Pediatric Diabetes最新文献

Introduction: Disorders of the lower limb are common in people with diabetes and may result in significant long-term complications. Currently, most evidence for lower limb complications in children with diabetes relies on infrequent clinical observations and occasionally invasive assessments that can cause discomfort. Clinical guidelines do not provide explicit guidance on frequency of neurovascular assessments for children with diabetes. Aim: To systematically review the prevalence and presentation of clinical neuropathy and vasculopathy in children with diabetes. Methods: A systematic search of the literature was conducted in March 2024 using the EMBASE, Cochrane, PubMed (including MEDLINE) and CINAHL databases. At least two authors independently screened studies for inclusion and assessed methodological quality for each paper using the downs and black quality appraisal checklist. Extracted data was summarised and tabulated. Meta-analysis was also performed. Results: Eighteen studies with 3533 participants were included. Participants were aged 3.5-18 years, and 95% had type 1 diabetes, while 5% had type 2 diabetes. These studies used a range of assessments, including monofilament, vibrioception, sharp-blunt discrimination, temperature perception, reflexes, muscle strength and tone, joint perception, pedal pulses, and ankle brachial index (ABI). Prevalence of clinical neuropathy ranged from 0% to 57.1% with a prospective cohort study reporting a 2.6-fold increase in 5 years, while prevalence of vascular complications ranged from 0% to 37.8%. The meta-analysis reported 0%-7% of children could report abnormality on assessments for neuropathy. Conclusion: The broad range may be due to heterogeneous methodological designs and diagnostic assessments, and potentially inadequate reporting. There is emerging evidence that children with diabetes may develop complications before age 18, which provides impetus for clinical caution. Higher quality evidence, particularly from longitudinal studies, is required to guide clinical screening for lower limb vascular and neurological complications in this vulnerable and growing paediatric population.

Background: Distress is one of the most common negative emotions in parents of children and adolescents diagnosed with type 1 diabetes (T1D). Because of the differences in the developmental stages between children and adolescents with T1D and their subsequent diabetes management needs, their parents may experience different levels of distress. This study aimed to compare diabetes-specific distress between parents of children with T1D and parents of adolescents with T1D in China and explore the associated factors. Methods: A cross-sectional design was used. Parents of children (aged 8-12 years) and adolescents (aged 13-18 years) diagnosed with T1D for >6 months were recruited online via social media. Using established online questionnaires, data were collected on sociodemographic and T1D-related characteristics, diabetes-specific distress, anxiety symptoms, perceived stress, depressive symptoms, and parent-child conflict. Hierarchical linear regression was conducted to explore the potential factors associated with parental diabetes-specific distress. Results: The final sample included 365 parents of children with T1D and 268 parents of adolescents with T1D. Notably, the parents of children with T1D exhibited a higher level of diabetes-specific distress compared to the parents of adolescents with T1D (p  < 0.001). Among the parents of children with T1D, higher parental diabetes-specific distress was associated with fathers with 9 years or less of education, higher annual family income (≥US$2857), higher levels of parental anxiety symptoms and perceived stress, and children's episodes of frequent hypoglycemia in the past 6 months (F = 8.497, p  < 0.001, R ² = 0.433, adjusted R ² = 0.382). Among the parents of adolescents with T1D, higher parental diabetes-specific distress was associated with fathers with 9 years or less of education and higher levels of parental anxiety symptoms and perceived stress (F = 4.955, p  < 0.001, R ² = 0.385, adjusted R ² = 0.308). Conclusions: The parents of children with T1D experienced higher levels of diabetes-specific distress than the parents of adolescents with T1D in China. Fathers with 9 years or less of education and parents with more anxiety and perceived stress were particularly affected in both groups; thus, interventions are warranted.

Objectives: This study aims to determine the relationship between social media use, healthy lifestyle behaviors, and metabolic parameters in adolescents with Type 1 diabetes (T1D). Methods: The study was conducted with descriptive and cross-sectional design, andwas carried out on 108 adolescents, aged 11-18, who were diagnosed with T1D mellitus (T1DM) via Google Form. An adolescent descriptive information form, the Scale of Social Media Use Purposes (SSMUP), the Social Media Addiction Scale (SMAS), and the Adolescent Lifestyle Profile (ALP) were used in the study. The data were analyzed using descriptive statistics such as number, percentage, mean and standard deviation (SD), and statistical methods such as t-tests and Pearson correlation analysis. Findings: The results of the study indicated that social media addiction is significantly related to adolescents' interpersonal relationships and metabolic parameters, while the purposes of social media use are positively associated with physical activity, healthy eating, and interpersonal relationships. Conclusions: Nurses should closely maintain vigilant oversight of social media use and interpersonal communication among adolescents with chronic diseases, create social media content appropriate for diabetes management, and organize trainings on the effects of social media use.

