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Background Seasonal variation in glycated hemoglobin levels has been observed, and sun exposure has been considered as one of the factors associated with this relationship. Fructosamine is a short-time marker of blood protein glycation. Aim We investigated the effect of seven days of sunbathing on blood fructosamine concentration in healthy volunteers using different ultraviolet radiation ( UVR) protections. Materials and Methods Participants were assigned to one of three groups: group A - used a UVA and UVB absorbing sunscreen ( N = 15), group B - used a UVB absorbing sunscreen ( N = 18), and group C - followed uncontrolled sun protection habits ( N = 22). Results Overall, the fructosamine concentration did not change after sun exposure (baseline 248.8 μmol/l, 25-75%: 238.5 to 258.8 μmol/l vs. after 247.3 μmol/l, 25-75%: 234.9 to 261.8 μmol/l, P = 0.6637). Median change of fructosamine differed significantly between groups (A: −1.90 μmol/l, 25-75%: −17.10 to 1.80 μmol/l vs. B: −3.80 μmol/l, 25-75%: −18.50 to 2.40 μmol/l vs. C: +4.05 μmol/l, 25-75%: −3.20 to 22.0 μmol/l; one-way ANOVA P = 0.0277). After age adjustment and combining groups A and B, the difference in change of fructosamine concentration was statistically significant between groups A + B (decrease) vs. group C (increase, P = 0.0193). Conclusion Appropriate sunscreen use during sunbathing resulted in decreased fructosamine concentrations, while inadequate UVR protection resulted in its increase. [ABSTRACT FROM AUTHOR]

Background: We investigated whether in young children with inadequately controlled type 1 diabetes and technical problems with continuous subcutaneous infusion of insulin at 100 units/mL the switch to insulin diluted to 10 units/mL (U10) can limit technical problems and improve glycemic control. Subjects and Methods: Diluted U10 insulin was started in three children 3.8, 3.2, and 1.3 years old with a hemoglobin A1c (HbA1c) level (mean±SD) of 8.1±0.17% (65±1.7 mmol/mol) and insulin dose of 8.80±2.93 units/day. Patients were evaluated with continuous glucose monitoring (iPro™2; Medtronic Minimed, Northridge, CA) and a quality of life questionnaire (PedsQL™; ) and surveyed for pump-related problems at baseline and after 3 and 9 months of U10 insulin therapy. Results: Continuous glucose monitoring records showed that glycemic variability assessed by SD and M100 decreased significantly ( P=0.0085 and P=0.0482, respectively). HbA1c levels dropped to 7.3±1.00% (56±11.0 mmol/mol) after 3 months and to 6.7±0.55% (50±6.1 mmol/mol) after 9 months ( P=0.12). Technical difficulties were minimized. Conclusions: These results suggest that the use of U10 insulin decreases glycemic variability and improves hampered pump therapy in young children with inadequately controlled type 1 diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Hemoglobin A1c (HbA1c) is a widely accepted marker of glycemic control in patients with type 1 diabetes (TIDM) and a predictor of future development of microvascular complications. Aim of the study was to perform a cross-sectional evaluation of glycemic control as reflected by HbA1c in TIDM children and adolescents from one medical centre. Material and methods: The study comprised 473 patients aged 2.4-18 years (mean±SD, 13.3±3.7 years), with TIDM duration of>6 months (5.8±3.5 years), treated with either multiple daily insulin injections or continuous subcutaneous insulin infusion (i.e. insulin pump). The analysis included last for each patient HbA1c result from the period June - October 2009 as well as all HbA1c results of all patients obtained during the period (November 2008- October 2009). HbA1c was measured with Bio-Rad VARIANT™ Hemoglobin A1c Program using ion-exchange high-performance liquid chromatography (HPLC); normal values for healthy people 4.3-5.7%. Results: Mean (±SD) HbA1c level in the study group was 7.4±1.3% (median and (25-75% range): 7.1% (6.6-7.9%)). In 113 (23.9%) patients HbA1c level was ⩽6.5% (ideal glycemic control), in 195 (41.2%) it was between 6.5% and ⩽7.5% (satisfactory glycernic control), and in 165 (34.9%) it was >7.5% (unsatisfactory glycemic control). Positive correlation was found between HbA1c and: patients' age (R=0.23; p<0.0001) and diabetes duration (R=0.22; p<0.0001). Mean HbA1c level calculated for the 12-month period (November 2008- October 2009) was 7.7±1.5% (from 5.2% to 15.7%; median and (25-75% range): 7.4% (6.7%-8.2%), N= 1417 measurements). Conclusions: I. In the study group the overall glycemic control was good, however HbA1c goal of ⩽6.5% set by the Polish Diabetological Association was only achieved by 23.9% of patients. 2. Longer TIDM duration and older age are associated with worse glycemic control and should be considered in the goal-oriented therapy of young TIDM patients. [ABSTRACT FROM AUTHOR]

