OBJECTIVE To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. RESEARCH DESIGN AND METHODS We analyzed data on 17,280 cases of T1D diagnosed during 2018–2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. RESULTS The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1–12.2) in 2018 to 21.7 (20.6–22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2–14.0) in 2018 to 26.7 (25.7–27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5–12.9) to 24.7 (24.0–25.5) for adolescents ages 12–18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018–2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic. CONCLUSIONS The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.

Background There is a need for further understanding pediatric long COVID syndrome (LCS) to be able to create specific case definitions and guidelines for providing good clinical care. Methods Medical records of all LCS patients who presented at our designated LC clinic were collected. We carried out descriptive analyses summarizing the history, clinical presentation, and findings of children, while doing a diagnosis of exclusion with multi-disciplinary medical examinations (physical, laboratory, and radiological examinations, specialist consultations, etc.) without a control group. Results Most children reported at least minor impairment to their quality of life, of which 17 (23%) had moderate or severe difficulties. Findings that could be directly connected to the linked complaint category were observed in an average of 18%, respiratory symptoms with objective alterations being the most frequent (37%). Despite our detecting mostly non-specific conditions, in a smaller number we identified well-described causes such as autoimmune thyroiditis (7%). Conclusions The majority of children stated an impairment in their quality of life, while symptom-related conditions were detected only in a minority. Controlled studies are needed to separate the effect of the pandemic era from the infection itself. Evidence-based pediatric guidelines could aid to rationalize the list of recommended examinations. Impact Long COVID syndrome is a complex entity with a great impact on children’s everyday lives. Still, there is no clear guidance for pediatric clinical management. Systematic, detailed studies with medical assessment findings could aid the process of creating evidence-based guidelines. We present validated systematic information collected during in-person medical assessments with detailed medical findings and quality of life changes. While making a diagnosis of exclusion, we could confirm symptom-related conditions only in a minority of children; however, the majority reported at least minor impairment to their quality of life.

<p>  </p> <p><strong>Aims: </strong>To analyze whether the COVID-19 pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. </p> <p><strong>Methods:</strong> 17.280 cases of T1D diagnosed 2018 – 2021 from 92 worldwide centers participating in the SWEET registry were analysed using hierarchic linear regression models. </p> <p><strong>Results: </strong>The average number of new-onset T1D per center adjusted for the total number of patients treated at the center per year and stratified by age groups increased from 11.2 [95%-confidence interval: 10.1-12.2] in 2018 to 21.7 [20.6-22.8] in 2021 in the youngest age group <6 years, from 13.1 [12.2-14.0] in 2018 to 26.7 [25.7-27.7] in 2021 in children 6 to <12 year and from 12.2 [11.5-12.9] to 24.7 [24.0-25.5] in adolescents 12 to 18 years (all p<0.001). These increases remained within the expected increase with the 95%-confidence interval of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to pre-pandemic times in 2021 this was not the case in North America. Compared to 2018-2019 (HbA1c 7.7%), higher average A1c levels (2020: 8.1%, 2021: 8.6%, p<0.001) were present within the first year of T1D during the pandemic.</p> <p><strong>Conclusions: </strong>The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID pandemic but a change in the seasonality at onset became apparent. </p>

