851
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Obarcanin E, Krüger M, Müller P, Nemitz V, Schwender H, Hasanbegovic S, Kalajdzisalihovic S, Läer S. Pharmaceutical care of adolescents with diabetes mellitus type 1: the DIADEMA study, a randomized controlled trial. Int J Clin Pharm 2015; 37:790-8. [PMID: 25917376 DOI: 10.1007/s11096-015-0122-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Physiological and psychological changes during puberty and a low adherence to complex treatment regimens often result in poor glycemic control in adolescents with type 1 diabetes mellitus (T1DM). The benefit of pharmaceutical care in adults with diabetes mellitus type 2 has been explored; however, evidence in adolescents with T1DM is scarce. OBJECTIVE To evaluate the impact of pharmaceutical care in adolescents with T1DM provided by pharmacists, in collaboration with physicians and diabetes educators on important clinical outcomes (e.g., HbA1c and severe hypoglycemia) SETTING At the outpatient Helios Paediatric Clinic and at the 12 regular community pharmacies of the study patients with 14 pharmacists in the Krefeld area, Germany, and at the University Pediatric Clinic with one clinical pharmacist on-site in Sarajevo, Bosnia-Herzegovina. METHODS A randomized, controlled, prospective, multicenter study in 68 adolescents with T1DM. The intervention group received monthly structured pharmaceutical care visits delivered by pharmacists plus supplementary visits and phone calls on an as needed basis, for 6 months. The control group received usual diabetic care. Data were collected at baseline and after 3 and 6 months. MAIN OUTCOME MEASURES The between-group difference in the change from baseline in glycosylated hemoglobin (HbA1c) and the number of severe hypoglycemic events in both groups. RESULTS The improvement from baseline in HbA1c was significantly greater in the intervention group than in the control group after 6 months (change from baseline -0.54 vs. +0.32%, p = 0.0075), even after adjustment for country-specific variables (p = 0.0078). However, the effect was more pronounced after only 3 months (-1.09 vs. +0.23%, p = 0.00002). There was no significant between-group difference in the number of severe hypoglycemia events. (p = 0.1276). CONCLUSION This study suggests that multidisciplinary PhC may add value in the management of T1DM in adolescents with inadequate glycemic control. However, the optimal methods on how to achieve sustained, long-term improvements in this challenging population require further study.
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852
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Lukács A, Barkai L. Effect of aerobic and anaerobic exercises on glycemic control in type 1 diabetic youths. World J Diabetes 2015; 6:534-542. [PMID: 25897363 PMCID: PMC4398909 DOI: 10.4239/wjd.v6.i3.534] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/08/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the long-term effect of aerobic and/or anaerobic exercise on glycemic control in youths with type 1 diabetes.
METHODS: Literature review was performed in spring and summer 2014 using PubMed/MEDLINE, Google Scholar, Scopus, and ScienceDirect with the following terms: aerobic, anaerobic, high-intensity, resistance, exercise/training, combined with glycemic/metabolic control, glycated haemoglobin A1c (HbA1c) and type 1 diabetes. Only peer-reviewed articles in English were included published in the last 15 years. It was selected from 1999 to 2014. Glycemic control was measured with HbA1c. Studies with an intervention lasting at least 12 wk were included if the HbA1c was measured before and after the intervention.
RESULTS: A total of nine articles were found, and they were published between the years of 2002-2011. The sample size was 401 diabetic youths (166 males and 235 females) with an age range of 10-19 years except one study, in which the age range was 13-30 years. Study participants were from Australia, Tunisia, Lithuania, Taiwan, Turkey, Brazilia, Belgium, Egypt and France. Four studies were aerobic-based, four were combined aerobic and anaerobic programs, and one compared aerobic exercise to anaerobic one. Available studies had insufficient evidence that any type of exercise or combined training would clearly improve the glycemic control in type 1 diabetic youth. Only three (two aerobic-based and one combined) studies could provide a significant positive change in glycemic control.
CONCLUSION: The regular physical exercise has several other valuable physiological and health benefits that justify the inclusion of exercise in pediatric diabetes treatment and care.
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853
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Ostrauskas R. The prevalence of type 1 diabetes mellitus among 15-34-year-aged Lithuanian inhabitants during 1991-2010. Prim Care Diabetes 2015; 9:105-111. [PMID: 25132138 DOI: 10.1016/j.pcd.2014.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/06/2014] [Accepted: 07/22/2014] [Indexed: 12/15/2022]
Abstract
AIMS To summarize the data on the prevalence of type 1 diabetes mellitus among 15-34-year-aged Lithuania inhabitants (1991-2010). METHODS New prevalent cases consist of growing-up patients with diabetes onset in childhood, i.e., up to 14 years, new onset 15-34-year-aged type 1 diabetic patients Lithuanian inhabitants, and immigrants. The data on type 1 diabetes was collected with the help of general practitioners and regional endocrinologists in Lithuania. RESULTS On 31 December 1991, there were 1202 adolescent and adult 15-34-year-aged patients with type 1 diabetes mellitus or 103.59 per 100,000 inhabitants of the same age group (95% Poisson CI 97.90-109.62), and at the end of 2010 - 1533 or 187.80 (178.63-197.44), respectively in Lithuania. During 19-year period the mean increase of type 1 diabetic patients was 1.25±1.94% per year or 1.47±2.74 per 100,000 inhabitants per mean year of the study period (for males 1.42±2.14% or 1.69±3.05/100,000 and for females 1.05±1.99%, or 1.24±2.92/100,000). Regression-based linear trends showed that the prevalence of type 1 diabetes mellitus in 15-34-year-age group had a tendency to increase among males (r=0.953; p<0.001) and females (r=0.970; p<0.001). The age adjusted prevalence frequencies for males and females in 1991 were correspondingly 102.81/100,000 and 104.55/100,000, and in 2010 - 193.75 and 182.01. CONCLUSION The prevalence of type 1 diabetes mellitus among 15-34-year-age males and females had a tendency to increase during 1991-2010.
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Affiliation(s)
- Rytas Ostrauskas
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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854
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Abstract
Though children with type 1 diabetes mellitus (T1DM) are often tall at the time of diagnosis, they may experience growth retardation, pubertal delay or both, which may be due to poor glycemic control, associated diseases or chronic complications. Factors affecting growth include: gender, genetic environment, age at diagnosis, diabetes duration, puberty, metabolic control, and status of growth hormone (GH), insulin-like growth factors (IGFs), and IGF binding proteins (IGFBPs). Insulin regulates expression of hepatic GH receptors, affects IGFs and IGFBPs synthesis by modulating GH postreceptor events, and significantly increases IGF-I bioactivity. Low portal insulin seen in T1DM leads to GH hypersecretion, low circulating IGF-I and IGFBP-3, and high circulating IGFBP-1. Newly diagnosed T1DM patients have decreased GHBP which can be restored with insulin therapy. Growth velocity should be appropriate for the age of the child/adolescent, and the mid-parental height. Height, weight and blood pressure (BP) should be measured and plotted on a growth chart at least 2-3 times a year. Puberty should also be assessed annually. Following precautions are to be taken in T1DM children: checking for pubertal onset and ensuring it is not delayed, testing early when growth falters (hypothyroidism/celiac disease/puberty/other conditions), aiming for best possible metabolic control (multidose regimens, regardless of type of insulin), and encouraging dietary calcium and protein, exposure to sunlight, Vitamin D supplements and exercise.
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Affiliation(s)
- Anju Virmani
- Senior Consultant Diabetologist and Endocrinologist, Department of Pediatrics, Apollo, Max, Pentamed and SL Jain Hospitals, New Delhi, India
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855
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Abstract
Pathogenesis of type 1 diabetes is multi-faceted, including, autoimmunity, genetics and environment. Autoimmunity directed against pancreatic islet cells results in slowly progressive selective beta-cell destruction ("Primary autoimmune insulitis"), culminating over years in clinically manifested insulin-dependent diabetes mellitus (IDDM). Circulating serum autoantibodies directed against the endocrine cells of the islets of Langerhans (Islet cell autoantibodies - ICAb) are an important hallmark of this disease. Assays for islet cell autoantibodies have facilitated the investigation and understanding of several facets in the pathogenesis of autoimmune diabetes. Their applications have extended into clinical practice and have opened new avenues for early preclinical prediction and preventive prophylaxis in IDDM/type 1 DM. Recently, surprisingly, differences in insulin content between T1DM islets, as well as, 'patchy' or 'lobular' destruction of islets have been described. These unique pathobiological phenomena, suggest that beta cell destruction may not always be inexorable and inevitably complete/total, and thus raise hopes for possible therapeutic interruption of beta cell autoimmunity - destruction and cure of type 1 diabetes. "Recurrent or secondary autoimmune insulitis" refers to the rapid reappearance of islet cell autoantibodies post pancreas transplant, and selective islet beta cell destruction in the grafted pancreas [never forgetting or "anamnestic" beta cell destructive memory], in the absence of any graft pancreas rejection [monozygotic twin to twin transplantation]. The one definite environmental factor is congenital rubella, because of which a subset of children subsequently develop type 1 diabetes. The putative predisposing factors are viruses, gluten and cow's milk. The putative protective factors include gut flora, helminths, viral infections, and Vitamin D. Prevention of T1DM can include: Primary prevention strategies before the development of autoantibodies and Secondary prevention regimens after autoantibody development. Once islet cell autoantibodies have developed, the goal is to establish a therapeutic regimen to preserve at least 90% of the beta cells, and prevent the development of hyperglycaemia. The targets for T1DM reversal should include autoimmunity, beta cell regeneration and protection of beta cell mass. Anti-CD3 teplizumab and anti-CD3 otelixizumab have been shown to provide C-peptide preservation. The unanswered questions in diabetes research include elimination of autoimmune memory responses, reestablishment of immune self-tolerance, and mechanisms of disease initiation.
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Affiliation(s)
| | - S. Srikanta
- Medical Director, Senior Consultant and Gardener Mentor, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Jnana Sanjeevini Diabetes Hospital and Medical Center; Bangalore 560078, Karnataka, India
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856
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Abstract
It is estimated that India is housing about 97,700 children with type 1 diabetes mellitus (T1DM). A study of 30 children with insulin-dependent diabetes with age at diagnosis ≤15 years, conducted in 1992, reported a prevalence of 0.26/1000 children. The peak age at diagnosis was 12 years. This was the first population-based study of prevalence of insulin-dependent diabetes in South India and shows that insulin-dependent diabetes is not rare and is higher than that reported from many other Asian countries. The Karnataka state T1DM registry listed an incidence of 3.7/100,000 in boys and 4.0/100,000 in girls over 13 years of data collection. At Karnal, in Haryana, the prevalence of T1DM is 26.6/100,000 in urban and 4.27/100,000 in rural areas of the district, leading to an average prevalence of 10.20/100,000 population. Karnal city has a relatively high prevalence of T1DM (31.9/100,000). An estimated 18,000 children under the age of 15 were newly diagnosed for T1DM in the year 2011 in the above-mentioned regions. The prevalence of T1DM in children is 111,500 according to a World Health Organization report of the International Diabetes Federation for the South-East Asian Region.
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857
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Kolesnikova LI, Darenskaya MA, Semenova NV, Grebenkina LA, Suturina LV, Dolgikh MI, Gnusina SV. Lipid peroxidation and antioxidant protection in girls with type 1 diabetes mellitus during reproductive system development. Medicina (Kaunas) 2015; 51:107-11. [PMID: 25975879 DOI: 10.1016/j.medici.2015.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 01/16/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Type 1 diabetes mellitus (T1D) is found worldwide and is regarded as one of the main risks to human health. The objective of this study was to determine the state of lipid peroxidation (LPO) and antioxidant protection in girls with T1D type considering the stages of reproductive system development. MATERIALS AND METHODS This study enrolled 56 young girls with T1D and 60 healthy girls (control) matched by age. The study population was divided into 3 age groups: prepubertal, adolescent, and juvenile. The state of LPO and antioxidant system was assessed using the coefficient of oxidative stress that represented the ratio of LPO products to general antioxidative blood activity. Spectrophotometric and fluorometric methods were applied. RESULTS The results of our study showed increased conjugated diene (CD) and thiobarbituric acid reactant (TBAR) concentrations as well as a decreased reduced glutathione level in prepubertal girls with T1D. Adolescent girls with T1D had a significantly greater CD level and juvenile girls with T1D had a significantly greater TBAR level and lower α-tocopherol concentration than girls in the control group. The greatest coefficient of oxidative stress (1.16) was observed in the prepubertal period. CONCLUSIONS The prepubertal period is characterized by the most severe state of lipid peroxidation process-antioxidant protection.
