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Koufakis T, Patoulias D, Zografou I, Papanas N, Popovic DS. Drawing lines in the sand: The growing threat of obesity in type 1 diabetes. World J Diabetes 2024; 15:823-827. [PMID: 38766422 PMCID: PMC11099370 DOI: 10.4239/wjd.v15.i5.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 05/10/2024] Open
Abstract
In this editorial, we comment on the article by Zeng et al published in the recent issue of the World Journal of Diabetes in 2024. We focus on the epidemiological, pathophysiological, and clinical interplay between obesity and type 1 diabetes mellitus (T1DM). Overweight and obesity represent a growing threat for modern societies and people with T1DM could not be an exception to this rule. Chronic exogenous insulin administration, genetic and epigenetic factors, and psy-chosocial and behavioral parameters, along with the modern way of life that incorporates unhealthy eating patterns and physical inactivity, set the stage for the increasing obesity rates in T1DM. As our knowledge of the underlying mechanisms that lead to the development of obesity and hyperglycemia expands, it becomes clear that there are overlap zones in the pathophysiology of the two main types of diabetes. Stereotypes regarding strict dividing lines between "autoimmune" and "metabolic" phenotypes increase the risk of trapping physicians into ineffective therapeutic approaches, instead of individualized diabetes care. In this context, the use of adjuncts to insulin therapy that have the potential to alleviate cardiorenal risk and decrease body weight can reduce the burden of obesity in patients with T1DM.
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Affiliation(s)
- Theocharis Koufakis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Dimitrios Patoulias
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Ioanna Zografou
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Djordje S Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad 21000, Serbia
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2
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Maddaloni E, Tuccinardi D. Obesity in type 1 diabetes: an overlooked immune-metabolic issue. Expert Rev Endocrinol Metab 2024:1-3. [PMID: 38709217 DOI: 10.1080/17446651.2024.2351868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Dario Tuccinardi
- Research Unit of Endocrinology and Diabetology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Department of Endocrinology and Diabetes, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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3
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Raletsena MV, Pooe OJ, Mongalo NI. A Systematic Review of Curtisia dentata Endemic to South Africa: Phytochemistry, Pharmacology, and Toxicology. Life (Basel) 2023; 13:2159. [PMID: 38004299 PMCID: PMC10672514 DOI: 10.3390/life13112159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
The use of traditional medicine in treating a variety of both human and animal infections is ancient and still relevant. This is due to the resistance exhibited by most pathogenic microbial stains to currently-used antibiotics. The current work reports the phytochemistry, ethno-medicinal uses, toxicology, and most important pharmacological activities that validate the use of the plant species in African traditional medicine. Curtisia dendata is used in the treatment of many human and animal infections, including diarrhea, skin and related conditions, sexually transmitted infections, cancer, and a variety of ethno-veterinary infections. Pharmacologically, the plant species exhibited potent antimicrobial activity against a variety of pathogens. Further, both extracts and compounds isolated from the plant species exhibited potent antioxidant, anticancer, anti-parasitic, anti-inflammatory, and other important biological activities. Phytochemically, the plant species possess a variety of compounds, particularly triterpenes, that may well explain the various pharmacological activities of the plant species. The toxicological parameters, antimicrobial activities against microorganisms related to sexually transmitted infections, anti-diabetic effects, and inflammatory properties of the plant species are not well studied and still need to be explored. The biological activities observed validate the use of the plant species in African traditional medicine, particularly in the treatment of pulmonary infections associated with Mycobacterium species, and may well be due to the presence of triterpenes prevalent in the leaves.
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Affiliation(s)
- Maropeng Vellry Raletsena
- College of Agriculture and Environmental Sciences Laboratories, University of South Africa, Private Bag X06, Florida 0610, South Africa;
| | - Ofentse Jacob Pooe
- Department of Biochemistry, School of Life Sciences, University of KwaZulu Natal, Private Bag X54001, Durban 4000, South Africa;
| | - Nkoana Ishmael Mongalo
- College of Agriculture and Environmental Sciences Laboratories, University of South Africa, Private Bag X06, Florida 0610, South Africa;
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4
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Filho OCDSB, Peres WAF, Spinelli RR, Peniche BX, Silverio RN, da Costa VM, Luescher JL, Ribeiro SML, Vicente BM, Cunha LVSD, Padilha PDC. Evaluation of the dietary inflammatory index in children and adolescents with type 1 diabetes mellitus and its relationship with nutritional status and metabolic control. Nutrition 2023; 113:112082. [PMID: 37321044 DOI: 10.1016/j.nut.2023.112082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the association of the dietary inflammatory index (DII) with the nutritional status and metabolic control of children and adolescents with type 1 diabetes mellitus. METHODS This was a cross-sectional study that examined data of children and adolescents ages 7 to 16 y diagnosed with type 1 diabetes mellitus. Dietary intake was assessed using a 24-h dietary recall, from which the DII was calculated. The outcomes were body mass index, lipid profiles (low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol), and glycated hemoglobin. The DII was evaluated in tertiles and in a continuous way. Multiple linear regression was adopted in the analysis, with P < 0.05 considered significant. RESULTS Overall, 120 children and adolescents with a mean age of 11.7 (± 2.8) y were included, 53.3% (n = 64) of whom were girls. Excess weight was present in 31.7% participants (n = 38). The average DII was +0.25, ranging from -1.11 to +2.67. Higher values of selenium (P = 0.011), zinc (P = 0.001), fiber (P < 0.001), and other micronutrients were observed in the first tertile of the DII (diet with more antiinflammatory potential). The DII appeared as a predictor of body mass index (P = 0.002; β = 0.23; 95% confidence interval [CI], 0.39-1.75) and non-high-density lipoprotein cholesterol (P = 0.034; β = 0.19; 95% CI, -13.5 to 0.55). There was a tendency for DII to be associated with glycemic control (P = 0.09; β = 0.19; 95% CI, -0.04 to 0.51). CONCLUSIONS The inflammatory potential of the diet was associated with increased body mass index and aspects related to metabolic control in children and adolescents with type 1 diabetes mellitus.
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Affiliation(s)
| | | | - Renata Ribeiro Spinelli
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil
| | - Beatriz Xavier Peniche
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil
| | | | - Veronica Medeiros da Costa
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil
| | - Jorge Luiz Luescher
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil
| | | | | | | | - Patricia de Carvalho Padilha
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil; Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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5
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Ogrotis I, Koufakis T, Kotsa K. Changes in the Global Epidemiology of Type 1 Diabetes in an Evolving Landscape of Environmental Factors: Causes, Challenges, and Opportunities. Medicina (B Aires) 2023; 59:medicina59040668. [PMID: 37109626 PMCID: PMC10141720 DOI: 10.3390/medicina59040668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
The worldwide incidence of type 1 diabetes mellitus (T1DM) has increased in recent decades. The reasons behind this phenomenon are not yet fully understood. Early life infections, prenatal and perinatal factors, and diet composition have been associated with the triggering of autoimmunity and the risk of presentation of T1DM. However, the rapid increase in new cases of the disease raises the hypothesis that lifestyle factors, which have traditionally been associated with type 2 diabetes, such as obesity and unhealthy eating patterns could also play a role in the genesis of autoimmune diabetes. This article aims to highlight the changing epidemiology of T1DM and the importance of properly recognizing the environmental factors behind it, as well as the connections with the pathogenesis of the disorder and the need to prevent or delay T1DM and its long-term complications.
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Affiliation(s)
- Ioannis Ogrotis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Theocharis Koufakis
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-231-099-4706
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Du C, Whiddett RO, Buckle I, Chen C, Forbes JM, Fotheringham AK. Advanced Glycation End Products and Inflammation in Type 1 Diabetes Development. Cells 2022; 11:3503. [PMID: 36359899 PMCID: PMC9657002 DOI: 10.3390/cells11213503] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 08/08/2023] Open
Abstract
Type 1 diabetes (T1D) is an autoimmune disease in which the β-cells of the pancreas are attacked by the host's immune system, ultimately resulting in hyperglycemia. It is a complex multifactorial disease postulated to result from a combination of genetic and environmental factors. In parallel with increasing prevalence of T1D in genetically stable populations, highlighting an environmental component, consumption of advanced glycation end products (AGEs) commonly found in in Western diets has increased significantly over the past decades. AGEs can bind to cell surface receptors including the receptor for advanced glycation end products (RAGE). RAGE has proinflammatory roles including in host-pathogen defense, thereby influencing immune cell behavior and can activate and cause proliferation of immune cells such as islet infiltrating CD8+ and CD4+ T cells and suppress the activity of T regulatory cells, contributing to β-cell injury and hyperglycemia. Insights from studies of individuals at risk of T1D have demonstrated that progression to symptomatic onset and diagnosis can vary, ranging from months to years, providing a window of opportunity for prevention strategies. Interaction between AGEs and RAGE is believed to be a major environmental risk factor for T1D and targeting the AGE-RAGE axis may act as a potential therapeutic strategy for T1D prevention.
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Affiliation(s)
- Chenping Du
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
| | - Rani O. Whiddett
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
| | - Irina Buckle
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
- Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
| | - Chen Chen
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
| | - Josephine M. Forbes
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
- Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg 3084, Australia
| | - Amelia K. Fotheringham
- Glycation and Diabetes Complications Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba 4102, Australia
- Faculty of Medicine, The University of Queensland, St Lucia 4072, Australia
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7
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Mørk FB, Madsen JOB, Pilgaard KA, Jensen AK, Klakk H, Tarp J, Bugge A, Heidemann M, Van Hall G, Pociot F, Wedderkopp N, Johannesen J. The metabolic syndrome is frequent in children and adolescents with type 1 diabetes compared to healthy controls. Pediatr Diabetes 2022; 23:1064-1072. [PMID: 35678773 DOI: 10.1111/pedi.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE There is a rise in overweight and obesity among children and adolescents with type 1 diabetes (T1D) in parallel with the rise in the metabolic syndrome (MetS) among children and adolescents. The aim of the study was to describe the prevalence and characteristics of MetS in children and adolescents with T1D compared to their healthy counterparts. RESEARCH DESIGN AND METHODS The study includes two Danish cohorts; (i) the Copenhagen cross sectional cohort 2016 of 277 children and adolescents with T1D that attend the pediatric outpatient clinic at a large hospital in greater Copenhagen and (ii) the CHAMPS-study DK which is a population-based cohort study of Danish children and adolescents (control cohort). Participants were categorized to have MetS if at least two of the following criteria were met: (i) systolic and/or diastolic blood pressure ≥ 90th percentile, (ii) waist circumference ≥90th percentile, and (iii) triglyceride ≥90th percentile and/or HDL ≤10th percentile. RESULTS The prevalence of children with Mets in the T1D cohort was higher than in the control cohort (p = 0.002). Moreover, participants with T1D had MetS at a lower level of BMI (p < 0.001) and waist circumference (p < 0.001) than participants with MetS from the control cohort (z-scores = 0.90 and 1.51). Participants with MetS were younger than the other T1D participants (median 12.8 [9.9,14.8] vs. median 14.6 [11.2,16.9] years, p = 0.006). CONCLUSIONS Children and adolescents with T1D have an increased risk of MetS compared to healthy controls and clinicians and caretakers should consider early prevention and health promotion strategies.
