Annals of Pediatric Endocrinology & Metabolism最新文献

{"title":"The KISS1R gene rs350132 variant is significantly associated with central precocious puberty susceptibility among Asian girls: evidence from a case-control study and a meta-analysis.","authors":"Boyu Li, Xinyi Zhang, Weiguang Zhou, Yuping Chu, Jiangyi Ruan, Siqi Yuan, Qinyue Yang, Jiaxuan Dai, Qiantao Xiong, Bifeng Chen","doi":"10.6065/apem.2550456.228","DOIUrl":"https://doi.org/10.6065/apem.2550456.228","url":null,"abstract":"<p><strong>Purpose: </strong>It is widely known that kisspeptin receptor (KISS1R) plays central regulatory roles in the hypothalamus-pituitary-gonad (HPG) axis, whose premature activation has been implicated in the pathogenesis of central precocious puberty (CPP). The aim of our present study was to verify the contributions of the three most examined KISS1R gene variants (rs184749, rs350132, and rs3746146) to pubertal timing.</p><p><strong>Methods: </strong>Sanger sequencing was applied to genotype the KISS1R gene variants in 422 healthy girls and 384 CPP girls, all from Hubei province. Moreover, the data from previous related studies and present study were integrated and meta-analyzed.</p><p><strong>Results: </strong>The case-control study revealed that rs184749 G allele (P=0.004, OR=1.42, 95%CI=1.12-1.79) and rs350132 A allele (P=0.007, OR=1.38, 95%CI=1.09-1.75) acted as the risk factors for CPP susceptibility, and haplotype GAC carrying the rs184749 (G) and rs350132 (A) was associated with an increased CPP risk among Hubei Chinese girls (P=0.005, OR=1.44, 95%CI=1.12-1.86). The subsequent meta-analysis confirmed the effect of rs350132 on CPP susceptibility in Asian girls under the genetic models of A vs. T and AA vs. AT+TT. The expression quantitative trait loci (eQTL) analysis revealed that KISS1R gene mRNA is differentially expressed in clinical tissues across rs350132 genotypes.</p><p><strong>Conclusion: </strong>The present findings suggested that the KISS1R gene rs350132 may serve as a susceptible locus in CPP pathogenesis among Asian girls, which warrants confirmation and reinforcement in future studies.</p>","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MC4R-related monogenic obesity in children: insights from 2 cases.","authors":"Dhivya Shanmugam, Subbiah Sridhar, Nandini Kuppusamy, Kathirvel Manjini, Palaniappan Sreenivasan, Muthu Aravind Kumar","doi":"10.6065/apem.2550160.080","DOIUrl":"https://doi.org/10.6065/apem.2550160.080","url":null,"abstract":"<p><p>Childhood and adolescent obesity are growing global health concerns, with genetic factors playing an important role. Despite the increasing prevalence of obesity in India, monogenic obesity remains underdiagnosed. We report 2 cases of early-onset morbid obesity due to melanocortin-4 receptor (MC4R) gene mutation. Case 1 was a 5-year-old boy who presented with severe hyperphagia and rapid weight gain since infancy. Case 2 was a 12-year-old girl who presented with progressive obesity, hyperphagia, and bilateral genu varum. Both patients exhibited severe insulin resistance with no syndromic stigmata. Genetic analysis confirmed a homozygous MC4R mutation in both cases. They were managed with a multidisciplinary approach that included dietary modification, structured physical activity, and pharmacotherapy using the glucagon-like peptide-1 analog liraglutide and metformin. Both cases showed a satisfactory response to liraglutide. These case reports highlight the point at which monogenic obesity can be clinically suspected and distinguished from syndromic obesity. Moreover, they underscore the role of genetic testing for monogenic obesity and the targeted therapies in its management.</p>","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":"31 2","pages":"138-145"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Leydig cell activity using single-dose hCG stimulation in prepubertal children suspected of hypogonadism: experience from a tertiary institution.","authors":"Ramya Obbai Manohar, Vani Hebbal Nagarajappa, Meghana Narasimhegowda, Lakshmi Deepika Relangi","doi":"10.6065/apem.2550110.055","DOIUrl":"https://doi.org/10.6065/apem.2550110.055","url":null,"abstract":"<p><strong>Purpose: </strong>Multiple protocols exist for the dosing and duration of human chorionic gonadotropin (hCG) and the sampling schedule of the hCG stimulation test. This study analyzes the testosterone response following a single-dose hCG test.