Young adults (YA) with type 1 diabetes mellitus (T1D) are at high risk of worsening glycated haemoglobin (HbA1c) with fewer follow-up visits. We examined the association of demographic and diabetes characteristics with care utilization, including in-person and telehealth visits, pre- (1 April 2019 to 15 March 2020) and during the COVID-19 pandemic (30 March 2020 to 15 March 2021) for YA (ages: 18-30) with T1D, comparing those seen in paediatric versus adult diabetes clinics at a single diabetes centre.

Data were obtained from the electronic health record for YA with a pre-pandemic HbA1c. We performed descriptive statistics to describe the sample and paired t-tests to compare visits before and during the pandemic.

Data from 1762 YA (54% male; age 24.0 ± 3.6 (M ± SD) years; HbA1c 66 ± 18 mmol/mol (8.2 ± 1.6%) revealed that in the full sample, mean pre-pandemic visit frequency was 3.5 ± 3.4 and mean pandemic visit frequency was 3.1 ± 4.1 (p < 0.0001). Furthermore, the pandemic visit frequency declined in the adult clinic regardless of sex, pump therapy, CGM use, and pre-pandemic HbA1c, whereas in the paediatric clinic, visit frequency was only reduced for those with HbA1c <53 mmol/mol (<7%) but was otherwise maintained.

In this diabetes centre, the paediatric clinic maintained diabetes care delivery during the pandemic (30 March 2020 to 15 March 2021) to YA with glycaemic control above target, suggesting that preservation of remote care delivery should be considered in this high-risk group.

Diabetes organizations recommend nutrition education by a registered dietitian (RD) at least annually following type 1 diabetes (T1D) diagnosis in children. The study objectives were to describe differences over time in annual RD follow-up in children with T1D and to identify patient characteristics associated with RD engagement.

Data based on 6034 completed diabetes medical visits among 1982 patients aged <18 years with T1D for ≥1 year followed at a pediatric, tertiary care, academic medical center over a 5-year period (2018-2022) were analyzed. Generalized estimating equations models assessed for differences over time in the rates of RD visit completion in the year preceding the last diabetes medical encounter and identified sociodemographic, diabetes care-related, and clinical patient characteristics associated with RD follow-up. Models were fit for the whole sample and groups subset by race and ethnicity.

Observed annual RD follow-up rate over the 5-year period was 20.8%, with the lowest adjusted percentage in 2021 compared to 2018. In multivariable analysis, for each year increase in age (p = 0.004) and diabetes duration (p<0.001), there was a 3% and 15% reduction in the odds of RD follow-up, respectively. RD follow-up was associated with lower hemoglobin A1c within the subsequent year in adjusted analysis (p = 0.029), with the greatest improvement among Hispanic patients.

Annual RD visit frequency among children with T1D is suboptimal. Study findings provide insights for targeted intervention to improve RD engagement. RD follow-up may be associated with improved glycemic outcomes.

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

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

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

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

The prevalence of young onset (≤30 years) type 2 diabetes (T2D) is increasing in South Asians, reflecting rise in childhood obesity. This systematic review analyses current data on thecohort prevalence of young onset T2D in South Asians.

PubMed, Scopus,Science Direct,and Ebscohost were searched for articles published between 1990 and 2024, anda manual search identified additional articles. This study included case series, cross-sectional, retrospective cohort, or case reports.

Out of 5073 studies, 26 eligible studies were found including three case reports. Seventeen studies were from India, five werefrom other South Asian countries (Pakistan, Bangladesh, Nepal, Maldives), and nine were on migrant South Asians residing in different countries (UK,USA,Qatar, Canada). The cohort prevalence of young onset T2D in South Asians ranged from 0.1 % to 28.3 % (India 0.4 to 26.8 %, other SA countries 0.1 to 28.3 %, and migrant South Asians 4.1 to 18.1 %).

The burden of T2D among native South Asian children and young adults is higher than among migrant South Asians. This contrasts with traditional perceptions that T2D primarily affects older individuals and the South Asian diaspora i.e., those who have migrated from South Asia.

Immune-mediated inflammatory diseases (IMIDs) are chronic inflammatory diseases caused by immune system dysregulation, affecting multiple systems and organs. Children and adolescents aged 10-24 are among the high-risk groups, and the global burden is substantial.

Using the latest data from global burden of disease (GBD) 2021, we employed Joinpoint regression analysis, Socio-Demographic Index (SDI) correlation analysis, and cross-national equity analysis to elucidate the spatiotemporal differences in the burden of IMIDs among 10-24-year-olds from 1990 to 2021.

The burden of IMIDs in adolescents aged 10-24, ranked by severity, includes asthma, atopic dermatitis (AD), psoriasis, diabetes, rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and multiple sclerosis (MS). Among these, asthma, AD, psoriasis, RA, and MS are more prevalent in females. Compared to 1990, the incidence rates of asthma and AD decreased in 2021, while the rates of psoriasis, diabetes, and RA increased. IMIDs are more common in Western Europe and North America, with rising incidence rates in South America and Asia. Concentration indices and slope indices indicate that these diseases are primarily concentrated in high SDI regions, although the differences in incidence rates between countries are decreasing.

While focusing on high-incidence regions, we must also pay attention to the incidence of IMIDs in emerging regions such as Asia and South America. Only in this way can we effectively reduce the heavy burden that IMIDs place on younger people globally.

A hospital-based cross-sectional study involving children aged 2-15 years attending the obesity clinic of a tertiary care hospital from January 2016 to March 2018 was carried out to study carotid intima media thickness (cIMT) and its association with cardiometabolic risk factors in children with overweight and obesity. Secondary objective was to compare children with elevated (EcIMT) and normal cIMT (NcIMT). Out of 223 patients enrolled for the study, 102 (45·7 %) had EcIMT. Mean cIMT of the study participants was 0·41 (sd 0·13) mm. Median alanine transaminase levels (27 v. 24, P= 0·006) and proportion of patients with fatty liver (63·7 % v. 48·8 %, P= 0·025) and ≥ 3 risk factors (80·4 % v. 66·1 %, P= 0·003) were higher in the EcIMT group compared with NcIMT group. Proportion of patients with hypercholesterolemia (36·4 % v. 16 %, P= 0·024), elevated LDL-cholesterol (38·6 % v. 16 %, P= 0·013), low HDL-cholesterol (40·9 % v. 20 %, P= 0·027) and dyslipidemia (84·1 % v. 58 %, P= 0·006) was higher in the pubertal EcIMT group and those with fatty liver (63·8 % v. 45·1 %, P= 0·034) was higher in the prepubertal EcIMT group compared with pubertal and prepubertal NcIMT groups, respectively. No significant correlations were observed between cIMT and various cardiometabolic parameters. Our finding of EcIMT in nearly half of the study participants including young children is very concerning as these children are at increased risk of atherosclerotic CVD in adulthood. Interventions starting at a young age are important when trajectories are likely to be more malleable and adverse cardiometabolic phenotypes and subclinical atherosclerosis are reversible.

