Pediatric Diabetes最新文献

Young people with type 1 diabetes mellitus (T1DM) transition from paediatric to adult services when they reach late adolescence. This can be a risky period for young people, and it has been associated with a deterioration in glycaemic control and disengagement from diabetes services. This review aimed to identify current interventions addressing the following questions: What adolescents with T1DM healthcare transition interventions have been evaluated? What are the underlying theories and components of these interventions? What outcomes have been considered in these evaluations? Databases, trial registries and other sources were searched using the population and intervention keywords. Studies were included if they explicitly reported a transition intervention targeting young people aged 10-25 years. Studies were critically apprised, and data were extracted. Both tabular and narrative data synthesis were used. The review included 22 studies. Most interventions were service-oriented, with little use of theory. The interventions included transition planning, service coordination, pre-transition education, transition clinics, prompting strategies and other less frequent components. Most studies reported metabolic outcomes, with limited data on psychological outcomes such as diabetes adaptation, acceptance and self-management activation. It is inconsistent how each outcome was defined, measured or reported. Consequently, effective theory-based interventional transition models are yet to be identified.

Background: Advanced hybrid closed-loop (AHCL) therapy improves glycemia. However, it is not known if there is an improvement in overall outcomes with AHCL for youth with type 1 diabetes (T1D) at high risk of diabetes-related complications. The study aimed to capture the experiences of youth with suboptimal glycemic control when commencing AHCL therapy in a clinical trial setting.

Methods: This was a singlecenter substudy of a multicenter 6-month randomized clinical trial. Youth between 12 and 25 years of age on insulin pump therapy with HbA1c > 8.5% (> 69 mmol/mol) who commenced AHCL therapy with Medtronic MiniMed™ system were invited to participate in a semistructured interview after 6 months of AHCL. Open-ended questions were used to explore the participants' lived experience of AHCL in improving their glucose levels and its impact on diabetes management and well-being. The interviews were audiorecorded, transcribed, and analyzed using thematic analysis.

Results: Ten youth with T1D with a mean (SD) age of 17.4 (2.9) years, diabetes duration 10.7 (4.8) years, HbA1c 10.2 (0.8)%, or 87 (9.5) mmol/mol at enrollment participated in the interview. Three main themes were identified: (1) improved glycemia despite not using closed loop to its full potential; (2) persistent diabetes burden; and (3) a need for increased psychosocial and clinical support. Although improved glycemia was noted with AHCL therapy, participants reported ongoing motivation issues and used the system suboptimally. They continued to experience distress with overall diabetes management and acknowledged the need for ongoing support from family and health professionals.

Conclusion: All participants reported overall satisfaction with improved glucose levels, however, the persistent diabetes burden impacted their ability to use AHCL optimally. The need for ongoing monitoring with support and interventions to enhance psychological care remains vital for youth with suboptimal diabetes management.

Background: The increasing use of continuous glucose monitor (CGM) necessitates a review of variables that impact accuracy and interrupt use. Manufacturer recommendations include removing CGMs before diagnostic imaging, such as X-ray and computed tomography (CT). Early removal and replacement of CGM components present financial, clinical, and psychosocial burdens to the wearer and interrupt optimal management of diabetes for pediatric patients who receive a total pancreatectomy with islet autotransplantation (TPIAT). The study's aim was to evaluate the effect of scatter dose exposure during X-ray or CT if the CGM remained intact but outside the field of view (FoV).

Materials and methods: Participants were followed through the first 3 months after TPIAT surgery, managed diabetes with an insulin pump and CGM, and were routinely exposed to diagnostic imaging. Participants' CGMs were unshielded by a protective apron during any X-ray or CT procedures for the duration of the study period, and the transmitter was collected after expiration or removal. Glucometer data was collected from hospital records and home glucometer downloads. Mixed models were used to analyze absolute differences between matched CGM and glucometer values, and Clarke error grid analyses (EGA) were performed. Scatter dose exposure was derived using anthropomorphic phantoms and calculated retrospectively.

