Elvan Bayramoğlu

Background/Objectives: Bedtime snacks are frequently used in youth with type 1 diabetes (T1D) to reduce nocturnal hypoglycemia risk; however, the optimal macronutrient composition remains uncertain, particularly in those treated with multiple daily injections (MDI). This randomized crossover study evaluated whether standardized whole-food bedtime snacks with different macronutrient profiles yield distinct overnight continuous glucose monitoring (CGM) patterns. Methods: Twelve children and adolescents with T1D using glargine/lispro-based MDI completed four bedtime snack protocols: carbohydrate-only (CHO), carbohydrate-plus-protein (CHO + PRO), carbohydrate-plus-fat (CHO + FAT), and carbohydrate-plus-fiber (CHO + FIB). Each snack was consumed for three consecutive nights at 21:00 without additional bolus insulin. Blinded CGM data were analyzed for 21:00–09:00 and for predefined postprandial intervals. Because no a priori sample size calculation was performed, the study was conducted as an exploratory pilot trial. Nights per snack were averaged before within-subject comparisons. Results: Overnight time in range (TIR; 70–180 mg/dL) varied across protocols (p = 0.014), with the highest TIR following CHO + PRO (85.8% ± 12.1%) and the lowest following CHO + FAT (70.9% ± 19.1%); however, adjusted whole-night pairwise comparisons were not statistically significant. Differences were more pronounced during the first 6 h following snack consumption, when CHO + PRO was associated with higher TIR than CHO + FAT (91.2% ± 7.6% vs. 71.4% ± 20.8%; adjusted p = 0.011). Moreover, CHO + PRO was associated with lower peak-to-nadir glucose amplitude than CHO + FAT (88.1 ± 24.9 vs. 123.9 ± 36.5 mg/dL; adjusted p = 0.041). Hypoglycemic and hyperglycemic event rates did not significantly differ across protocols. Conclusions: In children and adolescents with T1D using MDI, bedtime snack composition was associated with differences in early nocturnal glycemic stability. CHO + PRO demonstrated higher early night TIR and lower glucose amplitude than CHO + FAT; however, event-based safety outcomes did not significantly differ. Because only two pairwise comparisons remained significant after correction for multiple testing and the four snacks were not matched for energy content, these findings should be regarded as preliminary and hypothesis-generating; in particular, they do not demonstrate that any snack composition protects against nocturnal hypoglycemia. Confirmation is required in larger, adequately powered studies that include energy-matched snacks and a no-snack control condition.

Adolescents with Type 1 diabetes are at increased risk of eating disorders, which have been associated with suboptimal metabolic control and an increased r

Objective: Childhood obesity is a growing global health problem linked to chronic inflammation and metabolic complications, including dyslipidemia, insulin resistance, type 2 diabetes mellitus, nonalcoholic fatty liver disease, and hypertension. Fetuin-A, a hepatokine involved in insulin signaling and inflammation, has been studied in adults, but its role in pediatric obesity is unclear. This study evaluated fetuin-A levels in obese adolescents and their association with anthropometric and metabolic parameters. Materials and Methods: This cross-sectional study included 40 obese adolescents (BMI > 95th percentile) and 30 healthy controls (BMI between the 15th and 85th percentiles) who had no additional systemic diseases and were not receiving any medication. Anthropometric measurements and fasting glucose, insulin, high-sensitivity C-reactive protein, and fetuin-A were assessed. The presence of dyslipidemia, hepatic steatosis, and hypertension was evaluated. Results: Hs-CRP levels were significantly higher in obese patients than in controls (p=0.015) However, fetuin-A levels did not differ significantly between the groups. Fetuin-A showed no correlation with insulin resistance, lipid parameters, hepatic steatosis, or hypertension. Conclusion: Obesity-related complications (insulin resistance, dyslipidemia, fatty liver, and hypertension) were observed in more than half of our group. Although hs-CRP levels of obese cases were high, fetuin-A concentrations were observed to be similar in all cases and in subgroup analyzes. It may be due to factors affecting fetuin-A levels or its posttranslational modification. Further large-scale longitudinal studies are required to elucidate its contribution to metabolic inflammation in children.

Background: Achieving optimal glycemic control in children with type 1 diabetes(T1D) is challenging. Insulin glargine U300 offers a flatter pharmacodynamic profile and longer duration of action than glargine U100, but pediatric real-world data are limited. This study evaluated the effects of switching from U100 to U300 on glycemic control, body composition, pain, and quality of life. Methods: This prospective, single-center observational study included children aged 6–20 years with T1D who switched from U100 to U300. Assessments were performed at baseline, week12, and week24. The primary endpoint was change in HbA1c; secondary endpoints included insulin dose(U/kg), hypoglycemia frequency, 3:00 a.m. glucose, lipid parameters, body composition, Numeric Rating Scale (NRS) for pain, and Pediatric Quality of Life Inventory (PedsQL) scores. Participants were stratified by baseline HbA1c (< 9% vs. ≥ 9%). Results: Sixty-three participants (mean age 14.98 ± 3.53 years) were analyzed. Basal insulin dose increased significantly from 0.48 ± 0.12 U/kg/day on Gla-100 to 0.51 ± 0.14 and 0.51 ± 0.15 U/kg/day at weeks 12 and 24, respectively ( p < 0.001). HbA1c levels demonstrated a small but statistically significant change during follow-up ( p = 0.048). (8.20 (5.9–14.8) %→ 8.00 (6.0–12.2) %→ 8.25 (5.7–12.6) %). Participants with HbA1c ≥ 9% showed a significant reduction(ΔHbA1c − 0.50 (− 3.80–1.00) %; p = 0.014), while those < 9% had a mild increase(ΔHbA1c 0.10 (− 0.90–5.30) %). Night-time (03:00 AM) blood glucose levels decreased significantly across the three time points ( p = 0.007), more prominently in the higher HbA1c group. NRS improved markedly ( p < 0.001), though PedsQL scores were unchanged. Conclusions: Switching from U100 to U300 maintained glycemic control with modest insulin dose increases. Greater benefits were observed in patients with higher baseline HbA1c, alongside reduced nocturnal glucose and injection pain.U300 appears to enhance comfort and nighttime stability in pediatric T1D. Clinical trial number: Not applicable.

