Pediatric Diabetes最新文献

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.

Aims: This study of interactions between attention-deficit hyperactivity disorder (ADHD) and type 1 diabetes has two aims. First, compare the prevalence of prescribed ADHD medications in individuals with type 1 diabetes to the general paediatric population in Norway. Second, study trajectories in mean glycated haemoglobin (HbA1c) in individuals with comorbid ADHD in comparison to individuals with type 1 diabetes only.

Methods: Part 1 uses data from the Norwegian Prescription Database and register linkage between the Norwegian Childhood Diabetes Registry (NCDR) and the Norwegian Prescribed Drug Registry to obtain yearly prevalence in the general population and NCDR between 2005 and 2019. Part 2 uses data from annual controls in NCDR between 2005 and 2022. Linear mixed-effects models adjusted for age and diabetes duration were used to compare mean HbA1c in 365 individuals (66% males) with comorbid ADHD to 5,888 individuals (54% males) with type 1 diabetes only.

Results: Part 1: Yearly prevalence (2009-2019) ranged from 0.02 to 0.52 percentage points higher in NCDR than in the general population. The difference was significant only for 2017. Part 2: Mean national HbA1c decreased from 2012 to 2022 but was higher in individuals with comorbid ADHD. This difference was significant from 2016 (67.6 mmol/mol [8.3%] vs. 64.5 mmol/mol [8.1%]) to 2022 (57.5 mmol/mol [7.4%] vs. 54.7 mmol/mol [7.2%]). When grouped by sex, these differences continued to be significant in males (except in 2018), but not in females. Individuals with ADHD were more likely to have experienced at least one episode of diabetic ketoacidosis (odds ratio [OR] = 1.39, 95% confidence interval [CI] [1.04, 1.86]; males: OR = 1.65, 95% CI [1.15, 2.36]; females: OR = 1.10, 95% CI [0.658, 1.83]).

Conclusion: Mean national HbA1c decreased in Norway during the last decade, but continued to be higher in individuals with comorbid ADHD than in individuals with type 1 diabetes only.

Background: Type 1 diabetes mellitus (T1DM) in adolescents requires continuous self-care and emotional adjustment. Palestinian youth with T1DM face unique challenges within the context of the West Bank healthcare system, where political instability, resource limitations, and cultural factors create additional barriers to optimal diabetes management. These youth experience heightened social stigma, cultural dietary pressures, and restricted access to specialized healthcare services.

Aim: To explore the lived experiences, challenges, and coping strategies of Palestinian youth with T1DM in the West Bank.

Methods: This qualitative content analysis study was conducted from May-June 2025. Eighteen Palestinian adolescents (12-18 years) with T1DM were recruited through purposive sampling from West Bank diabetes clinics. Participants were approached directly at clinics by trained researchers who explained the study's voluntary nature and ensured understanding that participation would not affect clinical care. For minors under 16, guardians were present during consent, and all participants provided appropriate consent/assent. Data were collected via semi-structured interviews (45-90 min) and analyzed using conventional content analysis methods. Credibility was established through prolonged engagement, peer debriefing, and member checking with five participants.

Results: Four main themes emerged from the analysis: challenges from social and cultural pressures, including stigma and dietary expectations; reliance on support systems involving family, peers, and healthcare access; emotional and spiritual coping through resilience, anxiety management, and faith-based strategies; daily self-management focused on insulin routines and food planning. Participants described significant barriers, including limited healthcare resources, medication shortages, cultural food pressures during religious fasting periods, and social misunderstandings about diabetes. Despite these challenges, many demonstrated remarkable resilience through family support, religious coping, and adaptive self-care routines.

Conclusion: Palestinian adolescents with T1DM navigate complex challenges that extend beyond medical management to include cultural, social, and political barriers. Their coping strategies are deeply embedded in family support systems and religious faith. The findings highlight the critical need for culturally responsive, family-centered diabetes care that addresses both medical and psychosocial needs while considering the unique context of life in the West Bank.

Objective: To investigate whether human leukocyte antigens (HLAs) influence gut microbiota composition and contributes to delayed type 1 diabetes mellitus (T1DM) onset in children.

Methods: This multicenter cross-sectional study included 106 newly diagnosed pediatric T1DM patients (age <18 years) and 69 healthy controls from nine Chinese cities. Gut microbiota was profiled via whole-metagenome shotgun sequencing, and HLA alleles were genotyped by PCR sequence-based typing. Participants were stratified by HLA-risk scores. Statistical analyses included α/β-diversity metrics, linear discriminant analysis effect size analysis (LEfSe), and Spearman correlation adjusted for confounders.