Results: A total of 14 patients (median 12.2 years, 64% female) received a median of five diagnostic imaging procedures with a median cumulative scatter dose of 559 µGy. The absolute difference between the CGM and glucometer values was not significantly associated with the cumulative scatter dose (p=0.17) or time from TPIAT (p=0.24) when analyzed in a mixed model. Regardless of scatter dose exposure, time from TPIAT, or glucometer, ≥98% of glucose values fell within zones A and B on EGA.

Conclusion: Scatter dose exposure from diagnostic imaging did not affect the clinical accuracy of CGM values for the duration of transmitter use. Leaving CGM components in place when not in the FoV during diagnostic imaging successfully mitigated interruptions to use and undue burden or cost to participants.

Objective: Capillary glycated hemoglobin (HbA1c) may enhance screening for childhood prediabetes and diabetes, but variations in this parameter remain unclear. We aimed to develop percentiles of HbA1c and explore the influence of various variables on HbA1c level among Chinese children. Study Design and Methods. The data were derived from the Shanghai Children's Health and Nutrition Community-based Epidemiologic Survey (CHANCE). A total of 4,615 children aged 3-12 years were included. The capillary HbA1c level was measured using point-of-care (POC) testing analyzers. Abnormal HbA1c level was identified as HbA1c (%) value equal to or above the 95th percentile of the nomograms.

Results: The mean HbA1c value was 5.30% (SD = 0.50%). The age-specific 95th percentile thresholds of HbA1c (%) ranged from 5.9 to 6.2 among all children. In the whole participants, body mass index (BMI), total cholesterol (TC), outdoor activity frequency, and daily sleep duration were positively associated with high HbA1c. Among preschool-aged children, TC and sleep duration ≥10 hr per day were associated with increased risk of being in the higher HbA1c (both P < 0.05). Among the school-aged group, positive associations with HbA1c levels were identified for TC, living with grandparents, frequency of outdoor activity, and sleep duration (all P < 0.05).

Conclusions: The present study established capillary HbA1c percentiles based on a large sample of Chinese children among aged 3-12 years. Daily sleep duration and frequency of outdoor activity, BMI, and TC were found to be associated with high HbA1c. Actions of successful public strategies that focus on promoting a healthy lifestyle, including regular physical exercise to reduce weight among children, are needed. Key Points. We used POC testing for capillary HbA1c with a finger-stick sample which may offer an opportunity to enhance screening and early diagnosis for childhood and adolescent diabetes, which was suggested as an essential premise to determine the subject's glycemic status by the American Diabetes Association (ADA). Capillary HbA1c levels fluctuate during childhood, while there has been no population-based study on HbA1c reference values in Chinese youths.

Background: Type 1 diabetes mellitus (T1DM) screening facilitates access to early intervention and prevention of severe complications, such as diabetic ketoacidosis. Despite its significance, many countries lack a systematic T1DM screening program. Understanding how the public perceives T1DM screening for children is essential for successfully implementing such programs but is currently an area with limited research. Our study aims to fill this gap by developing a standardized tool designed to assess the acceptability of T1DM screening programs for children, focusing on caregiver perspectives within the general population.

Materials and methods: We developed the Type 1 Diabetes Mellitus Screening Acceptability (DMSA) scale based on the theoretical framework of acceptability and integrated components from the Pediatric Testing Attitudes Scale-Diabetes (P-TAS-D). It covers a broad spectrum of acceptability constructs. The DMSA scale underwent iterative modifications following expert feedback to refine clarity and content validity. We tested the scale in both Arabic and English with adults living in Saudi Arabia, regardless of their parental status, focusing on the potential of screening their children. The psychometric strengths of the scale were evaluated through reliability analyses and exploratory factor analysis.

Results: Of the 599 participants, the majority were female (89.2%), with a mean age of 35.9 ± 8.6 years. The final DMSA scale consists of 10 items, with two distinct factors: "individual acceptability" and "psychosocial acceptability." The mean total score was 42.9 ± 5.1 across a potential range of 10-50 points. The English and Arabic versions of the scale demonstrated strong reliability, with Cronbach's alpha values of 0.84 and 0.79, respectively.

