Background/Objectives: The global incidence of diabetes in childhood is increasing, raising concern about its long-term effects on the developing brain. Although paediatric diabetes research has traditionally focused on microvascular and macrovascular complications, accumulating evidence indicates that the brain is also a vulnerable target. Methods: This narrative review synthesizes current knowledge on the impact of diabetes on brain health in children and adolescents, with emphasis on epidemiology, neuroimaging and cognitive outcomes, underlying mechanisms, risk and protective factors, and clinical implications. Results: In type 1 diabetes (T1D), studies consistently demonstrate subtle but measurable alterations in brain structure, including reduced growth of total, grey, and white matter volumes, alongside functional and microstructural changes. These neurobiological differences are associated with mild deficits in cognition, particularly in attention, executive function, memory, and processing speed. While clinically significant impairment affects a minority, subclinical alterations are common and may accumulate over time. Key risk factors include chronic hyperglycaemia, glycaemic variability, severe hypoglycaemia, diabetic ketoacidosis, and younger age at onset, whereas good glycaemic stability, diabetes technologies, supportive psychosocial environments, and adequate sleep appear protective. Proposed mechanisms involve oxidative stress, neuroinflammation, disrupted insulin signalling, altered cerebral metabolism, and vulnerability of the immature brain during critical developmental windows. Type 2 diabetes (T2D), increasingly diagnosed in youth, is also associated with adverse brain outcomes. Emerging data link early-onset T2D to alterations in brain structure and connectivity, poorer cognitive performance, and increased mental health burden, mediated by hyperglycaemia, insulin resistance, inflammation, and psychosocial stressors. Conclusions: Overall, childhood diabetes—both T1D and T2D—is associated with meaningful effects on brain development and function. Longitudinal and interventional studies are needed to establish causality and determine whether optimizing glycaemic control and psychosocial support can mitigate neurocognitive risk. Recognizing brain health as a potential complication of paediatric diabetes has important implications for monitoring, prevention, and clinical care.

Childhood obesity is associated with insulin resistance, type 2 diabetes, and metabolic syndrome. Although accurate, traditional insulin measurement techniques are not practical for routine clinical usage in pediatric populations. This study investigates whether the ratio of triglycerides to HDL cholesterol can be used as a straightforward indicator of insulin resistance in obese children and adolescents. A retrospective study of 123 obese people aged 5 to 19 years discovered a moderate but substantial positive relationship between this ratio and insulin resistance, as evaluated by HOMA-IR. Higher ratios were associated with higher HOMA-IR readings and insulin levels. The triglyceride-to-HDL ratio may therefore provide a useful substitute for evaluating insulin resistance in clinical contexts, although more investigation is needed to validate its applicability in larger populations.

Albuminuria within the normal range may predict an increased risk of subsequent nephropathy in type 1 diabetes (T1D). The role of sustained hyperglycaemia in the development of nephropathy is well-known. The relationship between albuminuria within the normal range and parameters of continuous glucose monitoring (CGM) in childhood has not yet been investigated. The aim of the present study was to analyze this relationship in young T1D patients. A total of 54 normoalbuminuric, normotensive, real time CGM user pubertal children and adolescents with T1D were recruited for this study. Patients with medium to high normal (1.0-2.9 mg/mmol; n = 18) and those with low normal (< 1.0 mg/mmol; n = 36) urinary albumin-to-creatinin ratio (UACR) were compared regarding CGM metrics data. Relationships of UACR with clinical variables and CGM-derived metrics were analysed by multiple logistic regression. Time in range (TIR) was lower in medium to high normal UACR patients than in low normal UACR patients (mean ± SD: 58.2 ± 8.4