Eating disorders are increasingly prevalent during adolescence, a critical developmental stage, and there is a pressing need for concise, yet robust assess

Cystic fibrosis (CF) is a chronic genetic disorder characterized by pancreatic insufficiency and lung disease. Advancements in highly effective modulator therapies (HEMTs) have improved life expectancy, shifting the focus to endocrine comorbidities, such as CF-related diabetes (CFRD) and bone disease (CFRBD). Therefore, current guidelines recommend routine screening for diabetes and osteoporosis in people with cystic fibrosis (PwCF) starting from age of 10 years. Increased risk of osteoporosis has been shown in type 1 and type 2 diabetes; however, there are limited studies evaluating the impact of glucose metabolism disorders on osteoporosis in children with cystic fibrosis. Therefore, this study investigates the impact of glucose metabolism disorders on PwCF. This cross-sectional retrospective study included 81 PwCF, aged between 10 and 21 years, who were screened routinely for diabetes and bone metabolism between 2019 and 2024. Data on demographics, CFTR variants, glucose metabolism, and biochemical bone parameters, including calcium, phosphorus, ALP, PTH, vitamin D levels with bone mineral density (BMD) of L1-L4 lumber spine were analyzed. Cases were categorized as normal, indeterminate, impaired glucose tolerance (IGT), or CFRD based on OGTT. Statistical analyses were conducted to determine factors affecting BMD, including pairwise comparison and multivariate regression analysis. Of the 81 cases, 55 (67.9%) had normal glucose tolerance, 9 (11.1%) had indeterminate (INDET), 9 (11.1%) had impaired glucose tolerance (IGT), and 8 (9.9%) had CFRD. IGT and CFRD cases demonstrated significantly lower body mass index (BMI), lung function, and BMD z-score than the normal group ( p < 0.05). HbA1c had the negative association with BMD z-score ( β = -0.36 per %1 increase in HbA1c, p < 0.001), while elevated BMI levels had positive relation ( β = 0.28 per 1 kg/m ² increase in BMI, p = 0.009 ) . HEMT showed no significant impact on glucose or bone metabolism, likely due to short treatment durations. Conclusions : Impaired glucose metabolism has a significant association with BMD in PwCF. Integrated monitoring of glucose and bone metabolism, along with a multidisciplinary approach is essential to optimize outcomes and reduce complications. What is Known : • Cystic fibrosis-related diabetes (CFRD) is the most common non-pulmonary comorbidity in CF .• Impaired glucose metabolism has been associated with reduced bone mineral density and increased fracture risk. What is New : • This study demonstrates that even early glucose metabolism disorders are associated with reduced bone mineral density in CF patients .• Higher HbA1c levels were found to be associated with lower bone mineral density, highlighting the relationship between hyperglycemia and bone health in CF .

The global prevalence of type 1 diabetes mellitus (T1DM) is steadily increasing, particularly among children and young adults. Health-related myths can significantly influence patients’ dietary behaviors and treatment adherence, thereby compromising disease management and metabolic outcomes. This cross-sectional study included 190 adolescents and young adults with T1DM attending a pediatric endocrinology outpatient clinic. Data on demographics, BMI, HbA1c values, and nutrition-related myths were collected through face-to-face interviews. Statistical analyses, including chi-square tests and Spearman correlation coefficients, were performed using SPSS 22.0 software. Logistic regression analysis was conducted to identify independent predictors of metabolic control status (p < 0.05). Participants had a mean diabetes duration of 7.5 ± 4.63 years, with a mean HbA1c of 7.9 ± 1.44%. Approximately 27.0% of adolescents and 20.0% of young adults were overweight or obese. Only 29.0% of individuals had good metabolic control (HbA1c <%7), while 71.0% had HbA1c ≥ 7. An increase in diabetes duration was found to elevate the risk of poor metabolic control by 1.107 times, whereas a higher total number of answers was associated with a 0.696-fold decrease in this risk (p < 0.05). Improved knowledge about nutrition myths is associated with better metabolic control among adolescents and young adults with T1DM. Structured education programs tailored to this population may contribute to improved glycemic outcomes. A multidisciplinary team approach is essential to effectively deliver educational content and reinforce evidence-based dietary practices.