ESPE Abstracts

Background: Drug intoxication is one of the rare reasons of hyperinsulinism; it may occur not only accidentally but also deliberately.Objective and hypotheses: Herein, we report a case who presented with factitious hyperinsulinaemic hypoglycemia and diagnosed with Münchausen syndrome by proxy (MSBP) which is an uncommon condition of child abuse.Method: A 7-year-old girl was referred to our department due to hyperglycemic and h...

Background: Type 1 diabetes mellitus (T1DM) is an autoimmune and inflammatory process and vitamin D (VD) is thought to reduce inflammation and prevent autoimmune destruction. Studies have shown that VD has an effect on insulin secretion and sensitivity in rats. And it has been shown that adult T2DM with normal levels of VD have decreased insulin requirements. Two prior studies in Turkey looked at the relationship between VD levels and daily insulin requirement in paediatric pa...

Background: Adequate sick day management at home may reduce the risk of progression to diabetic ketoacidosis (DKA) and admission to hospital. The UK does not have a consensus guideline for sick day management advice to children and young people with type 1 diabetes mellitus (T1DM). Children’s diabetes services vary in their practice of education and advice in the use of urine or blood ketone monitoring during illness.Objective and hypotheses: The ai...

Objective: The role of incretins in type 2 diabetes (T2D) is controversial. This study investigated the association between incretin levels in obese Korean children and adolescents with T2D.Patients and methods: We performed a 2-h oral glucose tolerance test in obese children and adolescents with T2D and with normal glucose tolerance. Twelve obese children and adolescents with newly diagnosed T2D (DM group) and 12 obese age-matched subjects without T2D (...

Background: Neonatal diabetes mellitus (NDM) is a rare (1:300 000–400 000 newborns) but potentially devastating metabolic disorder characterized by hyperglycemia combined with low levels of insulin. Two main groups have been recognized on clinical grounds, transient NDM (TNDM) and permanent NDM (PNDM).Objective and hypotheses: To describe clinical features and laboratory manifestations of patient with NDM and evaluate outcome of management.<p cl...

Background: Diabetic ketoacidosis (DKA) in children and young adults carries significant morbidity and mortality relating to complications such as cerebral oedema. Acute kidney injury (AKI) is a rare but potentially fatal complication of DKA. We present three cases of DKA complicated by AKI.Case 1: A 9-year-old girl presented with severe DKA at diagnosis. She was treated with intravenous fluids and insulin as per protocol. She had oliguria and haematuria...

Background: BMI in childhood is an indicator of future health.Objective and hypotheses: To assess BMI distribution among children and young people with type 1 diabetes.Method: The National Paediatric Diabetes Audit (NPDA) collates height and weight data on children and young people with diabetes in England and Wales. BMI centiles were calculated using the UK 1990 reference population. Underweight was defined as <5th centile, ov...

Background: Diabetes ketoacidosis (DKA) is the most severe complication in type 1 diabetes (T1D) but patient education and ketone monitoring may help decrease its frequency. However, the influence on glucose homeostasis of systematic ketone monitoring and of the nature of monitoring (urine vs blood) is unclear.Objective and hypotheses: To determine whether the use of blood ketone monitoring, as compared to urine ketone testing, decreases the duration of ...

Background: Elastargene 3C (E3C) is a cream specifically designed to improve lipoatrophy in patients with diabetes. It is made by many ingredients, among whom are elastin, arnica, collagen, caffeine, and L-carnitine.Objective and hypotheses: We started a 6-month, double-blind, randomized trial to test the efficacy of E3C in children with type 1 diabetes (T1D) using insulin pump (CSII), in whom infusion set usually left little withe scars.<...

Background: The diabetic ketoacidosis (DKA) represents one of the most frequent causes of death in childhood. The first therapeutic step is a quick rehydration, whereby a venous access must be ensured in every child with DKA, in order to infuse liquids immediately. The children conditions (state of shock, obesity) can make access extremely difficult. We present two cases of patients with severe DKA, where finding a venous access was almost impossible.Cli...

Background: Type 1 diabetes may have an influence on concentration, attention and behaviour. These effects are relevant, as they may affect school performance and later career options for paediatric diabetes patients.Objective and hypotheses: This study examined attention, concentration and behavioural difficulties in diabetic children aged 5–13 years and their association with hypoglycaemic episodes and HbA1c.Method: 48 child...

Background: In diabetic athletes, glycogen depletion can contribute to the early development of starvation ketones as is demonstrated by our patient.Case presentation: Our patient, a 15-year-old male triathlete with type 1 diabetes for 5 years was referred to our tertiary center because of suboptimal regulation on continuous subcutaneous insulin infusion (CSII). He frequently awoke with nausea and ketosis, which was initially attributed to failure of ins...

