Background: Total pancreatectomy with islet autotransplantation (TPIAT) requires strict glycemic management for islet survival using insulin pumps and continuous glucose monitors (CGMs). Hydroxyurea prevents reactive thrombocytosis but interferes with the accuracy of the Dexcom CGM. Hydroxyurea is reported to not interfere with the Libre CGM but has not been studied after TPIAT. Methods: Seven patients wore both Dexcom and Libre starting approximately a week after TPIAT. Dexcom and Libre values were obtained with point-of-care testing blood glucose (POCT BG) at 560 unique time points. Descriptive statistics included median, interquartile range (IQR), absolute difference between CGM and POCT, and mean absolute relative difference (MARD) for each Dexcom and Libre. Wilcoxon-Mann-Whitney tests were performed to compare parameters between Dexcom and Libre, with two-sided significance of P < 0.05. Clarke error grids and boxplots were constructed. Results: In the 9 h after hydroxyurea, median POCT BG was 110 mg/dL (IQR 88-143), median Dexcom BG was 172 mg/dL (135-219), and median Libre BG was 106 mg/dL (76-138). MARD for Dexcom was 59.5% and for Libre was 14.8% (P < 0.001). Median absolute difference between Dexcom and POCT BG (56 mg/dL [32-88]) was greater than that for Libre (12 mg/dL [6-23]; P < 0.001). In Clarke error grids, 98.3% of values fell within clinically acceptable Zones A/B for Libre; 77.9% of values fell within these zones for Dexcom. At all other times, median POCT BG was 110 mg/dL (86-133), median Dexcom BG was 124 mg/dL (97-154), and median Libre BG was 104 mg/dL (76-128). MARD for Dexcom was 19.8% and for Libre was 14.7% (P < 0.001). Median absolute difference between Dexcom and POCT BG (18 mg/dL [9-30]) was clinically similar to that for Libre (13 mg/dL [6-23], P < 0.001). Conclusion: Hydroxyurea does not seem to interfere with the accuracy of Libre in contrast to Dexcom. Use of Libre after TPIAT could facilitate improved glycemic management.

Objectives Increased diabetes distress and depression in adolescents with type 1 diabetes (T1D) are associated with poor glycemic control but it is not known whether they predict future glycemic control.Methods Patient Health Questionnaire (PHQ-9) and Problem Areas in Diabetes-Teen version (PAID-T) scores were given to 275 adolescents (age 13-17 years) with T1D. Robust rank order multivariate regression analysis was used to assess how age, duration of diabetes diagnosis, HbA1C at screen, PHQ-9 score, PAID-T screen, and insurance status predicted HbA1C at 1, 2, and 3 years after, and the changes in HbA1C over time.Results HbA1c and changes in HbA1c after one year were related to baseline HbA1c. At 2 and 3 years HbA1c was related to the initial HbA1C [beta: 0.64 (95 % CI 0.53-0.75) and beta: 0.47 (95 % CI 0.33-0.61), respectively], and to PHQ9 at screening [beta: 0.07 (95 % CI 0.01-0.14) and beta: 0.11 (95% CI 0.03-0.18), respectively]. Relationships were also demonstrated between PHQ9 and changes HbA1c after 2 and 3 years [beta: 0.07 (95% CI 0.01-0.14) and beta: 0.11 (95 % CI 0.03-0.18), respectively]. PAID-T score was not related to future glycemic control or changes in glycemic control at any time. Insurance status (private 1, public 2) also predicted future glycemic control and changes in HbA1C at 1, 2, and 3 years too.Conclusions Higher PHQ9 scores and public insurance predict worsening glycemic control over 3 years in adolescents with T1D while increased diabetes distress does not.

