Type 1 diabetes (T1D) is an autoimmune condition characterized by the destruction of insulin-producing pancreatic beta cells, leading to lifelong insulin dependence and significant complications. Early detection of T1D is essential to delay disease onset and improve outcomes. Recent advancements in artificial intelligence (AI) and machine learning (ML) have provided powerful tools for predicting and diagnosing T1D. This systematic review evaluates the current landscape of AI/ML-based approaches for early T1D detection. A comprehensive search across PubMed, EMBASE, Science Direct, and Scopus identified 1447 studies, of which 10 met the inclusion criteria for narrative synthesis after screening and full-text review. The studies utilized diverse ML models, including logistic regression, support vector machines, random forests, and artificial neural networks. The datasets encompassed clinical parameters, genetic risk markers, continuous glucose monitoring (CGM) data, and proteomic and metabolomic biomarkers. The included studies involved a total of 49,172 participants and employed case-control, retrospective cohort, and prospective cohort designs. Models integrating multimodal data achieved the highest predictive accuracy, with area under the curve (AUC) values reaching up to 0.993 in sex-specific models. CGM data and plasma biomarkers, such as CXCL10 and IL-1RA, also emerged as valuable tools for identifying at-risk individuals. While the results highlight the potential of AI/ML in revolutionizing T1D risk stratification and diagnosis, challenges remain. Data heterogeneity and limited model generalizability present barriers to widespread implementation. Future research should prioritize the development of universal frameworks and real-world validation to enhance the reliability and clinical integration of these tools. Ultimately, AI/ML technologies hold transformative potential for clinical practice by enabling earlier diagnosis, guiding targeted interventions, and improving long-term patient outcomes. These advancements could support clinicians in making more informed, timely decisions, thus reducing diagnostic delays and paving the way for personalized prevention strategies in both pediatric and adult populations.

Mobile monitoring devices offer an opportunity to characterize physical health recovery in children who survive critical illness.

To validate the BioIntelliSense BioButton® as a pediatric activity monitor, we studied healthy children (2-17 years-old) who wore the BioButton® device and an ActiGraph wGT3X-BT accelerometer, and a study team member documented activity in 1 min intervals (gold standard) during 45 min of scripted activities. In two-thirds of the cohort (derivation cohort), we identified BioButton activity count thresholds to differentiate activity levels based on highest Youden indices. Thresholds were applied to the remainder of the cohort (validation cohort) to determine sensitivity and specificity [95% confidence interval (CI)]. We also evaluated BioButton activity designations compared with accelerometer designations and calculated agreement between BioButton-measured body position and the activity log.

Forty-five participants provided a median 43 (IQR 41, 44) analyzable minutes. Sensitivity and specificity of derived BioButton thresholds were 0.78 (95% CI: 0.69, 0.88) and 0.95 (95% CI: 0.90, 0.97) to identify moderate or vigorous activity (MVPA) and 0.91 (95% CI: 0.87, 0.95) and 0.98 (95% CI: 0.98, 0.98) to identify sedentary behavior. Sensitivity and specificity compared with the accelerometer were 0.52 (95% CI: 0.45-0.60) and 0.88 (95% CI: (95% CI: 0.84, 0.93) to identify MVPA and 0.92 (95% CI: 0.89-0.96) and 0.70 (95% CI: 0.67, 0.73) to identify sedentary behavior. The BioButton accurately identified position during 1,125 of 1,432 (78.6%) minutes.

The BioButton device accurately identified physical activity and body position in children and may be a useful tool to quantify physical activity as an outcome in future trials.

Proinsulin has three distinct regions: the well-folded A- and B-chains and the dynamic disordered C-peptide. The highly conserved B-chain is a hotspot for diabetes-associated mutations, including the severe loss-of-function R(B22)Q mutation linked to childhood-onset diabetes. Here, we explore R(B22)'s role in proinsulin stability using AlphaFold-predicted structures and metadynamics simulations to achieve enhanced sampling of the free energy landscape. Our results show that R(B22) stabilizes proinsulin by interacting with N86. Substituting R(B22) with E or Q disrupts this interaction, increasing conformational flexibility. The R(B22)Q variant exhibits a flattened free energy landscape, favoring unfolded states. Additional substitutions, including Gly, Ala, Lys, Tyr, Asp, and Phe, destabilize proinsulin to varying extents by weakening hydrogen bonding. Disrupting the R(B22)-N86 interaction broadly reduces inter-chain contacts, raising the risk of aggregation-prone states. Given the link between R(B22) mutations and diabetes, our study provides crucial molecular insights into proinsulin instability. These findings highlight the role of key inter-domain (A-Chain-B-chain, B-Chain-C-peptide, and A-Chain-C-peptide) interactions in maintaining protein structures and the implications this has for understanding disease-associated proinsulin variants.

To investigate the status of self-management of health behaviors in children with Type 1 diabetes mellitus and to analyze their influencing factors. Self-management skills are essential for disease management in children with Type 1 diabetes.

This cross-sectional study was conducted on 132 children with Type 1 diabetes mellitus hospitalized in the Department of Endocrinology and Genetic Metabolism of a tertiary children's hospital. Children were selected from September 2023 to March 2024 by convenience sampling method. A general information questionnaire and the Type 1 Diabetes Behavioral Rating Scale were used to conduct the questionnaire survey.

The mean of health behavior self-management score was (0.60 ± 0.15), and the mean scores of the four dimensions were: daily care behaviors (0.74 ± 0.16), adjustment of diabetes care behaviors (0.29 ± 0.24), diabetes care behavior intervention (0.52 ± 0.25), and other diabetes care behaviors (0.61 ± 0.27) points; one-way analysis of variance showed that the differences in self-management scores of health behaviors of children with Type 1 diabetes mellitus were statistically significant when comparing children with different ages, years since diagnosis, whether they were only children, family structure, whether there was a family member with a diagnosis of diabetes mellitus, literacy level of the parents, and average monthly family income (p < 0.05); the differences between age, whether they were only children, family structure, whether there was a family member with a diagnosed with diabetes mellitus, and average monthly family income were influential factors in the self-management of health behaviors of children with Type 1 diabetes mellitus (p < 0.05).

The level of health behavior self-management of children with Type 1 diabetes mellitus is in the middle-low level, and individualized interventions can be carried out for children with different characteristics to promote the improvement of children's ability to manage their disease and improve their quality of life.

Numerous barriers to moderate and vigorous physical activity (MVPA) exist for youth with type 1 diabetes (T1D). The virtual exercise games for youth with T1D (ExerT1D) intervention implements synchronous support of MVPA including T1D peers and role models.

To understand the acceptability of this intervention to participants.

We conducted post-program, semi-structured, televideo interviews with participating youth to elicit perspectives on acceptability of the intervention and experience with the program. Two coders independently reviewed and analyzed each transcript using a coding scheme developed inductively by senior researchers. Discrepancies were resolved by team discussion, and multiple codes were grouped together to produce four main thematic areas.