Objective: Taking into account the burden of treatment (BOT) should favor psychological fulfillment and adherence of young patients to treatment, which largely determines the quality of type 1 diabetes (T1D) control. To identify BOT components, the Ariane study carried out a focus group survey among 84 children and adolescents with T1D aged 12.6 ± 3.7 years. Research Design and Methods: Focus groups were organized in 10 pediatric diabetes centers, a qualitative research method that brings together a small group of patients to express their perception of treatment and answer questions in a moderated nonmedical setting. Results: A total of 3640 verbatim voicing children's concerns were recorded, transcribed, and analyzed by five working groups composed of pediatric diabetologists, specialized nurses, adults with childhood-onset T1D, and two groups from the civil society. Each group studied the verbatim separately to extract 24 main concerns summarizing BOT. These concerns fell into two distinct categories: concerns about physical, material, and care organization (N = 15) or psychological concerns (N = 9). A BOT score summed the number of concerns of each patient. The mean BOT score was 7.4 ± 3.3 (range 1-18). Gender had a prominent influence on concerns (p=0.002). Conclusions: The identification of common concerns expressed through focus groups provides a new tool for estimation of BOT in childhood T1D.

Background: Olfactory dysfunction may be one of the clinical symptoms of neuropathy in diabetics. It is also known that taste and smell disorders in diabetes may impact dietary adherence and, consequently, good glycemic control. The study aimed to investigate taste perception and olfactory function in adolescents with type 1 diabetes (T1D) compared to the control group. Materials and Methods: The study was conducted on patients aged 11-15 from south-eastern Poland with T1D in the diabetes clinic of the 2nd Department of Pediatrics, Endocrinology, and Diabetology of the Provincial Clinical Hospital No. 2 in Rzeszów. Taste strips (sweet, salty, sour, and bitter), U-Sniff sticks (12 selected smells), and a filter paper strip impregnated with n-propylthiouracil (PROP) were used. Results: No significant differences were observed between both the groups in the taste tests, except for the sweet taste test. The sweet taste test scores were higher for diabetes, for whom the median score was 4 (3.0-4.0), than for the control group, for whom the median score was 3.0 (3.0-4.0), (p=0.0001). These results mean that diabetics were more sensitive to sweet taste. We also found no significant differences between T1D and the control group of the U-Sniff test. However, significantly lower U-Sniff test scores were seen in adolescents with diabetes of more than 10 years. Median U-Sniff test scores for people with diabetes for 10 years were 11 (10.0-12.0) while in the control group median was 10.0 (9.0-12.0), (p=0.0370). The analysis also showed that adolescents suffering from long-term T1D more often incorrectly identified bitter tastes than healthy adolescents. Conclusion: The duration of diabetes is important regarding changes in taste perception and olfactory function in adolescents with diabetes.

Background: Socioeconomic status (SES) and ethnic inequalities in type 1 diabetes (T1D) outcomes are well-established. There is concern that unequal access to technologies, including continuous glucose monitoring (CGM), may increase disparities. This systematic review summarises the evidence for inequalities in the prevalence of CGM use for children and young people (CYP) and outcomes for CGM users. Methods: Medline, Embase and Web of Science were searched for observational studies published between January 2020 and July 2023 which report CGM use stratified by any PROGRESS-Plus criteria for T1D patients under 26. Reports based in low- or middle-income countries, ≤500 participants or only reporting hybrid closed-loop systems were excluded. Primary outcomes were the proportion of patients using CGM and HbA1c of CGM users. Quality assessment was performed using the Newcastle-Ottawa Scale. Unadjusted odds ratios were calculated from the extracted summary data, though heterogeneity precluded meta-analysis. The protocol was preregistered with PROSPERO (CRD42023438139). Results: Of the 3369 unique studies identified, 27 met the inclusion criteria. Thirty-three percent were of 'good' or 'very good' quality. We found decreased CGM use and higher discontinuation for low SES, low education, publicly insured and minority ethnic, especially Black, CYP. These associations were generally robust to adjustment for other sociodemographic variables, suggesting an independent effect. Lower SES inequalities were seen in countries where CGM is reimbursed. Although low SES and minority ethnicity were associated with poorer outcomes in general, for CGM users there was no significant association between domains of disadvantage and higher HbA1c, excepting parental education. Conclusions: There are significant SES, ethnic and education inequalities in CGM use for CYP with T1D, particularly when reimbursement is limited. This inequity is contributing to inequalities in T1D outcomes. However, evidence suggests CYP benefit equally from CGM use, irrespective of ethnicity and SES. Increasing CGM funding and use is likely to reduce outcome inequalities.

