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den Brok EJ, Svensson CH, Panagiotou M, van Greevenbroek MMJ, Mertens PR, Vazeou A, Mitrakou A, Makrilakis K, Franssen GHLM, van Kuijk S, Proennecke S, Mougiakakou S, Pedersen-Bjergaard U, de Galan BE. The effect of bolus advisors on glycaemic parameters in adults with diabetes on intensive insulin therapy: A systematic review with meta-analysis. Diabetes Obes Metab 2024; 26:1950-1961. [PMID: 38504142 DOI: 10.1111/dom.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/21/2024]
Abstract
AIM To conduct a systematic review with meta-analysis to provide a comprehensive synthesis of randomized controlled trials (RCTs) and prospective cohort studies investigating the effects of currently available bolus advisors on glycaemic parameters in adults with diabetes. MATERIALS AND METHODS An electronic search of PubMed, Embase, CINAHL, Cochrane Library and ClinicalTrials.gov was conducted in December 2022. The risk of bias was assessed using the revised Cochrane Risk of Bias tool. (Standardized) mean difference (MD) was selected to determine the difference in continuous outcomes between the groups. A random-effects model meta-analysis and meta-regression were performed. This systematic review was registered on PROSPERO (CRD42022374588). RESULTS A total of 18 RCTs involving 1645 adults (50% females) with a median glycated haemoglobin (HbA1c) concentration of 8.45% (7.95%-9.30%) were included. The majority of participants had type 1 diabetes (N = 1510, 92%) and were on multiple daily injections (N = 1173, 71%). Twelve of the 18 trials had low risk of bias. The meta-analysis of 10 studies with available data on HbA1c showed that the use of a bolus advisor modestly reduced HbA1c compared to standard treatment (MD -011%, 95% confidence interval -0.22 to -0.01; I2 = 0%). This effect was accompanied by small improvements in low blood glucose index and treatment satisfaction, but not with reductions in hypoglycaemic events or changes in other secondary outcomes. CONCLUSION Use of a bolus advisor is associated with slightly better glucose control and treatment satisfaction in people with diabetes on intensive insulin treatment. Future studies should investigate whether personalizing bolus advisors using artificial intelligence technology can enhance these effects.
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Affiliation(s)
- Elisabeth J den Brok
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Cecilie H Svensson
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
| | - Maria Panagiotou
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | | | - Peter R Mertens
- Department of Kidney and Hypertension Diseases, Diabetology and Endocrinology, Otto-Von-Guericke-Univeristat Magdeburg, Magdeburg, Germany
| | | | - Asimina Mitrakou
- Diabetes Center, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gregor H L M Franssen
- University Library, Department Education, Content & Support, Maastricht University, Maastricht, The Netherlands
| | - Sander van Kuijk
- Clinical epidemiology & Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Stavroula Mougiakakou
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Lausanne, Denmark
| | - Bastiaan E de Galan
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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Vakali E, Rigopoulos D, Dinas PC, Drosatos IA, Theodosiadi AG, Vazeou A, Stergiou G, Kollias A. Relationship between Short- and Mid-Term Glucose Variability and Blood Pressure Profile Parameters: A Scoping Review. J Clin Med 2023; 12:jcm12062362. [PMID: 36983362 PMCID: PMC10053380 DOI: 10.3390/jcm12062362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Background. Increased variability of glucose (GV) and blood pressure (BPV) is linked to a higher risk of macro- and microvascular complications and other hard endpoints. This scoping review aims to summarize the existing evidence regarding the association between the parameters of the blood pressure (BP) profile, especially BPV, with indices of short- and mid-term GV. Methods. A literature search was conducted in the MEDLINE/PubMed, Cochrane, Embase, Web of Science, and Wiley Online Library databases. Results. The main findings of this review are as follows: (i) 13 studies were included, mainly with small sample sizes; (ii) there was a considerable degree of heterogeneity in the characteristics of the study participants (age range, individuals with normoglycemia, type 1 or 2 diabetes, normal BP, or hypertension), as well as in the methodologies (mainly in terms of the duration of the data collection period) and variability indices examined (mean amplitude of glycemic excursions and coefficient of glucose variation most frequently reported); and (iii) the results were heterogeneous regarding the association between GV and the parameters of the BP profile. Conclusions. There is a significant lack of evidence on the association between GV and BPV. Future research implementing a standardized methodology should focus on the determinants, association, and clinical relevance of GV and BPV.
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Affiliation(s)
- Elena Vakali
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
- Endocrinology-Growth and Development Department, P&A Kyriakou Children's Hospital, 11527 Athens, Greece
| | | | - Petros C Dinas
- FAME Laboratory, Department of Physical Education and Sports Science, University of Thessaly, 42100 Trikala, Greece
| | | | - Aikaterini G Theodosiadi
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Andriani Vazeou
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, 11527 Athens, Greece
| | - George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
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3
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Vazeou A, Tittel SR, Kordonouri O, Birkebaek NH, Iotova V, Piccini B, Seget S, Guness PK, Maahs DM, Stergiou GS. Increased prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes and hypertension: The SWEET international database. Diabetes Obes Metab 2022; 24:2420-2430. [PMID: 36089908 DOI: 10.1111/dom.14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the prevalence of modifiable cardiovascular risk factors (CVRFs), including dyslipidaemia, obesity and high glycated haemoglobin (HbA1c) concentration, in patients with type 1 diabetes (T1D), and to evaluate their association with blood pressure (BP) categories. METHODS We analysed 21 634 children and adolescents with T1D from the SWEET international database with office BP values assessed at a three or more visits within a year from 2010 to 2021. Participants were classified into a normotensive group, a group with elevated BP (90 to 94th percentile) or a hypertensive group (≥95th percentile), based on the median BP for the visits within the last treatment year. The prevalences of dyslipidaemia [cholesterol ≥ 5.18 mmol/L (200 mg/dL) and/or HDL cholesterol ≤ 1.036 mmol/L (40 mg/dL) and/or LDL cholesterol ≥ 2.59 mmol/L (100 mg/dL)], obesity (body mass index ≥2 standard deviation score) and elevated HbA1c [≥ 75 mmol/mol (9%)] were evaluated in patients within each BP group. RESULTS Patients with hypertension/elevated BP had less favourable lipid profiles, and a higher prevalence of obesity and HbA1c ≥ 75 mmol/mol than normotensive patients. A total of 38.4% of hypertensive patients and 36.0% of those with elevated BP had one CVRF, 15.1% and 10.1%, respectively, had two CVRFs, and 2.3% and 0.8%, respectively, had three CVRFs. Patients with hypertension/elevated BP had a higher prevalence of one or more CVRFs versus normotensive patients (P < 0.001). Obesity was the CVRF most strongly related to hypertension. Girls had a higher prevalence of one or more CVRFs than boys. Similar results were found in patients aged ≥13 years with hypertension compared to those aged <13 years. CONCLUSIONS The prevalence of modifiable CVRFs is higher in children and adolescents with T1D who have elevated BP/hypertension than in those with normotension, suggesting that they are more vulnerable to future morbidity and mortality requiring early detection and intervention.
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Affiliation(s)
- Andriani Vazeou
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospitals, Athens, Greece
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Olga Kordonouri
- Children's Hospital AUF DER BULT, Hannover Medical School, Hannover, Germany
| | - Niels H Birkebaek
- Department of Pediatrics and Steno Diabetes Center Aarhus, Aarhus University hospital, Aarhus, Denmark
| | - Violeta Iotova
- Department of Pediatrics, Medical University, Varna, Bulgaria
| | - Barbara Piccini
- Regional Center for Pediatric Diabetes, Meyer University Children's Hospital, Florence, Italy
| | - Sebastian Seget
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Pravesh Kumar Guness
- Department of diabetes, nutrition and endocrinology, Reunion Island and T1Diams Quatres Bornes, Vacoas, Mauritius
| | - David M Maahs
- Department of Pediatrics and Stanford Diabetes Research Center, Stanford University and the Lucile Packard Children's Hospital, Stanford, California, USA
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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Vazeou A, Tittel SR, Birkebaek NH, Kordonouri O, Iotova V, Piccini B, Saboo B, Pundziute Lyckå A, Seget S, Maahs DM, Stergiou G. The Importance of Office Blood Pressure Measurement Frequency and Methodology in Evaluating the Prevalence of Hypertension in Children and Adolescents With Type 1 Diabetes: The SWEET International Database. Diabetes Care 2022; 45:1462-1471. [PMID: 35476140 DOI: 10.2337/dc21-2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The prevalence of hypertension is higher in children and adolescents with type 1 diabetes (T1D) compared with those without. This retrospective analysis of a large cohort of children and adolescents with T1D from the SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) international consortium of pediatric diabetes centers aimed to 1) estimate the prevalence of elevated office blood pressure (BP) and hypertension and 2) investigate the influence of BP measurement methodology on the prevalence of hypertension. RESEARCH DESIGN AND METHODS A total of 27,120 individuals with T1D, aged 5-18 years, were analyzed. Participants were grouped into those with BP measurements at three or more visits (n = 10,440) and fewer than 3 visits (n = 16,680) per year and stratified by age and sex. A subgroup analysis was performed on 15,742 individuals from centers providing a score indicating BP measurement accuracy. RESULTS Among participants with BP measurement at three or more visits, the prevalence of hypertension was lower compared with those with fewer than three visits (10.8% vs. 17.5% P < 0.001), whereas elevated BP and normotension were higher (17.5% and 71.7% vs. 15.3% and 67.1%, respectively; both P < 0.001). The prevalence of hypertension and elevated BP was higher in individuals aged ≥13 years than in younger ones (P < 0.001) and in male than female participants (P < 0.001). In linear regression models, systolic and diastolic BP was independently determined by the BP measurement methodology. CONCLUSIONS The estimated prevalence of elevated BP and hypertension in children and adolescents with T1D is ∼30% and depends on the BP measurement methodology. Less frequent BP evaluation may overestimate the prevalence of hypertension.
