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Clapin HF, Earnest A, Colman PG, Davis EA, Jefferies C, Anderson K, Chee M, Bergman P, de Bock M, Kao KT, Fegan PG, Holmes-Walker DJ, Johnson S, King BR, Mok MT, Narayan K, Peña Vargas AS, Sinnott R, Wheeler BJ, Zimmermann A, Craig ME, Couper JJ, Andrikopoulos S, Barrett H, Batch J, Cameron F, Conwell L, Cotterill A, Cooper C, Donaghue K, Fairchild J, Fourlanos S, Glastras S, Goss P, Gray L, Hamblin S, Hofman P, Huynh T, James S, Jones T, Lafferty A, Martin M, McCrossin R, Neville K, Pascoe M, Paul R, Pawlak D, Phillips L, Price D, Rodda C, Simmons D, Smart C, Stone M, Stranks S, Tham E, Ward G, Woodhead H. Diabetic Ketoacidosis at Onset of Type 1 Diabetes and Long-term HbA1c in 7,961 Children and Young Adults in the Australasian Diabetes Data Network. Diabetes Care 2022; 45:2918-2925. [PMID: 36749868 DOI: 10.2337/dc22-0853] [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: 05/02/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The relationship between diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes and long-term glycemic control varies between studies. We aimed, firstly, to characterize the association of DKA and its severity with long-term HbA1c in a large contemporary cohort, and secondly, to identify other independent determinants of long-term HbA1c. RESEARCH DESIGN AND METHODS Participants were 7,961 children and young adults diagnosed with type 1 diabetes by age 30 years from 2000 to 2019 and followed prospectively in the Australasian Diabetes Data Network (ADDN) until 31 December 2020. Linear mixed-effect models related variables to HbA1c. RESULTS DKA at diagnosis was present in 2,647 participants (33.2%). Over a median 5.6 (interquartile range 3.2, 9.4) years of follow-up, participants with severe, but not moderate or mild, DKA at diagnosis had a higher mean HbA1c (+0.23%, 95% CI 0.11,0.28; [+2.5 mmol/mol, 95% CI 1.4,3.6]; P < 0.001) compared with those without DKA. Use of continuous subcutaneous insulin infusion (CSII) was independently associated with a lower HbA1c (-0.28%, 95% CI -0.31, -0.25; [-3.1 mmol/mol, 95% CI -3.4, -2.8]; P < 0.001) than multiple daily injections, and CSII use interacted with severe DKA to lower predicted HbA1c. Indigenous status was associated with higher HbA1c (+1.37%, 95% CI 1.15, 1.59; [+15.0 mmol/mol, 95% CI 12.6, 17.4]; P < 0.001), as was residing in postcodes of lower socioeconomic status (most vs. least disadvantaged quintile +0.43%, 95% CI 0.34, 0.52; [+4.7 mmol/mol, 95% CI 3.4, 5.6]; P < 0.001). CONCLUSIONS Severe, but not mild or moderate, DKA at diagnosis was associated with a marginally higher HbA1c over time, an effect that was modified by use of CSII. Indigenous status and lower socioeconomic status were independently associated with higher long-term HbA1c.
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Affiliation(s)
- Helen F Clapin
- Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | - Peter G Colman
- Royal Melbourne Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth A Davis
- Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | | | - Melissa Chee
- JDRF Australia, St Leonards, New South Wales, Australia
| | - Philip Bergman
- Monash University, Clayton, Victoria, Australia.,Monash Children's Hospital, Clayton, Victoria, Australia
| | - Martin de Bock
- Canterbury District Health Board, Christchurch, New Zealand.,Christchurch School of Medicine, University of Otago, Otago, New Zealand
| | - Kung-Ting Kao
- The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - P Gerry Fegan
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Stephanie Johnson
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Bruce R King
- John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
| | | | - Kruthika Narayan
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Alexia S Peña Vargas
- Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
| | | | - Benjamin J Wheeler
- Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin Central, Dunedin, New Zealand
| | - Anthony Zimmermann
- Lyell McEwin & Modbury Hospitals, Elizabeth Vale, South Australia, Australia
| | - Maria E Craig
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Jenny J Couper
- Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia
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Besser REJ, Bell KJ, Couper JJ, Ziegler AG, Wherrett DK, Knip M, Speake C, Casteels K, Driscoll KA, Jacobsen L, Craig ME, Haller MJ. ISPAD Clinical Practice Consensus Guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes 2022; 23:1175-1187. [PMID: 36177823 DOI: 10.1111/pedi.13410] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Rachel E J Besser
- Wellcome Centre for Human Genetics, NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Kirstine J Bell
- Charles Perkins Centre and Faculty Medicine and Health, University of Sydney, Sydney, Australia
| | - Jenny J Couper
- Department of Pediatrics, University of Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Diane K Wherrett
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mikael Knip
- Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Laura Jacobsen
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Maria E Craig
- Department of Pediatrics, The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Michael J Haller
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
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3
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Benitez-Aguirre PZ, Marcovecchio ML, Chiesa ST, Craig ME, Wong TY, Davis EA, Cotterill A, Couper JJ, Cameron FJ, Mahmud FH, Neil HAW, Jones TW, Hodgson LAB, Dalton RN, Marshall SM, Deanfield J, Dunger DB, Donaghue KC. Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort. Diabetologia 2022; 65:872-878. [PMID: 35182158 PMCID: PMC8960571 DOI: 10.1007/s00125-022-05661-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/01/2021] [Indexed: 11/04/2022]
Abstract
AIMS/HYPOTHESIS We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control. METHODS This was a prospective observational study in 710 normoalbuminuric adolescents with type 1 diabetes from the non-intervention cohorts of the Adolescent Cardio-Renal Intervention Trial (AdDIT). Participants were classified as 'high ACR' or 'low ACR' (lowest and middle ACR tertiles) using baseline standardised log10 ACR. The primary outcome, 3DR, was determined from centrally graded, standardised two-field retinal photographs. 3DR risk was determined using multivariable Cox regression for the effect of high ACR, with HbA1c, BP, LDL-cholesterol and BMI as covariates; diabetes duration was the time-dependent variable. RESULTS At baseline mean ± SD age was 14.3 ± 1.6 years and mean ± SD diabetes duration was 7.2 ± 3.3 years. After a median of 3.2 years, 83/710 (12%) had developed 3DR. In multivariable analysis, high ACR (HR 2.1 [1.3, 3.3], p=0.001), higher mean IFCC HbA1c (HR 1.03 [1.01, 1.04], p=0.001) and higher baseline diastolic BP SD score (HR 1.43 [1.08, 1.89], p=0.01) were independently associated with 3DR risk. CONCLUSIONS/INTERPRETATION High ACR is associated with greater risk of 3DR in adolescents, providing a target for future intervention studies. TRIAL REGISTRATION isrctn.org ISRCTN91419926.
