The Impact of Hypo- and Hyperglycemia on Cognition and Brain Development in Young Children with Type 1 Diabetes

Use of diabetes technology in children

Children with type 1 diabetes and their caregivers face numerous challenges navigating the unpredictability of this complex disease. Although the burden of managing diabetes remains significant, new technology has eased some of the load and allowed children with type 1 diabetes to achieve tighter glycaemic management without fear of excess hypoglycaemia. Continuous glucose monitor use alone improves outcomes and is considered standard of care for paediatric type 1 diabetes management. Similarly, automated insulin delivery (AID) systems have proven to be safe and effective for children as young as 2 years of age. AID use improves not only blood glucose levels but also quality of life for children with type 1 diabetes and their caregivers and should be strongly considered for all youth with type 1 diabetes if available and affordable. Here, we review key data on the use of diabetes technology in the paediatric population and discuss management issues unique to children and adolescents.

The effect of lavender and rosemary aromatherapy application on cognitive functions, anxiety, and sleep quality in the elderly with diabetes

OBJECTIVE

This study aimed to determine the effects of aromatherapy use on cognitive function, anxiety, and sleep quality in the elderly with diabetes.

METHODS

The study was conducted with 63 participants aged 65 and over. Participants were randomly divided into three groups: lavender, rosemary and control groups. The intervention continued for four weeks. Data was collected using the Blessed Orientation Concentration Test, State-Trait Anxiety Scale, and Pittsburgh Sleep Quality Scale. Data were analyzed using One-Way ANOVA, Mann-Whitney U/Kruskal-Wallis, Wilcoxon and Friedman tests.

RESULTS

In both intervention groups, the 4th week scores of cognitive functions, anxiety, and sleep quality after aromatherapy were significant compared to the baseline scores. In the control group, state anxiety scores were significantly higher in the 2nd and 4th weeks compared to the initial scores.

CONCLUSIONS

Inhaling lavender and rosemary has been observed to improve cognitive function and sleep quality and reduce anxiety levels. The effects of the essential oils used in the research were evaluated over four weeks. It is thought that studying for a longer period and with more samples would be beneficial. There is a need for studies examining its effects, especially in the elderly with diabetes.

Cognitive function 10 years after adolescent bariatric surgery

BACKGROUND

Adolescent bariatric surgery produces substantial weight loss and reduction of medical co-morbidities. Research in adult samples shows improved cognitive function postoperatively, although much less is known about the potential cognitive benefits of bariatric surgery in adolescents-especially at extended follow-up.

OBJECTIVE

Examine cognitive function 10 years after adolescent bariatric surgery.

SETTING

University hospital.

METHODS

A total of 99 young adults who underwent bariatric surgery as adolescents completed a computerized cognitive test battery as part of a larger 10-year postoperative assessment. All had been long-term participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study.

RESULTS

Cognitive dysfunction was prevalent on tests of attention and executive function (e.g., Continuous Performance Test - Reaction Time 30%; Maze Errors - Overrun 30%), and 53.5% met research criteria for mild cognitive impairment (MCI). Modified Poisson regression with robust error variance revealed participants with preoperative hypertension and those completing Roux-en-Y gastric bypass were more likely to meet criteria for MCI at 10-year follow-up.

CONCLUSIONS

The current findings indicate that cognitive deficits are common 10 years after bariatric surgery. Additional studies are needed to clarify possible cohort effects, determine whether these cognitive deficits persist to even later follow-up (e.g., 20 yr after surgery), and identify underlying mechanisms and mitigation strategies.

Psychosis Associated With Hyperglycemia in a Female Patient With Type 1 Diabetes Mellitus: A Case Report

This paper presents the case of a 22-year-old woman who was hospitalized multiple times with episodes of psychosis co-occurring with hyperglycemia. Her psychosis was characterized by auditory hallucinations, visual hallucinations, and disorganized speech and behavior. The patient has a prior medical history of type 1 diabetes mellitus (T1DM) and Graves' disease and was non-adherent to diabetic diet and medications. The patient is a Somalian refugee who moved to the United States (US) a year ago. We explore the relatively unique observation of hyperglycemia-induced psychosis in the patient, specifically in the context of autoimmune disorders. We also discuss some of the complexities associated with the cultural aspects of mental health and diabetes management in refugee communities and their implications in clinical practice.

