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While data on the efficacy and safety of continuous glucose monitoring (CGM) exist across a broad age spectrum, it is limited in very young children with type 1 diabetes (T1D). We aimed to assess real-world data in this high-risk population, focusing on glycemic variability and metrics beyond HbA1c. A 12-month multi-national, prospective, observational, registry-based cohort study in children with T1D aged 1-7 years compared glucose control using real-time CGM and using fingerstick blood glucose monitoring (BGM) alone. The prespecified primary endpoint was a difference in coefficient of variation (CV) between the CGM users and BGM-only cohort. Among 227 individuals using insulin pumps (42% female, age 5.3 years), 175 were CGM and 52 were BGM-only users. The median (IQR) CV was 39.1% (36.6-41.9) among CGM and 46.8% (42.3-51.2) among BGM-only users (P

Insulin pumps and glucose sensors are effective in improving diabetes therapy and reducing acute complications. The combination of both devices using an algorithm-driven interoperable controller makes automated insulin delivery (AID) systems possible. Many AID systems have been tested in clinical trials and have proven safety and effectiveness. However, currently, none of these systems are available for routine use in children younger than 6 years in Europe. For continued use, both users and prescribers must have sound knowledge of the features of the individual AID systems. Presently, all systems require various user interactions (e.g. meal announcements) because fully automated systems are not yet developed. Open-source systems are non-regulated variants to circumvent existing regulatory conditions. There are risks here for both users and prescribers. To evaluate AID therapy, the metric data of the glucose sensors, 'time in target range' and 'glucose management index', are novel recognized and suitable parameters allowing a consultation based on real glucose and insulin pump download data from the daily life of people with diabetes. Read out via cloud-based software or automatic download of such individual treatment data provides the ideal technical basis for shared decision-making through telemedicine, which must be further evaluated for general use.

Insulinpumpen und Glucosesensoren haben sich in Registerdaten als effektiv in der Verbesserung der Diabetestherapie und Reduktion akuter Komplikationen gezeigt. In der padiatrischen Diabetologie ist die Nutzung mindestens eines technischen Gerats Standard. Durch die Kombination beider Systeme ergibt sich Moglichkeit der automatischen Insulinabgabe („automated insulin delivery“, AID). Viele AID-Systeme sind in klinischen Studien getestet und haben sich als sicher und effektiv erwiesen. Die Versorgungsituation in Deutschland erlaubt es derzeit nur, Mitgliedern der gesetzlichen Krankenversicherungen ein bestimmtes System zu verordnen; dieses ist fur Kinder, die junger als 7 Jahre sind, nicht geeignet. Grunde liegen in gesetzlichen Hurden und mangelnder Zertifizierung durch die Hersteller. Die CE-Zertifikate konnen Probleme bei der Insulinverordnung mit sich bringen. „Open-source“-Systeme sind Varianten, mit denen bestehende Regularien umgangen werden konnen. Daraus ergeben sich sowohl fur Nutzer wie auch fur Verordner Risiken. Die dauerhafte Nutzung setzt sowohl auf Anwender- als auch auf Behandlerseite die fundierte Kenntnis der Eigenschaften der einzelnen AID-Systeme voraus. Eine vollstandige Automatisierung funktioniert noch nicht. Zur Evaluation der AID-Therapie sind die metrischen Daten der Glucosesensoren, die „Zeit im Zielbereich“ und der „Glucose Management Indicator“ anerkannte und geeignete Parameter, da sie eine Beratung auf Basis der reellen Daten aus dem Alltag der Menschen mit Diabetes zulassen. Da alle Glucosesensoren uber Cloud-basierte Software ausgelesen werden oder die Daten automatisch aus einem telefonverbundenen Empfangsgerat beziehen, ist die ideale technische Grundlage fur eine telemedizinische Betreuung geschaffen, die noch der Ausgestaltung bedarf.

Background We present the results of the pilot study of a multinational “Diabetes Know‐Me” project investigating knowledge regarding diabetes of medical students. This is the first collaborative project of the ISPAD JENIOUS group. Methods Students of the final year of medical studies from six countries answered a 25‐question survey regarding basic knowledge concerning diabetes (1091 surveys handed out, response rate 86%). Results Among the responders (58% female) 90% confirmed attending diabetology classes; 11% planned to specialize in diabetology. There were significant differences between countries in the median score of correct answers ranging from 10/25 to 22/25. Attending diabetes classes (20 vs. 13/25, p

Insulinpumpen und Glukosesensoren konnen laut Registerdaten die Diabetestherapie verbessern sowie die Rate akuter Komplikationen reduzieren. In der padiatrischen Diabetologie ist daher die Nutzung mindestens eines dieser technischen Gerate Standard. Deren Kombination macht Systeme zur automatischen Insulinabgabe („automated insulin delivery“ [AID]) moglich. Viele AID-Systeme wurden in klinischen Studien getestet und erwiesen sich als sicher und effektiv. Die Versorgungsituation in Deutschland jedoch lasst derzeit nur ein System als Verordnung bei Versicherten der gesetzlichen Krankenversicherungen zu, und Kinder unter 7 Jahren konnen damit derzeit nicht versorgt werden. Grunde hierfur sind gesetzliche Hurden und die mangelnde Zertifizierung durch die Hersteller. Die CE-Zertifikate konnen zudem zu Problemen bei der Insulinverordnung fuhren. Open-Source-Systeme sind nicht geprufte Varianten, um bestehende regulatorische Verhaltnisse zu umgehen. Deren Anwendung geht mit Risiken sowohl fur Nutzer als auch Verordner einher. Fur ihren dauerhaften Einsatz mussen sowohl Anwender als auch Behandler uber fundierte Kenntnisse der Eigenschaften der einzelnen AID-Systeme verfugen. Zur Evaluation der AID-Therapie sind die metrischen Daten der Glukosesensoren, die „time in range“ und der Glukosemanagementindex die anerkannten und geeigneten Parameter, da sie eine Beratung auf Basis der reellen Werte aus dem Alltag der Menschen mit Diabetes zulassen. Da alle Glukosesensoren uber Cloud-basierte Software ausgelesen werden oder die Daten direkt automatisch ubermitteln, ist hiermit die ideale technische Grundlage fur eine telemedizinische Betreuung geschaffen, die noch der Ausgestaltung bedarf.

