Zohar Landau | Tel Aviv University (original) (raw)

Papers by Zohar Landau

The Journal of Clinical Endocrinology and Metabolism, Nov 29, 2021

PURPOSE The incidences of obesity and attention-deficit/hyperactivity disorder (ADHD) have increa... more PURPOSE The incidences of obesity and attention-deficit/hyperactivity disorder (ADHD) have increased in parallel over recent decades. We assessed the association between obesity and ADHD in a national sample of adolescents. METHOD In a nationwide population-based study of 1,118,315 adolescents (57% males; mean age 17 years), risks of obesity were compared between individuals with severe and mild ADHD, and those without ADHD. Diagnoses of ADHD were confirmed by specialists in either neurology or psychiatry. Adolescents requiring regular and continuous treatment with stimulants with no improvement of symptoms under treatment were classified as having severe ADHD; data were available from 2004 to 2019. During 2015-2019, the diagnosis of ADHD was defined and 65,118 (16.76%) of 388,543 adolescents with mild symptoms who required medications only for learning or who used stimulants irregularly were defined as having mild ADHD. RESULTS The prevalence of severe ADHD was 0.3% and of mild ADHD 20.1%. Obesity was more prevalent among adolescents with severe ADHD than among those without ADHD (13.5% vs. 7.5%). In the mild ADHD group 12.6% of males and 8.4% of females were diagnosed with obesity compared to 9.7% and 6.4%, respectively, in the non-ADHD group. The adjusted odds of severe ADHD for males and females with obesity were 1.77(1.56-2.02) and 2.09 (1.63-2.66) times the odds for low-normal BMI males and females, respectively, and 1.42 (1.37-1.48) and 1.42 (1.34-1.50) for males and females with mild ADHD. The elevated risk persisted in several sensitivity analyses. CONCLUSIONS Both adolescents with severe and mild ADHD are at increased risk for obesity.

Journal of Pediatric Endocrinology and Metabolism, Jul 9, 2019

Background: The purpose of this study was to assess the benefit of a short workshop addressing kn... more Background: The purpose of this study was to assess the benefit of a short workshop addressing knowledge and confidence of inpatient caregivers (physicians and nurses) treating pediatric type 1 diabetes mellitus (T1DM) patients. Methods: Questionnaires to determine familiarity with T1DM management and confidence in care were distributed at three university-affiliated medical centers. A 5-h practical-skills workshop was conducted at one center. Same questionnaires were filled out immediately after the workshop and 3 months later. Evaluation of knowledge was based on 16 multiple-choice questions, and confidence based on 10 categorical questions. Results: Nurses and physicians (total 135, 106 women, 85 nurses) completed the questionnaires. The median knowledge score was 53.33 (40-66) and 46.7 (26.7-66.7) for nurses and physicians, respectively (p = 0.76). The confidence scores were 1.44 (1.1-1.9) and 1.56 (1.2-1.8), respectively (p = 0.7). More experience among nurses (>10 years) was associated with higher confidence scores (p = 0.04). Twenty-one physicians and 52 nurses, 66 women, attended the workshop. The median knowledge grade improved from 60 (47-67) to 81 (69-81), p < 0.001, immediately after, and to 69 (63-81), p < 0.001, 3 months postworkshop. The median confidence score improved from 1.8 (1.6-2) to 2.4 (2.1-2.6), p < 0.001, and to 2.2 (2-2.6), p < 0.001, respectively. There was no association with profession or seniority. Conclusions: Knowledge and confidence in care of medical staff treating inpatient T1DM pediatric patients are lacking. Both improved significantly after the workshop, independent of seniority or profession.

International Journal of Clinical Practice, Dec 22, 2013

Accuracy of blood sugar values, as examined by glucose analysis, has significant importance on th... more Accuracy of blood sugar values, as examined by glucose analysis, has significant importance on the diagnosis of diabetes and follow up of diabetes treatment. Usage of a designated test tube significantly improves the accuracy of measurement. Knowledge of the medical staff is a major determinant in the current usage of such a technology. The aim of the study was to assess the level of knowledge exhibited by medical staff in the diabetes field and specifically for the usage of a designated tube to test blood glucose level. A prospective study. The staff of the internal and surgical departments and outpatient clinics at the Wolfson Medical Center completed a questionnaire that assessed the level of knowledge about the designated glucose test tube, other randomly used test tubes, the parameters that influence the blood glucose values in a non-designated tube and the diagnosis of diabetes. A number of 160 questionnaires (50% from internal departments, 36% from surgical departments and 14% from outpatient clinics) were analysed. The majority of the staff members (65%) knew that diabetes is diagnosed by glucose levels in blood. Of the 35% that did not know, 91% were nurses. The majority (75%) knew that diabetes is diagnosed during fasting conditions; however, most of the staff indicated that 12 h is needed. Only 25% knew of the designated test tube, and most of the staff indicated that a regular chemistry tube was the tube of choice for them. The staff exhibited poor level of knowledge regarding the parameters that influence the quality of the test. Staff members are not aware of the various aspects of diabetes diagnosis and the designated test tube for glucose measurements, and most of them use a tube that gives inaccurate measurements, therefore there is an urgent need to improve diabetes knowledge among staff members.

