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Woelfle T, Linkohr B, Waterboer T, Thorand B, Seissler J, Chadeau-Hyam M, Peters A. Health impact of seven herpesviruses on (pre)diabetes incidence and HbA 1c: results from the KORA cohort. Diabetologia 2022; 65:1328-1338. [PMID: 35538159 PMCID: PMC9090457 DOI: 10.1007/s00125-022-05704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS The prevalence of type 2 diabetes is increasing worldwide, and previous studies have suggested that it is higher in individuals who are seropositive for herpesviruses. This study examines the prospective association of herpesviruses with (pre)diabetes to evaluate their potential role in diabetes aetiology. METHODS Two follow-up examinations of the German population-based KORA cohort (F4 and FF4) were used to identify participants with normal glucose tolerance at baseline, thus being at risk for (pre)diabetes (n = 1257). All participants had repeated OGTTs and antibody measurements for herpes simplex virus (HSV) 1 and 2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus (CMV) and human herpesvirus 6 and 7. Regression models were used to evaluate the association between serostatus with (pre)diabetes incidence after a 7 year follow-up and HbA1c. RESULTS HSV2 and CMV were associated with (pre)diabetes incidence after adjustment for sex, age, BMI, education, smoking, physical activity, parental diabetes, hypertension, lipid levels, insulin resistance and fasting glucose. Seropositivity of both viruses was also cross-sectionally associated with higher HbA1c at baseline, with the association of HSV2 being independent of confounders, including the prevalence of (pre)diabetes itself. While seropositivity for multiple herpesviruses was associated with a higher incidence of (pre)diabetes, this association was not independent of confounders. CONCLUSIONS/INTERPRETATION The associations of HSV2 and CMV serostatus with (pre)diabetes incidence indicate that these herpesviruses may contribute to the development of impaired glucose metabolism. Our results highlight the link between viral infection and (pre)diabetes, and the need for more research evaluating viral prevention strategies.
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Affiliation(s)
- Tim Woelfle
- Institute of Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians University, Munich, Germany
- School of Public Health, Imperial College London, London, UK
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Jochen Seissler
- Diabetes Centre, Medical Clinic and Policlinic IV, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | | | - Annette Peters
- Institute of Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians University, Munich, Germany.
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
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2
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Everett EM, Copeland TP, Moin T, Wisk LE. Insulin Pump-related Inpatient Admissions in a National Sample of Youth With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:e2381-e2387. [PMID: 35196382 PMCID: PMC9113825 DOI: 10.1210/clinem/dgac047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Insulin pump use in type 1 diabetes management has significantly increased in recent years, but we have few data on its impact on inpatient admissions for acute diabetes complications. METHODS We used the 2006, 2009, 2012, and 2019 Kids' Inpatient Database to identify all-cause type 1 diabetes hospital admissions in those with and without documented insulin pump use and insulin pump failure. We described differences in (1) prevalence of acute diabetes complications, (2) severity of illness during hospitalization and disposition after discharge, and (3) length of stay (LOS) and inpatient costs. RESULTS We identified 228 474 all-cause admissions. Insulin pump use was documented in 7% of admissions, of which 20% were due to pump failure. The prevalence of diabetic ketoacidosis (DKA) was 47% in pump nonusers, 39% in pump users, and 60% in those with pump failure. Admissions for hyperglycemia without DKA, hypoglycemia, sepsis, and soft tissue infections were rare and similar across all groups. Admissions with pump failure had a higher proportion of admissions classified as major severity of illness (14.7%) but had the lowest LOS (1.60 days, 95% CI 1.55-1.65) and healthcare costs ($13 078, 95% CI $12 549-$13 608). CONCLUSIONS Despite the increased prevalence of insulin pump in the United States, a minority of pediatric admissions documented insulin pump use, which may represent undercoding. DKA admission rates were lower among insulin pump users compared to pump nonusers. Improved accuracy in coding practices and other approaches to identify insulin pump users in administrative data are needed, as are interventions to mitigate risk for DKA.