All 15 participants provided interviews [14-19 years old; 2 non-binary, 6 females; 7.8% median HbA1c, 5 with HbA1c≥10.0%]. Qualitative data revealed four themes. (1) Motivation to engage in PA: Improving their physical capabilities and/or stabilizing glucose levels were cited as motivation for PA. Challenges of living with T1D were cited as PA barriers. (2) Experience with and motivation to manage diabetes while engaging in PA: Participants provided details of accommodating the inherent uncertainty or limitations of PA with diabetes. Sometimes preparing for PA involved psychological and motivational adjustments. Some relayed feelings of avoidance. (3) Peer support encouraged engagement with the intervention: Participants appreciated the peer aspects of components of ExerT1D. Participants' reflections of the facilitated group experience highlight many benefits of a small-group virtual program. (4) Improvements in PA and diabetes self-management efficacy: All participants credited the program with improving and/or raising awareness of T1D management skills.

Our virtual PA intervention using an active video game and discussion component provided adolescents with T1D the confidence and peer support to engage in PA, improve awareness of diabetes-specific tasks to prepare for exercise, and improved understanding of the effect of PA on glucose levels. Engaging youth with a virtual videogame intervention is a viable approach to overcome barriers to PA for adolescents with T1D.

Interviewed participants of clinical trial NCT05163912.

The incidence of Type 1 Diabetes (T1D) in children and adolescents is increasing by 3-4% per year. Children and adolescents with T1D (CwD) should receive person-centered, specialized treatment from a multidisciplinary team to ensure appropriate care. Italy is the first to implement a countrywide T1D screening program, which will raise the need for funding for specialized pediatric care. The study aims to update the organization of the Italian Centers for pediatric diabetes care.

In 2022, members of the 59 Italian Centers following CwD were invited to complete an email survey regarding the Centers' organization, characteristics, and activities. The questionnaire included information on responders, department organization, team composition, activities, and the organizational structures: department, ambulatory care services (AC), simple operational units (UOS), simple departmental operational units (UOSd), and complex operational units (UOC).

The data collected referred to the year 2022. According to the results, 21,318 people with diabetes were treated. Of these, 19,643 subjects (92.1%) have T1D (16,672 were CwD), 387 (1,8%) have Type 2 Diabetes, and 1,288 (6,1%) have other forms of diabetes. Compared to the 2012 survey, a 13% decrease (from 68 to 59 Centers) in the number of pediatric Centers caring for CwD was observed with a parallel increase of total (+ 6.6%) and average (+ 22%) number of CwD per Center. The estimated prevalence of T1D has increased (1.4 vs. 1.7 per 1,000 CwD-2012 vs. 2022). A reduction in numbers for AC (-22%) and UOS (-35%) was observed, whereas UOSd/UOC increased by 50%. Almost 35% of the dietitians and 40% of the psychologists were not permanent members of the multidisciplinary diabetes team.

The observed decrease in the overall number of pediatric diabetes Centers, the reduction in specialized and dedicated HCPs, and the concurrent increase in the number of treated CwD in the last ten years indicate an alarming situation for pediatric diabetes treatment in Italy. Furthermore, the projected rise in CwD due to the National T1D screening program emphasizes the need for increased resources for specialized pediatric care of CwD at all stages.

Continuous glucose monitor (CGM) use has been linked with better glycemic outcomes (HbA1c), yet many adolescents with type 1 diabetes (T1D) struggle to maintain optimal CGM use.

This study examined CGM use and its association with HbA1c and psychosocial factors among adolescents with T1D experiencing at least moderate diabetes distress (N = 198). We examined mean differences in HbA1c, diabetes distress, diabetes-related family conflict, and quality of life among CGM user groups (Current Users, Past Users, and Never Users).

Current Users demonstrated significantly lower HbA1c than Never Users and significantly lower diabetes distress than Past Users. CGM use was not associated with family conflict or quality of life.

CGM use was associated with lower HbA1c and diabetes distress but not with other psychosocial outcomes. Longitudinal data may explain why many adolescents do not experience improvements in quality of life with CGM use.

Objective: Most adolescents with Type 1 Diabetes (T1D) do not achieve recommended glycemic targets, placing them at risk for long-term complications. Executive functioning (EF), or the cognitive processes that support goal-directed action and management of behavior, emotion, and cognition, is proposed to support effective T1D management and contribute to glycemic stability. We sought to examine associations of EF with T1D management behaviors and diabetes-related distress in adolescents with T1D. Methods: Participants were 13-17-year-olds (M = 15.44, SD = 1.38 years) from a randomized controlled trial (N = 88). We conducted secondary analyses of preintervention data. Youth and their parents each reported on youth EF (Behavior Rating Inventory of Executive Functioning; BRIEF) and T1D management behaviors (Self-Care Inventory-Revised; SCI-R), parents reported on responsibility for T1D management (Diabetes Family Responsibility Questionnaire; DFRQ), and youth reported on their diabetes-related distress (Problem Areas In Diabetes-Teen; PAID-T). Youth also completed performance-based measures of EF. Results: Questionnaire-based and performance-based EF measures were generally unrelated. Regression analysis showed that youth self-reported EF predicted youth-reported T1D management (SCI-R) and diabetes distress (PAID-T) outcomes, and parent-reported youth EF predicted parent-reported T1D management behaviors, such that greater EF difficulties predicted suboptimal management and greater diabetes-related distress (youth PAID-T β: 0.41, p  < 0.01; youth SCI-R β: -0.40, p  < 0.01; parent SCI-R β: -0.33, p  < 0.01). Older child age and poorer performance-based EF also predicted greater youth responsibility for T1D management (age β: 0.43,p  < 0.01; EF reaction time β: 0.23,p < 0.05; EF accuracy β: -0.23, p < 0.05). Conclusions: Youth EF may shape which adolescents are at increased risk for suboptimal T1D management as well as diabetes distress; understanding EF challenges may help guide T1D family management across this developmental period. Implications for EF measurement approaches in youth are also discussed. Trial Registration: ClinicalTrials.gov identifier: NCT03688919.

Exocrine pancreatic insufficiency has been demonstrated in type 1 diabetes (T1D); lower concentrations of pancreatic enzymes have been associated with metabolic risk (MR). Influence of puberty and MR factors on serum concentrations of amylase and lipase remain unexplored in Indian youth with T1D. 1) To characterize and predict determinants of serum amylase and lipase concentrations in adolescents/youth with T1D. 2) To assess relationship between amylase, lipase, and prevalence of MR.

Cross sectional, observational study on 291 (155 girls) adolescents/youth (10-24 years) with T1D. History, examination, body composition, biochemistry (glycated hemoglobin [HbA1c], thyroid stimulating hormone [TSH], lipids).

Mean age, diabetes duration and HbA1c were 15.3, 7.0 years and 10.0 ± 2.1, respectively. Relative risk of lower amylase/higher lipase concentrations (9.5 %) was 1.42 and 1.34, respectively, though these did not reach statistical significance. In pubertal participants, amylase was lower and lipase higher; association was not found with MR. Higher TSH and lower serum calcium were significantly associated with higher lipase (p<0.001).

