Children and adolescents with type 1 diabetes mellitus (T1D) are less active than recommended and than their peers without T1D. Several barriers to physical activity have been reported, including lack of confidence in the support received from those who facilitate physical activity such as sports coaches and PE teachers (physical activity providers). This study aims to explore the experiences and needs of physical activity providers in supporting children and adolescents with T1D to engage in structured physical activity. A mixed-methods study, including an online survey and semi-structured interviews, was conducted to provide a broad understanding of the current context along with more in-depth exploration of strategies implemented. Thirty-four participants completed the survey and nine participated in semi-structured interviews. Survey data were summarised descriptively. Qualitative data were analysed using a reflective thematic approach. Fewer than one-third of respondents had received T1D-related training, and only 12% were aware of relevant policies at their institution. Despite moderate confidence among half of the respondents in supporting children and adolescents with T1D, nearly all expressed a need for specific training. Two overarching themes emerged from the interviews: the existing context within which providers operate and effective strategies to support T1D-related physical activity.

Findings suggest improvements can be made to (1) training for physical activity providers to allow them to better support children and adolescents with T1D to participate in physical activity and (2) policies to help ensure a supportive and safe environment for children and adolescents with T1D.

• Children and adolescents with type 1 diabetes are less physically active than peers, partly due to limited support and knowledge among physical activity providers.

• Most physical activity providers lack formal training on type 1 diabetes and rely on ad hoc communication with families or clinical teams for support. • There is a clear need for targeted training and policy development to improve safe and inclusive physical activity for children and adolescents with type 1 diabetes.

Type 1 diabetes (T1D) is a chronic organ-specific autoimmune disorder characterized by a progressive loss of the insulin-secreting pancreatic beta cells, which ultimately results in insulinopenia, hyperglycemia and lifelong need for exogenous insulin therapy. In the pathophysiological landscape of T1D, T helper 17 cells (Th17 cells) and their hallmark cytokine, interleukin (IL)-17, play pivotal roles from disease onset to disease progression. In this narrative mini-review, we discuss the dynamic interplay between Th17 cells and IL-17 in the context of T1D, providing insights into the underlying immunologic mechanisms contributing to the IL-17-immunity-mediated pancreatic beta-cell destruction. Furthermore, we summarized the main animal and clinical studies that investigated Th17- and IL-17-targeted interventions as promising immunotherapies able to alter the natural history of T1D.

Diabetic mellitus (DM) poses a significant challenge and stress to global health, comparing the burden of disease in the world's three most populous countries while projecting changes in trends in age-standardized rate (ASR) -deaths and disability adjusted life years (DALYs) up to 2050. Using GBD2021 data, we examined DM trends in China, US, India and globally for 1990-2021, and projected deaths and DALYs for DM (types 1 and 2) for 2022-2050 using Bayesian age-period-cohort (BAPC) model. It was found that the ASR-DALYs and deaths for T1DM are trending downward globally, while those for T2DM are trending upward. In terms of gender differences, the burden of T1DM by gender was insignificant, whereas the burden of disease was significantly higher in men with T2DM than in women. The burden of disease for T1DM peaks around the ages of 40-44 years, while the burden of disease for T2DM peaks at 65-69 years. Population growth and ageing are major factors influencing the disease burden of diabetes. The projection of ASR-deaths and DALYs globally for 2022-2050 showed a decreasing trend in T1DM and an increasing trend in T2DM (especially in China and India). The increasing burden of T2DM disease globally and in three countries by 2050 should be taken seriously.

Diabetes and cardiovascular disease are interlinked chronic conditions that necessitate continuous and precise monitoring of physiological and environmental parameters to prevent complications. Non-invasive monitoring technologies have garnered significant interest due to their potential to alleviate the current burden of diabetes and cardiovascular disease management. However, these technologies face limitations in accuracy and reliability due to interferences from physiological and environmental factors. This review investigates electronic textiles (e-textiles) that integrate biomedical sensors into wearable fabrics that can enable a multimodal platform for non-invasive continuous glucose monitoring (CGM). Current advancements in e-textiles show the potential of four key methods for glucose monitoring: optical, biochemical, biomechanical, and thermal sensing techniques. Biochemical sensing through sweat-based glucose detection has demonstrated potential for accurate and non-invasive monitoring but still faces numerous challenges. While optical, biomechanical and thermal sensing are less explored in e-textiles, they offer additional physiological and environmental insights that can improve the precision of glucose readings by providing cross-validation of data. This review proposes that integrating multiple sensing modalities into a single multimodal e-textile wearable can address the accuracy and reliability challenges by providing cross-validation of data. The development of such multimodal e-textiles has the potential to revolutionise diabetes and cardiovascular disease management by providing continuous, accurate, and holistic monitoring in real-time, which could significantly improve patient outcomes and quality of life. Further research and development are crucial to fully realise the potential of these integrated systems in clinical and everyday settings.

The onset of childhood diabetes necessitates that the child and family quickly must learn numerous self-management tasks. Diabetes education is key to successful self-management, and established diabetes-related habits are known to be difficult to change. Hence, the initial hospital-based diabetes education and support is a distinct opportunity to optimize habits and disease management. The aim of this study is to investigate parents' experiences with the education and support provided at the hospital when a child has been newly diagnosed with type 1 diabetes.

Twenty semi-structured interviews were conducted with parents of children (0-18 years) newly diagnosed with type 1 diabetes. Inductive thematic analysis was used for data analysis.

Four overarching themes, each with its own implications were identified: 1) From a feeling of uncertainty toward a sense of perceived security 2) Certainty induces calmness 3) A balanced approach to diabetes 4) Trying to learn all about diabetes in just one week. The four themes stress the families' need of immediate reassurance from the health professionals.

The study sheds light on families' challenges during initial hospital-based diabetes education, offering insights for healthcare professionals to tailor support strategies and improve diabetes management.

