Eating Problems in Youths with Type 1 Diabetes During and After Lockdown in Italy: An 8-Month Follow-Up Study

Eighty-five youths with T1D and 176 controls aged 8–19 years were asked to complete online questionnaires (ChEAT and EAT-26) measuring disordered eating behaviors (DEBs) during (baseline) and after (8-month follow-up) the lockdown. DEB symptoms in all participants (especially younger than 13 years), glycemic control, and zBMI were found unchanged from baseline to follow-up (all p >.05). After 8 months, the ChEAT/EAT-26 critical score frequency decreased significantly in controls (p =.004), as was the score for the ChEAT/EAT-26’s Oral Control subscale in both groups (T1D: p =.005; controls: p =.01). Participants with T1D, especially those older than 13 years, had higher ChEAT/EAT-26 Dieting scores (p =.037) and lower ChEAT/EAT-26 Oral Control scores (p =.046) than controls. Unchanged DEB symptoms suggest that the COVID-19 restrictions did not significantly affect participants’ eating behaviors and that a general adaptation to the challenges of lockdown and other pandemic containment measures occurred in both T1D and control participants

Disordered eating behaviors in youths with type 1 diabetes during COVID-19 lockdown: an exploratory study

Background: Recent research indicates that patients with type 1 diabetes (T1D) are at higher risk for disordered eating behaviors (DEBs) than their peers without diabetes. The present study aimed to explore the prevalence of DEBs in a sample of Italian children and adolescents with T1D and in matched-pair healthy controls during the COVID-19 lockdown. Methods: In a cross-sectional study, 138 children and adolescents with T1D (aged 8.01–19.11 years, 65 boys) attending a Southern Italian diabetic service and 276 age- and gender-matched healthy peers voluntarily completed an online survey about eating behaviors (ChEAT and EAT-26), anthropometric characteristics, and clinical characteristics. Results: 8.69% (N = 12) of participants with T1D and 13.4% (N = 37) of controls had ChEAT/EAT-26 scores indicating presence of DEBs, with no differences between patients—whether children (total ChEAT score F(1, 157) =.104, p =.748) or adolescents (total EAT-26 score F(1, 255) =.135, p =.731)—and healthy peers. zBMI values were lower than those measured in the latest diabetes visit (p <.0001), while HbA1c values remained unchanged (p =.110). In both groups, adolescents had lower Oral Control scores than children (T1D: F(1, 138) = 20.411, p <.0001, η2 =.132, controls: F(1, 276) = 18.271, p <.0001, η2 =.063); additionally, gender (female) and age were found to be significant predictors of several ChEAT/EAT-26 scores. Conclusions: This exploratory study suggested that children and adolescents with T1D did not experience more DEB symptoms during the COVID-19 lockdown compared to healthy controls. Results revealed DEBs as more of a female adolescent developmental issue rather than a result of the challenges of living with a chronic illness under quarantine measures. Possible effects of parental pressure on their children’s eating behaviors in the context of home confinement and of using a non-diabetes-specific measure to assess DEBs are discussed

Rethinking carbohydrate intake and time in range in children and adolescents with type 1 diabetes

none15The aim of this study was to evaluate the association between macronutrient intake and time in range (TIR) of 70–180 mg/dL in children and adolescents with type 1 diabetes (T1D). A multi-center study recruited patients with T1D using continuous glucose monitoring (CGM) between January 2019 and January 2020 from centers across Italy. Diet intake was recorded using three-day weighed food diaries. Nutrients were evaluated as percentages of total intake. TIR was considered at target if the percentage of readings was higher than 70%. Clinical and nutritional factors associated with TIR at target were analyzed using multiple correspondence analysis and multiple logistic regression. Data from 197 participants (53% male, median age 11.6 years, median HbA1c 55.2 mmol/mol, median TIR 60%) were analyzed. Macronutrient intake was 45.9% carbohydrates, 16.9% protein, 37.3% fat, and 13.1 g/day fiber (median values). TIR > 70% was observed in 28% of participants; their diet contained more protein (17.6%, p = 0.015) and fiber (14.4 g/day, p = 0.031) than those not at target. The probability of having a TIR > 70% was significantly higher with 40–44% consumption of carbohydrates compared with 45–50% consumption of carbohydrates and with the use of a carbohydrate counting system. Based on these results, a five percent reduction in the percentage of carbohydrate intake can help children and adolescents with T1D achieve the goal of a TIR > 70%. Both a lower and higher percentage of carbohydrate intake appears to reduce the probability of reaching the target TIR > 70%. These results require validation in other populations before being used in clinical practice.openCherubini V.; Marino M.; Marigliano M.; Maffeis C.; Zanfardino A.; Rabbone I.; Giorda S.; Schiaffini R.; Lorubbio A.; Rollato S.; Iannilli A.; Iafusco D.; Scaramuzza A.E.; Bowers R.; Gesuita R.Cherubini, V.; Marino, M.; Marigliano, M.; Maffeis, C.; Zanfardino, A.; Rabbone, I.; Giorda, S.; Schiaffini, R.; Lorubbio, A.; Rollato, S.; Iannilli, A.; Iafusco, D.; Scaramuzza, A. E.; Bowers, R.; Gesuita, R

