Aims/Introduction: The aim of the study was to compare two continuous glucose monitoring (CGM) systems, intermittently scanned CGM (isCGM) and real-time CGM (rtCGM), to determine which system achieved better glycemic control in pediatric patients. Materials and Methods: We carried out a retrospective cohort study of children and adolescents with type 1 diabetes, and compared the time in range (70-180 mg/dL), time below range (<70 mg/dL) and time above range (>180 mg/dL), and estimated glycated hemoglobin levels between patients on isCGM and rtCGM. Results: Of the 112 participants, 76 (67.9%) used isCGM and 36 (32.1%) used rtCGM for glycemic management. Patients on rtCGM had significantly greater time in range (57.7 -12.3% vs 52.3 -12.3%, P = 0.0368), and had significantly lower time below range (4.3 -2.7% vs 10.2% -5.4%, P < 0.001) than those on isCGM, but there was no significant difference in the time above range (37.4 -12.9% vs 38.0% -12.5%, P = 0.881) or the glycosylated hemoglobin A1c levels (7.4 -0.9% vs 7.5 -0.8%, P = 0.734) between the two groups. Conclusions: Pediatric patients with type 1 diabetes on rtCGM also showed more beneficial effects for increase of time in range, with a notable reduction of time below range compared with those on isCGM. Real-time CGM might provide better glycemic control than isCGM in children with type 1 diabetes.

Islet-cell associated antibodies are predictive and diagnostic markers for type 1 diabetes. We studied the differences in the early clinical course of children with type 1 diabetes with a single antibody and those with multiple antibodies against pancreatic β-cells. Sixty-seven children with type 1 diabetes aged less than 15 years diagnosed between 2010 and 2021 were included in the study and subdivided into two subgroups: children who were single positive for either glutamic acid decarboxylase (GAD) antibodies (n = 16) or insulinoma-associated antigen-2 (IA-2) antibodies (n = 13) and those positive for both antibodies (n = 38) at diagnosis. We compared the patients' clinical characteristics, pancreatic β-cell function, and glycemic control during the 5 years after diagnosis. All clinical characteristics at diagnosis were similar between the two groups. One and two years after diagnosis, children who tested positive for both antibodies showed significantly lower postprandial serum C-peptide (CPR) levels than those who tested positive for either GAD or IA-2 antibodies (p < 0.05). In other periods, there was no significant difference in CPR levels between the two groups. There was a significant improvement in glycosylated hemoglobin (HbA1c) levels after starting insulin treatment in both groups (p < 0.05), but no significant difference in HbA1c levels between the groups. Residual endogenous insulin secretion may be predicted based on the number of positive islet-cell associated antibodies at diagnosis. Although there are differences in serum CPR levels, optimal glycemic control can be achieved by individualized appropriate insulin treatment, even in children with type 1 diabetes.

Rationale: Neuromyelitis optica (NMO) is an inflammatory, demyelinating disease of the central nervous system characterized by severe optic neuritis and myelitis. NMO recurrence can be triggered by infection, pregnancy, and the tapering of oral corticosteroid medication. Patient concerns: A 14-year-old girl with no remarkable birth or developmental history was admitted to our hospital after experiencing visual loss in the right eye. The right eye was positive for relative afferent pupillary defects. Diagnosis: Orbital magnetic resonance imaging revealed a high-intensity area in the right optic nerve. Serum levels of anti–aquaporin 4 (AQP4) antibodies were high. She was diagnosed with anti-AQP4 antibody-positive right-sided optic neuritis. Interventions: Her symptoms improved after repeated intravenous methylprednisolone pulse therapy and intravenous immunoglobulin therapy. Subsequently, she continued to take oral steroids as a long-term preventive measure. Outcomes: She relapsed twice, at the ages of 14 and 16 years, due to nonadherence to oral corticosteroid medication at her discretion (fears of steroid side effects and worsening infection without other causes), with anti-AQP4 antibody-positive NMO leading to multiple lesions in the cerebral cortex. Lessons: To our knowledge, this is the first report of NMO with increasing recurrence severity due to nonadherence to oral corticosteroid medication. This case demonstrates the importance of oral corticosteroid therapy in preventing relapses of anti-AQP4 antibody-positive NMO and suggests the need to educate patients regarding steroid therapy.

The patient was a 3-year-old boy. He was admitted to our hospital because of unconsciousness, ataxic gait, dysarthria, and a cut wound on his left finger. A brain computed tomography scan on admission showed no abnormal findings. Blood tests showed hypoglycemia and elevated ketone levels. Blood glucose levels were normalized by the infusion treatment; however, he still had ataxic gait and dysarthria. Through interviews with the medical social worker and the family physician, we found that his mother was on medication for psychiatric illness. A urine drug test kit (Triage ® DOA) detected benzodiazepine. Based on this result, he was diagnosed with acute drug intoxication. If there is a family history of psychiatric illness, a urine drug test kit should be used for the diagnosis of drug intoxication as a differential for unexplained unconsciousness.