Hyperglycemia significantly initiates oxidative stress in children diagnosed with type 1 diabetes (T1DM). This study investigates the differences in oxidative stress markers between pediatric patients with T1DM and those experiencing transient hyperglycemia. In this case-control study, 42 children diagnosed with T1DM, according to ISPAD (International Society for Pediatric and Adolescent Diabetes), and their healthy counterparts, aged 1-6 years old, participated. Blood samples were analyzed for oxidative stress biomarkers such as malondialdehyde (MDA) and glutathione peroxidase (GPx). There was no statistically significant association found between the A1c % and age, BMI, and insulin dose (p > 0.05). A negative correlation was found between Se, Zn, cholesterol, GSH, and GPx (p < 0.05), as well as a statistically meaningful positive correlation with the A1c % (p < 0.001). GSH exhibited a statistically significant negative correlation (p < 0.001) with diabetic group. In comparison to control participants, plasma MDA levels (1.3 ± 0.36 µmol/L) had already increased significantly. MDA did correlate in a diabetic group with triglyceride levels (p > 0.0001) or total cholesterol. In the healthy group, the cholesterol levels were normal and apparently did not influence MDA levels. The oxidative state remained unchanged in the healthy participants experiencing temporary hyperglycemia, even though T1DM altered the link between selenium, zinc, and lipids.

Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease caused by the immune-mediated destruction of insulin-producing pancreatic beta cells, resulting in the lifelong need for exogenous insulin. Over the last few years, overweight and obesity have recently emerged as growing health issues also afflicting patients with T1D. In this context, the term "double diabetes" has been coined to indicate patients with T1D who have a family history of type 2 diabetes mellitus (T2D) and/or patients with T1D who are affected by insulin resistance and/or overweight/obesity and/or metabolic syndrome. At the same time, the use of second-generation incretin analogs semaglutide and tirzepatide has substantially increased on a global scale over the last few years, given the remarkable clinical benefits of these drugs (in terms of glucose control and weight loss) in patients with T2D and/or overweight/obesity. Although the glucagon-like peptide-1 (GLP-1) receptor agonists and the novel dual GIP (glucose-dependent insulinotropic polypeptide)/GLP-1 receptor agonist tirzepatide are currently not approved for the treatment of T1D, a growing body of evidence over the last few years has shown that these medications may serve as valid add-on treatments to insulin with substantial efficacy in improving glucose control, promoting weight loss, preserving residual beta-cell function and providing other beneficial metabolic effects in patients with T1D, double diabetes and latent autoimmune diabetes in adults (LADA). This manuscript aims to comprehensively review the currently available literature (mostly consisting of real-world studies) regarding the safety and therapeutic use (for different purposes) of semaglutide and tirzepatide in patients with T1D (at different stages of the disease), double diabetes and LADA.

Type 1 diabetes (T1D) incidence in adolescents varies widely, but has increased globally in recent years. This study reports T1D burden among adolescents and young adults aged 10-24-year-old age group at global, regional, and national levels.

Based on the Global Burden of Disease Study 2019, we described the burden of T1D in the 10-24-year-old age group. We further analyzed these trends by age, sex, and the Social Development Index. Joinpoint regression analysis was used to assess temporal trends.

T1D incidence among adolescents and young adults increased from 7·78 per 100,000 population (95% UI, 5·27-10·60) in 1990 to 11·07 per 100,000 population (95% UI, 7·42-15·34) in 2019. T1D mortality increased from 5701·19 (95% UI, 4642·70-6444·08) in 1990 to 6,123·04 (95% UI, 5321·82-6887·08) in 2019, representing a 7·40% increase in mortality. The European region had the highest T1D incidence in 2019. Middle-SDI countries exhibited the largest increase in T1D incidence between 1990 and 2019.

T1D is a growing health concern globally, and T1D burden more heavily affects countries with low SDI. Specific measures and effective collaboration among countries with different SDIs are required to improve diabetes care in adolescents.

We assessed trends in T1D incidence and burden among youth in the 10-24-year-old age group by evaluating data from the Global Burden of Disease Study 2019. Our results demonstrated that global T1D incidence in this age group increased over the past 30 years, with the European region having the highest T1D incidence. Specific measures and effective collaboration among countries with different SDIs are required to improve diabetes care in adolescents.

The mounting burden of type 2 diabetes is a major concern in healthcare systems worldwide. The purpose of this study is to investigate Burden of type 2 diabetes and its relationship with human development index in Asian countries.

All accessible data from the 2019 Global Burden of Disease study were used to estimate the diabetes mellitus type 2 prevalence, mortality and disability-adjusted life years and diabetes mellitus type 2 in Asia from 1990 to 2019. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs) and attributable risk.

The results indicated that the human development index (HID) was positively and significantly correlated with the incidence of type 2 diabetes in men (r = 0.481, P < 0.05) and women (r = 0.414, P < 0.05, but the correlation between death and the HDI was not significant in men and women (P > 0.05). The highest share of DALY risk factors in men (12093.2 per 100000) and in women (7122.4 per 100000) was related to behavioral factors. According to the results, air pollution, high fasting plasma glucose, and dietary risks are the main risk factors associated with the burden of type 2 diabetes in women and men, respectively.

Given that the burden of type 2 diabetes is escalating in Asia and the burden of disease can be largely controlled by managing its risk factors, the disease management program in different countries, especially in countries with high prevalence and high burden could be reduced by making policies.

Type 1 diabetes (T1D) is an autoimmune-mediated disorder caused by the destruction of pancreatic beta cells. Although there is an underlying genetic predisposition to developing T1D, the trigger is multifactorial and likely includes environmental factors. The intestinal microbiome has been identified as one such factor. Previous studies have illustrated differences in the microbiota of people with T1D compared with healthy controls. This study aims to describe the evolution of the microbiome and metabolome during the first year of clinical T1D, or stage 3 T1D diagnosis, and investigate whether there are differences in the microbiome and metabolome of children who present with and without diabetic ketoacidosis. The study will also explore possible associations between the microbiome, metabolome, glycaemic control and beta cell reserve.

This prospective cohort study will include children with newly diagnosed T1D and sibling controls (n=100, males and females) and their faecal microbiome will be characterised using shotgun metagenomic sequencing at multiple time points during the first year of diagnosis. We will develop a microbial culture biobank based on culturomic studies of stool samples from the healthy controls that will support future investigation. Metabolomic analysis will aim to identify additional biomarkers which may be involved in disease presentation and progression. Through this initial exploratory study, we aim to identify specific microbial biomarkers which may be used as future interventional targets throughout the various stages of T1D progression.

This study has been approved by the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study results will be available to patients with T1D and their families, carers, support networks and microbiome societies and other researchers.

The clinicaltrials.gov registration number for this trial is NCT06157736.

Diabetic ketoacidosis (DKA) is a morbid complication of Type 1 diabetes mellitus(T1DM), and its occurrence at diagnosis has rarely been studied in Ethiopia, despite the many cases seen in the pediatric population.

