Advantages from “do-it-yourself” loops among children and adolescents in Varna’s Diabetes Center

Introduction: In the last 5 years, the use of automatic insulin delivery systems has been increasing among patients with type 1 diabetes mellitus (T1DM). It has been shown that they improve metabolic control, decrease the time spent in hypoglycemia and the number of episodes of nocturnal hypoglycemia; increase the time spent in target and are feasible and safe.Aim: Our aim is to evaluate the glycemic control in children/adolescents using do-it-yourself (DIY) regulatory unapproved insulin-delivery loops vs sensor-augmented pump therapy (SAP).Materials and Methods: A total of 43 families with child/children with T1DM on pump treatment and continuous use of continuous glucose monitoring (CGM) were invited to participate in the study; 31 (72.1%) of the families accepted. The children were followed for 6 months, a total of 196 patient months.Results: The study group consisted of 31 children with T1DM, 24 (77.4%) of them were on SAP, and 7 (22.6%) used DIY loops. No differences were observed in regard to age, duration of diabetes, and daily insulin dose between groups. Patients on DIY loops spent significantly more time in range (83.0 vs 68.8%, p=0.02), less time in hyperglycemia above 14 mmol/L (2.1 vs 8.6%, p=0.02). They had significantly better HbA1c at the 6th month (6.5 vs 7.2%, p=0.006) vs SAP patients for the follow-up period. No severe hypoglycemia and diabetic ketoacidosis (DKA) occurred. There were no gender differences between and within both groups.Conclusion: DIY unregistered loop systems showed promising results for better metabolic control at least in terms of mean blood glucose levels (BGLs) and without increasing the risk of severe hypoglycemia and DKA. Further impact e. g. mean insulin dose, long-term efficacy, consumed fat/protein in the daily diets, etc., remains to be studied in future larger and longer studies

Screening for acid-labile subunit deficiency in patients with growth hormone deficiency at a tertiary pediatric endocrinology center

Introduction: Acid-labile subunit (ALS) is a glycoprotein, which is produced in the liver in response to growth hormone (GH), with its main role being the formation of a complex with insulin-like growth factor 1 (IGF-1) and IGF-binding-protein-3 (IGFBP-3) in order to extend their circulating half-life and thus support the action of GH. Acid-labile subunit-deficient patients are of research interest because of the unclear incidence of the condition among the short-statured population and the need of specific therapeutic approach.Aim: The aim of this study is to assess the prevalence of ALS deficiency in a cohort of patients with GH deficiency (GHD) followed up in a tertiary university pediatric endocrinology center.Design: The study participants were 71 children (76% boys, age range 2–18 years), diagnosed with GHD by 2 standard GH-stimulation tests (max GH < 10 ng/mL), on GH therapy, and at mean age at the time of collection of samples: 11.6 ± 3.3 years. Blood serum samples were collected from each patient during the routine visits at the center, and then were stored frozen at -80℃ in 0.5 mL aliquots until analysis.Results: Acid-labile subunit deficiency screening identified serum ALS levels with range from 2.2 to 60 mg/L, with a mean of 17.4 ± 8.7 mg/L. The mean ALS levels were significantly lower than the published ones from subjects without short stature but close to the levels in the referred for GHD patients (6.5 ± 4.8 mg/L). Very low ALS levels (< 4.0 mg/L) were detected in 3 (4.2%) of the patients. The low ALS levels corresponded with low SDSheight (-2.8 ± 1.2) and low SDSIGF-1 (-1.4 ± 1.0) before therapy. In one of the 3 patients, the ALS level (2.2 mg/L) was close to that in patients with IGFALS gene mutations (< 1.0 mg/L).Conclusion: The present results show the prevalence of ALS deficiency in the current GH treated cohort and support the evidence that investigation of ALS levels could be helpful in the differential diagnosis of growth disorders

Contribution of home availability, parental child-feeding practices and health beliefs on children’s sweets and salty snacks consumption in Europe: Feel4Diabetes-Study

