We aimed to analyze the relationship between epilepsy and glutamic acid decarboxylase autoantibodies (GADA) in patients with type 1 diabetes mellitus (T1DM) and the impact of GADA on demographic, clinical, and metabolic data in T1DM patients with epilepsy.We searched for patients with T1DM ≤20 years and GADA measurements, and within this group for patients with epilepsy. We formed groups: T1DM + Epilepsy + GADA positive; T1DM + Epilepsy + GADA negative; T1DM + GADA positive; T1DM + GADA negative. We used logistic regression to analyze the relationship between epilepsy and GADA with odds ratio adjusted for sex, duration of diabetes (DOD), and age at diabetes onset (ADO). We used logistic regression with odds ratio adjusted for DOD and ADO onset using epilepsy as a dependent variable and GADA, HbA1c, ketoacidosis, severe hypoglycemia (SH), sex, celiac disease, and autoimmune thyroiditis as independent variables. We conducted regression analyses adjusted for sex, DOD, and ADO to analyze differences in clinical/metabolic parameters between the groups.Epilepsy was not more frequent in GADA-positive patients (GPP). Logistic regression including all patients with GADA measurements showed that hypoglycemia with coma (HC) correlated with epilepsy when compared to no SH. We found no differences in clinical and metabolic data between GPP and GADA-negative patients (GNP) with epilepsy. SH occurred more often in GPP with epilepsy in comparison to GPP without epilepsy. GNP with epilepsy had a higher rate of HC than GPP without epilepsy.We found no relationship between epilepsy and GADA. A relationship between T1DM and epilepsy might be explainable by SH.
<b><i>Objective</i></b>: The aim of this study was to investigate the frequency of newly diagnosed type 1 diabetes without evidence of autoimmunity and the respective frequencies of ketoacidosis in children, adolescents, and young adults during the coronavirus disease 2019 (COVID-19) pandemic in Germany compared to the previous decade. <p><b><i>Research Design and Methods</i></b>: Based on data from the German Diabetes Prospective Follow-up Registry (DPV), we compared data from 715 children, adolescents, and young adults, newly diagnosed with type 1 diabetes during the COVID 19 pandemic in Germany between March 1, and June 30, 2020, with data from 5,428 children, adolescents, and young adults of the same periods from 2011 to 2019. Adjusted differences and relative risks (RR) of negative beta cell autoantibody test results and diabetic ketoacidosis, were estimated using multivariable log-binomial regression analysis. An upper non-inferiority test (margin 1%) was applied to evaluate whether the autoantibody-negativity rate in 2020 was not higher than that in 2011 to 2019.</p> <p><b><i>Results:</i></b> The estimated frequencies of autoantibody-negativity in 2020 and 2011–2019 were 6.6% (95% CI, 5.1–8.4%) and 7.2% (95% CI, 6.5–8.0%), respectively, with an absolute difference of -0.68% (90% CI, -2.07–0.71%, p<sub> upper non-inferiority </sub>= 0.023). The increase of the estimated frequency of diabetic ketoacidosis during the COVID-19 pandemic was similar between autoantibody negative and -positive type 1 diabetes (adjusted RRs, 1.28 (95% CI, 0.80–2.05) and 1.57 (1.41–1.75), respectively).</p> <p><b><i>Conclusion: </i></b>This study found no evidence that the COVID 19 pandemic leads to a significantly increased number of new cases with autoantibody negative type 1 diabetes in children, adolescents, and young adults. In addition, autoantibody negative type 1 diabetes showed no particular susceptibility to ketoacidosis, neither before nor during the pandemic.</p>
The aim of the study was to explore the metabolic characteristics and outcome parameters in youth with type 1 diabetes and anxiety disorders. HbA1c levels, rates of severe hypoglycemia, diabetic ketoacidosis (DKA), and hospital admission in children, adolescents, and young adults with type 1 diabetes and an anxiety disorder from 431 diabetes-care-centers participating in the nationwide German/Austrian/Swiss/Luxembourgian diabetes survey DPV were analyzed and compared with youth without anxiety disorders. Children, adolescents, and young adults with type 1 diabetes and anxiety disorders (n = 1325) had significantly higher HbA1c (8.5% vs. 8.2%), higher rates of DKA (4.2 vs. 2.5 per 100 patient-years), and higher hospital admission rates (63.6 vs. 40.0 per 100 patient-years) than youth without anxiety disorders (all p < 0.001). Rates of severe hypoglycemia did not differ. Individuals with anxiety disorders other than needle phobia (n = 771) had higher rates of DKA compared to those without anxiety disorders (4.2 vs. 2.5 per 100 patient-years, p = 0.003) whereas the rate of DKA in individuals with needle phobia (n = 555) was not significantly different compared to those without anxiety disorders. Children, adolescents, and young adults with anxiety disorders other than needle phobia had higher hospitalization rates (73.7 vs. 51.4 per 100 patient-years) and more inpatient days (13.2 vs. 10.1 days) compared to those with needle phobia (all p < 0.001). Children, adolescents, and young adults with type 1 diabetes and anxiety disorders had worse glycemic control, higher rates of DKA, and more hospitalizations compared to those without anxiety disorders. Because of the considerable consequences, clinicians should screen for comorbid anxiety disorders in youth with type 1 diabetes.
