Pediatric diabetes is growing in China. The annual incidence of childhood type 1 diabetes is about 2.02-5.3 per 100,000 person-years. Type 2 diabetes in children and adolescents is increasing dramatically with the high-speed urbanization of China. The prevalence of type 2 diabetes varies from 1.64/100, 000 to 15.16/100,000 based on the geography and economy. Monogenic diabetes used to be underestimated in China and now more cases are emerging. In this review, we give an overview of pediatric diabetes in China, present the progresses and challenges in management of pediatric diabetes, and discuss the government policy and potential actions in China, for better life quality of diabetic families.

This study investigates whether serum prolactin (PRL) is a key factor for nonalcoholic fatty liver disease (NAFLD) in children. A total of 691 obese childred participated in this study and were divided into a NAFLD group (n=366) and simple obesity (SOB) group (n=325) according to the hepatic ultrasound results. The two groups were matched for gender, age, pubertal development, and body mass index (BMI). All patients underwent an OGTT test, and fasting blood samples were collected to measure prolactin. Stepwise logistic regression was performed to identify significant predictors of NAFLD. Serum prolactin levels were significantly lower in NAFLD subjects than in the SOB subjects [82.4 (56.36, 118.70) vs. 99.78 (63.89, 153.82), p<0.001] (mIU/l). NAFLD was strongly associated with insulin resistance (HOMA-IR) and prolactin, with lower levels of prolactin increasing the risk of NAFLD (adjusted ORs = 1.741; 95% CI: 1.059–2.860) across the prolactin concentration tertiles after adjustment for confounders. Low serum prolactin levels are associated with the presence of NAFLD; thus, increased circulating prolactin might be a compensatory response for obesity in children.

Recent experiments have revealed that the order of the electro-optic (EO) effect depends on the frequency of electric field in paraelectric nanodisordered KTa1-xNb x O3 (KTN) crystal. Through the dielectric frequency spectrum under the bias electric field, enormous linear and quadratic EO effects were discovered at the resonance frequencies, which changed the perception that only the quadratic EO effect exists. Applying just a small AC electric field of 6 V/mm, the effective linear EO coefficient reached 478 pm/V at 609 kHz, and the effective quadratic EO coefficient reached 4.39*10−13m2V−2at 302 kHz. The reason why an extremely low electric field results in an enormous EO coefficient is attributed to the resonance between the polar nanoregions (PNRs) and the electric field, induced by the field-driven reorientation of free dipoles on the boundary of the PNRs. In addition, the order of EO effect depending on the frequency of electric field was attributed to the motion modes of the PNR. This finding improves the understanding of how the EO effect is caused by field-driven PNR dynamics, but also provides a basis for the development of EO devices.

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Objective: Diabetic ketoacidosis (DKA) is the leading cause of mortality in children with type 1 diabetes. Diagnosis of DKA is difficult in resource-limited areas owing to the unavailability of blood gas test, the gold standard for DKA diagnosis. The Simplified Pediatric Diabetes Severity Warning System (SPDSWS) has been developed to identify high-risk DKA patients with limited resources in China. Here we optimized and validated this system. Methods: This study included 835 children admitted between January 2011 and June 2020 with the principal diagnosis of type 1 diabetes. Data were collected based on demographic and clinical characteristics. DKA and its severity were defined according to the criteria of ISPAD. SPDSWS was optimized based on logistic regression analyses and then was validated in a validation cohort. Results: The 20-point optimized SPDSWS included strong positive urine ketone, young age, dehydration, fatigue, anorexia, vomiting, abdominal pain, abnormal pulse, and high blood glucose. The optimized SPDSWS predicted DKA with an AUC value of 0.882 in the derivation cohort. When the cut-point score ≥7 was used, the sensitivity and specificity were 75.5% and 86.0%, respectively, in the derivation cohort and were 90.0% and 85.8%, respectively, in the validation cohort. The optimized SPDSWS also predicted the moderate/severe DKA with an AUC value of 0.911 in the derivation cohort and 0.937 in the validation cohort. A score > 11 was associated with an extremely high incidence of DKA. Conclusions: The optimized SPDSWS could assist health care practitioners in underdeveloped remote areas to identify the children at high risk of DKA as early as on admission. K E Y W O R D S children, diabetes mellitus, diabetic ketoacidosis, early warning score 1 | INTRODUCTION Diabetes mellitus (DM) is a metabolic syndrome attaining epidemic proportions worldwide. In children, type 1 diabetes mellitus (T1DM) is Jiaqi Pu and Xuelian Zhou have contributed equally to this work.