Background: Paediatric diabetic ketoacidosis (DKA) management should be regulated by specific protocols. Following the Canadian Diabetes Association recommendations, our paediatric tertiary care hospital was provided with such a protocol in 2009.Objective and hypotheses: Assess the proportion of DKA episodes that are marked by non-adherence to our DKA management protocol (DKAp). We suspected a moderate non-adherence rate.Method: We...

Background: Cystic fibrosis-related diabetes (CFRD) and glucose abnormalities have a negative impact on pulmonary function and survival in cystic fibrosis (CF) patients. Oral glucose tolerance test (OGGT) is the screening test of choice for CFRD, although undetected high glucose levels can be missed with this test. The use of a continuous intersticial fluid glucose monitoring system (CGM) can be useful in these patients.Objective and hypotheses: To deter...

Background: Costs and health related quality of life study for type 1 diabetes mellitus (CHRYSTAL) pediatric patients in Spain is an observational study conducted in 2014 on a representative sample of 275 patients aged 1–17 years with type 1 diabetes mellitus (T1DM) in Spain. The study collects diabetes specific health related quality of life (HRQoL) using the Diabetes Module of the Pediatric Quality of Life Inventory (PedsQL). This scale has been identified to be one of ...

Background: Triglyceride (TG)/HDL ratio has recently been considered a index of cardio-metabolic risk in healthy and obese subjects. Diet, lifestyle indexes, anthropometric parameters, and metabolic control are the variables with possible influence on belonging to a certain cardio-metabolic risk group.Objective and hypotheses: To identify whether HbA1c per se has an influence on TG/HDL and to study other possible variables influencing the ratio....

Background: Non-high-density lipoprotein cholesterol (non-HDL-C) has been shown to be a suitable predictor of cardiovascular risk.Objective and hypotheses: We aimed to investigate factors influencing non-HDL-C levels in children with type 1diabetes (T1D, registered at the German/Austrian DPV database, n=26358) in order to increase the rare use of lipid-lowering therapies. Recommendations for acceptable (<120 mg/dl), borderline-high (120&#150...

Background: Self monitoring of blood glucose (SMBG) is an important part of diabetes management. Continuous glucose monitoring system (CGMS) provides the real time measurements of users’ glucose levels. The NICE guideline recommends use of CGMS if there is persistent hypoglycaemia unawareness or repeated hypoglycaemia or hyperglycaemia. In our paediatric diabetes clinic within a large DGH, we have a cohort of 12 children who were funded for the CGM use for a minimum of 1 ...

Background: Diabetic ketoacidosis (DKA) is a medical emergency. The most physiologic fluid/electrolytes replacement rates and insulin dosis are still controversial.Objective and hypotheses: To evaluate the effectiveness and security of DKA treatment. Our protocol consists of 2 h’ rehydration with 0.9% sodium chloride (NaCl), followed by insulin infusion (0.1 U/kg per h) associated to 0.45% NaCl with 5% glucose. Potassium is replaced with monophospha...

Background: Cardiovascular disease (CVD) is the major cause of mortality in diabetes mellitus type 1 (T1DM). Dyslipidemia will increase this risk. Several guidelines have been published, how to treat dyslipidemia in T1DM, yet some studies have shown that the number of patients who are treated according to these guidelines is low.Objective and hypotheses: To investigate the frequency of dyslipidemia in children and adolescents with T1DM and if they are tr...

Background: There have been reports that patients with diabetes have hearing loss greater than those without. Suggested pathogenesis for diabetes-associated hearing loss has included cochlear microangiopathy, hyperglycaemia of cerebrospinal fluid, auditory neuropathy and diabetic encephalopathy.Objective and hypotheses: This study is aimed to investigate hearing changes in children and adolescents with type 1 diabetes mellitus and to examine if hearing c...

Background: Maturity-onset diabetes of the young type 2 (MODY2) is an autosomal dominant inherited disease caused by heterozygous inactivating mutations in the glucokinase (GCK) gene. It mostly presents with mild fasting hyperglycaemia. MODY2 accounts for 2%–5% of all diabetes cases. It is treated with diet only, and complications are extremely rare. We presented here a family with MODY2 caused by a novel heterozygous p.E51*(c.151.G>T) mutation of the GCK gene.<p ...

Aim: To study incidence and risk factors of diabetic nephropathy (DN) in children and adolescents as per the Republic of Uzbekistan National Register.Method: An information list (card) and appropriate software were developed on the basis of the DN register. The cards were collected in every region of Uzbekistan to be introduced into a computer database.Results: DN screening performed in children by Alikhanova N M in 1998 showed tha...