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Affiliation(s)
- Paul Z Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
| | | | - Scott T Chiesa
- Institute of Cardiovascular Science, University College London, London, UK
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Tien Y Wong
- Centre for Eye Research Australia, Melbourne, VIC, Australia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | | | - Jenny J Couper
- Endocrinology and Diabetes Centre, Women's and Children's Hospital, and Robinson Institute, University of Adelaide, Adelaide, SA, Australia
| | - Fergus J Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Farid H Mahmud
- Division of Endocrinology, Hospital for Sick Children, Toronto, ON, Canada
| | - H Andrew W Neil
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | | | - R Neil Dalton
- St Thomas' Hospital, Well Child Laboratory, Evelina London Children's Hospital, London, UK
| | - Sally M Marshall
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - John Deanfield
- Institute of Cardiovascular Science, University College London, London, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
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4
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Robertson CA, Earnest A, Chee M, Craig ME, Colman P, Barrett HL, Bergman P, Cameron F, Davis EA, Donaghue KC, Fegan PG, Hamblin PS, Holmes-Walker DJ, Jefferies C, Johnson S, Mok MT, King BR, Sinnott R, Ward G, Wheeler BJ, Zimmermann A, Jones TW, Couper JJ. Longitudinal audit of assessment and pharmaceutical intervention for cardiovascular risk in the Australasian Diabetes Data Network. Diabetes Obes Metab 2022; 24:354-361. [PMID: 34713959 DOI: 10.1111/dom.14584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/10/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Claire A Robertson
- Women's and Children's Hospital and Robinson Research Institute University of Adelaide, North Adelaide, South Australia, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Melissa Chee
- JDRF Australia, St Leonard's, New South Wales, Australia
| | - Maria E Craig
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of NSW, Sydney, New South Wales, Australia
| | - Peter Colman
- Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
| | | | - Philip Bergman
- Monash Children's Hospital, Clayton, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - Fergus Cameron
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Elizabeth A Davis
- Perth Children's Hospital, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Kim C Donaghue
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of NSW, Sydney, New South Wales, Australia
| | - P Gerry Fegan
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - P Shane Hamblin
- The University of Melbourne, Parkville, Victoria, Australia
- Western Health, St Albans, Victoria, Australia
| | | | | | - Stephanie Johnson
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Meng T Mok
- Australasian Diabetes Data Network, Parkville, Australia
| | - Bruce R King
- John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
| | | | - Glenn Ward
- St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Benjamin J Wheeler
- Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Anthony Zimmermann
- Lyell McEwin & Modbury Hospitals, Elizabeth Vale, South Australia, Australia
| | - Timothy W Jones
- Perth Children's Hospital, Nedlands, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jenny J Couper
- Women's and Children's Hospital and Robinson Research Institute University of Adelaide, North Adelaide, South Australia, Australia
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5
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Bampton TJ, Holmes-Walker DJ, Drogemuller CJ, Radford T, Anderson P, Etherton C, Russell CH, Khurana S, Torpy DJ, Couper JJ, Couper RLT, Macintyre P, Neo EL, Benitez-Aguirre P, Thomas G, Loudovaris T, Thomas HE, Palmer LJ, Wu D, Rogers NM, Williams L, Hawthorne WJ, O'Connell PJ, Kay TW, Pleass H, Chen JW, Coates PT. Australian experience with total pancreatectomy with islet autotransplantation to treat chronic pancreatitis. ANZ J Surg 2021; 91:2663-2668. [PMID: 33956377 DOI: 10.1111/ans.16853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND This study aimed to describe the clinical outcomes of total pancreatectomy with islet autotransplantation (TP-IAT) in Australia. METHODS Individuals selected for TP-IAT surgery according to the Minnesota Criteria (Appendix) without evidence of diabetes were evaluated including time to transplantation from pancreatectomy, islet numbers infused and post-transplantation HbA1c, C-peptide, total daily insulin and analgesic requirement. RESULTS Sixteen individuals underwent TP-IAT from Australia and New Zealand between 2010 and 2020. Two recipients are deceased. The median islet equivalents/kg infused was 4244 (interquartile range (IQR) 2290-7300). The median C-peptide 1 month post-TP-IAT was 384 (IQR 210-579) pmol/L and at median 29.5 (IQR 14.5-46.5) months from transplant was 395 (IQR 139-862) pmol/L. Insulin independence was achieved in eight of 15 (53.3%) surviving recipients. A higher islet equivalents transplanted was most strongly associated with the likelihood of insulin independence (P < 0.05). Of the 15 surviving recipients, 14 demonstrated substantial reduction in analgesic requirement. CONCLUSION The TP-IAT programme in Australia has been a successful new therapy for the management of individuals with chronic pancreatitis including hereditary forms refractory to medical treatment to improve pain management with 50% insulin independence rates.
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Affiliation(s)
- Tristan J Bampton
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - D Jane Holmes-Walker
- Department of Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Chris J Drogemuller
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Toni Radford
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Patricia Anderson
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - C Etherton
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - C H Russell
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - S Khurana
- Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - David J Torpy
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J J Couper
- Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - R L T Couper
- Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Pamela Macintyre
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - E L Neo
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Paul Benitez-Aguirre
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - G Thomas
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Children's Hospital, Sydney, New South Wales, Australia
| | - T Loudovaris
- Islet biology, St Vincent's Institute, Melbourne, Victoria, Australia
| | - H E Thomas
- Islet biology, St Vincent's Institute, Melbourne, Victoria, Australia
| | - Lyle J Palmer
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Denghao Wu
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Natasha M Rogers
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - L Williams
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - W J Hawthorne
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - P J O'Connell
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Tom W Kay
- Islet biology, St Vincent's Institute, Melbourne, Victoria, Australia
| | - Henry Pleass
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - John W Chen
- The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Gastroenterology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - P Toby Coates
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,The Central and Northern Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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6
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Couper JJ, Jones TW, Chee M, Barrett HL, Bergman P, Cameron F, Craig ME, Colman P, Davis EE, Donaghue KC, Fegan PG, Hamblin PS, Holmes-Walker DJ, Jefferies C, Johnson S, Mok MT, King BR, Sinnott R, Ward G, Wheeler BJ, Zimmermann A, Earnest A. Determinants of Cardiovascular Risk in 7000 Youth With Type 1 Diabetes in the Australasian Diabetes Data Network. J Clin Endocrinol Metab 2021; 106:133-142. [PMID: 33120421 DOI: 10.1210/clinem/dgaa727] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Cardiovascular disease occurs prematurely in type 1 diabetes. The additional risk of overweight is not well characterized. OBJECTIVE The primary aim was to measure the impact of body mass index (BMI) in youth with type 1 diabetes on cardiovascular risk factors. The secondary aim was to identify other determinants of cardiovascular risk. DESIGN Observational longitudinal study of 7061 youth with type 1 diabetes followed for median 7.3 (interquartile range [IQR] 4-11) years over 41 (IQR 29-56) visits until March 2019. SETTING 15 tertiary care diabetes centers in the Australasian Diabetes Data Network.Participants were aged 2 to 25 years at baseline, with at least 2 measurements of BMI and blood pressure. MAIN OUTCOME MEASURE Standardized systolic and diastolic blood pressure scores and non-high-density lipoprotein (HDL) cholesterol were co-primary outcomes. Urinary albumin/creatinine ratio was the secondary outcome. RESULTS BMI z-score related independently to standardized blood pressure z- scores and non-HDL cholesterol. An increase in 1 BMI z-score related to an average increase in systolic/diastolic blood pressure of 3.8/1.4 mmHg and an increase in non-HDL cholesterol (coefficient + 0.16 mmol/L, 95% confidence interval [CI], 0.13-0.18; P < 0.001) and in low-density lipoprotein (LDL) cholesterol. Females had higher blood pressure z-scores, higher non-HDL and LDL cholesterol, and higher urinary albumin/creatinine than males. Indigenous youth had markedly higher urinary albumin/creatinine (coefficient + 2.15 mg/mmol, 95% CI, 1.27-3.03; P < 0.001) and higher non-HDL cholesterol than non-Indigenous youth. Continuous subcutaneous insulin infusion was associated independently with lower non-HDL cholesterol and lower urinary albumin/creatinine. CONCLUSIONS BMI had a modest independent effect on cardiovascular risk. Females and Indigenous Australians in particular had a more adverse risk profile.