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Affiliation(s)
- Estelle M Everett
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Timothy P Copeland
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Tannaz Moin
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lauren E Wisk
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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3
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Piccolo G, De Rose EL, Bassi M, Napoli F, Minuto N, Maghnie M, Patti G, d’Annunzio G. Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review. Front Endocrinol (Lausanne) 2022; 13:966344. [PMID: 36093078 PMCID: PMC9449538 DOI: 10.3389/fendo.2022.966344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Diabetes mellitus (DM) has been frequently associated with an impaired immune response against infectious agents, making affected patients at risk for more severe disease and sometimes causing worse outcomes. The recent COVID-19 pandemic has seriously affected patients with both diabetes, in particular those carrying comorbidities or with poor glycemic control. As regards pediatric diabetes mellitus, the availability of more accurate and technological tools for glycemic management and the improved markers of metabolic control might mitigate the negative impact of infections. Notably, good metabolic control of diabetes since its diagnosis reduces not only the risk of microangiopathic complications but also of impaired immune response to infectious diseases. Therefore, vaccinations are strongly recommended. Our paper aims to provide the most updated evidence regarding infectious diseases in type 1 pediatric DM.
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Affiliation(s)
- Gianluca Piccolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Neuro-oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Gianluca Piccolo, ; Giuseppa Patti,
| | - Elena Lucia De Rose
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marta Bassi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Flavia Napoli
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Minuto
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppa Patti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Gianluca Piccolo, ; Giuseppa Patti,
| | - Giuseppe d’Annunzio
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Esposito S, Mariotti Zani E, Torelli L, Scavone S, Petraroli M, Patianna V, Predieri B, Iughetti L, Principi N. Childhood Vaccinations and Type 1 Diabetes. Front Immunol 2021; 12:667889. [PMID: 34512622 PMCID: PMC8427438 DOI: 10.3389/fimmu.2021.667889] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Type 1 diabetes (T1D) is the most common paediatric endocrine disease, and its frequency has been found to increase worldwide. Similar to all conditions associated with poorly regulated glucose metabolism, T1D carries an increased risk of infection. Consequently, careful compliance by T1D children with schedules officially approved for child immunization is strongly recommended. However, because patients with T1D show persistent and profound limitations in immune function, vaccines may evoke a less efficient immune response, with corresponding lower protection. Moreover, T1D is an autoimmune condition that develops in genetically susceptible individuals and some data regarding T1D triggering factors appear to indicate that infections, mainly those due to viruses, play a major role. Accordingly, the use of viral live attenuated vaccines is being debated. In this narrative review, we discussed the most effective and safe use of vaccines in patients at risk of or with overt T1D. Literature analysis showed that several problems related to the use of vaccines in children with T1D have not been completely resolved. There are few studies regarding the immunogenicity and efficacy of vaccines in T1D children, and the need for different immunization schedules has not been precisely established. Fortunately, the previous presumed relationship between vaccine administration and T1D appears to have been debunked, though some doubts regarding rotavirus vaccines remain. Further studies are needed to completely resolve the problems related to vaccine administration in T1D patients. In the meantime, the use of vaccines remains extensively recommended in children with this disease.
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Affiliation(s)
- Susanna Esposito
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Elena Mariotti Zani
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Lisa Torelli
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Sara Scavone
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Maddalena Petraroli
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Viviana Patianna
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Principi
- Paediatric Clinic, Department of Medicine and Surgery, University Hospital, University of Parma, Parma, Italy
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5
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Chávez-Reyes J, Escárcega-González CE, Chavira-Suárez E, León-Buitimea A, Vázquez-León P, Morones-Ramírez JR, Villalón CM, Quintanar-Stephano A, Marichal-Cancino BA. Susceptibility for Some Infectious Diseases in Patients With Diabetes: The Key Role of Glycemia. Front Public Health 2021; 9:559595. [PMID: 33665182 PMCID: PMC7921169 DOI: 10.3389/fpubh.2021.559595] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023] Open
Abstract
Uncontrolled diabetes results in several metabolic alterations including hyperglycemia. Indeed, several preclinical and clinical studies have suggested that this condition may induce susceptibility and the development of more aggressive infectious diseases, especially those caused by some bacteria (including Chlamydophila pneumoniae, Haemophilus influenzae, and Streptococcus pneumoniae, among others) and viruses [such as coronavirus 2 (CoV2), Influenza A virus, Hepatitis B, etc.]. Although the precise mechanisms that link glycemia to the exacerbated infections remain elusive, hyperglycemia is known to induce a wide array of changes in the immune system activity, including alterations in: (i) the microenvironment of immune cells (e.g., pH, blood viscosity and other biochemical parameters); (ii) the supply of energy to infectious bacteria; (iii) the inflammatory response; and (iv) oxidative stress as a result of bacterial proliferative metabolism. Consistent with this evidence, some bacterial infections are typical (and/or have a worse prognosis) in patients with hypercaloric diets and a stressful lifestyle (conditions that promote hyperglycemic episodes). On this basis, the present review is particularly focused on: (i) the role of diabetes in the development of some bacterial and viral infections by analyzing preclinical and clinical findings; (ii) discussing the possible mechanisms by which hyperglycemia may increase the susceptibility for developing infections; and (iii) further understanding the impact of hyperglycemia on the immune system.