Type 1 diabetes (T1D) management requires following a complex and constant regimen relying on child or caregiver behaviors, skills, and knowledge. Psychological factors such as diabetes distress (DD), depression, and burnout are pertinent considerations in the treatment of pediatric T1D. Approximately 40% of youth and 61% of caregivers experience DD. Implementation of DD screening as part of clinical best practice is recommended and may facilitate treatment referral, perhaps leading to improved health or well-being for youth with T1D and their caregivers. By building on existing institutional infrastructure when available, screening via digital health platforms (applications, or "apps") may allow for timely screening of, and response to, DD.

This work details the creation, implementation, and refinement of a process to screen for DD in youth and their caregivers in the context of routine T1D care using a digital health platform.

DD screening was implemented in an outpatient endocrinology clinic over 1 year as part of a larger screen-to-treat trial for children aged 8-12.99 years and their caregivers. Validated measures were sent via digital health platform to be completed prior to the clinic visit. Results were initially reviewed manually, but a digital best practice alert (BPA) was later built to notify staff of elevated scores. Families experiencing DD received resources sent via the digital health platform. For this secondary analysis, child demographics and glycated hemoglobin A1c (HbA1c) were collected.

During the screening period, absolute completion rates were 36.78% and 38.83%, with adjusted screening rates at 52.02% and 54.48%, for children and caregivers, respectively. A total of 21 children (mean HbA1c 8.04%, SD 1.39%) and 26 caregivers (child mean HbA1c 8.04%, SD 1.72%) reported elevated DD. Prior to BPA development, resources were sent to all but 1 family. After BPA implementation, all families were sent resources.

Early findings indicate that DD education, screening, and response can be integrated via digital platforms in a freestanding outpatient endocrinology clinic, thereby facilitating timely treatment referral and provision of resources for those identified with distress. Notably, in the observed 1-year screening period, screening rates were low, and barriers to implementation were identified. While some implementation challenges were iteratively addressed, there is a need for future quality improvement initiatives to improve screening rates and the identification of, or response to, DD in our pediatric patients and their families.

This study sought to elucidate the interactions among physical activity (PA) patterns, mean glucose concentrations, and the incidence of nocturnal hypoglycemia events in children and adolescents with type 1 diabetes, examining the moderating influence of daily dosage on these associations.

Eighty-two participants aged 6 to 18 years (43.9% girls) from the Diactive-1 Cohort Study, diagnosed with type 1 diabetes, were included. Data collection involved continuous glucose monitoring, accelerometry to assess real-world PA, as well as documentation of daily insulin doses and carbohydrate counting over the same 7 days.

A total of 19 participants experienced at least 1 nocturnal hypoglycemia event over a span of 574 measurement days (106 days with and 451 days without nocturnal hypoglycemia). Higher levels of vigorous PA (VPA) were associated with lower same-day mean glucose levels (P = .014). Additionally, higher levels of moderate PA (P = .023), VPA (P = .011), and moderate-to-vigorous PA (P = .010) were associated with a greater number of nocturnal hypoglycemia events. Specifically, a significant association was identified between VPA and nocturnal hypoglycemia events when the daily insulin dose was at or above 1.04 units per kilogram of body weight per day (P = .016).

Daily VPA is associated with glucose reductions, potentially leading to more hypoglycemic episodes, particularly when there is an excess of daily insulin. This highlights the need for careful insulin management in children and adolescents with type 1 diabetes engaging in VPA.

Adolescents with type 1 diabetes (T1D) have elevated eating disorder risk. No studies have examined weight stigma as a potential factor associated with disordered eating. This study investigated cross-sectional associations among weight-based victimization, weight bias internalization, and disordered eating in adolescents with T1D. Adolescents (12-17 years; N = 166) self-reported experiences of weight-based victimization from peers, family members, and healthcare professionals. The Weight Bias Internalization Scale (WBIS) and Diabetes Eating Problems Survey (DEPS-R) assessed internalized weight bias and disordered eating, respectively. In a series of multiple hierarchical linear regression analyses (controlling for zBMI, diabetes duration, HbA1c, sex), weight bias internalization, weight-based victimization, and frequency of weight-based victimization by peers, family, and healthcare professionals were all positively associated with disordered eating. Weight stigma is an understudied but potentially important factor to address in adolescents with T1D. Reducing weight stigma may be a promising, novel target for eating disorder prevention in this population.

Type 1 Diabetes (T1D) is a progressive autoimmune disease often identified in childhood or adolescence, with early stages detectable through pre-diabetic markers such as autoantibodies and subclinical beta-cell dysfunction. The identification of the pre-T1D stage is critical for preventing complications, such as diabetic ketoacidosis, and for enabling timely interventions that may alter disease progression. This review examines the multifaceted approach to managing T1D risk in adolescents and teens, emphasizing early detection, nutritional interventions, beta-cell preservation strategies, and psychosocial support. Screening for T1D-associated autoantibodies offers predictive insight into disease risk, particularly when combined with education and family resources that promote lifestyle adjustments. Although nutritional interventions alone are not capable of preventing T1D, certain lifestyle interventions, such as weight management and specific nutritional choices, have shown the potential to preserve insulin sensitivity, reduce inflammation, and mitigate metabolic strain. Pharmacological strategies, including immune-modulating drugs like teplizumab, alongside emerging regenerative and cell-based therapies, offer the potential to delay disease onset by protecting beta-cell function. The social and psychological impacts of a T1D risk diagnosis are also significant, affecting adolescents' quality of life, family dynamics, and mental health. Supportive interventions, including counseling, cognitive-behavioral therapy (CBT), and group support, are recommended for managing the emotional burden of pre-diabetes. Future directions call for integrating universal or targeted screening programs within schools or primary care, advancing research into nutrition and psychosocial support, and promoting policies that enhance access to preventive resources. Advocacy for the insurance coverage of screening, nutritional counseling, and mental health services is also crucial to support families in managing T1D risk. By addressing these areas, healthcare systems can promote early intervention, improve beta-cell preservation, and support the overall well-being of adolescents at risk of T1D.