Results: Principal coordinates analysis (PCoA) exposed discernible disparities in gut microbiota structures within the high-HLA-risk T1DM cohort relative to both high- and low-HLA-risk control groups (R ² = 0.0562, p=0.003 and R ² = 0.0343, p=0.003). HLA-C ^∗ 0304 carriers exhibited delayed T1DM onset compared to noncarriers (adjusted R ² = 0.225, p=0.017). High-HLA-risk T1DM patients showed distinct microbiota divergence from controls (R ² = 0.0562, p=0.003), driven by reduced Lachnospiraceae and Blautia (butyrate producers) in noncarriers. Conversely, HLA-C ^∗ 0304-positive T1DM patients had enriched Blautia (p=0.005) and Lachnospiraceae (p=0.039), alongside lower opportunistic pathogens (Citrobacter; p < 0.05). High-HLA-risk patients also displayed lower fasting C-peptide levels than low-risk counterparts (0.19 ± 0.14 vs. 0.26 ± 0.19 µg/mL, p=0.029).

Conclusions: Our study demonstrates that specific HLA class I subtypes (e.g., C ^∗ 0304) may modulate T1DM onset through selective enrichment of beneficial gut microbiota. Elucidating the mechanisms by which HLA variants regulate mucosal immunity and coordinate HLA-microbiota-immune interactions holds significant potential for developing targeted interventions against T1DM pathogenesis.

Aim: This study aimed to explore the lived experiences and support needs of parents caring for children with type 1 diabetes mellitus (T1DM) in Zabol, Iran, a rural and resource-scarce region.

Methods: A qualitative phenomenological design was employed with 36 parents (25 mothers and 11 fathers) of children aged 4-17 years who had lived with T1DM for at least 6 months. Semistructured interviews were conducted in Persian, transcribed, translated, and thematically analyzed using Braun and Clarke's six-step framework, in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines.

Results: Three overarching themes emerged. Parents reported emotional and practical support gaps, including caregiver exhaustion, lack of respite opportunities, and limited guidance. They described social isolation and stigma driven by cultural misconceptions such as viewing diabetes as a curse, which led to exclusion of both parents and children. Families also faced healthcare system challenges, including limited specialist access, insufficient diabetes education, financial strain (2-15 million IRR monthly), and inadequate resources, all exacerbated by rural isolation.

Conclusions: Parents of children with T1DM in Zabol experience substantial unmet emotional, social, and systemic needs. Addressing these challenges requires structured peer support, culturally sensitive community education to reduce stigma, and expanded access to affordable healthcare. These findings provide a foundation for developing targeted interventions to strengthen resilience and improve outcomes among families in underserved rural regions.

Objective: This study aimed to assess the association between depressive symptoms and glycemic control among children and adolescents with diabetes and to determine if their self-care behaviors mediate this association.

Methods: A total of 207 patients of children and adolescents with diabetes were included in a cross-sectional survey study. The Chinese version of the Children's Depression Inventory (CDI) was used to evaluate the depressive symptoms of the patients. The Chinese version of the Summary of Diabetes of Self-Care Activities (SDSCA) was used to evaluate the level of diabetes self-care behaviors. The values of HbA1c of children and adolescents with diabetes were obtained from patients' medical history cases or self-reporting. Structural equation modeling (SEM) was used to examine the mediation effect of self-care behaviors between depressive symptoms and glycemic control.

Results: In 207 children and adolescents with diabetes, the total score of depressive symptoms was 12.71 ± 6.73 and the total score of self-care behaviors was 42.31 ± 14.09. The HbA1c of the patients was 9.14 ± 2.55%. High depressive symptoms and low self-care behaviors are related to high levels of HbA1c (all p  < 0.001). The results revealed that the effect of depressive symptoms on glycemic control was partly mediated by self-care behaviors and the mediation effect accounts for 30.65% of the total effect.

Conclusions: Depressive symptoms show a significant association with glycemic control among children and adolescents with diabetes, with self-care behaviors serving as a partial mediator in this relationship. Depressive severity may influence glycemic control partly by affecting self-care behaviors.

Since COVID-19 onset, pediatric endocrinologists have been making an assumption that there was a shift in diagnosis age of type 1 diabetes mellitus (T1DM) to younger children. Younger children are more likely to present in DKA, are more difficult to diagnose and treat, and age at diagnosis can affect prognosis. We performed a retrospective chart review of patients diagnosed with T1DM for 3 years before COVID-19 and the 3 years during COVID-19. Demographics were evaluated using the Chi-squared test for categorical data and Student's t-test or ANOVA for continuous data. During this time, 698 patients were diagnosed with T1DM, with more patients during COVID-19. The average age of diagnosis significantly increased by 0.7 years (p=0.025). There was a significant difference in the distribution of age groups between the two time periods (p=0.0065). There was a significant decrease in new cases among patients between the ages of 2-5 years from 2017 to 2020, a transient finding as they reverted back to previous rates by 2022. New diagnoses between 13 and 18 years were increasing prior to 2020 (7%-23%), subsequently leveling out. Patients were 1.6 times more likely to present in DKA during COVID-19; however, there was no significant change in hemoglobin A1c (HbA1c). There was no significant change in thyroperoxidase (TPO) antibody positivity. There was a significant decrease (p=0.018) in patients with elevated tissue transglutaminase (TTG)-IgA from pre-COVID to post-COVID. Average age at diagnosis in our cohort increased since the start of COVID-19, contradicting previous studies and our hypothesis. The number of new cases increased, and the age distribution changed. There was a significant decrease in number of younger patients in 2020, followed by a normalization of new cases in those 2-5 years old, which may have led to the belief that more toddlers were being diagnosed. The rate of other antibodies did not increase. These results illustrate that changes in demographics may have been short-lived post-COVID-19.