The aim of this study was to know the prevalence of DKA among patients with newly diagnosed diabetes mellitus and identify avoidable risk factors.

This institution-based retrospective cross-sectional study was conducted from December 1, 2018 to December1, 2022. Newly diagnosed T1DM under 15 years were included in the study. DKA and the new diagnosis of type 1 DM were defined based on the 2022 ISPAD and other international guidelines. A data collection form was used to collect sociodemographic and clinical data. Descriptive, bivariate, and multivariate logistic regression analyses were conducted to identify the risk factors.

Among the 61 newly diagnosed T1DM pediatric patients admitted, DKA was the initial presentation in 37 patients, accounting for 60.7% of the cases. The mean age at diagnosis was 8 (±3.85) years, with females being more affected. Clinical presentation revealed vomiting accompanied by signs of dehydration (32.4%), with polyuria, polydipsia and weight loss (26.2%) being the most common symptoms. The presence of adequate knowledge of signs and symptoms of DM (AOR = 0.07, 95%CI 0.019-0.0897, P value 0.017) and a family history of DM (AOR = 0.129 95%CI 0.019-0.897, P value 0.039) were protective factors against DKA as the initial diagnosis of DM. Moreover, new-onset type 1 DM without DKA was 1.5 times higher in children from families with a high monthly income (AOR = 1.473, 95% CI 0.679-3.195 p value 0.000) compared to those from families with low income. The presence of an infection prior to DKA (AOR = 11.69,95%CI 1.34-10.1,P value 0.026) was associated with the diagnosis of DKA at the initial presentation of DM.

A high number of children present with diabetic ketoacidosis (DKA) at the initial diagnosis of diabetes mellitus (DM), which is associated with inadequate knowledge of the signs and symptoms of DM as well as the masking effect of concomitant infections in these children. Healthcare professionals should endeavor to suspect and screen children. Continuous awareness creation of DM is encouraged to diagnose diabetes mellitus earlier and to decrease the prevalence of DKA as an initial presentation.

This study aimed to assess the strengths, limitations, opportunities, and threats presented by diabetes-in-pregnancy. We review the improvements in maternal and fetal mortality since the advent of insulin therapy, evaluate current health challenges, and identify opportunities for preventing increased mortality due to diabetes-in-pregnancy. Prior to 1922, women with type 1 diabetes mellitus (T1DM) of childbearing age were discouraged from becoming pregnant as the maternal and fetal/neonatal mortality rates were extremely high. Starvation-level dietary restriction was the only "treatment," with limited success in managing the disease. The discovery of insulin coupled with careful clinical management presented the possibility of successful pregnancies for women with T1dm. Over the course of the next half-century, maternal survival increased from 54 to 97%. However, the gains made in reducing adverse outcomes of diabetes in pregnancy are eroding due to modern challenges. The global obesity epidemic has led to an increase in type 2 and gestational diabetes mellitus (DM). T1DM also is on the rise. Together, the rise in the prevalence of pregestational diabetes has increased the risks for adverse outcomes. Here we review the ongoing challenges as well as opportunities for research to improve outcomes. We suggest that overweight, obesity, and diabetes management must be coupled with preconception counseling and education and must include, in addition to, Ob/Gyns, primary care, nutrition, weight management, and other experts to ensure that those at risk of pregnancy complications due to diabetes have the best possible outcomes. KEY POINTS: · Diabetes in pregnancy is affecting more people.. · The obesity epidemic is fueling an increase in pregestational diabetes.. · Research is needed to reduce inequities in diabetes in pregnancy outcomes.. · Blood glucose control should start prior to pregnancy..

This study aimed to investigate if individuals with childhood-onset type 1 diabetes having a parent with the same condition (parental diabetes) had worse metabolic control and an increased risk of death and renal failure compared with those with parents without type 1 diabetes (sporadic diabetes).

We conducted a population-based cohort study using data from the Swedish Childhood Diabetes Register, including cases with onset of type 1 diabetes before the age of 15 and recorded between 1977 and 2010. The cohort was linked to national registers to compare mortality, renal failure, and glycated hemoglobin (HBA1c) levels.

We identified 16 572 incident cases of childhood-onset type 1 diabetes. Of these, 15 701 had data on parental diabetes status, with 1390 (8.9%) having at least one parent with this condition. HbA1c data were available in 9105 individuals at 20-30 years of age, with the parental group showing higher levels compared with the sporadic diabetes group (8.4% (68 mmol/mol) vs 8.2% (66 mmol/mol), p=0.004). The Cox proportional HR for death in parental diabetes was 1.33 (95% CI 1.00 to 1.75), and the competing risk HR for renal failure was 1.27 (95% CI 1.08 to 1.50). Women in the parental diabetes group had a higher risk of early death (HR 1.79, 95% CI 1.17 to 2.72) compared with the sporadic diabetes group.

Individuals with parental diabetes had slightly higher HbA1c and elevated risks of renal failure and death compared with those with sporadic diabetes, especially pronounced in women. Although the exact mechanisms behind these differences are unclear, we suggest that individualized care may benefit individuals with parental type 1 diabetes.

Few studies were conducted to examine the correlation between the anxiety symptoms, depressive symptoms, self-efficacy, and social support variables and type 1 diabetes in developing countries, including Jordan. Thus, this study was conducted to assess the correlation between these psychosocial factors and self-care management among Jordanian adolescents with type 1 diabetes.

A cross-sectional, descriptive correlational design was used to perform a study among adolescents with type 1 diabetes (N = 351) aged 14-18 years who attended primary healthcare centers clinics, and diabetic clinics related to hospitals in Amman Governorate, Jordan. A convenience sampling method was used to recruit participants. The data were collected using self-reported questionnaire during the period from June to December 2023.

The results revealed that around 61.0 % of the sample were males and 39 % female, and 74.9 % of the participants experienced type 1 diabetes for more than one year. Only, 4.3 % of the participants had the recommended HbA1c (< 7.5 %). The participants had high percentage anxiety and depressive symptoms, poor self-efficacy, moderate social support, and low self-care management. There was a correlation between self-efficacy, social support, and self-care management. Also, social support mediated the relationship between self-efficacy and self-care management. However, no relationship existed between anxiety and depressive symptoms and self-care management.

Screening for anxiety and depressive symptoms should be a significant element of care for adolescents with type 1 diabetes in outpatient clinics. Policymakers and healthcare professionals including pediatric nurses should develop strategies and education programs on self-care management to enhance self-care practices and management for adolescents with type 1 diabetes.