The Feel4Diabetes-Study has received funding from the European Union's Horizon 2020 research and innovation program (Grant Agreement: n degrees 643708). The content of this article reflects only the authors' views, and the European Community is not liable for any use that may be made of the information contained therein. The funding body had no role in the design of this study and collection, analysis and interpretation of the data and inwriting this manuscript.Adoption of healthy dietary and snacking habits could support optimum physical and mental development in children as they define health in adulthood. This study assessed parameters associated with children’s snacking such as food home availability, parenting practices, and parents’ health beliefs. In this cross-sectional study 12, 039 children, 49.4% boys 5-12 years old, participating in the European Feel4Diabetes-Study were included. Children’s weekly consumption of sweets and salty snacks, home availability of snacks, food parenting practices, and health beliefs were assessed via questionnaires. Logistic regression was applied to explore associations of a) home availability of snacks, b) food parenting practices (permissiveness and rewarding with snacks) and c) parent’s opinions on deterministic health beliefs with children’s consumption of sweets and salty snacks. Results showed that home availability (sweets: ORadj 4.76, 95%CI: 4.32, 5.23; salty snacks: ORadj: 6.56, 95%CI: 5.64, 7.61), allowing to consume (sweets: ORadj: 3.29, 95%CI: 2.95, 3.67; salty snacks: ORadj: 3.41, 95%CI: 2.98, 3.90) and rewarding with sweets/salty snacks (sweets: ORadj: 2.69, 95%CI: 2.23, 3.24; salty snacks: ORadj: 4.34, 95%CI: 3.57, 5.28) ‘sometimes/or less frequently’ compared to ‘always/or often’ were associated with lower weekly consumption of sweets and snacks. Parents’ disagreement compared to agreement with deterministic health beliefs and inattentive eating were associated with lower consumption of salty snacks and sweets in children. Overall, the findings of this study indicate that attempts to promote healthy snacking habits in children should aim to improve parental dietary habits, food parenting practices, health beliefs, and reducing home availability of unhealthy foods and snacks.European Union's Horizon 2020 research and innovation program 64370

The emerging prevalence of obesity within families in europe and its associations with family socio-demographic characteristics and lifestyle factors; a cross-sectional analysis of baseline data from the feel4diabetes study

The Feel4Diabetes study is a type 2 diabetes prevention program that recruited 12,193 children [age: 8.20 (±1.01) years] and their parents from six European countries. The current work used pre-intervention data collected from 9576 children–parents pairs, to develop a novel family obesity variable and to examine its associations with family sociodemographic and lifestyle characteristics. Family obesity, defined as the presence of obesity in at least two family members, had a prevalence of 6.6%. Countries under austerity measures (Greece and Spain) displayed higher prevalence (7.6%), compared to low-income (Bulgaria and Hungary: 7%) and high-income countries (Belgium and Finland: 4.5%). Family obesity odds were significantly lower when mothers (OR: 0.42 [95% CI: 0.32, 0.55]) or fathers (0.72 [95% CI: 0.57, 0.92]) had higher education, mothers were fully (0.67 [95% CI: 0.56, 0.81]) or partially employed (0.60 [95% CI: 0.45, 0.81]), families consumed breakfast more often (0.94 [95% CI: 0.91 0.96]), more portions of vegetables (0.90 [95% CI: 0.86, 0.95]), fruits (0.96 [95% CI: 0.92, 0.99]) and wholegrain cereals (0.72 [95% CI: 0.62, 0.83]), and for more physically active families (0.96 [95% CI: 0.93, 0.98]). Family obesity odds increased when mothers were older (1.50 [95% CI: 1.18, 1.91]), with the consumption of savoury snacks (1.11 [95% CI: 1.05, 1.17]), and increased screen time (1.05 [95% CI: 1.01, 1.09]). Clinicians should familiarise themselves with the risk factors for family obesity and choose interventions that target the whole family. Future research should explore the causal basis of the reported associations to facilitate devising tailored family-based interventions for obesity prevention

Innovations Improving Treatment Success in Children and Adolescents with Diabetes // Иновации за подобряване на успехите в лечението на деца и юноши с диабет

