Comparison of the clinical characteristics and outcomes of pediatric patients with and without diabetic ketoacidosis at the time of type 1 diabetes diagnosis

Purpose@#We investigated the possible effects of diabetic ketoacidosis (DKA) at the initial diagnosis of type 1 diabetes mellitus (T1DM) on the clinical outcomes of pediatric patients. @*Methods@#Medical records of children and adolescents with newly diagnosed T1DM seen in the Ajou University Hospital from January 2008 to August 2020 were reviewed and analyzed. @*Results@#Among 129 diagnosed T1DM patients, 40.3% presented with DKA. Although demographic and basic characteristics did not differ between DKA and non-DKA patients, DKA patients needed a significantly higher insulin dosage than non-DKA patients for 2 years after diagnosis. However, control of glycated hemoglobin was not different between the DKA and non-DKA groups during the observation period. In the biochemical analysis, C-peptide, insulin-like growth factor-1, and insulin-like growth factor binding protein 3, high-density lipoprotein cholesterol, free T4, and T3 values were lower, but thyroid-stimulating hormone, initial serum glucose, uric acid, total cholesterol, triglyceride, and low-density lipoprotein cholesterol values were higher in DKA patients than non-DKA patients at the diagnosis of T1DM; however, these differences were temporarily present and disappeared with insulin treatment. Other clinical outcomes, such as height, thyroid function, and urine microalbumin level, did not vary significantly between the DKA and non-DKA groups during 5 years of follow-up. @*Conclusion@#DKA at initial presentation reflects the severity of disease progression, and the deleterious effects of DKA seem to impact insulin secretion. Although no difference in long-term prognosis was found, early detection of T1DM should help to reduce DKA-related islet damage and the socioeconomic burden of T1DM.

Long-term outcomes of Graves’ disease in children and adolescents receiving antithyroid drugs

Purpose@#Antithyroid drugs (ATDs) are primarily used as an initial treatment in pediatric patients with Graves’ disease (GD). We aimed to investigate the long-term outcomes in pediatric GD patients receiving ATDs. @*Methods@#Retrospective data from a single center were collected from April 2003 to July 2020. A total of 98 children and adolescents aged 2–16 years diagnosed with GD and receiving ATDs was enrolled. We investigated the factors correlated with remission by comparing children who achieved remission after 5 years and those with persistent disease. @*Results@#The study included 76 girls (77.6%) and 22 boys (22.4%). During the 5-year follow-up period, 18 children (18.3%) maintained remission, ATDs could not be discontinued in 74 patients (75.5%), and relapse occurred in 6 patients (6.2%). The remission group had significantly lower thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) level at diagnosis (P=0.002) and 3 months (P=0.002), 1 year (P=0.002), 2 years (P≤0.001), 3 years (P≤0.001), 4 years (P≤0.001), and 5 years (P≤0.001) after ATD treatment than did the nonremission group. The remission group also had a shorter time for TBII normalization after ATD treatment (P≤0.001). Multiple logistic regression analysis showed that the time to TBII normalization (cutoff time=2.35 years) was related to GD remission (odds ratio, 0.596; 95% confidence interval, 0.374–0.951). @*Conclusion@#TBII level and time to TBII normalization after ATD treatment can be used to predict remission in pediatric GD patients.

Age at menarche and adult height in girls born small for gestational age

PURPOSE: The aim of this study was to evaluate the association between birth characteristics based on birth weight for gestational age, timing of menarche and adult height in girls born small for gestational age (SGA). METHODS: Thirty subjects born from 1988 through 1999 whose birth weight below 10th percentile for their gestational ages were recruited based on hospital chart reviews. The age of each subject at menarche was recorded, and the subject's heights and bone age were assessed. RESULTS: The adult height of the girls born SGA was significantly lower than the normal adult height and slightly shorter than their target height. The adult height was associated with the birth weight for gestational age. The age at menarche was not different with the menarche timing of the general population. CONCLUSION: More attention may need to be paid to the growth outcomes of SGA patients whose birth weight is lower for their gestational age than other SGA subjects.

Age at menarche and adult height in girls born small for gestational age

PURPOSE: The aim of this study was to evaluate the association between birth characteristics based on birth weight for gestational age, timing of menarche and adult height in girls born small for gestational age (SGA). METHODS: Thirty subjects born from 1988 through 1999 whose birth weight below 10th percentile for their gestational ages were recruited based on hospital chart reviews. The age of each subject at menarche was recorded, and the subject's heights and bone age were assessed. RESULTS: The adult height of the girls born SGA was significantly lower than the normal adult height and slightly shorter than their target height. The adult height was associated with the birth weight for gestational age. The age at menarche was not different with the menarche timing of the general population. CONCLUSION: More attention may need to be paid to the growth outcomes of SGA patients whose birth weight is lower for their gestational age than other SGA subjects.