Conclusions: The DMSA scale emerges as a valid and reliable tool for gauging the acceptability of the general population of screening children for T1DM. It integrates key elements of the acceptability construct, pivotal for guiding the implementation of culturally sensitive T1DM screening initiatives. Future research should expand its application across various cultural settings and examine the correlation between scale scores and actual screening behaviors.

Objective: The time during which adolescents and young adults (AYAs) living with Type 1 Diabetes (T1D) transition from pediatric to adult care is associated with blood sugar levels outside of target ranges, care gaps, and an increased risk of acute diabetes complications. The aim of this study was to understand (1) the perspectives of AYAs and providers about the strengths, challenges, and opportunities of transition care and (2) the role of digital technologies in supporting the transition to adult care. Research Design and Methods. We conducted a qualitative descriptive study that involved 43 semistructured interviews in French or English with AYA living with T1D (aged 16-25; n = 22) and pediatric or adult diabetes health care providers (HCPs) (n = 21).

Results: We identified three themes. First, transition care is not standardized and varies widely, and there is a lack of awareness of transition guidelines. Second, virtual care can simultaneously hinder and help relationship-building between providers and AYA. Third, AYAs value a holistic approach to care; both HCPs and AYA highlighted the opportunity to better support overall mental wellbeing.

Conclusions: The design of digital technologies to support T1D transition care should consider methods for standardizing holistic care delivery and integrating hybrid diabetes care visits to support access to transition care. These findings can inform future transition intervention development that leverages existing transition guidelines, targets holistic care model integration, and considers quantitative diabetes metrics in conjunction with broader life experiences of AYA when providing transition care.

Background: Type 1 diabetes mellitus (T1DM) is prevalent in the Middle East and North Africa (MENA). Parents of children or young people (CYP) with T1D experience shock, devastation, guilt, and societal blame, which impact both physical and psychosocial-spiritual aspects of their lives. However, our knowledge of the breadth of these psychosocial-spiritual experiences and how they are assessed is limited.

Aim: (1) To examine the diabetes-specific psychosocial experiences of parents of CYP with T1D in the MENA region; (2) to assess the person-reported outcome measures (PROMs) that measure the psychosocial-spiritual outcomes in this population; and (3) to assess their reliability and validity.

Materials and methods: A systematic review methodology was implemented using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Ovid MEDLINE, Embase, APA PsycINFO, CINAHL, and Global Health databases were searched for relevant articles. A narrative synthesis approach was used for data analysis.

Results: Twenty-three studies were included. We identified four categories: (1) spiritual functioning, parents' ability to accept and cope with their CYP's condition, (2) psychological functioning, parents' emotional distress due to insufficient diabetes-related knowledge and skills, (3) social functioning, describing financial challenges, social support experiences, and cultural concerns faced by parents, and (4) physical functioning, parents' struggle with sleep deprivation. Our results revealed methodological and conceptual limitations of the current tools measuring these experiences. Some of the limitations of this review are (1) heterogeneity in the tools captured perhaps some but not all domains of the parents' psychosocial experiences, (2) only English studies were included, as no Arabic studies were found.

Conclusion: Our studied population experiences psychosocial-spiritual distress by managing the condition of their CYP and needs culturally specific psychosocial-spiritual support. Further studies are needed to develop a new measure to specifically assess the psychosocial-spiritual outcomes of this population.

Objectives: Cardiovascular disease (CVD) is the leading cause of death and disability among persons with diabetes. Early intervention on cardiovascular risk factors (CRFs) is important in reducing CVD burden. The SEARCH for Diabetes in Youth study assessed CRFs in incident cohorts of youth aged <20 years established from 2002 to 2016. Research Design and Methods. Regression models assessed trends over each incident year for lipids (total cholesterol (TC), HDL-c, LDL-c, triglycerides (TG), VLDL-c, and non-HDL-c), kidney function (albumin/creatinine ratio (ACR) ≥30 and ≥300, cystatin C, serum creatinine and estimated glomerular filtration rate (eGFR)), systolic and diastolic blood pressure (BP) z-scores, BMI z-score, waist circumference (WC), and an inflammatory marker (C-reactive protein (CRP)). Models were stratified by diabetes type (type 1 diabetes (T1D), N = 4,600; type 2 diabetes (T2D), N = 932) and adjusted for age at diagnosis, sex, race/ethnicity, and diabetes duration. An interaction analysis assessed differential time trends by type.