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Affiliation(s)
- Andriani Vazeou
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Niels H Birkebaek
- Department of Pediatrics and Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Olga Kordonouri
- Children's Hospital AUF DER BULT, Hannover Medical School, Hannover, Germany
| | - Violeta Iotova
- Department of Pediatrics, Medical University, Varna, Bulgaria
| | - Barbara Piccini
- Regional Center for Pediatric Diabetes, Meyer University Children's Hospital, Florence, Italy
| | - Banshi Saboo
- Dia Care - Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Auste Pundziute Lyckå
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, and Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Seget
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - David M Maahs
- Department of Pediatrics and Stanford Diabetes Research Center, Stanford, CA
| | - George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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5
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Nimri R, Oron T, Muller I, Kraljevic I, Alonso MM, Keskinen P, Milicic T, Oren A, Christoforidis A, den Brinker M, Bozzetto L, Bolla AM, Krcma M, Rabini RA, Tabba S, Smith L, Vazeou A, Maltoni G, Giani E, Atlas E, Phillip M. Adjustment of Insulin Pump Settings in Type 1 Diabetes Management: Advisor Pro Device Compared to Physicians' Recommendations. J Diabetes Sci Technol 2022; 16:364-372. [PMID: 33100030 PMCID: PMC8861776 DOI: 10.1177/1932296820965561] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIMS To compare insulin dose adjustments made by physicians to those made by an artificial intelligence-based decision support system, the Advisor Pro, in people with type 1 diabetes (T1D) using an insulin pump and self-monitoring blood glucose (SMBG). METHODS This was a multinational, non-interventional study surveying 17 physicians from 11 countries. Each physician was asked to provide insulin dose adjustments for the settings of the pump including basal rate, carbohydrate-to-insulin ratios (CRs), and correction factors (CFs) for 15 data sets of pumps and SMBG of people with T1D (mean age 18.4 ± 4.8 years; eight females; mean glycated hemoglobin 8.2% ± 1.4% [66 ± 11mmol/mol]). The recommendations were compared among the physicians and between the physicians and the Advisor Pro. The study endpoint was the percentage of comparison points for which there was an agreement on the direction of insulin dose adjustments. RESULTS The percentage (mean ± SD) of agreement among the physicians on the direction of insulin pump dose adjustments was 51.8% ± 9.2%, 54.2% ± 6.4%, and 49.8% ± 11.6% for the basal, CR, and CF, respectively. The automated recommendations of the Advisor Pro on the direction of insulin dose adjustments were comparable )49.5% ± 6.4%, 55.3% ± 8.7%, and 47.6% ± 14.4% for the basal rate, CR, and CF, respectively( and noninferior to those provided by physicians. The mean absolute difference in magnitude of change between physicians was 17.1% ± 13.1%, 14.6% ± 8.4%, and 23.9% ± 18.6% for the basal, CR, and CF, respectively, and comparable to the Advisor Pro 11.7% ± 9.7%, 10.1% ± 4.5%, and 25.5% ± 19.5%, respectively, significant for basal and CR. CONCLUSIONS Considerable differences in the recommendations for changes in insulin dosing were observed among physicians. Since automated recommendations by the Advisor Pro were similar to those given by physicians, it could be considered a useful tool to manage T1D.
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Affiliation(s)
- Revital Nimri
- The Jesse Z and Sara Lea Shafer
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes,
Schneider Children’s Medical Center of Israel, Petah, Tikva, Israel
- Revital Nimri, MD, The Jesse Z and Sara Lea
Shafer Institute for Endocrinology and Diabetes, National Center for Childhood
Diabetes, Schneider Children’s Medical Center of Israel, 14 Kaplan St. Petah
Tikva, 49202, Israel.
| | - Tal Oron
- The Jesse Z and Sara Lea Shafer
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes,
Schneider Children’s Medical Center of Israel, Petah, Tikva, Israel
| | - Ido Muller
- DreaMed Diabetes Ltd, Petah Tiqva,
Israel
| | - Ivana Kraljevic
- Department of Endocrinology and
Diabetes, UHC Zagreb, School of Medicine, University of Zagreb, Zagreb,
Croatia
| | - Montserrat Martín Alonso
- Department of Pediatrics, Children’s
Endocrinology Unit, University Hospital of Salamanca, Spain
| | - Paivi Keskinen
- Department of Pediatrics, University
Hospital of Tampere, Finland
| | - Tanja Milicic
- Clinic for Endocrinology, Diabetes and
Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine University of
Belgrade, Serbia
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes
Unit, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Israel
- Sackler School of Medicine, Tel Aviv
University, Israel
| | - Athanasios Christoforidis
- Pediatric Department, Aristotle
University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Marieke den Brinker
- Department of Pediatrics, Division of
Pediatric Endocrinology and Diabetology, Antwerp University Hospital and University
of Antwerp, Belgium
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and
Surgery, University of Naples “Federico II”, Italy
| | | | - Michal Krcma
- Department of Internal Medicine,
Diabetes and Endocrinology Unit, University Hospital Pilsen, Faculty of Medicine in
Pilsen, Charles University, Czech Republic
| | - Rosa Anna Rabini
- Department of Diabetology, Hospital
Mazzoni, Ascoli Piceno, Italy
| | - Shadi Tabba
- Children’s Hospital of the King’s
Daughters, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Lizl Smith
- Department of Internal Medicine,
Division of Endocrinology, University of Pretoria, South Africa
| | - Andriani Vazeou
- A’ Department of Pediatrics, Diabetes
Center, P&A Kyriakou, Athens, Greece
| | - Giulio Maltoni
- Department of Pediatrics, University
Hospital of Bologna Sant’Orsola-Malpighi Polyclinic, Italy
| | - Elisa Giani
- Department of Biomedical Sciences,
Humanitas Clinical and Research Center-IRCCS and Humanitas University, Milan,
Italy
| | - Eran Atlas
- DreaMed Diabetes Ltd, Petah Tiqva,
Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes,
Schneider Children’s Medical Center of Israel, Petah, Tikva, Israel
- Sackler School of Medicine, Tel Aviv
University, Israel
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6
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Xatzipsalti M, Alvertis H, Kourousi G, Patouni K, Konstantakopoulos S, Delis D, Vazeou A. Lipoatrophy, a rare complication of diabetes: a single-center experience. Hormones (Athens) 2022; 21:61-69. [PMID: 34671939 DOI: 10.1007/s42000-021-00324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lipoatrophy (LA), a rare skin complication in patients with type 1 diabetes (T1D), has decreased dramatically over the past decades due to the use of human purified insulin preparations. METHODS We collected data from the records of T1D patients with LA. Types of insulin and insulin regimen, presence of eosinophilia, anti-insulin (IAA), anti-GAD, anti-IA2 autoantibodies, other autoimmune disorders, site of atrophy and its relationship to catheter, HbA1c at LA onset and after resolution, and different treatment modalities (i.e., change of insulin type or site, sodium cromoglycate (SCG) cream, cortisone cream or percutaneous injections, and laser treatment) were recorded. RESULTS Thirteen out of 1200 T1D subjects (1%) presented with LA. The majority were on insulin pump using rapid-acting analogs. Twelve out of 13 patients had changed the type of insulin, and most of them had switched injection sites. Ten out of 13 patients used SCG cream and 7/10 showed complete/partial improvement. One patient used dexamethasone injection with improvement. Five patients showed self-improvement. In 3/7 patients who were receiving SCG, treatment was combined with change of insulin type (glulisine); however, in 1/3, the result should be attributed to concomitant laser treatment. In 4/7 patients, there was a clear, beneficial effect of SCG. In 1/4 with partial resolution of LA, laser treatment was used after SCG, which further improved the result. CONCLUSIONS LA is a rare skin complication seen even today with the use of insulin analogs. SCG alone or combined with change of insulin type seems to be the most effective treatment. Laser treatment is a promising new therapy.
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Affiliation(s)
- Maria Xatzipsalti
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece.
| | | | - Giannoula Kourousi
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Konstantina Patouni
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | | | - Dimitris Delis
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Andriani Vazeou
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
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7
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Bikouli EDC, Vazeou A, Xatzipsalti M, Servos G, Delis D, Maritsi DN. Blau Syndrome Complicated by Atypical Type IIa Takayasu Arteritis. Journal of Child Science 2021. [DOI: 10.1055/s-0041-1740463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractBlau syndrome (BS) is a rare, autosomal dominant monogenic autoinflammatory disease, usually presenting as a triad of symptoms (granulomatous dermatitis, uveitis, and nonerosive arthritis) and caused by gain-of-function mutations in the nucleotide oligomerization domain 2 (NOD2) gene. However, very few reports in children of copresence of BS with large vessel vasculitis exist. We hereby describe a case of BS associated with clinical features of Takayasu arteritis. An 8.5-year-old boy presented with hypertension, cardiac insufficiency, arthritis, and ocular disease. Among other investigations, he underwent cervical and chest computed tomography and computed tomography angiography scans that revealed the presence of type IIa Takayasu arteritis lesions. Genetic analysis revealed a heterozygous mutation of NOD2 gene leading to the amino acid exchange Arg-587-Cys in the NACHT domain of the NOD2 protein (R587C) as pathogenic cause of BS. He received treatment with prednisolone, methotrexate, and infliximab (antitumor necrosis factor-α) in addition to antihypertensive medication with a favorable clinical response. Cases of BS should be investigated for the coexistence of Takayasu arteritis. However, further research is required to delineate a possible common pathogenic mechanism between the two clinical entities.
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Affiliation(s)
| | - Andriani Vazeou
- First Department of Pediatrics, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - Maria Xatzipsalti
- First Department of Pediatrics, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - Georgios Servos
- Department of Pediatric Cardiology, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - Dimitrios Delis
- First Department of Pediatrics, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - Despoina N. Maritsi
- Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), “P.& A. Kyriakou” Children's Hospital, Athens, Greece
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8
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Xatzipsalti M, Bourousis E, Nikita M, Rontogianni D, Gkeli MG, Chrysis D, Giannakopoulos A, Delis D, Baka M, Vazeou A. Primary Thyroid Diffuse Large B-cell Lymphoma in a Child with Hashimoto's Thyroiditis: A Case Report. J Clin Res Pediatr Endocrinol 2021; 15:199-204. [PMID: 34565138 DOI: 10.4274/jcrpe.galenos.2021.2021.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Primary thyroid lymphoma (PTL) is a rare thyroid gland cancer, with diffuse large B-cell lymphomas (DLBCL) to be extremely rare in children and adolescents. Thus, effective therapy is debatable. We describe a rare case of thyroid DLBCL in an adolescent girl with a history of Hashimoto Thyroiditis (HT), its diagnostic difficulties and the outcome of treatment. A 12- year- old girl with known HT for the last 9 years, was admitted to our department with a right sided painless progressive swelling of the neck. Physical examination and imaging (U/S, CT, PET/CT scan) revealed an enlarged thyroid gland with right side lymphadenopathy and no metastasis. Two FNAs were done showing suspected lymphoblastic lesions for Non-Hodgkin Lymphoma without precise diagnosis. Ultra-sound guided core needle biopsy was finally performed confirming the diagnosis of DLBCL. She was treated according to LMB 96 - group B protocol with no surgical removal of thyroid. The patient responded very well to treatment and 14 months later there is no evidence of relapse or metastases. PTL is an extremely rare cause of thyroid malignancy in children However, it should be considered in the differential diagnosis of a thyroid mass in adolescents presenting with a rapidly enlarging neck mass and a history of HT. It is a treatable condition with a good prognosis even with the aggressive histological subtypes with no need of thyroidectomy.
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Affiliation(s)
- Maria Xatzipsalti
- A' Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Evangelos Bourousis
- A' Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Maria Nikita
- Oncology Department "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Dimitra Rontogianni
- Department of Histopathology and Molecular Pathology "Evangelismos" General Hospital, Athens, Greece
| | - Myrsini G Gkeli
- Department of Radiology, Unit of Sonography Saint Savvas Anticancer Oncological Hospital of Athens, Athens, Greece
| | - Dionisios Chrysis
- Division of Endocrinology, Department of Pediatrics, Medical School, University of Patras, Patras, Greece
| | - Aristeidis Giannakopoulos
- Division of Endocrinology, Department of Pediatrics, Medical School, University of Patras, Patras, Greece
| | - Dimitrios Delis
- A' Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Margarita Baka
- Oncology Department "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Andriani Vazeou
- A' Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
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9
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Patouni K, Cinek O, Pruhova S, Elblova L, Xatzipsalti M, Sertedaki A, Vazeou A. A case of digenic maturity onset diabetes of the young with heterozygous variants in both HNF1Α and HNF1Β genes. Eur J Med Genet 2021; 64:104264. [PMID: 34161864 DOI: 10.1016/j.ejmg.2021.104264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Maturity onset diabetes of the young (MODY) is the most commonly reported form of monogenic diabetes in the pediatric population. Only a few cases of digenic MODY have been reported up to now. CASE REPORT A female patient was diagnosed with diabetes at the age of 7 years and was treated with insulin. A strong family history of diabetes was present in the maternal side of the family. The patient also presented hypomagnesemia, glomerulocystic kidney disease and a bicornuate uterus. Genetic testing of the patient revealed that she was a double heterozygous carrier of HNF1A gene variant c.685C > T; (p.Arg229Ter) and a whole gene deletion of the HNF1B gene. Her mother was a carrier of the same HNF1A variant. CONCLUSION Digenic inheritance of MODY pathogenic variants is probably more common than currently reported in literature. The use of Next Generation Sequencing panels in testing strategies for MODY could unmask such cases that would otherwise remain undiagnosed.
