1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Wilson M, Al-Hamid A, Abbas I, Birkett J, Khan I, Harper M, Al-Jumeily Obe D, Assi S. Identification of diagnostic biomarkers used in the diagnosis of cardiovascular diseases and diabetes mellitus: A systematic review of quantitative studies. Diabetes Obes Metab 2024; 26:3009-3019. [PMID: 38637978 DOI: 10.1111/dom.15593] [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: 01/17/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
AIMS To perform a systematic review of studies that sought to identify diagnostic biomarkers for the diagnosis of cardiovascular diseases (CVDs) and diabetes mellitus (DM), which could be used in low- and middle-income countries (LMICs) where there is a lack of diagnostic equipment, treatments and training. MATERIALS AND METHODS Papers were sourced from six databases: the British Nursing Index, Google Scholar, PubMed, Sage, Science Direct and Scopus. Articles published between January 2002 and January 2023 were systematically reviewed by three reviewers and appropriate search terms and inclusion/exclusion criteria were applied. RESULTS A total of 18 studies were yielded, as well as 234 diagnostic biomarkers (74 for CVD and 160 for DM). Primary biomarkers for the diagnosis of CVDs included growth differentiation factor 15 and neurogenic locus notch homologue protein 1 (Notch1). For the diagnosis of DM, alpha-2-macroglobulin, C-peptides, isoleucine, glucose, tyrosine, linoleic acid and valine were frequently reported across the included studies. Advanced analytical techniques, such as liquid chromatography mass spectrometry, enzyme-linked immunosorbent assays and vibrational spectroscopy, were also repeatedly reported in the included studies and were utilized in combination with traditional and alternative matrices such as fingernails, hair and saliva. CONCLUSIONS While advanced analytical techniques are expensive, laboratories in LMICs should carry out a cost-benefit analysis of their use. Alternatively, laboratories may want to explore emerging techniques such as infrared, Fourier transform-infrared and near-infrared spectroscopy, which allow sensitive noninvasive analysis.
Collapse
Affiliation(s)
- Megan Wilson
- Faculty of Science, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Abdullah Al-Hamid
- Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, AlAhsa, Saudi Arabia
| | | | - Jason Birkett
- Faculty of Science, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Iftikhar Khan
- Faculty of Science, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Matthew Harper
- Faculty of Engineering and Technology, School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Dhiya Al-Jumeily Obe
- Faculty of Engineering and Technology, School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Sulaf Assi
- Faculty of Science, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Scutca AC, Jugănaru I, Nicoară DM, Brad GF, Bugi MA, Asproniu R, Cristun LI, Mărginean O. Systemic Inflammatory Response Index (SIRI) as a Predictive Marker for Adverse Outcomes in Children with New-Onset Type 1 Diabetes Mellitus. J Clin Med 2024; 13:2582. [PMID: 38731111 PMCID: PMC11084164 DOI: 10.3390/jcm13092582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Although most cases of new-onset type 1 diabetes mellitus (T1DM) are managed without serious events, life-threatening complications do arise in a subset of patients. Our objective was to assess the correlation between elevated SIRI values and adverse events related to the onset of T1DM. (2) Methods: This retrospective study, spanning ten years, included 187 patients with new-onset T1DM divided into three groups based on SIRI tertiles. The primary outcome was the occurrence of acute complications during hospital admission, while the secondary outcome was prolonged Intensive Care Unit (ICU) admission. (3) Results: Patients with high SIRI values were more likely to experience higher disease activity, leading to longer ICU admission times and more frequent complications. Multivariate logistic regression analysis revealed that the SIRI was independently associated with acute complications (p = 0.003) and prolonged ICU length of stay (p = 0.003). Furthermore, receiver operating characteristic analysis demonstrated the SIRI's superior predictive accuracy compared to venous pH (AUC = 0.837 and AUC = 0.811, respectively) and to the individual component cell lineages of the SIRI. (4) Conclusions: These findings emphasize the potential utility of the SIRI as a prognostic marker in identifying patients at increased risk during T1DM hospital admissions.
Collapse
Affiliation(s)
- Alexandra-Cristina Scutca
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
| | - Iulius Jugănaru
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
- Research Center for Disturbances of Growth and Development in Children BELIVE, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Delia-Maria Nicoară
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
| | - Giorgiana-Flavia Brad
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
| | - Meda-Ada Bugi
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
- Ph.D. School Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Raluca Asproniu
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
| | - Lucian-Ioan Cristun
- Ph.D. School Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Otilia Mărginean
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
- Research Center for Disturbances of Growth and Development in Children BELIVE, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| |
Collapse
|
6
|
Penaforte-Saboia JG, Couri CEB, Albuquerque NV, Linard LLP, Araújo DAC, de Oliveira SKP, Gomes TFP, Pinheiro MM, Castelo MHCG, Fernandes VO, Montenegro Júnior RM. PRE1BRAZIL Protocol: A Randomized Controlled Trial to Evaluate the Effectiveness and Safety of the DPP-4 Inhibitor Alogliptin in Delaying the Progression of Stage 2 Type 1 Diabetes. Diabetes Metab Syndr Obes 2024; 17:857-864. [PMID: 38406268 PMCID: PMC10894513 DOI: 10.2147/dmso.s437635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/12/2023] [Indexed: 02/27/2024] Open
Abstract
Background The incidence of Type 1 Diabetes Mellitus (T1DM) is on the rise. Since there is no curative treatment, it is urgent to look for therapies that can delay disease progression and protect pancreatic β-cells. Dipeptidyl peptidase-4 inhibitors (DPP-4i) have shown potential in modulating inflammation and preventing β-cell destruction. This protocol describes an upcoming trial to evaluate the effectiveness of the DPP-4i alogliptin in delaying the progression of stage 2 (presymptomatic) to stage 3 (symptomatic) T1DM. Patients and Methods We propose a two-year, two-arm, multicenter, randomized, open-label clinical trial targeting Brazilian patients aged 18 to 35 with stage 2 T1DM. The study, facilitated by the custom-developed "PRE1BRAZIL" web application, aims to enroll 130 participants. They will be randomly assigned in a 1:1 ratio to either a treatment group (alogliptin 25 mg daily plus regular clinical and laboratory assessments) or a control group (regular assessments only). The primary outcome is the rate of progression to stage 3 T1DM. Secondary outcomes include changes in A1c levels, glucose levels during a 2-hour oral glucose tolerance test (OGTT), C-peptide levels, exogenous insulin requirements, Insulin-Dose Adjusted A1c (IDAA1c), and the incidence of diabetic ketoacidosis (DKA) in those advancing to stage 3. Discussion This protocol outlines the first randomized clinical trial (RCT) to investigate the impact of a DPP-4i in the presymptomatic stage of T1DM. The trial is designed to provide critical insights into the role of DPP-4i in the secondary prevention of T1DM. Utilizing the "PRE1BRAZIL" web application is expected to enhance participant enrollment and reduce operational costs. Registration Brazilian Registry of Clinical Trials.
Collapse
Affiliation(s)
- Jaquellyne Gurgel Penaforte-Saboia
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/ EBSERH Fortaleza, Fortaleza, CE, Brazil
| | - Carlos Eduardo Barra Couri
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Natasha Vasconcelos Albuquerque
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/ EBSERH Fortaleza, Fortaleza, CE, Brazil
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Lana Livia Peixoto Linard
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/ EBSERH Fortaleza, Fortaleza, CE, Brazil
| | | | | | - Thisciane Ferreira Pinto Gomes
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/ EBSERH Fortaleza, Fortaleza, CE, Brazil
| | | | | | - Virgínia Oliveira Fernandes
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/ EBSERH Fortaleza, Fortaleza, CE, Brazil
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Renan Magalhães Montenegro Júnior
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
- Clinical Research Unit, Walter Cantídio University Hospital, Federal University of Ceará/ EBSERH Fortaleza, Fortaleza, CE, Brazil
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil
| |
Collapse
|
7
|
ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S258-S281. [PMID: 38078582 PMCID: PMC10725814 DOI: 10.2337/dc24-s014] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
8
|
Bowden N, Dixon R, Anderson V, de Bock M, Boucsein A, Kewene-Edwards M, Gibb S, Kokaua J, Palmer O, Paul R, Taylor B, Vu H, Wheeler BJ. Associations between type 1 diabetes and educational outcomes: an Aotearoa/New Zealand nationwide birth cohort study using the Integrated Data Infrastructure. Diabetologia 2024; 67:62-73. [PMID: 37870651 PMCID: PMC10709242 DOI: 10.1007/s00125-023-06026-y] [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: 03/28/2023] [Accepted: 08/31/2023] [Indexed: 10/24/2023]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes is one of the most common chronic diseases of childhood. It is hypothesised that the metabolic and psychosocial consequences of type 1 diabetes may affect educational outcomes; however, existing literature presents conflicting results. This study aimed to assess whether educational outcomes differ for young people with and without type 1 diabetes in Aotearoa/New Zealand (NZ). METHODS This was a nationwide 9 year birth cohort study of all people born in NZ from 1993 to 2001 using linked administrative data held within the Integrated Data Infrastructure, a national research database containing linked health and non-health data. Educational outcomes of high school attainment, high school attendance and university enrolment were measured from age 13 years until 20 years. Generalised linear regression models with log link and Gaussian distributions were used to compare educational outcomes between those with and those without type 1 diabetes, adjusting for sociodemographic and maternal characteristics. RESULTS Of the 442,320 children in the birth cohort, type 1 diabetes was identified in 2058 (0.47%) (mean [SD] age of type 1 diabetes diagnosis 7.7 [3.4] years). Educational outcomes were significantly lower for children with type 1 diabetes than for those without type 1 diabetes, including for any high school qualification (RR 0.97 [95% CI 0.95, 0.99]), university entrance-level high school attainment (RR 0.88 [95% CI 0.84, 0.92]), regular high school attendance (RR 0.91 [95% CI 0.85, 0.97]) and university enrolment (RR 0.93 [95% CI 0.88, 0.98]), even after adjusting for sociodemographic and maternal factors. In addition, educational outcomes were substantially lower for those with post type 1 diabetes diagnosis hospitalisations for diabetic ketoacidosis and hypoglycaemia. CONCLUSIONS/INTERPRETATION In this whole NZ birth cohort study, type 1 diabetes was associated with lower educational outcomes spanning secondary school and into university enrolment. Ongoing efforts to support students with type 1 diabetes are needed, particularly for those with a greater risk profile.
