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Since the 1980s, there has been a dramatic rise in the prevalence of overweight and obesity in pediatric populations, in large part driven by sedentary lifestyles and changing dietary patterns with more processed foods. In parallel with the rise in pediatric obesity in the general population, the prevalence of overweight and obesity has increased among children and adolescents with type 1 diabetes. Adiposity has been implicated in a variety of mechanisms both potentiating the risk for type 1 diabetes as well as exacerbating long-term complications, particularly cardiovascular disease. Treatment options targeting the unique needs of obese pediatric patients, both before and after diagnosis of type 1 diabetes, are limited. In this review, we discuss the history of the epidemiology of the obesity epidemic in the context of pediatric type 1 diabetes, highlight the possible role of obesity in type 1 diabetes pathogenesis and review the concept of “double diabetes”. The impact of obesity at and after diagnosis will be discussed, including noted differences in clinical and biochemical markers, lipid abnormalities, and long-term cardiovascular complications. Finally, we will review the existing literature on pharmacologic and nutritional interventions as potential treatment strategies for youth with coexisting type 1 diabetes and obesity.

Immediately after participating in simulation, pediatrics residents reported a significant improvement in self-reported readiness to respond to discriminatory comments made by a parent and reported the simulation experience was beneficial.

Background: The American Diabetes Association recommends risk-based screening for dysglycaemia (prediabetes and type 2 diabetes) in youth with overweight/obesity plus ≥1 risk factor. However, evidence for these recommendations is lacking.Objectives: Examine the association between the number of risk factors and the prevalence of dysglycaemia in youth with overweight/obesity at initial presentation.Methods: In a paediatric obesity registry, youth (>10 and <20 years old, body mass index ≥85th percentile) were categorized into four groups according to number of risk factors (1, 2, 3 and ≥4). Based on oral glucose tolerance test, participants were classified into normal glucose tolerance or dysglycaemia.Results: Of 635 youth, 31.5% had prediabetes and 6.1% had type 2 diabetes. The prevalence of dysglycaemia was 23.1% with 1 risk factor and increased to 44.9% with ≥4 risk factors (p = 0.025). Dyslipidaemia, family history of type 2 diabetes and maternal history of gestational diabetes were significantly associated with dysglycaemia.Fasting and 2-h insulin, 2-h glucose increased (all p < 0.0001) and ALT increased (p = 0.001) with increasing risk factors. Insulin sensitivity and β-cell function deteriorated significantly with increasing risk factors. Conclusion:Screening for dysglycaemia in youth with obesity and any additional risk factor is warranted to target early management.impaired glucose tolerance, prediabetes, risk factors, youth-type 2 diabetes | INTRODUCTIONParallel to the increasing rates of childhood obesity, the incidence 1 and the prevalence 2 of youth-type 2 diabetes (T2D) is escalating worldwide, particularly in non-white racial/ethnic populations. The highest rate of youth-T2D exists in the United States, with an incidence that increased from 9 to 12.5 cases per 100 000 between 2002 and 2012. 1,3 While the trends in Europe and Asia are similar, the overall incidence remains lower. [4][5][6] Scientific information suggests that youth-T2D is an aggressive disease with early and rapidly progressing complications. [7][8][9] Youth with T2D have higher complications and mortality compared to peers with type 1 diabetes. 10,11 These youth also have a higher risk of early death than adults with T2D when matched for diabetes duration. 12 The treatment options for T2D in Adolescents and Youth (TODAY) showed >50% glycaemic failure rates on metformin, the only Abbreviations: ADA, American Diabetes Association; BMI, body mass index; GDM, gestational diabetes mellitus; HAPO FUS, Hyperglycaemia and Adverse Pregnancy Outcome Follow-up Study; HDL, high density lipoprotein; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; ΔI 30 /ΔG 30 , insulinogenic index; 1/I F , inverse of fasting insulin; LDL, low density lipoprotein; oDI, oral disposition index; OGTT, oral glucose tolerance test; PCOS, polycystic ovary syndrome; SEM, standard error of the mean; SGA, small for gestational age; TC, total cholesterol; TG, triglycerides; TODAY, treatment options for type 2 diabetes in adolescents and youth; T2D, type 2...