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Affiliation(s)
- Jenny J Couper
- Women's and Children's Hospital and Robinson Research Institute University of Adelaide, North Adelaide, SA, Australia
| | - Timothy W Jones
- Perth Children's Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | | | | | - Philip Bergman
- Monash Children's Hospital, Clayton, VIC, Australia
- Monash University, Clayton, VIC, Australia
| | | | - Maria E Craig
- The Children's Hospital at Westmead, Westmead, NSW, Australia
- University of NSW, Sydney, NSW, Australia
| | - Peter Colman
- Royal Melbourne Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Elizabeth E Davis
- Perth Children's Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Kim C Donaghue
- The Children's Hospital at Westmead, Westmead, NSW, Australia
- University of NSW, Sydney, NSW, Australia
| | | | - P Shane Hamblin
- Western Health, St Albans, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | | | | | | | | | - Bruce R King
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
| | | | - Glenn Ward
- St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Benjamin J Wheeler
- Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin Central, Dunedin, New Zealand
| | | | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
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7
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Augustine P, Gent R, Louise J, Taranto M, Penno M, Linke R, Couper JJ. Pancreas size and exocrine function is decreased in young children with recent-onset Type 1 diabetes. Diabet Med 2020; 37:1340-1343. [PMID: 31094026 DOI: 10.1111/dme.13987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2019] [Indexed: 12/22/2022]
Abstract
AIMS To measure pancreatic area and exocrine function in young children with recent-onset Type 1 diabetes to determine whether the exocrine pancreas is also affected in the pathophysiology of early childhood diabetes. METHODS Thirty-two children (14 boys) aged 5.5 (4.5, 7.3) median (IQR) years presenting with recent-onset Type 1 diabetes and 90 controls (44 boys) of similar age had ultrasound imaging of the pancreas. Children with Type 1 diabetes were receiving insulin and were without ketosis. Transverse and longitudinal areas of the pancreas were measured by digitalized outline. Pancreatic faecal elastase-1 was analysed using an enzyme-linked immunosorbent assay kit in recent-onset Type 1 diabetes and 38 first-degree relative control children. RESULTS Pancreatic area and exocrine function were reduced in Type 1 diabetes. Mean transverse area (SD) in Type 1 diabetes was 6.82 cm2 (1.61) vs. 8.31 cm2 (1.74) in controls, adjusted estimate (95% CI) 1.45 (-2.12, -0.79), P < 0.001; longitudinal area was 1.28 cm2 (0.44) vs. 1.55 cm2 (0.43), adjusted estimate (95% CI) -0.27 (-0.45, -0.09), P = 0.003. Faecal elastase-1 levels in Type 1 diabetes were 455 (323, 833) ug/g, median (IQR) vs. 1408 μg/g (1031, 1989) in controls, P < 0.001. CONCLUSION Pancreatic area and accompanying subclinical exocrine function were reduced in very young children with recent-onset Type 1 diabetes. This supports changes in the exocrine pancreas in the pathophysiology of Type 1 diabetes presenting in early life.
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Affiliation(s)
- P Augustine
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, South Australia
| | - R Gent
- Department of Medical Imaging, Women's and Children's Hospital, South Australia
| | - J Louise
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, South Australia
| | - M Taranto
- PathWest Laboratories, Fiona Stanley Hospital Network, Western Australia
| | - M Penno
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, South Australia
| | - R Linke
- Department of Medical Imaging, Women's and Children's Hospital, South Australia
| | - J J Couper
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, South Australia
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Perano SJ, Rayner CK, Kritas S, Horowitz M, Donaghue K, Mpundu-Kaambwa C, Giles L, Couper JJ. Gastric Emptying Is More Rapid in Adolescents With Type 1 Diabetes and Impacts on Postprandial Glycemia. J Clin Endocrinol Metab 2015; 100:2248-53. [PMID: 25871840 DOI: 10.1210/jc.2015-1055] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 02/07/2023]
Abstract
CONTEXT Gastric emptying is a critical determinant of postprandial glycemic control in health and type 1 diabetes. There are few studies that assess the relationship between gastric emptying and postprandial glycaemia in adolescents with type 1 diabetes. OBJECTIVE The objectives of the study were to quantify gastric emptying in adolescents with type 1 diabetes and examine its relationship to postprandial glycaemia and autonomic function. DESIGN This was a case-control study. Gastric half-emptying time of a solid meal was measured by a (13)C-octanoate breath test. Cardio-autonomic function was measured by heart rate variability. Chronic and postprandial gastrointestinal symptoms were evaluated by questionnaire and visual analog scales. Blood glucose concentrations were monitored frequently during the study. SETTING The study was conducted at a tertiary pediatric hospital in South Australia. PARTICIPANTS Thirty adolescents (aged 15 ± 2.5 y) with type 1 diabetes and age- and sex-matched controls (gastric emptying, n = 20; heart rate variability, n = 135) participated in the study. MAIN OUTCOME Gastric half-emptying time was the main outcome in the study. RESULTS Gastric emptying was more rapid in subjects with type 1 diabetes than controls [median half emptying time 78 (interquartile range 61-99) vs 109 (interquartile range 71-124) min, P = .02]. The postprandial rise in blood glucose at 60 minutes was strongly related to gastric half-emptying time (R = -0.65, P = .0001). Gastric emptying was slower in subjects with fasting hyperglycemia but was not related to heart rate variability. Nausea, bloating, and anxiety were related to fasting glycemia (P = .03). CONCLUSION Rapid gastric emptying is a major determinant of postprandial glycemia in adolescents with type 1 diabetes. This observation has significant implications for therapy.
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Affiliation(s)
- Shiree J Perano
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Chris K Rayner
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Stamatiki Kritas
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Michael Horowitz
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Kim Donaghue
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Christine Mpundu-Kaambwa
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Lynne Giles
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Jenny J Couper
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
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Maftei O, Pena AS, Sullivan T, Jones TW, Donaghue KC, Cameron FJ, Davis E, Cotterill A, Craig ME, Gent R, Dalton N, Daneman D, Dunger D, Deanfield J, Couper JJ. Early atherosclerosis relates to urinary albumin excretion and cardiovascular risk factors in adolescents with type 1 diabetes: Adolescent type 1 Diabetes cardio-renal Intervention Trial (AdDIT). Diabetes Care 2014; 37:3069-75. [PMID: 25071076 DOI: 10.2337/dc14-0700] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 02/03/2023]
Abstract
OBJECTIVE The origins of cardiovascular and renal disease in type 1 diabetes begin during childhood. We aimed to evaluate carotid (cIMT) and aortic intima-media thickness (aIMT) and their relationship with cardiovascular risk factors and urinary albumin excretion in adolescents with type 1 diabetes in the Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT). RESEARCH DESIGN AND METHODS A total of 406 adolescents with type 1 diabetes, who were 14.1 ± 1.9 years old with type 1 diabetes duration of 6.7 ± 3.7 years, and 57 age-matched control subjects provided clinical and biochemical data and ultrasound measurements of vascular structure (cIMT and aIMT). Vascular endothelial and smooth muscle function was also measured in 123 of 406 with type 1 diabetes and all control subjects. RESULTS In type 1 diabetic subjects, mean/maximal aIMT (P < 0.006; <0.008), but not mean/maximal cIMT, was greater than in control subjects. Mean/maximal aIMT related to urinary albumin-to-creatinine ratio (multiple regression coefficient [SE], 0.013 [0.006], P = 0.03; 0.023 [0.007], P = 0.002), LDL cholesterol (0.019 [0.008], P = 0.02; 0.025 [0.011], P = 0.02), and age (0.010 [0.004], P = 0.004; 0.012 [0.005], P = 0.01), independent of other variables. Mean/maximal cIMT was greater in males (0.023 [0.006], P = 0.02; 0.029 [0.007], P < 0.0001), and mean cIMT related independently to systolic blood pressure (0.001 [0.001], P = 0.04). Vascular smooth muscle function related to aIMT and cIMT but not to urinary albumin excretion. CONCLUSIONS aIMT may be a more sensitive marker of atherosclerosis than cIMT in type 1 diabetes during mid-adolescence. Higher urinary albumin excretion, even within the normal range, is associated with early atherosclerosis and should direct clinical attention to modifiable cardiovascular risk factors.