Background: Prediabetes often precedes type 2 diabetes, which is associated with obesity and increased risk of developing cardiovascular disease. Haemoglobin A1c (HbA1c) has been recently recommended as a useful tool for the diagnosis of diabetes and prediabetes.Objective and hypotheses: We investigated whether prediabetes according to HbA1c was associated with cardiometabolic risk factors in Korean children and adolescents.Method:...

Aims: To define the normal ranges of the thicknesses of the skin and subcutaneous tissues via ultrasonography, and to determine whether the current syringe needle-lengths used for the subcutaneous injections were appropriate.Methods: The thicknesses of the skin and subcutaneous tissues of 2 244 students were measured at the left arm using ultrasonography. Patients were divided into three groups based on age: 6–8, 9–12 and 13–17 ye...

Background: The hyperosmolar hyperglycaemic state (HHS) is rare, but recognised, life-threatening clinical entity in children with type 2 diabetes (T2DM). It is also reported as presenting feature in other types of diabetes and metabolic disorders. The estimated mortality in HHS is 10–20%, ten times higher than Diabetic Ketoacidosis (DKA).The mainstay of management involves aggressive fluid therapy with insulin and managing complications namely; rhabdomyolysis, multi-orga...

Background: Wolfram syndrome (WS) is an autosomal recessive neurodegenerative disorder characterized by non-autoimmune diabetes mellitus and progressive optic atrophy. WS includes other possible disorders, such as diabetes insipidus, sensorineural deafness, genitourinary tract problems, neurological or psychiatric disorders and others.Case presentation: A 12-years-old boy presented with glicosuria and shortly developed insulin-dependent diabetes mellitus...

Background: Persistent hyperinsulinaemic hypoglycaemia (HH) of infancy (PHHI) is a rare condition which presents with severe hypoglycaemia during the neonatal period. For medically unresponsive forms of diffuse HH, subtotal pancreatectomy was previously the only treatment option, with the potential consequences of recurrence of hyperinsulinism, diabetes mellitus and exocrine pancreatic insufficiency. The novel use of sirolimus treatment was recently reported in four infants wh...

Background: Diabetes mellitus is not characteristic of Beckwith Wiedeman Syndrome (BWS). If anything, BWS is associated with hypoglycaemia secondary to hyperinsulinaemia. A case of permanent neonatal diabetes mellitus and BWS have never been reported from our setting.Objective and hypotheses: To report on a 17 years old boy with BWS diagnosed with permanent neonatal diabetes mellitus at 4 months of age and to determine the molecular genetics study which ...

Background: Screening guidelines for vascular complications in children with type 1 diabetes (T1DM) are based on results from Diabetes Control and Complications Trial (DCCT) and its follow-up, the Epidemiology of Diabetes Interventions and Complications (EDIC) trial. These studies established conclusively that early and intensive diabetes care improves long-term outcomes.Objective and hypotheses: To establish screening practices and prevalence of vascula...

Background: Hyperglycaemia is a common occurrence during the treatment for paediatric acute lymphoblastic leukaemia (ALL). Emergence of new evidence exhibits conflicting results. The incidence of hyperglycaemia during chemotherapy has not been well described in the Asian population.Objective and hypotheses: The aim of study is to delineate the characteristics of paediatric patients at risk for hyperglycaemia during chemotherapy.Met...

Background: Seip-Berardinelli syndrome is a rare form of congenital lipodystrophy.Objective and hypothesis: To report a patient later diagnosed with Seip-Berardinelli syndrome referred initially for evaluation due to low weight gain.Population and/or methods: We performed the report of the case along with a literature review.Results: The patient was referred due to low weight gain. She was the second daughter...

Background: Metabolic control is important in prevention and delay of microvascular and macrovascular complications of type 1 diabetes mellitus (DM). Psychological disorders and, a lack of motivation may negatively affect metabolic control. Therefore, motivational and psychological support can be needed as a part of medical treatment to improve metabolic control in patients with type 1 DM.Objective and hypotheses: To investigate the impact of reward-base...

Background: Fanconi-Bickel syndrome (FBS) is a glycogen storage disease caused by the homozygous mutations of SLC2A2 gene which codes GLUT2 protein. It is characterized by growth retardation, hepatomegaly and hypophosphataemic rickets. While most of the cases with FBS have fasting hypoglycaemia and postprandial hyperglycaemia, only few cases had been shown to have neonatal diabetes (ND).Case presentation: A 14 days old girl was admitted to hospital with ...