Because of the complexity of their child's diabetes management, parents often assume all care duties and report needing additional assistance to resume family routines.

To examine the preliminary efficacy of a telehealth occupation-based coaching intervention for rural parents of a child living with Type 1 diabetes (T1D) to improve child glycemic levels, family quality of life, and parental self-efficacy.

Double-blinded, two-arm, pilot randomized controlled trial.

Telehealth video conferencing at home.

16 dyads of rural parents and children ages 2 to 12 yr diagnosed with T1D.

Occupation-based coaching delivered through telehealth sessions, once weekly for 12 wk, informed by community partners.

Child measures: hemoglobin A1c and glucose time in range. Family measures: Parenting Sense of Competence, World Health Organization Quality of Life Brief Questionnaire, Goal Attainment Scale, Evidence of Independent Capacity Rating Scale (EICRS), and caregiver talk.

Families in the intervention group were more likely to achieve family-centered participation goals (p = .006) than those in the controlled group. Caregiver talk increased significantly over the 12-wk period (p = .034), and the average rating on the EICRS also improved significantly (p < .001). There were no statistically significant changes in glycemic levels or family quality of life.

OBC may be more efficacious in helping families to improve health management routines after a child's diagnosis with T1D than usual endocrinology care alone. Most child health outcomes were in target range at the start of the study; therefore, it was not expected to see significant improvements. Plain-Language Summary: Occupational therapy is an untapped resource in the provision of care for children with Type 1 diabetes (T1D). Occupational therapy practitioners can also provide families with evidence-based support to address the self-management skills of children with this chronic condition. This clinical trial examined the preliminary efficacy of a new 12-wk telehealth occupational therapy intervention for rural families with a child living with T1D to improve caregiver diabetes management skills, family participation, and child health. Families who received occupational therapy services were more likely to improve their family participation in meaningful activities and diabetes self-efficacy; however, there were no differences in the child's health outcomes or the family's quality of life.

Insulin pens are the mainstay of insulin delivery in the pediatric population, especially among patients unable to use an insulin pump. Safety pen needle (SPN) devices have been embraced by both nurses and patients because they limit the risks of needlestick injury and exposure to blood-borne pathogens. With the commonly used traditional passive SPN device, however, it can be difficult to observe that the dose has been accurately or fully administered.

The purpose of this study was to determine nurses' perceptions about the feasibility of using an active SPN device (specifically the Unifine SafeControl insulin pen needle), compared with the currently used passive SPN device, in pediatric patients ages 21 years or younger who require subcutaneous insulin injections.

This feasibility study was conducted on a pediatric inpatient unit at 1 pediatric hospital in the southeastern United States. A total of 49 RNs completed both a pre-device change survey regarding the currently used passive SPN device and a post-device change survey regarding the active SPN device. The RNs also completed daily evaluations assessing the ease of teaching patients and their caregivers how to use the active SPN device. Participation consent was also obtained for 132 pediatric patients with diabetes who were admitted to the unit.

The majority of the RNs (87.8%) reported overall satisfaction with the active SPN device, compared to about half (52.7%) who reported overall satisfaction with the passive SPN device. Almost all the RNs (98.6%) reported that the active SPN device was easy or very easy to use. Nearly all the nurses (93.9%) reported feeling completely or very confident that the active SPN device allowed them to deliver the full intended dose; and nearly all reported that it was easy or very easy to teach patients (98.2%) and their caregivers (96.4%) how to use the active device.

As frontline workers in patient care, nurses can lead the innovation and development of new treatment approaches, protocols, and equipment. This nurse-led study explored the nurses' perceptions about the feasibility of a new active SPN device versus the passive SPN device in terms of safety, ease of use, ease of and confidence in dose administration, and ease of teaching device use to pediatric patients and their caregivers. The RNs' clear preference for the active over the passive SPN device suggests that the newer, active devices warrant more widespread use in hospital settings, with further research also recommended.

Youth-onset type 2 diabetes (T2D) results from genetic, environmental, and metabolic causes that differ among individuals and populations. This chapter builds on the 2022 ISPAD guidelines and summarizes recent advances in the management of T2D in children and adolescents. Updates include diagnostic algorithm for youth with new onset T2D, algorithms and tables for treatment, management, and assessment of comorbidities and complications and recommendations on recently approved pharmacologic therapies for the treatment of youth-onset T2D and management strategies. Youth-onset type 2 diabetes (T2D) results from genetic, environmental, and metabolic causes that differ among individuals and populations. This chapter builds on the 2022 ISPAD guidelines and summarizes recent advances in the management of T2D in children and adolescents. Updates include diagnostic algorithm for youth with new onset T2D, algorithms and tables for treatment, management, and assessment of comorbidities and complications and recommendations on recently approved pharmacologic therapies for the treatment of youth-onset T2D and management strategies.

Adolescents with diabetes mellitus (DM) experience poorer glycemic outcomes and lower adherence to self-management regimens compared to other age groups. The coronavirus 2019 (COVID-19) pandemic posed new barriers to DM self-management, including social distancing measures and additional stressors. We conducted a scoping review of peer-reviewed literature to examine self-management regimens and outcomes among adolescents aged 10-17 years with type 1 and type 2 DM during the pandemic. Our scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched three online databases, screened articles through a rigorous process, and assessed bias using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. The findings from the included articles were categorized into six thematic areas: glycemic control/monitoring, insulin administration/regimens, weight/lifestyle behaviors, inpatient care/acute complications, outpatient care/telemedicine utilization, and psychosocial well-being. The findings from the included articles (n = 32) varied. Adolescents who used continuous glucose monitoring (CGM), regularly adjusted insulin doses, and utilized telemedicine generally maintained or improved glycemic control during the pandemic. However, many adolescents gained weight, reduced their physical activities, worsened their diet and sleep habits, and experienced increased stress, all of which negatively impacted glycemic control. Rates of acute complications and hospitalizations varied among adolescents. Telemedicine was widely used and viewed positively by adolescents with DM. Adolescents with DM faced various physical, behavioral, and psychosocial challenges during the COVID-19 pandemic. Further research is needed to assess the long-term impacts of the pandemic on this population. Multilevel interventions and preparedness efforts are required to improve and sustain adolescents' DM self-management outcomes during public health emergencies, particularly focused on promoting CGM use, increasing physical activity levels, improving dietary habits, and reducing stress.

