Glycemic variability through the perspective of the glycemia risk index and time in range and their association with glycated hemoglobin A1c in pediatric patients on sensor-augmented pump therapy.

Introduction: From the introduction of continuous glucose monitoring (CGM) in treatments of type 1 diabetes, particularly its integration with insulin pumps, there has been a quest for new parameters that describe optimal glycemic control. As of the consensus reached in 2019, the ambulatory glucose profile (AGP) has become the standard, with time in range (TIR) emerging as a fundamental parameter for metabolic control assessment. However, with technological advancements, new parameters, such as the glycemia risk index (GRI), have been introduced and clinically utilized. Therefore, exploring the relationships between traditional and novel parameters to understand metabolic control comprehensively is imperative. Materials and methods: This study was conducted at the Pediatric Clinic of the University Hospital of the Republic of Srpska Banja Luka between January and July 2023. The participants were randomly selected, with the inclusion criteria specifying an age greater than eight years and a diabetes type 1 duration exceeding two years. All participants were required to use a sensor-augmented insulin pump for the next three months (90 days), irrespective of prior use, with the suspend-before-low option activated. Results: Of the 35 participants, 30 completed the study, 14 (46.7%) of whom were male. The mean age of the subjects was 14.90 ± 2.88 years, and the mean duration of diabetes was 7.83 ± 4.76 years. Over the 90-day period, HbA1c increased to an average of 7.31%. The analysis revealed significant effects of TIR (ß=-0.771) and GRI (ß=0.651) on HbA1c. Furthermore, GRI and TIR strongly correlated (ß=-0.953). Discussion and conclusion: New parameters generated from the ambulatory glucose profile (AGP) can help clinicians create a complete picture of a patient's metabolic control in relation to HbA1c levels. Additionally, the GRI is a mathematically tailored parameter that incorporates all components of the ambulatory glucose profile and demonstrates strong correlations with laboratory-measured HbA1c and TIR. The GRI potentially can become a valuable statistical parameter for evaluating and managing patients in routine clinical practice.

Evidence of increasing incidence of type 1 diabetes and ketoacidosis among children in the Republic of Srpska in period 2017-2022 with special focus on COVID-19 global pandemic years.

Background and objectives: Primary focus of the research was to determine the incidence of type 1 diabetes mellitus in the period from 2017 to 2022, and whether COVID-19 had an impact on the increase in the number of newly diagnosed children with diabetes type 1 under the age of 15 in the Republic of Srpska (Bosnia and Herzegovina). In the period 2001-2016 the incidence of type 1 diabetes mellitus was 11/100,000, with an annual increasing rate of 14.2%. Methods: Available data from pediatric endocrinology clinics, in the Republic of Srpska, on the number of newly diagnosed patients with diabetes mellitus in the period from January 1, 2017 until December 31, 2022 were used. A retrospective analysis was performed, and the capture-recapture method was used for the final assessment, and the obtained result corresponds to about 99% of the population. Results: The total number of children in the group of 0-14 years of age diagnosed with type 1 diabetes mellitus in this period was 183, of which 96 (52.46%) were boys, and 87 (47.54%) were girls. The average age at which diabetes mellitus was diagnosed was 8.3 ± 3.9 years. Average incidence of diabetes in the period 2017-2022 was 19/100,000 (95% CI 13.1-25.0). The highest incidence was 28.7/100,000 in 2020, the first year of the global COVID-19 pandemic. Out of a total of 183 newly diagnosed cases in the period 2017-2022, 73 (39.9%) were diagnosed with ketoacidosis upon admission. The largest number of newly diagnosed children was recorded in the group of children aged 10-14 years. Conclusion: In the last 6 years, there has been a significant increase in the incidence of type 1 diabetes mellitus in children under the age of 15. With an incidence of 19.4/100,000 in the Republic of Srpska, we entered the group of countries with high-risk for diabetes. Further steps must focus on the education of the entire society in order to recognize the symptoms of the disease in time and prevent the occurrence of ketoacidosis, which could significantly reduce the burden on health systems, especially in times of global pandemics, such as the COVID-19 pandemic.

The incidence of type 1 diabetes in Republic of Srpska (Bosnia and Herzegovina) and Slovenia in the period 1998-2010.