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Affiliation(s)
- Freja Barrett Mørk
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Jens Otto Broby Madsen
- Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Kasper Ascanius Pilgaard
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Heidi Klakk
- Center for Applied Health Science, University College South, Haderslev, Denmark.,Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Jakob Tarp
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Anna Bugge
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, University College Copenhagen, Copenhagen, Denmark
| | - Malene Heidemann
- Odense University Hospital, Hans Christian Andersen Children's Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Gerrit Van Hall
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Clinical Metabolomics Core Facility, Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Flemming Pociot
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Wedderkopp
- Odense Patient Data Explorative Network, Institute of Clinical Research OPEN, Odense University Hospital, Odense, Denmark.,Pediatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Johannesen
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Paediatrics and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Wang SC, Liao JY. Epidemiologic Implication of the Association between Herpes Simplex Virus Infection and the Risk of Type 1 Diabetes Mellitus: A Nationwide Case-Control Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137832. [PMID: 35805493 PMCID: PMC9265894 DOI: 10.3390/ijerph19137832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023]
Abstract
Enterovirus infection is a known risk factor for type 1 diabetes (T1DM). Whether infection with other viruses induces T1DM remains undetermined. This study investigated the association between human herpesvirus (HHV) infection and the development of T1DM, using the data from Taiwan’s National Health Insurance Research Database. Patients with T1DM and age- and sex-matched controls were included. Subjects with HHV infection were subgrouped into those with histories of varicella-zoster virus, herpes simplex virus (HSV), Epstein-Barr virus, and human cytomegalovirus infections. The odds ratio of the risk of T1DM was calculated using a multivariable conditional logistic regression model. Atopic diseases, autoimmune thyroid diseases, and history of enterovirus infection served as adjusted comorbidities. Our findings suggested a significant association between HSV infection and the risk of T1DM (adjusted odds ratio: 1.21; 95% CI: 1.01–1.47, p = 0.048), while infection with other HHVs was not. The result of HSV infection remained significant when subjects were restricted to age ≤ 18 years (adjusted odds ratio: 1.35; 95% CI: 1.08–1.70, p = 0.010). We found a history of HSV infection might be an independent predictive risk factor for T1DM. This could be potentially helpful to the practice in public health.
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Affiliation(s)
- Shao-Chang Wang
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan;
| | - Jung-Yu Liao
- Department of Public Health, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 2106)
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9
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Environmental Factors and the Risk of Developing Type 1 Diabetes-Old Disease and New Data. BIOLOGY 2022; 11:biology11040608. [PMID: 35453807 PMCID: PMC9027552 DOI: 10.3390/biology11040608] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/10/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022]
Abstract
Simple Summary Despite many studies, the risk factors of type 1 diabetes (T1DM) in children and adolescents are still not fully understood and remain a big challenge. Therefore, an extensive online search for scientific research on factors related to diabetes has been performed for the identification of new factors of unexplained etiology. A better understanding of the role of viral, bacterial, and yeast-like fungi infections related to the risk of T1DM in children and adolescents and the identification of new risk factors, especially those spread by the droplet route, is of great importance for people and families with diabetes. Abstract The incidence of type 1 diabetes (T1D) is increasing worldwide. The onset of T1D usually occurs in childhood and is caused by the selective destruction of insulin-producing pancreatic islet cells (β-cells) by autoreactive T cells, leading to insulin deficiency. Despite advanced research and enormous progress in medicine, the causes of T1D are still not fully understood. Therefore, an extensive online search for scientific research on environmental factors associated with diabetes and the identification of new factors of unexplained etiology has been carried out using the PubMed, Cochrane, and Embase databases. The search results were limited to the past 11 years of research and discovered 143 manuscripts published between 2011 and 2022. Additionally, 21 manuscripts from between 2000 and 2010 and 3 manuscripts from 1974 to 2000 were referenced for historical reference as the first studies showcasing a certain phenomenon or mechanism. More and more scientists are inclined to believe that environmental factors are responsible for the increased incidence of diabetes. Research results show that higher T1D incidence is associated with vitamin D deficiency, a colder climate, and pollution of the environment, as well as the influence of viral, bacterial, and yeast-like fungi infections. The key viral infections affecting the risk of developing T1DM are rubella virus, mumps virus, Coxsackie virus, cytomegalovirus, and enterovirus. Since 2020, i.e., from the beginning of the COVID-19 pandemic, more and more studies have been looking for a link between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and diabetes development. A better understanding of the role of viral, bacterial, and yeast-like fungi infections related to the risk of T1DM in children and adolescents and the identification of new risk factors, especially those spread by the droplet route, is of great importance for people and families with diabetes.
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Ciężki S, Kurpiewska E, Bossowski A, Głowińska-Olszewska B. Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children - From Disease Pathogenesis to Complications. Front Endocrinol (Lausanne) 2022; 13:890833. [PMID: 35784568 PMCID: PMC9243381 DOI: 10.3389/fendo.2022.890833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children's population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.
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11
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Zheng Y, Rostami Haji Abadi M, Gough J, Johnston JJD, Nour M, Kontulainen S. Higher Body Fat in Children and Adolescents With Type 1 Diabetes-A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:911061. [PMID: 35813369 PMCID: PMC9263393 DOI: 10.3389/fped.2022.911061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Higher prevalence of overweight and obesity in children and adolescents with type 1 diabetes (T1D) suggests alterations are required in body composition. However, differences in body composition between children with T1D and typically developing children (TDC) have not been synthesized using meta-analysis. Therefore, we conducted a systematic review and meta-analysis to compare body composition between children with T1D and TDC, and to explore the role of disease and non-disease related factors in potential body composition differences. METHODS Studies were performed comparing dual-energy x-ray absorptiometry-acquired total body fat and lean mass, absolute (kg) and relative (%) values, between children with T1D and TDC. We reported mean differences with 95% confidence intervals (CI) from meta-analysis and relative between-group %-differences. We used meta-regression to explore the role of sex, age, height, body mass, body mass index, Hemoglobin A1c, age of onset, disease duration, and insulin dosage in the potential body composition differences between children with T1D and TDC, and subgroup analysis to explore the role of geographic regions (p < 0.05). RESULTS We included 24 studies (1,017 children with T1D, 1,045 TDC) in the meta-analysis. Children with T1D had 1.2 kg more fat mass (kg) (95%CI 0.3 to 2.1; %-difference = 9.3%), 2.3% higher body fat % (0.3-4.4; 9.0%), but not in lean mass outcomes. Age of onset (β = -2.3, -3.5 to -1.0) and insulin dosage (18.0, 3.5-32.6) were negatively and positively associated with body fat % mean difference, respectively. Subgroup analysis suggested differences among geographic regions in body fat % (p < 0.05), with greater differences in body fat % from Europe and the Middle East. CONCLUSION This meta-analysis indicated 9% higher body fat in children with T1D. Earlier diabetes onset and higher daily insulin dosage were associated with body fat % difference between children with T1D and TDC. Children with T1D from Europe and the Middle East may be more likely to have higher body fat %. More attention in diabetes research and care toward body composition in children with T1D is needed to prevent the early development of higher body fat, and to minimize the cardiovascular disease risk and skeletal deficits associated with higher body fat.
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Affiliation(s)
- Yuwen Zheng
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Jonathan Gough
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - James J D Johnston
- College of Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - Munier Nour
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Saija Kontulainen
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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12
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Valente F, Valente T, Crispim F, Bittencourt CS, Piveta VM, Moises RCMS, de Sá JR, Dib SA. Parents' cardiovascular risk factors are related to overweight and obesity in young Brazilians with type 1 diabetes. J Diabetes Complications 2022; 36:108082. [PMID: 34865986 DOI: 10.1016/j.jdiacomp.2021.108082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/20/2022]
Abstract
AIM To identify family background characteristics and cardiovascular disease (CVD) risk factors linked to overweight and obesity in Brazilian with type 1 diabetes (T1D). METHODS We performed cross-sectional anthropometric and laboratory analyses in young individuals with T1D. RESULTS Among 181 participants, 87 were women and 94 were men (64%/78% normal weight, 27%/15% overweight and 9%/7% obese). Obese men were older; were more likely to be Black; had higher triglyceride levels and diastolic blood pressure (BP), lower estimated glucose disposal rate (eGDR) and higher prevalence of first-degree relatives (FDR) with hypertension and early CVD. Overweight and obese women were more likely to have lower eGDR, and obese women were more likely to have FDR with obesity. CONCLUSION One third of young people with T1D were overweight or obese. Excess weight was associated with family history (FH) of obesity for women and FH of early CVD or hypertension for men. BMI was related to decreased insulin sensitivity in both genders, but only men with T1D had metabolic impairment. Our data highlight the importance of considering family background in individuals with T1D.
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Affiliation(s)
- Fernando Valente
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil.
| | - Tatiana Valente
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
| | - Felipe Crispim
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
| | | | - Valdecira Maria Piveta
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
| | | | - João Roberto de Sá
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
| | - Sérgio Atala Dib
- Diabetes Centre of Universidade Federal de São Paulo, Escola Paulista de Medicina, Brazil
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13
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Flint SA, Gunn AJ, Hofman PL, Cutfield WS, Han DY, Mouat F, Willis J, Jefferies CA. Evidence of a plateau in the incidence of type 1 diabetes in children 0-4 years of age from a regional pediatric diabetes center; Auckland, New Zealand: 1977-2019. Pediatr Diabetes 2021; 22:854-860. [PMID: 34018288 DOI: 10.1111/pedi.13236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/28/2021] [Accepted: 04/29/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the incidence of new onset type 1 diabetes in children aged 0-14 years from 1977 to 2019 in Auckland, New Zealand. RESEARCH DESIGN AND METHODS A cohort study of children with type 1 diabetes aged 0-14 years (n = 1688; 50.4% male) managed by the regional diabetes service between 1977 and 2019. Incidence rates were estimated using census data. RESULTS The incidence of type 1 diabetes increased by 2.9%/year from 1977 to 2006 (95% confidence interval [CI] 2.13% - 3.48%). Although there was no significant change from 2006 to 2019 (-0.3%/year, 95% CI -1.62% - 1.08%), there was a dramatic fall from 1976 to 2018 in the proportion of New Zealand Europeans, from 69.9 to 33.9%. New Zealand Europeans had the highest incidence (23.3/100,000, 95% CI 20.6-26.1) compared to Māori (8.3/100,000, 95% CI 6.3-10.2), Pasifika (8.6/100,000, 95% CI 6.9-10.4) and other (6.4/100,000, 95% CI 4.7-8.0). All groups showed an overall increase in incidence over time, Māori 4.4%/year, Pasifika 3.7%, compared to New Zealand European 2.7%, and other 2.1%. Incidence increased consistently in 5-9 and 10-14 year olds (2.0% and 2.2%/year, respectively). By contrast, whereas 0-4 year olds showed an increase of 4.6%/year from 1977 to 2003 (p < 0.01), there was no change from 2003 to 2019 (p = 0.2). CONCLUSION There has been a plateau in the incidence of type 1 diabetes in children 0-4 years of age in the Auckland region since 2003, but not older children. The apparent plateau in the overall incidence of new onset type 1 diabetes in children 0-14 years since 2006 was mediated by substantial changes in the ethnic makeup of the Auckland region.