We have characterized amylase and lipase concentrations across puberty; poor glycemic control tended to be associated with lower amylase and higher lipase, though these findings did not reach statistical significance. Amylase and lipase concentrations should be monitored in Indian adolescents with T1D, particularly in those with poor metabolic control, puberty, uncontrolled hypothyroidism, or reduced calcium intake, while further longitudinal and larger studies are needed to generalize these findings.

Objectives: Type 1 diabetes (T1D) with its worldwide increasing incidence is one of the most serious chronic conditions of adolescence. This study aimed to assess the Palestinian adolescent diabetic patients' health-related quality of life (HRQOL) and to identify specific factors that could predict poor quality of life. We also aimed to compare adolescents' reported HRQOL to proxy reports by their parents. Methods: A cross-sectional study was carried out between November 2022 and October 2023 in the six governorates of northern West Bank/Palestine: Jenin, Nablus, Qalqilya, Salfit, Tubas, and Tulkarm. Patients who were diagnosed with T1D for over 6 months from their recruitment, aged between 10 and 18 years, were recruited from diabetes clinics of the Ministry of Health (MOH) and the Palestine Diabetes Institute (PDI). One hundred seventy adolescents and 170 parents (or guardians) completed the Pediatric Quality of Life Inventory (Peds QL) 3.2 Diabetes Module for adolescents and parents, respectively. Results: An acceptable mean of 70.6 for the total score was reported for the Peds QL 3.2 Diabetes Module. Better scores were reported for the diabetes management summary score compared to the diabetes symptom summary score. Worry and communication were the lowest and highest reported subscores, respectively. Parents reported significantly lower results than adolescents. Income, gender, and hemoglobin A1c (HbA1c) were the main predictors of HRQOL among adolescents with T1D in Palestine. Conclusions: Future national health strategies should consider income differences and try to overcome health gaps among adolescents with T1D coming from low-income families. Future research is needed to explore the political and cultural aspects and their effects on HRQOL among diabetic adolescents in Palestine.

Low-carbohydrate (LC) diets have gained popularity. We compared glycaemic and metabolic parameters following an LC versus a Mediterranean (MED) diet in adolescents and youths with type 1 diabetes.

In a six-month, open-label, randomised trial, 40 individuals were assigned to either diet. Glycaemic outcomes, based on continuous glucose monitoring, included per cent time of blood glucose in the range [3.9-10.0 mmol/L (70-180 mg/dL)] and haemoglobin A1c (HbA1c).

Twenty-eight (70%) were females. The median age was 18 years. After 6 months, the median time in range increased from 47% to 58% in the LC and from 52% to 64% in the MED diet group (p = 0.98). The delta values for the time in range were 16% and 7% for the respective groups (p = 0.09). The percentage of time >13.9 mmol/L (>250 mg/dL) improved more in the LC diet than in the MED diet group: -10% vs. -2% (p = 0.005). The percentage of time <3.0 mmol/L (<54 mg/dL) was comparable. The delta HbA1c improved in both groups: -0.7% vs. -0.1% (p = 0.02). Changes in BMI Z-score and lipid levels were similar.

Both diets improved glycaemic outcomes in adolescents and youths with type 1 diabetes, without increasing hypoglycaemia or cardiovascular risk factors, indicating comparable safety and efficacy.

Geographic Information System (GIS) mapping, is a novel way to provide insights into spatial distribution of type 1 diabetes (T1D) and associations between T1D outcomes and potential predictors. We aimed to explore GIS in children with T1D, and identify predictors of poor glycemic control.

Design: Cross-sectional; Participants: 402 children and youth (187 boys) with T1D. Place of residence (coordinates) of participants were geocoded in GIS. They were divided into two groups living in urban or peri-urban areas using ArcGIS Pro. The characteristics of urban/peri-urban living were linked to sociodemographic and biochemical data and spatial autocorrelation analysis was performed. Association between glycemic control and distance to our unit was studied.

Mean age was 13.2 ± 4.7 years; 196 children were living in urban areas, 206 in peri-urban areas. There was significant difference in HbA1c between groups (Urban 9.9 (9.7, 10.2) %, Peri-urban 10.5 (10.1, 10.8) %) (p=0.004); mean difference 0.5 (0.1, 1.0) with poorer glycemic control and higher prevalence of vitamin D sufficiency in peri-urban and higher prevalence of hypothyroidism in urban areas. There was significant correlation between glycemic control (HbA1c) and distance to our unit r=0.108 (0.023, 0.218) (p=0.031). Individuals with an HbA1c ≥9.5 were residing farther away (58.9 (49.4, 68.5) km) as compared to those with HbA1c <9.5 (44.5 (35.1, 53.9) km) (p<0.05).

Children with T1D when grouped using GIS had differences in glycemic control and comorbidities; peri-urban participants and those residing further away from our unit had poorer glycemic control. Future efforts may be aimed at identifying centers and channelizing resources towards children showing poor glycemic control, thus optimizing disease management.

Introduction: The shaping of the human intestinal microbiota starts during the intrauterine period and continues through the subsequent stages of extrauterine life. The microbiota plays a significant role in the predisposition and development of immune diseases, as well as various inflammatory processes. Importantly, the proper colonization of the fetal digestive system is influenced by maternal microbiota, the method of pregnancy completion and the further formation of the microbiota. In the subsequent stages of a child's life, breastfeeding, diet and the use of antibiotics influence the state of eubiosis, which determines proper growth and development from the neonatal period to adulthood. The literature data suggest that there is evidence to confirm that the intestinal microbiota of the infant plays an important role in regulating the immune response associated with the development of allergic diseases. However, the identification of specific bacterial species in relation to specific types of reactions in allergic diseases is the basic problem. Background: The main aim of the review was to demonstrate the influence of the microbiota of the mother, fetus and newborn on the functioning of the immune system in the context of allergies and asthma. Methods: We reviewed and thoroughly analyzed the content of over 1000 articles and abstracts between the beginning of June and the end of August 2024. Over 150 articles were selected for the detailed study. Results: The selection was based on the PubMed National Library of Medicine search engine, using selected keywords: "the impact of intestinal microbiota on the development of immune diseases and asthma", "intestinal microbiota and allergic diseases", "the impact of intrauterine microbiota on the development of asthma", "intrauterine microbiota and immune diseases", "intrauterine microbiota and atopic dermatitis", "intrauterine microbiota and food allergies", "maternal microbiota", "fetal microbiota" and "neonatal microbiota". The above relationships constituted the main criteria for including articles in the analysis. Conclusions: In the present review, we showed a relationship between the proper maternal microbiota and the normal functioning of the fetal and neonatal immune system. The state of eubiosis with an adequate amount and diversity of microbiota is essential in preventing the development of immune and allergic diseases. The way the microbiota is shaped, resulting from the health-promoting behavior of pregnant women, the rational conduct of the medical staff and the proper performance of the diagnostic and therapeutic process, is necessary to maintain the health of the mother and the child. Therefore, an appropriate lifestyle, rational antibiotic therapy as well as the way of completing the pregnancy are indispensable in the prevention of the above conditions. At the same time, considering the intestinal microbiota of the newborn in relation to the genera and phyla of bacteria that have a potentially protective effect, it is worth noting that the use of suitable probiotics and prebiotics seems to contribute to the protective effect.