Objective: This study aimed to identify novel proteomic and lipidomic biomarkers of insulin resistance (IR) in young children with obesity and to assess the ability of hub lipids and proteins in the diagnosis of IR.

Methods: The discovery cohort consisted of 50 prepubertal children, including 30 children with obesity and 20 lean. The validation cohort included 25 children with obesity and IR (obese-IR) and 25 children with obesity without IR (obese-NIR). Fasting plasma was collected from all participants for Olink proteomics and untargeted lipidomics. Pearson correlation analysis was used to identify proteins and lipids associated with IR, and area under the receiver operating characteristic (AUROC) was applied to compare the ability of the identified proteins and lipids with traditional indices in the diagnosis of IR.

Results: In the discovery cohort, a total of 15 lipids and 10 proteins had significant correlation with IR. In the validation cohort, protein fatty acid binding protein 4 (FABP4) and gene serpin family E member 1 (PAI) were overexpressed in obese-IR children compared to obese-NIR children, while insulin like growth factor binding protein 1 (IGFBP-1) and paraoxonase 3 (PON3) were lower in the IR group than in the obese-NIR group; five lipids including sphingosine (d16:0), coenzyme (Q8), ceramides phosphate (d42:2), phosphatidylethanolamine (37:2e), and phosphatidylcholine (18:1e_16:0), showed significant (p < 0.05) change in obese-IR children compared to obese-NIR children. In addition, the AUC-ROC was 0.89 for IGFBP-1, 0.81 for PON3, and 0.65 for PAI. The ability of IGFBP-1, PON3, and PAI to diagnose IR was better than that of adiponectin and leptin. The AUROC of phosphatidylcholine (18:1e_16:0) and coenzyme (Q8) were 0.80 and 0.73, respectively, which was significantly higher than the AUROC of triglycerides(TGs), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C).

Conclusion: Proteomic and lipidomic analysis can allow for the identification of potential new candidate biomarkers for IR. The ability of novel biomarkers to diagnose IR was better than traditional indicators.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2300072179.

Objective: Wolfram Syndrome Type 1 (WS1) is a rare neurodegenerative disorder characterized by diabetes insipidus (DI), diabetes mellitus (DM), optic atrophy (OA), and deafness (D) due to biallelic mutations in the WFS1 gene. As the cardinal symptoms of DI, polyuria and polydipsia, overlap with those of DM, DI might be underdiagnosed or delayed in the early stages of WS1. In the present study, we assessed whether DI could be an early sign of WS1 and analyzed genotype-phenotype correlations in a group of Turkish patients with Type 1 DM. Patients and Methods: We applied a polyuria/polydipsia questionnaire to 1278 children with Type 1 DM. Patients with suggestive symptoms of DI were further evaluated for other clinical features of WS1 and molecular genetic analysis of the WFS1 gene. Clinical, laboratory, and genetic characteristics of cases identified using questionnaires were compared with a historical case series of seven children with WS1 and previously published literature data. Results: Eighteen patients were considered to have a diagnosis of DI, thereby being eligible for genetic analysis of WFS1 variants. Of those, six had biallelic variations (four missense variants, one in-frame duplication, and three frameshift variants) in the WFS1 gene, and a diagnosis of WS1 was confirmed. The age of admission for DM was younger in the historical cases (5.1 ± 2.0 vs. 8.7 ± 3.4; p=0.04). There was no statistically significant difference between the ages for the diagnosis of WS1 (12.9 ± 5.0 vs. 9.6 ± 2.7; p=0.191), though the diagnostic delay from DM onset to WS1 diagnosis was significantly shorter in the screened group (median 1.8 vs. 6.9 years; p ≈ 0.015). Conclusion: Our findings suggest that DI may present before OA in WS1. Enriching the diagnosis of DI using a simple polyuria/polydipsia questionnaire may provide an earlier diagnosis of WS1 in patients followed with Type 1 DM. Screening and early genetic testing of these patients enhances the diagnosis, follow-up, and management strategies of patients with WS1.