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2. Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia

Author

Stefano Zucchini, Stefano Tumini, Andrea Enzo Scaramuzza, Riccardo Bonfanti, Maurizio Delvecchio, Roberto Franceschi, Dario Iafusco, Lorenzo Lenzi, Enza Mozzillo, Stefano Passanisi, Claudia Piona, Ivana Rabbone, Novella Rapini, Andrea Rigamonti, Carlo Ripoli, Giuseppina Salzano, Silvia Savastio, Riccardo Schiaffini, Angela Zanfardino, Valentino Cherubini, Diabetes Study Group of the Italian Society for Pediatric Endocrinology Diabetes, Albino Claudia Accursia, Aloe Monica, Anzelotti Maria Teresa, Arnaldi Claudia, Barbetti Fabrizio, Bassi Marta, Berioli Maria Giulia, Bernardini Luca, Bertelli Enrica, Biagioni Martina, Bobbio Adriana, Bombaci Bruno, Bonfanti Riccardo, Bonura Clara, Bracciolini Giulia Patrizia, Bruzzese Mariella, Bruzzi Patrizia, Buono Pietro, Buscarino Piera, Cadario Francesco, Calcaterra Valeria, Calzi Elena, Cappa Marco, Cardani Roberta, Cardella Francesca, Cardinale Giuliana Marcella, Casertano Alberto, Castorani Valeria, Cauvin Vittoria, Cenciarelli Valentina, Ceruti Franco, Cherubini Valentino, Chiarelli Francesco, Chiari Giovanni, Cianfarani Stefano, Cicchetti Mario, Cipriano Paola, Cirillo Dante, Citriniti Felice, Coccioli Maria Susanna, Confetto Santino, Contreas Giovanna, Coro Anna, Correddu Antonella, Corsini Elisa, Crino’ Antonino, d’Annunzio Giuseppe, De Berardinis Fiorella, De Donno Valeria, De Filippo Gianpaolo, De Marco Rosaria, De Sanctis Luisa, Del Duca Elisabetta, Delvecchio Maurizio, Deodati Annalisa, Di Bonito Procolo, Di Candia Francesca, Faleschini Elena, Fattorusso Valentina, Favia Anna, Federico Giovanni, Felappi Barbara, Ferrari Mara, Ferrito Lucia, Fichera Graziella, Fontana Franco, Fornari Elena, Franceschi Roberto, Franco Francesca, Franzese Adriana, Frongia Anna Paola, Frontino Giulio, Gaiero Alberto, Galassi Sabrina Maria, Gallo Francesco, Gargantini Luigi, Giani Elisa, Gortan Anna Jolanda, Graziani Vanna, Grosso Caterina, Gualtieri Antonella, Guasti Monica, Guerraggio Lucia Paola, Guzzetti Chiara, Iafusco Dario, Iannicelli Gennaro, Iezzi Maria Laura, Ignaccolo Maria Giovanna, Innaurato Stefania, Inzaghi Elena, Iovane Brunella, Iughetti Lorenzo, Kaufmann Peter, La Loggia Alfonso, Lambertini Anna Giulia, Lapolla Rosa, Lasagni Anna, Lazzaro Nicola, Lazzeroni Pietro, Lenzi Lorenzo, Lera Riccardo, Levantini Gabriella, Lezzi Marilea, Lia Rosanna, Liguori Alice, Lo Presti Donatella, Lombardo Fortunato, Lonero Antonella, Longhi Silvia, Lorubbio Antonella, Lucchesi Sonia, Maccioni Rosella, Macedoni Maddalena, Macellaro Patrizia Cristiana, Madeo Simona Filomena, Maffeis Claudio, Mainetti Benedetta, Maltoni Giulio, Mameli Chiara, Mammì Francesco, Manca Bitti Maria Luisa, Mancioppi Valentina, Manco Melania, Marigliano Marco, Marino Monica, Marsciani Alberto, Matteoli Maria Cristina, Mazzali Elena, Minute Marta, Minuto Nicola, Monti Sara, Morandi Anita,, Morganti Gianfranco, Morotti Elisa, Mozzillo Enza, Musolino Gianluca, Olivieri Francesca, Ortolani Federica, Pampanini Valentina, Pardi Daniela, Pascarella Filomena, Pasquino Bruno, Passanisi Stefano, Patera Ippolita Patrizia, Pedini Annalisa, Pennati Maria Cristina, Peruzzi Sonia, Peverelli Paola, Pezzino Giulia, Piccini Barbara, Piccinno Elvira Eugenia Rosaria, Piona Claudia, Piredda Gavina, Piscopo Alessia, Pistone Carmelo, Pozzi Erica, Prandi Elena, Predieri Barbara, Prudente Sabrina, Pulcina Anna, Rabbone Ivana, Randazzo Emioli, Rapini Novella, Reinstadler Petra, Riboni Sara, Ricciardi Maria Rossella, Rigamonti Andrea, Ripoli Carlo, Rossi Virginia, Rossi Paolo, Rutigliano Irene, Sabbion Alberto, Salvatoni Alessandro, Salvo Caterina, Salzano Giuseppina, Sanseviero Mariateresa, Savastio Silvia, Savini Rosanna, Scanu Mariapiera, Scaramuzza Andrea Enzo, Schiaffini Riccardo, Schiavone Maurizio, Schieven Eleonardo, Scipione Mirella, Secco Andrea, Silvestri Francesca, Siri Giulia, Sogno Valin Paola, Sordelli Silvia, Spiri Daniele, Stagi Stefano, Stamati Filomena Andreina, Suprani Tosca, Talarico Valentina, Tiberi Valentina, Timpanaro Tiziana Antonia Lucia, Tinti Davide, Tirendi Antonina, Tomaselli Letizia Grazia, Toni Sonia, Torelli Cataldo, Tornese Gianluca, Trada Michela,, Trettene Adolfo Andrea, Tumini Stefano, Tumminelli Marilena, Valerio Giuliana, Vandelli Sara, Ventrici Claudia, Zampolli Maria, Zanatta Manuela, Zanfardino Angela, Zecchino Clara, Zonca Silvia, and Zucchini Stefano

