The COVID-19 pandemic represents an unprecedented challenge for public health worldwide, not only for the very high number of cases and deaths but also due to a wide variety of indirect consequences. Among these, the possible relationship between SARS-CoV-2 infection and type 1 diabetes (T1D) in pediatric age has aroused notable interest in the scientific community.This perspective article aims to focus on the epidemiological trend of T1D during the pandemic, the diabetogenic role of SARS-CoV-2, and the influence of preexisting T1D on COVID-19 outcomes.The incidence of T1D has considerably changed during the COVID-19 pandemic, but any direct role of SARS-CoV-2 is uncertain. It is more likely that SARS-CoV-2 infection acts as an accelerator of pancreatic β-cell immunological destruction, which is activated by known viral triggers whose spread has been abnormal during these pandemic years. Another interesting aspect to consider is the role of immunization as a potential protective factor both for T1D development and the risk of severe outcomes in already diagnosed patients. Future studies are still required to address unmet needs, including the early use of antiviral drugs to reduce the risk of metabolic decompensation in children with T1D.
Although type 1 diabetes (T1D) represents one of the most common chronic diseases in pediatric age, few studies on the epidemiology of T1D exist globally and the exact prevalence and incidence rates of the disease are unknown. In many countries, including Italy, national registries are missing.This study aims to assess T1D incidence in the pediatric population of the Calabria region (southern Italy) in the period 2019-2021. The secondary objective was to describe the main demographical, clinical and immunological features of incident cases. Case ascertainment and all clinical data were assessed by retrospectively reviewing the electronic medical records of children and adolescents diagnosed with diabetes at any Pediatric Diabetes Center belonging to the Rete Diabetologica Calabrese (Calabria Region Diabetes Network), from January 2019 to December 2021. The incidence of T1D was estimated for the entire region and was stratified according to age group (0-4 years, 5-9 years, and 10-14 years) and gender. Standardized incidence ratios for each province in the region were also calculated.The crude incidence of T1D was 20.6/100,000 person/years. Incidence rates were higher among females and children aged 5-9 years. The crude incidence of T1D was higher in the province of Reggio Calabria (26.5/100,000 person-years). The provinces of Crotone, Catanzaro, and Vibo Valentia showed significantly lower standardized incidence ratios. The annual incidence in the region progressively increased by 43% during the study period.Our study revealed a relatively high incidence in the Calabria region. The marked increasing incidence trend over the past two years could be related to the global impact of the COVID-19 pandemic, but further long-scale population-based studies are needed to confirm these findings.
Background: The aim of this multicenter observational real-world study was to investigate glycemic outcomes in children and adolescents with type 1 diabetes over the first 6-month use of MiniMed™ 780G. The secondary objective was to evaluate demographic and clinical factors that may be significantly associated with the achievement of therapeutic goals. Methods: Demographic, anamnestic, and clinical data of study participants were collected at the time of enrollment. Data on ambulatory glucose profile were acquired at 3 and 6 months after activating automatic mode. Aggregated glucose metrics and device settings of the entire study period were analyzed to identify predictors of optimal glycemic control, assessed by the concomitant achievement of time in range (TIR) >70%, coefficient of variation (CV) <36%, glucose management indicator (GMI) <7%, and time below range (TBR) <4%. Results: Our study cohort consisted of 111 children and adolescents (54.1% female) aged 7-18 years. All the most relevant clinical targets were achieved according to recommendations from the International Consensus both at 3 and 6 months. When considering aggregated data, primary goals in terms of TIR, CV, GMI, and TBR were achieved, respectively, by 72.1%, 74.8%, 68.5%, and 74.8% of participants. In addition, 44 individuals (39.6%) concomitantly addressed all the above clinical targets. Regression analysis revealed that older age, briefer duration of disease, and shorter active insulin time were significant predictors of optimal glucose control. Comparing two groups of individuals stratified according to the glycated hemoglobin (HbA1c) mean value in the year preceding MiniMed 780G use, achieving glycemic targets was observed in the subgroup with lower HbA1c. Conclusions: Our study highlights the effectiveness and safety of MiniMed 780G in the pediatric population. More extensive and personalized training on advanced hybrid closed-loop use should be considered for younger people and those with long disease duration.