Beyond HbA1c: Identifying Gaps in Glycemic Control Among Children and Young People with Type 1 Diabetes Using Continuous Glucose Monitoring

OBJECTIVES

To describe continuous glucose monitoring (CGM) derived glycemic variables, and study their association with HbA1c and socio-economic factors in young people with Type 1 diabetes mellitus (T1DM).

METHODS

Ninety-two participants [age 15.7 ± 5.0 y (mean ± SD), HbA1c 8.0 ± 1.5% (mean ± SD)] wore a professional CGM sensor for 14 d.

RESULTS

Median (IQR) time in range (TIR) was 41 (18)%. Participants spent 41 ± 20% of their day in hyperglycemia (>180 mg/dl), and 14 (13)% in hypoglycemia (<70 mg/dl). High glycemic variability (percent CV >36%) was seen in 92% participants. Older age at diagnosis was associated with higher TIR (β = 0.267, p = 0.01), lower time above range (TAR) (β = -0.352, p <0.001), but higher time below range (TBR) (β = 0.274, p = 0.006). The use of NPH vs. glargine basal insulin was associated with higher TBR (β = -0.262, p = 0.009) but lower TAR (β = 0.202, p = 0.041). HbA1c showed negative correlation with TIR (r = -0.449, p <0.001) and TBR (r = -0.466, p <0.001) and positive correlation with TAR (r = 0.580, p <0.001) and mean glucose (r = 0.589, p <0.001).

CONCLUSIONS

These data demonstrate wide gaps between the recommended vs. real world glycemic variables in patients with T1DM in this region on multiple daily insulin injections. CGM identifies glycemic variability and complements HbA1c in improving glycemic control.

Dynamic associations between glucose and ecological momentary cognition in Type 1 Diabetes

Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations.

Effectiveness of Non-pharmacological Interventions for Adolescents With Type 1 Diabetes in the Last Five Years: A Systematic Review and Meta-analysis

PURPOSE

Evidence on non-pharmacological interventions for adolescents with type 1 diabetes is unclear. This review aimed to evaluate the effectiveness of non-pharmacological intervention in adolescents with type 1 diabetes.

METHODS

We conducted a search on databases from November 11 to 19, 2022, for randomized controlled trials for the effects of non-pharmacological intervention in adolescents with type 1 diabetes. To identify recent research trends, we included studies published from 2017 to November 2022. The risk of bias was assessed using the Cochrane risk-of-bias tool 2.0. To estimate the effect size, a meta-analysis was performed using RevMan 5.4 program and R Studio.

RESULTS

A total of 45 studies were included in the systematic review. Among those, 30 studies were included in the meta-analysis. Non-pharmacological interventions were significantly effective in improving Glycated hemoglobin (HbA1c) (standardized mean difference [SMD] = -0.26, 95% confidence interval [CI]: -0.42, -0.09), quality of life (SMD = 0.44, 95% CI: 0.13 to 0.76), and anxiety (SMD = -0.91, 95% CI: -1.26, -0.56). Subgroup analysis showed that duration of intervention was not a covariate related to HbA1c levels.

CONCLUSIONS

Non-pharmacological interventions have shown effectiveness in improving the HbA1c, quality of life, and anxiety in adolescents with type 1 diabetes. Future studies with more rigorous methodology are needed to confirm and strengthen the validity of these findings. Additionally, attention to changes in the lipid profile and self-care motivation among adolescents with type 1 diabetes is warranted.

TRIAL REGISTRATION NUMBER

Prospective Register of Systematic Reviews (CRD42022382190).

MiniMed 780GTM in children with type 1 diabetes under seven years of age: Prospective open-label, single-arm, double-center, follow-up study

BACKGROUND

Given the steadily rising incidence of type 1 diabetes (T1D), particularly among the youngest preschool children, coupled with well-documented challenges of achieving and maintaining optimal metabolic control in this age group, there is a growing need for advanced technological devices.

