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Bell KJ, Brodie S, Couper JJ, Colman P, Davis E, Deed G, Hagopian W, Haynes A, Hendrieckx C, Henry A, Gordon A, Howard K, Huynh T, Kerr B, Mikler K, Nassar N, Norris S, Oram R, Pawlak D, Shand A, Sinnott RO, Wadling B, Wentworth JM, Craig ME. Protocol for the Australian Type 1 Diabetes National Screening Pilot: Assessing the feasibility and acceptability of three general population screening models in children. Diabet Med 2024:e15419. [PMID: 39129150 DOI: 10.1111/dme.15419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/13/2024]
Abstract
AIM One third of Australian children diagnosed with type 1 diabetes present with life-threatening diabetic ketoacidosis (DKA) at diagnosis. Screening for early-stage, presymptomatic type 1 diabetes, with ongoing follow-up, can substantially reduce this risk (<5% risk). Several screening models are being trialled internationally, without consensus on the optimal approach. This pilot study aims to assess three models for a routine, population-wide screening programme in Australia. METHODS An implementation science-guided pilot study to evaluate the feasibility, acceptability and costs of three screening models in children will be conducted between July 2022 and June 2024. These models are as follows: (1) Genetic risk-stratified screening using newborn heel prick dried bloodspots, followed by autoantibody testing from 11 months of age; (2) genetic risk-stratified screening of infant (6-12 months) saliva followed by autoantibody testing from 10 months of age; and (3) autoantibody screening using capillary dried bloodspots collected from children aged 2, 6 or 10 years. Cohorts for each model will be recruited from targeted geographic areas across Australia involving ≥2 states per cohort, with a recruitment target of up to 3000 children per cohort (total up to 9000 children). The primary outcome is screening uptake for each cohort. Secondary outcomes include programme feasibility, costs, parental anxiety, risk perception, satisfaction, well-being and quality of life, and health professional attitudes and satisfaction. CONCLUSIONS This pilot is the first direct comparison of three screening implementation models for general population screening. Findings will provide evidence to inform a potential national screening programme for Australian children. TRIAL REGISTRATION ACTRN12622000381785.
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Affiliation(s)
- Kirstine J Bell
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Shannon Brodie
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer J Couper
- Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Royal Melbourne Hospital, University of Melbourne Department of Medicine, Parkville, Victoria, Australia
| | - Elizabeth Davis
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Gary Deed
- Monash University, Melbourne, Victoria, Australia
| | - William Hagopian
- University of Washington, Seattle, Washington, USA
- Indiana University, Indianapolis, Indiana, USA
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- UWA Medical School, Paediatrics, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Amanda Henry
- Discipline of Women's Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tony Huynh
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
- Department of Chemical Pathology, Mater Pathology, South Brisbane, Queensland, Australia
| | - Bernadette Kerr
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kara Mikler
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Norris
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard Oram
- University of Exeter College of Medicine and Health, Exeter, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Antonia Shand
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Richard O Sinnott
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bethany Wadling
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John M Wentworth
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Royal Melbourne Hospital, University of Melbourne Department of Medicine, Parkville, Victoria, Australia
- Population Health and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Maria E Craig
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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McGrail C, Sears TJ, Kudtarkar P, Carter H, Gaulton K. Genetic association and machine learning improves discovery and prediction of type 1 diabetes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.31.24311310. [PMID: 39132494 PMCID: PMC11312647 DOI: 10.1101/2024.07.31.24311310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Type 1 diabetes (T1D) has a large genetic component, and expanded genetic studies of T1D can lead to novel biological and therapeutic discovery and improved risk prediction. In this study, we performed genetic association and fine-mapping analyses in 817,718 European ancestry samples genome-wide and 29,746 samples at the MHC locus, which identified 165 independent risk signals for T1D of which 19 were novel. We used risk variants to train a machine learning model (named T1GRS) to predict T1D, which highly differentiated T1D from non-disease and type 2 diabetes (T2D) in Europeans as well as African Americans at or beyond the level of current standards. We identified extensive non-linear interactions between risk loci in T1GRS, for example between HLA-DQB1*57 and INS, coding and non-coding HLA alleles, and DEXI, INS and other beta cell loci, that provided mechanistic insight and improved risk prediction. T1D individuals formed distinct clusters based on genetic features from T1GRS which had significant differences in age of onset, HbA1c, and renal disease severity. Finally, we provided T1GRS in formats to enhance accessibility of risk prediction to any user and computing environment. Overall, the improved genetic discovery and prediction of T1D will have wide clinical, therapeutic, and research applications.
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Affiliation(s)
- Carolyn McGrail
- Biomedical sciences graduate program, University of California San Diego, La Jolla CA
| | - Timothy J. Sears
- Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla CA
| | - Parul Kudtarkar
- Department of Pediatrics, University of California San Diego, La Jolla CA
| | - Hannah Carter
- Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla CA
- Moore’s Cancer Center, University of California San Diego, La Jolla CA
- Department of Medicine, University of California San Diego, La Jolla CA
| | - Kyle Gaulton
- Department of Pediatrics, University of California San Diego, La Jolla CA
- Pediatric Diabetes Research Center, University of California San Diego, La Jolla CA
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Ware J, Boughton CK, Allen JM, Wilinska ME, Hartnell S, Thankamony A, Randell T, Ghatak A, Besser RE, Elleri D, Trevelyan N, Campbell FM, Sibayan J, Bailey R, Calhoun P, Dunseath G, Hovorka R. Effect of 48 Months of Closed-Loop Insulin Delivery on Residual C-Peptide Secretion and Glycemic Control in Newly Diagnosed Youth With Type 1 Diabetes: A Randomized Trial. Diabetes Care 2024; 47:1441-1448. [PMID: 38924772 PMCID: PMC11272979 DOI: 10.2337/dc24-0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE We evaluated the effect of long-term intensive metabolic control with hybrid closed-loop (CL) on residual C-peptide secretion and glucose control compared with standard insulin therapy in youth with type 1 diabetes over 48 months. RESEARCH DESIGN AND METHODS Following the 24-month primary phase of a multicenter, randomized, parallel trial of 96 newly diagnosed youth aged 10 to 16.9 years, participants were invited to an extension phase using treatment allocated at randomization. They continued with hybrid CL using the Cambridge algorithm or standard insulin therapy (control) until 48 months after diagnosis. Analysis was by intention-to-treat. RESULTS At 24 months after diagnosis, 81 participants (mean ± SD age 14 ± 2 years) continued in the extension phase (47 CL, 34 control). There was no difference in fasting C-peptide corrected for fasting glucose at 48 months between groups (CL: 5 ± 9 vs. control: 6 ± 14 pmol/L per mmol/L; mean adjusted difference -2 [95% CI -7, 4; P = 0.54]). Central laboratory HbA1c remained lower in the CL group by 0.9% (10 mmol/mol [95% CI 0.2, 1.5; 3, 17 mmol/mol); P = 0.009). Time in target range of 3.9 to 10.0 mmol/L was 12 percentage points (95% CI 3, 20; P = 0.008) higher in the CL group compared with control. There were 11 severe hypoglycemic events (6 CL, 5 control) and 7 diabetic ketoacidosis events (3 CL, 4 control) during the extension phase. CONCLUSIONS Improved glycemic control was sustained over 48 months after diagnosis with CL insulin delivery compared with standard therapy in youth with type 1 diabetes. This did not appear to confer a protective effect on residual C-peptide secretion.
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Affiliation(s)
- Julia Ware
- Institute of Metabolic Science-Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, University of Cambridge, Cambridge, U.K
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Charlotte K. Boughton
- Institute of Metabolic Science-Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, University of Cambridge, Cambridge, U.K
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, U.K
| | - Janet M. Allen
- Institute of Metabolic Science-Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, University of Cambridge, Cambridge, U.K
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Malgorzata E. Wilinska
- Institute of Metabolic Science-Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, University of Cambridge, Cambridge, U.K
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Sara Hartnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, U.K
| | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
| | - Tabitha Randell
- Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham, U.K
| | - Atrayee Ghatak
- Department of Diabetes, Alder Hey Children's National Health Service Foundation Trust, Liverpool, U.K
| | - Rachel E.J. Besser
- Department of Paediatrics, University of Oxford, Oxford, U.K
- National Institute for Health and Care Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, U.K
| | - Daniela Elleri
- Department of Diabetes, Royal Hospital for Sick Children, Edinburgh, U.K
| | - Nicola Trevelyan
- Paediatric Diabetes, Southampton Children’s Hospital, Southampton, U.K
| | - Fiona M. Campbell
- Department of Paediatric Diabetes, Leeds Children’s Hospital, Leeds, U.K
| | | | | | | | | | - Roman Hovorka
- Institute of Metabolic Science-Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, University of Cambridge, Cambridge, U.K
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
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Cymbaluk A, Huang X, Minard C, DeSalvo D, Redondo MJ. Diabetic ketoacidosis in youth with diabetes mellitus during the COVID-19 pandemic. J Pediatr Endocrinol Metab 2024; 0:jpem-2024-0107. [PMID: 39090525 DOI: 10.1515/jpem-2024-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/14/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES We sought to determine if the early months of the coronavirus disease 2019 (COVID-19) pandemic influenced pediatric diabetic ketoacidosis (DKA) hospitalization characteristics. METHODS This is a cross-sectional study of youth with laboratory-confirmed DKA admitted to a large tertiary children's hospital in the USA. Data were collected from admissions in March through July 2019 and March through July 2020, respectively. We evaluated the clinical characteristics of hospitalization, including demographic data and DKA severity. We used univariable ordinal logistic regression followed by multiple ordinal logistic regression to adjust for potential confounders. RESULTS We included 137 children with diabetes admitted for DKA in the relevant period in 2019 and 173 patients admitted for DKA in the same period in 2020. Hemoglobin A1C (HbA1c) upon admission was higher in 2020 (median=12.2 %) than in 2019 (11.5 %, p=0.018). Children who were admitted with DKA in 2020 were less likely to be autoantibody positive than those in 2019 (83 vs. 91 %, p=0.028). In the univariable model, being admitted in 2020 was significantly associated with more severe DKA (p=0.038), as was HbA1c (p=0.001). After adjusting for HbA1c upon admission, admission year was no longer significantly associated with more severe DKA. CONCLUSIONS In this study of pediatric diabetes of any type and duration of diabetes, youth admitted for DKA at the start of the COVID-19 pandemic, compared with those admitted during the year before, were more likely to have autoantibody-negative diabetes and had significantly higher HbA1c. Additionally, higher HbA1c seemed to mediate more severe DKA during the pandemic.
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Affiliation(s)
- Anna Cymbaluk
- Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, 3989 Baylor College of Medicine , Houston, TX, USA
| | - Xiaofan Huang
- 3989 Institute for Clinical and Translational Research, Baylor College of Medicine , Houston, TX, USA
| | - Charles Minard
- 3989 Institute for Clinical and Translational Research, Baylor College of Medicine , Houston, TX, USA
| | - Daniel DeSalvo
- Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, 3989 Baylor College of Medicine , Houston, TX, USA
| | - Maria J Redondo
- Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, 3989 Baylor College of Medicine , Houston, TX, USA
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Achenbach P, Berner R, Bonifacio E, Brämswig S, Braig S, Dunstheimer D, Ermer U, Ewald D, Gemulla G, Hauer J, Haupt F, Haus G, Hubmann M, Hummel S, Kandler M, Kordonouri O, Lange K, Laub O, Lorrmann A, Nellen-Hellmuth N, Sindichakis M, von dem Berge T, Warncke K, Weber L, Winkler C, Wintermeyer P, Ziegler AG. [Early Detection Of Type 1 Diabetes By Islet Autoantibody Screening: A Position Paper Of The Fr1daplex Project Leaders And Training Centres, Bvkj Bavaria And Paednetz (Registered) Bavaria]. DAS GESUNDHEITSWESEN 2024. [PMID: 38710228 DOI: 10.1055/a-2320-2859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
This position paper is based on the authors' many years of clinical experience and basic science research on the diagnosis and treatment of children and adolescents with a presymptomatic early stage of type 1 diabetes. The benefits as well as potential disadvantages of early detection of type 1 diabetes by islet autoantibody screening are critically discussed. In addition, the perspectives of delaying the onset of the clinical metabolic disease through treatment with teplizumab are addressed. Today, we see the chance for a relevant improvement in therapeutic options and life perspectives of affected children and adolescents. Important next steps for the implementation of islet autoantibody screening in Germany are the training of pediatricians who should inform families about the screening, establishment of a few transregional laboratories that carry out the test, and expansion of regional capacities for the training and care of children with an early stage of type 1 diabetes.
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Affiliation(s)
- Peter Achenbach
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Reinhard Berner
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinder- und Jugendmedizin, Technische Universität Dresden, Dresden, Germany
| | - Ezio Bonifacio
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Susanne Brämswig
- Klinik für Kinder- und Jugendmedizin, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Sonja Braig
- Klinik für Kinder und Jugendliche, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Desiree Dunstheimer
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Uwe Ermer
- Kinder- und Jugendmedizin, Ameos Klinikum St. Elisabeth Neuburg, Neuburg an der Donau, Germany
| | - Dominik Ewald
- Bahnhofstr. 24, Kinderarztpraxis, Regensburg, Germany
| | - Gita Gemulla
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinder- und Jugendmedizin, Technische Universität Dresden, Dresden, Germany
- Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Julia Hauer
- Zentrum für Kinder und Jugendmedizin, München Klinik und Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Florian Haupt
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Gabi Haus
- Hans-Mielich-Str. 35, Kinderarztpraxis, München, Germany
| | | | - Sandra Hummel
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | | | - Olga Kordonouri
- Diabetologie, Endokrinologie und Allgemeine Pädiatrie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Karin Lange
- Medizinische Psychologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Otto Laub
- Happinger Str. 98, Kinderarztpraxis, Rosenheim, Germany
| | - Anja Lorrmann
- Kinder und Jugendmedizin, KJF Klinik Josefinum GmbH, Augsburg, Germany
| | | | - Marina Sindichakis
- Klinik für Kinder- und Jugendmedizin, Kinderdiabetologie, Klinikum Traunstein, Traunstein, Germany
| | - Thekla von dem Berge
- Diabetologie, Endokrinologie und Allgemeine Pädiatrie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - Katharina Warncke
- Zentrum für Kinder und Jugendmedizin, München Klinik und Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | - Leonie Weber
- Klinik für Kinderheilkunde und Jugendmedizin, Kinderdiabetologie, Klinikum Kempten-Oberallgau GmbH, Kempten, Germany
| | - Christiane Winkler
- Institut für Diabetesforschung, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
| | | | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München Fakultät für Medizin, Munchen, Germany
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6
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Gangqiang G, Hua C, Hongyu S. Risk predictors of glycaemic control in children and adolescents with type 1 diabetes: A systematic review and meta-analysis. J Clin Nurs 2024; 33:2412-2426. [PMID: 38661073 DOI: 10.1111/jocn.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/09/2024] [Accepted: 03/01/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To conduct systematic evaluation of the risk predictors of glycaemic control in children and adolescents with type 1 diabetes mellitus. METHODS Cohort studies on risk predictors of glycaemic control in children and adolescents with type 1 diabetes were retrieved from CNKI, PubMed, Web of Science, Embase databases, etc. from the construction of the repository to 3 February 2023. Literature screening was conducted according to inclusion and exclusion criteria, then data extraction of region, sample size, age, follow-up time, risk predictors, outcome indicators, etc., and quality evaluation of The Newcastle-Ottawa Scale were conducted by two researchers while the third researcher makes decisions if there are disagreements. Finally, Revman5.4 and StataMP17 were used for meta-analysis. RESULTS A total of 29 studies were included, and the results showed that insulin pump [Weighed mean difference (WMD) = -.48, 95% CI (-.73, -.24), p < .01], high-frequency sensor monitoring, early use of insulin pumps, prospective follow-up male, white race, large body mass index-standardised scoring, conscientiousness, agreeableness of mothers, eicosapentaenoic acid, leucine and protein (p < .05) were beneficial for reducing HbA1c levels in children and adolescents with diabetes. Ketoacidosis [WMD = .39, 95% CI (.28, .50), p < .01], selective admission, higher HbA1c level at one time (p < .01), higher glutamate decarboxylase antibody at 1 month after diagnosis, lower socio-economic status, non-living with biological parents, non-two-parent family, family disorder, family history of diabetes and high carbohydrate intake (p < .05) increased HbA1c levels in children and adolescents with diabetes. CONCLUSION For children and adolescents with type 1 diabetes mellitus, the use of insulin pump, high-frequency sensor monitoring, prospective follow-up, good family support and reasonable diet are conducive to blood glucose control, while selective admission and DKA are not. Disease characteristics and demographic characteristics of children are closely related to subsequent blood glucose control, and the relationship between diagnosis age and blood glucose control needs to be further explored.