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Affiliation(s)
- Konstantina Patouni
- Diabetes Center, First Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, Athens, Greece.
| | - Ondrej Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Stepanka Pruhova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Lenka Elblova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Maria Xatzipsalti
- Diabetes Center, First Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Amalia Sertedaki
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Andriani Vazeou
- Diabetes Center, First Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
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Stambolliu E, Kollias A, Bountzona I, Ntineri A, Servos G, Vazeou A, Stergiou GS. Nighttime Home Blood Pressure in Children: Association with Ambulatory Blood Pressure and Preclinical Organ Damage. Hypertension 2021; 77:1877-1885. [PMID: 33840203 DOI: 10.1161/hypertensionaha.121.17016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Emelina Stambolliu
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - George Servos
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Andriani Vazeou
- First Department of Pediatrics (A.V.), P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
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11
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Harrington DM, Brady EM, Weihrauch-Bluher S, Edwardson CL, Gray LJ, Hadjiconstantinou M, Jarvis J, Khunti K, Vergara I, Erreguerena I, Ribeiro RT, Troughton J, Vazeou A, Davies MJ. Development of an Interactive Lifestyle Programme for Adolescents at Risk of Developing Type 2 Diabetes: PRE-STARt. Children (Basel) 2021; 8:children8020069. [PMID: 33494347 PMCID: PMC7912284 DOI: 10.3390/children8020069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/26/2022]
Abstract
Background: Type 2 diabetes (T2D) is increasing in young people. Reporting on the processes used when developing prevention interventions is needed. We present the development of a family-based interactive lifestyle intervention for adolescents with risk factors for T2D in the future. Method: A multidisciplinary team in the UK site led the intervention development process with sites in Portugal, Greece, Germany and Spain. Potential programme topics and underpinning theory were gathered from literature and stakeholders. A theoretical framework based on self-efficacy theory and the COM-B (capability, opportunity, motivation, behaviour) model was developed. Sessions and supporting resources were developed and refined via two iterative cycles of session and resource piloting, feedback, reflection and refinement. Decision on delivery and content were made by stakeholders (young people, teachers, parents, paediatricians) and all sites. Materials were translated to local languages. Site-specific adaptations to the language, content and supporting resources were made. Results: The “PRE-STARt” programme is eight 90-min interactive sessions with supporting curriculum and resources. Iterative development work provided valuable feedback on programme content and delivery. Conclusion: Reporting on the intervention development process, which includes stakeholder input, could yield a flexible approach for use in this emerging ‘at risk’ groups and their families.
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Affiliation(s)
- Deirdre M. Harrington
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (C.L.E.); (M.H.); (K.K.)
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow G1 1QE, UK
- Correspondence: ; Tel.: +44-078-4776-5092
| | - Emer M. Brady
- Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, UK;
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (J.J.); (J.T.); (M.J.D.)
| | - Susann Weihrauch-Bluher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany;
- Department for Operative and Nonoperative Pediatric and Adolescent Medicine, University HospitalHalle (Saale), 06120 Halle (Saale), Germany
| | - Charlotte L. Edwardson
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (C.L.E.); (M.H.); (K.K.)
| | - Laura J. Gray
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | | | - Janet Jarvis
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (J.J.); (J.T.); (M.J.D.)
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (C.L.E.); (M.H.); (K.K.)
| | - Itziar Vergara
- Instituto de Investigación en Servicios de Salud Kronikgune, 48902 Barakaldo (Bizkaia), Spain; (I.V.); (I.E.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas-REDISSEC, 48902 Barakaldo (Bizkaia), Spain
| | - Irati Erreguerena
- Instituto de Investigación en Servicios de Salud Kronikgune, 48902 Barakaldo (Bizkaia), Spain; (I.V.); (I.E.)
| | - Rogério T. Ribeiro
- Education and Research Department (ERC), APDP-Portuguese Diabetes Association, 1250-189 Lisbon, Portugal;
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (J.J.); (J.T.); (M.J.D.)
| | - Andriani Vazeou
- Diabetes Center, Department of Pediatrics, P&A Kyriakou Children’s Hospital, 115 27 Athens, Greece;
| | - Melanie J. Davies
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (J.J.); (J.T.); (M.J.D.)
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
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12
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Stergiou GS, Bountzona I, Alamara C, Vazeou A, Kollias A, Ntineri A. Reproducibility of Office and Out-of-Office Blood Pressure Measurements in Children: Implications for Clinical Practice and Research. Hypertension 2021; 77:993-1000. [PMID: 33423526 DOI: 10.1161/hypertensionaha.120.16531] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the reproducibility of office (OBP), ambulatory (ABP), and home blood pressure (HBP) measurements in children and adolescents, and their implications in diagnosing hypertension in clinical practice and in pediatric hypertension research. Apparently healthy children and adolescents referred for suspected hypertension were included. Measurements of 2-visit OBP, 7-day HBP, and 24-hour ABP were performed twice, 1 to 6 months apart. Reproducibility was quantified using the SD of differences between repeated measurements. The sample size of clinical trials comparing the efficacy of antihypertensive drugs using each method was calculated. Fifty-eight individuals were analyzed (mean age, 13.0±2.9 years, 60.3% boys). The reproducibility of 24-hour ABP (SD of differences 5.7/4.5 systolic/diastolic) and HBP (5.9/5.0 mm Hg) were comparable and superior to that of visit-2 OBP (9.2/7.8) and awake (6.7/5.5) or asleep ABP (7.6/6.1). As a consequence, a parallel-group comparative trial aiming to detect a difference in the effect of 2 drugs of 10 mm Hg systolic BP, would require 36 participants when using OBP measurements, 14 using 24-hour ABP, and 15 using HBP (102/34/42 respectively for detecting a 5 mm Hg difference in diastolic BP). For a crossover design trial, the corresponding sample sizes are 9/3/4 for systolic BP and 26/9/11 for diastolic, respectively. These data suggest that in children and adolescents 24-hour ABP and 7-day HBP have similar reproducibility, superior to OBP and daytime or asleep ABP. These findings have major implications in diagnosing hypertension in children in clinical practice and in designing clinical research trials in pediatric hypertension.
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Affiliation(s)
- George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Christina Alamara
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Andriani Vazeou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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13
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Ntineri A, Kollias A, Bountzona I, Servos G, Moyssakis I, Destounis A, Vazeou A, Soldatou A, Stergiou GS. Twenty-four-hour ambulatory central blood pressure in adolescents and young adults: association with peripheral blood pressure and preclinical organ damage. J Hypertens 2020; 38:1980-1988. [PMID: 32890274 DOI: 10.1097/hjh.0000000000002518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the relationship of 24-h ambulatory central blood pressure (ABP) with preclinical organ damage in youth. METHODS Individuals aged 10-25 years referred for suspected hypertension and healthy volunteers had simultaneous 24-h peripheral and central ABP monitoring (Mobil-O-Graph 24 h PWA). Central BP was calculated using two different calibration methods (c1 using oscillometric systolic/diastolic ABP; c2 using mean arterial/diastolic ABP). Their association with preclinical organ damage [left ventricular mass index (LVMI), carotid intima-media thickness (IMT), 24-h pulse wave velocity (PWV)] was investigated. RESULTS A total of 136 participants were analyzed (age 17.9 ± 4.7 years, 54% adolescents, 77% males, 34% with elevated ABP). Twenty-four-hour peripheral systolic ABP (pSBP) was higher than c1 systolic ABP (c1SBP) by 14.1 ± 3.7 mmHg, but lower than c2SBP by 6.5 ± 7.6 mmHg (all P < 0.01). c2SBP quartiles provided better stratification of preclinical organ damage than pSBP. Both c1SBP/c2SBP were significantly associated with LVMI (r = 0.35/0.33) and IMT (r = 0.23/0.42; all P < 0.01; primary endpoint). These associations were stronger for c2SBP compared with those of pSBP in adolescents but not in adults. PWV was more closely associated with pSBP than c2SBP (r = 0.94/0.83, P < 0.01). LVMI variation was best determined by c2SBP in adolescents and pSBP in adults; IMT by c2SBP and PWV by pSBP in both subgroups. CONCLUSION These findings suggest that in young individuals, the calibration method for 24-h central ABP plays a major role in determining its association with preclinical organ damage. In adolescents, 24-h central ABP appears to be more strongly associated with early cardiac and carotid damage than peripheral BP.
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Affiliation(s)
- Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
| | - George Servos
- Department of Cardiology, P. & A. Kyriakou Children's Hospital
| | | | - Antonios Destounis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
| | - Andriani Vazeou
- First Department of Pediatrics, P. & A. Kyriakou Children's Hospital
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital
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14
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Christou E, Bourousis E, Servos G, Xatzipsalti M, Kaditis AG, Delis D, Vazeou A. Unilateral pulmonary artery agenesis in an infant with 22q11.2 deletion syndrome. Pediatr Pulmonol 2020; 55:2184-2186. [PMID: 32531097 DOI: 10.1002/ppul.24867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/18/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Evangelos Christou
- First Department of Pediatrics, Athens General Children's Hospital "Panagiotis and Aglaia Kyriakou", Athens, Greece
| | - Evangelos Bourousis
- First Department of Pediatrics, Athens General Children's Hospital "Panagiotis and Aglaia Kyriakou", Athens, Greece
| | - Giorgos Servos
- Division of Pediatric Cardiology, Athens General Children's Hospital "Panagiotis and Aglaia Kyriakou", Athens, Greece
| | - Maria Xatzipsalti
- First Department of Pediatrics, Athens General Children's Hospital "Panagiotis and Aglaia Kyriakou", Athens, Greece
| | - Athanasios G Kaditis
- Division of Pediatric Pulmonology, First Department of Pediatrics, School of Medicine, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Delis
- First Department of Pediatrics, Athens General Children's Hospital "Panagiotis and Aglaia Kyriakou", Athens, Greece
| | - Andriani Vazeou
- First Department of Pediatrics, Athens General Children's Hospital "Panagiotis and Aglaia Kyriakou", Athens, Greece
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Ntineri A, Kollias A, Zeniodi ME, Vazeou A, Soldatou A, Stergiou GS. Insight into the 24-hour ambulatory central blood pressure in adolescents and young adults. J Clin Hypertens (Greenwich) 2020; 22:1789-1796. [PMID: 32812687 DOI: 10.1111/jch.13999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
This study attempted to investigate the behavior of 24-hour central ambulatory blood pressure (ABP) in adolescents and young adults. Adolescents and young adults (age 10-25 years) referred for elevated blood pressure (BP) and healthy volunteers had simultaneous 24-hour peripheral (brachial) and central (aortic) ABP monitoring using the same automated upper-arm cuff device (Mobil-O-Graph 24h PWA). Central BP was calculated by the device using two different calibration methods (C1SBP using peripheral systolic (pSBP)/diastolic BP and C2SBP using mean arterial/diastolic BP). A total of 136 participants (age 17.9 ± 4.7 years, 54% adolescents, 77% males, 25% volunteers, 34% with elevated peripheral ABP) were analyzed. Twenty-four-hour pSBP was higher than C1SBP, with this difference being more pronounced during daytime than nighttime (16.3 ± 4.5 and 10.5 ± 3.2 mm Hg, respectively, P < .001). Younger age, higher body height, and male gender were associated with greater systolic ABP amplification (pSBP-C1SBP difference). C1SBP followed the variation pattern of pSBP, yet with smaller nighttime dip (8.4 ± 6.0% vs 11.9 ± 4.6%, P < .001), whereas C2SBP increased (2.4 ± 7.2%) during nighttime sleep (P < .001 for comparison with pSBP change). Older age remained independent determinant of larger nighttime BP fall for pSBP and C1SBP, whereas male gender predicted a larger nighttime C2SBP rise. These data suggest that the calibration method of the BP monitor considerably influences the diurnal variation in central BP, showing a lesser nocturnal dip than pSBP or even nocturnal BP rise, which are determined by the individual's age and gender.
