Metabolic control in children and adolescents with insulin-dependent diabetes mellitus at King Abdul-Aziz University Hospital

Autoimmune diseases and their prevalence in Saudi Arabian patients with type 1 diabetes mellitus

OBJECTIVES

To evaluate the prevalence of autoimmune disorders among young and adult populations diagnosed with type 1 diabetes mellitus (T1DM) in Al-Madinah Al-Munawarah, Saudi Arabia, and assess the potential impact of these conditions on other comorbidities.

METHODS

A retrospective, descriptive study examined autoimmune disorders in T1DM youth and adults. A total of 2258 verified T1DMs were tested. Analyzed hospital and laboratory data. Autoimmune T1DM was investigated clinically and laboratory.

RESULTS

A total of 2258 T1DM adults, adolescents, and children were investigated; 500 (22.2%) were under 12, 540 (23.9%) were 13-17, and 1218 (53.9%) were 18 plus. Autoimmune with T1DM was 67.4%. Gender and age affect prevalence. 25.7% of adult females had autoimmune thyroiditis. Children and adolescents have greater rates of celiac disease than adults of both genders. Adrenal insufficiency was more frequent in adults. Adult males had 28.5% polyglandular autoimmune diseases, and women had 19.7%. Type 1 DM and other autoimmune illnesses increase the risk of nephropathy, CVD, and hypoglycemia. Bloodstream biomarkers linked to these disorders corroborate this.

CONCLUSION

Autoimmune diseases in Saudi patients with T1DM exhibited specificity with respect to gender and age. Al-Madinah Al-Munawwarah have a heightened prevalence of autoimmune diseases among young individuals diagnosed with T1DM, such as celiac disease and autoimmune thyroiditis. Conversely, older individuals in the region have been observed to exhibit a greater incidence of adrenal failure and polyglandular autoimmune disorders. Autoimmune diseases that result in nephropathy, CVD, and hypoglycemia are highly prevalent based on biomarker levels.

Quality of Life Among Children With Type 1 Diabetes Mellitus in Alahsa: A Cross-Sectional Study

BACKGROUND

Diabetes mellitus (DM) is the most common endocrine disease in children, and its annual prevalence is increasing worldwide. Health-related quality of life (HRQoL) is a crucial indicator of chronic illnesses such as DM. This study aimed to assess the HRQoL and determine the associated factors among children and adolescents with type 1 DM in Alahsa region in 2022.

METHODS

An analytical cross-sectional study was conducted in the DiabeterSA center using the Arabic version of the Pediatric Quality of Life Inventory (PedsQl 3.2). All patients aged 5-16 years and diagnosed with type 1 DM were included in the study. Face-to-face interviews were conducted during the patients' routine visits to the outpatient clinic from September 2022 to January 2023.

RESULT

A total of 254 children aged 5-16 years (mean age: 10.87 ± 2.89 years) were recruited. The mean HRQoL total score reported by the children and adolescents was 72.61 ± 15.36. Older age, higher family socioeconomic status, excellent school performance, and higher parental education level, particularly in mothers, were significantly associated with higher total HRQoL scores. In the regression analysis, male sex (β = -0.157,P = 0.018), older age (β = 0.246, P <0.001), and excellent school performance (β = -0.290, P < 0.001) were identified as independent predictors of the HRQoL total score. Nearly 19% of the participants achieved glycemic control.

CONCLUSION

The quality of life of children and adolescents with type 1 DM in Alahsa region was relatively good. Increased age, good family economic status, and higher parent education levels positively influenced the participants' quality of life. Therefore, regular evaluation of HRQoL is recommended for children and adolescents with type 1 DM to identify problems and initiate an appropriate intervention for improving child health and the health care system.

24-Hour Movement Behaviours (Physical Activity, Sedentary Behaviour and Sleep) Association with Glycaemic Control and Psychosocial Outcomes in Adolescents with Type 1 Diabetes: A Systematic Review of Quantitative and Qualitative Studies

Type 1 Diabetes (T1D) is a condition requiring 24-hour management. The way in which an individual combines their 24-hour movement behaviours (24-h MBs), which is comprised of physical activity (PA), sedentary behaviour (SB), and sleep, throughout the day can have a significant impact on physical and mental health. This mixed methods systematic review aimed to investigate 24-h MBs' relationship with glycaemic control and psychosocial outcomes in adolescents (11-18 years) with T1D. Ten databases were searched for quantitative and qualitative English language articles reporting at least one of the behaviours and their relationship with outcomes. There were no restrictions on article publication dates or study design. Articles were subjected to title and abstract screening, full text screening, data extraction and quality assessment. Data were summarised narratively, and a meta-analysis was conducted where possible. From 9922 studies, 84 were included for data extraction (quantitative (n = 76), qualitative (n = 8)). Meta-analyses revealed a significant favourable association between PA and HbA1c (-0.22 [95% CI: -0.35, -0.08; I² = 92.7%; p = 0.001). SB had an insignificant unfavourable association with HbA1c (0.12 [95% CI: -0.06, 0.28; I² = 86.1%; p = 0.07]) and sleep had an insignificant favourable association (-0.03 [95% CI: -0.21, 0.15; I² = 65.9%; p = 0.34]). Importantly, no study investigated how combinations of behaviours collectively interacted and impacted on outcomes.