Introduction: Depression and suicide are more prevalent in adolescents with chronic illnesses such as diabetes. Psychosocial assessment is recommended in routine diabetes care. The goal of this study was to determine the prevalence of suicide risk in youth with diabetes and to determine the utility of the Patient Health Questionnaire-9 (PHQ-9) Item 9 compared to the Ask Suicide-Screening Questions (ASQ). Methods: The PHQ-9 and ASQ were prospectively administered to patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), ages 11-24 years at routine diabetes visits at a pediatric diabetes center from January to December 2023. Depression and suicide risk were assessed using PHQ-9 Item 9 and ASQ. The sensitivity and specificity of PHQ-9 were determined using ASQ as the reference standard. Results: Among the 309 patients included in this study, 237 (76.6%) had T1D and 72 (23.3%) had T2D. The mean age was 15.1 ± 2.6 years, 145 (46.9%) were female, and the mean HbA1c was 8.6% ± 2.3%. The prevalence of suicide risk using PHQ-9 Item 9 was 5.9% in T1D and 12.5% in T2D, and 8.4% in T1D and 19.4% in T2D, using ASQ. The sensitivity of the PHQ-9 Item 9 was 55.9% (95% CI: 37.9, 72.8%), specificity was 98.5% (95% CI: 96.3, 99.6%), PPV was 82.6% (95% CI: 61.2, 95%), and NPV was 94.8% (95% CI: 91.5, 97%) as compared to ASQ as reference standard. After a positive suicide risk screen, only 52.9% completed mental health follow-up at 1 month. The feasibility survey showed providers could identify high risk patients without workflow impact. Conclusion: Prevalence of suicide risk is higher in youth with T2D compared to T1D. PHQ-9 is less sensitive in identifying suicide risk in adolescents and young adults (AYA) compared to the ASQ. Diabetes care teams should consider using a specific suicide risk screener in routine diabetes care. Follow-up with mental health is suboptimal, and should be encouraged.

Aims: Published information on youth-onset diabetes in Haiti is scarce, with limited data available on diabetes autoimmunity and genetic susceptibility to the disease. We determined the anthropometric, metabolic, and immunological characteristics and human leukocyte antigen (HLA)-associated risks in patients with youth-onset diabetes. Methods: One hundred and ten subjects with type 1 diabetes (T1D) aged <22 years and diagnosed for < 2 years were evaluated. Demographic and clinical information, as well as biochemical parameters, including blood glucose, hemoglobin A1c, fasting C-peptide (FCP), and T1D-associated autoantibodies, were assessed. DNA from 54 subjects and 66 controls was genotyped for classical HLA loci. Results: Of the 110 patients, 54% were male. Onset age was 13.5 ± 4.2 years (range 2-21), and disease duration was 11.7 ± 8.1 months (range 0-24). Idiopathic T1D was found in 62 (56.4%) patients and was diagnosed at an older age than immune-mediated T1D (14.4 ± 3.5 years vs., 12.3 ± 4.8 years, p=0.01), with a higher BMI z-score in patients aged <14 years than in those aged ≥14 years (-0.29 ± 1.52 vs., -1.15 ± 1.18, p=0.01). No correlation was found between immune-mediated T1D and BMI z-score. Diabetic ketoacidosis was present at diagnosis in 18 (16.4%) patients. Zinc transporter 8 autoantibodies (ZnT8A) were marginally more common in younger patients. Low FCP levels were found in 71 (64.5%) patients. Thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (TG-Ab) were positive in 1.1% and 2.2% of the patients, respectively. The alleles DRB1⁣ ^∗ 03:01, DRB1⁣ ^∗ 09:01, DQB1⁣ ^∗ 02:01, and DQB1⁣ ^∗ 02:02 showed a significant T1D risk, whereas DRB1⁣ ^∗ 08:04, DRB1⁣ ^∗ 15:03, and DQB1⁣ ^∗ 06:02 were protective. Three DRB1~DQB1 haplotypes were strongly associated with T1D: DRB1⁣ ^∗ 03:01:01~DQB1⁣ ^∗ 02:01:01, DRB1⁣ ^∗ 09:01:02~DQB1⁣ ^∗ 02:02:01, both predisposing, and DRB1⁣ ^∗ 15:03:01~DQB1⁣ ^∗ 06:02:01, protective. Conclusions: Idiopathic T1D is common among youth in Haiti. A significant proportion of all patients had preserved C-peptide secretion. Overall, predisposing and protective HLA patterns were identified. Study results highlight the importance of distinguishing T1D endotypes within and between populations.