Collapse
Affiliation(s)
- Nicholas Bowden
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- A Better Start National Science Challenge, Auckland, New Zealand
| | - Rachael Dixon
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
| | | | - Martin de Bock
- Department of Paediatrics, Te Whatu Ora/Health NZ, Christchurch, New Zealand
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Alisa Boucsein
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Sheree Gibb
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jesse Kokaua
- Centre for Pacific Health, Va'a O Tautai, Health Sciences Division, University of Otago, Dunedin, New Zealand
| | - Octavia Palmer
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ryan Paul
- Waikato Regional Diabetes Service, Hamilton, New Zealand
- Te Hutaki Waiora School of Health, University of Waikato, Hamilton, New Zealand
| | - Barry Taylor
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- A Better Start National Science Challenge, Auckland, New Zealand
| | - Hien Vu
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
- Paediatric Endocrinology, Te Whatu Ora/Health NZ - Southern, Dunedin, New Zealand.
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Putarek NR, Krnic N, Knezevic-Cuca J, Kusec V, Baretic M, Dumic M. Relative Frequency of Islet Autoimmunity in Children and Adolescents with Autoimmune Thyroid Disease. J Clin Res Pediatr Endocrinol 2023; 15:348-355. [PMID: 37074226 PMCID: PMC10683547 DOI: 10.4274/jcrpe.galenos.2023.2023-10-18] [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: 02/02/2023] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
Objective The aim of the present study was to investigate islet autoimmunity and susceptibility to type 1 diabetes (T1D) in children/adolescents with autoimmune thyroid disease (AITD, and in family members of AITD patients with islet autoimmunity. Methods Islet-cell cytoplasmic, glutamic-acid decarboxylase, and tyrosine-phosphatase autoantibodies (AAbs) were measured in 161 AITD patients [127 with autoimmune thyroiditis (AT); 34 with Graves’ disease (GD)], 20 family members of AITD patients with islet autoimmunity, and 155 age-matched controls. Results Islet autoimmunity was found in 10.6% of AITD patients, significantly more frequent than in controls (1.9%; p=0.002). A higher prevalence of islet AAbs was found in females with AITD (p=0.011) but not in males (p=0.16) and in AT (p=0.013) but not in GD patients (p=0.19), compared to corresponding controls. Two or three islet AAbs were found concurrently in six AITD patients with islet autoimmunity. They all developed T1D and had significantly higher islet AAbs titers (p=0.01) than AITD patients with single islet AAbs but normal glucose metabolism. T1D was found in 3.7% of AITD patients compared to 0.2% of the age-matched, general Croatian population. Islet AAbs were found in 5/20 family members of AITD patients with islet autoimmunity, among whom two developed T1D. None of the controls was positive for more than one islet AAb or developed T1D. Conclusion Children/adolescents with AITD, particularly females and patients with AT, appear to represent a risk group for islet autoimmunity and T1D, as do family members of AITD patients with positive islet AAbs. However, these findings should be validated in larger studies.
Collapse
Affiliation(s)
| | - Nevena Krnic
- University Hospital Centre Zagreb Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Zagreb, Croatia
| | - Jadranka Knezevic-Cuca
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases; University Hospital Merkur Faculty of Medicine; University of Zagreb, Zagreb, Croatia
| | - Vesna Kusec
- University Hospital Centre Zagreb, Clinical Institute of Laboratory Diagnosis, Zagreb, Croatia
| | - Maja Baretic
- University Hospital Centre Zagreb Faculty of Medicine, Department of Endocrinology, Zagreb, Croatia
| | - Miroslav Dumic
- University Hospital Center Zagreb Faculty of Medicine, Department of Pediatrics, Zagreb, Croatia
| |
Collapse
|
11
|
Simmons KM, Sims EK. Screening and Prevention of Type 1 Diabetes: Where Are We? J Clin Endocrinol Metab 2023; 108:3067-3079. [PMID: 37290044 DOI: 10.1210/clinem/dgad328] [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: 02/09/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
A diagnosis of type 1 diabetes (T1D) and the subsequent requirement for exogenous insulin treatment is associated with considerable acute and chronic morbidity and a substantial effect on patient quality of life. Importantly, a large body of work suggests that early identification of presymptomatic T1D can accurately predict clinical disease, and when paired with education and monitoring, can yield improved health outcomes. Furthermore, a growing cadre of effective disease-modifying therapies provides the potential to alter the natural history of early stages of T1D. In this mini review, we highlight prior work that has led to the current landscape of T1D screening and prevention, as well as challenges and next steps moving into the future of these rapidly evolving areas of patient care.
Collapse
Affiliation(s)
- Kimber M Simmons
- Barbara Davis Center for Diabetes, Division of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Emily K Sims
- Division of Pediatric Endocrinology and Diabetology, Herman B Wells Center for Pediatric Research; Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| |
Collapse
|
12
|
Dolatshahi M, Sanjari Moghaddam H, Saberi P, Mohammadi S, Aarabi MH. Central nervous system microstructural alterations in Type 1 diabetes mellitus: A systematic review of diffusion Tensor imaging studies. Diabetes Res Clin Pract 2023; 205:110645. [PMID: 37004976 DOI: 10.1016/j.diabres.2023.110645] [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: 03/29/2022] [Revised: 02/18/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
AIMS Type 1 diabetes mellitus (T1DM) is a chronic childhood disease with potentially persistent CNS disruptions. In this study, we aimed to systematically review diffusion tensor imaging studies in patients with T1DM to understand the microstructural effects of this entity on individuals' brains METHODS: We performed a systematic search and reviewed the studies to include the DTI studies in individuals with T1DM. The data for the relevant studies were extracted and a qualitative synthesis was performed. RESULTS A total of 19 studies were included, most of which showed reduced FA widespread in optic radiation, corona radiate, and corpus callosum, as well as other frontal, parietal, and temporal regions in the adult population, while most of the studies in the juvenile patients showed non-significant differences or a non-persistent pattern of changes. Also, reduced AD and MD in individuals with T1DM compared to controls and non-significant differences in RD were noted in the majority of studies. Microstructural alterations were associated with clinical profile, including age, hyperglycemia, diabetic ketoacidosis and cognitive performance. CONCLUSION T1DM is associated with microstructural brain alterations including reduced FA, MD, and AD in widespread brain regions, especially in association with glycemic fluctuations and in adult age.
Collapse
Affiliation(s)
- Mahsa Dolatshahi
- NeuroImaging Laboratories, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, United States; NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | | | - Parastoo Saberi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheil Mohammadi
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Hadi Aarabi
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy.
| |
Collapse
|
13
|
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.
Collapse
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
| | | |
Collapse
|
14
|
Toomey V, Klein MJ, Vidmar AP, Chao LC, Pineda J, Bhalla A. Association Between COVID-19 and Severity of Illness for Children With Hyperglycemic Crisis. Hosp Pediatr 2023; 13:794-801. [PMID: 37539478 DOI: 10.1542/hpeds.2023-007195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Admissions to the ICU for children with hyperglycemic crisis (HGC, defined as diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, or hyperosmolar ketoacidosis) increased during the COVID-19 pandemic. We sought to identify if severity of illness for HGC also increased from prepandemic to pandemic years 1 and 2. METHODS Retrospective study of children aged ≤18 years hospitalized in the Pediatric Health Information System for HGC. Pre-COVID-19 years were defined as March 2017-February 2020, COVID-19 year 1 as March 2020-February 2021, and COVID-19 year 2 as March 2021-February 2022. The primary outcome was ICU admission. Secondary outcomes included mortality, length of stay, cost, and use of neurologic therapies, mechanical ventilation, or vasoactive support. RESULTS There were 46 425 HGC admissions to 42 hospitals, 20 045 (43.2%) of which were ICU admissions. In comparison with pre-COVID-19, children admitted in COVID-19 year 1 (odds ratio, 1.31 [95% confidence interval, 1.25-1.38], P < .0001) and year 2 (odds ratio, 1.17 [95% confidence interval, 1.11-1.22], P < .0001) had a higher odds of ICU admission in multivariable modeling after controlling for confounding variables. Severity of illness was higher during COVID-19 years when considering secondary outcomes, although these associations were not consistent across outcomes and year. There was no difference in mortality. CONCLUSIONS Children with HGC had a higher severity of illness during the pandemic which was sustained over 2 years. Reduction in social distancing and evolving variants of SARS-CoV-2 over the 2 years of the pandemic did not significantly alter the relationship between HGC and higher requirement for ICU care.