The aims of the study were: 1. to evaluate the levels of insulin antibodies (IA) during the first 2 years of type 1 diabetes in children and adolescents, 2. to analyze relations between IA and several clinical and metabolic markers. Material and methods: Fifty seven patients (37 males and 20 females) aged 7.6-17.9 years (mean 13.2±2.4) participated in the study. Patients were treated with human insulins and/or with rapid acting human insulin analogs. During the 1st week after diabetes diagnosis, 6 months after diagnosis (N=57) and 24 months after diagnosis (N=42) the following parameters were studied: residual insulin secretion, daily insulin dose, HbA1c, BMI and insulin sensitivity. IA were measured by radioimmunoprecipitation (normal values <7%), C-peptide was measured by radioimmunoassay (the increase in C-peptide concentration 6 minutes after an intravenous injection of glucagon was measured, ΔC-pep). M index measured by euglycemic hyperinsulinemic clamp method by DeFronzo was the measure of insulin sensitivity (higher M index indicates higher insulin sensitivity). Results: Median values (and quartiles) of IA were: 6.7% (5.6-7.4), 16.6% (10.2-37.1) and 17.0% (9.4-38.9) respectively in the 1st week of diabetes and after 6 and 24 months of follow up. IA levels rose significantly during the first 6 months of diabetes (p<0.0001) and remained stable thereafter. After 6 months of diabetes duration the following statistically significant correlations were found: negative between IA and ΔC-pep (r=-0.36, p=0.007), positive between IA and M index (r=0.27, p=0.04) and negative between IA and BMI (ρ?=-0.4, p=0.02); a slight, statistically nonsignificant, correlation between IA and daily insulin dose was noted, too (r=0.19, p=0.16). After 24 months correlation coefficients were as follows: for IA and M index ρ?=0.16, p=0.32, for IA and ΔC-pep ?=-0.08, p=ns, for IA and BMI ρ?=-0.34, p=0.03. Conclusions: 1. Modern insulin preparations induce production of IA in young type 1 diabetic patients. 2. Patients with lower residual insulin secretion require higher daily insulin doses during the first months of diabetes, which may preclude higher IA production. 3. Negative correlation between IA and insulin resistance may be a) secondary to the well known correlation: lower BMI - higher insulin sensitivity or may be due to b) IA acting as a temporary "reservoir" of administered insulin or to c) hypoglycemic activity of IA-insulin complexes. [ABSTRACT FROM AUTHOR]

Aim: The study aim was to evaluate the feasibility, safety and efficacy of automated insulin delivery (AID) assisted by home health care (HHC) services in people with type 2 diabetes unable to manage multiple daily insulin injections (MDI) at home on their own. Patients and Methods: This was an open label, multicentre, randomized, parallel group trial. In total, 30 adults with type 2 diabetes using MDI and requiring nursing support were randomly allocated to AID or kept their usual therapy over a 12‐week period. Both treatments were managed with the support of HHC services. The primary outcome was the percentage time in the target glucose range of 70‐180 mg/dl (TIR). Secondary outcomes included other continuous glucose monitoring metrics, glycated haemoglobin (HbA1c) levels, daily insulin doses, body weight, and of quality of life scores, fear of hypoglycaemia and satisfaction questionnaires. Results: Age (69.7 vs. 69.3 years) and HbA1c (9.25 vs. 9.0) did not differ in MDI and AID at baseline. Compared with MDI, AID resulted in a significant increase in TIR by 27.4% [95% CI (15.0‐39.8); p <.001], a decrease in time above range by 27.7% and an unchanged time below range of <1%. A between‐group difference in HbA1c was 1.3% favouring AID. Neither severe hypoglycaemia nor ketoacidosis occurred in either group. Patient and caregiver satisfaction with AID was high. Conclusions: AID combined with tailored HHC services significantly improved glycaemic control with no safety issues in people with type 2 diabetes previously under an MDI regimen with HHC. AID should be considered a safe option in these people when lacking acceptable glucose control. [ABSTRACT FROM AUTHOR]

