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AimsLittle information is published on diabetes in young people in Bangladesh. We aimed to investigate the demographic, clinical, and biochemical features, and HLA-DRB1 alleles in new cases of diabetes affecting Bangladeshi children and adolescents

OBJECTIVE: To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. RESEARCH DESIGN AND METHODS: We analyzed data on 17,280 cases of T1D diagnosed during 2018–2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. RESULTS: The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1–12.2) in 2018 to 21.7 (20.6–22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2–14.0) in 2018 to 26.7 (25.7–27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5–12.9) to 24.7 (24.0–25.5) for adolescents ages 12–18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018–2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic. CONCLUSIONS: The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent. [ABSTRACT FROM AUTHOR]

Objectives: High prevalence of vitamin D deficiency (VDD) in children and adolescents with type 1 diabetes (T1D) was found in several epidemiological studies. The current study aimed to assess the Vitamin D status in children and adolescents with T1D and to examine the influence of the disease characteristics on vitamin D status in a specialized care centre in a tertiary hospital in Bangladesh. Methods: Participants were enrolled in the cross‐sectional study at the time of a regularly scheduled visit to the CDiC Paediatric Diabetes Center in BIRDEM 2(Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders), a tertiary care hospital in Bangladesh. The demographic and clinical data were collected through medical records with a structured questionnaire. Results: Among sixty study participants, most had inadequate levels of vitamin D: deficiency 31 (51.7%), insufficiency 14 (23.3%) and sufficiency 15 (25.0%). Participants with vitamin D deficiency (VDD) were significantly older compared to the sufficient and insufficient group (p =.029), and were residing in urban areas (p =.036) and from higher socioeconomic status (p =.014). BMI was significantly higher in VDD compared to the sufficient group (p =.040). Although we observed higher median values of daily insulin requirements and HbA1c values in patients with VDD compared to patients with vitamin D insufficiency or vitamin D sufficiency, these differences did not reach statistical significance. Conclusions: The present study revealed that the prevalence of vitamin D deficiency and insufficiency among T1 diabetes children was very high. Future studies in large sample are required to assess hypovitaminosis D in youth with T1D and also the possible relating factors of vitamin D deficiency. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Despite the advantages offered by current basal analogs, the management of type 1 diabetes (T1D) in children and adolescents is a great challenge till now. Insulin degludec (IDeg) is alternative basal insulin to be used in persons not responding to other basal insulins. The aim of the study was to compare the efficacy of IDeg (once daily) and insulin detemir (IDet) in children and adolescents with T1D in Bangladesh. Materials and Methods: In this retrospective analysis, we included T1D patients who were treated with IDet or IDeg in CDiC Diabetes Center, BIRDEM Hospital from January to June 2018. Thirty patients with IDeg were compared with 30 patients who were taking IDet; patients were randomly selected from the data set. Insulin dose requirement, weight, body mass index, fasting plasma glucose (FPG), and HbA1c were compared at the base level and at three and six months after treatment. Results: While comparing between two groups, the median FPG was high, 15.0 (13.6-18.3) vs. 14.4 (10.5-16.9), in both groups at the base level. Over the six months, FPG was gradually reduced in both groups but significantly reduced in IDeg patients (P = 0.03), although median HbA1c was higher, 9.9 (8.4-12.0), in IDeg patients than in IDet patients, 9.3 (8.1-10.4), at the base level but reduced significantly in IDeg patients, 8.4 (7.6-9.0), compared with IDet patients, 9.0 (8.1-9.7), after six months (P = 0.042). Though mild hypoglycemia was documented, there was no incidence of severe hypoglycemia in IDet or IDeg groups. Conclusion: In conclusion, in our study population, the IDeg group had more improvement in glycemic control, reducing FPG, than the IDet group. Moreover, there was more reduction of basal insulin dose in IDeg than in IDet after six months of starting the therapy. [ABSTRACT FROM AUTHOR]