Long-term data on ustekinumab in real-life Crohn's disease patients are still missing, though randomized controlled trials demonstrated it as a favorable therapeutic option. We aimed to evaluate ustekinumab's clinical efficacy, drug sustainability, and safety in a prospective, nationwide, multicenter Crohn's disease patient cohort with a three-year follow-up. Crohn's disease patients on ustekinumab treatment were consecutively enrolled from 9 Hungarian Inflammatory Bowel Disease centers between January 2019 and May 2020. Patient and disease characteristics, treatment history, clinical disease activity (Harvey Bradshaw Index (HBI)), biomarkers, and endoscopic activity (Simple Endoscopic Score for Crohn's Disease (SES-CD)) were collected for three-years' time. A total of 148 patients were included with an overall 48.9% of complex behavior of the Crohn's disease and 97.2% of previous anti-TNF exposure. The pre-induction remission rates were 12.2% (HBI), and 5.1% (SES-CD). Clinical remission rates (HBI) were 52.2%, 55.6%, and 50.9%, whereas criteria of an endoscopic remission were fulfilled in 14.3%, 27.5%, and 35.3% of the subjects at the end of the first, second, and third year, respectively. Dose intensification was high with 84.0% of the patients on an 8-weekly and 29.9% on a 4-weekly regimen at the end of year 3. Drug sustainability was 76.9% during the follow-up period with no serious adverse events observed. Ustekinumab in the long-term is an effective, sustainable, and safe therapeutic option for Crohn's disease patients with severe disease phenotype and high previous anti-TNF biological failure, requiring frequent dose intensifications.

Abstract Background While randomized controlled trials have shown ustekinumab (UST) as an effective therapeutic option for Crohn’s disease (CD), there is a lack of long-term observational data in real-world CD patient settings. This prospective study seeks to evaluate the clinical effectiveness, sustainability, and safety of UST in a nationwide multicentre cohort of CD patients over three years. The aim is to bridge the gap in our understanding of UST's real-world implications for long-term CD management. Methods CD patients undergoing ustekinumab (UST) treatment were consecutively enrolled at nine Hungarian Inflammatory Bowel Disease centers from January 2019 to May 2020. Over a three-year period, comprehensive data on patient demographics, disease characteristics, treatment history, clinical disease activity (measured by the Harvey Bradshaw Index (HBI)), biomarkers, and endoscopic activity (evaluated using the Simple Endoscopic Score for Crohn’s Disease (SES-CD)) were systematically collected. Results Involving 148 patients, the cohort comprised 48.9% with complex behavior of CD and 97.2% with previous anti-TNF exposure. Pre-induction remission rates were observed at 12.2% (HBI) and 5.1% (SES-CD). Clinical remission rates (HBI) at the end of the first, second, and third years were 52.2%, 55.6%, and 50.9%, respectively. Criteria for endoscopic remission were met in 14.3%, 27.5%, and 35.3% of subjects at the end of the first, second, and third years. Dose intensification was notable, with 84.0% of patients on an 8-weekly and 29.9% on a 4-weekly regimen by the end of year 3. Throughout the follow-up period, drug sustainability stood at 76.9%, and no serious adverse events were observed. Conclusion Our study confirms that ustekinumab is a sustainable, effective, and safe long-term treatment for Crohn's disease patients with a severe disease phenotype and a history of high anti-TNF failure, with the need for frequent dose adjustments.

Az 1-es típusú diabéteszes páciensek egyre nagyobb számban próbálják ki az ún. do-it-yourself (csináld magad) artificial pancreas (mesterséges hasnyálmirigy), röviden DIY AP rendszereket, illetve maguk is bekapcsolódnak a fejlesztésbe. Összefoglaló tanulmány keretében mutatjuk be a világszinten trendszerűen növekvő „csináld magad” AP mozgalmat, összefoglaljuk az elérhető rendszereket és a hozzájuk kapcsolódó nemzetközi eredményeket. A mozgalom keretében a felhasználók szabad kezet kaphatnak a betegségük kezelésére a használt rendszer kialakításában, ami egyrészről járhat előnyökkel, másrészről azonban minőségi garanciák, etikai megfontolások és egészségügyi kockázatok terén számos bizonytalan tényező is felmerül. Célunk rálátást biztosítani az említett rendszerek tulajdonságaira, előnyeire és hátrányaira, esetleges kockázataira. A bemutatott tanulmányokból kiderül, hogy a DIY AP rendszerek biztonságosságot és hatékonyságot tekintve is összemérhetők a teljeskörűen, hatóság által tesztelt és jóváhagyott AP-készülékekkel, a szenzorral kiegészített pumpás terápiához képest jelentősen nagyobb time in range (3,9–10 mmol/l céltartományban eltöltött idő) érhető el.

