Pediatric Diabetes最新文献

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.

Purpose: Insulin resistance (IR)/hyperinsulinemia in young individuals is associated with the subsequent development of diabetes and cardiovascular disease. To assess trends in the prevalence of IR/hyperinsulinemia among nondiabetic/nonprediabetic adolescents in the US from 1999 to 2020. Methods: A total of 6111 adolescents without diabetes and prediabetes were included from ten cycles of National Health and Nutrition Examination Survey (NHANES) between 1999-2000 and 2017-2020. Hyperinsulinemia or IR was defined as fasting insulin or homeostasis model assessment of insulin resistance [HOMA-IR] above the 75th percentile in all participants who underwent blood tests on fasting insulin, glucose, and hemoglobin A1c. Trends in prevalence rates were estimated using joinpoint regressions with heteroscedastic and uncorrelated errors. Results: The overall weighted median fasting insulin level, prevalence of hyperinsulinemia, and IR were 9.9 μU/ml [95% confidence interval (CI): 9.6, 10.1], 17.2% (95% CI: 15.7, 18.6), and 16.4% (95% CI: 15.2, 17.9), respectively. The estimated prevalence of hyperinsulinemia and HOMA-IR increased significantly from 15.2% (95% CI: 12.1, 18.9) and 14.0% (95% CI: 11.1, 17.8) in 1999-2000% to 21.5% (95% CI: 17.1, 26.3) and 20.4% (95% CI: 16.4, 25.6) in 2017-2020, respectively, with a 3.35% (95% CI: 1.74, 4.99) and 3.41% (95% CI: 1.72, 5.12) relative increase per 2-year survey cycle, respectively (p for trend <0.05). Substantial increases were observed in the subgroups of girls, Hispanic, non-Hispanic white, and overweight adolescents. Conclusions: The prevalence of hyperinsulinemia/IR increased substantially among US nondiabetic/nonprediabetic adolescents over the last two decades. Early detection and effective interventions are in dire need to reverse the rising tide.

Context: Mutations in hepatocyte nuclear factor 1B (HNF1B) are rare but they are known to cause structural renal disease and diabetes mellitus. There is limited data on pediatric HNF1B disease. Objective: To analyze the clinical characteristics of HNF1B-related disease in a cohort of children identified at a single pediatric tertiary medical center, with a specific focus on endocrine-related disease. Methods: Subjects with HNF1B genetic variants were identified from the Children's Hospital of Philadelphia Atypical Diabetes Registry between 2013 and 2022. Results: Of the 11 pediatric subjects with HNF1B mutations or deletions, 7 (64%) initially presented with diabetes, sometimes referred to as MODY5, while 4 (36%) were diagnosed based on family history or a genetic evaluation of renal disease. Only one patient presented with diabetic ketoacidosis, and three presented with diabetic ketosis. Of the four children with HNF1B mutations identified by familial mutation analysis or based on renal disease, two developed diabetes during the course of the study. Abnormalities in fasting lipid profiles were common: 10 with triglycerides >90 mg/dL, 5 with LDL-C >110 mg/dL, 5 with HDL-C <45, and 7/11 with non-HDL cholesterol >120 mg/dL. Over half of the subjects had hyperparathyroidism with PTH (>65 pg/mL) and a calcium concentration >9 mg/dL. Conclusion: This case series represents one of the largest pediatric HNF1B-related disease cohorts at a single center. The majority of patients with diabetes presented with clinical features distinct from Type 1 or Type 2 diabetes. Pediatricians should consider genetic testing for HNF1B mutations when children are diagnosed with diabetes and have renal abnormalities, hyperlipidemia, and hyperparathyroidism.

