The increased survival of sick and preterm neonates may be associated with long-term problems which must be recognised and managed if outcome is to be optimised. In a prospective study of 35 neonates (median gestational age at birth 34 weeks) admitted to a neonatal intensive care unit over a 3-month period, we have documented a high incidence (14 of 35) of immature or abnormal feeding patterns when infants were assessed at 36 to 40 weeks postmenstrual age. Neonates with prolonged respiratory support and delayed enteral and oral feeding were most affected. Compared with neonates who have normal initial feeding assessments, neonates with disorganised or dysfunctional feeding were six times more likely to vomit and three times more likely to cough when offered solid food at 6 months of age. At 12 months of age significant differences were also found in tolerating lumpy food and enjoying mealtimes. We hypothesise that these feeding problems contribute to failure to thrive and psychosocial distress after discharge from the neonatal unit and propose potential neonatal measures to reduce their incidence.

Background. One in three adolescents and young adults with type 1 diabetes have at least one early diabetes-related complication/comorbidity. However, the prevalence, patterning, and risk factors for co-occurring complications in this population are not well understood. Methods. The SEARCH for Diabetes in Youth observational cohort study includes 1327 individuals diagnosed with type 1 diabetes before 20 years of age from 5 United States locations. Sociodemographic and metabolic risk factors were assessed at baseline (mean diabetes duration = 0·8 years, mean age = 10·9 years) and follow-up (mean diabetes duration = 7.8 years, mean age = 18·0 years). Early diabetes complications (diabetic kidney disease, diabetic retinopathy, peripheral neuropathy, cardiovascular autonomic neuropathy, and arterial stiffness) were assessed at follow-up. We aimed to describe co-occurrence of complications and examine differences in co-occurrence within demographic and metabolic risk factor clusters identified using cluster analysis. Findings. Overall, co-occurrence of any ≥2 complications was observed in 5·9% of all participants, more frequently than expected by chance alone (4·4%, p=0·015). Specifically, retinopathy and diabetic kidney disease, retinopathy and arterial stiffness, and arterial stiffness and cardiac autonomic neuropathy all co-occurred more frequently than expected (all p<0·05). The cluster analysis produced four unique clusters characterized by progressively worsening metabolic risk factor profiles (longer duration; higher A1c, non-HDL cholesterol, and waist to height ratio) and differences in sociodemographic characteristics (race/ethnicity, household income, type of health insurance). Prevalence of ≥2 complications progressively increased with worsening metabolic profiles (from 2·3% to 20·8%, p<0·001). Interpretation. We report that early complications co-occur in adolescents and young adults with type 1 diabetes more frequently than expected after an average of less than eight years of diabetes duration. A cluster of high risk factors identifies groups that may benefit most from interventions to reduce complications.

To evaluate the contemporary prevalence of diabetic peripheral neuropathy (DPN) in participants with type 1 diabetes in the T1D Exchange Clinic Registry throughout the U.S. RESEARCH DESIGN AND METHODSDPN was assessed with the Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) in adults with ‡5 years of type 1 diabetes duration. A score of ‡4 defined DPN. Associations of demographic, clinical, and laboratory factors with DPN were assessed. RESULTSAmong 5,936 T1D Exchange participants (mean 6 SD age 39 6 18 years, median type 1 diabetes duration 18 years [interquartile range 11, 31], 55% female, 88% non-Hispanic white, mean glycated hemoglobin [HbA 1c ] 8.1 6 1.6% [65.3 6 17.5 mmol/mol]), DPN prevalence was 11%. Compared with those without DPN, DPN participants were older, had higher HbA 1c , had longer duration of diabetes, were more likely to be female, and were less likely to have a college education and private insurance (all P < 0.001). DPN participants also were more likely to have cardiovascular disease (CVD) (P < 0.001), worse CVD risk factors of smoking (P 5 0.008), hypertriglyceridemia (P 5 0.002), higher BMI (P 5 0.009), retinopathy (P 5 0.004), reduced estimated glomerular filtration rate (P 5 0.02), and Charcot neuroarthropathy (P 5 0.002). There were no differences in insulin pump or continuous glucose monitor use, although DPN participants were more likely to have had severe hypoglycemia (P 5 0.04) and/or diabetic ketoacidosis (P < 0.001) in the past 3 months. CONCLUSIONSThe prevalence of DPN in this national cohort with type 1 diabetes is lower than in prior published reports but is reflective of current clinical care practices. These data also highlight that nonglycemic risk factors, such as CVD risk factors, severe hypoglycemia, diabetic ketoacidosis, and lower socioeconomic status, may also play a role in DPN development.Diabetic neuropathy is a prevalent complication in patients with diabetes and a major cause of morbidity and mortality (1). Among the various forms of diabetic neuropathy, distal symmetric polyneuropathy (DPN) and diabetic autonomic neuropathies are by far the most studied (1).

The increased survival of sick and preterm neonates may be associated with long‐term problems which must be recognised and managed if outcome is to be optimised. In a prospective study of 35 neonates (median gestational age at birth 34 weeks) admitted to a neonatal intensive care unit over a 3‐month period, we have documented a high incidence (14 of 35) of immature or abnormal feeding patterns when infants were assessed at 36 to 40 weeks postmenstrual age. Neonates with prolonged respiratory support and delayed enteral and oral feeding were most affected. Compared with neonates who have normal initial feeding assessments, neonates with disorganised or dysfunctional feeding were six times more likely to vomit and three times more likely to cough when offered solid food at 6 months of age. At 12 months of age significant differences were also found in tolerating lumpy food and enjoying mealtimes. We hypothesise that these feeding problems contribute to failure to thrive and psychosocial distress after discharge from the neonatal unit and propose potential neonatal measures to reduce their incidence.

Distinct patterns of stress emerged for both the adolescent and parent cohorts. Resilience at the time of diagnosis was particularly protective for adolescents. These results suggest that stress-reducing and resilience-promoting interventions for newly diagnosed adolescents with T1D may have potential to improve longer-term outcomes.

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