Diabetic ketoacidosis at diabetes onset: still an all too common threat in youth.

OBJECTIVE: To define the demographic and clinical characteristics of children at the onset of type 1 diabetes (T1D), with particular attention to the frequency of diabetic ketoacidosis (DKA). STUDY DESIGN: The Pediatric Diabetes Consortium enrolled children with new-onset T1D into a common database. For this report, eligible subjects were aged <19 years, had a pH or HCO(3) value recorded at diagnosis, and were positive for at least one diabetes-associated autoantibody. Of the 1054 children enrolled, 805 met the inclusion criteria. A pH of <7.3 and/or HCO(3) value of <15 mEq/L defined DKA. Data collected included height, weight, hemoglobin A1c, and demographic information (eg, race/ethnicity, health insurance status, parental education, family income). RESULTS: The 805 children had a mean age of 9.2 years, 50% were female; 63% were non-Hispanic Caucasian. Overall, 34% of the children presented in DKA, half with moderate or severe DKA (pH <7.2). The risk for DKA was estimated as 54% in children aged <3 years and 33% in those aged ≥ 3 years (P = .006). In multivariate analysis, younger age (P = .002), lack of private health insurance (P < .001), African-American race (P = .01), and no family history of T1D (P = .001) were independently predictive of DKA. The mean initial hemoglobin A1c was higher in the children with DKA compared with those without DKA (12.5% ± 1.9% vs 11.1% ± 2.4%; P < .001). CONCLUSION: The incidence of DKA in children at the onset of T1D remains high, with approximately one-third presenting with DKA and one-sixth with moderate or severe DKA. Increased awareness of T1D in the medical and lay communities is needed to decrease the incidence of this life-threatening complication.

El síndrome metabólico: un reto creciente en la atención primaria / The metabolic syndrome: a growing challenge in primary care

A medida que la prevalencia de la obesidad en los niños aumenta, lo hace igualmente el síndrome metabólico con sus consecuentes riesgos en salud, principalmente en enfermedad cardiovascular. La identificación temprana y el tratamiento son esenciales para disminuir las complicaciones y el riesgo de muerte temprana en la edad adulta.

Bullying, regimen self-management, and metabolic control in youth with type I diabetes.

OBJECTIVE: To determine the association among diabetes-related bullying, diabetes self-management, metabolic control, and depression in children and adolescents with type I diabetes (TID). STUDY DESIGN: Measures of diabetes-related bullying and depression were administered to 167 youth with TID at their regularly scheduled diabetes care visits. Parents were administered a clinician-rated index of their child's diabetes self-management. HbA1c levels were assessed. RESULTS: Diabetes-related bullying was positively related to HbA1c concentration and negatively related to overall self-management and specifically to adherence to glucose testing and dietary tasks. Depressive symptoms partially mediated the relation between diabetes-related bullying and overall self-management. CONCLUSION: Given the associations between diabetes-related bullying and regimen self-management, the issue of illness-related bullying merits serious attention for pediatricians and school personnel.

Social-psychological correlates of peer victimization in children with endocrine disorders.

OBJECTIVE: To examine the relation between victimization by peers and child and parent reports of social-psychological adjustment. STUDY DESIGN: The Social Experience Questionnaire, Children's Depression Inventory, Social Anxiety Scale for Children-Revised, and Asher Loneliness Scale were administered to 93 children diagnosed with various endocrine disorders. The child's parent/guardian completed the Child Behavior Checklist. RESULTS: For the entire sample, peer victimization was positively related to child-reported depression, social anxiety, loneliness, and parent-reported externalizing symptoms. Those children with endocrine disorders without observable features had a stronger relation between peer victimization and depression and internalizing and externalizing behavior problems than did those who had endocrine disorders with observable physical features. CONCLUSIONS: Recognition of the magnitude of the problem and means of evaluating for peer victimization is important for clinicians who see children with chronic diseases.

Predictors of control of diabetes: monitoring may be the key.

The factors affecting glycated hemoglobin concentration were examined in a cohort of children attending diabetes camp. Multivariate regression analysis revealed that frequency of self-monitoring of blood glucose correlated with lower glycated hemoglobin, whereas the number of insulin types used correlated with increased glycated hemoglobin. Frequent self-monitoring of blood glucose promotes long-term metabolic control.