This study explored the frequency of adolescents with diabetes who endorse suicidality on the Patient Health Questionnaire (PHQ-9) with varying degrees of depression scores. Additionally, compared whether diabetes distress levels from the Problem Areas in Diabetes-Teen (PAID-T) assessment tool is associated with and without suicidal ideation. Chi(2) analysis was used to assess differences in subjects with or without suicidal ideation based on depression severity. Since all the data were nonparametrically distributed (Shapiro-Wilk test, p < .05), Kruskal-Wallis test assessed differences in continuous variables. Overall, 27 of 355 adolescents screened endorsed suicidal ideation. Both PHQ-9 [13 (9-17.8) vs 1 (0-4.5)] and PAID-T [88 (61.8-104.5) vs 40 (30-58.8)] scores were significantly higher in patients with suicidal ideation. The frequency of suicidal ideation increased with the severity of depression. The frequency of severe depression was higher in adolescents with type 2 diabetes (n = 48) than in type 1, but there was no difference in suicidality. Adolescents with no demonstrable or minimal depression can still have potential suicidal ideation. Suicidality is a separate construct that should be screened routinely and apart from any measures screening for distress or adjustment disorders associated with adolescents experiencing life-long chronic conditions in a healthcare follow-up setting.

Purpose Thyroid nodules are uncommon in children and adolescents but carry an increased risk of malignancy when present. The Thyroid Imaging Reporting and Data System (TI-RADS) is an adult-validated ultrasound-based risk assessment providing a prediction of malignant potential for thyroid nodules, thereby guiding recommendations for fine needle aspiration biopsy (FNAB). Minimal data exist regarding the applicability of TI-RADS to predict malignancy in pediatric thyroid nodules. This study aims to analyze the performance of TI-RADS for children and adolescents with thyroid nodules, hypothesizing that applying TI-RADS criteria would improve accuracy and reduce the number of recommended FNAB compared to American Thyroid Association (ATA) size criteria alone. Methods A multi-institutional retrospective analysis was conducted including patients < 21 years with a thyroid nodule by sonographic thyroid imaging between 2015-2020. TI-RADS scores were assigned at each institution by a pediatric radiologist trained in thyroid imaging and TI-RADS criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of TI-RADS scoring were compared to existing ATA size-based recommendation for performing a FNAB. Accounting for relative size differences between adults and children, a novel PED TI-RADS category was developed and tested, recommending FNAB for thyroid nodules with a TI-RADS 3 and >1.5cm, TI-RADS 4 and >1.0cm, and TI-RADS 5 any feasible size. Results 291 nodules from 260 patients (median age 14.9 years, 78.8% female) were assessed using TI-RADS. Applying adult TI-RADS criteria resulted in recommendation of FNAB for 35.1% of nodules, in contrast to 76.6% recommended by ATA guidelines (p<.0001) (Table). Utilizing the adult TI-RADS score ≥ 3 as an FNAB indicator resulted in 100% sensitivity and 28.5% specificity, with 0 cases of missed malignant nodules on pathology. When novel PED TI-RADS criteria were applied, 88 patients would have been spared an unnecessary FNAB with improved sensitivity and accuracy over ATA criteria. Conclusions The application of adult and PED TI-RADS scoring to thyroid nodules in pediatric patients enhances the accuracy of malignancy prediction compared to current American Thyroid Association size criteria alone. The utilization of PED TI-RADS scoring eliminated unnecessary biopsies in many children while not missing a single thyroid malignancy. Level of Evidence Level III