Asthma is considered one of the most common and serious noncommunicable diseases, with high morbidity and mortality rates in both children and adults.

To estimate the frequency and to determine the associated factors of self-reported asthma among children diagnosed with type 1 diabetes.

A cross-sectional study design was employed, and 175 subjects having type 1 diabetes for more than 1 year were included from the pediatrics endocrine clinic. Validated questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC) were used for data collection. Statistical analysis was performed using SPSS version 23.0.

The study included 175 participants (48% boys, 52% girls) with a mean age of 10.9 ± 3.76 years. The majority were of high socioeconomic status, that is, with a monthly family income >15,000 Saudi Riyal (SR) . Notably, 78 participants (44.6%) were diagnosed with type 1 diabetes (2-5 years' duration, and the average age at diagnosis was 7.4 ± 3.27 years). Hospital admissions due to diabetes in the past year were reported in 101 (57.7%) patients. Moreover, 143 (81.7%) participants reported hyperglycemic symptoms, while 125 (71.4%) experienced hypoglycemic symptoms. About 36 (20.6%) participants had self-reported asthma, with wheezing reported in 46 (26.3%) participants. Other sociodemographic and diabetes factors showed no significant associations. The prevalence of self-reported asthma was noted in 36 children with type 1 diabetes (20.6%). The presence of a family history of asthma was the only significant variable associated with self-reported asthma in children with type 1 diabetes (p<0.001). The odds of developing asthma increased by almost 11 times among children with type 1 diabetes who had a positive family history of asthma (p=0.002). Middle-income status also showed increased odds of risk for developing asthma by 4.4 times, but it did not reach the level of statistical significance (p=0.21).

A higher prevalence of self-reported asthma was found among children with type 1 diabetes. Those with a family history of asthma may be considered for screening and educational programs.

Diabetes technology in the form of digital health or medical devices holds a promise for improving the quality of life and glycemic outcomes. A comprehensive insight into diabetes technology and its impact in Saudi Arabia and the MENA region may improve type 1 diabetes mellitus (T1DM) management.

This study aimed to assess the impact of different DM-specific technologies: Insulin pump therapy, continuous glucose monitoring (CGM), and automated insulin delivery system in terms of glycemic control and QoL among T1DM patients in Saudi Arabia and the MENA region.

A systematic literature search was performed in PubMed and Scopus from 2005 until August 2023. The search was based on the PICO strategy, focusing on T1DM patients, diabetes technology, and QoL. The inclusion criteria were studies illustrating the effect of diabetes technologies on glycemic control or quality of life or both among T1DM patients. Systematic reviews, books, letters, or studies, including type 2 diabetes mellitus, were excluded.

From 101 articles, eighteen studies were duplicated, and thirty-three studies were excluded after reading the title and abstract. Of the 50 articles analyzed, twenty-five articles did not meet the inclusion criteria. Therefore, 25 articles involving a total of 3088 participants were enrolled in the study. It was shown that a continuous glucose monitoring system and continuous subcutaneous insulin infusion improved the glycemic control and the QoL of T1DM patients.

There was a positive impact of insulin pumps, continuous glucose monitoring (CGM) systems, and telemedicine in achieving optimal glucose control and better QoL. Further studies are recommended to clarify the significant role of advanced diabetes technologies.

The purpose of this quantitative study was to consider factors that may negatively impact glycemic levels in Black and White children 8-12 years old with a diagnosis of type 1 diabetes mellitus.

Perceived stress, diabetes distress, morning and afternoon salivary cortisol, inflammatory biomarkers, and hemoglobin A1c (HbA1c) were measured in this quantitative, cross-sectional phase of a larger, mixed methods study. Thirty-four children and their parents completed self-report surveys, and children provided blood and salivary samples, to examine effect sizes of relationships among variables of interest.

Most children did not meet ADA recommendations for HbA1c. HbA1c was higher in Black children. Medium-to-large effects were noted between perceived stress and HbA1c. Cortisol and IL-8 may mediate the relationship between perceived stress and HbA1c in children.

Understanding causes of elevated glycemic levels in children, especially from low-income and underrepresented populations, may help tailor diabetes management interventions to improve health outcomes.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Background Type I diabetes mellitus (T1DM) is a prevalent chronic illness that typically manifests in childhood. In patients who are genetically predisposed to diabetes, complex interactions between environmental and genetic factors play a role in the development of type 1 diabetes. There is proof that the onset of type 1 diabetes raises the possibility of developing additional autoimmune conditions. This has to do with the hereditary predisposition to these illnesses. As the autoimmune process in pancreatic beta cells advances, it may also impact other organs, leading to the emergence of autoimmune diseases that are either organ-specific or organ-nonspecific. Purpose The purpose of this study is to determine the prevalence of autoimmune disorders among children who are diagnosed with T1DM in Al-Ahsa, Saudi Arabia, and assess the potential impact of these conditions on other comorbidities. Methods Over the course of three years, from 2020 to 2023, children with T1DM were the subjects of this descriptive retrospective cross-sectional study conducted in the Endocrinology and Diabetes Unit of the Maternity and Children's Hospital in Al-Ahsa, Saudi Arabia. There were 281 participants in total. Clinical and laboratory research was conducted on autoimmune T1DM. Results A total of 281 T1DM children were investigated, with 59.9% being female and 43.1% being male. The mean age was 12.8 ± 3.3 years, and the mean disease duration at the end of follow-up was 6.6 ± 2.9 years. Among these participants, 5.3% were diagnosed with at least one autoimmune disease (AID). Celiac disease is the most commonly reported AID, accounting for 56.3%, followed by hypothyroidism (31.3%). An increased risk of developing AIDs was linked to significant associations between older age (>10 years old) and longer duration of DM (p<0.05). Conclusion The data show a high prevalence of autoimmune comorbidities among pediatric T1DM patients treated at our department. The findings highlight the importance of regular screenings in facilitating timely diagnosis and intervention, which is critical in promoting the well-being and normative development of pediatric patients.

Studies on machine learning (ML) for the prediction of diabetic nephropathy (DN) in type 1 diabetes mellitus (T1DM) patients are rare. This study focused on the development and external validation of an explainable ML model to predict the risk of DN among individuals with T1DM.