OBJECTIVE

To evaluate glycaemic control in children below the age of seven with type 1 diabetes (T1D) and assess the safety of the advanced hybrid closed loop (AHCL) system in comparison to the previous treatment method, a sensor-augmented pump with predictive low-glucose suspend (SAP-PLGS).

METHOD

Data from 10 children (aged 2.60-6.98 years) with T1D who transitioned to the AHCL system from SAP-PLGS were analysed. SAP-PLGS records from two weeks prior to the initiation of AHCL were compared with records from the initial four weeks post-switch (excluding the training period). These data were examined at two 2-week intervals and compared with records from two weeks post six-month usage of the AHCL.

RESULTS

A significant decrease in the average nighttime glucose concentration was observed compared to pre-AHCL values (p= 0.001, concordance W = 0.53). The Glucose Management Indicator (GMI) value significantly decreased from 6.88 ± 0.37% to 6.52 ± 0.32% (p= 0.018, rbc = 0.93) immediately following the device switch and stabilized at 6.50 ± 0.28% (p= 0.001, W = 0.53) and 6.55 ± 0.41% (p= 0.001, W = 0.53) at subsequent stages of the study. An improvement was also observed in mean glucose values for time spent < 54 mg/dl, while the proportion of time within this range was maintained, both during the day (p< 0.001, W = 0.58) and at night (p= 0.002, W = 0.83).

CONCLUSION

The AHCL MiniMed 780GTM system improved glycaemic control in the studied group of children under seven years of age with T1D compared to previous SAP-PLGS therapy. It proved to be safe for delivering insulin in this age group.

Cognitive disengagement syndrome in children with type 1 diabetes: important implications for clinical outcomes

AIMS

Children with type 1 diabetes (T1D) are prone to a variety of psychiatric disorders, however, to date, no study has examined cognitive disengagement syndrome (CDS) in children with T1D. The present study aimed to evaluate the frequency of CDS symptoms in children with T1D and whether it is related to glycemic control.

METHODS

This cross-sectional study included 74 children with T1D and 88 healthy (control) children, aged 8-14 years. All children were evaluated through a semi-structured psychiatric interview, the Kent-EGY test, porteus maze test, stroop test TBAG form, Barkley child attention scale, and Conners' parent rating scale-revised-short form.

RESULT

Children with T1D had considerably higher rates of elevated CDS symptoms than control children (35.1% vs. 10.2%, p < 0.001). Children with T1D performed poorly on attention and cognitive tests. High levels of CDS symptomatology were strongly associated with earlier diabetes onset age, longer disease duration, a higher percentage of diabetic ketoacidosis at diagnosis, higher HbA1c levels, and higher daily insulin dosages. Also, T1D patients with elevated CDS symptoms had lower IQ and attention scores and worse cognitive function performance compared to participants with low levels of CDS symptomatology.

CONCLUSIONS

Elevated CDS symptoms are significantly higher in children with T1D and are associated with poorer diabetes control. The routine psychiatric examination of children with T1D should also include a screening for CDS, particularly in patients with poor glycemic control.

A comparative study using insulin pump therapy and continuous glucose monitoring in newly diagnosed very young children with type 1 diabetes: it is possible to bend the curve of HbA1c

AIMS

The target of metabolic control (HbA1c < 7% or 53 mmol/mol) recommended by the ADA and ISPAD is attained by 30% of children with Type 1 Diabetes (T1D). Advances in technologies for T1D aim to improve metabolic outcomes and reduce complications. This observational study assesses the long-term outcomes of advanced technologies for treatment of T1D compared to conventional approach started at onset in a group of very young children with T1D.

METHODS

54 patients with less 4 years old at onset of T1D were enrolled and followed for up to 9 years after diagnosis. 24 subjects started continuous subcutaneous insulin (CSII) treatment and 30 subjects received MDI therapy from onset. Auxological data, HbA1c and total daily insulin dose (TDD/kg) have been collected at admission and every 4 months. HbA1cAUC>6%, rates of acute complications, glycemic variability indices and glucometrics were also recorded.