Skin reactions due to technological devices pose a significant concern in the management of type 1 diabetes (T1D). This multicentric, comparative cross-sectional study aimed to assess the psychological impact of device-related skin issues on youths with T1D and their parents.
<p dir="ltr">Objective. To investigate glucose metrics and identify potential predictors of the achievement of glycemic outcomes in children and adolescents during their first 12 months of MiniMed™ 780G use. Research design and methods. In this multicenter, longitudinal, real-world study, 368 children and adolescents with type 1 diabetes starting SmartGuard technology between June 2020 and June 2022 were recruited. Ambulatory glucose profile data were collected during a 15-day run-in period (baseline), two weeks after automatic mode activation, and every 3 months. The influence of covariates on glycemic outcomes after 1 year of Minimed™ 780G use was assessed. Results. After 15 days of automatic mode use, all glucose metrics improved compared to baseline (p<0.001), except for time below range and coefficient of variation (p=0.113 and p=0.330, respectively). After one year, time in range (TIR) remained significantly higher than at baseline (75.3% vs 62.8%, p<0.001). The mean glycated hemoglobin over the study duration was lower than the previous year (6.9 ± 0.6% vs 7.4 ± 0.9%, p<0.001). Time spent in tight range (70-140 mg/dl) was 51.1% and glycemia risk index was 27.6. Higher TIR levels were associated with a reduced number of automatic correction boluses (p<0.001), fewer SmartGuard exits (p=0.021), and longer time in automatic mode (p=0.030). Individuals with baseline HbA1c > 8% showed more relevant improvement in TIR levels (from 54.3% to 72.3%). Conclusions. Our study highlights the sustained effectiveness of Minimed™ 780G among youths with T1D. Findings suggest that even children and adolescents with low therapeutic engagement may benefit from SmartGuard technology.</p>
OBJECTIVE To investigate glucose metrics and identify potential predictors of the achievement of glycemic outcomes in children and adolescents during their first 12 months of MiniMed 780G use. RESEARCH DESIGN AND METHODS This multicenter, longitudinal, real-world study recruited 368 children and adolescents with type 1 diabetes (T1D) starting SmartGuard technology between June 2020 and June 2022. Ambulatory glucose profile data were collected during a 15-day run-in period (baseline), 2 weeks after automatic mode activation, and every 3 months. The influence of covariates on glycemic outcomes after 1 year of MiniMed 780G use was assessed. RESULTS After 15 days of automatic mode use, all glucose metrics improved compared with baseline (P < 0.001), except for time below range (P = 0.113) and coefficient of variation (P = 0.330). After 1 year, time in range (TIR) remained significantly higher than at baseline (75.3% vs. 62.8%, P < 0.001). The mean glycated hemoglobin (HbA1c) over the study duration was lower than the previous year (6.9 ± 0.6% vs. 7.4 ± 0.9%, P < 0.001). Time spent in tight range (70–140 mg/dL) was 51.1%, and the glycemia risk index was 27.6. Higher TIR levels were associated with a reduced number of automatic correction boluses (P < 0.001), fewer SmartGuard exits (P = 0.021), and longer time in automatic mode (P = 0.030). Individuals with baseline HbA1c >8% showed more relevant improvement in TIR levels (from 54.3% to 72.3%). CONCLUSIONS Our study highlights the sustained effectiveness of MiniMed 780G among youth with T1D. Findings suggest that even children and adolescents with low therapeutic engagement may benefit from SmartGuard technology.
