Diabetic Ketoacidosis in Type 1 Diabetes Onset in Latin American Children.

OBJECTIVE: To describe the patterns of diabetic ketoacidosis (DKA) occurrence in children newly diagnosed with type 1 diabetes (T1DM) across several Latin American pediatric diabetes centers from 2018 to 2022. METHODS: A retrospective chart review included children under 18 with new-onset T1DM from 30 Latin American pediatric diabetes centers (Argentina, Chile, and Peru) between 30 December 2018 and 30 December 2022. Multiple logistic regression models examined the relationships between age, gender, medical insurance, BMI, and DKA at new-onset T1DM. As far as we know, there are no large studies in Latin American countries exploring the patterns of DKA in new-onset T1DM. RESULTS: A total of 2,026 (983 females) children, median age 9.12 (5.8 -11.7) years with new-onset-T1DM were included. Approximately 50% had no medical insurance. Mean glucose values were 467 mg/dL, pH 7.21, bicarbonate 13 mEq/L, HbA1c 11.3%, and BMI 18. The frequency of DKA was 1,229 (60.7%), out of which only 447 (36%) were severe. There was a significant decrease in the frequency of DKA as age increased: 373 (70.2%) in children under 6, 639 (61.6%) in those between 6 and 12, 217 and (47.5%) in those over 12. Children with medical insurance (58.8%) had a significantly lower frequency of DKA than those without (62.7%). The multiple logistic regression models showed that DKA was significantly and inversely associated with age [OR, 0.72 (95% CI 0.60-0.86)], BMI [OR, 0.95 (95% CI 0.92-0.99)], and medical insurance [OR, 0.75 (95% CI 0.60-0.94)] adjusted for sex. CONCLUSION: Latin American children with new-onset T1DM exhibited a substantial occurrence of DKA. Younger ages and the lack of medical insurance were significantly associated with DKA in new-onset T1DM.

Influence of Telemedicine on the Number of Visits and HbA1c Determinations in Latin American Children with Type 1 Diabetes.

Objective: To measure the changes in the number of medical visits and the number of hemoglobin A1c (HbA1c) determinations according to telemedicine access in children with type 1 diabetes (T1DM) during the pandemic 2020 compared with 2019 and 2018. Methods: This is a multinational study of children with T1DM from four Latin American countries. The number of medical visits, the number of HbA1c determinations, and access to telemedicine during 2020 were extracted from their records. Results: Two hundred twenty-seven children (59% females) aged 12.7 ± 3.2 years with a duration of 5.4 ± 2.7 years of T1DM in 2018 were evaluated. There was a higher prevalence of children with telemedicine access in the pandemic 2020 versus those without [145 (63.9%) vs. 82 (36.1%); P < 0.01]. There was a higher number of medical visits during 2020 in children with telemedicine access versus those without (6.9 vs. 2.6; P < 0.01). Children with telemedicine access had a higher number of visits in 2020 versus 2018 (6.87 vs. 5.04, P < 0.01), but similar to 2019. Children without access had a lower number of visits in 2020 versus 2019 (2.6 vs. 5.5; P < 0.01) and versus 2018 (2.6 vs. 5.1; P < 0.01). In 2020, the number of HbA1c determinations in children with telemedicine access was higher versus those without (1.8 vs. 0.9; P < 0.01). Children with telemedicine access had a lower number of HbA1c determinations in 2020 versus 2019 (1.8 vs. 2.4; P < 0.01), but similar to 2018. Furthermore, children without access had a lower number of HbA1c determinations in 2020 versus 2019 (0.9 vs. 1.9; P < 0.01) and versus 2018 (0.9 vs. 2.0; P < 0.01). Conclusions: We found that children with T1DM with telemedicine access had a significantly higher number of medical visits and HbA1c determinations during lockdown than those without access in different Latin American centers.

Asociación del peso al nacer con adiposidad en niños escolares de distintas regiones de argentina / Association of birth weight with adiposity in school children from different regions of argentina

Introducción: diversos estudios han sugerido que el bajo y alto peso al nacer (PN) se asocian a obesidad (OB) y sobrepeso (SP) durante la infancia y la edad adulta. Objetivos: determinar la asociación entre PN y OB en escolares de 9 años de tres regiones de Argentina. Materiales y métodos: las medidas antropométricas y la presión arterial (PA) se tomaron en 1.131 escolares (505 masculinos) de 8,8±2,1 años de edad promedio, en tres regiones de Argentina durante el año 2019. Se interrogó, además, acerca del peso al nacer y el estilo de vida. Resultados: el 21,1% (239) de los niños presentaba SP (IMC>85 <95 percentilo según CDC) y el 21,8% (246) OB (IMC>95 percentilo). La prevalencia de PN bajo (<2.500 g) fue de fue de 6,2% (n=70) y de PN alto (>4.000 g) de 7,3% (n=82). El puntaje z-IMC de los niños de 9 años aumentaba significativamente con el aumento del PN: PN bajo (z-IMC=0,33), normal (z-IMC=0,72) y alto (z-IMC=1,12). En modelos de regresión logística múltiple se observó que el PN bajo se asoció inversamente a la OB (OR, 0.41 [IC del 95%: 0,19-0,92]), mientras que el PN alto se asoció directamente con la OB ajustado por edad y sexo (OR, 2.48 [95% IC 1,53-4,02]). Conclusiones: nuestros datos indican que el alto PN, pero no el bajo PN, se asocia con OB en niños en edad escolar de 9 años, mientras que el bajo PN está inversamente asociado con OB.

Introduction: several studies have suggested that low and high birth weight are associated with obesity (OB) and overweight (OW) during childhood and adulthood. Objectives: to determine the association between birth weight and OB in 9-year-old schoolchildren from three areas of Argentina. Materials and methods: anthropometric measurements and blood pressure (BP) were taken in 1.131 schoolchildren (505 males) of an average age of 8.8±2.1 years in three areas of Argentina during 2019. Mothers were asked about their children's birth weight and lifestyle. Results: 21.1% (239) of the children had OW (BMI>85 <95 percentile according to the CDC) and 21.8% (246) OB (BMI>95 percentile). The prevalence of low birth weight (<2.500 g) was 6.2% (n=70) and of high birth weight (>4.000 g) was 7.3% (n=82). The 9-year-old z-BMI score increased significantly with increasing birth weight: low birth weight (z-BMI=0.33), normal (z-BMI=0.72) and high (z-BMI=1.12). In multiple logistic regression models, it was found that low birth weight was inversely associated with OB (OR, 0.41 [95% CI: 0.19-0.92]), while high birth weight was directly associated with OB adjusted for age and sex (OR, 2.48 [95% CI 1.53-4.02]). Conclusions: our data indicate that high birth weight, but not low birth weight, is associated with OB in 9-year-old schoolchildren, while low birth weight is inversely associated with OB

Adiposity, lifestyle behaviors, and cardiometabolic markers in Argentinean schoolchildren.

BACKGROUND: We determined the association between schoolchildren's OW/OB with age, sex, lifestyle behaviors, and cardiometabolic markers. METHODS: Age, sex, anthropometric measures, and BP (blood pressure) were recorded in 1249 (554 M) schoolchildren. OW/OB was defined as BMI > 85%ile and BMI > 95%ile respectively. A validated questionnaire for lifestyle behaviors was performed. We offered free laboratory testing to a subgroup of 168 children. RESULTS: Schoolchildren aged 8.8 ± 2.1 y from 9 elementary schools in 4 areas of Argentina were examined between April and September 2019. 265 (21.2%) of the children were OW, 265 (21.2%) were OB, and 425 (35%) had central OB. OW/OB was associated with low milk intake (OR = 1.92; 95% CI, 1.1-3.3), skipping breakfast (OR = 2.00; 95% CI, 1.2-3.4), a family history of hypertension (OR = 1.74; 95% CI, 1.1-2.9), and systolic BP (OR = 1.03; 95% CI, 1.01-1.05); adjusted for confounding variables. The subgroup analysis showed that OW/OB children had lower iron (83 vs. 94 ug/dl, respectively) and HDL-C (43 vs. 47 mg/dl) levels, but higher non-HDL-C (107 vs. 99 mg/dl) levels than normal-weight children. Multiple logistic regression analysis showed that OW/OB was inversely associated with iron (OR = 0.99; 95% CI, 0.98-0.998) and HDL-C (OR = 0.94; 95% CI, 0.91-0.97) levels; adjusted for confounding variables. CONCLUSION: Adiposity in schoolchildren was associated with unhealthy lifestyle behaviors, higher atherogenic risk, and lower iron concentrations, suggesting that OW/OB children are at increased risk for anemia and cardiometabolic disease.

Cardio-metabolic risk factors in Argentine children. A comparative study.

UNLABELLED: Obesity and its complications are emerging in an epidemic manner in Latin American countries. AIMS: To estimate the prevalence of Cardio-Metabolic Risk Factors (CMRFs) and Metabolic Syndrome (MS) in overweight/obese (OW/OB) and normal weight (NW) adolescents and to examine the associated variables. MATERIAL AND METHODS: A cross-sectional comparative study was conducted in two groups of children, between 10 and 19 years of age, in seven Argentine provinces. A survey on dietary habits, physical activity, anthropometric and biochemical data was collected to identify CMRF and MS. The WHO definition adapted to children was used. RESULTS: 1009 children were assessed; 398 were male (39.4%), 601 (59.6%) were NW and 408 (40.4%) were OW/OB. The OW/OB had a significantly higher proportion of values defined as CMRF: 3.7% impaired fasting glucose >110mg/dl; 27.9% insulin >15 or 20µU/l as they were pubertal/prepubertal; 53.2% Homeostatic Model Assessment (HOMA)>2.5; 45.6% High Density Lipoprotein (HDL)<40mg/dl; 37.7% TG>110mg/dl and 13.5% hypertension (SBP and/or diastolic Blood Pressure percentile >90). Prevalence of the MS in OW/OB patients was 40.3%. The MS was not observed in NW children. Significant differences were found for: family history of OW/OB, birth weight (BW), age at menarche, presence of acanthosis nigricans, waist circumference (WC) >90th percentile. The WC was positively correlated with BP, TG, insulin, HOMA and Body mass index Z score and negatively with HDL in the study population. CONCLUSIONS: We confirm obesity as a major determinant of CMRF and MS (40%), especially fat centralization. We stress the need to address obesity prevention plans in children and adolescents.

Estudio clínico del síndrome metabólico en niños y adolescentes de Argentina / Clinical study of metabolic syndrome in children and adolescents of Argentina

INTRODUCCIÓN: la obesidad y el síndrome metabólico (SM) representan un problema de Salud Pública. OBJETIVO: estimar la prevalencia y distribución del SM en adolescentes consobrepeso/obesidad (SP/OB) y normopesos (NP) y examinar variablesasociadas a SM y sus componentes. MÉTODOS: estudio comparativo transversal, en dos grupos de adolescentes de 10 a 19 años de siete provincias argentinas. Se realizó una encuesta social, demográfica, de hábitos alimentarios, de actividad física (AF), examen físico y determinamos indicadores antropométricos y bioquímicos. RESULTADOS: se evaluaron 1.009 adolescentes, de los cuales 398 eran varones (39,4 %), 601 (59,6 %) controles (NP) y 408 (40,4%) casos (SP/OB). La prevalencia de SM en los SP/OB fue 40.3% y de 0 % en los NP. Se encontraron diferencias significativas para: antecedentes familiares de SP/OB, peso de nacimiento, edad de la menarca, presencia de acantosis nigricans, circunferencia de cintura (CC) mayor al punto de corte y las variables metabólicas de laboratorio. Los SP/OB presentaron mayor proporción de componentes de SM (3,7 % hiperglucemia basal; 27,9 % hiperinsulinemia, 53,2 % índice HOMA elevado, 45,6 % colesterol HDL bajo, 37,7% triglicéridos altos y 13,5% hipertensión arterial). La CC se correlacionó positivamente con: presión arterial, triglicéridos, insulina, HOMA y Score Z de índice de masa corporal y negativamente con colesterol HDL. Todoslos pacientes estudiados presentaron malos hábitos alimentarios y los adolescentes con SM tuvieron menor tiempo de actividad física.CONCLUSIONES: la obesidad es un determinante del SM (40%) y la grasa corporal central se asocia con sus componentes.