</p><p><strong>Methods: </strong>This observational study analyzes 103 prepubertal undervirilized males who underwent a single-dose hCG test. A dosage of 1,500 IU was used for those under 2 years of age and 5,000 IU for those over. Testosterone levels were measured before and 72 hours after the hCG injection, and the fold of increase was analyzed. As part of the unit protocol, those with a suboptimal response to a single-dose test (n=19) underwent a 3-day hCG test.</p><p><strong>Results: </strong>A significant 23.65-fold increment of testosterone, with a poststimulated value of 167.26 (interquartile range [IQR], 62.30-279.15) ng/dL, was observed following a single dose of hCG. Of the 103 subjects, 19 (18.4%) had a subnormal response with testosterone levels of 8.20 (IQR, 3.48-29.70) ng/dL. A 3-day test on these 19 subjects showed a testosterone level of 18.4 (IQR, 10.6-64.2) ng/dL, which is statistically significant. However, the 3-day hCG test revealed an adequate response in only 3 patients. The remaining 16 did not achieve the expected outcome, and 15 of these patients had laboratory evidence of hypogonadism either genetically or biochemically.</p><p><strong>Conclusion: </strong>A single-dose hCG stimulation test could serve as an alternative to a 3-day hCG test in the initial assessment of Leydig cell function, thereby avoiding repeated injections, hospital visits, and school absenteeism.</p>","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":"31 2","pages":"110-118"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclinical inflammation in children with Down syndrome: implications for preventive care.","authors":"Charu Sharma, Muhammad Jawad Hashim, Tarek El Azzabi, Sania Al Hamad, Ekhlass Mohammed, Javed Yasin, Yousef M Abdulrazzaq, Elhadi Husein Aburawi","doi":"10.6065/apem.2550148.074","DOIUrl":"https://doi.org/10.6065/apem.2550148.074","url":null,"abstract":"<p><strong>Purpose: </strong>Down syndrome (DS) is associated with metabolic dysregulation, obesity, and increased risk of chronic inflammation. This study aimed to assess subclinical inflammation in children with DS by evaluating inflammatory biomarkers, such as high-sensitivity C-reactive protein (hs-CRP), and their association with metabolic parameters including ghrelin, lipid profiles, and vitamin D levels.</p><p><strong>Methods: </strong>A total of 49 children with DS (aged 1-18 years) and 22 age-matched healthy controls were enrolled. Anthropometric data, body fat percentage, and metabolic parameters were assessed. Inflammatory markers (hs-CRP, apolipoprotein-B [Apo B], adiponectin), metabolic hormones (ghrelin, insulin), and lipid profiles were determined from venous blood samples. Statistical analyses included bivariate correlation, analysis of variance, and multiple linear regression to identify predictors of inflammation.</p><p><strong>Results: </strong>Children with DS exhibited significantly higher hs-CRP levels than controls (p=0.03), indicative of increased systemic inflammation. Higher hs-CRP levels were associated with older age (r=0.33, p=0.006), greater obesity (body mass index: r=0.32, p=0.011), and elevated serum insulin and low-density lipoprotein levels. Ghrelin levels correlated negatively with Apo B (r=-0.41, p&lt;0.001) and positively with hs-CRP (r=0.30, p=0.012). Predictors of inflammation (based on hs-CRP) included older age, male sex, higher gamma-glutamyl transferase level, and a diagnosis of DS (adjusted R²=0.276).</p><p><strong>Conclusion: </strong>Children with DS are prone to metabolic inflammation, with increasing age and obesity exacerbating inflammatory responses. Clinicians should monitor and manage weight, dyslipidemia, and inflammation in this population to prevent long-term complications such as cardiovascular diseases and insulin resistance.