Paulina Wais

Background/Objectives: Subtle cognitive alterations have been described in children with type 1 diabetes (T1D), but the association between cognition and real-time glycemia during cognitive testing remains unclear. This study aimed to investigate whether blood glucose level (BGL) measured immediately before the MOXO Continuous Performance Test (MOXO-CPT) is associated with cognitive performance and modified by clinical factors. Methods: A total of 117 children with T1D (aged 6–18 years) completed the MOXO-CPT assessing sustained attention, timeliness, impulsivity, and hyperactivity. Participants were stratified by BGL measured immediately before testing (p = 0.036) and timeliness scores (p = 0.040) than those with BGL < 200 mg/dL. However, these differences did not remain statistically significant after Benjamini–Hochberg correction and were not confirmed after adjustment for relevant covariates. No differences were observed in impulsivity or hyperactivity. In multivariable models, higher BGLs were independently associated with higher impulsivity scores (B = 0.013, p = 0.007), with higher scores indicating better impulse-control performance. A significant BGL–sex interaction was observed for timeliness. Sex-stratified analyses showed that higher BGLs were associated with better attention and timeliness in girls, whereas the association with impulsivity observed in boys was not confirmed using robust analysis. No significant interactions between BGL and HbA1c, age, treatment modality, or diabetes duration were observed after robust analysis. Conclusions: Real-time glycemia during cognitive testing was associated with subtle, domain-specific differences in cognitive performance in children with T1D. These findings do not establish causality or indicate that higher glucose levels improve cognitive performance. Concurrent glucose levels may be worth considering when interpreting cognitive assessments, although this should be confirmed in prospective studies.

Cel pracy: Niewiele wiadomo na temat związku między stresem cukrzycowym, jakością życia i kontrolą metaboliczną u polskich nastolatków z cukrzycą typu 1 w okresie przechodzenia spod opieki pediatrycznej do opieki dla dorosłych. Niniejsze badanie analizuje czynniki związane z cukrzycą typu 1 u 18-latków w momencie tranzycji. Metoda: W badaniu wzięło udział 110 pacjentów w wieku 18 lat z cukrzycą typu 1, którzy wypełnili kwestionariusz Obszarów Problemowych w Cukrzycy (PAID) oraz Kwestionariusz Stanu Zdrowia (SF-36v1). Kontrolę metaboliczną oceniano na podstawie parametrów z ciągłego monitorowania glukozy (CGM). Wyniki: Stres cukrzycowy wiązał się ze wszystkimi wymiarami jakości życia, ale nie z kontrolą glikemii. Kobiety zgłaszały wyższy stres cukrzycowy (p=0,017) oraz niższą jakość życia w sferze zdrowia psychicznego (p=0,009) w porównaniu z mężczyznami. Osoby palące charakteryzowały się gorszymi parametrami glikemicznymi (p=0,016), podobnie jak osoby z niższym poziomem zdrowia psychicznego (p=0,008). Wbrew oczekiwaniom, gorsza kontrola glikemii korelowała z lepszą jakością życia. Dłuższy czas trwania choroby oraz młodszy wiek w momencie diagnozy wiązały się z gorszą kontrolą glikemii. Wnioski: U polskich 18-latków z cukrzycą typu 1 stres cukrzycowy jest silniej powiązany z jakością życia niż z kontrolą metaboliczną. Kobiety, osoby z długim czasem trwania choroby oraz osoby palące są szczególnie narażoną grupą, która powinna zostać objęta wsparciem psychologicznym oraz edukacją.

Background/Objectives: Attention is a fundamental cognitive parameter, essential for developmental processes. It enables the selective processing of environmental stimuli and guides behavioral responses. Obesity, apart from its broad influence on human somatic health, is also associated with mental and cognitive functioning. In childhood obesity, detailed attention assessment could help elucidate the relationship between the condition and cognitive development, and perhaps also help predict specific difficulties during treatment. The aim of the study was to investigate attention functioning in children and adolescents with obesity using the computerized continuous performance test (CPT). Methods: The study involved 71 children, including 23 with obesity and 48 healthy children with normal body weight. The MOXO CPT was used to assess attention parameters in all participants. The test covered four parameters: sustained attention, timing, impulsivity, and hyperactivity. Results: Children with obesity obtained significantly lower CPT results in terms of timing (p = 0.024), hyperactivity (p = 0.001), and impulsivity (p < 0.001), while the difference in sustained attention did not reach statistical significance (p = 0.074). Conclusions: Attention efficiency appears to be reduced in children with obesity compared with their healthy peers. Assessment of attention parameters in this group of patients could be valuable in the context of planning and implementing therapeutic interventions. Children with coexisting obesity and impaired attention functioning would probably require more assistance in following daily behavioral and nutritional recommendations.

Introduction: Managing type 1 diabetes (T1D) is complex and requires frequent glucose monitoring, insulin dosing, and lifestyle adjustments to attain appropriate metabolic control. These self-management tasks demand intact cognitive and executive functions, particularly attention. Attention deficits in children and adolescents with T1D have been associated with poor metabolic control and an increased risk of complications. However, research into cognitive performance within this population remains limited. We evaluated attention abilities in children and adolescents with type 1 diabetes compared to healthy controls.Materials and Methods: The study included 209 children (77 females), comprising 115 with T1D (54 females) and 94 healthy controls (23 females). The mean age of T1D patients was 12.95 years (SD 3.11), with an average disease duration of 5.22 years (SD 3.95). Cognitive functions were assessed using the MOXO Continuous Performance Test (MOXO-CPT), which evaluates attention-related parameters including sustained attention, reaction time, impulsivity, and hyperactivity. The relationship between cognitive performance and clinical parameters, including HbA1c level, treatment methods, glycemic monitoring, and disease duration, was analyzed.Results: Children with T1D demonstrated significantly lower sustained attention scores, slower reaction times, and worse hyperactivity levels than controls. Impulsivity did not differ significantly. Patients with HbA1c levels greater than 8% showed noticeably poorer attention performance. Gender, disease duration, treatment method, and type of glycemic monitoring were not associated with attention outcomes.Conclusions: Children and adolescents with T1D exhibit worse neurocognitive performance, particularly in attention, compared to healthy peers. Poor metabolic control is linked to attention deficits. Routine cognitive screening of children and adolescents with T1D may enhance disease management and highlight the need for additional support in therapeutic tasks.

