predominance of incident T2D subtype is concerning for the adverse effects of pandemic-related lifestyle changes among pediatric patients.

Objectives: This study explored the perceptions of adolescents with type 1 diabetes mellitus (T1DM) regarding their self-management and the impact of a diabetes specialty outpatient clinic on their quality of life (QOL) in Barbados.

Design: A qualitative, descriptive-interpretive study using semi-structured online interviews.

Setting: Paediatric diabetes specialty outpatient clinic at the Queen Elizabeth Hospital (QEH), Barbados.

Participants: Twelve adolescents aged 13-17 years with T1DM for > 1 year who attended the diabetes specialty outpatient clinic for at least 6 months.

Methods: Interviews were transcribed verbatim, coded using ATLAS.ti 23, and analysed thematically using a constant comparison approach.

Results: Three organising themes-autonomy, internal resilience and clinic and social support-contributed to the global theme of diabetic health literacy. Participants demonstrated varied levels of diabetes self-management confidence. Clinic interactions, family support and peer understanding were key influences on autonomy and resilience. Adolescents identified a need for age-appropriate communication and psychosocial support.

Conclusions: Diabetic health literacy among Barbadian adolescents is influenced by clinical support, psychosocial resources, and educational strategies. Adolescents' autonomy should be fostered through youth-centred approaches that enhance self-efficacy and support transition readiness.

Aim: To quantify the prevalence of microvascular complications of children and adolescents with type 1 and type 2 diabetes by performing a meta-analysis of observational studies.

Methods: A systematic search in PubMed, EMBASE, and Web of Science was performed from 2000 to August 2025. Studies that reported the prevalence of microvascular complications in children and adolescents with diabetes were included. Study characteristics and prevalence estimates were extracted from each study. Pooled prevalence rates for microvascular complications were calculated using a random-effects model with Freeman-Tukey double arcsine transformation to stabilize variance.

Results: A total of 57 studies were included, comprising 51,819 children and adolescents diagnosed with diabetes (type 1: n = 44,150 and type 2: n = 7,669), with a mean age of 14.5 and 15.2 years old, respectively. Pooled prevalence of complications in youth with type 1 vs. type 2 diabetes was 22.07% (95% CI: 16.86-27.75) vs. 11.04% (95% CI: 2.73-23.45) for peripheral neuropathy, 31.98% (95% CI: 11.13-57.44) vs. 15.37% (95% CI: 3.09-34.29) for autonomic neuropathy, 13.76% (95% CI: 6.43-23.24) vs. 2.97% (95% CI: 0.00-10.33) for retinopathy, and 13.70% (95% CI: 10.25-17.54) vs. 12.63% (95% CI: 7.99-18.07) for nephropathy, with high heterogeneity across studies and no significant differences between diabetes types. Meta-regression analyses showed no significant associations between complication prevalence and HbA1c, diabetes duration, lipid levels, cohort year, or age.

Conclusions/interpretation: Microvascular complications affect at least one in 10 youths with diabetes before age 20, with similar prevalence in type 1 and type 2 diabetes. Given the high rates and early onset, routine screening and early intervention are essential for all young people with diabetes to prevent or limit progression of vascular damage, regardless of diabetes type, glycemic stability, or disease duration.

Background: To assess the real-world effectiveness of switching from first-generation basal insulins (1BIs) to either glargine U300 (Gla-300) or degludec U100 (Deg-100) in children and adolescents with type 1 diabetes (T1D), using data from the Italian ISPED CARD clinical registry.

Materials and methods: This multicenter retrospective observational study included 1063 pediatric patients with T1D from 22 diabetes centers across Italy who switched from 1BI to either Gla-300 (64.6%) or Deg-100 (35.4%) between 2021 and 2023. Propensity score matching (PSM) was applied to create comparable groups (n = 353 per group). Primary endpoint was the change in HbA1c at 6 months. Secondary endpoints included fasting blood glucose (FBG), standardized body mass index (BMI/SDS), and insulin doses at 6 and 12 months. Longitudinal models for repeated measures were used to assess treatment effectiveness.

Results: Both groups showed significant and clinically relevant reductions in HbA1c at 6 months from ~ 8.7% to ~ 7.4% (-1.3 percentage points), maintained at 12 months, with no significant differences between groups. FBG also decreased significantly in both groups, slightly favoring Deg-100, but without statistical significance between groups. BMI/SDS remained stable. Gla-300 was associated with a slight increase in basal insulin dose over 12 months, while Deg-100 showed a temporary reduction at 6 months. A significant reduction in short-acting insulin dose (-0.03 U/kg) was observed in both groups.

Conclusion: Switching from 1BI to either Gla-300 or Deg-100 significantly improves glycemic control in pediatric T1D patients without weight gain. Although both insulins showed comparable effectiveness, differences in titration patterns highlight the need for individualized treatment strategies and improved clinician education in insulin optimization. Safety outcomes, particularly hypoglycemia, could not be assessed.

Aims: Acidosis at type 1 diabetes mellitus (T1DM) onset results from unregulated massive overproduction of ketoacids. However, renal tubular damage (RTD), a complication of T1DM onset, may impair bicarbonate reabsorption, exacerbating acidosis. We aimed to assess RTD role in acidosis at T1DM onset.