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Affiliation(s)
- Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Maria Elena Zeniodi
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Andriani Vazeou
- First Department of Pediatrics, Panagiotis and Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Panagiotis and Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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Gray LJ, Brady EM, Albaina O, Edwardson CL, Harrington D, Khunti K, Miksza J, Raposo JF, Smith E, Vazeou A, Vergara I, Weihrauch-Blüher S, Davies MJ. Evaluation and refinement of the PRESTARt tool for identifying 12-14 year olds at high lifetime risk of developing type 2 diabetes compared to a clinicians assessment of risk: a cross-sectional study. BMC Endocr Disord 2019; 19:79. [PMID: 31345191 PMCID: PMC6659313 DOI: 10.1186/s12902-019-0410-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Traditionally Type 2 Diabetes Mellitus (T2DM) was associated with older age, but is now being increasingly diagnosed in younger populations due to the increasing prevalence of obesity and inactivity. We aimed to evaluate whether a tool developed for community use to identify adolescents at high lifetime risk of developing T2DM agreed with a risk assessment conducted by a clinician using data collected from five European countries. We also assessed whether the tool could be simplified. METHODS To evaluate the tool we collected data from 636 adolescents aged 12-14 years from five European countries. Each participant's data were then assessed by two clinicians independently, who judged each participant to be at either low or high risk of developing T2DM in their lifetime. This was used as the gold standard to which the tool was evaluated and refined. RESULTS The refined tool categorised adolescents at high risk if they were overweight/obese and had at least one other risk factor (High waist circumference, family history of diabetes, parental obesity, not breast fed, high sugar intake, high screen time, low physical activity and low fruit and vegetable intake). Of those found to be at high risk by the clinicians, 93% were also deemed high risk by the tool. The specificity shows that 67% of those deemed at low risk by the clinicians were also found to be a low risk by the tool. CONCLUSIONS We have evaluated a tool for identifying adolescents with risk factors associated with the development of T2DM in the future. Future work to externally validate the tool using prospective data including T2DM incidence is required.
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Affiliation(s)
- Laura J. Gray
- Department of Health Sciences, College of Life Sciences, University of Leicester, George Davies Centre, University Road, Leicester, LE1 7RH UK
| | - Emer M. Brady
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, LE5 4PW UK
| | - Olatz Albaina
- Kronikgune, Torre del BEC (Bilbao Exhibition Centre), Ronda de Azkue, 1, 48902 Barakaldo, Bizkaia Spain
| | | | - Deirdre Harrington
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW UK
| | - Joanne Miksza
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW UK
| | | | - Ellesha Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, George Davies Centre, University Road, Leicester, LE1 7RH UK
| | - Andriani Vazeou
- Diabetes Center, Department of Pediatrics, P&A Kyriakou Children’s Hospital, Athens, Greece
| | - Itziar Vergara
- Kronikgune, Torre del BEC (Bilbao Exhibition Centre), Ronda de Azkue, 1, 48902 Barakaldo, Bizkaia Spain
- Unidad de Investigación APOSIs Gipuzkoa, Osakidetza, Instituto Biodonostia, San Sebastián, Spain
- Red de Investigación en Servicios de Salud y Cronicidad REDISSEC, San Sebastián, Spain
| | - Susann Weihrauch-Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Pediatrics/ Pediatric Endorinology I, University Hospital of Halle/S, Halle, Germany
| | - Melanie J. Davies
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, LE5 4PW UK
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW UK
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Ntineri A, Kollias A, Stambolliu E, Bountzona I, Vazeou A, Stergiou G. ISOLATED SYSTOLIC HYPERTENSION IN ADOLESCENTS AND YOUNG ADULTS. J Hypertens 2019. [DOI: 10.1097/01.hjh.0000572300.61877.cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Stergiou G, Stambolliu E, Bountzona I, Ntineri A, Kollias A, Vazeou A, Soldatou A. Home Blood Pressure Monitoring in Children and Adolescents: Systematic Review of Evidence on Clinical Utility. Curr Hypertens Rep 2019; 21:64. [PMID: 31240404 DOI: 10.1007/s11906-019-0967-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW For the accurate diagnosis and management of hypertension, out-of-office blood pressure evaluation using ambulatory (ABPM) or home monitoring (HBPM) is currently recommended. In children, there is considerable evidence on the clinical utility of ABPM, whereas the evidence on HBPM is limited. This systematic review presents (i) the benefits of HBPM in children; (ii) the evidence on normal range, diagnostic accuracy, and relationship with preclinical organ damage; and (iii) guidance for devices, monitoring schedule, and interpretation. RECENT FINDINGS HBPM is a useful adjunct to the conventional office measurements for the evaluation of children with suspected or treated hypertension. HBPM is feasible in children and has good reproducibility, diagnostic accuracy and acceptability by users, and relatively low cost. Thus, it has greater potential for widespread and long-term use than ABPM, which is more expensive and often not available or not tolerated. Automated monitors that have been clinically validated specifically in children should be used with appropriate cuff size. HBPM for 7 days (minimum 3) with duplicate morning and evening measurements (minimum 12 readings) should be performed in children with suspected or treated hypertension before each office visit. Until more data become available, in case of diagnostic disagreement between office blood pressure and HBPM, treatment decisions should be based on ABPM. HBPM is clinically useful in children with hypertension. More research is needed on its clinical application, and more automated devices need to be clinically validated in this population.
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Affiliation(s)
- George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
| | - Emelina Stambolliu
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Andriani Vazeou
- First Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, P&A Kyriakou Children's Hospital, Athens, Greece
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Sumnik Z, Szypowska A, Iotova V, Bratina N, Cherubini V, Forsander G, Jali S, Raposo JF, Stipančic G, Vazeou A, Veeze H, Lange K. Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: The SWEET perspective. Pediatr Diabetes 2019; 20:434-443. [PMID: 30773756 DOI: 10.1111/pedi.12833] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/25/2018] [Accepted: 01/28/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Frequent use of modern diabetes technologies increases the chance for optimal type 1 diabetes (T1D) control. Limited reimbursement influences the access of patients with T1D to these modalities and could worsen their prognosis. We aimed to describe the situation of reimbursement for insulins, glucometers, insulin pumps (CSII) and continuous glucose monitoring (CGM) for children with T1D in European countries participating in the SWEET Project and to compare data from EU countries with data from our previous study in 2009. METHODS The study was conducted between March 2017 and August 2017. First, we approached diabetes technology companies with a survey to map the reimbursement of insulins and diabetic devices. The data collected from these companies were then validated by members of the SWEET consortium. RESULTS We collected data from 29 European countries, whereas all types of insulins are mostly fully covered, heterogeneity was observed regarding the reimbursement of strips for glucometers (from 90 strips/month to no limit). CSII is readily available in 20 of 29 countries. Seven countries reported significant quota issues or obstacles for CSII prescription, and two countries had no CSII reimbursement. CGM is at least partially reimbursed in 17 of 29 countries. The comparison with the 2009 study showed an increasing availability of CSII and CGM across the EU. CONCLUSIONS Although innovative diabetes technology is available, a large proportion of children with T1D still do not benefit from it due to its limited reimbursement.
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Affiliation(s)
- Zdenek Sumnik
- Department of Pediatrics, Motol University Hospital, Prague, Czech Republic
| | | | - Violeta Iotova
- Department of Pediatrics, Medical University-Varna, UMHAT "Sv. Marina", Varna, Bulgaria
| | - Natasa Bratina
- Department of Endocrinology, Diabetes and Metabolism, UMC, University Children's Hospital, Ljubljana, Slovenia
| | - Valentino Cherubini
- Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, "G. Salesi" Hospital, Ancona, Italy
| | - Gun Forsander
- Institute for Clinical Sciences, Dept of Ped, University of Gothenburg and the Queen Silvia Children's Hospital, Sahlgrenska Univ. Hospital, Gothenburg, Sweden
| | - Sujata Jali
- Department of Pediatrics, KLE University's Jawaharlal Nehru Medical College Belgaum, Belgaum, India
| | | | - Gordana Stipančic
- Department of Pediatrics, University Hospital Center "Sestre milosrdnice", School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Andriani Vazeou
- Department of Pediatrics, Diabetes Center, P & A Kyriakou Children's Hospital, Athens, Greece
| | | | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
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Maffeis C, Birkebaek NH, Konstantinova M, Schwandt A, Vazeou A, Casteels K, Jali S, Limbert C, Pundziute-Lycka A, Toth-Heyn P, de Beaufort C, Sumnik Z, Cherubini V, Svensson J, Pacaud D, Kanaka-Gantenbein C, Shalitin S, Bratina N, Hanas R, Alonso GT, Poran L, Pereira AL, Marigliano M. Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: Data from the international SWEET registry. Pediatr Diabetes 2018; 19:1211-1220. [PMID: 30033651 DOI: 10.1111/pedi.12730] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/08/2018] [Accepted: 07/11/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To assess the prevalence of underweight (UW), overweight (OW), and obesity in children and adolescents with type 1 diabetes (T1D). METHODS An international cross-sectional study including 23 026 T1D children (2-18 years, duration of diabetes ≥1 year) participating in the SWEET prospective, multicenter diabetes registry. Body mass index SD score (BMI-SDS) was calculated using the World Health Organization BMI charts. Children were categorized as UW (BMI-SDS < -2SD), OW (+1SD < BMI-SDS ≤ +2SD), and obese (OB) (BMI-SDS > +2SD). Hierarchic regression models were applied with adjustment for sex, age, and duration of diabetes. RESULTS The prevalence of UW, OW, and obesity was: 1.4%, 22.3%, and 7.3% in males and 0.6%, 27.2%, and 6.8% in females. Adjusted BMI-SDS was significantly higher in females than in males (mean ± SEM: 0.54 ± 0.05 vs 0.40 ± 0.05, P < 0.0001). In males, BMI-SDS significantly decreased by age (P < 0.0001) in the first three age categories 0.61 ± 0.06 (2 to <10 years), 0.47 ± 0.06 (10 to <13 years), 0.34 ± 0.05 (13 to <16 years). In females, BMI-SDS showed a U-shaped distribution by age (P < 0.0001): 0.54 ± 0.04 (2 to <10 years), 0.39 ± 0.04 (10 to <13 years), 0.55 ± 0.04 (13 to <16 years). BMI-SDS increased by diabetes duration (<2 years: 0.38 ± 0.05, 2 to <5 years: 0.44 ± 0.05, and ≥5 years: 0.50 ± 0.05, P < 0.0001). Treatment modality did not affect BMI-SDS. Adjusted HbA1c was significantly higher in females than in males (8.20% ± 0.10% vs 8.06% ± 0.10%, P < 0.0001). In both genders, the association between HbA1c and BMI-SDS was U-shaped with the highest HbA1c in the UW and obesity groups. CONCLUSIONS The high rate of OW and obesity (31.8%) emphasize the need for developing further strategies to prevent and treat excess fat accumulation in T1D.
