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Similar changes have been seen in medical practice with an increase in telemedicine care, and, unfortunately, a decrease in seeking routine medical care, and preventative vaccination. In their article, “Loss to Follow-Up: Patients with Type 1 Diabetes During the SARS-CoV-2 Pandemic,” they explore the issue of loss to follow-up and the importance of access to care, including a discussion of the associated morbidity and the role of tele-health care. Rev Panam Salud Publica. 2023 Aug 21:47:e129. 10.26633/RPSP.2023.129 Elizabeth Littlejohn, MD, MS, is a Pediatric Endocrinology Consultant, University of Michigan Health-Sparrow Medical Group, and an Associate Professor of Pediatrics, Michigan State University.

In 1997, the World Health Organization declared obesity a global epidemic. Despite multiple efforts, obesity rates have been exponentially increasing for the past few decades. In the last few years, obesity rates have reached an alarming number. Multiple factors play a role in pediatric obesity, such as diet, sedentarism, and poor sleep, as well as psychosocial and environmental factors. Pediatricians and primary care providers are key in the management of overweight and obesity. They have the advantage of observing children over a long period of time, having a family centered perspective, and often being seen as a reliable source of information. Studies have shown that not only is obesity underdiagnosed, but there is a lack of knowledge among physicians and available resources regarding pediatric obesity. This article reviews the principles of prevention in a primary care outpatient setting. Additionally, it discusses some of the challenges commonly faced when addressing pediatric obesity. [Pediatr Ann. 2023;52(2):e51–e56.]

Over the last few decades, the pediatric endocrine community has noticed a rise in metabolic consequences of childhood obesity. [...]this issue of Pediatric Annals highlights these consequences to make the general pediatrician aware of these conditions with the goal of identifying them early to avoid the complications likely to arise if left untreated. Several hypotheses have been explored surrounding the increasing incidence of diabetes and other consequences of obesity, such as vitamin D deficiency and polycystic ovary syndrome (PCOS). The increasing incidence of diabetes has necessitated a rise in technology with the aim of easing the burden of diabetes self-care. [...]we are now seeing the evolution of semi-closed loop insulin delivery and blood glucose monitoring systems, with the goal of moving toward closed-loop systems in which children with diabetes can “set and forget” diabetes self-care, but we are not quite there yet.

Obesity remains a significant public health issue that leads to serious acute and chronic diseases. The prevalence of childhood obesity is on the rise, especially when taking into consideration the novel coronavirus disease 2019 (COVID-19) pandemic. Pediatricians and primary care providers can help support children at risk for many obesity-related comorbidities by using a family based approach for intervention. In this review, we will provide a brief overview of childhood obesity with COVID-19 pandemic ramifications and guidance for pediatricians to provide needed support and initial treatment. [Pediatr Ann. 2023;52(2):e48–e50.]

Hypertriglyceridaemia-induced acute pancreatitis (HTG-AP) remains one of the common metabolic causes of acute pancreatitis in the paediatric population and the third most common cause after alcohol and gallstones in the adult population. We report a case of an early adolescent girl with global developmental delay and moderate cognitive impairment of unknown aetiology who presented with recurrent acute pancreatitis and uncompensated hypovolaemic shock. She was found to have serum triglyceride level of 7877 mg/dL (reference range<150 mg/dL) and hyperglycaemia with ketosis (no prior history of diabetes mellitus) that was successfully treated with lipid apheresis. This sometimes is an early modality for treatment in adults; however, it remains a last resort in children, used only for severe cases. A brief literature review on severe HTG-AP and its management is also provided.

The case of a 14-year-old white male athlete with atopy who complains of a 6-month history of progressive proximal muscle weakness, which significantly impacts his ability to run short distances and swing his baseball bat is presented. His mother states he has presented to multiple emergency departments (ED) for continued weakness and that most diagnosed him with dehydration and educated the family on how to maintain fluid balance.

Abstract Context Prader-Willi syndrome (PWS) is a rare neurobehavioral-metabolic disease caused by the lack of paternally expressed genes in the chromosome 15q11-q13 region, characterized by hypotonia, neurocognitive problems, behavioral difficulties, endocrinopathies, and hyperphagia resulting in severe obesity if not controlled. Objective The primary end point was change from baseline in hyperphagia using the Hyperphagia Questionnaire for Clinical Trials (HQ-CT). Other end points included Global Impression Scores, and changes in body composition, behaviors, and hormones. Methods In DESTINY PWS, a 13-week, randomized, double-blind, placebo-controlled, phase 3 trial, 127 participants with PWS aged 4 years and older with hyperphagia were randomly assigned 2:1 to diazoxide choline extended-release tablet (DCCR) or placebo. Results DCCR did not significantly improve hyperphagia (HQ-CT least-square mean (LSmean) [SE] −5.94 [0.879] vs −4.27 [1.145]; P = .198), but did so in participants with severe hyperphagia (LSmean [SE] −9.67 [1.429] vs −4.26 [1.896]; P = .012). Two of 3 secondary end points were improved (Clinical Global Impression of Improvement [CGI-I]; P = .029; fat mass; P = .023). In an analysis of results generated pre-COVID, the primary (HQ-CT; P = .037) and secondary end points were all improved (CGI-I; P = .015; Caregiver Global Impression of Change; P = .031; fat mass; P = .003). In general, DCCR was well tolerated with 83.3% in the DCCR group experiencing a treatment-emergent adverse event and 73.8% in the placebo group (not significant). Conclusion DCCR did not significantly improve hyperphagia in the primary analysis but did in participants with severe baseline hyperphagia and in the pre-COVID analysis. DCCR treatment was associated with significant improvements in body composition and clinician-reported outcomes.

Abstract Objective We set forth to compare ethnicities for metabolic and immunological characteristics at the clinical diagnosis of type 1 diabetes (T1D) and assess the effect of ethnicity on beta-cell functional loss within 3 years after clinical diagnosis. Research Methods and Design We studied participants in TrialNet New Onset Intervention Trials (n = 624, median age = 14.4 years, 58% male, 8.7% Hispanic) and followed them prospectively for 3 years. Mixed meal tolerance tests (MMTT) were performed within 6 months following clinical diagnosis and repeated semiannually. Unless otherwise indicated, analyses were adjusted for age, sex, BMI Z-score, and diabetes duration. Results At T1D clinical diagnosis, Hispanics, compared with non-Hispanic whites (NHW), had a higher frequency of diabetic ketoacidosis (DKA) (44.7% vs 25.3%, OR = 2.36, P = 0.01), lower fasting glucose (97 vs 109 mg/dL, P = 0.02) and higher fasting C-peptide (1.23 vs 0.94 ng/mL, P = 0.02) on the first MMTT, and higher frequency of ZnT8 autoantibody positivity (n = 201, 94.1% vs 64%, OR = 7.98, P = 0.05). After exclusion of participants in experimental arms of positive clinical trials, C-peptide area under the curve (AUC) trajectories during the first 3 years after clinical diagnosis were not significantly different between Hispanics and NHW after adjusting for age, sex, BMI-z score, and DKA (n = 413, P = 0.14). Conclusion Despite differences in the metabolic and immunological characteristics at clinical diagnosis of T1D between Hispanics and NHW, C-peptide trajectories did not differ significantly in the first 3 years following clinical diagnosis after adjustment for body mass index and other confounders. These findings may inform the design of observational studies and intervention trials in T1D.