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Advances in paediatric type 1 diabetes management and increased use of diabetes technology have led to improvements in glycaemia, reduced risk of severe hypoglycaemia, and improved quality of life. Since 1993, progressively lower HbA1ctargets have been set. The aim of this study was to perform a longitudinal analysis of HbA1c, treatment regimens, and acute complications between 2013 and 2022 using data from eight national and one international paediatric diabetes registries.

Recent studies have suggested a link between type 1 diabetes mellitus (T1D) and metabolic dysfunction associated steatotic liver disease (MASLD) in children and adolescent, but longitudinal evidence is lacking. This study aimed to investigate the potential association between poorly controlled T1D and elevated alanine aminotransferase (ALT), serving as a proxy for MASLD in children and adolescents over time. The study included 32,325 children aged 2−17 years with T1D from Germany, Austria, and Switzerland who had undergone at least one assessment of liver enzyme levels recorded in the Diabetes‐Patienten‐ Verlaufsdokumentation registry. Multivariable logistic and Cox regression models were calculated to show possible associations between T1D and elevated ALT values (>26 U/L in males, >22 U/L in females) as a proxy for MASLD. Children with poorly controlled T1D (HbA1c > 11%) exhibited increased odds of elevated ALT values, after adjustment for age, sex, diabetes duration and overweight (odds ratio [OR] 2.54; 95% confidence interval [CI], 2.10–3.10; p< 0.01). This finding is substantiated by a longitudinal analysis, which reveals that inadequately controlled T1D was associated with a higher hazard ratio (HR) of elevated ALT values compared to children with controlled T1D over an observation period extending up to 5.5 (HR: 1.54; 95% CI, 1.19–2.01; p< 0.01). In conclusion, the current study strongly links poorly controlled T1D in children and adolescents to MASLD irrespective of overweight. This association is not only present cross‐sectionally but also increases over time. The study underscores the critical role of effective diabetes management in reducing the risk of MASLD in this population. Graphical Abstract showing the associaton between uncontrolled type 1 diabetes and MASLD in children. Metabolic dysfunction associated steatotic liver disease (MASLD) is linked to type 2 diabetes. However, the connection between MASLD and type 1 diabetes (T1D) is less explored.MASLD prevalence in children with T1D varies (0−27%).Insulin deficiency and poorly controlled T1D contribute to MASLD. Hyperglycemia and insulin deficiency trigger excessive glucose influx, leading to MASLD. Metabolic dysfunction associated steatotic liver disease (MASLD) is linked to type 2 diabetes. However, the connection between MASLD and type 1 diabetes (T1D) is less explored. MASLD prevalence in children with T1D varies (0−27%). Insulin deficiency and poorly controlled T1D contribute to MASLD. Hyperglycemia and insulin deficiency trigger excessive glucose influx, leading to MASLD. Poorly controlled T1D increases the risk for elevated alanine aminotransferase levels irrespective of overweight.Longitudinal analysis showed that poorly controlled T1D was associated with a higher hazard ratio of elevated ALT values over an observation period extending up to 5.5 years.Finding: Regular transaminase monitoring is crucial for early detection and prevention of liver injury in pediatric T1D patients with MASLD. Poorly controlled T1D increases the risk for elevated alanine aminotransferase levels irrespective of overweight. Longitudinal analysis showed that poorly controlled T1D was associated with a higher hazard ratio of elevated ALT values over an observation period extending up to 5.5 years. Finding: Regular transaminase monitoring is crucial for early detection and prevention of liver injury in pediatric T1D patients with MASLD.

The effect of continuous glucose monitoring on the risk of severe hypoglycaemia and ketoacidosis in patients with diabetes is unclear. We investigated whether rates of acute diabetes complications are lower with continuous glucose monitoring, compared with blood glucose monitoring, and which metrics predict its risk in young patients with type 1 diabetes.

OBJECTIVE Type 1 diabetes and multiple sclerosis (MS) are typical autoimmune diseases in children and young adults. We assessed the co-occurrence of type 1 diabetes and MS by estimating the [...]