Objective: To evaluate cardiovascular autonomic neuropathy (CAN) in type 1 Diabetics and to detect its relation to coronary artery calcification.Patients and methods: It is a cross sectional study included 62 diabetics and 30 controls. Clinical, laboratory assessment and 24 h holter were done for all patients and controls and coronary artery calcium (CAC) scoring by multisclice CT was done for all patients only. t-test, Mann–Whitney U-test ...

Background: An association between type 1 diabetes mellitus (T1DM) and idiopathic generalized epilepsy is reported. Some authors suggest an autoimmune mechanism mediated by antibodies to glutamic-acid-decarboxylase (GAD), that is an enzyme involved in the synthesis of the neurotransmitter GABA. Dravet syndrome (DS) is a rare, severe epilepsy disorder characterized by febrile hemiclonic seizures or generalized status epilepticus starting at 6 months of age. In classical DS, a d...

Background: According to the World Health Organization, the social determinants of health, the conditions in which people are born, grow, live and work – significantly influences on health. The CAF Foundation, the Endocrinology Scientific Center and the Institute for Family Health under the Alfa-Endo Program studied prevalence of some social determinants in families of children with type 1 diabetes mellitus.Objective and hypotheses: Investigate soci...

Background and aims: The aim of this study was to investigate the frequency of diabetic ketoacidosis and diagnostic mistakes in onset diabetes mellitus type l in children and their relationship with age.Materials and methods: In this study were included 269 patients (from 7 month to 17 years) in onset diabetes mellitus type l since 2010–2013. All patients were divided in to two groups. The first group consists of 92 patients (children were younger t...

Objective: To determine the influence of adolescent girls with type 1 DM on circulating levels of adiponectin and to study the relation between adiponectin level with glycemic control and complication of diabetes.Patients and methods: The study included 40 female adolescent type 1 diabetic patients and 40 healthy volunteer of the same age and sex. Blood sample was taken for assessment of glycosylated haemoglobin, lipid profile and adiponectine. Urine sam...

Background: Hypoglycaemia represents a common issue in diabetic children, and the achievement of good metabolic control together with the avoidance of hypoglycemia remains a tightrope walk. As hypoglycaemia is not always recognised, data about hypoglycemia frequency are limited.Aims: We previously reported about nocturnal hypoglycaemia in diabetic children. This study now focusses on the frequency and duration of hypoglycemia at daytime and risk factors ...

Background: Neonatal diabetes is a rare disorder with an incidence of between 1 in 215 000–500 000 live births with approximately 50% having permanent neonatal diabetes (PNDM). Insulin gene (INS) mutations have recently been described as a cause of PNDM.Objective and hypotheses: To describe clinical features and laboratory manifestations of patient with PNDM due to INS gene mutation and evaluate outcome of management....

Background: 6 patients with neonatal diabetes presenting to a single centre from April 2014 to March 2015 were studied for clinical presentation, biochemical findings of the disorder, genetics and treatment outcomes.Objective and hypotheses: Six children presenting to a single centre in South India were studied for correlation of disease with clinical features and genetics, suitability of current treatment regimens and treatment outcomes.<p class="ab...

Background: Type 1 diabetes mellitus (T1DM) is a chronic and demanding disease affecting not only the patient’s life but also the whole family’s perspective. Many studies have explored the effect of T1DM on the emotional and social life of the family; however, a small amount of evidence for the dietary habits of the unaffected members of the family currently exists.Objective and hypotheses: To explore the effects that T1DM has on the dietary ha...

Background: In type 1 diabetes (T1D) adolescents it is necessary to design effective interventions to take care of their health and psychological problems. This leads to effective transition to an adult unit.Objectives: Evaluate the relationship of lifestyle with metabolic control in diabetic adolescents.Methods: Retrospective study of 42 T1D adolescents managed in a Pediatric Diabetes Unit. Patients completed a questionnaire on li...

Background: Diabetic ketoacidosis (DKA) is a severe and often the inaugural clinical manifestation of type 1 Diabetes (T1D). Diabetic nephropathy is one of the most devastating chronic complications of T1D and its’ early diagnosis is traditionally based on microalbuminuria.Objective and hypotheses: The aim was to investigate the possible associations between the initial clinical manifestations and the chronic complications of T1D.<p class="abste...

Background: Anti-islet autoantibodies are predictive and diagnostic markers for type 1 diabetes (T1D). The most frequently determined pancreatic autoantibodies in T1D are anti-glutamic acid decarboxilase (GAD), anti-tyrosine phosphatase (IA-2) and anti-insulin (AAI).Objective and hypotheses: To study whether the pancreatic autoimmunity profile influences the initial presentation of diabetes, its metabolic behaviour and the presence of other autoimmune di...