Background and aim A continuous glucose monitoring (CGM) helps the user stay continuously informed about blood glucose levels and reach the right target range. This study aimed to compare glycemic control and mental health of adults with type 1 diabetes with or without CGM and to examine their experiences using it. Methods Patients were included in the survey, whether or not they had used a CGM. Standardized questionnaires were used to assess mental health, problems with disease management, hypoglycemia attitudes and behavior, as well as glucose monitoring satisfaction. Results 277 people participated in the study. CGM users (61.3%) had a more favorable glycemic control than those who were not. No differences were observed between the 2 groups in mental health and in response to hypoglycemic events; however, users reported more disease-related problems. CGM users reported they felt more open and free about diabetes, however, the pain and skin irritation caused by the device was disturbing and it was difficult to cope emotionally with the constant thought and worrying about diabetes. Conclusions CGM did not show clear satisfaction among users, however, less fear of hypoglycemia, fewer depression symptomology and improved glycemic control indicate better clinical status, which is one of the most important goals of disease management.

In this study, generic health-related quality of life (HRQoL) of young children with type 1 diabetes (T1D) was compared to healthy peers taken in consideration of family functioning and psychological well-being of mothers. A total of 113 mothers provided data (28 mothers had a preschool-aged child with T1D). There were no significant differences in background parameters of two investigated groups. No significant differences between children with and without T1D were detected either in HRQoL or in family functioning. Moreover, mothers of children with diabetes reported lower levels of resilience and more depressive symptoms than mothers of healthy peers. In the regression analysis, mothers' depressive symptoms and the family functioning significantly affected children's HRQoL regardless of the presence of diabetes. These results suggest that parents of children with T1D handle the burden of diabetes well and integrate into the daily activities of the families. Mothers experience distress, presumably because diabetes management is burdensome; however, the family can function well and the young children can live in a similar way to their healthy peers.

Abstract Background Emerging data suggest that a treat-to-target approach and early therapeutic intervention using regular objective disease assessment leads to improved outcomes. Our aim was to evaluate the value of objective disease monitoring during regular follow-up. Methods Patients presenting in our IBD center between January and December in, 2018 were included and followed up for, 1 year. Data from clinical visits, clinical disease activity using Crohn’s Disease Activity Index and partial Mayo Score, biomarkers (CBC, CRP, FCAL), stool culture, colonoscopy/sigmoidoscopy, CT/MRI scans, abdominal US, total number of visits, hospitalization or surgery rates, and change in medical therapy were collected. We compared monitoring strategy according to the clinical disease activity in the given quarter-year period based on the patient’s status of clinical disease activity (remission/ flare / post-flare/ continuous activity). Results N=161 patients were included (CD:118/UC:43; male:, 56%), with predominantly moderate-to-severe disease phenotype (70% on biological therapy). In total, n=644 quarter year periods (n=, 554 with patient visit) were evaluated (remission, 57%; continuous activity, 19%; post-flare, 11%; flare, 13%). CBC and CRP were performed in, 82.9% and, 83.9% of all patients with at least one clinical visit in a quarter-year period, regardless of clinical activity in IBD. Colonoscopy was performed in patients with flare or continuous disease activity in, 21.1% and, 18.9%, but, 10.1% of the patients in clinical remission also underwent colonoscopy in a given quarter-year period. In a sub-analysis of UC patients, 24.1% of the patients presenting with disease flare had colonoscopy in a given period. Stool culture and C.difficile stool tests were performed in, 17.2% of UC patients with flare. CT scans were performed at a low rate of, 2.4% in CD patients with disease flare, while MRI scans were similar in all subgroups of CD patients (7.7–16.7%)., 13.2% of patients with cont. activity and, 24.5% of patients with flare needed initiation or dose optimization of corticosteroids, while biological start or dose optimization was needed in, 31.1% and, 33.8% in a given quarter-year period. Mean number of follow-up visits per quarter-year period was high(1.6) even for patients in remission, and, 2.4 in flare. Conclusion Our study confirmed the use of regular objective biomarker monitoring, independent of clinical activity. We report high utilization of c-scope/sigmoidoscopy as well as MRI (in CD) in the objective evaluation of patients with clinical symptoms or even as part of routine monitoring. CT was reserved for emergency situations, while the use of US was relatively low. Objective monitoring resulted in frequent and early optimization of the therapeutic strategy.

