BACKGROUND Insulin pump therapy is a real breakthrough in managing diabetes Mellitus,particularly in children. It can deliver a tiny amount of insulin and decreases the need for frequent needle injections. It also hel...BACKGROUND Insulin pump therapy is a real breakthrough in managing diabetes Mellitus,particularly in children. It can deliver a tiny amount of insulin and decreases the need for frequent needle injections. It also helps to maintain adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.Children are suitable candidates for pump therapy as they need a more freestyle and proper metabolic control to ensure adequate growth and development.Therefore, children and their caregivers should have proper education and training and understand the proper use of insulin pumps to achieve successful pump therapy. The pump therapy continuously improves to enhance its performance and increase its simulation of the human pancreas. Nonetheless, there is yet a long way to reach the desired goal.AIM To review discusses the history of pump development, its indications, types, proper use, special conditions that may enface the children and their families while using the pump, its general care,and its advantages and disadvantages.METHODS We conducted comprehensive literature searches of electronic databases until June 30, 2022,related to pump therapy in children and published in the English language.RESULTS We included 118 articles concerned with insulin pumps, 61 were reviews, systemic reviews, and meta-analyses, 47 were primary research studies with strong design, and ten were guidelines.CONCLUSION The insulin pump provides fewer needles and can provide very tiny insulin doses, a convenient and more flexible way to modify the needed insulin physiologically, like the human pancreas, and can offer adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.展开更多
Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of ...Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of 77 critically ill children and 33 non-diabetic healthy children (controls) who were admitted between 07/2015 and 05/2016. Patient data, clinical information, and blood samples were collected on admission, alongside a large number of laboratory parameters that were routinely assessed. Critically ill patients were divided into sepsis and non-sepsis/systemic inflammatory response syndrome (SIRS). Serum GLUT4 was measured using western blotting and enzyme-linked immunosorbent assays. Insulin resistance indexes, clinical data, laboratory parameters, and inflammatory cytokines were assessed. Results: GLUT4 serum levels were higher in critically ill children than in healthy children (90.5 vs. 30.3 μg/L, P 0.05). Compared to healthy children, hyperglycemic patients (n = 48) had elevated GLUT4 serum levels (30.3 vs. 103.7 g/L, P Conclusions: GLUT4 serum levels might be significantly increased in critically ill children compared with healthy children, particularly those in septic shock. Serum GLUT4 could predict disease severity.展开更多
Childhood obesity represents a complex disease with a well-known cardiometabolic burden including fatty liver,type 2 diabetes,metabolic syndrome,and cardiovascular disease.From a pathogenic point of view,insulin resis...Childhood obesity represents a complex disease with a well-known cardiometabolic burden including fatty liver,type 2 diabetes,metabolic syndrome,and cardiovascular disease.From a pathogenic point of view,insulin resistance(IR)represents the key factor underlying the spectrum of these obesity consequences.As observed in adults,recent data supported the occurrence of microalbuminuria(MA)as marker of early kidney dysfunction and its potential link with cardiometabolic factors also in children with obesity.In fact,a well-documented pathophysiological hypothesis both in adults and children supported an intimate correlation with the major feature of obesity such as IR through the influence of insulin on renal hemodynamics.Based on the clinical and prognostic relevance of this relationship in daily practice(including an increased risk of chronic kidney disease development overtime),more scientific attention needs to be paid to the evaluation of early kidney damage in children with obesity.In this paper,we attempt to address three debated questions regarding the intriguing liaison between IR and MA in children with obesity:(1)What is the prevalence of pediatric MA?(2)What is the state of art of MA in children with obesity?and(3)Is there a link between IR and MA in children with obesity?展开更多