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Affiliation(s)
- Lubov I Kolesnikova
- Department of Reproductive Pathophysiology, Scientific Centre of Family Health and Human Reproduction Problems, Siberian Branch, Russian Academy of Medical Sciences, Irkutsk, Russian Federation
| | - Marina A Darenskaya
- Department of Reproductive Pathophysiology, Scientific Centre of Family Health and Human Reproduction Problems, Siberian Branch, Russian Academy of Medical Sciences, Irkutsk, Russian Federation
| | - Natalia V Semenova
- Department of Reproductive Pathophysiology, Scientific Centre of Family Health and Human Reproduction Problems, Siberian Branch, Russian Academy of Medical Sciences, Irkutsk, Russian Federation.
| | - Lyudmila A Grebenkina
- Department of Reproductive Pathophysiology, Scientific Centre of Family Health and Human Reproduction Problems, Siberian Branch, Russian Academy of Medical Sciences, Irkutsk, Russian Federation
| | - Larisa V Suturina
- Department of Reproductive Pathophysiology, Scientific Centre of Family Health and Human Reproduction Problems, Siberian Branch, Russian Academy of Medical Sciences, Irkutsk, Russian Federation
| | - Marya I Dolgikh
- Department of Reproductive Pathophysiology, Scientific Centre of Family Health and Human Reproduction Problems, Siberian Branch, Russian Academy of Medical Sciences, Irkutsk, Russian Federation
| | - Svetlana V Gnusina
- Department of Reproductive Pathophysiology, Scientific Centre of Family Health and Human Reproduction Problems, Siberian Branch, Russian Academy of Medical Sciences, Irkutsk, Russian Federation
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858
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Litmanovitch E, Geva R, Rachmiel M. Short and long term neuro-behavioral alterations in type 1 diabetes mellitus pediatric population. World J Diabetes 2015; 6:259-270. [PMID: 25789107 PMCID: PMC4360419 DOI: 10.4239/wjd.v6.i2.259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/03/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
Type 1 diabetes mellitus (T1DM) is one of the most prevalent chronic conditions affecting individuals under the age of 18 years, with increasing incidence worldwide, especially among very young age groups, younger than 5. There is still no cure for the disease, and therapeutic goals and guidelines are a challenge. Currently, despite T1DM intensive management and technological interventions in therapy, the majority of pediatric patients do not achieve glycemic control goals. This leads to a potential prognosis of long term diabetic complications, nephrological, cardiac, ophthalmological and neurological. Unfortunately, the neurological manifestations, including neurocognitive and behavioral complications, may present soon after disease onset, during childhood and adolescence. These manifestations may be prominent, but at times subtle, thus they are often not reported by patients or physicians as related to the diabetes. Furthermore, the metabolic mechanism for such manifestations has been inconsistent and difficult to interpret in practical clinical care, as reported in several reviews on the topic of brain and T1DM. However, new technological methods for brain assessment, as well as the introduction of continuous glucose monitoring, provide new insights and information regarding brain related manifestations and glycemic variability and control parameters, which may impact the clinical care of children and youth with T1DM. This paper provides a comprehensive review of the most recently reported behavioral, cognitive domains, sleep related, electrophysiological, and structural alterations in children and adolescences from a novel point of view. The review focuses on reported impairments based on duration of T1DM, its timeline, and modifiable disease related risk parameters. These findings are not without controversy, and limitations of data are presented in addition to recommendations for future research direction.
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859
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Marigliano M, Tadiotto E, Morandi A, Sabbion A, Contreas G, Avossa F, Fedeli U, Maffeis C. Epidemiology of type 1 diabetes mellitus in the pediatric population in Veneto Region, Italy. Diabetes Res Clin Pract 2015; 107:e19-21. [PMID: 25641011 DOI: 10.1016/j.diabres.2014.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/28/2014] [Accepted: 12/29/2014] [Indexed: 01/21/2023]
Abstract
We assessed the prevalence and incidence of type 1 diabetes mellitus (T1DM) in Veneto Region in Italy. The average prevalence and incidence rates were 1.26/1000 subjects and 16.5/100,000 person-years, respectively. This study shows that the Veneto Region is an area with intermediate-high risk of T1DM.
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Affiliation(s)
- Marco Marigliano
- Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy.
| | - Elisa Tadiotto
- Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy
| | - Anita Morandi
- Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy
| | - Alberto Sabbion
- Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy
| | - Giovanna Contreas
- Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy
| | - Francesco Avossa
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131 Padova, Italy
| | - Ugo Fedeli
- Epidemiological Department, Veneto Region, Passaggio Gaudenzio 1, 35131 Padova, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, Clinical Nutrition & Obesity, Department of Life & Reproduction Sciences, University of Verona, Verona, Italy
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860
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Malekifard F, Delirezh N, Hobbenaghi R, Malekinejad H. Immunotherapeutic effects of pentoxifylline in type 1 diabetic mice and its role in the response of T-helper lymphocytes. Iran J Basic Med Sci 2015; 18:247-52. [PMID: 25945237 PMCID: PMC4414990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 02/04/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Pentoxifylline is an immunomodulatory and anti-inflammatory agent and is used in vascular disorders. It has been shown that pentoxifylline inhibits proinflammatory cytokines production. The purpose of this study was to investigate the therapeutic effects of pentoxifylline on the treatment of autoimmune diabetes in mice. MATERIALS AND METHODS Diabetes was induced by multiple low dose of streptozotocin (MLDS) injection (40 mg/kg/day for 5 consecutive days) in male C57BL/6 mice. After induction of diabetes, mice were treated with pentoxifylline (100 mg/kg/day IP) for 21 days. Blood glucose levels and plasma levels of insulin were measured. Splenocytes were tested for proliferation by MTT test and cytokine production by ELISA. RESULTS Pentoxifylline treatment prevented hyperglycemia and increased plasma insulin levels in the diabetic mice. Aside from reducing lymphocyte proliferation, pentoxifylline significantly inhibited the production of proinflammatory interleukin 17 (IL-17) as well as interferon gamma (IFN-γ), while increased anti-inflammatory cytokine IL-10 as compared with those in MLDS group (diabetic control group). CONCLUSION These findings indicate that pentoxifylline may have therapeutic effect against the autoimmune destruction of the pancreatic beta-cells during the development of MLDS-induced type 1 diabetes in mice.
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Affiliation(s)
- Farin Malekifard
- Department of Microbiology, School of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Nowruz Delirezh
- Department of Microbiology, School of Veterinary Medicine, Urmia University, Urmia, Iran,*Corresponding author: Nowruz Delirezh. Department of Microbiology, School of Veterinary Medicine, Urmia University, Urmia, Iran.
| | - Rahim Hobbenaghi
- Department of Pathobiology, School of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Hassan Malekinejad
- Department of Pharmacology & Toxicology, School of Veterinary Medicine, Urmia University, Urmia, Iran
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861
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Villa-Nova H, Spinola-Castro AM, Garcia FE, Solé D. Prevalence of allergic diseases and/or allergic sensitisation in children and adolescents with type 1 diabetes mellitus. Allergol Immunopathol (Madr) 2015; 43:157-61. [PMID: 25092354 DOI: 10.1016/j.aller.2013.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/07/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND The prevalence of atopic diseases in children with type 1 diabetes mellitus (DM1) has been reported as lower. The aim of this study was to evaluate the prevalence of allergic diseases and allergic sensitisation in Brazilian children and adolescents with DM1. PATIENTS AND METHODS 96 patients with DM1 (aged 4-18 years, 45 boys) followed for at least one year were evaluated for allergic disease through a detailed allergological anamnesis and skin prick tests (SPT) to inhalant allergens (Dermatophagoides pteronyssinus, D. farinae, Blomia tropicalis, Blattella germanica, Periplaneta americana, dog epithelium, cat epithelium, mix fungi), foods (cow's milk, egg-white, yolk, soy, wheat, corn), and positive (histamine 1 mg/ml) and negative (saline) controls. Wheals with a mean diameter of induration equal to or greater than 3mm identified a positive SPT. RESULTS The prevalence values of rhinitis, asthma and atopic eczema (isolated or associated) were 68.0%, 59.1% and 44.4%, respectively. 20.6% of the patients had no allergic disease. 46.8% of the patients had been diagnosed with DM1 for at least four years and there was no relationship between the period of DM1 and the presence of allergic disease, nor of the gender. 48.0% patients were sensitised with predominance of D. pteronyssinus, B. topicalis and D. farinae. The frequency of positive SPT was significantly higher among patients with history of allergic disease (OR=6.98, 95%CI: 2.60-18.74, p<0.001). CONCLUSION The prevalence of allergic diseases and sensitisation in patients with DM1 was higher than usually expected and deserves further investigation to identify possible causes for these findings and to evaluate their importance and influence on the metabolic control.
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Affiliation(s)
- H Villa-Nova
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil
| | - A M Spinola-Castro
- Division of Endocrinology, Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil
| | - F E Garcia
- Division of Endocrinology, Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil
| | - D Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, SP, Brazil.
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862
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Son MK, Yoo HY, Kwak BO, Park HW, Kim KS, Chung S, Chae HW, Kim HS, Kim DH. Regression and progression of microalbuminuria in adolescents with childhood onset diabetes mellitus. Ann Pediatr Endocrinol Metab 2015; 20:13-20. [PMID: 25883922 PMCID: PMC4397268 DOI: 10.6065/apem.2015.20.1.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/20/2014] [Accepted: 12/08/2014] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although microalbuminuria is considered as an early marker of nephropathy in diabetic adults, available information in diabetic adolescents is limited. The aim of this study was to investigate prevalence and frequency of regression of microalbuminuria in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) patients with childhood onset. METHODS One hundred and nine adolescents (median, 18.9 years; interquartile range (IQR), 16.5-21.0 years) with T1DM and 18 T2DM adolescents (median, 17.9 years; IQR, 16.8-18.4 years) with repeated measurements of microalbuminuria (first morning urine microalbumin/creatinine ratios) were included. The median duration of diabetes was 10.1 (7.8-14.0) years and 5.0 (3.5-5.6) years, respectively, and follow-up period ranged 0.5-7.0 years. Growth parameters, estimated glomerular filtration rate, glycosylated hemoglobin (HbA1c) and lipid profiles were obtained after reviewing medical record in each subject. RESULTS The prevalence of microalbuminuria at baseline and evaluation were 21.1% and 17.4% in T1DM, and 44.4% and 38.9% in T2DM. Regression of microalbuminuria was observed in 13 T1DM patients (56.5%) and 3 T2DM patients (37.5%), and progression rate was 10.5% and 20% in T1DM and T2DM respectively. In regression T1DM group, HbA1c at baseline and follow-up was lower, and C-peptide at baseline was higher compared to persistent or progression groups. In T2DM, higher triglyceride was observed in persistent group. CONCLUSION Considerable regression of microalbuminuria more than progression in diabetes adolescents indicates elevated urinary microalbumin excretion in a single test does not imply irreversible diabetic nephropathy. Careful monitoring and adequate intervention should be emphasized in adolescents with microalbuminuria to prevent rapid progression toward diabetic nephropathy.
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Affiliation(s)
- Mi Kyung Son
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
| | - Ha Young Yoo
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
| | - Byung Ok Kwak
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea.,Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea.,Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Kyo Sun Kim
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea.,Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea.,Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Duk Hee Kim
- Department of Pediatrics, Sowha Children's Hospital, Seoul, Korea
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863
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Dorchy H. One center in Brussels has consistently had the lowest HbA1c values in the 4 studies (1994-2009) by the Hvidoere International Study Group on Childhood Diabetes: What are the "recipes"? World J Diabetes 2015; 6:1-7. [PMID: 25685273 PMCID: PMC4317302 DOI: 10.4239/wjd.v6.i1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/30/2014] [Accepted: 12/01/2014] [Indexed: 02/05/2023] Open
Abstract
The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications (retinopathy, neuropathy, nephropathy, cardiovascular disease, etc.) by maintaining blood glucose concentrations close to normal level. Glycated hemoglobin levels (HbA1c) provide a good criterion of overall glycemic control. The Hvidoere Study Group (HSG) on Childhood Diabetes, founded in 1994, is an international group representing about twenty highly experienced pediatric centers from Europe, North America, Japan and Australia. Four international comparisons of metabolic control (1995, 1998, 2005, 2009) have been performed. The one center that has consistently had the lowest HbA1c values (approximate 7.3% or 56.3 mmol/mol) is my center in Brussels. This is more often obtained with a twice-daily free-mixed regimen with additional supplemental fast insulins ad hoc. The so-called “Dorchy’s recipes” are summarized. The conclusion is that the number of daily insulin injections, 2 or ≥ 4, or the use of pumps, by itself does not necessarily give better results. Intensified therapy should not depend upon the number of insulin doses per day, by syringe, pen or pump but rather should be redefined as to intent-to-treat ascertainment (i.e., goals). When there are no mutually agreed upon goals for BG and/or HbA1c, when there is insufficient education and psychosocial support by the medical team or at home, there is likely to be poor outcomes, as shown by the HSG. One of our recipes is not to systematically replace rapid-acting human insulins by fast-acting analogues. Because the multicenter studies of the HSG, performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of HbA1c are very different, diabetes treatment teams should individually explore the reasons for failure, without any prejudice or bias. Any dogmatism must be avoided. Treatment cost vs results must also be taken into account.
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864
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Bock A, François G, Gillet D. A therapy parameter-based model for predicting blood glucose concentrations in patients with type 1 diabetes. Comput Methods Programs Biomed 2015; 118:107-123. [PMID: 25577673 DOI: 10.1016/j.cmpb.2014.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
In this paper, the problem of predicting blood glucose concentrations (BG) for the treatment of patients with type 1 diabetes, is addressed. Predicting BG is of very high importance as most treatments, which consist in exogenous insulin injections, rely on the availability of BG predictions. Many models that can be used for predicting BG are available in the literature. However, it is widely admitted that it is almost impossible to perfectly model blood glucose dynamics while still being able to identify model parameters using only blood glucose measurements. The main contribution of this work is to propose a simple and identifiable linear dynamical model, which is based on the static prediction model of standard therapy. It is shown that the model parameters are intrinsically correlated with physician-set therapy parameters and that the reduction of the number of model parameters to identify leads to inferior data fits but to equivalent or slightly improved prediction capabilities compared to state-of-the-art models: a sign of an appropriate model structure and superior reliability. The validation of the proposed dynamic model is performed using data from the UVa simulator and real clinical data, and potential uses of the proposed model for state estimation and BG control are discussed.