Abstract Disclosure: C.P. Damilano: None. C. Yu: None. D. Zhou: None. R.P. Hoffman: None. Introduction: Cardiovascular disease will be the primary cause of future death for adolescents with type 1 diabetes (T1D) and its origins are likely to occur in this age group. Adolescents with T1D have increased systemic inflammation which is likely to play a significant role in the pathogenesis of cardiovascular disease. The complement system, in particular, components C3 and C4 are part of the innate immune system that regulates inflammation. Increased C3 and C4 levels are associated with increased cardiometabolic risk. Objective: Most studies of inflammation are done while fasting but TNFα and IL6 increase postprandially in adolescent T1D following both high and low glycemic index (GI) meals. The goal of this study was to determine whether there are similar post-prandial changes in C3 and C4 levels. Methodology: Twelve, non-obese children and adolescents, 10-18 years old, with T1D were recruited from the Diabetes Clinic of Nationwide Children's Hospital. A randomized cross-over design for their two subsequent visits was used. After an overnight fast baseline blood samples were taken to measure plasma glucose, C3, total C4 protein, and total C4. Rapid acting insulin was given to cover meal carbohydrate without glucose correction, and blood samples were repeated (30, 60, 90, and 120 minutes) to measure glucose and C3 and C4 levels. Visits 1 and 2 were identical except for GI of the given meal. Visits were rescheduled if the fasting glucose was greater than 200 mg/dl. Repeated measures ANOVA and Spearman’s correlation were used. Results: Glucose response was significantly greater following high GI meal (Δglucose: high 52±12 vs low 6±5 mg/dl, mean±SE, p<0.001). For C3 levels, there was a significant post-prandial decrease (time effect p=0.049), but no meal effect or meal x time interaction. No specific time differences were found. C4 levels were also suppressed postprandially (p<0.001) and there was again no meal effect or meal by time interaction. Post hoc analysis found that C4 levels were lower at 60 min than at 0 min (p=0.007), 90 min (p=0.002) or 120 min (p<0.001). Conclusions: C3 and C4 levels decrease post-prandially in adolescents with T1D in contrast to increases in TNFα and IL6. Future research is clearly needed to clarify the postprandial interactions between the complement and inflammatory systems and potential pathogenic role in cardiovascular disease. Presentation: 6/3/2024

BackgroundAtherosclerosis is a chronic inflammatory disease that has its origins in childhood. The goal of this study was to explore the relationships of hematologic inflammatory markers to body mass, biochemical inflammatory markers and cardiometabolic risk factors.MethodsHealthy, white, non-Hispanic identifying adolescents (n = 75, age 12 to 18 years) were enrolled. Measures studied included body mass index percentile (BMI%), neutrophil and platelet to lymphocyte ratio (NLR, PLR), pan immune inflammation value (PIV), lipids, augmentation index, reactive hyperemia, inflammatory markers (interleukin 6: IL6, c-reactive protein: CRP), complement (C3, C3a, C4, C4a, C5a) insulin secretion and insulin sensitivity (oral glucose tolerance test: Matusda index, and disposition index (DI)).ResultsNLR (r(S) = 0.31, p < 0.01), PLR (r(S) = 0.32, p < 0.01), PIV (r(S) = 0.32, p < 0.01) and CRP (r(S) = 0.51, p < 0.001) all positively correlated with BMI% but IL-6 did not. NLR, PLR and PIV all positively correlated with each other. NLR correlated with the reactive hyperemia response (r(S) = 0.29, p < 0.02) but this relationship was lost when BMI% was included. NLR positively correlated with C3a, C4, CRP and IL6 even when BMI% was included.ConclusionIn healthy adolescents hematologic markers of inflammation increase with increasing body mass and neutrocyte to lymphocyte ratio is associated with increased complement and inflammatory markers independent of obesity.Impact statementHematologic and biochemical markers of inflammation increase with increased body mass in healthy adolescents.Hematologic and biochemical markers of inflammation are positively related independent of body mass in healthy adolescents.Hematologic inflammatory markers are not related to markers of cardiometabolic risk in healthy adolescents.