serum levels of T3,T4,TSH,GH and INS in 57 iron deficient children were measured before and after treatment with intramuscular iron respectively and compared with those in healthy control group.According to the result...serum levels of T3,T4,TSH,GH and INS in 57 iron deficient children were measured before and after treatment with intramuscular iron respectively and compared with those in healthy control group.According to the results,the concentrations of serum T3, T4 and GH in iron deficient children were all lower than those in healthy control group,but TSH and INS levels were significantly higher than in the control. Arter treatment,the concentrations of serum T3,T4,TSR, GH and INS recovered to normal,in parallel with improvement of iron status.Hence it is concluded that iron deficiency can affect hormone metabolism. The reason might lie in that the activity of ironcontaining enzymes was decreased by iron deficiency.展开更多
Obesity is an independent risk factor for developing cardiovascular disease and increases insulin resistance in children. Interleukin (IL)-18 is a novel pro-inflammatory cytokine with potential atherogenetic propertie...Obesity is an independent risk factor for developing cardiovascular disease and increases insulin resistance in children. Interleukin (IL)-18 is a novel pro-inflammatory cytokine with potential atherogenetic properties. This study ai- med to identify circulating levels of IL-18 in obese children and examine the effects of combined nutritional education-physical activity course on circulating IL-18. Plasma IL-18, body mass index (BMI), fasting glucose and insulin, homeostasis model assessment insulin resistance (HOMA IR), lipid profile, uric acid, high- sensitive C-reactive protein (hs-CRP), and homocysteine were determined in 70 obese children aged 10-12 years before and after attending a 13-week weight reduction program, which included physical activities and nutritional education. Twenty-five age-matched non-obese children served as controls. At baseline, obese children had significantly higher levels of BMI, fasting insulin, HOMA IR, triglyceride (TG), uric acid, hs-CRP, and IL-18 but lower high-density lipoprotein-cholesterol (HDL-C) than non-obese children. Plasma IL-18 levels in obese children decreased significantly after the weight reduction program. At baseline, plasma IL-18 levels in obese children positively correlated with BMI, HOMA IR, insulin and TG but negatively correlated with HDL-C. There was a significant relationship between plasma IL-18 and BMI changes. Moreover, fasting insulin was responsible for IL-18 variability in obese children. These findings suggest that elevated plasma IL-18 levels in obese children are partly associated with parameters of obesity and insulin resistance, and are significantly affected by modest weight loss.展开更多
Various pathological conditions can cause fatty liver in children. Nonalcoholic steatohepatitis(NASH) in children has been known since 1983. However, NASH diagnosed in childhood does not have a favorable outcome.The p...Various pathological conditions can cause fatty liver in children. Nonalcoholic steatohepatitis(NASH) in children has been known since 1983. However, NASH diagnosed in childhood does not have a favorable outcome.The pathological characteristics of NASH are significantly different between children and adults. Nonalcoholic fatty liver disease(NAFLD)/NASH is accompanied by insulin resistance, which plays a pivotal role in its pathophysiology in both children and adults. In NASH,a "two-hit" model involving triglyceride accumulation(first hit) and liver damage(second hit) has been accepted. Insulin resistance was found to correlate with changes in fat levels; however, it did not correlate with fibrosis or NAFLD activity score in children. Therefore,insulin resistance may be important in the first hit.Because there is obvious familial clustering in NASH,genetic predisposition as well as environmental factors including diet might be the second hit of NAFLD/NASH.展开更多
Introduction: In Senegal, with the CDIC “Changing Diabetes In children” project, insulin has been made free. The objective of this study was to evaluate the accessibility and modalities of insulin therapy in the man...Introduction: In Senegal, with the CDIC “Changing Diabetes In children” project, insulin has been made free. The objective of this study was to evaluate the accessibility and modalities of insulin therapy in the management of type 1 diabetes. Methodology: This was a retrospective study including patients followed for type 1 diabetes (T1DM) in hospital between April 2018 and December 2020. Results: 281 patients were included. The mean age was 14.22 years. The mean age at diagnosis was 11.28 years. Ketoacidosis was the main mode of discovery of diabetes at 51.6%. Premix and rapid insulins were most commonly used at 84.7% and 82.9% respectively, most often in combination. The most commonly used treatment regimen was three injections/day in 82.5% of cases. The average daily insulin dose was 0.62 IU/Kg/dr. Of the patients, 219 (78%) were self-monitoring of blood glucose. The average number of blood glucose checks was 1.78 per day. 76 patients (27%) went days without an insulin injection and up to 7 days in 51% of cases. The main reasons were forgetfulness, therapeutic errors and stock-outs. Hypoglycaemia was observed in 14.2%. The average glycated haemoglobin was 10%. Conclusion: Despite the efforts made, there are still challenges to improve access to insulin. The reinforcement of therapeutic education on insulin therapy is essential for a better quality of life of diabetic children and adolescents.展开更多