Background: Previous studies have shown that growing up with rheumatic conditions can fuel dissatisfaction and psychological distress, which in turn affects disease self-management and treatment adherence. Primary objective of this study was to estimate the prevalence of anxiety and depression symptoms in adolescents and young adults (AYA) with juvenile idiopathic arthritis (JIA) and to identify correlates of conspicuous screening results. Methods: Initiated as part of the COACH multicenter observational study, outpatients aged 12 to 21 years participating in the National Pediatric Rheumatological Database (NPRD) were prospectively screened for mental health using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder Scale-7 (GAD-7). Results: Data from 1,150 adolescents with JIA (mean age 15.6 ± 2.2 years; mean disease duration 7.2 ± 4.9 years, 69% female, 43% oligoarthritis, 26% polyarthritis) were analysed. Overall, 32.7% (n= 316) of AYA showed conspicuous screening results, of whom 30.4% reported clinically relevant suicidal or self-harm thoughts. About 19% of screened patients showed moderate to severe depressive or anxious symptoms. AYA with conspicuous screening results were older (15.8 vs. 15.2 years; p&lt; 0.0001), more often female (81% vs. 64%; p&lt; 0.0001) and more often overweight (25% vs. 17%; p= 0.006). They had higher disease activity (physician global assessment on NRS 0–10; 1.7 vs. 1.2; p&lt; 0.0001), more functional limitations (CHAQ; 0.44 vs. 0.14; &lt;0.0001) and rated their health status worse (NRS 0–10; 3.5 vs. 1.8; p&lt; 0.0001) than AYA with inconspicuous screening results. Females (OR 2.33 [CI 1.53–3.56]; p&lt; 0.0001), older age (OR 1.09 [CI 1.01–1.18]; p= 0.026), patients with more functional limitations (OR 3.36 [CI 1.98–5.72]; p&lt; 0.0001), and patients with worse subjective health status (OR 1.17 [CI 1.07–1.27]; p&lt; 0.0001) were more likely to have a conspicuous screening result. Regular sports participation was associated with a lower likelihood of conspicuous screening result (OR 0.69 [CI 0.49–0.98]; p= 0.039). Conclusions: A large-scale outpatient screening of AYA with JIA in Germany shows a high prevalence of anxiety and depression symptoms. The need for routine screening for early detection of mental health problems became apparent.

An increased prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes in children was observed in various diabetes centres worldwide during the COVID-19 pandemic. We aimed to evaluate trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes before and during the COVID-19 pandemic, and to identify potential predictors of changes in diabetic ketoacidosis prevalence during the pandemic.

OBJECTIVE--We aimed at developing and cross-validating a mathematical prediction model for an optimal basal insulin infusion pattern for children with type 1 diabetes on continuous subcutaneous insulin infusion therapy (CSII). [...]

OBJECTIVE--Down syndrome (DS) is associated with an increased risk of diabetes, particularly in young children. HLA-mediated risk is however decreased in children with DS and diabetes (DSD). We hypothesized that [...]

OBJECTIVE--The prevalence of cystic fibrosis-related diabetes (CFRD) has increased with improved life expectancy of patients. Clinical and care characteristics were compared with type 1 diabetes mellitus (TIDM) in a multicenter [...]

OBJECTIVE--To evaluate self- and parent reports of general health status and health-related quality of life (QoL) in children and adolescents with early-onset and long-lasting type I diabetes compared with the [...]

OBJECTIVE--To investigate the temporal trend of metabolic control and potential predictors in German and Austrian children and adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS--This study is based on [...]

OBJECTIVE--Young children have an unacceptably high prevalence of diabetic ketoacidosis (DKA) at the clinical diagnosis of type 1 diabetes. The aim of this study was to determine whether knowledge of [...]

OBJECTIVE--To describe the diabetes phenotype in Wolfram syndrome compared with type 1 diabetes, to investigate the effect of glycemic control on the neurodegenerative process, and to assess the genotype-phenotype correlation. [...]

OBJECTIVE--To find a simple definition of partial remission in type 1 diabetes that reflects both residual β-cell function and efficacy of insulin treatment. RESEARCH DESIGN AND METHODS--A total of 275 [...]

OBJECTIVE--Arterial hypertension is a key player in the development of diabetes complications. We used a nationwide database to study risk factors for abnormal 24-h blood pressure regulation and microalbuminuria in [...]

OBJECTIVE--To give an up-to-date profile of nephropathy and the involvement of risk factors in a large, prospective cohort of patients with type 1 diabetes and largely pediatric and adolescent onset [...]

OBJECTIVE--We hypothesized systematic differences in the patterns of programmed basal insulin infusion rates in children and adolescents with type 1 diabetes on continuous subcutaneous insulin infusion (CSII). We aimed at [...]

OBJECTIVE--The aim of this data analysis was to ascertain the type and prevalence rate as well as age and sex distribution of cardiovascular risk factors in type 1 diabetic patients [...]