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Affiliation(s)
- Gao Gangqiang
- School of Nursing, Peking University, Beijing, China
| | - Chen Hua
- School of Nursing, Peking University, Beijing, China
| | - Sun Hongyu
- School of Nursing, Peking University, Beijing, China
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7
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Wersäll JH, Ekelund J, Åkesson K, Hanas R, Adolfsson P, Ricksten SE, Forsander G. Relative poverty is associated with increased risk of diabetic ketoacidosis at onset of type 1 diabetes in children. A Swedish national population-based study in 2014-2019. Diabet Med 2024; 41:e15283. [PMID: 38213059 DOI: 10.1111/dme.15283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/13/2024]
Abstract
AIMS The aim of the study was to estimate the effect of household relative poverty on the risk of diabetic ketoacidosis at diagnosis of children with type 1 diabetes using an international standard measurement of relative poverty. METHODS A national population-based retrospective study was conducted. The Swedish National Diabetes Register (NDR) was linked with data from Sweden's public statistical agency (Statistics Sweden). Children who were diagnosed with new-onset type 1 diabetes in the period of 2014-2019 were common identifiers. The definition of diabetic ketoacidosis was venous pH <7.30 or a serum bicarbonate level <18 mmol/L. The exposure variable was defined according to the standard definition of the persistent at-risk-of-poverty rate used by the statistical office of the European Union (Eurostat) and several other European public statistical agencies. Univariate and multi-variable analyses were used to calculate the effect of relative poverty on the risk of diabetic ketoacidosis. RESULTS Children from households with relative poverty had a 41% higher risk of diabetic ketoacidosis (1.41, CI 1.12-1.77, p = 0.004) and more than double the risk of severe diabetic ketoacidosis (pH <7.10) (RR 2.10, CI 1.35-3.25, p = 0.001), as compared to children from households without relative poverty. CONCLUSIONS Relative poverty significantly increases the risk of diabetic ketoacidosis at onset of type 1 diabetes in children, even in a high-income country with publicly reimbursed health care.
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Affiliation(s)
- Johan H Wersäll
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Karin Åkesson
- Division of Paediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ragnar Hanas
- Institute of Clinical Sciences, Department of Paediatrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Adolfsson
- Institute of Clinical Sciences, Department of Paediatrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gun Forsander
- Institute of Clinical Sciences, Department of Paediatrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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8
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Hirschler V, Gonzalez CD, Krochik G, Rousos AM, Andres ME, Riera F, Ibarcena PP, Molinari C, Porta LFP, Prieto M, Mateu CM, Barcala C, Arrigo MA, Tachetti J, Raggio M, Vacarezza V, Major ML, Sobrero AF, Bogado E, Lopez S, Povedano PP, Scaiola E, Leiva F, Pacheco G, Pasayo P, Dupuy M, Torossi MB, Benitez AJ, Marassi AE, Caballero Z, Garcia AL, Mazzetti S, Pugliese MIR, Gonzalez DS, Grabois F, Villar CMDA, Flores AB. Diabetic Ketoacidosis in Type 1 Diabetes Onset in Latin American Children. J Pediatr Health Care 2024; 38:544-551. [PMID: 38597850 DOI: 10.1016/j.pedhc.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/19/2023] [Accepted: 01/28/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To describe the patterns of diabetic ketoacidosis (DKA) occurrence in children newly diagnosed with type 1 diabetes (T1DM) across several Latin American pediatric diabetes centers from 2018 to 2022. METHODS A retrospective chart review included children under 18 with new-onset T1DM from 30 Latin American pediatric diabetes centers (Argentina, Chile, and Peru) between 30 December 2018 and 30 December 2022. Multiple logistic regression models examined the relationships between age, gender, medical insurance, BMI, and DKA at new-onset T1DM. As far as we know, there are no large studies in Latin American countries exploring the patterns of DKA in new-onset T1DM. RESULTS A total of 2,026 (983 females) children, median age 9.12 (5.8 -11.7) years with new-onset-T1DM were included. Approximately 50% had no medical insurance. Mean glucose values were 467 mg/dL, pH 7.21, bicarbonate 13 mEq/L, HbA1c 11.3%, and BMI 18. The frequency of DKA was 1,229 (60.7%), out of which only 447 (36%) were severe. There was a significant decrease in the frequency of DKA as age increased: 373 (70.2%) in children under 6, 639 (61.6%) in those between 6 and 12, 217 and (47.5%) in those over 12. Children with medical insurance (58.8%) had a significantly lower frequency of DKA than those without (62.7%). The multiple logistic regression models showed that DKA was significantly and inversely associated with age [OR, 0.72 (95% CI 0.60-0.86)], BMI [OR, 0.95 (95% CI 0.92-0.99)], and medical insurance [OR, 0.75 (95% CI 0.60-0.94)] adjusted for sex. CONCLUSION Latin American children with new-onset T1DM exhibited a substantial occurrence of DKA. Younger ages and the lack of medical insurance were significantly associated with DKA in new-onset T1DM.
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Affiliation(s)
- Valeria Hirschler
- Coordinator of the Diabetes Argentine Society, Epidemiology, CAPITAL FEDERAL, Argentina.
| | - Claudio D Gonzalez
- Coordinator of the Diabetes Argentine Society, Epidemiology, CAPITAL FEDERAL, Argentina
| | - Gabriela Krochik
- Head Physician Hospital de Pediatría. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Adriana M Rousos
- Head Physician Hospital de Niños Ricardo Gutierrez, Nutrition, Buenos Aires, Argentina
| | - Maria E Andres
- Head Physician Hospital de Niños Pedro de Elizalde, Nutrition, Buenos Aires, Argentina
| | - Francisca Riera
- Head Physician Pontificia Universidad Católica de Chile, Santiago, Chile, Pediatric Endocrinology, Santiago de Chile, Chile
| | - Paola Pinto Ibarcena
- Head Physician Endocrinology and Metabolism Service of the National Institute of Child Health, Lima, Peru
| | - Claudia Molinari
- Professor of the University of Buenos Aires, School of Pharmacy and Biochemistry, Mathematics, Buenos Aires, Argentina
| | | | - Mariana Prieto
- Head Physician Hospital de Pediatría. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | - Consuelo Barcala
- Head Physician Hospital de Pediatría. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Maria A Arrigo
- Head Physician HOSPITAL RAMON EXENI, San Justo, Argentina
| | - Jacqueline Tachetti
- Head Physician Hospital Italiano de San Justo Agustín Rocca, San JustoO, Argentina
| | - Marcela Raggio
- Head Physician Hospital Universitario Austral, Pilar, Argentina
| | | | - Maria L Major
- Head Physician Hospital Materno Infantil de San Isidro, San Isidro, Argentina
| | | | | | - Stella Lopez
- Head Physician Hospital Infantil Municipal, Cordoba, Argentina
| | - Paula Paz Povedano
- Head Physician Hospital de Niños de la Santísima Trinidad de Cordoba, Cordoba, Argentina
| | - Edit Scaiola
- Head Physician Private Clinic former Ushuaia, Ushuaia, Argentina
| | - Fabiana Leiva
- Head Physician Hospital Regional Rio Grande, Rio Grande, Argentina
| | - Gabriela Pacheco
- Head Physician Hospital Publico Materno Infantil De Salta, Pediatric Endocrinology, Salta, Argentina
| | - Patricia Pasayo
- Head Physician Hospital Materno Infantil Dr Hector Quintana, San Salvador De Jujuy, Argentina
| | - Mariana Dupuy
- Head Physician Hospital del niño Jesús - Tucumán, San Miguel De Tucuman, Argentina
| | - Maria B Torossi
- Head Physician Hospital de Clínicas Pte. Dr. Nicolás Avellaneda, San Miguel de Tucuman, Argentina
| | - Amanda J Benitez
- Amanda J. Benitez-Hospital Pediatrico Juan Pablo Segundo, Corrientes, Argentina
| | | | - Zulema Caballero
- Head Physician Hospital Pediatrico Dr. Avelino Lorenzo Castelán, Resistencia, Argentina
| | - Ana L Garcia
- Head Physician Hospital de Niños Orlando Alassia, Santa Fe, Argentina
| | - Sandra Mazzetti
- Head Physician Hospital de Niños Victor J Vilela, Rosario, Argentina
| | | | - Diana S Gonzalez
- Hospital Provincial Neuquen Dr. Castro Rendon, Neuquen, Argentina
| | | | | | - Adriana B Flores
- Head Physician Fundacion Hospitalaria Htal privado materno infanto juvenil, Buenos Aires, Argentina
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9
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Hadley SM, Michelson KA. Delayed diagnosis of new onset pediatric diabetes leading to diabetic ketoacidosis: a retrospective cohort study. Diagnosis (Berl) 2024; 0:dx-2024-0024. [PMID: 38920269 DOI: 10.1515/dx-2024-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES Patients with a delayed diagnosis of diabetes are more likely to present in diabetic ketoacidosis (DKA). The objective of this study was to assess the prevalence, risk factors, and consequences of missed pediatric diabetes diagnoses in emergency departments (EDs) potentially leading to DKA. METHODS Cases of children under 19 years old with a first-time diagnosis of diabetes mellitus presenting to EDs in DKA were drawn from the Healthcare Cost and Utilization Project database. A total of 11,716 cases were included. A delayed diagnosis of diabetes leading to DKA was defined by an ED discharge in the 14 days prior to the DKA diagnosis. The delayed diagnosis cases were analyzed using multivariate analysis to identify risk factors associated with delay, with the primary exposure being child opportunity index (COI) and secondary exposure being race/ethnicity. Rates of complications were compared across groups. RESULTS Delayed diagnosis of new onset diabetes leading to DKA occurred in 2.9 %. Delayed diagnosis was associated with COI, with 4.5 , 3.5, 1.9, and 1.5 % occurring by increasing COI quartile (p<0.001). Delays were also associated with younger age and non-Hispanic Black race. Patients with a delayed diagnosis were more likely to experience complications (4.4 vs. 2.2 %, p=0.01) including mechanical ventilation, as well as more frequent intensive care unit admissions and longer length of stays. CONCLUSIONS Among children with new-onset DKA, 2.9 % had a delayed diagnosis. Delays were associated with complications. Children living in areas with lower child opportunity and non-Hispanic Black children were at higher risk of delays.
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Affiliation(s)
| | - Kenneth A Michelson
- Division of Emergency Medicine, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA
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10
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Scudder C, Townson J, Bowen-Morris J, Gillespie K, Evans P, Jones S, Thomas NPB, Stanford J, Fox R, Todd JA, Greenfield S, Dayan CM, Besser REJ. General population screening for type 1 diabetes using islet autoantibodies at the preschool vaccination visit: a proof-of-concept study (the T1Early study). Arch Dis Child 2024:archdischild-2023-326697. [PMID: 38925883 DOI: 10.1136/archdischild-2023-326697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Type 1 diabetes (T1D) screening programmes testing islet autoantibodies (IAbs) in childhood can reduce life-threatening diabetic ketoacidosis. General population screening is required to detect the majority of children with T1D, since in >85% there is no family history. Age 3-5 years has been proposed as an optimal age for a single screen approach. DESIGN Capillary samples were collected from children attending their preschool vaccination and analysed for IAbs to insulin, glutamic acid decarboxylase, islet antigen-2 and zinc transporter 8 using radiobinding/luciferase immunoprecipitation system assays. Acceptability was assessed using semistructured interviews and open-ended postcard questionnaires with parents. SETTING Two primary care practices in Oxfordshire, UK. MAIN OUTCOME MEASURES The ability to collect capillary blood to test IAbs in children at the routine preschool vaccination (3.5-4 years). RESULTS Of 134 parents invited, 66 (49%) were recruited (median age 3.5 years (IQR 3.4-3.6), 26 (39.4%) male); 63 provided a sample (97% successfully), and one participant was identified with a single positive IAb. Parents (n=15 interviews, n=29 postcards) were uniformly positive about screening aligned to vaccination and stated they would have been less likely to take part had screening been a separate visit. Themes identified included preparedness for T1D and the long-term benefit outweighing short-term upset. The perceived volume of the capillary sample was a potential concern and needs optimising. CONCLUSIONS Capillary IAb testing is a possible method to screen children for T1D. Aligning collection to the preschool vaccination visit can be convenient for families without the need for an additional visit.
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Affiliation(s)
- Claire Scudder
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Julia Townson
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Jane Bowen-Morris
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - Kathleen Gillespie
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - Philip Evans
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
| | | | | | | | - Robin Fox
- Bicester Health Centre, Bicester, UK
| | - John A Todd
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Colin M Dayan
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Rachel E J Besser
- JDRF/Wellcome Diabetes and Inflammation Laboratory, Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
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11
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Bonifacio E, Winkler C, Achenbach P, Ziegler AG. Effect of population-wide screening for presymptomatic early-stage type 1 diabetes on paediatric clinical care. Lancet Diabetes Endocrinol 2024; 12:376-378. [PMID: 38723647 DOI: 10.1016/s2213-8587(24)00101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Ezio Bonifacio
- Technische Universität Dresden, Center for Regenerative Therapies Dresden, Dresden 01307, Germany; Paul Langerhans Institute Dresden of the Helmholtz Munich at University Hospital Carl Gustav Carus and Faculty of Medicine, TU Dresden, Germany.