Objective: To explore the different effects of living high - training low and living low - training low on insulin sensitivity and cytokine secretion in obese children. Methods: A total of 218 obese children who were ...Objective: To explore the different effects of living high - training low and living low - training low on insulin sensitivity and cytokine secretion in obese children. Methods: A total of 218 obese children who were treated in this hospital between September 2015 and February 2018 were selected and randomly divided into the living high - training low group (n=109) and living low - training low group (n=109). Living high - training low group received living high- training low intervention, living low - training low group received living low - training low intervention, and the intervention of both groups lasted for 4 weeks. The differences in serum levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines were compared between the two groups of children before intervention and after 4 weeks of intervention. Results: Before intervention, the levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines in serum were not significantly different between the two groups of obese children. After 4 weeks of intervention, serum insulin sensitivity-related indexes ISI, FPIR and GDR levels of living high-training low group were higher than those of living low - training low group;appetite-related hormones CCK and PYY3-36 contents were higher than those of living low - training low group whereas Ghrelin content was lower than that of living low - training low group;adipocytokines omentin-1 and APN contents were higher than those of living low - training low group whereas chemerin and LEP contents were lower than those of living low - training low group. Conclusion: Compared with traditional living low - training low intervention, living high - training low intervention is more effective in improving the insulin sensitivity and balance the secretion of appetite-related hormones and adipocytokines in obese children.展开更多
Objective:To study the effect of continuous subcutaneous insulin pump infusion on glucolipid metabolism as well as inflammation and oxidative stress in placenta of patients with gestational diabetes mellitus (GDM).Met...Objective:To study the effect of continuous subcutaneous insulin pump infusion on glucolipid metabolism as well as inflammation and oxidative stress in placenta of patients with gestational diabetes mellitus (GDM).Methods:Patients with GDM who received insulin therapy between March 2013 and May 2016 were selected as the research subjects and randomly divided into multiple subcutaneous insulin injection (MSII) group and continuous subcutaneous insulin pump infusion (CSII) group. Before and after treatment, serum glucolipid metabolism as well as inflammation and oxidative stress inexes in placenta were determined respectively.Results:2 weeks and 4 weeks after treatment, FBG, 1hPBG, 2hPBG, Chemerin, Vaspin and Visfatin levels of both groups of patients were significantly lower than those before treatment and FBG, 1hPBG, 2hPBG, Chemerin, Vaspin and Visfatin levels of CSII group were significantly lower than those of MSII group;after delivery, TNF-α, IL-6, ROS and AGEs levels in placenta of CSII group were significantly lower than those of MSII group.Conclusion:Continuous subcutaneous insulin infusion can more effectively improve the glucolipid metabolism and inhibit the inflammation and oxidative stress in placenta of patients with GDM than multiple subcutaneous insulin injection.展开更多
Objective:To study the effect of insulin pump and continuous intravenous insulin on ketone body metabolism, blood gas indexes and stress state in patients with diabetic ketoacidosis. Methods:Patients with diabetic ket...Objective:To study the effect of insulin pump and continuous intravenous insulin on ketone body metabolism, blood gas indexes and stress state in patients with diabetic ketoacidosis. Methods:Patients with diabetic ketoacidosis who were treated in Meizhou Maternal and Child Heath Hospital between May 2014 and March 2017 were selected as the research subjects and randomly divided into the group A who received subcutaneous insulin infusion by insulin pump and the group B who received intravenous small-dose insulin injection by micropump. The indexes of ketone