Abstract Disclosure: S. Bakjaji: None. R.P. Hoffman: None. Title: Isolated gonadotropin deficiency transmitted from mother to daughter conceived through assisted reproduction due newly identified, autosomal dominant mutation within the SOX10 gene. Objectives: We report a case of genetic isolated gonadotropin deficiency occurring in a mother and in her daughter conceived through assisted reproductive technology using mother’s ovum. Methods Case report Results: The daughter was initially seen at 12 years 0 months for evaluation of short stature and concerns she had not grown in the last year. She was otherwise in good health and reported normal sense of smell. At the time of assessment, her height was 132.6 cm (0.61 percentile; Z=-2.5). The mother had been diagnosed with Kallmann’s syndrome and achieved pregnancy through ovarian stimulation. Her height was 152.4 cm, while the father's height was 177.8 cm. Two male siblings were born at the same time and were in normal health. Physical examination of the daughter was unremarkable. She had Tanner stage 1 pubic hair and Tanner stage 1 breasts. The growth chart displayed a notable deceleration in growth Laboratory results showed normal free T4 of (0.9 ng/dL) with slightly elevated TSH (8.348 uIU/mL), positive thyroid antibodies, normal IGFI at 164 ng/mL (normal range for Tanner I: 54 - 301) and IGFBP-3 at 5.8 ug/mL (2.4 - 8.4 ug/mL). The karyotype was 46 XX. Her peak growth hormone using glucagon-arginine stimulation was 12.8 ng/ml. When no pubertal development was seen over the next 6 months, GnRH stimulation testing revealed baseline LH of 0.04 mIU/ml and a peak of 1.78 and baseline FSH of 0.41 mIU/ml with a peak of 2.83. Bone age was 8 years 4 months.Over the next year her growth velocity was 4.8 cm/year and she remained prepubertal. Genetic testing done identified a new heterozygous sequence variant (c.226G>A) in the SOX10 gene which would lead to replacement of valine by isoleucine at position 76 and was thought to be damaging in silico. This variant was subsequently found to be shared with her mother but not her father. Conclusions: Most Kallmann’s syndrome or genetic isolated gonadotropin deficiency cases are due to autosomal dominant but spontaneous new mutations since infertility is usually present in those with the syndrome. This case emphasizes the importance of genetic counselling regarding inheritance risk when assisted reproduction technology using maternal ovum is used. Presentation: 6/2/2024

Introduction: Cardiovascular disease will be the primary cause of future death for adolescents with type 1 diabetes (T1D). Increased systemic inflammation is likely to play a role in this. The complement system is part of the innate immune system regulating inflammation. C4 total gene copy number (GCN) and C4 subtype (C4A, C4B, C4Long, and C4Short) CGN have been associated with various aspects of the metabolic syndrome. Objective: To determine if C4 GCN is associated with fasting and/or post-prandial inflammation in adolescents with T1D. Methodology: 12 non-obese children and adolescents, 10-18 years old, with T1D were recruited from the Diabetes Clinic of Nationwide Children's Hospital. A randomized cross-over design for two subsequent visits was used. Fasting baseline blood samples were taken to measure glucose, TNFα, IL6, C3 and C4 protein levels and total C4, C4A, and C4B GCN. Rapid acting insulin was given to cover meal carbohydrate without glucose correction. Blood samples were repeated at 30, 60, 90, and 120 minutes. Visits 1 and 2 were identical except for GI of the meal. Visits were rescheduled if fasting glucose was > 200 mg/dl. Spearman’s correlation was used. Results: Total C4 GCN C4A and C4 Long GCN did not correlate with TNFα, IL6, C3, or C4 levels pre or post prandially for either meal. C4 short CGN positively correlated with baseline TNFα for the high glycemic index meal (rs=0.80, p<0.001) but not the low glycemic index meal. C4B GCN positively correlated with baseline TNFα (rs=0.64; rs=0.68 p<0.02) and IL6 (rs=0.79, p<0.01; rs=0.67 p<0.02) levels and 30 min TNFα (rs=0.80; rs=0.70, p<0.01) for both the high and low glycemic index meals, respectively. C4B GCN also correlated with 60 min C4 levels for both meals (rs=0.80; rs=0.70 p<0.01). Conclusions: High C4B GCN is associated with increased inflammatory markers (TNFα and IL6) in adolescent T1D. This association may indicate that individuals with high C4B GCN are at increased future risk for diabetes related cardiovascular disease. Disclosure C.P. Damilano: None. D. Zhou: None. C. Yu: None. R.P. Hoffman: Research Support; Pfizer Inc.