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Affiliation(s)
- Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, University City Hospital, Verona, Italy
| | - Niels H Birkebaek
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Maia Konstantinova
- Clinic for Endocrinology, Diabetes and Genetics, Medical University Sofia, University Pediatric Hospital, Sofia, Bulgaria
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Andriani Vazeou
- Diabetes Center, P & A Kyriakou Children's Hospital, Athens, Greece
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Sujata Jali
- KLE Diabetes Centre, KLE University JNMC and KLE'S Dr. Prabhakar Kore Hospital & MRC, Belagavi, India
| | - Catarina Limbert
- Hospital Dona Estefânia, Unit of Pediatric Endocrinology and Diabetes, Lisbon, Portugal
| | - Auste Pundziute-Lycka
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Toth-Heyn
- Ist. Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Carine de Beaufort
- Deccp, Pediatric Clinic/Centre Hospitalier de Luxembourg, Luxembourg, Grand Duche de Luxembourg
| | - Zdenek Sumnik
- Department of Pediatrics, Motol University Hospital, Prague, Czech Republic
| | | | - Jannet Svensson
- Department of Pediatric and adolescents, Copenhagen University hospital, Herlev, Denmark
| | - Daniele Pacaud
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Kanaka-Gantenbein
- Diabetes Center, First Department of Pediatrics, Medical School,National and Kapodistrian University of Athens, Agia Sophia Children's Hospital, Athens, Greece
| | - Shlomit Shalitin
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natasa Bratina
- University Children's Hospital, Department of Endocrinology, Diabetes and Metabolic Diseases, Ljubljana, Slovenia
| | - Ragnar Hanas
- The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and NU Hospital Group, Uddevalla, Sweden
| | - Guy T Alonso
- Barbara Davis Center, University of Colorado, Aurora, Colorado
| | - Luxmi Poran
- General Private Practitioner at T1diams, Mauritius, Island
| | - Ana L Pereira
- APDP-Diabetes Portugal, Department of Pediatric and adolescents, Lisbon, Portugal
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, University City Hospital, Verona, Italy
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Thomakos P, Vazeou A, Sakkas D, Panagopoulos G, Anifantakis K, Smyrnaki P, Arvanitaki T, Kyrlaki E, Kefalogiannis N, Mamoulakis D, Pappas A, Mitrakou A. Avoiding hypoglycemia: the use of insulin pump combined with continuous glucose monitor in type 1 diabetes crossing a Rocky Gorge. QJM 2018; 111:629-633. [PMID: 29939323 DOI: 10.1093/qjmed/hcy136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGMS) have been proven very effective in diabetes management. AIM This study evaluated the usefulness of these devices during prolonged, intense physical activity in an uncontrolled natural environment away from the clinical research center. DESIGN Non-randomized, prospective and observational study. METHODS During the summer, 38 participants with type 1 diabetes crossed the Samaria gorge, the second largest gorge in Europe (17 km). Twenty subjects on CSII combined with real-time CGMS and 18 on multiple daily injections (MDI) combined with professional (retrospective) CGMS participated in the program. All participants were unsupervised during the event. RESULTS All 38 participants managed to reach the destination point safely. There were no episodes of severe hypoglycemia. The duration of the exercise (mean ±SD) was 6.4 ± 1.3 h. The CSII group exhibited significantly lower hypoglycemic episodes during exercise (0.1 ± 0.3 vs. 0.4 ± 0.6; P = 0.047) as well as lower AUC below 70 mg/dl compared with the MDI, during the 24 h (0.61 ± 0.78 vs. 1.84 ± 1.55; P = 0.007). Individuals on CSII were significantly less likely to develop a hypoglycemic episode during exercise (P = 0.038). Exercise induced nocturnal hypoglycemia was not prevented effectively in neither group. CONCLUSIONS CSII combined with CGMS is effective in controlling blood glucose levels in type 1 diabetics who perform prolonged strenuous exercise. The use of insulin pump technology in regions with hot Mediterranean climates is safe and can provide protection against exercise-induced hypoglycemia. Development of precise instructions for T1DM who occasionally get involved in exercise activities, requires further studies.
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Affiliation(s)
- P Thomakos
- From the Department of Clinical Therapeutics Medical School of National and Kapodistrian University of Athens, Alexandra Hospital, Lourou Street, 115 28 Athens, Greece
- Hygeia General Hospital, Diabetes Center, 4, Erythrou Stavrou, 151 23 Marousi, Athens, Greece
| | - A Vazeou
- Pediatric Unit, P&A Kyriakou Children's Hospital, Diabetes Unit, Livadias Street, 115 27 Athens, Greece
| | - D Sakkas
- From the Department of Clinical Therapeutics Medical School of National and Kapodistrian University of Athens, Alexandra Hospital, Lourou Street, 115 28 Athens, Greece
| | - G Panagopoulos
- From the Department of Clinical Therapeutics Medical School of National and Kapodistrian University of Athens, Alexandra Hospital, Lourou Street, 115 28 Athens, Greece
| | - K Anifantakis
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - P Smyrnaki
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - T Arvanitaki
- Chania General Hospital, Pediatric Unit, Diabetes Unit, Agiou Eleftheriou Street, 733 00 Chania, Greece
| | - E Kyrlaki
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - N Kefalogiannis
- Asklipios Center, Diabetes Unit, 10, Mahis Critis Street, 713 03 Heraclion, Greece
| | - D Mamoulakis
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - A Pappas
- Venizeleio Hospital-PAGN, Diabetes Unit, Knosou Avenue, 714 09 Heraclion, Greece
| | - A Mitrakou
- From the Department of Clinical Therapeutics Medical School of National and Kapodistrian University of Athens, Alexandra Hospital, Lourou Street, 115 28 Athens, Greece
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22
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Kollias A, Stambolliu E, Kyriakoulis K, Ntineri A, Vazeou A, Stergiou G. RELATIONSHIP OF AORTIC AND CAROTID STIFFNESS WITH AMBULATORY BLOOD PRESSURE IN CHILDREN AND YOUNG ADULTS. J Hypertens 2018. [DOI: 10.1097/01.hjh.0000539432.73234.b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kime NH, Waldron S, Webster E, Lange K, Zinken K, Danne T, Aschemeier B, Sumnik Z, Cinek O, Raposo JF, Vazeou A, Bratina N, Campbell F. Pediatric diabetes training for healthcare professionals in Europe: Time for change. Pediatr Diabetes 2018; 19:578-585. [PMID: 28880485 DOI: 10.1111/pedi.12573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/21/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Training for healthcare professionals (HCPs) in Europe who care for children and young people (CYP) with type 1 diabetes and their families is variable depending on the country. Building on the work of SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) and using the German Certified Diabetes Educators (CDEs) curriculum, a European collaboration of pediatric diabetes experts aimed to (1) establish current core elements that should be included in a pediatric diabetes education training course and (2) create a template for a European CDE's training curriculum. METHODS A qualitative methodology incorporating a survey questionnaire, focus group discussions, individual semi-structured interviews and workshops was employed to explore participants' experiences and opinions. HCPs-pediatric consultants, diabetes nurses, dietitians and psychologists, national and local diabetes leads, academic and education leads and children, and young people with diabetes and families took part in the study. The total number of participants equaled 186. RESULTS A template for a European Certified Diabetes Educator Curriculum (EU-CDEC) was developed based on the themes that emerged from the participants' expertise and experiences. This provides a model for HCPs' pediatric diabetes training provision. CONCLUSIONS There is a severe shortage of high quality, standardized training for HCPs across the majority of European countries. Lack of trained HCPs for CYP with diabetes will result in the delivery of suboptimal care and impact on health, wellbeing and clinical and psychological outcomes. The EU-CDEC template can be used to increase access to high quality training provision for all HCPs across Europe and worldwide.
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Affiliation(s)
- Nicky Helen Kime
- Carnegie School of Sport, Leeds Beckett University, Leeds, England
| | - Sheridan Waldron
- Children and Young People's Diabetes Centre, St. James's University Hospital, Leeds, England
| | | | - Karin Lange
- Medizinische Psychologie 5430, Medizinische Hochschule Hannover, Hannover, Germany
| | - Katarzyna Zinken
- Ward KD-A, Crisis and Diagnostics, ZPP Mannheim am Zentralinstitut für seelische Gesundheit, Mannheim, Germany
| | - Thomas Danne
- Diabeteszentrum für Kinder und Jugendliche AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Bärbel Aschemeier
- Diabeteszentrum für Kinder und Jugendliche AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Zdenek Sumnik
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Ondrej Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | | | - Andriani Vazeou
- A' Department of Pediatrics, Diabetes Center, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Natasa Bratina
- Department for Endocrinology, Diabetes and Metabolic Diseases, University Childrens Hospital Ljubljana, Ljubljana, Slovenia
| | - Fiona Campbell
- Children and Young People's Diabetes Centre, St. James's University Hospital, Leeds, England
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Kordonouri O, Vazeou A, Scharf M, Würsig M, Battelino T. Striving for control: lessons learned from a successful international Type 1 Diabetes Youth Challenge. Acta Diabetol 2017; 54:403-409. [PMID: 28154987 DOI: 10.1007/s00592-017-0964-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/07/2017] [Indexed: 10/20/2022]
Abstract
AIMS To demonstrate whether young people with T1D using modern insulin treatment and CGM could successfully participate in extreme sport activity while maintaining good glycemic control. METHODS The challenge took place in Crete/Greece over 4 days combining a long-distance trek of different levels of severity with final destination the summit of the White Mountains at 2080 m. Eleven participants (5/6 female/male, age 18.2 ± 1.3 years, T1D duration 7.9 ± 3.5 years, HbA1c 7.3 ± .7% (56 ± 16 mmol/mol); mean ± SD) from 11 SWEET centers in Belgium, Brazil, Canada, Germany, Greece, France, India, Italy, Portugal, Slovenia and Sweden participated to the challenge. Five participants were on CSII, six on MDI; all were wearing a continuous glucose monitoring system. The glycemic targets during trekking were defined as 80-180 mg/dl (4.4-10 mmol/l). RESULTS All participants completed the challenge. In total, the group walked 54.5 km under varying climate conditions (temperature 14-35 °C). During the challenge, insulin requirements decreased significantly compared to baseline: total daily insulin by 31.1 ± 16.7% (p < .001), basal by 30.8 ± 14.9% (p < .001), and prandial by 32.5 ± 28.0% (p = .023), with no differences between participants with CSII or MDI. No episode of severe hypoglycemia or DKA occurred. Mean glucose levels were 170.7 ± 60.1 mg/dl with 61.5 ± 18.7% of CGM values in the target range, 5.4 ± 5.4% under 80 mg/dl and 32.8 ± 16.6% above 180 mg/dl. CONCLUSIONS The results of this SWEET Initiative activity demonstrated that well-educated adolescents and young adults with T1D using modern insulin treatments are able to perform successfully even extraordinary physical challenges while maintaining good glycemic control without diabetes-related acute complications.