Background: Mutations in the PPARG gene, encoding peroxisome proliferator-activated receptor-gamma (PPARG) are associated with Familial lipodystrophy type 3. PPARG regulates fatty acid storage and glucose metabolism. The genes activated by PPARG stimulate lipid uptake and adipogenese by fat cells. In cases of lipodystrophy and defects of adipogenesis lipoid accumulates ectopically in the liver, skeletal muscle, pancreas and cardiovascular tissues and impairs the function of th...

Background: The integration of technology in health care has led to improved medical care and better compliance, especially in chronic diseases such as diabetes. Despite these advances, compliance has always been an issue in caring for adolescents with diabetes. Text messaging has become a popular way to communicate with peers especially for teens. Multiple studies support the theory that texting is an easy and affordable resource that health care providers can utilise to educ...

Background: Wolfram syndrome, also known as Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, Deafness (DIDMOAD), is a rare neurodegenerative disease of autosomal recessive inheritance with incomplete penetrance. In addition, it may present with different endocrine and metabolic abnormalities such as pituitary dysfunction. We reported clinical features, biochemical features and mutational analysis of a boy with Wolfram syndrome.Case presentation: A 7...

Background: Diabetics have an increased risk of cardiovascular disease. In young adults with type 1 diabetes mellitus (T1DM), cardiovascular events are more often the cause of premature death than nephropathy. In pediatric T1DM population, 35% have 2 or more cardiovascular risk factors (cvRF).Objective and hypotheses: This study aimed to determine the prevalence of traditional cvRF in children and adolescents with T1DM, and their association with the deg...

Background: Rogers syndrome or thiamine responsive megaloblastic anaemia (TRMA) with diabetes mellitus (DM) and deafness is an uncommon autosomal recessive disorder. We report the case of an eleven-month-old girl with TRMA.Case presentation: She was admitted to the hospital with paleness, hypotonia, diarrhoea and fever. She was born to first degree consanguineous Moroccan parents. Our patient medical history was relevant for hemolytic anaemia at the age ...

Background: Suboptimal glycaemic control in type 1 diabetes, measured by HbA1c, increases the risk for long-term complications.Aims and objectives: To calculate and compare glycaemic control in children with Type 1 Diabetes in Malta in 2013 and 2014. To identify any need to change the way services are structured and delivered.Methods: Almost all diabetic children less than 16 years of age in Malta fall under the same paediatric dia...

Aim: The work was initiated to study efficacy of prestarium in normoalbuminuric patients with type 1 diabetes mellitus by ACE genotype upon primary diabetic nephropathy (DN) prevention.Materials and methods: We examined normoalbuminuric 22 patients with type 1 diabetes mellitus aged from 12 to 17 years with DN duration ≧ 10 years divided into two groups by ACE polymorphism, that is, the one with II genotype (n=11) and the one with DD geno...

Background: Diabetes as a disease and its treatment can have a profound effect on the quality of life (QoL) in terms of social and psychological well-being as well as physical ill health. Current goals of diabetes management focus on optimising metabolic control, along with preserving a good QoL.Aims and objectives: To assess QoL in adolescents with type 1 diabetes (T1D) at the Diabetes Endocrine and Metabolism Pediatric Unit at Cairo University.<p c...

Background: MODY is monogenic. About 1% of diabetes has a monogenic cause but is frequently misdiagnosed as DM1 or DM2.Objective and hypotheses: It is important to study family history of patients with atypical diabetes forms for verification of diagnosis and prognosis.Method: Genetic, biochemical and hormonal testing, 2 patients were examined.Results: At pre-school medical examination a general practitioner ...

Background: Type 1 DM is an autoimmune disease, characterized by destruction of the insulin-producing beta-cells in the islets of Langerhans. The absolute insulin deficiency leads to metabolic imbalance with hyperglycaemia, acidosis and proneness to ketosis. This acute disturbance can change thyroid hormone metabolism.Objective and hypotheses: To examine the influence of metabolic acidosis/ketoacidosis in type 1 DM on thyroid hormone levels.<p class=...

Background: Coping skills are very important for the management of developmental changes among young people, and especially so, for adolescents with chronic diseases such as type 1 diabetes (T1DM).Objective and hypotheses: To study the various coping behaviours in a sample of children and adolescents with T1DM and to evaluate their association with metabolic control and duration of disease.Method: The study population consisted of ...

Objective: To establish a diabetes nurse case manager guided care team in a tertiary hospital paediatric diabetes outpatient clinic. Disease-management programs have demonstrated effectiveness for improving glycaemic control in adults with diabetes. Currently, there is an absence of published literature exploring this model of care in paediatric type 1 diabetes.Methods: Using a before–after research design, the nurse case manager model of care was i...