Experiences and needs of Saudi mothers when a child or adolescent is diagnosed with type 1 diabetes mellitus: a qualitative study

Aim

To explore the experiences of Saudi mothers with children or adolescents who have Type 1 diabetes mellitus at time of diagnosis.

Background

The Kingdom of Saudi Arabia (KSA) has one of the highest incidence rates of Type 1 diabetes mellitus in children and adolescents in the world. Few studies have considered the most appropriate methods of support for parents in the KSA and none report the experiences of Saudi mothers.

Design

Phenomenological inquiry.

Method

Qualitative interviews were conducted with 11 Saudi mothers and data were analysed following Giorgi’s 5-step method.

Results

The lived experiences of Saudi mothers coalesced around three overarching themes and eight subthemes: 1. In the dark (mother’s instinct, challenges of diagnosis phase, cultural reflections); 2. Empowerment (methods of support, mother’s health and wellbeing); 3. Coping and acceptance (stigma and cultural perceptions, coping strategies, transformation and adaptation).

Conclusions

Effective interventions delivered in other countries to support mothers may be effective in the KSA. However, the central role that Saudi mothers play in the management of their child’s condition, and the place of Islam in Saudi society, indicate the need for customized methods of support that take into account psychosociocultural needs of both mother and child.

Characteristics of diabetes diagnosis and control in toddlers and preschoolers from families with limited resources: A single center experience

AIM

To describe the characteristics of diabetes diagnosis, insulin therapy regarding type, dose and frequency also the degree of glycemic control achieved in toddlers and preschoolers coming from families with limited resources.

METHODS

Over one year, 69 toddlers and preschoolers clinically diagnosed as type 1 diabetes were included. Data related to presentation at diagnosis, insulin therapy and glycemic control was reviewed from patients' care givers and medical records.

RESULTS

Diabetic ketoacidosis (DKA) was recorded in 71% of the children at initial diagnosis. The mean time since diabetes diagnosis was 2 ± 1 years. Most of children (65/69, 94%) were on basal-bolus regimen while four (6%) were on basal insulin only. NPH and long acting analogues were used as basal insulin in (74%) and (26%). Regular insulin and rapid acting analogues were used as bolus insulin (27%) and (73%).The mean frequency of daily self monitoring of blood glucose was (2.9 ± 1). The arithmetic mean of HbA1c done over past 6 months to one year before inclusion in the study was 8.2 ± 1.5% (66 ± 12 mmol/mol) with 65% having HbA1c ≥ 7.5% (≥58 mmol/mol).

CONCLUSION

Toddlers and preschoolers with diabetes coming from families with limited resources frequently present with DKA at diagnosis and have suboptimal self-monitoring of blood glucose and glycemic control. NPH is more commonly used in this age group, combined with postprandial rapid analogues and less commonly preprandial regular insulin and that yields more favorable HbA1c but with a greater risk of hypoglycemia. The most common cause of hospital readmission was ketoacidosis and uncontrolled hyperglycemia.

Audit of glycemic control in patients with type 1 diabetes referred to a pediatric clinic in a specialized center in Kuwait

INTRODUCTION

Intensive glycemic control reduces the risk of microvascular and macrovascular complications. Furthermore, optimal glycemic control is essential for normal growth and development. Thus, there is a need to monitor and evaluate glycemic control in patients with type 1 diabetes (T1D). Our aim was to audit glycemic control in patients with T1D in a specialized center as per the Society of Pediatric and Adolescent Diabetes (ISPAD) Hemoglobin A1C (HbA1C) target recommendations published in 2014.

METHODS

This is a retrospective cross-sectional study reporting on glycemic control (HbA1C) of patients younger than 21 years of age and with T1D treated at Dasman Diabetes Institute (DDI) between January 2013 and December 2015.