Diabetes Technology & Therapeutics, Mar 1, 2019

BACKGROUND The use of insulin pumps in pediatric patients with type 1 diabetes (T1D) has expanded... more BACKGROUND The use of insulin pumps in pediatric patients with type 1 diabetes (T1D) has expanded; however, data comparing devices remain scarce. We compared glycemic control, technical difficulties, and quality of life (QOL) between pump devices of three companies. METHODS This prospective observational trial is based on clinical data retrieved during 12 months of follow-up of pediatric patients who started pump therapy as part of their clinical care in four medical centers. The devices fully reimbursed by the national health insurance are as follows: MiniMed™ 640G, MiniMed® Veo™, Animas® Vibe®, and Abbott OmniPod®. Parameters investigated included discontinuation rate, glycated hemoglobin (HbA1c), mean self-monitoring of blood glucose (SMBG), total daily dose of insulin (TDD), pump setting parameters, body mass index (BMI), frequency of technical difficulties, significant skin reactions, and QOL. RESULTS Of 113 children (mean age 9.1 ± 4.1 years, 46% females), 68 (60%) used Medtronic devices, 33 (29%) OmniPod, and 12 (11%) Animas devices. Twelve percent of the cohort stopped using the pump during the study period, with no difference according to device. There were no differences between groups regarding mean SMBG values (P = 0.86), insulin TDD (P = 0.24), BMI (P = 0.87), level of insertion site pain or local reaction (P = 0.51), technical problems (P = 0.66), and QOL (P = 0.38). Changes in HbA1c from study initiation to end were also not statistically significant for any of the devices: from 7.99% ± 1.14% to 7.93% ± 0.99% for Medtronic, from 7.71% ± 1.29% to 7.92% ± 1.38% for OmniPod, and from 8.75% ± 1.3% to 7.70% ± 1.33% for Animas (P = 0.63). CONCLUSIONS Pump devices were comparable regarding glycemic control, weight gain, and satisfaction among pediatric patients with T1D.

Journal of the Endocrine Society, May 1, 2021

Aims: Children with chronic diseases were unable to receive their usual care during COVID-19 lock... more Aims: Children with chronic diseases were unable to receive their usual care during COVID-19 lockdown. We assessed the feasibility and impact of telehealth visits on the time-in-range (TIR) of pediatric individuals with type 1 diabetes (T1D). Methods: An observational multicenter real-life study. Patients scheduled for an in-clinic visit during the lockdown were offered to participate in a telehealth visit. Sociodemographic, clinical, continuous glucose monitor and pump data were recorded 2 weeks prior and 2 weeks after telehealth visit. The primary endpoint was change in relative-TIR, i.e change in TIR divided by the percent of possible change (∆TIR/(100-TIRbefore)*100). Results: The study group comprised 195 individuals with T1D (47.7% males), mean±SD age 14.6±5.3 years, diabetes duration 6.0±4.6 years. Telehealth was accomplished with 121 patients and their parents (62.0%); 74 (38.0%) did not transfer complete data. Mean TIR was significantly higher for the two-week period after the telehealth visit than for the two-week period prior the visit (62.9±16.0, p&lt;0.001 vs. 59.0±17.2); the improvement in relative-TIR was 5.7±26.1%. Initial higher mean glucose level, lower TIR, less time spent at &lt;54 mg/dl range, longer time spent at 180–250 mg/dl range, higher daily insulin dose and single parent household were associated with improved relative-TIR. Multiple regression logistic analysis demonstrated only initial lower TIR and single-parent household were significant, odds ratio: -0.506, (95%CI -0.99,-0.023), p=0.04 and 13.82, (95%CI 0.621, 27.016), p=0.04, respectively. Conclusions: Pediatric patients with T1D benefited from a telehealth visit during COVID-19. This modality and its benefit should be employed, and used in the future as well. However, this modality is not yet suitable for a considerable proportion of patients.

