<scp>ISPAD</scp>Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes

Fröhlich‐Reiterer, Elke; Elbarbary, Nancy; Simmons, Kimber M.; Buckingham, Bruce A.; Humayun, Khadija Nuzhat; Johannsen, Jesper; Holl, Reinhard W.; Betz, Shana; Mahmud, Farid H.

doi:10.1111/pedi.13445

Cited by 14 publications

(18 citation statements)

References 255 publications

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“…Bei den Follow-up-Untersuchungen sollen routinemäßig die Körperlänge, das Körpergewicht, der Blutdruck (unter Verwendung von alters- und geschlechtsspezifischen Perzentilen und BMI-Standards), das Pubertätsstadium (Tanner Stadien) sowie die Injektionsstellen bzw. Katheter-Injektionsstellen (cave Lipohypertrophien/Lipoatrophien und Hautirritationen) und der CGM-Stellen (Ekzeme/Hautirritationen/Abszesse) kontrolliert werden [ 28 , 29 ].…”

Section: Langzeitkomplikationen Und Screening-untersuchungenunclassified

“…Bis zu 29 % der Menschen mit T1D haben bei T1D Erstmanifestation positive Schilddrüsenantikörper, welche prädiktiv für die Entwicklung einer AIT sind, 3–8 % davon entwickeln eine AIT wobei die Meisten eine Hypothyreose haben. Die AIT ist die häufigste assoziierte Autoimmunerkrankung und kommt häufiger bei Mädchen vor, oft manifestiert sie sich in der Pubertät, und sie ist mit einer längeren Diabetesdauer assoziiert [ 28 , 29 ].…”

Section: Assoziierte Erkrankungenunclassified

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Diabetes mellitus im Kindes- und Jugendalter (Update 2023)

Rami‐Merhar

Fröhlich‐Reiterer

Hofer

et al. 2023

Wien Klin Wochenschr

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ZusammenfassungIm Kindes- und Jugendalter ist, im Gegensatz zum Erwachsenenalter, der Diabetes mellitus Typ 1 (T1D) die am häufigsten auftretende Form des Diabetes mellitus (> 90 %). Nach der Diagnosestellung sollte die Betreuung der Kinder und Jugendlichen in einem pädiatrischen Zentrum mit viel Erfahrung in pädiatrischer Diabetologie erfolgen. Eine lebenslange Insulintherapie ist notwendig, wobei diese individuell an das Alter und den Alltag der Familie angepasst werden soll. In diesem Alter wird ausdrücklich die Verwendung von Diabetestechnologie (Sensorglukosemessung, Insulinpumpentherapie und seit kurzem eine Hybrid-Closed-Loop-Therapie) empfohlen. Eine möglichst optimale metabolische Einstellung ab Therapiebeginn verbessert die Langzeitprognose der jungen Menschen mit Diabetes. Ein wesentlicher Teil in der Betreuung ist die Schulung von PatientInnen und Eltern von einem entsprechend ausgebildeten multidisziplinären Team, bestehend aus pädiatrischen DiabetologInnen, DiabetesberaterInnen, DiätologInnen, PsychologInnen und SozialarbeiterInnen. Die APEDÖ (Arbeitsgruppe für pädiatrische Endokrinologie und Diabetologie Österreich) und die ISPAD (International Society for Pediatric and Adolescent Diabetes) empfehlen als metabolisches Ziel für alle pädiatrischen Altersgruppen einen HbA1c-Wert ≤ 7,0 % (IFCC ≤ 53 mmol/mol) mit einer „Time in Range“ (TIR) > 70 % ohne schwere Hypoglykämien. Eine altersentsprechend normale körperliche, kognitive und psychosoziale Entwicklung sowie die Vermeidung von Akutkomplikationen (schwere Hypoglykämien, diabetische Ketoazidose), das Screening auf assoziierte Erkrankungen und die Prävention von diabetesbedingten Spätkomplikationen zum Erhalt einer hohen Lebensqualität sind die Ziele der pädiatrischen Diabetestherapie.

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Section: Langzeitkomplikationen Und Screening-untersuchungenunclassified

Section: Assoziierte Erkrankungenunclassified

Diabetes mellitus im Kindes- und Jugendalter (Update 2023)

Rami‐Merhar

Fröhlich‐Reiterer

Hofer

et al. 2023

Wien Klin Wochenschr

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“…CD and type 1 diabetes (T1D) are both autoimmune diseases caused by immunological mechanisms resulting in villous and pancreatic beta cell damage respectively [ 9 ]. The prevalence of CD ranges from 1% to 16% in type 1 diabetes patients according to different studies and increases with a longer duration of diabetes [ 10 ]. Most cases of celiac disease are diagnosed within the first year of diabetes diagnosis, but the diagnosis can be made as late as adulthood and the association is common to both genders.…”