RESULTS

A total of 470 patients with T1D (250 males and 220 females) were included. Only 53 (11.3%) patients met the ISPAD target for optimal glycemic control with HbA1C < 7.5% (58 mmol/mol). Older age was positively associated with poor glycemic control (p = 0.001) while Continuous Subcutaneous Insulin Infusion (CSII) therapy was negatively associated with poor glycemic control, adjusted Odds Ratio (OR) 0.33 (95% confidence interval (CI): 0.16-0.66) for CSII and adjusted OR 0.42 (95% CI: 0.27-0.64) for shifting to CSII (p < 0.001).

CONCLUSION

Achieving optimal glycemic control is a significant challenge for young patients with T1D. Glycemic control goals should be individualized to achieve such goals safely, realistically and with a better quality of life for patients with T1D.

Glycemic Control in Children and Youth With Type 1 Diabetes Mellitus in Saudi Arabia

Objective:

To determine the glycemic control and cardio-metabolic complications of children and adolescents with type 1 diabetes mellitus (T1DM) attending a tertiary care diabetes clinic in Saudi Arabia.

Methods:

We conducted a retrospective cross-sectional study of children and adolescents with T1DM attending King Abdulaziz Medical City-Jeddah from 2010 to 2013. We assessed their glycemic control and diabetes management. Vitamin D status was compared with glycemic control and gender differences.

Results:

We identified 301 subjects (53.5% females); mean age was 13.9 ± 3.8 years. The mean duration of diabetes was 7.7 ± 3.7 years, body mass index (BMI) was 21.1 ± 4.5 kg/m², and hemoglobin A_1c (HbA_1c) was 9.6% ± 1.9% in both genders. There were modest gender-specific differences in Saudi patients with T1DM, with males having more symptoms than females. Mean age at diagnosis of T1DM was slightly younger in males (6.01 ± 3.65 years) than in females (6.33 ± 3.45 years). Education was the most common reason for admission in males (32.9%), whereas diabetic ketoacidosis (DKA) was the most common reason in females (38.8%). Frequency of symptomatic hypoglycemic attacks was relatively higher in males (47.1%) than in females (42.9%). The majority of our patients (83%) were on intensive insulin regimen, having 4 injections or more per day. The remaining (17%) were on conventional insulin therapy. Only 26.2% had satisfactory HbA_1c (⩽8%). The mean level of 25-hydroxyvitamin D was 35.15 ± 15.9 nmol/L and cholesterol was 4.75 ± 1.1 nmol/L. Vitamin D deficiency (25-hydroxyvitamin D ⩽ 37.5 nmol/L) was detected in 63.6% males and 67.7% females. No significant correlation between HbA_1c and vitamin D deficiency was observed.

Conclusions:

Metabolic control among Saudi children with T1DM is less satisfactory compared with other countries. The high prevalence of vitamin D deficiency in this population supports the recommendation of vitamin D supplementation in T1DM subjects. Further studies in a larger cohort are needed to confirm our findings.

Risk factors and predictors of uncontrolled hyperglycemia and diabetic ketoacidosis in children and adolescents with type 1 diabetes mellitus in Jeddah, western Saudi Arabia

BACKGROUND

Little is known about levels of glycemic control and risk factors for uncontrolled hyperglycemia in Saudi children with type 1 diabetes mellitus (T1DM). The aim of the present study was to identify levels of glycemic control, risk factors and predictors of uncontrolled hyperglycemia (HG) and diabetic ketoacidosis (DKA) in children with T1DM.

METHODS

A retrospective study was performed on Saudi children and adolescents with confirmed T1DM who were followed at the Pediatric Endocrinology Clinic of the Maternity and Children Hospital, Jeddah, from 2000 to 2014. Data collection included all possible factors that may be associated with uncontrolled T1DM. Patients were classified according to American Diabetes Association guidelines for target HbA1c levels per age group. Comparisons were made between well-controlled (WC) patients, HG patients, and DKA patients. Calculation of odds ratios and logistic regression allowed for estimation of the role of each risk factor in uncontrolled T1DM.

RESULTS

Only 31.2 % of children and adolescents with T1DM were well controlled. Better glycemic control was associated with age < 6 years, urban residence, and T1DM duration <5 years. Glycemic control was not affected by gender, insulin therapy, or comorbidities. The most significant independent predictors of hyperglycemia and DKA were poor compliance with a healthy lifestyle (adjusted hazards ratio [AHR] 28.94; 95 % confidence interval [CI] 8.37-100.04) and an excess intake of sweets (AHR 3.31; 95 % CI 1.54-7.11).

CONCLUSION

The most significant independent predictor for poor glycemic control (particularly DKA rather than hyperglycemia) in Saudi children and adolescents was poor compliance with a healthy lifestyle with an excessive intake of sweets.