Metabolic Treatment of Wolfram Syndrome

Wolfram Syndrome (WS) is a very rare genetic disorder characterized by several symptoms that occur from childhood to adulthood. Usually, the first clinical sign is non-autoimmune diabetes even if other clinical features (optic subatrophy, neurosensorial deafness, diabetes insipidus) may be present in an early state and may be diagnosed after diabetes' onset. Prognosis is poor, and the death occurs at the median age of 39 years as a consequence of progressive respiratory impairment, secondary to brain atrophy and neurological failure. The aim of this paper is the description of the metabolic treatment of the WS. We reported the experience of long treatment in patients with this syndrome diagnosed in pediatric age and followed also in adult age. It is known that there is a correlation between metabolic control of diabetes, the onset of other associated symptoms, and the progression of the neurodegenerative alterations. Therefore, a multidisciplinary approach is necessary in order to prevent, treat and carefully monitor all the comorbidities that may occur. An extensive understanding of WS from pathophysiology to novel possible therapy is fundamental and further studies are needed to better manage this devastating disease and to guarantee to patients a better quality of life and a longer life expectancy

Corrigendum: The silent epidemic of diabetic ketoacidosis at diagnosis of type 1 diabetes in children and adolescents in italy during the covid-19 pandemic in 2020(Front. Endocrinol., (2022), 13, (878634), 10.3389/fendo.2022.878634)

[This corrects the article .]

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019

MANAGING PIZZA MARGHERITA WITH INSULIN PUMP. ANALYSIS OF GLUCOSE RESPONSE AFTER CONSUMPTION OF PIZZAS WITH DIFFERENT KINDS OF FERMENTATION, USING A SIMPLE WAVE BOLUS

Background and Aims Pizza is considered a "junk food", because of high content of fat and carbohydrates. The glycaemic response to pizza could change according to the fermentation of the dough. Dual-wave bolus is usually used to manage pizza meal. Aim of our study was to evaluate glycemic response in a pediatric population with T1DM, after consumption of pizzas made with two different kinds of fermentation but the same Italian recipe,with a simple wave bolus. Method We enrolled 18 patients with T1DM on CSSI to evaluate their glycaemic response to the short and the long fermented pizza (less than 8 hours or more than 24 hours). Results We observed that glucose values were between 70 and 180 mg/dl for a good percentage of time in both types of pizza during all the periods of observation. For male patients the mean percentage of time between 70-180 mg/dl, for 2 hours after bolus, was 71% for the first pizza and 95% for the second (p=0·044). Considering the same time window, there was a significant difference as far as percentage of time is concerned for patients with metabolic compensation ”not in target” with SG<70mg/dl (p=0·045) and between 70mg/dl and 180mg/dl (p=0·009). About the AUC of hypoglycemic events, we observed a statistically significant difference for the subset of prepuberal patients (p=0·05) and for the patients with metabolic compensation “not in target” (p=0·024). Conclusion Pizza can generate a good post-prandial glycemic response.Evaluating the fermentation time of the dough can help the diabetic patient in choosing the type of insulin bolus to self-administer

Very low birth weight newborn with diabetes mellitus due to pancreas agenesis managed with insulin pump reservoir filled with undiluted insulin: 16-month follow-up

Background: When very low doses of insulin are used insulin dilution, a procedure prone to errors, is recommended.Case presentation: We managed a neonate with pancreas agenesis with insulin pump therapy from the first days of life to 16 months of age without insulin dilution. Predictive low glucose suspend mode first and then closed loop control were used. No episodes of severe hypoglycemia were observed. Conclusions: Though limited to a single patient with pancreas agenesis we believe that the use of pump should be warranted in patients with permanent neonatal diabetes mellitus and intestinal malabsorp-tion, even with undiluted insulin.(c) 2022 Diabetes India. Published by Elsevier Ltd. All rights reserved

Continuous subcutaneous insulin infusion in preschool children : Butt or tummy, which is the best infusion set site?

Background: Choosing the right infusion set site can be an important factor in obtaining good glycemic control, especially in very young children. In an attempt to identify the best infusion site, we performed a crossover study in six preschool children with type 1 diabetes using insulin pump therapy. Subjects and Methods: We enrolled six patients 5.2\ub10.7 years old (range, 4-6 years), with type 1 diabetes for more than 1.5 years, using insulin pump therapy for at least 6 months. For each patient, body mass index, glycated hemoglobin, and all data downloaded from the system were evaluated on two occasions: the first with the infusion set placed on the buttock and the second on the abdomen, each for 3 days. The order of infusion set placement was randomized. Mean capillary blood glucose, mean continuous glycemia, mean area under the curve (AUC) using the trapezoidal rule for both >140mg/dL and 140mg/dL, and MAGE were significantly lower when the infusion set was placed on the buttock versus the abdomen (144.6\ub131.9mg/dL vs. 166.0\ub134.8mg/dL [P=0.000], 28.4\ub118.3% vs. 48.8\ub128.2% [P=0.000], and 32\ub110 vs. 60\ub115mg/dL [P<0.001], respectively), whereas mean AUC <70mg/dL was higher (1.47\ub12.77% vs. 0.87\ub11.03% [P<0.001]). Conclusions: The present findings suggest that preschool children with type 1 diabetes using insulin pump therapy could benefit from inserting the infusion set in the buttock instead of the abdomen. \ua9 Copyright 2014, Mary Ann Liebert, Inc. 2014