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Affiliation(s)
- Oana Maftei
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia
| | - Alexia S Pena
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia Robinson Institute and Discipline of Paediatrics, University of Adelaide, Adelaide, Australia
| | - Thomas Sullivan
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Australia Telethon Institute for Child Health Research, University of Western Australia, Subiaco, Australia School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Fergus J Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia Murdoch Childrens Research Institute, Melbourne, Melbourne, Australia
| | - Elizabeth Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Australia Telethon Institute for Child Health Research, University of Western Australia, Subiaco, Australia School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia
| | - Andrew Cotterill
- Department of Paediatric Endocrinology, Mater Children's Hospital, Brisbane, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Roger Gent
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia
| | - Neil Dalton
- WellChild Laboratory, St. Thomas' Hospital, London, U.K
| | - Denis Daneman
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - David Dunger
- University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, U.K
| | - John Deanfield
- National Centre for Cardiovascular Disease Prevention and Outcomes, University College London, London, U.K
| | - Jenny J Couper
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia Robinson Institute and Discipline of Paediatrics, University of Adelaide, Adelaide, Australia
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Sawyer MG, Reynolds KE, Couper JJ, French DJ, Kennedy D, Martin J, Staugas R, Baghurst PA. A two-year prospective study of the health-related quality of life of children with chronic illness--the parents' perspective. Qual Life Res 2005; 14:395-405. [PMID: 15892428 DOI: 10.1007/s11136-004-0786-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess prospectively changes in the health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF). One hundred and twenty-two parents of children aged 10-16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Parents described their children's HRQL using the Child Health Questionnaire (PF98) at baseline, 6, 12, 18 and 24 months post-baseline. They reported that the general health of children with CF was significantly worse than that of children with asthma and diabetes at baseline. In other domains there were few differences between the HRQL of children in the three groups. In several domains, the HRQL of children with asthma or diabetes improved over the 2 years of the study. This improvement was less evident for children with CF.
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Affiliation(s)
- M G Sawyer
- Women's and Children's Hospital, University of Adelaide, Australia.
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Abstract
OBJECTIVE To assess longitudinal changes in folate status in South Australian children and adolescents during fortification of food with folic acid. METHODS Sixty-nine children and adolescents (age 12.8 +/- 2.3 years), 47 with diabetes and 22 healthy controls, had their folate status assessed at the beginning of 1999 and again after a mean 1.1 +/- 0.23 years. Intake of folate at baseline was assessed with a quantitative food frequency questionnaire. RESULTS Baseline red cell folate (mean +/- standard deviation (SD)) was 756 +/- 294.5 nmol/L and remained constant at follow up at 736 +/- 299 nmol/L (P = 0.55) in the whole group. Serum folate increased from 24.4 +/- 6.3 nmol/L to 27.2 +/- 8.8 nmol/L (P = 0.002). Children with diabetes showed a significant increase in serum folate (from 26.3 +/- 5.7-30.1 +/- 7.9, P < 0.001) and stable red cell folate (835.8 +/- 278.6 and 808.6 +/- 296.7, P = 0.51) between baseline and the second samples, while controls showed stable serum (20.4 +/- 5.7 and 21.1 +/- 7.7, P = 0.7) and red cell folate (586.6 +/- 255.9 and 579.8 +/- 240.1, P = 0.92). A third sample collected in 17 subjects after a further 9 +/- 1.3 months showed a further increase in serum and red cell folate. Mean folate intake at baseline was 301 +/- 129 micro g/day, below the mean recommended for prevention of neural tube defects. CONCLUSIONS Voluntary fortification of food with folate is associated with improved folate status in South Australian children and adolescents, but may not be sufficient at current levels to provide maximal protection against neural tube defects at a population level.
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Affiliation(s)
- E J Wiltshire
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
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Abstract
Congenital and acquired forms of osteoporosis in childhood and adolescence can result in morbidity from fracture and pain in childhood, and place an individual at significant risk for problems in adult life. A range of therapies exist for the prevention and treatment of osteoporosis, including optimization of daily calcium intake, adequate vitamin D status, weight-bearing exercise, treatment with sex steroids where delayed puberty is a problem and, more recently, use of bisphosphonate therapy. Intravenous pamidronate therapy (a bisphosphonate) has been shown to reduce fractures and improve bone density in children with osteogenesis imperfecta, and might prove to be of benefit in other osteoporotic conditions in childhood. However, a number of issues regarding the optimal use of bisphosphonate therapy in children and adolescents remain to be resolved, including total annual dose and frequency and duration of administration. Bisphosphonate therapy should, therefore, be used only in the context of a well-run clinical programme with specialist knowledge in the management of osteopenic disorders in childhood.
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Affiliation(s)
- J A Batch
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Brisbane, Queensland, Australia.
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Abstract
High risk HLA class II alleles account for 40% of the genetic susceptibility to type 1 diabetes in Caucasians, but the majority of the genetically predisposed do not develop the disease. This supports some environmental modification of the autoimmune destruction of beta cells that precedes type 1 diabetes. Identical twin studies and geographical variation in incidence also argue for a critical role of environmental factors. Attention has been directed to the possible harmful effect of cow's milk protein (or protective effect of breast-feeding) and enteric infections in early life. Natural history studies that follow children at increased risk of type 1 diabetes provide the best opportunity to study environmental triggers. The Australian Baby Diab Study has followed approximately 500 babies from birth who have a first-degree relative with type 1 diabetes. No prospective association between duration of breast-feeding or introduction of cow's milk and the development of islet autoimmunity was found. The same Australian cohort demonstrated a relationship between rotavirus infection and the first appearance or increase in islet antibodies. Enteroviral infection is seen more frequently in prediabetic children and prior to the onset of islet autoimmunity in Finnish cohorts. Environmental factors may interact. Breast milk protects against enteric infections; enteric infections in turn could increase immunity to dietary antigens by increasing intestinal permeability. It is also possible that an alteration in gut mucosal immune function in genetically susceptible individuals underlies any effect of dietary or viral proteins on the development of islet autoimmunity in early life.