Background: Transition is a difficult period for adolescents with type 1 diabetes. The non-linear development of the adolescent brain along with increasing insulin resistance, increasing autonomy and risk of psychopathology means that adolescents are vulnerable to poor mental and physical health and ensuing deterioration in metabolic control. It is also during this period of turmoil that adolescents often transfer from paediatric to adult services.Object...

Background: Many epidemiological studies have found high prevalence of vitamin D deficiency in children with type 1-diabetes mellitus (T1D). 1,25(OH)2D is a potent immune-modulator that also enhances the production and secretion of several hormones, including insulin. The association of low serum 1,25(OH)2D levels with high glucose level and diminished insulin sensitivity suggests that vitamin D may modulate insulin metabolism.Aim and objectives: To scre...

Background: Preservation of C-peptide is important and has become regarded a relevant endpoint as already a quite small residual C-peptide seems to be related to both less acute and late diabetes complications.Objective: To assess the residual C-peptide secretion in pediatric patient with T1D.Method: Cross-sectional study of 157 patients with T1D. We analyzed: age at diagnosis, age at time of study (years), sex, diabetes duration (...

Background: Wolfram syndrome is a rare autosomal recessive neurodegenerative disorder caused by mutations in the WFS1 gene. The WFS1 gene is active in cells of body, with highly expression in the, brain, lungs, heart, inner ear, and pancreas. Within cells, WFS1 gene encodes wolframin protein that is located in a structure of endoplasmic reticulum. Endoplasmic reticulum has critical role in protein folding and material transportation within the cell o...

Introduction: Health literacy has been linked to poorer diabetes control and outcomes. Caregivers with poor health literacy may fail to comprehend various elements of diabetes education leading to poor glycaemic control of their children. No studies to date had investigated the link between caregivers’ health literacy and their children’s glycaemic control in an Arabic-speaking population.Objectives and hypothesis: Our aim is to study the link ...

Objective and hypotheses: The work was initiated to assess efficacy of training and achievement of therapy targets in children and adolescents with type 1 diabetes mellitus in “Diabetes Schools”.Method: The five-day training course was conducted in “Type 1 Diabetes School” at the Center for the Scientific and Clinical Study of Endocrinology, Uzbekistan Public Health Ministry (Tashkent). The training was conducted by means of a structu...

Background: It is debated whether oral glucose tolerance test (OGTT) should be routine in child obesity units to identify high risk individuals for impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).Aims: To investigate the prevalence of some signs of metabolic syndrome in child obesity.Methods: All consecutive newly referred obese children (BMI>30) at a Swedish university unit were evaluated with fasting glucos...

Background: Ramadan is the holy month of fasting for Muslims. New evolving technology in the treatment of type 1 diabetes (T1DM) had encouraged Muslim diabetics to pursuit the practice of fasting. There are limited data on fasting of children and adolescence with T1DM during the holy month.Objective and hypotheses: Our aim is to investigate the ability, effect and safety of children and adolescence with T1DM to fast the Holy Month of Ramadan 2014.<p ...

Objectives: To describe a new therapy protocol for the long-term insulin management in neonates and infants with diabetes.Methods: All the infants were fed with 3 hours intervals. The patients were started insulin therapy with 0.6 U/kg per day divided equally into four doses. All the insulin doses were given as premixed insulin (25% insulin lispro and 75% neutral protamine Hagedorn (NPH) insulin) when the number of breast feed was more than three during ...

Objective: The number of heavy newborns is increasing steadily. Often the gestational diabetes (GDM) has not been identified even though an increasing number of pregnant woman are being screened. We examined in a circumscribed area how often the pregnant women passed through an oral glucose tolerance test (oGTT) and had it been realized and interpreted according to the AWMF guidelines.Methods: In this prospective study we analyzed the OGTT results from 1...

Background: Patients with type 1 diabetes (T1D) are at higher risk for developing coexisting autoimmune diseases.Objective and hypotheses: To evaluate thyroid and celiac disease prevalence in children with T1D in Lithuanian paediatric population.Method: 777 patients (49.7% males) <18yrs with T1D, covering all T1D pediatric Lithuanian population, were examined. Serum free thyroxine (FT4), thyrotropin (TSH), antithyroid peroxidas...

Background: Severe hypertriglyceridemia (HTG) is a very rare complication of childhood diabetic ketoacidosis (DKA). The exact mecanism is unclear but transient insulin deficiency may cause a decrease in the activity of lipoprotein lipase. We report a case of girl with DKA and HTG.Case report: A 14-year-old girl, previously healthy and nonobese, presented with DKA following two months malaise, two weeks of polyuria and polydipsia. She was found to have DK...

