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Objective: The aim of the study was to describe how physical exercise affects metabolic control, insulin requirements and carbohydrate intake in children who use hybrid closed-loop systems. Methods: Cross-sectional study design. The sample included 21 children and adolescents diagnosed with type 1 diabetes. During the study, participants were monitored for a period of 7 days to gather comprehensive data on these factors. Results: Nine participants (42.9%) had switched to exercise mode to raise the target glucose temporarily to 150 mg/dL. The HbA1c values ranged from 5.5% to 7.9% (median, 6.5%; IQR, 0.75). The percentage of time within the target range of 70−180 mg/dL was similar; however, there was an increased duration of hyperglycaemia and more autocorrections on exercise days. The time spent in severe hyperglycaemia (>250 mg/dL) increased by 2.7% in exercise compared to non-exercise days (P = .02). It is worth noting that hypoglycaemic episodes did not increase during the exercise days compared with non-exercise days. Conclusion: The hybrid closed-loop system was effective and safe in children and adolescents with type 1 diabetes during the performance of competitive sports in real life. Resumen: Objetivo: El objetivo de este estudio es describir cómo el ejercicio físico afecta el control metabólico, las necesidades de insulina y el consumo de carbohidratos en niños usuarios de un sistema híbrido de circuito cerrado. Métodos: Diseño de estudio transversal. Se reclutaron veintiún niños y adolescentes diagnosticados con diabetes tipo 1. Durante el estudio, los participantes fueron monitoreados durante un período de 7 días para recopilar datos completos sobre estos factores. Resultados: Nueve participantes (42,9%) habían activado el modo de ejercicio, para elevar temporalmente la glucosa objetivo a 150 mg/dL. La HbA1c osciló entre 5,5% y 7,9% (mediana 6,5%, IQR 0,75). El porcentaje de tiempo dentro del rango de 70−180 mg/dL fue similar; sin embargo, hubo una mayor duración de la hiperglucemia y más autocorrecciones en los días en que se realizó ejercicio. El porcentaje de tiempo en hiperglucemia grave (>250 mg/dL) fue 2,7 mayor durante el ejercicio versus los días sin ejercicio (p = 0,02). En particular, los episodios de hipoglucemia no aumentaron durante los días de práctica de ejercicio, en comparación con los días sin ejercicio. Conclusiones: El sistema híbrido de circuito cerrado fue efectivo y seguro en niños y adolescentes diagnosticados con diabetes tipo 1 durante ejercicios físicos competitivos en la vida real.

Background and aims: To face the rapid spread of SARS-CoV2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D). Patients and methods: Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70–180 mg/dl), hypoglycemia (180 and> 250 mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications and lockdown of caregivers were assessed via a survey. Results: 80 patients were studied (mean age 12.61 ± 3.32 years, mean time of evolution of the disease 5.85 ± 3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: Guardian 3 (65%), FreeStyle Libre (18.8%) and Dexcom G6 (16.2%). Time in range in the cohort increased significantly during confinement (72.1 ± 10.5 vs 74.8 ± 10.5%; P = 0.011) with lower time in hypoglycemia both 250 mg/dl (4.6 ± 3.9 vs 3.7 ± 3.7%; P = 0.038). CV also decreased (35.8 ± 6.3 vs 33.1 ± 6.1%; P 180 y >250 mg/dl), uso del sensor y número de glucemias capilares. Mediante encuesta se obtuvo información acerca de rutinas de ingesta, ejercicio físico, necesidad de ajustes en la terapia, complicaciones agudas surgidas y acompañamiento de los pacientes por sus cuidadores durante el confinamiento. Resultados: Se incluyeron 80 pacientes (edad media 12,61 ± 3,32 años, tiempo medio de evolución de la enfermedad 5,85 ± 3,92 años), 66,2% tratados con bomba de insulina, usuarios de los siguientes sistemas de monitorización: Guardian 3 (65%), FreeStyle Libre (18,8%) y Dexcom G6 (16,2%). El tiempo en rango en la cohorte se incrementó de forma significativa durante el confinamiento (72,1 ± 10,5 vs 74,8 ± 10,5%; p = 0,011) a expensas de una disminución del tiempo en hipoglucemia tanto 250 mg/dl (4,6 ± 3,9 vs 3,7 ± 3,7%; p = 0,038), reduciéndose también el CV (35,8 ± 6,3 vs 33,1 ± 6,1%; p