Background: Myokines are secreted by skeletal muscle and play a role in their metabolic function and crosstalk with various tissues. Myokines appear to be involved in the pathogenesis of obesity and type 2 diabetes (T2D), yet little is known regarding their function in type 1 diabetes (T1D). Aim: To assess the levels and clinical correlates of a panel of five myokines, comparing adolescents with recent-onset T1D, prolonged disease, and healthy controls. Methods: Fifty-eight adolescents participated; 20 with recent-onset T1D, 20 with over 7 years of T1D, and 18 healthy controls were included. Clinical and laboratory data were collected, including levels of Apelin, Irisin, Interleukin-6 (IL-6), Fibroblast growth factor 21 (FGF21), and Myostatin. Results: Apelin levels were lower in patients with prolonged T1D compared with patients with recent-onset T1D and controls, (117.9 ± 94.3, 228.3 ± 181.6, and 224.4 ± 138.4 pg/ml, respectively; analysis of variance (ANOVA) p = 0.029). Other myokines did not differ significantly between groups. Apelin levels correlated with fasting C-peptide levels (r = 0.337, p = 0.010). In patients with prolonged T1D, myostatin positively correlated with insulin doses (total daily dose r = 0.590, p = 0.006 and basal daily dose r = 0.645, p = 0.002). Both apelin and myostatin levels negatively correlated with the diastolic blood pressure (BP) percentile (r = - 0.324, p = 0.013; r = - 0.302, p = 0.024, respectively). Conclusions: Our results demonstrate lower levels of apelin, a myokine related to the beneficial metabolic effects of skeletal muscle, in prolonged T1D. The correlations of apelin with C-peptide and myostatin with insulin doses may reflect a relationship with beta-cell function and insulin sensitivity.

Type 1 diabetes mellitus (T1DM) is associated with an increased risk of mental illness. In recent years, specialized summer camps for children and adolescents with type 1 diabetes have emerged, aimed at normalizing life with diabetes and building skills needed for optimal management of the condition. This project analyzed the effects of one such camp, Camp Sweeney, on glycemic control, physical health, and psychosocial wellbeing of camp attendees (children 5-17, mean age 14.4 years old) and their parents/caregivers. The standard Pediatric Quality of Life Inventory (PedsQL) was modified by the addition of questions pertaining to self-assessment of diabetes management, and questionnaires were distributed to parents and campers to complete at the start of and 2 months after completion of the camp. A total of 14 completed surveys (7 child/camper-parent/caregiver pairs) were collected and analyzed. Self-reported glycemic control (DM management), perceived overall quality of life (wellness), physical wellness, and psychosocial wellness improved after attendance of Camp Sweeney as reported by both campers/children (Δ17.86% DM management, Δ10.96% overall wellness, Δ16.25% psychosocial wellness) and their parents/caregivers (Δ16.07% DM management, Δ14.54% overall wellness, Δ17.86% psychosocial wellness). Importantly, we established a significant positive correlation between glycemic control (DM management) and overall wellness, psychosocial wellness, and average quality of life (correlation coefficient = 0.92, 0.80, and 0.94, respectively). While previous studies do provide some evidence that these types of camps improve the mental wellbeing of participants, this is the first study to establish a direct correlation between improved mental and psychosocial wellbeing and diabetes management.

Objective: Most adolescents with Type 1 Diabetes (T1D) do not achieve recommended glycemic targets, placing them at risk for long-term complications. Executive functioning (EF), or the cognitive processes that support goal-directed action and management of behavior, emotion, and cognition, is proposed to support effective T1D management and contribute to glycemic stability. We sought to examine associations of EF with T1D management behaviors and diabetes-related distress in adolescents with T1D. Methods: Participants were 13-17-year-olds (M = 15.44, SD = 1.38 years) from a randomized controlled trial (N = 88). We conducted secondary analyses of preintervention data. Youth and their parents each reported on youth EF (Behavior Rating Inventory of Executive Functioning; BRIEF) and T1D management behaviors (Self-Care Inventory-Revised; SCI-R), parents reported on responsibility for T1D management (Diabetes Family Responsibility Questionnaire; DFRQ), and youth reported on their diabetes-related distress (Problem Areas In Diabetes-Teen; PAID-T). Youth also completed performance-based measures of EF. Results: Questionnaire-based and performance-based EF measures were generally unrelated. Regression analysis showed that youth self-reported EF predicted youth-reported T1D management (SCI-R) and diabetes distress (PAID-T) outcomes, and parent-reported youth EF predicted parent-reported T1D management behaviors, such that greater EF difficulties predicted suboptimal management and greater diabetes-related distress (youth PAID-T β: 0.41, p  < 0.01; youth SCI-R β: -0.40, p  < 0.01; parent SCI-R β: -0.33, p  < 0.01). Older child age and poorer performance-based EF also predicted greater youth responsibility for T1D management (age β: 0.43,p  < 0.01; EF reaction time β: 0.23,p < 0.05; EF accuracy β: -0.23, p < 0.05). Conclusions: Youth EF may shape which adolescents are at increased risk for suboptimal T1D management as well as diabetes distress; understanding EF challenges may help guide T1D family management across this developmental period. Implications for EF measurement approaches in youth are also discussed. Trial Registration: ClinicalTrials.gov identifier: NCT03688919.