RESULTS

Patients with CSII therapy had significantly lower mean HbA1c values compared to subjects receiving MDI treatment. CSII approach also recorded lower mean HbA1cAUC>6% and TDD/kg than MDI therapy. At the last download data, the time in range (TIR) was higher in patients with CSII and hyperglycemia events were lower. Better glycemic variability indices have been described during CSII therapy, including mean glycemia, standard deviation, coefficient of variation (CV), glycemia risk index (GRI) and high blood glucose index (HBGI). There was no statistically significant difference between frequency of severe hypoglycemia and ketoacidosis episodes between groups.

CONCLUSIONS

Early initiation of diabetes technologies is safe and able to determine a better long term glycemic control in young children with T1D. It also allows to flatten the trajectory of HbA1c, probably reducing microvascular, macrovascular and neurological complications of diabetes in this very peculiar age group.

Cognitive Function in Early Onset Type 1 Diabetes in Children

OBJECTIVES

To assess cognitive function and factors affecting it in Indian children with early-onset type 1 diabetes (T1D) (less than 6 y).

METHODS

This cross-sectional, single-centre study recruited children diagnosed with T1D before 6 y of age and having a disease duration of at least 2 y, as cases. Controls were age- and sex-matched apparently healthy children or siblings. Children with birth asphyxia, intellectual disability, syndromic children, or pre-existing psychiatric illness were excluded. Enrolled children underwent cognitive assessment using Malin's Intelligence Scale for Indian Children (MISIC), and scores in various subtests were compared between cases and controls.

RESULTS

A total of 60 children were enrolled in each group. When compared to controls, cases had significantly lower scores on most subtests, verbal, performance and overall Intelligence Quotient (IQ- 100.62 ± 3.26 vs. 103.23 ± 1.22). HbA1c >9%, severe hypoglycemia and lesser duration since the last diabetic ketoacidosis (DKA) episode significantly correlated with lower neurocognitive scores.

CONCLUSIONS

Children with early onset T1D showed significant deficits in various cognitive domains and IQ. Poor glycemic control, higher glycemic variability and exposure to severe hypoglycemia are risk factors for poor cognitive outcomes in these children. Further longitudinal studies could potentially aid in a finer understanding of factors affecting cognitive functioning in T1D children in developing countries.

A High intensity Interval training (running and swimming) and resistance training intervention on heart rate variability and the selected biochemical factors in boys with type 1 diabetes

OBJECTIVE

The purpose of this research is to investigate the effect of High Intensity Interval Training and Resistance training (HIITR) on heart rate variability (HRV), blood glucose, and plasma biomarkers levels in adolescents with type 1 diabetes (T1D).

RESEARCH DESIGN AND METHODS

24 boys with T1D (FBS: 274.66 ± 52.99, age: 15.2 ± 1.78 years, and BMI = 19.61 ± 1.11) and 12 healthy boys (FBS: 92.75 ± 5.22, age: 15.08 ± 1.67 years, and BMI = 20.26 ± 2.66) were divided into three groups: Diabetes Training (DT, n = 12), Diabetes Control (DC, n = 12), and Healthy Control (HC, n = 12). HRV (24 h) was computed in time and frequency domains, anthropometric, biochemical parameters at rest, and aerobic capacity (VO2peak) obtained during a graded exercise testing (GXT). All variables were evaluated at the baseline and following 12 weeks of exercise training, done 3 days weekly. The statistical method used for data analysis was analysis of covariance (ANCOVA) test.

RESULTS

HRV, Hemoglobin A1c (HbA1c) and Fasting blood sugar (FBS), VO2peak, norepinephrine (NEP), and HDL-C indicated significant differences between both T1D groups compared to HC at baseline (p < 0.001). BMI, LDL-C, TC, and TG parameters were similar in all groups. HRV parameters, VO2peak and HDL-C, and NEP were significantly improved by exercise training, and HbA1c and FBS levels were significantly reduced (p < 0.001). There is a negative and significant correlation between LF/HF Ratio Difference (post-test minus pre-test) and VO2Peak Difference variables (post-test minus pre-test) (p < 0.001).

CONCLUSIONS

The present study suggests the importance of early screening for CVD risk factors in adolescent males with T1D. Also, it was revealed HIITR training compared to other training patterns, and cardiovascular health improves via enhancement of autonomic modulation, VO2peak, plasma lipids, and catecholamine levels.