Objective: The aim of the study was to describe how physical exercise affects metabolic control, insulin requirements and carbohydrate intake in children who use hybrid closed-loop systems., Methods: Cross-sectional study design. The sample included 21 children and adolescents diagnosed with type 1 diabetes. During the study, participants were monitored for a period of 7 days to gather comprehensive data on these factors., Results: Nine participants (42.9%) had switched to exercise mode to raise the target glucose temporarily to 150 mg/dL. The HbA1c values ranged from 5.5% to 7.9% (median, 6.5%; IQR, 0.75). The percentage of time within the target range of 70-180 mg/dL was similar; however, there was an increased duration of hyperglycaemia and more autocorrections on exercise days. The time spent in severe hyperglycaemia (>250 mg/dL) increased by 2.7% in exercise compared to non-exercise days (P = .02). It is worth noting that hypoglycaemic episodes did not increase during the exercise days compared with non-exercise days., Conclusion: The hybrid closed-loop system was effective and safe in children and adolescents with type 1 diabetes during the performance of competitive sports in real life., (Copyright © 2024 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Background and aims: Post-prandial glucose control is essential to achieve metabolic goals in patients with type 1 diabetes mellitus (T1DM). The new “faster aspart” insulin has a pharmacological profile noted for its faster absorption and onset of action, and increased early availability, resulting in improved blood glucose control after meals. The main objective of the study was to analyse the efficacy of “faster aspart” vs. “insulin aspart” in children and adolescents with DM1 on sensor-augmented pump treatment. Patients and methods: Multicentre, longitudinal and prospective analytical trial evaluating the use of faster aspart insulin for three months in children with T1DM with MiniMed640G® sensor-augmented pumps previously treated with aspart insulin. At the beginning and end of the study the following variables were analysed for subsequent comparison: mean sensor glucose, percentage of time in range, hypoglycaemia and hyperglycaemia, area under the curve (AUC) 180 mg/dL, mean sensor glucose pre- and postprandial in main meals, daily insulin requirements, basal/bolus percentage, and HbA1c. Acute complications, adverse events and satisfaction survey were assessed. Results: The study included 32 patients with a mean of 13.49 ± 2.42 years of age and with T1DM of 7.0 ± 3.67 years of onset. The use of faster aspart was associated with lower time in hyperglycaemia >180 mg/dL (25.8 ± 11.3 vs. 22.4 ± 9.5; p = .011) and >250 mg/dL (5.2±4.9 vs. 4.0 ± 3.6; p = .04), lower AUC >180 mg/dL (10.8 ± 6.5 vs. 9.3 ± 6.1; p = .03), and increased time in range (71.4 ± 10.0 vs. 74.3 ± 9.2; p = .03). No significant changes in hypoglycaemia, HbA1c, insulin requirements, and basal/bolus percentages were detected. Faster aspart was safe and well-evaluated by patients and caregivers. Conclusions: Faster aspart achieves better glycaemic control by increasing glucose time in range in children and adolescents with T1DM on treatment with sensor-augmented pumps. Resumen: Introducción y objetivos: El control glucémico postprandial es fundamental para conseguir los objetivos metabólicos en pacientes con diabetes mellitus tipo 1 (DM1). La nueva insulina faster aspart presenta un perfil farmacológico caracterizado por una absorción e inicio de acción más rápidos, mayor disponibilidad precoz y menor incremento de la glucosa postprandial. El objetivo principal del estudio fue analizar su eficacia en pacientes con DM1 tratados con un sistema integrado. Pacientes y métodos: Estudio analítico, longitudinal, prospectivo y multicéntrico, evaluando el empleo de faster aspart durante tres meses en pacientes en edad pediátrica con DM1 con sistema integrado MiniMed640G® tratados previamente con insulina aspart. Al inicio y final del estudio se analizaron para posterior comparación: glucosa media, porcentajes de tiempo en objetivo, tiempo en hipoglucemia e hiperglucemia, área bajo la curva (AUC) 180 mg/dL, glucosa media pre y postprandial en comidas principales, necesidades diarias de insulina, porcentaje basal/bolo y HbA1c. Se registraron complicaciones agudas y eventos adversos, y se evaluó grado de satisfacción mediante encuesta. Resultados: Se incluyeron 32 pacientes de 13,49 ± 2,42 años de edad con DM1 de 7,0 ± 3,67 años de evolución. Faster aspart se asoció a menor porcentaje de tiempo en hiperglucemia >180 mg/dL (25,8 ± 11,3 vs. 22,4 ± 9,5; p = 0,011) y >250 mg/dL (5,2 ± 4,9 vs. 4,0 ± 3,6; p = 0,04) y AUC >180 mg/dL (10,8 ± 6,5 vs. 9,3 ± 6,1; p = 0,03), incrementándose el tiempo en objetivo (71,4 ± 10,0 vs. 74,3 ± 9,2; p = 0,03) sin aumentar hipoglucemias. Las necesidades de insulina, porcentajes basal/bolo y HbA1c no se modifican significativamente. Faster aspart fue bien tolerada y valorada por los participantes. Conclusiones: Faster aspart consigue un mejor control glucémico, aumentando el tiempo de glucosa en objetivo en niños y adolescentes con DM1 en tratamiento con un sistema integrado.