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Munich, German Center for Environmental Health, Munich, Germany
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Munich, German Center for Environmental Health, Munich, Germany; Forschergruppe Diabetes, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Munich, German Center for Environmental Health, Munich, Germany; Forschergruppe Diabetes, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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12
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Tosur M, Huang X, Inglis AS, Aguirre RS, Redondo MJ. Inaccurate diagnosis of diabetes type in youth: prevalence, characteristics, and implications. Sci Rep 2024; 14:8876. [PMID: 38632329 PMCID: PMC11024140 DOI: 10.1038/s41598-024-58927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Classifying diabetes at diagnosis is crucial for disease management but increasingly difficult due to overlaps in characteristics between the commonly encountered diabetes types. We evaluated the prevalence and characteristics of youth with diabetes type that was unknown at diagnosis or was revised over time. We studied 2073 youth with new-onset diabetes (median age [IQR] = 11.4 [6.2] years; 50% male; 75% White, 21% Black, 4% other race; overall, 37% Hispanic) and compared youth with unknown versus known diabetes type, per pediatric endocrinologist diagnosis. In a longitudinal subcohort of patients with data for ≥ 3 years post-diabetes diagnosis (n = 1019), we compared youth with steady versus reclassified diabetes type. In the entire cohort, after adjustment for confounders, diabetes type was unknown in 62 youth (3%), associated with older age, negative IA-2 autoantibody, lower C-peptide, and no diabetic ketoacidosis (all, p < 0.05). In the longitudinal subcohort, diabetes type was reclassified in 35 youth (3.4%); this was not statistically associated with any single characteristic. In sum, among racially/ethnically diverse youth with diabetes, 6.4% had inaccurate diabetes classification at diagnosis. Further research is warranted to improve accurate diagnosis of pediatric diabetes type.
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Affiliation(s)
- Mustafa Tosur
- The Division of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, 77030, USA.
- Children's Nutrition Research Center, Baylor College of Medicine, USDA/ARS, Houston, TX, 77030, USA.
| | - Xiaofan Huang
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Audrey S Inglis
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA
| | - Rebecca Schneider Aguirre
- The Division of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, 77030, USA
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Maria J Redondo
- The Division of Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, 77030, USA
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13
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Bai H, He N, Zhang Y, Ahmad A, Yang XX, Ma Y, Liang LJ. Quality of Life and Glucose Regulation in Pediatric Patients with Type 1 Diabetes: A Study in the Ningxia Hui Autonomous Region. Diabetes Metab Syndr Obes 2024; 17:1267-1278. [PMID: 38496005 PMCID: PMC10944302 DOI: 10.2147/dmso.s446387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Objective In this study, we aimed to evaluate the current status of the quality of life (QOL) of pediatric patients and plasma glucose concentration regulation in children with type 1 diabetes (T1DM) in the Ningxia Hui autonomous region. Methods The study involved children with T1DM admitted to the General Hospital of Ningxia Medical University between October 2011 and October 2021. The children and their parents completed general information and quality of life (QOL) questionnaires. The regulation of plasma glucose concentration was assessed based on HbA1c levels, and plasma glucose and QOL-influencing components were investigated. Results Among the 136 pediatric patients diagnosed with T1DM, the mean glycated hemoglobin (HbA1c) level was recorded at 8.7% (7.2%, 10.5%). A breakdown of the patient cohort revealed that 44 patients (32.4%) demonstrated good regulation of plasma glucose, 33 patients (24.3%) exhibited acceptable glycemic control, and 59 patients (43.3%) displayed poor regulation of plasma glucose. The control of plasma glucose in pediatric patients diagnosed with T1DM was affected by the duration of the disease, the patient's age, the frequency of daily plasma glucose measurements, the use of CGM, diabetic ketoacidosis (DKA), and the education level of the mother. The control of plasma glucose, dietary management, DKA, the ability to learn, and health education are interfering factors of quality of life in children diagnosed with T1DM. Effective control of plasma glucose may ensure the QOL in children with T1DM, and DKA was the risk factor for QOL. Conclusion In Ningxia, the regulation of plasma glucose in pediatric and adolescent patients with T1DM remains suboptimal, leading to poor QOL. There is a pressing need to enhance glucose regulation and QOL through comprehensive strategies, which include reinforced dietary management, rigorous monitoring of plasma glucose levels, and heightened health education levels.
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Affiliation(s)
- Hua Bai
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Na He
- PKUFH-NINGXIA Women Children’s Hospital, Yinchuan, 750001, People’s Republic of China
| | - Yan Zhang
- The First Clinical Medical College of Ningxia Medical University General Hospital, Yinchuan, 750004, People’s Republic of China
| | - Aqsa Ahmad
- The First Clinical Medical College of Ningxia Medical University General Hospital, Yinchuan, 750004, People’s Republic of China
| | - Xing-Xing Yang
- The First Clinical Medical College of Ningxia Medical University General Hospital, Yinchuan, 750004, People’s Republic of China
| | - Yan Ma
- The First Clinical Medical College of Ningxia Medical University General Hospital, Yinchuan, 750004, People’s Republic of China
| | - Li-Jun Liang
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
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14
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Lakshman R, Najami M, Allen JM, Ware J, Wilinska ME, Hartnell S, Thankamony A, Randell T, Ghatak A, Besser RE, Elleri D, Trevelyan N, Campbell FM, Hovorka R, Boughton CK. Diabetic Ketoacidosis at Onset of Type 1 Diabetes and Glycemic Outcomes with Closed-Loop Insulin Delivery. Diabetes Technol Ther 2024; 26:198-202. [PMID: 38444312 PMCID: PMC10877390 DOI: 10.1089/dia.2023.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The presence of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) is associated with higher glycated hemoglobin levels over time. We evaluated whether hybrid-closed loop (HCL) therapy from onset of T1D could prevent the adverse impact of DKA at diagnosis on long-term glycemic outcomes. This was a posthoc analysis from 51 adolescents using HCL from diagnosis of T1D as part of the CLOuD trial (NCT02871089). We compared glycemic and insulin metrics between adolescents with (n = 17) and without (n = 34) DKA at diagnosis. Participants with and without DKA at diagnosis had similar time in target glucose range 3.9-10.0 mmol/L (70-180 mg/dL), time below range (<3.9 mmol/L, <70 mg/dL) and HbA1c at 6, 12, and 24 months. While insulin requirements at 6 months were higher in those with DKA at diagnosis, this was not statistically significant after adjusting for bodyweight. Residual C-peptide secretion was similar between groups. We conclude that HCL therapy may mitigate against the negative glycemic effects of DKA at T1D diagnosis.
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Affiliation(s)
- Rama Lakshman
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Mazin Najami
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Janet M. Allen
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Julia Ware
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Malgorzata E. Wilinska
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Sara Hartnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Tabitha Randell
- Department of Paediatric Diabetes and Endocrinology, Nottingham Children's Hospital, Nottingham, United Kingdom
| | - Atrayee Ghatak
- Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Rachel E.J. Besser
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Daniela Elleri
- Department of Diabetes, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Nicola Trevelyan
- Paediatric Diabetes, Southampton Children's Hospital, Southampton, United Kingdom
| | - Fiona M. Campbell
- Department of Paediatric Diabetes, Leeds Children's Hospital, Leeds, United Kingdom
| | - Roman Hovorka
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Charlotte K. Boughton
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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15
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Montaser E, Brown SA, DeBoer MD, Farhy LS. Predicting the Risk of Developing Type 1 Diabetes Using a One-Week Continuous Glucose Monitoring Home Test With Classification Enhanced by Machine Learning: An Exploratory Study. J Diabetes Sci Technol 2024; 18:257-265. [PMID: 37946401 PMCID: PMC10973864 DOI: 10.1177/19322968231209302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Detection of two or more autoantibodies (Ab) in the blood might describe those individuals at increased risk of developing type 1 diabetes (T1D) during the following years. The aim of this exploratory study is to propose a high versus low T1D risk classifier using machine learning technology based on continuous glucose monitoring (CGM) home data. METHODS Forty-two healthy relatives of people with T1D with mean ± SD age of 23.8 ± 10.5 years, HbA1c (glycated hemoglobin) of 5.3% ± 0.3%, and BMI (body mass index) of 23.2 ± 5.2 kg/m2 with zero (low risk; N = 21), and ≥2 (high risk; N = 21) Ab, were enrolled in an NIH (National Institutes of Health)-funded TrialNet ancillary study. Participants wore a CGM for a week and consumed three standardized liquid mixed meals (SLMM) instead of three breakfasts. Glycemic features were extracted from two-hour post-SLMM CGM traces, compared across groups, and used in four supervised machine learning Ab risk status classifiers. Recursive Feature Elimination (RFE) algorithm was used for feature selection; classifiers were evaluated through 10-fold cross-validation, using the receiver operating characteristic area under the curve (AUC-ROC) to select the best classification model. RESULTS The percent time of glucose >180 mg/dL (T180), glucose range, and glucose CV (coefficient of variation) were the only significant differences between the glycemic features in the two groups with P values of .040, .035, and .028 respectively. The linear SVM (Support Vector Machine) model with RFE features achieved the best performance of classifying low-risk versus high-risk individuals with AUC-ROC = 0.88. CONCLUSIONS A machine learning technology, combining a potentially self-administered one-week CGM home test, has the potential to reliably assess the T1D risk.
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Affiliation(s)
- Eslam Montaser
- Center for Diabetes Technology, School
of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Sue A. Brown
- Center for Diabetes Technology, School
of Medicine, University of Virginia, Charlottesville, VA, USA
- Division of Endocrinology and
Metabolism, Department of Medicine, School of Medicine, University of Virginia,
Charlottesville, VA, USA
| | - Mark D. DeBoer
- Center for Diabetes Technology, School
of Medicine, University of Virginia, Charlottesville, VA, USA
- Division of Pediatric Endocrinology,
Department of Pediatrics School of Medicine, University of Virginia,
Charlottesville, VA, USA
| | - Leon S. Farhy
- Center for Diabetes Technology, School
of Medicine, University of Virginia, Charlottesville, VA, USA
- Division of Endocrinology and
Metabolism, Department of Medicine, School of Medicine, University of Virginia,
Charlottesville, VA, USA
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16
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Zaharieva DP, Ding VY, Addala A, Prahalad P, Bishop F, Hood KK, Desai M, Wilson DM, Buckingham BA, Maahs DM. Diabetic Ketoacidosis at Diagnosis in Youth with Type 1 Diabetes Is Associated with a Higher Hemoglobin A1c Even with Intensive Insulin Management. Diabetes Technol Ther 2024; 26:176-183. [PMID: 37955644 PMCID: PMC10877392 DOI: 10.1089/dia.2023.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Introduction: Diabetic ketoacidosis (DKA) at diagnosis is associated with short- and long-term complications. We assessed the relationship between DKA status and hemoglobin A1c (A1c) levels in the first year following type 1 diabetes (T1D) diagnosis. Research Design and Methods: The Pilot Teamwork, Targets, Technology, and Tight Control (4T) study offered continuous glucose monitoring to youth with T1D within 1 month of diagnosis. A1c levels were compared between historical (n = 271) and Pilot 4T (n = 135) cohorts stratified by DKA status at diagnosis (DKA: historical = 94, 4T = 67 versus without DKA: historical = 177, 4T = 68). A1c was evaluated using locally estimated scatter plot smoothing. Change in A1c from 4 to 12 months postdiagnosis was evaluated using a linear mixed model. Results: Median age was 9.7 (interquartile range [IQR]: 6.6, 12.7) versus 9.7 (IQR: 6.8, 12.7) years, 49% versus 47% female, 44% versus 39% non-Hispanic White in historical versus Pilot 4T. In historical and 4T cohorts, DKA at diagnosis demonstrated higher A1c at 6 (0.5% [95% confidence interval (CI): 0.21-0.79; P < 0.01] and 0.38% [95% CI: 0.02-0.74; P = 0.04], respectively), and 12 months (0.62% [95% CI: -0.06 to 1.29; P = 0.07] and 0.39% [95% CI: -0.32 to 1.10; P = 0.29], respectively). The highest % time in range (TIR; 70-180 mg/dL) was seen between weeks 15-20 (69%) versus 25-30 (75%) postdiagnosis for youth with versus without DKA in Pilot 4T, respectively. Conclusions: Pilot 4T improved A1c outcomes versus the historical cohort, but those with DKA at diagnosis had persistently elevated A1c throughout the study and intensive diabetes management did not mitigate this difference. DKA prevention at diagnosis may translate into better glycemic outcomes in the first-year postdiagnosis. Clinical Trial Registration: clinicaltrials.gov: NCT04336969.
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Affiliation(s)
- Dessi P. Zaharieva
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Victoria Y. Ding
- Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California, USA
| | - Ananta Addala
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
| | - Priya Prahalad
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
| | - Franziska Bishop
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Korey K. Hood
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
| | - Manisha Desai
- Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California, USA
| | - Darrell M. Wilson
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Bruce A. Buckingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - David M. Maahs
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, California, USA
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17
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Uenishi GI, Repic M, Yam JY, Landuyt A, Saikumar-Lakshmi P, Guo T, Zarin P, Sassone-Corsi M, Chicoine A, Kellogg H, Hunt M, Drow T, Tewari R, Cook PJ, Yang SJ, Cerosaletti K, Schweinoch D, Guiastrennec B, James E, Patel C, Chen TF, Buckner JH, Rawlings DJ, Wickham TJ, Mueller KT. GNTI-122: an autologous antigen-specific engineered Treg cell therapy for type 1 diabetes. JCI Insight 2024; 9:e171844. [PMID: 38516892 PMCID: PMC11063937 DOI: 10.1172/jci.insight.171844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 02/02/2024] [Indexed: 03/23/2024] Open
Abstract
Tregs have the potential to establish long-term immune tolerance in patients recently diagnosed with type 1 diabetes (T1D) by preserving β cell function. Adoptive transfer of autologous thymic Tregs, although safe, exhibited limited efficacy in previous T1D clinical trials, likely reflecting a lack of tissue specificity, limited IL-2 signaling support, and in vivo plasticity of Tregs. Here, we report a cell engineering strategy using bulk CD4+ T cells to generate a Treg cell therapy (GNTI-122) that stably expresses FOXP3, targets the pancreas and draining lymph nodes, and incorporates a chemically inducible signaling complex (CISC). GNTI-122 cells maintained an expression profile consistent with Treg phenotype and function. Activation of CISC using rapamycin mediated concentration-dependent STAT5 phosphorylation and, in concert with T cell receptor engagement, promoted cell proliferation. In response to the cognate antigen, GNTI-122 exhibited direct and bystander suppression of polyclonal, islet-specific effector T cells from patients with T1D. In an adoptive transfer mouse model of T1D, a mouse engineered-Treg analog of GNTI-122 trafficked to the pancreas, decreased the severity of insulitis, and prevented progression to diabetes. Taken together, these findings demonstrate in vitro and in vivo activity and support further development of GNTI-122 as a potential treatment for T1D.