Background: Childhood obesity is an epidemic and a significant health concern all over the world. Several factors can influence excess weight gain, including eating behaviors, physical inactivity, and genetics. Children and adolescents with obesity have a four-times greater risk of developing type 2 diabetes (T2D) compared with their normal-weight peers. The management of obesity before the development of its comorbidities may prevent its escalation into significant medical and psychosocial problems. However, treatment options for obesity and T2D in youth remained limited for many years, and moreover, available drugs were characterized by low efficacy. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study showed that metformin in monotherapy failed in almost 52% of children with T2D, while adjuncts to rosiglitazone and lifestyle intervention failed in 38.6% and 46.6%, respectively. Recently approved antiobesity medications and/or bariatric surgery are revolutionizing the management of adolescents with obesity and T2D. This work aims to provide a comprehensive overview of the current treatment possibilities for childhood obesity and T2D. Methods: An in-depth review of articles with evidence-based research from different countries discussing novel management options for adolescents with obesity and/or T2D was conducted in this review paper. Results: The new medications, such as SGLT2 receptor agonists and GLP-1 agonists, are highly effective in treating T2D in adolescents with obesity. Conclusions: Based on the performed literature review, the recent approval of a novel generation of drugs seems to be the dawn of a new era in childhood obesity and T2D treatment.

Short stature affects approximately 2.5% of children. Some of them, when diagnosed with growth hormone deficiency (GHD), benefit from recombinant human growth hormone (rhGH) therapy; in others, this treatment is controversial. We aimed to present the clinical characteristics of Polish short stature children in the context of current GHD diagnostic standards, as obtaining more data gives a broader foundation for the potential modifications of diagnostic and therapeutic recommendations. This retrospective analysis was based on a cohort of 277 short stature children divided into two subgroups depending on their peak growth hormone (GH) cutoff level, set at 10 ng/mL: 138 had growth hormone deficiency (GHD) and 137 had normal growth hormone secretion (GHN). These subgroups were then compared based on the extracted clinical data. In the obtained result, no significant differences between the GHD and GHN subgroups were found in any of the variables, including the following: gender distribution, birth weight, bone age delay, height SDS, IGF-1 SDS, vitamin D levels, celiac disease indices, prevalence of hypothyroidism or anemia. As our results point to major clinical similarities between the GHD and GHN children, it seems that distinguishing patients with normal GH secretion from those with deficient GH secretion based on a 10 ng/mL cutoff value might not be clinically relevant.

There are several observations that the onset of coronavirus 19 (COVID‐19) pandemic was associated with an increase in the incidence of diabetic ketoacidosis (DKA). However, due to heterogeneity in study designs and country‐specific healthcare policies, more national‐level evidence is needed to provide generalizable conclusions. To compare the rate of DKA in Polish children diagnosed with type 1 diabetes (T1D) between the first year of COVID‐19 pandemic (15 March 2020 to 15 March 2021) and the preceding year (15 March 2019 to 15 March 2020). Reference centers in 13 regions (covering ~88% of Polish children) retrospectively reported all new‐onset T1D cases in children from assessed periods, including DKA status at admission, administered procedures and outcomes. Secondly, we collected regions' demographic characteristics and the daily‐reported number of COVID‐19‐related deaths in each region. We recorded 3062 cases of new‐onset T1D (53.3% boys, mean age 9.5 ± 4.3 years old) of which 1347 (44%) had DKA. Comparing pre‐ and post‐COVID‐19 period, we observed a significant increase in the rate of DKA (37.5%–49.4%, p < .0001). The fraction of moderate (+5.4%) and severe (+3.4%) DKA cases increased significantly (p = .0089), and more episodes required assisted ventilation (+2.1%, p = .0337). Two episodes of DKA during 2020/2021 period were fatal. By region, change in DKA frequency correlated with initial COVID‐19 death toll (March/April 2020) (R = .6, p = .0287) and change in T1D incidence (R = .7, p = .0080). The clinical picture of new‐onset children T1D in Poland deteriorated over a 2‐year period. The observed increase in the frequency of DKA and its severity were significantly associated with the overlapping timing of the COVID‐19 epidemic.

Introduction. Food is the basic source of energy for humans. Properly matched for the age and needs of the body, a balanced diet is a condition for proper growth and development during childhood. The aim of the study is to review the current state of knowledge regarding the impact of the nutrition model, diet composition and behavioral aspects related to food intake on the occurrence of obesity in children and adolescents. Conclusions. Too much energy charge in food, disturbing the balance between energy supply and expenditure, is a common cause of childhood obesity. The rate of weight gain in children is also affected by other factors, such as the model of feeding during infancy, eating habits in the early years of life, and a number of behavioral aspects related to food intake. Taste preferences and eating habits are formed in a child from the first years of life and are often continued during adulthood, therefore, an essential element of obesity prevention must cover the extensive early education involving parents, caregivers and the children themselves.