Introduction: School-aged children with type 1 diabetes (DM1) require access to appropriate and safe care for their disease during their stay in the educational centre. Objective: To identify the needs perceived by families of schoolchildren with DM1 that affect their educational integration, safety, and well-being during the school day. Methodology: A descriptive and cross-sectional study was conducted using a questionnaire based on information and opinions provided by families of 362 schoolchildren between 3 and 16 years old with DM1 registered in their health history in the Public Health System of Extremadura. Results: The response rate was 56.9% (206). It was shown that 35% of schoolchildren with DM1 were treated with continuous subcutaneous insulin infusion therapy. Almost all of them (95.1%) required glucose monitoring, and 57.8% required insulin administration during the school day. Most (88%) children had adjusted well to school and did not describe any type of discriminatory treatment (87.4%). Glucagon is available in 82% of educational centres, in which 43.7% had a trained adult person to administer it. That teachers could recognise a hypoglycaemia was expressed by 21.4% of the families, and 29.1% were unaware of the existence of coordination protocols in the school. More than half (58.7%) claimed that the information available in schools about diabetes was low, and 77.2% stated that the control of the disease would improve if more training was provided to teachers. Conclusions: There are aspects optimally covered in the care of schoolchildren with DM1 in the schools of Extremadura. Among situations identified with potential room for improvement were adherence to the coordination protocol, information about diabetes, and training of adults to deal with emergency situations. Resumen: Introducción: El alumnado con diabetes tipo 1 (DM1) requiere durante su estancia en el centro educativo unos cuidados adecuados y seguros para su enfermedad. Objetivo: Identificar las necesidades percibidas por las familias del alumnado con DM1 que afecten a la integración educativa, seguridad y bienestar durante la jornada educativa. Métodos: Estudio descriptivo y transversal, mediante encuesta, basado en la información y opiniones proporcionada por las familias de los 362 pacientes entre 3 y 16 años con DM1, registrados en la historia de salud del Sistema Sanitario Público de Extremadura. Resultados: Tasa de respuesta del 56,9% (206). El 35% del alumnado con DM1 estaba en tratamiento con infusión subcutánea continua de insulina. El 95,1% precisó medir la glucemia y el 57,8% administrarse insulina durante la jornada escolar. Un 88% presentó buena adaptación al colegio y el 87,4% no describió ningún tipo de trato discriminatorio. El 82% de centros dispuso de glucagón y en un 43,7% hubo alguna persona adulta entrenada para administrarlo. Un 21,4% de familias pensaban que los profesores podían reconocer una hipoglucemia. El 29,1% desconocían la existencia de protocolos de coordinación en centros educativos, el 58,7% alegaron que la información en el centro sobre diabetes fue poca y un 77,2% que su control mejoraría con más formación del profesorado. Conclusiones: Existen aspectos óptimamente cubiertos en la atención al alumnado con DM1 en los centros educativos de Extremadura. Las situaciones con margen de mejora son la adherencia al protocolo de coordinación, la información sobre la diabetes y el adiestramiento de adultos ante emergencias.