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Affiliation(s)
- Olga Kordonouri
- Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Germany.
| | | | - Mauro Scharf
- Centro de Diabetes Curitiba, Division of Pediatric Endocrinology os Hospital Nossa Senhora Das Graças, Curitiba, Brazil
| | - Martina Würsig
- Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Germany
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Fotis L, Vazeou A, Xatzipsalti M, Stamoyannou L. Hypotonic hyporesponsive episode and the 13-valent pneumococcal vaccine. Turk J Pediatr 2014; 56:427-429. [PMID: 25818964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hypotensive-hyporesponsive episodes are rare events after immunizations performed for diphtheria, tetanus, Haemophilus influenzae type b and hepatitis B virus vaccines, but most of the reported episodes have been associated with pertussis-containing vaccines. We report the case of a 3-month-old girl, previously healthy otherwise, presenting with the unusual event of a hypotonic-hyporesponsive episode after vaccination with the 13-valent pneumococcal vaccine. Diagnosis was established after a thorough evaluation of the patient and by exclusion of other clinical conditions.
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Affiliation(s)
- Lampros Fotis
- 1st Department of Pediatrics, P. & A. Kyriakou Children's Hospital, Athens, Greece.
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26
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Papastamataki M, Papassotiriou I, Bartzeliotou A, Vazeou A, Roma E, Chrousos G, Kanaka-Gantenbein C. Incretins, amylin and other gut–brain axis hormones in children with celiac disease. Clin Biochem 2014. [DOI: 10.1016/j.clinbiochem.2014.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oikarinen S, Tauriainen S, Hober D, Lucas B, Vazeou A, Sioofy-Khojine A, Bozas E, Muir P, Honkanen H, Ilonen J, Knip M, Keskinen P, Saha MT, Huhtala H, Stanway G, Bartsocas C, Ludvigsson J, Taylor K, Hyöty H. Virus antibody survey in different European populations indicates risk association between coxsackievirus B1 and type 1 diabetes. Diabetes 2014; 63:655-62. [PMID: 24009257 DOI: 10.2337/db13-0620] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Enteroviruses (EVs) have been connected to type 1 diabetes in various studies. The current study evaluates the association between specific EV subtypes and type 1 diabetes by measuring type-specific antibodies against the group B coxsackieviruses (CVBs), which have been linked to diabetes in previous surveys. Altogether, 249 children with newly diagnosed type 1 diabetes and 249 control children matched according to sampling time, sex, age, and country were recruited in Finland, Sweden, England, France, and Greece between 2001 and 2005 (mean age 9 years; 55% male). Antibodies against CVB1 were more frequent among diabetic children than among control children (odds ratio 1.7 [95% CI 1.0-2.9]), whereas other CVB types did not differ between the groups. CVB1-associated risk was not related to HLA genotype, age, or sex. Finnish children had a lower frequency of CVB antibodies than children in other countries. The results support previous studies that suggested an association between CVBs and type 1 diabetes, highlighting the possible role of CVB1 as a diabetogenic virus type.
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Affiliation(s)
- Sami Oikarinen
- Department of Virology, University of Tampere, Tampere, Finland
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Papastamataki M, Papassotiriou I, Bartzeliotou A, Vazeou A, Roma E, Chrousos GP, Kanaka-Gantenbein C. Incretins, amylin and other gut-brain axis hormones in children with coeliac disease. Eur J Clin Invest 2014; 44:74-82. [PMID: 24151959 DOI: 10.1111/eci.12193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 10/19/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous research indicated that coeliac disease (CD) is associated with type 1 diabetes mellitus (T1DM). However, the gut-brain axis peptide hormones secretion has not been evaluated so far in patients with CD prior to treatment initiation or under treatment, irrespective of patients having concomitant T1DM or not. The aim of the study was therefore to evaluate these gut hormones at the preprandial levels of patients with CD before and under treatment. METHODS Of forty-seven CD children, 12 untreated (UCD), 22 treated with gluten-free diet (TCD) and 13 treated CD with coexisting T1DM (DCD), and 18 healthy controls (HC) were enrolled. Preprandial glucagon-like-peptide-1 (GLP-1), glucose-dependent-insulinotropic-polypeptide (GIP), active amylin, acylated ghrelin (AG), leptin, pancreatic polypeptide (PP) and peptide-tyrosine-tyrosine (PYY) were determined with hormone-map-array technology. RESULTS We found in patients with CD compared with HC that the concentration of (i) GLP-1 was reduced remarkably in all patients with CD (P = 0.008), (ii) GIP was lower in patients with UCD (P = 0.008), (iii) amylin was remarkably reduced (P < 0.01) in all patients with CD, (iv) AG was significantly decreased in patients with DCD (P < 0.01), while (v) leptin, PP and PYY were not significantly different. GIP, GLP-1 and amylin levels correlated positively with insulin concentrations (P < 0.001, P = 0.004 and P < 0.01, respectively) in all patients. Amylin and GIP levels were strongly associated with triglycerides concentrations (P < 0.001, for both peptides) in children with CD. CONCLUSIONS Our study revealed a different secretion pattern of gut-brain axis hormones in children with CD compared with HC. The alterations in the axis were more pronounced in children with both CD and T1DM.
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Affiliation(s)
- Maria Papastamataki
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
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Stergiou GS, Vazeou A, Stefanidis CJ, Kapogiannis A, Georgakopoulos D, Stabouli S, Douma S, Doumas M, Zebekakis P, Makris T, Tsioufis CP, Manolis A. Practical recommendations for the diagnosis, investigation and management of hypertension in children and adolescents: hellenic society of hypertension consensus document. Hellenic J Cardiol 2013; 54:199-211. [PMID: 23685657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- George S Stergiou
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
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Cinek O, Sumník Z, de Beaufort C, Rurik I, Vazeou A, Madácsy L, Papo NL, Danne T. Heterogeneity in the systems of pediatric diabetes care across the European Union. Pediatr Diabetes 2012; 13 Suppl 16:5-14. [PMID: 22931219 DOI: 10.1111/j.1399-5448.2012.00907.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It is known that the systems of pediatric diabetes care differ across the member states of the European Union (EU). The aim of this project was to characterize some of the main differences among the national systems. METHODS Data were collected using two questionnaires. The first one was distributed among leading centers of pediatric diabetes (one per country) with the aim of establishing an overview of the systems, national policies, quality control (QC) and financing of pediatric diabetes care. Responses were received from all 27 EU countries. The second questionnaire was widely disseminated among all 354 International Society for Pediatric and Adolescent Diabetes members with a domicile in an EU country; it included questions related to individual pediatric diabetes centers. A total of 108 datasets were collected and processed from healthcare professionals who were treating more than 29 000 children and adolescents with diabetes. Data on the reimbursement policies were verified by representatives of the pharmaceutical and medical device companies. RESULTS The collected data reflect the situation in 2009. There was a notable heterogeneity among the systems for provision of pediatric diabetes care across the EU. Only 20/27 EU countries had a pediatric diabetes register. Nineteen countries had officially recognized centers for pediatric diabetes, but only nine of them had defined criteria for becoming such a center. A system for QC of pediatric diabetes at the national level was reported in 7/26 countries. Reimbursement for treatment varied significantly across the EU, potentially causing inequalities in access to modern technologies. CONCLUSIONS The collected data help develop strategies toward improving equity and access to modern pediatric diabetes care across Europe.
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Affiliation(s)
- Ondrej Cinek
- University Hospital Motol, Prague, Czech Republic; Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
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Zarkogianni K, Vazeou A, Mougiakakou SG, Prountzou A, Nikita KS. An Insulin Infusion Advisory System Based on Autotuning Nonlinear Model-Predictive Control. IEEE Trans Biomed Eng 2011; 58:2467-77. [DOI: 10.1109/tbme.2011.2157823] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Continuous glucose monitoring system (CGMS) is a developing technology in the field of diabetes treatment since it enables patients to effectively control and adjust their insulin therapy. Clinical trials have shown its efficacy in lowering HbAlc significantly especially in adults with type 1 diabetes and those with HbAlc >8%. Improvement is sustained for at least one year. Conflicting data exist for children. Most recent studies agree that the nearly daily use of CGMS is accompanied by significant lowering of HbA1c independent of age. However, the randomized clinical trials have shown that the use of CGMS does not reduce significantly the number of severe hypoglycemic episodes as it is expected, but recent data indicate that it reduces the time spent in hypoglycemia. Accuracy remains a key issue for CGMS, particularly in children and adolescents who may have increased variability of blood glucose. CGMS cost is another barrier to the everyday use since reimbursement of CGM is limited to a few countries only. This review will focus on the present status of the use of CGMS in type 1 diabetes (T1D) patients.
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Affiliation(s)
- Andriani Vazeou
- A Department of Pediatrics, P & A Kyriafeou Children's Hospital, Athens, Greece.
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Abstract
There is an increasing interest in pediatric hypertension, the prevalence of which is rising in parallel with the obesity epidemic. Traditionally the assessment of hypertension in children has relied on office blood pressure (BP) measurements by the physician. However, as in adults, office BP might be misleading in children mainly due to the white coat and masked hypertension phenomena. Thus, out-of-office BP assessment, using ambulatory or home monitoring, has gained ground for the accurate diagnosis of hypertension and decision-making. Ambulatory monitoring is regarded as indispensable for the evaluation of pediatric hypertension. Preliminary data support the usefulness of home monitoring, yet more evidence is needed. Office, ambulatory and home BP normalcy tables providing thresholds for diagnosis have been published and should be used for the assessment of elevated BP in children.
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Affiliation(s)
- Nikos Karpettas
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece
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Stergiou GS, Giovas PP, Kollias A, Rarra VC, Papagiannis J, Georgakopoulos D, Vazeou A. Relationship of home blood pressure with target-organ damage in children and adolescents. Hypertens Res 2011; 34:640-4. [PMID: 21326307 DOI: 10.1038/hr.2011.10] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The objective of this study was to compare home blood pressure (HBP) vs. ambulatory (ABP) and clinic (CBP) measurements in terms of their association with target-organ damage in children and adolescents. A total of 81 children and adolescents (mean age 13 ± 3 years, 53 boys) referred for elevated CBP had measurements of CBP (1 visit), HBP (6 days) and ABP (24-h). Seventy-six participants were also assessed with carotid-femoral pulse wave velocity (PWV) and 54 with echocardiography. Average CBP was 122.1 ± 15.1/71 ± 12.9 mm Hg (systolic/diastolic), HBP 121.3 ± 11.5/69.4 ± 6.6 mm Hg and 24-h ABP 118.9 ± 12/66.6 ± 6.1 mm Hg. Left ventricular mass (LVM) was correlated with systolic blood pressure (BP) (coefficient r = 0.55/0.54/0.45 for 24-h/daytime/nighttime ABP, 0.53 for HBP and 0.41 for CBP; all P< 0.01). No significant correlations were found for diastolic BP. PWV was also significantly correlated with systolic BP (r = 0.52/0.50/0.48 for 24-h/daytime/nighttime ABP, 0.50 for HBP and 0.47 for CBP; all P < 0.01). Only diastolic ABP and HBP were significantly correlated with PWV (r = 0.30 and 0.28, respectively, P<0.05). In multivariate stepwise regression analysis (with age, gender, body mass index [BMI], clinic, home and 24-h ambulatory systolic/diastolic BP and pulse pressure, clinic, home and 24-h heart rate as independent variables), PWV was best predicted by systolic HBP (R(2) = 0.22, beta ± s.e. = 0.06 ± 0.01), whereas LVM was determined (R(2) = 0.67) by 24-h pulse pressure (beta = 1.21 ± 0.41), age (beta = 2.93 ± 1.32), 24-h heart rate (beta = -1.27 ± 0.41) and BMI (beta = 1.78 ± 0.70). These data suggest that, in children and adolescents, ABP as well as HBP measurements appear to be superior to the conventional CBP measurements in predicting the presence of subclinical end-organ damage.