Journal of the Endocrine Society, Apr 1, 2019

Abstract Background: The goals of growth hormone treatment (GHT) during childhood and adolescence... more Abstract Background: The goals of growth hormone treatment (GHT) during childhood and adolescence are to normalize height velocity and attain a final adult height within the normal range. Despite decades of use, little data is available on GHT patterns and outcomes in a real-life environment. Maccabi Health Services (MHS) is Israel's second biggest health maintenance organization and the database includes up to 20 years of data on 2 million members, offering a unique opportunity to follow real-life GHT children's demographics, clinical data and adherence to therapy. Objective: To assess a decade of GHT patterns and outcomes in a real-world setting via the MHS database. Methods: This was a retrospective cohort database study of all children initiating GHT in MHS (January 2004-December 2014) who met uniform criteria for diagnosis and initiation of therapy. Age, sex, socioeconomic status (SES) and auxologic parameters were recorded at initiation of therapy, and height gain standard deviation score (ΔHtSDS) was calculated during the study period. Adherence was evaluated using proportion of days covered (PDC). Results: 3325 children initiated GHT of whom 2379 were included in the study cohort (62.1% males). The two main indications observed were Idiopathic Short Stature (ISS; n=1615, 67.9%) and Growth Hormone Deficiency (GHD; n=611, 25.7%). Children belonging to the upper third of SES comprised 61.3% of ISS and 59.7% of GHD patients. At initiation of GHT, mean height-SDS was -2.36±0.65 (-2.36±0.6 for GHD and -2.30±0.67 for ISS, p=0.0417); mean age was 9.8±3.1 years (9.42±3.42 for GHD and 10.12±2.9 for ISS, p≤0.0001); time from first diagnosis of short stature (as recorded in the Electronic Medical Record) to first GH purchase was 4.8±3.3 years (4.4±3.1 for GHD and 5.0±3.3 for ISS, p=0.0001). Mean treatment period was 3.5±0.95 years (3.6±1.6 for GHD and 3.4±1.9 for ISS, p=0.017), with 79.4% of patients treated for more than 3 years. The overall mean height gain (ΔHtSDS) was 1.35 and 1.37 for GHD and ISS respectively, and was mainly achieved in the first three years. Final height (at age 15 for girls and 17 for boys) was recorded for 624 patients (26.2%) with GHD patients achieving better outcomes than ISS (-1.0±0.82 vs -1.28±0.93 respectively, p=0.0002). Good adherence (PDC >80%) was achieved in 78.2% of the cohort during the first year, 57.6% in the second, and 68.1% in the third. GHD patients had better adherence than ISS (67.3% vs 58.7%). Conclusions: This large real-life study of treatment patterns in Israel revealed that children initiate GHT a long period after initial recognition of short stature, belong mainly to the upper SES, and have suboptimal adherence from the second year of therapy. This was most pronounced in the ISS group. Over-representation of the upper SES among those receiving GHT reflects treatment bias. Appropriate referral, diagnosis and follow up care may result in better treatment outcomes with GHT.

Frontiers in Pediatrics, Nov 1, 2022

Background: Pubertal gynecomastia (PG), a benign condition with varied reported prevalence, typic... more Background: Pubertal gynecomastia (PG), a benign condition with varied reported prevalence, typically appears at 13-14 years-old and is mostly idiopathic and self-limited. Psychologic impairments are common among adolescents with gynecomastia. Surgical intervention is reserved to severe cases and is offered towards the end of puberty. Pharmacological treatment is seldom given by clinicians mainly due to insufficient published data. We conducted this systematic literature review to assess the efficacy, safety, side effects, and complications of pharmacological treatments published. Methods: MEDLINE, Embase, and Cochrane CENTRAL were searched for the terms "gynecomastia", "pubertal", and "adolescent" in conjunction with medications from the Selective Estrogen Receptor Modulator (SERM), aromatase inhibitors (AI), and androgens groups in different combinations to optimize the search results. Exclusion criteria included: studies based on expert opinion, similar evidence-based medicine levels studies, and studies which discuss gynecomastia in adults. Selected articles were assessed by two authors. Data collected included: the level of evidence, population size, treatment regimen, follow-up, outcomes, complications, and side effects. Results: Of 1,425 published studies found and examined meticulously by the authors, only 24 publications met all the study research goals. These were divided into 16 publications of patients treated with SERM, of whom four had AI and four androgens. In general, the data regarding pharmacologic therapy for PG is partial, with insufficient evidence-based research. Tamoxifen and SERM drugs have long been used as treatments for PG. Tamoxifen was the chosen drug of treatment in most of the reviewed studies and found to be effective, safe, and with minimal side effects. Conclusions: Pharmacological treatment as a new standard of care has an advantage in relieving behavioral and psychological distress. Although high quality publications are lacking, pharmacological intervention with tamoxifen is appropriate in select patients. Conduction large-scale high-quality studies are warranted with various drugs.