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Affiliation(s)
- J J Couper
- Department of Endocrinology, Women and Children's Hospital, North Adelaide, SA 5006, Australia.
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Affiliation(s)
- R T Couper
- Department of Paediatrics, University of Adelaide, North Adelaide, South Australia, Australia.
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Honeyman MC, Coulson BS, Stone NL, Gellert SA, Goldwater PN, Steele CE, Couper JJ, Tait BD, Colman PG, Harrison LC. Association between rotavirus infection and pancreatic islet autoimmunity in children at risk of developing type 1 diabetes. Diabetes 2000; 49:1319-24. [PMID: 10923632 DOI: 10.2337/diabetes.49.8.1319] [Citation(s) in RCA: 253] [Impact Index Per Article: 10.5] [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: 12/12/2022]
Abstract
Pancreatic islet autoimmunity leading to type 1 diabetes could be triggered by viruses in genetically susceptible individuals. Rotavirus (RV), the most common cause of childhood gastroenteritis, contains peptide sequences highly similar to T-cell epitopes in the islet autoantigens GAD and tyrosine phosphatase IA-2 (IA-2), suggesting T-cells to RV could trigger islet autoimmunity by molecular mimicry. We therefore sought an association between RV infection and islet autoantibody markers in children at risk for diabetes who were followed from birth. There was a specific and highly significant association between RV seroconversion and increases in any of these antibodies: 86% of antibodies to IA-2, 62% to insulin, and 50% to GAD first appeared or increased with increases in RV IgG or IgA. RV infection may therefore trigger or exacerbate islet autoimmunity in genetically susceptible children.
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Affiliation(s)
- M C Honeyman
- Autoimmunity and Transplantation Division, Walter and Eliza Hall Institute of Medical Research, Royal Melbourne Hospital, Victoria, Australia.
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Abstract
Studies of two post-mortem pancreata of children at the onset of type I diabetes have suggested activation and expansion of islet infiltrating T cells by a superantigen. We present the first reported case of a superantigen mediated disease, toxic shock syndrome (TSS), occurring at the diagnosis of type I diabetes. A 12-year-old girl presented with TSS and newly diagnosed diabetes with ketoacidosis. At presentation she was unconscious, febrile and hypotensive, with a desquamating erythematous rash and Kussmaul breathing. During resuscitation, her renal impairment, diarrhoea, thrombocytopaenia and ketoacidosis resolved. Vaginal discharge and blood cultures grew Staphylococcus aureus. T cell studies at 2 weeks after diagnosis detected a high level of spontaneous and islet antigen-specific proliferation with associated interleukin-10 production compared to human leucocyte antigen DR matched controls.
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Affiliation(s)
- J J Couper
- Department of Endocrinology, Women's and Children's Hospital, North Adelaide, Australia.
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Colman PG, Steele C, Couper JJ, Beresford SJ, Powell T, Kewming K, Pollard A, Gellert S, Tait B, Honeyman M, Harrison LC. Islet autoimmunity in infants with a Type I diabetic relative is common but is frequently restricted to one autoantibody. Diabetologia 2000; 43:203-9. [PMID: 10753042 DOI: 10.1007/s001250050030] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [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: 10/27/2022]
Abstract
AIMS/HYPOTHESIS To determine the sequence of development of islet autoantibodies and their relation to HLA genes in infants at risk for Type I diabetes followed from birth. METHODS We followed 357 (189 male, 168 female) infants, with a first degree relative with Type I diabetes for a mean of 3 years from birth. Human leukocyte antigen typing and assays for insulin autoantibodies (IAA), glutamic acid decarboxylase antibodies (GADAb) and tyrosine phosphatase IA2 (IA2Ab) antibodies were done on cord blood, and venous blood was sampled every 6 months for IAA, GADAb and IA2Ab. RESULTS We did not find any antibodies in 263 (73%) infants; 50 (14%) were positive for a single antibody once, 19 (5%) for a single antibody more than once and 25 (7%) for two or more antibodies. Of the latter, 10 (2.8% overall) were persistently positive; they had higher frequencies of HLA DR4 (p < 0.01) and HLA DR3, 4 (p < 0.05). Of the group persistently positive for two or more antibodies four infants developed diabetes. Insulin autoantibodies were the first ones to develop in 64% of infants with two or more antibodies. CONCLUSION/INTERPRETATION Infants with high risk HLA-DR alleles and multiple antibodies at high risk for diabetes were identified. A much larger group of infants had transient low level increases usually of a single antibody. Whereas transient low level positivity could be attributed to difficulties with assay technique and cut off levels for normality, the results overall support the phenomenon of transient 'self limited' islet autoimmunity in at risk infants.
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Affiliation(s)
- P G Colman
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Victoria, Australia
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Abstract
OBJECTIVE To determine whether a 6-month home-based intervention program in adolescents with poorly controlled diabetes improves metabolic control and whether benefits are maintained after the intervention. RESEARCH DESIGN AND METHODS Adolescents with a mean HbA1c of > 9.0% over the preceding 12 months received either routine care in a diabetes clinic and an ambulatory intervention for 6 months (n = 37) or routine care only (n = 32). A diabetes educator provided monthly home visits and weekly phone contact to educate and support the adolescents in setting goals for insulin adjustment, blood glucose monitoring, and target blood glucose range. There was no systematic change in the frequency of insulin injections. After the intervention, there was a 12-month follow-up when the intervention and control groups both received only routine care. Outcome measures were HbA1c and Diabetes Knowledge Assessment (DKN). RESULTS During the intervention, mean HbA1c fell (baseline: 11.1 +/- 1.3%, 6 months: 9.7 +/- 1.6%; P = 0.0001) and mean knowledge scores increased (P = 0.0001) in the intervention group but not in control subjects. However, this improvement in HbA1c and increase in knowledge was not maintained in the intervention group at 12- and 18-month follow-up assessments. Parents' knowledge scores also improved significantly from baseline levels in the intervention group at 6 and 12 months (P = 0.001, P = 0.005, respectively). CONCLUSIONS An ambulatory program improves metabolic control and knowledge in adolescents with poorly controlled type 1 diabetes; however, it is effective only while the intervention is maintained.
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Affiliation(s)
- J J Couper
- Department of Endocrinology, Women's and Children's Hospital, North Adelaide, Australia.
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Couper JJ, Steele C, Beresford S, Powell T, McCaul K, Pollard A, Gellert S, Tait B, Harrison LC, Colman PG. Lack of association between duration of breast-feeding or introduction of cow's milk and development of islet autoimmunity. Diabetes 1999; 48:2145-9. [PMID: 10535447 DOI: 10.2337/diabetes.48.11.2145] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [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] [Indexed: 02/03/2023]
Abstract
The hypothesis that early exposure to cow's milk or lack of breast-feeding predisposes to type 1 diabetes remains controversial. We aimed to determine prospectively the relationship of, first, duration of exclusive breast-feeding and total duration of breast-feeding, and second, introduction of cow's milk protein as infant formula, cow's milk, or dairy products, to the development of islet antibodies in early life. Some 317 children with a first-degree relative with type 1 diabetes were followed prospectively from birth for 29 months (4-73). Mothers kept a home diary and answered infant feeding questionnaires at 6-month intervals. No systematic feeding advice was given. Insulin autoantibodies (normal range <5.5%), anti-GAD antibodies (<5.0 U), and anti-IA2 antibodies (<3.0 U) were measured at 6-month intervals. Cox proportional hazards model of survival analysis detected no significant difference between children who did not develop islet antibodies (225 of 317 [71%]), children with one islet antibody raised once (52 of 317 [16.4%]), children with one antibody raised repeatedly (18 of 317 [5.7%]), or children with two or more antibodies raised (22 of 317 [6.9%]), in terms of duration of exclusive breast-feeding, total duration of breast-feeding, or introduction of cow's milk-based infant formulas, cow's milk, or dairy products (relative risk: 0.91-1.09). Four of the children with two or more islet antibodies developed type 1 diabetes. We conclude that there is no prospective association between duration of breast-feeding or introduction of cow's milk and the development of islet autoimmunity in high-risk children.
