Recommendations for the use of sensor-augmented pumps with predictive low-glucose suspend features in children: The importance of education.

Sensor-augmented pumps, which consist of a pump and a continuous glucose monitoring system, offer considerable therapeutic opportunities, despite requiring close attention in the early phase of their use. The aim of this paper is to provide recommendations on the use of a predictive low glucose management (PLGM) system (Minimed 640G™, Medtronic, Northridge, CA, USA) in adolescents with type 1 diabetes either at the start of therapy or during follow-up. Sound clinical recommendations on PLGM are of increasing importance since several recent papers have reported significant clinical improvements in patients with PLGM, especially in adults. These recommendations are based on the experience of a group of pediatric endocrinologists who collaborated to closely and intensively study the on-boarding of adolescent patients with type 1 diabetes on automated systems to gain first-hand experience and peer-to-peer insights in a unique free-living environment. The suggestions provided here are indicative, so can be adapted to the individual realities and experiences of different diabetes centers. However, we believe that close adherence to the proposed scheme is likely to increase the chances of improving the clinical and metabolic outcomes of patients treated with this therapy.

The association with Down's syndrome can affect phenotypic expression of Hashimoto's thyroiditis in childhood.

BACKGROUND: It is not well known whether the association with Down's syndrome (DS) may be able to affect the phenotypic expression of Hashimoto's thyroiditis (HT). OBJECTIVES: To review the most recent literature data about the specific peculiarities of HT in DS children. DESIGN: The main epidemiological features of DS-related HT were compared with those generally reported in HT children without DS. The prevalence rates of the different thyroid function patterns detected at the time of HT diagnosis and five years later were summarized in Tables 1 and 2. CONCLUSIONS: 1) the association with DS can condition a peculiar phenotypic expression of HT in pediatric age, as confirmed by the analysis of both epidemiological and biochemical features; 2) in DS children thyroid function status may be severely impaired both at HT presentation and some years later.

In children with Hashimoto's thyroiditis the evolution over time of thyroid status may differ according to the different presentation patterns.

AIM: to report the salient literature news concerning the relationships between thyroid function presenting patterns and subsequent biochemical evolution of Hashimoto's thyroiditis (HT) in pediatric age. DESIGN: the most recent reports from pediatric literature concerning biochemical thyroid function patterns at HT presentation and their spontaneous changes over time were analyzed and shortly commented. RESULTS: from the analysis of pediatric literature on this theme, it emerges that HT in children may present with a very heterogeneous biochemical picture ranging from overt hypothyroidism to overt hyperthyroidism. The presenting biochemical pattern may also condition its subsequent evolution over time. CONCLUSIONS: a) the most common biochemical pattern at HT diagnosis in children is euthyroidism, followed by overt hypothyroidism, subclinical hypothyroidism (SH) and hyperthyroidism; b) the association with HT negatively affects the evolution over time of SH; c) in the cases with either Turner syndrome or Down syndrome the evolution over time of SH is more severe than in those without these chromosomopathies.