Background: The rising prevalence of childhood obesity and sedentary lifestyles has blurred the traditional distinction between type 1 and type 2 diabetes. Double diabetes represents the coexistence of autoimmune β-cell destruction and insulin resistance, posing diagnostic and therapeutic challenges, particularly in adolescents. Case presentation: We report the case of a 17-year-old obese female with a three-year history of type 1 diabetes who developed marked insulin resistance and metabolic syndrome features. Despite high insulin requirements (1.6 U/kg/day), glycemic control remained poor (HbA1c 12.8%). Clinical examination revealed obesity (BMI 32.4 kg/m²) and acanthosis nigricans. Laboratory evaluation showed preserved C-peptide secretion, dyslipidemia, elevated leptin and homocysteine levels, and positivity for anti-GAD65 and islet cell antibodies, supporting the diagnosis of double diabetes. Management and Outcomes: A combined therapeutic strategy including optimization of basal-bolus insulin therapy, adjunctive metformin, structured nutritional intervention, and regular physical activity was implemented. Six months later, and at the stage of her transition, HbA1c decreased to 7.8%, body weight was reduced by 8 kg, daily insulin requirements decreased by 35%, and lipid parameters improved significantly. Conclusion: This case highlights the importance of early recognition of double diabetes in youth and demonstrates that integrated metabolic and autoimmune-targeted management can significantly improve glycemic control and cardiometabolic risk.

Background Cardiovascular disease (CVD) remains the leading cause of premature morbidity and mortality among individuals living with type 1 diabetes mellitus (T1DM). Although overt cardiovascular events are uncommon during childhood, endothelial dysfunction and subclinical atherosclerosis develop early, making timely cardiovascular risk assessment essential. Plasma homocysteine has emerged as a potential biomarker of vascular injury; however, its clinical value in pediatric T1DM remains controversial, and evidence from African populations is scarce. This study aimed to evaluate plasma homocysteine concentrations in children and adolescents with T1DM and to investigate their relationship with cardiovascular risk profiles and diabetes-related complications. Methods A cross-sectional observational study was conducted at the Department of Pediatrics B, in the university hospital center of Oran, Algeria. A total of 50 children and adolescents aged 5-19 years with confirmed T1DM were included. Demographic, anthropometric, clinical, and laboratory data were retrospectively collected from medical records. Plasma total homocysteine (tHcy) concentrations, glycemic control, lipid profile, diabetes duration, insulin therapy, nephropathy, and cardiovascular risk factors were analyzed. Hyperhomocysteinemia prevalence was determined, and its association with cardiovascular risk stratification was assessed using descriptive and inferential statistical analyses. Results The study included 27 male (54%) and 23 female patients (46%), and hyperhomocysteinemia was identified in 17 of 50 participants (34%). Plasma tHcy concentrations were significantly higher in participants with HbA1c >7.5% than in those with HbA1c ≤7.5% (18.9 ± 5.8 vs. 11.8 ± 3.9 μmol/L; Student’s t-test, t = 4.44, p < 0.001). Plasma tHcy concentrations were positively correlated with HbA1c (r = 0.61, p < 0.001), diabetes duration (r = 0.49, p = 0.001), LDL cholesterol (r = 0.42, p = 0.004), and triglycerides (r = 0.35, p = 0.015). Participants with diabetic nephropathy had significantly higher plasma tHcy concentrations than those without nephropathy (21.1 ± 5.9 vs. 15.2 ± 5.3 μmol/L; Student’s t-test, t = 2.53, p = 0.015). In exploratory multivariable analysis, poor glycemic control (HbA1c >7.5%; aOR = 3.26, 95% CI: 1.18-9.02; p = 0.021) and diabetes duration ≥5 years (aOR = 2.54, 95% CI: 1.01-6.42; p = 0.047) were independently associated with hyperhomocysteinemia. Plasma tHcy showed good discriminative ability for the study-specific moderate-to-high cardiovascular risk classification (AUC = 0.82, 95% CI: 0.69-0.94; p < 0.001). Conclusion Hyperhomocysteinemia was prevalent among children and adolescents with T1DM in our cohort and was associated with an unfavorable cardiovascular risk-factor profile. These findings suggest that plasma homocysteine may represent a potential investigational adjunctive marker of cardiovascular risk-factor burden in pediatric T1DM. Prospective multicenter studies are warranted to validate these associations and determine their incremental clinical value beyond established cardiovascular risk factors.