</p>","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":"31 2","pages":"119-128"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A commentary on &quot;Association between initial mental health status and glycemic control in pediatric diabetes&quot.","authors":"Hye Young Jin","doi":"10.6065/apem.2625118edi02","DOIUrl":"https://doi.org/10.6065/apem.2625118edi02","url":null,"abstract":"","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":"31 2","pages":"87-88"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypothalamic-superior frontal gyrus functional connectivity alterations and luteinizing hormone correlations in girls with central precocious puberty.","authors":"Hongqiang Cai, Lianzi Su, Xiyan Chen, Moran Yang, Jiajia Xu, Yanqi Shan, Ru Zhao, Longsheng Wang, Yue Yu, Liwei Zou","doi":"10.6065/apem.2550194.097","DOIUrl":"https://doi.org/10.6065/apem.2550194.097","url":null,"abstract":"<p><strong>Purpose: </strong>In this study, the neural communication patterns between hypothalamic structures and cortical areas in girls diagnosed with central precocious puberty (CPP) were explored. Endocrine profiles were incorporated to clarify the pathophysiological interactions between cerebral networks and hormonal regulation. The hypothalamus was designated as the key focus area for connectivity analysis.</p><p><strong>Methods: </strong>Fifty-seven girls (37 CPP, 20 non-CPP) were recruited from the Pediatric Development Clinic at the Second Affiliated Hospital of Anhui Medical University. The collected data included demographic information, gonadotropin-releasing hormone stimulation tests, and magnetic resonance imaging scans. Hypothalamic functional connectivity (FC) was analyzed using predefined region of interest coordinates, and correlations between hormone levels and FC values were assessed.</p><p><strong>Results: </strong>Compared to the non-CPP group, the CPP group exhibited elevated baseline follicle-stimulating hormone (FSH), baseline luteinizing hormone (LH), peak FSH, peak LH, and peak LH/FSH ratios. Patients with CPP exhibited enhanced neural synchronization linking the right lateral hypothalamic effector zone to the right superior frontal gyrus (displaying a borderline significant correlation with peak LH concentrations), concurrent with diminished functional coupling of the right lateral hypothalamic efferent to the right fusiform/supramarginal gyri. The left lateral hypothalamic projections demonstrated amplified connectivity with the right cuneus. No FC differences were observed in the medial hypothalamus.</p><p><strong>Conclusion: </strong>Abnormal lateral hypothalamus FC patterns were identified in CPP girls and were particularly linked to peak LH levels. The findings offer novel insights into the neuroendocrine mechanisms underlying CPP.</p>","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":"31 2","pages":"129-137"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of genetic biomarkers for childhood stunting surveillance and early detection in Southeast Asia: a systematic review.","authors":"Ismail Ismail, Muhammad Nur, Sukma Saini, Alfi Syahar Yakub","doi":"10.6065/apem.2550142.071","DOIUrl":"https://doi.org/10.6065/apem.2550142.071","url":null,"abstract":"<p><p>Stunting remains a major public health concern in Southeast Asia, and is shaped by a complex interplay of genetic, inflammatory, and nutritional factors. This scoping review sought to map genetic polymorphisms associated with stunting in Southeast Asian children and to identify candidate biomarkers for early diagnosis and biologically targeted interventions. Following the Arksey and O&apos;Malley framework and the PCC (Population, Concept, Context) model, a systematic search was conducted across 7 databases. Eligible studies were peer-reviewed, published in English from 2015-2024, involved children under 18 years of age, and investigated gene variants in relation to stunting. A total of 902 records were screened independently by 3 reviewers using predefined