Pediatric Diabetes最新文献

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.

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.

Objectives: Type 1 diabetes (T1D) with its worldwide increasing incidence is one of the most serious chronic conditions of adolescence. This study aimed to assess the Palestinian adolescent diabetic patients' health-related quality of life (HRQOL) and to identify specific factors that could predict poor quality of life. We also aimed to compare adolescents' reported HRQOL to proxy reports by their parents. Methods: A cross-sectional study was carried out between November 2022 and October 2023 in the six governorates of northern West Bank/Palestine: Jenin, Nablus, Qalqilya, Salfit, Tubas, and Tulkarm. Patients who were diagnosed with T1D for over 6 months from their recruitment, aged between 10 and 18 years, were recruited from diabetes clinics of the Ministry of Health (MOH) and the Palestine Diabetes Institute (PDI). One hundred seventy adolescents and 170 parents (or guardians) completed the Pediatric Quality of Life Inventory (Peds QL) 3.2 Diabetes Module for adolescents and parents, respectively. Results: An acceptable mean of 70.6 for the total score was reported for the Peds QL 3.2 Diabetes Module. Better scores were reported for the diabetes management summary score compared to the diabetes symptom summary score. Worry and communication were the lowest and highest reported subscores, respectively. Parents reported significantly lower results than adolescents. Income, gender, and hemoglobin A1c (HbA1c) were the main predictors of HRQOL among adolescents with T1D in Palestine. Conclusions: Future national health strategies should consider income differences and try to overcome health gaps among adolescents with T1D coming from low-income families. Future research is needed to explore the political and cultural aspects and their effects on HRQOL among diabetic adolescents in Palestine.

Background: Transitioning adolescents with diabetes from pediatric to adult care poses significant challenges, especially in low-resource settings like Ghana. Poorly coordinated transitions can disrupt care continuity and adversely impact health outcomes. Objective: This study explored how adolescents with diabetes mellitus (DM) transition from pediatric to adult care at Ho Teaching Hospital, Ghana. Methods: A qualitative exploratory-descriptive design was used. Semistructured interviews were conducted with 15 adolescents and their caregivers. Thematic analysis was applied to identify key themes and subthemes. Findings: Six key themes emerged: (1) inadequate education on DM management, with gaps in adolescents' and caregivers' understanding of the disease and emergency symptoms; (2) limited self-management skills, with caregivers performing most care tasks; (3) poor timing and uncoordinated transfer, with abrupt transitions at age 13; (4) overreliance on caregivers, as caregivers were hesitant to shift responsibilities to adolescents; (5) limited adolescent involvement in care decisions, with healthcare providers engaging more with caregivers; and (6) recommendations for transition improvement, including raising the transfer age, providing skills training, and establishing a transition clinic. Conclusion: The study underscores the need for a structured, developmentally appropriate transition process with targeted education, skills training, and adolescent participation to promote self-management and improve transition outcomes for adolescents with DM.

Objective: Adolescents managing type 1 diabetes (T1D) are at increased risk of experiencing eating disorders (EDs). Identifying risk factors is essential to develop preventive strategies. This study examines the potential mediation value of self-esteem and the perfectionism associated with EDs in the relationship between sociocultural attitudes toward appearance and eating attitudes related to EDs in a sample of adolescents with T1D. Methods: Forty-six adolescents aged 12-17 years diagnosed with T1D participated in the current study. Sociocultural attitudes toward appearance, perfectionism associated with EDs, and self-esteem were measured. Multiple and simple mediator analyses using the bootstrapping method with bias-corrected confidence estimates were conducted. Results: Our results show that perfectionism associated with eating problems is not only related to sociocultural attitudes toward appearance and eating attitudes, but rather the relationship between these last two variables would be fully mediated by perfectionism. Conclusions: A high degree of perfectionism could be a risk variable when developing potential eating problems in T1D adolescents. Perfectionism and its self-management would be a prominent factor that may help to design interventions developed for adolescents with diabetes who show behaviors that potentially conflict with eating. The clinical implications are discussed.