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Affiliation(s)
- Jesús Chávez-Reyes
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Carlos E Escárcega-González
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico.,Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Erika Chavira-Suárez
- Unidad de Vinculación Científica de la Facultad de Medicina, Universidad Nacional Autónoma de México en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Angel León-Buitimea
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico.,Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Priscila Vázquez-León
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - José R Morones-Ramírez
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico.,Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Carlos M Villalón
- Departamento de Farmacobiología, Cinvestav-Coapa, Mexico City, Mexico
| | - Andrés Quintanar-Stephano
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - Bruno A Marichal-Cancino
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
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6
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d'Annunzio G, Maffeis C, Cherubini V, Rabbone I, Scaramuzza A, Schiaffini R, Minuto N, Piccolo G, Maghnie M. Caring for children and adolescents with type 1 diabetes mellitus: Italian Society for Pediatric Endocrinology and Diabetology (ISPED) statements during COVID-19 pandemia. Diabetes Res Clin Pract 2020; 168:108372. [PMID: 32827594 PMCID: PMC7438223 DOI: 10.1016/j.diabres.2020.108372] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022]
Abstract
AIMS Our study aimed to review the impact of COVID-19 pandemia in children and adolescents with type 1 diabetes mellitus, to analyze the clinical characteristics of the infection and to propose clinical practice recommendations from the Italian Society for Pediatric Endocrinology and Diabetology (ISPED). METHODS A literature search was carried out in the guideline databases, Medline and Embase and in Diabetes Societies websites until May 21st, 2020 for guidelines and recommendations on type 1 diabetes mellitus management during COVID-19 pandemic. RESULTS COVID-19 infection in pediatric patients seems to be clinically less severe than in adults; children have so far accounted for 1-5% of diagnosed cases, with a median age of 6.7 years (1 day-15 years) and better prognosis. Clinical manifestations include mild, moderate, severe disease up to critical illness. There is currently no evidence suggesting a higher risk of COVID-19 infection in children with diabetes than unaffected peers. Besides general recommendations for pediatric patients, ISPED has proposed specific measures for patients with diabetes. CONCLUSION COVID-19 outbreak modified type 1 diabetes management, and telemedicine has been demonstrating to be an effective new tool for patients care. Moreover psychological aspects deserve attention and future researchs are mandatory.