OBJECTIVE -- To investigate thyroid autoimmunity in a very large nationwide cohort of children and adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS -- Data were analyzed from 17,749 [...]

HILARY HOEY (1) HENK-JAN AANSTOOT (2) FRANCESCO CHIARELLI (3) DENIS DANEMAN (4) THOMAS DANNE (5) HARRY DORCHY (6) MICHAEL FITZGERALD (7) PATRICK GARANDEAU (8) STEPHEN GREENE (9) REINHARD HOLL (10) [...]

Cardiovascular outcome trials have shown cardiovascular benefit with sodium-glucose co-transporter-2 (SGLT2) inhibitors in patients with type 2 diabetes, whereas dipeptidyl peptidase-4 (DPP-4) inhibitors have not shown an effect. We aimed to address knowledge gaps regarding the comparative effectiveness of SGLT2 inhibitor use in clinical practice (with DPP-4 inhibitor use as an active comparator) across a range of cardiovascular risks and in diverse geographical settings.

OBJECTIVE--Urinary excretion of albumin is a marker for incipient diabetic nephropathy in adults. The intra-individual variability, as well as the relationship to duration of diabetes, onset of the disease, and [...]

OBJECTIVE--To investigate diabetes-specific autoantibodies and additional autoimmune phenomena in a large cohort of young patients with type 1 diabetes. RESEARCH DESIGN AND METHODS--Data from 28,671 patients RESULTS--At least one [beta]-cell [...]

OBJECTIVE--To investigate if long-acting insulin analogs decrease the risk of diabetic ketoacidosis (DKA) in young individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS--Of 48,110 type 1 diabetic patients prospectively [...]

Type 1 diabetes is associated with a high risk for early atherosclerotic complications. Patients with type 1 diabetes have a fourfold (in men) to eightfold (in women) excess risk of [...]

Although continuous subcutaneous insulin infusion therapy (ie, insulin pump therapy) is associated with improved metabolic control compared with multiple daily insulin injections in children with type 1 diabetes, it is unclear when it is best to start it after diagnosis. In this study, we aimed to compare the outcomes between early and delayed start of insulin pump therapy in young patients with type 1 diabetes.

Objective: Obesity is associated with many cardiovascular risk factors (CVRF) in childhood. There is an ongoing discussion whether there is a linear relationship between degree of overweight and deterioration of CVRFs justifying body mass index (BMI) cut-offs for treatment decisions. Methods: We studied the impact of BMI-SDS on blood pressure, lipids, and glucose metabolism in 76,660 children (aged 5–25 years) subdivided in five groups: overweight (BMI-SDS 1.3 to &lt;1.8), obesity class I (BMI-SDS 1.8 to &lt;2.3), class II (BMI-SDS 2.3–2.8), class III (BMI-SDS > 2.8–3.3), and class IV (BMI-SDS > 3.3). Analyses were stratified by age and sex. Results: We found a relationship between BMI-SDS and blood pressure, triglycerides, HDL cholesterol, liver enzymes, and the triglycerides–HDL-cholesterol ratio at any age and sex. Many of these associations lost significance when comparing children with obesity classes III and IV: In females &lt; 14 years and males &lt; 12 years triglycerides and glucose parameters did not differ significantly between classes IV and III obesity. Prevalence of dyslipidemia was significantly higher in class IV compared to class III obesity only in females ≥ 14 years and males ≥ 12 years but not in younger children. In girls &lt; 14 years and in boys of any age, the prevalences of type 2 diabetes mellitus did not differ between classes III and IV obesity. Conclusions: Since a BMI above the highest BMI cut-off was not associated consistently with dyslipidemia and disturbed glucose metabolism in every age group both in boys and girls, measurements of CVRFs instead of BMI cut-off seem preferable to guide different treatment approaches in obesity such as medications or bariatric surgery.

This article explores the challenges faced by banks in adapting to changing markets and technology. It discusses the shift of assets from banks to other financial institutions and emphasizes the importance of technology, such as digital payments, in banking. The article also mentions the risks banks face, including regulatory requirements and cyber threats, and suggests that banks should focus on technology, risk culture, and global opportunities to remain competitive. It highlights the need for banks to implement technological improvements, have a clear strategy, and adapt to changes in the balance sheet. The article concludes by urging financial executives to embrace the new era and approach the future with a different mindset. [Extracted from the article]

The effect of closed-loop insulin delivery on the risk of acute diabetes complications in people with type 1 diabetes is unclear. We investigated whether the rates of severe hypoglycaemia and diabetic ketoacidosis are lower with hybrid closed-loop insulin therapy compared with sensor-augmented (open-loop) pump therapy in a large cohort of young people.