Antecedentes: La diabetes tipo 1 (DT1) y la enfermedad celíaca (EC) son 2 enfermedades autoinmunes frecuentes en la infancia y comparten su predisposición genética (HLA-DQ2 y DQ8). La prevalencia de ambas se ha incrementado en el mundo. En el estado de Sonora (15 habitantes/km2), se desconoce información sobre su riesgo genético o la distribución de los alelos asociados en la población general. Objetivo: Comparar la frecuencia alélica HLA-DQ de una muestra representativa de recién nacidos sonorenses con la de pacientes DT1 y EC para determinar el gradiente de riesgo e identificar la presencia de autoinmunidad celíaca en el grupo de DT1. Métodos: Se incluyeron 397 recién nacidos sonorenses, 44 casos DT1 y 25 EC, diagnosticados clínicamente y con autoanticuerpos por ELISA. Se colectó una muestra de sangre, se extrajo ADNg y tipificaron HLA-DQ2 y DQ8 por PCR. El gradiente de riesgo se calculó comparando las frecuencias alélicas de los casos con respecto a los recién nacidos. Resultados: La proporción de heterodímeros de riesgo en sonorenses fue de 16.1% para HLA-DQ2 y de 13.6% para HLA-DQ8 con una proporción HLA-DQ2:DQ8 de 1.2:1. El genotipo DQ8/DQ2 representó un riesgo de 1:14 para DT1, mientras que para EC el DQ8/DQB1*0201 generó un riesgo de 1:6. La prevalencia de autoinmunidad asociada a EC fue del 7% en los niños DT1. Conclusión: Los sonorenses tienen una distribución de alelos HLA-DQ distintiva debido a su ascendencia. Las combinaciones del HLA-DQ8 con DQ2 o uno de sus alelos confirieron el máximo riesgo para ambas enfermedades. La DT1 y EC frecuentemente se presentan juntas.

Background: Type 1 diabetes (T1D) and celiac disease (CD) are the two most common autoimmune childhood diseases that share their HLA-DQ2 and DQ8 genetic origin. There has been a current increase in both diseases worldwide. In children from the low-population State of Sonora (15 inhabitants/km2) in northwestern Mexico, there is no information on their genetic risk or the distribution of the related alleles in the general population. Aims: To compare the HLA-DQ allele frequency in a representative sample of newborns from Sonora with that of T1D and CD patients to determine the risk gradient and identify the presence of celiac autoimmunity in the T1D group. Methods: The study included 397 Sonoran newborns, 44 cases of T1D, and 25 CD cases. The CD and T1D cases were clinically diagnosed by specialists at the Hospital Infantil del Estado de Sonora and the autoantibodies were determined by ELISA. Whole blood was collected, gDNA was extracted, and HLA-DQ2 and DQ8 were typed by PCR-SSP. The risk gradient was calculated by comparing the allele frequencies of the cases with those of the newborns. Results: The Sonoran HLA-DQ risk heterodimer proportion was 16.1% for HLA-DQ2 and 13.6% for HLA-DQ8 with an HLA-DQ2: HLA-DQ8 ratio of 1.2:1. The DQ8/DQ2 genotype represented a 1:14 risk for T1D, whereas the DQ8/DQB1*0201 combination resulted in a 1:6 risk for CD. The prevalence of CD autoimmunity in T1D children was 7%. Conclusion: The Sonoran population has a distinctive HLA-DQ allele distribution due to its ancestry. The HLA-DQ8 combinations with DQ2 or one of its alleles conferred the highest risk for both diseases and T1D and CD frequently appear together.

