Twice-daily injections and multiple daily injections of insulin in toddlers with type 1 diabetes: a retrospective cohort study

To the Editor:Incidence of type 1 diabetes(T1D)in young children has been increasing over time in China.[1]There are challenges in achieving metabolic control without leading to severe hypoglycemia or adverse effect on the quality of life in toddlers,as they showed marked sensitivity to insulin and higher variability in insulin requirements.

Hormonal changes throughout puberty in boys:an observational study on the treatment outcome of congenital hypogonadotropic hypogonadism

To the Editor:It is difficult to capture the exact time of initiation of puberty in normal children,such as when breasts in girls and testicles in boys begin to grow,especially in boys.As a result,research on the detailed patterns of physical development during puberty and the cut-off values and changes of hormones at the initiation of puberty and developmental maturation is rare.It is generally believed that hormonal changes during puberty are a direct result of the stimulating effect of luteinizing hormone(LH)on initiation of puberty;[1]thus,LH is widely accepted as an indicator to evaluate initiation of puberty.However,researchers have not yet reached an agreement on the cut-off value of LH,especially in boys.

Clinical features and predictors of remission in children under the age of 7 years with Graves’disease

Importance:Graves’disease(GD)is rare in children under the age of 7 years.Children with this disease exhibit greater thyrotoxicity at diagnosis and require a longer course of medical therapy,compared with pubertal and postpubertal children and adults.Objective:To investigate the clinical features and identify predictors of remission in children under the age of 7 years with GD.Methods:This retrospective study included 77 children who were diagnosed with GD under the age of 7 years and were treated in the Department of Endocrinology,Beijing Children’s Hospital from 2010 to 2018.Clinical manifestations,laboratory data,and follow-up records were collected for all patients.Children who achieved remission of treatment with methimazole were compared with those who had persistent disease to identify which variables were associated with remission;multiple logistic regression and Cox regression analyses were used to evaluate interactions among predictive variables.Results:Sixty-three boys and 14 girls were included;the median age at diagnosis was 4.2 years(interquartile range:3.2-5.3 years).Forty-six(56.7%)patients had no family history of thyroid disease,17 patients had family history of thyroid disease and 14 patients with unknown family history.Of the 77 patients,18(23.4%)patients achieved remission of treatment with methimazole and 59 patients did not;moreover,51(66.2%)had Graves’ophthalmopathy.Univariate analyses revealed no significant differences between the remission group and non-remission group in terms of age at diagnosis,sex,initial goiter size,or initial thyroid hormone concentration.However,there were a trend of correlation between the initial level of thyroid peroxidase antibody(TPOAb)and remission status(univariate analysis OR 1.002,P=0.038;multivariate analysis OR 1.004,P=0.019).Similar results were observed in univariate analysis of the initial thyrotropin receptor antibody(TRAb)level,but this association was not significant in multivariate analysis.Cox regression analyses revealed that children with high TRAb level required longer duration of remission,compared with low TRAb level(OR 0.950,95%CI 0.904-0.997,P=0.037).Interpretation:Initial TRAb level was an independent predictor of remission outcome in young children under the age of 7 years with GD.Initial TRAb level may predict the likelihood of remission in patients with young-age-of-onset GD.

Efficacy and safety of octreotide treatment for diazoxide-unresponsive congenital hyperinsulinism in China

Importance: Octreotide is an off-label medicine for congenital hyperinsulinism (CHI), but is currently widely used for treatment of patients with CHI. Thus far, variable efficacy and adverse effects have been reported for octreotide.Objective: The present study evaluated the efficacy and safety of a subcutaneous octreotide injection for treatment of diazoxide-unresponsive CHI in China.Methods: This study was a retrospective review of children with diazoxide-unresponsive CHI who were treated with a subcutaneous octreotide injection. The efficacy and side effects of the treatment were assessed.Results: Twenty-five Chinese children (15 boys) were involved in the study. Their median age at diagnosis was 8 weeks (range, 1-24 weeks) and median age at the final follow-up was 1.8 years (range, 0.3-3.3 years). Octreotide therapy effectively increased blood glucose levels in all patients. The intravenous glucose infusion rate was reduced in all patients. Twenty-one patients gradually discontinued the intravenous glucose infusion while receiving octreotide combined with frequent carbohydrate/glucose-rich feeding. Among patients with a monoallelic ATP-sensitive potassium (KATP) channel mutation, 50.0% showed gradual remission during follow up, indicating that the octreotide treatment may be a feasible alternative to surgery, especially for patients with monoallelic KATP-channel mutations. Transient elevation of liver enzymes occurred in 20.0% of patients, while asymptomatic gallbladder pathology occurred in one patient. The growth rates of these patients were normal (height standard deviation score was 0.3 ± 1.5 at the final follow-up).Interpretation: Octreotide was a well-tolerated, effective therapy for most children with diazoxide-unresponsive CHI.