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Affiliation(s)
- Alain Bock
- React Group, École Polytechnique Fédérale de Lausanne (EPFL), Switzerland.
| | - Grégory François
- Laboratoire d'Automatique, École Polytechnique Fédérale de Lausanne (EPFL), Switzerland.
| | - Denis Gillet
- React Group, École Polytechnique Fédérale de Lausanne (EPFL), Switzerland.
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865
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Jaacks LM, Liu W, Ji L, Mayer-Davis EJ. Type 1 diabetes stigma in China: a call to end the devaluation of individuals living with a manageable chronic disease. Diabetes Res Clin Pract 2015; 107:306-7. [PMID: 25547225 DOI: 10.1016/j.diabres.2014.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/04/2014] [Indexed: 11/26/2022]
Abstract
Stigma is a significant barrier to improving care for individuals with type 1 diabetes mellitus (T1DM). This commentary describes this phenomenon in China, where stigma has led to labeling and devaluing of individuals with T1DM. Difficulties finding a spouse and regulations restricting admission to universities and government employment have forced many individuals to hide their diabetes. The shame, fear, and guilt stemming from stigma may preclude the use of insulin pumps; multiple daily injections, which require pre-meal insulin dosing at school or the workplace; participation in research studies; and general health-seeking behaviors. A multifaceted, multilevel approach is urgently needed and should involve improving public awareness and understanding of T1DM; adoption by health care providers of holistic rather than biomedical approaches to disease management; patient counseling on positive coping skills; and expansion of the scope of research to consider the psychosocial realities of diabetes care in China. Recent media attention in the form of a nationally broadcasted documentary on T1DM is an important step in the right direction. We believe that coordinated action by multiple stakeholders can lead to meaningful improvements in treatment, ultimately leading to better physical and emotional health outcomes for individuals living with this manageable chronic disease.
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Affiliation(s)
- Lindsay M Jaacks
- Department of Nutrition, The University of North Carolina, Chapel Hill, NC, USA.
| | - Wei Liu
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
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866
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Ortega E, Amor AJ, Rojo-Martínez G, Castell C, Giménez M, Conget I. [Cardiovascular disease in patients with type 1 and type 2 diabetes in Spain]. Med Clin (Barc) 2015; 145:233-8. [PMID: 25561182 DOI: 10.1016/j.medcli.2014.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/11/2014] [Accepted: 10/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the prevalence of cardiovascular disease (CVD) in type 1 diabetes (T1DM) and to compare it with that observed in type 2 diabetes (T2DM) and normal population in Spain. PATIENTS AND METHODS Cross-sectional study (18-70 years-old). Information on CVD was available from a nurse-administered questionnaire (Di@bet.es Study, NORMAL=3,430, T2DM=312) and from a physician reporting form (T1DM=1,382). Differences in the crude and adjusted prevalence of coronary heart (CHD), cerebrovascular (CNSD), peripheral vascular (PVD) and overall CV (CVD) disease were investigated between T1DM vs. NORMAL, and T1DM vs. T2DM groups. RESULTS We found differences in age, body mass index, proportion of women, dyslipemia and antihypertensive medication between T1DM vs. NORMAL and T1DM vs. T2DM (all P<.001). Smoking prevalence was not different between T1DM vs. T2DM and it was lower in T1DM compared to NORMAL (P<.0001). The percentage of CHD, CNSD, PVD, and overall CVD in T1DM vs. NORMAL was 3.0 vs. 2.5 (P=.31), 0.70 vs. 1.10 (P=.22), 2.61 vs. 0.20 (P<.0001), and 5.1 vs. 3.44 (P<.01), respectively. The prevalence in T2DM (vs. T1DM) was 11.3 (P<.0001), 3.5 (P<.0001), 4.2 (P=.13), and 17% (P<.0001), respectively. Multiple logistic regression adjusted models showed a higher prevalence of CHD (odds ratio [OR] 2.27, 95% confidence interval [95% CI] 1.41-3.67), PVD (OR 15.35, 95% CI 5.61-42.04), and overall CVD (OR 2.32, 95% CI 1.55-3.46), but not for CNSD (OR 0.49, 95% CI 0.19-1.27) in T1DM compared to NORMAL. No differences were found between T1DM and T2DM. CONCLUSIONS We found a higher prevalence of CVD in a Mediterranean population of T1DM individuals compared with non-diabetic subjects. This prevalence was similar to that observed in T2DM.
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Affiliation(s)
- Emilio Ortega
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Institut de Malalties Digestives i Metabòliques, Hospital Clínic i Universitari de Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), España
| | - Antonio J Amor
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Institut de Malalties Digestives i Metabòliques, Hospital Clínic i Universitari de Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Gemma Rojo-Martínez
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), España
| | - Conxa Castell
- Departament de Salut, Servei Català de la Salut, Barcelona, España
| | - Marga Giménez
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Institut de Malalties Digestives i Metabòliques, Hospital Clínic i Universitari de Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), España
| | - Ignacio Conget
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Institut de Malalties Digestives i Metabòliques, Hospital Clínic i Universitari de Barcelona, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), España.
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867
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Felício JS, de Souza ACCB, Koury CC, Neto JFA, Miléo KB, Santos FM, Motta ARB, Silva DD, Arbage TP, Carvalho CT, de Rider Brito HA, Yamada ES, Cobas RA, Matheus A, Tannus L, Palma CCS, Japiassu L, Carneiro JRI, Rodacki M, Zajdenverg L, de Araújo NBC, de Menezes Cordeiro M, Luescher JL, Berardo RS, Nery M, Cani C, do Carmo Arruda Marques M, Calliari LE, de Noronha RM, Manna TD, Savoldelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Negrato CA, de Fatima Guedes M, Dib SA, Dualib P, da Silva SC, Sepúlveda J, Sampaio E, Rea RR, de Almeida Faria ACR, Tschiedel B, Lavigne S, Cardozo GA, Azevedo M, Canani LH, Zucatti AT, Coral MHC, Pereira DA, de Araujo LA, Pedrosa HC, Tolentino M, Prado FA, Rassi N, de Araujo LB, Fonseca RMC, Guedes AD, de Mattos OS, Faria M, Azulay R, e Forti AC, Façanha CFS, Junior RM, Montenegro AP, Melo NH, Rezende KF, Ramos A, Jezini DL, Gomes MB. Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr 2015; 7:87. [PMID: 26448787 PMCID: PMC4596564 DOI: 10.1186/s13098-015-0081-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. METHODS This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. RESULTS We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. CONCLUSIONS Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.
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Affiliation(s)
- João Soares Felício
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Carolina Contente Braga de Souza
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Camila Cavalcante Koury
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - João Felício Abrahão Neto
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Karem Barbosa Miléo
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Flávia Marques Santos
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Regina Bastos Motta
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Denisson Dias Silva
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Thaís Pontes Arbage
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Carolina Tavares Carvalho
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Hana Andrade de Rider Brito
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Elizabeth Sumi Yamada
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Roberta Arnoldi Cobas
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Alessandra Matheus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lucianne Tannus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Catia Cristina Sousa Palma
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Leticia Japiassu
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - João Regis Ivar Carneiro
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Melanie Rodacki
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lenita Zajdenverg
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | | | | | - Jorge Luiz Luescher
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Renata Szundy Berardo
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Marcia Nery
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | - Catarina Cani
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | | | | | | | - Thais Della Manna
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Roberta Savoldelli
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Fernanda Garcia Penha
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Milton Cesar Foss
- />Ribeirão Preto Medical School of São Paulo University, Ribeirão Preto, Brazil
| | | | - Antonio Carlos Pires
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | - Fernando Cesar Robles
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | | | | | - Sergio Atala Dib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | - Patricia Dualib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | | | - Janice Sepúlveda
- />Endocrinology Unit, Hospital of Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais Brazil
| | - Emerson Sampaio
- />Diabetes Unit, State University Hospital of Londrina, Paraná, Brazil
| | | | | | - Balduino Tschiedel
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | - Suzana Lavigne
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | | | - Mirela Azevedo
- />Clinical Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Manuel Faria
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | - Rossana Azulay
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | | | | | | | | | | | | | - Alberto Ramos
- />Federal University Hospital of Campina Grande, Campina Grande, Paraíba Brazil
| | - Deborah Laredo Jezini
- />Getúlio Vargas University Hospital of Amazonas, Adriano Jorge Hospital, Manaus, Amazonas Brazil
| | - Marilia Brito Gomes
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
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868
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Ramos-Lobo AM, Buonfiglio DC, Cipolla-Neto J. Streptozotocin-induced diabetes disrupts the body temperature daily rhythm in rats. Diabetol Metab Syndr 2015; 7:39. [PMID: 25960780 PMCID: PMC4424512 DOI: 10.1186/s13098-015-0035-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/16/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In mammals, the temperature rhythm is regulated by the circadian pacemaker located in the suprachiasmatic nuclei, and is considered a "marker rhythm". Melatonin, the pineal gland hormone, is a major regulator of the endogenous rhythms including body temperature. Its production is influenced by many factors, such as type 1 diabetes mellitus. In rats, diabetes leads to hypothermia and reduced melatonin synthesis; insulin treatment reestablishes both. AIM To study the body temperature daily rhythm of diabetic animals and the effects of insulin and/or melatonin treatment on its structure. METHODS We studied the effects of streptozotocin-induced diabetes (60 mg/kg) on the body temperature rhythm of Wistar rats and the possible modifications resulting from early and late treatments with insulin (6U/day) and/or melatonin (daily 0.5 mg/kg). We monitored the daily body temperature rhythm, its rhythmic parameters (MESOR, amplitude and acrophase), glycemia and body weight for 55 days. Data were classified by groups and expressed as mean ± SEM. One-way ANOVA analysis was performed followed by Bonferroni posttest. Statistical significance was set at p < 0.05. RESULTS Diabetes led to complete disruption of the temperature rhythm and hypothermia, which were accentuated over time. All early treatments (insulin or/and melatonin) prevented the temperature rhythm disruption and hypothermia. Insulin plus melatonin restored the body temperature rhythm whereas insulin alone resulted less efficient; melatonin alone did not restore any of the parameters studied; however, when supplemented close to diabetes onset, it maintained the temperature rhythmicity. All these corrective effects of the early treatments were dependent on the continuous maintenance of the treatment. CONCLUSIONS Taken together, our findings show the disruption of the body temperature daily rhythm, a new consequence of insulin-dependent diabetes, as well as the beneficial effect of the complementary action of melatonin and insulin restoring the normal rhythmicity.
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Affiliation(s)
- Angela M Ramos-Lobo
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Lineu Prestes, 1524, São Paulo, SP 05508-000 Brazil
| | - Daniella C Buonfiglio
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Lineu Prestes, 1524, São Paulo, SP 05508-000 Brazil
| | - José Cipolla-Neto
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Lineu Prestes, 1524, São Paulo, SP 05508-000 Brazil
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869
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Jindal A, Parihar AS, Sood M, Singh P, Singh N. Relationship between Severity of Periodontal Disease and Control of Diabetes (Glycated Hemoglobin) in Patients with Type 1 Diabetes Mellitus. J Int Oral Health 2015; 7:17-20. [PMID: 26668475 PMCID: PMC4672852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Both diabetes mellitus (DM) and periodontitis are chronic diseases affecting large number of the population worldwide. Changes in human behavior and lifestyle over the last century have resulted in a dramatic increase in the incidence of diabetes in the world. This study was designed to evaluate the relationship between severity of periodontal disease and control of diabetes (glycated hemoglobin [HBA1c]) in patients with Type 1 DM in a hospital based study. MATERIALS AND METHODS Fifty patients (n = 50) with Type 1 diabetes were enrolled in the study. They were divided into three groups based on the degree of glycemic control by measuring HbA1c levels as: "Good" (HBA1c ≤7) Group A, fair (HBA1c = 7-8) Group B and poor (HBA1c >8) Group C. All enrolled patients underwent detailed history and dental checkup. Evaluation for periodontal disease was done by measuring dental plaque (plaque index), inflammation of gums (gingival index), probing pocket depth (PPD), and clinical attachment level. RESULTS Type 1 diabetics with poor glycemic control had increased gingival inflammation (P < 0.05), more dental plaque (P < 0.05), increased PPDs (P < 0.05) and attachment loss (P < 0.05) as compared to those with fair and good glycemic control, respectively. CONCLUSION Severity of periodontal disease increases with poor glycemic control in patients with Type 1 DM.