OBJETIVO: Avaliar a acurácia, utilidade e complicações da monitorização subcutânea contínua da glicemia em crianças e adolescentes com diabetes melito tipo 1 (DM1). MÉTODOS: Foram estudados retrospectivamente 16 pacientes (16,12±4,41 anos), submetidos à monitorização subcutânea contínua da glicemia (Medtronic; Northridge, CA, EUA) por 72 horas. Foram analisados os valores de glicemia capilar média e pelo sensor monitorização subcutânea contínua da glicemia; excursões glicêmicas (monitorização subcutânea contínua da glicemia versus. glicemia capilar); hiperglicemia pós-prandial (< 140 mg/dl); hipoglicemia noturna assintomática; complicações (trauma, infecção local, desconexão) e conduta terapêutica após a monitorização subcutânea contínua da glicemia. Os níveis de A1c foram determinados antes e 3 meses após a monitorização subcutânea contínua da glicemia. RESULTADOS: A glicemia capilar média durante a monitorização subcutânea contínua da glicemia foi de 214,3±66,5 mg/dl vs. 207,6±54,6 detectada pelo sensor, com correlação significante (p = 0,001). O coeficiente de correlação e erro médio absoluto foram de 0,86±0,21 e mediana de 12,6%, respectivamente. A monitorização subcutânea contínua da glicemia mostrou-se mais eficaz na detecção de excursões glicêmicas (p = 0,04; W = 74) em relação à glicemia capilar em ponta de dedo. A hiperglicemia pós-prandial foi identificada em 60% dos pacientes com DM1, com mediana de 157 mg/dl (< 140 mg/dl). A hipoglicemia noturna assintomática foi detectada em 46,7% dos casos. A avaliação dos níveis de A1c em oito (50%) pacientes, antes e após 3 meses da monitorização subcutânea contínua da glicemia, mostrou redução significante da A1c (8,18±1,5 vs. 7,28±1,3; p = 0,034) nesse grupo de pacientes. A mudança de conduta terapêutica foi instituída em 100% das crianças e adolescentes. Não houve complicações durante o exame em 93,7% dos casos. CONCLUSÕES: A monitorização subcutânea contínua da glicemia mostrou-se método seguro, bem tolerado, com alta acurácia nos valores glicêmicos detectados, com baixo índice de complicações. Esse método mostrou-se eficaz na detecção de excursões glicêmicas, hiperglicemia pós-prandial, na promoção de mudanças terapêuticas com redução importante da A1c em crianças e adolescentes diabéticos. A eficácia desse método na identificação da hipoglicemia assintomática ainda mostra-se indefinida na literatura.OBJECTIVE: To evaluate the accuracy, utility and complications of continuous glucose monitoring system in children and adolescents with type 1 diabetes. METHODS: This retrospective study assessed 16 type 1 diabetic patients (16.12±4.41 years) submitted to continuous glucose monitoring system (Medtronic; Northridge, CA) for 72 hours. The following parameters were analyzed: mean capillary glucose level and mean glucose value measured by the continuous glucose monitoring system; glucose excursions (continuous glucose monitoring system vs. capillary glucose measurement), postprandial hyperglycemia (NR < 140 mg/dl), nocturnal hypoglycemia, complications (trauma, local infection, disconnection) and therapeutic management after continuous glucose monitoring. A1c levels were measured at the beginning and after 3 months of the study. RESULTS: The mean capillary glucose values were 214.3±66.5 mg/dl vs. 207.6±54.6 mg/dl by continuous glucose monitoring system, with a significant correlation (p = 0.001). The correlation coefficient and mean absolute error were 0.86±0.21 and 12.6% of the median, respectively. The continuous glucose monitoring system was significantly more efficient in detecting glucose excursion than fingerstick capillary blood sampling (p = 0.04; W = 74), and postprandial hyperglycemia was identified in 60% of type 1 diabetic patients with a median value of 157 mg/dl (< 140 mg/dl). Nocturnal hypoglycemia was detected in 46.7% of these patients. The evaluation of A1c levels in eight (50%) patients before continuous glucose monitoring and after 3 months showed a significantly lower level of A1c in this population (8.18±1.5 vs. 7.28±1.3; p = 0.034). The therapeutic management of type 1 diabetes was changed in 100% of patients. No complications were detected in 93.7% of patients. CONCLUSIONS: The continuous glucose monitoring system showed to be a very safe, well-tolerated and highly accurate method, with a low complication rate. It is a good method to identify glucose excursion and postprandial hyperglycemia, and to improve metabolic changes in therapeutic strategies, with a significant impact on the A1c levels of pediatric diabetic patients. The efficacy of the continuous glucose monitoring system in detecting hypoglycemia is still unclear in the medical literature.