Objective: To evaluate the impact of missed or late meal boluses (MLBs) on glycemic outcomes in children and adolescents with type 1 diabetes using automated insulin delivery (AID) systems. Research Design and Methods: AID-treated (Tandem Control-IQ or Medtronic MiniMed 780G) children and adolescents (aged 6-21 years) from Stanford Medical Center and Steno Diabetes Center Copenhagen with ≥10 days of data were included in this two-center, binational, population-based, retrospective, 1-month cohort study. The primary outcome was the association between the number of algorithm-detected MLBs and time in target glucose range (TIR; 70-180 mg/dL). Results: The study included 189 children and adolescents (48% females with a mean ± standard deviation age of 13 ± 4 years). Overall, the mean number of MLBs per day in the cohort was 2.2 ± 0.9. For each additional MLB per day, TIR decreased by 9.7% points (95% confidence interval [CI] 11.3; 8.1), and compared with the quartile with fewest MLBs (Q1), the quartile with most (Q4) had 22.9% less TIR (95% CI: 27.2; 18.6). The age-, sex-, and treatment modality-adjusted probability of achieving a TIR of >70% in Q4 was 1.4% compared with 74.8% in Q1 (P < 0.001). Conclusions: MLBs significantly impacted glycemic outcomes in AID-treated children and adolescents. The results emphasize the importance of maintaining a focus on bolus behavior to achieve a higher TIR and support the need for further research in technological or behavioral support tools to handle MLBs.

Despite advancements in T1D care regimens, racially and ethnically diverse youth with low income continue to experience worse health outcomes, more psychosocial challenges, and higher barriers to care. Alternative care models are needed to address the needs of this population.

Team Clinic is a person-centered virtual peer group (VPG) care model that was assessed in a 15-month, pragmatic randomized controlled trial. Youth (ages 10-17) and their families were assigned to study arms based on their clinician's group (standard care or person-centered care, PCC) and then randomized to VPGs or no groups.

Data from 79 youth and their families were examined. While positive outcomes were seen across all study groups, youth that participated in Team Clinic (PCC + VPG) reported the largest increases in resilience at the end of the study (+7.42, to 51.63, p = 0.009). These participants also reported the lowest levels of depressive symptoms as assessed by PHQ-8 scores (-5.07, p = 0.002) at the end of the study.

Team Clinic can serve as an alternative care model for racially and ethnically diverse youth with T1D and their families. VPGs can provide unique benefits, including an increase in resilience, a decrease in depressive symptoms, and a safe space for families to connect, learn, and receive support.

Managing diabetes in pregnancy can be overwhelming, with numerous dramatic physiologic changes taking place that require constant diligence and attention. Advances in diabetes technology have improved glycemic outcomes, well-being, and quality of life for people with type 1 diabetes of all ages. However, regulatory approval and access to diabetes technology in pregnancy has lagged behind these advancements, leaving many pregnant individuals without tools that could dramatically improve diabetes care before, during, and after gestation. Here, we review the benefits of continuous glucose monitors and automated insulin-delivery systems in pregnancy and highlight specific scientific and structural supports to help implement diabetes technology safely, effectively, and equitably in pregnancy.

Objectives: Regular retrospective review of glucose data is an important aspect of type 1 diabetes (T1D) management. Continuous glucose monitors (CGMs) facilitate retrospective review by capturing glucose data and generating standardized reports. However, only a minority of adults with T1D retrospectively review their glucose data, and adolescents are understudied. The objectives of this study were to determine the prevalence of self-reported retrospective glucose data review by adolescents with T1D, determine factors associated with self-reported retrospective glucose data review, and assess whether self-reported retrospective glucose data review was associated with improved glycemia. Methods: We conducted a cross-sectional survey of adolescents aged 12-18 years with T1D in conjunction with review of the associated electronic medical record, which included age, sex, date of diagnosis, clinic hemoglobin A1c (HbA1c), type of insurance, and CGM data. The survey included the Hypoglycemia Fear Survey (HFS) and questions regarding habits and attitudes associated with retrospective review. Results: 112 out of 218 eligible individuals completed the survey (51%). Fifty-three percent of adolescents who completed the survey reported that they had engaged in retrospective glucose data review. Of these, 88% of individuals reported that they reviewed data regularly. Age, sex, race, type of insurance, and CGM use were not associated with retrospective review status. Self-report of retrospective glucose data review was associated with improved glycemia as measured by HbA1c and time in range (TIR) compared to adolescents who indicated they do not review glucose data (p=0.006 and p=0.04, respectively). There was no difference in HFS scores between reviewers and nonreviewers including the behavioral subscale, worry subscale, and total score. Conclusions: Self-report of retrospective glucose data review was associated with improved glycemia as measured by HbA1c and TIR. Adolescent-initiated glucose data self-review does not appear to be driven by fear of hypoglycemia (FoH).

Glycaemic control is a crucial aspect of managing type 1 diabetes mellitus (T1DM). Strict glycaemic control has been proven to reduce the long-term complications of the disease.

The aim of this study was to investigate the effect of parental involvement in diabetes care and social support on glycaemic control in adolescents with T1DM.

In this cross-sectional study, 94 adolescents and their parents admitted to a university hospital between January and July 2023 were included in the study. The Multidimensional Scale of Perceived Social Support (PMDC-R) and Parental Monitoring Scale (MSPSS) in Diabetes Care of Adolescents with T1DM were used as data collection tools.