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Affiliation(s)
- George S Stergiou
- Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
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Kouris I, Mougiakakou S, Scarnato L, Iliopoulou D, Diem P, Vazeou A, Koutsouris D. Mobile phone technologies and advanced data analysis towards the enhancement of diabetes self-management. ACTA ACUST UNITED AC 2011; 5:386-402. [PMID: 21041177 DOI: 10.1504/ijeh.2010.036209] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Advances in the area of mobile and wireless communication for healthcare (m-Health) along with the improvements in information science allow the design and development of new patient-centric models for the provision of personalised healthcare services, increase of patient independence and improvement of patient's self-control and self-management capabilities. This paper comprises a brief overview of the m-Health applications towards the self-management of individuals with diabetes mellitus and the enhancement of their quality of life. Furthermore, the design and development of a mobile phone application for Type 1 Diabetes Mellitus (T1DM) self-management is presented. The technical evaluation of the application, which permits the management of blood glucose measurements, blood pressure measurements, insulin dosage, food/drink intake and physical activity, has shown that the use of the mobile phone technologies along with data analysis methods might improve the self-management of T1DM.
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Affiliation(s)
- Ioannis Kouris
- School of Electrical and Computer Engineering, National Technical University of Athens, 9, Heroon Polytechneiou Str., 15780 Zografou, Athens, Greece.
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Abstract
OBJECTIVE The aim of the study was to investigate the seasonal variation of type 1 diabetes mellitus (T1DM) diagnosis in Greek children. DESIGN The study group consisted of 1148 patients (604 males and 544 females) who were diagnosed with T1DM during the period 1978-2008. The mean age at diagnosis was 8.32 ± 5.01 years. The date of birth and the date at diagnosis were recorded from the patients' files. RESULTS Significantly more children were diagnosed with T1DM during the cold months as opposed to the warm months (p=0.001), with no differences between boys and girls. When children were categorized into the age groups ≤ 3 and >3 years old the seasonal variation pattern was different in younger ages suggesting that environmental factors which possibly interfere with T1DM diagnosis may have a different effect in those of younger than older age. With regard to date of birth, significantly more children with diabetes were born during the Spring-Summer than in Autumn-Winter (p=0.004). CONCLUSIONS The results of the study support the concept of seasonality in T1DM diagnosis, implying a possible relationship between clinical expression of T1DM and various climatic factors. Seasonal variation at diagnosis appears to be different in younger compared to older children.
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Affiliation(s)
- Maria I Kalliora
- Diabetes Center, Department of Pediatrics, Faculty of Nursing, University of Athens at the P & A Kyriakou Children's Hospital, Athens, Greece.
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Cohen O, Körner A, Chlup R, Zoupas CS, Ragozin AK, Wudi K, Bartaskova D, Pappas A, Niederland T, Taybani Z, Barák L, Vazeou A. Improved glycemic control through continuous glucose sensor-augmented insulin pump therapy: prospective results from a community and academic practice patient registry. J Diabetes Sci Technol 2009; 3:804-11. [PMID: 20144331 PMCID: PMC2769970 DOI: 10.1177/193229680900300429] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Conducted by highly experienced investigators with abundant time and resources, phase III studies of continuous glucose sensing (CGS) may lack generalizability to everyday clinical practice. METHOD Community or academic practices in six Central and Eastern European or Mediterranean countries prospectively established an anonymized registry of consecutive patients with type 1 insulin-dependent diabetes mellitus starting CGS-augmented insulin pump therapy with the Paradigm X22 (Medtronic MiniMed, Northridge, CA) under everyday conditions, without prior CGS with another device. We compared glycosylated hemoglobin (GHb) values before and after 3 months of CGS and assessed relationships between insulin therapy variables and glycemia-related variables at weeks 1, 4, and 12 of CGS. RESULTS Of 102 enrolled patients, 85 (83%) with complete weeks 1, 4, and 12 sensor data and baseline/3-month GHb data were evaluable. Evaluable patients were approximately 54% male and approximately 75% adult (mean age, 33.2 +/- 16.9 years) with longstanding diabetes and high personal/family education levels. Mean GHb declined significantly after 3 months of CGS (7.55 +/- 1.33% at baseline to 6.81 +/- 1.08% after 12 weeks, 0.74% absolute decrease, P < 0.001). The absolute GHb reduction correlated significantly (P < 0.0005) with baseline GHb: larger absolute reductions tended to occur when baseline levels were higher. An increased basal insulin dose as a percentage of the total daily insulin dose and a decreased daily bolus count from week 1 to week 12 of CGS predicted GHb improvement from baseline to week 12. CONCLUSIONS CGS-augmented insulin pump therapy appears to improve glycemic control in type 1 diabetes in varied everyday practice settings.
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Affiliation(s)
- Ohad Cohen
- Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Bachou T, Giannakopoulos A, Trapali C, Vazeou A, Kattamis A. A novel mutation in the G4.5 (TAZ) gene in a Greek patient with Barth syndrome. Blood Cells Mol Dis 2009; 42:262-4. [PMID: 19261493 DOI: 10.1016/j.bcmd.2008.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 11/28/2008] [Indexed: 10/21/2022]
Abstract
Barth Syndrome (BTHS) is a rare X-linked recessive inborn error of metabolism, which is characterized by dilated cardiomyopathy, neutropenia, skeletal myopathy and short stature. Barth Syndrome is associated with mutations in the tafazzin (TAZ) gene at Xq28 that result in cardiolipin deficiency and abnormal mitochondria. Here we report a 5.5-month old boy with BTHS phenotype who carries a novel missense T43P mutation in exon 2 of the TAZ gene.
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Affiliation(s)
- Theodora Bachou
- First Department of Pediatrics 'A & P Kyriakou' Children's Hospital, Athens
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Danne T, Battelino T, Jarosz-Chobot P, Kordonouri O, Pánkowska E, Ludvigsson J, Schober E, Kaprio E, Saukkonen T, Nicolino M, Tubiana-Rufi N, Klinkert C, Haberland H, Vazeou A, Madacsy L, Zangen D, Cherubini V, Rabbone I, Toni S, de Beaufort C, Bakker-van Waarde W, van den Berg N, Volkov I, Barrio R, Hanas R, Zumsteg U, Kuhlmann B, Aebi C, Schumacher U, Gschwend S, Hindmarsh P, Torres M, Shehadeh N, Phillip M. Establishing glycaemic control with continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes: experience of the PedPump Study in 17 countries. Diabetologia 2008; 51:1594-601. [PMID: 18592209 DOI: 10.1007/s00125-008-1072-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 05/20/2008] [Indexed: 01/15/2023]
Abstract
AIMS/HYPOTHESIS To assess the use of paediatric continuous subcutaneous infusion (CSII) under real-life conditions by analysing data recorded for up to 90 days and relating them to outcome. METHODS Pump programming data from patients aged 0-18 years treated with CSII in 30 centres from 16 European countries and Israel were recorded during routine clinical visits. HbA(1c) was measured centrally. RESULTS A total of 1,041 patients (age: 11.8 +/- 4.2 years; diabetes duration: 6.0 +/- 3.6 years; average CSII duration: 2.0 +/- 1.3 years; HbA(1c): 8.0 +/- 1.3% [means +/- SD]) participated. Glycaemic control was better in preschool (n = 142; 7.5 +/- 0.9%) and pre-adolescent (6-11 years, n = 321; 7.7 +/- 1.0%) children than in adolescent patients (12-18 years, n = 578; 8.3 +/- 1.4%). There was a significant negative correlation between HbA(1c) and daily bolus number, but not between HbA(1c) and total daily insulin dose. The use of <6.7 daily boluses was a significant predictor of an HbA(1c) level >7.5%. The incidence of severe hypoglycaemia and ketoacidosis was 6.63 and 6.26 events per 100 patient-years, respectively. CONCLUSIONS/INTERPRETATION This large paediatric survey of CSII shows that glycaemic targets can be frequently achieved, particularly in young children, and the incidence of acute complications is low. Adequate substitution of basal and prandial insulin is associated with a better HbA(1c).
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Affiliation(s)
- T Danne
- Kinderkrankenhaus auf der Bult, Hanover, Janusz-Korczak-Allee 12, 30173 Hanover, Germany.
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Vazeou A, Papadopoulou A, Miha M, Drakatos A, Georgacopoulos D. Cardiovascular impairment in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM). Eur J Pediatr 2008; 167:877-84. [PMID: 17965882 DOI: 10.1007/s00431-007-0603-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 08/24/2007] [Accepted: 08/27/2007] [Indexed: 11/27/2022]
Abstract
Left ventricular (LV) function was assessed in 42 patients (mean age +/- SD, 18.45 +/- 3.76 years; 17 males) with type I diabetes mellitus (T1DM; mean duration 9.89 years) and in 43 healthy controls (mean age +/- SD, 18.27 +/- 3.36 years; 18 males). Systolic, diastolic cardiac function and LV dimensions were assessed using M-mode and Doppler echocardiography. Neural autonomic function was assessed by measuring RR variation during deep breathing, Valsava maneuver, 30/15 ratio, and blood pressure response to standing. Fractional shortening, peak velocity of early ventricular filling (E wave), peak velocity of LV filling (A wave), E/A ratio, deceleration time, isovolumic relaxation time, LV dimensions (interventricular septum, posterior wall thickness, end diastolic diameter [EDD] and systolic diameter [ESD]) were all comparable between patients with T1DM and controls. However, in 11 T1DM patients with microalbuminuria and/or retinopathy, EDD, ESD, E/A ratio, and E wave were all lower (p = 0.0011, p = 0.019, p = 0.0011, and p = 0.030, respectively) while, A wave, heart rate, and diastolic blood pressure were all higher (p = 0.008, p = 0.0024 and p = 0.004, respectively) compared to matched for age and sex controls. Furthermore, in six of the 11 T1DM patients with microangiopathy who had E/A <1.12 (<2 SD of the control mean), significant and marginally significant correlations were found between E/A ratio and the duration of the disease as well as the mean HbA1c of the last year (r = -0.38, p = 0.011 and r = -0.287, p = 0.064, respectively). In conclusion, it has been found that impairment of diastolic, but not systolic, LV function can be detected early in young patients with T1DM and microangiopathy.
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Affiliation(s)
- A Vazeou
- First Department of Pediatrics, P & A Kyriakou Children's Hospital, Thivon & Levadias, 115 27, Athens, Greece.