Background and Aims: To face the rapid spread of SARS-CoV2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D)., Patients and Methods: Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70-180mg/dl), hypoglycemia (<70 and <54mg/dl) and hyperglycemia (>180 and> 250mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications and lockdown of caregivers were assessed via a survey., Results: 80 patients were studied (mean age 12.61±3.32 years, mean time of evolution of the disease 5.85±3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: Guardian 3 (65%), FreeStyle Libre (18.8%) and Dexcom G6 (16.2%). Time in range in the cohort increased significantly during confinement (72.1±10.5 vs 74.8±10.5%; P=0.011) with lower time in hypoglycemia both <70mg/dl (4.6±3.2 vs 3.2±2.7%; P<0.001) and <54mg/dl (1.2±1.6 vs 0.7±1.2%; P<0.001) and hyperglycemia >250mg/dl (4.6±3.9 vs 3.7±3.7%; P=0.038). CV also decreased (35.8±6.3 vs 33.1±6.1%; P<0.001). Patients treated with multiple doses of insulin and poorer baseline glycemic control experienced greatest improvement. Daily insulin requirements remained stable. Regular practice of physical exercise and caregivers' confinement did not have a significant impact., Conclusions: Glycemic control in children and adolescents with T1D improved during quarantine, particularly in those with worse baseline control., (Copyright © 2022 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Aims: Post-prandial glucose control is essential to achieve metabolic goals in patients with type 1 diabetes mellitus (T1DM). The new "faster aspart" insulin has a pharmacological profile noted for its faster absorption and onset of action, and increased early availability, resulting in improved blood glucose control after meals. The main objective of the study was to analyse the efficacy of "faster aspart" vs. "insulin aspart" in children and adolescents with DM1 on sensor-augmented pump treatment., Patients and Methods: Multicentre, longitudinal and prospective analytical trial evaluating the use of faster aspart insulin for three months in children with T1DM with MiniMed640G® sensor-augmented pumps previously treated with aspart insulin. At the beginning and end of the study the following variables were analysed for subsequent comparison: mean sensor glucose, percentage of time in range, hypoglycaemia and hyperglycaemia, area under the curve (AUC) <70 and >180 mg/dL, mean sensor glucose pre- and postprandial in main meals, daily insulin requirements, basal/bolus percentage, and HbA1c. Acute complications, adverse events and satisfaction survey were assessed., Results: The study included 32 patients with a mean of 13.49 ± 2.42 years of age and with T1DM of 7.0 ± 3.67 years of onset. The use of faster aspart was associated with lower time in hyperglycaemia >180 mg/dL (25.8 ± 11.3 vs. 22.4 ± 9.5; p = .011) and >250 mg/dL (5.2±4.9 vs. 4.0 ± 3.6; p = .04), lower AUC >180 mg/dL (10.8 ± 6.5 vs. 9.3 ± 6.1; p = .03), and increased time in range (71.4 ± 10.0 vs. 74.3 ± 9.2; p = .03). No significant changes in hypoglycaemia, HbA1c, insulin requirements, and basal/bolus percentages were detected. Faster aspart was safe and well-evaluated by patients and caregivers., Conclusions: Faster aspart achieves better glycaemic control by increasing glucose time in range in children and adolescents with T1DM on treatment with sensor-augmented pumps., (Copyright © 2021 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Aims: To face the rapid spread of SARS-CoV-2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D)., Patients and Methods: Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70-180mg/dl), hypoglycemia (<70 and <54mg/dl), and hyperglycemia (>180 and>250mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications, and lockdown of caregivers were assessed via a survey., Results: 80 patients were studied (mean age 12.61±3.32 years, mean time of evolution of the disease 5.85±3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: Guardian TM 3 (65%), FreeStyle Libre TM (18.8%) and Dexcom G6 TM (16.2%). Time in range in the cohort increased significantly during confinement (72.1±10.5 vs. 74.8±10.5%; P=.011) with lower time in hypoglycemia both<70mg/dl (4.6±3.2 vs. 3.2±2.7%; P<.001) and<54mg/dl (1.2±1.6 vs. 0.7±1.2%; p<0.001) and hyperglycemia >250mg/dl (4.6±3.9 vs. 3.7±3.7%; P=.038). CV also decreased (35.8±6.3 vs. 33.1±6.1%; P<.001). Patients treated with multiple doses of insulin and poorer baseline glycemic control experienced greatest improvement. Daily insulin requirements remained stable. Regular practice of physical exercise and caregivers' confinement did not have a significant impact., Conclusions: Glycemic control in children and adolescents with T1D improved during quarantine, particularly in those with worse baseline control., (Copyright © 2021. Publicado por Elsevier España, S.L.U.)