Subjects
adolescents, automated insulin delivery, children, hypoglycemia, glucagon, oral glucose, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

There has been continuous progress in diabetes management over the last few decades, not least due to the widespread dissemination of continuous glucose monitoring (CGM) and automated insulin delivery systems. These technological advances have radically changed the daily lives of people living with diabetes, improving the quality of life of both children and their families. Despite this, hypoglycemia remains the primary side-effect of insulin therapy. Based on a systematic review of the available scientific evidence, this paper aims to provide evidence-based recommendations for recognizing, risk stratifying, treating, and managing patients with hypoglycemia. The objective of these recommendations is to unify the behavior of pediatric diabetologists with respect to the timely recognition and prevention of hypoglycemic episodes and the correct treatment of hypoglycemia, especially in patients using CGM or advanced hybrid closed-loop systems. All authors have long experience in the specialty and are members of the Italian Society of Pediatric Endocrinology and Diabetology. The goal of treating hypoglycemia is to raise blood glucose above 70 mg/dL (3.9 mmol/L) and to prevent further decreases. Oral glucose at a dose of 0.3 g/kg (0.1 g/kg for children using “smart pumps” or hybrid closed loop systems in automated mode) is the preferred treatment for the conscious individual with blood glucose

Published
2024
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3. Significant and persistent improvements in time in range and positive emotions in children and adolescents with type 1 diabetes using a closed-loop control system after attending a virtual educational camp