Methods: RTD was defined by urinary β2-microglobulin > 0.33 mg/L and/or neutrophil gelatinase-associated lipocalin (NGAL) > 95^th percentile for age. Acute kidney injury (AKI) was classified using Kidney Disease/Improving Global Outcomes (KDIGO) criteria. Participants were grouped by serum ketone levels (cut-off: 3 mmol/L, above which indicates diabetic ketoacidosis [DKA]) and bicarbonate levels (cut-off: 22 mmol/L, below which indicates acidosis):- Group 1: Ketones ≥ 3 mmol/L, bicarbonate < 22 mmol/L.- Group 2: Ketones < 3 mmol/L, bicarbonate < 22 mmol/L.- Group 3: Ketones ≥ 3 mmol/L, bicarbonate ≥ 22 mmol/L.- Group 4: Ketones < 3 mmol/L, bicarbonate ≥ 22 mmol/L.

Results: Of 185 individuals, 111 (60%) were in Group 1, 18 (9.7%) in Group 2, 8 (4.3%) in Group 3, and 48 (26%) in Group 4. Group 1 had the most severe clinical and biochemical derangements, followed by Groups 2, 3, and 4. Logistic regression, adjusted for AKI, relative difference of weight loss and glycated hemoglobin (HbA1c), identified RTD (odds ratio [OR] = 22.3; 95% confidence interval [CI]: 6.9-71.5; p  < 0.001), and relative difference of weight loss, (OR = 1.2; 95% CI: 1.1-1.4; p  < 0.006), as significant factors associated with Group 1 and only RTD (OR = 29.9; 95% CI: 3.0-292.9; p=0.004) as significant factor associated with Group 2. Serum bicarbonate and blood pH showed an inverse correlation with urinary NGAL (r ² = 0.61 and 0.56, respectively, both p  < 0.001) and β2-microglobulin (r ² = 0.67 and 0.59, respectively, both p  < 0.001), regardless of ketone levels. The ketone-to-bicarbonate ratio predicted RTD (area under the receiver-operating characteristic (ROC) curve (AUROC) = 0.94; 95% CI: 0.91-0.97; p  < 0.001), while serum bicarbonate levels predicted normal renal tubular function (AUROC = 0.95; 95% CI: 0.92-0.98; p  < 0.001).

Conclusions: A link exists between biological markers of RTD and metabolic acidosis at T1DM onset.

Background: Type 1 diabetes (T1D) requires numerous daily self-management decisions and, for children, parents have a crucial role in this. The aim of this study was to evaluate treatment satisfaction among parents of children with T1D and the associations with the child's health-related quality of life (HRQoL) and perceived diabetes control. A secondary aim was to evaluate treatment satisfaction among school children with T1D and the associations with HRQoL and perceived diabetes control.

Methods: In this cross-sectional study, 111 parents of children with T1D (0-12 years) and 75 children with T1D (8-12 years) were included. Treatment satisfaction was measured using the diabetes treatment satisfaction questionnaire (DTSQ), parent version, scored 0-60, or teens version, scored 0-48. HRQoL was measured with DISABKIDS. Differences between groups were analyzed using independent t-tests and one-way analysis of variance. Linear regression was used to investigate associations between treatment satisfaction and HRQoL and perceived diabetes control.

Results: The mean value for treatment satisfaction among parents was 41.0 (95% confidence interval (CI): 39.5-42.5) and among children 36.3 (95% CI: 34.5-38.0). Parents' treatment satisfaction was associated with their child's HRQoL (by proxy), perceived diabetes control, and diabetes duration (correlations coefficient [R ²] = 0.54, p  < 0.001). Children's treatment satisfaction was associated with HRQoL (R ² = 0.29, p=0.005).

Conclusion: The child's HRQoL and perceived diabetes control are important for treatment satisfaction among parents of children with T1D.

Introduction: Cardiovascular disease (CVD) disproportionately affects females with type 1 diabetes (T1D), yet the emergence of sex-specific metabolic risk during early disease remains unclear. We evaluated whether sex differences in BMI percentile (BMIp) and LDL-cholesterol (LDL-C) trajectories appear within the first 2 years following T1D diagnosis.

Methods: We conducted a retrospective cohort study of 542 youth with new-onset T1D (mean age 10.4 ± 3.9 years; 54.1% male) and assessed sex differences in BMIp and LDL-C trajectories using linear mixed-effects models, adjusting for age, HBA1c and diabetic ketoacidosis (DKA) status at diagnosis, and baseline weight category (LDL-C model only).

Results: At diagnosis, median BMIp did not differ by sex (females: 50.9 [IQR: 19.2-84.1] vs. males: 63.0 [17.8-93.0]; p=0.15). Over 2 years, females experienced significantly greater BMIp increases (median change: 27.4 [5.1, 49.7] vs. 13.1 [-4.3, 30.5] percentage points; p=0.002). Adjusted models confirmed steeper increases in BMIp for females compared to males (sex × time interaction: 7.54 [3.13, 11.94]; p  < 0.001). LDL-C was higher in females at diagnosis (2.51 ± 0.80 vs. 2.30 ± 0.70 mmol/L [97 ± 31 vs. 89 ± 27 mg/dL]; p=0.003) and follow-up (2.25 ± 0.59 vs. 2.12 ± 0.65 mmol/L [87 ± 23 vs., 82 ± 25 mg/dL]; p=0.02), with adjusted models confirming a persistent difference (0.17 [0.06, 0.27] mmol/L [6.39 [2.39, 10.40] mg/dL]; p=0.002).

Discussion: Females with T1D exhibit steeper early increases in adiposity and persistently higher LDL-C levels compared to males, independent of age, glycemic control, and DKA status at diagnosis. These findings underscore the importance of sex-specific metabolic monitoring and early intervention beginning at diagnosis to mitigate long-term cardiovascular risk.