Treatment with continuous subcutaneous insulin infusion (CSII) allows a large degree of treatment individualization and intensification in children with diabetes. The study's aim was to evaluate the impact of treatment with CSII on glycated haemoglobin level (HbA1c) in children with diabetes and investigate whether introduction of CSII is associated with an increased risk of acute complications of diabetes. Patients treated throughout the recruitment period exclusively with multiple daily injections (MDI) were matched for duration of diabetes and HbA1c level at baseline with patients treated exclusively with CSII in a 1:1 group ratio ( n = 223 and 231 for MDI and CSII, respectively). The CSII group showed lower HbA1c after the observation period (7.98 ± 1.38 vs. 7.56 ± 0.97; P = 0.002). HbA1c variability measured as standard deviations of average values was also lower in the CSII group (0.73 ± 0.45 vs. 0.84 ± 0.54; P = 0.049). The rate of hospitalization due to acute events was similar in both groups (14.7/100 vs. 14.0/100 person/years in the MDI and CSII group, P = 0.72). Duration of hospital stay per year was on average 1.25 days shorter in the CSII group ( P = 0.0004), but the risk of acute complications resulting in hospitalization did not differ between the groups (hazard ratio (HR) 1.16; 95% confidence interval (95% CI) 0.68-1.63). The most significant risk factor for hospitalization due to acute complications was baseline HbA1c concentration (HR 1.25; 95% CI 1.14-1.37). In conclusion, CSII treatment may improve glycemic control and reduce its variability. Change of MDI to CSII does not alter the risk of hospitalization and may reduce the annual duration of hospitalization in children with diabetes. [ABSTRACT FROM AUTHOR]

Introduction: In the pathogenesis of type 1 diabetes mellitus (T1DM), apart from insulin secretion deficiency,insulin resistance is also observed. Insulin resistance is conditioned by genetic background and environmental factors. We discuss one of the most important mediators associated with the metabolism of adipose tissue adiponectin. Aim of the study was to evaluate adiponectin level and the association between adiponectin level and C peptide level, as a residual insulin secretion factor, in children with T1DM. Material and methods: The study group comprised 197 type 1 diabetic children, aged 1-18 years (average 10.4), 84 girls and 113 boys, and 47 healthy children, aged 10.2, 17 girls and 30 boys as a control group. Plasma adiponectin and C-peptide levels were detected by radioimmunoassay at diagnosis, after 6 months and after 2, 3 and 4 years of disease. Results: We observed a gradual decrease in adiponectin level in the course of T1DM (p <0.001). In the diabetic patients slightly higher adiponectin level (21.8± 6.1 μg/ml) than in the control group was noted (16.6± 14.1μg/ml; p=0.1). There was a negative correlation between age at the disease onset and adiponectin level after 6 months of disease (r=-0.22; p=0.01). In patients with higher C-peptide level at the disease onset we observed slightly higher adiponectin level than in children with lower C-peptide level (19.9 (14.8-32.1) vs. 18.0 .(10.2-26.5) μg/ml, respectively; p=0.1). Conclusions: We observed a decrease in adiponectin level in children with T1DM. After six months of the disease, negative correlation between adiponectin level and age at the diabetes onset is noted. Our results suggest that adiponectin level could be regarded as a marker of insulin sensitivity and further investigations to prove that it is related with residual insulin secretion in type 1 diabetic children are needed. [ABSTRACT FROM AUTHOR]

The article reports that Continuous glucose monitoring become the target standard of care for people with diabetes and an abundant source of health care data. Topics include examines downloading those data is difficult and researchers have to rely on manufacturer or commercial software for analysis.