Background: The aim of this single-center observational study was to assess the real-world performance of first- and second-generation automated insulin delivery (AID) systems in a cohort of children and adolescents with type 1 diabetes over a one-year follow-up. Methods: Demographic, anamnestic, and clinical data of the study cohort were collected at the start of automatic mode. Data on continuous glucose monitoring metrics, system settings, insulin requirements, and anthropometric parameters at three different time points (start period, six months, 12 months) were retrospectively gathered and statistically analyzed. Results: Fifty-four individuals (55.6% of females) aged 7 to 18 years switching to AID therapy were included in the analysis. Two weeks after starting automatic mode, subjects using advanced hybrid closed-loop (AHCL) showed a better response than hybrid closed-loop (HCL) users in terms of time in range ( P = .016), time above range 180 to 250 mg/dl ( P = .022), sensor mean glucose ( P = .047), and glycemia risk index ( P = .012). After 12 months, AHCL group maintained better mean sensor glucose ( P = .021) and glucose management indicator ( P = .027). Noteworthy, both HCL and AHCL users achieved the recommended clinical targets over the entire study period. The second-generation AID system registered longer time spent with automatic mode activated and fewer shifts to manual mode at every time point ( P < .001). Conclusions: Both systems showed sustained and successful glycemic outcomes in the first year of use. However, AHCL users achieved tighter glycemic targets, without an increase of hypoglycemia risk. Improved usability of the device may also have contributed to optimal glycemic outcomes by ensuring better continuity of the automatic mode activation.
Abstract Background. A retrospective observational study was conducted to assess the prevalence of maturity onset diabetes of the young (MODY) in a large paediatric population of Southern Italy. Clinical and genetic features of the identified MODY patients were also described. Methods. Genetic testing was performed in children and adolescents newly diagnosed with diabetes who presented autoantibody negativity and fasting C-peptide levels ≥ 0.8 ng/mL. Patients with a low insulin daily dose and optimal glycaemic control after two years from diabetes onset were also investigated for monogenic diabetes, regardless of their autoimmunity status and/or C-peptide levels. Results. A prevalence of 6.5% of MODY was found. In particular, glucokinase-MODY was the most common type of MODY. The mean age at diagnosis was 9.1 years. Clinical presentation and biochemical data were heterogeneous also among patients belonging to the same MODY group. No clear criteria to screen patients eligible for diagnostic investigations were identified. Conclusions. Our findings highlight that a more detailed clinical evaluation of patients diagnosed with diabetes along with easier and less expensive approachability to genetic testing may allow diagnosing an increasing number of MODY cases. A correct, prompt diagnosis is crucial to choose the most appropriate treatment and offer adequate genetic counselling.
<p dir="ltr">Objective. To investigate glucose metrics and identify potential predictors of the achievement of glycemic outcomes in children and adolescents during their first 12 months of MiniMed™ 780G use. Research design and methods. In this multicenter, longitudinal, real-world study, 368 children and adolescents with type 1 diabetes starting SmartGuard technology between June 2020 and June 2022 were recruited. Ambulatory glucose profile data were collected during a 15-day run-in period (baseline), two weeks after automatic mode activation, and every 3 months. The influence of covariates on glycemic outcomes after 1 year of Minimed™ 780G use was assessed. Results. After 15 days of automatic mode use, all glucose metrics improved compared to baseline (p<0.001), except for time below range and coefficient of variation (p=0.113 and p=0.330, respectively). After one year, time in range (TIR) remained significantly higher than at baseline (75.3% vs 62.8%, p<0.001). The mean glycated hemoglobin over the study duration was lower than the previous year (6.9 ± 0.6% vs 7.4 ± 0.9%, p<0.001). Time spent in tight range (70-140 mg/dl) was 51.1% and glycemia risk index was 27.6. Higher TIR levels were associated with a reduced number of automatic correction boluses (p<0.001), fewer SmartGuard exits (p=0.021), and longer time in automatic mode (p=0.030). Individuals with baseline HbA1c > 8% showed more relevant improvement in TIR levels (from 54.3% to 72.3%). Conclusions. Our study highlights the sustained effectiveness of Minimed™ 780G among youths with T1D. Findings suggest that even children and adolescents with low therapeutic engagement may benefit from SmartGuard technology.</p>