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Affiliation(s)
- Giuseppe d'Annunzio
- Pediatric Clinic and Endocrinology, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital, Verona, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | | | - Nicola Minuto
- Pediatric Clinic and Endocrinology, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gianluca Piccolo
- Pediatric Clinic and Endocrinology, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Pediatric Clinic and Endocrinology, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of General and Specialist Pediatric Sciences, Pediatric Clinic, IRCCS Giannina Gaslini Institute, University of Genova, Genoa, Italy
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7
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Calliari LE, Almeida FJ, Noronha RM. Infections in children with diabetes. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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8
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Calliari LE, Almeida FJ, Noronha RM. Infections in children with diabetes. J Pediatr (Rio J) 2020; 96 Suppl 1:39-46. [PMID: 31666181 PMCID: PMC9432288 DOI: 10.1016/j.jped.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The association between diabetes mellitus and infections is very common. These infections, even when mild, interfere with blood glucose control. The aim of this review is to describe infections that occur in children and adolescents with DM, as well as to provide recommendations on glycemia management during these episodes. SOURCE OF DATA A non-systematic review was carried out in the PubMed database, using the terms "diabetes mellitus," "infection," "children," and "adolescents." The most relevant publications were selected. SYNTHESIS OF DATA In addition to the usual community diseases, some infections may occur predominantly in diabetic patients, especially when there is inadequate glycemic control, and common infections can be more severe in these patients. Alterations caused by the disease itself and the immune response are responsible for the risk of higher frequency and severity of infections. During infections, an increase in blood glucose occurs and usually an increase in insulin dose is required. CONCLUSIONS Pediatric patients with diabetes have some immune system disorders that, when associated with high glycemia, increase the risk of infections and their severity, and should be promptly identified and treated. The presence of an infectious condition, in turn, raises blood glucose and increases the risk of decompensation, and pediatricians should be cautioned to intensify monitoring and insulin therapy, and to avoid the risk of DKA. It should also be noted that many infections are preventable and can be avoided with adequate vaccine coverage.
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Affiliation(s)
- Luis Eduardo Calliari
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, Unidade de Endocrinologia Pediátrica e Ambulatório de Diabetes Pediátrico, São Paulo, SP, Brasil.
| | - Flávia J Almeida
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, Unidade de Infectologia Pediátrica, São Paulo, SP, Brasil
| | - Renata Maria Noronha
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Pediatria, Ambulatório de Diabetes Pediátrico, São Paulo, SP, Brasil
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Auzanneau M, Rosenbauer J, Icks A, Karges B, Neu A, Ziegler R, Marg W, Kapellen T, Holterhus PM, Holl RW. Hospitalization in Pediatric Diabetes: A Nationwide Analysis of all Admission Causes for Germany in 2015. Exp Clin Endocrinol Diabetes 2019; 128:615-623. [PMID: 31426109 DOI: 10.1055/a-0972-1060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Regarding pediatric diabetes, hospital admission for acute complications of type 1 diabetes (T1D) has often been investigated, but little is known about other causes of hospitalization. This study aimed to explore the total burden of hospitalization in individuals with diabetes<20 years of age in Germany. METHODS Using the German Diagnosis-Related Groups data for 2015, we examined the frequencies of hospitalization with diabetes (20 251 inpatient cases), stratified by diabetes type [T1D, type 2 diabetes (T2D), other specified diabetes types (T3D), and unclear diabetes], and without diabetes (1 269 631 inpatient cases). Using estimates of the population at risk with T1D, T2D, and without diabetes, we evaluated hospitalization rates (per patient-year) by Poisson regression. For T1D, T2D, and T3D, we investigated the most frequent diagnoses and the median length of stay. Most analyses were stratified by sex, age-group and east/west residence. RESULTS Children and adolescents with diabetes had a 6 to 9 times higher hospitalization risk than peers without diabetes (hospitalization rate 0.09). The hospitalization rate was higher for T2D compared with T1D (0.84 vs. 0.53, P<0.001). In T2D, two-third of inpatient cases were not directly related to diabetes, and stay was shorter compared with T1D and T3D (3 vs. 4 and 5 days, respectively). In T1D, hospitalization was more frequent among girls than boys (0.58 vs. 0.49, P<0.001), and mostly due to "diabetes without complications" (65.7%). Hospitalization tended to be more frequent and longer in the youngest patients, and in those with east residence. CONCLUSION Hospitalization rate in pediatric diabetes in Germany remained high, especially for T2D patients, girls with T1D, and young children.