Females constituted 63.8% of the adolescents who participated in the study and the glycaemic control of females was significantly lower than males (p < 0.05). The mean HbA1c of the adolescents was 8.65 + 1.57. In the study, PMDC-R and MSPSS scores of adolescents with good and poor glycaemic control were compared. The PMDC-R of the good control group were statistically significantly higher than the poor control group (p < 0.05), but there was no significant difference between the MSPSS scores.

Parental supervision plays a protective role in adolescents, and glycaemic control is better as parental supervision increases. Paediatric nurses should collaborate with parents in diabetes management. This approach may help adolescents to be more successful in diabetes management.

Introduction: In recent decades, an increase in the incidence of type 2 diabetes mellitus (T2DM) in children and adolescents has been observed. Pediatric-onset T2DM differs from the adult-onset form, particularly regarding the durability of glycemic control and earlier appearance of complications. However, the scarcity of approved treatments and comprehensive studies on T2DM management in youth persists. Ongoing clinical trials seek to ascertain the efficacy and safety of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients aged between 10 and 24 years with T2DM. Therefore, we aimed to perform a meta-analysis exploring the efficacy and safety of SGLT2i in pediatric patients and young adults with T2DM. Methods: We searched PubMed, Embase, Cochrane, and Web of Science for randomized controlled clinical trials on the efficacy and safety of SGLT2i in children, adolescents, and young adults with T2DM compared with placebo. Statistical analysis was performed using RevMan 5.4 and R statistical software 4.2.1. Heterogeneity was assessed with I2 statistics. Results: We included three studies totaling 334 patients followed for 37.79 weeks. Reduction in HbA1C (MD = -0.93; 95% CI = -1.36 to -0.49; p  < 0.0001; I2  = 0%) was significantly higher in SGLT2i group compared with placebo. The proportion of patients requiring rescue or discontinuation of study medication due to lack of efficacy was statistically lower in SGLT2i group compared with placebo (RR = 0.64; 95% CI = 0.43-0.94; p= 0.02; I2  = 0%). SGLT2i and placebo were similar in terms of any adverse event (RR = 1.10; 95% CI = 0.96-1.27; p= 0.17; I2  = 0%), serious side effects (RR = 1.06; 95% CI = 0.44-2.57; p=0.90; I2  = 0%), and individual adverse effects. Conclusion: In children, adolescents, and young adults with T2DM, SGLT2i appears to be effective and safe for glycemic control.

Despite the implementation of preventive measures to counteract the obesity epidemics, the prevalence of childhood obesity is still alarming all over the world. Childhood obesity is the most common risk factor for both cardiovascular and metabolic diseases. In fact, an earlier onset of obesity can cause a greater risk of adiposity tracking across the lifespan and consequently a longer exposure to cardiometabolic risk factors. Accumulating evidence provided by prospective and intervention studies demonstrated the link between pediatric obesity and selected subclinical signs of cardiovascular damage (atherosclerosis and left ventricular hypertrophy), or fatal and not fatal cardiovascular events as early as 40 years of age.The numerous guidelines and scientific documents published in the last years demonstrate the relevance of assessing cardiometabolic risk factors in children and adolescents with OB.This Position paper, released by experts of the "Childhood Obesity study group" within the Italian Society for Pediatric Endocrinology and Diabetology, aims to review the assessment of cardiometabolic risk factors and comorbidities in children and adolescents with OW/OB on the light of the most recent scientific evidence.The main recommendations are: (a) early detection of comorbidities, including hypertension, dyslipidemia, prediabetes/type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, polycystic ovary syndrome, inactivity, obstructive sleep apnea and decline in kidney function; (b) weight loss treatment, which is associated with a reduction of all cardiometabolic risk factors; (c) specific treatment of comorbidities, through lifestyle modifications or pharmacological treatment added to lifestyle for suitable individuals; d). monitoring comorbidities for mitigating future morbidity and mortality.

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

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

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

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

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

Double diabetes (DD) refers to patients with type 1 diabetes who have developed insulin resistance. The objective of this review is to update relevant information on the prescription of physical activity, pharmacological adjustments and consumption of carbohydrates in DD. A systematic search for scientific articles was carried out in the following databases: PubMed, Cochrane, EBSCO, WoS, ScienceDirect and Medline. The evidence analyzed shows that both physical activity (PA) and physical exercise (PE) are essential to achieve metabolic control in people with DD. Physiological considerations such as: insulin adjustments, insulin injection sites, time to perform PA and PE, absolute and relative contraindications are essential to avoid complications, especially hypoglycemia.

Type 1 diabetes management for young children requires caregiver involvement to prevent serious health complications. Objectives: Explore the lived experience of rural caregivers' health management routines and perceptions of an occupation-based coaching (OBC) intervention.

Following a 12-week, OBC telehealth intervention designed to promote diabetes management and caregiver psychosocial well-being, researchers interviewed eight rural caregivers to explore their perceived quality of life utilizing a phenomenological approach.

Three themes emerged related to caregivers' OBC intervention needs: occupational deprivation and decreased well-being; longing for connection with social supports; and desire for knowledgeable, relatable, and accessible providers. Two themes emerged related to their experiences postintervention: satisfaction with diabetes management and psychosocial support and renewed hope for childhood normalcy.

Despite drastic shift in family routines after a child's T1D diagnosis, caregivers reported acceptability of OBC for improving health management routines in a rural community following OBC intervention.

This paper reports on the initial outcomes of a new mHealth intervention to reduce diabetes distress (DD) in families of school-age children living with type 1 diabetes (T1D) entitled, 'Remedy to Diabetes Distress' (R2D2).

We randomized 34 families (mean child age = 10 ± 1.4 years; 53% male, 85% White, mean HbA1c = 7.24 ± 0.71%) to one of three delivery arms differing only by number of telehealth visits over a 10-week period: zero visits = self-guided (SG), three visits = enhanced self-guided (ESG), or eight visits = video visits (VV). All families had 24 × 7 access to digital treatment materials for 10 weeks. We examined the feasibility and acceptability of R2D2. We used the Problem Areas in Diabetes-Child (PPAIDC and PAIDC, parent and child, respectively) to examine treatment effects by time and delivery arm. We performed sensitivity analyses to characterize families who responded to R2D2.