Background: Accurate estimation of glycated hemoglobin (HbA1c) from continuous glucose monitoring (CGM) remains challenging in clinic. We propose two statistical models and validate them in real-life conditions against the current standard, glucose management indicator (GMI). Materials and Methods: Modeling utilized routinely collected data from patients with type 1 diabetes from central Poland (eligibility criteria: age >1 year, diabetes duration >3 months, and CGM use between 01/01/2015 and 12/31/2019). CGM records were extracted from dedicated Medtronic/Abbott databases and cross-referenced with HbA1c values; 28-day periods preceding HbA1c measurement with >75% of the sensor-active time were analyzed. We developed a mixed linear regression, including glycemic variability indices and patient's ID (glucose variability-based patient specific model, GV-PS) intended for closed-group use and linear regression using patient-specific error of GMI (proportional error-based patient agnostic model, PE-PA) for general use. Models were validated with either new HbA1cs from closed-group patients or separate patient-HbA1c pool. External validation was performed with data from clinical trials. Performance metrics included bias, its 95% confidence interval (95% CI), coefficient of determination (R2), and root mean square error (RMSE). Results: We included 723 HbA1c-CGM pairs from 174 patients (mean age 9.9 ± 4.4 years and diabetes duration 3.7 ± 3.6 years). GMI yielded R2 = 0.58, with different bias between Medtronic and Abbott devices [0.120% vs. -0.152%, P < 0.0001], and overall 95% CI = -0.9% to +1%, RMSE = 0.47%. GV-PS successfully captured patient-specific variance (closed-group validation: R2 = 0.83, bias = 0.026%, 95% CI = -0.562% to 0.591%, RMSE = 0.31%). PE-PA performed similarly on new patients (R2 = 0.76, bias = -0.069%, 95% CI = -0.790% to 0.653%, RMSE = 0.37%). In external validation GMI, GV-PS, and PE-PA produced 73.8%, 87.5%, and 91.0% predictions within 0.5% (5.5 mmol/mol) from the true value. Conclusion: Constructed models performed better than GMI. PE-PA provided an accurate estimate of HbA1c with fast and straightforward implementation. [ABSTRACT FROM AUTHOR]

Regular physical activity increases lifespan for those with type 1 diabetes. However, disease-related barriers may deter children from exercise and affect their fitness. This study examined the safety of the Cooper test concerning diabetes-related acute complications in children with type 1 diabetes and their fitness. Blood glucose was recorded before and 0, 30, 60 min after the test. The covered distances were transformed to z-scores based on the national charts. Body mass index, body fat percentage and glycated hemoglobin were measured. The run was completed by 80 individuals (45 % boys, age 13.6 ± 2.1 years; diabetes duration 6.3 ± 3.5 years). During the follow-up 11 children reached glucose alert values (3-3.9 mmol/L), 3 presented clinically significant hypoglycemia (< 3 mmol/L), none experienced severe hypoglycemia. The covered distance was 1914 ± 298 m, not significantly different from the reference population (zscore - 0.12 ± 0.71 vs 0, p = 0.12). The study participants were more overweight than general pediatric population in terms of body mass index (z-score 0.48 ± 0.94 vs 0, p < 0.001) and body fat percentage (z-score: 0.37 ± 0.85 vs 0, p < 0.001). In conclusion, the Cooper test can be safely used in children with diabetes to assess their physical capacity. Youth with type 1 diabetes present fitness similar to healthy children but exhibit increased body mass index and adiposity. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy and time expenditure of screening models based on glycated hemoglobin (HbA(1c)) level and psychometric measures for mood disorder (MD) among children with type 1 diabetes.Research Design and Methods: With semistructured clinical interviews (Schedule for Affective Disorders and Schizophrenia for Children-Present and Lifetime version, 120 min/patient) as a reference for diagnosing MD, including major depressive disorder (MDD), we tested 163 subjects, aged 8 to 18 years, with type 1 diabetes. We evaluated four screening approaches: 1) Children's Depression Inventory (CDI) at 30 min/patient, 2) HbA(1c) level, 3) HbA(1c) level plus CDI, and 4) HbA(1c) level plus Children's Depression Rating Scale (CDRS) at 40 min/patient. These tests were conducted with all participants, and the total time expenditure for all four approaches was calculated as the total time needed to implement successfully the screening for MD or MDD in the center.Results: HbA(1c) performed on par with individual psychometric tests in diagnosing MD or MDD. The HbA(1c) plus CDRS model was the best screening procedure for both MD and MDD, with diagnostic thresholds for HbA(1c) established at 8.7% and 9.0%, respectively. Cutoff points for CDRS assessed after filtering by HbA(1c) were 26 (MD) and 30 (MDD) points. Center-wide application of this procedure would result in an 83% reduction of the examination time necessary for the psychiatrist for MD screening and a 91% reduction for MDD screening, as compared with standard screening with CDI.Conclusions: Use of HbA(1c) level followed by CDRS is a time-efficient procedure to screen for MD in children with type 1 diabetes. [ABSTRACT FROM AUTHOR]

