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BackgroundGiven limited experience in applying the creatine-(methyl-D3) (D3Cr) dilution method to measure skeletal muscle mass (SMM) in young children, the feasibility of deployment in a fielding setting and performance of the method was assessed in a cohort of 4-year-old children in Dhaka, Bangladesh.MethodsFollowing D3Cr oral dose (10 mg) administration, single fasting urine samples were collected at 2-4 days (n = 100). Twenty-four-hour post-dose collections and serial spot urine samples on days 2, 3 and 4 were obtained in a subset of participants (n = 10). Urinary creatine, creatinine, D3Cr and D3-creatinine enrichment were analyzed by liquid chromatography-tandem mass spectrometry. Appendicular lean mass (ALM) was measured by dual-energy x-ray absorptiometry and grip strength was measured by a hand-held dynamometer.ResultsSMM was measured successfully in 91% of participants, and there were no adverse events. Mean ± SD SMM was greater than ALM (4.5 ± 0.4 and 3.2 ± 0.6 kg, respectively). Precision of SMM was low (intraclass correlation = 0.20; 95% CI: 0.02, 0.75; n = 10). Grip strength was not associated with SMM in multivariable analysis (0.004 kg per 100 g of SMM; 95% CI: -0.031, 0.038; n = 91).ConclusionsThe D3Cr dilution method was feasible in a community setting. However, high within-child variability in SMM estimates suggests the need for further optimization of this approach.ImpactThe D3-creatine (D3Cr) stable isotope dilution method was considered a feasible method for the estimation of skeletal muscle mass (SMM) in young children in a community setting and was well accepted among participants. SMM was weakly associated with both dual-energy x-ray absorptiometry-derived values of appendicular lean mass and grip strength. High within-child variability in estimated values of SMM suggests that further optimization of the D3Cr stable isotope dilution method is required prior to implementation in community research settings.

Aim: To test whether an audit and feedback‐based intervention improved HbA1c 12 months after transfer to type 1 diabetes adult care. Methods: Multi‐centre, quasi‐experimental pre‐post study of an AF‐based intervention targeting paediatric diabetes teams, which encouraged the implementation of an evidence‐informed structured transition process at five paediatric diabetes centres in Ontario, Canada. Participants entered the study at their final paediatric visit. A parallel control cohort was ascertained using population‐based administrative datasets. The primary outcome was HbA1c 12 months after transfer. The main exposure was the study period: pre‐implementation (June 2018–May 2019); early‐implementation (June 2019–September 2020); and late‐implementation (October 2020–September 2021). Multivariable linear regression models were fit separately in each cohort. Results: There were 449 and 2844 individuals in the intervention and control cohorts, respectively. Twelve months after transfer, participants in the late‐implementation intervention cohort had an HbA1c that was, on average, 0.41% lower than participants in the pre‐implementation period (p = 0.016). Among the control cohort, there was no significant difference in the HbA1c 12 months after transfer between study periods. Conclusions: We found an effect of the intervention on glycaemic management one year following transfer to adult care. Future work will focus on refining and testing the effectiveness of the intervention in an expanded number of study sites and in collaboration with adult diabetes care providers. [ABSTRACT FROM AUTHOR]

Objectives Children with type 1 diabetes have early changes in vascular structure with increased aortic intima-media thickness ( aIMT) or carotid IMT ( cIMT). aIMT may be an earlier, more sensitive marker; however, longitudinal data in type 1 diabetes are lacking. This study will aim to evaluate changes in vascular structure ( aIMT and cIMT) over 2 yr during puberty in children with type 1 diabetes and compare them with those in healthy children. Research design and methods A total of 110 children (aged 10-18 yr, 55 males) participated in a prospective cohort study, including 77 children with type 1 diabetes and 33 age- and sex-matched healthy children. Ultrasound assessments of aIMT and cIMT; and clinical and biochemical data were collected at baseline and 2 yr later. Results Mean and maximal aIMT or cIMT did not worsen over time in children with type 1 diabetes compared with healthy children. Longer duration of diabetes related to an increase in aIMT. Improvement in HDL cholesterol and leptin related to a decrease in aIMT. Higher baseline IMT related to an improvement in IMT in children with type 1 diabetes (mean and maximal aIMT: β = −0.52, p < 0.001; β = −0.49, p = 0.001, and mean and maximal cIMT: β = −0.36, p = 0.003; β = −0.40, p = 0.001), independent of cardiovascular risk factors. Conclusions Aortic and carotid IMT does not deteriorate during puberty in children with type 1 diabetes. This has implications for the design of interventional studies in this important age group. [ABSTRACT FROM AUTHOR]

Information about the 40th anniversary meeting of the International Society for Pediatric and Adolescent Diabetes (ISPAD) in Toronto, Canada in 2014. Topics of the meeting include environmental risk factors on diabetes, mechanism and consequences of autoimmune conditions in endocrine autoimmunity and health outcomes of cardiovascular disease. The meeting also featured executives Jill Hamilton, Micheal Bliss and Denis Daneman.

Objective The effect of continuous subcutaneous insulin infusion ( CSII) and glucose variability on vascular health in type 1 diabetes (T1D) is not known. We aimed to determine whether initiation of CSII improves vascular function and reduces glucose variability, independent of changes in HbA1c. Methods Twenty-two children with T1D (12.5 ± 2.9 yr) were reviewed immediately prior, 3 wk, and 12 months after initiation of CSII. Vascular function [flow-mediated dilatation ( FMD), glyceryl trinitrate-mediated dilatation ( GTN)], glucose variability [mean of daily differences ( MODD), mean amplitude of glycaemic excursions ( MAGE) and continuous overlapping net glycaemic action ( CONGA)], and clinical and biochemical data were measured at each visit. Results for the first two visits were compared to a previously studied cohort of 31 children with T1D who remained on multiple daily injections ( MDI). Results FMD, GTN, blood pressure, HbA1c, fructosamine, and glucose variability significantly improved 3 wk after CSII commencement (all p < 0.05), but there was no change in the MDI control group. At 3 wk, vascular function related to glucose variability [( FMD: MODD, r = −0.62, p = 0.002) and ( GTN: MAGE, r = −0.59, p = 0.004; CONGA-4, r = −0.51, p = 0.01; MODD, r = −0.62, p = 0.002)] but not to blood pressure, HbA1c, or fructosamine. At 12 months, FMD, GTN, blood pressure, and glucose variability returned to baseline levels, while HbA1c deteriorated. Carotid intima media thickness was unchanged over 12 months. Conclusions Initiation of CSII rapidly improves vascular function in association with decreased glucose variability; however, the effects are not sustained with deterioration of metabolic control and glucose variability. [ABSTRACT FROM AUTHOR]