OBJECTIVE: To establish and compare the incidence and trends of type 1 diabetes mellitus (T1DM) in Republic of Srpska and Slovenia in age group 0-18 yr from 1998 to 2010. METHODS: The subjects (413 newly diagnosed T1DM patients in the Republic of Srpska and 664 in Slovenia) were grouped into the age groups: 0-4, 5-9, 10-14, and 15-18 yr. Confidence intervals (CI) for crude incidence rates were estimated assuming numbers of cases were counts from the Poisson distribution. Gender and age-specific standardization was done according to the EURODIAB criteria. Statistical analysis used Poisson-regression models to analyze difference rate between countries and to investigate the incidence trend. RESULTS: Case ascertainment was estimated to be 99.95% for the Republic of Srpska and 100% for Slovenia by using the capture-recapture method. The standardized incidence of T1DM for age group 0-18 yr in the Republic of Srpska was 7.5/100 000/yr (95% CI: 6.8-8.3). For the same period and the same age group incidence in Slovenia was 12.5/100 000/yr (95% CI: 11.5-13.5). Annual increase in the incidence in the Republic of Srpska was 2.3% (95% CI: -0.3 to 5.0%), whereas in Slovenia 4.3% (95% CI: 2.2-6.5%). CONCLUSION: The incidence for age group 0-18 yr standardized to the world population is remarkably higher in Slovenia than in the Republic of Srpska. Further follow-up and investigations are needed to explain the high difference in incidence of T1DM between the two geographically related countries.

Short-term use of continuous glucose monitoring system adds to glycemic control in young type 1 diabetes mellitus patients in the long run: a clinical trial.

BACKGROUND/AIM: Balancing strict glycemic control with setting realistic goals for each individual child and family can optimize growth, ensure normal pubertal development and emotional maturation, and control long term complications in children with type 1 diabetes (T1DM). The aim of this study was to evaluate the efficacy of short-term continuous glucose monitoring system (CGMS) application in improvement of glycemic control in pediatric type 1 diabetes mellitus (T1DM) patients. METHODS. A total of 80 pediatric T1DM patients were randomly assigned into the experimental and the control group. The experimental group wore CGMS sensor for 72 hours at the beginning of the study. Self-monitored blood glucose (SMBG) levels and hemoglobin A1c (HbA1c) levels were obtained for both groups at baseline, and at 3 and 6 months. RESULTS. There was a significant improvement in HbA1c (p < 0.001), in both the experimental and the control group, without a significant difference between the groups. Nevertheless, after 6 months the improvement of mean glycemia was noticed only in the experimental group. This finding was accompanied with a decrease in the number of hyperglycemic events and no increase in the number of hypoglycemic events in the experimental group. CONCLUSIONS: The results suggest that the CGMS can be considered as a valuable tool in treating pediatric T1DM patients, however further research is needed to more accurately estimate to what extent, if any, it outperforms intensive self-monitoring of blood glucose.

Physical activity as an important determinant in developing childhood obesity.

The correlation between physical activity and sedentary life style was investigated as a determinant of the body mass index in children and adolescents in Banjaluka region. The study involved 1204 children and adolescents, 6-17 years old, 578 boys, 626 girls. BMI was calculated from their height and weight using standard formula. Each child, together with their parents answered the questions considering their level of involvement in physical versus sedentary activities. Physical activity was defined as involvement in sports activities, while sedentary life style was defined as time spent on computer, games,video, and TV. The prevalence of overweight and obesity were 12.2% and 6.1% in our study group. Increased physical activity showed strong positive correlation with normal, lower BMI in boys (p<0.05), and girls (p<0.001). Sedentary lifestyle, prolonged TV watching was strongly associated with increased BMI only in girls (p<0.05). However, computer use for 2 hours/day was strongly associated with increased BMI (p<0.05) only in boys, although computer use for more than 3 hours/day was associated with lower BMI in boys. Physical activity and sedentary lifestyle are significant determinants of BMI and risk factors in developing overweight and obesity in childhood, as shown in our study.

[Determinants of body mass index in children and adolescents].

INTRODUCTION: Body Mass Index (BMI) in boys and girls is predicted by parental BMI, age and occupation. OBJECTIVE: Correlation of BMI among children and adolescents in Banjaluka region (Bosnia and Herzegovina) and parental age, BMI, parents'educational level and occupation, as well as the number of family members were investigated as the possible determinants of overweight and obesity in childhood. METHOD: The study included 1204 children and adolescents (578 males, 626 females), 6-17 years old from primary and secondary schools in the Banjaluka region. BMI was calculated from height and weight using the standard formula. Each subject along with his parents answered the questionnaire that contained information about parents' height and weight, educational level and occupation, as well as the number of family members. RESULTS: In all studied children, the prevalence of overweight was 12.2% and of obesity 6.1%. Strong positive correlation was found between parental BMI and age (older than 40 years) in males and females (p<0.001), while parental higher BMI and higher educational level had positive correlation only in males (p<0.001). The number of family members showed negative correlation with overweight/obesity only in females. CONCLUSION: The prevalence of overweight and obesity in children's population in the Banjaluka region is 12.2% and 6.1%, respectively. There is a positive correlation of overweight and obesity in children with parental overweight and obesity, as well as older age, and parental higher educational level.