Introduction: Urticaria is a clinical entity presenting as wheals, angioedema, or both simul-taneously. Elevated D-dimer levels were reported in the course of chronic spontaneous urticaria. Data regarding D-dimer levels in acute urticaria in children are limited. Objectives: To assess potential associations between duration of glucocorticosteroid (GCS) therapy and D-dimer concentrations in children with acute urticaria. Patients, materials, and methods: Hospital records of 106 children (59 females), aged 5.57 ± 4.91 years, hospitalized in 2014–2018 were analyzed retrospectively. The study group consisted of pediatric patients admitted to the hospital due to severe acute urticaria resistant to anti-histaminic treatment that was ordered in the ambulatory care (out-patient clinic). Patients were divided into subgroups: no GCS treatment, short-duration treatment (up to 5 days) and long-duration treatment (6 and more days) GCS treatment. Simultaneously, patients received antihistaminic drugs. D-dimer level and other inflammatory factors such as white blood cell (WBC) count, platelet (PLT) count, and C-reactive protein (CRP) in each group were analyzed. Results: The D-dimer level was elevated in 51% of cases. In the subgroup with longer GCS treatment, D-dimer concentration was significantly higher in comparison to patients with a shorter GCS course. There were no differences in the distribution of CRP, PLT, and WBC concentrations between these subgroups. Conclusions: In the studied group of children, there was a tendency for higher D-dimer levels in patients, who required a longer GCS treatment. This finding is hypothesis-generating and requires further investigation to confirm if D-dimers can be used as a prognostic factor in acute urticaria in children.

Background Telemedicine for routine care of people with diabetes (PwD) during the COVID‐19 pandemic rapidly increased in many countries, helping to address the several barriers usually seen. Objective This study aimed to describe healthcare professionals' (HCPs) experience on telemedicine use in diabetes care and investigate the changes and challenges associated with its implementation. Methods A cross‐sectional electronic survey was distributed through the global network of JENIOUS members of ISPAD. Respondents' professional and practice profiles, clinic sizes, their country of practice, and data regarding local telemedicine practices during COVID‐19 pandemic were investigated. Results Answers from 209 HCPs from 33 countries were analyzed. During the pandemic, the proportion of PwD receiving telemedicine visits increased from 50% (66.5%). There was an increase in specific privacy requirements for remote visits (37.3% to 75.6%), data protection policies (42.6% to 74.2%) and reimbursement for remote care (from 41.1% to 76.6%). Overall, 83.3% HCPs reported to be satisfied with the use of telemedicine. Some concerns (17.5%) about the complexity and heterogeneity of the digital platforms to be managed in everyday practice remain, feeding the need for unifying and making interoperable the tools for remote care. Also, 45.5% of professionals reported to feel stressed by the need for extra‐time for telemedicine consultations. Conclusions Telemedicine was rapidly and broadly adopted during the pandemic globally. Some issues related to its use were promptly addressed by local institutions. Challenges with the use of different platforms and for the need of extra‐time still remain to be solved.

OBJECTIVE Insulin delivery methods, glucose-monitoring modalities, and related outcomes were examined in a large, international, diverse cohort of children and adolescents with type 1 diabetes from the Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) -Registry. RESEARCH DESIGN AND METHODS Participants with type 1 diabetes of >= 1 year, aged, Abbott; Boehringer Ingelheim; Dexcom; Insulet; Eli Lilly and Company; Medtronic; Sanofi, This work was supported by the SWEET corporate members, namely, Abbott, Boehringer Ingelheim, Dexcom, Insulet, Eli Lilly and Company, Medtronic, and Sanofi. No other potential conflicts of interest relevant to this article were reported.

Aims: To investigate the short-term effects of the first wave of COVID-19 on clinical parameters in children with type 1 diabetes (T1D) from 82 worldwide centers participating in the Better Control in Pediatric and Adolescent DiabeteS: Working to CrEate CEnTers of Reference (SWEET) registry. Materials and Methods: Aggregated data per person with T1D £21 years of age were compared between May/June 2020 (first wave), August/September 2020 (after wave), and the same periods in 2019. Hierarchic linear and logistic regression models were applied. Models were adjusted for gender, age-, and diabetes duration-groups. To distinguish the added burden of the COVID-19 pandemic, the centers were divided into quartiles of first wave COVID-19-associated mortality in their country. Results: In May/June 2019 and 2020, respectively, there were 16,735 versus 12,157 persons, 52% versus 52% male, median age 13.4 (Q1; Q3: 10.1; 16.2) versus13.5 (10.2; 16.2) years, T1D duration 4.5 (2.1; 7.8) versus 4.5 (2.0; 7.8) years, and hemoglobin A1c (HbA1c) 60.7 (53.0; 73.8) versus 59.6 (50.8; 70.5) mmol/mol [7.8 (7.0; 8.9) versus 7.6 (6.8; 8.6) %]. Across all country quartiles of COVID-19 mortality, HbA1c and rate of severe hypoglycemia remained comparable to the year before the first wave, while diabetic ketoacidosis rates increased significantly in the centers from countries with the highest mortality rate, but returned to baseline after the wave. Continuous glucose monitoring use decreased slightly during the first wave (53% vs. 51%) and increased significantly thereafter (55% vs. 63%, P < 0.001).Conclusions: Although glycemic control was maintained, a significant rise in DKA at follow-up was seen during first wave in the quartile of countries with the highest COVID mortality.