Background: Celiac disease is a chronic immune-mediated enteropathy caused by gluten exposure in genetically susceptible individuals, for which lifelong adherence to a gluten-free diet remains the only validated treatment. Data on dietary adherence and health-related quality of life in North African pediatric populations remain limited. This study aimed to assess GFD adherence, HRQoL, and factors associated with poor adherence among Algerian children with CD. Methods: This prospective observational cohort study was conducted in the Pediatric Department B of the University Hospital Center of Oran, Algeria, between January 2022 and June 2024. Children aged 2–16 years with confirmed CD (2020 ESPGHAN diagnostic criteria) were consecutively enrolled and prospectively followed at approximately three-month intervals (mean follow-up 18 ± 6 months). GFD adherence was assessed through structured dietary interviews; nutritional status was evaluated clinically and by laboratory assays (hemoglobin, ferritin, vitamin D); HRQoL was measured using the PedsQL and PROMIS pediatric measures. Univariate and multivariable logistic regression were used to identify factors associated with poor adherence, with odds ratios and adjusted odds ratios (aORs) and their 95% confidence intervals. Results: Of 130 children assessed, 100 were included (mean age, 8.7 ± 3.4 years); 38% were classified as adherent and 62% as non-adherent. Children subsequently classified as non- adherent had lower baseline global quality-of-life scores than adherent children (59.7 ± 12.8 versus 78.4 ± 9.6; p < 0.001). Anxiety scores were higher in the non-adherent group among 84 children with available scores (57.2 ± 9.3 versus 46.8 ± 7.8; p < 0.001). Limited access to gluten-free products (adjusted odds ratio, 4.34; 95% confidence interval, 2.00–9.40), economic difficulties (3.70; 1.80–7.60), and psychological stress (2.60; 1.20–5.40) were associated with non-adherence. Nutritional abnormalities were present at enrollment in 72% of children and were associated with lower baseline quality-of-life scores (p < 0.001). Conclusions: GFD adherence is suboptimal among Algerian children with CD and is associated with socioeconomic and psychosocial barriers and reduced HRQoL. Multidisciplinary management addressing nutritional, socioeconomic, and psychological factors is warranted. Given the observational design, the associations identified should not be interpreted as causal; larger multicenter longitudinal studies are needed to confirm these findings.

Continuous glucose monitoring (CGM) has transformed diabetes management by providing real-time glucose measurements and supporting improved glycemic control. Consequently, the methodological quality of CGM accuracy studies has become increasingly important for clinicians, regulatory agencies, and healthcare decision-makers. The recent real-world evaluation of the Sinocare iCan i3 CGM system provides valuable evidence regarding device performance under routine clinical conditions. However, several methodological aspects warrant further consideration before the reported findings can be generalized to clinical practice. This perspective critically examines key aspects of CGM validation, including study design, selection of the reference glucose measurement, statistical methodology, temporal pairing strategies, sensor survival analysis, potential sponsorship-related bias, and interpretation of clinical accuracy metrics. We also discuss additional methodological considerations that were not fully addressed in the original publication, including uncertainty estimation, subgroup analyses, longitudinal sensor performance, missing-data mechanisms, and reproducibility assessment. Finally, we propose recommendations aimed at improving the methodological rigor of future real-world CGM validation studies and facilitating meaningful comparisons across CGM technologies.

Congenital cytomegalovirus (cCMV) infection has a broad clinical spectrum and may result in permanent neurological, auditory, visual, and developmental sequelae. We report the case of a six-month-old male infant investigated primarily for microcephaly who had a complex phenotype comprising a cutaneous rash present from birth that evolved into moderate early-onset atopic dermatitis with severe clinical and quality-of-life impairment, growth impairment, congenital arthrogryposis, neonatal jaundice with hyperbilirubinemia, mild neonatal thrombocytopenia, and neurosensory abnormalities. He was born at 36 weeks and four days after reduced amniotic fluid volume was noted at approximately 36 weeks. Neonatal hyperbilirubinemia did not require phototherapy, and a follow-up peripheral blood smear was unremarkable. At six months, the dermatitis consisted of widespread erythematous-squamous, intensely pruritic lesions with facial and periorbital involvement and sleep disturbance. After 40 days of conventional treatment with emollients, skin-barrier care, and topical corticosteroids, the SCORAD (Scoring Atopic Dermatitis) index decreased from 45 to 18, although residual lesions persisted. Growth was impaired, with marked underweight (weight-for-age z-score <−3) and reduced linear growth (length-for-age z-score −2.6), while head circumference was 40.8 cm (z-score −2.2), consistent with microcephaly. Brain magnetic resonance imaging showed preserved cerebral architecture with symmetric periventricular and peritrigonal T2 hyperintensity considered indeterminate and potentially related to incomplete physiological myelination. Auditory brainstem evoked responses and visual evoked potentials were abnormal. Creatine kinase was mildly elevated, whereas neurological examination and electromyography were normal. Quantitative immunoglobulins, serum protein electrophoresis, and lymphocyte subset analysis were unremarkable. Maternal CMV-specific IgM and IgG were positive during the eighth month of pregnancy, and the infant had positive CMV-specific IgM and IgG at six months. In the absence of virological testing within the first 21 days of life or an archived neonatal dried blood spot, congenital infection could not be definitively confirmed. This case emphasizes the critical importance of recognizing suggestive neonatal findings and testing for cCMV within the first 21 days of life, particularly in settings where retrospective dried-blood-spot testing is unavailable.