Pediatric Type 1 Diabetes: Mechanisms and Impact of Technologies on Comorbidities and Life Expectancy

Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood, with a progressively increasing incidence. T1D management requires lifelong insulin treatment and ongoing health care support. The main goal of treatment is to maintain blood glucose levels as close to the physiological range as possible, particularly to avoid blood glucose fluctuations, which have been linked to morbidity and mortality in patients with T1D. Indeed, the guidelines of the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend a glycated hemoglobin (HbA1c) level < 53 mmol/mol (<7.0%) for young people with T1D to avoid comorbidities. Moreover, diabetic disease strongly influences the quality of life of young patients who must undergo continuous monitoring of glycemic values and the administration of subcutaneous insulin. In recent decades, the development of automated insulin delivery (AID) systems improved the metabolic control and the quality of life of T1D patients. Continuous subcutaneous insulin infusion (CSII) combined with continuous glucose monitoring (CGM) devices connected to smartphones represent a good therapeutic option, especially in young children. In this literature review, we revised the mechanisms of the currently available technologies for T1D in pediatric age and explored their effect on short- and long-term diabetes-related comorbidities, quality of life, and life expectation.

Cognitive Outcome After Islet Transplantation

Severe or repeated hypoglycemia events may favor memory complaints in type 1 diabetes (T1D). Pancreatic islet transplantation (IT) is an alternative option to exogenous insulin therapy in case of labile T1D, implying a maintenance immunosuppression regimen based on sirolimus or mycophenolate, associated with tacrolimus, that may also have neurological toxicity. The objective of this study was to compare a cognitive rating scale Mini-Mental State Examination (MMSE) between T1D patients with or without IT and to identify parameters influencing MMSE.

Methods

This retrospective cross-sectional study compared MMSE and cognitive function tests between islet-transplanted T1D patients and nontransplanted T1D controls who were transplant candidates. Patients were excluded if they refused.

Results

Forty-three T1D patients were included: 9 T1D patients before IT and 34 islet-transplanted patients (14 treated with mycophenolate and 20 treated with sirolimus). Neither MMSE score (P = 0.70) nor higher cognitive function differed between islet versus non-islet-transplanted patients, whatever the type of immunosuppression. In the whole population (N = 43), MMSE score was negatively correlated to glycated hemoglobin (r = -0.30; P = 0.048) and the time spent in hypoglycemia on the continuous glucose monitoring (r = -0.32; P = 0.041). MMSE score was not correlated to fasting C-peptide level, time spent in hyperglycemia, average blood glucose, time under immunosuppression, duration of diabetes, or beta-score (success score of IT).

Conclusions

This first study evaluating cognitive disorders in islet-transplanted T1D patients argues for the importance of glucose balance on cognitive function rather than of immunosuppressive treatment, with a favorable effect of glucose balance improvement on MMSE score after IT.

Mouse Models with SGLT2 Mutations: Toward Understanding the Role of SGLT2 beyond Glucose Reabsorption

The sodium–glucose cotransporter 2 (SGLT2) mainly carries out glucose reabsorption in the kidney. Familial renal glycosuria, which is a mutation of SGLT2, is known to excrete glucose in the urine, but blood glucose levels are almost normal. Therefore, SGLT2 inhibitors are attracting attention as a new therapeutic drug for diabetes, which is increasing worldwide. In fact, SGLT2 inhibitors not only suppress hyperglycemia but also reduce renal, heart, and cardiovascular diseases. However, whether long-term SGLT2 inhibition is completely harmless requires further investigation. In this context, mice with mutations in SGLT2 have been generated and detailed studies are being conducted, e.g., the SGLT2−/− mouse, Sweet Pee mouse, Jimbee mouse, and SAMP10-ΔSglt2 mouse. Biological changes associated with SGLT2 mutations have been reported in these model mice, suggesting that SGLT2 is not only responsible for sugar reabsorption but is also related to other functions, such as bone metabolism, longevity, and cognitive functions. In this review, we present the characteristics of these mutant mice. Moreover, because the relationship between diabetes and Alzheimer’s disease has been discussed, we examined the relationship between changes in glucose homeostasis and the amyloid precursor protein in SGLT2 mutant mice.

