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1.
Curr Diabetes Rev ; 19(4): e110422203403, 2023.
Article in English | MEDLINE | ID: mdl-35410614

ABSTRACT

BACKGROUND: Diabetes control without developing hypoglycemia is challenging in Type 1 diabetes (T1D) management, with few studies evaluating the effect of insulin glargine timing on glucoregulation. OBJECTIVES: The aim is to compare glycemic control using continuous glucose monitoring (CGM) in children with T1D receiving bedtime versus morning glargine and to assess CGM effect on glycemia. METHODS: This cross-sectional observational study was conducted on 30 pediatric patients with T1D receiving glargine (19 at bedtime and 11 in the morning). CGM sensor was applied for 3-5 days using the I-Pro2 blood glucose sensor. RESULTS: Total daily dose of glargine showed a significant correlation with HbA1C (p=0.006) and percentage of glucose readings within average (p=0.039). HbA1C correlated significantly with time in range (TIR) (p=0.049). Nocturnal hypoglycemia was significantly higher in the bedtime glargine group than in the morning one (p=0.016). The morning glargine group showed better control in terms of lower HbA1C and higher TIR, but these did not reach statistical significance. Follow- up after 3 months revealed significant improvement in the percentage of hyperglycemia, BG readings within average, as well as HbA1c (p:0.001). CONCLUSIONS: Bedtime glargine administration was associated with a higher frequency of occurrence of nocturnal hypoglycemia. No statistically significant difference in glycemic control between both groups was found. CGM use improved glycemic control.


Subject(s)
Diabetes Mellitus, Type 1 , Hypoglycemia , Humans , Child , Insulin Glargine/adverse effects , Diabetes Mellitus, Type 1/drug therapy , Hypoglycemic Agents/adverse effects , Glycated Hemoglobin , Blood Glucose Self-Monitoring , Egypt , Cross-Sectional Studies , Glycemic Control , Insulin, Long-Acting/adverse effects , Blood Glucose , Insulin/adverse effects , Hypoglycemia/chemically induced , Hypoglycemia/prevention & control
2.
Curr Rheumatol Rev ; 19(2): 197-204, 2023.
Article in English | MEDLINE | ID: mdl-36043726

ABSTRACT

BACKGROUND: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can involve any organ system. SLE typically affects the musculoskeletal system to varying degrees, and patients are frequently most prone to have pain in the hand joints. OBJECTIVES: The study aims to assess by ultrasound the presence of joint inflammation in patients with juvenile Systemic Lupus Erythematosus (JSLE) not complaining of painful joints of the hand and wrist (asymptomatic) and compare the findings with those in JSLE patients complaining of painful hand and wrist joints (symptomatic) and in healthy controls. METHODS: This was a cross-sectional case control study on 37 JSLE patients. Thirty were asymptomatic for joint complaints. Ultrasound examined wrists and joints of both hands, 11 joints in each hand, to assess synovial hypertrophy, effusion and pathological vascularization (using power Doppler) (PD), and were given a score of 0-3. Patients were compared with 8 healthy controls. RESULTS: Ultrasound abnormalities (synovial hypertrophy and increased vascularity) were detected in 22/30 of the asymptomatic patients (73.3%) and in all 7 symptomatic patients (100%). In asymptomatic children, 29 joints were affected (4.4% of all joints), compared to 13 joints in the symptomatic patients (8.4% of all joints). Synovitis score was mild or moderate (1 or 2) in both symptomatic and asymptomatic patients, with all showing increased vascularity. In the control group, 5 joints (2.8% of all joints) showed synovial hypertrophy but no increased vascularity. CONCLUSION: Increased vascularity (PD more than 0) is a more reliable indicator of inflammation than synovial hypertrophy, which may be detected in healthy individuals.


Subject(s)
Lupus Erythematosus, Systemic , Synovitis , Humans , Child , Wrist , Case-Control Studies , Cross-Sectional Studies , Wrist Joint/diagnostic imaging , Synovitis/diagnostic imaging , Synovitis/pathology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnostic imaging , Lupus Erythematosus, Systemic/pathology , Inflammation/pathology , Pain
3.
Front Endocrinol (Lausanne) ; 13: 814991, 2022.
Article in English | MEDLINE | ID: mdl-35360079