To investigate whether the remission period in type 1 diabetes, as measured by insulin-dose adjusted A1c (IDAA1C), was affected by the COVID-19 pandemic. Data from 7603 children and adolescents with type 1 diabetes from the prospective diabetes follow-up (DPV) registry were available. We compared two time periods of diabetes onset, 2020/2021 vs. 2018/2019. IDAA1C and remission prevalence (IDAA1c < 9%) were analyzed using logistic and linear regression models adjusted for age groups (0.5-<6, 6-<12, and 12-<18 years), sex, diabetic ketoacidosis (DKA) at onset, use of continuous glucose monitoring (CGM) systems, insulin pumps, sensor-augmented pumps (SAPs) or automated insulin delivery (AID) systems, BMI categories (<90. percentile of BMI, 90. -<97. percentile of BMI, 97. -<99.5 percentile of BMI, > = 99.5 percentile of BMI) and immigrant background. Data from three time periods were analyzed: 3-5 months, 6-10 months, and 11-13 months after diagnosis of type 1 diabetes. Compared to the prepandemic period, during the COVID-19 pandemic adjusted IDAA1C was significantly higher at 3-5 months after diagnosis (mean estimated differences 0.26 [95% confidence interval 0.17; 0.35], p  < 0.001), but not at 6-10 months and 11-13 months after diagnosis (mean estimated difference 0.08 [-0.01; 0.17], p=0.07; and -0.03 [-0.12; 0.07], p=0.60), reflecting a lower percentage of patients in remission at 3-5 months. Reasons may be changes in autoimmune progression during the pandemic, lack of physical activities, increased stress or psychological burden, or altered access to care with delayed diagnosis of diabetes. Underlying causes need to be evaluated in future studies.

Aim: Data on the impact of metabolic dysfunction-associated fatty liver disease (MAFLD) on diabetes complications in youth with type 1 diabetes are lacking. However, MAFLD is well known to contribute to cardiovascular disease (CVD) in people with type 2 diabetes. We aimed to investigate markers of MAFLD in youth with type 1 diabetes and their relationship with chronic complications. Methods: A prospective study of 102 adolescents (mean age 14.7 ± 1.9 years) with type 1 diabetes underwent repeated annual diabetes complications assessments, including annual measures of liver enzymes. Early cardiac autonomic nerve dysfunction (CAN) was defined as ≥1 abnormality in seven heart rate variability parameters derived from a 10-min resting electrocardiogram. Multivariate generalized estimating equations explored predictors of CAN and other microvascular complications (retinopathy and early kidney dysfunction). Results: After a median follow-up of 3.5 years (IQR 2.7-4.6), there were significant increases in the mean alanine transaminase level (ALT) and systolic blood pressure (SBP) percentiles. Upper ALT and gamma-glutamyl transferase (GGT) tertiles (T3 vs. T1-2: odds ratio [OR], 95% confidence interval [CI], 2.05 [1.20, 3.48], and 2.99 [1.61, 5.58], respectively) predicted CAN development (23%, n = 24) independent of HbA1c and diabetes duration. They were not associated with retinopathy or early kidney dysfunction. Conclusion: Higher ALT and GGT associate with early CAN in adolescents with type 1 diabetes, suggesting hepatic inflammation may compound the impact of the diabetes milieu on systemic endothelial dysfunction.