The efficacy of insulin degludec and insulin glargine over NPH insulin among toddlers and preschoolers with type 1 diabetes using glycemic variability and time in range

Optimizing glycemic control without risking hypoglycemia is crucial in toddlers and preschoolers with type 1 diabetes (T1D) to avoid cognitive impairment later in life. Hence, this study aims to compare glycemic parameters among toddlers and preschoolers with T1D in relation to different basal insulins. Sixty toddlers and preschoolers with T1D with mean age of 3.53 ± 1.17 years (range, 2-6) and mean diabetes duration of 9.37 ± 1.85 months were randomly assigned into three equal groups; group A received insulin degludec, group B received insulin glargine, and group C were on NPH. At baseline, the three groups were matched regarding clinical and laboratory parameters (p > 0.05). They were followed up at 3 and 6 months for insulin daily dose (IDD), hypoglycemia and severe-hypoglycemia frequency, and glycated hemoglobin (HbA1c). At the study endpoint, continuous glucose monitoring (CGM) was assessed in a random sample of 10 patients from each group. The mean time in range (TIR) of the studied cohort was 55.07 ± 24.05%, and their mean coefficient of variation (CV) was 42.82 ± 11.69%. The TIR was significantly higher in the degludec group (69.36 ± 18.54) and the glargine group (55.43 ± 26.51) than the NPH group (32.56 ± 9.11), p < 0.001. Meanwhile, the CV was significantly lower in the degludec group (35.12 ± 6.47) than the gargine (44.1 ± 13.13) and the NPH (53.8 ± 7.54) groups, p < 0.001. The insulin degludec and glargine groups had significantly lower HbA1c (p = 0.002), hypoglycemia (p = 0.006), severe hypoglycemia (p = 0.029), and IDD (p = 0.015) than the NPH group.

CONCLUSION

Insulin degludec and glargine resulted in better HbA1c and TIR with reduced hypoglycemia and IDD than NPH among toddlers and preschoolers with T1D. Moreover, CV was lowest in the insulin degludec group.

WHAT IS KNOWN

• Insulin therapy is the mainstay of T1D management. • Optimal insulin therapy for young children with T1D should provide effective glycemic.

WHAT IS NEW

• Insulin degludec and insulin glargine have better efficacy than NPH insulin among toddlers and preschoolers with T1D in the term of significantly lower coefficient of variation, HbA1c and IDD and significantly higher time in range. • Insulin degludec and insulin glargine have better safety in the term of less hypoglycemia and severe hypoglycemia episodes than NPH insulin among toddlers and preschoolers with T1D.

Insulin Pump Therapy Efficacy and Key Factors Influencing Adherence in Pediatric Population-A Narrative Review

Objective: we aimed to highlight the state of the art in terms of pediatric population adherence to insulin pumps. This study intends to underline the significance of identifying and minimizing, to the greatest extent feasible, the factors that adversely affect the juvenile population's adherence to insulin pump therapy. Materials and methods: articles from PubMed, Embase, and Science Direct databases were evaluated using the following search terms: adherence, pump insulin therapy, children, pediatric population, and type 1 diabetes, in combination with several synonyms such as compliance, treatment adherence, pump adherence, patient dropouts, and treatment refusal. Results: A better glycemic control is connected to a better adherence to diabetes management. We identify, enumerate, and discuss a number of variables which make it difficult to follow an insulin pump therapy regimen. Several key factors might improve adherence to insulin pump therapy: efficient communication between care provider and patients (including home-based video-visits), continuous diabetes education, family support and parental involvement, as well as informational, practical assistance, and emotional support from the society. Conclusions: every cause and obstacle that prevents young patients from adhering to insulin pumps optimally is an opportunity for intervention to improve glycemic control and, as a result, their quality of life.

