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OBJECTIVE To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. RESEARCH DESIGN AND METHODS We analyzed data on 17,280 cases of T1D diagnosed during 2018–2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. RESULTS The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1–12.2) in 2018 to 21.7 (20.6–22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2–14.0) in 2018 to 26.7 (25.7–27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5–12.9) to 24.7 (24.0–25.5) for adolescents ages 12–18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018–2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic. CONCLUSIONS The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.

During the last two decades, there have been several reports of an increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, especially among those belonging to minority ethnic groups. This trend, which parallels the increases in prevalence and degree of pediatric obesity, has caused great concern, even though T2DM remains a relatively rare disease in children. Youth T2DM differs not only from type 1 diabetes in children, from which it is sometimes difficult to differentiate, but also from T2DM in adults, since it appears to be an aggressive disease with rapidly progressive β-cell decline, high treatment failure rate, and accelerated development of complications. Despite the recent research, many aspects of youth T2DM still remain unknown, regarding both its pathophysiology and risk factor contribution, and its optimal management and prevention. Current management approaches include lifestyle changes, such as improved diet and increased physical activity, together with pharmacological interventions, including metformin, insulin, and the recently approved glucagon-like peptide-1 analog liraglutide. What is more important for everyone to realize though, from patients, families and physicians to schools, health services and policy-makers alike, is that T2DM is a largely preventable disease that will be addressed effectively only if its major contributor ( i.e. , pediatric obesity) is confronted and prevented at every possible stage of life, from conception until adulthood. Therefore, relevant comprehensive, coordinated, and innovative strategies are urgently needed.

Abstract. Langerhans cell histiocytosis (LCH) is a rare hematologic disorder that results from the clonal multiplication and accumulation of immature dendritic Langerhans cells. Its reported incidence rate varies, but is considered to be 2.6-8.9 per million children who are <15 years of age each year. It may affect any system or organ. The present study reported 4 pediatric LCH cases in order to highlight the heterogeneity of the initial presentation, and the pitfalls that may mislead clinicians and delay diagnosis. The clinical features, as well as the pathognomonic imaging, pathology findings and treatment options were presented. LCH may be rare, but it should always be included in the differential diagnosis of persistent eczema, unexplained skin lesions, diabetes insipidus and persistent bone pain, among others. While the debate on pathogenesis and treatment is ongoing, high index of suspicion among pediatricians, pediatric oncologists and other specialists (pathologists, dermatologists, orthopaedic surgeons, general practitioners or family physicians) is essential for early diagnosis, and optimal outcome. IntroductionLangerhans cell histiocytosis (LCH) is a rare hematological disorder caused by the clonal proliferation and accumulation of LCH cells, which have similar phenotypic features and are thought to be a myeloid-derived precursor of epidermal Langerhans cells (1). Its exact aetiology remains unknown but recent data show that in a significant percentage of LCH patients mutations that activate the RAS-RAF-MEK-ERK pathway are identified [BRAF oncogene (V600E): 50-60%, MAP2KI genes: 10-20%, other genes (ERBB3 and ARAF)] (2). The disease has an extreme variety of possible clinical presentations ranging from a single focal bone lesion to a life-threatening multisystem disease requiring emergency and aggressive chemotherapy (3). LCH is a rare condition affecting <1 in 200,000 children younger than 15 years of age. Its incidence ranges from 2 to 9 cases per million per year, with a male to female ratio close to one. It can present at any age but among children its peak age at presentation is 3-4 years. There seems to be a seasonal variation with spikes in fall and winter (4). Whether this rare disorder is a neoplasia or a cancer-like condition of the immune system is still hotly debated and international collaborative trials aiming to identify the optimal treatment duration for the prevention of recurrent and the treatment of resistant disease are ongoing.Herein, we report a striking series of four patients diagnosed with LCH in a single Pediatric Department with a catchment area of approximately 270,000 inhabitants during an eight-month period. We aim to highlight the heterogeneity of disease's presentation, to present the management and treatment options and to raise the index of suspicion for health care practitioners. Case reportFour patients that were diagnosed with LCH in the Pediatric Department of a University Affiliated Hospital between September 2014 and April 2015 are presented after retrospective ...