To study whether prenatal and postnatal exposure to antibiotics is associated with the risk of type 1 diabetes in childhood.

This case cohort study included 2869 children diagnosed with type 1 diabetes by the end of 2009 who were born between January 1, 1996, and December 31, 2008, in Finland and a reference cohort (n = 74 263) representing 10% of each birth cohort. Exposure to antibiotics was assessed in different time periods. The data were derived from Special Reimbursement Register, Drug Prescription Register, and Population Register and analyzed with weighted Cox proportional hazards regression models.

Exposure to any antibiotics before or during pregnancy, in the neonatal ward, during the first year of life, or during the 2 first years of life, was not associated with the risk of type 1 diabetes in the offspring. Exposure to macrolides in the year preceding pregnancy (adjusted hazard ratio [HR], 1.17; 95% CI, 1.02-1.33) and to sulfonamides and trimethoprim during pregnancy (adjusted HR, 1.91; 95% CI, 1.07-3.41) was associated with an increased risk of type 1 diabetes in the offspring. Exposure to sulfonamides and trimethoprim during first 2 years of life was associated with a decreased risk of type 1 diabetes (adjusted HR, 0.84; 95% CI, 0.73-0.97). The number of antibiotic purchases among mothers or children was not associated with type 1 diabetes risk.

Prenatal and postnatal exposure to antibiotics in general did not increase the risk of type 1 diabetes in the offspring. However, the type of antibiotic and timing of exposure may play a role in type 1 diabetes risk.

This study investigated the relationship between parent-reported degree of openness and extent of problems in parent-adolescent communication and parent involvement in adolescent Type 1 diabetes management, parent and family wellbeing and adolescent glycaemic control.

A cross-sectional quantitative survey was conducted. Parents completed measures of parent-adolescent communication, parent monitoring of diabetes care, diabetes family responsibility, parent knowledge of diabetes care, parent activation, parent diabetes distress, and diabetes family conflict.

In total, 146 parents/guardians (121 mothers, mean age 46.56 years, SD 5.18) of adolescents aged 11-17 years (mean age 13.9 years, SD 1.81) with Type 1 diabetes completed the survey. Open parent-adolescent communication was significantly correlated to adolescents' voluntarily disclosing diabetes-specific information to their parents more frequently, increased parental knowledge of their adolescent's diabetes care completion, parents feeling more capable and willing to take action in relation to their adolescent's diabetes health, lower levels of diabetes-related parental distress, less diabetes-specific family conflict, and optimal glycaemic control.

Parent-adolescent communication has an important role to play in Type 1 diabetes healthcare management and psychosocial wellbeing during adolescence. Optimising open parent-adolescent communication represents a potentially useful target for interventional research and should be considered by healthcare professionals during healthcare encounters.

Type 1 diabetes is one of the fastest-growing chronic health conditions. Estimating the incidence rate of childhood type 1 diabetes will allow to aid in adequate planning of health care resources. The study's aim was to assess the incidence rate of type 1 diabetes in children below 15 years of age from Greater Poland (Poland) between 2006 and 2018, and then to compare obtained data to records collected between 1998 and 2003 in pediatric population aged 0-14 years from the same area.

In this cohort study covering the period from January 1998 to December 2018, data were collected for children and adolescents below 14 years of age with newly diagnosed type 1 diabetes living in Greater Poland. The overall population size was taken from the Statistical Office of Poland. Total, sex-, and age-specific incidence rates per 100,000 person-years were calculated for each calendar year.

Over a 20-year period, the incidence rate of type 1 diabetes in children aged 0-14 years rose around 3.6-fold, from 8.4/100,000 in 1998 to 30.8/100,000 in 2018, with the peak incidence recorded in last year of the study. A clear male predominance of type 1 diabetes was seen in all ages. The rate of type 1 diabetes incidence growth was comparable between all age groups, while the highest incidence rate was mostly observed in children aged 5-9 and 10-14 years.

The incidence of type 1 diabetes in children aged 0-14 years is rapidly increasing in Greater Poland.

Type 1 diabetes is a chronic autoimmune condition characterized by the selective destruction of insulin-producing beta cells in the pancreas. The etiology of T1D is multifactorial, with a combination of genetic susceptibility and environmental triggers believed to underlie beta-cell destruction. Preserving and prolonging beta-cell function in T1D is a pivotal therapeutic objective that can mitigate disease progression and improve glycemic control.

Insulin secretagogues have long been used in the management of type 2 diabetes, but do not have a significant beneficial effect in individuals with long-standing type 1 diabetes. Enhancement of beta-cell function early in the course of type 1 diabetes may offer important benefits in glycemic control and reduced hypoglycemia risk. Glucagon-like peptide-1 receptor agonists, glucokinase activators, free fatty acid receptor agonists, and glimins are drug classes which may offer benefit in enhancing insulin secretion in individuals with type 1 diabetes.

Drugs which enhance insulin secretion in individuals may offer clinical benefits to individuals with type 1 diabetes. However, the lack of beta-cell capacity introduces a challenge without regeneration of insulin-producing cells. Stem cell therapies combined with regulation of islet autoimmunity may offer the best prospect of increased insulin secretion in individuals with T1D.

As part of our work to develop small-molecule inhibitors (SMIs) of the CD40-CD40L(CD154) costimulatory protein-protein interaction, here, we describe the ability of two of our most promising SMIs, DRI-C21041 and DRI-C21095, to prolong the survival and function of islet allografts in two murine models of islet transplantation (under the kidney capsule and in the anterior chamber of the eye) and to prevent autoimmune type 1 diabetes (T1D) onset in NOD mice. In both transplant models, a significant portion of islet allografts (50%-80%) remained intact and functional long after terminating treatment, suggesting the possibility of inducing operational immune tolerance via inhibition of the CD40-CD40L axis. SMI-treated mice maintained the structural integrity and function of their islet allografts with concomitant reduction in immune cell infiltration as evidenced by direct longitudinal imaging in situ. Furthermore, in female NODs, three-month SMI treatment reduced the incidence of diabetes from 80% to 60% (DRI-C21041) and 25% (DRI-C21095). These results (i) demonstrate the susceptibility of this TNF superfamily protein-protein interaction to small-molecule inhibition, (ii) confirm the in vivo therapeutic potential of these SMIs of a critical immune checkpoint, and (iii) reaffirm the therapeutic promise of CD40-CD40L blockade in islet transplantation and T1D prevention. Thus, CD40L-targeting SMIs could ultimately lead to alternative immunomodulatory therapeutics for transplant recipients and prevention of autoimmune diseases that are safer, less immunogenic, more controllable (shorter half-lives), and more patient-friendly (i.e., suitable for oral administration, which makes them easier to administer) than corresponding antibody-based interventions.