BackgroundIn response to the COVID-19 pandemic, many countries relaxed restrictions on telemedicine, allowing for a robust transition to virtual visits for routine care. In response, centers rapidly instituted and scaled telemedicine for pediatric diabetes care. Despite numerous center reports on their experience, little is known about parent perspectives on the widespread increase of telemedicine for pediatric diabetes appointments.ObjectiveTo assess parent satisfaction with virtual care for pediatric diabetes during the COVID-19 pandemic.MethodsWe conducted an online, cross-sectional survey of parents of youth with diabetes who receive care at a large, academic diabetes center regarding their perspectives on newly introduced virtual appointments. Parents were surveyed at two time points during the pandemic using a validated scale which was adapted for diabetes. We explored demographic and clinical factors which may influence parental satisfaction.ResultsOverall, parents expressed high levels of satisfaction (&gt;90%) with functional aspects of the visit, though only approximately half (56%) felt the visit was as good as an in-person encounter. Nearly three-quarters (74%) would consider using telemedicine again in the future. Prior use of telemedicine significantly influenced parent satisfaction, suggesting that parent preferences may play a role in continued use of telemedicine in the future. There was no difference in responses across the two timepoints, suggesting high satisfaction early in the pandemic which persisted.ConclusionsIf permissive policies for telemedicine continue, diabetes centers could adopt hybrid in-person and virtual care models, while considering various stakeholder perspectives (providers and patients) and equity in access to virtual care.

Purpose The purpose of this study is to survey parents of youth with type 1 diabetes during the COVID-19 pandemic with school closures to better understand the implications of the school day on health care behaviors. Methods A cross-sectional, online survey was distributed to parents of youth with type 1 diabetes ≤19 years of age in a large, academic diabetes center. Questions encompassed perceived changes in management behaviors and plans for return to school. Subgroup analysis compared parent responses by child’s age, reported stressors, and socioeconomic markers. Results Parents reported a worsening in their child’s diabetes health behaviors during school closures compared to what they perceived during a regular school day before the pandemic. More than half of parents reported feeling that their child was unable to maintain a normal routine, with particular implications for snacking between meals, daily physical activity, and sleep habits. Families with adolescents or those experiencing multiple pandemic-related stressors reported greater challenges. In open-ended responses, families highlighted difficulty in balancing school, work, and diabetes care and expressed concerns about the mental health repercussions of school closures for their children. Nearly half of parents reported being at least moderately worried about return to school, whereas only a minority reported seeking guidance from their diabetes provider. Conclusions Parent-reported disruptions of school-day routines frequently had adverse consequences for diabetes management in this population. These findings highlight the importance of a school-day routine for children with type 1 diabetes; during closures, families may benefit from mitigating strategies to maintain effective habits.

Objective Although the importance of stakeholder engagement (SE) for patient-centered research is recognized, few studies document SE processes and influence on research outcomes in the diabetes field. We applied a research-informed framework to evaluate the impact of SE on a pediatric diabetes study exploring school nurse perspectives on modern diabetes devices. Methods We recruited parents of children with type 1 diabetes, school nurses, and diabetes providers. Stakeholders convened virtually every 2 months for 12 months. Goals for SE included input on research materials, interpretation of findings, and future research directions. Processes were assessed using a validated survey. Immediate outcomes included changes to research materials and satisfaction. Secondary outcomes included research efficiency and value (acceptance by community partners). Results Each role was represented at every meeting. The majority of stakeholders (&gt;70%) completed the survey at study midpoint and end points. All surveyed indicated that they had received all desired information, shared feedback, and felt valued. Stakeholders were satisfied with the meeting frequency. Participants appreciated learning from each other and expressed enthusiasm for continued research participation. They described their role as one of consultant rather than research team members. SE resulted in five additional interview questions. Nearly 70 comments added to the interpretation of qualitative themes. Findings were published within 12 months and recognized by the state school nursing organization. Conclusion SE was well received and led to meaningful changes in content and dissemination of a diabetes study. A systematic approach to evaluating SE can increase scientific rigor and reproducibility and contribute to best practices for SE in diabetes research.