This was a retrospective, multicenter study conducted across 19 hospitals in Gansu Province, China (No: 2022-473). In total, 1368 patients were eligible for analysis among 1633 collected T1DM patients from January 2016 to December 2023. Recursive feature elimination using random forest and fivefold cross-validation was conducted to identify key features. Among the 12 initial ML algorithms, the optimal ML model was developed and validated externally in a distinct population, and its predictive outcomes were explained via the SHapley additive exPlanations method, which offered personalized decision insights.

Among the 1368 T1DM patients, 324 had DN. The extreme gradient boosting (XGBoost) model, which achieved optimal performance with an AUC of 83% (95% confidence interval [CI]: 76‒89), was selected to predict the risk of DN among T1DM patients. The DN predictive model included variables such as T1DM duration, postprandial glucose (PPG), systolic blood pressure (SBP), glycated hemoglobin (HbA1c), serum creatinine (Scr) and low-density lipoprotein cholesterol (LDL-C). External validation confirmed the reliability of the model, with an AUC of 76% (95% CI: 70‒82).

The ML prediction tool has potential for advancing early and precise identification of the risk of DN among T1DM patients. Although successful external validation indicated that the developed model can provide a promising strategy for clinical adoption and help improve patient outcomes through timely and accurate risk assessment, additional prospective data and further validation in diverse populations are necessary.

Living with type 1 diabetes requires burdensome and complex daily diabetes self-management behaviors. This study aimed to determine the association between integrated behavior performance and HbA1c, while identifying the behavior with the most significant impact on HbA1c.

A simple and feasible questionnaire was used to collect diabetes self-management behavior in patients with type 1 diabetes (n = 904). We assessed six dimensions of behavior performance: continuous glucose monitor (CGM) usage, frequent glucose testing, insulin pump usage, carbohydrate counting application, adjustment of insulin doses, and usage of apps for diabetes management. We evaluated the association between these behaviors and HbA1c.

In total, 21.3% of patients performed none of the allotted behavior, while 28.5% of patients had a total behavior score of 3 or more. 63.6% of patients with a behavior score ≥ 3 achieved HbA1c goal, contrasting with only 30.4% of patients with a behavior score of 0-1. There was a mean 0.54% ± 0.05% decrease in HbA1c for each 1-unit increase in total behavior score after adjustment for age, family education and diabetes duration. Each behavior was independently correlated with a lower HbA1c level, with CGM having the most significant effect on HbA1c levels.

Six optimal self-management behaviors, especially CGM usage, were associated with improved glycemic control, emphasizing the feasibility of implementing a simplified version of DSMES in the routine clinical care.

ClinicalTrials.gov Identifier: NCT03610984.

Prevalence of diabetes in Arab region has significantly increased, resulting in a significant economic burden on healthcare systems. This surge can be attributed to obesity, rapid urbanization, changing dietary habits, and sedentary lifestyles. The Arab Diabetes Forum (ADF) has established localized recommendations to tackle the region's rising diabetes prevalence. The recommendations, which incorporate worldwide best practices, seek to enhance the quality of treatment for people with diabetes by raising knowledge and adherence among healthcare providers. The guidelines include comprehensive recommendations for screening, diagnosing, and treating type 1 and type 2 diabetes in children and adults for better overall health results.

Children and adolescents with type 1 diabetes require frequent outpatient evaluation to assess glucose trends, modify insulin doses, and screen for comorbidities. Continuous glucose monitoring (CGM) provides a detailed glycemic control assessment. Telemedicine has been increasingly used since the COVID-19 pandemic.

To investigate CGM profile parameter improvement immediately following pediatric outpatient diabetes visits and determine if visit modality impacted these metrics, completion of screening laboratory tests, or diabetic emergency occurrence.

A dual-center retrospective review of medical records assessed the CGM metrics time in range and glucose management indicator for pediatric outpatient diabetes visits during 2021. Baseline values were compared with those at 2 and 4 weeks post visit. Rates of completion of screening laboratory tests and diabetic emergencies following visits were determined.

A total of 269 outpatient visits (41.2% telemedicine) were included. Mean time in range increased by 1.63% and 1.35% at 2 and 4 weeks post visit (P=.003 and .01, respectively). Mean glucose management indicator decreased by 0.07% and 0.06% at 2 and 4 weeks post visit (P=.003 and .02, respectively). These improvements in time in range and glucose management indicator were seen across both telemedicine visits and in-person visits without a significant difference. However, patients seen in person were 2.69 times more likely to complete screening laboratory tests (P=.03). Diabetic emergencies occurred too infrequently to analyze.

Our findings demonstrate an immediate improvement in CGM metrics following outpatient visits, regardless of modality. While statistically significant, the magnitude of these changes was small; hence, multiple visits over time would be required to achieve clinically relevant improvement. However, completion of screening laboratory tests was found to be more likely after visits occurring in person. Therefore, we suggest a hybrid approach that allows patient convenience with telemedicine but also incorporates periodic in-person assessment.

Food insecurity (FI) is associated with poor health outcomes in children, and studies have shown higher FI among children with diabetes mellitus. This study assessed provider (N = 22, 35.5% response rate) and parent/guardian (N = 207, 14.6% response rate) perspectives toward FI screening in a pediatric diabetes program. Among 22 providers, most "rarely" (54.5%) or "never" (27.3%) screened for FI although all felt that screening was at least "slightly important." Barriers included lack of time (63.6%), not remembering to screen (59.1%), lack of knowledge about how to address positive screens (45.5%), and being unsure how to screen (40.9%). Among 186 parent/guardians, only 24.1% had been asked about FI at a pediatric medical appointment, but only 8.6% disliked the idea of being asked by a medical provider at endocrinology visits. To be effective and sustainable, FI screening must fit within the visit flow, and providers need education on how to address positive screens.

Diabetic ketoacidosis (DKA) is a life-threatening emergency that can result from delayed diagnosis of type 1 diabetes mellitus (T1DM). Three-quarters of Australian children with a new diagnosis of T1DM visit their general practitioner (GP) the week prior to developing DKA, with similar trends observed internationally.

To summarise interventions in general practice to reduce diagnostic delay in paediatric T1DM and to evaluate their effectiveness.

Six databases (Ovid, Web of Science, CINAHL, Evidence-Based Medicine Reviews, Google Scholar and EMBASE) were searched. Any English language, less than 20 years study involving interventions targeting GPs specifically in the prevention of paediatric DKA, was included. Primary outcomes were (a) the number of children presenting to the hospital in DKA following diagnostic delay after a GP visit and (b) DKA rate. The secondary outcome was changes in GPs' behaviour regarding timeliness of referrals. Two reviewers completed title, abstract and full-text review, with conflicts resolved by a third reviewer. ROBINS-I risk of bias was used for appraisal. High heterogeneity among studies rendered meta-analysis unsuitable. Structured tabulation of results was completed for analysis. The date of last search was 2 July 2023.

Eight studies were included (three conference abstracts and five peer-reviewed publications.) We identified six intervention types attempting to facilitate timely diagnosis of type 1 diabetes in the general practice setting: direct communication, indirect communication, education sessions, electronic clinical decision support tools, updated referral pathways and provision of glucose and/or ketone monitors. Due to the limited number of peer-reviewed studies identified by this review, we were not able to identify the extent to which these interventions were successful.