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Affiliation(s)
- Samuel A Flint
- Auckland Medical School, University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatric Endocrinology and Diabetes, Starship Children's Health, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatric Endocrinology and Diabetes, Starship Children's Health, Auckland, New Zealand
| | - Dug Yeo Han
- Department of Paediatric Endocrinology and Diabetes, Starship Children's Health, Auckland, New Zealand
| | - Fran Mouat
- Department of Paediatric Endocrinology and Diabetes, Starship Children's Health, Auckland, New Zealand
| | - Jinny Willis
- New Zealand Nurses Organisation, Christchurch, New Zealand
| | - Craig A Jefferies
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatric Endocrinology and Diabetes, Starship Children's Health, Auckland, New Zealand
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14
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Serdarova M, Dimova R, Chakarova N, Grozeva G, Todorova A, Tankova T. Relationship between cardiac autonomic neuropathy and cardio-metabolic risk profile in adults with type 1 diabetes. Diabetes Res Clin Pract 2021; 174:108721. [PMID: 33640411 DOI: 10.1016/j.diabres.2021.108721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
AIM The present study aims to determine the prevalence and association of cardiac autonomic neuropathy (CAN) with some traditional cardio-metabolic risk factors in adults with type 1 diabetes (T1D). MATERIAL AND METHODS 235 adults with T1D, divided into three groups according to diabetes duration, were recruited in this cross-sectional study from May 2017 till December 2018. Anthropometric parameters and blood pressure were measured. Lipids, liver enzymes, uric acid, creatinine, HbA1c and high sensitive C-reactive protein (hsCRP) were measured at fasting. Albumin/creatinine ratio (ACR) was measured in a first spot urine sample. Body composition was evaluated using bio-impedance analysis, Inbody720 (Biospace, USA). Advanced glycation end products (AGEs) were assessed by autofluorescence method, AGE Reader (Diagnoptics, The Netherlands). CAN was assessed by ANX-3.0 monitoring technology (ANSAR Medical Technologies, Inc., Philadelphia, PA), applying standard clinical tests. 2005 IDF and 2009 JIS definitions were used to define Metabolic Syndrome (MetS). RESULTS The prevalence of CAN was 23% and increased with diabetes duration. Sympathetic activity was independently related to age, albumin/creatinine ratio (ACR) and total body fat mass, and parasympathetic activity - to age and ACR. Elevated hsCRP, AGEs and body fat, diabetic retinopathy and nephropathy, as well as hypertension, dyslipidemia and metabolic syndrome were found to increase the risk of CAN in T1D. CONCLUSION CAN appears to be a common complication of T1D, especially with longer duration, and is found to be related to diabetic microvascular disease and metabolic syndrome components.
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Affiliation(s)
- M Serdarova
- Department of Endocrinology, Medical University of Sofia, Bulgaria.
| | - R Dimova
- Department of Endocrinology, Medical University of Sofia, Bulgaria
| | - N Chakarova
- Department of Endocrinology, Medical University of Sofia, Bulgaria
| | - G Grozeva
- Department of Endocrinology, Medical University of Sofia, Bulgaria
| | - A Todorova
- Department of Endocrinology, Medical University of Sofia, Bulgaria
| | - T Tankova
- Department of Endocrinology, Medical University of Sofia, Bulgaria
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15
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Abstract
The growing proportion of type 1 diabetes mellitus (T1DM) patients with clinical features of insulin resistance (IR) has led to the description of a distinctive T1DM subgroup, still unrecognised by current guidelines, called double diabetes, assumingly associated with poorer metabolic phenotype and increased risk of micro- and macrovascular complications. The main goal of identifying double diabetes, estimated to be present in up to half of T1DM patients, is timely implementation of appropriate therapeutic interventions to reduce the increased risk of chronic complications and other adverse metabolic traits associated with this condition. Proposed diagnostic criteria are largely divided into three different groups: family history of type 2 diabetes mellitus (T2DM), obesity/metabolic syndrome, and IR. Estimated glucose disposal rate may prove the most reliable marker of double diabetes. In addition to general measures (diet, physical activity, antihypertensive, and lipid-lowering medications, etc.) and development of new insulin preparations with more hepatic action, double diabetes patients may derive more benefit from agents developed for T2DM. Indeed, such potentially promising agents include glucagon-like peptide-1 receptor agonists, sodium-glucose contrasporter-2 inhibitors, and their combination. We are now awaiting long-term trials assessing metabolic and vascular benefits of these medications in double diabetes.
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Affiliation(s)
- Djordje S Popovic
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, SERBIA.,Medical Faculty, University of Novi Sad, Novi Sad, SERBIA
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, GREECE
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16
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Qu J, Qu HQ, Bradfield JP, Glessner JT, Chang X, Tian L, March ME, Roizen JD, Sleiman PM, Hakonarson H. Association of DLL1 with type 1 diabetes in patients characterized by low polygenic risk score. Metabolism 2021; 114:154418. [PMID: 33157082 DOI: 10.1016/j.metabol.2020.154418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 01/21/2023]
Abstract
Type 1 diabetes (T1D) is a heterogeneous disease. This study identified T1D cases with low polygenic risk score (PRS) to better represent T1D cases with less prominent autoimmune response (T1bD), and performed a gene-based association study to identify novel susceptibility loci in two independent cohorts, characterized by low PRS. The Notch ligand Delta-like 1 gene (DLL1) was identified with genome-wide significance in both cohorts, highlighting the roles of DLL1 genetic variants in T1D patients with low PRS, supported by functional evidence from a recent study by Rubey et al.
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Affiliation(s)
- Jingchun Qu
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Hui-Qi Qu
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - Joseph T Glessner
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Xiao Chang
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Lifeng Tian
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Michael E March
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jeffrey D Roizen
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Patrick M Sleiman
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Hakon Hakonarson
- The Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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17
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Abela AG, Fava S. Why is the Incidence of Type 1 Diabetes Increasing? Curr Diabetes Rev 2021; 17:e030521193110. [PMID: 33949935 DOI: 10.2174/1573399817666210503133747] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/14/2021] [Accepted: 03/11/2021] [Indexed: 11/22/2022]
Abstract
Type 1 diabetes is a condition that can lead to serious long-term complications and can have significant psychological and quality of life implications. Its incidence is increasing in all parts of the world, but the reasons for this are incompletely understood. Genetic factors alone cannot explain such a rapid increase in incidence; therefore, environmental factors must be implicated. Lifestyle factors have been classically associated with type 2 diabetes. However, there are data implicating obesity and insulin resistance to type 1 diabetes as well (accelerator hypothesis). Cholesterol has also been shown to be correlated with the incidence of type 1 diabetes; this may be mediated by immunomodulatory effects of cholesterol. There is considerable interest in early life factors, including maternal diet, mode of delivery, infant feeding, childhood diet, microbial exposure (hygiene hypothesis), and use of anti-microbials in early childhood. Distance from the sea has recently been shown to be negatively correlated with the incidence of type 1 diabetes. This may contribute to the increasing incidence of type 1 diabetes since people are increasingly living closer to the sea. Postulated mediating mechanisms include hours of sunshine (and possibly vitamin D levels), mean temperature, dietary habits, and pollution. Ozone, polychlorinated biphenyls, phthalates, trichloroethylene, dioxin, heavy metals, bisphenol, nitrates/nitrites, and mercury are amongst the chemicals which may increase the risk of type 1 diabetes. Another area of research concerns the role of the skin and gut microbiome. The microbiome is affected by many of the factors mentioned above, including the mode of delivery, infant feeding, exposure to microbes, antibiotic use, and dietary habits. Research on the reasons why the incidence of type 1 diabetes is increasing not only sheds light on its pathogenesis but also offers insights into ways we can prevent type 1 diabetes.
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Affiliation(s)
- Alexia G Abela
- Department of Medicine, University of Malta & Mater Dei Hospital, Tal-Qroqq, Msida, Malta
| | - Stephen Fava
- Department of Medicine, University of Malta & Mater Dei Hospital, Tal-Qroqq, Msida, Malta
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18
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Olamoyegun MA, Ala OA, Ugwu E. Coexistence of type 1 and type 2 diabetes mellitus: a case report of "double" diabetes in a 17-year-old Nigerian girl. Pan Afr Med J 2020; 37:35. [PMID: 33209162 PMCID: PMC7648474 DOI: 10.11604/pamj.2020.37.35.25191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/07/2020] [Indexed: 01/16/2023] Open
Abstract
Double diabetes otherwise known as hybrid diabetes, a new variant, is a combination of both type 1 and type 2 diabetes in children and adolescents. It is a diabetes variant increasing in prevalence in developed countries because of epidemic obesity among children and adolescents but extremely rare in developing countries. Double diabetes is characterized by features of both type 1 (diabetes auto-antibodies) and type 2 (obesity and insulin resistance). This occurrence can either develop on a background of type 1 diabetes due to an abnormal increase in weight from physiological growth spurt in adolescents or from high insulin dosage developing on a background of type 2 diabetes. The variant has been linked to possible increased cardiovascular risks and worsened morbidity including poor glycaemic control. Here, we report a case of a 17-year-old girl who developed features of type 2 diabetes on a background of type 1 diagnosed 6 years after T1D diagnosis.
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Affiliation(s)
- Michael Adeyemi Olamoyegun
- Department of Medicine, Endocrinology, Diabetes and Metabolism Unit, Ladoke Akintola University of Technology, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Oluwabukola Ayodele Ala
- Department of Medicine, Bowen University, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Ejiofor Ugwu
- Department of Medicine, Enugu State University of Technology, Enugu, Enugu State, Nigeria
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19
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Beik P, Ciesielska M, Kucza M, Kurczewska A, Kuźmińska J, Maćkowiak B, Niechciał E. Prevention of Type 1 Diabetes: Past Experiences and Future Opportunities. J Clin Med 2020; 9:E2805. [PMID: 32872668 PMCID: PMC7563637 DOI: 10.3390/jcm9092805] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022] Open
Abstract
Type 1 diabetes (T1D) results from autoimmune destruction of insulin-producing beta-cells in the pancreas, caused by the interplay of genetic and environmental factors. Despite the introduction of advanced technologies for diabetes management, most patients fail to achieve target glycemic control, and T1D still has a high burden of long-term end-organ complications. Over several decades, multiple clinical trials have attempted to find prevention for T1D in at-risk individuals or to stabilize, ultimately reverse, the disease in those with T1D. To date, T1D remains yet incurable condition; however, recently improved understanding of the natural history of the disease may lead to new strategies to preserve or improve beta-cell function in those at increased risk and T1D patients. This publication aims to provide an overview of past experiences and recent findings in the prevention of T1D.