Collapse
Affiliation(s)
- Vanessa Toomey
- Department of Anesthesiology and Critical Care, Children's Hospital of Los Angeles, Los Angeles, California
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Margret J Klein
- Department of Anesthesiology and Critical Care, Children's Hospital of Los Angeles, Los Angeles, California
| | - Alaina P Vidmar
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lily C Chao
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jose Pineda
- Department of Anesthesiology and Critical Care, Children's Hospital of Los Angeles, Los Angeles, California
- University of Southern California Keck School of Medicine, Los Angeles, California
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Anoopindar Bhalla
- Department of Anesthesiology and Critical Care, Children's Hospital of Los Angeles, Los Angeles, California
- University of Southern California Keck School of Medicine, Los Angeles, California
| |
Collapse
|
15
|
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.
Collapse
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.
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Cai LY, Tanase C, Anderson AW, Patel NJ, Lee CA, Jones RS, LeStourgeon LM, Mahon A, Taki I, Juvera J, Pruthi S, Gwal K, Ozturk A, Kang H, Rewers A, Rewers MJ, Alonso GT, Glaser N, Ghetti S, Jaser SS, Landman BA, Jordan LC. Exploratory Multisite MR Spectroscopic Imaging Shows White Matter Neuroaxonal Loss Associated with Complications of Type 1 Diabetes in Children. AJNR Am J Neuroradiol 2023; 44:820-827. [PMID: 37263786 PMCID: PMC10337627 DOI: 10.3174/ajnr.a7895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND PURPOSE Type 1 diabetes affects over 200,000 children in the United States and is associated with an increased risk of cognitive dysfunction. Prior single-site, single-voxel MRS case reports and studies have identified associations between reduced NAA/Cr, a marker of neuroaxonal loss, and type 1 diabetes. However, NAA/Cr differences among children with various disease complications or across different brain tissues remain unclear. To better understand this phenomenon and the role of MRS in characterizing it, we conducted a multisite pilot study. MATERIALS AND METHODS In 25 children, 6-14 years of age, with type 1 diabetes across 3 sites, we acquired T1WI and axial 2D MRSI along with phantom studies to calibrate scanner effects. We quantified tissue-weighted NAA/Cr in WM and deep GM and modeled them against study covariates. RESULTS We found that MRSI differentiated WM and deep GM by NAA/Cr on the individual level. On the population level, we found significant negative associations of WM NAA/Cr with chronic hyperglycemia quantified by hemoglobin A1c (P < .005) and a history of diabetic ketoacidosis at disease onset (P < .05). We found a statistical interaction (P < .05) between A1c and ketoacidosis, suggesting that neuroaxonal loss from ketoacidosis may outweigh that from poor glucose control. These associations were not present in deep GM. CONCLUSIONS Our pilot study suggests that MRSI differentiates GM and WM by NAA/Cr in this population, disease complications may lead to neuroaxonal loss in WM in children, and deeper investigation is warranted to further untangle how diabetic ketoacidosis and chronic hyperglycemia affect brain health and cognition in type 1 diabetes.
Collapse
Affiliation(s)
- L Y Cai
- From the Department of Biomedical Engineering (L.Y.C., A.W.A., B.A.L.)
| | - C Tanase
- Departments of Psychiatry and Behavioral Sciences (C.T.)
| | - A W Anderson
- From the Department of Biomedical Engineering (L.Y.C., A.W.A., B.A.L.)
- Vanderbilt University Institute of Imaging Science (A.W.A., B.A.L.)
- Departments of Radiology and Radiological Sciences (A.W.A., S.P., B.A.L.)
| | - N J Patel
- Pediatrics (N.J.P., R.S.J., S.S.J., L.C.J.)
| | | | - R S Jones
- Pediatrics (N.J.P., R.S.J., S.S.J., L.C.J.)
| | | | - A Mahon
- Psychology (A.M., S.G.), University of California, Davis, Davis, California
| | - I Taki
- Department of Pediatrics (I.T., A.R., M.J.R.)
| | - J Juvera
- Department of Psychiatry (J.J.), University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - S Pruthi
- Departments of Radiology and Radiological Sciences (A.W.A., S.P., B.A.L.)
| | - K Gwal
- Departments of Radiology (K.G., A.O.)
| | - A Ozturk
- Departments of Radiology (K.G., A.O.)
| | - H Kang
- Biostatistics (H.K.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - A Rewers
- Department of Pediatrics (I.T., A.R., M.J.R.)
| | - M J Rewers
- Department of Pediatrics (I.T., A.R., M.J.R.)
| | | | - N Glaser
- Pediatrics (N.G.), University of California Davis Health, University of California Davis School of Medicine, Sacramento, California
| | - S Ghetti
- Psychology (A.M., S.G.), University of California, Davis, Davis, California
| | - S S Jaser
- Pediatrics (N.J.P., R.S.J., S.S.J., L.C.J.)
| | - B A Landman
- From the Department of Biomedical Engineering (L.Y.C., A.W.A., B.A.L.)
- Vanderbilt University Institute of Imaging Science (A.W.A., B.A.L.)
- Department of Electrical and Computer Engineering (B.A.L.), Vanderbilt University, Nashville, Tennessee
- Departments of Radiology and Radiological Sciences (A.W.A., S.P., B.A.L.)
| | - L C Jordan
- Pediatrics (N.J.P., R.S.J., S.S.J., L.C.J.)
- Neurology (C.A.L., L.C.J.)
| |
Collapse
|
18
|
Abstract
Diabetic ketoacidosis (DKA) is a common, serious acute complication in children with diabetes mellitus (DM). DKA can accompany new-onset type 1 insulin-dependent DM, or it can occur with established type 1 DM, during the increased demands of an acute illness or with decreased insulin delivery due to omitted doses or insulin pump failure. In addition, DKA episodes in children with type 2 DM are being reported with greater frequency. Although the diagnosis is usually straightforward in a known diabetes patient with expected findings, a sizable proportion of patients with new-onset DM present with DKA. The purpose of this comprehensive review is to acquaint clinicians with details regarding the pathophysiology, treatment caveats, and potential complications of DKA.
Collapse
|
19
|
Passanisi S, Salzano G, Basile P, Bombaci B, Caime F, Rulli I, Valenzise M, Gitto E, Lombardo F. Prevalence and clinical features of severe diabetic ketoacidosis treated in pediatric intensive care unit: a 5-year monocentric experience. Ital J Pediatr 2023; 49:58. [PMID: 37210518 PMCID: PMC10199737 DOI: 10.1186/s13052-023-01448-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/23/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is one of the most alarming concerns in the management of type 1 diabetes (T1D) in pediatric age. Prevalence of DKA at the onset of diabetes ranges from 30 to 40%. In selected cases of severe DKA, admission to pediatric intensive care unit (PICU) should be considered. METHODS This study aims to assess the prevalence of severe DKA treated in PICU in our 5-year monocentric experience. Secondary outcome of the study was to describe the main demographical and clinical features of individuals who required admission to PICU. All clinical data were collected by retrospectively reviewing the electronic medical records of children and adolescents with diabetes hospitalized in our University Hospital from January 2017 to December 2022. RESULTS During the study period, 103 children and adolescents were newly diagnosed with T1D. Among these, 51.5% presented clinical criteria for DKA and almost 10% needed to be treated in PICU. A higher rate of new T1D diagnoses was observed in 2021, as well as episodes of severe DKA being more frequent than in previous years. Due to severe clinical manifestations of DKA, 10 subjects (9.7%) with T1D onset needed to be treated in PICU. Of these, four children were younger than 5. The great majority came from a low household income and some of them had also immigrant background. The most common complication of DKA was acute kidney injury presented by four children. Other complications were cerebral edema, papilledema and acute esophageal necrosis. A 15-year-old girl had deep vein thrombosis (DVT) that evolved into multiple organ failure leading to death. CONCLUSIONS Our findings demonstrated that severe DKA is still quite common in children and adolescents at T1D onset, especially in some areas such as Southern Italy. Public awareness campaigns should be increasingly promoted to facilitate the recognition of early symptoms of diabetes and to reduce morbidity and mortality related to DKA.
Collapse
Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy.