Author

Rabbone, Ivana, Savastio, Silvia, Pigniatiello, Ciro, Carducci, Chiara, Berioli, Maria Giulia, Cherubini, Valentino, Lo Presti, Donatella, Maltoni, Giulio, Mameli, Chiara, Marigliano, Marco, Minuto, Nicola, Mozzillo, Enza, Piccinno, Elvira, Predieri, Barbara, Rigamonti, Andrea, Ripoli, Carlo, Schiaffini, Riccardo, Lombardo, Fortunato, Tinti, Davide, Toni, Sonia, Zanfardino, Angela, Scaramuzza, Andrea Enzo, BassiBassi, Marta, Bonfanti, Riccardo, Bruzzi, Patrizia, Delvecchio, Maurizio, Giorda, Sara, Iafusco, Dario, Salzano, Giuseppina, Maffeis, Claudio, Redaelli, Francesca Chiara, Marino, Monica, Piccini, Barbara, Ricciardi, Maria Rossella, Rosanio, Francesco Maria, Tiberi, Valentina, Trada, Michela, Zanetta, Sara, Zucchini, Stefano, Calandretti, Michela, Daga, Federico Abate, Gesuita, Rosaria, Cavalli, Claudio, Rabbone, Ivana, Savastio, Silvia, Pigniatiello, Ciro, Carducci, Chiara, Berioli, Maria Giulia, Cherubini, Valentino, Lo Presti, Donatella, Maltoni, Giulio, Mameli, Chiara, Marigliano, Marco, Minuto, Nicola, Mozzillo, Enza, Piccinno, Elvira, Predieri, Barbara, Rigamonti, Andrea, Ripoli, Carlo, Schiaffini, Riccardo, Lombardo, Fortunato, Tinti, Davide, Toni, Sonia, Zanfardino, Angela, Scaramuzza, Andrea Enzo, Bonfanti, Riccardo, Rabbone, I., Savastio, S., Pigniatiello, C., Carducci, C., Berioli, M. G., Cherubini, V., Lo Presti, D., Maltoni, G., Mameli, C., Marigliano, M., Minuto, N., Mozzillo, E., Piccinno, E., Predieri, B., Rigamonti, A., Ripoli, C., Schiaffini, R., Lombardo, F., Tinti, D., Toni, S., Zanfardino, A., Scaramuzza, A. E., Bassibassi, Marta, Bruzzi, Patrizia, Delvecchio, Maurizio, Giorda, Sara, Iafusco, Dario, Salzano, Giuseppina, Maffeis, Claudio, Redaelli, Francesca Chiara, Marino, Monica, Piccini, Barbara, Ricciardi, Maria Rossella, Rosanio, Francesco Maria, Tiberi, Valentina, Trada, Michela, Zanetta, Sara, Zucchini, Stefano, Calandretti, Michela, Daga, Federico Abate, Gesuita, Rosaria, and Cavalli, Claudio

Subjects
Blood Glucose, Virtual educational camp, Type 1 diabete, Adolescent, Endocrinology, Diabetes and Metabolism, Emotions, Adolescents, Advanced hybrid closed loop, Children, Closed-loop control, Type 1 diabetes, Blood Glucose Self-Monitoring, Child, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Diabetes Mellitus, Type 1, Endocrinology, Diabetes Mellitus, Internal Medicine, Emotion, General Medicine, Type 1
Abstract

Objective To evaluate the six-month impact of the advanced automated functions of a closed-loop control (CLC) system (Control-IQ) and a virtual educational camp (vEC) on emotions and time in range (TIR) of children and adolescents with type 1 diabetes. Methods Children and their parents participated in a three-day vEC. Clinical, glucose, and emotion data were evaluated before, just after, and six months after the vEC. Emotions were evaluated using adapted Plutchik's and Geneva Emotion Wheels. Results Forty-three children and adolescents (7–16 years) showed significant improvements in positive emotions immediately and six months after the vEC (67% and 65% vs 38%, p < 0.05, respectively), while mixed emotions were reduced (32% and 15% vs 61%, p < 0.05 and p < 0.001, respectively). The median percentage TIR increased from 64% (IQR 54–72) to 75% (IQR 70–82) with Control-IQ (p < 0.001) six months after the vEC. Conclusions Positive emotions (joy, serenity, and satisfaction) significantly improved while mixed emotions were significantly worse six months after the initiation of a CLC system (Control-IQ) and a vEC.

Published
2022

4. Albuminuric and non-albuminuric reduced eGFR phenotypes in youth with type 1 diabetes: Factors associated with cardiometabolic risk