It was feasible for families to access R2D2 mHealth content independently, though attendance at telehealth visits was variable. Parents and children reported high satisfaction scores. There were significant pre-post reductions in PPAIDC (p = 0.026) and PAIDC (p = 0.026) scores but no differences by delivery arm. There were no differences in child age, sex, race, or pre-treatment HbA1c for responders versus non-responders, though families who responded reported higher PPAID-C scores pre-treatment (p = 0.01) and tended to report shorter diabetes duration (p = 0.08).

Initial results support the acceptability and treatment effects of R2D2 regardless of the frequency of adjunctive virtual visits. Characterizing responders may help to identify families who could benefit from R2D2 in the future.

We aimed to obtain pre-adolescent/adolescent and parent input on a proposed transdisciplinary model for routine type 1 diabetes (T1D) healthcare in which an advanced practice nurse, dietitian, and psychologist with expertise in T1D and extensive cross-discipline training co-deliver care during quarterly T1D care visits using a family-focused approach.

Participants were 17 parent-youth dyads plus one additional adolescent who responded to open-ended questions about the structure and format of the proposed transdisciplinary care model via an online, private social network. A six-member coding team developed and revised a codebook, coded question responses through iterative cycles of inductive coding, and distilled major recurring themes to obtain perspectives on the transdisciplinary care model and feedback on improving the model.

We identified nine themes regarding reactions to our proposed transdisciplinary care model, which fell into three broad categories: 1) General Perceptions of Transdisciplinary Care (e.g., Transdisciplinary Care may facilitate improved communication and collaboration among providers and result in more holistic care); 2) Perceptions about Transdisciplinary Care Providers (e.g., Perspectives on the inclusion of dietitians and psychologists as members of the transdisciplinary care team were mixed); and 3) Suggestions for Improving the Transdisciplinary Care Model (e.g., Ensure care is patient/family centered and holistic).

The present findings provided important feedback to modify our transdisciplinary care model and on parent and youth preferences for T1D healthcare delivery.

Adolescents with Type 1 diabetes (T1D) are at significantly greater risk for disordered eating behaviors compared to their peers without T1D. Given that this is a dangerous and potentially lethal combination, this review aims to support pediatric medical providers in increasing competence in identification, assessment, and prevention of disordered eating behaviors in adolescents with T1D.

This review provides an up-to-date synthesis of unique risk factors for disordered eating behaviors in adolescents with T1D, including the daily diabetes management tasks, effects of insulin on weight and hunger, family conflict, and reinforcement from their environment for disordered behaviors. This review recommends two brief screening tools, the Diabetes Eating Problems Survey-Revised (DEPS-R) and Modified SCOFF (mSCOFF), to be used in busy practices; it also provides practical strategies for providersto use with patients in the form of effective, nonjudgmental language.

A clear understanding of unique experiences impacting adolescents with T1D may increase use of evidence-based screening tools and identification of disordered eating behaviors among a high-risk population in clinic/practice. In addition, providers' intentional use of nonjudgmental and de-stigmatizing language may lead to more positive interactions for adolescents and willingness to engage in further treatment.

Examine body mass index (BMI) trajectories in American youth with type 1 diabetes (T1D) over the first 5 years following diagnosis.

Retrospective record review of BMI trajectories in youth with T1D diagnosed in 2015 to 2016.

Near the time of diabetes diagnosis, 35.5% of youth had BMIs in the overweight/obesity range. These rates increased over time (P < .001), with 52.8% having overweight/obesity 5 years after diagnosis. Average age when BMI rose from healthy to overweight/obese or overweight to obese (rise group) was at 12.7 years, occurring 2.5 years after diagnosis. There were no differences between hemoglobin A1c, use of continuous glucose monitors, or use of insulin pumps between the rise group and those with healthy BMI throughout the study period.

Alarmingly high rates of overweight/obesity in youth were observed within 5 years following T1D diagnosis. Awareness and further research are necessary to address this independent risk factor for morbidities.

This review explores the emerging evidence regarding pathogenesis, future trajectories, treatment options, and phenotypes of youth-onset type 2 diabetes (T2D).

Youth-onset T2D is increasing in incidence and prevalence worldwide, disproportionately affecting First Nations communities, socioeconomically disadvantaged youth, and people of colour. Youth-onset T2D differs in pathogenesis to later-onset T2D and progresses more rapidly. It is associated with more complications, and these occur earlier. While there are limited licensed treatment options available, the available medications also appear to have a poorer response in youth with T2D. Multiple interacting factors likely contribute to this rising prevalence, as well as the increased severity of the condition, including structural inequities, increasing obesity and sedentary lifestyles, and intergenerational transmission from in-utero exposure to maternal hyperglycemia and obesity. Youth-onset T2D is also associated with stigma and poorer mental health, and these impact clinical management. There is an urgent need to develop effective interventions to prevent youth-onset T2D and enhance engagement of affected youth. It is also critical to better understand the differing phenotypes of youth-onset T2D, to effectively target treatments, and to address intergenerational transmission in high-risk populations.

Time in Tight Range (TITR) is a novel glycaemic metric in monitoring type 1 diabetes (T1D) management. The aim of this study was to assess the attainability of the TITR target in children and adolescents using the advanced hybrid closed loop (AHCL).

The 2128-day CGM data from 56 children and adolescents with T1D using AHCL (Minimed-780G) were analysed. Time in Range (TIR) (3.9-10 mmol/L), TITR (3.9-7.7 mmol/L), and other glycaemic parameters were separately analysed in terms of whole day, daytime (06.00-23:59), and nighttime (00.00-05.59) results. The participants were divided into two groups by autocorrection rate where Group 1 had a rate of <30% and Group 2 had a rate of ≥30.

All glycaemic parameters indicated a better glycaemic outcome in the nighttime with higher TIR and TITR values compared with daytime (for TIR 87.5 ± 9.5% vs. 78.8 ± 8%, p < 0.001, and TITR 68.2 ± 13.5% vs. 57.5 ± 8.8%, p < 0.001). The rates of TITR >50% and >60% were 87% and 52%, respectively. When those with TITR >60% (n: 29) and those without (n: 27) were evaluated in terms of hypoglycaemia, no statistically significant difference was found in time below range (TBR) 3-3.9 mmol/L (0.3% vs. 2.1%, p: 0.084) and TBR < 3 mmol/L (0.47% vs. 0.3%, p: 0.298). Group 1 had a significantly higher TIR and TITR compared to Group 2 (82.6 ± 6.1% vs. 75.6 ± 8.6%, p: 0.008 and 62.1 ± 7.5% vs. 53.8 ± 7.5%, p: 0.002, respectively).