criteria, with consensus procedures to resolve any discrepancies. Eleven studies met the final inclusion criteria. Thematic analysis and protein-protein interaction mapping revealed that 5 key polymorphisms-IGF1R, GHSR, MTRR, CASP1, and CARD17-were significant contributors to growth impairment. IGF1R polymorphisms were associated with a 2.46-fold increase in stunting risk (odds ratio [OR], 2.46; 95% confidence interval [CI], 1.60-3.78), while MTRR&lt; variants yielded an OR of 1.93 (95% CI, 1.22-3.05). Similarly, GHSR and CASP1 polymorphisms were linked to increased odds of stunting (OR, 2.15; 95% CI, 1.38-3.34 and OR, 1.67; 95% CI, 1.10-2.54, respectively). These polymorphisms were consistently associated with disrupted growth hormone signaling, chronic inflammation, and nutrient-sensitive pathways. The biological network underlying stunting in this population points to a converging mechanism of impaired endocrine function and inflammatory dysregulation. However, this review's scope is limited by underrepresentation of some Southeast Asian nations and exclusion of non-English literature. Early genetic screening for high-risk biomarkers and precision-driven nutritional interventions may offer more effective strategies to reduce the burden of stunting in Southeast Asian children.</p>","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":"31 2","pages":"89-100"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between initial mental health status and glycemic control in pediatric diabetes.","authors":"Jeongho Han, Mi Yang, Hakyung Lee, Dong Jun Ha, Hwa Young Kim, Hee Jeong Yoo, Jae Hyun Han, Jaehyun Kim","doi":"10.6065/apem.2550236.118","DOIUrl":"10.6065/apem.2550236.118","url":null,"abstract":"<p><strong>Purpose: </strong>Psychiatric conditions are common in children and adolescents with diabetes and can hinder disease management. In this study, we examined whether mental health status at diagnosis predicts glycemic control at 1 year.</p><p><strong>Methods: </strong>We included 57 patients aged 6-18 years diagnosed with type 1 or type 2 diabetes between 2019 and 2023 at Seoul National University Bundang Hospital. Mental health was assessed within 3 months of diagnosis using the Eating Disorder Inventory-2, Children's Depression Inventory, and Child Behavior Checklist (CBCL) for ages 6-18. Poor glycemic control was defined as glycated hemoglobin &gt;6.5% at 1 year. Associations between screening results and glycemic control were analyzed using Fisher exact test and multivariate logistic regression.</p><p><strong>Results: </strong>Of the 57 patients, 32 (56.1%) had type 1 diabetes, and the mean age at diagnosis was 12.9±3.1 years; 31 (54.4%) were male. Poor glycemic control at 1 year was observed in 16 patients (28.1%). Although individual subscale positivity was not significantly associated with glycemic control, borderline somatic complaints on the CBCL were significantly associated with poor control (p=0.022). In multivariate analysis, having 2 or more positive CBCL subscales showed a trend toward association with poor glycemic control (adjusted odds ratio=21.47, p=0.054).</p><p><strong>Conclusion: </strong>Early psychological screening, especially for somatic symptoms or multiple psychological problems, may help identify those at risk for poor glycemic control in pediatric diabetes. These findings underscore the importance of early detection and intervention in optimizing diabetes management.</p>","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":" ","pages":"101-109"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical accuracy of Dexcom G6 and G7 continuous glucose monitors in hospitalized pediatric patients with type 1 diabetes: a real-world study.","authors":"Dong Jun Ha, Ha Kyoung Lee, Jeong Ho Han, Mi Yang, Hwa Young Kim, Jaehyun Kim","doi":"10.6065/apem.2550338.169","DOIUrl":"https://doi.org/10.6065/apem.2550338.169","url":null,"abstract":"<p><strong>Purpose: </strong>Continuous glucose monitoring (CGM) is being increasingly utilized in inpatient pediatric diabetes care; however, data on its real-world accuracy remain limited.