PURPOSE To assess the bone status in children with inflammatory bowel diseases (IBD) using quantitative ultrasound (QUS) measurement and dual-energy X-ray absorptiometry (DXA) at baseline and after two years of adequate treatment of the IBD and bone protection medication. METHODS Sixteen children (six boys) with IBD, aged 13.4±2.4 years, were examined at baseline and two years later. DXA was used to asses bone mineral density (BMD) and reference data were provided by the device's manufacturer (Hologic Explorer). QUS measurements were performed in patients and controls - 48 healthy children. RESULTS Mean Z-scores for TB- and s-BMD were significantly below zero for both, baseline and follow-up (-2.61±0.99 and -2.48±0.88 for TB, and -1.83±1.33 and -1.61±1.19 for s-BMD, respectively), and did not differ significantly, as well as mean Ad-SoS Z-score. The changes in time of TB Z-score and body weight Z-score correlated positively (r=0.63; P

W cukrzycy typu 1 przerwanie leczenia (insulinoterapii) prowadzi do cukrzycowej kwasicy ketonowej (DKA), będącej stanem bezpośredniego zagrożenia życia. Celem przedstawionego opisu przypadku jest zwrócenie uwagi na sytuację pacjentów z cukrzycą typu 1 i istotnymi problemami socjalnymi/psychicznymi, którzy ze względu na brak odpowiednich uregulowań prawnych „wypadają z systemu”, który mógłby zapewnić im odpowiednią opiekę warunkującą prawidłowe leczenie. Zaburzenia psychiczne i/lub problemy socjalne utrudniają lub uniemożliwiają prowadzenie samokontroli i leczenia. Pacjenci tacy stanowią istotne wyzwanie dla zespołu diabetologicznego i wymagają zindywidualizowanego postępowania ze strony systemu opieki społecznej. Niezbędne jest też skoncentrowane na bezpieczeństwie pacjenta wsparcie ze strony konsultujących lekarzy innych specjalności. Przypadek naszej pacjentki podkreśla potrzebę opracowania odpowiednich uregulowań prawnych i administracyjnych, które pozwoliłyby na szybkie, bezpieczne i adekwatne zaopiekowanie się takim pacjentem., Discontinuation of type 1 diabetes (T1DM) treatment (interruption of insulin therapy) rapidly leads to diabetic ketoacidosis (DKA) which is a life-threatening condition. Our case report is intended to draw attention to persons with T1DM and significant social/ psychological problems. They typically, due to the lack of legal regulations, “fall out of the system”, which should provide in such cases additional assistance in care conditioning proper treatment. Psychological an psychiatric disorders and/or social problems may interfere with self-control and diabetes treatment, making it difficult or even impossible. These patients represent a significant challenge for the diabetes team and require individualized management from the social care system. Patient safety-focused support from consulting physicians of other specialties is also essential. The case of our patient highlights the need for relevant legal and administrative regulations that would allow for quick, safe and adequate care.

Introduction: This study presents a 10-year longitudinal assessment of bone status in adolescents and young adults with type 1 diabetes (T1D). Material and methods: Thirty-two patients (12 female, aged 20.5 ± 3.93 years, T1D duration 13.9 ± 1.97 years) were studied using quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA). Standard deviation scores (SDS) for these results were calculated. The following clinical parameters were analysed: sex, age, T1D duration, anthropometric parameters, daily insulin requirement (DIR), mean glycated haemoglobin (HbA1c) in the year preceding the examination, medication other than insulin, history of bone fractures, and comorbidities. Results: The current and past (measured 10 years earlier) QUS results did not differ and showed a significant correlation (r = 0.55, p = 0.001). We found no relation of QUS results and anthropometric parameters or gender. DXA parameters did not correlate with the present QUS measurement. DXA and QUS results were independent of HbA1c, co-morbidities, or intake of additional medicaments. Conclusions: Bone status parameters of the examined patients with currently suboptimal glycaemic control were found to be lowered in comparison to a normative reference population, both at baseline and follow-up, although no further deterioration was observed during the 10-year follow-up period.

Background/objective The study aimed to analyze the frequency of partial remission (PR) and its association with chosen clinical and laboratory factors among pediatric patients with newly diagnosed type 1 diabetes (T1D). The long-term effect of PR on chosen parameters was also investigated. Methods In 194 patients (95 girls) aged 8.1 ± 4.3 years, we analyzed data at T1D onset: glycemia, pH, C-peptide, antibodies, weight, and concomitant autoimmune diseases. Anthropometric parameters, daily insulin requirement (DIR), and HbA1c 2 and 4 years after T1D diagnosis were also analyzed. We determined PR based on HbA1c and DIR measurements at least every 3 months. Results PR occurred in 59% of patients. Remitters had significantly higher pH (7.33 vs 7.28, P = 0.03), weight SD score (SDS) (0.25 vs -0.24, P = 0.002), and body mass index SDS (0.19 vs -0.66, P = 0.02) compared with non-remitters. Concomitant diseases correlated negatively with PR. Multivariate analysis indicated only pH at onset was an independent predictor of PR. pH was the most important factor associated with the beginning of PR. There was a positive correlation between the start and duration of PR. Four years after T1D onset remitters had lower HbA1c (7.24% vs 8.05%, 53 vs 63.9 mmol/mol, P Conclusions PR occurred quite often and developed more frequently in children with higher: weight and BMI SDS, but the main factor influencing PR presence and duration was higher pH at T1D onset. There was a beneficial impact of PR on HbA1c and DIR after 4 years of treatment.