Paucity of information regarding study methodology and high heterogeneity among study design and outcome measures limited our conclusions regarding acceptability, effectiveness and reach. Future studies should include GPs in their design and consider the sustainability of interventions in the long term.

CRD42023412504.

Type 1 diabetes mellitus (T1DM) is regarded as the most chronic autoimmune disease affecting children and adolescents that results from a destruction of pancreatic β-cell and leads to insulin insufficiency and persistent hyperglycemia (HG). Children and adolescents with T1DM are at an increased risk of developing microvascular complications, including diabetic nephropathy (DNE), diabetic retinopathy (DR), and diabetic neuropathy (DNU). The risk factors and prevalence of these complications differ greatly in pediatric studies. Screening for T1DM microvascular complications undergoes different stages and it is recommended to identify early symptoms and clinical signs. The identification of biomarkers in T1DM microvascular complications is needed to provide optimal treatment. Despite several studies on early biomarkers for DNE in children, the potential biomarkers for predicting DR and DNU have not been completely illustrated. This review fills this gap by identifying biomarkers of T1DM microvascular complications in children and adolescents through searches in the PubMed/Medline database.

Diabetes has become a global epidemic, necessitating effective self-management strategies. This is particularly crucial for parents of children with type 1 diabetes mellitus, as they must make numerous daily decisions and perform complex care activities. Therefore, the aim of this study was to develop a comprehensive diabetes self-management scale specifically for parents of children with type 1 diabetes. This scale aims to holistically address behaviors impacting diabetes self-management and to evaluate its psychometric properties.

A methodological, correlational, and cross-sectional study was conducted with a sample of 190 parents of children with type 1 diabetes mellitus. The scale items were reviewed by five experts to ensure they adequately covered the parents' evaluation of their children's diabetes self-management. Following this, a Turkish language expert assessed the draft scale for language accuracy, comprehensibility, and grammar. The data were analyzed using descriptive statistics (numbers and percentages), Cronbach's α reliability coefficient, factor analysis, and correlation analysis.

The Cronbach's alpha for the overall scale was 0.893, and the Cronbach's alpha for the subscales was between 0.757 and 0.845. The item-total score correlations ranged between 0.408 and 0.660 (p < .05). The exploratory factor analysis showed that the scale explained 61.427% of the total variance, and the factor loadings of items ranged from 0.574 to 0.859. The confirmatory factor analysis also showed that the factor loadings of the scale items ranged from 0.574 to 0.859.

The validity and reliability analyses revealed that the scale is a valid and reliable measurement tool for the Turkish culture.

Recent advancements in the management of type 1 diabetes mellitus (T1DM) have significantly improved outcomes and quality of life for patients, particularly children. Technological innovations, such as continuous glucose monitoring (CGM) systems and insulin pump therapy, including hybrid closed-loop systems, have enhanced glycemic control by providing real-time data and automated insulin delivery. Ultrarapid-acting insulins and adjunctive pharmacotherapies, like sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists, offer improved postprandial glucose management and reduced insulin requirements. Immunotherapy and beta-cell replacement therapies, including stem cell research and encapsulation devices, aim to preserve or restore endogenous insulin production. Digital health platforms and telemedicine have expanded access to education and support, fostering better self-management. Future directions in precision medicine, artificial intelligence, and microbiome research hold promise for personalized and potentially curative treatments. Collectively, these advances are transforming T1DM management, reducing disease burden, and enhancing the prospects for children with T1DM.

We examined the inter-correlation between diet quality, objectively measured sleep duration, and subjectively measured sleep quality with flash glucose monitoring (FGM)-measured glycemia among young patients with type 1 diabetes (T1D).

Following cross-sectional design, Fitbit® accelerometers were used to objectively assess sleep duration, while the validated questionnaires Pittsburgh sleep quality index and Mediterranean diet (MD) adherence were used to subjectively assess sleep quality and diet quality, respectively. Glycated hemoglobin (HbA1c) and FGM-reported glycemia components among children with T1D were assessed as well.

Of the 47 participants surveyed (25 boys, 22 girls, 9.31 ± 2.88 years), the majority reported high HbA1c, good sleep quality, and high adherence to the MD. However, only one-third of the participants reported a healthy sleep duration. Only the sleep latency was significantly (P < 0.05) associated with the time above range level 2 and time below range level 2 (P = 0.048) components of the FGM. A positive correlation (r = 0.309, P = 0.035) was reported between adherence to MD and time in range of the FGM.

Diet quality and sleep quality are variably inter-correlated with FGM-measured glycemia among young patients with T1D and are suggested to be considered influential factors in FGM-monitored diabetes research on this age group.

The time during which adolescents and young adults (AYAs) living with Type 1 Diabetes (T1D) transition from pediatric to adult care is associated with blood sugar levels outside of target ranges, care gaps, and an increased risk of acute diabetes complications. The aim of this study was to understand (1) the perspectives of AYAs and providers about the strengths, challenges, and opportunities of transition care and (2) the role of digital technologies in supporting the transition to adult care. Research Design and Methods. We conducted a qualitative descriptive study that involved 43 semistructured interviews in French or English with AYA living with T1D (aged 16-25; n = 22) and pediatric or adult diabetes health care providers (HCPs) (n = 21).

We identified three themes. First, transition care is not standardized and varies widely, and there is a lack of awareness of transition guidelines. Second, virtual care can simultaneously hinder and help relationship-building between providers and AYA. Third, AYAs value a holistic approach to care; both HCPs and AYA highlighted the opportunity to better support overall mental wellbeing.

The design of digital technologies to support T1D transition care should consider methods for standardizing holistic care delivery and integrating hybrid diabetes care visits to support access to transition care. These findings can inform future transition intervention development that leverages existing transition guidelines, targets holistic care model integration, and considers quantitative diabetes metrics in conjunction with broader life experiences of AYA when providing transition care.

Type 1 diabetes (T1D) is a complex, chronic autoimmune disease that affects over 1.6 million people in the United States. It is now understood that T1D may be undetected for many years while the disease progresses quietly without producing symptoms. T1D can be identified through diabetes-related autoantibody screening and staged accordingly, enabling healthcare providers to identify high-risk individuals in the early stages of the disease and either provide a stage-specific intervention or offer clinical trial opportunities to preserve beta cell function and anticipate the onset of clinical T1D. Evidence-based clinical practice guidelines currently do not exist for routine diabetes-related autoantibody screening of individuals at risk of developing T1D or of the general population. The purpose of this article is to help clinicians acquire an understanding of the rationale and protocols recommended for identifying patients at risk of developing T1D and monitoring such patients for autoimmune markers and progression of disease from Stage 1 to Stage 3 (clinical disease).