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Affiliation(s)
- Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Germany
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andreas Neu
- University Children's Hospital Tübingen, Tübingen, Germany
| | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Müenster, Germany
| | - Wolfgang Marg
- Center for Pediatrics and Adolescent Medicine, Bremen-Mitte Hospital, Bremen, Germany
| | - Thomas Kapellen
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Paul-Martin Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, Kiel, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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10
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Cui M, Fang Q, Zheng J, Shu Z, Chen Y, Fan Y, Zhao J, Wood C, Zhang T, Zeng Y. Kaposi's sarcoma-associated herpesvirus seropositivity is associated with type 2 diabetes mellitus: A case-control study in Xinjiang, China. Int J Infect Dis 2019; 80:73-79. [PMID: 30639407 DOI: 10.1016/j.ijid.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/24/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess the potential relationship between Kaposi's sarcoma-associated herpesvirus (KSHV) infection and type 2 diabetes mellitus (DM-2) in Xinjiang, China. METHODS A case-control study of consecutively included DM-2 patients and normal controls was conducted among the Uygur and Han populations in Xinjiang Uygur Autonomous Region, China. Blood samples were collected and KSHV seroprevalence, antibody titers, and viral load were investigated. Logistic regression analysis and multiple linear regression analysis were applied to explore determinants of the main outcome measures. RESULTS A total of 324 patients with DM-2 and 376 normal controls were included. The seroprevalence of KSHV was 49.1% (95% confidence interval (CI) 43.6-54.5%) for diabetic patients and 23.7% (95% CI 19.4-28.0%) for the control group. After adjusting for variables of ethnicity, sex, body mass index, occupation, educational level, marital status, age, and smoking and alcohol consumption habits, the association between DM-2 and KSHV infection still existed (odds ratio (OR) 2.94, 95% CI 2.05-4.22), and the risk of KSHV infection increased with glucose concentration (OR 1.35, 95% CI 1.21-1.51). KSHV was more likely to express both the latent and lytic antigens in diabetic patients (latent: OR 3.27, 95% CI 2.25-4.75; lytic: OR 3.99, 95% CI 2.68-5.93). Antibody titers and viral load increased in patients with higher blood glucose levels (p<0.001). CONCLUSIONS Patients with DM-2 have an elevated risk of KSHV infection. Both antibody titers and viral load increased with blood glucose levels.
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Affiliation(s)
- Meng Cui
- Key Laboratory of Xinjiang Endemic and Ethnic Disease and Department of Biochemistry, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Qiwen Fang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Jun Zheng
- Department of Stomatology, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Zhanjun Shu
- Division of AIDS Research, National Traditional Chinese Medicine Clinical Research Bases in Xinjiang, Urumqi 830000, China; The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830013, China
| | - Yin Chen
- The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830013, China
| | - Yage Fan
- Key Laboratory of Xinjiang Endemic and Ethnic Disease and Department of Biochemistry, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Juan Zhao
- Key Laboratory of Xinjiang Endemic and Ethnic Disease and Department of Biochemistry, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Charles Wood
- Nebraska Center of Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Yan Zeng
- Key Laboratory of Xinjiang Endemic and Ethnic Disease and Department of Biochemistry, School of Medicine, Shihezi University, Shihezi 832000, China.
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11
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Robinette ED, Brower L, Schaffzin JK, Whitlock P, Shah SS, Connelly B. Use of a Clinical Care Algorithm to Improve Care for Children With Hematogenous Osteomyelitis. Pediatrics 2019; 143:peds.2018-0387. [PMID: 30567715 DOI: 10.1542/peds.2018-0387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Acute hematogenous osteomyelitis (AHO) causes significant morbidity in children. Quality improvement (QI) methods have been used to successfully improve care and decrease costs through standardization for numerous conditions, including pediatric AHO. We embarked on a QI initiative to standardize our approach to the inpatient management of AHO, with a global aim of reducing inpatient costs. METHODS We used existing literature and local consensus to develop a care algorithm for the inpatient management of AHO. We used the Model for Improvement as the framework for the project, which included process mapping, failure mode analysis, and key driver identification. We engaged with institutional providers to achieve at least 80% consensus regarding specific key drivers and tested various interventions to support uptake of the care algorithm. RESULTS Fifty-seven patients were included. There were 31 patients in the preintervention cohort and 26 in the postintervention cohort, of whom 19 were managed per the algorithm. Mean inpatient charges decreased from $45 718 in the preintervention cohort to $32 895 in the postintervention cohort; length of stay did not change. Adherence to recommended empirical antimicrobial agents trended upward. CONCLUSIONS A simple and low-cost QI project was used to safely decrease the cost of inpatient care for pediatric AHO at a tertiary care children's hospital. A robust local consensus process proved to be a key component in the uptake of standardization.
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Affiliation(s)
| | - Laura Brower
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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