OBJECTIVE--To compare the diagnostic accuracy and time expenditure of screening models based on glycated hemoglobin (HbA1c) level and psychometric measures for mood disorder (MD) among children with type 1 diabetes. RESEARCH DESIGN AND METHODS--With semistructured clinical interviews (Schedule for Affective Disorders and Schizophrenia for Children-Present and Lifetime version, 120 min/patient) as a reference for diagnosing MD, including major depressive disorder (MDD), we tested 163 subjects, aged 8 to 18 years, with type 1 diabetes. We evaluated four screening approaches: 1) Children's Depression Inventory (CDI) at 30 min/patient, 2) HbA1c level, 3) HbA1c level plus CDI, and 4) HbA1c level plus Children's Depression Rating Scale (CDRS) at 40 min/patient. These tests were conducted with all participants, and the total time expenditure for all four approaches was calculated as the total time needed to implement successfully the screening for MD or MDD in the center. RESULTS--HbA1c performed on par with individual psychometric tests in diagnosing MD or MDD. The HbA1c plus CDRS model was the best screening procedure for both MD and MDD, with diagnostic thresholds for HbA1c established at 8.7% and 9.0%, respectively. Cutoff points for CDRS assessed after filtering by HbA1c were 26 (MD) and 30 (MDD) points. Center-wide application of this procedure would result in an 83% reduction of the examination time necessary for the psychiatrist for MD screening and a 91%reduction for MDD screening, as compared with standard screening with CDI. CONCLUSIONS--Use of HbA1c level followed by CDRS is a time-efficient procedure to screen for MD in children with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Recently the prevalence of overweight and obesity in pediatric population - also in type 1 diabetic adolescents - has increased. Aim of the study: Aim of the study was to evaluate prevalence of obesity and central obesity in type 1 diabetic youth. Material and methods: 192 patients (81 girls, 111 boys), aged 10-18 years, with diabetes duration 0.5-15 years were included into the study. The anthropometric parameters were examined. Obesity was recognized according to WHO definition: overweight - BMI 85-95 pc, obesity - BMI >95 pc and according to International Obesity Task Force (IOTF): overweight - BMI >IOTF 25 kg/m2, obesity - BMI >IOTF 30 kg/m2. Central obesity was defined as waist circumference above 90 percentile for sex and age and as waist/height rate (WHtR) >0.5. Local BMI and waist circumference percentiles charts were used. Results: According to WHO criteria overweight was found in 19 girls and 13 boys, obesity properly in 4 and 10, together in 28% and 20.9%. According to IOTF overweight was recognized in 21 girls and boys, obesity properly in 1 and 8, together in 29.3% and 26.4%. According to percentiles charts, central obesity was recognized in 21 girls (25.6%) and in 18 boys (16.4%), together in 20.3% patients. Using WHtR abdominal obesity was found in 7 girls (8.5%) and in 13 boys (11.8%), together in 10.3%. Conclusions: Irrespectively of adopted criteria, overweight/obesity was found in every fourth adolescent with type 1 diabetes. The prevalence of central obesity depends on the adopted criteria. According to local percentiles waist circumference charts, abdominal obesity was recognized twice more frequently than using WHtR. [ABSTRACT FROM AUTHOR]

Symptomatic, chemotherapy-related hypoglycemia is a rare complication associated with the administration of purine analogs. The aim of the study was to evaluate 24 h glucose variability and frequency of hypoglycemia among patients with acute lymphoblastic leukemia (ALL) during maintenance therapy (MT). Eighteen children with ALL underwent continuous glucose monitoring (CGM). The number of episodes of hypoglycemia and glucose variability were analyzed. Serum alanine aminotransferase, asparagine aminotransferase, and γ-glutamyl transferase levels were measured as liver function markers. The mean glucose level in CGM equaled 105 ± 13 mg/dL, with standard deviation (SD) 13.8 ± 6.1 mg/dL, and the mean amplitude of glycemic excursions (MAGE) equaled 44.7 ± 19.9 mg/dL. Eight patients had at least one measurement below 70 mg/dL while four patients had measurements below 50 mg/dL. Children with hypoglycemia in CGM examination had a lower median body mass index standard deviation score (BMI Z-score) (−0.65 [[−0.94 to −0.27]] vs. −0.14 [[−0.29 to 0.35]]; p == 0.05) and shorter duration of MT (6.5 [[4-15]] vs. 22.5 [[16.5-28]] weeks; p == 0.004). Glucose variability parameters were strongly correlated with BMI Z-score and liver function enzymes. Hypoglycemia, particularly at night-time, may develop as a complication of MT in children with ALL. The risk factors for low glucose level are low BMI Z-score and initiation of MT. [ABSTRACT FROM AUTHOR]