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Affiliation(s)
| | | | | | | | | | | | - Elżbieta Niechciał
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznan, Poland; (P.B.); (M.C.); (M.K.); (A.K.); (J.K.); (B.M.)
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20
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Khawandanah J. Double or hybrid diabetes: A systematic review on disease prevalence, characteristics and risk factors. Nutr Diabetes 2019; 9:33. [PMID: 31685799 PMCID: PMC6828774 DOI: 10.1038/s41387-019-0101-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus is a worldwide epidemic affecting the health of millions of people. While type 1 diabetes (T1D) is caused by autoimmune destruction of the insulin-producing beta cells of the pancreas, type 2 diabetes (T2D) results from a combination of insulin resistance and beta cell insulin secretory defect. Clear definition and diagnosis of these two types of diabetes has been increasing more and more difficult, leading to the inclusion of a new category, namely double or hybrid diabetes (DD) that demonstrates symptoms of both T1D and T2D via the accelerator hypothesis. In this review, we discuss the worldwide prevalence of DD, its main physiological characteristics, including beta-cell autoimmunity, insulin resistance, and cardiovascular disease, the main risk factors of developing DD, mainly genetics, obesity and lifestyle choices, as well as potential treatments, such as insulin titration, metformin and behavioural modifications. Increasing awareness of DD among the general population and primary care practitioners is necessary for successfully treating this complex, hybrid disease in the future.
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Affiliation(s)
- Jomana Khawandanah
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. .,Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom.
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21
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[Epidemiological Evolution of Type 1 Diabetes in Children: Data from the Register of the Department of Oran, Algeria, 1973-2017]. Rev Epidemiol Sante Publique 2019; 67:369-374. [PMID: 31645290 DOI: 10.1016/j.respe.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Diabetes in children is undergoing a profound change in terms of frequency and age at onset worldwide. Algeria is particularly impacted by the epidemic to the point of appearing in the "top 10" 2016 of countries with very high incidence of T1D. Our study was aimed to present the epidemiological evolution of T1D in children using data from the register of the department of Oran. METHODS New cases of T1D are children under 15 years old coming from primary care units and pediatric departments. Registration was centralized at the level of the "C" pediatric unit of Oran University Hospital since 1973 with an assessment close to 100%. RESULTS From 1973 to 2017, 2358 T1D new cases aged less than 15 years at T1D diagnosis have been registered. The average annual incidence under 15 years old for the last 5 years 2013-2017 is 31.12±3.60 cases per 100,000 and 22.62±5.18, 36.92±6.88 et 37.93±6.53 for children 0-4, 5-9 et 10-14 years old, respectively. The average annual evolution was at 12.78% in the last 25 years for the whole group and 15.03, 15.50 and 9.10% for children of 0-4, 5-9 and 10-14 years old, respectively. The estimated prevalence on December 31st 2017 was 207 per 100,000 equivalent to 1 T1D for 482 children under 15. The sex ratio for all cases is 0.94 with non-significant fluctuations. The winter/summer seasonality, significant from 1973 to 2013 in favor of winter months is no longer present starting from 2013. CONCLUSION We confirm, in agreement with other teams, the outsized increase in the incidence of T1D and the younger age at onset in children under 15 in our country. This evolution, mainly related to environmental problems poses new difficulties to families and teams in charge of the disease.
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22
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Hidayat K, Zou SY, Shi BM. The influence of maternal body mass index, maternal diabetes mellitus, and maternal smoking during pregnancy on the risk of childhood-onset type 1 diabetes mellitus in the offspring: Systematic review and meta-analysis of observational studies. Obes Rev 2019; 20:1106-1120. [PMID: 31090253 DOI: 10.1111/obr.12858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/07/2019] [Accepted: 03/07/2019] [Indexed: 12/12/2022]
Abstract
There is emerging evidence that events occurring before and shortly after birth may be important in determining the risk of childhood-onset type 1 diabetes mellitus (T1DM). We aimed to summarize and synthesize the associations between maternal body mass index (BMI), maternal diabetes mellitus (DM), and maternal smoking during pregnancy and the risk of childhood-onset T1DM in the offspring by performing a systematic review and meta-analysis of observational studies. A random effects model was used to generate the summary risk estimates. The PubMed and Web of Science databases were searched to identify relevant observational studies. Twenty one observational studies were included in the present meta-analysis. Compared with offspring of mothers with normal weight, offspring of women with overweight or obesity were at an increased risk of developing childhood-onset T1DM (overweight: relative risk [RR] 1.09, 95% confidence interval [CI], 1.03-1.15; obesity: RR 1.25, 95% CI, 1.16-1.34; per 5 kg m-2 increase in BMI: RR 1.10, 95% CI, 1.06-1.13). No association was found for maternal underweight (RR 0.92, 95% CI, 0.75-1.13). Maternal DM was associated with an increased risk of childhood-onset T1DM (RR 3.26, 95% CI, 2.84-3.74). Regarding the type of maternal DM, the greatest risk of T1DM in the offspring appeared to be conferred by maternal T1DM (RR 4.46, 95% CI, 2.89-6.89), followed by maternal gestational diabetes mellitus (RR 1.66, 95% CI, 1.16-2.36), and lastly by maternal type 2 diabetes mellitus (RR 1.11, 95% CI, 0.69-1.80). Additional analysis of studies comparing maternal versus paternal T1DM within the same population revealed that offspring of fathers with T1DM had a 1.5 times higher risk of developing childhood-onset T1DM than offspring of mothers with T1DM (RR 9.58, 95% CI, 6.33-14.48 vs. RR 6.24, 95% CI, 5.52-7.07). Furthermore, a reduced risk of childhood-onset T1DM was observed in infants born to mothers who smoked during pregnancy compared with infants born to mothers who did not smoke during pregnancy (RR 0.79, 95% CI, 0.71-0.87). In summary, our findings add further evidence that early-life events or environmental factors may play a role in modulating infants' risk of developing T1DM later in life.
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Affiliation(s)
- Khemayanto Hidayat
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng-Yi Zou
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bi-Min Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
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23
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Yong J, Tian J, Dang H, Wu TT, Atkinson MA, Sun R, Kaufman DL. Increased risk for T cell autoreactivity to ß-cell antigens in the mice expressing the A vy obesity-associated gene. Sci Rep 2019; 9:4269. [PMID: 30862859 PMCID: PMC6414670 DOI: 10.1038/s41598-019-38905-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 01/14/2019] [Indexed: 12/17/2022] Open
Abstract
There has been considerable debate as to whether obesity can act as an accelerator of type 1 diabetes (T1D). We assessed this possibility using transgenic mice (MIP-TF mice) whose ß-cells express enhanced green fluorescent protein (EGFP). Infecting these mice with EGFP-expressing murine herpes virus-68 (MHV68-EGFP) caused occasional transient elevation in their blood glucose, peri-insulitis, and Th1 responses to EGFP which did not spread to other ß-cell antigens. We hypothesized that obesity-related systemic inflammation and ß-cell stress could exacerbate the MHV68-EGFP-induced ß-cell autoreactivity. We crossed MIP-TF mice with Avy mice which develop obesity and provide models of metabolic disease alongside early stage T2D. Unlike their MIP-TF littermates, MHV68-EGFP-infected Avy/MIP-TF mice developed moderate intra-insulitis and transient hyperglycemia. MHV68-EGFP infection induced a more pronounced intra-insulitis in older, more obese, Avy/MIP-TF mice. Moreover, in MHV68-EGFP-infected Avy/MIP-TF mice, Th1 reactivity spread from EGFP to other ß-cell antigens. Thus, the spreading of autoreactivity among ß-cell antigens corresponded with the transition from peri-insulitis to intra-insulitis and occurred in obese Avy/MIP-TF mice but not lean MIP-TF mice. These observations are consistent with the notion that obesity-associated systemic inflammation and ß-cell stress lowers the threshold necessary for T cell autoreactivity to spread from EGFP to other ß-cell autoantigens.
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Affiliation(s)
- Jing Yong
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, 90095-1735, United States.,Sanford-Burnham-Prebys Medical Discovery Institute, La Jolla, CA, 92037, United States
| | - Jide Tian
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, 90095-1735, United States
| | - Hoa Dang
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, 90095-1735, United States
| | - Ting-Ting Wu
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, 90095-1735, United States
| | - Mark A Atkinson
- Departments of Pathology and Paediatrics, University of Florida Diabetes Institute, Gainesville, FL, 32610, United States
| | - Ren Sun
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, 90095-1735, United States
| | - Daniel L Kaufman
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, 90095-1735, United States.
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Agrawal S, Gensure R. Commentary on the Impact of Obesity on PediatricDiabetes. Clin Ther 2018; 40:1631-1637. [PMID: 30193749 DOI: 10.1016/j.clinthera.2018.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 02/07/2023]
Abstract
While conventionally most children diagnosed with diabetes are thought to have type 1 diabetes mellitus (T1DM), with the increased prevalence of obesity, more are being affected by type 2 (T2) DM. Obesity leads to increased insulin resistance, which over time can lead to progressive β-cell failure and ultimately T2DM. However, patients developing T1DM may also be obese, making both the proper classification and management of diabetes in children more challenging. In this commentary, the authors discuss the impact ofobesity on the presentation of pediatric diabetes, how to differentiate between T1DM and T2DM, and the proper management of both diseases.
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Affiliation(s)
- Sungeeta Agrawal
- Division of Pediatric Endocrinology, Floating Hospital in children at Tufts Medical Center/Tufts University School of Medicine, Boston, Massachusetts.
| | - Robert Gensure
- Division of Pediatric Endocrinology, Floating Hospital in children at Tufts Medical Center/Tufts University School of Medicine, Boston, Massachusetts
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Huda N, Hosen MI, Yasmin T, Sarkar PK, Hasan AKMM, Nabi AHMN. Genetic variation of the transcription factor GATA3, not STAT4, is associated with the risk of type 2 diabetes in the Bangladeshi population. PLoS One 2018; 13:e0198507. [PMID: 30044774 PMCID: PMC6059405 DOI: 10.1371/journal.pone.0198507] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 05/21/2018] [Indexed: 12/20/2022] Open
Abstract
Type 2 diabetes mellitus is a multifactorial metabolic disorder caused by environmental factors and has a strong association with hereditary issues. These hereditary issues result in an imbalance in CD4+T cells and a decreased level of naïve CD4+T cells, which may be critical in the pathogenesis of type 2 diabetes. Transcription factors GATA3 and STAT4 mediate the cytokine-induced development of naïve T cells into Th1 or Th2 types. In the present study, genetic analyses of GATA3 SNP rs3824662 and STAT4 SNP rs10181656 were performed to investigate the association of allelic and genotypic variations with the risk of T2D in the Bangladeshi population. A total of 297 unrelated Bangladeshi patients with type 2 diabetes and 247 healthy individuals were included in the study. The allelic and genotypic frequencies of rs10181656 located in the STAT4 gene were not found to be associated with risk of type 2 diabetes. The GATA3 rs3824662 T allele and mutant TT genotype had a significant association with the risk of T2D [OR: 1.52 (1.15–2.02), X2 = 8.66, p = 0.003 and OR: 2.98 (1.36–6.55), X2 = 7.98, p = 0.04, respectively]. Thus, the present study postulates that the genetic variation of the transcription factor GATA3, not STAT4, is associated with the risk of type 2 diabetes in the Bangladeshi population.
