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While data on the efficacy and safety of continuous glucose monitoring (CGM) exist across a broad age spectrum, it is limited in very young children with type 1 diabetes (T1D). We aimed to assess real-world data in this high-risk population, focusing on glycemic variability and metrics beyond HbA1c. A 12-month multi-national, prospective, observational, registry-based cohort study in children with T1D aged 1-7 years compared glucose control using real-time CGM and using fingerstick blood glucose monitoring (BGM) alone. The prespecified primary endpoint was a difference in coefficient of variation (CV) between the CGM users and BGM-only cohort. Among 227 individuals using insulin pumps (42% female, age 5.3 years), 175 were CGM and 52 were BGM-only users. The median (IQR) CV was 39.1% (36.6-41.9) among CGM and 46.8% (42.3-51.2) among BGM-only users (P

Objective: To measure the changes in the number of medical visits and the number of hemoglobin A1c (HbA1c) determinations according to telemedicine access in children with type 1 diabetes (T1DM) du...

Objective: To compare the number of medical visits during the 2020 lockdown with the previous two years (2018, 2019) and with post-lockdown (2021) in Latin American children with type 1 diabetes (T1DM) with and without telemedicine access. Methods: Children with T1DM in 2018 from three Latin American countries and at least one consultation in 2018 were consecutively recruited between February and November 2021. The number of medical visits and telemedicine access were extracted from their medical records. Results: 217 children (60.4% females) aged 13.1± 3.2 years with a duration of 6.1 ± 2.7 years of T1DM were evaluated. There was a higher prevalence of children with telemedicine access than those without (139 (64.1%) vs. 78 (35.9%) ; p Conclusion: the number of medical visits of Latin American children during post-lockdown returned to a similar number to pre-lockdown 2018 in children with telemedicine access, but not in those without access. Disclosure A.M. Figueroa Sobrero: None. D.S. Gonzalez: None. E.R. Scaiola: None. P. Bocco: None. P.M. Pinto Ibarcena: None. C.M. Del Aguila: None. A.I. Mac: None. S. Lapertosa: None.

ImportanceContinuous glucose monitoring (CGM) devices have demonstrated efficacy in adults and more recently in youths and older adults with type 1 diabetes. In adults with type 1 diabetes, the use of real-time CGM compared with intermittently scanned CGM was associated with improved glycemic control, but there are limited data available for youths.ObjectiveTo assess real-world data on achievement of time in range clinical targets associated with different treatment modalities in youths with type 1 diabetes.Design, Setting, and ParticipantsThis multinational cohort study included children, adolescents, and young adults younger than 21 years (hereinafter referred to collectively as youths) with type 1 diabetes for a duration of at least 6 months who provided CGM data between January 1, 2016, and December 31, 2021. Participants were enrolled from the international Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Data from 21 countries were included. Participants were divided into 4 treatment modalities: intermittently scanned CGM with or without insulin pump use and real-time CGM with or without insulin pump use.ExposuresType 1 diabetes and the use of CGM with or without an insulin pump.Main Outcomes and MeasuresProportion of individuals in each treatment modality group achieving recommended CGM clinical targets.ResultsAmong the 5219 participants (2714 [52.0%] male; median age, 14.4 [IQR, 11.2-17.1] years), median duration of diabetes was 5.2 (IQR, 2.7-8.7) years and median hemoglobin A1c level was 7.4% (IQR, 6.8%-8.0%). Treatment modality was associated with the proportion of individuals achieving recommended clinical targets. Adjusted for sex, age, diabetes duration, and body mass index standard deviation score, the proportion achieving the recommended greater than 70% time in range target was highest with real-time CGM plus insulin pump use (36.2% [95% CI, 33.9%-38.4%]), followed by real-time CGM plus injection use (20.9% [95% CI, 18.0%-24.1%]), intermittently scanned CGM plus injection use (12.5% [95% CI, 10.7%-14.4%]), and intermittently scanned CGM plus insulin pump use (11.3% [95% CI, 9.2%-13.8%]) (P P P Conclusions and RelevanceIn this multinational cohort study of youths with type 1 diabetes, concurrent use of real-time CGM and an insulin pump was associated with increased probability of achieving recommended clinical targets and time in range target as well as lower probability of severe adverse events compared with other treatment modalities.

Aims: To evaluate access to screening tools for monogenic diabetes in paediatric diabetes centres across the world and its impact on diagnosis and clinical outcomes of children and youth with genetic forms of diabetes. Methods: 79 centres from the SWEET diabetes registry including 53,207 children with diabetes participated in a survey on accessibility and use of diabetes related antibodies, c-peptide and genetic testing. Results: 73, 63 and 62 participating centres had access to c-peptide, antibody and genetic testing, respectively. Access to antibody testing was associated with higher proportion of patients with rare forms of diabetes identified with monogenic diabetes (54 % versus 17 %, p = 0.01), lower average whole clinic HbA1c (7.7[Q1,Q2: 7.3-8.0]%/61[56-64]mmol/mol versus 9.2[8.6-10.0]%/77[70-86]mmol/mol, p < 0.001) and younger age at onset (8.3 [7.3-8.8] versus 9.7 [8.6-12.7] years p < 0.001). Additional access to c-peptide or genetic testing was not related to differences in age at onset or HbA1c outcome. Conclusions: Clinical suspicion and antibody testing are related to identification of different types of diabetes. Implementing access to comprehensive antibody screening may provide important information for selecting individuals for further genetic evaluation. In addition, worse overall clinical outcomes in centers with limited diagnostic capabilities indicate they may also need support for individualized diabetes management. info:eu-repo/semantics/publishedVersion