Journal of Adolescent Health, May 1, 2020

Epilepsia, Mar 1, 2007

To investigate the effect of epilepsy and/or valproate (VPA) monotherapy on physical growth, weig... more To investigate the effect of epilepsy and/or valproate (VPA) monotherapy on physical growth, weight gain, pubertal development, and hormonal status in adolescent girls with epilepsy. Methods: The study group included 88 consecutive female patients with epilepsy aged 6-20 years (28 premenarche, 60 postmenarche) attending an endocrinology institute of a major tertiary center. Forty-five patients were under treatment with VPA, and 43 were before treatment initiation. The groups were compared for the relevant biochemical, anthropometric, ultrasonographic, and endocrine parameters. Results: No statistically significant differences were found in any of the parameters studied between the groups, as a whole or by menarche status. The treated postmenarcheal subgroup had a higher mean testosterone level than the untreated postmenarcheal controls (1.83 ± 0.65 vs. 0.88 ± 0.24, p = 0.006). Body mass index-standard deviation score (BMI-SDS) was 0.75 in the treated group and 0.63 in the untreated group; rates of obesity were 16.3% and 15.5%, respectively. No between-group differences were found in menses irregularities, hirsutism, or acne. No correlation was found between duration or dosage of treatment and BMI-SDS, height-SDS, or androgen level. The treated group had higher levels of thyroid-stimulating hormone and lower levels of free thyroxine than did the untreated group, although still within normal range. Conclusions: Long-term treatment with VPA in girls with epilepsy is associated with increased testosterone levels after menarche, without clinical hyperandrogenism, polycystic ovary syndrome, or an increase in BMI-SDS. VPA is a good treatment option in this age group but should be accompanied by careful endocrine observation.

Frontiers in Pediatrics, Aug 20, 2021

Objective: To assess a decade of growth hormone (GH) treatment patterns and outcomes in a real-wo... more Objective: To assess a decade of growth hormone (GH) treatment patterns and outcomes in a real-world setting in Israel using a state-of-the-art computerized database. Methods: This large retrospective database study included 2,379 children initiating GH treatment in Maccabi Healthcare Services (between January 2004 and December 2014). Good adherence with therapy (proportion of days covered >80%) was assessed during follow-up. Results: At GH treatment initiation: 62.1% were boys; height standard deviation score (SDS) was −2.36 ± 0.65 (mean ± SD); age was 9.8 ± 3.1 years; and time from short stature diagnosis to first GH purchase was 4.8 ± 3.3 years. Mean treatment period was 3.5 ± 0.95 years; 79.4% of children were treated for more than 3 years. The two main indications for GH therapy were idiopathic short stature (ISS) (n = 1,615, 67.9%) and GH deficiency (GHD) (n = 611, 25.7%). Children in the highest socioeconomic status (SES) tertile comprised 61.3% of ISS and 59.7% of GHD. After 3 years, mean height gain SDS was 1.09 ± 0.91 for GHD and 0.96 ± 0.57 for ISS (p = 0.0004). Adult height (age 15 for girls and 17 for boys) was recorded for 624 patients (26.2%) with better outcomes for GHD than ISS (−1.0±0.82 vs. −1.28±0.93, respectively; p = 0.0002). Good adherence was achieved in 78.2% of the cohort during the first year and declined thereafter to 68.1% during the third year of the treatment. Conclusions: Children who initiate GH therapy are predominantly male, belong mainly to the upper SES, commence treatment a long period after initial recognition of short stature, and have suboptimal adherence. Appropriate referral, diagnosis, and follow-up care may result in better treatment outcomes with GH therapy.

