Objective: Real-time continuous glucose monitoring (RT-CGM) provides detailed information on glucose patterns and trends, thus allowing the patients to manage their diabetes more effectively.Design: The aim of this study was to explore the potential beneficial effects of the use of RT-CGM on diabetes management compared with self blood glucose measurement (SBGM) in patients with type 1 diabetes mellitus (T1DM), by means of a systematic review and meta-analysis of randomized controlled trials (RCTs).Methods: MEDLINE, EMBASE, and the Cochrane Library were searched through by two independent investigators for RCTs concerning the use of RT-CGM in patients with T1DM. Only studies with a similar insulin regimen in the experimental and control groups were included in the analysis.Results: Seven RCTs (n=948) met the inclusion criteria. Combined data from all studies showed better HbA1c reduction in subjects using RT-CGM compared with those using SBGM (mean difference (MD) −0.25; 95% confidence interval (95% CI): from −0.34 to −0.17; P<0.001). Patients treated with insulin pump and RT-CGM had a lower HbA1c level compared with subjects managed with insulin pump and SBGM (four RCTs, n=497; MD −0.26; 95% CI: from −0.43 to −0.10; P=0.002). The benefits of applying RT-CGM were not associated with an increasing rate of major hypoglycemic episodes. The use of RT-CGM for over 60–70% of time was associated with a significant lowering of HbA1c.Conclusions: RT-CGM is more beneficial than SBGM in reducing HbA1c in patients with type 1 diabetes. Further studies are needed to evaluate the efficacy of this system in the pediatric population, especially in very young children.

Introduction: Recent evidence has demonstrated that, among other factors, dysbiosis (imbalances in the composition and function of the gut microbiota) may be relevant in the development of type 1 diabetes (T1D). Thus, gut microbiota may be a target for improving outcomes in subjects with T1D. The aim of the study is to examine the effects of Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 on beta-cell function in children with newly diagnosed T1D. Methods and analysis: A total of 96 children aged 8 to 17 years with newly diagnosed T1D, confirmed by clinical history and the presence of at least one positive autoantibody, will be enrolled in a double-blind, randomised, placebo-controlled trial in which they will receive L. rhamnosus GG and B. lactis Bb12 at a dose of 10 ⁹ colony-forming units or an identically appearing placebo, orally, once daily, for 6 months. The follow-up will be for 12 months. The primary outcome measures will be the area under the curve of the C-peptide level during 2-hour responses to a mixed meal. Ethics and dissemination: The Bioethics Committee approved the study protocol. The findings of this trial will be submitted to a peer-reviewed paediatric journal. Abstracts will be submitted to relevant national and international conferences. Trial registration number: NCT03032354; Pre-results.

Diabetic ketoacidosis (DKA) is still a severe complication associated with significant morbidity and mortality. The aim of this study was to determine the predictors of DKA in children with newly diagnosed type 1 diabetes mellitus (T1DM). The study group consisted of new-onset type 1 diabetic patients admitted to our hospital between January 2006 and March 2008. One hundred and eighty-seven children were identified (95 females and 92 males) and their mean age was 8.9 ± 4.6 yr (0.8-17.8). Hemoglobin A1c, blood gases, and fasting c-peptide level were evaluated in all children. DKA was defined as a capillary pH < 7.3 and blood glucose >11 mmol/L. At the time of T1DM diagnosis, 26% of children had DKA. Misdiagnosis was significantly associated with the incidence of DKA. In the group with DKA, c-peptide level was significantly lower than in the group without DKA (p = 0.003.) The most prone to DKA were children under 2 yr of age (n = 14). In this age group, DKA was present in 71% of individuals and the lowest c-peptide level was observed compared to older children (p < 0.0001). There was significant correlation between the c-peptide level and age of children (r = 0.41, p < 0.0001). The incidence of DKA among newly diagnosed patients with T1DM remains unacceptably high and indicates greater necessity of medical alertness for this diagnosis, especially in the youngest children. Children under 2 yr of age remain the most prone to DKA, which may be related to delay in diagnosis and more aggressive β-cell destruction.

The etiology of type 1 diabetes has polygenic and environmental determinants that lead to autoimmune responses against pancreatic β cells and promote β cell death. The autoimmunity is considered silent without metabolic consequences until late preclinical stages,and it remains unknown how early in the disease process the pancreatic β cell is compromised. To address this, we investigated preprandial nonfasting and postprandial blood glucose concentrations and islet autoantibody development in 1,050 children with high genetic risk of type 1 diabetes. Pre- and postprandial blood glucose decreased between 4 and 18 months of age and gradually increased until the final measurements at 3.6 years of age. Determinants of blood glucose trajectories in the first year of life included sex, body mass index, glucose-related genetic risk scores, and the type 1 diabetes–susceptible INS gene. Children who developed islet autoantibodies had early elevations in blood glucose concentrations. A sharp and sustained rise in postprandial blood glucose was observed at around 2 months prior to autoantibody seroconversion, with further increases in postprandial and, subsequently, preprandial values after seroconversion. These findings show heterogeneity in blood glucose control in infancy and early childhood and suggest that islet autoimmunity is concurrent or subsequent to insults on the pancreatic islets.