RECOMMENDATIONS/EXECUTIVE SUMMARY Education is the key to successful management of diabetes [E]. To maximize the effectiveness of diabetes treatment and the advances in diabetes management and technology (especially insulin pumps and continuous glucose monitoring) it is advisable that quality assured structured education is available to all young people with diabetes and their carers [E]. The content and delivery of structured education needs regular review to ensure it suits the needs of people with diabetes in that community, matches local practice, and reflects changes in diabetes management and technology [E]. Evaluation of structured educational programs should include measurement of outcomes directly related to diabetes education such as the patient's achievement of self‐selected diabetes‐care goals, improved psychosocial adaptation and enhanced self‐efficacy, in addition to measures of glycemic control [E]. There is evidence that educational interventions in childhood and adolescent diabetes have a beneficial effect on glycemic and psychosocial outcomes [A]. Educational interventions shown to be effective include those: based on clear theoretical psychoeducational principles [E] integrated into routine clinical care (eg, as an essential integral part of intensive insulin management) [A] referred to as an ongoing process of provision of individualized self‐management and psychosocial support [E] involving the continuing responsibility of parents and other carers throughout adolescence [B] making use of cognitive behavioral techniques most often related to problem solving, goal setting, communication skills, motivational interviewing, family conflict resolution, coping skills, and stress management [A] utilizing new technologies in diabetes care as one of the vehicles for educational motivation [A] Health care professionals require appropriate specialized training in the principles and practice of teaching and education to implement successfully behavioral approaches to education designed to empower young people and carers in promoting self‐management [E]. An interdisciplinary education team sharing the same philosophy and goals and speaking “with one voice” has beneficial effects on metabolic and psychosocial outcomes [B]. It is important that goals and targets for blood glucose and HbA1c align with those of ISPAD. A major task during the first 2 weeks after diagnosis of diabetes is to get the family to agree to encompass the same targets. [E] Mobile and web‐based applications can be useful tools for diabetes self‐management education to improve diabetes management. [E] Interactive web‐based educational resources designed by diabetes‐related device manufacturing companies are widely used for device‐specific patient training and education. [E] Telemedicine, if available, offers an alternative method to face‐to‐face diabetes review for people who live in remote areas and do not have access to professional counseling and diabetes education resources locally. [B] Diabetes peers and/or diabetes youth leaders can reinforce the principles of living well with diabetes and support the families learning especially in the resource limited setting. [E]

OBJECTIVE To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. RESEARCH DESIGN AND METHODS We analyzed data on 17,280 cases of T1D diagnosed during 2018–2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. RESULTS The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1–12.2) in 2018 to 21.7 (20.6–22.8) in 2021 for the youngest age-group, CONCLUSIONS The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.

Objectives: Different parenting practices contribute differently to the development of adolescent self-care. However, little is known about the impact of consistent parenting practices on adolescent self-care and metabolic control. Our study aimed to explore the association between parenting practices and adolescent metabolic control when both parents were consistent in supporting the adolescent’ management of (i) diabetes alone, (ii) psychosocial life issues alone and (iii) both diabetes and psychosocial life issues. Moreover, we looked at the types of consistent parenting practices most frequently associated with optimal metabolic control. Methods: 31 adolescents with type 1-diabetes aged 13 to 15 were interviewed during a diabetes summer camp in France. A mixed-methods (both qualitative and quantitative) design was used in order to code the different reported parenting practices, and to identify associations between different types of perceived parental consistencies and the adolescents’ metabolic control. Results: The results significantly support the hypothesis that consistent parental support of all aspects of self-care is associated with better glycaemic control in young adolescents. Conclusion: A dimension of family work should be more systematically included in diabetes care in order to strengthen the parents’ capacity to effectively and adequately support their adolescents’ emerging self-care capacity in the medical and psychosocial dimensions of self-care.

This chapter briefly defines and articulates the developmental task of identity formation and the medical task of developing autonomy and self-care capacity in adolescents and young adults with chronic conditions. The psychological challenge of integrating one’s identity as an ill person with other dimensions of one’s identity, in order to feel healthy and experience life and illness as challenges worth living, is discussed. Literature is reviewed in order to provide insight on how Antonovsky’s sense of coherence construct has been shown to relate to important medical as well as psychosocial outcomes that are relevant to adolescent health and development: (1) adherence and self-care; (2) general health behaviors; (3) perceived health, quality of life, and general well-being; and (4) a sense of self and identity. With reference to the concepts of health-promoting hospitals, clinical health promotion, positive psychology, and healthy youth development, we advocate that salutogenesis should be more systematically put into practice for young people in healthcare settings.