Most children and adolescents on AHCL achieved the 50% target for TITR whereas more than half achieved the >60% target. A target of >50% for TITR seems realistic in children with T1D using AHCL.

Albuminuria is a marker of diabetic kidney disease. Raised albuminuria in children and young people with diabetes is associated with an increased risk of microvascular and macrovascular complications. This review provides guidance for paediatricians caring for children and young people with type 1 and type 2 diabetes on screening, investigations and treatments for albuminuria in line with relevant national and international recommendations.

The glycemic control of children with type 1 diabetes (T1D) may be influenced by the economic status of their parents.

To investigate the association between parental economic status and blood glucose levels of children with T1D using a mobile health application.

Data from children with T1D in China's largest T1D online community, Tang-TangQuan®. Blood glucose levels were uploaded every three months and parental economic status was evaluated based on annual household income. Children were divided into three groups: Low-income (< 30000 Yuan), middle-income (30000-100000 Yuan), and high-income (> 100000 yuan) (1 Yuan = 0.145 United States Dollar approximately). Blood glucose levels were compared among the groups and associations were explored using Spearman's correlation analysis and multivariable logistic regression.

From September 2015 to August 2022, 1406 eligible children with T1D were included (779 female, 55.4%). Median age was 8.1 years (Q1-Q3: 4.6-11.6) and duration of T1D was 0.06 years (0.02-0.44). Participants were divided into three groups: Low-income (n = 320), middle-income (n = 724), and high-income (n = 362). Baseline hemoglobin A1c (HbA1c) levels were comparable among the three groups (P = 0.072). However, at month 36, the low-income group had the highest HbA1c levels (P = 0.036). Within three years after registration, glucose levels increased significantly in the low-income group but not in the middle-income and high-income groups. Parental economic status was negatively correlated with pre-dinner glucose (r = -0.272, P = 0.012). After adjustment for confounders, parental economic status remained a significant factor related to pre-dinner glucose levels (odds ratio = 13.02, 95%CI: 1.99 to 126.05, P = 0.002).

The blood glucose levels of children with T1D were negatively associated with parental economic status. It is suggested that parental economic status should be taken into consideration in the management of T1D for children.

To examine the cross-sectional associations between diabetes distress, BMI (zBMI; BMI z-score), objectively measured mean daily blood glucose readings and insulin boluses administered, and A1C in adolescents with type 1 diabetes (T1D) using insulin pumps.

T1D self-management behaviour data were downloaded from adolescents' (N = 79) devices and mean daily frequency of blood glucose readings and insulin boluses were calculated. Diabetes distress was measured (Problem Areas in Diabetes-Teen questionnaire [PAID-T]), A1C collected, and zBMI calculated from height and weight. Three multiple linear regressions were performed with blood glucose readings, insulin boluses, and A1C as the three dependent variables and covariates (age, T1D duration), zBMI, diabetes distress, and the diabetes distress x zBMI interaction as independent variables.

Participants (55.7% female) were 14.9 ± 1.9 years old with T1D for 6.6 ± 3.4 years. zBMI moderated the relationship between diabetes distress and mean daily insulin boluses administered (b = -0.02, p = 0.02); those with higher zBMI and higher diabetes distress administered fewer daily insulin boluses. zBMI was not a moderator of the association between diabetes distress and blood glucose readings (b = -0.01, p = 0.29) or A1C (b = 0.002, p = 0.81).

Using objective behavioural data is useful for identifying how adolescent diabetes distress and zBMI affect daily bolusing behaviour amongst adolescent insulin pump users. Although distinct interventions exist to improve T1D self-management or diabetes distress, none addresses them together while considering zBMI. Decreasing diabetes distress could be especially important for youth with high zBMI.

The available evidence on the impact of specific non-pharmacological interventions on glycaemic control is currently limited. Consequently, there is a need to determine which interventions could provide the most significant benefits for the metabolic health of young individuals with type 1 diabetes mellitus. The aim of this study was to identify optimal nonpharmacological interventions on glycaemic control, measured by glycated haemoglobin (HbA1c), in children and adolescents with type 1 diabetes. Systematic searches were conducted in PubMed, Web of Science, Scopus, and SPORTDiscus from inception to July 1, 2023. Randomised clinical trials (RCT) investigating nonpharmacological interventions (e.g., physical activity, nutrition, and behavioural therapies) were included. Primary outcome was change in HbA1c levels. Secondary outcome was change in daily insulin dose requirement. Seventy-four RCT with 6,815 participants (49.43% girls) involving 20 interventions were analysed using a network meta-analysis. Most interventions showed greater efficacy than standard care. However, multicomponent exercise, which includes aerobic and strength training (n = 214, standardised mean difference [SMD] =- 0.63, 95% credible interval [95% CrI] - 1.09 to - 0.16) and nutritional supplements (n = 146, SMD =- 0.49, - 0 .92 to - 0.07) demonstrated the greatest HbA1c reductions. These interventions also led to the larger decreases in daily insulin needs (n = 119, SMD =- 0.79, 95% CrI -  1.19 to - 0.34) and (n = 57, SMD =- 0.62, 95% CrI -  1.18 to - 0.12, respectively). The current study underscores non-pharmacological options such as multicomponent exercise and nutritional supplements, showcasing their potential to significantly improve HbA1c in youth with type 1 diabetes. Although additional research to confirm their efficacy is required, these approaches could be considered as potential adjuvant therapeutic options in the management of type 1 diabetes among children and adolescents.

Few young people with type 1 diabetes (T1D) meet glucose targets. Continuous glucose monitoring improves glycemia, but access is not equitable. We prospectively assessed the impact of a systematic and equitable digital-health-team-based care program implementing tighter glucose targets (HbA1c < 7%), early technology use (continuous glucose monitoring starts <1 month after diagnosis) and remote patient monitoring on glycemia in young people with newly diagnosed T1D enrolled in the Teamwork, Targets, Technology, and Tight Control (4T Study 1). Primary outcome was HbA1c change from 4 to 12 months after diagnosis; the secondary outcome was achieving the HbA1c targets. The 4T Study 1 cohort (36.8% Hispanic and 35.3% publicly insured) had a mean HbA1c of 6.58%, 64% with HbA1c < 7% and mean time in the range (70-180 mg dl-1) of 68% at 1 year after diagnosis. Clinical implementation of the 4T Study 1 met the prespecified primary outcome and improved glycemia without unexpected serious adverse events. The strategies in the 4T Study 1 can be used to implement systematic and equitable care for individuals with T1D and translate to care for other chronic diseases. ClinicalTrials.gov registration: NCT04336969 .