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Affiliation(s)
- Nafiul Huda
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Md. Ismail Hosen
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Tahirah Yasmin
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | | | - A. K. M. Mahbub Hasan
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - A. H. M. Nurun Nabi
- Laboratory of Population Genetics, Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
- * E-mail:
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Antvorskov JC, Aunsholt L, Buschard K, Gamborg M, Kristensen K, Johannesen J, Sørensen TIA, Svensson J. Childhood body mass index in relation to subsequent risk of type 1 diabetes-A Danish cohort study. Pediatr Diabetes 2018; 19:265-270. [PMID: 28940941 DOI: 10.1111/pedi.12568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022] Open
Abstract
The incidence of type 1 diabetes (T1D) is increasing, and obesity may be a contributing factor by increasing the risk and accelerating the onset. We investigated the relation between childhood body mass index z-scores (BMIz) and the later risk of T1D, including association with age at onset of T1D. The study included 238 cases and 10 147 controls selected from the Copenhagen School Health Record Register (CSHRR). Cases of T1D were identified in the Danish Registry of Childhood and Adolescent Diabetes and 2 regional studies and linked to CSHRR. Using conditional logistic regression models, the association of childhood prediagnostic BMIz at 7 and 13 years of age and changes between these ages with subsequent risk (odds ratio, OR) of T1D was estimated. A greater BMIz at 7 and 13 years of age was associated with increased risk of T1D with OR of 1.23 (confidence interval, CI 1.09-1.37; P = .0001) and 1.20 (CI 1.04-1.40; P = .016), respectively. The risk was increased by upward changes in z-scores from birth to 7 years (OR=1.21, P = .003) and from 7 to 13 years of age (OR=1.95, P = .023), but in the latter age interval also by a decline in BMIz (OR = 1.91, P = .034). There were no associations between BMIz at 7 and 13 years of age and the age of onset (P = .34 and P = .42, respectively). Increased BMIz is associated with a moderate increase in risk of T1D, but with no relation to age at onset within the analyzed age range. Increased BMIz over time is unlikely to explain the rising incidence of T1D.
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Affiliation(s)
| | - Lise Aunsholt
- Department of Pediatrics, Hans Christian Andersen Children's hospital, Odense, Denmark
| | | | - Michael Gamborg
- Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
| | | | - Jesper Johannesen
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
| | - Thorkild I A Sørensen
- Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jannet Svensson
- Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
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27
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Dayem SMAE, Battah AA, Bohy AEME, Yousef RN, Ahmed AM, Talaat AA. Apelin, Nitric Oxide and Vascular Affection in Adolescent Type 1 Diabetic Patients. Open Access Maced J Med Sci 2017; 5:934-939. [PMID: 29362622 PMCID: PMC5771298 DOI: 10.3889/oamjms.2017.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 01/22/2023] Open
Abstract
AIM To evaluate the relationship of apelin and nitric oxide (NO) to endothelial dysfunction in type 1 diabetics. PATIENTS AND METHODS Sixty two type 1 diabetics and 30 healthy age and sex matched controls were included. Blood samples for apelin, NO, glycosylated hemoglobin (HbA1c), and lipid profile were collected. Albumin/creatinine ratio was assessed in urine. Flow mediated dilatation (FMD) via ultrasound was done. RESULTS The mean age of diabetics were 16.3 ± 1.5 yrs (14.0 - 19.0 yrs), and duration of disease, were 9.4 ± 2.9 yrs (5.0 - 16.5 yrs). FMD and FMD/nitrate mediated dilatation (NMD) ratio were lower in diabetics. NO was decreased, while apelin and albumin/creatinine ratio were increased significantly in diabetics. There was a positive correlation between apelin and HbA1c. On the contrary, NO had a negative correlation with HbA1c, albumin/creatinine ratio, LDL-c and OxLDL. CONCLUSION Diabetic patients had endothelial dysfunction and high apelin level, with no related to each other. High level of apelin is associated with bad glycemic control. Obesity had no role to increase in apelin level. NO is related to diabetic nephropathy and atherosclerosis. We recommend a further large study to evaluate the relationship of apelin with endothelial dysfunction.
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Affiliation(s)
| | - Ahmed A Battah
- Critical Care Department, Cairo University, Cairo, Egypt
| | | | - Rash Nazih Yousef
- Clinical Pathology Department, National Research Centre, Cairo, Egypt
| | - Azza M Ahmed
- Pediatrics Department, National Research Centre, Cairo, Egypt
| | - Ahmed A Talaat
- Pediatrics Department, National Research Centre, Cairo, Egypt
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28
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Pyziak A, Zmyslowska A, Bobeff K, Malachowska B, Fendler W, Wyka K, Baranowska-Jazwiecka A, Szymanska M, Szadkowska A, Mlynarski W. Markers influencing the presence of partial clinical remission in patients with newly diagnosed type 1 diabetes. J Pediatr Endocrinol Metab 2017; 30:1147-1153. [PMID: 29016353 DOI: 10.1515/jpem-2017-0100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/28/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of the study was to compare the selected markers in children with and without partial clinical remission (CR) of newly diagnosed type 1 diabetes (T1D). METHODS The study group consisted of 186 patients (F/M; 87/99) at onset of T1D and 24 months of follow-up. Partial CR was defined as insulin requirement <0.5 IU/kg and glycated hemoglobin (HbA1c) <7%. RESULTS Partial CR was observed in 115/186 (61.83%) of patients. At diagnosis body mass index standard deviation (BMI SDS) was higher among remitters than in non-remitters (p=0.0051) and remitters were younger (p=0.0029). In the follow-up a higher triglyceride concentration in non-remitters compared to remitters (p=0.0455) and a lower high density lipoprotein (HDL) cholesterol level (p=0.0119) were noticed. CONCLUSIONS Younger age and higher BMI at diagnosis of T1D can predispose to partial CR in children. In patients with CR of T1D after 2 years of follow-up a lipid profile improvement is observed.
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Liu CW, Bramer L, Webb-Robertson BJ, Waugh K, Rewers MJ, Zhang Q. Temporal expression profiling of plasma proteins reveals oxidative stress in early stages of Type 1 Diabetes progression. J Proteomics 2017; 172:100-110. [PMID: 28993202 DOI: 10.1016/j.jprot.2017.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 02/07/2023]
Abstract
Blood markers other than islet autoantibodies are greatly needed to indicate the pancreatic beta cell destruction process as early as possible, and more accurately reflect the progression of Type 1 Diabetes Mellitus (T1D). To this end, a longitudinal proteomic profiling of human plasma using TMT-10plex-based LC-MS/MS analysis was performed to track temporal proteomic changes of T1D patients (n=11) across 9 serial time points, spanning the period of T1D natural progression, in comparison with those of the matching healthy controls (n=10). To our knowledge, the current study represents the largest (>2000 proteins measured) longitudinal expression profiles of human plasma proteome in T1D research. By applying statistical trend analysis on the temporal expression patterns between T1D and controls, and Benjamini-Hochberg procedure for multiple-testing correction, 13 protein groups were regarded as having statistically significant differences during the entire follow-up period. Moreover, 16 protein groups, which play pivotal roles in response to oxidative stress, have consistently abnormal expression trend before seroconversion to islet autoimmunity. Importantly, the expression trends of two key reactive oxygen species-decomposing enzymes, Catalase and Superoxide dismutase were verified independently by ELISA. BIOLOGICAL SIGNIFICANCE The temporal changes of >2000 plasma proteins (at least quantified in two subjects), spanning the entire period of T1D natural progression were provided to the research community. Oxidative stress related proteins have consistently different dysregulated patterns in T1D group than in age-sex matched healthy controls, even prior to appearance of islet autoantibodies - the earliest sign of islet autoimmunity and pancreatic beta cell stress.
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Affiliation(s)
- Chih-Wei Liu
- Center for Translational Biomedical Research, University of North Carolina at Greensboro, North Carolina Research Campus, Kannapolis, NC, United States
| | - Lisa Bramer
- Applied Statistics & Computational Modeling, Pacific Northwest National Laboratory, Richland, WA, United States
| | - Bobbie-Jo Webb-Robertson
- Applied Statistics & Computational Modeling, Pacific Northwest National Laboratory, Richland, WA, United States
| | - Kathleen Waugh
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
| | - Marian J Rewers
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States
| | - Qibin Zhang
- Center for Translational Biomedical Research, University of North Carolina at Greensboro, North Carolina Research Campus, Kannapolis, NC, United States; Department of Chemistry & Biochemistry, University of North Carolina at Greensboro, Greensboro, NC, United States.
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30
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Channanath AM, Elkum N, Al-Abdulrazzaq D, Tuomilehto J, Shaltout A, Thanaraj TA. Ethnic differences in association of high body mass index with early onset of Type 1 diabetes - Arab ethnicity as case study. PLoS One 2017; 12:e0175728. [PMID: 28406962 PMCID: PMC5391107 DOI: 10.1371/journal.pone.0175728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/30/2017] [Indexed: 11/18/2022] Open
Abstract
Objective The “accelerator hypothesis” predicts early onset of Type 1 diabetes (T1D) in heavier children. Studies testing direction of correlation between body mass index (BMI) and age at onset of T1D in different continental populations have reported differing results–inverse, direct, and neutral. Evaluating the correlation in diverse ethnic populations is required to generalize the accelerator hypothesis. Methods The study cohort comprised 474 Kuwaiti children of Arab ethnicity diagnosed with T1D at age 6 to 18 years during 2011–2013. Age- and sex-adjusted BMI z-scores were calculated by comparing the BMI measured at diagnosis with Kuwaiti pediatric population reference data recorded during comparable time-period. Multiple linear regression and Pearson correlation analyses were performed. Results BMI z-score was seen inversely associated with onset age (r,-0.28; p-value<0.001). Children with BMI z-score>0 (i.e. BMI >national average) showed a stronger correlation (r,-0.38; p-value<0.001) than those with BMI z-score<0 (r,-0.19; p-value<0.001); the former group showed significantly lower mean onset age than the latter group (9.6±2.4 versus 10.5±2.7; p-value<0.001). Observed inverse correlation was consistent with that seen in Anglo-saxon, central european, caucasian, and white children while inconsistent with that seen in Indian, New Zealander, and Australian children. Conclusions The accelerator hypothesis generalizes in Arab pediatric population from Kuwait.