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Skevofilakas M, Mougiakakou SG, Zarkogianni K, Aslanoglou E, Pavlopoulos SA, Vazeou A, Bartsocas CS, Nikita KS. A communication and information technology infrastructure for real time monitoring and management of type 1 diabetes patients. ACTA ACUST UNITED AC 2008; 2007:3685-8. [PMID: 18002797 DOI: 10.1109/iembs.2007.4353131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper is focused on the integration of state-of-the-art technologies in the fields of telecommunications, simulation algorithms, and data mining in order to develop a Type 1 diabetes patient's semi to fully-automated monitoring and management system. The main components of the system are a glucose measurement device, an insulin delivery system (insulin injection or insulin pumps), a mobile phone for the GPRS network, and a PDA or laptop for the Internet. In the medical environment, appropriate infrastructure for storage, analysis and visualizing of patients' data has been implemented to facilitate treatment design by health care experts.
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Affiliation(s)
- Marios Skevofilakas
- Faculty of Electrical and Computer Engineering, National Technical University of Athens, 9 Heroon Polytechneiou Str., 15780 Zographou, Greece.
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Mougiakakou SG, Prountzou A, Iliopoulou D, Nikita KS, Vazeou A, Bartsocas CS. Neural network based glucose - insulin metabolism models for children with Type 1 diabetes. Conf Proc IEEE Eng Med Biol Soc 2008; 2006:3545-8. [PMID: 17947036 DOI: 10.1109/iembs.2006.260640] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this paper two models for the simulation of glucose-insulin metabolism of children with Type 1 diabetes are presented. The models are based on the combined use of Compartmental Models (CMs) and artificial Neural Networks (NNs). Data from children with Type 1 diabetes, stored in a database, have been used as input to the models. The data are taken from four children with Type 1 diabetes and contain information about glucose levels taken from continuous glucose monitoring system, insulin intake and food intake, along with corresponding time. The influences of taken insulin on plasma insulin concentration, as well as the effect of food intake on glucose input into the blood from the gut, are estimated from the CMs. The outputs of CMs, along with previous glucose measurements, are fed to a NN, which provides short-term prediction of glucose values. For comparative reasons two different NN architectures have been tested: a Feed-Forward NN (FFNN) trained with the back-propagation algorithm with adaptive learning rate and momentum, and a Recurrent NN (RNN), trained with the Real Time Recurrent Learning (RTRL) algorithm. The results indicate that the best prediction performance can be achieved by the use of RNN.
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Zarkogianni K, Mougiakakou SG, Prountzou A, Vazeou A, Bartsocas CS, Nikita KS. An insulin infusion advisory system for type 1 diabetes patients based on non-linear model predictive control methods. Annu Int Conf IEEE Eng Med Biol Soc 2007; 2007:5972-5. [PMID: 18003374 DOI: 10.1109/iembs.2007.4353708] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this paper, an Insulin Infusion Advisory System (IIAS) for Type 1 diabetes patients, which use insulin pumps for the Continuous Subcutaneous Insulin Infusion (CSII) is presented. The purpose of the system is to estimate the appropriate insulin infusion rates. The system is based on a Non-Linear Model Predictive Controller (NMPC) which uses a hybrid model. The model comprises a Compartmental Model (CM), which simulates the absorption of the glucose to the blood due to meal intakes, and a Neural Network (NN), which simulates the glucose-insulin kinetics. The NN is a Recurrent NN (RNN) trained with the Real Time Recurrent Learning (RTRL) algorithm. The output of the model consists of short term glucose predictions and provides input to the NMPC, in order for the latter to estimate the optimum insulin infusion rates. For the development and the evaluation of the IIAS, data generated from a Mathematical Model (MM) of a Type 1 diabetes patient have been used. The proposed control strategy is evaluated at multiple meal disturbances, various noise levels and additional time delays. The results indicate that the implemented IIAS is capable of handling multiple meals, which correspond to realistic meal profiles, large noise levels and time delays.
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Affiliation(s)
- Konstantia Zarkogianni
- Faculty of Electrical and Computer Engineering, National Technical University of Athens, 9 Heroon Polytechneiou Str. 15780 Zographou, Greece.
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Hermann R, Bartsocas CS, Soltész G, Vazeou A, Paschou P, Bozas E, Malamitsi-Puchner A, Simell O, Knip M, Ilonen J. Genetic screening for individuals at high risk for type 1 diabetes in the general population using HLA Class II alleles as disease markers. A comparison between three European populations with variable rates of disease incidence. Diabetes Metab Res Rev 2004; 20:322-9. [PMID: 15250035 DOI: 10.1002/dmrr.455] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To develop screening strategies for identification of individuals at increased genetic risk for type 1 diabetes in three populations with variable disease incidence rates and distinct ethnic origin. METHODS A stepwise HLA DQB1-DQA1-DRB1-based screening approach was evaluated. Patients with childhood-onset type 1 diabetes were recruited from Finland (n = 1739), Hungary (n = 149), and Greece (n = 119). Consecutive newborns (2568 from Finland and 1047 from Greece) or healthy schoolchildren (n = 177 from Hungary) served as controls. RESULTS The DQB1*02/0302 genotype conferred the highest disease risk in all populations. The DQB1*02/y (y not equal DQB1*0301,*0302,*0602,*0603, *0604) genotypes were more common and conferred a higher disease risk in the Greek population (OR 4.9) compared to the Finns (OR 1.2). DQB1*0302/x (x not equal DQB1*02, *0301, *0602, *0603, *0604) genotypes were, in contrast, more prevalent among Finnish cases (32.7%) as compared to Hungarians (18.1%) or Greeks (13.5%). The protective DQB1*0602 or *0603 positive genotypes were most common in the Finns, while DQB1*0301 was more common in Hungarians and Greeks. In all groups, DQA1 and DRB1*04 typing considerably increased the sensitivity of the DQB1-based screening. The different high-risk genotype combinations present in about 10% of the background population had a diagnostic sensitivity of 60% in Finland and 80% in Hungary and Greece. CONCLUSIONS HLA DR-DQ-based screening is a feasible tool for the identification of individuals at increased genetic risk for type 1 diabetes in populations with diverse genetic background. The risk markers should, however, be individually selected for the target population since the screening efficiency of various markers is highly dependent on the ethnic group studied.
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Affiliation(s)
- R Hermann
- JDRF Center for Prevention of type I diabetes in Finland, University of Turku, Turku, Finland.
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Vazeou A, Papadopoulou A, Papadimitriou A, Kitsou E, Stathatos M, Bartsocas CS. Autonomic neuropathy and gastrointestinal motility disorders in children and adolescents with type 1 diabetes mellitus. J Pediatr Gastroenterol Nutr 2004; 38:61-5. [PMID: 14676596 DOI: 10.1097/00005176-200401000-00014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION There is little information on the gastrointestinal motility abnormalities and autonomic neuropathy of children with gastrointestinal symptoms and type 1 diabetes mellitus (T1DM). METHODS The authors studied 33 consecutive patients (mean age, 15.3 years; 13 males) with T1DM (median duration, 7.7 years) attending the outpatient clinic because of chronic dyspepsia (CD; n = 14), or chronic constipation (CC; n = 19), and 48 consecutive non-T1DM patients (mean age, 13.7 years; 18 males), who presented with similar symptoms (18 with CD; 30 with CC). Fasting serum motilin concentrations and cardiovascular autonomic function tests (CAFT) were assessed and compared with those of age- and gender-matched healthy control subjects. Gastric emptying half time (GE t1/2) of a solid meal and mouth-to-anus transit time (MATT) were measured in patients with CD and CC, respectively. RESULTS CAFT was comparable between patients with T1DM and healthy control subjects. GE t1/2 and MATT were not different between T1DM patients and non-T1DM patients with CD and CC, respectively. However, a marginally significant positive correlation was found in the patients with T1DM between GE t1/2 and blood glucose concentrations (R = 0.54; P = 0.08). In addition, serum motilin concentrations were significantly lower in patients with T1DM compared with healthy control subjects (P < 0.0005), and in patients with T1DM and higher serum glucose concentrations compared with those with lower serum glucose concentrations (P = 0.03). CONCLUSION Autonomic neuropathy is not an etiological factor of gastrointestinal symptoms in children and adolescents with diabetes. Mild or moderate hyperglycemia does not affect gastrointestinal motility.
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Affiliation(s)
- A Vazeou
- Department of Paediatrics, Faculty of Nursing, University of Athens, P & A Kyriakou Children's Hospital, Athens, Greece.
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Ilonen J, Sjöroos M, Knip M, Veijola R, Simell O, Akerblom HK, Paschou P, Bozas E, Havarani B, Malamitsi-Puchner A, Thymelli J, Vazeou A, Bartsocas CS. Estimation of genetic risk for type 1 diabetes. Am J Med Genet 2002; 115:30-6. [PMID: 12116174 DOI: 10.1002/ajmg.10341] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The most important gene loci defining risk of type 1 diabetes mellitus (T1DM) are located within the HLA gene region. HLA-DQ molecules are of primary importance but HLA-DR gene products modify the risk conferred by HLA-DQ. The risk associated with an HLA genotype is defined by the particular combination of susceptible and protective alleles. The highest risk is associated with a combination of two different risk haplotypes (7% risk to develop T1DM in Finland) whereas protective genotypes covering 69% of population have a risk of less than 0.2%). The complicated analysis of HLA genotypes is simplified by strong linkage disequilibrium between HLA-DRB1, -DQA1 and -DQB1 loci. In many cases one can deduce the alleles of other loci based on determination of the alleles in one locus. Differences between various populations in the frequency of marker alleles and in the linkages between them has to be taken into account. We have developed PCR based typing methods that utilize blood spot samples, microtiter plate format and lanthanide labeled oligonucleotide probes to define HLA-DQ and -DR alleles relevant for T1DM risk. Typing is run stepwise so that after initial HLA-DQB1 typing only those samples will be further analyzed in which -DQA1 or -DRB1 typing is informative and expected to contribute to the risk estimation. This method has been used to screen more than 50,000 newborn infants in Finland over a time period of 6 years, and it has been able to identify most children who have developed T1D during the follow-up period. The efficiency of the procedure has also been tested in Finnish and Greek populations.
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Affiliation(s)
- Jorma Ilonen
- Institute of Microbiology and Pathology, University of Turku, Finland.
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Abstract
Chronic dyspepsia is common in children. However, the association of individual predominant symptoms with gastric emptying and their impact on nutritional status are poorly defined. We therefore studied 31 children (mean age 11 years, 14 boys) with chronic dyspepsia and classified their predominant symptoms (PS) by their character and severity. Gastric emptying (GE) T(1/2) of a solid meal was carried out in all patients, while upper gastrointestinal endoscopy was done in the treatment failures. All patients received two months treatment with cisapride. Weight for age z scores were recorded before and three months after treatment. There were 12 patients with epigastric pain (EP) as the PS (7 moderate/severe). Postprandial fullness (PF) was the PS in 19 patients (12 moderate/severe). GE T(1/2) was prolonged and weight for age z scores were lower in children who had moderate/severe (but not mild) PF comparing to those who had EP (P < 0.0001 and P = 0.003, respectively). A significant improvement in weight was observed in the same group alone following treatment with cisapride (P = 0.0003). In conclusion, impaired GE is common in dyspeptic children with PF and have adverse effects on nutritional status.
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Affiliation(s)
- A Papadopoulou
- Department of Paediatrics, Faculty of Nursing, University of Athens, P & A Kyriakou Children's Hospital, Greece
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