Positive Association between Preserved C-Peptide and Cognitive Function in Pregnant Women with Type-1 Diabetes

This study focused on the cognitive function of women with type 1 diabetes in pregnancy. We investigated risk factors for a low cognitive score such as age, duration of Diabetes, BMI, subclinical hypothyroidism, cardiovascular autonomic neuropathy, the impact of hypo-/hyperglycemia, and C-peptide preservation. Material and methods. Seventy-eight pregnant women with type 1 diabetes (age 31.1 ± 5.4 years, diabetes duration 14.3 ± 8.9 years) were included in the study. Cognitive function was assessed in different domains, such as reasoning, memory, attention, coordination, and perception. Results. The cognitive test values ≥400 were considered high scores, and values <400 were considered low. Relative risks for low scores for general cognitive function were associated with increased BMI > 25 kg/m2 2.208 (95% CI 1.116−4.370), HbA1c > 6.5% RR 0.774 (95% CI 0.366−1.638), subclinical hypothyroidism RR 3.111 (95% CI 1.140−8.491), and impaired cardiovascular autonomic neuropathy RR 2.250 (95% CI 1.000−5.062). Pregnant women with a lower score for general cognitive function had higher BMI and higher leptin levels. Preserved C-peptide reduces the risk for cognitive impairment (RR 0.297 (95% CI 0.097−0.912)) in pregnant women with type 1 diabetes Conclusion. BMI > 25 kg/m2, subclinical hypothyroidism, and cardiovascular autonomic neuropathy are associated with increased risk, and postprandial C-peptide preservation with reduced risk for cognitive impairment in pregnant women with type 1 diabetes.

Metabolism and memory: α-synuclein level in children with obesity and children with type 1 diabetes; relation to glucotoxicity, lipotoxicity and executive functions

Background/Objectives

Children with obesity and those with type 1diabetes (T1D) exhibit subtle neurocognitive deficits, the mechanism of which remains unknown. α-synuclein plays a fundamental role in neurodegeneration. Moreover, its role in glucose and lipids metabolism is emerging. This study aims to assess whether α-synuclein is correlated with the degree of neurodegeneration in children with obesity and those with T1D in comparison to healthy controls and correlate it to various neurocognitive and metabolic parameters.

Subjects/Methods

Forty children with obesity, 40 children with T1D and 40 matched-healthy controls were assessed for anthropometric measurements and blood-pressure. Cognitive evaluation was performed using Stanford–Binet scale and Barkley Deficits in Executive Functioning (EF) Scale-Children and Adolescents. α-synuclein, fasting lipids and glucose were measured with calculation of the homeostatic model of insulin-resistance and estimated-glucose disposal rate.

Results

Children with obesity and those with T1D had significantly higher α-synuclein (p < 0.001) and total EF percentile (p = 0.001) than controls. α-synuclein was negatively correlated to total IQ (p < 0.001 and p = 0.001), and positively correlated with total EF percentile (p = 0.009 and p = 0.001) and EF symptom count percentile (p = 0.005 and p < 0.001) in children with T1D and obesity, respectively. Multivariate-regression revealed that α-synuclein was independently related to age (p = 0.028), diabetes-duration (p = 0.006), HbA1C% (p = 0.034), total IQ (p = 0.013) and EF symptom count percentile (p = 0.003) among children with T1D, and to diastolic blood-pressure percentile (p = 0.013), waist/hip ratio SDS (p = 0.007), total EF percentile (P = 0.033) and EF symptom count percentile (p < 0.001) in children with obesity.

Conclusion

α-synuclein could have a mechanistic role in neurocognitive deficit among children with obesity and T1D.

Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus: a narrative review

Type 1 diabetes mellitus (T1DM) is a type of diabetes caused by the destruction of pancreatic β cells and the absolute lack of insulin secretion. T1DM usually starts in adolescence or develops directly as a severe disease state of ketoacidosis. T1DM and its complications make many people suffer and have psychological problems, which make us have to pay more attention to the prevention and early control of T1DM. Cognitive impairment (CI) is one of the major complications of T1DM. It can further develop into Alzheimer's disease, which can seriously affect the quality of life of the elderly. Furthermore, the relationship between T1DM and CI is unclear. Hence, we conducted a narrative review of the existing literature through a PubMed search. We summarized some risk factors that may be associated with the cognitive changes in T1DM patients, including onset age and duration, education and gender, glycemic states, microvascular complications, glycemic control, neuropsychology and emotion, intestinal flora, dyslipidemia, sleep quality. We aimed to provide some content related to CI in T1DM, and hoped that it could play a role in early prediction and treatment to reduce the prevalence.