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Affiliation(s)
- J J Couper
- Department of Endocrinology, Women's and Children's Hospital, North Adelaide SA, Australia.
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Couper JJ, Harrison LC, Aldis JJ, Colman PG, Honeyman MC, Ferrante A. IgG subclass antibodies to glutamic acid decarboxylase and risk for progression to clinical insulin-dependent diabetes. Hum Immunol 1998; 59:493-9. [PMID: 9712353 DOI: 10.1016/s0198-8859(98)00040-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [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: 02/08/2023]
Abstract
Pancreatic islet beta cell destruction leading to insulin-dependent diabetes mellitus (IDDM) is believed to be mediated by a T-helper 1 (T(H)1) lymphocyte response to islet antigens. In the mouse, T(H)1 (IL-2, IFN-gamma) and T(H)2 (IL-4, -5, -6, -10) responses are associated with the generation of IgG2a and IgG1 subclasses, respectively. The equivalent human subclasses have not been defined. Because the IgG subclass response to an antigen may be a potentially useful marker of T(H)1/T(H)2 immune balance we measured IgG subclass antibodies to glutamic acid decarboxylase (GAD), a major islet autoantigen in IDDM, in 34 newly-diagnosed IDDM patients and in 28 at-risk, first-degree relatives of people with IDDM. In the newly-diagnosed patients, total IgG antibodies to GAD were detected in 74% (25/34); IgG1 and/or IgG3 were significantly more frequent than IgG4 or IgG4/IgG2 (14/34 versus 5/34, p = 0.01). GAD antibody-negative patients were significantly younger (p = 0.01). In 15 at-risk relatives who had not progressed to clinical diabetes after a median of 4.5 years, 10 had IgG2 and/or IgG4 antibodies compared to only 3/13 progressors (p = 0.02). Total IgG and IgG2 antibodies were higher in non-progressors. Non-progressors were older than progressors (p = 0.01), and relatives with IgG2 and/or IgG4 responses were also older (p = 0.01). These results suggest that IgG subclass antibodies to GAD may contribute to diabetes risk assessment in islet antibody relatives.
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Affiliation(s)
- J J Couper
- Department of Endocrinology, Women's and Children's Hospital, South Australia, Australia
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Abstract
In this study we have investigated both the expression of c-met in cultured human mesangial cells and the proliferative effect of HGF on these cells. RNAse protection analysis using a c-met riboprobe showed c-met to be expressed and further that this expression was unaffected by the glucose concentration or osmolality of the media. Immunofluorescence studies performed using anti-HGF or anti-c-met antibodies clearly showed that both proteins are localised to human mesangial cells. Proliferation of human mesangial cells after 24-h treatment with HGF was also examined. HGF 10 ng/ml and 100 ng/ml stimulated 3-H-Thymidine incorporation 1.35-fold (P = 0.001) and 1.6-fold (P<0.00001) respectively in cells made quiescent for 24 h. A similar dose-dependent stimulation of proliferation was observed in cells made quiescent for 48 h. Finally, using RNAse protection analysis we have shown that HGF (10 ng/ml, 100 ng/ml) induces the expression of c-met in these cells in a dose-dependent manner. Together these results indicate for the first time a potential autocrine role for HGF in the human mesangium.
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Affiliation(s)
- N C Kallincos
- Department of Endocrinology, Women's and Children's Hospital, Adelaide, S.A. Australia.
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22
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Abstract
OBJECTIVE To investigate power spectral analysis (PSA) of heart rate variability (HRV) in children and adolescents with IDDM, its relationship with other measures of HRV and standard cardiovascular responses, and factors associated with reduced HVR. RESEARCH DESIGN AND METHODS A total of 130 subjects with IDDM aged 12.8 +/- 3.2 years and 108 healthy control subjects were studied. Power spectra were analyzed from supine electrocardiograph (ECG) recordings by processing into consecutive R-R intervals and analysis using fast Fourier transformation. Standard cardiovascular responses to deep breathing and standing were performed. RESULTS IDDM subjects had a reduction in total power including both low-frequency (0.05-0.14 Hz; P = 0.0001) and high-frequency (0.14-0.40 Hz; P = 0.0002) components. These changes were seen from diagnosis. Other measures of HRV, coefficient of variation (CV) and standard deviation (SD) of mean resting heart rate, were also significantly lower in IDDM. All 20 (15%) of the 130 IDDM subjects with total power less than the 5th percentile in control subjects also had reduced HRV when measured by CV of heart rate. There was an independent relationship between age and the high-frequency component in IDDM subjects and control subjects. Total power correlated with mean heart rate (r = -0.56; P < 0.0001), CV of heart rate (r = 0.90; P < 0.00001), SD of heart rate (r = 0.91; P < 0.00001), heart rate response to deep breathing (r = 0.45; P < 0.0001), and duration in IDDM subjects. There was no correlation with short-term or long-term metabolic control. Retesting of 27 subjects showed a variability in total power and its components comparable to other measures of HRV and standard heart rate responses. CONCLUSIONS Changes in HRV are a sensitive and reproducible measure of early autonomic dysfunction in childhood. In this age-group, PSA appears no more sensitive a measure of reduced HRV than other closely correlated measures of HRV.
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Affiliation(s)
- A M Wawryk
- Endocrine and Diabetes Unit, Women's and Children's Hospital, North Adelaide, Australia.
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23
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Couper JJ, Clarke CF, Byrne GC, Jones TW, Donaghue KC, Nairn J, Boyce D, Russell M, Stephens M, Raymond J, Bates DJ, McCaul K. Progression of borderline increases in albuminuria in adolescents with insulin-dependent diabetes mellitus. Diabet Med 1997; 14:766-71. [PMID: 9300227 DOI: 10.1002/(sici)1096-9136(199709)14:9<766::aid-dia467>3.0.co;2-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [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: 02/05/2023]
Abstract
We aimed to determine the natural history of borderline increases in albuminuria in adolescents with insulin-dependent (Type 1) diabetes mellitus (IDDM) and factors which are associated with progression to persistent microalbuminura. Fifty-five normotensive adolescents with IDDM and intermittent microalbuminura (overnight albumin excretion ratte of 20-200 micrograms min-1 on one of three consecutive timed collections, n = 29) or borderline albuminura (mean overnight albumin excretion rate of 7.2-20 micrograms min-1 on one of three consecutive timed collections, n = 30) were followed prospectively at 3 monthly intervals. The endpoint was persistent microalbuminuria defined as a minimum of three of four consecutive overnight albumin excretion rates of greater than 20 micrograms min-1. One hundred and forty-two adolescents with IDDM and normoalbuminura were also followed prospectively. Fifteen of the 59 patients (25.4%) with intermittent (9/29) or borderline (6/30) albuminura progressed to persistent microalbuminura (progressors) over 28 (15-50) months [median (range)] in comparison with two of the 142 patients with normoalbuminuria at entry (relative risk = 12.6; p = 0.001). Progressors to persistent microalbuminura were pubertal and had higher systolic (p = 0.02) and diastolic (p = 0.02) blood pressure, and HbA1c (p = 0.004) than non-progressors. All patients remained normotensive. Glomerular filtration rate, apolipoproteins, dietary phosphorus, protein and sodium intakes, and prevalence of smoking did not differ between progressors and non-progressors. Total renin was higher in the diabetic patients without a difference between progressors and non-progressors. In conclusion there is a relatively high rate of progression to persistent microalbuminuria in pubertal adolescents with borderline increases in albuminura and duration greater than 3 years. These patients require attention to minimize associated factors of poor metabolic control and higher blood pressure in the development of incipient nephropathy.