The prevalence of hypertension is higher in children and adolescents with type 1 diabetes (T1D) compared with those without. This retrospective analysis of a large cohort of children and adolescents with T1D from the SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) international consortium of pediatric diabetes centers aimed to 1) estimate the prevalence of elevated office blood pressure (BP) and hypertension and 2) investigate the influence of BP measurement methodology on the prevalence of hypertension.A total of 27,120 individuals with T1D, aged 5-18 years, were analyzed. Participants were grouped into those with BP measurements at three or more visits (n = 10,440) and fewer than 3 visits (n = 16,680) per year and stratified by age and sex. A subgroup analysis was performed on 15,742 individuals from centers providing a score indicating BP measurement accuracy.Among participants with BP measurement at three or more visits, the prevalence of hypertension was lower compared with those with fewer than three visits (10.8% vs. 17.5% P < 0.001), whereas elevated BP and normotension were higher (17.5% and 71.7% vs. 15.3% and 67.1%, respectively; both P < 0.001). The prevalence of hypertension and elevated BP was higher in individuals aged ≥13 years than in younger ones (P < 0.001) and in male than female participants (P < 0.001). In linear regression models, systolic and diastolic BP was independently determined by the BP measurement methodology.The estimated prevalence of elevated BP and hypertension in children and adolescents with T1D is ∼30% and depends on the BP measurement methodology. Less frequent BP evaluation may overestimate the prevalence of hypertension.
Introduction: Our aim was to characterize and compare people diagnosed with T1D, T2D, or LADA in a real world setting to better understand the clinical impact of the diagnosis LADA.
Psychological stress is a known general health risk potentially increasing the risk of type 1 diabetes. Consistent with this hypothesis, there were reports of a higher incidence of type 1 diabetes after other stressful catastrophic events, e.g., the Chernobyl incident in 1986 or the Los Angeles earthquake in 1994 (1,2). Over the past few months, coronavirus disease 2019 (COVID-19) and subsequent social distancing have affected biological, psychological, economic, and social aspects of life. Social distancing during the lockdown could be perceived as a stressful situation for children and adolescents, who could not attend kindergarten or school and were unable to pursue hobbies like sports or meeting friends. Perceived stress caused by feelings of isolation may have increased the risk of type 1 diabetes (3). Since type 1 diabetes is also associated with viral infections (4), explaining, for example, the higher type 1 diabetes incidence during winter months, COVID-19 infection may have caused an increase of type 1 diabetes manifestations by affecting immune regulation or by directly damaging pancreatic β-cells (5 …
Objective: The COVID-19 pandemic has brought many challenges to pediatrics including diabetes care. In our district general pediatric unit during COVID-19 we have experienced ten new type 1 diabetes with 50% presenting in severe diabetic ketoacidosis (DKA). 40% of all DKAs were complicated with hypokalemia and 70% with acute kidney injury. Due to the severity of the presentations and frequency of complications, a dynamic education program was introduced to improve DKA management and patient outcomes. Methods: A DKA education week was introduced which was organized and implemented by the clinical registrar team. The week consisted of didactic consultant teaching on the DKA guideline, registrar led multi-disciplinary team (MDT) simulation sessions of a severe DKA in ED and cerebral edema developing in the ward setting, including nursing staff and general pediatric consultants. This was complimented with a practical skills session for prescribing in DKA, a focused session on the important aspects for reviewing a child with DKA and a journal club session on the evidence behind the DKA guideline. Reiterating the MDT approach, there was a specific teaching session for nurses. Remote teaching was incorporated for all sessions, via ZOOM, to ensure maximal impact. Results: 94% of the junior team participated in at least one aspect of the teaching program, feedback rated it as 5/5 for useful content. 100% of DKA management adhered to the DKA guideline following the education week with a significant improvement in junior trainee efficiency and competences. Individual peer feedback demonstrated improved confidence with prescribing and reviewing patients in particular for the junior members of the medical team. Conclusion: It is crucial that education in diabetes is reactive and dynamic to adapt to the challenges from COVID-19. Themed MDT education weeks in response to emerging trends is important for patient care and it can be junior led by an engaged registrar team.