Background: Microalbuminuria is usually the earliest sign of diabetic nephropathy. However, it does not always progress to macroalbuminuria,and may regress to normoalbuminuria. Mean HbA1c and HbA1c variability was known to be independent risk factors for microalbuminuria in children with type 1 diabetes.Objective and hypotheses: We hypothesised that both mean and variability of HbA1c could affect the progression to macroalbuminuria in children with type ...

Background: Acute painful neuropathy (APN) is a rare manifestation of diabetic neuropathy (DN) in T1D adolescents, associated with poor metabolic control. Eating disorders (ED) often present in T1D patients in association with metabolic derangement, leading to the development of diabetic complications.Case presentation: A teenage girl aged 12 years with a recently diagnosed T1D (duration: 9 months) was admitted with diabetic ketoacidosis...

Background: Tacrolimus is highly potent immunosuppressant agent. Despite it is quite prophylactic effect on renal allogreft rejection, the most marked side effect of tacrolimus is lead to posttranslated diabetes mellitus. There are some predictive risk factors which are determined on development of tacrolimus related diabetes mellitus: Advanced age, familial history, genetic factors, ethnicity, impaired glucose tolerance or metabolic syndrome in pre-transplantation period, obe...

Background: Several studies show there may be a relationship between the use of continuous glucose monitoring systems (CGMS) and improved glycaemic control in patients with type 1 diabetes mellitus (t1dm).Objective and hypotheses: The purpose of this study was to determine if there is a significant correlation between the clinical (office based) use of short-term CGMS and improvement in glycaemic control in paediatric patients with t1dm.<p class="abs...

Background: Neonatal diabetes can present from birth to six months of age. This can often be confused with sepsis as there is considerable overlap of symptoms in this age group as illustrated below.Objective and hypotheses: The cases described illustrate the importance of blood glucose monitoring in sick infants presenting to emergency care settings we recommend an initial check of blood glucose concentrations in all sick infants who present to Accident ...

Background: There is no specific guideline for management of children with type 1 diabetes just after diabetic ketoacidosis (DKA) treatment. There are different insulin dosage practices (from 0.8 to 2.0 U/kg per day) in different centres based on personal experiences.Objective and hypotheses: To assess daily subcutaneous insulin requirements and frequency of hypoglycaemic events (blood glucose < 50 mg/dl) just after DKA treatment of children with typ...

Background: The management of type 1 diabetes is complex, requires a multidisciplinary team and knowledge of the possible advantages of new technologies such as insulin bolus calculators.Aims and objectives: To assess if the use of an automated bolus calculator glucometer Accu-Check Aviva Expert® improves the diabetes control in paediatric patients in multiple daily injections (MDI). To identify which patients benefit most from its use.<p class=...

Background: Maturity Onset Diabetes of the Young (MODY) is a monogenic form of diabetes with onset before 25 years. It is a heterogeneous disorder due to heterozygous monogenic mutations with an autosomal dominant transmission. It represents 2 to 5 percent of diabetes but is often underdiagnosed. We report three cases of MODY highlighting the features of different subtypes, two without associated abnormalities and one with renal disorder.Cases presentati...

Background: Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes that occurs in the first 6 months of life. Infants with NDM do not produce enough insulin, leading to hyperglycaemia. An identified and potentially treatable form of monogenic diabetes is the neonatal diabetes caused by activating mutations of the KCNJ11 gene, which codes for the Kir6.2 subunit of the beta cell of the ATP sensitive potassium channel (KATP). The identification of KCNJ11 mutation has im...

Background: Permanent neonatal diabetes mellitus is caused by mutations in the KATP channel subunits. DEND (Developmental delay, Epilepsy, and Neonatal Diabetes) syndrome is the most severe form of permanent neonatal diabetes. We experienced a patient with DEND syndrome, who was initially misdiagnosed as type 1 diabetes, who has been successfully switched from insulin injection to oral sulfonylurea therapy.Case presentation: A 50-day-old male ...

Background: Neonatal diabetes mellitus (NDM) is a rare insulin-requiring form of diabetes, diagnosed in the first six months of life. Unlike type 1 diabetes mellitus, it is caused by the mutation genes involved in the development and secretory function of the pancreas. ABCC8 gene mutation, resulting in both transient and permanent NDM, increases the sensitivity to the stimulatory actions of ADP, so it remain the potassium channel open and prevent insulin release. Sulfonylurea ...

Background: Type 1 diabetes is one of the most common chronic disease in pediatric age. The incidence is increasing worldwide, with significant variations between countries. In Portugal, the prevalence in pediatric age is about 0.16%.Objective and hypotheses: This study aims to characterize a pediatric population with type 1 diabetes and to identify factors influencing the metabolic control.Method: Retrospective analysis of childre...

