Aims:To evaluate bone turnover in children with type 1 diabetes mellitus (DM1) at onset, after 3 and 12 months of treatment, and in children with longer duration of disease, and its association with glycemic control. Patients and Methods: 17 children with DM1 at onset, 30 with DM1 of longer duration and 45 controls participated in the study. Tartrateresistant acid phosphatase 5b (TRACPSb), crosslinked C-terminal telopeptides of type I collagen (CTX) and osteocalcin (OC) were assessed. Results: At onset of DM1 osteocalcin (p <0.0003) and log CTX (p <0.003) were lower than in controls but returned to reference levels after 3 months of therapy. TRACPSb in children with DM1 increased gradually and after 12 months was higher than at onset (p <0.03). OC at onset inversely correlated with HbAi c (r = -0.40, p = 0.03). In children with DM1 of longer duration and HbAi c >6.5%, sex-dependent differences were found in OC and CTX. Girls with HbAi c >6.5% had lower OC and CTX than controls (p <0.005, p <0.003). Inverse correlations were found between HbAi c and OC and CTX (r = -0.50, p = 0.04; r = -0.49, p = 0.03). Conclusions: Proper glycemic control has a beneficial influence on bone turnover, which may prevent low bone mass in adulthood.

Background Youth with type 1 diabetes (T1D) (16–18 y.o.) present worst disease control of all age groups and need structured interventions. Those should be based on unbiased, national‐scale outcomes, which have not yet been successfully assessed in Poland. Objective To evaluate the glycemic control in young patients with T1D in Poland. Method All pediatric diabetes care centers and the nine largest centers for adults with T1D were invited to this cross‐sectional study, conducted in March 2018. Eligibility was defined as age ≤ 30 years and diabetes duration ≥1 year. Blinded samples of capillary blood and clinical questionnaires were sent to coordinating center, where HbA1c was measured by high‐pressure liquid chromatography. Results Nine adult and 25/28 pediatric centers participated, providing data for 1255 patients (50.8% males), mean age 12.3 years (95%CI:12.1–12.6) for children and 23.2 years (22.9–23.6) for adults; mean diabetes duration 7.1 years (6.8–7.3). This covered ~8% of pediatric population and 2% of 18–30‐years‐olds with T1D. Mean HbA1c was comparable between children and adults (57 mmol/mol [7.4%], 95%CI:56‐57 mmol/mol [7.3–7.4%] vs. 57 mmol/mol [7.4%], 95%CI:56–60 mmol/mol [7.3–7.6%], p = 0.1870). Overall, 45.2% of patients achieved ISPAD target (<53 mmol/mol [<7.0%]). During the month preceding the study, 0.9% of patients experienced severe hypoglycemia and 0.4% suffered ketoacidosis. HbA1c was related to the method of insulin therapy, continuous glucose monitoring use and body weight (p < 0.0001). Conclusions In Polish children and young adults with T1D glycemic control expressed as HbA1c is promising in the light of ISPAD guidelines. Our results confirm the known associations between better glycemic control and the use of new technologies and maintaining optimal body weight.

Maturity onset diabetes of the young (MODY) belongs to the group of diseases which have monogenic, autosomally dominant inheritance and manifests as a diabetes of forward onset (revealing itself before the age of 25). The most common forms are: a mutation of hepatocyte nuclear factor 1α (HNF) called MODY 3 and a mutation within glucokinase (GCK) gene called MODY 2. The patients with MODY are often initially classified as a diabetes type 1 or a diabetes type 2. We are introducing 3 patient cases of MODY 2 and 2 patient cases of MODY 3 diagnosed and treated in the Department of Paediatrics, Endocrinology and Diabetology of Provincial Children's Hospital in Bydgoszcz. Characteristic clinical picture, familial appearance of diabetes, a lack of immune background and a mild course of the disease has drawn suspicion about different type of diabetes. The evidence of genetic background of diabetes has given an opportunity to modify treatment whether for diagnosed patients or their relatives. A proper recognition of MODY determines an optimal treatment and forecast prognosis for the possible future complications.

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