Type 1 diabetes mellitus (T1DM) is the most common form of diabetes mellitus in childhood, where, unlike in adults, it accounts for more than 90% of all cases of diabetes. The constant change in the epidemiology of T1DM with significant differences in populations and regions requires systematic data collection and analysis for timely monitoring of T1DM trends.

Analysis of the main epidemiological indicators of T1DM in children in the Russian Federation over the past 10 years - from 2014 to 2023.

The object of the study was the data obtained from the federal statistical observation form No. 12 «Information on the number of diseases registered in patients living in the service area of a medical organization» for the period from 2014 to 2023. The prevalence (total number of registered cases) and incidence (cases with a diagnosis established for the first time) of T1DM (ICD-10 code: E10) were analyzed in children in three age groups: from 0 to 14 years, from 15 to 17 years, and combined from 0 to 17 years (inclusive).

Over the analyzed period, the prevalence of T1DM increased steadily from 238.6 in 2014 to 374.2 cases per 100,000 children in 2023. The prevalence of T1DM in adolescents from 15 to 17 years was higher than in children and amounted to 120.3-203.2 cases per 100,000 adolescents, while in children under 14 years of age, the prevalence was 100.1-172.2 cases per 100,000 children. The annual increase in the prevalence of T1DM averaged 6.3% (95% CI 4.9-7.8). The incidence of T1DM during the analyzed period was 19.1-27.2 cases per 100,000 children and also had a general tendency toward an annual increase in new cases. At the same time, over the past three years, there has been a relative stabilization of incidence rates at 26.5-27.2 per 100,000 children. The annual increase in incidence averaged 4.9% (95% CI 0.9-8.9). The greatest increase in the incidence of T1DM was observed in regions with low incidence.

The epidemiology of T1DM in the Russian Federation is characterized by significant regional and dynamic changes. Over the period 2014-2023, the incidence of type 1 diabetes in children has increased significantly, increasing annually by an average of 5%, while there has been a relative stabilization of incidence rates over the past three years.

To determine the incidence and presenting features of type 1 diabetes mellitus and diabetic ketoacidosis in a paediatric population serviced by a regional health service in Queensland, Australia.

All patients less than 16 years old diagnosed with type 1 diabetes mellitus between 01 January 2015 and 31 December 2021 were included in this retrospective, observational study. The electronic medical records of each patient were reviewed to collect data on demographics, presentation and ongoing diabetes care.

Sixty-four paediatric patients were diagnosed with type 1 diabetes mellitus during the study period, giving an incidence of 25 cases per 100 000 person years. Half the patients presented with diabetic ketoacidosis, with 14 (22% of the total cohort) presenting in severe diabetic ketoacidosis. There was no significant increase in the incidence of type 1 diabetes mellitus or proportion of patients with diabetic ketoacidosis across the years of the study. Patients that had a delayed diagnosis had an increased likelihood of presenting with severe diabetic ketoacidosis.

Incidence of type 1 diabetes mellitus in the paediatric population in this regional centre in Queensland, Australia, is similar to national data. High proportions of patients presenting with diabetic ketoacidosis and severe diabetic ketoacidosis were identified in the study population, with delayed diagnosis, a risk factor for severe diabetic ketoacidosis.

Type 1 diabetes mellitus (T1DM) is a common autoimmune pathology requiring lifelong insulin therapy. We report the case of a 12-year-old girl with T1DM admitted to Department C of the National Institute of Nutrition of Tunis for diabetic ketosis. She had suffered from T1DM for five years, with poor glycemic control (hemoglobin A1C = 10%) and poor therapeutic adherence. On examination, she had abdominal bloating with homogeneous hepatomegaly. Her height was 146 cm (less than the second percentile), her weight was 38 kg (less than the second percentile), and her body mass index was 17.8 kg/m². Tanner's stage was S1P1A1. Biological investigations showed mixed dyslipidemia, normal liver and renal functions, and normal thyroid-stimulating hormone levels. The aspartate aminotransferase/alanine aminotransferase ratio was 1.35. Ultrasound of the abdomen revealed hepatomegaly with a liver span of 19 cm. Based on the clinical history and investigations, Mauriac syndrome was the most likely diagnosis of our patient. A holistic multidisciplinary approach, in collaboration with the child psychiatrist, was opted to optimize diabetes management and reduce hepatic metabolic overload. Further investigations were conducted to rule out differential diagnoses, especially viral and autoimmune hepatitis. Poor acceptance of type 1 diabetes leads to non-compliance with insulin therapy. Then, energy metabolism becomes defective with growth retardation and pubertal delay. Glucose accumulates in the liver leading to metabolic liver disease. Liver damage could be irreversible. Therapeutic education, a good doctor-patient relationship, and family support are the cornerstones of managing T1DM diabetes complicated by Mauriac syndrome.

The mortality rates associated with cardiovascular disease (CVD) and diabetes exhibit disparities by region, with Central Africa ranking fourth globally in terms of mortality rate. The Democratic Republic of Congo (DRC) does not possess mortality data pertaining to these specific underlying causes of death. This study aimed to determine the death rate attributable to CVD and diabetes in two cities in the DRC.

The data on CVD and diabetes utilized in this study were obtained from a pilot project and were registered in the National Health Information System (NHIS). Data quality was initially evaluated using an automated Digital Open Rule Integrated Selection (DORIS), followed by an assessment conducted manually by three assessors. Descriptive and comparative analyses were carried out to determine the proportion of mortality related to CVD and diabetes.

CVD accounted for 20.4% (95%CI: 17.7-23.4%) of deaths in the two cities (Kinshasa and Matadi), whereas diabetes accounted for 5.4% (95%CI: 3.9-7.2%). After adjusting for age and city, the proportional mortality from CVD and diabetes was higher for women than men and increased with age. This study recorded 4.4% of deaths among men and 7.0% among women as the proportional mortality from diabetes.