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Affiliation(s)
- J J Couper
- Department of Endocrinology, Women's and Children's Hospital, Adelaide, Australia
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24
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Abstract
The study aimed to determine the prevalence of impaired nocturnal BP fall in adolescents with Type 1 diabetes. Thirty-six normoalbuminuric normotensive adolescents with Type 1 diabetes (19 males, 17 females) aged 14.4 +/- 2.1 years (mean +/- SD) with duration of 4.0 (2.6-7.5) years (median (25-75th percentile)) and 23 controls (11 males, 12 females) aged 15.0 +/- 1.6 years were studied. Day/night BP variation was examined using Ambulatory Accutracker II Monitor (Raleigh, NC). Recordings were made at 30 min intervals during the day and 60 min intervals during the night. Time records were set according to individual diaries. There was no significant difference in day and night systolic or diastolic BP or in mean day/night BP variability between patients with Type 1 diabetes and control subjects. 15/36 patients compared to 3/23 controls (chi squared = 5.43, p < 0.02) were non-dippers defined as a nocturnal fall in either systolic (13/36) or diastolic (6/36) BP or both (4/36) of less than 10%. These non-dippers had normal day-night ratio of heart rate when compared with the remainder of the patients or controls. In conclusion a significant number of young normotensive normoalbuminuric patients with Type 1 diabetes show an impaired fall in blood pressure at night, predominantly in systolic BP. These changes may be relevant to the long-term development of macrovascular or microvascular disease.
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Affiliation(s)
- N Khan
- Department of Endocrinology and Diabetes, Adelaide Children's Hospital, North Adelaide, South Australia
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25
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Abstract
We aimed to examine the longitudinal relationship between lipoprotein(a) and haemoglobin A1c, albumin excretion rate, and puberty in peripubertal children with insulin-dependent diabetes. A total of 114 patients aged 11.5 +/- 3.6 years (mean (SD)) were followed prospectively for 15.2 +/- 2.8 months. Lipoprotein(a), apolipoproteinB-100, haemoglobin A1c, mean overnight albumin excretion rate and Tanner stage were determined at the beginning and end of the study period. Lipoprotein(a) and apolipoproteinB-100 were measured using nephelometry. This method was correlated with radioimmunoassay and there was no significant change in mean bias during the study. Lipoprotein(a) fell significantly over time (214, (152, 276); 160 (84, 236) mg l-1 geometric mean (0.95 confidence intervals), p < 0.001); apolipoproteinB-100 did not change. Lipoprotein(a) and apolipoproteinB-100 did not differ in 233 cross-sectional controls of similar age. The change in lipoprotein(a) did not correlate with a small fall in haemoglobin A1c or with overnight albumin excretion rate, Tanner stage or insulin dose. Separate analysis of male and female patients and prepubertal and pubertal patients continued to show a significant fall in lipoprotein(a) independent of change in haemoglobin A1c or albumin excretion rate. Likewise, 53 patients with a change in haemoglobin A1c of greater than 1%, and 20 patients who progressed from normal albumin excretion rate to albumin excretion rate above the 95th centile, showed no relationship between lipoprotein(a) and haemoglobin A1c or albumin excretion rate. In conclusion, longitudinal changes in lipoprotein(a) do not relate to metabolic control or early changes in albuminuria in young patients with insulin-dependent diabetes.
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Affiliation(s)
- J J Couper
- Department of Endocrinology, Women's and Children's Hospital, Adelaide, South Australia
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26
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Couper JJ, Jones TW, Donaghue KC, Clarke CF, Thomsett MJ, Silink M. The Diabetes Control and Complications Trial. Implications for children and adolescents. Australasian Paediatric Endocrine Group. Med J Aust 1995; 162:369-72. [PMID: 7715519] [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: 01/26/2023]
Affiliation(s)
- J J Couper
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, SA
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27
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Abstract
Recent evidence suggests the rise in urinary albumin excretion preceding diabetic nephropathy may represent a continuum. We therefore studied factors relating to albumin excretion rate in children with insulin-dependent diabetes. Normal overnight albumin excretion rate was determined in 690 healthy schoolchildren. The 95th centile was 7.2 micrograms min-1. Patients included 169 children with IDDM aged 12.4 +/- 3.1 years who performed 4.8 +/- 0.4 overnight collections during 15 +/- 0.5 months and were analysed cross sectionally. They were stratified accordingly to mean albumin excretion rate: normal < 7.2 micrograms min-1, borderline 7.2-20 micrograms min-1, microalbuminuria 20-200 micrograms min-1; 96/169 patients performed 6.4 +/- 0.2 overnight collections during 24 months follow-up and were analysed longitudinally. Cigarette smoking was determined by history and urine cotinine levels. Smoking correlated with albumin excretion rate, independent of age and other variables, in cross-sectional and longitudinal analysis (p < 0.003). Smoking was more prevalent in the borderline albuminuria and microalbuminuria groups (p < 0.004, p < 0.001). Mean HbA1c during follow-up and mean HbA1c since diagnosis were significantly higher in the microalbuminuric group, compared with the normal patient group. HbA1c since diagnosis, mean blood pressure, lipoprotein(a), and apolipoprotein B did not correlate with albumin excretion rate, after controlling for other variables. Our findings highlight the continuing need for strategies to prevent smoking in this age group.
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Affiliation(s)
- J J Couper
- Department of Endocrinology and Diabetes, Adelaide Children's Hospital, South Australia
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28
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Abstract
OBJECTIVE Pancreatic beta-cell mass increases rapidly during gestation and early infancy. Infants who are small for gestational age, which is a marker for poor intrauterine nutrition, have reduced beta-cell mass. We examined whether weight and length in early infancy, and in inference beta-cell mass, is related to age at onset of insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS Data from infant records of 232 patients with IDDM, including birth weight, birth length, gestational age, weight at 6 months of age, and feeding history during the first 6 months of life, were analyzed. Maternal recall was not used for data collection. RESULTS Low-birth-weight infants (<2.5 kg) showed a significantly earlier onset of diabetes (4.3 [3.2-6.0] years vs. 9.0 [5.3-11.8] years, median [25-75th percentile]; P < 0.0001). Infants small for gestational age also had earlier onset than those with birth weight above the 10th percentile after correction for gestational age (6.2 [3.6-10.5] vs. 9.2 [5.4-11.8] years; P < 0.0001). Infants with corrected birth weight: length ratio below the 10th percentile had earlier onset, as did infants with corrected 6-months weight below the 10th percentile (4.9 [2.8-6.0] years vs. 8.8 [5.2-11.8] years; P < 0.0001). Infants who were exclusively breast-fed for 6 months showed a slightly later onset of diabetes than those who were bottle- or mixed-fed, independent of weight (9.4 [5.0-11.3] years vs. 8.3 [4.2-11.7] years; P < 0.0001). CONCLUSIONS Weight and growth parameters in utero and early infancy may influence the age at onset of IDDM. beta-cell mass is likely to be a significant factor.