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Affiliation(s)
- Ankita Jindal
- Senior Lecturer, Department of Periodontology, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India
| | - Anuj Singh Parihar
- Post-graduate Student, Department of Periodontology, People’s College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India,Correspondence: Dr. Parihar AS. Department of Periodontology, People’s College of Dental Sciences and Research Centre, Bhopal - 462 037, Madhya Pradesh, India. Phone: +91-8827047003.
| | - Meenakshi Sood
- Post-graduate Student, Department of Oral Medicine and Radiology, People’s College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Pinojj Singh
- MDS, Department of Periodontology, Dr. D.Y. Patil Dental College and Hospital, Navi Mumbai, Maharashtra, India
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870
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Byrne C, Jensen T, Hjortkjær HØ, Mogensen UM, Kuhl JT, Fuchs A, Hilsted J, Nordestgaard BG, Køber L, Kofoed KF. Myocardial perfusion at rest in patients with Diabetes Mellitus Type 1 compared with healthy controls assessed with Multi Detector Computed Tomography. Diabetes Res Clin Pract 2015; 107:15-22. [PMID: 25467625 DOI: 10.1016/j.diabres.2014.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/18/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
AIM Type 1 diabetes mellitus (T1DM) is associated with an increased risk of ischemic heart disease (IHD). The relative contribution of structural and functional abnormalities of the coronary circulation determining clinically manifested IHD remains unknown. The aim of this study was to assess potential differences in myocardial perfusion at rest and coronary atherosclerosis between asymptomatic T1DM patients and healthy controls. METHODS Left ventricular (LV) myocardial perfusion at rest measured as LV myocardial Attenuation Density/LV blood pool Attenuation Density (MyoAD-ratio) and coronary artery atherosclerosis were evaluated with 320-multidetector computed tomography angiography in 57 asymptomatic T1DM patients and 114 sex and age matched controls. RESULTS In both groups median age was 53 years (p5,p95: 42,67) and 59.6% were men. Median duration of diabetes in the T1DM group was 35 years (p5,p95: 17,49). Median coronary calcium score was higher in T1DM patients (51 vs. 2, p=0.037) compared with controls. However, a similar frequency of >50% stenosis in one or more coronary arteries was found in T1DM patients and controls (18% vs. 14%, p=0.49). LV myocardial perfusion at rest (MyoAD-ratio) was 18% higher in T1DM patients than controls (0.13 vs. 0.11, p<0.0001). This difference was noted throughout all the LV myocardial segments. In a multiple regression analysis including diabetes, sex, age, cardiovascular risk factors, heart rate, calcium score and coronary stenosis >50%, MyoAD-ratio remained significantly higher in T1DM patients (p=0.0001). CONCLUSIONS LV myocardial perfusion at rest is higher in T1DM patients compared with controls independent of coronary atherosclerosis and cardiovascular risk factors.
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Affiliation(s)
- Christina Byrne
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
| | - Tonny Jensen
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Denmark
| | | | - U M Mogensen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - J T Kuhl
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Jannik Hilsted
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, University of Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
| | - K F Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark; Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
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871
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Knychala MA, Jorge MLMP, Muniz CK, Faria PN, Jorge PT. High-risk alcohol use and anxiety and depression symptoms in adolescents and adults with type 1 diabetes mellitus: a cross-sectional study. Diabetol Metab Syndr 2015; 7:24. [PMID: 25821523 PMCID: PMC4376997 DOI: 10.1186/s13098-015-0020-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 03/05/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The medical literature shows that alcohol consumption is common among diabetic individuals and is associated with poor adherence to treatment, resulting in increased morbidity and mortality. However, no study has assessed the association between high-risk alcohol consumption and the presence of anxiety and depression in individuals with type 1 diabetes mellitus (1DM). METHODS The present cross-sectional study was conducted in Uberlândia, Brazil, and it assessed 209 outpatients in relation to alcohol consumption and the presence of anxiety and depression symptoms, using the Alcohol Use Disorders Identification Test (AUDIT), the Hospital Anxiety and Depression (HAD) scale, and glycemic control, according to the levels of glycated hemoglobin (HbA1c). The chi-square test and logistic regression analysis were used to investigate the association between the investigated variables. RESULTS The prevalence of high-risk alcohol consumption (AUDIT ≥ 8) among individuals with 1DM was high, specifically 24.9% among the entire group of subjects, 12.9% among the adolescents, 14.7% among the females, and 34.6% among the males. In comparisons based on gender and age, the odds of high-risk drinking were higher among males and participants aged 30 to 40 years (33.9%). The frequency of high-risk alcohol consumption did not differ as a function of gender among adolescents (females: 9.0%, males: 16.2%; p = 0.374). There was a linear trend in proportions related to the scores of anxiety and depression symptoms with high-risk alcohol consumption scores, indicating the association of these variables (p = 0.0229 and p = 0.0262, respectively). Moreover, the odds of female subjects exhibiting anxiety and depression symptoms were higher (odds ratio - OR: 4.4 and OR: 7.4, respectively). Glycemic control did not exhibit an association between high-risk alcohol consumption and the presence of anxiety and depression symptoms. CONCLUSIONS The frequency of high-risk drinking increased along with age and was greater among males; however, this frequency did not exhibit differences in terms of gender among adolescents. There was a positive association between high risk alcohol consumption and anxiety and depression symptoms, although glycemic control was inadequate in most of the sample independent of alcohol consumption and the presence of anxiety and depression symptoms.
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Affiliation(s)
- Maria Aparecida Knychala
- />Graduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia, Uberlândia, MG CEP: 38400-902 Brazil
| | | | - Cinara Knychala Muniz
- />Management of Nutrition and Dietetics, Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG Brazil
| | | | - Paulo Tannús Jorge
- />Graduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia, Uberlândia, MG CEP: 38400-902 Brazil
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872
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Quirós C, Patrascioiu I, Perea V, Bellart J, Conget I, Vinagre I. Postpartum metabolic control in a cohort of women with type 1 diabetes. ACTA ACUST UNITED AC 2015; 62:125-9. [PMID: 25544593 DOI: 10.1016/j.endonu.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/29/2014] [Accepted: 11/05/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Pregnancy in women with type 1 diabetes (T1D) involves greater risks as compared to non-diabetic women, but less information is available about blood glucose and weight control after delivery. Our aim was to evaluate the postpartum metabolic profile (blood glucose and weight control) of women with T1D and the factors related to those metabolic outcomes. METHODS A retrospective, observational study of 36 women with T1D during pregnancy and for up to one year after delivery. RESULTS Fifty percent of patients attended a preconceptional planning program (PPP), and 44.4% of women were treated with continuous subcutaneous insulin infusion. Mean preconceptional HbA1c and body mass index (BMI) were 7.2±1.2% and 23.8±5.0 respectively. In the total cohort, blood glucose control significantly worsened one year after delivery (HbA1c: 7.2±1.2 vs 7.6±1.2%, P<0.001). Lower preconceptional HbA1c values were found in patients who attended PPP (6.6±0.5 vs. 7.8±1.4%; P=0.02), and were maintained for one year after delivery. No differences were found in body mass index (BMI) from the pregestational period to one year after delivery in any of two groups (No PPP 22.5±4.6 vs 23.2±4.8, P=0.078; PPP 25.4±3.4 vs 25.5±3.4 kg/m(2), P=0.947). Preconceptional HbA1c was shown to be the most important determinant of metabolic control (β=0.962, p<0.001) and weight one year after delivery (β=0.524, p=0.025) and weight gain during pregnancy (β=0.633, p=0.004). CONCLUSIONS Pregnant women with T1D return to prepregnancy body weight one year after delivery, especially those with lower HbA1c levels and BMI before pregnancy. However, blood glucose control deteriorates after delivery, suggesting the need for changes in clinical practice after delivery.
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873
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Giordano S, Martocchia A, Toussan L, Stefanelli M, Pastore F, Devito A, Risicato MG, Ruco L, Falaschi P. Diagnosis of hepatic glycogenosis in poorly controlled type 1 diabetes mellitus. World J Diabetes 2014; 5:882-888. [PMID: 25512791 PMCID: PMC4265875 DOI: 10.4239/wjd.v5.i6.882] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/02/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023] Open
Abstract
Hepatic glycogenosis (HG) in type 1 diabetes is a underrecognized complication. Mauriac firstly described the syndrome characterized by hepatomegaly with altered liver enzymes, growth impairment, delay puberty and Cushingoid features, during childhood. HG in adulthood is characterized by the liver disorder (with circulating aminotransferase increase) in the presence of poor glycemic control (elevation of glycated hemoglobin, HbA1c levels). The advances in the comprehension of the metabolic pathways driving to the hepatic glycogen deposition point out the role of glucose transporters and insulin mediated activations of glucokinase and glycogen synthase, with inhibition of glucose-6-phosphatase. The differential diagnosis of HG consists in the exclusion of causes of liver damage (infectious, metabolic, obstructive and autoimmune disease). The imaging study (ultrasonography and/or radiological examinations) gives information about the liver alterations (hepatomegaly), but the diagnosis needs to be confirmed by the liver biopsy. The main treatment of HG is the amelioration of glycemic control that is usually accompanied by the reversal of the liver disorder. In selected cases, more aggressive treatment options (transplantation) have been successfully reported.
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874
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Timar B, Timar R, Albai A, Stoian D, Nitu R, Craina M. Predictors for pregnancy outcomes in Romanian women with Type 1 Diabetes Mellitus: a prospective study. Diabetol Metab Syndr 2014; 6:125. [PMID: 25435920 PMCID: PMC4247610 DOI: 10.1186/1758-5996-6-125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 11/17/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Type 1 diabetes mellitus in pregnant women is associated with an increased risk of congenital malformations, obstetric complications, neonatal morbidity, and mortality. Our aim was to evaluate which factors from the first trimester of pregnancy have a significant impact on the pregnancy outcomes of women with type 1 diabetes. METHODS We included 94 pregnant women with type 1 diabetes in this study. In these patients, we analyzed the influence of several diabetes-related parameters on the pregnancy outcome. We compared the parameters between two cohorts: those with successful pregnancies and those with adverse pregnancy outcomes, defined as spontaneous abortion or congenital malformations. The influence of several factors on the pregnancy outcome was assessed using multivariate and univariate logistic regressions. RESULTS The prevalence of adverse pregnancy outcomes was 28.7%, and was associated with poorer glycemic control (p <0.001), lower frequency of daily self-monitoring tests (p <0.001), smoking status (p <0.001), alcohol consumption (p <0.001), increased prevalence of chronic complications of diabetes, and the presence of ketosis. However, the adverse outcomes were not significantly associated with age, duration of diabetes, presence of thyroid disease, or body mass index. Furthermore, planned pregnancy was found to be a significant protective factor (odds ratio, 0.15; p <0.001). CONCLUSION These results indicate that by carefully planning the pregnancy, ensuring optimal glycemic control, and eliminating habitual risk factors, the fetal risk in pregnancies among women with type 1 diabetes may decrease to a value similar to that noted in women without diabetes.
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Affiliation(s)
- Bogdan Timar
- />Department III – Functional Sciences, “Victor Babes”, University of Medicine and Pharmacy, Timisoara, Romania
| | - Romulus Timar
- />Department VII – Internal Medicine, “Victor Babes”, University of Medicine and Pharmacy, Timisoara, Romania
| | - Alin Albai
- />Department VII – Internal Medicine, “Victor Babes”, University of Medicine and Pharmacy, Timisoara, Romania
| | - Dana Stoian
- />Department XII – Obstetrics and Gynecology, “Victor Babes”, University of Medicine and Pharmacy, Timisoara, Romania
| | - Razvan Nitu
- />Department XII – Obstetrics and Gynecology, “Victor Babes”, University of Medicine and Pharmacy, Timisoara, Romania
| | - Marius Craina
- />Department XII – Obstetrics and Gynecology, “Victor Babes”, University of Medicine and Pharmacy, Timisoara, Romania
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875
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van Dijk PR, Logtenberg SJJ, Groenier KH, Gans ROB, Bilo HJG, Kleefstra N. Report of a 7 year case-control study of continuous intraperitoneal insulin infusion and subcutaneous insulin therapy among patients with poorly controlled type 1 diabetes mellitus: favourable effects on hypoglycaemic episodes. Diabetes Res Clin Pract 2014; 106:256-63. [PMID: 25305134 DOI: 10.1016/j.diabres.2014.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/18/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
AIMS Continuous intraperitoneal insulin infusion (CIPII) is a last-resort treatment option for patients with type 1 diabetes mellitus (T1DM) who fail to reach adequate glycaemic control with subcutaneous (SC) insulin therapy. Aim was to compare the long-term effects of CIPII and SC insulin therapy among patients with T1DM in poor glycaemic control. METHODS Patients in which CIPII was initiated in 2006 were compared with a control group of T1DM patients who continued SC therapy. Linear mixed models were used to calculate differences between the baseline (2006) and final (2013) measurements within and between groups. RESULTS A total of 95 patients of which 21 were using CIPII and 74 using SC insulin were included. Within the CIPII group, the number of hypoglycaemic episodes decreased with -5 (95% CI -8 to -3) per 2 weeks while it remained stable among SC patients. Over time, only the number of hypoglycaemic episodes decreased more with CIPII as compared to SC insulin treatment (difference: -6 (95% CI -9 to -4)). There were no differences between treatment groups regarding clinical parameters and quality of life scores over time. Pump or catheter dysfunction led to ketoacidosis in 6 patients: 2 using CIPII and 4 SC insulin. CONCLUSIONS After 7 years of follow-up, there is a persistent decline of hypoglycaemic events among CIPII treated T1DM patients. Besides less hypoglycaemic episodes with CIPII therapy, there are no differences between long-term CIPII and SC insulin therapy.
