Nutritional management is one of the cornerstones of diabetes care and education. Different countries and regions have widely varying cultures and socio- economic status that influence and dominate dietary habits. Although there is strong evidence for nutritional requirements in young people the scientific evidence base for many aspects of diabetes dietary management is still emerging and it is important to individualize nutrition interventions and meal plans. This article is protected by copyright. All rights reserved.

ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes.

Genomic risk prediction of complex human disease and its clinical application

Carmel E Smarta, Francesca Annanb, Luciana PC Brunoc, Laurie A Higginsd and Carlo L Acerinie aDepartment of Endocrinology, John Hunter Children’s Hospital, Newcastle, Australia; bDepartment of Nutrition and Dietetics, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK; cDepartment of Endocrinology, University Federal of Sao Paulo, Sao Paulo, Brazil; dPediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA and eDepartment of Paediatrics, University of Cambridge, Cambridge, UK

ISPAD Clinical Practice Consensus Guidelines 2014. Nutritional management in children and adolescents with diabetes.

This multi-centric cohort study [1] from four countries followed a group of infants with the HLA haplotype DR3-DQ2 or DR4-DQ8, from birth through the first few years of life; seeking the appearance of antibodies to tissue transglutaminase (tTG) (labeled as celiac disease autoimmunity), and development of celiac disease. This was part of a larger study evaluating the development of type 1 diabetes in a cohort of infants with genetic susceptibility (based on carrying the HLA haplotype DR3-DQ2 or DR4-DQ8) [2]. Over a median follow-up duration of nearly five years, the investigators reported 12% prevalence of celiac disease autoimmunity and 3% prevalence of celiac disease. They also identified that the respective risks of these two outcomes varied by the HLA genotype: 26% and 11% with homozygosity for DR3-DQ2 haplotype; 11% and 3% with DR3-DQ2/DR4-DQ8 haplotype; 8% and 3% with DR4-DQ8 homozygosity; and 3% and <1% among those with DR4-DQ8/DR8-DQ4 haplotype. There was statistically significant higher risk of celiac disease autoimmunity and celiac disease in infants from Europe (highest risk in Sweden), female gender, and those with family history of celiac disease.

Risk of pediatric celiac disease according to HLA haplotype and country

Monitoring of anthropometric measurements and physical development, using age- appropriate standards and taking mid-parental height into account, is a crucial element in the care of children and adolescents with diabetes. This article is protected by copyright. All rights reserved.

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ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes.

The revised BSPGHAN guidelines for the diagnosis and management of coeliac disease represent an important shift in diagnostic strategy, aimed at simplifying and shortening the diagnostic process in selected cases. Guidance is given concerning the indications for testing for coeliac disease, which is still significantly underdiagnosed in the UK. While screening data suggest a likely incidence of 1 in 100 persons, only 10%-20% of this figure is currently being diagnosed.The BSPGHAN guidelines follow the new ESPGHAN guidelines in overall diagnostic strategy, while providing more didactic stratagems, which should be of assistance for paediatricians in specialties other than gastroenterology.

https://adc.bmj.com/content/archdischild/98/10/806.full.pdf

Bruce McLain

Papers

Joint BSPGHAN and Coeliac UK guidelines for the diagnosis and management of coeliac disease in children