body, blood gas and stress were measured before and after treatment. Results: 12 h and 24 h after treatment, serumβ-hydroxybutyrate, MDA, NE, ACTH and Cor contents of both groups of patients were significantly lower than those before treatment while pH, HCO3- and base excess levels as well as serum SOD, GSH-Px, CAT and TAC contents were significantly higher than those before treatment, and serumβ-hydroxybutyrate, MDA, NE, ACTH and Cor contents of group A were significantly lower than those of group B while pH, HCO3- and base excess levels as well as serum SOD, GSH-Px, CAT and TAC contents were significantly higher than those of group B.Conclusion:Subcutaneous insulin infusion by insulin pump can improve ketone body metabolism, acidosis status and stress state in patients with diabetic ketoacidosis.展开更多
文摘BACKGROUND Insulin pump therapy is a real breakthrough in managing diabetes Mellitus,particularly in children. It can deliver a tiny amount of insulin and decreases the need for frequent needle injections. It also helps to maintain adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.Children are suitable candidates for pump therapy as they need a more freestyle and proper metabolic control to ensure adequate growth and development.Therefore, children and their caregivers should have proper education and training and understand the proper use of insulin pumps to achieve successful pump therapy. The pump therapy continuously improves to enhance its performance and increase its simulation of the human pancreas. Nonetheless, there is yet a long way to reach the desired goal.AIM To review discusses the history of pump development, its indications, types, proper use, special conditions that may enface the children and their families while using the pump, its general care,and its advantages and disadvantages.METHODS We conducted comprehensive literature searches of electronic databases until June 30, 2022,related to pump therapy in children and published in the English language.RESULTS We included 118 articles concerned with insulin pumps, 61 were reviews, systemic reviews, and meta-analyses, 47 were primary research studies with strong design, and ten were guidelines.CONCLUSION The insulin pump provides fewer needles and can provide very tiny insulin doses, a convenient and more flexible way to modify the needed insulin physiologically, like the human pancreas, and can offer adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.
文摘Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of 77 critically ill children and 33 non-diabetic healthy children (controls) who were admitted between 07/2015 and 05/2016. Patient data, clinical information, and blood samples were collected on admission, alongside a large number of laboratory parameters that were routinely assessed. Critically ill patients were divided into sepsis and non-sepsis/systemic inflammatory response syndrome (SIRS). Serum GLUT4 was measured using western blotting and enzyme-linked immunosorbent assays. Insulin resistance indexes, clinical data, laboratory parameters, and inflammatory cytokines were assessed. Results: GLUT4 serum levels were higher in critically ill children than in healthy children (90.5 vs. 30.3 μg/L, P 0.05). Compared to healthy children, hyperglycemic patients (n = 48) had elevated GLUT4 serum levels (30.3 vs. 103.7 g/L, P Conclusions: GLUT4 serum levels might be significantly increased in critically ill children compared with healthy children, particularly those in septic shock. Serum GLUT4 could predict disease severity.
文摘Childhood obesity represents a complex disease with a well-known cardiometabolic burden including fatty liver,type 2 diabetes,metabolic syndrome,and cardiovascular disease.From a pathogenic point of view,insulin resistance(IR)represents the key factor underlying the spectrum of these obesity consequences.As observed in adults,recent data supported the occurrence of microalbuminuria(MA)as marker of early kidney dysfunction and its potential link with cardiometabolic factors also in children with obesity.In fact,a well-documented pathophysiological hypothesis both in adults and children supported an intimate correlation with the major feature of obesity such as IR through the influence of insulin on renal hemodynamics.Based on the clinical and prognostic relevance of this relationship in daily practice(including an increased risk of chronic kidney disease development overtime),more scientific attention needs to be paid to the evaluation of early kidney damage in children with obesity.In this paper,we attempt to address three debated questions regarding the intriguing liaison between IR and MA in children with obesity:(1)What is the prevalence of pediatric MA?(2)What is the state of art of MA in children with obesity?and(3)Is there a link between IR and MA in children with obesity?