Introduction: This study was designed to assess the influence of chosen aspects of anorexia nervosa eating disorders (AN ED) on 13C-methacetin breath test (MBT) results. Material and methods: We investigated a group of 81 girls, including 41 patients with confirmed diagnosis of AN ED. The study group was divided in two subgroups. According to the DSM-5 classification, 25 underweight patients met the criteria of anorexia nervosa (AN), and 16 girls with BMI value > 5th percentile for age and sex were diagnosed as atypical anorexia nervosa (AAN). Laboratory tests assessing the liver function and the MBT were performed in all the participants of the study. Results: In all healthy females the values of anthropometric parameters and laboratory results concerning the liver function were normal. Girls with AN ED achieved higher cumulative 13CO2 dose salvage during the MBT than healthy controls. Also, DOB (delta over baseline) values were significantly higher in the study group, as well as in both ANN and AN subgroups, compared to controls. Comparison of the patients’ subgroups revealed higher elimination of the cumulative 13CO2 dose in females with AN compared to those with AAN. Among the study group there was a negative correlation between the DOB values in all time points of the test and the weight, weight percentile, BMI, and BMI percentile. Conclusions: Girls with weight deficiency in the course of AN achieved higher cumulative 13CO2 dose recovery during the MBT than healthy controls and other AN patients. The recovery of 13CO2 during the MBT was negatively correlated with parameters describing patients’ weight status. The obtained results suggest a significantly faster 13C-methacetin metabolism in girls with AN ED, which is probably a consequence of the characteristics of the primary disease. The presented observations suggest that MBT is not useful in monitoring liver function in patients with AN ED.

Background Obesity and diabetes became a grooving problem in both adults and children. Many hypotheses concerned agents involved in the excessive weight gain process and it’s consequences. Not only genetic or environmental factors, but also intestinal microbiome seems to play a role in the pathophysiology of this phenomenon. Data sources A systematic review was conducted using Pubmed as the medical database source. Studies concerning connection between microbiome and metabolic disorders such as obesity and diabetes from last 10 years were analyzed. Results Intestinal bacteria may be involved both in the development of obesity, and its further complications. The pro-infammatory and immunomodulating efect of dysbiosis are possible triggers of insulin resistance and diabetes. Early interventions aimed at the microbiome, as well as attempts to modify the microbiome at later stages may become new opportunities in the prevention and treatment of obesity and carbohydrate metabolism disorders. Conclusions The gut microbiome has been shown to be an important part of the metabolic processes. The use of probiotic, prebiotics and symbiotics is promising, but requires further investigations to determine the specifc metabolic efects of each bacteria strain and substance.

Aim. The aim of the study was to assess markers of anemia in type 1 diabetes (T1D) children, compare them to results obtained in the control group, and estimate their relation to BMI SDS. Methods. 94 (59% ♀) T1D children without other autoimmune disorders, aged 12.5 ± 4.1 years, T1D duration: 4.2 ± 3.6 years, HbA1c 7.3 ± 1.5% (57 ± 12.6 mmol/mol). Sex- and age-matched controls (43 children). In all children, anthropometric measurements, the blood count, iron turnover parameters, and vitamin B12 concentration were taken. Results. T1DM children had significantly higher red cell distribution width (RDW) (13.6 versus 12.6%; p<0.001), hepcidin (0.25 versus 0.12 ng/ml; p<0.001), and vitamin B12 concentrations (459 versus 397 pg/ml; p<0.01) and lower TIBC (59.09 versus 68.15 μmol/l; p<0.001) than in the control group. Logistic regression revealed that RDW, TIBC (both p<0.001), and hepcidin (p<0.05) significantly differentiated both groups. In T1DM children, BMI SDS negatively correlated with vitamin B12 (p<0.01) concentration and mean corpuscular hemoglobin concentration (p<0.05) and positively with TIBC (p<0.01) and HbA1c (p<0.001). Conclusions. Patients and controls differed especially in terms of RDW and TIBC. In studied T1DM children, BMI SDS was associated to iron metabolism parameters and vitamin B12 concentration.

Introduction: Despite the current decline in the number of suicides, they are the second most common cause of death among children and adolescents. At the end of the 20th century, suicides represented about 10% of all causes of death of people up to 18 years old, but currently they reach up to 20%. Over the years, the number of suicide attempts (SA) has also increased. Aim of the study: The aim of the study was to analyse the cases of hospitalisation of children in the Department of Paediatrics of the Independent Public Clinical Hospital No. 1 in Zabrze (DP IPCH1) due to a suicide attempt. Material and methods: Medical records of 87 patients hospitalised due to SA in the years 2010–2016 in the DP IPCH1 were retrospectively analysed. Results: All children who were admitted to the hospital survived their suicide attempt. An almost 2.5-fold increase was observed in the numbers of hospitalisations in years 2010–2016. Up to 86.2% of the patients were girls. The average age in group was 15.2 ±1.4 years. In order to commit suicide, children most often used medications (97.7%). They regularly combined them with alcohol or self-harm. 3/4 of overdose incidents included prescription-only medicaments. Almost half of the patients previously showed self-destructive tendencies in the form of self-harm. For 78.2% of the responders it was the first suicide attempt. 40.7% of patients had pre-existing chronic diseases, and the next 20% were under the control of a psychologist or psychiatrist. After hospitalisation 11 children were transferred to a psychiatric ward for further treatment. Conclusions: The increase of hospitalisations due to suicide attempts is disturbing. In this context, special attention should be given to children from risk groups such as: previous suicide attempts, chronically ill, addicted to alcohol or drugs, with impaired parent-child relationship, or with self-harm history

Objective We aimed to assess the prevalence of autoantibodies against the 4A subunit of the gastric proton pump (ATP4A) in pediatric type 1 diabetes (T1D) patients and explore the relationship between ATP4A positivity and blood cell count, iron turnover, and vitamin B12 concentration. Subjects The study included 94 (59% female) T1D children (aged 12.5 ± 4.1 years, T1D duration 4.2 ± 3.6 years, HbA1c 7.3 ± 1.5% (57 ± 12.6 mmol/mol) with no other autoimmune diseases. Methods ATP4A antibodies were measured in T1D patients using a radioimmunoprecipitation assay. Blood cell count, iron concentration, total iron binding capacity, ferritin, transferrin, hepcidin, and vitamin B12 concentration were measured in all the study participants. Results A total of 16 (17%) children were ATP4A positive. Serum concentrations of ferritin were significantly lower in ATP4A positive than in antibody negative subjects (P = .034). Overall the levels of ATP4A antibodies (ATP4A Index) correlated positively with the age at T1D diagnosis (r = 0.228, P = .026) and negatively with ferritin levels (r = −0.215, P = .037). In ATP4A positive patients, the ATP4A Index correlated positively with age at diagnosis (r = 0.544, P = .032) and negatively with vitamin B12 levels (r = −0.685, P = .004). Conclusions ATP4A antibodies were present in a significant proportion of children with T1D. Higher ATP4A levels in T1D children are associated with lower, yet still fitting within the normal range, levels of vitamin B12, and ferritin. Routine screening of T1D children for gastric autoimmunity (ATP4A) should be considered with follow-up of those positive for vitamin B12 and iron deficiency.