Author

Maurizio Delvecchio, C. Ripoli, Claudia Piona, Alberto Casertano, Roberto Franceschi, Riccardo Schiaffini, Maria R Ricciardi, Valentino Tiberi, Elvira Piccinno, T. Suprani, Giulio Maltoni, Enza Mozzillo, Procolo Di Bonito, Angela Zanfardino, Dario Iafusco, Gianluca Tornese, Silvia Savastio, C. Arnaldi, Valentino Cherubini, Francesco Maria Rosanio, Brunella Iovane, Claudio Maffeis, Adriana Franzese, Di Bonito, P., Mozzillo, E., Rosanio, F. M., Maltoni, G., Piona, C. A., Franceschi, R., Ripoli, C., Ricciardi, M. R., Tornese, G., Arnaldi, C., Iovane, B., Iafusco, D., Zanfardino, A., Suprani, T., Savastio, S., Cherubini, V., Tiberi, V., Piccinno, E., Schiaffini, R., Delvecchio, M., Casertano, A., Maffeis, C., Franzese, A., Di Bonito, Procolo, Mozzillo, Enza, Rosanio, Francesco Maria, Maltoni, Giulio, Piona, Claudia Anita, Franceschi, Roberto, Ripoli, Carlo, Ricciardi, Maria Rossella, Tornese, Gianluca, Arnaldi, Claudia, Iovane, Brunella, Iafusco, Dario, Zanfardino, Angela, Suprani, Tosca, Savastio, Silvia, Cherubini, Valentino, Tiberi, Valentina, Piccinno, Elvira, Schiaffini, Riccardo, Delvecchio, Maurizio, Casertano, Alberto, Maffeis, Claudio, and Franzese, Adriana

Subjects
Male, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), White, Diabetic nephropathy, 030204 cardiovascular system & hematology, Kidney, Gastroenterology, chemistry.chemical_compound, 0302 clinical medicine, cardiovascular disease, Retrospective Studie, Prevalence, eGFR, Medicine, Age Factor, Diabetic Nephropathies, Child, Children, Nutrition and Dietetics, cardiometabolic risk factor, type 1 diabete, Age Factors, Cardiovascular disease, Phenotype, Type 1 diabetes, Italy, Child, Preschool, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Human, Glomerular Filtration Rate, Type 1, medicine.medical_specialty, microalbuminuria, Type 1 diabete, Adolescent, Renal function, 030209 endocrinology & metabolism, Risk Assessment, White People, Autoimmune thyroiditis, 03 medical and health sciences, children, Internal medicine, Diabetes Mellitus, Humans, Albuminuria, Diabetic kidney disease, diabetic nephropathy, diabetic kidney disease, cardiometabolic risk factors, type 1 diabetes, Retrospective Studies, Cross-Sectional Studie, Creatinine, Cardiometabolic risk factor, business.industry, Thyroiditis, Autoimmune, Biomarker, medicine.disease, Cardiometabolic risk factors, Cross-Sectional Studies, Diabetes Mellitus, Type 1, chemistry, Diabetic Nephropathie, Uric acid, Microalbuminuria, business, Biomarkers
Abstract

Background and aim: Albuminuria and reduced eGFR are hallmarks of Diabetic Kidney Disease in adults. Our aim was to analyze factors associated with albuminuric and non-albuminuric mildly reduced eGFR phenotypes in youths with type 1 diabetes. Methods and results: This multicenter cross-sectional study included 1549 youths (age 5–17 years) with type 1 diabetes enrolled at 14 Italian Pediatric Diabetes Centers. Albuminuria, creatinine, glycosylated hemoglobin (HbA1c), lipids, blood pressure (BP), neutrophils (N) and lymphocytes (L) count were analyzed. Uric acid (UA) was available in 848 individuals. Estimated GFR (eGFR) was calculated using bedside Schwartz's equation. The sample was divided in three phenotypes: 1) normoalbuminuria and eGFR ≥90 mL/min/1.73 m2 (reference category, n = 1204), 2) albuminuric and normal GFR phenotype (n = 106), 3) non-albuminuric mildly reduced GFR (MRGFR) phenotype (eGFR 60–89 mL/min/1.73 m2, n = 239). Albuminuric and non-albuminuric reduced eGFR phenotypes were significantly associated with autoimmune thyroiditis (P =0.028 and P=0.044, respectively). Albuminuric phenotype showed high risk of high HbA1c (P=0.029), high BP (P < 0.001), and low HDL-C (P =0.045) vs reference category. Non-albuminuric MRGFR phenotype showed high risk of high BP (P < 0.0001), low HDL-C (P =0.042), high Triglycerides/HDL-C ratio (P =0.019), and high UA (P < 0.0001) vs reference category. Conclusion: Non albuminuric MRGFR phenotype is more prevalent than albuminuric phenotype and shows a worst cardiometabolic risk (CMR) profile). Both phenotypes are associated with autoimmune thyroiditis. Our data suggest to evaluate both albuminuria and eGFR earlier in type 1 diabetes to timely identify young people with altered CMR profile.

Published
2021

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