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31
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Metabolic control of immune tolerance in health and autoimmunity. Semin Immunol 2016; 28:491-504. [PMID: 27720234 DOI: 10.1016/j.smim.2016.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/23/2016] [Accepted: 09/30/2016] [Indexed: 12/15/2022]
Abstract
The filed that links immunity and metabolism is rapidly expanding. The adipose tissue, by secreting a series of immune regulators called adipokines, represents the common mediator linking metabolic processes and immune system functions. The dysregulation of adipokine secretion, occurring in obese individuals or in conditions of malnutrition or dietary restriction, affects the activity of immune cells resulting in inflammatory autoimmune responses or increased susceptibility to infectious diseases. Alterations of cell metabolism that characterize several autoimmune diseases strongly support the idea that the immune tolerance is also regulated by metabolic pathways. The comprehension of the molecular mechanisms underlying these alterations may lead to the development of novel therapeutic strategies to control immune cell differentiation and function in conditions of autoimmunity.
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32
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Østergaard JA, Laugesen E, Leslie RD. Should There be Concern About Autoimmune Diabetes in Adults? Current Evidence and Controversies. Curr Diab Rep 2016; 16:82. [PMID: 27457237 DOI: 10.1007/s11892-016-0780-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Autoimmune diabetes has a heterogeneous phenotype. Although often considered a condition starting in childhood, a substantial proportion of type 1 diabetes presents in adult life. This holds important implications for our understanding of the factors that modify the rate of progression through the disease prodrome to clinical diabetes and for our management of the disease. When autoimmune diabetes develops in adulthood, insulin treatment is often not required at the time of diagnosis, and this autoimmune non-insulin requiring diabetes is generally termed latent autoimmune diabetes in adults (LADA). Patients with LADA are generally leaner, younger at diabetes onset; have a greater reduction in C-peptide; and have a greater likelihood of insulin treatment as compared with patients with type 2 diabetes. The LADA subset of patients with adult-onset autoimmune diabetes has highlighted many shortcomings in the classification of diabetes and invokes the case for more personalized data analysis in line with the move towards precision medicine. Perhaps most importantly, the issues highlight our persistent failure to engage with the heterogeneity within the most common form of autoimmune diabetes, that is adult-onset type 1 diabetes, both insulin-dependent and initially non-insulin requiring (LADA). This review discusses characteristics of autoimmune diabetes and specifically aims to illustrate the heterogeneity of the disease.
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Affiliation(s)
- Jakob Appel Østergaard
- Department of Clinical Medicine, Aarhus University & Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus & The Danish Diabetes Academy, Odense, Denmark
| | - Esben Laugesen
- Department of Clinical Medicine, Aarhus University & Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus & The Danish Diabetes Academy, Odense, Denmark
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Huus K, Åkerman L, Raustorp A, Ludvigsson J. Physical Activity, Blood Glucose and C-Peptide in Healthy School-Children, a Longitudinal Study. PLoS One 2016; 11:e0156401. [PMID: 27270732 PMCID: PMC4896630 DOI: 10.1371/journal.pone.0156401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 05/15/2016] [Indexed: 11/24/2022] Open
Abstract
Aim To further elucidate the relationship between physical activity and several risk factors for development of diabetes (glucose, C-peptide and obesity) over time. Methods A prospective longitudinal study where physical activity was measured on 199 children from Kalmar and Linköping at age 8, and the same 107 children from Linköping again at age 12. Anthropometric data was collected and blood was analyzed for C-peptide and f-glucose. The children in the study were representative for the general Swedish child population, and on an average lean. Results High physical activity was related to lower C-peptide at age 8 and 12. This correlation was especially pronounced in boys, who also were more physically active than girls at both time points. The association seen at 8 years of age was similar at age 12 in most children. Children with higher BMI Z-Score had a higher fasting C-peptide (age 12) but linear regression showed that children with more steps per day were less likely to have a higher fasting C-peptide irrespective of BMI. Longitudinal follow-up showed that a decrease in physical activity increased insulin resistance and β-cell load. Conclusions Already in young children, physical activity improves insulin sensitivity and decreases the need of C-peptide over time. This seems to become even more pronounced with increasing age when children are followed longitudinally. Low physical activity increases the load on insulin producing β-cells, might increase the risk for both type 1- and 2 diabetes.
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Affiliation(s)
- Karina Huus
- CHILD research group, Department of Nursing, School of Health and Welfare, SE- 551 11 Jönköping, Sweden
- * E-mail:
| | - Linda Åkerman
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE- 58185 Linköping, Sweden
| | - Anders Raustorp
- Linnaeus University, School of Sport Sciences, SE-39182 Kalmar, Sweden
- Department of Nutrition and Sport Sciences, University of Gothenburg, SE-40530 Gothenburg, Sweden
| | - Johnny Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE- 58185 Linköping, Sweden
- Pediatric Clinic, Östergötland, County Council, SE -58185 Linköping, Sweden
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Meah FA, DiMeglio LA, Greenbaum CJ, Blum JS, Sosenko JM, Pugliese A, Geyer S, Xu P, Evans-Molina C. The relationship between BMI and insulin resistance and progression from single to multiple autoantibody positivity and type 1 diabetes among TrialNet Pathway to Prevention participants. Diabetologia 2016; 59:1186-95. [PMID: 26995649 PMCID: PMC5081287 DOI: 10.1007/s00125-016-3924-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/24/2016] [Indexed: 01/10/2023]
Abstract
AIMS/HYPOTHESIS The incidence of type 1 diabetes is increasing at a rate of 3-5% per year. Genetics cannot fully account for this trend, suggesting an influence of environmental factors. The accelerator hypothesis proposes an effect of metabolic factors on type 1 diabetes risk. To test this in the TrialNet Pathway to Prevention (PTP) cohort, we analysed the influence of BMI, weight status and insulin resistance on progression from single to multiple islet autoantibodies (Aab) and progression from normoglycaemia to diabetes. METHODS HOMA1-IR was used to estimate insulin resistance in Aab-positive PTP participants. Cox proportional hazards models were used to evaluate the effects of BMI, BMI percentile (BMI%), weight status and HOMA1-IR on the progression of autoimmunity or the development of diabetes. RESULTS Data from 1,310 single and 1,897 multiple Aab-positive PTP participants were included. We found no significant relationships between BMI, BMI%, weight status or HOMA1-IR and the progression from one to multiple Aabs. Similarly, among all Aab-positive participants, no significant relationships were found between BMI, weight status or HOMA1-IR and progression to diabetes. Diabetes risk was modestly increased with increasing BMI% among the entire cohort, in obese participants 13-20 years of age and with increasing HOMA1-IR in adult Aab-positive participants. CONCLUSIONS/INTERPRETATION Analysis of the accelerator hypothesis in the TrialNet PTP cohort does not suggest a broad influence of metabolic variables on diabetes risk. Efforts to identify other potentially modifiable environmental factors should continue.
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Affiliation(s)
- Farah A Meah
- Department of Medicine, Indiana University School of Medicine, 635 Barnhill Drive, MS 2031A, Indianapolis, IN, USA
- Department of Endocrinology, Edward Hines Junior VA Hospital, Hines, IL, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Janice S Blum
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jay M Sosenko
- Diabetes Research Institute, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alberto Pugliese
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Microbiology and Immunology, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Susan Geyer
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - Ping Xu
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - Carmella Evans-Molina
- Department of Medicine, Indiana University School of Medicine, 635 Barnhill Drive, MS 2031A, Indianapolis, IN, USA.
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA.
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35
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Szendroedi J, Saxena A, Weber KS, Strassburger K, Herder C, Burkart V, Nowotny B, Icks A, Kuss O, Ziegler D, Al-Hasani H, Müssig K, Roden M. Cohort profile: the German Diabetes Study (GDS). Cardiovasc Diabetol 2016; 15:59. [PMID: 27053136 PMCID: PMC4823856 DOI: 10.1186/s12933-016-0374-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/24/2016] [Indexed: 12/16/2022] Open
Abstract
Background The German Diabetes Study (GDS) is a prospective longitudinal cohort study describing the impact of subphenotypes on the course of the disease. GDS aims at identifying prognostic factors and mechanisms underlying the development of related comorbidities. Study design and methods The study comprises intensive phenotyping within 12 months after clinical diagnosis, at 5-year intervals for 20 years and annual telephone interviews in between. Dynamic tests, including glucagon, mixed meal, intravenous glucose tolerance and hyperinsulinemic clamp tests, serve to assess beta-cell function and tissue-specific insulin sensitivity. Magnetic resonance imaging and multinuclei spectroscopy allow quantifying whole-body fat distribution, tissue-specific lipid deposition and energy metabolism. Comprehensive analyses of microvascular (nerve, eye, kidney) and macrovascular (endothelial, cardiorespiratory) morphology and function enable identification and monitoring of comorbidities. The GDS biobank stores specimens from blood, stool, skeletal muscle, subcutaneous adipose tissue and skin for future analyses including multiomics, expression profiles and histology. Repeated questionnaires on socioeconomic conditions, patient-reported outcomes as quality of life, health-related behavior as physical activity and nutritional habits are a specific asset of GDS. This study will recruit 3000 patients and a group of humans without familiy history of diabetes. 237 type 1 and 456 type 2 diabetes patients have been already included. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0374-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Szendroedi
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Aaruni Saxena
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Katharina S Weber
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Bettina Nowotny
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,Public Health Unit, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Oliver Kuss
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hadi Al-Hasani
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Clinical Biochemistry and Pathobiochemistry German Diabetes Center, Leibniz Institute for Diabetes Research, Düsseldorf, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany. .,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
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36
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Cohen R. Response to M. Deitel. Surg Obes Relat Dis 2016; 12:719-720. [DOI: 10.1016/j.soard.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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Dayal D, Samprathi M, Jayaraman D, Kohat D, Bhalla AK. Secular trends of body mass index in North Indian children with Type 1 diabetes do not support the Accelerator Hypothesis. Clin Endocrinol (Oxf) 2016; 84:338-41. [PMID: 26342175 DOI: 10.1111/cen.12941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/25/2015] [Accepted: 09/01/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The accelerator hypothesis, which proposes a link between Type 1 diabetes (T1D) and Type 2 diabetes (T2D) through weight-related insulin resistance, remains untested in developing countries with increasing rates of childhood obesity and T1D, and different ethnicities. We aimed to test the accelerator hypothesis in the context of a significant increase in T1D at our centre. DESIGN AND METHODS Medical records of children diagnosed with T1D between January 2005 and December 2014 were retrospectively reviewed. The body mass index (BMI) standard deviation scores (SDSs) were calculated using height and weight measurements recorded 1-2 months after diagnosis of T1D and compared with age-matched anthropometric data. The rate of change in BMI SDSs over time was calculated. Analysis of BMI data was undertaken for the three age categories: <5, 5 to <10 and >10 years. RESULTS The mean age at diagnosis of 467 children with T1D was 7·27 ± 0·32 years and showed no change over the study period. There was a yearly increase of 14·11% in patient numbers; this increase was similar in the three age categories (22·7%, 17·0%, 16·3%, respectively, P = 1·0). Comparison of patient numbers between the two time periods of 5 years each showed a marked increase during 2010-2014 (148 vs 319, % increase 115·5%). The mean BMI SDSs at diagnosis in the three age categories were similar (P = 1·0) and showed a yearly change of -0·36; the mean change in the three age categories was also similar (-0·35, -0·27, -0·46, respectively, P = 1·0). No correlation was found between age at diagnosis and BMI SDSs (correlation coefficient 0·010, P = 0·82). The mean BMI SDS in patients was significantly lower compared to controls (-0·54 vs -0·02, P = 0·001). CONCLUSION There was no association between BMI SDS and age at diagnosis in children with new onset T1D. Further studies are needed to test whether the accelerator hypothesis is relevant in developing countries.