AIMS To present the incidence trend for Type 1 diabetes in Polish children aged 0-14 years, updated using data collected during 2005-2012, and assess the reliability of the predictive model constructed previously using the 1989-2004 database. METHODS Children aged < 15 years with newly diagnosed Type 1 diabetes are recorded prospectively (EURODIAB criteria) in several regional registers in Poland. Age- and gender-standardized incidence rates for Type 1 diabetes were calculated per 100 000 persons/year. Incidence rates were analysed in terms of the dependency on age, gender, geographical region and population density. Incidence rate trends over time were modelled using generalized linear models. RESULTS The mean standardized incidence for 1989-2012 was 12.72 per 100 000 persons/year [95% confidence interval (CI), 11.35 to 14.21]. Over the 24-year observation period, the incidence increased from 5.36 to 22.74 per 100 000 persons/year. The lowest incidence rate was in children aged 0-4 years (8.35, 95% CI 7.27 to 9.57 per 100 000 persons/year). There was no difference between genders, or urban and rural regions. Incidence rates were higher in northern compared with southern Poland [14.04 (95% CI 12.59 to 15.63) vs. 11.94 (95% CI 10.62 to 13.39) per 100 000 persons/year]. The new data corrected the earlier predictive model by changing the estimates of some factors related to patient age, gender and their interactions with the remaining factors. The incidence rate shows periodic 5.33-year fluctuations. The periodicity component allows for a more accurate prediction of the incidence rate over time. CONCLUSIONS This cohort study reveals a sustained increase in Type 1 diabetes incidence in Polish children aged 0-14 years with regular, sinusoidal fluctuations and a slight levelling off in past few years. It is of concern that are the highest increases in incidence are found in children aged 0-4 years.

Background: To determine the bone status in children with inflammatory bowel diseases (IBD) using quantitative ultrasound (QUS) measurement at hand phalanges and compare the obtained results with dual-energy X-ray absorptiometry (DXA). Methods: Fifty-one children with IBD underwent DXA and QUS measurements at hand phalanges in the year 2013. The control group for the QUS consisted of 460 children. Reference data for DXA comes from Hologic Explorer. Results: QUS measurements did not differ significantly between IBD patients and healthy controls. There was no difference between UC and CD subjects. DXA measurements in patients with IBD were lower than in the healthy population. Tanner stage and nutritional status correlated with bone status contrary to steroids therapy. Conclusion: Low bone mineral density often complicates IBD in children. QUS is not an appropriate method for the assessment of bone status in children. Nutritional status seems to have a greater impact on bone status than corticosteroids therapy

Anti-parietal cell antibodies (APCA) are an advantageous tool for screening for autoimmune atrophic gastritis (AAG) and pernicious anemia (PA). The target for APCA is the H+/K+ ATP-ase. It has been demonstrated, that APCA target both, the alpha, and beta subunits of the proton pump, although the major antigen is the alpha subunit. Circulating serum APCA can be detected by means of immunofluorescence, enzyme-linked immunosorbent assay – currently the most commonly used method, and radioimmunoprecipitation assay (RIA) – the 4A subunit has been optimized as a molecularspecific antigen probe. RIA is the most accurate method of antibody assessment, characterized by highest sensitivity. APCA can be found in 85–90% of patients with PA. Their presence is not sufficient for diagnosis, because they are not specific for PA as they are also found in the circulation of individuals with other diseases. APCA are more prevalent in the serum of patients with T1D, autoimmune thyroid diseases, vitiligo, celiac disease. People with autoimmune diseases should be closely screened for AAG/ PA. The anemia develops longitudinally over many years in APCA-positive patients, symptomless, slowly promotes atrophy of the gastric mucosa and parietal cells. APCA are present in 7.8–19.5% of the general healthy adult population. A fraction of these sero-positive people, will never develop AAG or PA. An interesting and not fully explained question is whether APCA presence is related to Helicobacter pylori infection. APCA are found in up to 20.7% of these patients. H. pylori is implicated as one of the candidates causing AAG.

Background Anorexia nervosa (AN) concerns approximately up to 1.8% of the pediatric female population. One of the complications that can occur in the course of this disease is acute liver failure. This study’s objective was to assess the usefulness of the 13C labeled Methacetin Breath Test (MBT) in the diagnostics of the liver function in girls with eating disorders. Methods For the study 81 girls aged 12 to 17 years were recruited, including 41 patients with confirmed diagnosis of AN (mean age 14.7 ± 1.48 years) and 40 age-matched controls. The diagnosis was based on the present Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Weight and height were measured in all study participants and the Body Mass Index (BMI) was calculated. In the study and control group laboratory tests assessing the liver function and the MBT were performed. Results In all controls the anthropometric as well as laboratory liver function parameters were normal. In the study group 25 patients (61%) had BMI below the lower limit for age. The total percentage of 13CO2 recovery in the 120th minute of the test did not exceed the lower limit in patients and controls. A result of the 13CO2 cumulative recovery above the upper normal range was found in 18 girls with AN (44% of the study group) and 2 controls (5%). Patients with AN were characterized by significantly higher 13CO2 cumulative dose recovery after ingestion of the substrate in comparison to the control group in all time points of the test. Conclusions The obtained results confirm a significant stimulation of the liver metabolism of 13C labeled methacetin in female patients with AN. The increased cumulative dose recovery of the substrate in girls with AN impacts the credibility of this measurement and implies a risk of false negative results.