To characterize the initial presentation and clinical course of patients with hepatocyte nuclear factor (HNF) 4A‒ and HNF1B‒MODY in a multinational registry.

Congenital adrenal hyperplasia (CAH) due to CYP21A2gene mutations is associated with a variety of clinical phenotypes (salt wasting, SW; simple virilizing, SV; nonclassical, NC) depending on residual 21-hydroxylase activity. Phenotypes and genotypes correlate well in 80–90% of cases. We set out to test the predictive value of CAH phenotype assignment based on genotype classification in a large multicenter cohort. A retrospective evaluation of genetic data from 538 CAH patients (195 screened) collected from 28 tertiary centers as part of a German quality control program was performed. Genotypes were classified according to residual 21-hydroxylase activity (null, A, B, C) and assigned clinical phenotypes correlated with predicted phenotypes, including analysis of Prader stages. Ultimately, concordance of genotypes with clinical phenotypes was compared in patients diagnosed before or after the introduction of nationwide CAH-newborn screening. Severe genotypes (null and A) correlated well with the expected phenotype (SW in 97 and 91%, respectively), whereas less severe genotypes (B and C) correlated poorly (SV in 45% and NC in 57%, respectively). This was underlined by a high degree of virilization in girls with C genotypes (Prader stage >1 in 28%). SW was diagnosed in 90% of screening-positive babies with classical CAH compared with 74% of prescreening patients. In our CAH series, assigned phenotypes were more severe than expected in milder genotypes and in screened vs prescreening patients. Diagnostic discrimination between phenotypes based on genotypes may prove overcome due to the overlap in their clinical presentations.

ObjectivesTo investigate the frequency of coeliac disease (CD)-specific human leucocyte antigen (HLA) genotypes in paediatric patients with type 1 diabetes (T1D), who are known to have a higher prevalence of CD than the general population, and to evaluate whether HLA genotyping is a suitable first-line screening method for CD.Study designThe study was a multicentre observational analysis of patients with T1D aged <20 years of whom a subgroup had undergone HLA genotyping. Patient data were retrieved from the Diabetes Prospective Follow-up database, a large diabetes follow-up registry. The present analysis included data from 439 centres throughout Germany, Austria, Switzerland and Luxembourg.ResultsIn March 2017, the database contained 75 202 patients with T1D (53% male, mean age (SD) 14.6 (4.1) years, mean age at diagnosis 8.8 (4.3) years and mean diabetes duration 5.8 (4.3) years). 1624 patients had undergone coeliac-specific HLA genotyping, of whom 1344 (82.8%) were positive for HLA-DQ2, HLA-DQ8 or both, while 17.2% had no coeliac-specific HLA-markers. 26.6% of at-risk patients had a clinical suspected diagnosis of CD, and 3.6% had biopsy-proven CD.ConclusionsGenotyping for HLA-DQ2, HLA-DQ8 or both is positive in the vast majority (>80%) of patients with T1D. Therefore, screening for coeliac-specific HLA genotypes as a first-line test is not a suitable method to exclude CD in T1D. Regular screening for coeliac-specific antibodies in T1D is still recommended.

THOMAS DANNE, MD [1] HENRIK B. MORTENSEN, DR MED SCI [2] PHILIP HOUGAARD, PHD. DSC [3] HELLE LYNGGAARD, MSC [3] HENK-JAN AANSTOOT, MD, PHD [4] FRANCESCO CHIARELLI, MD [5] DENIS [...]

ANDREA ICKS, MD, MPH [1] JOACHIM ROSENBAUER, MD, DIPL MATH [1] REINHARD W. HOLL, MD [2] MATTHIAS GRABERT, PHD [3] WOLFGANG RATHMANN, MD, MSPH [1] GUIDO GIANI, PHD [1] OBJECTIVE [...]

While the growth of assets under management outside of banks' balance sheets is not new, our analysis suggests that the traditional core of the banking sector - the balance sheet - now finds itself at a tipping point. Below the surface, too, much has changed: balance sheet and transactions have increasingly moved out of traditional banks to nontraditional institutions and to parts of the market that are capital-light and often differently regulated - for example, to digital payments specialists and private markets, including alternative asset management firms. Time for bold late-cycle moves 2018: Banks in the changing world of financial intermediation 2017: Remaking the bank for an ecosystem world 2016: A brave new world for global banking 2015: The fight for the customer 2014: The road back The ROE growth was accompanied by volatility over the past 18 months. [Extracted from the article]