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has been associated with significant challenges pertaining to the management of children and adolescents with type 1 diabetes (T1D). Issues such as fear of infection and lockdown measures have resulted in delayed and more severe clinical presentations of this disease. Objectives: This study aimed at reporting the frequency and severity of diabetic ketoacidosis (DKA) and the rate of DKA complications in children with diabetes who presented to the emergency unit during COVID-19 pandemic. Furthermore, the purpose of this study was to compare the data collected from the first and second COVID-19 waves with that of the pre-COVID-19 period and describe the challenges encountered during disease management. Methods: This cross-sectional study included all children and adolescents with T1D who presented to the emergency department at Abo El Rish Children's Hospital, Cairo University, during the first and second COVID-19 waves. It also included data collected from the pre-COVID-19 period. Demographic and clinical data, investigations, and management details were collected from the patients' medical records. Results: Three hundred twenty-four Egyptian children and adolescents diagnosed with T1D were recruited. One hundred forty patients (43.2%) presented with severe DKA, and approximately 66% were newly diagnosed with T1D. The participants presented with manifestations suggestive of COVID-19, such as fever (29.5%), respiratory manifestations (7.2%), and gastrointestinal symptoms (14.7%). Thirty-seven patients were tested for severe acute respiratory syndrome coronavirus 2 infection using nasopharyngeal swabs, and four patients tested positive. Around 18% of patients developed hypokalemia during disease management. A comparison between these data and the data from previous years revealed that there was a significant increase in the number of newly diagnosed cases with more severe DKA at presentation and a higher frequency of development of hypokalemia during both COVID-19 waves. Conclusion: An increase in the frequency of newly diagnosed cases was identified during the first and the second COVID-19 waves compared with the pre-COVID-19 period. The patients presented with more severe DKA, probably due to a more delayed presentation. The frequency of hypokalemia development was also significantly higher, and the severity of DKA was associated with a longer ICU admission. Further studies are required to establish a definitive link between the COVID-19 pandemic and the severity of presentation.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adolescent , COVID-19/complications , COVID-19/epidemiology , Child , Communicable Disease Control , Cross-Sectional Studies , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Egypt/epidemiology , Humans , Pandemics
4.
Diabetes Metab Syndr ; 15(1): 7-12, 2021.
Article in English | MEDLINE | ID: mdl-33276255

ABSTRACT

BACKGROUND AND AIMS: To determine the effect of high protein and high fat meals on post prandial glycemia in patients with type 1 diabetes. METHODS: This study included 51 children and adolescents with type 1 diabetes who were following up at Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU), Abo Elrish Children's hospital, Cairo University. Post prandial blood glucose levels were recorded and compared following three breakfast meals with varying protein and fat content (standard carbohydrate meal, high fat meal, and high protein meal) over a period of 5 hours on 3 consecutive days. RESULTS: High protein meal resulted in hyperglycemia with the peak level at 3.5 hours and continued for 5 hours post prandial while high fat meal caused early hyperglycemia reached the peak at 2 hours then declined towards 5 hours. Comparison of the three different breakfast meals revealed statistically significant difference regarding the postprandial glycemia at 30, 60, 90,120, 180, 210, 240, 270, 300 min. CONCLUSION: Meals high in protein caused sustained increase in postprandial glucose levels over a period of 5 h. However, high fat meals caused early postprandial hyperglycemia. Protein and fat content of meals affect the timing and values of the peak blood glucose as well as the duration of postprandial hyperglycemia. Therefore, fat/protein unit should be taken in consideration while calculating the bolus insulin dose and anticipating the postprandial glucose response.


Subject(s)
Blood Glucose , Diabetes Mellitus, Type 1/blood , Diet, High-Fat , Diet, High-Protein , Postprandial Period/physiology , Adolescent , Child , Cross-Over Studies , Egypt , Female , Humans , Longitudinal Studies , Male , Prospective Studies , Young Adult
5.
Diabetes Res Clin Pract ; 159: 107966, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31805353

ABSTRACT

AIM: To describe the characteristics of diabetes diagnosis, insulin therapy regarding type, dose and frequency also the degree of glycemic control achieved in toddlers and preschoolers coming from families with limited resources. METHODS: Over one year, 69 toddlers and preschoolers clinically diagnosed as type 1 diabetes were included. Data related to presentation at diagnosis, insulin therapy and glycemic control was reviewed from patients' care givers and medical records. RESULTS: Diabetic ketoacidosis (DKA) was recorded in 71% of the children at initial diagnosis. The mean time since diabetes diagnosis was 2 ± 1 years. Most of children (65/69, 94%) were on basal-bolus regimen while four (6%) were on basal insulin only. NPH and long acting analogues were used as basal insulin in (74%) and (26%). Regular insulin and rapid acting analogues were used as bolus insulin (27%) and (73%).The mean frequency of daily self monitoring of blood glucose was (2.9 ± 1). The arithmetic mean of HbA1c done over past 6 months to one year before inclusion in the study was 8.2 ± 1.5% (66 ± 12 mmol/mol) with 65% having HbA1c ≥ 7.5% (≥58 mmol/mol). CONCLUSION: Toddlers and preschoolers with diabetes coming from families with limited resources frequently present with DKA at diagnosis and have suboptimal self-monitoring of blood glucose and glycemic control. NPH is more commonly used in this age group, combined with postprandial rapid analogues and less commonly preprandial regular insulin and that yields more favorable HbA1c but with a greater risk of hypoglycemia. The most common cause of hospital readmission was ketoacidosis and uncontrolled hyperglycemia.


Subject(s)
Blood Glucose/analysis , Diabetes Mellitus, Type 1/drug therapy , Diabetic Ketoacidosis/diagnosis , Hyperglycemia/diagnosis , Hypoglycemia/diagnosis , Hypoglycemic Agents/adverse effects , Insulin/adverse effects , Child, Preschool , Cross-Sectional Studies , Diabetes Mellitus, Type 1/blood , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/epidemiology , Egypt/epidemiology , Female , Humans , Hyperglycemia/chemically induced , Hyperglycemia/epidemiology , Hypoglycemia/chemically induced , Hypoglycemia/epidemiology , Incidence , Infant , Male , Risk Factors , Socioeconomic Factors
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