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Affiliation(s)
| | | | | | | | | | - Tingxi Guo
- GentiBio Inc, Cambridge, Massachusetts, USA
| | | | | | | | | | - Martina Hunt
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Travis Drow
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Ritika Tewari
- Center for Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Peter J. Cook
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Soo Jung Yang
- Center for Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Karen Cerosaletti
- Center for Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | | | | | - Eddie James
- Center for Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | | | | | - Jane H. Buckner
- Center for Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
- Department of Medicine
- Department of Immunology, and
| | - David J. Rawlings
- Center for Immunity and Immunotherapies and the Program for Cell and Gene Therapy, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Immunology, and
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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18
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Fanaropoulou NM, Tsatsani GC, Koufakis T, Kotsa K. Teplizumab: promises and challenges of a recently approved monoclonal antibody for the prevention of type 1 diabetes or preservation of residual beta cell function. Expert Rev Clin Immunol 2024; 20:185-196. [PMID: 37937833 DOI: 10.1080/1744666x.2023.2281990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/07/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Type 1 diabetes (T1D) is a chronic autoimmune endocrinopathy with increasing incidence that results in the depletion of pancreatic beta cells and exogenous insulin dependence. Despite technological advances in insulin delivery, disease control remains suboptimal, while previous immunotherapy options have failed to prevent T1D. Recently, teplizumab, an immunomodulating monoclonal antibody, was approved to delay or prevent T1D. AREAS COVERED Five randomized controlled trials have tested different regimens of administration, mostly 14-day schemes with dose escalation. In participants with new-onset T1D, teplizumab delayed C-peptide decline, improved glycemic control, and reduced insulin demand for a median of 1 or 2 years. Studies in at-risk relatives of patients showed a decrease in T1D incidence during 2 years of follow-up. Subgroups of responders with unique metabolic and immunological characteristics were identified. Mild to moderate adverse effects were reported, including transient rash, cytopenia, nausea, vomiting, and infections. EXPERT OPINION Teplizumab marks a turning point in T1D therapy. Areas of future research include the ideal population for screening, cost-effectiveness, and challenges in treatment accessibility. More studies are essential to evaluate the ideal duration of the regimen, the potential benefit of combinations with other drugs, and to identify endophenotypes with a high probability of response.
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Affiliation(s)
- Nina Maria Fanaropoulou
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia C Tsatsani
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theocharis Koufakis
- Second Propaedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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19
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Averbuch S, Yackobovitch-Gavan M, Ben Simon A, Interator H, Lopez A, Borger O, Laurian I, Dorfman A, Chorna E, Oren A, Eyal O, Brener A, Lebenthal Y. Muscle-to-fat ratio in children and adolescents with type 1 diabetes in predicting glycaemic control and partial clinical remission. Diabetes Metab Res Rev 2024; 40:e3767. [PMID: 38407547 DOI: 10.1002/dmrr.3767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Advances in treatment could mitigate the expected adverse changes in the body composition of children and adolescents with type 1 diabetes (T1D). OBJECTIVES To examine the evolution of weight status and body composition and their association with glycaemic control and partial clinical remission in youth with T1D. METHODS Ninety-nine participants with T1D (median age 9.5 years [interquartile range 7.3, 12.9], 59.6% boys) were longitudinally followed for 3 years since diagnosis. Data at seven pre-determined time points were extracted from medical files. Outcome measures included body mass index (BMI) z-scores, muscle-to-fat ratio (MFR) z-scores, haemoglobin A1c (HbA1c) levels, continuous glucose monitoring metrics, and insulin dose-adjusted HbA1c (IDAA1c) levels. RESULTS The BMI z-scores increased significantly (p < 0.001) for both sexes, with no significant change in MFR z-scores over time. The girls had higher BMI z-scores (p < 0.001) and lower MFR z-scores than the boys (p = 0.016). The mean HbA1c levels decreased during the first month and at 3 months since diagnosis (p < 0.001), then plateaued and achieved a median overall HbA1c of 7.1% for the entire cohort. At 12 months, 37 participants (37.6%) were in partial clinical remission, as evidenced by IDAA1c ≤ 9. The odds of partial clinical remission at 2 years increased by 2.1-fold for each standard deviation increase in the MFR z-score (p < 0.001). Higher MFR z-scores were associated with better metabolic control. CONCLUSIONS Integration of body composition assessments could mitigate adverse body changes in paediatric patients with T1D.
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Affiliation(s)
- Shay Averbuch
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Ben Simon
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagar Interator
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Nutrition & Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adar Lopez
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Nutrition & Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ophir Borger
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Nutrition & Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Irina Laurian
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Nursing Services, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anna Dorfman
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Nursing Services, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Efrat Chorna
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Social Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Asaf Oren
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Eyal
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Brener
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lebenthal
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Karavanaki K, Korona A, Karanasios S, Kossiva L. Predictors of the clinical severity of T1DM presentation at diagnosis in children and adolescents with type 1 diabetes mellitus (T1DM). Hormones (Athens) 2023:10.1007/s42000-023-00518-7. [PMID: 38150136 DOI: 10.1007/s42000-023-00518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE We aimed to assess factors associated with the presence and severity of ketoacidosis (DKA) at pediatric type 1 diabetes (T1DM) diagnosis, in relation to pancreatic, associated and familial autoimmunity. METHODS Antibodies against pancreatic beta-cells, organ specific autoantibodies (thyroid, celiac, and parietal) and family history of autoimmunity were retrospectively evaluated in 116 T1DM patients aged 11.9 ± 4.6 (mean ± SD) years, with disease duration 7.62 ± 3.67 years (mean ± SD). RESULTS Most patients (67.2%) presented with DKA at diagnosis. Younger children (< 2 years) had tenfold risk of DKA, compared to older children (12.1-15 years) (OR = 10.8, 95% CI: 1.0-116.9, P = 0.05). Fasting c-peptide levels were lower in the DKA group (OR = 0.26, 95% CI = 0.07-0.89, P = 0.033). The number of anti-pancreatic antibodies at disease onset did not show any significant correlations with the presence (p = 0.889) or severity of DKA (p = 0.863). All patients with multiple autoimmunity (> 2 autoimmune diseases plus T1DM) presented with DKA. Familial autoimmunity acted protectively against DKA manifestation (OR = 0.40, 95% CI = 0.16-1.0, P = 0.051). CONCLUSIONS Among newly diagnosed T1DM patients, 67.2% presented with DKA. Younger age, lower c-peptide and the presence of associated autoimmunity were predictive factors of the presence and severity of DKA at diagnosis. High degree of suspicion, due to family history, may prevent DKA development and severity.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetic Clinic, 2nd Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, National and Kapodistrian University of Athens, Thivon & Levadeias Str, 115 27, Athens, Greece
| | - Anastasia Korona
- Diabetic Clinic, 2nd Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, National and Kapodistrian University of Athens, Thivon & Levadeias Str, 115 27, Athens, Greece
| | - Spyridon Karanasios
- Diabetic Clinic, 2nd Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, National and Kapodistrian University of Athens, Thivon & Levadeias Str, 115 27, Athens, Greece
| | - Lydia Kossiva
- Diabetic Clinic, 2nd Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, National and Kapodistrian University of Athens, Thivon & Levadeias Str, 115 27, Athens, Greece.
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21
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O'Donnell HK, Rasmussen CG, Dong F, Simmons KM, Steck AK, Frohnert BI, Bautista K, Rewers MJ, Baxter J. Anxiety and Risk Perception in Parents of Children Identified by Population Screening as High Risk for Type 1 Diabetes. Diabetes Care 2023; 46:2155-2161. [PMID: 37673098 DOI: 10.2337/dc23-0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To assess anxiety and risk perception among parents whose children screened positive for islet autoantibodies, indicating elevated risk for type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS The Autoimmunity Screening for Kids (ASK) study identified 319 children age 1 to 17 years at risk for T1D via screening for islet autoantibodies; 280 children with confirmed islet autoantibodies and their caregivers enrolled in a follow-up education and monitoring program to prevent diabetic ketoacidosis at diagnosis. Parents completed questionnaires at each monitoring visit, including a 6-item version of the State Anxiety Inventory (SAI), to assess anxiety about their child developing T1D, and a single question to assess risk perception. RESULTS At the first ASK follow-up monitoring visit, mean parental anxiety was elevated above the clinical cutoff of 40 (SAI 46.1 ± 11.2). At the second follow-up monitoring visit (i.e., visit 2), mean anxiety remained elevated but started to trend down. Approximately half (48.9%) of parents reported their child was at increased risk for T1D at the initial follow-up monitoring visit (visit 1). Parents of children with more than one islet autoantibody and a first-degree relative with T1D were more likely to report their child was at increased risk. CONCLUSIONS Most parents of autoantibody-positive children have high anxiety about their child developing T1D. Information about the risk of developing T1D is difficult to convey, as evidenced by the wide range of risk perception reported in this sample.
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Affiliation(s)
- Holly K O'Donnell
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Cristy Geno Rasmussen
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Fran Dong
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Kimber M Simmons
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K Steck
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Brigitte I Frohnert
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Kimberly Bautista
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Marian J Rewers
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Judith Baxter
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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22
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Leocadio P, Kelleher C, Fernández E, Hawkes CP. Adolescents' Experiences of Transition to Self-Management of Type 1 Diabetes: Systematic Review and Future Directions. Sci Diabetes Self Manag Care 2023; 49:477-492. [PMID: 37927049 PMCID: PMC10666500 DOI: 10.1177/26350106231206779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE The purpose of this systematic literature review was to explore studies that report the experiences of adolescents, their families, and health care professionals of adolescents' transition to self-management of type 1 diabetes (T1DM). METHODS SocINDEX, PsycInfo, APA PsycArticles, and MEDLINE electronic databases were searched. Studies reporting on experiences of transition to self-management of T1DM for adolescents, their parents, siblings, and health care professionals published between January 2010 amd December 2021 were included. The Mixed Methods Appraisal Tool guided trustworthiness and relevance of selected studies. RESULTS A total of 29 studies met the inclusion criteria. Findings indicate that adolescents' experiences of transitioning to self-management of T1DM are interconnected with the supports provided by others (eg, family, teachers, friends). Considering interdependence and collective lived experiences is essential to developing effective and personalized family, peer, and social interventions to facilitate transition and to avoid negative outcomes in later life. The renegotiation of roles within the network of supports that impact adolescents' transition and adolescents' self-negotiation have been neglected. CONCLUSION Transition to self-management of T1DM is a dynamic and iterative process comprising of continuous shifts between interdependence and independence, making it challenging for all involved. A number of research gaps and avenues for future research are outlined.
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Affiliation(s)
- Paula Leocadio
- Department of Management and Marketing, University College Cork, Cork, Ireland
| | - Carol Kelleher
- Department of Management and Marketing, University College Cork, Cork, Ireland
| | - Eluska Fernández
- School of Applied Social Studies, University College Cork, Cork, Ireland
| | - Colin P. Hawkes
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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23
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Ospelt E, Hardison H, Rioles N, Noor N, Weinstock RS, Cossen K, Mathias P, Smego A, Mathioudakis N, Ebekozien O. Understanding Providers' Readiness and Attitudes Toward Autoantibody Screening: A Mixed-Methods Study. Clin Diabetes 2023; 42:17-26. [PMID: 38230325 PMCID: PMC10788649 DOI: 10.2337/cd23-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Screening for autoantibodies associated with type 1 diabetes can identify people most at risk for progressing to clinical type 1 diabetes and provide an opportunity for early intervention. Drawbacks and barriers to screening exist, and concerns arise, as methods for disease prevention are limited and no cure exists today. The availability of novel treatment options such as teplizumab to delay progression to clinical type 1 diabetes in high-risk individuals has led to the reassessment of screening programs. This study explored awareness, readiness, and attitudes of endocrinology providers toward type 1 diabetes autoantibody screening.
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Affiliation(s)
| | | | | | | | | | | | - Priyanka Mathias
- Albert Einstein College of Medicine–Montefiore Medical Center, Bronx, NY
| | - Allison Smego
- University of Utah, Intermountain Health, Salt Lake City, UT
| | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi Medical Center School of Population Health, Jackson, MS
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24
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Montaser E, Breton MD, Brown SA, DeBoer MD, Kovatchev B, Farhy LS. Predicting Immunological Risk for Stage 1 and Stage 2 Diabetes Using a 1-Week CGM Home Test, Nocturnal Glucose Increments, and Standardized Liquid Mixed Meal Breakfasts, with Classification Enhanced by Machine Learning. Diabetes Technol Ther 2023; 25:631-642. [PMID: 37184602 PMCID: PMC10460684 DOI: 10.1089/dia.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background: Predicting the risk for type 1 diabetes (T1D) is a significant challenge. We use a 1-week continuous glucose monitoring (CGM) home test to characterize differences in glycemia in at-risk healthy individuals based on autoantibody presence and develop a machine-learning technology for CGM-based islet autoantibody classification. Methods: Sixty healthy relatives of people with T1D with mean ± standard deviation age of 23.7 ± 10.7 years, HbA1c of 5.3% ± 0.3%, and body mass index of 23.8 ± 5.6 kg/m2 with zero (n = 21), one (n = 18), and ≥2 (n = 21) autoantibodies were enrolled in an National Institutes of Health TrialNet ancillary study. Participants wore a CGM for a week and consumed three standardized liquid mixed meals (SLMM) instead of three breakfasts. Glycemic outcomes were computed from weekly, overnight (12:00-06:00), and post-SLMM CGM traces, compared across groups, and used in four supervised machine-learning autoantibody status classifiers. Classifiers were evaluated through 10-fold cross-validation using the receiver operating characteristic area under the curve (AUC-ROC) to select the best classification model. Results: Among all computed glycemia metrics, only three were different across the autoantibodies groups: percent time >180 mg/dL (T180) weekly (P = 0.04), overnight CGM incremental AUC (P = 0.005), and T180 for 75 min post-SLMM CGM traces (P = 0.004). Once overnight and post-SLMM features are incorporated in machine-learning classifiers, a linear support vector machine model achieved the best performance of classifying autoantibody positive versus autoantibody negative participants with AUC-ROC ≥0.81. Conclusion: A new technology combining machine learning with a potentially self-administered 1-week CGM home test can help improve T1D risk detection without the need to visit a hospital or use a medical laboratory. Trial registration: ClinicalTrials.gov registration no. NCT02663661.
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Affiliation(s)
- Eslam Montaser
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Marc D. Breton
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Sue A. Brown
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D. DeBoer
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Boris Kovatchev
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Leon S. Farhy
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
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25
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Hummel S, Carl J, Friedl N, Winkler C, Kick K, Stock J, Reinmüller F, Ramminger C, Schmidt J, Lwowsky D, Braig S, Dunstheimer D, Ermer U, Gerstl EM, Weber L, Nellen-Hellmuth N, Brämswig S, Sindichakis M, Tretter S, Lorrmann A, Bonifacio E, Ziegler AG, Achenbach P. Children diagnosed with presymptomatic type 1 diabetes through public health screening have milder diabetes at clinical manifestation. Diabetologia 2023; 66:1633-1642. [PMID: 37329450 PMCID: PMC10390633 DOI: 10.1007/s00125-023-05953-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
AIMS/HYPOTHESIS We aimed to determine whether disease severity was reduced at onset of clinical (stage 3) type 1 diabetes in children previously diagnosed with presymptomatic type 1 diabetes in a population-based screening programme for islet autoantibodies. METHODS Clinical data obtained at diagnosis of stage 3 type 1 diabetes were evaluated in 128 children previously diagnosed with presymptomatic early-stage type 1 diabetes between 2015 and 2022 in the Fr1da study and compared with data from 736 children diagnosed with incident type 1 diabetes between 2009 and 2018 at a similar age in the DiMelli study without prior screening. RESULTS At the diagnosis of stage 3 type 1 diabetes, children with a prior early-stage diagnosis had lower median HbA1c (51 mmol/mol vs 91 mmol/mol [6.8% vs 10.5%], p<0.001), lower median fasting glucose (5.3 mmol/l vs 7.2 mmol/l, p<0.05) and higher median fasting C-peptide (0.21 nmol/l vs 0.10 nmol/l, p<0.001) compared with children without previous early-stage diagnosis. Fewer participants with prior early-stage diagnosis had ketonuria (22.2% vs 78.4%, p<0.001) or required insulin treatment (72.3% vs 98.1%, p<0.05) and only 2.5% presented with diabetic ketoacidosis at diagnosis of stage 3 type 1 diabetes. Outcomes in children with a prior early-stage diagnosis were not associated with a family history of type 1 diabetes or diagnosis during the COVID-19 pandemic. A milder clinical presentation was observed in children who participated in education and monitoring after early-stage diagnosis. CONCLUSIONS/INTERPRETATION Diagnosis of presymptomatic type 1 diabetes in children followed by education and monitoring improved clinical presentation at the onset of stage 3 type 1 diabetes.