Regular physical activity and exercise are fundamental components of a healthy lifestyle for youth living with type 1 diabetes (T1D). Yet, few youth living with T1D achieve the daily minimum recommended levels of physical activity. For all youth, regardless of their disease status, minutes of physical activity compete with other daily activities, including digital gaming. There is an emerging area of research exploring whether digital games could be displacing other physical activities and exercise among youth, though, to date, no studies have examined this question in the context of youth living with T1D.

We examined characteristics of digital gaming versus nondigital gaming (other exercise) sessions and whether youth with T1D who play digital games (gamers) engaged in less other exercise than youth who do not (nongamers), using data from the Type 1 Diabetes Exercise Initiative Pediatric study.

During a 10-day observation period, youth self-reported exercise sessions, digital gaming sessions, and insulin use. We also collected data from activity wearables, continuous glucose monitors, and insulin pumps (if available).

The sample included 251 youths with T1D (age: mean 14, SD 2 y; self-reported glycated hemoglobin A1c level: mean 7.1%, SD 1.3%), of whom 105 (41.8%) were female. Youth logged 123 digital gaming sessions and 3658 other exercise (nondigital gaming) sessions during the 10-day observation period. Digital gaming sessions lasted longer, and youth had less changes in glucose and lower mean heart rates during these sessions than during other exercise sessions. Youth described a greater percentage of digital gaming sessions as low intensity (82/123, 66.7%) when compared to other exercise sessions (1104/3658, 30.2%). We had 31 youths with T1D who reported at least 1 digital gaming session (gamers) and 220 youths who reported no digital gaming (nongamers). Notably, gamers engaged in a mean of 86 (SD 43) minutes of other exercise per day, which was similar to the minutes of other exercise per day reported by nongamers (mean 80, SD 47 min).

Digital gaming sessions were longer in duration, and youth had less changes in glucose and lower mean heart rates during these sessions when compared to other exercise sessions. Nevertheless, gamers reported similar levels of other exercise per day as nongamers, suggesting that digital gaming may not fully displace other exercise among youth with T1D.

Early-life cardiovascular risk factors (CVRFs) are known to be associated with target organ damage during adolescence and premature cardiovascular morbidity and mortality during adulthood. However, contemporary data describing whether the prevalence of CVRFs and treatment and control rates have changed are limited. This study aimed to examine the temporal trends in the prevalence, treatment, and control of CVRFs among US adolescents over the past 2 decades.

This is a serial cross-sectional study using data from nine National Health and Nutrition Examination Survey cycles (January 2001-March 2020). US adolescents (aged 12 to 19 years) with information regarding CVRFs (including hypertension, elevated blood pressure [BP], diabetes, prediabetes, hyperlipidemia, obesity, overweight, cigarette use, inactive physical activity, and poor diet quality) were included. Age-adjusted trends in CVRF prevalence, treatment, and control were examined. Joinpoint regression analysis was performed to estimate changes in the prevalence, treatment, and control over time. The variation by sociodemographic characteristics were also described.

A total of 15,155 US adolescents aged 12 to 19 years (representing ≈ 32.4 million people) were included. From 2001 to March 2020, there was an increase in the prevalence of prediabetes (from 12.5% [95% confidence interval (CI), 10.2%-14.9%] to 37.6% [95% CI, 29.1%-46.2%]) and overweight/obesity (from 21.1% [95% CI, 19.3%-22.8%] to 24.8% [95% CI, 21.4%-28.2%]; from 16.0% [95% CI, 14.1%-17.9%] to 20.3% [95% CI, 17.9%-22.7%]; respectively), no improvement in the prevalence of elevated BP (from 10.4% [95% CI, 8.9%-11.8%] to 11.0% [95% CI, 8.7%-13.4%]), diabetes (from 0.7% [95% CI, 0.2%-1.2%] to 1.2% [95% CI, 0.3%-2.2%]), and poor diet quality (from 76.1% [95% CI, 74.0%-78.2%] to 71.7% [95% CI, 68.5%-74.9%]), and a decrease in the prevalence of hypertension (from 8.1% [95% CI, 6.9%-9.4%] to 5.5% [95% CI, 3.7%-7.3%]), hyperlipidemia (from 34.2% [95% CI, 30.9%-37.5%] to 22.8% [95% CI, 18.7%-26.8%]), cigarette use (from 18.0% [95% CI, 15.7%-20.3%] to 3.5% [95% CI, 2.0%-5.0%]), and inactive physical activity (from 83.0% [95% CI, 80.7%-85.3%] to 9.5% [95% CI, 4.2%-14.8%]). Sex and race/ethnicity affected the evolution of CVRF prevalence differently. Whilst treatment rates for hypertension and diabetes did not improve significantly (from 9.6% [95% CI, 3.5%-15.8%] to 6.0% [95% CI, 1.4%-10.6%]; from 51.0% [95% CI, 23.3%-78.7%] to 26.5% [95% CI, 0.0%-54.7%]; respectively), BP control was relatively stable (from 75.7% [95% CI, 56.8%-94.7%] to 73.5% [95% CI, 40.3%-100.0%]), while glycemic control improved to a certain extent, although it remained suboptimal (from 11.8% [95% CI, 0.0%-31.5%] to 62.7% [95% CI, 62.7%-62.7%]).

From 2001 to March 2020, although prediabetes and overweight/obesity increased, hypertension, hyperlipidemia, cigarette use, and inactive physical activity decreased among US adolescents aged 12 to 19 years, whereas elevated BP, diabetes, and poor diet quality remained unchanged. There were disparities in CVRF prevalence and trends across sociodemographic subpopulations. While treatment and control rates for hypertension and diabetes plateaued, BP control were stable, and improved glycemic control was observed.