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Affiliation(s)
- Devi Dayal
- Paediatric Endocrinology & Diabetes Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhusudan Samprathi
- Paediatric Endocrinology & Diabetes Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dhaarani Jayaraman
- Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dilesh Kohat
- Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Kumar Bhalla
- Child Growth and Anthropology Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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38
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The Alarming Increase of Diabetes in Bermuda. W INDIAN MED J 2015; 63:685-6. [PMID: 26360544 DOI: 10.7727/wimj.2015.439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/18/2022]
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Pivovarov JA, Taplin CE, Riddell MC. Current perspectives on physical activity and exercise for youth with diabetes. Pediatr Diabetes 2015; 16:242-55. [PMID: 25754326 DOI: 10.1111/pedi.12272] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 12/19/2022] Open
Abstract
Regular physical activity (PA) for youth with diabetes improves cardiorespiratory fitness, body composition, bone health, insulin sensitivity, and psychosocial well-being. However many youth with diabetes or pre-diabetes fail to meet minimum PA guidelines and a large percentage of youth with diabetes are overweight or obese. Active youth with type 1 diabetes tend to have lower HbA1c levels and reduced insulin needs, whereas activity in adolescents at-risk for type 2 diabetes improves various measures of metabolism and body composition. Insulin and nutrient adjustments for exercise in type 1 diabetes is complex because of varied responses to exercise type and because of the different times of day that exercise is performed. This review highlights the benefits of exercise and the established barriers to exercise participation in the pediatric diabetes population. A new exercise management algorithm for insulin and carbohydrate intake strategies for active youth with type 1 diabetes is presented.
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Affiliation(s)
- Jacklyn A Pivovarov
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
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40
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Yu HW, Lee YJ, Cho WI, Lee YA, Shin CH, Yang SW. Preserved C-peptide levels in overweight or obese compared with underweight children upon diagnosis of type 1 diabetes mellitus. Ann Pediatr Endocrinol Metab 2015; 20:92-7. [PMID: 26191513 PMCID: PMC4504996 DOI: 10.6065/apem.2015.20.2.92] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We hypothesized that overweight or obese children might develop type 1 diabetes mellitus (T1DM) early despite residual beta-cell function. Factors independently associated with preservation of C-peptide level were analyzed. METHODS We retrospectively reviewed the medical data of 135 children aged 2.1-16.5 years with autoimmune T1DM. Body mass index (BMI), pubertal stage, and glycosylated hemoglobin (HbA1c) and C-peptide levels were evaluated. Patients were assigned to underweight (22.2%), normal weight (63.7%), and overweight or obese (14.1%) groups according to their BMI. RESULTS Preservation of serum C-peptide levels (≥0.6 ng/mL) was found in 43.0% of subjects. With increasing BMI, the proportions of children with preserved C-peptide levels increased from 33.3% to 41.9% to 63.2%, with marginal significance (P=0.051). Interaction analysis indicated no effect of BMI score on age at onset associated with serum C-peptide levels. The lower the C-peptide level, the younger the age of onset (P<0.001), after adjustment for BMI z-score and HbA1c level. However, no significant relationship between BMI z-score or category and onset age was evident. Upon multivariate-adjusted modeling, the odds that the C-peptide level was preserved increased by 1.2 fold (P=0.001) per year of life, by 3.1 folds (P=0.015) in children presenting without (compared to with) ketoacidosis, and by 5.0 folds (P=0.042) in overweight or obese (compared to underweight) children. CONCLUSION Overweight or obese children had slightly more residual beta-cell function than did underweight children. However, we found no evidence that obesity temporally accelerates T1DM presentation.
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Affiliation(s)
- Hyeoh Won Yu
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won Im Cho
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Demir F, Günöz H, Saka N, Darendeliler F, Bundak R, Baş F, Neyzi O. Epidemiologic Features of Type 1 Diabetic Patients between 0 and 18 Years of Age in İstanbul City. J Clin Res Pediatr Endocrinol 2015; 7:49-56. [PMID: 25800476 PMCID: PMC4439892 DOI: 10.4274/jcrpe.1694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the epidemiologic, clinical and laboratory characteristics of a group of children with type 1 diabetes mellitus (T1DM) living in a Turkish city. METHODS The records of 395 (boys/girls: 199/196) children with newly diagnosed T1DM hospitalized in the years 1985-2004 were evaluated retrospectively. The data were assessed by gender and age subgroups (≤5, 6-10 and ≥11 years). RESULTS Mean age of children at diagnosis was 8.1±4.1 years. At T1DM onset, the number of children ≤5, between 6-10 and ≥11 years old was 110 (27.9%), 147 (37.2%) and 138 (34.9%), respectively. The patients were mostly diagnosed at ages 6-8 years (24.1%), followed by cases aged 3-5 years (22.0%). Polyuria and polydipsia were the most common symptoms (94.7%). Mean duration of symptoms was 21.5±18.6 days. Although the patients mostly presented in autumn (30.7%), no season-related significant differences were found. The frequency of ketoacidosis was relatively high (48.5%). When compared to boys, the girls experienced higher rates of ketoacidosis (55.1% vs. 41.7%, p=0.042); had a higher frequency of anti-thyroid peroxidase antibodies (11.7% vs. 4.2%, p=0.049) and higher insulin requirement (0.89±0.41 vs. 0.77±0.36 IU/kg, p=0.005). Cases with a family history of T1DM were more likely to have anti-endomysial antibodies (42.9% vs. 8.1%, p=0.027) and higher initial blood glucose levels (510.5±145.0 vs. 436.1±156.5 mg/dL, p=0.005). CONCLUSION The findings possibly indicate a decreasing age of T1DM onset. The high frequency of ketoacidosis at presentation is noteworthy. Girls had higher rates of ketoacidosis, higher frequency of anti-thyroid antibodies and higher insulin requirements as compared to boys. Patients with a family history of T1DM had higher initial glucose levels and higher frequency of anti-endomysial antibodies.
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Affiliation(s)
- Fikri Demir
- Dicle University Faculty of Medicine, Department of Pediatrics, Diyarbakır, Turkey. E-mail:
| | - Hülya Günöz
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Nurçin Saka
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Rüveyde Bundak
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Olcay Neyzi
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Trellu M, Lacombe S, Morin D, Dalla-Vale F. [Epidemiology of diabetes in children in Languedoc-Roussillon (France)]. Arch Pediatr 2015; 22:241-6. [PMID: 25656455 DOI: 10.1016/j.arcped.2014.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 07/25/2014] [Accepted: 12/17/2014] [Indexed: 12/21/2022]
Abstract
Since 1st January 2000, the PEDIAB-LR registry has listed new cases of diabetes in children under 16 years of age in the Languedoc-Roussillon region of France, in order to assess the incidence and epidemiological characteristics of children affected by diabetes. At the end of December 2010, 745 children had been registered. The characteristics of these children included an identical proportion of girls and boys, a mean age of 8 years at diagnosis, and a family history of type 1 diabetes in 8.4% of the cases. Inaugural ketoacidosis was observed in 69.5% of the patients and was severe in 23.7% of these cases. To replace intravenous insulin, a two-injection dosing regimen (in the morning and before dinner) was prescribed in 76.5% of cases, multi-injections of basal-bolus in 16%, and subcutaneous insulin infusion (insulin pump therapy) in 7.5% of cases. Between 2000 and 2010, there was no increase in overall incidence. It is noteworthy that age at diagnosis tended to decrease, but this was not statistically significant. In conclusion, the PEDIAB-LR registry is currently the only French registry on diabetes in children, analyzing many factors related to its incidence, such as age at diagnosis and the existence of ketoacidosis.
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Affiliation(s)
- M Trellu
- Service de diabétologie pédiatrique, hôpital Arnaud-de-Villeneuve, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - S Lacombe
- Institut universitaire de recherche clinique (IURC), 641, avenue du Doyen-Gaston-Giraud, 34093 Montpellier cedex 5, France
| | - D Morin
- Service de diabétologie pédiatrique, hôpital Arnaud-de-Villeneuve, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Pédiatrie spécialisée, institut marin Saint-Pierre, 371, avenue de l'Évêché de Maguelone, 34250 Palavas-les-Flots, France
| | - F Dalla-Vale
- Service de diabétologie pédiatrique, hôpital Arnaud-de-Villeneuve, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Pédiatrie spécialisée, institut marin Saint-Pierre, 371, avenue de l'Évêché de Maguelone, 34250 Palavas-les-Flots, France.
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43
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Lauria A, Barker A, Schloot N, Hosszufalusi N, Ludvigsson J, Mathieu C, Mauricio D, Nordwall M, Van der Schueren B, Mandrup-Poulsen T, Scherbaum WA, Weets I, Gorus FK, Wareham N, Leslie RD, Pozzilli P. BMI is an important driver of β-cell loss in type 1 diabetes upon diagnosis in 10 to 18-year-old children. Eur J Endocrinol 2015; 172:107-13. [PMID: 25378371 DOI: 10.1530/eje-14-0522] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Body weight-related insulin resistance probably plays a role in progression to type 1 diabetes, but has an uncertain impact following diagnosis. In this study, we investigated whether BMI measured at diagnosis was an independent predictor of C-peptide decline 1-year post-diagnosis. DESIGN Multicentre longitudinal study carried out at diagnosis and up to 1-year follow-up. METHODS Data on C-peptide were collected from seven diabetes centres in Europe. Patients were grouped according to age at diagnosis (<5 years, n=126; >5 years <10 years, n=295; >10 years <18 years, n=421; >18 years, n=410). Linear regression was used to investigate whether BMI was an independent predictor of change in fasting C-peptide over 1 year. Models were additionally adjusted for baseline insulin dose and HbA1c. RESULTS In individuals diagnosed between 0 and 5 years, 5 and 10 years and those diagnosed >18 years, we found no association between BMI and C-peptide decline. In patients aged 10-18 years, higher BMI at baseline was associated with a greater decline in fasting C-peptide over 1 year with a decrease (β 95% CI; P value) of 0.025 (0.010, 0.041) nM/kg per m(2) higher baseline BMI (P=0.001). This association remained significant after adjusting for gender and differences in HbA1c and insulin dose (β=0.026, 95% CI=0.0097, 0.042; P=0.002). CONCLUSIONS These observations indicate that increased body weight and increased insulin demand are associated with more rapid disease progression after diagnosis of type 1 diabetes in an age group 10-18 years. This should be considered in studies of β-cell function in type 1 diabetes.