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Affiliation(s)
- Sandra Hummel
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.
- German Center for Diabetes Research (DZD), Munich, Germany.
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany.
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany.
| | - Johanna Carl
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Nadine Friedl
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Christiane Winkler
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
| | - Kerstin Kick
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Joanna Stock
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Franziska Reinmüller
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Claudia Ramminger
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
| | - Jennifer Schmidt
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
| | | | - Sonja Braig
- Pediatric Clinic of the Bayreuth Hospital, Bayreuth, Germany
| | | | - Uwe Ermer
- St Elisabeth Klinik, Neuburg an der Donau, Germany
| | | | | | | | | | | | | | | | - Ezio Bonifacio
- German Center for Diabetes Research (DZD), Munich, Germany
- Center for Regenerative Therapies Dresden, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Centre Munich at the University Clinic Carl Gustav Carus of TU Dresden and Faculty of Medicine, Dresden, Germany
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Peter Achenbach
- Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.
- German Center for Diabetes Research (DZD), Munich, Germany.
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, Munich, Germany.
- Forschergruppe Diabetes at Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany.
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Kelly L, Tuthill A. Does diabetic ketoacidosis at diagnosis of type 1 diabetes mellitus predict poorer long-term glycemic control. Ir J Med Sci 2023; 192:1703-1709. [PMID: 37010775 DOI: 10.1007/s11845-023-03345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus. AIMS This study aimed to determine (1) whether DKA at diagnosis of type 1 diabetes is associated with poorer long-term glycemic control and (2) whether there are confounding factors which may impact the mode of presentation of type 1 diabetes mellitus or subsequent glycemic control. METHODS This study was conducted via review of 102 patient files extracted from the Young Person's Type 1 Diabetes Clinic at Cork University Hospital. Glycemic control was measured using the average of the patient's three most recent HbA1C levels, recorded a median of 11 years post-diagnosis of type 1 diabetes mellitus. RESULTS Data analysis revealed a positive association between DKA at diagnosis and poorer long-term glycemic control, with HbA1c levels tracking 6.58 mmol/mol (0.6%) higher at follow up in the group with DKA compared to the group without DKA at diagnosis. Certain sociodemographic factors were found to predict worse glycemic control at follow-up: Individuals using recreational drugs and those reporting mental health difficulties were found to have higher levels of HbA1C at follow up (p = ·006,·012, respectively) compared to individuals who did not. CONCLUSIONS Diabetic ketoacidosis at diagnosis of type 1 diabetes mellitus was shown to be associated with poorer long-term glycemic control in this study. Furthermore, individuals who utilize recreational drugs or have mental health difficulties had significantly worse glycemic control at follow-up.
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Affiliation(s)
- Louise Kelly
- University College Cork, Cork, Ireland.
- Department of Diabetes and Endocrinology, Cork University Hospital, Cork, Ireland.
| | - Antoinette Tuthill
- University College Cork, Cork, Ireland
- Department of Diabetes and Endocrinology, Cork University Hospital, Cork, Ireland
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27
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Cherubini V, Chiarelli F. Autoantibody test for type 1 diabetes in children: are there reasons to implement a screening program in the general population? A statement endorsed by the Italian Society for Paediatric Endocrinology and Diabetes (SIEDP-ISPED) and the Italian Society of Paediatrics (SIP). Ital J Pediatr 2023; 49:87. [PMID: 37468976 DOI: 10.1186/s13052-023-01438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/06/2023] [Indexed: 07/21/2023] Open
Abstract
In recent years screening of type 1 diabetes (T1D) in both at risk children and general population has been widely discussed with the aim of increasing awareness of the importance to early detect (and possibly treat) at-risk children in early stages of the chronic autoimmune progression to T1D.In fact, it is well known that first-degree relatives have the highest risk of T1D, but up to 90% of children who develop T1D do not have a family history and belong to the general population.The reasons for screening children well before the clinical onset of T1D include prevention of DKA (still up to 60% children are diagnosed with DKA) and related morbidities and mortality, reducing the need for hospitalisation, time to provide emotional support and education to ensure a smooth transition to insulin treatment, and opportunities for new treatments to prevent or delay progression.There are pros and cons of screening of T1D in children, but recent evidences suggest that it is now time to consider possible a screening for T1D in children.Recently, the European Society for Paediatric Endocrinology (ESPE) has endorsed a Position Statement, discussing the pros and cons of screening for T1D in the general population; ESPE supports national Societies for Paediatric Endocrinology to spread information on this important issue in various countries throughout Europe; the Italian Society for Paediatric Endocrinology and Diabetes (SIEDP-ISPED) and the Italian Society of Paediatrics (SIP) endorse this document with the specific aim of increasing awareness on screening for paediatric T1D in the general population.
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Affiliation(s)
| | - Francesco Chiarelli
- Department of Paediatrics, University of Chieti, Via dei Vestini, 5, I-66100, Chieti, Italy.
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28
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Quattrin T, Mastrandrea LD, Walker LSK. Type 1 diabetes. Lancet 2023; 401:2149-2162. [PMID: 37030316 DOI: 10.1016/s0140-6736(23)00223-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/03/2022] [Accepted: 01/26/2023] [Indexed: 04/10/2023]
Abstract
Type 1 diabetes is a chronic disease caused by autoimmune destruction of pancreatic β cells. Individuals with type 1 diabetes are reliant on insulin for survival. Despite enhanced knowledge related to the pathophysiology of the disease, including interactions between genetic, immune, and environmental contributions, and major strides in treatment and management, disease burden remains high. Studies aimed at blocking the immune attack on β cells in people at risk or individuals with very early onset type 1 diabetes show promise in preserving endogenous insulin production. This Seminar will review the field of type 1 diabetes, highlighting recent progress within the past 5 years, challenges to clinical care, and future directions in research, including strategies to prevent, manage, and cure the disease.
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Affiliation(s)
- Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA.
| | - Lucy D Mastrandrea
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Lucy S K Walker
- Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London, London, UK
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29
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Tosur M, Huang X, Inglis AS, Aguirre RS, Redondo MJ. Imprecise Diagnosis of Diabetes Type in Youth: Prevalence, Characteristics, and Implications. RESEARCH SQUARE 2023:rs.3.rs-2958200. [PMID: 37293006 PMCID: PMC10246228 DOI: 10.21203/rs.3.rs-2958200/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Classifying diabetes at diagnosis is crucial for disease management but increasingly difficult due to overlaps in characteristics between the commonly encountered diabetes types. We evaluated the prevalence and characteristics of youth with diabetes type that was unknown at diagnosis or was revised over time. We studied 2073 youth with new-onset diabetes (median age [IQR]=11.4 [6.2] years; 50% male; 75% White, 21% Black, 4% other race; overall, 37% Hispanic) and compared youth with unknown versus known diabetes type, per pediatric endocrinologist diagnosis. In a longitudinal subcohort of patients with data for ≥3 years post-diabetes diagnosis (n=1019), we compared youth with unchanged versus changed diabetes classification. In the entire cohort, after adjustment for confounders, diabetes type was unknown in 62 youth (3%), associated with older age, negative IA-2 autoantibody, lower C-peptide, and no diabetic ketoacidosis (all, p<0.05). In the longitudinal subcohort, diabetes classification changed in 35 youth (3.4%); this was not statistically associated with any single characteristic. Having unknown or revised diabetes type was associated with less continuous glucose monitor use on follow-up (both, p<0.004). In sum, among racially/ethnically diverse youth with diabetes, 6.5% had imprecise diabetes classification at diagnosis. Further research is warranted to improve accurate diagnosis of pediatric diabetes type.
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Affiliation(s)
- Mustafa Tosur
- Baylor College of Medicine, Texas Children's Hospital
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30
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Abate MD, Semachew A, Emishaw S, Meseret F, Azmeraw M, Algaw D, Temesgen D, Feleke SF, Nuru A, Abate M, Bantie B, Andualem A. Incidence and predictors of hyperglycemic emergencies among adult diabetic patients in Bahir Dar city public hospitals, Northwest Ethiopia, 2021: A multicenter retrospective follow-up study. Front Public Health 2023; 11:1116713. [PMID: 37006547 PMCID: PMC10063795 DOI: 10.3389/fpubh.2023.1116713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/21/2023] [Indexed: 03/19/2023] Open
Abstract
Background Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome are the two commonly known life-threatening hyperglycemic emergencies of diabetes mellitus. Despite the growing hyperglycemic emergency impact among adult patients with diabetes, its incidence and predictors have not been well studied in Ethiopia. Thus, this study aimed to assess the incidence and predictors of hyperglycemic emergencies among adult patients with diabetes. Method A retrospective follow-up study design was conducted among a randomly selected sample of 453 adult patients with diabetes. Data were entered into EPI data version 4.6 and analyzed using STATA version 14.0. A Cox-proportional hazard regression model was fitted to identify the independent predictors of hyperglycemic emergencies, and variables having a p < 0.05 in the multivariable model were considered statistically significant. Result Among the total adult patients with diabetes included in the study, 147 (32.45%) developed hyperglycemic emergencies. Hence, the overall incidence of hyperglycemic emergencies was 14.6 per 100 person-years observation. The incidence of diabetic ketoacidosis was 12.5 per 100 person-years (35.6 and 6.3 among T1DM and T2DM, respectively). The incidence of the hyperglycemic hyperosmolar syndrome was 2.1 per 100 person-years (0.9 and 2.4 among T1DM and T2DM, respectively). The overall median free survival time was 53.85 months. Type 1 diabetes mellitus [AHR = 2.75, 95% CI (1.68, 4.51)], diabetes duration of ≥ 3 years [AHR = 0.33, 95% CI (0.21, 0.50)], recent acute illness [AHR = 2.99, 95% CI (2.03, 4.43)], presence of comorbidity [AHR = 2.36, 95% CI (1.53, 3.63)], poor glycemic control [AHR = 3.47, 95% CI (2.17, 5.56)], history of medication non-compliance [AHR = 1.85,95% CI (1.24, 2.76)], follow-up frequency of 2-3 months [AHR = 1.79,95% CI (1.06, 3.01)], and without community health insurance [AHR = 1.63, 95% CI (1.14, 2.35)] were significant predictors of hyperglycemic emergencies. Conclusion The incidence of hyperglycemic emergencies was high. Therefore, giving greater attention to patients with identified predictors could decrease the occurrence of hyperglycemic emergencies and related public health and economic impacts.
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Affiliation(s)
- Melsew Dagne Abate
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Ayele Semachew
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Solomon Emishaw
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fentahun Meseret
- Department of Pediatrics and Child Health Nursing, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Molla Azmeraw
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Dawit Algaw
- Department of Nursing, Bahirdar Health Sciences College, Bahir Dar, Ethiopia
| | - Dessie Temesgen
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Ahmed Nuru
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Makda Abate
- Department of Nursing, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Berihun Bantie
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Atsedemariam Andualem
- Department of Nursing, School of Nursing and Midwifery, Injibara University, Injibara, Ethiopia
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31
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Kinney M, You L, Sims EK, Wherrett D, Schatz D, Lord S, Krischer J, Russell WE, Gottlieb PA, Libman I, Buckner J, DiMeglio LA, Herold KC, Steck AK. Barriers to Screening: An Analysis of Factors Impacting Screening for Type 1 Diabetes Prevention Trials. J Endocr Soc 2023; 7:bvad003. [PMID: 36741943 PMCID: PMC9891344 DOI: 10.1210/jendso/bvad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Indexed: 01/12/2023] Open
Abstract
Context Participants with stage 1 or 2 type 1 diabetes (T1D) qualify for prevention trials, but factors involved in screening for such trials are largely unknown. Objective To identify factors associated with screening for T1D prevention trials. Methods This study included TrialNet Pathway to Prevention participants who were eligible for a prevention trial: oral insulin (TN-07, TN-20), teplizumab (TN-10), abatacept (TN-18), and oral hydroxychloroquine (TN-22). Univariate and multivariate logistic regression models were used to examine participant, site, and study factors at the time of prevention trial accrual. Results Screening rates for trials were: 50% for TN-07 (584 screened/1172 eligible), 9% for TN-10 (106/1249), 24% for TN-18 (313/1285), 17% for TN-20 (113/667), and 28% for TN-22 (371/1336). Younger age and male sex were associated with higher screening rates for prevention trials overall and for oral therapies. Participants with an offspring with T1D showed lower rates of screening for all trials and oral drug trials compared with participants with other first-degree relatives as probands. Site factors, including larger monitoring volume and US site vs international site, were associated with higher prevention trial screening rates. Conclusions Clear differences exist between participants who screen for prevention trials and those who do not screen and between the research sites involved in prevention trial screening. Participant age, sex, and relationship to proband are significantly associated with prevention trial screening in addition to key site factors. Identifying these factors can facilitate strategic recruitment planning to support rapid and successful enrollment into prevention trials.
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Affiliation(s)
- Mara Kinney
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Lu You
- Health Informatics Institute, University of South Florida, Tampa, FL 33620, USA
| | - Emily K Sims
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Diane Wherrett
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto M5G 1X8, Canada
| | - Desmond Schatz
- Department of Pediatrics, University of Florida, Gainesville, FL 32611, USA
| | - Sandra Lord
- Diabetes Research Program, Benaroya Research Institute, Seattle, WA 98101, USA
| | - Jeffrey Krischer
- Health Informatics Institute, University of South Florida, Tampa, FL 33620, USA
| | | | - Peter A Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Ingrid Libman
- Division of Endocrinology, Diabetes and Metabolism, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jane Buckner
- Diabetes Research Program, Benaroya Research Institute, Seattle, WA 98101, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Kevan C Herold
- Departments of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Andrea K Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO 80045, USA
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32
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Scutca AC, Nicoară DM, Mărăzan M, Brad GF, Mărginean O. Neutrophil-to-Lymphocyte Ratio Adds Valuable Information Regarding the Presence of DKA in Children with New-Onset T1DM. J Clin Med 2022; 12:jcm12010221. [PMID: 36615022 PMCID: PMC9821096 DOI: 10.3390/jcm12010221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is an acute life-threatening complication occurring mainly at the onset of type 1 diabetes mellitus. The neutrophil-to-lymphocyte ratio (NLR), a marker for systemic inflammation, has recently generated increasing interest in many chronic diseases. The aim of this cross-sectional study was to determine the value of the neutrophil-to-lymphocyte ratio (NLR) in association with DKA severity across these cases. A total of 155 children with new-onset type 1 DM from one large center were included in the study. Total and differential leukocyte counts were measured upon admission and calculation of the NLR was performed. Patients were classified into four groups: without DKA, mild, moderate, and severe DKA at disease onset. Total WBCs, neutrophils, and monocytes increased with DKA severity (p-value < 0.005), while eosinophiles displayed an inverse relationship (p-value < 0.001). Median NLR scores increased from those without ketoacidosis (1.11) to mild (1.58), moderate (3.71), and severe (5.77) ketoacidosis groups. The statistical threshold value of the NLR in predicting DKA was 1.84, with a sensitivity of 80.2% and a specificity of 80%. Study findings indicate that a higher NLR score adds valuable information regarding the presence of DKA in children with new-onset T1DM.