Results: For youth with T1D, all CRFs significantly improved over time, with the exception of ACR > 300, cystatin C, serum creatinine, eGFR, and CRP. For youth with T2D, TC, LDL-c, and non-HDL-c significantly improved, while eGFR, BMI z-score, and CRP significantly worsened. Significant differences in trends over time by type were seen for TC, HDL-c, BMI z-score, BP z-scores, WC, and CRP.

Conclusions: Overall, improvements in CRFs were more often observed in youth with T1D. Youth with T2D had worsening trends over time in BMI z-score, CRP, and kidney function. Further research is needed to better understand these trends and their implications for long-term CVD risk.

Aims: Diabetic retinopathy (DR) is the primary microvascular complication associated with diabetes. Evidence on DR prevalence among children in New Zealand is scarce. We examined DR rates and associated risk factors in youth with type 1 diabetes (T1D) aged <16 years receiving care from a regional diabetes service in January 2006-December 2020.

Materials and methods: DR diagnosis followed the International Society for Pediatric and Adolescent Diabetes guidelines. The study included 646 participants; mean age (±SD) at T1D diagnosis was 7.4 ± 3.6 years, 47% were female, and 69% identified as NZ Europeans.

Results: The initial DR screening occurred at a mean age of 12.6 ± 2.4 years and 5.2 ± 2.2 years after T1D diagnosis. At the first DR screen, 23.5% of participants (152/646) were diagnosed with DR: 69.1% (105/152) with minimal, 30.3% (46/152) with mild, and one moderate case (0.7%). Older age at diagnosis (p=0.029) and longer diabetes duration (p=0.015) were predictors of DR at first screen. Patients with at least one positive DR screen had a higher average HbA1c at their first screen (+2.6 mmol/mol; p=0.042). Overall, 55.6% (359/646) of patients had a positive DR screen, whose worst grade was mostly either minimal (58.2%) or mild (40.7%) DR, with only three moderate cases (0.8%) and one severe (0.3%). Children diagnosed with T1D before age 10 were 72% more likely to have DR than older children (p < 0.0001), and DR risk was 32% and 41% higher among Pacific children than NZ European (p=0.008) and Māori (p=0.014) children. Lastly, the only predictor of DR at discharge from paediatric services was HbA1c at the first screen (p < 0.0001).

Conclusions: In this regional cohort of children with T1D, there was a high rate of low-grade DR overall and at first retinal screen, with an increasing rate until transfer to adult services. Our findings underscore the importance of ongoing DR screening, reducing glycaemic levels, and supporting vulnerable high-risk groups.

Insulin resistance, an increasingly prevalent characteristic among children and adolescents with obesity, is now recognized as a significant contributor to the development of type 2 diabetes mellitus (T2DM) and other metabolic diseases in individuals with obesity. Insulin resistance refers to a decrease in the sensitivity of peripheral tissues (primarily skeletal muscle, adipose tissue, and liver) to insulin, which is mainly characterized by impaired glucose uptake and utilization. Although the mechanisms underlying insulin resistance in children with obesity remain incompletely elucidated, several risk factors including lipid metabolism disorders, oxidative stress (OS), mitochondrial dysfunction, inflammation, and genetic factors have been identified as pivotal contributors to the pathogenesis of obesity-related insulin resistance. In this review, we comprehensively analyze relevant literature and studies to elucidate the underlying mechanisms of insulin resistance in childhood obesity. Additionally, we discuss treatment strategies for pediatric obesity from a perspective centered on improving insulin sensitivity, aiming to provide valuable insights for the prevention and management of pediatric obesity.