We present the first scientific study in Bulgaria on the effects of the new technologies in treating type 1 diabetes mellitus (T1DM) in children and adolescents. It covers the period 2015 – 2019, and consists of 5 sub-studies, involving 550 children. The results showed insufficient care for children with T1DM in kindergartens on the background of increasing frequency of glucose sensors (CGM) usage in the absence of reimbursement at that period. We searched for a correlation between improved glycemic control after introduction of pump therapy and scheduled remote monitoring. For the first time in Bulgaria we registered proved benefits from tighter follow up and more frequent contact with the diabetes team, leading to significant improvement of metabolic control. For the first time in Bulgaria we evaluated: the benefits of the constant use of sensors and their influence on patients' metabolic control and quality of life and their families. Regular CGM usage leads to better glycemic control without increasing the incidence of hypoglycemia and DKA in children. The strong significant relationship between the innovative sensor-generated indices and diabetes control makes them suitable for routine follow-up of patients with diabetes while providing a better quality of life. The current research gives evidence that with the expanding of the sensors and their full registration and reimbursement, their benefits will become available for a more considerable proportion of the Bulgarian diabetes population and the results of their use will improve. By incorporating the new technologies' potential into the requirements for diabetes control and with the adaptation of the health care professionals, better metabolic health will be provided to more children and young people with diabetes, which is of utmost importance for their future.Първото научно проучване в България, което представя ефекта на новите технологии в лечението на тип 1 захарен диабет (Т1ЗД) в детско-юношеска възраст. То обхваща периода 2015-19г. и се състои от 5 подпроучвания, в които участват общо 550 деца. Резултатите показват недостатъчна грижа за децата с Т1ЗД в детските градини на фона на нарастваща честота на употреба на сензори (CGM) при липсата на реимбурсация към момента на изследването. Потърсени са доказателства за подобрен гликемичен контрол при въвеждане на помпената терапия и организирано дистанционно наблюдение. За първи път у нас са доказани ползите от близкото наблюдение и честата връзка с лекуващия екип, водещи до значимо подобрение на метаболитния контрол. За първи път у нас са оценени ползите от постоянната употреба на сензорите и ролята на CGM показателите за метаболитния контрол и качеството на живот на пациентите и техните семейства. Постоянно използващите сензори деца имат по-добър гликемичен контрол без увеличена честота на хипогликемиите и ДКА. Силната значима връзка между новите сензорни показатели и диабетния контрол ги определя като подходящи за рутинно наблюдение на пациентите с диабет, като същевременно им осигурява по-добро качество на живот. Настоящите изследвания доказват, че с разширяване на употребата на сензори и осигуряване на тяхната пълна регистрация и реимбурсация, ползите им ще стават достъпни за по-голям дял от българската диабетна популация, а резултатите от употребата им – по-добри. С внедряването на възможностите на новите технологии в изискванията за диабетния контрол и с адаптацията на лечителите им към тях ще се осигури по-добро метаболитно здраве на все повече деца и млади хора с диабет, което е особено важно за тяхното бъдеще

Noonan syndrome patients with short stature at a single paediatric endocrinology centre

Introduction: Noonan syndrome (NS) is caused by mutations in RAS/MAPK signalling pathway genes. Growth hormone (GH) treatment is an established yet not fully standardized treatment. Aim: The aim of this article is to assess the first 2 years of GH treatment in NS patients at a single centre.Patients and Methods: A total of 20 (16 males) NS clinically diagnosed regularly followed patients participated (2011–2020). Of these, 9 (45%) had cardiac defects, and 8 (40%) had short stature. Growth hormone deficiency (GHD) was confirmed in 5 patients who started GH treatment, and 2 were treated as short, small for gestational age children. Patients underwent anthropometry, clinical, laboratory and imaging investigations.Results: The mean age at NS diagnosis was 7.8 ± 3.4 years (1.3 ÷ 10.5), and at GH start 9.1 ± 1.5 years. At GH start, SDSheight was -3.42±0.58 (-4.1 ÷ -2.6), SDSweight -3.07 ± 0.58 (-3.73 ÷ -2.27), and SDSIGF1 -1.12 ± 0.98 (-2.44 ÷ 0.25). The mean BA at diagnosis was delayed by 2.6 ± 0.9 years. The GH starting dose was 0.035 ± 0.005 mg/kg/d, and changed little thereafter.The growth velocity for the 1st year of treatment was 8.9 ± 1.4 cm, and for the 2nd year 6.9±1.1 cm. The first year ΔSDSheight was 0.72 (p = 0.002), ΔSDSweight was 0.83 (p = 0.025), the 2nd year increments being insignificant. The 1st and 2nd year ΔSDSIGF1 were 1.70 (p = 0.007) and 0.25 (n.s.), resp. Bone age remained significantly delayed. No treatment side effects were observed.Conclusion: Our study showed that GH-treated NS patients follow the general growth patterns. In order to improve outcomes, the treatment should be further standardized

Treatment with recombinant growth hormone in children with Turner syndrome: a study from a tertiary university center