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Pietro Basile
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Flavia Caime
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Immacolata Rulli
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Pediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, ME, Italy
| |
Collapse
|
20
|
Shapiro ALB, Bellatorre A, Dabelea D, Stafford JM, D'Agostino R, Shah AS, Urbina EM, Barrett CE, Pihoker C, Marcovina S, Liese AD, Mottl AK, Jensen ET, Wilkening G. Diabetes complications and cognitive function in young adults with youth-onset type 1 or type 2 diabetes: the SEARCH for Diabetes in Youth Study. Pediatr Diabetes 2023; 2023:4860831. [PMID: 38706530 PMCID: PMC11068325 DOI: 10.1155/2023/4860831] [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: 05/07/2024] Open
Abstract
Aims/hypotheses People with type 1 (T1D) or type 2 diabetes (T2D) who also have diabetes complications can have pronounced cognitive deficits. It remains unknown, however, whether and how multiple diabetes complications co-occur with cognitive dysfunction, particularly in youth-onset diabetes. Methods Using data from the SEARCH for Diabetes in Youth study cohort, a prospective longitudinal cohort, we examined clustering of complications and their underlying clinical factors with performance on cognitive tests in young adults with youth-onset T1D or T2D. Cognition was assessed via the NIH Toolbox Cognition Battery. The main cognitive variables were age-corrected scores for composite fluid cognition and associated cognitive subdomains. Diabetes complications included retinopathy, microalbuminuria, and peripheral neuropathy (PN). Lipids, systolic blood pressure (SBP), hemoglobin A1c, and other clinical factors were included in the analyses. Clustering was applied separately to each group (T1D=646; T2D=165). A three-cluster(C) solution was identified for each diabetes type. Mean values and frequencies of all factors were compared between resulting clusters. Results The average age-corrected score for composite fluid cognition differed significantly across clusters for each group (p<0.001). People with T1D and the lowest average fluid cognition scores had the highest frequency of self-reporting at least one episode of hypoglycemia in the year preceding cognitive testing and the highest prevalence of PN. Persons with T2D and the lowest average fluid cognition scores had the highest SBP, the highest central systolic and diastolic blood pressures, and highest prevalence of PN. Conclusions/interpretations These findings highlight shared (PN) and unique factors (hypoglycemia in T1D; SBP in T2D) that could be targeted to potentially mitigate cognitive issues in young people with youth-onset diabetes.
Collapse
Affiliation(s)
- Allison L B Shapiro
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus
| | - Anna Bellatorre
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | | | - Ralph D'Agostino
- Department of Biostatistics and Data Science, Wake Forest University
| | - Amy S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati
| | - Elaine M Urbina
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati
| | - Catherine E Barrett
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | | | - Santica Marcovina
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina
| | - Amy K Mottl
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina, Chapel Hill
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Public Health Sciences, Wake Forest University
| | - Greta Wilkening
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus
| |
Collapse
|
21
|
Odeh R, Gharaibeh L, Daher A, Albaramki J, Ashour B, Barakat FA, Dahabreh D, Hadadin H, Melhem T, Alassaf A. Frequency, Clinical Characteristics and Predictors of Ketoacidosis at Diagnosis of Type One Diabetes Mellitus in Children and Adolescents from Jordan. J Clin Res Pediatr Endocrinol 2023; 15:46-54. [PMID: 36264035 PMCID: PMC9976172 DOI: 10.4274/jcrpe.galenos.2022.2022-5-8] [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] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Data regarding diabetic ketoacidosis (DKA) at diagnosis of type one diabetes (T1D) in developing countries are scarce. The aim of this study was to describe the frequency of DKA at the onset of T1D in children and adolescents in Jordan and to compare the clinical and biochemical characteristics between the group that presented with DKA and the group that did not. METHODS The records of 341 children and adolescents, less than sixteen years of age, who were diagnosed with T1D between 2015 and 2019 were evaluated retrospectively. RESULTS Of all the children diagnosed with T1D, 108 (31.7%) presented with DKA. The majority had mild or moderate DKA (38% and 33.3% respectively). Higher paternal education levels were associated with a lower probability of presenting with DKA (p=0.043). A family history of T1D had a protective effect on the occurrence of DKA (Odds ratio=2.138; 95% confidence interval=1.167-3.917, p=0.014). Patients with celiac disease and higher HbA1c levels were more likely to experience recurrent episodes of DKA, (p=0.004 and 0.011, respectively). CONCLUSION In Jordan, the rate of DKA at presentation of T1D remains high. Prevention campaigns are needed to increase diabetes awareness among the public and healthcare providers.
Collapse
Affiliation(s)
- Rasha Odeh
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan,* Address for Correspondence: University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan Phone: +962799178517 E-mail:
| | - Lobna Gharaibeh
- AI-Ahliyya Amman University, Faculty of Pharmacy, Pharmacological and Diagnostic Research Center, Amman, Jordan
| | - Amirah Daher
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
| | - Jumana Albaramki
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
| | - Bahaa Ashour
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
| | - Fatima Al Barakat
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
| | - Dina Dahabreh
- University of Jordan, School of Medicine, Amman, Jordan
| | - Hiba Hadadin
- University of Jordan, School of Medicine, Amman, Jordan
| | - Tala Melhem
- University of Jordan, School of Medicine, Amman, Jordan
| | - Abeer Alassaf
- University of Jordan School of Medicine, Department of Pediatrics, Amman, Jordan
| |
Collapse
|
22
|
Azova S, Liu E, Wolfsdorf J. Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic. Pediatr Diabetes 2023; 2023:5123197. [PMID: 38050487 PMCID: PMC10695073 DOI: 10.1155/2023/5123197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
The incidence of pediatric diabetic ketoacidosis (DKA) increased during the peak of the COVID-19 pandemic. The objective of this study was to investigate whether rates of hyperosmolar therapy administration for suspected clinically apparent brain injury (CABI) complicating DKA also increased during this period as compared to the three years immediately preceding the pandemic and to compare the characteristics of patients with suspected CABI before the pandemic, patients with suspected CABI during the peak of the pandemic, and those with DKA but without suspected CABI during the pandemic. Patients aged ≤18 years presenting with DKA before (March 11, 2017-March 10, 2020) and during the peak of the pandemic (March 11, 2020-March 10, 2021) were identified through a rigorous search of two databases. Predefined criteria were used to diagnose suspected CABI. Biochemical, clinical, and sociodemographic data were collected from a comprehensive review of the electronic medical record. The proportion of patients with DKA who received hyperosmolar therapy was significantly higher (P = 0.014) during the pandemic compared to the prepandemic period; however, this was only significant among patients with newly diagnosed diabetes. Both groups with suspected CABI had more severe acidosis, lower Glasgow Coma Scale scores, and longer hospital admissions (P< 0.001 for all) than cases without suspected CABI. During the pandemic, the blood urea nitrogen concentration was significantly higher in patients with suspected CABI than those without suspected CABI, suggesting they were more severely dehydrated. The clinical, biochemical, and sociodemographic characteristics of patients with suspected CABI were indistinguishable before and during the pandemic. In conclusion, administration of hyperosmolar therapy for suspected CABI was more common during the peak of the COVID-19 pandemic, possibly a result of delayed presentation, highlighting the need for increased awareness and early recognition of the signs and symptoms of diabetes and DKA, especially during future surges of highly transmissible infections.
Collapse
Affiliation(s)
- Svetlana Azova
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts 02115, USA
| | - Joseph Wolfsdorf
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts 02115, USA
| |
Collapse
|
23
|
Saroufim R, Hannon T. Nonketotic hyperglycemic hemichorea-hemiballismus in a pediatric patient: A case report. Clin Case Rep 2023; 11:e6857. [PMID: 36698526 PMCID: PMC9851085 DOI: 10.1002/ccr3.6857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/26/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
Nonketotic hyperglycemic hemichorea-hemiballismus (NHHH) is an infrequent complication of diabetes mellitus, and rarely occurs in children. We present an adolescent boy with recent diagnosis of type 1 diabetes who presented with hemichorea and brain imaging findings consistent with NHHH. His symptoms resolved with euglycemia and valproic acid after few weeks.
Collapse
Affiliation(s)
- Rita Saroufim
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at IU HealthIndiana University School of MedicineIndianapolisIndianaUSA
| | - Tamara Hannon
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at IU HealthIndiana University School of MedicineIndianapolisIndianaUSA
| |
Collapse
|
24
|
Ibrahim BA, Hussein SA, Abdullah WH. COGNITIVE FUNCTIONS IN CHILDREN WITH TYPE I DIABETES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:944-950. [PMID: 37326074 DOI: 10.36740/wlek202305108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: To assess the patterns and severity of cognitive impairment in children with type 1 diabetes as well as its association with disease onset and poor glycemic control. PATIENTS AND METHODS Materials and methods: We assessed higher mental function and screened for psychosocial functioning in 60 children with type 1 DM and 60 age-matched control using the Modified Mini-Mental State examination and Pediatric Symptoms Checklist and its relation with age, gender, socioeconomic status, age at the onset of disease, duration of disease, HbA1c level, frequency of diabetic ketoacidosis and hypoglycemic attacks and type of treatment. RESULTS Results: Diabetic patients demonstrated a lower Modified Mini-Mental State examination score than controls (25.12±4.58 versus 30.08±2.95) with a highly significant difference. Furthermore, the mean Pediatric symptoms checklist score in patients was 39.08±8.18 which was much lower than that of controls 54.42±6.0 with a highly significant difference. CONCLUSION Conclusions: There is neurocognitive impairment in diabetic children compared to non-diabetics, and poor glycemic control whether hyper or hypoglycemia could affect their cognition and mental health.