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Affiliation(s)
- N Khan
- Department of Endocrinology and Diabetes, Adelaide Children's Hospital, South Australia
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29
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Couper JJ, Littleford KD, Couper RT, Nakamura T, Ferrante A. High glucose and hyperosmolality stimulate hepatocyte growth factor secretion from cultured human mesangial cells. Diabetologia 1994; 37:533-5. [PMID: 8056193 DOI: 10.1007/s001250050143] [Citation(s) in RCA: 9] [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] [Indexed: 01/28/2023]
Abstract
Hepatocyte growth factor is a recently cloned potent mitogen to hepatocytes, but its extrahepatic roles are not completely defined. It causes proliferation of endothelial and epithelial cells implicating potential action in the glomerulus. We aimed to determine whether cultured human mesangial cells secrete hepatocyte growth factor and the effect of high glucose conditions. Mesangial cells were isolated from the normal cortex of a child's kidney. After differential glomerular sieving and trypsin digestion of glomeruli, mesangial cells were cultured in 20% fetal calf serum/RPMI. Glucose concentration in the medium was adjusted to 5 mmol/l, 11 mmol/l, 25 mmol/l or 5 mmol/l/20 mmol/l mannitol to correct for osmolality. After 0, 24, 48, 72 h incubation, hepatocyte growth factor was measured in the supernatant by enzyme immuno assay using recombinant hepatocyte growth factor and monoclonal antibodies to human hepatocyte growth factor. Hepatocyte growth factor was secreted by cultured mesangial cells. High glucose and hyperosmolar conditions caused a 100-200% increase in hepatocyte growth factor secretion at 48-72 h (p = 0.001). Hepatocyte growth factor secretion at 48 h in 5 mmol/l glucose was 16.46 +/- 1.09 ng/ml (mean +/- SEM), 11 mmol/l glucose: 32.98 +/- 4.54, 25 mmol/l glucose: 33.32 +/- 7.89, 5 mmol/l glucose/20 mmol/l mannitol: 34.05 +/- 3.64; at 72 h in 5 mmol/l glucose: 23.92 +/- 2.85 ng/ml, 11 mmol/l glucose: 28.26 +/- 2.03, 25 mmol/l glucose: 62.04 +/- 12.2, 5 mmol/l glucose/20 mmol/l mannitol: 45.76 +/- 6.25. Trypan blue exclusion demonstrated membrane integrity.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J J Couper
- Department Endocrinology and Diabetes, Adelaide Children's Hospital, Australia
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30
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Couper JJ, Cocciolone R, Nairn J, Ryall RG. Lp(a) and insulin dose in IDDM. Diabetes Care 1993; 16:1402. [PMID: 8269801 DOI: 10.2337/diacare.16.10.1402a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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31
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Abstract
OBJECTIVE To determine serum lipoprotein(a) in a large sample of IDDM and control children and to examine a possible association with puberty. RESEARCH DESIGN AND METHODS Serum lipoprotein(a), apoB-100, and apoA-I were measured under identical conditions in 170 Caucasian children with IDDM aged 12.3 +/- 3.59 yr and 233 Caucasian control children aged 13.6 +/- 1.12 yr. Patients with persistent microalbuminuria were excluded. Lipoprotein(a), apoB-100, and apoA-I were measured by nephelometry using a specific monoclonal antibody. Pubertal assessment was performed using Tanner staging and testicular volume measurement. RESULTS Lipoprotein(a) was higher in the IDDM than control group (geometric mean 237 mg/L, 25-75th percentile 134-465 vs. 172 [99-316] mg/L, P = 0.0008). When analyzed according to pubertal stage, only pubertal and postpubertal patients had higher levels than control subjects (265 [148-560] vs. 174 [101-320] mg/L, P = 0.0001), with prepubertal patients showing no difference. Pubertal and postpubertal patients showed both higher lipoprotein(a) (P = 0.01) levels and higher albumin excretion rates (P = 0.02) than prepubertal patients, correcting for the other variable. Lipoprotein(a) was not related to HbA1c, albumin excretion rate, duration, age, sex, mean arterial pressure, or a family history of premature coronary artery disease in the IDDM group. Lipoprotein(a) was not higher in patients with overnight albumin excretion rate above the 95th percentile but below the microalbuminuric range. ApoB-100 did not differ between IDDM and control children. ApoA-I was significantly lower in the IDDM group (1.04 [0.94-1.17] vs. 1.21 [1.10-1.31] g/L; P < 0.0001). CONCLUSIONS Pubertal and postpubertal IDDM patients have higher serum lipoprotein(a) than Caucasian control subjects. Our findings suggest a rise in lipoprotein(a) may occur during puberty in IDDM. Longitudinal studies are required to clarify the relationship between lipoprotein(a), albumin excretion rate, and puberty.
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Affiliation(s)
- J J Couper
- Department of Endocrinology and Diabetes, Adelaide Children's Hospital, South Australia
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32
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Abstract
A female with congenital adrenal hyperplasia (21-hydroxylase deficiency) received prenatal dexamethasone treatment. Suppression of the fetal adrenal was initially inadequate but adequate in later pregnancy. The baby showed masculinisation without clitoral enlargement and a narrow urogenital sinus with resulting hydrometrocolpos. It is possible that dexamethasone treatment which is initially inadequate increases the risk of this latter complication.
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Affiliation(s)
- J J Couper
- Department of Endocrinology and Diabetes, Royal Children's Hospital (RCH), Melbourne, Australia
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33
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Couper JJ, Hudson I, Werther GA, Warne GL, Court JM, Harrison LC. Factors predicting residual beta-cell function in the first year after diagnosis of childhood type 1 diabetes. Diabetes Res Clin Pract 1991; 11:9-16. [PMID: 2019237 DOI: 10.1016/0168-8227(91)90135-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [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: 12/29/2022]
Abstract
Twenty-five children aged 2-14 years (mean age 8.39 +/- 0.78 years) were studied prospectively during the first year after the diagnosis of type 1 diabetes. Of their clinical and metabolic features at diagnosis, only age showed a significant independent relationship with endogenous C-peptide production during the first year. Age was correlated with higher values for basal and stimulated plasma C-peptide at 7-14 days after diagnosis, at 6 months and at 12 months. At diagnosis, age was also associated with a higher value for HbA1c and a lower prevalence of insulin antibodies. C-peptide production peaked at 3 months and thereafter declined. Mean HbA1c and insulin requirement were both minimal at 6 months. At diagnosis, there were significant inverse relationships between basal C-peptide production and both insulin dose and HbA1c and between stimulated C-peptide production and HbA1c. Basal and stimulated C-peptide production were inversely related to insulin dose at 6 and 12 months. Stimulated C-peptide was higher at 12 months in children retaining islet cell antibodies. These findings confirm the importance of age as a predictor of residual beta-cell function in type 1 diabetes and indicate that older children present clinically following a slower course of beta cell destruction.
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Affiliation(s)
- J J Couper
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
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