Comparative risk of end-stage renal disease, myocardial infarction and stroke in young and older onset diabetes in UK Biobank

In recent years, coinciding with the increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, the global prevalence of diabetic kidney disease (DKD) and end-stage renal disease (ESRD) are rising year on year. In contrast, the mortality and morbidity due to cardiovascular disease (CVD) and stroke in people with diabetes have been declining. The precise cause of the disparate vascular outcomes in diabetes remains unexplored. To elucidate the relationship, we conducted a retrospective cohort study on the UK Biobank data. In our study, the exposure variables were the age of diabetes and hypertension diagnosis, while the outcome variables were ESRD, myocardial infarction, angina, and stroke. Univariable and multivariable logistic regression models were fitted to assess odds ratios (ORs) and 95% confidence intervals (CIs). Model performance was evaluated using the receiver operating characteristic (ROC) curve. Sensitivity analyses were conducted on participants who developed diabetes before and after the age of 20 years and with and without female participants. Univariable logistic regression showed that compared to those diagnosed after the age of 60, the odds of ESRD for those diagnosed at ages < 20, 20–40, and 41–60 years were 5.26 (3.00 – 9.40), 7.78 (4.81 – 13.16) and 2.33 (1.50 – 3.84), respectively. Myocardial infarction and stroke did not have a statistically significant relationship with younger age of diabetes diagnosis. In those with a dual diagnosis of diabetes and hypertension, irrespective of the age of diabetes diagnosis, the age of hypertension diagnosis at age < 20, 20–40, and 41–60 years, compared to those who developed it after the age of 60 years, had a greater risk of ESRD, 2.20 (1.58 – 3.11), 5.03 (3.79 – 6.81), and 1.53 (1.16 – 2.06), respectively. After adjusting for sex and albuminuria, multivariable logistic regression model 1 showed that compared to those who developed diabetes above the age of 60, those who developed it < 20, 20–40 and 41–60 had a higher risk of ESRD, 4.71 (2.47 – 9.28), 4.67 (2.63 – 8.78), and 1.94 (1.16 – 3.49), respectively. Likewise, in model 2, when the duration of diabetes was used as the explanatory variable, each year of increased duration of diabetes increased the odds of ESRD by 2%, with an odds ratio of 1.02 (1.01–1.03). Younger onset of hypertension but not diabetes increased the odds of myocardial infarction (MI). There was no statistically significant relationship between the age of diabetes, and hypertension diagnoses with angina and stroke. Model performance was excellent, with over 80% of the data points falling below the area under the curve. Sensitivity analyses showed young-onset diabetes as a significant determinant of ESRD. Young-onset and longer-duration of diabetes increase the risk of ESRD. For those with diabetes and hypertension, a younger onset of hypertension but not diabetes may also increase the risk of MI

Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy progression compared with multiple daily injections of insulin

AIMS/HYPOTHESIS: We aimed to compare diabetic retinopathy outcomes in people with type 1 diabetes following introduction of continuous subcutaneous insulin infusion (CSII) therapy with outcomes in people receiving continuing therapy with multiple daily insulin injections (MDI). METHODS: This is a retrospective cohort study using the Scottish Care Information – Diabetes database for retinal screening outcomes and HbA(1c) changes in 204 adults commenced on CSII therapy between 2013 and 2016, and 211 adults eligible for CSII during the same period but who continued on MDI therapy. Diabetic retinopathy progression (time to minimum one-grade worsening in diabetic retinopathy from baseline grading) was plotted for CSII and MDI cohorts using Kaplan–Meier curves, and outcomes were compared using multivariate Cox regression analysis adjusting for age, sex, baseline HbA(1c), blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA(1c) and change in HbA(1c) on diabetic retinopathy progression was assessed within CSII and MDI cohorts. RESULTS: CSII participants were significantly younger, were from less socially deprived areas, and had lower HbA(1c) and higher diastolic BP at baseline. There was a larger reduction in HbA(1c) at 1 year in those on CSII vs MDI (−6 mmol/mol [−0.6%] vs −2 mmol/mol [−0.2%], p < 0.01). Diabetic retinopathy progression occurred in a smaller proportion of adults following commencement of CSII vs continued MDI therapy over mean 2.3 year follow-up (26.5% vs 18.6%, p = 0.0097). High baseline HbA(1c) (75 mmol/mol [9%]) was associated with diabetic retinopathy progression in the MDI group (p = 0.0049) but not the CSII group (p = 0.93). Change in HbA(1c) at follow-up, irrespective of baseline glycaemic status, did not significantly affect diabetic retinopathy progression in either group. CONCLUSIONS/INTERPRETATION: CSII was associated with reduced diabetic retinopathy progression compared with continued MDI therapy, and may be protective against diabetic retinopathy progression for those with high baseline HbA(1c). Progression of diabetic retinopathy over 3 years was not associated with a change in HbA(1c). GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains peer-reviewed but unedited supplementary material available at 10.1007/s00125-021-05456-w

The COVID-19 Pandemic Affects Seasonality, With Increasing Cases of New-Onset Type 1 Diabetes in Children, From the Worldwide SWEET Registry

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.info:eu-repo/semantics/publishedVersio

Growth hormone therapy in a girl with Turner syndrome – An experience from Bangladesh

Turner syndrome (TS) is the most common sex chromosome abnormality in females. Short stature and hypogonadism are principal signs of TS. Turner syndrome is well-established. There have been studies that have evaluated the benefits of growth hormone in TS with significant benefit in adult height. A 9-year 11 months-old girl who presented to the Paediatric Endocrinologist, with complaint of not growing according to her age. Her growth was noticed to be slow from early age but her parents initially thought it was normal. They however became worried when she was not growing yet to start pubertal development. Her parents eventually took her to this referral hospital for further evaluation and management.</jats:p