Section: Introductionmentioning

confidence: 99%

“…Celiac disease is often asymptomatic and is not necessarily associated with poor growth, deterioration of glycemic control, or hypoglycemia. Screening for CD is recommended at diabetes onset and after 2 and 5 years, according to the International Society for Pediatric and Adolescent Diabetes Consensus Guidelines [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…The GFD normalizes the intestinal mucosa and often leads to the disappearance of antibodies but does not necessarily have an impact on glycemic control. Children and adolescents with T1D, with poor adherence to a gluten-free diet, may also have a reduced quality of life and poorer glycemic control [ 10 , 11 , 12 ]. Moreover, a GFD can be difficult to manage to maximize glycemic control with high glycemic index (GI) foods.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Different Types of Rice and Cooking on Postprandial Glycemic Trends in Children with Type 1 Diabetes with or without Celiac Disease

et al. 2023

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The aims of this study were to evaluate: (i) the chemical and nutritional composition of rice before and after cooking and (ii) postprandial glycemic impacts in children and adolescents with type 1 diabetes (T1D) after eating two different types of rice (“Gigante Vercelli” white rice and “Artemide” black rice) or white rice cooked “risotto” style or boiled using an advanced hybrid closed loop (AHCL) system (Tandem Control-IQTM). General composition and spectrophotometric analyses of raw and cooked rice were performed. Eight T1D subjects (four males and four females, aged 11 ± 1.4 years), two with celiac disease (CD), using an AHCL system were enrolled. “Gigante Vercelli” white rice cooked as risotto or boiled and boiled “Artemide” rice were prepared by the same cook on two evenings. Continuous glucose monitoring metrics were evaluated for 12 h after meal consumption. Total dietary fiber was higher for both rice types after cooking compared with raw rice. Cooking as risotto increased polyphenols and antioxidants (p < 0.05) in both rice varieties, and total starch decreased after boiling (p < 0.05) in white rice. There was a significant peak in glycemia after consuming risotto and boiled white rice (p < 0.05), while the mean glycemic peak remained <180 mg/dL in individuals eating boiled Artemide rice. There were no significant differences in automatic basal or auto-bolus insulin deliveries by the AHCL according to different types of rice or cooking method. Our findings suggest that glycemic trends are impacted by the different chemical and nutritional profiles of rice but are nevertheless well controlled by AHCL systems.

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Autoimmune comorbidity in type 1 diabetes and its association with metabolic control and mortality risk in young people: a population-based study

Samuelsson,

Bertilsson,

Bülow

et al. 2024

Diabetologia

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Aims/hypothesis This register-based study aimed to describe autoimmune comorbidity in children and young adults from type 1 diabetes onset, and to investigate whether such comorbidity was associated with a difference in HbA1c or mortality risk compared with children/young adults with type 1 diabetes without autoimmune comorbidity. Methods A total of 15,188 individuals from the Swedish National Diabetes Register, registered with type 1 diabetes before 18 years of age between 2000 and 2019, were included. Five randomly selected control individuals from the Swedish population (Statistics Sweden) were matched to each individual with type 1 diabetes (n=74,210 [346 individuals with type 1 diabetes were not found in the Statistics Sweden register at the date of type 1 diabetes diagnosis, so could not be matched to control individuals]). The National Patient Register was used to attain ICD-10 codes on autoimmune diseases and the Cause of Death Register was used to identify deceased individuals. Results In the total type 1 diabetes cohort, mean±SD age at onset of type 1 diabetes was 9.5±4.4 years and mean disease duration at end of follow-up was 8.8±5.7 years. Of the individuals with type 1 diabetes, 19.2% were diagnosed with at least one autoimmune disease vs 4.0% of the control group. The HRs for comorbidities within 19 years from onset of type 1 diabetes were 11.6 (95% CI 10.6, 12.6) for coeliac disease, 10.6 (95% CI 9.6, 11.8) for thyroid disease, 1.3 (95% CI 1.1, 1.6) for psoriasis, 4.1 (95% CI 3.2, 5.3) for vitiligo, 1.7 (95% CI 1.4, 2.2) for rheumatic joint disease, 1.0 (95% CI 0.8, 1.3) for inflammatory bowel disease, 1.0 (95% CI 0.7, 1.2) for systemic connective tissue disorder, 1.4 (95% CI 1.1, 1.9) for uveitis, 18.3 (95% CI 8.4, 40.0) for Addison’s disease, 1.8 (95% CI 0.9, 3.6) for multiple sclerosis, 3.7 (95% CI 1.6, 8.7) for inflammatory liver disease and 19.6 (95% CI 4.2, 92.3) for atrophic gastritis. Autoimmune disease in addition to type 1 diabetes had no statistically significant effect on HbA1c or mortality risk. Conclusions/interpretation To our knowledge, this is the first comprehensive study where young individuals with type 1 diabetes were followed regarding development of a wide spectrum of autoimmune diseases, from onset of type 1 diabetes. In this nationwide and population-based study, there was already a high prevalence of autoimmune diseases in childhood, especially coeliac and thyroid disease. The presence of autoimmune comorbidity did not have a statistically significant effect on metabolic control or mortality risk. Graphical Abstract

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ISPADClinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes

Cited by 14 publications

References 255 publications

Diabetes mellitus im Kindes- und Jugendalter (Update 2023)

Diabetes mellitus im Kindes- und Jugendalter (Update 2023)

The Impact of Different Types of Rice and Cooking on Postprandial Glycemic Trends in Children with Type 1 Diabetes with or without Celiac Disease

Autoimmune comorbidity in type 1 diabetes and its association with metabolic control and mortality risk in young people: a population-based study

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