Pediatric Diabetes

Aims. This study aimed to identify the quantity and range of protein, fat, and carbohydrate consumed in meals and snacks in children with Type 1 diabetes (T1D), and to explore associations between the variability in fat and protein intakes with the glycemic outcomes. Methods. This was a cross-sectional dietary study of children 6–18 years attending pediatric diabetes service in Australia. Three-day weighed food records were analyzed for the macronutrient intake. Impacts of dietary intake on glycemic outcomes were explored. Results. Forty-eight children (63% male) aged 11.7 ± 2.9 (mean ± SD) with HbA1c 6.7 ± 1.1% (mmol/mol), BMI Z-score 0.51 ± 0.83, and daily insulin dose 0.99 units/kg completed 3-day weighed food records. Mean intakes at breakfast were 47-g carbohydrate, 15-g protein, and 12-g fat. Lunch: 49-g carbohydrate, 19-g protein, and 19-g fat. Dinner: 57-g carbohydrate, 33-g protein, and 26-g fat. Fifty-five percent (n = 80) of the dinner meals met criteria for a high-fat, high-protein (HFHP) meal. In a subset (n = 16) of participants, exploratory analysis indicated a trend of reduced %TIR (58%) in the 8 hr following HFHP dinner, compared to %TIR (74%) following non-HFHP dinner (). Seventy-eight percent of the participants aged 12–18 years intake at dinner varied by more than 20-g fat or more than 25-g protein. There was no association between the variability in fat and protein intake at dinner with HbA1c. Saturated fat contributed to 14.7% (±3.0) of participants energy intake. Conclusions. Children with T1D frequently consume quantities of fat and protein at dinner that have been shown to cause delayed postprandial hyperglycemia. HFHP dinners were associated with the reduced %TIR over 8 hr, presenting an opportunity for insulin-dose adjustments. Future research that explores the meal dietary variability with postprandial glycemia in this population is needed. Excessive intake of the saturated fat highlights the need for dietary interventions to reduce CVD risk. This trial is registered with ACTRN12622000002785.

Introduction. The landscape of childhood diabetes has evolved and addressing the knowledge gaps in non-Type 1 diabetes mellitus are key to accurate diagnosis. Objectives. A national surveillance study was completed between 2006 and 2008 and then repeated between 2017 and 2019 to describe Canadian incidence trends and clinical characteristics of non-Type 1 diabetes mellitus. Methods. We prospectively tracked new cases of non-Type 1 diabetes mellitus in children <18 years of age between June 1, 2017 and May 31, 2019. For each reported new case, a detailed questionnaire was completed, and cases were classified as Type 2 diabetes mellitus, medication-induced diabetes (MID), monogenic diabetes, or “indeterminate.” Minimum incidence rates and 10-year incidence trends of non-Type 1 diabetes mellitus and its subtypes were calculated. Results. 441 cases of non-Type 1 diabetes mellitus were included (Type 2 diabetes mellitus = 332; MID = 52; monogenic diabetes = 30; indeterminate = 27). Compared to 10 years ago, the incidence of MID and monogenic diabetes remained stable, while Type 2 diabetes mellitus increased by 60% () overall and by 37% () and 50% () in females and males, respectively. Type 2 diabetes mellitus incidence increased by 1.5 times in Indigenous () and doubled in Asian () children. Conclusions. Canadian incidence rates of childhood-onset Type 2 diabetes mellitus have significantly increased. Further research, policy, and prevention efforts are needed to curb rising rates of youth onset Type 2 diabetes mellitus.

Aim. The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the pediatric occurrence of type 1 diabetes (T1D) is inconclusive. We aimed to assess associations between seroprevalences of the distinct anti-SARS-CoV-2 antibodies and T1D occurrence in children and adolescents. Methods. This multicenter prospective observational cohort comprised children diagnosed with T1D between October 2020 and July 2022 and unrelated children who performed endocrine tests (control group) in a 1 : 3 ratio. Anti-SARS-CoV-2 antibodies, including anti-S, anti-N, and neutralizing antibodies, were assessed in each group. Results. The cohort included 51 children with T1D and 182 children in the control group. The median (interquartile range) age was 11.4 (8.2, 13.3) years, with 45% being female. Increases were not observed in the seroprevalence of any of the anti-SARS-CoV-2 antibodies among the children with new-onset T1D compared to the control group. Among the T1D group, anti-S seroprevalence was higher among those without diabetic ketoacidosis (DKA) than in those with DKA upon T1D diagnosis (72% vs. 42%, ). After adjustment to vaccination status, this difference was not statistically significant. Additionally, anti-N antibodies and neutralizing antibodies did not differ between the DKA and the non-DKA groups. None of the anti-SARS-CoV-2 antibodies were associated with any of the glycemic parameters. Conclusions. This study is the first to assess several distinct anti-SARS-CoV-2 antibodies in new-onset T1D, and our findings do not support an association between SARS-CoV-2 infection and the occurrence of T1D in children and adolescents. Since autoimmunity may emerge years after a viral infection, we recommend conducting follow-up epidemiological studies to assess whether there is a change in the incidence of T1D following the SARS-CoV-2 pandemic.