Our aim was to report our telemedicine experience with type 1 diabetes patients using insulin pumps who fasted for Ramadan 2020 during the COVID‐19 pandemic. The routine diabetes outpatient care in our Changing Diabetes in Children (CDiC) Pediatric Diabetes Center at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders hospital was closed, as there was a lockdown from 26 March in Bangladesh. The diabetes team in our center started telemedicine care for routine follow up of patients. Nine patients who wished to fast for Ramadan contacted our diabetes team over the phone. The mean age was 19.3 ± 5.0 years, and five (55.6%) were female. Most of the patients fasted >20 days. Hyperglycemia and mild hypoglycemia were common complications during fasting. There was no episode of severe hypoglycemia or diabetic ketoacidosis, and none of the patients required admission. During the COVID‐19 crisis in Bangladesh, patients with type 1 diabetes using an insulin pump could fast safely for Ramadan with the support of the telemedicine service by the diabetes team. [ABSTRACT FROM AUTHOR]

Objectives: Diabetic retinopathy (DR) is the most common microvascular complications seen in children and adolescents with type 1 diabetes. The aim of this study was to evaluate the prevalence of retinopathy and its association with other risk factors in young people with type 1 diabetes. Methods: This study was a cross‐sectional study, which was done as part of the ongoing complication assessment in the paediatric diabetes clinic in BIRDEM (Bangladesh Institute of Research and Rehabilitation of Diabetes Endocrine and Metabolic Disorders), a tertiary care hospital. Children, adolescents and young adults with type 1 diabetes who were having diabetes duration >2 years were included in this study. Retinopathy was detected using fundal photography, and grading was done by National Screening Committee of UK by trained ophthalmologists. Results: Diabetic retinopathy was observed in 44 (6.6%) patients. Majority (95.4%) of them had early diabetic retinopathy in the form of mild NPDR (nonproliferative diabetic retinopathy) (R1). Patients with retinopathy had higher HbA1c 9.6[8.4‐12.3] vs 9.1 [7.9‐10.8] (P =.013), longer duration of diabetes 7.6 [5.5‐10.7] vs 6.0 [4.5‐8.2] years (P =.001) and were older 21.5 [18.0‐23.0] vs 18 [16.0‐21.0] years (P =.0001) compared with those without retinopathy. On multivariate regression analysis, higher age and median HbA1c were significantly associated with DR. Conclusions: Higher HbA1c was the only modifiable risk factor for development of DR in our study population. Early detection of DR with improvement of glycaemic control may reduce the risk of progression of severe stages of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Dyslipidemia and hyperglycemia are metabolic abnormalities commonly found in young patients with Type 1 diabetes mellitus (T1DM) and both increase the risk of cardiovascular disease. Methods: This cross-sectional study was aimed to evaluate the pattern of dyslipidemia and its relationship with other risk factors in children and adolescents with T1DM. A total of 576 T1DM patients aged 10-18 years who attended Changing Diabetes in Children, a pediatric diabetes clinic in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders over 1 year period from July 2015 to June 2016 were included in this study. Results: The overall frequency of dyslipidemia was 65%. The high triglyceride, high cholesterol, high low-density lipoprotein (LDL) and low high-density lipoprotein were found in 50%, 66%, 75%, and 48%, respectively. Compared to patients without dyslipidemia, patients with dyslipidemia had significantly lower mean body mass index (kg/m2) (18.4 [interquartile range; 16.2-21.4] vs. 19.5 [17.3-21.5] (P = 0.005)); significantly higher median fasting blood sugar (12.7 [9.9-15.2] vs. 10.6 [7.9-12.6] (P < 0.0001)) and higher median glycosylated hemoglobin (9.8 [8.4-11.8] vs. 7.9 [9.3-10.5] (P < 0.0001)). Hypertension was significantly higher in dyslipidemic patients (9.4% vs. 2.5% P < 0.002). Conclusion: More than half (65%) of our children and adolescents with T1DM had dyslipidemia, among them high LDL was the most common. These findings emphasize the screening of lipid profile in T1DM children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence (AI) appears capable of detecting diabetic retinopathy (DR) with a high degree of accuracy in adults; however, there are few studies in children and young adults. Methods: Children and young adults (3-26 years) with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) were screened at the Dhaka BIRDEM-2 hospital, Bangladesh. All gradable fundus images were uploaded to Cybersight AI for interpretation. Two main outcomes were considered at a patient level: 1) Any DR, defined as mild non-proliferative diabetic retinopathy (NPDR or more severe; and 2) Referable DR, defined as moderate NPDR or more severe. Diagnostic test performance comparing Orbis International's Cybersight AI with the reference standard, a fully qualified optometrist certified in DR grading, was assessed using the Matthews correlation coefficient (MCC), area under the receiver operating characteristic curve (AUC-ROC), area under the precision-recall curve (AUC-PR), sensitivity, specificity, positive and negative predictive values. Results: Among 1274 participants (53.1% female, mean age 16.7 years), 19.4% (n = 247) had any DR according to AI. For referable DR, 2.35% (n = 30) were detected by AI. The sensitivity and specificity of AI for any DR were 75.5% (CI 69.7-81.3%) and 91.8% (CI 90.2-93.5%) respectively, and for referable DR, these values were 84.2% (CI 67.8-100%) and 98.9% (CI 98.3%-99.5%). The MCC, AUC-ROC and the AUC-PR for referable DR were 63.4, 91.2 and 76.2% respectively. AI was most successful in accurately classifying younger children with shorter duration of diabetes. Conclusions: Cybersight AI accurately detected any DR and referable DR among children and young adults, despite its algorithms having been trained on adults. The observed high specificity is particularly important to avoid over-referral in low-resource settings. AI may be an effective tool to reduce demands on scarce physician resources for the care of children with diabetes in low-resource settings. [ABSTRACT FROM AUTHOR]