Introduction: Turner syndrome (TS) is a rare disease with typical phenotype manifestations and short stature. Part of the therapy in TS patients is the recombinant human growth hormone (rhGH) that leads to improved height velocity and final height.Aim: The aim of the current study is to summarize the results of the diagnosis and treatment with rhGH of the TS patients followed up at a tertiary university center from 2011 to 2020.Patients and Methods: The study design is a retrospective cohort evaluation. All study participants had at least one full year of observation at the center. A total of 28 children with genetically confirmed TS or TS variation karyotype, aged between 2 and 18 years, 92.9 % of whom were girls, participated in the study.Results: The mean age at diagnosis was 9.6±3.7 years. Therapy with rhGH was started at 9.27±3.4 years in 22 (78.5%) of them with a mean rhGH dose of 0.035±0.006 mg/kg/d, which led to height gain of 8.0±1.3 cm for the first year. With a similar rhGH dose for the 2nd year of treatment (0.033±0.007 mg/kg/d), height velocity of 6.8±1.1 cm was achieved (p<0.005). A positive change in SDSheight was observed for the first year of therapy (-2.75±1.2 vs. -2.27±1.2, p=0.005). SDSIGF-1 before and after one treatment year increased significantly (-0.74±1.1 vs.1.57±1.4, p=0.001), without exceeding 2.0 SD.Conclusion: The achieved growth in the presented TS cohort is suboptimal though consistent with the international guidelines for treatment of TS, and could help optimize future treatment approach to TS patients in our center

Role of parenting practices and digital media on beverage intake in European schoolchildren of different weight status : Feel4Diabetes-study

Objectives: Halting the rise in childhood obesity is an ongoing challenge in Europe. Sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption has become common practice at home and during family meals. The objective of this study was to investigate associations of parenting practices and home digital media availability with beverage intake in European schoolchildren of different weight groups. Methods: Cross-sectional data were derived from six countries taking part in the multicentered Feel4Diabetes-study. Anthropometric data were measured for 12 030 schoolchildren (n = 6097 girls; median age = 8.1 y). Details on sociodemographic characteristics, beverage intake, food parenting practices, and home availability of digital media were collated from questionnaires. The outcomes, daily SSB and ASB intakes, were included as dependent variables in multivariable regression models that provided odds ratios reflecting their association with parenting practices and digital media (exposures), after stratifying for children's weight status (underweight or normal versus overweight or obese). Results: After controlling for children's sex, region, maternal body mass index, and education, the multivariate model found that in both body mass index groups, permissive parenting practices, such as rewarding and allowing consumption of unhealthy foods "very often or often," as compared with "rarely or never," were associated with a high daily intake of SSBs and ASBs in children, while parents "watching television together with their child," rewarding with screen time, and availability of television in children's rooms increased the likelihood of both beverages in the underweight or normal-weight group. Conclusions: Modification of permissive parenting practices and removal of television from children's rooms could effectively reduce SSB intake and curb the ongoing threat of child obesity in Europe

Contribution of home availability, parental child-feeding practices and health beliefs on children’s sweets and salty snacks consumption in Europe : Feel4Diabetes-Study

Adoption of healthy dietary and snacking habits could support optimum physical and mental development in children as they define health in adulthood. This study assessed parameters associated with children’s snacking such as food home availability, parenting practices, and parents’ health beliefs. In this cross-sectional study 12, 039 children, 49.4% boys 5-12 years old, participating in the European Feel4Diabetes-Study were included. Children’s weekly consumption of sweets and salty snacks, home availability of snacks, food parenting practices, and health beliefs were assessed via questionnaires. Logistic regression was applied to explore associations of a) home availability of snacks, b) food parenting practices (permissiveness and rewarding with snacks) and c) parent’s opinions on deterministic health beliefs with children’s consumption of sweets and salty snacks. Results showed that home availability (sweets: ORadj 4.76, 95%CI: 4.32, 5.23; salty snacks: ORadj: 6.56, 95%CI: 5.64, 7.61), allowing to consume (sweets: ORadj: 3.29, 95%CI: 2.95, 3.67; salty snacks: ORadj: 3.41, 95%CI: 2.98, 3.90) and rewarding with sweets/salty snacks (sweets: ORadj: 2.69, 95%CI: 2.23, 3.24; salty snacks: ORadj: 4.34, 95%CI: 3.57, 5.28) ‘sometimes/or less frequently’ compared to ‘always/or often’ were associated with lower weekly consumption of sweets and snacks. Parents’ disagreement compared to agreement with deterministic health beliefs and inattentive eating were associated with lower consumption of salty snacks and sweets in children. Overall, the findings of this study indicate that attempts to promote healthy snacking habits in children should aim to improve parental dietary habits, food parenting practices, health beliefs, and reducing home availability of unhealthy foods and snacks