Type 1 diabetes is one of the most common chronic diseases in children. Wearable technology (insulin pumps and continuous glucose monitoring devices) that makes diabetes management relatively simple, in addition to education and follow-ups, enhances the quality of life and health of individuals with diabetes.

To evaluate the impact of wearable technology on metabolic management and the quality of life in children and adolescents with type 1 diabetes.

Systematic review and meta-analysis.

The Preferred Reporting System for Systematic Reviews and Meta-Analyses was used to conduct a systematic review and meta-analysis. PubMed, Web of Science, MEDLINE, Cochrane Library, EBSCO, Ulakbim and Google Scholar were searched in July 2022 and July 2023 using predetermined keywords. The methodological quality of the studies was evaluated using the Joanna Briggs Institute’s Critical Appraisal Checklists for randomized controlled experimental and cross-sectional studies. The meta-analysis method was used to pool the data.

Eleven studies published between 2011 and 2022 were included. The total sample size of the included studies was 1,853. The meta-analysis revealed that the decrease in hemoglobin A1C (HbA1c) level in those using wearable technology was statistically significant [mean difference (MD): -0.33, Z = 2.54, p = 0.01]. However, the technology had no effect on the quality of life [standardized mean difference (SMD): 0.44, Z = 1.72, p = 0.09]. The subgroup analyses revealed that the decrease in the HbA1c level occurred in the cross-sectional studies (MD: -0.49, Z = 2.54, p = 0.01) and the 12-19 (MD = 0.59, Z = 4.40, p < 0.001) and 4-18 age groups (MD: -0.31, Z = 2.56, p = 0.01). The subgroup analyses regarding the quality of life revealed that there was no difference according to the research design. However, the quality of life was higher in the wearable technology group than in the control group in the 8-12 and 4-18 age groups (SMD: 1.32, Z = 2.31, p = 0.02 and SMD: 1.00, Z = 5.76, p < 0.001, respectively).

Wearable technology effectively reduces the HbA1c levels in children and adolescents with type 1 diabetes in some age groups. However, it does not affect the quality of life.

Hypoglycemia constitutes a communication barrier between youth with type 1 diabetes, their family members and health professionals. A narrative tool may contribute to a more effective communication.

Semi-structured interviews with six open-ended questions using narrative techniques collect and analyze (thematic and comparative analysis) different ways of "naming" the lived experience of hypoglycemia.

103 participants, 40 with type 1 Diabetes aged 10-18 years (17 female), 63 relatives (40 female). Group 1 (G1), 10-14 years old (n = 21), Group 2 (G2), 15-18 years old (n = 19), Group 3 (G3) relatives, 30-59 years old. G3 was divided, G3.1: female (n = 42) and G3.2: male (n = 21).G1 and G2 presents greater attention to symptoms. G1 refers a greater need for help, G2 emphasizes autonomy. G2 and G3 describes better the medical protocol. G1 and G2 refer more topics such as "discomfort", "frustration", "obligation", "difficulty in verbalizing", G3 refers to "gilt", "fear" and "responsibility". G3.1 refer more "symptoms", "responsibility", "fault", "incapacity".

A narrative tool enhances the singularity of a common experience, proving itself useful to adolescents, relatives, and healthcare professionals.

In addition to gathering information that is usually acquired empirically, a narrative tool exposes knowledge gaps and may allow implementing intervention strategies.

The SARS-CoV-2 (severe acute respiratory syndrome related coronavirus 2) pandemic revealed many flaws in our health care system. This review aims to explore the significance of loss to follow-up on patients with type 1 diabetes during the pandemic, the morbidity and mortality associated, and strategies to prevent loss to follow-up or to re-engage patients in longitudinal care. [Pediatr Ann. 2024;53(7):e254-e257.].

Adolescents with type 1 diabetes (T1D) and their caregivers endorse high diabetes distress (DD). Limited studies have documented the impact of DD on Black youth. The aims of the present study were to (1) describe DD among a sample of Black adolescents with T1D and their caregivers, (2) compare their DD levels with published normative samples, and (3) determine how DD relates to glycemic outcomes, diabetes self-management, parental monitoring of diabetes, and youth depressive symptoms.

Baseline data from a multicenter clinical trial were used. Participants (N = 155) were recruited from 7 Midwestern pediatric diabetes clinics. Hemoglobin A1c (HbA1c) and measures of DD, parental monitoring of diabetes care, youth depression and diabetes management behaviors were obtained. The sample was split into (1) adolescents (ages 13-14; N = 95) and (2) preadolescents (ages 10-12; N = 60). Analyses utilized Cohen's d effect sizes, Pearson correlations, t-tests, and multiple regression.

DD levels in youth and caregivers were high, with 45%-58% exceeding either clinical cutoff scores or validation study sample means. Higher DD in youth and caregivers was associated with higher HbA1c, lower diabetes self-management, and elevated depressive symptoms, but not with parental monitoring of diabetes management.

Screening for DD in Black youth with T1D and caregivers is recommended, as are culturally informed interventions that can reduce distress levels and lead to improved health outcomes. More research is needed on how systemic inequities contribute to higher DD in Black youth and the strategies/policy changes needed to reduce these inequities.

Down syndrome is the most common genetic cause of intellectual disability and has previously been associated with a variety of autoimmune disorders affecting multiple organ systems. The high prevalence of autoimmune disease, in conjunction with other inflammatory and infectious diseases, in this population suggests an intrinsic immune dysregulation associated with triplication of chromosome 21. Emerging data on the role of chromosome 21 in interferon activation, cytokine production, and activation of B-cell mediated autoimmunity are emerging hypotheses that may explain the elevated prevalence of autoimmune thyroid disease, celiac disease, type I diabetes, autoimmune skin disease, and a variety of autoimmune neurologic conditions. As the life expectancy for individuals with Down syndrome increases, knowledge of the epidemiology, clinical features, management and underlying causes of these conditions will become increasingly important. Disorders such as Hashimoto's thyroiditis are prevalent in between 13 and 34% of individuals with Down syndrome but only 3% of the neurotypical population, a pattern similarly recognized in individuals with Celiac Disease (5.8% v 0.5-2%), alopecia areata (27.7% v. 2%), and vitiligo (4.4% v. 0.05-1.55%), respectively. Given the chronicity of autoimmune conditions, early identification and management can significantly impact the quality of life of individuals with Down syndrome. This comprehensive review will highlight common clinical autoimmune conditions observed in individuals with Down syndrome and explore our current understanding of the mechanisms of disease in this population.

Type I diabetes mellitus (T1DM) is a significant health challenge, especially for children, owing to its chronic autoimmune nature. Although the exact etiology of T1DM remains elusive, the interplay of genetic predisposition, immune responses, and environmental factors are postulated. Genetic factors control immune reactivity against β-cells. Given the pivotal roles of CIITA and CLEC2D genes in modulating a variety of immune pathologies, we hypothesized that genetic variations in CIITA and CLEC2D genes may impact T1DM disease predisposition. This study was designed to explore the association between gene polymorphisms in CIITA (rs8048002) and CLEC2D (rs2114870) and type 1 diabetes (T1DM), with a focus on analyzing the functional consequence of those gene variants.