Összefoglaló. Bevezetés: A HbA1c integrált retrospektív mutatója az elmúlt időszak vércukrának, rendszeres vizsgálata a cukorbetegek anyagcserekontrolljának megítélésében elengedhetetlen. Helyes értékelése azonban nem egyszerű, mert a HbA1c és a vércukor közötti összefüggés nem lineáris. A mérést közvetlenül megelőző hyperglykaemiás epizódok hatása a HbA1c szintjére nagyobb, mint azoké, amelyek régebben történtek. A jelenségre a glikáció biokinetikus modellje ad magyarázatot. Célkitűzés: A mért és a biokinetikus modell alapján számított HbA1c közötti egyezés, illetve diszkordancia vizsgálata. Módszer: A vizsgálatokat 157, 1-es és 2-es típusú cukorbeteg 1793, laboratóriumban mért éhomi vércukor- és 511 HbA1c-adatából végeztük. A különbséget a glikációs index segítségével számítottuk, amely a mért és a számított HbA1c-érték aránya. Eredmények: Egyezést mindössze a vizsgált betegek kevesebb mint egyötödödében találtunk, 60%-ban az index értéke alacsony (<0,95) és 21%-ban magas (>1,05) volt. Az adatok részletes analízise szerint jó anyagcserekontroll esetében gyakoribb a vártnál magasabb, mért HbA1c-érték, mint a biokinetikus egyenlet által számítotté, és rosszabb kontroll (magasabb átlagos vércukor) esetében ez fordítva van. Egyezés esetén a regressziós egyenlet együtthatói gyakorlatilag azonosak a modell alapján számított értékekkel. Következtetés: Vizsgálataink felvetik azt a lehetőséget, hogy a biokinetikus modell magyarázatot adhat a vércukor és a HbA1c közötti diszkordanciára. Orv Hetil. 2021; 162(41): 1652-1657. SUMMARY: INTRODUCTION:HbA1c is an integrated retrospective marker of previous blood glucose concentrations and its regular measurement is indispensable in the assessment of glycaemic compensation of diabetic patients. However, its proper interpretation is not simple becasuse the relationship between HbA1c and average glycemia is not a linear one. Hyperglycemic episodes occuring immediately before the measurement have greater impact on the HbA1c level as compared with those taking place earlier. OBJECTIVE:Assessment of concordance and discordance between measured and according to the biokinetic model calculated values of HbA1c. METHOD:The calculations were made from averages of 1793 fasting blood glucose and 511 HbA1c of 157, type 1 and 2 diabetic patients. The glycation index is the quotient between measured and calculated HbA1c. RESULTS:Agreement was found in less than one fifth of the 157 patients; in 60% the value of glycation was low (<0.95) and in 21% high (>1.05). Analysis of the glycation index according to the level of glycemic compensation revealed that in patients with good compensation, the measured HbA1c value was more often higher than the expected and in patients with unsatisfactory compensation the opposite was true. CONCLUSION:These results raise the possibility that the discordance between average glycemia and measured HbA1c can be explained by the biokinetic model. Orv Hetil. 2021; 162(41): 1652-1657.