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Affiliation(s)
- Alexandra-Cristina Scutca
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Delia-Maria Nicoară
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Correspondence:
| | - Monica Mărăzan
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Giorgiana-Flavia Brad
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Otilia Mărginean
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
- Department XI Pediatrics, Discipline I Pediatrics, Disturbances of Growth and Development in Children–BELIVE, 300011 Timisoara, Romania
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33
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Clapin HF, Earnest A, Colman PG, Davis EA, Jefferies C, Anderson K, Chee M, Bergman P, de Bock M, Kao KT, Fegan PG, Holmes-Walker DJ, Johnson S, King BR, Mok MT, Narayan K, Peña Vargas AS, Sinnott R, Wheeler BJ, Zimmermann A, Craig ME, Couper JJ, Andrikopoulos S, Barrett H, Batch J, Cameron F, Conwell L, Cotterill A, Cooper C, Donaghue K, Fairchild J, Fourlanos S, Glastras S, Goss P, Gray L, Hamblin S, Hofman P, Huynh T, James S, Jones T, Lafferty A, Martin M, McCrossin R, Neville K, Pascoe M, Paul R, Pawlak D, Phillips L, Price D, Rodda C, Simmons D, Smart C, Stone M, Stranks S, Tham E, Ward G, Woodhead H. Diabetic Ketoacidosis at Onset of Type 1 Diabetes and Long-term HbA1c in 7,961 Children and Young Adults in the Australasian Diabetes Data Network. Diabetes Care 2022; 45:2918-2925. [PMID: 36749868 DOI: 10.2337/dc22-0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The relationship between diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes and long-term glycemic control varies between studies. We aimed, firstly, to characterize the association of DKA and its severity with long-term HbA1c in a large contemporary cohort, and secondly, to identify other independent determinants of long-term HbA1c. RESEARCH DESIGN AND METHODS Participants were 7,961 children and young adults diagnosed with type 1 diabetes by age 30 years from 2000 to 2019 and followed prospectively in the Australasian Diabetes Data Network (ADDN) until 31 December 2020. Linear mixed-effect models related variables to HbA1c. RESULTS DKA at diagnosis was present in 2,647 participants (33.2%). Over a median 5.6 (interquartile range 3.2, 9.4) years of follow-up, participants with severe, but not moderate or mild, DKA at diagnosis had a higher mean HbA1c (+0.23%, 95% CI 0.11,0.28; [+2.5 mmol/mol, 95% CI 1.4,3.6]; P < 0.001) compared with those without DKA. Use of continuous subcutaneous insulin infusion (CSII) was independently associated with a lower HbA1c (-0.28%, 95% CI -0.31, -0.25; [-3.1 mmol/mol, 95% CI -3.4, -2.8]; P < 0.001) than multiple daily injections, and CSII use interacted with severe DKA to lower predicted HbA1c. Indigenous status was associated with higher HbA1c (+1.37%, 95% CI 1.15, 1.59; [+15.0 mmol/mol, 95% CI 12.6, 17.4]; P < 0.001), as was residing in postcodes of lower socioeconomic status (most vs. least disadvantaged quintile +0.43%, 95% CI 0.34, 0.52; [+4.7 mmol/mol, 95% CI 3.4, 5.6]; P < 0.001). CONCLUSIONS Severe, but not mild or moderate, DKA at diagnosis was associated with a marginally higher HbA1c over time, an effect that was modified by use of CSII. Indigenous status and lower socioeconomic status were independently associated with higher long-term HbA1c.
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Affiliation(s)
- Helen F Clapin
- Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | - Peter G Colman
- Royal Melbourne Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth A Davis
- Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | | | - Melissa Chee
- JDRF Australia, St Leonards, New South Wales, Australia
| | - Philip Bergman
- Monash University, Clayton, Victoria, Australia.,Monash Children's Hospital, Clayton, Victoria, Australia
| | - Martin de Bock
- Canterbury District Health Board, Christchurch, New Zealand.,Christchurch School of Medicine, University of Otago, Otago, New Zealand
| | - Kung-Ting Kao
- The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - P Gerry Fegan
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Stephanie Johnson
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Bruce R King
- John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
| | | | - Kruthika Narayan
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Alexia S Peña Vargas
- Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
| | | | - Benjamin J Wheeler
- Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin Central, Dunedin, New Zealand
| | - Anthony Zimmermann
- Lyell McEwin & Modbury Hospitals, Elizabeth Vale, South Australia, Australia
| | - Maria E Craig
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Jenny J Couper
- Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
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Rugg-Gunn CEM, Dixon E, Jorgensen AL, Usher-Smith JA, Marcovecchio ML, Deakin M, Hawcutt DB. Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients: A Systematic Review. JAMA Pediatr 2022; 176:1248-1259. [PMID: 36215053 DOI: 10.1001/jamapediatrics.2022.3586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Presenting with diabetic ketoacidosis (DKA) at onset of type 1 diabetes (T1D) remains a risk. Following a 2011 systematic review, considerable additional articles have been published, and the review required updating. OBJECTIVE To evaluate factors associated with DKA at the onset of T1D among pediatric patients. EVIDENCE REVIEW In this systematic review, PubMed, Embase, Scopus, CINAHL, Web of Science, and article reference lists were searched using the population, intervention, comparison, outcome search strategy for primary research studies on DKA and T1D onset among individuals younger than 18 years that were published from January 2011 to November 2021. These studies were combined with a 2011 systematic review on the same topic. Data were pooled using a random-effects model. FINDINGS A total of 2565 articles were identified; 149 were included, along with 46 from the previous review (total 195 articles). Thirty-eight factors were identified and examined for their association with DKA at T1D onset. Factors associated with increased risk of DKA were younger age at T1D onset (<2 years vs ≥2 years; odds ratio [OR], 3.51; 95% CI, 2.85-4.32; P < .001), belonging to an ethnic minority population (OR, 0.40; 95% CI, 0.21-0.74; P = .004), and family history of T1D (OR, 0.46; 95% CI, 0.37-0.57; P < .001), consistent with the 2011 systematic review. Some factors that were not associated with DKA in the 2011 systematic review were associated with DKA in the present review (eg, delayed diagnosis: OR, 2.27; 95% CI, 1.72-3.01; P < .001). Additional factors associated with risk of DKA among patients with new-onset T1D included participation in screening programs (OR, 0.35; 95% CI, 0.21-0.59; P < .001) and presentation during the COVID-19 pandemic (OR, 2.32; 95% CI, 1.76-3.06; P < .001). CONCLUSIONS AND RELEVANCE In this study, age younger than 2 years at T1D onset, belonging to an ethnic minority population, delayed diagnosis or misdiagnosis, and presenting during the COVID-19 pandemic were associated with increased risk of DKA. Factors associated with decreased risk of DKA included greater knowledge of key signs or symptoms of DKA, such as a family history of T1D or participation in screening programs. Future work should focus on identifying and implementing strategies related to these factors to reduce risk of DKA among new patients with T1D.
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Affiliation(s)
| | - Eleanor Dixon
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Andrea L Jorgensen
- Department of Biostatistics, University of Liverpool, Liverpool, England
| | - Juliet A Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, England
| | | | - Mark Deakin
- Alder Hey Children's Hospital, Liverpool, England
| | - Daniel B Hawcutt
- NIHR Alder Hey Clinical Research Facility, Liverpool, England.,Department of Women's and Children's Health, University of Liverpool, Liverpool, England
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Besser REJ, Bell KJ, Couper JJ, Ziegler AG, Wherrett DK, Knip M, Speake C, Casteels K, Driscoll KA, Jacobsen L, Craig ME, Haller MJ. ISPAD Clinical Practice Consensus Guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes 2022; 23:1175-1187. [PMID: 36177823 DOI: 10.1111/pedi.13410] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Rachel E J Besser
- Wellcome Centre for Human Genetics, NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Kirstine J Bell
- Charles Perkins Centre and Faculty Medicine and Health, University of Sydney, Sydney, Australia
| | - Jenny J Couper
- Department of Pediatrics, University of Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Diane K Wherrett
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mikael Knip
- Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Laura Jacobsen
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Maria E Craig
- Department of Pediatrics, The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Michael J Haller
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
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36
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Gut Microbiota Functional Traits, Blood pH, and Anti-GAD Antibodies Concur in the Clinical Characterization of T1D at Onset. Int J Mol Sci 2022; 23:ijms231810256. [PMID: 36142163 PMCID: PMC9499637 DOI: 10.3390/ijms231810256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Alterations of gut microbiota have been identified before clinical manifestation of type 1 diabetes (T1D). To identify the associations amongst gut microbiome profile, metabolism and disease markers, the 16S rRNA-based microbiota profiling and 1H-NMR metabolomic analysis were performed on stool samples of 52 T1D patients at onset, 17 T1D siblings and 57 healthy subjects (CTRL). Univariate, multivariate analyses and classification models were applied to clinical and -omic integrated datasets. In T1D patients and their siblings, Clostridiales and Dorea were increased and Dialister and Akkermansia were decreased compared to CTRL, while in T1D, Lachnospiraceae were higher and Collinsella was lower, compared to siblings and CTRL. Higher levels of isobutyrate, malonate, Clostridium, Enterobacteriaceae, Clostridiales, Bacteroidales, were associated to T1D compared to CTRL. Patients with higher anti-GAD levels showed low abundances of Roseburia, Faecalibacterium and Alistipes and those with normal blood pH and low serum HbA1c levels showed high levels of purine and pyrimidine intermediates. We detected specific gut microbiota profiles linked to both T1D at the onset and to diabetes familiarity. The presence of specific microbial and metabolic profiles in gut linked to anti-GAD levels and to blood acidosis can be considered as predictive biomarker associated progression and severity of T1D.
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Patton SR, Maahs D, Prahalad P, Clements MA. Psychosocial Needs for Newly Diagnosed Youth with Type 1 Diabetes and Their Families. Curr Diab Rep 2022; 22:385-392. [PMID: 35727439 PMCID: PMC9211050 DOI: 10.1007/s11892-022-01479-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE OF REVIEW To synthesize findings from studies published within the last 5 to 10 years and recruiting families of children with new-onset type 1 diabetes (T1D). RECENT FINDINGS Children can establish glycated hemoglobin (HbA1c) trajectories in the new-onset period that may persist for up to a decade. Demographic factors, family conflict, and diabetic ketoacidosis at the time of diagnosis may be risk factors for sub-optimal child HbA1c, while new immune modulating therapies and a treatment approach that combines advanced technologies and remote patient monitoring may improve child HbA1c. Nonetheless, recent trials in the new-onset period have largely overlooked how treatments may impact families' psychosocial functioning and longitudinal observational studies have been limited. The new-onset period of T1D is an important time for research and clinical intervention, though gaps exist specific to families' psychosocial needs. Filling these gaps is essential to inform clinical management and standard of care guidelines and improve outcomes.
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Affiliation(s)
- Susana R. Patton
- grid.472715.20000 0000 9331 5327Center for Healthcare Delivery Science, Nemours Children’s Health, 807 Children’s Way, Jacksonville, FL 32207 USA
| | - David Maahs
- grid.168010.e0000000419368956Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA 94304 USA
- grid.168010.e0000000419368956Stanford Diabetes Research Center, Stanford University, Stanford, CA 94304 USA
- grid.168010.e0000000419368956Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA 94304 USA
| | - Priya Prahalad
- grid.168010.e0000000419368956Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA 94304 USA
- grid.168010.e0000000419368956Stanford Diabetes Research Center, Stanford University, Stanford, CA 94304 USA
| | - Mark A. Clements
- grid.239559.10000 0004 0415 5050Department of Pediatrics, Division of Endocrinology and Diabetes, Children’s Mercy Kansas City, 2401 Gilham Road, Kansas City, MO 64108 USA
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38
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Auzanneau M, Rosenbauer J, Warncke K, Maier W, Kamrath C, Hofmann T, Wurm M, Hammersen J, Schröder C, Hake K, Holl RW. Frequency of Ketoacidosis at Diagnosis of Pediatric Type 1 Diabetes Associated With Socioeconomic Deprivation and Urbanization: Results From the German Multicenter DPV Registry. Diabetes Care 2022; 45:1807-1813. [PMID: 35727029 DOI: 10.2337/dc21-2227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether socioeconomic deprivation and urbanization are associated with the frequency of diabetic ketoacidosis (DKA) at diagnosis of pediatric type 1 diabetes. RESEARCH DESIGN AND METHODS Children and adolescents aged ≤18 years, living in Germany, with newly diagnosed type 1 diabetes documented between 2016 and 2019 in the Diabetes Prospective Follow-up Registry (DPV; Diabetes-Patienten-Verlaufsdokumentation), were assigned to a quintile of regional socioeconomic deprivation (German Index of Socioeconomic Deprivation) and to a degree of urbanization (Eurostat) by using their residence postal code. With multiple logistic regression models, we investigated whether the frequency of DKA at diagnosis was associated with socioeconomic deprivation or urbanization and whether associations differed by age-group, sex, or migration status. RESULTS In 10,598 children and adolescents with newly diagnosed type 1 diabetes, the frequency of DKA was lowest in the least deprived regions (Q1: 20.6% [95% CI 19.0-22.4], and increased with growing socioeconomic deprivation to 26.9% [25.0-28.8] in the most deprived regions [Q5]; P for trend <0.001). In rural areas, the frequency of DKA at diagnosis was significantly higher than in towns and suburbs (intermediate areas) or in cities (27.6% [95% CI 26.0-29.3] vs. 22.7% [21.4-24.0], P < 0.001, or vs. 24.3% [22.9-25.7], P = 0.007, respectively). The results did not significantly differ by age-group, sex, or migration background or after additional adjustment for socioeconomic deprivation or urbanization. CONCLUSIONS This study provides evidence that prevention of DKA at diagnosis by means of awareness campaigns and screening for presymptomatic type 1 diabetes should particularly target socioeconomically disadvantaged regions and rural areas.