Background and Aims: Post-prandial glucose control is essential to achieve metabolic goals in patients with type 1 diabetes mellitus (T1DM). The new «faster aspart» insulin has a pharmacological profile noted for its faster absorption and onset of action, and increased early availability, resulting in improved blood glucose control after meals. The main objective of the study was to analyse the efficacy of «faster aspart» vs. «insulin aspart» in children and adolescents with DM1 on sensor-augmented pump treatment., Patients and Methods: Multicentre, longitudinal and prospective analytical trial evaluating the use of faster aspart insulin for three months in children with T1DM with MiniMed640G® sensor-augmented pumps previously treated with aspart insulin. At the beginning and end of the study the following variables were analysed for subsequent comparison: mean sensor glucose, percentage of time in range, hypoglycaemia and hyperglycaemia, area under the curve (AUC) < 70 and > 180 mg/dL, mean sensor glucose pre and postprandial in main meals, daily insulin requirements, basal/bolus percentage, and HbA1c. Acute complications, adverse events and satisfaction survey were assessed., Results: The study included 31 patients with a mean of 13.49 ± 2.42 years of age and with T1DM of 7.0 ± 3.67 years of onset. The use of faster aspart was associated with lower time in hyperglycaemia > 180 mg/dL (25.8 ± 11.3 vs. 22.4 ± 9.5; p = 0.011) and > 250 mg/dL (5.2 ± 4.9 vs. 4.0 ± 3.6; p = 0.04), lower AUC > 180 mg/dL (10.8 ± 6.5 vs. 9.3 ± 6.1; p = 0.03), and increased time in range (71.4 ± 10.0 vs. 74.3 ± 9.2; p = 0.03). No significant changes in hypoglycaemia, HbA1c, insulin requirements, and basal/bolus percentages were detected. Faster aspart was safe and well-evaluated by patients and caregivers., Conclusions: Faster aspart achieves better glycaemic control by increasing glucose time in range in children and adolescents with T1DM on treatment with sensor-augmented pumps., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

Introduction: School-aged children with type 1 diabetes (DM1) require access to appropriate and safe care for their disease during their stay in the educational centre., Objective: To identify the needs perceived by families of schoolchildren with DM1 that affect their educational integration, safety, and well-being during the school day., Methodology: A descriptive and cross-sectional study was conducted using a questionnaire based on information and opinions provided by families of 362 schoolchildren between 3 and 16 years old with DM1 registered in their health history in the Public Health System of Extremadura., Results: The response rate was 56.9% (206). It was shown that 35% of schoolchildren with DM1 were treated with continuous subcutaneous insulin infusion therapy. Almost all of them (95.1%) required glucose monitoring, and 57.8% required insulin administration during the school day. Most (88%) children had adjusted well to school and did not describe any type of discriminatory treatment (87.4%). Glucagon is available in 82% of educational centres, in which 43.7% had a trained adult person to administer it. That teachers could recognise a hypoglycaemia was expressed by 21.4% of the families, and 29.1% were unaware of the existence of coordination protocols in the school. More than half (58.7%) claimed that the information available in schools about diabetes was low, and 77.2% stated that the control of the disease would improve if more training was provided to teachers., Conclusions: There are aspects optimally covered in the care of schoolchildren with DM1 in the schools of Extremadura. Among situations identified with potential room for improvement were adherence to the coordination protocol, information about diabetes, and training of adults to deal with emergency situations., (Copyright © 2018 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Abstract Objectives: In prepubertal type 1 diabetic patients (DM1), the availability of an informal primary caregiver (ICP) is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire), family functionality (family APGAR), support of another person in patient care, stress (Perceived Stress Scale), and socioeconomic status (Bronfman questionnaire). Multivariate logistic and linear regression analyses were performed. Results: The patients' median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06-151.9, p = 0.001). While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238-1.743, p = 0.011) and stress (β 1.918, 95% CI 1.10-2.736, p = 0.001) in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336-2.177, p = 0.008) were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients.