Evaluation of the systemic-immune inflammation index (SII) and systemic immune-inflammation response index (SIRI) in children with type 1 diabetes mellitus and its relationship with cumulative glycemic exposure.

OBJECTIVES: In this study, the systemic proinflammatory status was assessed using the systemic immune-inflammation index (SII) and SIRI systemic immune-inflammatory response index (SIRI) in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS: The study involved 159 patients aged between 6 and 16 years. The SII and SIRI values were calculated based on the complete blood count. Basic blood biochemistry evaluated, and carotid intima-media thickness (cIMT) was measured and recorded. The cumulative glycemic exposure was calculated by multiplying the value above the normal reference range of the HbA1c value. The sum of all these values obtained from the time of diagnosis to obtain the cumulative glycemic exposure. All findings were compared statistically. All statistically significant parameters were evaluated in the multivariate logistic regression analysis. RESULTS: The analysis revealed that only cIMT (Exp(B)/OR: 0.769, 95 % CI: 0.694-0.853, p<0.001), high-density lipoprotein (Exp(B)/OR: 3.924, 95 % CI: 2.335-6.596, p<0.001), monocyte count (Exp(B)/OR: 1.650, 95 % CI: 1.257-2.178, p<0.001), hematocrit (Exp(B)/OR: 0.675, 95 % CI: 0.523-0.870, p<0.001), and SIRI (Exp(B)/OR: 1.005, 95 % CI: 1.002-1.008, p<0.001) were significantly associated with T1DM. A statistically significant positive association was found between cumulative glycemic exposure and SIRI only (r=0.213, p=0.032). To our knowledge, this is the first study to evaluate SII and SIRI in children with type 1 diabetes. CONCLUSIONS: These findings indicate that SIRI could serve as a potential biomarker for detecting early-onset proatherosclerotic processes in diabetic children. However, further clinical studies are required to confirm this.

Adherence to Growth Hormone Treatment in Children During COVID-19 Pandemic

Objective: Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported nonadherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the COVID-19 pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated. Materials and Methods: This was a multicenter survey study that was sent to pediatric endocrinologists in pandemic period (June 2021-December 2021). Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, the person administering therapy (either parent/patient), duration of missed doses, reasons for missed doses, as well as problems associated with GH therapy, and missed dose data and the causes in the recent year (after the onset of the pandemic) were queried. Treatment adherence was categorized based on missed dose rates over the past month (0 to 5%, full adherence; 5.1 to 10% moderate adherence; >10% nonadherence). Results: The study cohort consisted of 427 cases (56.2% male) from thirteen centers. Median age of diagnosis was 8.13 (0.13-16) years. Treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), small for gestational age (2.8%), and "others" (6.8%). GH therapy was administered by parents in 70% and by patients in 30%. Mean daily dose was 32.3 mcg/kg, the annual growth rate was 1.15 SDS (min -2.74, max 9.3). Overall GH adherence rate was good in 70.3%, moderate in 14.7%, and poor in 15% of the patients. The reasons for nonadherence were mainly due to forgetfulness, being tired, inability to access medication, and/or pen problems. It was noteworthy that there was a negative effect on adherence during the COVID-19 pandemic reported by 22% of patients and the main reasons given were problems obtaining an appointment, taking the medication, and anxiety about going to hospital. There was no difference between genders in the adherence rate. Nonadherence to GH treatment decreased significantly when the patient: administered the treatment; was older; had longer duration of treatment; and during the pandemic. There was a non-significant decrease in annual growth rate as nonadherence rate increased. Conclusion: During the COVID-19 pandemic, the poor adherence rate was 15%, and duration of GH therapy and older age were important factors. There was a negative effect on adherence during the pandemic period.

An Evaluation of Difficulty in Emotion Regulation, Impulsivity, and Emotional Eating in Children and Adolescents Diagnosed with Type 1 Diabetes Mellitus.

OBJECTIVE: The aim of this study was to investigate difficulties in emotion regulation, emotional eating, and impulsivity in children diagnosed with type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS: The study included 53 children who were diagnosed with T1DM, and a control group of 50 subjects. The Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Version, Difficulties in Emotion Regulation Scale- Short Form (DERS-16), Emotional Eating Scale-Child and Adolescent Form (EES-C), and the Barratt Impulsivity Scale 11-Short Form (BIS-11) were administered to the participants. RESULTS: In the T1DM group, the disease duration was a mean of 52.7 ± 40.62 months, and only 17% had good metabolic control. The rate of psychiatric disorder determined was significantly higher in the T1DM group (P = .001). No significant difference was determined between the 2 groups in respect of the DERS-16, EES-C, and BIS-11 total and subscale scores. However, in multivariate linear regression, the increase in BIS-11 total score was affected by increasing DERS impulse (ß = 0.475), decreasing age (ß = -0.209), and presence of T1DM (ß = 0.211). An increase in the DERS-16 total score was associated with the presence of psychiatric disorder (ß = -0.258) and an increase in BIS-11-A (the second scale assesses concentration problems) (ß = 0.317) score. In the T1DM group, the glycated hemoglobin level was lower in the group with insulin treatment with the injection method (8.2 ± 2.1%) than in those with the pump method (9.1 ± 1.5%) (P = .069). CONCLUSION: It is important that mental health professionals take an active role in all processes of the disease in order to protect the mental health of children with T1DM. Cite this article as: Yildiz Miniksar D, Öz B, Kiliç M, et al. An evaluation of difficulty in emotion regulation, impulsivity, and emotional eating in children and adolescents diagnosed with type 1 diabetes mellitus. Turk Arch Pediatr. 2024;59(1):78-86.

Comparison of mothers of adolescents diagnosed with type 1 diabetes mellitus and mothers of healthy adolescents in terms of difficulty in emotion regulation, depression and anxiety levels and clinical variables.

BACKGROUND: The aim of our study was to evaluate the difficulty in emotion regulation, depression and anxiety levels of mothers with a child diagnosed with type 1 diabetes mellitus (T1DM) compared to mothers of the non- T1DM control group. METHODS: Our study included 72 adolescents followed up with T1DM and 72 healthy adolescents and their mothers. Psychiatric evaluation of children was performed according to DSM-IV diagnostic criteria. All mothers were administered the `Difficulties in Emotion Regulation Scale-Brief Form (DERS-16)` and the `Hospital Anxiety-Depression Scale (HAD)`. RESULTS: The most common psychiatric diagnoses in the T1DM group were attention deficit and hyperactivity disorder and anxiety disorders. The total and subscale scores of the DERS-16 and HAD scales of the mothers in the T1DM group were significantly higher than the control group. There was a statistically significant positive correlation between the DERS-16 total score and the HAD total and subscale scores of the mothers in the T1DM group. In the multivariate model found to be significant (p < 0.001), only HbA1c levels an indicator of metabolic control, had significant and negative effects on emotion regulation, anxiety and depression (p < 0.05), while sociodemographic characteristics did not have a significant effect (p > 0.05) Conclusions. Difficulty in emotion regulation and depression-anxiety levels were found to be higher in mothers of adolescents with T1DM compared to the control group. Difficulties in emotion regulation, depression and anxiety symptoms in the parent may reduce the treatment compliance of the adolescent with T1DM, which may result in worse metabolic control. Therefore, both adolescents and their parents should be evaluated in terms of psychiatric symptoms and necessary guidance should be given.

Frequency of Asthma and Atopic Diseases in Inflammatory Bowel Disease and Celiac Disease.

OBJECTIVE: To compare the frequency of asthma and allergic diseases in patients with inflammatory bowel disease and Celiac disease using international study of asthma and allergies in childhood questionnaire. STUDY DESIGN: Cross-sectional, descriptive study. PLACE AND DURATION OF STUDY: Pediatric gastroenterology outpatient clinics and pediatric pulmonology outpatient clinics, from May 2015 to August 2015. METHODOLOGY: Patients aged between 6 and 18 years with the diagnoses of celiac and inflammatory bowel disease were included in the study. After recording the socio-demographic characteristics of all patients, the International study of asthma and allergies in childhood questionnaire was applied and required information collected. RESULTS: Eighty-three patients (31 males, 52 females) diagnosed with celiac, 42 patients (24 males, 18 females) diagnosed with ulcerative colitis, and 28 patients (11 females, 17 males) diagnosed with Crohn's disease were included. No significant difference was found between the groups in terms of the frequency of wheezing, wheezing in the last year, lifelong allergic rhinitis, long-term use of nasal steroids, and history of eczema (p >0.05). The frequency of atopic dermatitis was significantly higher in the celiac disease group than the other groups. CONCLUSION: The frequencies of asthma and atopy are similar in patients with celiac disease and inflammatory bowel disease.