Non-communicable diseases (NCDs) continue to be a major cause of death, and CVD and diabetes are among the leading causes of early mortality in adults in urban areas. The proportional mortality related to CVD and diabetes appears to be higher in women than in men. Special emphasis should be placed on women, particularly during adulthood, to ensure the prompt detection of diabetes and cardiovascular conditions.

To assess the incidence and the temporal trend of type 1 diabetes (T1D) and diabetic ketoacidosis (DKA) during the period 2014-2023 in youths aged 0-14 years in the Trentino-Alto Adige region, Italy.

A retrospective review of all incident cases of T1D diagnosed at the two Pediatric Diabetes Centers of Bolzano and Trento was matched with diabetes exemptions (No. 344). Demographic, clinical, and socioeconomic status (SES) data at first hospitalization were collected from subjects who agreed to participate (No. 272).

The incidence of T1D was 21.5/100,000 person/years, with a peak of 31.1 in 2021 during the COVID-19 pandemic. The mean age at the onset was 8.8 ± 3.9 years. Seventy-nine percent of the subjects were Italians, primarily residents in rural areas, and SES was equally represented. The mean incidence of DKA was 36.9%. The logistic regression analysis showed that the independent characteristics of the patients with DKA were of a younger age and displayed higher glycated hemoglobin (HbA1c) values. No relation of DKA with seasonality, ethnicity, or first-degree relative (FDR) with T1D or SES was detected.

Our study revealed an incidence of T1D in the Trentino-Alto Adige region comparable to other areas in the North of Italy. The DKA rate negatively correlated with age; therefore, targeted prevention educational campaigns to increase awareness are needed.

Aim: Type 1 diabetes (T1D) is one of the most common chronic conditions in children and adolescents. Approximately 1.5 million young people are currently living with T1D throughout the world. Despite recent improvement in overall indices of metabolic control in children and adolescents with T1D, control remains suboptimal and additional approaches are needed. The aim of the study was to conduct a systematic review and meta-analysis of educational and psychoeducational self-management interventions, to help optimize future interventions including physical activity support. Methods: A systematic review and meta-analysis were conducted according to our registered protocol (PROSPERO CRD42022295932) and are reported in line with the PRISMA 2020 guidance. We searched five databases (MEDLINE, EMBASE, PsycINFO [via Ovid], CINAHL [via EBSCO], Cochrane Library) from 1994 up to May 2024. We included randomized controlled trials assessing the effectiveness of self-management interventions. Outcomes of interest included HbA1c and quality of life (QoL) as well as self-care behaviors, diabetes knowledge, and self-efficacy. Meta-analyses were conducted using a random effects model. Results: In total, 46 papers were included, reporting on 30 interventions. Meta-analyses showed small short-term improvements in HbA1c (MD = -2.58 mmol/L, 95% CI -4.44 to -0.71, p=0.007) and QoL (mean difference [MD] = 1.37, 95% CI 0.19-2.54, p=0.02). Prespecified subgroup analyses suggested no significant difference in effectiveness of psychoeducational and education-only interventions. Quality of included studies was low with 27 having a high risk of bias. Conclusion: There is a lack of robust evidence that current self-management interventions result in clinically meaningful improvements in HbA1c and QoL. Future research should focus on redefining approaches to supporting and encouraging self-management.

To update the incidence rate (IR) and trends of type 1 diabetes mellitus (T1DM) in children aged 0-14 years from 2003 to 2022, in Biscay, Spain.

We used the capture-recapture method: primary cases were prospectively extracted from the hospital registry and a secondary independent data source was obtained from diabetes associations and a public health database. The IRs standardized by age and sex were calculated using the direct method, assuming an equal distribution in each age/sex group. The IR occurring during the various COVID-19 waves was compared with the pre-pandemic IR.

A total of 378 new cases were identified. The mean age at diagnosis was 9.7 years (5.8-11.9). The completeness of ascertainment was 99.1%. The mean annual age-standardized IR was 12.92 (95%CI, 11.35-13.91). The mean IRs for the 0-4, 5-9, and 10-14 age groups were 7.67, 13.41 and 17.83 cases/100,000 children/year, respectively. The IR trend was statistically significant in the entire group and in the 5-9 year-old group with a mean annual increase of 1.9% (95%CI, 0.1-3.8) and 3.3% (95%CI, 1.002-1.065); p=0.039. The 5-year period analysis confirmed that the increase was significant only in the last 5 years (20%). When 2020-2022 (pandemic) and 2017-2019 (pre-pandemic) periods were compared this difference goes up to 44.5%; p=0.029.

After a long period of stability in the IR of T1DM in children younger than 15 years of age in Biscay, Spain, an increase in recent years has been reported, which is consistent with the SARS-CoV2 pandemic, with the largest increase being reported in the 5-to 9-year-old age group.

The aim of this study was to evaluate the admission indicators and characteristics of individuals diagnosed with type 1 diabetes (T1D) to ascertain potential impact on the choice of glucose control therapy after discharge.

A total of 398 eligible T1D patients were selected. We conducted multivariable logistic regression analysis to determine the independent influence of predictors on the selection of glucose control therapy after discharge. To explore the influencing factors of different subgroups, we additionally performed subgroup analyses based on gender and age.

Our study revealed that body mass index (BMI) was noteworthy influence factor for prescription of insulin and non-insulin antidiabetic drug (NIAD prescription) in T1D patients of general population [OR = 1.109 (1.033-1.195), p = 0.006], male [OR = 1.166 (1.040-1.318), p = 0.011] and individuals below the age of 30 years [OR = 1.146 (1.020-1.301), p = 0.028]. Diastolic blood pressure (DBP) was a protective factor for NIAD prescription in the general population [OR = 0.971 (0.949-0.992), p = 0.008] and women [OR = 0.955 (0.923-0.988), p = 0.008]. The other risk factor of NIAD prescription in men was dyslipidemia [OR = 4.824 (1.442-22.246), p = 0.020]. Pulse pressure [OR = 1.036 (1.007-1.068), p = 0.016] constituted an additional risk factor of NIAD prescription among individuals below the age of 30 years. The risk factors of NIAD prescription for people aged 30 to 50 years were length of stay [OR = 1.097 (1.014-1.196), p = 0.026] and initial blood glucose [OR = 1.078 (1.007-1.168), p = 0.047]. In the case of individuals aged above 50 years, physicians exhibited a higher tendency to prescribe supplementary non-insulin medications to men [OR = 9.385 (1.501-87.789), p = 0.029].