OBJECTIVE:To investigate whether perioperative calcium and 1,25 OH vitamin D supplementation (PCDS) influences the rates of postoperative hypocalcemia and length of stay (LOS) following pediatric thyroidectomy.STUDY DESIGN:Retrospective Cohort Review.SETTING:Tertiary children's hospital.METHODS:94 patients who underwent completion or total thyroidectomy with or without concomitant neck dissection from 2010 to 2020 at a single institution were included. Patients with pre-existing hypocalcemia or preoperative vitamin D insufficiency were excluded. Rates of postoperative hypocalcemia and LOS were compared for patients receiving PCDS to those receiving no supplementation.RESULTS:Thirty percent of patients with PCDS had documented postoperative hypocalcemia compared to 64% of patients without PCDS (p = 0.01). Patients with PCDS had a median LOS of 30 h compared to 36 h (p = 0.002). Multivariable analyses confirmed that patients with PCDS had lower odds of postoperative hypocalcemia (OR: 0.32, CI: 0.11, 0.89) and shorter LOS by 17 h (SE: 8, p = 0.04) after adjustment for confounders.CONCLUSION:PCDS is associated with significantly lower risk of hypocalcemia and shorter LOS. Standardizing preoperative care for pediatric patients undergoing thyroidectomy may decrease variability and improve outcomes following surgery.

Genetic deficiencies of early components of the classical complement activation pathway (especially C1q, r, s, and C4) are the strongest monogenic causal factors for the prototypic autoimmune disease systemic lupus erythematosus (SLE), but their prevalence is extremely rare. In contrast, isotype genetic deficiency of C4A and acquired deficiency of C1q by autoantibodies are frequent among patients with SLE. Here we review the genetic basis of complement deficiencies in autoimmune disease, discuss the complex genetic diversity seen in complement C4 and its association with autoimmune disease, provide guidance as to when clinicians should suspect and test for complement deficiencies, and outline the current understanding of the mechanisms relating complement deficiencies to autoimmunity. We focus primarily on SLE, as the role of complement in SLE is well-established, but will also discuss other informative diseases such as inflammatory arthritis and myositis.

Background/purpose: The process of evaluating pediatric thyroid nodules at our institution was inconsistent with a high rate of negative biopsies raising concern of appropriate patient selection for biopsy. Our aim was to institute a standardized risk strati fication reporting system for thyroid nodules to increase utilization and agreement of TI-RADS reporting at our institution. Methods: Radiology report data were collected and analyzed as part of a quality improvement project. A standardized TI-RADS dictation template was created, ultrasound technicians were trained, a multidisciplinary conference initiated, and education provided for radiologists and clinicians. Control charts were used to track utilization and agreement of scoring of TI-RADS reporting based upon review by a radiologist trained in TI-RADS scoring. Results: From January 2019 to January 2021, 218 patients with a thyroid nodule had a thyroid ultrasound performed at our institution. TI-RADS was utilized in 0 % (0 of 57) of children in the four months prior to project initiation. Following creation of the template, utilization increased to 65 % (39 of 60) over 5 months. Utilization further increased after the first training conference and was maintained above 90 % for 13 months. Ultrasound reports were in agreement in 46.7 % (28 of 60) of children initially. Agreement in reporting improved to 71.4 % (10 of 14) in the 3 months following the first training and to 78.4 % (58 of 74) over 12 months. Agreement in reporting was maintained at 80 % in the following 6 months. Conclusions: A quality improvement initiative can improve utilization and agreement of scoring using the TI-RADS system in pediatrics. This may ultimately reduce unnecessary biopsies and sedation in children. Level of evidence: Level III. Type of study: Quality Improvement. (c) 2023 Elsevier Inc. All rights reserved.