INTRODUCTION: Obesity and Metabolic Syndrome (MS) represent a public health problem. OBJECTIVE: To estimatethe prevalence and distribution of MS in adolescents with overweight/obesity (OW/OB) and normal weight (NW)and examine variables associated with MS and its components.METHODS: A cross-sectional comparative study in 2 groups of adolescents aged 10 to 19 years of 7 provinces of Argentina. A survey social, demographic, dietary habits, physical activity (AF), physical examination and determine the anthropometric and biochemical indicators. RESULTS: We evaluated 1,009 adolescents, 398 males (39.4 %), 601 (59.6 %) controls (NW)and 408 (40.4 %) cases (OW/OB). The prevalence of MS in the OW/OB was 40.3 % and 0 % in the NP. We found significant differences in family history of OW/OB, birth weight, age atmenarche, presence of acanthosis nigricans, waist circumference (WC) above the cut-off and all metabolic laboratory measures.The OW/OB had a higher proportion of constituents of MS (3.7 % basal hyperglycemia, 27.9 % hyperinsulinemia, 53.2 % higher HOMA index, 45.6 % low HDL cholesterol, 37.7 % higher triglycerides and 13.5 % higher blood pressure). The WC was positively correlated with blood pressure, triglycerides, insulin, HOMA and Body Mass Index - Z Score and negatively with HDL cholesterol. All patients studied had poor eating habits and adolescents with MS had shorter physical activity. CONCLUSIONS: Obesity is a determinant of SM (40%) and central body fat is associated with its components.

Profilaxis de raquitismo en niños sanos de Ushuaia. Efecto de dos dosis de 100.000 UI de vitamina D durante el invierno / Rickets prophylaxis in healthy children fron Usuahia. Effect of 2 doses of 100.000 UI of vitamin D during winter

Como provilaxis de raquitismo, se administró a niños sanos de Ushuaia (55ºS), una doble suplemenación de vitamina D de 100.000 UI al inicio del invierno (marzo 2004), y tres meses después durante el invierno (junio 2004). Se midió 25-hidroxivitamina D sérica (250HD) antes, 1 mes después de la primera suplementación, y 3 meses después de la segunda suplementación (marzo, abril y septiembre). Se estudiaron 18 niños sanos, edad (media más menos DS) 7.3 más menos 4.4 años (rango 1.2 a 14.6), 7 niñas y 11 niños. Antes del tratamiento, la 250 HD sérica fue 29.3 más menos 5.9 ng/ml. Aumentó significativamente 1 mes después de la primera suplementación (Abril): 35.3 más menos 4.4 ng/ml (p<0.001), y disminuyo significativamente 3 meses después de la segunda suplementación 22.4 más menos 4.6 ng/ml (Septiembre (p<0.01). Ningún niño tuvo deficiencia (<10 ng/ml) ni insuficiencia (10-15 bg/ml) de vitamina D. En abril, 1 mes después de la primera suplementación, ningún niño tuvo intoxicación de vitamina D (>50 ng/ml). Conclusión: los resultados sugieren que la doble suplementación con 100.000 UI de vitamina D durante otoño e invierno, previene la deficiencia de vitamina D de niños que habitan en zonas de riesgo del sur de nuestro país.

Twice single doses of 100,000 IU of vitamin D in winter is adequate and safe for prevention of vitamin D deficiency in healthy children from Ushuaia, Tierra Del Fuego, Argentina.

In order to improve vitamin D status of children from Ushuaia (55 degrees S), at the South of Argentina, double supplementation with 100.000 IU of vitamin D was administered at the beginning of winter (March 2004), and 3 months later during winter (June 2004). In 2004, serum 25-hydroxyvitamin D (25OHD) was measured before the first supplementation, a month after, and 3 months after receiving the second supplementation (March, April and September). We studied 18 healthy children from Ushuaia, age (mean+/-S.D.) 7.3+/-4.4 years old (range 1.2-14.6), seven girls and 11 boys. Before treatment, serum 25OHD was 29.3+/-5.9 ng/ml. It increased significantly 1 month after the first supplementation (April): 35.3+/-4.4 ng/ml (p<0.001), and decreased significantly 3 months after the second supplementation: 22.4+/-4.6 ng/ml (September (p<0.001). No child was neither deficient (<10 ng/ml) nor insufficient (10-15 ng/ml) of vitamin D. On April, a month after the first supplementation, no children had vitamin D intoxication levels (>50 ng/ml). These results disclosed that to prevent vitamin D deficiency for children at zones of risk at the south of our country, double supplementation of 100,000 IU of vitamin D during autumn and winter, would be adequate and safe.