Collapse
|
25
|
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S230-S253. [PMID: 36507640 PMCID: PMC9810473 DOI: 10.2337/dc23-s014] [Citation(s) in RCA: 81] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
26
|
Sayedahmed AMS, Mohammed Alkhair Ebrahim AA, Mohamedali AMA, Mahgoub MSS. Epilepsia Partialis continua secondary to diabetic ketoacidosis. Clin Case Rep 2022; 10:e6701. [PMID: 36483874 PMCID: PMC9723475 DOI: 10.1002/ccr3.6701] [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: 06/29/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Epilepsia partialis continua is a rare epileptic syndrome presenting with simple, partial, repetitive motor seizures. It can be a result of structural central nervous system lesion or due to metabolic causes. We report a case of a 65-year-old male patient diagnosed with EPC secondary to diabetic ketoacidosis.
Collapse
|
27
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
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
| |
Collapse
|
29
|
Albloui F, John J, Alghamdi O, Alseraye F, Alqahtani A, Tamimi W, Albloshi A, Aldakheel FM, Mateen A, Syed R. Effect of hematocrit, galactose and ascorbic acid on the blood glucose readings of three point-of-care glucometers. Scand J Clin Lab Invest 2022; 82:563-570. [PMID: 36332153 DOI: 10.1080/00365513.2022.2138779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Glucometers are commonly used in a variety of healthcare settings and use in critically ill patients should not be assumed without appropriate tool validation. The study objective was to evaluate the accuracy of three point-of-care glucometers (POCGs) to assess glucose concentration in human blood sample. The POCGs tested included three different instruments and utilized three factors (hematocrit [Hct], galactose and ascorbic acid) in glucose measurements to determine the glucometers' accuracy and compared to the reference laboratory biochemical analyzer (Cobs 8000, Roche, Basal, Switzerland). In this study, the Nova StatStrip glucometer showed no significant variation compared to the laboratory method at high glucose level with various Hct%. ACCU-Chek Inform II overestimated the glucose results at Hct 22% and underestimated at Hct 62%. The Freestyle glucometer showed lower glucose levels compared to the Cobas 8000 at Hct 62%. The ACCU-Check showed significant increase of blood glucose with low Hct% levels when compared to the laboratory method. The Freestyle showed a decreased level of glucose with high Hct 62% interference compared to the Cobas 8000. Galactose interference 100 and 200 mg/dL dramatically affected the accuracy of ACCU-Chek Inform II. Nevertheless, among all three POCGs in this study, the Nova StatStrip showed the most reliable and stable results for glucose level in the presence of interference. Especially, those in critical care units, whereas the Freestyle Precision Pro and ACCU-Chek Inform II were insufficiently accurate for critically ill patients.
Collapse
Affiliation(s)
- Fawaz Albloui
- Department of Pathology and Laboratory Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - James John
- Department of Medical Laboratory Technology, School of Allied Health Science, Sathyabama Institute of Science and Technology, Chennai, India
| | - Osama Alghamdi
- Department of Pathology and Laboratory Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Faisal Alseraye
- Department of Pathology and Laboratory Medicine, Kind Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Alqahtani
- Department of Pathology and Laboratory Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Waleed Tamimi
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, National Guard Health Affairs, Riyadh,Saudi Arabia
| | - Abdullah Albloshi
- Department of Anatomy, College of Medicine, Al Baha University, Al Bahah, Saudi Arabia
| | - Fahad M Aldakheel
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ayesha Mateen
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Rabbani Syed
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
30
|
Jaromy M, Miller JD. Potential Clinical Applications for Continuous Ketone Monitoring in the Hospitalized Patient with Diabetes. Curr Diab Rep 2022; 22:501-510. [PMID: 35984565 PMCID: PMC9388986 DOI: 10.1007/s11892-022-01489-6] [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] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW In this review, the authors discuss potential clinical applications for continuous ketone monitoring (CKM) in a broad continuum of clinical settings from pre-hospital care and the emergency department to acute inpatient management and post-discharge follow-up. RECENT FINDINGS Though in its early stages, the concept of a novel continuous ketone sensing technology exerts great potential for use in the detection and hospital management of DKA, namely to overcome diagnostic barriers associated with ketoacidosis in patients with diabetes and obtain real-time BOHB levels, which may be useful in understanding both patients' response to treatment and DKA trajectory. Peri- and intra-operative use of CKM technology can potentially be applied in a number of urgent and elective surgical procedures frequently underwent by patients with diabetes and in the observation of patients during peri-operative fasting. In transitional care management, CKM technology could potentially facilitate patients' safe transition through levels of care, following hospital discharge from a DKA episode. This evaluation of the literature presents the potential advantages of adopting CKM and integrating this technology into the care algorithm of patients at risk for ketoacidosis.
Collapse
Affiliation(s)
- Michelle Jaromy
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, Oyster Bay, NY 11545 USA
| | - Joshua D. Miller
- Division of Endocrinology and Metabolism, Renaissance School of Medicine at Stony Brook University, 100 Nicolls Rd, Stony Brook, Brookhaven, NY 11794 USA
| |
Collapse
|
31
|
Holder M, Kapellen T, Ziegler R, Bürger-Büsing J, Danne T, Dost A, Holl RW, Holterhus PM, Karges B, Kordonouri O, Lange K, Müller S, Raile K, Schweizer R, von Sengbusch S, Stachow R, Wagner V, Wiegand S, Neu A. Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents. Exp Clin Endocrinol Diabetes 2022; 130:S49-S79. [PMID: 35913059 DOI: 10.1055/a-1624-3388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Martin Holder
- Klinikum Stuttgart, Olgahospital, Department of Pediatric Endocrinology and Diabetology, Germany
| | - Thomas Kapellen
- Department of Paediatrics and Adolescent Medicine, University Hospital, Leipzig, Germany
| | - Ralph Ziegler
- Practice for Paediatrics and Adolescent Medicine, Focus on Diabetology, Münster, Germany
| | - Jutta Bürger-Büsing
- Association of Diabetic Children and Adolescents, Diabetes Center, Kaiserslautern, Germany
| | - Thomas Danne
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Axel Dost
- Department of Paediatrics and Adolescent Medicine, University Hospital Jena, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany
| | - Paul-Martin Holterhus
- Department of General Paediatrics, University Hospital Schleswig-Holstein, Kiel Campus, Germany
| | - Beate Karges
- Endocrinology and Diabetology Section, University Hospital, RWTH Aachen University, Germany
| | - Olga Kordonouri
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | | | - Klemens Raile
- Virchow Hospital, University Medicine, Berlin, Germany
| | - Roland Schweizer
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
| | - Simone von Sengbusch
- Department of Paediatrics and Adolescent Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Rainer Stachow
- Sylt Specialist Hospital for Children and Adolescents, Westerland, Germany
| | - Verena Wagner
- Joint Practice for Paediatrics and Adolescent Medicine, Rostock, Germany
| | | | - Andreas Neu
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
| |
Collapse
|
32
|
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.
Collapse
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,
| |
Collapse
|
33
|
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.
Collapse
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
| | | |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Mitchell RJ, McMaugh A, Woodhead H, Lystad RP, Zurynski Y, Badgery‐Parker T, Cameron CM, Hng T. The impact of type 1 diabetes mellitus in childhood on academic performance: A matched population-based cohort study. Pediatr Diabetes 2022; 23:411-420. [PMID: 35080102 PMCID: PMC9306722 DOI: 10.1111/pedi.13317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The impact of type 1 diabetes mellitus (T1D) on academic performance is inconclusive. This study aims to compare scholastic performance and high-school completion in young people hospitalized with T1D compared to matched peers not hospitalized with diabetes. RESEARCH DESIGN Retrospective case-comparison cohort study. METHOD A population-level matched case-comparison study of people aged ≤18 hospitalized with T1D during 2005-2018 in New South Wales, Australia using linked health-related and education records. The comparison cohort was matched on age, gender, and residential postcode. Generalized linear mixed modeling examined risk of school performance below the national minimum standard (NMS) and generalized linear regression examined risk of not completing high school for young people hospitalized with T1D compared to peers. Adjusted relative risks (ARR) were calculated. RESULTS Young females and males hospitalized with T1D did not have a higher risk of not achieving the NMS compared to peers for numeracy (ARR: 1.19; 95%CI 0.77-1.84 and ARR: 0.74; 95%CI 0.46-1.19) or reading (ARR: 0.98; 95%CI 0.63-1.50 and ARR: 0.85; 95%CI 0.58-1.24), respectively. Young T1D hospitalized females had a higher risk of not completing year 11 (ARR: 1.73; 95%CI 1.19-2.53) or 12 (ARR: 1.65; 95%CI 1.17-2.33) compared to peers, while hospitalized T1D males did not. CONCLUSIONS There was no difference in academic performance in youth hospitalized with T1D compared to peers. Improved glucose control and T1D management may explain the absence of school performance decrements in students with T1D. However, females hospitalized with T1D had a higher risk of not completing high school. Potential associations of this increased risk, with attention to T1D and psycho-social management, should be investigated.