文摘serum levels of T3,T4,TSH,GH and INS in 57 iron deficient children were measured before and after treatment with intramuscular iron respectively and compared with those in healthy control group.According to the results,the concentrations of serum T3, T4 and GH in iron deficient children were all lower than those in healthy control group,but TSH and INS levels were significantly higher than in the control. Arter treatment,the concentrations of serum T3,T4,TSR, GH and INS recovered to normal,in parallel with improvement of iron status.Hence it is concluded that iron deficiency can affect hormone metabolism. The reason might lie in that the activity of ironcontaining enzymes was decreased by iron deficiency.
文摘Obesity is an independent risk factor for developing cardiovascular disease and increases insulin resistance in children. Interleukin (IL)-18 is a novel pro-inflammatory cytokine with potential atherogenetic properties. This study ai- med to identify circulating levels of IL-18 in obese children and examine the effects of combined nutritional education-physical activity course on circulating IL-18. Plasma IL-18, body mass index (BMI), fasting glucose and insulin, homeostasis model assessment insulin resistance (HOMA IR), lipid profile, uric acid, high- sensitive C-reactive protein (hs-CRP), and homocysteine were determined in 70 obese children aged 10-12 years before and after attending a 13-week weight reduction program, which included physical activities and nutritional education. Twenty-five age-matched non-obese children served as controls. At baseline, obese children had significantly higher levels of BMI, fasting insulin, HOMA IR, triglyceride (TG), uric acid, hs-CRP, and IL-18 but lower high-density lipoprotein-cholesterol (HDL-C) than non-obese children. Plasma IL-18 levels in obese children decreased significantly after the weight reduction program. At baseline, plasma IL-18 levels in obese children positively correlated with BMI, HOMA IR, insulin and TG but negatively correlated with HDL-C. There was a significant relationship between plasma IL-18 and BMI changes. Moreover, fasting insulin was responsible for IL-18 variability in obese children. These findings suggest that elevated plasma IL-18 levels in obese children are partly associated with parameters of obesity and insulin resistance, and are significantly affected by modest weight loss.
文摘Various pathological conditions can cause fatty liver in children. Nonalcoholic steatohepatitis(NASH) in children has been known since 1983. However, NASH diagnosed in childhood does not have a favorable outcome.The pathological characteristics of NASH are significantly different between children and adults. Nonalcoholic fatty liver disease(NAFLD)/NASH is accompanied by insulin resistance, which plays a pivotal role in its pathophysiology in both children and adults. In NASH,a "two-hit" model involving triglyceride accumulation(first hit) and liver damage(second hit) has been accepted. Insulin resistance was found to correlate with changes in fat levels; however, it did not correlate with fibrosis or NAFLD activity score in children. Therefore,insulin resistance may be important in the first hit.Because there is obvious familial clustering in NASH,genetic predisposition as well as environmental factors including diet might be the second hit of NAFLD/NASH.
文摘Introduction: In Senegal, with the CDIC “Changing Diabetes In children” project, insulin has been made free. The objective of this study was to evaluate the accessibility and modalities of insulin therapy in the management of type 1 diabetes. Methodology: This was a retrospective study including patients followed for type 1 diabetes (T1DM) in hospital between April 2018 and December 2020. Results: 281 patients were included. The mean age was 14.22 years. The mean age at diagnosis was 11.28 years. Ketoacidosis was the main mode of discovery of diabetes at 51.6%. Premix and rapid insulins were most commonly used at 84.7% and 82.9% respectively, most often in combination. The most commonly used treatment regimen was three injections/day in 82.5% of cases. The average daily insulin dose was 0.62 IU/Kg/dr. Of the patients, 219 (78%) were self-monitoring of blood glucose. The average number of blood glucose checks was 1.78 per day. 76 patients (27%) went days without an insulin injection and up to 7 days in 51% of cases. The main reasons were forgetfulness, therapeutic errors and stock-outs. Hypoglycaemia was observed in 14.2%. The average glycated haemoglobin was 10%. Conclusion: Despite the efforts made, there are still challenges to improve access to insulin. The reinforcement of therapeutic education on insulin therapy is essential for a better quality of life of diabetic children and adolescents.