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Affiliation(s)
- Marie Auzanneau
- Zentralinstitut für Biomedizinische Technik (ZIBMT), Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Katharina Warncke
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, Munich, Germany
| | - Werner Maier
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Clemens Kamrath
- Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Thomas Hofmann
- Pediatric Practice of the Medical Center Arnsberg, Hochsauerland Clinic, Arnsberg, Germany
| | - Michael Wurm
- St. Hedwig Clinic for Pediatric and Adolescent Medicine, Regensburg University, Hospital of the Order of St. John of God, Regensburg, Germany
| | - Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Carmen Schröder
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Greifswald, Greifswald, Germany
| | - Kathrin Hake
- Children's Hospital, Müritzklinikum Waren, Waren, Germany
| | - Reinhard W Holl
- Zentralinstitut für Biomedizinische Technik (ZIBMT), Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Małachowska B, Pietrowska K, Młynarski W, Szadkowska A, Krętowski A, Ciborowski M, Fendler W. Multi-Timepoint Metabolic Fingerprinting of a Post-Episode Period of Hypoglycemia and Ketoacidosis Among Children With Type 1 Diabetes. Front Mol Biosci 2022; 9:869116. [PMID: 35813820 PMCID: PMC9259852 DOI: 10.3389/fmolb.2022.869116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Acute complications of type 1 diabetes mellitus such as diabetes ketoacidosis (DKA) and hypoglycemia (HG) are detrimental in a short- and long-term perspective. Restoration of normoglycemia and correction of pH do not mean that all metabolic disturbances caused by HG or DKA are immediately reversed. Aim: This study aimed to identify serum metabolic changes caused by an episode of DKA and HG that may indicate the mechanisms contributing to long-term consequences of DKA/HG. Materials and methods: Four groups of children with type 1 diabetes were recruited. The first two study groups included patients after an episode of DKA or HG, respectively. Additionally, two comparative groups were recruited—children with established type 1 diabetes (EDM) and patients with newly diagnosed diabetes without diabetes ketoacidosis (NDM). Serum samples were collected in three group-specific time points (since the hospital admission): HG 0h-12h–48h; DKA or NDM 0h-24h–72 h; and one random fasting sample from patients with EDM. Two batches of 100 samples each were created: for DKA batch 20 × 3 DKA patients, 10 × 3 NDM and 10 EDM; for HG batch: 10 × 3 HG patients, 25 EDM and 15 × 3 NDM. All patients within the batches were age and sex matched. Metabolic fingerprinting was performed with LC-QTOF-MS. Results: Four metabolites were associated with a DKA episode occurring in the preceding 72 h: three were found higher after the DKA episode versus comparative groups: lysophosphatidylcholine (LPC) (18:1), sphingomyelins (SM) (34:0 and d18:0/15:0), and one was found lower: LPC (18:0). Similarly, four metabolites were identified for the HG episode in the last 48 h: three were found higher after the HG episode versus comparative groups: two lysophosphatidylethanolamines (LPE) (18:2 and 20:3) and one LPC (18:2); and one was found lower after the HG episode: oxy-phosphatidylocholine (PC O-34:4). Conclusions: We found eight metabolites whose levels may be traced in the serum, indicating the DKA or HG episode for up to 72 h and 48 h, respectively. Acute complications of diabetes may cause persistent metabolic disturbances long after pH and glucose level normalization.
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Affiliation(s)
- Beata Małachowska
- Medical University of Lodz, Department of Biostatistics and Translational Medicine, Łódź, Poland
| | - Karolina Pietrowska
- Medical University of Bialystok, Clinical Research Center, Metabolomics Laboratory, Białystok, Poland
| | - Wojciech Młynarski
- Medical University of Lodz, Department of Pediatric Oncology and Hematology, Łódź, Poland
| | - Agnieszka Szadkowska
- Medical University of Lodz, Department of Pediatrics, Diabetology Endocrinology and Nephrology, Łódź, Poland
| | - Adam Krętowski
- Medical University of Bialystok, Clinical Research Center, Metabolomics Laboratory, Białystok, Poland
- Medical University of Bialystok, Department of Endocrinology, Diabetology and Internal Medicine, Bialystok, Poland
| | - Michał Ciborowski
- Medical University of Bialystok, Clinical Research Center, Metabolomics Laboratory, Białystok, Poland
| | - Wojciech Fendler
- Medical University of Lodz, Department of Biostatistics and Translational Medicine, Łódź, Poland
- Dana-Farber Cancer Institute, Department of Radiation Oncology, Boston, MA, United States
- *Correspondence: Wojciech Fendler,
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40
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Li GH, Huang K, Dong GP, Zhang JW, Gong CX, Luo FH, Luo XP, Wang CL, Zhu M, Li P, Wang L, Fu JF. Clinical Incidence and Characteristics of Newly Diagnosed Type 1 Diabetes in Chinese Children and Adolescents: A Nationwide Registry Study of 34 Medical Centers. Front Pediatr 2022; 10:888370. [PMID: 35783304 PMCID: PMC9242427 DOI: 10.3389/fped.2022.888370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the clinical incidence and characteristics of type 1 diabetes mellitus (T1DM) of children and adolescents at the time of initial diagnosis in China. Methods Data on all pediatric patients with newly diagnosed T1DM were retrospectively collected from 34 medical centers in 25 major cities in China from January 2015 to January 2020. Patients were classified into three age groups: <5 years, 5 to <10 years, and ≥10 years of age. The same patient population was also categorized into diabetic ketoacidosis (DKA) and non-DKA groups based on clinical criteria. Results The mean annual clinical incidence of T1DM was 3.16/100,000 from the years 2015 to 2019. A total of 6,544 patients with newly diagnosed T1DM aged 0-16 years (median 7.84 ± 3.8) were studied [ages <5 years (29.3%), 5 to <10 years (38.7%), and ≥10 years (32%)], 52.4% of them were women. In total, 90.5% of the cases were occurred in individuals without a family history. Patients had lower C-peptide (CP) and body mass index (BMI) z scores when compared with healthy children, 41.8% of them had measurable T1DM-related antibodies and 52.7% had DKA. Among all three age groups, the <5 years group had the lowest BMI z score, CP, and glycated hemoglobin (HbA1c) on average, while it had the highest incidence rate of DKA (56.9%). Compared to the non-DKA group, the DKA group was significantly younger, with a lower BMI z score and CP, higher antibody positive rate, HbA1c, and the rate of insulin pump therapy. Conclusion The clinical incidence of T1DM in children and adolescents in China was 3.16/100,000. Patients with DKA at the first diagnosis of T1DM have a worse β-cell function. Public health measures for the prevention and treatment of T1DM should focus on preschoolers (aged <5 years) in particular, considering the severity and the highest frequency of DKA in this age group. More efforts should be dedicated to early screening and diagnosis of the T1DM.
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Affiliation(s)
- Guo-Hua Li
- The Children's Hospital of the Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ke Huang
- The Children's Hospital of the Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guan-Ping Dong
- The Children's Hospital of the Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jian-Wei Zhang
- Department of Pediatrics, Shaoxing Maternal and Child Health Care Hospital, Hangzhou, China
| | - Chun-Xiu Gong
- Endocrinology, Genetics, and Metabolism, Beijing Diabetes Center for Children and Adolescents, Medical Genetics Department, Beijing Children's Hospital, Beijing, China
| | - Fei-Hong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Xiao-Ping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun-Lin Wang
- Department of Pediatric, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Min Zhu
- Department of Endocrinology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Pin Li
- Department of Endocrinology, Shanghai Children's Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Ling Wang
- Laboratory for Translational Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Jun-Fen Fu
- The Children's Hospital of the Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Clapin H, Smith G, Vijayanand S, Jones T, Davis E, Haynes A. Moderate and severe diabetic ketoacidosis at type 1 diabetes onset in children over two decades: A population-based study of prevalence and long-term glycemic outcomes. Pediatr Diabetes 2022; 23:473-479. [PMID: 35218122 DOI: 10.1111/pedi.13327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/13/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate in a population-based pediatric cohort: prevalence of moderate-severe diabetic ketoacidosis (DKA) at type 1 diabetes (T1D) diagnosis over two decades and its association with long-term glycemic control. RESEARCH DESIGN AND METHODS Children <16 years diagnosed with T1D in Western Australia 2000-2019 were included and followed up for ≤14 years. Moderate-severe DKA at diagnosis was defined as serum pH < 7.2 or bicarbonate<10 mmol/L with hyperglycemia and ketosis. HbA1c was measured ~3-monthly. Trend in prevalence of moderate-severe DKA at diagnosis was investigated using a logistic regression model adjusting for sex, age, socioeconomic status, and area of residence. Long-term glycemic control associated with DKA at diagnosis was investigated using linear mixed models adjusting for the same variables and also for visit frequency, CGM and pump use. RESULTS Moderate-severe DKA occurred in 534 of 2111 (25.3%) participants. Odds of presenting with moderate-severe DKA increased by 4.1% (95% CI: 2.3, 5.9; p < 0.001) per year. Patients with moderate-severe DKA at diagnosis had higher HbA1c levels than other patients initially; the groups were similar between 2 and 6 years duration; from 7 years HbA1c levels tracked higher in the group with moderate-severe DKA at diagnosis with significant differences at 8 and 12 years (p < 0.05). CONCLUSION The increasing prevalence of DKA at diagnosis of pediatric T1D is concerning and highlights the need for early detection programs. Unlike a similar US study, this study did not find a consistent, clinically significant relationship between DKA at diagnosis and long-term HbA1c, raising important questions about the influence of other factors on long-term glycemic outcomes.
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Affiliation(s)
- Helen Clapin
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Grant Smith
- Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Sathyakala Vijayanand
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Timothy Jones
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Elizabeth Davis
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
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Seo YJ, Kum CD, Rho JG, Shim YS, Lee HS, Hwang JS. Comparison of the clinical characteristics and outcomes of pediatric patients with and without diabetic ketoacidosis at the time of type 1 diabetes diagnosis. Ann Pediatr Endocrinol Metab 2022; 27:126-133. [PMID: 35073669 PMCID: PMC9260367 DOI: 10.6065/apem.2142174.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We investigated the possible effects of diabetic ketoacidosis (DKA) at the initial diagnosis of type 1 diabetes mellitus (T1DM) on the clinical outcomes of pediatric patients. METHODS Medical records of children and adolescents with newly diagnosed T1DM seen in the Ajou University Hospital from January 2008 to August 2020 were reviewed and analyzed. RESULTS Among 129 diagnosed T1DM patients, 40.3% presented with DKA. Although demographic and basic characteristics did not differ between DKA and non-DKA patients, DKA patients needed a significantly higher insulin dosage than non-DKA patients for 2 years after diagnosis. However, control of glycated hemoglobin was not different between the DKA and non-DKA groups during the observation period. In the biochemical analysis, C-peptide, insulin-like growth factor-1, and insulin-like growth factor binding protein 3, high-density lipoprotein cholesterol, free T4, and T3 values were lower, but thyroid-stimulating hormone, initial serum glucose, uric acid, total cholesterol, triglyceride, and low-density lipoprotein cholesterol values were higher in DKA patients than non-DKA patients at the diagnosis of T1DM; however, these differences were temporarily present and disappeared with insulin treatment. Other clinical outcomes, such as height, thyroid function, and urine microalbumin level, did not vary significantly between the DKA and non-DKA groups during 5 years of follow-up. CONCLUSION DKA at initial presentation reflects the severity of disease progression, and the deleterious effects of DKA seem to impact insulin secretion. Although no difference in long-term prognosis was found, early detection of T1DM should help to reduce DKA-related islet damage and the socioeconomic burden of T1DM.
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Affiliation(s)
- Young-Jun Seo
- Department of Pediatrics, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Chang Dae Kum
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jung Gi Rho
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Young Suk Shim
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hae Sang Lee
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea,Address for correspondence: Jin Soon Hwang
Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, 164 World cupro, Yeongtong-gu, Suwon 16499, Republic of Korea
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43
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Karl FM, Winkler C, Ziegler AG, Laxy M, Achenbach P. Costs of Public Health Screening of Children for Presymptomatic Type 1 Diabetes in Bavaria, Germany. Diabetes Care 2022; 45:837-844. [PMID: 35156126 DOI: 10.2337/dc21-1648] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/09/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to evaluate costs associated with public health screening for presymptomatic type 1 diabetes in 90,632 children as part of the Fr1da study in Bavaria and in forecasts for standard care. RESEARCH DESIGN AND METHODS We report on resource use and direct costs for screening-related procedures in the Fr1da study coordination center and laboratory and in participating pediatric practices and local diabetes clinics. Data were obtained from Fr1da study documents, an online survey among pediatricians, and interviews and records of Fr1da staff members. Data were analyzed with tree models that mimic procedures during the screening process. Cost estimates are presented as they were observed in the Fr1da study and as they can be expected in standard care for various scenarios. RESULTS The costs per child screened in the Fr1da study were €28.17 (95% CI 19.96; 39.63) and the costs per child diagnosed with presymptomatic type 1 diabetes were €9,117 (6,460; 12,827). Assuming a prevalence of presymptomatic type 1 diabetes of 0.31%, as in the Fr1da study, the estimated costs in standard care in Germany would be €21.73 (16.76; 28.19) per screened child and €7,035 (5,426; 9,124) per diagnosed child. Of the projected screening costs, €12.25 would be the costs in the medical practice, €9.34 for coordination and laboratory, and €0.14 for local diabetes clinics. CONCLUSIONS This study provides information for the planning and implementation of screening tests for presymptomatic type 1 diabetes in the general public and for the analysis of the cost-effectiveness of targeted prevention strategies.
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Affiliation(s)
- Florian M Karl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Garching, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Christiane Winkler
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute of Diabetes Research, Helmholtz Zentrum München, Munich-Neuherberg, Germany
| | - Anette-Gabriele Ziegler
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute of Diabetes Research, Helmholtz Zentrum München, Munich-Neuherberg, Germany.,Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Garching, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany.,Faculty of Sport and Health Science, Technical University of Munich, Munich, Germany.,Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Peter Achenbach
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute of Diabetes Research, Helmholtz Zentrum München, Munich-Neuherberg, Germany.,Forschergruppe Diabetes, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
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44
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Sims EK, Besser RE, Dayan C, Geno Rasmussen C, Greenbaum C, Griffin KJ, Hagopian W, Knip M, Long AE, Martin F, Mathieu C, Rewers M, Steck AK, Wentworth JM, Rich SS, Kordonouri O, Ziegler AG, Herold KC. Screening for Type 1 Diabetes in the General Population: A Status Report and Perspective. Diabetes 2022; 71:610-623. [PMID: 35316839 PMCID: PMC9114719 DOI: 10.2337/dbi20-0054] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/05/2022] [Indexed: 01/10/2023]
Abstract
Most screening programs to identify individuals at risk for type 1 diabetes have targeted relatives of people living with the disease to improve yield and feasibility. However, ∼90% of those who develop type 1 diabetes do not have a family history. Recent successes in disease-modifying therapies to impact the course of early-stage disease have ignited the consideration of the need for and feasibility of population screening to identify those at increased risk. Existing population screening programs rely on genetic or autoantibody screening, and these have yielded significant information about disease progression and approaches for timing for screening in clinical practice. At the March 2021 Type 1 Diabetes TrialNet Steering Committee meeting, a session was held in which ongoing efforts for screening in the general population were discussed. This report reviews the background of these efforts and the details of those programs. Additionally, we present hurdles that need to be addressed for successful implementation of population screening and provide initial recommendations for individuals with positive screens so that standardized guidelines for monitoring and follow-up can be established.
