Diabetes mellitus type 1 might interfere with pubertal development. Particularly, longterm metabolic control and intensity of insulin treatment have been reported to contribute to a delay in pubertal onset. Data on somatic development in diabetic children are conflicting; therefore we studied bone age in 1788 children from Germany and Austria with type 1 diabetes. Bone age was retarded by -0.27 ± 1.1 years in the whole group, but particularly in the adolescents at the end of puberty (>16 years; -0.76±1.29y). Bone age delay was more pronounced in boys, and in children with longterm median HbA1c levels of 7.5 – 9.0%. No associations were found with current HbA1c levels or the intensity of insulin treatment. Bone age determinations in diabetic children should only be performed when clinical signs of impaired somatic development are present. In addition, the potential influence of diabetes on bone development needs to be considered in the interpretation of carpograms.
To investigate longitudinal trends of admissions with diabetic ketoacidosis (DKA) in new-onset type 1 diabetes (T1D) and subsequent duration of hospitalization in association with structural health care properties, such as size of treatment facility, population density and linear distance between home and treatment centers.
Data from 24,321 German and Austrian pediatric patients with newly-diagnosed T1D between 2008 and 2017 within the DPV registry were analyzed.
Onset-DKA rates fluctuated at around 19% and slightly increased over the observation period (p<0.001). Compared to children without onset-DKA, children with onset-DKA were more frequently treated at centers located closer to their homes, independent of center size or urbanity. Annual median duration of hospitalization decreased from 13.1 (12.6;13.6) to 12.7 (12.3;13.2) days (p<0.001). It was highest in patients younger than 5 years, with migration background, and in severe DKA.
Patients with onset-DKA are admitted to the nearest hospital, independent of center size. Facilities close to patients’ homes therefore play an important role in the acute management of T1D onset. In Germany and Austria, diabetes education at diagnosis is mainly performed in inpatient settings. This is reflected by a long duration of hospitalization, which has decreased only slightly over the past decade.
Textural and compositional microscale (10–100 μm) and nanoscale (10–100 nm) zoning in a plagioclase phenocryst from a fresh, syn-mineralization diorite porphyry (Black Mountain porphyry Cu-Au deposit, Philippines) was characterized for major and trace elements using electron microprobe, laser ablation-inductively coupled plasma-mass spectrometry, and atom probe tomography. The complex plagioclase crystal (3.0 × 5.4 mm) has a patchy andesine core (An41–48 mol%), eroded bytownite mantle (An71–80 mol%), and oscillatory andesine rim (An39–51 mol%). Microscale variations with a periodic width of 50 to 200 μm were noted for most major and trace elements (Si, Ca, Al, Na, K, Fe, Mg, Ti, Sr, Ba, Pb, La, Ce, and Pr) with a ΔAn amplitude of 4–12 mol% in both the core and rim. The mantle has a distinct elemental composition, indicating the addition of hotter mafic magma to the andesitic magma. Atom probe tomography shows an absence of nanoscale variations in the andesine rim but alternating nanoscale (25–30 nm) Al-rich, Ca-rich, and Si-rich, Na-rich zones with a Ca/(Ca+Na)at% amplitude of ~10 in the bytownite mantle.
The restricted variations in physiochemical parameters (H2O-rich, T = 865 to 895 °C, P = 5.3 to 6.2 kbar; fO2 = NNO+0.6 to NNO+1.1 recorded by co-precipitated amphibole) suggest microscale oscillatory zoning was likely controlled by internal crystal growth mechanisms, and not by periodic variations in physiochemical conditions. However, the uniform diffusion timescale for CaAl-NaSi interdiffusion in the mantle is far shorter than the crystallization timescale of the grain from mantle to rim, suggesting nanoscale zonation in the bytownite mantle formed by exsolution after crystallization. The occurrence of micro-scale zoning in plagioclase indicates a minimum cooling rate of 0.0005 °C/yr during crystallization, assuming an initial temperature of 880 °C, the width of 50 μm, and NaSi-CaAl interdiffusion under hydrous conditions. Assuming a formation temperature of ~675 °C for the nanoscale exsolution texture as constrained by zircon crystallization temperatures, the retention of nanoscale zoning (~28 nm) requires a minimum cooling rate of 0.26 °C/yr. Given that this is significantly faster cooling than would occur in a magma chamber, this texture likely records the post-crystallization emplacement history.
Aims: To describe the development of weight in children and adolescents with type 1 diabetes in Germany.
Methods: We analyzed the body mass index (BMI) of the most recent treatment year of each patient with diabetes in the Pediatric Quality Initiative (DPV) database. BMI SD score (SDS) was calculated based on pooled historical German normative data (AGA) and based on healthy children from the CrescNet database. Thus, 25,762 children and adolescents with diabetes were compared with more than 75,000 healthy controls.
Results: BMI-SDS was 0.49±0.88 and 0.26±0.79 when children and adolescents, respectively, with diabetes were compared with AGA reference or with CrescNet controls from the same year. In both analyses, female patients (0.57±0.89 and 0.30±0.79) had significantly higher BMI-SDS than male patients (0.41±0.86 and 0.22±0.78; p<0.0001). Analysis of different age groups showed highest BMI-SDS in patients below 6 years (0.61 and 0.56, respectively). After adjustment for metabolic control, center, and insulin treatment, BMI-SDS was significantly influenced by diabetes duration, age, and female gender.
Conclusions: BMI of children and adolescents with type 1 diabetes is higher compared with healthy children measured in the same year. Especially, very young children and adolescent girls are at risk for overweight independent of annual trends.