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Affiliation(s)
- P R van Dijk
- Isala, Diabetes Centre, Zwolle, The Netherlands.
| | - S J J Logtenberg
- Isala, Diabetes Centre, Zwolle, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - K H Groenier
- Isala, Diabetes Centre, Zwolle, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - R O B Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - H J G Bilo
- Isala, Diabetes Centre, Zwolle, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands; Isala, Department of Internal Medicine, Zwolle, The Netherlands
| | - N Kleefstra
- Isala, Diabetes Centre, Zwolle, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands; Langerhans Medical Research Group, Zwolle, The Netherlands
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876
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Antonelli A, Ferrari SM, Giuggioli D, Di Domenicantonio A, Ruffilli I, Corrado A, Fabiani S, Marchi S, Ferri C, Ferrannini E, Fallahi P. Hepatitis C virus infection and type 1 and type 2 diabetes mellitus. World J Diabetes 2014; 5:586-600. [PMID: 25317237 PMCID: PMC4138583 DOI: 10.4239/wjd.v5.i5.586] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 04/10/2014] [Accepted: 07/12/2014] [Indexed: 02/05/2023] Open
Abstract
Hepatitis C virus (HCV) infection and diabetes mellitus are two major public health problems that cause devastating health and financial burdens worldwide. Diabetes can be classified into two major types: type 1 diabetes mellitus (T1DM) and T2DM. T2DM is a common endocrine disorder that encompasses multifactorial mechanisms, and T1DM is an immunologically mediated disease. Many epidemiological studies have shown an association between T2DM and chronic hepatitis C (CHC) infection. The processes through which CHC is associated with T2DM seem to involve direct viral effects, insulin resistance, proinflammatory cytokines, chemokines, and other immune-mediated mechanisms. Few data have been reported on the association of CHC and T1DM and reports on the potential association between T1DM and acute HCV infection are even rarer. A small number of studies indicate that interferon-α therapy can stimulate pancreatic autoimmunity and in certain cases lead to the development of T1DM. Diabetes and CHC have important interactions. Diabetic CHC patients have an increased risk of developing cirrhosis and hepatocellular carcinoma compared with non-diabetic CHC subjects. However, clinical trials on HCV-positive patients have reported improvements in glucose metabolism after antiviral treatment. Further studies are needed to improve prevention policies and to foster adequate and cost-effective programmes for the surveillance and treatment of diabetic CHC patients.
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877
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Gao Z, Zhao X, Yang T, Shang J, Shang L, Mai H, Qi G. Immunomodulation therapy of diabetes by oral administration of a surfactin lipopeptide in NOD mice. Vaccine 2014; 32:6812-9. [PMID: 25239487 DOI: 10.1016/j.vaccine.2014.08.082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/31/2014] [Accepted: 08/30/2014] [Indexed: 01/24/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is considered an autoimmune disease, which can be attenuated by modulation of immune pathway from Th1- to Th2-type through vaccination. WH1fungin surfactin is a Bacillus-produced natural immunomodulator. NOD mice were orally treated with 5mg/kg or 25mg/kg WH1fungin once a week for total 4 weeks. After the final administration, the diabetes incidence and the anti-inflammatory roles of WH1fungin were investigated by immunohistochemistry, FACS and ELISA. The results showed oral WH1fungin obviously resulted in a WH1fungin-unspecific suppression of T1DM. Diabetes incidence was significantly reduced when compared to phosphate buffered saline (PBS) control. Mice in the control group began to be onset of diabetes at week 15, following with an increased mortality from week 16 to 28. At the end of observation, the diabetes incidence reached to 81% at week 30, while only 25% in WH1fungin groups. The splenocytes assay showed oral WH1fungin could suppress T cells proliferation, down-regulate amounts of activated CD8(+) T cells with the production of tumor necrosis factor (TNF)-α and interferon (IFN)-γ, and increase CD4(+)CD25(+)FOXP3(+) regulator T cells (Tregs). The serum assay revealed oral WH1fungin down-regulated TNF-α and IgG2a but increased interleukin (IL)-10 and IgG1 in mice. All of these data showed oral WH1fungin tended to switch the immune response from Th1- to Th2-type. The further surveys revealed that less IFN-γ but more transfer growth factor (TGF)-β were found in the islets of mice with oral WH1fungin when compared to that in the control group. As a result, the normal islet architecture and slight inflammatory cells infiltration was observed with a slight insulitis in the oral WH1fungin groups. These results demonstrate that oral WH1fungin might be a novel therapeutic approach for the prevention of T1DM.
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Affiliation(s)
- Zhenqiu Gao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, PR China; College of Pharmacy, Yancheng Teachers' University, Yancheng 224051, PR China
| | - Xiuyun Zhao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, PR China
| | - Tao Yang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, PR China
| | - Jun Shang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, PR China
| | - Long Shang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, PR China
| | - Haizhe Mai
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, PR China
| | - Gaofu Qi
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, PR China.
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878
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Mohsenifar Z, Feridoni MJ, Bayat M, Masteri Farahani R, Bayat S, Khoshvaghti A. Histological and biomechanical analysis of the effects of streptozotocin-induced type one diabetes mellitus on healing of tenotomised Achilles tendons in rats. Foot Ankle Surg 2014; 20:186-91. [PMID: 25103706 DOI: 10.1016/j.fas.2014.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/29/2014] [Accepted: 04/01/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tendon healing is impaired in patient with diabetes mellitus. The effects of streptozotocin-induced type 1 diabetes (STZ-D) on the healing of the transected Achilles tendon in rats was studied. METHODS In the experimental group, type one diabetes was induced via administration of STZ. The right Achilles tendon of all the rats was transected 30 days after the STZ administration. The Achilles tendons were examined for biomechanical and histological examinations. RESULTS The statistical analysis showed that Young's modulus of elasticity and stress tensile load of the control group were significantly higher than those of the experimental group, and inflammation in the experimental group was significantly higher than that in the control group. At the same time, fibrosis in the experimental group was significantly lower than that of the control group. CONCLUSION Induction of type 1 diabetes by STZ significantly delayed the healing of the transected Achilles tendon in rats.
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Affiliation(s)
- Zhaleh Mohsenifar
- Pathology Department, Ayatallah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
| | - Mohammad Javad Feridoni
- Anatomy and Biology Department, Medical Faculty, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
| | - Mohammad Bayat
- Anatomy and Biology Department, Medical Faculty, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran.
| | - Reza Masteri Farahani
- Anatomy and Biology Department, Medical Faculty, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
| | - Shiva Bayat
- Shiraz University of Medical Sciences, Shiraz, Iran
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879
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van Dijk PR, Logtenberg SJJ, Groenier KH, Keers JC, Bilo HJG, Kleefstra N. Fifteen-year follow-up of quality of life in type 1 diabetes mellitus. World J Diabetes 2014; 5:569-576. [PMID: 25126403 PMCID: PMC4127592 DOI: 10.4239/wjd.v5.i4.569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/11/2014] [Accepted: 05/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate metabolic control and health-related quality of life (HRQOL) in a type 1 diabetes mellitus (T1DM) population.
METHODS: As part of a prospective cohort study, 283 T1DM patients treated with various insulin treatment modalities including multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) were examined annually. HRQOL was measured using the SF-36 and EuroQol questionnaires. Data regarding HRQOL, glycaemic and metabolic control from baseline and follow-up measures in 2002 and 2010 were analysed. Linear mixed models were used to calculate estimated values and differences between the three moments in time and the three treatment modalities.
RESULTS: Significant changes [mean Δ (95%CI)] in body mass index [2.4 kg/m2 (1.0, 3.8)], systolic blood pressure [-6.4 mmHg (-11.4, -1.3)] and EuroQol-VAS [-7.3 (-11.4, -3.3)] were observed over time. In 2010, 168 patients were lost to follow-up. Regarding mode of therapy, 52 patients remained on MDI, 28 remained on CSII, and 33 patients switched from MDI to CSII during follow-up. Among patients on MDI, HRQOL decreased significantly over time: mental component summary [-9.8 (-16.3, -3.2)], physical component summary [-8.6 (-15.3, -1.8)] and EuroQol-VAS [-8.1 (-14.0, -2.3)], P < 0.05 for all. For patients using CSII, the EuroQol-VAS decreased [-9.6 (-17.5, -1.7)]. None of the changes over time in HRQOL differed significantly with the changes over time within the other treatment groups.
CONCLUSION: No differences with respect to metabolic and HRQOL parameters between the various insulin treatment modalities were observed after 15 years of follow-up in T1DM patients.
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880
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Pipi E, Marketou M, Tsirogianni A. Distinct clinical and laboratory characteristics of latent autoimmune diabetes in adults in relation to type 1 and type 2 diabetes mellitus. World J Diabetes 2014; 5:505-510. [PMID: 25126396 PMCID: PMC4127585 DOI: 10.4239/wjd.v5.i4.505] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/14/2014] [Accepted: 06/18/2014] [Indexed: 02/05/2023] Open
Abstract
Ever since its first appearance among the multiple forms of diabetes, latent autoimmune diabetes in adults (LADA), has been the focus of endless discussions concerning mainly its existence as a special type of diabetes. In this mini-review, through browsing important peer-reviewed publications, (original articles and reviews), we will attempt to refresh our knowledge regarding LADA hoping to enhance our understanding of this controversial diabetes entity. A unique combination of immunological, clinical and metabolic characteristics has been identified in this group of patients, namely persistent islet cell antibodies, high frequency of thyroid and gastric autoimmunity, DR3 and DR4 human leukocyte antigen haplotypes, progressive loss of beta cells, adult disease onset, normal weight, defective glycaemic control, and without tendency to ketoacidosis. Although anthropomorphic measurements are useful as a first line screening, the detection of C-peptide levels and the presence of glutamic acid decarboxylase (GAD) autoantibodies is undoubtedly the sine qua non condition for a confirmatory LADA diagnosis. In point of fact, GAD autoantibodies are far from being solely a biomarker and the specific role of these autoantibodies in disease pathogenesis is still to be thoroughly studied. Nevertheless, the lack of diagnostic criteria and guidelines still puzzle the physicians, who struggle between early diagnosis and correct timing for insulin treatment.
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881
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Nansel TR, Lipsky LM, Liu A, Laffel LM, Mehta SN. Contextual factors are associated with diet quality in youth with type 1 diabetes mellitus. J Acad Nutr Diet 2014; 114:1223-9. [PMID: 24651028 PMCID: PMC4111984 DOI: 10.1016/j.jand.2014.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 01/16/2014] [Indexed: 02/06/2023]
Abstract
This study examined differences in diet quality by meal type, location, and time of week in youth with type 1 diabetes mellitus. A sample of youth with type 1 diabetes mellitus (n=252; 48% female) age 8 to 18 years (mean±standard deviation=13.2±2.8 years) with diabetes duration ≥1 year (mean±standard deviation=6.3±3.4 years) completed 3-day diet records. Multilevel linear regression models tested for differences in diet quality indicators by meal type, location, and time of week (weekdays vs weekends). Participants showed greater energy intake and poorer diet quality on weekends relative to weekdays, with lower intake of fruit and vegetables, and higher intake of total and saturated fat. Differences in diet quality were seen across meal types, with higher nutrient density at breakfast and dinner than at lunch and snacks. Participants reported the highest whole-grain and lowest fat intake at breakfast, but higher added sugar than at lunch or dinner. Dinner was characterized by the highest fruit intake, lowest added sugar, and lowest glycemic load, but also the highest sodium intake. The poorest nutrient density and highest added sugar occurred during snacks. Diet quality was poorer for meals consumed away from home than those consumed at home for breakfast, dinner, and snacks. Findings regarding lunch meal location were mixed, with higher nutrient density, lower glycemic load, and less added sugar at home lunches, and lower total fat, saturated fat, and sodium at lunches away from home. Findings indicate impacts of meal type, location, and time of week on diet quality, suggesting targets for nutrition education and behavioral interventions.
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Affiliation(s)
- Tonja R. Nansel
- Senior Investigator, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, NIH, DHHS, 6100 Executive Blvd., Rm 7B13, MSC 7510, Bethesda, MD 20892-7510, Phone: 301-435-6937, Fax: 301-402-2084
| | - Leah M. Lipsky
- Staff Scientist, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, NIH, DHHS, 6100 Executive Blvd., Rm 7B13, MSC 7510, Bethesda, MD 20892-7510, Phone: 301-435-6951, Fax: 301-402-2084
| | - Aiyi Liu
- Senior Investigator, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, NIH, DHHS, 6100 Executive Blvd., Rm 7A05, MSC 7510, Bethesda, MD 20892-7510, Phone: 301-435-6952, Fax: 301-402-2084
| | - Lori M.B. Laffel
- Chief, Pediatric, Adolescent and Young Adult Section, Investigator, Section on Genetics and Epidemiology, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, Phone: 617-732-2603, Fax: 617-309-2451
| | - Sanjeev N. Mehta
- Assistant Investigator, Section on Genetics and Epidemiology, Joslin Diabetes Center, One Joslin Place, Boston, MA, 02215, Phone: 617-732-2603, Fax: 617-309-2451
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882
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Abstract
Growth failure and pubertal abnormalities are not uncommon in chronic uncontrolled metabolic diseases like diabetes mellitus. We present a young girl with uncontrolled type 1 diabetes mellitus, who presented with short stature and primary amenorrhea, and on evaluation was found to have anterior pituitary hypoplasia. In addition to uncontrolled diabetes mellitus, she presented with early onset growth failure and lack of spontaneous secondary sexual characteristics. She had central hypothyroidism and inappropriately normal gonadotropin levels. However her serum cortisol levels were normal. MRI of the sellar-suprasellar region revealed a small anterior pituitary gland with thinning of the pituitary stalk consistent with pituitary hypoplasia. While uncontrolled type 1 diabetes itself may cause growth retardation and pubertal abnormalities, this girl had coexisting pituitary maldevelopment - a rare co-existence of two major illnesses of unrelated etiologies. The partial pituitary hormonal deficiency, which spared the hypothalamo-pituitary-adrenal axis, may be due to a transcription factor defect.