The study enlisted 178 healthy controls and 148 individuals with type 1 diabetes (T1DM) from Suez Canal University Hospital. Genotyping for CIITA and CLEC2D was done using allelic-discrimination polymerase chain reaction (PCR). Levels of glycated hemoglobin (HbA1c) and lipid profiles were determined through automated analyzer, while fasting blood glucose and insulin serum levels were measured using the enzyme-linked immunosorbent assay (ELISA) technique. RegulomeDB was used to examine the regulatory functions of CIITA (rs8048002) and CLEC2D (rs2114870) gene variants.

Analysis of the genotype distribution of the CIITA rs8048002 polymorphism revealed a significantly higher prevalence of the rare C allele in T1DM patients compared to the control group (OR = 1.77; P = 0.001). Both the CIITA rs8048002 heterozygote TC genotype (OR = 1.93; P = 0.005) and the rare homozygote CC genotype (OR = 3.62; P = 0.006) were significantly more frequent in children with T1DM when compared to the control group. Conversely, the rare A allele of CLEC2D rs2114870 was found to be significantly less frequent in T1DM children relative to the control group (OR = 0.58; P = 0.002). The heterozygote GA genotype (OR = 0.61; P = 0.033) and the rare homozygote AA genotype (OR = 0.25; P = 0.004) were also significantly less frequent in T1DM patients compared to the control group. Both CIITA (rs8048002) and CLEC2D (rs2114870) gene variants were predicted to have regulatory functions, indicated by a RegulomeDB score of (1f) for each.

The rare C allele of CIITA rs8048002 genetic variant was associated with an increased risk of developing T1DM, while the less common A allele of CLEC2D rs2114870 was associated with a reduced risk of T1DM.

The online version contains supplementary material available at 10.1007/s40200-024-01402-w.

Maturity Onset Diabetes of the Young (MODY) is a young-onset, monogenic form of diabetes without needing insulin treatment. Diagnostic testing is expensive. To aid decisions on who to test, we aimed to develop a MODY probability calculator for paediatric cases at the time of diabetes diagnosis, when the existing "MODY calculator" cannot be used. Firth logistic regression models were developed on data from 3541 paediatric patients from the Swedish 'Better Diabetes Diagnosis' (BDD) population study (n = 46 (1.3%) MODY (HNF1A, HNF4A, GCK)). Model performance was compared to using islet autoantibody testing. HbA1c, parent with diabetes, and absence of polyuria were significant independent predictors of MODY. The model showed excellent discrimination (c-statistic = 0.963) and calibrated well (Brier score = 0.01). MODY probability > 1.3% (ie. above background prevalence) had similar performance to being negative for all 3 antibodies (positive predictive value (PPV) = 10% v 11% respectively i.e. ~ 1 in 10 positive test rate). Probability > 1.3% and negative for 3 islet autoantibodies narrowed down to 4% of the cohort, and detected 96% of MODY cases (PPV = 31%). This MODY calculator for paediatric patients at time of diabetes diagnosis will help target genetic testing to those most likely to benefit, to get the right diagnosis.

Serious games, which are gaming applications used for purposes beyond entertainment to educate users on, and address, specific issues, may present a timely approach to promote healthy diabetes management behaviors among children with type 1 diabetes mellitus (T1DM). The lasting benefits associated with these serious games encompass improved patient education; enhanced glycemic control; the reinforcement of bonds within the community of people with diabetes; the facilitation of meaningful dialogues with caregivers, especially within the familial setting; and a significant reduction in the economic burdens associated with subsequent complications.

This paper primarily aims to provide a detailed overview of the iterative design process and the associated evaluation methods used in the development of the educational game. Furthermore, this study aims to enhance motivation for sustained and extended engagement with the game over time. The MyDiabetic game design aims to educate children on various aspects, including the connections among food, insulin, and physical activity. Furthermore, it seeks to impart knowledge related to the operation of a glucometer and an insulin pen, as well as more advanced technologies such as administering glucagon, measuring ketoacidosis, and continuous glucose monitoring.

The co-design methodology was applied, involving interviews, design workshops, and prototype feedback sessions. A combination of several approaches, such as tailoring, observational learning, social and family support, decision-making practice, and reward systems, was used to support children's compliance. Moreover, incorporating the literature, guidelines, and current practices into the design ensured that the game was aligned with established health care pathways and included relevant information and best practices for diabetes management.

The game was tested on 32 children in 3 iterations. Positive responses were received from children who tested the game as well as their parents. The game was also presented to 5 schoolmates of children with T1DM who appreciated a better understanding of the disease and the opportunity to support their friends more efficiently in T1DM compensation. The involvement of children and clinicians in participatory co-design contributed to to the game's high acceptance. With regard to the game's impact on education, 1 week of testing revealed an enhancement in educational outcomes.

The game is especially suitable for children newly diagnosed with T1DM because it acquaints them in a fun way with new terminology; for example, they can try to measure glycemia levels in an interactive way. The game also caters to children who still need to develop reading skills by including an audio guide. The guide ensures that children of all literacy levels can benefit from the game's educational content and interactive experiences. The game is available for download on Google Play and the Apple App Store.

To examine educational outcomes among adolescents with type 1 diabetes and determine the role of comorbidity.

We conducted a nationwide register-based cohort study including 3370 individuals born between 1991 and 2003 and diagnosed with type 1 diabetes before the age of 16. They were all matched with up to four individuals without type 1 diabetes on age, gender, parents' educational level and immigration status. Information on comorbidity was based on hospital diagnoses. The individuals were followed in registers to determine whether they finished compulsory school (9th grade, usually at the age of 15-16 years), and were enrolled in secondary education by age 18 years.

Individuals with type 1 diabetes were more likely not to complete compulsory school (OR 1.44, 95% CI 1.26-1.64), and not being enrolled in an upper secondary education by age 18 (OR 1.50, 95% CI 1.31-1.73) compared to their peers. A total of 1869 (56%) individuals with type 1 diabetes were registered with at least one somatic (n = 1709) or psychiatric comorbidity (n = 389). Those with type 1 diabetes and psychiatric comorbidity were more likely not to complete compulsory school (OR 2.47, 95% CI 1.54-3.96), and not being enrolled in an upper secondary education by age 18 (OR 3.66, 95% CI 2.27-5.91) compared to those with type 1 diabetes only. Further, there was a tendency towards an association between having somatic comorbidity and adverse educational outcomes (OR 1.25, 95% CI 0.97-1.63; OR 1.26, 95% CI 0.95-1.66) among adolescents with type 1 diabetes. The associations differed markedly between diagnostic comorbidity groups.

Type 1 diabetes affects educational attainment and participation among adolescents. Psychiatric comorbidity contributes to adverse educational outcomes in this group, and there is a tendency that somatic comorbidity also plays a role.