Certain patients with type 1 diabetes (T1DM), often shortly after initiating the treatment, may require smaller doses of insulin. This phenomenon is commonly referred to as the remission or honeymoon phase. In majority the remission is partial, but in very rare cases complete remission might occur. Recent studies have enlightened that an appropriate treatment and follow-up during the honeymoon could potentially enable the prolongation of this period for years or even permanently stop the destruction of the remaining ß cells, hence the renewal of interest on the subject. On average, the remission usually appears approximately 3 months after the insulin therapy was started. The duration of the partial remission ranges from 1 month up to 13 years, with an average of 9.2 months. Various clinical and metabolic factors have been analysed to assess whether they are influencing the remission rate and the duration of the honeymoon period. However, the degree of their influence is still a point of discussion. Also, new potential factors are investigated. This article gives an up-to-date status on recent papers concerning remission in T1DM.Niektórzy pacjenci z cukrzycą typu 1 (T1DM) często wkrótce po rozpoczęciu leczenia insuliną wymagają podaży jej mniejszych dawek. W piśmiennictwie zjawisko to określa się okresem remisji lub miesiąca miodowego. U większości pacjentów remisja jest jedynie częściowa, natomiast w bardzo rzadkich przypadkach może być również całkowita. Ostatnie doniesienia sugerują, że odpowiednie leczenie oraz opieka i kontrola w trakcie fazy miesiąca miodowego mogą potencjalnie wydłużyć ten okres lub nawet całkowicie zatrzymać proces destrukcji pozostałych komórek ß. Z tego powodu ten okres choroby budzi tak wielkie zainteresowanie. Faza remisji następuje zwykle około 3 miesiący po rozpoczęciu leczenia insuliną. Czas trwania okresu miesiąca miodowego wynosi od 1 miesiąca do nawet 13 lat – przyjmując średnią wartość 9,2 miesiąca. Przeanalizowano różnorodne czynniki kliniczne oraz metaboliczne, aby określić ich potencjalny wpływ na częstość występowania remisji oraz czas jej trwania. Jednakże stopień, w jakim wpływają one na fazę miesiąca miodowego, jest nadal przedmiotem dyskusji. Nowe potencjalne czynniki są również obecnie tematem badań naukowych. Nasz artykuł przedstawia najnowsze doniesienia dotyczące okresu remisji w T1DM.

Takayasu arteritis (TA) is a rare disease that belongs to the group of large vessel vasculitis with unknown etiopathogenesis. Immunological disorders, genetic and environmental factors are probably involved in its development. The inflammatory process affects the aorta, its main branches, pulmonary arteries and results in segmental stenosis, occlusion, dilatation and aneurysm formation in the arterial wall. In the acute, early phase of TA non-specific general symptoms associated with the inflammatory process dominate. In the second phase hypertension or symptoms of tissues and organs ischemia may occur in the result of segmental stenosis of vessels. The most frequent symptoms in children are: hypertension, headaches, fever and weight loss. We present the case of 14-year-old boy with microcytic anaemia and highly elevated values of inflammatory parameters, who presented abdominal pain which is not a typical symptom of TA. Wide differential diagnosis allowed us to recognise TA.

Aim This Polish study estimated the prevalence of the Helicobacter pylori infection in symptomatic children aged 3-18 and investigated its association with gastrointestinal complaints. Methods We prospectively enrolled 1984 children (54% female) with a mean age of 9.5 ± 4.1 years, from Silesia, Poland, for the Good Diagnosis Treatment Life screening programme from 2009 to 2016. They underwent a 13 C-isotope-labelled urea breath test (UBT) to assess their Helicobacter pylori status, making this the biggest Polish study to use this approach. Further analysis included parental-reported gastrointestinal symptoms and standard deviation scores (SDS) of anthropometric measurements. Results The Helicobacter pylori infection was identified in 220 (11%) children (48% female) and was independent of age and sex. The frequency of symptoms did not differ between Helicobacter positive and negative children (all p > 0.05). Children with a positive UBT result had a lower body mass SDS (-0.41 ± 0.98 versus -0.26 ± 1.01, p = 0.04) and height SDS (-0.45 ± 1.34 versus -0.23 ± 1.27, p = 0.02), but similar body mass index SDS. Conclusion We found a low prevalence of Helicobacter pylori in symptomatic children, and positive UBT results were not associated with symptoms that suggested Helicobacter pylori infections. Our findings support the 2017 European and North American guidelines for Helicobacter infections in children.

Częstość zachorowań na cukrzycę typu 1 (T1D) wciąż wzrasta. Pacjenci z T1D należą do grupy zwiększonego ryzyka rozwoju innych chorób autoimmunologicznych ze względu na podobne patogenetyczne podłoże zaburzeń. Wraz z czasem trwania choroby pacjenci narażeni są na występowanie powikłań. Jednym z nierzadko występujących objawów jest anemia. Kiedy wykluczy się podstawowe przyczyny występowania anemii, w diagnostyce różnicowej należy wziąć pod uwagę prawdopodobieństwo obecności towarzyszącej choroby z autoagresji – autoimmunologicznego zanikowego zapalenia żołądka. Do jej objawów zalicza się nie tylko anemia makrocytarna, spowodowana niedoborem witaminy B12, ale także mikrocytarna – z niedoboru żelaza, a także niespecyficzne objawy neurologiczne. Zwykle autoimmunologiczne zanikowe zapalenie żołądka oraz jego ciężka postać – anemia złośliwa rozwijają się bezobjawowo przez wiele lat, często pozostają niezdiagnozowane. Z tego powodu pacjenci z DMT1 powinni podlegać okresowej kontroli w celu wczesnego wykrycia nieprawidłowości. Przeciwciała przeciwko komórkom okładzinowym żołądka, skierowane przeciwko H+/K+ ATP-azie, są dobrym markerem służącym do skriningu. U chorych z DMT1 występują ze zwiększoną częstością, co sprawia, że zaliczają się oni do grupy wysokiego ryzyka rozwoju choroby. Istnieją sugestie konieczności wykonywania regularnych oznaczeń: APCA, morfologii, żelaza, witaminy B12 oraz poziomu gastryny, jednak nie są one ujęte w oficjalnych wytycznych polskich i zagranicznych.