Collapse
Affiliation(s)
- Rebecca J. Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
| | - Anne McMaugh
- The Macquarie School of EducationMacquarie UniversitySydneyNSWAustralia
| | - Helen Woodhead
- School of Women's and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNSWAustralia,Department of Paediatric Diabetes and EndocrinologyRoyal North Shore HospitalSydneyNSWAustralia,Department of Endocrinology and DiabetesSydney Children's HospitalSydneyNSWAustralia
| | - Reidar P. Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
| | - Tim Badgery‐Parker
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
| | - Cate M. Cameron
- Jamieson Trauma InstituteRoyal Brisbane & Women's Hospital, Metro North Hospital and Health Services DistrictBrisbaneQLDAustralia,Centre for Healthcare Transformation, Australian Centre for Health Services InnovationQueensland University of TechnologyBrisbaneQLDAustralia
| | - Tien‐Ming Hng
- Department of Diabetes and EndocrinologyBlacktown and Mount Druitt HospitalSydneyNSWAustralia,School of MedicineWestern Sydney UniversitySydneyNSWAustralia
| |
Collapse
|
36
|
Glaser N, Chu S, Weiner J, Zdepski L, Wulff H, Tancredi D, ODonnell ME. Effects of TRAM-34 and minocycline on neuroinflammation caused by diabetic ketoacidosis in a rat model. BMJ Open Diabetes Res Care 2022; 10:10/3/e002777. [PMID: 35584854 PMCID: PMC9119135 DOI: 10.1136/bmjdrc-2022-002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) causes acute and chronic neuroinflammation that may contribute to cognitive decline in patients with type 1 diabetes. We evaluated the effects of agents that reduce neuroinflammation (triarylmethane-34 (TRAM-34) and minocycline) during and after DKA in a rat model. RESEARCH DESIGN AND METHODS Juvenile rats with DKA were treated with insulin and saline, either alone or in combination with TRAM-34 (40 mg/kg intraperitoneally twice daily for 3 days, then daily for 4 days) or minocycline (45 mg/kg intraperitoneally daily for 7 days). We compared cytokine and chemokine concentrations in brain tissue lysates during DKA among the three treatment groups and in normal controls and diabetic controls (n=9-15/group). We also compared brain inflammatory mediator levels in these same groups in adult diabetic rats that were treated for DKA as juveniles. RESULTS Brain tissue concentrations of chemokine (C-C) motif ligand (CCL)3, CCL5 and interferon (IFNγ) were increased during acute DKA, as were brain cytokine composite scores. Both treatments reduced brain inflammatory mediator levels during acute DKA. TRAM-34 predominantly reduced chemokine concentrations (chemokine (C-X-C) motif ligand (CXCL-1), CCL5) whereas minocycline had broader effects, (reducing CXCL-1, tumor necrosis factor (TNFα), IFNγ, interleukin (IL) 2, IL-10 and IL-17A). Brain inflammatory mediator levels were elevated in adult rats that had DKA as juveniles, compared with adult diabetic rats without previous DKA, however, neither TRAM-34 nor minocycline treatment reduced these levels. CONCLUSIONS These data demonstrate that both TRAM-34 and minocycline reduce acute neuroinflammation during DKA, however, treatment with these agents for 1 week after DKA does not reduce long-term neuroinflammation.
Collapse
Affiliation(s)
- Nicole Glaser
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, California, USA
| | - Steven Chu
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, California, USA
| | - Justin Weiner
- Department of Physiology and Membrane Biology, UC Davis, Davis, California, USA
| | - Linnea Zdepski
- Department of Physiology and Membrane Biology, UC Davis, Davis, California, USA
| | - Heike Wulff
- Department of Pharmacology, UC Davis, Davis, California, USA
| | - Daniel Tancredi
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, California, USA
| | - Martha E ODonnell
- Department of Physiology and Membrane Biology, UC Davis, Davis, California, USA
| |
Collapse
|
37
|
Yuan X, Wang J, Chen X, Yan W, Niu Q, Tang N, Zhang MZ, Gu W, Wang X. Effects of the timing of the initiation of dietary intake on pediatric type 1 diabetes for diabetic ketoacidosis. BMC Pediatr 2022; 22:206. [PMID: 35418062 PMCID: PMC9008930 DOI: 10.1186/s12887-022-03243-z] [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: 11/03/2021] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Precision treatment of pediatric diabetic ketoacidosis (DKA) has been the focus of research for decades. Whether the timing of the initiation of dietary intake contributes to DKA correction is ignored. Methods We conducted a retrospective study to investigate the effects of the timing of the initiation of dietary intake on DKA correction in Children’s Hospital of Nanjing Medical University, a tertiary children’s hospital, from June 2017 to December 2020. Individual basic characteristic and clinical information of all DKA cases (n = 183) were collected. Multiple linear regression, logistic regression model and random forest (RF) model were used to assess the effect of the timing of the initiation of dietary intake on DKA correction. Results The mean age of the children diagnosed with DKA was 6.95 (SD 3.82) years. The median DKA correction time and the timing of the initiation of dietary intake was 41.72 h and 3.13 h, respectively. There were 62.3% (n = 114) patients corrected DKA at the end of the 48-h rehydration therapy. For each hour delay in starting dietary intake, child’s DKA correction was prolonged by 0.5 (95% CI 1.05, 1.11, P < 0.001) hours and the adjusted odds of DKA over 48 h was increased by 8% (OR = 1.08, 95% CI: 1.05, 1.11, P < 0.001) after adjustment for potential confounders. The RF model based on the timing of the initiation of dietary intake and child’s weight and systolic pressure achieved the highest AUC of 0.789. Conclusion Pediatricians should pay attention to the effect of the timing of the initiation of dietary intake, a controllable factor, on DKA correction. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03243-z.
Collapse
Affiliation(s)
- Xuewen Yuan
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Rd, Nanjing, 210008, China
| | - Jieguo Wang
- Department of Emergency, Pediatric intensive care unit, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xiaofeng Chen
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Wu Yan
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Qing Niu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Rd, Nanjing, 210008, China
| | - Ning Tang
- Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Ming Zhi Zhang
- School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Wei Gu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Rd, Nanjing, 210008, China.
| | - Xu Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Rd, Nanjing, 210008, China
| |
Collapse
|
38
|
Tharmaraja T, Ho JS, Sia CH, Lim NA, Chong YF, Lim AY, Rathakrishnan RR, Yeo LL, Sharma VK, Tan BY. Sodium-glucose cotransporter 2 inhibitors and neurological disorders: a scoping review. Ther Adv Chronic Dis 2022; 13:20406223221086996. [PMID: 35432846 PMCID: PMC9006360 DOI: 10.1177/20406223221086996] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/24/2022] [Indexed: 01/24/2023] Open
Abstract
Background Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of antidiabetic medications with a favourable cardiovascular, renal and overall safety profile. Given the limited treatment options available for neurological disorders, it is important to determine whether the pleiotropic effects of SGLT2i can be utilised in their prevention and management. Methods All articles published before 20 March 2021 were systematically searched in MEDLINE, EMBASE, Scopus, Web of Science, APA PsycINFO and ClinicalTrials.gov. Overall, 1395 titles were screened, ultimately resulting in 160 articles being included in the qualitative analysis. Screening and data extraction were conducted by two independent authors and studies were excluded if they were not an original research study. Findings Of the 160 studies, 134 addressed stroke, 19 cognitive impairment, 4 epilepsy and 4 movement disorders, encompassing a range from systematic reviews and randomised controlled trials to bioinformatic and animal studies. Most animal studies demonstrated significant improvements in behavioural and neurological deficits, which were reflected in beneficial changes in neurovascular units, synaptogenesis, neurotransmitter levels and target receptors' docking energies. The evidence from the minority clinical literature was conflicting and many studies did not reach statistical significance. Interpretation SGLT2i may exert neurological benefits through three mechanisms: reduction in cardiovascular risk factors, augmentation of ketogenesis and anti-inflammatory pathways. Most clinical studies were observational, meaning that a causal relationship could not be established, while randomised controlled trials were heterogeneous and powered to detect cardiovascular or renal outcomes. We suggest that a longitudinal study should be conducted and specifically powered to detect neurological outcomes.