Objective: To compare rates of microvascular complications in adolescents with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI). Research Design and Methods: Prospective cohort of 989 patients (aged 12–20 years; diabetes duration >5 years) treated with CSII or MDI for >12 months. Microvascular complications were assessed from 2000–14: early retinopathy (seven-field fundal photography), peripheral nerve function (thermal and vibration threshold testing), autonomic nerve abnormality (heart rate variability analysis of electrocardiogram recordings) and albuminuria (albumin creatinine ratio/timed overnight albumin excretion). Generalized estimating equations (GEE) were used to examine the relationship between treatment and complications rates, adjusting for socio-economic status (SES) and known risk factors including HbA1c and diabetes duration. Results: Comparing CSII with MDI: HbA1C was 8.6% [70mmol/mol] vs. 8.7% [72 mmol/mol]) (p = 0.7), retinopathy 17% vs. 22% (p = 0.06); microalbuminuria 1% vs. 4% (p = 0.07), peripheral nerve abnormality 27% vs. 33% (p = 0.108) and autonomic nerve abnormality 24% vs. 28% (p = 0.401). In multivariable GEE, CSII use was associated with lower rates of retinopathy (OR 0.66, 95% CI 0.45–0.95, p = 0.029) and peripheral nerve abnormality (OR 0.63, 95% CI 0.42–0.95, p = 0.026), but not albuminuria (OR 0.46, 95% CI 0.10–2.17, p = 0.33). SES was not associated with any of the complication outcomes. Conclusions: In adolescents, CSII use is associated with lower rates of retinopathy and peripheral nerve abnormality, suggesting an apparent benefit of CSII over MDI independent of glycemic control or SES. [ABSTRACT FROM AUTHOR]

Our aim was to investigate the ability, frequency of acute complications and impact on glycemic control in uncontrolled T1DM who fasted during Ramadan. 74 Patients with T1D who insisted on fasting were enrolled 1 month prior to Ramadan and given intensive education by Diabetes team on insulin dose, glucose monitoring and dietary adjustments. Patients were divided into two groups ; group A- HbA1c < 9%(<75 mmol/mol) and group B- HbA1c ≥ 9% (≥75 mmol/mol) and different variables were compared. Most of the patients fasted 58 (78.4%) for more than 15 days. There was no significant difference (p = 0.790), while comparing the breaking the fast in the two groups. Hypoglycaemia was common acute complications among them. There was no significant difference in the frequency of hypoglycaemia between two groups (P = 0.448). There was increased insulin requirement in both groups during Ramadan (p = 0.00001), with an increase in basal insulin in well controlled (from 24 to 34 units). There was significant reduction of Post Ramadan mean HbA1C in both groups [P = 0.0001)]. Children, adolescents and young adults with T1D with poor glycaemic control can fast safely during Ramadan with proper education and intensive monitoring. [ABSTRACT FROM AUTHOR]