Impact of Vitamin D Status on Cardiometabolic Complications among Children and Adolescents with Type 1 Diabetes Mellitus

OBJECTIVE

There is an ongoing interest in the relationship between vitamin D status and diabetes control and complications. However, data from Saudi Arabia are limited. To determine the impact of vitamin D status on glycemic control and cardiometabolic complications of children and adolescents with type 1 diabetes mellitus (T1DM) attending a tertiary care diabetes clinic in Saudi Arabia.

METHODS

Demographic, clinical, and laboratory data of 301 children and adolescent subjects with T1DM (53.5% females) of a mean age of 13.9 years attending King Abdulaziz Medical City-Jeddah during 2010-2013 were retrospectively collected. Relationships between vitamin D status and frequency of hypoglycemia, hemoglobin A1c (HbA1c) level, body mass index (BMI), blood pressure, and lipid profile were evaluated.

RESULTS

The mean duration of diabetes was 7.7±3.7 years. Mean BMI value was 21.1±4.5 kg/m2 and HbA1c was 9.6±1.9% in both genders. Only 26.2% of the patients had a satisfactory HbA1c level. The mean level of 25-hydroxyvitamin D [25(OH)D] was 35.15 and that of cholesterol was 4.75. Vitamin D deficiency [25(OH)D≤37.5 nmol/L] was detected in 63.6% of the male and 67.7% of the female subjects. In males, it was inversely associated with frequency of hypoglycemia (p<0.01), BMI (p<0.05), diastolic blood pressure (p<0.05), and triglyceride levels (p<0.01), while in females, it was inversely associated with current age (p<0.05), age at diagnosis (p<0.01), and triglyceride levels (p<0.01). No significant correlation between HbA1c and vitamin D deficiency was observed.

CONCLUSION

Vitamin D deficiency was highly prevalent in our study sample and was found to be associated with frequency of hypoglycemic episodes and with adverse cardiometabolic control.

Effectiveness of multiple daily injections or continuous subcutaneous insulin infusion for children with type 1 diabetes mellitus in clinical practice

Aims. To determine whether multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) contributes to better glucose control in children with different type 1 diabetes duration. Methods. Subjects were grouped according to early (≤1 year after disease onset; 1A) or late (1-3 years after onset; 2A) MDIs/CSII treatment initiation. Corresponding control groups (1B, 2B) received insulin injections twice daily. Results. HbA1c levels were consistently lower in group 1A than in group 1B (6 months (T2): 7.37% versus 8.21%; 12 months (T3): 7.61% versus 8.41%; 24/36 months (T4/T5): 7.61% versus 8.72%; all P < 0.05), but were lower in group 2A than in group 2B only at T2 (8.36% versus 9.19%; P = 0.04). Levels were lower in group 1A than in group 2A when disease duration was matched (7.61% versus 8.49%; P < 0.05). Logistic regression revealed no correlation between HbA1c level and MDIs/CSII therapy. HbA1c levels were only negatively related to insulin dosage. Conclusions. Blood glucose control was better in patients receiving MDIs/CSII than in those receiving conventional treatment. Early MDIs/CSII initiation resulted in prolonged maintenance of low HbA1c levels compared with late initiation. MDIs/CSII therapy should be combined with comprehensive management.

Demographic and clinical characteristics of type 1 diabetes mellitus in omani children - single center experience

OBJECTIVES

To describe the demographic characteristics and clinical presentation of Omani children with type 1 diabetes mellitus at Sultan Qaboos University Hospital, Muscat, Oman.

METHODS

A retrospective analysis of all children with type 1 diabetes mellitus attending the Pediatric Endocrine Unit at Sultan Qaboos University Hospital, Oman from June 2006 to May 2013.

RESULTS

One hundred and forty-four patients were included in the study. The mean±SD of age at diagnosis was 6.7 ± 3.7 years. The median duration of symptoms was 10 days (IQR; 5-14). The most commonly reported presenting symptoms were polyuria (94%), polydipsia (82%), and weight loss (59%). Diabetic ketoacidosis at initial presentation was diagnosed in 31% of the patients. Different insulin regimens were prescribed: multiple daily injections in 109 (76%) patients, twice daily insulin regimen in 23 (16%) patients, and insulin pump therapy in 12 (8%) patients. Family history of type 1 diabetes mellitus was present in 31 (22%) patients. There were no significant differences in presenting complaints (polyuria, p=0.182; polydipsia, p=0.848), duration of symptoms (p=0.331), reported weight loss (p=0.753), or diabetic ketoacidosis at presentation (p=0.608) between patients with and without family history of type 1 diabetes mellitus.

CONCLUSION

Polyuria, polydipsia and weight loss are the most common presenting symptoms. Family history of type 1 diabetes mellitus is highly prevalent among the studied patients. Diabetic ketoacidosis was found to be less common in Oman compared to other diabetes centers in the Middle East.