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Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus.

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Duration and age; Education and gender and Glycemic states.

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Diabetic ketoacidosis; Microvascular complications and Glycemic control–HbA1c.

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Neuropsychology and emotion; Intestinal flora; Dyslipidemia and Sleep Quality.

The Impact of a Self-Management Program Based on the 5 A's Model on Type 1 Diabetes in School-Aged Children

INTRODUCTION

Diabetes is a chronic metabolic condition characterized by abnormally high blood glucose levels that eventually results in catastrophic damage to the heart, blood vessels, eyes, kidneys, and nerves. The available data from previous studies on the application of the 5A's model-based self-management programmer to increase knowledge and self-care practices in children is insufficient. Therefore, the purpose of this study was to determine the effect of a self-management programmer based on the 5 A's paradigm on school-aged children with type 1 diabetes.

METHODS

The research design was quasi-experimental. The investigation was conducted at EL Mogamma EL Teby AL Shamal diabetes facility. This study enrolled a convenience sample of 90 children who were accompanied by their moms. Five tools were utilized to collect the data. Questionnaire for children's examination; Questionnaire for diabetic knowledge; a Questionnaire on Diabetes Self-Care and Diabetic Attitude Scale and Self-Care Practices for Diabetics.

RESULTS

72.2 %, 90.0 %, 91.1 %, 93.3 %, and 96.7 % of youngsters, respectively, lacked knowledge, engaged in ineffective self-care activities, had a negative attitude, and practiced incompetently. Differences between pre- and post-program implementation are statistically significant when a self-management programmer based on the 5A's model is implemented.

DISCUSSION/CONCLUSIONS

Self-management and self-care models, particularly the 5A model, are helpful at improving the control of these symptoms, reducing associated problems, enhancing nursing care, and enhancing patients' quality of life. Increasing the duration of a self-management programmer based on the 5 A's model for children with type 1 diabetes reduces negative attitudes and improves quality of life, but requires follow-up.

Metabolic Treatment of Wolfram Syndrome

Wolfram Syndrome (WS) is a very rare genetic disorder characterized by several symptoms that occur from childhood to adulthood. Usually, the first clinical sign is non-autoimmune diabetes even if other clinical features (optic subatrophy, neurosensorial deafness, diabetes insipidus) may be present in an early state and may be diagnosed after diabetes' onset. Prognosis is poor, and the death occurs at the median age of 39 years as a consequence of progressive respiratory impairment, secondary to brain atrophy and neurological failure. The aim of this paper is the description of the metabolic treatment of the WS. We reported the experience of long treatment in patients with this syndrome diagnosed in pediatric age and followed also in adult age. It is known that there is a correlation between metabolic control of diabetes, the onset of other associated symptoms, and the progression of the neurodegenerative alterations. Therefore, a multidisciplinary approach is necessary in order to prevent, treat and carefully monitor all the comorbidities that may occur. An extensive understanding of WS from pathophysiology to novel possible therapy is fundamental and further studies are needed to better manage this devastating disease and to guarantee to patients a better quality of life and a longer life expectancy.

Impact of glucose metabolism on the developing brain

Glucose is the most important substrate for proper brain functioning and development, with an increased glucose consumption in relation to the need of creating new brain structures and connections. Therefore, alterations in glucose homeostasis will inevitably be associated with changes in the development of the Nervous System. Several studies demonstrated how the alteration of glucose homeostasis - both hyper and hypoglycemia- may interfere with the development of brain structures and cognitivity, including deficits in intelligence quotient, anomalies in learning and memory, as well as differences in the executive functions. Importantly, differences in brain structure and functionality were found after a single episode of diabetic ketoacidosis suggesting the importance of glycemic control and stressing the need of screening programs for type 1 diabetes to protect children from this dramatic condition. The exciting progresses of the neuroimaging techniques such as diffusion tensor imaging, has helped to improve the understanding of the effects, outcomes and mechanisms underlying brain changes following dysglycemia, and will lead to more insights on the physio-pathological mechanisms and related neurological consequences about hyper and hypoglycemia.