Fasting during the month of Ramadan, the ninth month of Islamic lunar calendar, is obligatory for all healthy adult and adolescent Muslims from the age of 12 years. Fasting starts from early dawn (Sohur/Sehri) till sunset (Iftar). During this period one has to abstain from eating and drinking. Islam has allowed many categories of people to be exempted from fasting, for example, young children, travelers, the sick, the elderly, pregnant, and lactating women. According to expert opinion, patients with type 1 diabetes (type 1 DM) who fast during Ramadan are at a very high risk to develop adverse events. However, some experienced physicians are of the opinion that fasting during Ramadan is safe for type 1 DM patients, including adolescents and older children, with good glycemic control who do regular self-monitoring and are under close professional supervision. The strategies to ensure safety of type 1 diabetic adolescents who are planning to fast include the following: Ramadan-focused medical education, pre-Ramadan medical assessment, following a healthy diet and physical activity pattern, modification in insulin regimen, and blood glucose monitoring as advised by the physician. [ABSTRACT FROM AUTHOR]

• The COVID-19 pandemic led to significant changes in global care for pediatric type 1 diabetes. • We present diabetes outcomes in >40,000 youths with T1D from the international SWEET registry before and during the pandemic. • We evaluated trends in HbA1c and severe adverse events across a 4-year observation period. • Changes in HbA1c and acute diabetes complications were consistent with shifts in provision of diabetes care. • There was a positive impact of transition to telemedicine on glycemic outcomes regardless of the increase in technology use. This study aimed to provide a global insight into initiatives in type 1 diabetes care driven by the COVID-19 pandemic and associations with glycemic outcomes. An online questionnaire regarding diabetes care before and during the pandemic was sent to all centers (n = 97, 66,985 youth with type 1 diabetes) active in the SWEET registry. Eighty-two responded, and 70 (42,798 youth with type 1 diabetes) had available data (from individuals with type 1 diabetes duration >3 months, aged ≤21 years) for all 4 years from 2018 to 2021. Statistical models were adjusted, among others, for technology use. Sixty-five centers provided telemedicine during COVID-19. Among those centers naive to telemedicine before the pandemic (n = 22), four continued only face-to-face visits. Centers that transitioned partially to telemedicine (n = 32) showed a steady increase in HbA1c between 2018 and 2021 (p < 0.001). Those that transitioned mainly to telemedicine (n = 33 %) improved HbA1c in 2021 compared to 2018 (p < 0.001). Changes to models of care delivery driven by the pandemic showed significant associations with HbA1c shortly after the pandemic outbreak and 2 years of follow-up. The association appeared independent of the concomitant increase in technology use among youth with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Aims HLA association with type 1 diabetes (T1D) is well established. HLA alleles and haplotype combinations vary among populations; however, the vast majority of T1D association studies have focused on subjects of European descent. Even the Type 1 Diabetes Genetics Consortium collection is predominantly comprised of European samples. The aim of this study is to determine HLA association with T1D in understudied populations around the globe, with a particular focus on developing countries, to elucidate differences in HLA-associated T1D susceptibility among populations and increase predictive power for T1D for all. Methods In collaboration with the Life for a Child program, we are collecting 100 blood samples from T1D patients and 200 saliva samples from unrelated controls from each of six countries, including Azerbaijan, Pakistan, Bangladesh, Mali, Sudan, and Haiti. For 469 samples collected to date, DNA was extracted and HLA DRB1 genes were sequenced with exon-based NGS technology on the Roche 454 GS Junior platform. Association analyzes were performed by gene counting, followed by chi-square analysis. Results To date, we have received 20 patients and 209 controls from Azerbaijan, 20 patients and 110 controls from Pakistan, and 110 controls from Bangladesh; DRB1 was genotyped for all samples. In preliminary analyzes, for Azerbaijan, DRB1 ∗ 03:01 (OR = 8.22; p = 1.35 × 10 - 9 ) and DRB1 ∗ 04:02 (OR = 6.93; p = 1.39 × 10 - 7 ) are significantly predisposing for T1D, while both DRB1 ∗ 15:01 and DRB1 ∗ 15:02 appear protective, but do not yet reach statistical significance. For Pakistan, the DRB1 ∗ 03:01 association is even stronger (OR = 10.37; p = 1.26 × 10 - 9 ), and DRB1 ∗ 15:02 protection is nearly significant (OR = 0.00, p = 0.063); however, no T1D association was observed for any DRB1 ∗ 04 allele. Conclusion These data illustrate the differences in HLA associated T1D susceptibility among populations. Additional differences will be revealed as we continue to receive and genotype samples. These differences are relevant for understanding the basic biology of HLA-associated T1D susceptibility, for prediction and differential diagnosis of T1D, and for eventual development of precision medicine-based treatment strategies for all individuals, regardless of ethnic heritage. [ABSTRACT FROM AUTHOR]