Background: In this study, we analysed the clinical and genetic characteristics and follow-up data of patients with maturity-onset diabetes of the young (MODY). Methods: From January 2015 to December 2022, patients with persistent hyperglycaemia suspected of having monogenic diabetes or diabetes syndrome were recruited, and next-generation sequencing (NGS) was performed at the Shanghai Children's Medical Center. Patients' clinical and laboratory findings were recorded preceding follow-ups. Candidate variants were verified using Sanger sequencing. Variant pathogenicity was evaluated according to the American College of Medical Genetics and Genomics (ACMG) guidelines. Results: Genetic testing was performed in 175 children. MODY-related pathogenic or likely pathogenic gene variants were identified in 30 patients from different families. Of these, 11 were diagnosed with GCK-MODY (36.7%), six with INS-MODY (20%), five with HNF1A-MODY (16.7%), five with ABCC8-MODY (16.7%), two with HNF1B-MODY (6.7%) and one with HNF4A-MODY (3.3%). There was one shift variant and seven splice-site variants, and the rest were missense variants. We discovered six novel variants. Of the 30 patients, 63.3% had a family history of diabetes, 13.3% had diabetic ketoacidosis (DKA), and 16.7% had positive diabetes-associated autoantibodies. The diabetes phenotype of patients with the INS variant was similar to that of patients with type 1 diabetes. All patients, including those having positive autoantibodies, required long-term insulin therapy during follow-ups. Four patients with the ABCC8 variant were unable to switch to oral sulfonylurea therapy and continued insulin therapy. Conclusion: Genetic testing is helpful for the precise diagnosis and treatment of patients with MODY, including those with DKA history and positive diabetes autoantibody. GCK-MODY is the most common type of MODY, and patients with INS variant account for a relatively large proportion of MODY cases in our cohort.

Objectives: Adolescents with type 2 diabetes (T2D) are more likely than those with type 1 diabetes (T1D) to develop complications soon after diagnosis. However, limited data exist about diabetes-specific distress (DD) and how diabetes teams can better support adolescents with T2D. We aimed to assess DD and other aspects of emotional/mental health among adolescents with T2D and qualitatively explore their lived experience and support needs. Methods: This study used a cross-sectional mixed methods survey of adolescents with T2D, recruited via two tertiary diabetes clinics. Study outcomes included the Diabetes Distress Scale (DDS), World Health Organization-Five Well-being Index (WHO-5), Patient Health Questionnaire-2 (PHQ-2) and two free-text questions concerning what they wished their health professionals understood about living with T2D and diabetes support. Descriptive statistics and inductive thematic analysis were applied. Results: Forty adolescents with T2D (22 females, predominantly from non-Indigenous background) completed all questionnaires. Nineteen were taking metformin, 18 were taking metformin plus injectables, and 3 were on lifestyle management. They had mean ± standard deviation (SD) age of 15.7 ± 2.1 years, median (interquartile range [IQR]) diabetes duration of 1.8 (0.8-2.6) years and median (IQR) glycated haemoglobin (HbA1c) of 6.9 (6.0-9.5)% (52 [42-80] mmol/mol). Twenty-one (53%) adolescents had moderate-to-severe DD, 16 (40%) had suboptimal emotional well-being, and 23 (58%) had depressive symptoms; 15 (38%) had both DD and depressive symptoms, while 11 (28%) had neither. Four themes described what adolescents wished their health professionals understood about living with diabetes: diabetes stigma, diabetes management burden, diabetes is challenging for young people and impact on mental health. Five themes described the support adolescents desired from their diabetes teams: show empathy and assist with motivation; mental health support; more frequent and convenient appointments; access to, and choice of, medications and management tools; and discussions about the future. Conclusions: Most adolescents with T2D experience significant DD, impaired general emotional well-being and/or depressive symptoms. They also have considerable unmet support needs relevant to optimising their well-being and diabetes self-management.

Background: Clinical guidelines on driving for people with diabetes exist, but there are limited studies analyzing glucose data and hypoglycemia risk while driving. No published studies have analyzed teenage or emerging adult drivers with type 1 diabetes (T1D). The primary aim of our pilot study was to explore the glycemic patterns of young drivers with T1D as they relate to clinical guidelines and identify trends that could be used to improve road safety. Methods: In this pilot study, we collected continuous glucose monitoring (CGM) data from five drivers with T1D (median age 19, range 17-21 years) over a 1-month period. The driving trips were divided into two categories: (1) Short trips (<60 min) and (2) Long trips (≥60 min). Hypoglycemia was defined as <70 mg/dL as recorded by CGM for at least four consecutive readings. Trips <10 min were excluded from the analysis. Results: Data on 284 total trips with associated CGM readings were recorded. The average number of trips taken by drivers during the study was 56.8 trips (range 9-82). For short trips (n = 276), no episodes of hypoglycemia occurred when starting glucose was >90 mg/dL (n = 227). For short trips with starting glucose of 70-90 mg/dL (n = 32), each hypoglycemic event (n = 5) had a drop in the first CGM glucose value while driving. Seventeen (5.7%) of short trips started with a glucose <70 mg/dL. A total of eight long trips (>60 min) were recorded, all had a starting CGM value of >90 mg/dL, and none had hypoglycemia events. Conclusions: These real-world findings from a small sample of teenage and young adult drivers with T1D support the American Diabetes Association (ADA) recommendation for starting glucose of >90 mg/dL when driving. Larger studies would be helpful in clearly identifying and improving road safety concerns in young drivers with T1D.