Hormone Research in Paediatrics, Jul 26, 2006

Hyperreninemic hypoaldosteronism due to aldosterone synthase (AS) deficiency is a rare condition ... more Hyperreninemic hypoaldosteronism due to aldosterone synthase (AS) deficiency is a rare condition typically presenting as salt-wasting syndrome in the neonatal period. A one-month-old Portuguese boy born to non-consanguineous parents was examined for feeding difficulties and poor weight gain. A laboratory workup revealed severe hyponatremia, hyperkaliaemia and high plasma renin with unappropriated normal plasma aldosterone levels, raising the suspicion of AS deficiency. Genetic analysis showed double homozygous of two different mutations in the CYP11B2 gene: p.Glu198Asp in exon 3 and p.Val386Ala in exon 7. The patient maintains regular follow-up visits in endocrinology clinics and has demonstrated a favourable clinical and laboratory response to mineralocorticoid therapy. To our knowledge, this is the first Portuguese case of AS deficiency reported with confirmed genetic analysis.

Pediatric Diabetes, Mar 9, 2021

Data regarding glycemic control in children and adolescents with a dual diagnosis of type 1 diabe... more Data regarding glycemic control in children and adolescents with a dual diagnosis of type 1 diabetes mellitus (T1DM) and attention‐deficit/hyperactivity disorder (ADHD) are limited.

Journal of Pediatric Endocrinology and Metabolism, 2013

An 8-year-old girl admitted to the Department of Pediatrics for 2 days history of diarrhea and vo... more An 8-year-old girl admitted to the Department of Pediatrics for 2 days history of diarrhea and vomiting. Physical examination revealed a solid, hyperemic, spherical mass at the base of the tongue (Panel A). Apart from past medical history of tonsillectomy and adenoidectomy at the age of 3 years, the patient is otherwise healthy. The parents were not informed of other pathologies within the oral cavity. The mother underwent subtotal thyroidectomy at the age of 18 years and is currently on Levothyroxine therapy. Due to fatigue and mild weight gain for the last several weeks, thyroid function tests were conducted to rule out hypothyroidism. Blood level of thyrotropin was 31.2 μIU per milliliter (normal range, 0.66–4.14) and free thyroxine (T4) was 1.6 ng per deciliter (normal range, 0.95–1.65 ng per deciliter). A Tc-99m thyroid scan showed focal uptake only at the base of the tongue, a feature consistent with lingual thyroid (Panel B). Hence, Levothyroxine replacement therapy was initiated. A lingual thyroid is a specific type of ectopic thyroid resulting from the lack of normal caudal migration of the thyroid gland. It is often asymptomatic in children. The presence of symptoms, such as dysphagia, disphonia, swallowing and respiratory difficulties, leads to correct diagnosis (1, 2).

Journal of Pediatric Endocrinology and Metabolism, Mar 26, 2020

Background: The prevalence of both vitamin D (VitD) deficiency and type 1 diabetes mellitus (T1DM... more Background: The prevalence of both vitamin D (VitD) deficiency and type 1 diabetes mellitus (T1DM) has increased worldwide over the last few decades. The objectives of this study were: (1) to evaluate the prevalence of VitD deficiency and insufficiency among Israeli youth with T1DM and (2) to assess the association between VitD status, seasonality and T1D glycemic control characteristics. Methods: This was a multi-centered, cross-sectional study. VitD levels were routinely tested during the years 2008-2011 in T1DM patients aged up to 21 years. Medical records were reviewed for demographic, clinical and laboratory characteristics. Results: The study population consisted of 199 participants (53% males), mean age 12.24 ± 4.11 years, mean T1DM duration 3.77 ± 3.43 years. VitD levels were within the normal range in 19.6%, insufficient (15-29 ng/mL, 37-72 nmol/L) in 62.3% and deficient (< 15 ng/mL, < 37 nmol/L) in 18.1%. Mean VitD level was higher during the summer than during spring, autumn and winter (28.65 ng/mL, 23.16 ng/mL, 21.65 ng/mL, 17.55 ng/mL, respectively, p < 0.001). Mean VitD level was higher among secular patients compared to the religious (whole-year heavily dressed) population (23.57 ng/mL, 15.54 ng/mL, respectively, p < 0.001). VitD level was negatively associated with body mass index calculation of standard deviation scores (BMI-SDS), high-density lipoprotein (HDL) and age at diagnosis (r = −0.171, p = 0.016; r = −0.149, p = 0.043; r = −0.150, p = 0.037, respectively). No association was demonstrated with disease duration and glycemic control indices and metabolic parameters. Conclusions: VitD insufficiency is largely prevalent among Israeli youth with T1DM, as is in Israeli youth in general. The VitD level is associated with seasonality, clothing habits and BMI.