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Affiliation(s)
- Jostol Pinto
- Department of General Medicine, Father Muller Medical College, Rajiv Gandhi University of Health Sciences, India.
| | - K Sudeep
- Head of Endocrinology Unit, Father Muller Medical College, Rajiv Gandhi University of Health Sciences, India
| | - B M Venkatesha
- Department of General Medicine, Father Muller Medical College, Rajiv Gandhi University of Health Sciences, India
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883
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Abstract
OBJECTIVE Melatonin is an indolamine hormone, synthesized from tryptophan in the pineal gland primarily. Melatonin exerts both antioxidative and immunoregulatory roles but little is known about melatonin secretion in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to measure serum melatonin levels in patients with T1DM and investigates their relationship with type 1 diabetes mellitus. MATERIALS AND METHODS Forty children and adolescents with T1DM (18 boys and 22 girls) and 30 healthy control subjects (17 boys and 13 girls) participated in the study. All patients followed in Pediatric Endocrinology and Metabolism Unit of Gaziantep University Faculty of Medicine and also control subjects had no hypertension, obesity, hyperlipidemia, anemia, and infection. Blood samples were collected during routine analysis, after overnight fasting. Serum melatonin levels were analyzed with ELISA. RESULTS There were no statistically significant differences related with age, sex, BMI distribution between diabetic group and control group. Mean diabetic duration was 2.89 ± 2.69 years. The variables were in the equation. Mean melatonin level in diabetic group was 6.75 ± 3.52 pg/ml and mean melatonin level in control group was 11.51 ± 4.74 pg/ml. Melatonin levels were significantly lower in diabetic group compared to controls (P < 0.01). CONCLUSIONS Melatonin was associated with type 1 diabetes mellitus significantly. Because of the varied roles of melatonin in human metabolic rhythms, these results suggest a role of melatonin in maintaining normal rhythmicity. Melatonin may play role in preventing process of inflammation and oxidative stress.
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Affiliation(s)
- Yilmaz Kor
- Department of Pediatric Endocrinology and Metabolism, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey
| | - Iclal Geyikli
- Department of Biochemistry and Clinical Biochemistry, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey
| | - Mehmet Keskin
- Department of Pediatric Endocrinology and Metabolism, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey
| | - Muslum Akan
- Department of Biochemistry and Clinical Biochemistry, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey
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884
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Demuru M, van Duinkerken E, Fraschini M, Marrosu F, Snoek FJ, Barkhof F, Klein M, Diamant M, Hillebrand A. Changes in MEG resting-state networks are related to cognitive decline in type 1 diabetes mellitus patients. Neuroimage Clin 2014; 5:69-76. [PMID: 25003029 PMCID: PMC4081980 DOI: 10.1016/j.nicl.2014.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 02/06/2023]
Abstract
Objective Integrity of resting-state functional brain networks (RSNs) is important for proper cognitive functioning. In type 1 diabetes mellitus (T1DM) cognitive decrements are commonly observed, possibly due to alterations in RSNs, which may vary according to microvascular complication status. Thus, we tested the hypothesis that functional connectivity in RSNs differs according to clinical status and correlates with cognition in T1DM patients, using an unbiased approach with high spatio-temporal resolution functional network. Methods Resting-state magnetoencephalographic (MEG) data for T1DM patients with (n = 42) and without (n = 41) microvascular complications and 33 healthy participants were recorded. MEG time-series at source level were reconstructed using a recently developed atlas-based beamformer. Functional connectivity within classical frequency bands, estimated by the phase lag index (PLI), was calculated within eight commonly found RSNs. Neuropsychological tests were used to assess cognitive performance, and the relation with RSNs was evaluated. Results Significant differences in terms of RSN functional connectivity between the three groups were observed in the lower alpha band, in the default-mode (DMN), executive control (ECN) and sensorimotor (SMN) RSNs. T1DM patients with microvascular complications showed the weakest functional connectivity in these networks relative to the other groups. For DMN, functional connectivity was higher in patients without microangiopathy relative to controls (all p < 0.05). General cognitive performance for both patient groups was worse compared with healthy controls. Lower DMN alpha band functional connectivity correlated with poorer general cognitive ability in patients with microvascular complications. Discussion Altered RSN functional connectivity was found in T1DM patients depending on clinical status. Lower DMN functional connectivity was related to poorer cognitive functioning. These results indicate that functional connectivity may play a key role in T1DM-related cognitive dysfunction. MEG RSN functional connectivity was estimated among T1DM+ and T1DM− patients and controls. Lower alpha band in DMN, ECN and SMN significantly differed among groups. Functional connectivity may play a key role in T1DM-related cognitive dysfunction.
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Affiliation(s)
- Matteo Demuru
- Department of Electrical and Electronic Engineering, University of Cagliari, Italy ; Department of Public Health, Clinic and Molecular Medicine, University of Cagliari, Italy
| | - Eelco van Duinkerken
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands ; Diabetes Centre/Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Matteo Fraschini
- Department of Electrical and Electronic Engineering, University of Cagliari, Italy
| | - Francesco Marrosu
- Department of Public Health, Clinic and Molecular Medicine, University of Cagliari, Italy
| | - Frank J Snoek
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martin Klein
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Michaela Diamant
- Diabetes Centre/Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and MEG Centre, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
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885
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Joshi AS, Varthakavi PK, Bhagwat NM, Chadha MD, Mittal SS. Coeliac autoimmunity in type I diabetes mellitus. Arab J Gastroenterol 2014; 15:53-7. [PMID: 25097046 DOI: 10.1016/j.ajg.2014.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/11/2013] [Accepted: 04/18/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND STUDY AIMS Coeliac autoimmunity (CA) has a known association with type 1 diabetes mellitus (T1DM) for which screening is routinely recommended but less frequently followed. The impact of CA in T1DM has been variably reported. The aims of this study are as follows: (1) to study the prevalence of CA in patients with T1DM and (2) to study the impact of CA not only on nutritional parameters but also on glycaemic control, endocrine axes and bone health. PATIENTS AND METHODS Eighty-six consecutive patients with T1DM were screened for CA using immunoglobulin A (IgA) tissue transglutaminase as a marker (TTG; IgG anti-gliadin in IgA-deficient case). CA positive (CA+) cases were compared with age-matched and sex-matched CA negative (CA-) T1DM cases for anthropometry, glycaemic control (assessed by glycated haemoglobin (HbA1c) and hypoglycaemic/hyperglycaemic episodes), endocrine (thyroid function, cortisol, growth hormone (GH) axis, gonadal axes), haematological (haemoglobin, iron profile and vitamin B12 status) and calcium metabolism parameters and bone densitometry (by dual-energy X-ray absorptiometry (DXA)). Consenting patients with CA also underwent upper gastrointestinal (GI) endoscopy with duodenal biopsy. RESULTS Out of 86 patients, 11 (12.75%) screened positive for CA (seven patients underwent duodenal biopsies which were suggestive of Marsh grade III(2), II(3) and I(2) disease). The CA+ T1DM patients were comparable with CA- T1DM in terms of anthropometry. CA+ patients had higher HbA1c (10.7±1.8 vs. 8.4±1.0 (93±19 vs. 68±11 mmol/mol); p<0.01), more hypoglycaemic episodes (five vs. two; p<0.05), higher prevalence of iron and vitamin B12 deficiency, lower insulin-like growth factor-1 (IGF-1) levels and lower bone mineral density (BMD) z-score at total body (-1.91±1.05 vs. -0.63±0.73; p<0.05) and lumbar spine (-1.69±0.92 vs. -0.36±0.93; p<0.05). The incidence of fractures in the past 3years was also more in CA+ patients than in CA- patients (four vs. one; p<0.05). CONCLUSION CA has an important autoimmune association with T1DM. The concomitant presence of CA adversely affects stature, bone health, glycaemic control and iron and B12 levels in T1DM. IgA sufficiency should be ensured before using an IgA-based screening test for CA.
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Affiliation(s)
- Ameya S Joshi
- Department of Endocrinology, 407, College Building, 4th Floor, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai Central, Maharashtra 400008, India.
| | - Premlata K Varthakavi
- Department of Endocrinology, 407, College Building, 4th Floor, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai Central, Maharashtra 400008, India
| | - Nikhil M Bhagwat
- Department of Endocrinology, 407, College Building, 4th Floor, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai Central, Maharashtra 400008, India
| | - Manoj D Chadha
- Department of Endocrinology, 407, College Building, 4th Floor, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai Central, Maharashtra 400008, India
| | - Sachin S Mittal
- Department of Endocrinology, 407, College Building, 4th Floor, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai Central, Maharashtra 400008, India
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886
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Fourlanos S, Elkassaby S, Varney MD, Colman PG, Harrison LC. Higher body mass index in adults at diagnosis of the slowly progressive form of type 1 diabetes mellitus is associated with lower risk HLA genes. Diabetes Res Clin Pract 2014; 104:e69-71. [PMID: 24698405 DOI: 10.1016/j.diabres.2014.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/01/2014] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
Abstract
We hypothesised that higher body weight, a proposed risk factor for type 1 diabetes mellitus, would be associated with increased penetrance of lower risk genes. In adults at diagnosis of the slowly progressive form of type 1 diabetes mellitus we found that higher body mass index was associated with the absence of the highest risk HLA genes.
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Affiliation(s)
- S Fourlanos
- The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville 3052, VIC; Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville 3050, VIC, Australia
| | - S Elkassaby
- The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville 3052, VIC; Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville 3050, VIC, Australia
| | - M D Varney
- Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, West Melbourne 3003, VIC, Australia
| | - P G Colman
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville 3050, VIC, Australia
| | - L C Harrison
- The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville 3052, VIC.
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887
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Jung ES, Han DK, Yang EM, Kim MS, Lee DY, Kim CJ. Thyroid autoimmunity in children and adolescents with newly diagnosed type 1 diabetes mellitus. Ann Pediatr Endocrinol Metab 2014; 19:76-9. [PMID: 25077089 PMCID: PMC4114047 DOI: 10.6065/apem.2014.19.2.76] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aim to investigate the occurrence of autoimmune thyroid disease in children and adolescents at onset of type 1 diabetes mellitus (T1DM) and to assess whether the presence of diabetes-specific autoantibodies can predict the autoimmune thyroid disorder. METHODS Seventy-three children with T1DM were recruited. Glutamic acid decarboxylase antibodies (GADA), islet cell antibodies (ICA), insulin autoantibodies (IAA), and thyroid antibodies were determined in all patients at the time of diagnosis. RESULTS The majority of patients (87.7%) had at least one pancreatic antibody (74.0% for GADA, 20.5% for ICA, and 24.7% for IAA). Thyroid autoantibodies were found in 19 of 73 patients (26.0%) at diagnosis. Thyroid autoimmunity (TA) incidence was not statistically significant by GADA or ICA positivity, but significantly higher by IAA positivity (P=0.03), and IAA positivity showed odds ratio, 4.931; 95% confidence interval, 1.323-18.381 for TA. CONCLUSION The IAA positivity in children and adolescents with TIDM was strongly related to positivity of thyroid autoantibodies and thus it could serve as an index for early prediction of the development of the thyroid autoimmune disorder among children and adolescents with TIDM.
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Affiliation(s)
- Eui Seok Jung
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Kyun Han
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Min Sun Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Dae-Yeol Lee
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Chan Jong Kim
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
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888
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Dai S, Jia R, Zhang X, Fang Q, Huang L. The PD-1/PD-Ls pathway and autoimmune diseases. Cell Immunol 2014; 290:72-9. [PMID: 24908630 DOI: 10.1016/j.cellimm.2014.05.006] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/17/2014] [Accepted: 05/07/2014] [Indexed: 12/27/2022]
Abstract
The programmed death (PD)-1/PD-1 ligands (PD-Ls) pathway, is a new member of the B7/CD28 family, and consists of the PD-1 receptor and its ligands PD-L1 (B7-H1, CD274) and PD-L2 (B7-DC, CD273). Recently, it is reported that PD-1, PD-L1 and PD-L2 also have soluble forms aside from their membrane bound forms. The soluble forms increase the diversity and complexity of PD-1/PD-Ls pathway in both composition and function. The PD-1/PD-Ls pathway is broadly expressed and exerts a wider range of immunoregulatory roles in T-cell activation and tolerance compared with other B7/CD28 family members. Studies show that the PD-1/PD-Ls pathway regulates the induction and maintenance of peripheral tolerance and protects tissues from autoimmune attack in physiological conditions. In addition, it is also involved in various diseases mediated by T cells, such as autoimmunity, tumor immunity, chronic viral infections, and transplantation immunity. In this review, we will summarize the relevance of the soluble forms and the latest researches on the role of PD-1/PD-Ls pathway in autoimmune diseases.