</p><p><strong>Methods: </strong>We retrospectively assessed the clinical accuracy of factory-calibrated Dexcom G6 and G7 CGM systems in 69 pediatric patients with type 1 diabetes at a Korean tertiary hospital between 2019 and 2025. A total of 1838 CGM readings were temporally paired with point-of-care (POC) capillary glucose measurements. Accuracy was evaluated using the mean absolute relative difference (MARD), mean absolute difference (MAD), Bland-Altman analysis, and Clarke error grid classification. Subgroup analyses were performed according to the sensor day, glucose range, care setting, and CGM type.</p><p><strong>Results: </strong>The overall MARD was 10.6±10.1% and MAD was 15.4±16.2 mg/dL. Accuracy improved over time, with MARD declining from 13.8% (G6) and 11.0% (G7) on Day 1 to <10% on Days 6 and 4, respectively. Bland-Altman limits narrowed from ±60 to ±39 mg/dL. During Days 6-11, 86% of CGM-POC pairs were within Clarke Zone A and 97% in Zones A+B. The MAD increased with higher glucose levels, whereas the MARD was highest during hypoglycemia (15.2%) and lowest during hyperglycemia (8.5%). ICU admission significantly increased the MAD (p=0.001) without affecting the MARD. G7 demonstrated superior accuracy to G6 (pooled MARD: 9.8% vs. 11.2%, p=0.003). Mixed-effects modeling confirmed that sensor day was an independent predictor of accuracy improvement (-0.34% MARD/d, p<0.001).</p><p><strong>Conclusion: </strong>The Dexcom G6 and G7 CGMs met the ISO 15197:2013 and FDA integrated-CGM criteria after a short inpatient stabilization period.</p>","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary clinical outcomes and adoption of continuous glucose monitoring following reimbursement implementation in patients with type 1 diabetes in Thailand.","authors":"Nichapa Yordsudueam, Nattakarn Numsriskulrat, Worapimon Lerdrassameethad, Pattayarporn Paleekul, Jutipond Jitchana, Nitchakarn Laichuthai, Taninee Sahakitrungruang","doi":"10.6065/apem.2550096.048","DOIUrl":"10.6065/apem.2550096.048","url":null,"abstract":"<p><strong>Purpose: </strong>Continuous glucose monitoring (CGM) is recommended by clinical guidelines for children and adults with type 1 diabetes mellitus (T1DM) to improve clinical outcomes. In Thailand, CGM was incorporated into the Universal Healthcare Coverage (UHC) program in mid-2023. This study aimed to evaluate preliminary clinical outcomes and device adoption at a single tertiary care center. Glycemic outcomes were assessed before and after CGM use following the UHC reimbursement program and results were compared across 4 groups: self-monitoring blood glucose, CGM, open-loop insulin pump, and hybrid closed-loop (HCL). CGM adherence and parameters were also analyzed.</p><p><strong>Methods: </strong>This retrospective-prospective study collected and analyzed demographic data, hemoglobin A1c (HbA1c) levels, and CGM parameters.</p><p><strong>Results: </strong>A total of 142 T1DM patients (median age, 17.3 years; range, 3.5-69.2 years) were included. Baseline HbA1c was 8.1%±1.5%, with no significant differences among groups (P=0.223). The HCL group showed the largest HbA1c reduction at 12 months (-0.99%, P= 0.001), particularly in patients &lt;18 years (-1.21%, P=0.014). CGM users showed improvements in HbA1c (-0.29%) and a higher proportion achieving time in range (TIR) ≥70% at 12 months (69.2% vs. 47.1%, P=0.08), though this was not statistically significant. Preliminary CGM uptake was 12% (17 of 142). The HCL group exhibited higher TIR and better sensor adherence (P&lt;0.05), while other groups showed no significant changes.</p><p><strong>Conclusion: </strong>The HCL system significantly improved glycemic outcomes, particularly in younger patients. However, CGM adoption remains low, highlighting the need for expanded access, enhanced reimbursement policies, and improved adherence strategies.</p>","PeriodicalId":44915,"journal":{"name":"Annals of Pediatric Endocrinology & Metabolism","volume":" ","pages":"66-75"},"PeriodicalIF":3.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}