Collapse
Affiliation(s)
- Thahesh Tharmaraja
- Intensive Care Unit, University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jamie S.Y. Ho
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicole-Ann Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Feng Chong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Amanda Y.L. Lim
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore
| | - Rahul R. Rathakrishnan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard L.L. Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road Level 11, 119228 Singapore
| | - Vijay K. Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Benjamin Y.Q. Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Smuel-Zilberberg K, Shalitin S, Yackobovitch-Gavan M, Phillip M, Nimri R. Diabetes ketoacidosis recovery in youth with newly diagnosed and established type 1 diabetes. Pediatr Res 2022; 91:1272-1277. [PMID: 34148066 DOI: 10.1038/s41390-021-01618-z] [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: 01/29/2021] [Revised: 05/06/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to describe the differences in metabolic parameters and in time to recovery from diabetes ketoacidosis (DKA), between children and adolescents with newly diagnosed diabetes compared with established type 1 diabetes (T1DM). METHODS This was a single-center, retrospective study. The cohort consists of 356 children and adolescents with T1DM who had DKA during 2008-2018. Data were obtained from the patients' medical files. Recovery of DKA was defined as the resolution of acidosis (pH >7.3 and bicarbonate >15 meq/L). RESULTS The mean time to recovery from DKA was significantly longer in patients with newly diagnosed diabetes than in those with established diabetes (13± versus 8.5± h) (p < 0.001). This difference was maintained in an analysis according to DKA severity: mild, moderate, and severe. pH at presentation did not differ between the groups, but bicarbonate at presentation was significantly lower in patients with newly diagnosed diabetes than in those with established diabetes, 9.9± versus 12± mmol/L (p < 0.001). Potassium and phosphorus levels were lower, and sodium and chloride levels were higher in patients with newly diagnosed diabetes than in those with established diabetes (p < 0.001). CONCLUSIONS DKA is associated with a shorter recovery time in patients with established diabetes compared to newly diagnosed diabetes. This may have implications on the treatment of people with established diabetes. IMPACT DKA is associated with a shorter recovery time in patients with established diabetes compared with newly diagnosed diabetes. Shorter recovery time in a patient with established diabetes compared with newly diagnosed diabetes was observed in any DKA severity. The time to recovery from DKA did not differ significantly between patients treated with an insulin pump and those treated with multiple daily injections. Triggers for DKA among patients with established diabetes were poor compliance with treatment, infection, pump dysfunction, and dehydration.
Collapse
Affiliation(s)
- Keren Smuel-Zilberberg
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Shlomit Shalitin
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 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, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| |
Collapse
|
41
|
Chang CH, Lian HW, Sung YF. Cystic Encephalomalacia in a Young Woman After Cardiac Arrest Due to Diabetic Ketoacidosis and Thyroid Storm. Cureus 2022; 14:e23707. [PMID: 35505739 PMCID: PMC9056232 DOI: 10.7759/cureus.23707] [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] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
Cystic encephalomalacia is commonly reported in neonates with prenatal or perinatal hypoxic events. It is rarely observed in adults. A 25-year-old woman with a history of type 1 diabetes mellitus and hyperthyroidism presented to the emergency department with diabetic ketoacidosis (DKA) and a thyroid storm. She sustained cardiac arrest due to ventricular fibrillation and subsequently developed hypoxic encephalopathy. Initial brain computed tomography showed no significant findings; however, follow-up magnetic resonance imaging three months later revealed cystic encephalomalacia in the bilateral parieto-occipital lobes. A Tc-99m ethyl cysteinate dimer (ECD) brain perfusion scan revealed extensive hypoperfusion in the bilateral frontal and parieto-occipital lobes. She showed severe cognitive impairment and marked spasticity in all her limbs. Although cystic encephalomalacia is mostly reported in neonates with hypoxic injury, it can be seen in adults with hypoxic encephalopathy, leading to a significant neurological deficit.
Collapse
|
42
|
ATALAR AÇ, BAYKAN B. Different Prognostic Patterns in Epilepsies and Considerations About the Denotations of Atypical Patterns. Noro Psikiyatr Ars 2022; 59:68-76. [PMID: 35317501 PMCID: PMC8895800 DOI: 10.29399/npa.27976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/12/2021] [Indexed: 06/14/2023] Open
Abstract
Epilepsy is a dynamic and heterogeneous neurological disease, and in long-term studies on prognosis, classically 5 basic patterns (early remission, late remission, relapsing-remitting, worsening, and non-remitting) have been identified. The most frequent pattern was relapsing-remitting course, and factors such as the presence of genetic etiology, rare seizures at the beginning of epilepsy and the absence of psychiatric comorbid diseases were found to be related with this pattern as well as reaching 5 years of remission in the follow-ups. Anti-seizure drug resistance (ASD-R) and factors affecting the presence of this resistance (such as symptomatic etiology, abnormal electroencephalographic findings, having multiple seizure types together, status epilepticus and febrile seizure history) decrease the chance of remission, while idiopathic/genetic etiology, generalized epilepsy, and absence of comorbid diseases seem to be associated with achieving long-term remission. Apart from these basic course patterns, there are some patients with an "atypical prognosis" such as drug-resistant juvenile myoclonic epilepsy (JME), benign hippocampal sclerosis-related mesial temporal lobe epilepsy (HS-MTLE), and severe childhood epilepsy with centro-temporal spikes (CESTS), in which the pathophysiological mechanisms underlying these patterns have not been clarified despite the suggestions of various hypotheses. The presence of comorbid diseases such as hormonal factors (as in catamenial epilepsy), autoimmune processes, thyroid disorders and metabolic and psychiatric diseases may also cause an atypical prognostic pattern by affecting the course of the disease. In this review, our aim is to provide the clinician with an up-to-date and questioning perspective on the prognostic markers of epilepsy, by examining in detail some specific epilepsy syndromes that may show atypical prognosis as well as the general prognostic features of epilepsy.
Collapse
Affiliation(s)
- Arife Çimen ATALAR
- University of Health Sciences, Istanbul Education and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Betül BAYKAN
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul, Turkey
| |
Collapse
|
43
|
Raghunathan V, Jevalikar G, Dhaliwal M, Singh D, Sethi SK, Kaur P, Singhi SC. Risk Factors for Cerebral Edema and Acute Kidney Injury in Children with Diabetic Ketoacidosis. Indian J Crit Care Med 2022; 25:1446-1451. [PMID: 35027807 PMCID: PMC8693099 DOI: 10.5005/jp-journals-10071-24038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives To study the clinical profile and risk factors of cerebral edema and acute kidney injury in children with diabetic ketoacidosis. Design Retrospective review of medical records. Patients Fifty consecutive patients (age <18 years) admitted to our pediatric intensive care unit with a diagnosis of diabetic ketoacidosis over 5 years. Materials and methods Retrospective analysis of medical records was done, and data including patients’ age, sex, presenting features, biochemical profile including blood glucose, osmolality, urea, creatinine, and venous blood gas, electrolytes were recorded at admission, at 12 and 24 hours. Treatment details including fluid administration, rate of fall of glucose, time to resolution of diabetic ketoacidosis were noted. Complications such as cerebral edema and acute kidney injury were recorded. Patients with and without cerebral edema and acute kidney injury were compared. Variables that were significant on univariate analysis were entered in a multiple logistic regression analysis to determine the independent predictors for cerebral edema and acute kidney injury. Odds ratio and 95% confidence interval were calculated using SPSS version 22. Measurements and main results Between November 2015 and 2020, 48 patients were admitted for a total of 50 episodes of diabetic ketoacidosis. Two patients had recurrent diabetic ketoacidosis. Median age was 9.5 years (range 1–17). Thirty-one patients (62%) had new-onset type I diabetes mellitus. Twenty-two patients (44%) presented with severe diabetic ketoacidosis. Cerebral edema and acute kidney injury were seen in 11 (22%) and 15 (30%) patients, respectively. On multiple logistic regression analysis, higher blood urea level, lower serum bicarbonate level, and higher corrected sodium levels at admission were identified to be variables independently associated with risk of cerebral edema. Conclusions Higher corrected sodium, higher urea level, and lower serum bicarbonate levels at admission are predictive of cerebral edema in patients presenting with diabetic ketoacidosis. The severity of dehydration and acidosis in DKA appears to be a common factor responsible for the development of dysfunction of both brain and kidney. How to cite this article Raghunathan V, Jevalikar G, Dhaliwal M, Singh D, Sethi SK, Kaur P, et al. Risk Factors for Cerebral Edema and Acute Kidney Injury in Children with Diabetic Ketoacidosis. Indian J Crit Care Med 2021;25(12):1446–1451.
Collapse
Affiliation(s)
| | - Ganesh Jevalikar
- Department of Endocrinology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Maninder Dhaliwal
- Department of Pediatric Critical Care, Medanta-The Medicity, Gurugram, Haryana, India
| | - Dhirendra Singh
- Department of Pediatric Critical Care, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sidharth K Sethi
- Department of Pediatric Nephrology, Kidney Institute, Medanta-The Medicity, Gurugram, Haryana, India
| | - Parjeet Kaur
- Department of Endocrinology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sunit C Singhi
- Department of Pediatrics, Medanta-The Medicity, Gurugram, Haryana, India
| |
Collapse
|
44
|
Cacciatore M, Grasso EA, Tripodi R, Chiarelli F. Impact of glucose metabolism on the developing brain. Front Endocrinol (Lausanne) 2022; 13:1047545. [PMID: 36619556 PMCID: PMC9816389 DOI: 10.3389/fendo.2022.1047545] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
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.