文摘Objective: To explore the different effects of living high - training low and living low - training low on insulin sensitivity and cytokine secretion in obese children. Methods: A total of 218 obese children who were treated in this hospital between September 2015 and February 2018 were selected and randomly divided into the living high - training low group (n=109) and living low - training low group (n=109). Living high - training low group received living high- training low intervention, living low - training low group received living low - training low intervention, and the intervention of both groups lasted for 4 weeks. The differences in serum levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines were compared between the two groups of children before intervention and after 4 weeks of intervention. Results: Before intervention, the levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines in serum were not significantly different between the two groups of obese children. After 4 weeks of intervention, serum insulin sensitivity-related indexes ISI, FPIR and GDR levels of living high-training low group were higher than those of living low - training low group;appetite-related hormones CCK and PYY3-36 contents were higher than those of living low - training low group whereas Ghrelin content was lower than that of living low - training low group;adipocytokines omentin-1 and APN contents were higher than those of living low - training low group whereas chemerin and LEP contents were lower than those of living low - training low group. Conclusion: Compared with traditional living low - training low intervention, living high - training low intervention is more effective in improving the insulin sensitivity and balance the secretion of appetite-related hormones and adipocytokines in obese children.
文摘Objective:To study the effect of continuous subcutaneous insulin pump infusion on glucolipid metabolism as well as inflammation and oxidative stress in placenta of patients with gestational diabetes mellitus (GDM).Methods:Patients with GDM who received insulin therapy between March 2013 and May 2016 were selected as the research subjects and randomly divided into multiple subcutaneous insulin injection (MSII) group and continuous subcutaneous insulin pump infusion (CSII) group. Before and after treatment, serum glucolipid metabolism as well as inflammation and oxidative stress inexes in placenta were determined respectively.Results:2 weeks and 4 weeks after treatment, FBG, 1hPBG, 2hPBG, Chemerin, Vaspin and Visfatin levels of both groups of patients were significantly lower than those before treatment and FBG, 1hPBG, 2hPBG, Chemerin, Vaspin and Visfatin levels of CSII group were significantly lower than those of MSII group;after delivery, TNF-α, IL-6, ROS and AGEs levels in placenta of CSII group were significantly lower than those of MSII group.Conclusion:Continuous subcutaneous insulin infusion can more effectively improve the glucolipid metabolism and inhibit the inflammation and oxidative stress in placenta of patients with GDM than multiple subcutaneous insulin injection.
文摘Objective:To study the effect of insulin pump and continuous intravenous insulin on ketone body metabolism, blood gas indexes and stress state in patients with diabetic ketoacidosis. Methods:Patients with diabetic ketoacidosis who were treated in Meizhou Maternal and Child Heath Hospital between May 2014 and March 2017 were selected as the research subjects and randomly divided into the group A who received subcutaneous insulin infusion by insulin pump and the group B who received intravenous small-dose insulin injection by micropump. The indexes of ketone body, blood gas and stress were measured before and after treatment. Results: 12 h and 24 h after treatment, serumβ-hydroxybutyrate, MDA, NE, ACTH and Cor contents of both groups of patients were significantly lower than those before treatment while pH, HCO3- and base excess levels as well as serum SOD, GSH-Px, CAT and TAC contents were significantly higher than those before treatment, and serumβ-hydroxybutyrate, MDA, NE, ACTH and Cor contents of group A were significantly lower than those of group B while pH, HCO3- and base excess levels as well as serum SOD, GSH-Px, CAT and TAC contents were significantly higher than those of group B.Conclusion:Subcutaneous insulin infusion by insulin pump can improve ketone body metabolism, acidosis status and stress state in patients with diabetic ketoacidosis.