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Affiliation(s)
- A Lauria
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - A Barker
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - N Schloot
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - N Hosszufalusi
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - J Ludvigsson
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - C Mathieu
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - D Mauricio
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - M Nordwall
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
| | - B Van der Schueren
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - T Mandrup-Poulsen
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
| | - W A Scherbaum
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - I Weets
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
| | - F K Gorus
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
| | - N Wareham
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - R D Leslie
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - P Pozzilli
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
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Surgical treatment of medically refractory gastroparesis in the morbidly obese. Surg Endosc 2015; 29:2683-9. [DOI: 10.1007/s00464-014-3990-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 11/05/2014] [Indexed: 12/18/2022]
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Procaccini C, Pucino V, Mantzoros CS, Matarese G. Leptin in autoimmune diseases. Metabolism 2015; 64:92-104. [PMID: 25467840 DOI: 10.1016/j.metabol.2014.10.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/20/2014] [Indexed: 12/22/2022]
Abstract
The past twenty years of research on leptin has provided crucial information on the link between metabolic state and immune system function. Adipocytes influence not only the endocrine system but also the immune response, through several cytokine-like mediators known as adipokines, which include leptin. Initially described as an antiobesity hormone, leptin has subsequently been shown also to influence hematopoiesis, thermogenesis, reproduction, angiogenesis, and more importantly immune homeostasis. As a cytokine, leptin can affect thymic homeostasis and the secretion of acute-phase reactants such as interleukin-1 (IL-1) and tumor-necrosis factor-alpha (TNF-α). Leptin links nutritional status and proinflammatory T helper 1 (Th1) immune responses and the decrease in leptin plasma concentration during food deprivation leads to impaired immune function. Conversely, elevated circulating leptin levels in obesity appear to contribute to the low-grade inflammatory background which makes obese individuals more susceptible to increased risk of developing cardiovascular diseases, diabetes, or degenerative disease including autoimmunity and cancer. In this review, we provide an overview of recent advances on the role of leptin in the pathogenesis of several autoimmune disorders that may be of particular relevance in the modulation of the autoimmune attack through metabolic-based therapeutic approaches.
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Affiliation(s)
- Claudio Procaccini
- Laboratorio di Immunologia, Istituto di Endocrinologia e Oncologia Sperimentale, Consiglio Nazionale delle Ricerche (IEOS-CNR) c/o Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli "Federico II", 80131 Napoli, Italy
| | - Valentina Pucino
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli "Federico II", 80131 Napoli, Italy
| | - Christos S Mantzoros
- Section of Endocrinology, Boston VA Healthcare System, Jamaica Plain, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Medicine, Boston Medical Center, Boston University, 72 Evans Street, Boston, MA 02217, USA
| | - Giuseppe Matarese
- Dipartimento di Medicina e Chirurgia, Facoltà di Medicina e Chirurgia, Università di Salerno, Baronissi Campus, 84081 Baronissi, Salerno, Italy; IRCCS-MultiMedica, 20138 Milano, Italy.
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Islam ST, Srinivasan S, Craig ME. Environmental determinants of type 1 diabetes: a role for overweight and insulin resistance. J Paediatr Child Health 2014; 50:874-9. [PMID: 24893825 DOI: 10.1111/jpc.12616] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 01/10/2023]
Abstract
Rates of type 1 diabetes are rising globally, with a decreasing proportion of high-risk genotypes and twin concordance rates below 50%. Therefore, environmental factors such as viruses, nutrition and overweight have been examined as putative aetiological agents. The accelerator hypothesis proposes that overweight and insulin resistance are central to both type 1 and type 2 diabetes and may explain, in part, the rise in type 1 diabetes incidence. The temporal rise in body mass index at type 1 diabetes onset and the observation that pre-diabetic children are heavier and more insulin resistant than their peers suggests convergence of type 1 and type 2 diabetes phenotypes. The influence of insulin resistance may begin in utero, although the aetiological role of birthweight in type 1 diabetes remains unclear. Further research to elucidate the role of these modifiable risk factors in today's obesogenic environment may provide future potential for diabetes prevention.
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Affiliation(s)
- Sadia T Islam
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Obesity in autoimmune diseases: Not a passive bystander. Autoimmun Rev 2014; 13:981-1000. [DOI: 10.1016/j.autrev.2014.07.001] [Citation(s) in RCA: 406] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/20/2014] [Indexed: 02/06/2023]
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Kuchlbauer V, Vogel M, Gausche R, Kapellen T, Rothe U, Vogel C, Pfäffle R, Kiess W. High birth weights but not excessive weight gain prior to manifestation are related to earlier onset of diabetes in childhood: 'accelerator hypothesis' revisited. Pediatr Diabetes 2014; 15:428-35. [PMID: 24350794 DOI: 10.1111/pedi.12107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/07/2013] [Accepted: 11/06/2013] [Indexed: 01/27/2023] Open
Abstract
AIMS/HYPOTHESIS Aim of this study was to test Wilkin's 'accelerator hypothesis': whether excessive weight gain accelerates the onset of type 1 diabetes. SUBJECTS AND METHODS Anthropometric birth data of 1117 children who developed diabetes between 1988 and April 2013 were compared with those of a sex, age, and gestational age matched, contemporary regional control group (n = 54 344). Cases were divided into three manifestation groups (G1:0-4.9 yr, G2:5-9.9 yr, and G3: 10-20 yr). Furthermore, growth data of 540 children with diabetes were compared with controls (n = 134 249) in pre-, peri-, and post-onset intervals (interval: 1-6). Also, correlation of age at onset and body mass index (BMI) standard deviation score (SDS) at this point of time were examined. RESULTS Cases had significantly higher SDSs for birth weight when compared with controls (boys: p = 0.007, girls: p = 0.002). Children with early manifestation had the highest mean of birth weight SDS (G1>G2>G3), (p = 0.22, adjusted r(2) = 0.001). BMI SDS trend curves of cases are slightly higher compared with those of the healthy controls. This was only significant in years after diagnosis (interval 6, p < 0.000). Cases did not show excessive weight gain in any of the examined intervals before the onset of diagnosis (interval 1-3). One year after diagnosis, we found an inverse correlation between age at diagnosis and BMI SDS at diabetes manifestation. The youngest children at diagnosis (G1) had the lowest BMI SDS at manifestation and vice versa (G1<G2<G3, p = 0.06). CONCLUSIONS Our data do not support the 'accelerator hypothesis'. There was no sign of excessive weight gain before manifestation. Discrepant results from other studies could be due to non-age-adjusted controls.
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Affiliation(s)
- Veronika Kuchlbauer
- Department of Woman and Child Health, Centre of Paediatric Research, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
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Kapellen TM, Gausche R, Dost A, Wiegand S, Flechtner-Mors M, Keller E, Kiess W, Holl RW. Children and adolescents with type 1 diabetes in Germany are more overweight than healthy controls: results comparing DPV database and CrescNet database. J Pediatr Endocrinol Metab 2014; 27:209-14. [PMID: 24197766 DOI: 10.1515/jpem-2013-0381] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/04/2013] [Indexed: 11/15/2022]
Abstract
AIMS To describe the development of weight in children and adolescents with type 1 diabetes in Germany. METHODS We analyzed the body mass index (BMI) of the most recent treatment year of each patient with diabetes in the Pediatric Quality Initiative (DPV) database. BMI SD score (SDS) was calculated based on pooled historical German normative data (AGA) and based on healthy children from the CrescNet database. Thus, 25,762 children and adolescents with diabetes were compared with more than 75,000 healthy controls. RESULTS BMI-SDS was 0.49±0.88 and 0.26±0.79 when children and adolescents, respectively, with diabetes were compared with AGA reference or with CrescNet controls from the same year. In both analyses, female patients (0.57±0.89 and 0.30±0.79) had significantly higher BMI-SDS than male patients (0.41±0.86 and 0.22±0.78; p<0.0001). Analysis of different age groups showed highest BMI-SDS in patients below 6 years (0.61 and 0.56, respectively). After adjustment for metabolic control, center, and insulin treatment, BMI-SDS was significantly influenced by diabetes duration, age, and female gender. CONCLUSIONS BMI of children and adolescents with type 1 diabetes is higher compared with healthy children measured in the same year. Especially, very young children and adolescent girls are at risk for overweight independent of annual trends.
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Peet A, Hämäläinen AM, Kool P, Ilonen J, Knip M, Tillmann V. Early postnatal growth in children with HLA-conferred susceptibility to type 1 diabetes. Diabetes Metab Res Rev 2014; 30:60-8. [PMID: 24038878 DOI: 10.1002/dmrr.2449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 08/12/2013] [Accepted: 08/19/2013] [Indexed: 11/09/2022]
Abstract
AIMS/HYPOTHESIS An association between increased length/height and weight gain and risk of type 1 diabetes (T1D) has been reported in children. We set out to investigate the potential contribution of T1D human leukocyte antigen (HLA) risk genotypes to this association in two countries with a contrasting disease incidence. METHODS In Estonia and Finland, length and weight were monitored up to the age of 24 months in 688 subjects. According to their HLA genotypes, the children were divided into four groups, those with very high, high or moderate risk for T1D, as well as a neutral/control group. Relative length and weight (SDS) were assessed and compared at 3, 6, 12, 18 and 24 months using World Health Organization (WHO) growth curves. RESULTS The mean relative length at the age of 24 months was lower in the group with the very high risk HLA genotype compared to the controls (p < 0.05). The mean relative weight differed between those two groups at the age of 12, 18 and 24 months (p < 0.05). When Estonian and Finnish cohorts were analyzed separately, the relative length showed similar but non-significant trends in both countries, while in Estonia the changes in weight at some time points still remained significant (p < 0.05). CONCLUSIONS Children with the highest HLA-conferred risk for T1D gained less weight and length during the first 24 months of life, and this feature was more pronounced in the Estonian children.
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Affiliation(s)
- A Peet
- Department of Paediatrics, University of Tartu, Tartu, Estonia; Tartu University Hospital, Tartu, Estonia
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