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Affiliation(s)
- Emily K. Sims
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Rachel E.J. Besser
- Department of Paediatrics, National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, U.K
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, U.K
| | - Colin Dayan
- Cardiff University School of Medicine, Cardiff, U.K
| | - Cristy Geno Rasmussen
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | | | | | - Mikael Knip
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
| | - Anna E. Long
- Bristol Medical School, University of Bristol, Bristol, U.K
| | | | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Marian Rewers
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - John M. Wentworth
- Departments of Diabetes and Endocrinology and Population Health and Immunity, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Olga Kordonouri
- Kinder und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Anette-Gabriele Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Kevan C. Herold
- Department of Immunobiology and Department of Internal Medicine, Yale University, New Haven, CT
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45
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Jacobsen LM, Vehik K, Veijola R, Warncke K, Toppari J, Steck AK, Gesualdo P, Akolkar B, Lundgren M, Hagopian WA, She JX, Rewers M, Ziegler AG, Krischer JP, Larsson HE, Haller MJ. Heterogeneity of DKA Incidence and Age-Specific Clinical Characteristics in Children Diagnosed With Type 1 Diabetes in the TEDDY Study. Diabetes Care 2022; 45:624-633. [PMID: 35043162 PMCID: PMC8918232 DOI: 10.2337/dc21-0422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 12/11/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Environmental Determinants of Diabetes in the Young (TEDDY) study is uniquely capable of investigating age-specific differences associated with type 1 diabetes. Because age is a primary driver of heterogeneity in type 1 diabetes, we sought to characterize by age metabolic derangements prior to diagnosis and clinical features associated with diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS The 379 TEDDY children who developed type 1 diabetes were grouped by age at onset (0-4, 5-9, and 10-14 years; n = 142, 151, and 86, respectively) with comparisons of autoantibody profiles, HLAs, family history of diabetes, presence of DKA, symptomatology at onset, and adherence to TEDDY protocol. Time-varying analysis compared those with oral glucose tolerance test data with TEDDY children who did not progress to diabetes. RESULTS Increasing fasting glucose (hazard ratio [HR] 1.09 [95% CI 1.04-1.14]; P = 0.0003), stimulated glucose (HR 1.50 [1.42-1.59]; P < 0.0001), fasting insulin (HR 0.89 [0.83-0.95]; P = 0.0009), and glucose-to-insulin ratio (HR 1.29 [1.16-1.43]; P < 0.0001) were associated with risk of progression to type 1 diabetes. Younger children had fewer autoantibodies with more symptoms at diagnosis. Twenty-three children (6.1%) had DKA at onset, only 1 (0.97%) of 103 with and 22 (8.0%) of 276 children without a first-degree relative (FDR) with type 1 diabetes (P = 0.008). Children with DKA were more likely to be nonadherent to study protocol (P = 0.047), with longer duration between their last TEDDY evaluation and diagnosis (median 10.2 vs. 2.0 months without DKA; P < 0.001). CONCLUSIONS DKA at onset in TEDDY is uncommon, especially for FDRs. For those without familial risk, metabolic monitoring continues to provide a primary benefit of reduced DKA but requires regular follow-up. Clinical and laboratory features vary by age at onset, adding to the heterogeneity of type 1 diabetes.
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Affiliation(s)
| | - Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Riitta Veijola
- PEDEGO Research Unit, Department of Pediatrics, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Katharina Warncke
- Institute of Diabetes Research, Helmholtz Zentrum München and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, Centre for Population Health Research, University of Turku, Turku, Finland
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Patricia Gesualdo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Beena Akolkar
- Diabetes Division, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Markus Lundgren
- Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA
| | - Marian Rewers
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Anette-G. Ziegler
- PEDEGO Research Unit, Department of Pediatrics, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jeffrey P. Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Helena Elding Larsson
- Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
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46
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Steck AK, Dong F, Geno Rasmussen C, Bautista K, Sepulveda F, Baxter J, Yu L, Frohnert BI, Rewers MJ. CGM Metrics Predict Imminent Progression to Type 1 Diabetes: Autoimmunity Screening for Kids (ASK) Study. Diabetes Care 2022; 45:365-371. [PMID: 34880069 DOI: 10.2337/dc21-0602] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Children identified with stage 1 type 1 diabetes are at high risk for progressing to stage 3 (clinical) diabetes and require accurate monitoring. Our aim was to establish continuous glucose monitoring (CGM) metrics that could predict imminent progression to diabetes. RESEARCH DESIGN AND METHODS In the Autoimmunity Screening for Kids study, 91 children who were persistently islet autoantibody positive (median age 11.5 years; 48% non-Hispanic White; 57% female) with a baseline CGM were followed for development of diabetes for a median of 6 (range 0.2-34) months. Of these, 16 (18%) progressed to clinical diabetes in a median of 4.5 (range 0.4-29) months. RESULTS Compared with children who did not progress to clinical diabetes (nonprogressors), those who did (progressors) had significantly higher average sensor glucose levels (119 vs. 105 mg/dL, P < 0.001) and increased glycemic variability (SD 27 vs. 16, coefficient of variation, 21 vs. 15, mean of daily differences 24 vs. 16, and mean amplitude of glycemic excursions 43 vs. 26, all P < 0.001). For progressors, 21% of the time was spent with glucose levels >140 mg/dL (TA140) and 8% of time >160 mg/dL, compared with 3% and 1%, respectively, for nonprogressors. In survival analyses, the risk of progression to diabetes in 1 year was 80% in those with TA140 >10%; in contrast, it was only 5% in the other participants. Performance of prediction by receiver operating curve analyses showed area under the curve of ≥0.89 for both individual and combined CGM metric models. CONCLUSIONS TA140 >10% is associated with a high risk of progression to clinical diabetes within the next year in autoantibody-positive children. CGM should be included in the ongoing monitoring of high-risk children and could be used as potential entry criterion for prevention trials.
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Goldman S, Pinhas-Hamiel O, Weinberg A, Auerbach A, German A, Haim A, Zung A, Brener A, Strich D, Azoulay E, Levy-Khademi F, Ludar H, Koren I, Rachmiel M, Yackobovitch-Gavan M, Zuckerman-Levin N, David O, Halloun R, Cahn R, Ben-Ari T, Yeshayahu Y, Landau Z, Phillip M, Lebenthal Y. Alarming increase in ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes during the first wave of the COVID-19 pandemic in Israel. Pediatr Diabetes 2022; 23:10-18. [PMID: 34865288 DOI: 10.1111/pedi.13296] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/02/2021] [Accepted: 11/26/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the incidence and severity of ketoacidosis (DKA) at type 1 diabetes diagnosis during the first wave of the coronavirus disease 2019 (COVID-19) pandemic in Israel. RESEARCH DESIGN AND METHODS A population-based study the product of a national collaboration of Israeli pediatric diabetes centers investigated the presentation of childhood-onset type 1 diabetes. The frequencies of DKA and severe DKA observed during the COVID-19 period from March 15, 2020 (commencement of the first nationwide lockdown) until June 30, 2020 were compared with the same periods in 2019, 2018, and 2017 using multivariable logistic regression, adjusting for age, sex, and socioeconomic position. RESULTS During the COVID-19 period, DKA incidence was 58.2%, significantly higher than in 2019 (adjusted OR [aOR] 2.18 [95% CI, 1.31-3.60], P = 0.003); 2018 (aOR 2.05 [95% CI, 1.26-3.34], P = 0.004); and 2017 (aOR, 1.79 [95% CI, 1.09-2.93], P = 0.022). The incidence of severe DKA was 19.9%, significantly higher than in 2018 (aOR, 2.49 [95% CI, 1.20-5.19], P = 0.015) and 2017 (aOR, 2.73 [95% CI, 1.28-5.82], P = 0.009). In 2020, admissions and duration of stay in the intensive care unit were higher than in previous years (P = 0.001). During the COVID-19 pandemic, children aged 6-11 years had higher incidences of DKA (61.3% vs. 34.0%, 40.6%, and 45.1%, respectively, P = 0.012), and severe DKA (29.3% vs. 15.1%, 10.9%, and 5.9%, respectively, P = 0.002). CONCLUSIONS The dramatic increase in DKA at presentation of childhood-onset type 1 diabetes during the COVID-19 pandemic mandates targeted measures to raise public and physician awareness.
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Affiliation(s)
- Shira Goldman
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adi Weinberg
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Adi Auerbach
- Pediatric Endocrinology and Diabetes Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alina German
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alon Haim
- Pediatric Endocrinology and Metabolic Unit, Soroka University Medical Center, Beer Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amnon Zung
- The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Endocrinology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Avivit Brener
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Strich
- Pediatric Endocrinology and Diabetes Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Specialist Clinic, Clalit Health Services, Jerusalem, Israel
| | - Erez Azoulay
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Floris Levy-Khademi
- Pediatric Endocrinology and Diabetes Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hanna Ludar
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Endocrine Unit, Ha'Emek Medical Center, Afula, Israel
| | - Ilana Koren
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Endocrinology and Diabetes Unit, Carmel Medical Center, Clalit Health Services, Haifa, Israel
| | - Marianna Rachmiel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nehama Zuckerman-Levin
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Diabetes Clinic, Diabetes, Endocrinology, and Metabolism Institute, Rambam Health Care Campus, Haifa, Israel
| | - Odeya David
- Pediatric Endocrinology and Metabolic Unit, Soroka University Medical Center, Beer Sheva, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Rana Halloun
- Pediatric Diabetes Clinic, Diabetes, Endocrinology, and Metabolism Institute, Rambam Health Care Campus, Haifa, Israel.,Pediatric Endocrinology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Ranit Cahn
- The School of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tal Ben-Ari
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology Unit, Edith Wolfson Medical Center, Holon, Israel
| | - Yonatan Yeshayahu
- Pediatric Endocrinology and Diabetes Unit, Assuta Ashdod Hospital, Ashdod, Israel.,Goldman School of Medicine, Ben-Gurion University, Beer-Sheva, Israel
| | - Zohar Landau
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatrics Department, Barzilai Medical Center, Ashkelon, Israel
| | - Moshe Phillip
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yael Lebenthal
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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48
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Nagl K, Waldhör T, Hofer SE, Fritsch M, Meraner D, Prchla C, Rami-Merhar B, Fröhlich-Reiterer E. Alarming Increase of Ketoacidosis Prevalence at Type 1 Diabetes-Onset in Austria-Results From a Nationwide Registry. Front Pediatr 2022; 10:820156. [PMID: 35237540 PMCID: PMC8882618 DOI: 10.3389/fped.2022.820156] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We analyzed the annual prevalence of onset-DKA (diabetic ketoacidosis) from 2012 to 2020 with a sub-analysis for lockdown-periods during the COVID-19 pandemic in 2020. DESIGN All newly diagnosed children with type 1 diabetes (T1D) aged <15 years are prospectively registered in the population-based Austrian Diabetes Incidence Study in Austria. MAIN OUTCOME MEASURES The annual DKA prevalence was analyzed using Joinpoint regression. Definition of DKA: pH <7.3, mild DKA: pH 7.3 to ≤ 7.1, severe DKA: pH <7.1. DKA prevalence during the lockdown periods in 2020 and the corresponding periods in 2015-2019 were examined using Fisher's exact test. RESULTS In the years 2012-2020 the mean prevalence for onset-DKA in Austria was 43.6% [95%CI (confidence interval): 41.6, 45.7] and thus above the mean prevalence of previous decades (1989-2011) of 37,1 % (95%CI: 35.6, 38.6). A particularly high prevalence was found among children <2 years of age (72.0% DKA, 32.8% severe DKA). No significant gender difference was found. Prevalence of severe DKA at T1D-onset increased significantly since 2015 (p = 0.023). During the lockdown in 2020, 59.3% of children were diagnosed with DKA at T1D-onset, compared to 42.1% during the previous 5 years (p = 0.022). Moreover, 20% of children had severe DKA at T1D diagnosis, compared to 14% during the comparison period. CONCLUSIONS The previously already high prevalence of DKA at T1D-onset has further increased over time. The COVID-19 pandemic has exacerbated the problem of a late or delayed diagnosis of diabetes in children resulting in onset-DKA. The alarmingly increased prevalence of DKA in Austrian children with T1D calls for urgent action.
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Affiliation(s)
- Katrin Nagl
- Department for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Waldhör
- Department for Epidemiology, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Sabine E Hofer
- Department for Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Dagmar Meraner
- Department for Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Birgit Rami-Merhar
- Department for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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49
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Alfayez OM, Aldmasi KS, Alruwais NH, Bin Awad NM, Al Yami MS, Almohammed OA, Almutairi AR. Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies. Front Endocrinol (Lausanne) 2022; 13:856958. [PMID: 35355556 PMCID: PMC8959619 DOI: 10.3389/fendo.2022.856958] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/08/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous reports suggest that the Coronavirus Disease-2019 (COVID-19) pandemic might have affected incidences of diabetic ketoacidosis (DKA) and new diagnoses of type 1 diabetes. This systematic review and meta-analysis aimed to estimate the risk of DKA, including severe DKA, during the COVID-19 pandemic versus the prior-to-COVID-19 period among pediatric patients with type 1 diabetes. METHODS PubMed and EMBASE were searched for observational studies investigating the risk of DKA among pediatric patients with type 1 diabetes during the COVID-19 pandemic and the prior-to-COVID-19 period. A random meta-analysis model was performed to estimate the relative risk of DKA during the COVID-19 pandemic compared to before the pandemic. Subgroup analyses were conducted based on the type 1 diabetes status, established or newly diagnosed. In addition, sensitivity analysis was conducted for studies that reported results from adjusted analysis for potential confounders using fixed effect model. RESULTS A total of 20 observational studies reported the risk of DKA, of which 18 reported the risk of severe DKA. The risks of DKA and severe DKA were 35% (RR 1.35, 95%CI 1.2-1.53, I2 = 71%) and 76% (RR 1.76, 95%CI 1.33-2.33, I2 = 44%) higher in the during-COVID-19 group compared to the prior-to-COVID-19 group, respectively. Among patients with newly diagnosed type 1 diabetes, the risk of DKA was 44% higher for the during-COVID-19 group compared to the prior-to-COVID-19 group (RR 1.44, 95%CI 1.26-1.65; I2 = 64%). Only two studies reported the risk of DKA among patients with established type 1 diabetes and the cumulative risk was not statistically significant. In the sensitivity analysis, four studies reported an adjusted odds ratio (aOR) of the risk of DKA during COVID-19 compared to the prior-to-COVID-19 period. The fixed estimate from the meta-analysis found an increase in the risk of DKA in the during-COVID-19 group compared to the prior-to-COVID-19 group (aOR 2.04, 95%CI 1.66-2.50). CONCLUSIONS This study showed that DKA risk, especially the risk of severe DKA, has increased significantly during the pandemic. Healthcare systems must be aware and prepared for such an increase in DKA cases and take all necessary measures to prevent future spikes during the pandemic. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272775, identifier PROSPERO [CRD42021272775].
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Affiliation(s)
- Osamah M. Alfayez
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
- *Correspondence: Osamah M. Alfayez,
| | | | - Nada H. Alruwais
- College of Pharmacy, University of Shaqra, Al Dawadmi, Saudi Arabia
| | - Nouf M. Bin Awad
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, United States
| | - Majed S. Al Yami
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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50
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Affiliation(s)
- R E J Besser
- Department of Paediatrics, NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - S M Ng
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Department of Paediatrics, Southport and Ormskirk NHS Trust, Southport, UK
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