Assessment of the liver function, and the need of constant monitoring of the organ’s capacity, concerns not only patients with primary liver diseases, but also those at risk of hepatopathies secondary to other chronic diseases. Most commonly, the diagnostics is based on measurements of static biochemical parameters, which allow us to draw conclusions only indirectly about the function and the degree of damage of the organ. On the other hand, liver biopsy is an invasive procedure and therefore it is associated with a considerable risk of complications. Dynamic tests enable us to assess quantitatively the organ’s functional reserve by analyzing the kinetics of the metabolization of the substrate by the liver. In practice applied are breath tests using substances such as aminopyrine, caffeine, methacetin, erythromycin (for assessment of the microsomal function); phenylalanine, galactose (for assessment of the cytosolic function); methionine, octanoate, ketoisocaproic acid (for assessment of the mitochondrial function). The test with 13C methacetin belongs to the best described and most widely applied methods in noninvasive liver function assessment. Due to the rising availability of this method, knowledge concerning its limitations and controversies regarding the methodology, as well as its usefulness in chosen groups of patients, seems to be vital.

Transition from pediatric to the adult care system is an important issue for diabetes management. The objective was to evaluate the transition of young adults with type 1 diabetes (T1DM) from pediatric to adult diabetes care. Questionnaires were sent to all T1DM patients (166), who left pediatric diabetes care in Katowice, Poland (2003–2007). Analyzed parameters included: date of first visit and visit frequency in adult care, HbA1c (mean and final at pediatric care, HbA1c_M and F respectively, reported in questionnaire – HbA1c_Q), and history of acute complications. 132(82.5 %) responses were received. 96(73 %) patients undertook their first visit at adult clinic ≤3 months after finishing pediatric care, 8(6 %) – after 4-6 months, 10(7 %) >6 months, and 12(9 %) remained under the observation of a GP. Subgroup >6 months differed significantly by HbA1c_Q from the

Summary Persistent presence of ATP4A autoantibodies (ATP4AA) directed towards parietal cells is typical for atrophic body gastritis (ABG), an autoimmune disease associated with type 1 diabetes. We assessed whether Helicobacter pylori (Hp) infection might be associated with positivity for ATP4AA in children with type 1 diabetes. Sera were collected from 70 (38♀) type 1 diabetes children [aged 13·2 ± 4·5 years, age at diagnosis 8·8 ± 4·3 years, diabetes duration 4·5 ± 3·8 years, mean HbA1c 7·8 ± 1·6% (62 ± 17·5 mmol/mol)] seen at the regional diabetes clinic in Katowice, Poland. Patients were tested concurrently for Hp infection by means of a 13C urea breath test. ATP4AA were measured using a novel radioimmunoprecipitation assay developed at the Barbara Davies Center for Childhood Diabetes, University of Colorado. ATP4AA were present in 21 [30%, 95% confidence interval (CI) = 19–41%] and Hp infection was detected in 23 (33%, 95% CI = 22–44%) children. There was no statistically significant association between ATP4AA presence and Hp status. ATP4AA presence was not associated with current age, age at type 1 diabetes diagnosis, diabetes duration or current HbA1c. ATP4AA were more prevalent in females [42% (26–58%)] than males [16% (3–28%)], P = 0·016. ATP4A are found in nearly one-third of children with type 1 diabetes and more common among females. In this cross-sectional analysis, Hp infection was not associated with autoimmunity against parietal cells.

Mesenteric cystic lymphangioma is a rare disease which can cause both acute and chronic abdominal pain. These lessions are classified as a bening neoplasma or congenital anomaly. The main cause of the lessions is benign proliferation of ectopic lymphatic vessels of mesenterium lacking communication with the normal lymphatic system. Abdominal ultrasonography is the imaging modality of choice, but in majority of cases verification using other examinations like TK or MR is required. Preoperative diagnosis is sometimes very difficult. The authors present the case of 4-year-old girl that presented abdominal pain from 1 month. Intestinal obstruction which was generated by volvulus caused extension of diagnosis and set the right preoperative diagnosis. The complete cystic resection was done in the case of the girl. The postoperative course was not complicated. Nowdays the condition of the girl is good.

This case-control study aimed to assess bone status in children with type 1 diabetes mellitus (T1DM). Fifty-seven pre-pubertal patients (37 boys, aged 7.9 ± 2.5 years, T1DM duration 3.1 ± 1.6 years) and 171 age-matched healthy controls (111 boys) were studied. Quantitative ultrasound (QUS) was used to measure amplitude dependent speed of sound (Ad-SoS) at hand phalanges (expressed as standard deviation score [SDS]). Anthropometric and disease-related data (including mean HbA(1c) from whole T1DM duration [T], last year [Y], examination day [D]) were collected. Mean Ad-SoS SDS in patients -0.13 ± 1.32 (95% confidence interval [CI] -0.48, 0.22) was similar to that of controls. Subgroups discriminated according to HbA(1c) D, Y and T (cut-off 7.0%) did not differ regarding analyzed parameters. In patients, Ad-SoS SDS was comparable for both genders. Multivariable stepwise regression analysis showed significant negative influence of diabetes duration on Ad-SoS SDS. QUS findings in pre-pubertal children with T1DM do not differ from those in healthy children. Disease duration seems to affect negatively Ad-SoS SDS. However, independent prospective studies are needed to elucidate the true associations.

