The usefulness of the FlashStyle Libre system in glycemic control in children with type 1 diabetes during summer camp.

THE AIM OF THE STUDY: was to evaluate the usefulness of Flash FreeStyle Libre in glycemic control in children during summer camp on the basis of the participants' completed questionnaire and on the basis of the assessment o the suitability of the system performed by medical staff based on a comparative analysis: glycemia by sensor and glucometer. MATERIAL AND METHODS: A study using the new Flash FreeStyle Libre glycemic control system was conducted at a seaside summer camp for children with diabetes at the seaside. The study included 75 children (32 boys and 43 girls), in mean 13.4 (SD 4.6) years old, with an average duration of diabetes of 6.5 (SD 4.5) years and mean HbA1c of 7.81% (SD 2.05). All camp participants were provided with Libre sensors, however, routine glucose control measurements with therapeutic decisions was made using traditional glucose meters. On the last day of the camp, after the removal of the sensors, a satisfaction survey was conducted to assess with a new self-monitoring method and a comparative analysis of the glucose results from the sensor with the personal glucose meters - MARD, MAD, and clinical errors on the Clarke Error Grid were calculated. RESULTS: In the Libre user's survey, wearing comfort and ease of installation were described as very good / good by 86% and 94% of the respondends, respectively. Ease of reading blood glucose by scan was positively evaluated by 92% of the respondents, 95% of the subjects did not report any side effects. The sensor remained intact for 14 days in 46 children (62%), which value was the basis for the statistical calculations. Comparative analysis of glucose results obtained from Libre measurements performed with glucose meters (3143 measurements) showed a relatively good MARD index - 18.22% on average, with a large individual variation (6.36-29.51%). Clarke Error Grid showed that 75.2% (2309) of the results were in Zone A (Acceptable Errors) and 95.81% (3012) in Zone A and B (Non-Negative Errors). CONCLUSION: Libre user's satisfaction survey revealed that most of the respondents rated the cooperation with Flash FreeStyle Libre positively. The relatively good results of Libre in comparison with glucose meters have confirmed the usefulness of this method of monitoring glucose in summer camps for children with diabetes.

Polymorphism of the FTO Gene Influences Body Weight in Children with Type 1 Diabetes without Severe Obesity.

The objective was to compare the impact of clinical and genetic factors on body mass index (BMI) in children with type 1 diabetes (T1DM) without severe obesity. A total of 1,119 children with T1DM (aged 4-18 years) were qualified to take part in the study. All children were genotyped for variants of FTO, MC4R, INSIG2, FASN, NPC1, PTER, SIRT1, MAF, IRT1, and CD36. Results. Variants of FTO showed significant association with BMI-SDS in the T1DM group. The main factors influencing BMI-SDS in children with T1DM included female gender (P = 0.0003), poor metabolic control (P = 0.0001), and carriage of the A allele of the FTO rs9939609 gene (P = 0.02). Conclusion. Our research indicates, when assessing, the risk of overweight and obesity carriage of the A allele in the rs9939609 site of the FTO gene adds to that of female gender and poor metabolic control. This trial is registered with ClinicalTrials.gov (NCT01279161).

[Frequency and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes]. / Ocena stanu klinicznego i czestosci wystepowania kwasicy ketonowej u dzieci ze swiezo rozpoznana cukrzyca typu 1.

INTRODUCTION: Diabetic ketoacidosis (DKA) is still the most dangerous acute complication of type 1 diabetes mellitus (T1DM). It is a life-threatening condition requiring intensive treatment. DKA may be the first symptom of previously undiagnosed diabetes, especially in children. AIM OF THE STUDY: Assessment of the incidence and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes. MATERIAL AND METHODS: We analyzed 535 medical files of children (aged 9 months to 17 years, mean age 4.41-9.96, 261 girls (48%)) hospitalized from 2006 to 2009 because of the newly diagnosed type 1 diabetes mellitus. DKA was diagnosed (according to ISPAD) in children with pH <7.3, blood glucose level >11 mmol/L (>200 mg/dL) and/or blood concentration of bicarbonate <15 mmol/L with ketonuria. Severe DKA was diagnosed in children with pH <7.2. RESULTS: DKA was diagnosed in 123 patients (23%) (63 girls (51%)). The mean age of children with DKA was significantly lower than the age of the children without DKA (9.05-4.45 vs 9.48-4.39 years; p<0.001). Mean pH was 7.21-1.03 (min. 6,82; max. 7,30). In 32.5% of children with DKA severe ketoacidosis (pH -7.2) was observed. The prevalence of acidosis was higher in the 0-4 age group compared to children over 4 years (28 vs. 22%, p<0.001). Neither sex, nor symptoms duration were associated with the development of DKA. Polyuria (95%), polydipsia (95%), weight loss (85%) and abdominal pain (50%) were the most common symptoms reported by patients. CONCLUSIONS: Despite the typical symptomatology of type 1 diabetes mellitus, about 1/4 of newly diagnosed diabetes in children is accompanied by ketoacidosis. The risk of acidosis is greater in younger children.

Nonketotic hyperosmolar syndrome as an acute complication of type 1 diabetes onset in a 20-month-old boy with congenital central nervous system defect.

Hyperglycemic hyperosmolar syndrome (HHS) is one of the most severe acute complications of type 2 diabetes, but may also be developed in type 1 diabetes. Similar to ketoacidosis,HHS still remains one of the major causes of morbidity and mortality in patients with diabetes,despite a significant progress in understanding its pathogenesis and greater consensus on HHS diagnosis and treatment. It is mainly observed in elderly patients with type 2 diabetes. However,it may also occur in children,especially in infants and those with concomitant central nervous system (CNS) defects or suffering from severe infections associated with dehydration. The authors report a case of HHS in a 20-month-old child with central nervous system abnormality. Symptoms observed in our patient are characteristic for HHS. It must be emphasized that HHS may accompany diabetes onset also in children.

Multicenter cross-sectional analysis of values of glycated haemoglobin (HbA1c) in Polish children and adolescents with long-term type 1 diabetes in Poland: PolPeDiab study group.

INTRODUCTION: Glycated haemoglobin is currently a golden standard of evaluation of metabolic control of diabetes. According to the Evidence based Medicine data, better metabolic control of diabetes decreases the prevalence of chronic complications. AIM OF THE STUDY: to analyse HbA1c in children with a longer duration of type 1 diabetes mellitus (t1DM). MATERIAL AND METHODS: We analysed an epidemiological database (2006-2009) of 7783 HbA1c values of 996 children (465 girls) with t1DM treated at three academic centres (Gdansk, Lódz, Katowice) in Poland. the mean age was 13.04±3.43 years and the mean duration of diabetes was 6.93±2.33 years. RESULTS: the overall mean HbA1c was 7.6±1.5% (by age groups: 7.0±0.8%, 2-5 yrs; 7.1±1.0%, 6-10 yrs; 7.8±1.7%, 11-19 yrs) without gender-related differences. HbA1c increased significantly with increasing age and t1DM duration. HbA1c values differed significantly between the centres. A group of 455 (55.7%) children reached a stable course of diabetes with HbA1c <7.5%, and 110 (13.5%) had HbA1c levels >9%. The mean HbA1c ?6.5% was found in 150 children (18.4%). CONCLUSIONS: In more than 50% of Polish children with longer t1DM duration, the international target of glycaemic control (HbA1c) is achieved; however, only 18% of them reached Polish national target. Age, t1DM duration and centre-specific factors influence the HbA1c values.