Collapse
|
45
|
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.
Collapse
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
| |
Collapse
|
46
|
Cai LY, Tanase C, Anderson AW, Ramadass K, Rheault F, Lee CA, Patel NJ, Jones S, LeStourgeon LM, Mahon A, Pruthi S, Gwal K, Ozturk A, Kang H, Glaser N, Ghetti S, Jaser SS, Jordan LC, Landman BA. Multimodal neuroimaging in pediatric type 1 diabetes: a pilot multisite feasibility study of acquisition quality, motion, and variability. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12032:120323U. [PMID: 36303580 PMCID: PMC9604061 DOI: 10.1117/12.2611553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Type 1 diabetes (T1D) affects over 200,000 children and is associated with an increased risk of cognitive dysfunction. Prior imaging studies suggest the neurological changes underlying this risk are multifactorial, including macrostructural, microstructural, and inflammatory changes. However, these studies have yet to be integrated, limiting investigation into how these phenomena interact. To better understand these complex mechanisms of brain injury, a well-powered, prospective, multisite, and multimodal neuroimaging study is needed. We take the first step in accomplishing this with a preliminary characterization of multisite, multimodal MRI quality, motion, and variability in pediatric T1D. We acquire structural T1 weighted (T1w) MRI, diffusion tensor MRI (DTI), functional MRI (fMRI), and magnetic resonance spectroscopy (MRS) of 5-7 participants from each of two sites. First, we assess the contrast-to-noise ratio of the T1w MRI and find no differences between sites. Second, we characterize intervolume motion in DTI and fMRI and find it to be on the subvoxel level. Third, we investigate variability in regional gray matter volumes and local gyrification indices, bundle-wise DTI microstructural measures, and N-acetylaspartate to creatine ratios. We find the T1-based measures to be comparable between sites before harmonization and the DTI and MRS-based measures to be comparable after. We find a 5-15% coefficient of variation for most measures, suggesting ~150-200 participants per group on average are needed to detect a 5% difference across these modalities at 0.9 power. We conclude that multisite, multimodal neuroimaging of pediatric T1D is feasible with low motion artifact after harmonization of DTI and MRS.
Collapse
Affiliation(s)
- Leon Y. Cai
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Costin Tanase
- Department of Psychiatry, University of California, Davis, Davis, CA, USA
| | - Adam W. Anderson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA,Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Karthik Ramadass
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Francois Rheault
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Chelsea A. Lee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J. Patel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sky Jones
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alix Mahon
- Department of Psychology, University of California, Davis, Davis, CA, USA
| | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kriti Gwal
- Department of Radiology, UC Davis Health, UC Davis School of Medicine, Sacramento, CA, USA
| | - Arzu Ozturk
- Department of Radiology, UC Davis Health, UC Davis School of Medicine, Sacramento, CA, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicole Glaser
- Department of Pediatrics, UC Davis Health, UC Davis School of Medicine, Sacramento, CA, USA
| | - Simona Ghetti
- Department of Psychology, University of California, Davis, Davis, CA, USA
| | - Sarah S. Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C. Jordan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bennett A. Landman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA,Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA,Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
47
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
48
|
Figueroa-Pizano MD, Campa-Mada AC, Carvajal-Millan E, Martinez-Robinson KG, Chu AR. The underlying mechanisms for severe COVID-19 progression in people with diabetes mellitus: a critical review. AIMS Public Health 2021; 8:720-742. [PMID: 34786431 PMCID: PMC8568590 DOI: 10.3934/publichealth.2021057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) has a high incidence of comorbidities among patients with severe coronavirus disease 2019 (COVID-19). The elevated prevalence of DM in the world population makes it a significant risk factor because diabetic individuals appear to be prone to clinical complications and have increased mortality rates. Here, we review the possible underlying mechanisms involved in DM that led to worse outcomes in COVID-19. The impacts of hyperglycemia side effects, secondary comorbidities, weakened innate and adaptive immunity, chronic inflammation, and poor nutritional status, commonly present in DM, are discussed. The role of the SARS-CoV-2 receptor and its polymorphic variations on higher binding affinity to facilitate viral uptake in people with DM were also considered. Clinical differences between individuals with type 1 DM and type 2 DM affected by COVID-19 and the potential diabetogenic effect of SARS-CoV-2 infection were addressed.
Collapse
Affiliation(s)
- María D Figueroa-Pizano
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Alma C Campa-Mada
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Elizabeth Carvajal-Millan
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Karla G Martinez-Robinson
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Agustin Rascon Chu
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| |
Collapse
|
49
|
Emilia K, Aneta S, Barbara M, Małgorzata J, Aleksandra H, Paulina B, Agnieszka S. Is diabetic ketoacidosis a good predictor of 5-year metabolic control in children with newly diagnosed type 1 diabetes? BMC Endocr Disord 2021; 21:218. [PMID: 34727899 PMCID: PMC8561920 DOI: 10.1186/s12902-021-00882-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The study aimed to evaluate whether the presence of DKA at diabetes diagnosis was associated with poorer metabolic control during a 5-year follow-up. METHODS The study included children treated due to newly diagnosed T1D complicated with DKA between 2010 and 2014 with a complete 5-year follow-up. In every case we performed individual matching for age, gender and BMI with a person without DKA (nDKA) on recognition. We collected data regarding treatment modality, HbA1C, total daily insulin dose, basal insulin and BMI-SDS. RESULTS 85 children at the median age of 7.93 years had DKA at diabetes diagnosis. The median pH was 7.19.Continuous subcutaneous insulin infusion (CSII) was used in 87% of participants in each group. No differences in HbA1C level (7,3%vs7,2%;p = .413) were noted after 5 years of disease duration. The severity of ketoacidosis exerted no significant effect on HbA1C. The method of insulin delivery at baseline was significantly associated with HbA1C levels after 5 years of observation, βCSII = - 1.46,95%CI[- 2.01 to - 0.92],p < .001. CONCLUSIONS The presence of DKA at diabetes diagnosis is not associated with deteriorated long-term metabolic control in children using modern technologies. The early implementation of CSII into diabetes treatment may change the effect of DKA and lead to a long-term HbA1C improvement.
Collapse
Affiliation(s)
- Kowalczyk Emilia
- Department of Pediatric Diabetology and Pediatrics, Pediatric Teaching Clinical Hospital of the Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland.
| | - Stypułkowska Aneta
- Department of Pediatric Diabetology and Pediatrics, Pediatric Teaching Clinical Hospital of the Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland
| | - Majewska Barbara
- Students' Scientific Association, Medical University of Warsaw, Warsaw, Poland
| | | | - Hoffmann Aleksandra
- Students' Scientific Association, Medical University of Warsaw, Warsaw, Poland
| | - Buła Paulina
- Students' Scientific Association, Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|
50
|
Wersäll JH, Adolfsson P, Forsander G, Ricksten SE, Hanas R. Delayed referral is common even when new-onset diabetes is suspected in children. A Swedish prospective observational study of diabetic ketoacidosis at onset of Type 1 diabetes. Pediatr Diabetes 2021; 22:900-908. [PMID: 33978305 DOI: 10.1111/pedi.13229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/04/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Delayed treatment for new-onset diabetes Type 1 (T1D) can lead to diabetic ketoacidosis (DKA) with potentially devastating consequences. This prospective observational study aimed to characterize pediatric patients with DKA at hospital admission, regarding parental awareness of diabetes-related symptoms and delayed referrals from primary health care providers to pediatric emergency wards. RESEARCH DESIGN AND METHODS Patients 0-18 years admitted to hospital with new-onset T1D and DKA between 2015 and 2017 were invited to participate. Questionnaires were filled out separately by the caregivers and by the attending hospital staff. Data from the Swedish National Diabetes Registry (SWEDIABKIDS) were used for comparison. Delayed referral was defined as a primary healthcare contact due to diabetes-related symptoms 0-4 weeks before hospital admission without immediate referral, or registered elevated glucose levels at primary healthcare centers without immediate referral. RESULTS The study included 237 patients, among which parental suspicion of new-onset diabetes before healthcare contacts was reported in 39%. Parental suspicion of diabetes was associated with higher pH values at diagnosis. Patients in contact with primary health care providers before hospital admission had a delayed referral in 43% of the cases. Delayed referral was associated with lower pH values at hospital admission. Symptoms leading to primary healthcare contacts were similar regardless of whether delay occurred or not. CONCLUSIONS Parental suspicion of diabetes was associated with milder DKA at hospital admission. Delayed referral was seen in a considerable proportion of children with primary healthcare contacts for symptoms associated with diabetes. Increased awareness of diabetes symptoms is of paramount importance.
Collapse
Affiliation(s)
- Johan H Wersäll
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Adolfsson
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
| | - Gun Forsander
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ragnar Hanas
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
| |
Collapse
|