Aims The aim of the study was to investigate the potential negative impact of type 1 diabetes on bone status of adolescents. Bone status in adolescents with type 1 diabetes was assessed by means of quantitative ultrasound (QUS) and the influence of metabolic control and other diseaserelated and growth variables was analysed. Methods Group I consisted of 99 pubertal (Tanner ≥2) adolescents (49 female), aged 14.3±2.5 years, diabetes duration 4.6±2.3 years. Controls (group II) were 297 children, matched by sex and age, from a healthy population. The influence of glycated haemoglobin (current: HbA1cD; last year’s mean: HbA1cY; whole duration mean: HbA1cT), diabetes duration, percentage of life with disease and daily insulin requirement (DIR) on amplitude dependent speed of sound (Ad-SoS) at distal phalanges was studied. Results In comparison to the control group, adolescents with type 1 diabetes presented significantly higher BMI SDS (0.82 [95% CI 0.54, 1.10] vs −0.06 [95% CI −0.16, 0.04] p

Aims The incidence of pediatric type 1 diabetes mellitus (T1DM) in Poland is intermediate relative to the rest of the world. T1DM prevalence in the region of Silesia approximates national estimates for all of Poland. This epidemiologic study aimed to analyze the changes in incidence rates of T1DM among children ages 0–14 years from 1989 to 2012 in this region. Methods Data collection methods for the registry followed EURODIAB criteria. To estimate overall population size, data from the Central and regional Statistical Office in Katowice were used. T1DM incidence rates/100,000 children ages 0–14 years/annum and their 95 % CI were calculated for all children and in age subgroups (0–4, 5–9, 10–14 years). For comparative analysis incidence rates were age and sex standardized to the population of Poland in 2005. For statistical analyses open source R Bioconductor software was used. Results During this 24-year period, 2,215 new cases (1,146 boys) were diagnosed. The standardized incidence rate rose about 7 % annually. The mean standardized incidence rates estimated in four 6-year time periods (1989–1994, 1995–2000, 2001–2006, 2007–2012) separately showed significant increases from 5.80/100,000/year (1989–1994) through 10.44/100,000/year (1995–2000) and 15.05/ 100,000/year (2001–2006) to 18.94/100,000/year (2007– 2012). From 1989 to 2012, the greatest relative rise in annual incidence (/100,000/year) was among the very young: 2.58–14.00 (0–4 years); 4.96–19.43 (5–9 years); 8.84– 22.15 (10–14 years). The highest average annual increment of the incidence rate was in the middle age subgroup (5–9 years). No significant sex difference was observed. Conclusions The overall incidence rate increased 3.8 times, suggesting an epidemic of pediatric T1DM in Silesia, Poland. These temporal changes confirm that Poland currently has one of the highest incidence rates of pediatric T1DM in Europe.

Leptin is produced by mature adipocytes. Its amount correlates positively with the mass of the adipose tissue. Leptin plays a crucial role in maintaining body weight and glucose homeostasis. It is transported through the blood-brain barrier to the central nervous system, where it activates the autonomic nervous system, causing the feeling of satiety and inhibiting appetite. It also acts through central and peripheral pathways, including the regulation of insulin secretion by pancreatic  cells. Leptin may also directly affect the metabolism and function of peripheral tissues. It has been found to play a role in peripheral insulin resistance by attenuating insulin action, and perhaps also insulin signaling, in various insulin-responsive cell types.Recent data provide convincing evidence that leptin has a beneficial influence on glucose homeostasis. Studies suggest that leptin could be used as an adjunct of insulin therapy in insulin-deficient diabetes, thereby providing an insight into the therapeutic implications of leptin as an anti-diabetic agent. Extensive research will be needed to determine long-term safety and efficacy of such a therapy.

Aims/hypothesis We analysed the temporal changes in the incidence of childhood type 1 diabetes and its demographic determinants in Poland from 1989 to 2004, validating the model with data from 1970 to 1989. We also estimated a predictive model of the trends in childhood diabetes incidence for the near future. Methods Children under 15 years with newly diagnosed type 1 diabetes mellitus and drawn from seven regional registries in Poland were ascertained prospectively using the Epidemiology and Prevention of Diabetes study (EURODIAB) criteria. The type 1 diabetes incidence rates (IRs) were analysed in dependency of age, sex, seasonality, geographical region and population density. Time trends in IR were modelled using several approaches. Results The average incidence, standardised by age and sex, for 1989 to 2004 was 10.2 per 100,000 persons per year and increased from 5.4 to 17.7. No difference was found between boys and girls, or between urban and rural regions. In children above 4 years, IR was significantly higher in the population of northern Poland than in that of the country’s southern part, as well as in the autumn–winter season, this finding being independent of child sex. Based on the trend model obtained, almost 1,600 Polish children aged 0 to 14 years are expected to develop type 1 diabetes in 2010, rising to more than 4,800 in 2025. The estimates suggest at least a fourfold increase of IR between 2005 and 2025, with the highest dynamics of this increment in younger children. Conclusions/interpretation These estimates show that Poland will have to face a twofold higher increase in childhood type 1 diabetes than predicted for the whole European population. The dramatic increase could have real downstream effects on Poland’s healthcare system.

There is a 10-30% prevalence of HP infection in the general pediatric population in Poland. This study aimed to determine its prevalence in T1DM children in Upper Silesia, Poland and estimate its influence on metabolic control of patients. We studied 149 (82 female) children with T1DM (duration > 12 months, mean HbA1c) and 298 (164 female) age-matched controls. In all cases height and weight z-scores and Cole's index were assessed. In T1DM patients additionally glycated hemoglobin A1c and T1DM duration were analyzed. Presence of HP infection was determined using 13C-isotope-labeled urea breath test (UBT) (fasting and 30 min after ingestion 75 mg of 13C urea). HP infection was present in 17 (11.4%) T1DM patients and in 49 (16.4%) controls (p > 0.05). T1DM patients presented higher values of anthropometric parameters than healthy controls (weight SDS 0.25[-0.46 divided by 0.84] vs. -0.25 [-1.06 divided by 0.26], height SDS 0.09 [-0.60 divided by 0.69] vs. -0.31[-1.17 divided by 0.48] and Cole's index 103% [93 divided by 111%] vs. 97% [86 divided by 106%]; for all p < 0001). Within both groups--T1DM children and controls--no differences regarding sex, age and any of the anthropometric parameters were determined. T1DM duration and HbA1c showed no relation to prevalence of HP infection. Prevalence of HP infection in pediatric T1DM patients is similar to that of healthy peers and shows no relation to glycemic control.