Összefoglaló. Bevezetés: A HbA1c integrált retrospektív mutatója az elmúlt időszak vércukrának, rendszeres vizsgálata a cukorbetegek anyagcserekontrolljának megítélésében elengedhetetlen. Helyes értékelése azonban nem egyszerű, mert a HbA1c és a vércukor közötti összefüggés nem lineáris. A mérést közvetlenül megelőző hyperglykaemiás epizódok hatása a HbA1c szintjére nagyobb, mint azoké, amelyek régebben történtek. A jelenségre a glikáció biokinetikus modellje ad magyarázatot. Célkitűzés: A mért és a biokinetikus modell alapján számított HbA1c közötti egyezés, illetve diszkordancia vizsgálata. Módszer: A vizsgálatokat 157, 1-es és 2-es típusú cukorbeteg 1793, laboratóriumban mért éhomi vércukor- és 511 HbA1c-adatából végeztük. A különbséget a glikációs index segítségével számítottuk, amely a mért és a számított HbA1c-érték aránya. Eredmények: Egyezést mindössze a vizsgált betegek kevesebb mint egyötödödében találtunk, 60%-ban az index értéke alacsony (<0,95) és 21%-ban magas (>1,05) volt. Az adatok részletes analízise szerint jó anyagcserekontroll esetében gyakoribb a vártnál magasabb, mért HbA1c-érték, mint a biokinetikus egyenlet által számítotté, és rosszabb kontroll (magasabb átlagos vércukor) esetében ez fordítva van. Egyezés esetén a regressziós egyenlet együtthatói gyakorlatilag azonosak a modell alapján számított értékekkel. Következtetés: Vizsgálataink felvetik azt a lehetőséget, hogy a biokinetikus modell magyarázatot adhat a vércukor és a HbA1c közötti diszkordanciára. Orv Hetil. 2021; 162(41): 1652–1657. Summary. Introduction: HbA1c is an integrated retrospective marker of previous blood glucose concentrations and its regular measurement is indispensable in the assessment of glycaemic compensation of diabetic patients. However, its proper interpretation is not simple becasuse the relationship between HbA1c and average glycemia is not a linear one. Hyperglycemic episodes occuring immediately before the measurement have greater impact on the HbA1c level as compared with those taking place earlier. Objective: Assessment of concordance and discordance between measured and according to the biokinetic model calculated values of HbA1c. Method: The calculations were made from averages of 1793 fasting blood glucose and 511 HbA1c of 157, type 1 and 2 diabetic patients. The glycation index is the quotient between measured and calculated HbA1c. Results: Agreement was found in less than one fifth of the 157 patients; in 60% the value of glycation was low (<0.95) and in 21% high (>1.05). Analysis of the glycation index according to the level of glycemic compensation revealed that in patients with good compensation, the measured HbA1c value was more often higher than the expected and in patients with unsatisfactory compensation the opposite was true. Conclusion: These results raise the possibility that the discordance between average glycemia and measured HbA1c can be explained by the biokinetic model. Orv Hetil. 2021; 162(41): 1652–1657.

but in practice its implementation and effectiveness are limited. At present, pharmacological intervention can only be used in certain selected cases with this age group. Further clinical research is needed to measure insulin resistance, lifestyle and drug intervention options in order to develop successful strategies to prevent and re-duce cardiovascular death.

that in patients with good compensation, the measured HbA 1c value was more often higher than the expected and in patients with unsatisfactory compensation the opposite was true. Conclusion: These results raise the possibility that the discordance between average glycemia and measured HbA 1c can be explained by the biokinetic model.

A bizonyítékokon alapuló egészségügyi szakmai irányelvek az egészségügyi szakemberek és egyéb felhasználók döntéseit segítik meghatározott egészségügyi környezetben. A szisztematikus módszertannal kifejlesztett és alkalmazott egészségügyi szakmai irányelvek, tudományos vizsgálatok által igazoltan, javítják az ellátás minőségét. Az egészségügyi szakmai irányelvben megfogalmazott ajánlások sorozata az elérhető legmagasabb szintű tudományos eredmények, a klinikai tapasztalatok, az ellátottak szempontjai, valamint a magyar egészségügyi ellátórendszer sajátságainak együttes figyelembevételével kerülnek kialakításra. Az irányelv szektorsemleges módon fogalmazza meg az ajánlásokat. Bár az egészségügyi szakmai irányelvek ajánlásai a legjobb gyakorlatot képviselik, amelyek az egészségügyi szakmai irányelv megjelenésekor a legfrissebb bizonyítékokon alapulnak, nem pótolhatják minden esetben az egészségügyi szakember döntését, ezért attól indokolt esetben dokumentáltan el lehet térni.