Patients with type 1 diabetes (T1D) have lower life expectancy than individuals without diabetes. Most of this reduction is due to cardiovascular disease, the major cause of death in patients with T1D. Post-prandial inflammation after high glycemic index (GI) meals may cause cardiovascular disease in adults. Differences in postprandial inflammatory responses between high and low GI foods have not been studied in children and adolescents with T1D. Twelve non-obese children and adolescents, 10-18 years old, with type 1 diabetes were recruited from the Diabetes Clinic of Nationwide Children's Hospital. A randomized cross-over design for their two subsequent visits was used. Baseline blood sample were taken (plasma glucose, triglyceride, IL-6, CRP, and TNF-α), rapid acting insulin was given to cover meal carbohydrate without glucose correction, and blood samples were repeated (30, 60, 90, and 120 minutes) after an overnight fast. Visits 1 and 2 were identical except for the GI of the given meal. Visits were rescheduled if the fasting glucose was greater than 200 mg/dl. Glucose response were significantly greater following high GI meal (Δglucose: high 52±12 vs low 6±5 mg/dl, mean±SE, repeated measures ANOVA, p<0.001), as expected. TNF-α (High 0 min: 0.86±0.08, 30 min: 1.83±0.08; Low 0 min: 0.82±0.06, 30 min 1.81±0.06 ng/ml) and IL-6 (High 0 min: 0.38±0.06, 120 min: 0.68±0.25; Low 0 min: 0.49±0.11, 120 min 0.71±0.14 ng/ml) increased following both high and low GI meals (p <0.001 and p=0.008, respectively), but there were no statistically significant differences between the two groups. CRP did not increase with either type of meal. Children and adolescent with T1D have post prandial inflammation, as indicated by increased TNFα and IL-6 levels. The post-prandial inflammation is not different between high and low GI meals in spite of higher glucose levels with the former. Disclosure C.P.Damilano: None. R.P.Hoffman: None. Funding Abigail Wexner Research Institute; University of Ohio

Abstract Disclosure: E.E. Bell-Sambataro: None. R.P. Hoffman: None. A. Lahoti: None. Background: Recent studies have shown significant increase in incidence of type 2 diabetes (T2D) in youth in the first 12 months of COVID-19 pandemic likely related to lockdowns, decreased physical activity and increased food consumption, leading to increased weight gain and worsening insulin resistance in at risk adolescents. However, it is unclear if these patterns have persisted beyond the first year of pandemic. We hypothesized that the proportion of T2D amongst youth with new onset diabetes (DM) would decrease to pre pandemic levels after 3/1/2021. Methodology: In this single institution study, youth with new onset DM were identified from the electronic medical record (EMR) database using ICD-10 diagnoses codes. Patients meeting ADA criteria of DM diagnosis were included while patients with diagnosis before 3/1/2018 or after 2/28/2022, age >18 years at diagnosis or DM types other than type 1 diabetes (T1D) or T2D were excluded. Patient characteristics and anthropometric data at DM diagnosis were collected. Frequency of T1D and T2D per year were calculated (Year 1: 3/1/2018-2/28/2019, Year 2: 3/1/2019-2/29/2020, Year 3: 3/1/2020-2/28/2021, Year 4: 3/1/2021-2/28/2022). Descriptive categorical data is reported as frequency and proportion. Chi square, independent sample t tests, and ANOVA were used as appropriate to evaluate differences between years. Results: Frequency of new onset T1D and T2D per year (proportion of T2D among new onset DM), respectively for year 1 was 191 and 63 (24.8%); year 2 was 193 and 45 (18.9%); year 3 was 231 and 109 (32.1%); year 4 was 262 and 130 (33.2%). The increase in proportion of T2D from year 1 to 4 was statistically significant (p <0.001). From year 1 to 4, age at diagnosis and percentage females for both groups and race for T1D patients were not statistically significant. Percentage Blacks amongst all new onset T2D youth increased significantly from 31% in year 1 to 51.3% in year 4 (p< 0.01). BMI z-scores increased significantly in T1D patients from year 1 to 4 (p= 0.008). BMI z-scores in T2D patients decreased significantly between year 2 & 3 (p= 0.002) and rose back between year 3 & 4 (p= 0.005). Conclusions: Our study shows the increase in proportion of T2D patients amongst youth with new onset DM has persisted beyond the first year of COVID-19 pandemic suggesting the increase may not be only due to pandemic era restrictions and lifestyle changes. While prior studies showed higher BMI z-scores at T2D diagnosis compared to pre pandemic period, in our study BMI z-scores for new onset T2D youth decreased significantly in the 1st year of pandemic. This could have been due to swift implementation of telehealth in our community and institution that allowed continued access to healthcare, DM screening and earlier T2D diagnosis. The rapid change in the landscape of pediatric diabetes with growing proportion of T2D is an alarming trend that requires additional studies. Presentation: Thursday, June 15, 2023