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Affiliation(s)
- Suya Dai
- Department of Laboratory Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Ru Jia
- Department of Laboratory Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Xiao Zhang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Qiwen Fang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Lijuan Huang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China.
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889
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Aoyama T, Ikeda H, Hamamoto Y, Honjo S, Nomura K, Wada Y, Fujikawa J, Hayashino Y, Fukuhara S, Koshiyama H. Clinical heterogeneity of adult Japanese diabetes depending on titers of glutamic acid decarboxylase autoantibodies. J Diabetes Investig 2014; 3:266-70. [PMID: 24843575 PMCID: PMC4014948 DOI: 10.1111/j.2040-1124.2011.00190.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Aims/Introduction: We examined whether levels of glutamic acid decarboxylase autoantibodies (GADAb) might show the clinical heterogeneity of adult Japanese diabetes. MATERIALS AND METHODS In this cross-sectional study, the serum levels of GADAb were measured in a total of 1857 consecutive adult diabetic patients aged 20 years or older. The patients with positive GADAb, arbitrarily defined as ≥1.5 U/mL, were divided into quartiles according to the number of patients. The age- and sex-matched diabetic patients without GADAb were selected as a control group. RESULTS A total of 103 (5.5%) of the diabetic patients had GADAb, and showed higher HbA1c and serum high-density lipoprotein (HDL) cholesterol levels, lower body mass index (BMI), urinary C-peptide immunoreactivity (CPR), serum triglycerides (TG) and uric acid (UA) levels, and lower prevalence of metabolic syndrome than the control group (P < 0.05). Quartiles 3 and 4 (i.e. GADAb ≥4.6 U/mL) showed a higher HbA1c level, lower BMI, urinary CPR, serum TG and UA levels, quartile 2 (2.5 ≤ GADAb < 4.6 U/mL) showed a lower BMI level than the control group (P < 0.05). Among the clinical parameters, we observed significant upward trends for both HbA1c and serum HDL cholesterol levels, and significant downward trends for BMI, serum TG and UA, urinary CPR levels, and prevalence of metabolic syndrome across GADAb quartiles (P < 0.05 for trend). CONCLUSIONS These results show that the clinical phenotype of adult Japanese diabetes correlates with GADAb levels, and that patients with GADAb (≥2.5 U/mL) show different characteristics from those without GADAb, although further longitudinal studies are required. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00190.x, 2011).
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Affiliation(s)
| | - Hiroki Ikeda
- Center for Diabetes and Endocrinology ; Ikeda Hospital, Hyogo
| | | | | | | | | | - Jun Fujikawa
- Department of Laboratory Medicine, The Tazuke Kofukai Foundation Medical Research Institute Kitano Hospital, Osaka
| | | | | | - Hiroyuki Koshiyama
- Center for Diabetes and Endocrinology ; Diabetes and Clinical Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
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890
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Abstract
Aims/Introduction: Patients with type 1 diabetes mellitus often show a precipitous postprandial rise in blood glucose that cannot be controlled, even by intensive insulin therapy. The combined use of an α‐glucosidase inhibitor with insulin seems to be highly beneficial in such cases. Materials and Methods: We investigated the efficacy and safety of miglitol, an α‐glucosidase inhibitor, for 12 weeks in 43 type 1 diabetes patients on intensive insulin therapy. Results: Co‐administration of miglitol resulted in only a modest and temporal decrease in HbA1c level. However, it resulted in a significant reduction of plasma glucose level after breakfast (250.7 ± 102.0 mg/dL at 2 h after breakfast before treatment; 212.0 ± 95.8 mg/dL at 2 h after breakfast after treatment for 12 weeks, P = 0.01) and a significant reduction of insulin dosage (41.6 ± 17.1 U/day before treatment; 39.8 ± 17.4 U/day 12 weeks after treatment, P < 0.001). During the study period, 88.4% (38/43) of subjects experienced hypoglycemia, but all events were mild except for one case, which was considered to be moderate. No unexpected adverse events were observed during the study period. Conclusions: Co‐administration of miglitol in type 1 diabetes patients on intensive insulin therapy resulted in an improvement of postprandial hyperglycemia with the reduction of insulin dosage. Considering the importance of postprandial hyperglycemia in the onset of cardiovascular disease, the combination therapy of miglitol and insulin could be advantageous in type 1 diabetes mellitus patients.
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Affiliation(s)
- Sayaka Kubo
- Department of Medicine, Metabolism & Endocrinology
| | - Hirotaka Watada
- Department of Medicine, Metabolism & Endocrinology ; Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryuzo Kawamori
- Department of Medicine, Metabolism & Endocrinology ; Center for Therapeutic Innovations in Diabetes ; Center for Beta Cell Biology and Regeneration ; Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
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891
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Ishibashi F, Okino M, Ishibashi M, Kawasaki A, Endo N, Kosaka A, Uetake H. Corneal nerve fiber pathology in Japanese type 1 diabetic patients and its correlation with antecedent glycemic control and blood pressure. J Diabetes Investig 2014; 3:191-8. [PMID: 24843565 PMCID: PMC4020739 DOI: 10.1111/j.2040-1124.2011.00157.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aims/Introduction: Morphological changes to corneal C‐fibers in Japanese type 1 diabetic patients were visualized by corneal confocal microscopy (CCM). The effects of prior glycemic control and blood pressure on morphological parameters were clarified. Materials and Methods: Corneal nerve fibers were visualized by CCM in 38 Japanese type 1 diabetic patients (14 with and 24 without neuropathy) and 38 controls. Morphological parameters were compared and related to annual mean HbA1c, blood pressure, and serum lipid levels of previous years prior to CCM examination. Results: Compared with controls, diabetic patients had reduced corneal nerve fiber length (CNFL; 9.80 ± 0.38 vs 13.65 ± 0.88 mm/mm2; P < 0.001), reduced density (CNFD; 25.32 ± 1.04 vs 36.62 ± 2.37/mm2; P < 0.0005), lower frequency of beading (22.38 ± 0.73 vs 30.44 ± 1.03/0.1 mm; P < 0.0001), and increased tortuosity (3.13 ± 0.09 vs 1.74 ± 0.06; P < 0.0001). These changes were found in patients without neuropathy. There was no difference in nerve branches between controls and diabetic patients. The mean annual HbA1c level for the 7–10 years prior to CCM examination was an independent predictor of reduced CNFL and CNFD; HbA1c levels obtained 1–3 months and 1 year prior to CCM, as well as blood pressure 3, 5, and 6 years prior to CCM, were independent predictors of reduced beading frequency. Conclusions: Corneal confocal microscopy is a novel, noninvasive technique to evaluate morphological changes of corneal C‐fibers in type 1 diabetes. Antecedent hyperglycemia and blood pressure have different time‐dependent effects on CNFL and CNFD and the frequency of beading. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00157.x, 2011)
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892
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Hashimoto T, Kawamura T, Kashihara Y, Hirose M, Higashide T, Tsuruhara A, Fujimoto H, Noi K, Shintaku H. Factors associated with basal insulin dose in Japanese children and young adult type 1 diabetics. J Diabetes Investig 2014; 3:276-82. [PMID: 24843577 PMCID: PMC4014950 DOI: 10.1111/j.2040-1124.2011.00171.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction: The daily basal insulin doses/body weight and the daily basal insulin doses/total daily insulin doses of Japanese type 1 diabetes mellitus patients are less than those of Western type 1 diabetes mellitus patients. It is known that Western meals are richer in fat than Japanese meals. We speculated that fat intake might be associated with basal insulin dose in type 1 diabetes mellitus patients. Materials and Methods: Forty‐one outpatients with type 1 diabetes mellitus (20 males, 21 females, mean age 15.9) were enrolled. Variables investigated included: gender, SDS‐BMI, HbA1c, duration of diabetes, therapy (MDI or CSII), insulin doses and meal contents. Meal contents were recorded for 3 days using a digital camera. Correlation and multiple regression analyses were performed for all subjects and each age group. Results: The mean daily basal insulin doses/total daily insulin doses was 0.35. In the multiple regression analysis among all subjects, when daily basal insulin doses/body weight was used as a dependent variable, fat energy ratio of the meal was obtained as an entered variable (P = 0.001). This tendency was particularly strong among the patients aged 14 or above (P < 0.001, standardized coefficient β = 0.683). Conclusions: In the type 1 diabetes patients who are aged 14 or above, an association between daily basal insulin doses/body weight and fat energy ratio of meal was suggested. This may explain the aforementioned expectation of increased fat intakes making higher basal insulin doses. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00171.x, 2011)
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Affiliation(s)
- Tomomi Hashimoto
- Department of Pediatrics, Osaka City University Graduate School of Medicine
| | - Tomoyuki Kawamura
- Department of Pediatrics, Osaka City University Graduate School of Medicine
| | - Yoneo Kashihara
- Department of Pediatrics, Osaka City University Graduate School of Medicine
| | - Masakazu Hirose
- Department of Pediatrics, Osaka City University Graduate School of Medicine
| | | | - Akitoshi Tsuruhara
- Department of Pediatrics, Osaka City University Graduate School of Medicine
| | | | - Kaori Noi
- Nutrition Dietary Section, Osaka City University, Osaka
| | - Haruo Shintaku
- Department of Pediatrics, Osaka City University Graduate School of Medicine
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893
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Tsuji T, Inoue M, Yoshida Y, Fujita T, Kaino Y, Kohno T. Therapeutic approach for type 1 diabetes mellitus using the novel immunomodulator FTY720 (fingolimod) in combination with once-daily injection of insulin glargine in non-obese diabetic mice. J Diabetes Investig 2014; 3:132-7. [PMID: 24843556 PMCID: PMC4020730 DOI: 10.1111/j.2040-1124.2011.00160.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction: The therapeutic effectiveness against type 1 diabetes mellitus (DM) of the novel immunomodulator FTY720 (fingolimod), alone and in combination with insulin glargine, was examined in the non‐obese diabetic (NOD) mouse model. Materials and Methods: Female NOD mice that had developed DM spontaneously were divided into four groups: (i) an FTY720 (0.1 mg/kg, p.o., twice weekly)‐treated group; (ii) an insulin glargine (1.0 IU, s.c., once daily)‐treated group; (iii) a combination FTY720 + insulin glargine (0.1–1.0 IU, s.c., once daily)‐treated group; and (iv) a placebo (vehicle)‐treated group. Treatment was initiated at the time of onset of DM and continued for 70 days or until death. The therapeutic efficacy of FTY720, insulin glargine and FTY720 + insulin glargine was evaluated by measuring the ratio of insulin‐positive β‐cells/total islet area, the extent of islet inflammation (insulitis score), blood glucose levels, and serum C‐peptide levels. Results: Therapeutic administration of FTY720 to NOD mice with hyperglycemia (i.e. overt DM) significantly prolonged survival (P < 0.05 vs placebo). In the placebo group, all mice died within 63 days on the onset of DM; in contrast, 45% of FTY720‐treated mice survived during the observation period (up to 70 days after the onset of DM). Therapeutic administration of FTY720 in combination with insulin glargine to NOD mice with hyperglycemia further improved survival (P < 0.05) compared with either FTY720 or insulin glargine alone (i.e. 85% of FTY720 + insulin glargine‐treated mice survived to the end of the observation period). The efficacy of FTY720 in combination with insulin glargine was confirmed by histochemical, immunohistochemical and endocrinologic observations. Conclusions: Combination therapy with FTY720 plus insulin glargine is a promising candidate for the treatment of DM and may allow for a reduction in the frequency of insulin self‐injections. (J Diabetes Invest, doi:10.1111/j.2040‐1124.2011.00160.x, 2011)
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Affiliation(s)
- Takumi Tsuji
- Department of Pathological Biochemistry, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka
| | - Mariko Inoue
- Department of Pathological Biochemistry, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka
| | - Yuya Yoshida
- Department of Pathological Biochemistry, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka
| | - Tetsuro Fujita
- Research Institute for Production and Development, Kyoto
| | | | - Takeyuki Kohno
- Department of Pathological Biochemistry, Faculty of Pharmaceutical Sciences, Setsunan University, Osaka
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894
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Gómez-Rico I, Pérez-Marín M, Montoya-Castilla I. [ Type 1 Diabetes Mellitus: brief review of the main associated psychological factors]. An Pediatr (Barc) 2014; 82:e143-6. [PMID: 24809830 DOI: 10.1016/j.anpedi.2014.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/12/2014] [Accepted: 04/02/2014] [Indexed: 11/20/2022] Open
Abstract
Type 1 Diabetes Mellitus (T1DM) is a widespread chronic disease among children and adolescents. Diagnosis and evolution usually involves a significant burden on the patient, and their families must change various aspects of their lifestyle to fulfill the demands of treatment. This study aims to identify the main psychological, family, and adjustment to illness features of children and adolescents diagnosed with DM1 and, in particular to highlight the associated psychopathological factors. The methodology involved a systematic literature search in the main scientific databases. Due to the biopsychosocial impact of DM1 usually assumed in the life of the child and family, and how it may compromise the quality of life and emotional well-being of both, different studies have agreed on the importance of identifying the set of psychological factors involved in healthy adjustment to illness in the child and adolescent with DM1.