Diabetes Technology & Therapeutics, Jun 14, 2023

Hormone Research in Paediatrics, Mar 14, 2015

To prospectively evaluate the long-term impact of valproate (VPA) versus carbamazepine (CBZ) on a... more To prospectively evaluate the long-term impact of valproate (VPA) versus carbamazepine (CBZ) on anthropometric, hormonal, and metabolic parameters in young male patients treated for epilepsy. Of 61 boys with newly diagnosed epilepsy followed up, 24 were excluded from analysis (17 were lost to follow-up and 7 changed therapy within &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 year). Findings were compared by time, treatment (VPA or CBZ), and epilepsy type (generalized or partial) as well as against a matched control group with adequately treated hypothyroidism. Twenty-four boys were treated with VPA and 13 with CBZ. The weight-standard deviation score (SDS) significantly increased during the first 6 months of treatment (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), irrespective of the drug type, but decreased between the first and the last visit (p = 0.01). In patients with generalized epilepsy, there was a slight decrease in height- and weight-SDS between the first and the last visit (p = 0.04 and p = 0.01, respectively). The height-SDS at the last visit was comparable to the parental height-SDS. The mean age at puberty onset was 11.2 and 11.4 years in the study and the control group, respectively (p = 0.08). There were no significant differences in the other parameters by treatment or epilepsy type. Long-term therapy with VPA or CBZ has no significant endocrinological or metabolic adverse effect on male children and adolescents with epilepsy. © 2015 S. Karger AG, Basel.

Acta Diabetologica, Dec 27, 2013

To compare sleep quality and sleep-wake patterns in parents of children with type 1 diabetes befo... more To compare sleep quality and sleep-wake patterns in parents of children with type 1 diabetes before routine use of the continuous glucose monitoring system (CGMS) and while using it. Thirteen parents completed the Pittsburg Sleep Quality Index (PSQI), a 7-day sleep diary, and wore an actigraph (a wristwatch-size motion detector) during the night for 1 week before pediatric use of CGMS and 4-8 weeks after initiating routine use of the CGMS. Mean age of parents (ten mothers, three fathers) was 39 (range 32-47) years; mean age of children was 9.3 years (range 5.5-16.5 years); mean disease duration was 3.4 (range 0.6-11.2) years. PSQI total score demonstrated similar quality of sleep with and without use of the CGMS (4.6 and 4.9, respectively, p = 0.45). Six of the 13 parents reported severe sleep problems (PSQI C 5) with and without the CGMS. The sleep diary indicated a greater number of awakening episodes during CGMS use than without the CGMS (1.6 and 1, respectively, p = 0.03), and actigraphy documented an increase in the number of wake bouts (22.9 and 19.7, p = 0.03) as well as in total wake time (48.3 and 42.2 min, p = 0.03) during CGMS use as compared with the period prior to CGMS use. Although self-perception of sleep quality remained unchanged, CGMS use appeared to affect actual parental sleep continuity somewhat negatively. This should be made clear to parents who may hold expectations of improvement in sleep quality following initiation of CGMS use.

Archives of pediatrics, 2018

Aims: Knowledge about the risk factors for oral pathology among children with Type 1 Diabetes Mel... more Aims: Knowledge about the risk factors for oral pathology among children with Type 1 Diabetes Mellitus (T1DM) is essential for establishing appropriate preventive and therapeutic strategies. We compared the oral health of youngsters with T1DM with that of non-diabetic children according to dietary and hygiene habits, dental caries history, gingival health, saliva secretion, saliva composition and number of mutant's streptococci (MS, pathognomonic for early childhood caries) colonies in the saliva. We also examined a possible association between glycemic control and oral health among T1DM children. Methods: The T1DM children were examined by pediatric dentists who scored their oral health status using three indices: decayed (D), missing (M) or filled (F) teeth ("DMFT" for permanent dentitions and "dmft" for primary dentitions) for caries parameters, and the plaque index (PI) and gingival index (GI) for periodontal parameters. Age-matched siblings and friends of the study children comprised the control group. Results: The T1DM children (n=24, age 8.2 ± 2.4 yr) had higher MS levels, a higher prevalence of caries, and significantly higher salivary Na levels compared to the controls (n=30, age 6.4 ± 2.7 yr). Caries history, evidence of current periodontal disease, oral health-related behaviors, PI and GI findings, and other salivary parameters were similar for both groups. Glycemic control did not influence oral health status. Conclusions: T1DM children may bear potential compromised oral conditions, making early identification of those at high risk essential for preventing oral complications. Salivary MS counts may be a useful tool to identify T1DM children at increased risk for developing caries.