We identified notable factors that influence discharge prescriptions in patients with T1D. In order to enhance the treatment outcome for the patient, clinicians ought to have a special focus on these indicators or factors.

The aim of the current study was to investigate the tear proteome in children and adolescents with type 1 diabetes (T1D) compared to healthy controls, and to identify differences in the tear proteome of children with T1D depending on different characteristics of the disease. Fifty-six children with T1D at least one year after diagnosis, aged 6-17 years old, and fifty-six healthy age- and sex-matched controls were enrolled in this cross-sectional study. The proteomic analysis was based on liquid chromatography tandem mass spectrometry (LC-MS/MS) enabling the identification and quantification of the protein content via Data-Independent Acquisition by Neural Networks (DIA-NN). Data are available via ProteomeXchange with the identifier PXD052994. In total, 3302 proteins were identified from tear samples. Two hundred thirty-nine tear proteins were differentially expressed in children with T1D compared to healthy controls. Most of them were involved in the immune response, tissue homeostasis and inflammation. The presence of diabetic ketoacidosis at diagnosis and the level of glycemic control of children with T1D influenced the tear proteome. Tear proteomics analysis revealed a different proteome pattern in children with T1D compared to healthy controls offering insights on deregulated biological processes underlying the pathogenesis of T1D. Differences within the T1D group could unravel biomarkers for early detection of long-term complications of T1D.

Autoimmune thyroid disease (AIT) is the most frequently linked autoimmune condition to type 1 diabetes (T1D). The analysis of immune profiles could provide valuable insights into the study of these diseases. This knowledge could play a crucial role in understanding the relationship between immune profiles and microcirculation structures and functions. The present study aimed to test the hypothesis that cytokine levels in T1D patients without and those with comorbid Hashimoto's disease differ significantly. The total study group (total T1D) consisted of 62 diabetic young patients: 43 T1D and 19 T1D + AIT matched for age, age at onset, and duration of diabetes. The control group consisted of 32 healthy young subjects. The levels of cytokines (including TNF-α, IL-35, IL-4, IL-10, IL-18, IL-12, VEGF, and angiogenin) were quantified throughout this investigation. A comparative assessment of the cytokines profiles between the control group and total T1D revealed a statistically significant elevation in the levels of IL-4, TNF-α, IL-18, VEGF, and angiogenin, accompanied by a notable decline in IL-10. However, IL-35 and IL-12 exhibited comparable levels between the two groups. A comparison of cytokine levels between T1D + AIT and T1D groups revealed that only angiogenin levels were statistically significantly higher in T1D + AIT. The results of our study indicated that the alterations in cytokine levels associated with AIT did not correspond to the observed changes in T1D-related outcomes. The sole notable observation was the elevation of angiogenin expression, an angiogenic factor.

The Canary Islands inhabitants, a recently admixed population with significant North African genetic influence, has the highest incidence of childhood-onset type 1 diabetes (T1D) in Spain and one of the highest in Europe. HLA accounts for half of the genetic risk of T1D.

To characterize the classical HLA-DRB1 and HLA-DQB1 alleles in children from Gran Canaria with and without T1D.

We analyzed classic HLA-DRB1 and HLA-DQB1 alleles in childhood-onset T1D patients (n = 309) and control children without T1D (n = 222) from the island of Gran Canaria. We also analyzed the presence or absence of aspartic acid at position 57 in the HLA-DQB1 gene and arginine at position 52 in the HLA-DQA1 gene. Genotyping of classical HLA-DQB1 and HLA-DRB1 alleles was performed at two-digit resolution using Luminex technology. The chi-square test (or Fisher's exact test) and odds ratio (OR) were computed to assess differences in allele and genotype frequencies between patients and controls. Logistic regression analysis was also used.

Mean age at diagnosis of T1D was 7.4 ± 3.6 years (46% female). Mean age of the controls was 7.6 ± 1.1 years (55% female). DRB1*03 (OR = 4.2; p = 2.13-13), DRB1*04 (OR = 6.6; p ≤ 2.00-16), DRB1* 07 (OR = 0.37; p = 9.73-06), DRB1*11 (OR = 0.17; p = 6.72-09), DRB1*12, DRB1*13 (OR = 0.38; p = 1.21-05), DRB1*14 (OR = 0.0; p = 0.0024), DRB1*15 (OR = 0.13; p = 7.78-07) and DRB1*16 (OR = 0.21; p = 0.003) exhibited significant differences in frequency between groups. Among the DQB1* alleles, DQB1*02 (OR: 2.3; p = 5.13-06), DQB1*03 (OR = 1.7; p = 1.89-03), DQB1*05 (OR = 0.64; p = 0.027) and DQB1*06 (OR = 0.19; p = 6.25-14) exhibited significant differences. A total of 58% of the studied HLA-DQB1 genes in our control population lacked aspartic acid at position 57.

In this population, the overall distributions of the HLA-DRB1 and HLA-DQB1 alleles are similar to those in other European populations. However, the frequency of the non-Asp-57 HLA-DQB1 molecules is greater than that in other populations with a lower incidence of T1D. Based on genetic, historical and epidemiological data, we propose that a common genetic background might help explain the elevated pediatric T1D incidence in the Canary Islands, North-Africa and middle eastern countries.

Viral respiratory infections may precipitate type 1 diabetes (T1D). A possible association between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, and the incidence of T1D is being determined. This study was carried out using Portuguese registries, aiming at examining temporal trends between COVID-19 and T1D.

Hospital data, comparing the incidence before and during the COVID-19 pandemic, from children and young adults diagnosed with new-onset T1D, was acquired beginning in 2017 and until the end of 2022. Data was obtained from nine different Portuguese hospital units. The impact of the COVID-19 pandemic, beginning in March 2020, was assessed comparing the annual numbers of new-onset T1D cases. The annual median levels of glucose, glycated hemoglobin (HbA1c) and fasting C-peptide at T1D diagnosis were compared. The annual number of diabetic ketoacidosis (DKA) episodes among new T1D cases was also assessed at two centers.