Összefoglaló. Bevezetés: Az 1-es típusú diabetes mellitus és a coeliakia gyakori társulása jól ismert. Néhány tanulmány beszámol átmeneti antitranszglutamináz-emelkedésről 1-es típusú diabeteses betegekben, akiknél az emelkedett antitestszint gluténmentes diéta bevezetése nélkül normalizálódik. Célkitűzés: Kutatásunk során az átmeneti antitranszglutamináz-emelkedés gyakoriságának meghatározását tűztük ki célul. További célunk volt a coeliakia gyakoriságának megállapítása 1-es típusú diabetesszel gondozott betegeink között. Módszer: A Semmelweis Egyetem I. Gyermekgyógyászati Klinikáján 1-es típusú diabetesszel gondozott betegeket vontuk be vizsgálatunkba (238 lány, 265 fiú, medián [IR] életkor az 1-es típusú diabetes diagnózisakor: 7,83 [4,67–11] év). Vizsgáltuk a jelenség időbeli megjelenését, az emelkedés mértékét, gyakoriságát és az antitest típusát. Leíró statisztikai módszereket és khi-négyzet-próbát alkalmaztunk. Eredmények: A vizsgált populációban a coeliakia gyakorisága 12,52%. Átmeneti antitranszglutamináztiter-emelkedést 48 gyermeknél (10,9%) észleltünk. Összesen 71-szer mértünk átmeneti antitranszglutamináz-emelkedést. A gyermekek közül 34 esetben (70,83%) egyszer fordult elő emelkedést mutató antitest, a többi betegnél 2–8 alkalommal. Gyakrabban tapasztaltunk izolált IgA-típusú emelkedést, mint izolált IgG-típusút (54 vs. 5). Következtetés: Az átmeneti antitranszglutamináz-emelkedés gyakorisága magas, összevethető a valódi coeliakiás csoporttal. Kutatásunk alátámasztja a nemzetközi ajánlást, miszerint mérsékelt mértékű antitranszglutamináz-emelkedés esetén, tünetmentes 1-es típusú diabetesszel gondozott betegben a gluténfogyasztás folytatása és az antitestszintek gyakori kontrollja javasolt. Orv Hetil. 2021; 162(48): 1924–1930. Summary. Introduction: The frequent association of type 1 diabetes mellitus with coeliac disease is well known. Development of transitional elevation of anti-tissue transglutaminase antibodies in the diagnosis of type 1 diabetes is reported in some studies. In these cases, the anti-tissue transglutaminase antibodies returned to normal without gluten-free diet. Objective: Our aim was to assess the frequency of transitional elevation of anti-tissue transglutaminase in our type 1 diabetes patients. We aimed to investigate the prevalence of coeliac disease in patients with type 1 diabetes. Method: Patients with type 1 diabetes at the Ist Department of Paediatrics, Semmelweis University, were enrolled in the study (238 girls, 265 boys; the median age at the time of type 1 diabetes diagnosis was 7.83 [4.67–11] years). Descriptive statistical analysis was done and the time of appearance, extent, frequency and type of elevated anti-tissue transglutaminase antibodies were examined. Results: The proportion of children with diagnosed coeliac disease was 12.52%. We detected transitional anti-tissue transglutaminase elevation in 48 cases (10.9%). Temporarily elevated antibody levels were measured 71 times. In 34 children (70.83%), the temporary elevation occured once, while in the others, antibody levels became positive 2–8 times. The elevation of the IgA antibody was more frequent than the elevation of the IgG antibody (54 vs. 5). Conclusion: The frequency of temporary elevated anti-tissue transglutaminase levels is considered high. Our study confirms the recommendation that in the case of moderate anti-tissue transglutaminase levels with lack of clinical symptoms, control antibody measurement is necessary with ongoing gluten consumption. Orv Hetil. 2021; 162(48): 1924–1930.

Összefoglaló: A biztonságos egészség-magatartásra való nevelés szempontjából a serdülőkor kiemelten fontos időszak. Jelen tanulmányban egy komplex, pedagógiai, ifjúságpszichológiai és orvos-szakmai szempontok mentén fejlesztett, kortársoktatáson alapuló iskolai egészségnevelő-programot mutatunk be a COM-B modell tükrében. A COM-B modell szerint a viselkedést (behaviour – B) befolyásoló tényezőket alapvetően három csoportba lehet rendezni, ezek a képesség (capability – C), a lehetőség (opportunity – O), és a motiváció (motivation – M). Programunk, a Balassagyarmati Egészségnevelő Program kiemelt hangsúlyt fektet a célcsoport tagjainak tudás-bővítésére (C), a pozitív egészségmagatartást előmozdító környezet megteremtésére (O) és jutalmazáson, valamint személyes interakciókon keresztül a motiváció mélyítésére (M).

<p>  </p> <p><strong>Aims: </strong>To analyze whether the COVID-19 pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. </p> <p><strong>Methods:</strong> 17.280 cases of T1D diagnosed 2018 – 2021 from 92 worldwide centers participating in the SWEET registry were analysed using hierarchic linear regression models. </p> <p><strong>Results: </strong>The average number of new-onset T1D per center adjusted for the total number of patients treated at the center per year and stratified by age groups increased from 11.2 [95%-confidence interval: 10.1-12.2] in 2018 to 21.7 [20.6-22.8] in 2021 in the youngest age group <6 years, from 13.1 [12.2-14.0] in 2018 to 26.7 [25.7-27.7] in 2021 in children 6 to <12 year and from 12.2 [11.5-12.9] to 24.7 [24.0-25.5] in adolescents 12 to 18 years (all p<0.001). These increases remained within the expected increase with the 95%-confidence interval of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to pre-pandemic times in 2021 this was not the case in North America. Compared to 2018-2019 (HbA1c 7.7%), higher average A1c levels (2020: 8.1%, 2021: 8.6%, p<0.001) were present within the first year of T1D during the pandemic.</p> <p><strong>Conclusions: </strong>The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID pandemic but a change in the seasonality at onset became apparent. </p>

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