Pediatric Diabetes最新文献

Objective: Having been facing a progressive increase in the prevalence of type 1 diabetes (T1D), there might be a growing risk of the development of diabetic ketoacidosis (DKA) at disease onset. The prevalence of DKA varies widely by geographic region, ranging from approximately 13% in Sweden to 80% in the United Arab Emirates. This study aimed to compare the prevalence of DKA in childhood-onset T1D from Greater Poland (Poland) in two 9-year periods. Methods: We assessed the prevalence of DKA in children aged <18 years with newly diagnosed T1D in Greater Poland (Poland) in two 9-year periods, 2006-2014 and 2015-2023, in a retrospective review of a complete regional cohort. DKA and its severity were classified according to International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Results: Over the 18 years, 2432 children below 18 years of age with newly diagnosed T1D were recorded. The overall prevalence of DKA was 51.3% (n = 1248), and it rose significantly in two nine-year periods, from 47.7% in 2006-2014 to 53.4% in 2015-2023 (p=0.007). There was a significant shift toward more severe presentations of DKA. While the prevalence of mild DKA decreased slightly from 51.3% to 47.0% (p=0.145), and moderate DKA had a notable decline from 33.1% to 25.2% (p=0.003), the proportion of severe DKA cases rose sharply from 15.5% to 27.7% (p < 0.001). Conclusions: Despite the increasing incidence of T1D in Poland, healthcare, and parental awareness of T1D symptoms remain low, which results in delayed T1D recognition. The escalating prevalence of DKA at T1D onset in children is a concerning public health issue that necessitates a multifaceted approach to education, prevention, and early intervention. Addressing these challenges might help reduce the prevalence of DKA and improve clinical outcomes for children with T1D.

Aim: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). We determined the incidence, trends, cost and characteristics of children with and without DKA at T1D diagnosis and association with DKA readmissions. Methods: Children aged <16 years with T1D and residing in New South Wales, Australia, were identified from population-based hospital records (Admitted Patient Data Collection; APDC) for 2002-2019. Diagnoses of T1D and DKA were identified using ICD10 codes. Costs were determined using the 'Australian Refined-Diagnosis Related Group' (AR-DRG) code multiplied by the cost weight and National Efficient Price for the admission year. Associations were assessed using Chi-squared analyses and multivariate regression. Results: A total of 5832 children with T1D were identified, and 36% had DKA at diagnosis. The proportion with DKA at diagnosis was 34.4% in 2002-2003 and 41.0% in 2018-2019, with limited evidence to support a meaningful change over time (Cochrane-Armitage test-for-trend, p=0.062). DKA at diagnosis was associated with age <2 years, lower socio-economic status (SES) and rural/regional areas. DKA at diagnosis was also associated with an increased risk of readmission(s) for DKA (odds ratio [OR]: 1.35 [95% confidence interval [CI] 1.23, 1.49]). DKA doubled the costs/person, considering all available follow-up ($20,571 [interquartile range: $10,825, $37,845] vs. $9743 [$4980, $18,287]). Conclusion: DKA at diagnosis of T1D is a common and expensive health issue in Australia, with the rate of DKA at diagnosis not improving over the last two decades. Effective strategies are needed to improve health outcomes and reduce the economic burden.

Aims: Assessment of celiac disease and gluten-free diet (GFD) associations with metabolic control and growth parameters in children and adolescents with type 1 diabetes mellitus (T1DM) during the first year after diagnosis of celiac disease. Methods: This was a retrospective case-control study that included 47 children and adolescents with T1DM aged <18 years who attended the pediatric diabetes clinic at Sohag University Hospital, Egypt, and had a biopsy-proven diagnosis of celiac disease between January 2017 and December 2021. Each case had two age-, sex-, and duration of diabetes-matched control participants with T1DM who had persistently negative celiac screening tests. Clinical characteristics, growth parameters, insulin doses, celiac autoantibody titers, and HbA1c levels throughout the first year after diagnosis of celiac disease were obtained from the medical records. Results: Children and adolescents with celiac disease had significantly lower insulin doses at diagnosis (p=0.002) compared to their matched controls. There were no significant differences between both groups regarding the HbA1c levels at diagnosis of celiac disease or after 1 year (p=0.27 and 0.81, respectively). Patients with celiac disease had significantly lower weight, height, and body mass index (BMI) standard deviation scores (SDSs) at diagnosis and after 1 year. There were no significant differences between both groups regarding the fasting lipid profiles at diagnosis or after 1 year. Patients with villous atrophy at diagnosis had significantly higher HbA1c levels after 1 year (p=0.04). There were no significant improvements in weight, height, and BMI SDS after 1 year even in patients with normalized celiac autoantibodies. Conclusions: Children and adolescents with T1DM had lower insulin requirements and growth parameters at diagnosis of celiac disease. Villous atrophy at diagnostic small bowel biopsies was associated with worsening glycemic control after 1 year. Longer follow-up periods are required to detect significant improvements in growth parameters.

Hypertriglyceridemia (HTG) in the setting of newly diagnosed diabetes is common in both adult and pediatric populations, as insulin deficiency promotes lipolysis and impairs triglyceride (TG) clearance. Severe HTG (defined as TG levels above 1000 mg/dL) in pediatric patients with new-onset type 1 diabetes mellitus (T1D) is rare; the true incidence and sequela of this phenomenon have not been well characterized. We present a single-center experience on severe HTG in pediatric patients with new-onset T1D between 2013 and 2022 and summarize the cases previously reported in the literature. Our cases display variability in their presentation and in their association with high-risk complications, such as acute pancreatitis. We discuss suggestions of early screening for HTG and pancreatitis in patients with protracted abdominal pain, and close monitoring of those identified to have significant HTG.

Background: Developmental challenges of adolescence, such as puberty and social pressures, exacerbate the complexity of managing type 1 diabetes (T1D) as they transition from pediatric to adult care. However, there is a paucity of codesigned, evidence-based diabetes education and support programs and services to guide adolescents through this transition. Objective: This study aimed to explore the experiences, perspectives, facilitators, and barriers faced by adolescents with T1D in diabetes education and program services and to identify feasible approaches to support them as they transition from pediatric to adult care. Methods: Semistructured interviews were conducted with 13 adolescents aged 13-19 years with T1D. Thematic analysis was used to understand participants' past experiences, facilitators, barriers, and preferences regarding diabetes education programs and services. Results: Participants highly valued the opportunity to meet with peers living with T1D and the emotional support from those interactions. Participants also highlighted the need for age-appropriate content and interactive learning experiences. Suggested gamification features were well-received, with participants emphasizing the importance of interactivity. While there was not a strong preference between virtual or in-person game formats, it was suggested that online options offered flexibility and inclusiveness regardless of physical abilities. Participants were not as enthusiastic for a one-on-one live chat compared to an online community chat, again, for the opportunity for peer support. Conclusion: The study highlights the value that adolescents with T1D place on peer support that arises from opportunities to meet others through in-person events. It was evident that codesigning diabetes education programs and services with adolescents with T1D is key to develop tailored offerings for this population.

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.