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Affiliation(s)
- I Gómez-Rico
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Valencia, España
| | - M Pérez-Marín
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Valencia, España.
| | - I Montoya-Castilla
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Valencia, España
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895
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Whitfield-Larry F, Felton J, Buse J, Su MA. Myeloid-derived suppressor cells are increased in frequency but not maximally suppressive in peripheral blood of Type 1 Diabetes Mellitus patients. Clin Immunol 2014; 153:156-64. [PMID: 24769355 DOI: 10.1016/j.clim.2014.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/08/2014] [Accepted: 04/11/2014] [Indexed: 12/29/2022]
Abstract
Type 1 Diabetes Mellitus (T1D) results from the destruction of insulin-producing beta cells in the pancreas by autoreactive T cells. Myeloid derived suppressor cells (MDSCs) are a recently identified immune cell subset that down-regulate T cells. Whether defects in MDSC numbers or function may contribute to T1D pathogenesis is not known. We report here that MDSCs are unexpectedly enriched in peripheral blood of both mice and patients with autoimmune diabetes. Peripheral blood MDSCs from T1D patients suppressed T cell proliferation in a contact-dependent manner; however, suppressive function could be enhanced with in vitro cytokine induction. These findings suggest that native T1D MDSCs are not maximally suppressive and that strategies to promote MDSC suppressive function may be effective in preventing or treating T1D.
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896
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Qiu YH, Deng FY, Li MJ, Lei SF. Identification of novel risk genes associated with type 1 diabetes mellitus using a genome-wide gene-based association analysis. J Diabetes Investig 2014; 5:649-56. [PMID: 25422764 PMCID: PMC4234227 DOI: 10.1111/jdi.12228] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/23/2014] [Accepted: 02/21/2014] [Indexed: 01/05/2023] Open
Abstract
Aims/Introduction Type 1 diabetes mellitus is a serious disorder characterized by destruction of pancreatic β-cells, culminating in absolute insulin deficiency. Genetic factors contribute to the susceptibility of type 1 diabetes mellitus. The aim of the present study was to identify more susceptibility genes of type 1 diabetes mellitus. Materials and Methods We carried out an initial gene-based genome-wide association study in a total of 4,075 type 1 diabetes mellitus cases and 2,604 controls by using the Gene-based Association Test using Extended Simes procedure. Furthermore, we carried out replication studies, differential expression analysis and functional annotation clustering analysis to support the significance of the identified susceptibility genes. Results We identified 452 genes associated with type 1 diabetes mellitus, even after adapting the genome-wide threshold for significance (P < 9.05E-04). Among these genes, 171 were newly identified for type 1 diabetes mellitus, which were ignored in single-nucleotide polymorphism-based association analysis and were not previously reported. We found that 53 genes have supportive evidence from replication studies and/or differential expression studies. In particular, seven genes including four non-human leukocyte antigen (HLA) genes (RASIP1, STRN4, BCAR1 and MYL2) are replicated in at least one independent population and also differentially expressed in peripheral blood mononuclear cells or monocytes. Furthermore, the associated genes tend to enrich in immune-related pathways or Gene Ontology project terms. Conclusions The present results suggest the high power of gene-based association analysis in detecting disease-susceptibility genes. Our findings provide more insights into the genetic basis of type 1 diabetes mellitus.
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Affiliation(s)
- Ying-Hua Qiu
- Center for Genetic Epidemiology and Genomics, School of Public Health, Soochow University Suzhou, Jiangsu, China ; Department of Epidemiology, School of Public Health, Soochow University Suzhou, Jiangsu, China
| | - Fei-Yan Deng
- Center for Genetic Epidemiology and Genomics, School of Public Health, Soochow University Suzhou, Jiangsu, China ; Department of Epidemiology, School of Public Health, Soochow University Suzhou, Jiangsu, China
| | - Min-Jing Li
- Center for Genetic Epidemiology and Genomics, School of Public Health, Soochow University Suzhou, Jiangsu, China ; Department of Epidemiology, School of Public Health, Soochow University Suzhou, Jiangsu, China
| | - Shu-Feng Lei
- Center for Genetic Epidemiology and Genomics, School of Public Health, Soochow University Suzhou, Jiangsu, China ; Department of Epidemiology, School of Public Health, Soochow University Suzhou, Jiangsu, China
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897
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Sundberg F, Augustsson M, Forsander G, Cederholm U, Axelsen M. Children under the age of seven with diabetes are increasing their cardiovascular risk by their food choices. Acta Paediatr 2014; 103:404-10. [PMID: 24325766 DOI: 10.1111/apa.12533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/14/2013] [Accepted: 12/05/2013] [Indexed: 01/02/2023]
Abstract
AIM Early-onset diabetes increases the risk of cardiovascular disease. This study examined the eating habits of children under 7 years of age with diabetes to see whether their diet increased that risk even further. METHODS A total of 24 children with type 1 diabetes (mean age 4.5 years) and 27 healthy controls (mean age 4.6 years) participated in this cross-sectional study. Food intake was assessed by two 4-day food records. RESULTS Children with type 1 diabetes had a higher energy intake from protein (18 vs 15%, p < 0.05) and fat (35 vs 31%, p < 0.05) but lower intake from carbohydrates (47 vs 54%, p < 0.05), than the healthy control group. Intake of saturated fat was higher than recommended in both groups, and consumption of fruit and vegetables was lower than recommended, but similar, in both the diabetes and control groups (191 vs 207 g per day). Total intake of fat was negatively correlated with intake of fruit and vegetables (r = -0.74 p < 0.05) in children with type 1 diabetes. CONCLUSION Children under 7 years of age with type 1 diabetes eat too much saturated fat and not enough fruit and vegetables. Their diet should be improved to reduce their cardiovascular risk.
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Affiliation(s)
- F. Sundberg
- Diabetes Unit; Department of Paediatrics; The Queen Silvia Children's Hospital/Sahlgrenska University Hospital; Gothenburg Sweden
| | - M Augustsson
- Department of Internal Medicine and Clinical Nutrition; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - G Forsander
- Diabetes Unit; Department of Paediatrics; The Queen Silvia Children's Hospital/Sahlgrenska University Hospital; Gothenburg Sweden
| | - U Cederholm
- Department of Internal Medicine and Clinical Nutrition; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - M Axelsen
- Department of Internal Medicine and Clinical Nutrition; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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898
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Marek-Trzonkowska N, Myśliwiec M, Dobyszuk A, Grabowska M, Derkowska I, Juścińska J, Owczuk R, Szadkowska A, Witkowski P, Młynarski W, Jarosz-Chobot P, Bossowski A, Siebert J, Trzonkowski P. Therapy of type 1 diabetes with CD4(+)CD25(high)CD127-regulatory T cells prolongs survival of pancreatic islets - results of one year follow-up. Clin Immunol 2014; 153:23-30. [PMID: 24704576 DOI: 10.1016/j.clim.2014.03.016] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 03/25/2014] [Indexed: 12/13/2022]
Abstract
It is hypothesized that CD4(+)CD25(+)FoxP3(+) regulatory T cells (Tregs) can prevent destruction of pancreatic islets protecting from type 1 diabetes (DM1). Here we present results of one year follow-up of 12 DM1 children treated with autologous expanded ex vivo Tregs. Patients received either a single or double Tregs infusion up to the total dose of 30×10(6)/kg. No severe adverse effects were observed. The treatment did not impair post-immunization antibody responses. Tregs infusion was followed by increase in Tregs number in peripheral blood. Most of the patients responded to the therapy with increase in C-peptide levels (8/12 and 4/6 after the first and the second dose, respectively). Tregs administration resulted also in lower requirement for exogenous insulin (8/12 treated patients versus 2/10 untreated controls in remission) with two children completely insulin independent at one year. Repetitive administration of Tregs is safe and can prolong survival of β-cells in DM1 (registration: ISRCTN06128462).
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Affiliation(s)
| | - Małgorzata Myśliwiec
- Department of Pediatric Diabetology and Endocrinology, Medical University of Gdańsk, Dębinki 7, 80-210 Gdańsk, Poland
| | - Anita Dobyszuk
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Dębinki 7, 80-210 Gdańsk, Poland
| | - Marcelina Grabowska
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Dębinki 7, 80-210 Gdańsk, Poland
| | - Ilona Derkowska
- Department of Pediatric Diabetology and Endocrinology, Medical University of Gdańsk, Dębinki 7, 80-210 Gdańsk, Poland
| | - Jolanta Juścińska
- Regional Center of Blood Donation and Treatment, Hoene-Wrońskiego, 180-210, Gdańsk, Poland
| | - Radosław Owczuk
- Department of Anesthesiology and Critical Care, Medical University of Gdańsk, Dębinki 7, 80-210 Gdańsk, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Sporna 36/50, 91-738 Łódź, Poland
| | - Piotr Witkowski
- Department of Surgery, Section of Transplantation, The University of Chicago, 5841 S. Maryland Ave. MC5027, Chicago, 60637 IL, USA
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Sporna 36/50, 91-738 Łódź, Poland
| | - Przemysława Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland
| | - Artur Bossowski
- Department of Pediatrics Endocrinology and Diabetology, Medical University of Białystok, Jana Kilińskiego 1, 15-089 Białystok, Poland
| | - Janusz Siebert
- Department of Family Medicine, Medical University of Gdańsk, Dębinki 2, 80-210 Gdańsk, Poland
| | - Piotr Trzonkowski
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Dębinki 7, 80-210 Gdańsk, Poland.
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899
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Cox ED, Fritz KA, Hansen KW, Brown RL, Rajamanickam V, Wiles KE, Fate BH, Young HN, Moreno MA. Development and validation of PRISM: a survey tool to identify diabetes self-management barriers. Diabetes Res Clin Pract 2014; 104:126-35. [PMID: 24552680 PMCID: PMC3992923 DOI: 10.1016/j.diabres.2014.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 12/31/2022]
Abstract
AIMS Although most children with type 1 diabetes do not achieve optimal glycemic control, no systematic method exists to identify and address self-management barriers. This study develops and validates PRISM (Problem Recognition in Illness Self-Management), a survey-based tool for efficiently identifying self-management barriers experienced by children/adolescents with diabetes and their parents. METHODS Adolescents 13 years and older and parents of children 8 years and older visiting for routine diabetes management (n=425) were surveyed about self-management barriers. HbA1c was abstracted from the electronic health record. To develop PRISM, exploratory and confirmatory factor analyses were used. To assess validity, the association of PRISM scores with HbA1c was examined using linear regression. RESULTS Factor analyses of adolescent and parent data yielded well-fitting models of self-management barriers, reflecting the following domains: (1) Understanding and Organizing Care, (2) Regimen Pain and Bother, (3) Denial of Disease and Consequences, and (4) Healthcare Team, (5) Family, or (6) Peer Interactions. All models exhibited good fit, with χ(2) ratios<2.21, root mean square errors of approximation<0.09, Confirmatory Fit Indices and Tucker-Lewis Indices both >0.92, and weighted root mean square residuals<1.71. Greater PRISM barrier scores were significantly associated with higher HbA1cs. CONCLUSIONS Our findings suggest at least six different domains exist within self-management barriers, nearly all of which are significantly related to HbA1c. PRISM could be used in clinical practice to identify each child and family's unique self-management barriers, allowing existing self-management resources to be tailored to the family's barriers, ultimately improving effectiveness of such services.
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Affiliation(s)
- Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States.
| | - Katie A Fritz
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
| | - Kristofer W Hansen
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
| | - Roger L Brown
- Department of Research Design & Statistics, University of Wisconsin School of Nursing, Madison, WI 53792, United States
| | - Victoria Rajamanickam
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
| | - Kaelyn E Wiles
- Department of Sociology, University of Wisconsin, Madison, WI 53792, United States
| | - Bryan H Fate
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
| | - Henry N Young
- School of Pharmacy, University of Wisconsin, Madison, WI 53792, United States
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
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900
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Qin WH, Wang HX, Qiu JL, Huang XB, Huang Y, Wu NR, Liang HS. A meta-analysis of association of vitamin D receptor BsmI gene polymorphism with the risk of type 1 diabetes mellitus. J Recept Signal Transduct Res 2014; 34:372-7. [PMID: 24665917 DOI: 10.3109/10799893.2014.903420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Association between vitamin D receptor (VDR) BsmI (rs1544410) gene polymorphism and the risk of type 1 diabetes mellitus (T1DM) from the published reports are still conflicting. This study was conducted to evaluate the relationship between VDR BsmI gene polymorphism and the risk of T1DM using meta-analysis method. The association studies were identified from PubMed, and Cochrane Library on 1 December 2013, and eligible investigations were included and synthesized using meta-analysis method. Twenty-three reports were recruited into this meta-analysis for the association of VDR BsmI gene polymorphism with T1DM susceptibility. In overall populations, bb genotype was associated with T1DM, but the B allele and BB genotype were not. In Asians and Latino population, B allele and bb genotype were associated with TIDM risk, but BB genotype was not. In Caucasians, VDR BsmI gene polymorphism was not associated with the T1DM risk. In Africans, B allele and BB genotype were associated with T1DM risk, but the bb genotype was not. However, the sample size for Latino population and Africans was small. In conclusion, VDR BsmI B allele, bb genotype was associated with T1DM risk in Asians, and bb genotype was associated with T1DM risk in overall populations. However, more studies should be conducted to confirm it.
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Affiliation(s)
- Wei-Hong Qin
- Department of Endocrinology, People's Hospital of Beihai , Beihai , China
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