To determine (1) differences in depression and distress scores between adolescents with type 1 (T1D) and type 2 diabetes (T2D), (2) how socioeconomic factors, obesity, race, and treatment regimen affect depression and diabetes distress in adolescent T2D, (3) the relationships between depression and diabetes distress scores in adolescents with T2D, and (4) how depression and diabetes distress scores relate to current and future glycemic control in adolescents with T2D. Diabetes distress is a negative emotional reaction to diabetes complications, self-management demands, unresponsive providers, poor interpersonal relationships, and to diabetes itself. It is frequently mistaken for depression and the two are interrelated. Increases in both predict poor glycemic control in adolescents with T1D. Depression (PHQ-9) and diabetes distress (PAID-T) scores from self-administered tests were studied in 364 patients with diabetes between the ages of 13–17. Kruskal–Wallis test was used to assess differences between types of diabetes, sexes, races, and insurance status. Spearman correlations, and robust rank order multivariable regression analysis were used to assess relationships. Medical records were reviewed for follow-up hemoglobin A1c (HbA1c) levels over 3 years. HbA1c was significantly lower in females with T2D than with T1D (p  =  0.019) but not in males. It, also, did not differ between females and males with T2D. Median PHQ-9 score in females with T2D was significantly greater than in females with T1D (p = 0.007) but did not differ between females and males with T2D. PHQ-9 scores did not differ between males with T2D and T1D. PAID-T scores, however, were higher in males with T2D than in males with T1D but did not differ between females. PHQ-9 scores and PAID-T scores were significantly related in T2D (rs = 0.65, p < 0.001). Neither was related to HbA1c in T2D. As in adolescents with T1D, depression and diabetes distress screening scores are closely related in adolescent T2D. However, unlike T1D, they are not related to glycemic control in T2D. Depression and diabetes distress may be more closely related to weight and lifestyle concerns.

Insulin is primarily considered for its glycemic effects in patients with diabetes. There are, however, non-glycemic adverse effects of insulin that may significantly impact patient health and interfere with glycemic control. Insulinogenic edema primarily occurs with rapid improvement in glycemic control either in patients with newly discovered diabetes or in patients with poorly-controlled diabetes. Insulin-induced sympathetic activation, vasodilation, changes in vascular permeability, and most importantly, sodium retention play significant etiologic roles in the development of edema. Clinically, it is usually self-limited, but significant complications can develop. Allergic reactions to all insulin preparations and various compounds used in insulin formulations with a wide range of severity have been reported. Frequently, changing the type of insulin or delivery method is sufficient, but more advanced treatments such as insulin desensitization and anti-IgE antibody treatment may be needed. Lipohypertrophy and lipoatrophy frequently develop with the overuse of injection sites. Lipohypertrophy can affect tissue insulin absorption and glycemic control.