Background: Neonatal diabetes mellitus (NDM) presents within 6months of life, is either permanent (PDM) or transient (TND). The incidence is 400 000/live births. Monogenic accounts for the majority of cases. We describe the case of what appears to be a familiar NDM with no current known cause.Case report: EM presented at 3 weeks old. She was born at term, IUGR (2.3 kg) with one day history of diarrhoea, vomiting and anorexia. There was no history of poly...

Background: Almost all diabetic patients eventually develop skin complications from the long-term effects of diabetes mellitus. Cutaneous manifestations generally appear subsequent to the development of diabetes but may be the first presenting sign, or even precede the diagnosis.Objective and hypotheses: To detect the prevalence and spectrum of skin manifestations in type 1 diabetic (T1D) patients attending the Diabetes Endocrine and Metabolism Pediatric...

Introduction: Le diabète de type 1 est l’endocrinopathie la plus fréquente chez l’enfant. Son incidence est en nette progression dans le monde. L’enfant diabétique nécessite une hygiène de vie adaptée et le suivi par une équipe pluridisciplinaire composée de pédiatre spécialiste en diabétologie, psychologue, diététicien, infirmier spécialisé.Objectif: Determiner les...

Background: Insulin pump (IP) is very popular and efficient mean for T1DM treatment in paediatric population. Delivery of basal insulin is automatically regulated 24 h basal set up. But, boluses must be delivered in meal time and their number and type are different.Aims and objectives: To evaluate number and type of boluses in IP treatment of T1DM children and to correlate them with clinical features of the patients and metabolic control of their T1DM.</...

Objective: Continuous subcutaneous insulin therapy (CSII) and therapy with insulin analogues are considered to provide physiological insulin replacement, which results in improvement of diabetes control. Rate metabolic compensation of diabetes mellitus (DM) in children on IPT and basal-bolus insulin therapy on the level HbA1c and self-control of glycemia.Methods: We analyzed retrospectively 88 histories of disease children with type 1 DM. The patients we...

Background: Mauriac syndrome (MS) classically involves hepatomegaly (hepatic glycogenosis), growth impairment and cushingoid features in a patient with poorly controlled type 1 diabetes mellitus (T1DM). The typical age of presentation is adolescence. With the advent of improved insulin regimens, MS has seen less frequently. However, new cases appear each year in medical literature.Clinical case: We report the case of a 9 years and 9 months of age male, w...

Background: Globally approximately 8%1 of children have type 1 diabetes mellitus (TIDM) with an incidence of 24.5 in every 100 000 children (0–14 years)2. TIDM is an autoimmune condition causing the destruction of beta islet cells and is associated with other autoimmune conditions such as coeliac disease (10% of children with TIDM test are positive for TTG) and hypothyroidism (25% have thyroid autoantibodies). We would like to report a case series of...

Background: Precocious puberty is defined as pubertal development that begins at an earlier age than expected; most paediatric endocrinology subspecialists use cutoff ages of 8 years for girls and 9 years for boys.Objective and hypotheses: We reported in this case, rare association between type 1 diabetes mellitus and precocious puberty.Method: We present a girl with type 1 diabetes developed at the age of 3 years, with good glycae...

Background: Type 1 diabetes mellitus has three common presentations: Typical (hyperglycaemia with cardinal symptoms), ketoacidosis and asymptomatic hyperglycaemia.Case presentation: A 7.5-year-old girl with a history of bronchial asthma presented to the emergency department with acute-onset diabetic symptoms. The previous year she was admitted to the Paediatric Ward for a pneumonia complicated by pleural effusion. She then developed hyperglycemia (400 mg...

Background: Several drugs and pharmaceutical formulations not sold in our country for different reasons: economic, market requirements or the prevalence of the disease. Like occur in so-called orphan treatments, diabetes mellitus (DM) children may be deprived of pharmaceutical presentations for its lower numerical prevalence vs the number of adult patients affections DMtipo2 One of the problems that young children face DM1 is its high sensitivity to insulin. Since May 2014 mar...

Background: 1 000 million people worldwide presenting vitamin D deficiency in children prevalence of vitamin D deficiency in certain regions described up to 80%, especially at high latitudes (above 37). Has been postulated role of vitamin D in the immune system and in clinical variability DM1.Objective and hypotheses: To study the degree of deficit VITD in our population (Location: 42° 51’north latitude 2° 41’west longitude) with DM1 ...

Background: Is to evaluate of the quality of the current education program for diabetic children and their parents at Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU).Objective and hypotheses: Is to evaluate of the quality of the current education program for diabetic children and their parents at DEMPU.Method: The present study was an observational longitudinal study conducted on 100 cases of T1D admitted in DEMPU inpatien...