Összefoglaló. Számos adat igazolja, hogy az inzulinrezisztencia gyakori jelenség gyermek- és serdülőkorban, és szoros kapcsolatban áll a cardiovascularis kockázat növekedésével, ami miatt a kérdéskörre az életnek ebben a korai szakaszában is kiemelt figyelmet kell fordítani. Ma már egyre több ismerettel rendelkezünk a kockázati tényezőket illetően, nincs azonban egységes álláspont az inzulinrezisztencia meghatározására vonatkozóan a klinikai gyakorlatban, és nem rendelkezünk megfelelő laboratóriumi markerekkel, melyek segítségével a veszélyeztetetteket széles körben eredményesen lehetne azonosítani. Mindezek alapján a laboratóriumi módszerrel történő szűrés ebben az életkorban nem indokolt, azonban a társuló és következményes kórállapotok klinikai alapon történő felismerésére törekedni kell. A cardiovascularis kockázat megelőzésére irányuló életmódbeli prevenció hatásos az inzulinrezisztencia csökkentésében, a gyakorlatban azonban kivitelezése és eredményessége korlátozott. A gyógyszeres intervenció jelenleg ebben az életkorban csak egyes szelektált esetekben kerülhet alkalmazásra. További klinikai kutatásokra van szükség az inzulinrezisztencia mérése, az életmódbeli és gyógyszeres intervenciós lehetőségek területén annak érdekében, hogy sikeres stratégiák legyenek kialakíthatók a cardiovascularis halálozás megelőzése, csökkentése érdekében. Orv Hetil. 2021; 162(11): 403-412. Summary. Numerous data confirm that insulin resistance is a common phenomenon in children, and closely links to an increase in cardiovascular risk, therefore it is urgent to pay attention to this from early childhood. Today, we have more and more knowledge about risk factors, but there is no common position on the definition of insulin resistance in clinical practice and we do not have adequate laboratory markers to identify those at risk effectively. Based on all these factors, laboratory screening is not justified at this age, however, efforts should be made to recognize associated and consequent conditions on a clinical basis. Lifestyle prevention to prevent cardiovascular risk is effective in reducing insulin resistance, but in practice its implementation and effectiveness are limited. At present, pharmacological intervention can only be used in certain selected cases with this age group. Further clinical research is needed to measure insulin resistance, lifestyle and drug intervention options in order to develop successful strategies to prevent and reduce cardiovascular death. Orv Hetil. 2021; 162(11): 403-412.

INTRODUCTION:The aim of the present study was to assess changes in the incidence and prevalence of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in children and adolescents in Hungary during the period 2001 to 2016 in order to provide nationwide population-based epidemiology data on diabetes in youths aged 0-18 years.MATERIAL AND METHODS:This was a retrospective cohort study of Hungarian children and adolescents aged 18 years or younger. Pharmacologically treated diabetes cases were obtained through a population-based registry of the Hungarian National Health Insurance Fund. Time series analysis was used to evaluate the changing patterns of the incidence and prevalence for type 1 and type 2 diabetes covering a 16-year period.RESULTS:During the study period, 6,138 and 1,997 new T1DM and T2DM cases were observed, respectively. Newly diagnosed T2DM cases accounted for 24.5% of all incident diabetes cases. Incidence of T1DM increased from 16/100,000 to 23/100,000 (R 2 = 0.7681; p < 0.0001). The male-to-female ratio among newly diagnosed T1DM patients did not change over the study period. Prevalence of T1DM rose from 114/100,000 to 209/100,000 (R 2 = 0.9909; p < 0.0001). The prevalent T1DM cases showed significant male predominance in every year (p < 0.05). Incidence of T2DM decreased from 8/100,000 to 5/100,000 (R 2 = 0.4977; p < 0.0014). The overall prevalence of T2DM did not change significantly. Prevalent T2DM cases showed significant female predominance in every year (p < 0.0001). A significant decrease in male-to female ratio was observed among newly diagnosed T2DM cases over the study period (p < 0.0001).CONCLUSIONS:According to these population-based Hungarian data of children and adolescents with diabetes, T1DM is still the most common form and its frequency continues to rise, affecting more males than females. A high proportion of patients have T2DM, affecting more females than males, but the occurrence of medically treated cases is not increasing. The decrease in male-to-female ratio in newly diagnosed T2DM cases needs further investigations.