Introduction. The underlying pathophysiology of diabetes mellitus after acute pancreatitis is unknown and overall risk of developing diabetes postacute pancreatitis in children is understudied. The objective of our study was to describe the frequency of islet cell autoimmunity and abnormal glucose testing in pediatric patients in the year following their index case of acute pancreatitis. Materials and Methods. Data were obtained from a single-center observational cohort study of patients with their first episode of acute pancreatitis. Islet cell autoantibody titers were measured on stored plasma collected from acute pancreatitis diagnosis, at 3 months and at 12 months postacute pancreatitis attack. Abnormal glucose testing was defined as the presence of prediabetes or diabetes, as defined by American Diabetes Association criteria. Results. Eighty-four patients with acute pancreatitis and islet cell autoantibody data were included, 71 had available glucose measures. Median age at first acute pancreatitis attack was 14 years (IQR 8.7–16.3) and 45/84 (54%) were females. Twenty-four patients (29%) were positive for at least one of four islet cell autoantibodies (IAA, GADA, IA-2A, and ZnT8A) and 6 (7%) had two or more positive islet cell autoantibodies. Nineteen patients out of 71 (27%) had abnormal glucose testing at or postacute pancreatitis diagnosis. A higher proportion (37%, 7/19) with abnormal glucose testing had severe acute pancreatitis compared to those with normal glucose testing (13%, 7/52) (). Patients with normal glucose testing were more likely to be positive for one or more islet cell autoantibodies (31%, 16/52) compared to those with abnormal glucose testing (0%, 0/19) (). Conclusions. Islet cell autoimmunity is more common in children after their index acute pancreatitis attack (29%) than in the general population (7%–8%). While the frequency of prediabetes and diabetes postacute pancreatitis is high, other mechanisms besides islet cell autoimmunity are responsible.

Background. Youth with Type 1 diabetes (T1D) who are Black, Hispanic, or lower socioeconomic status (SES) have lower rates of diabetes device use, higher hemoglobin A1c (HbA1c), and higher rates of diabetic ketoacidosis (DKA). However, the associations of individual-level social determinants of health (SDoH) and neighborhood-level factors with device use and clinical outcomes are unknown. Area deprivation index (ADI) is a neighborhood level measure of SES reported in deciles (range 1–10 with 10 representing most deprived neighborhood). Methods. We evaluated the association of ADI and other SDoH factors with pump/continuous glucose monitor (CGM) use, HbA1c, and DKA in 1,461 youth with T1D (50% female, age 12.8 ± 3.6 years, HbA1c 8.7 ± 2.1%, 52% pump, 70% CGM) seen between October 1, 2020 and September 30, 2021 at a large pediatric diabetes center. Multiple logistic regression and multiple linear regression analyses were used to determine statistically significant associations adjusting for potential confounders. Results. Youth were less likely to use an insulin pump if they lived in a higher ADI neighborhood, were Black or Hispanic, had Medicaid or were uninsured, or received government assistance (e.g., Supplemental Security Income, Supplemental Nutritional Assistance Program). Youth were less likely to use a CGM if they lived in a higher ADI neighborhood, were Black or Hispanic, had Medicaid or were uninsured. Youth had higher risk of DKA event in the past year if they used government assistance, whereas pump and CGM use were associated with lower DKA risk. HbA1c (%) increased by 0.09 (95% CI: 0.05, 0.13) per unit increase in ADI. HbA1c was 0.62 lower (95% CI: −0.82, −0.42) in pump users vs. nonusers and 0.78 lower (95% CI: −0.99, −0.56) in CGM users vs. nonusers. Conclusions. Interventions that tailor care plans to address SDoH in families living in deprived neighborhoods may be needed to increase successful technology uptake, optimize HbA1c, and prevent DKA.

Aims. Assessment of the glycemic outcomes of increasing and splitting mealtime insulin doses for mixed fat and protein meals in pediatric patients with type 1 diabetes mellitus (T1DM) using multiple daily injection regimen and comparing the effects of regular insulin and fast-acting insulin on glycemic outcomes following those meals. Methods. This single-center, randomized, cross-over trial included 43 children and adolescents with T1DM randomly assigned to receive three interventional insulin doses for lunch meals over 3 consecutive days; Intervention A (100% insulin-to-carbohydrate ratio (ICR) dose given as premeal insulin lispro with an additional insulin sensitivity factor-calculated correction dose after 3 hr), Intervention B (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal insulin lispro after 30 min), and Intervention C (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal regular insulin after 30 min). The test meal consisted of two slices of pizza (weight: 150 g, carbohydrates: 40 g, fat: 15 g, protein: 20 g, and calories: 380 kcal). Postprandial blood glucose levels were monitored for 6 hr. Results. There were no significant differences in postprandial blood glucose excursions following the three interventions. However, Intervention C had a significantly lower late (3–6 hr) blood glucose area under the curve (). Postprandial hypoglycemia developed in 12 participants (27.9%) following Interventions A and B and in 17 participants (39.5%) following Intervention C (). Conclusions. Using regular insulin as a postmeal portion of increased and split insulin doses provided better late postprandial glycemic outcomes following mixed fat and protein meals. However, the amount of additional insulin used needs optimization to reduce the frequency of postprandial hypoglycemia. This trial is registered with NCT04783376.