In total, data from 574 newly diagnosed T1D patients was analyzed, including 530 (92.3%) children. The mean ages for child and adult patients were 9.1 (SD 4.4) and 32.8 (SD 13.6) years, respectively. 57.8% (331/573) were male, one patient had unknown sex. The overall median (25-75 percentiles) levels of glucose, HbA1c and fasting C-peptide at diagnosis were 454 mg/dL (356-568), 11.8% (10.1-13.4) and 0.50 µg/L (0.30-0.79), respectively. DKA at T1D diagnosis was present in 48.4% (76/157). For eight centers with complete 2018 to 2021 data (all calendar months), no overall significant increase in T1D cases was observed during the COVID-19 pandemic, i.e. 90 cases in 2018, 90 cases in 2019, 112 in 2020 and 100 in 2021 (P for trend = 0.36). Two of the centers, Faro (CHUA) and Dona Estefânia (CHULC) hospitals, did however see an increase in T1D from 2019 to 2020. No significant changes in glucose (P = 0.32), HbA1c (P = 0.68), fasting C-peptide (P = 0.20) or DKA frequency (P = 0.68) at the time of T1D diagnosis were observed over the entire study period.

The T1D incidence did not increase significantly, when comparing the years before and during the COVID-19 pandemic, nor did key metabolic parameters or number of DKA episodes change.

Difficulties in emotion regulation (DERs) can contribute to disordered eating behavior in children and adolescents with type 1 diabetes (T1D), although it is unknown how DERs may affect eating behavior in these children and adolescents. This study examined the relationship between disordered eating behaviors and emotion regulation in children and adolescents with T1D.

For this cross-sectional study, 128 patients (aged 8-16 years) were recruited to complete the Diabetes Eating Problem Survey-Revised (DEPS-R) and Difficulties in Emotion Regulation Scale (DERs).

The mean age of the 128 patients (99 females) who completed the DEPS-R was 11.63 ± 2.27 years. The participants' mean DEPS-R score was 17.78 ± 8.56 points. Of the total sample, 61 participants' scores surpassed the established threshold, resulting in a DEPS-R positivity rate of 47.66%. The participants' mean total DERS score was 72.3 ± 21.15 points, and it was found that children and adolescents with T1D who had a positive DEPS-R screening result had significant differences in emotional regulation and that eating behavior disorders were positively correlated with emotional regulation and all dimensions scores.

The prevalence of disordered eating behavior is high among children and adolescents with T1D. DERs are related to disordered eating behavior in children and adolescents with T1D. The novel finding that DERs may be a predictor of eating problems lends preliminary support for the inclusion of DERs in future risk models and as a potential target for intervention.

Delivery by Caesarean section continues to rise globally and has been associated with the risk of developing type 1 diabetes and the rate of progression from pre-symptomatic stage 1 or 2 type 1 diabetes to symptomatic stage 3 disease. The aim of this study was to examine the association between Caesarean delivery and progression to stage 3 type 1 diabetes in children with pre-symptomatic early-stage type 1 diabetes.

Caesarean section was examined in 8135 children from the TEDDY study who had an increased genetic risk for type 1 diabetes and were followed from birth for the development of islet autoantibodies and type 1 diabetes.

The likelihood of delivery by Caesarean section was higher in children born to mothers with type 1 diabetes (adjusted OR 4.61, 95% CI 3.60, 5.90, p<0.0001), in non-singleton births (adjusted OR 4.35, 95% CI 3.21, 5.88, p<0.0001), in premature births (adjusted OR 1.91, 95% CI 1.53, 2.39, p<0.0001), in children born in the USA (adjusted OR 2.71, 95% CI 2.43, 3.02, p<0.0001) and in children born to older mothers (age group >28-33 years: adjusted OR 1.19, 95% CI 1.04, 1.35, p=0.01; age group >33 years: adjusted OR 1.80, 95% CI 1.58, 2.06, p<0.0001). Caesarean section was not associated with an increased risk of developing pre-symptomatic early-stage type 1 diabetes (risk by age 10 years 5.7% [95% CI 4.6%, 6.7%] for Caesarean delivery vs 6.6% [95% CI 6.0%, 7.3%] for vaginal delivery, p=0.07). Delivery by Caesarean section was associated with a modestly increased rate of progression to stage 3 type 1 diabetes in children who had developed multiple islet autoantibody-positive pre-symptomatic early-stage type 1 diabetes (adjusted HR 1.36, 95% CI 1.03, 1.79, p=0.02). No interaction was observed between Caesarean section and non-HLA SNPs conferring susceptibility for type 1 diabetes.

Caesarean section increased the rate of progression to stage 3 type 1 diabetes in children with pre-symptomatic early-stage type 1 diabetes.

Data from the TEDDY study ( https://doi.org/10.58020/y3jk-x087 ) reported here will be made available for request at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repository (NIDDK-CR) Resources for Research (R4R) ( https://repository.niddk.nih.gov/ ).

Capillary glycated hemoglobin (HbA1c) may enhance screening for childhood prediabetes and diabetes, but variations in this parameter remain unclear. We aimed to develop percentiles of HbA1c and explore the influence of various variables on HbA1c level among Chinese children. Study Design and Methods. The data were derived from the Shanghai Children's Health and Nutrition Community-based Epidemiologic Survey (CHANCE). A total of 4,615 children aged 3-12 years were included. The capillary HbA1c level was measured using point-of-care (POC) testing analyzers. Abnormal HbA1c level was identified as HbA1c (%) value equal to or above the 95th percentile of the nomograms.

The mean HbA1c value was 5.30% (SD = 0.50%). The age-specific 95th percentile thresholds of HbA1c (%) ranged from 5.9 to 6.2 among all children. In the whole participants, body mass index (BMI), total cholesterol (TC), outdoor activity frequency, and daily sleep duration were positively associated with high HbA1c. Among preschool-aged children, TC and sleep duration ≥10 hr per day were associated with increased risk of being in the higher HbA1c (both P < 0.05). Among the school-aged group, positive associations with HbA1c levels were identified for TC, living with grandparents, frequency of outdoor activity, and sleep duration (all P < 0.05).

The present study established capillary HbA1c percentiles based on a large sample of Chinese children among aged 3-12 years. Daily sleep duration and frequency of outdoor activity, BMI, and TC were found to be associated with high HbA1c. Actions of successful public strategies that focus on promoting a healthy lifestyle, including regular physical exercise to reduce weight among children, are needed. Key Points. We used POC testing for capillary HbA1c with a finger-stick sample which may offer an opportunity to enhance screening and early diagnosis for childhood and adolescent diabetes, which was suggested as an essential premise to determine the subject's glycemic status by the American Diabetes Association (ADA). Capillary HbA1c levels fluctuate during childhood, while there has been no population-based study on HbA1c reference values in Chinese youths.