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Childhood obesity, with its metabolic complications, is a problem of public health. The International Diabetes Federation (IDF) has recommended glucose levels 1 h post oral glucose load (1h-PG) > 155–209 mg/dL as diagnostic for intermediate hyperglycemia (IH), while >209 mg/dL for type 2 diabetes (T2D). The aim of the study was to assess the occurrence of prediabetes, IH, and T2D in children and adolescents with simple obesity according to the criteria of American Diabetes Association (ADA) and of IDF, and the effect of COVID-19 pandemic on these disorders. Analysis included 263 children with simple obesity, screened either in prepandemic (PRE—113 cases) or post-pandemic period (POST—150 cases). All children underwent 2 h OGTT with measurements of glucose and insulin every 0.5 h, lipid profile, and other tests; indices if insulin resistance (IR): HOMA, QUICKI, Matsuda index, AUC (glu/ins) were calculated. The incidence of T2D, prediabetes, and IH was higher in POST with respect to PRE, with significant differences in the indices of IR, except for HOMA. Significant differences were observed in the assessed parameters of glucose metabolism among the groups with T2D, prediabetes, IH, and normal glucose tolerance (NGT), with some similarities between IH (based on 1h-PG) and prediabetes. Increased frequency of dysglycemia among children and adolescents with simple obesity is observed after COVID-19 pandemic. Metabolic profile of patients with IH at 1h-PG is "intermediate" between NGT and prediabetes. [ABSTRACT FROM AUTHOR]

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Skin autofluorescence (sAF) measurement is a non-invasive method used to assess tissue advanced glycation end product (AGE) accumulation. This study aims to characterize sAF's association with (1) glycated hemoglobin (HbA1c) values, (2) cardiovascular risk markers, and (3) common comorbidities (autoimmune thyroiditis, celiac disease) in children with type 1 diabetes (T1D). Materials and methods: A total of 348 children with T1D aged 3–18 years and 85 age- and gender-matched control subjects were enrolled. sAF was quantified using an AGE Reader (Diagnoptics BV, The Netherlands). The analysis covered HbA1c, blood lipid, and C-reactive protein (CRP) levels, ambulatory blood pressure monitoring records, and body composition parameters. The associations between variables and sAF were assessed using the Mann–Whitney U test and Spearman correlation. Results: We observed significantly higher sAF values in the T1D group compared to the control (1.40 [1.27–1.53] vs. 1.20 [1.07–1.30, AU]; p = 0.004), consistent across all tested age groups. In the T1D group, sAF was positively correlated with current HbA1c, mean of historical HbA1c values, and T1D duration (r values, respectively: 0.27, 0.22, 0.14, all p < 0.01). Percentage of body fat was positively correlated with sAF (r = 0.120; p = 0.044). No significant correlations were found between sAF and lipid fractions, Z-score of BMI, parameters from 24 h ambulatory blood pressure monitoring, or the amount of albumin excreted in urine. sAF was positively correlated with CRP (r = 0.17, p < 0.05). sAF was significantly higher in patients with concomitant celiac disease (1.53 [1.43–1.63] vs. 1.40 [1.27–1.53, AU], p = 0.001). Conclusion: Among young T1D patients with relatively brief diabetes duration, sAF effectively mirrors prior glycemic control, as presented by historical average HbA1c. However, associations with conventional CV risk markers are not evident. The higher sAF values in patients with celiac disease warrant further exploration. [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]

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.

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

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]

Background: Globally millions of people with diabetes still prick their fingers to measure blood glucose. The aim of this study was to comprehensively evaluate and to compare three lancing devices set at the minimum ("1") and at the maximum ("5") lancing depth with respect to blood volume (BV) and pain related to lancing., Methods: Lancing devices tested were A- Glucoject Dual PLUS , B- droplet (both: HTL-Strefa S.A., Poland), and C- Microlet Next (Ascensia Diabetes Care, Switzerland), all used with personal lancets of three sizes 28G, 30G, and 33G. BVs were measured with calibrated capillaries. Pain related to lancing was expressed as a derivative of pain rating with visual analog scale., Results: In 90 participants with diabetes, 360 lancing procedures were performed. Overall, BV and pain were higher for "maximum" compared to "minimum" lancing depth (for both P < .001). Pain differed between devices ( P ≤ .001), overall was higher for device A compared to B or C; in paired comparisons differences were significant for the following settings: A > B for 28G/1 and 33G/1, B > C for 30G/1, and A > C for 28G/1, 30G/1, and 33G/1. In aggregated comparison we did not prove a significant effect of lancet size on either BV nor pain ( P = .1109, P = .4966, respectively)., Conclusions: BV depended mainly on lancing depth. Pain depended on lancing depth and to some degree on device type. The results may serve as a source of comparative data of lancing devices performance for studies in which other lancing devices and/or lancets would be tested.The study was registered at ClinicalTrials.gov: NCT03479619.

In the last 10 years tremendous progress has been made in the development of artificial pancreas (AP) systems for people with type 1 diabetes (T1D). The pan-European consortium CLOSE (Automated Glu cose Contro l at H ome for People with Chronic Disea se) is aiming to develop integrated AP solutions (APplus) tailored to the needs of people with type 2 diabetes (T2D). APplus comprises a product and service package complementing the AP system by obligatory training as well as home visits and telemedical consultations on demand. Outcome predictors and performance indicators shall help to identify people who could benefit most from AP usage and facilitate the measurement of AP impact in diabetes care. In a first step CLOSE will establish a scalable APplus model case working at the interface between patients, homecare service providers, and payers in France. CLOSE will then scale up APplus by pursuing geographic distribution, targeting additional audiences, and enhancing AP functionalities and interconnectedness. By being part of the European Institute of Innovation and Technology (EIT) Health public-private partnership, CLOSE is committed to the EIT "knowledge triangle" pursuing the integrated advancement of technology, education, and business creation. Putting stakeholders, education, and impact into the center of APplus advancement is considered key for achieving wide AP use in T2D care.