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Klupa T, Czupryniak L, Dzida G, Fichna P, Jarosz-Chobot P, Gumprecht J, Mysliwiec M, Szadkowska A, Bomba-Opon D, Czajkowski K, Malecki MT, Zozulinska-Ziolkiewicz DA. Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease. Diabetes Ther 2023:10.1007/s13300-023-01431-3. [PMID: 37322319 PMCID: PMC10299981 DOI: 10.1007/s13300-023-01431-3] [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] [Received: 04/25/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
Application of continuous glucose monitoring (CGM) has moved diabetes care from a reactive to a proactive process, in which a person with diabetes can prevent episodes of hypoglycemia or hyperglycemia, rather than taking action only once low and high glucose are detected. Consequently, CGM devices are now seen as the standard of care for people with type 1 diabetes mellitus (T1DM). Evidence now supports the use of CGM in people with type 2 diabetes mellitus (T2DM) on any treatment regimen, not just for those on insulin therapy. Expanding the application of CGM to include all people with T1DM or T2DM can support effective intensification of therapies to reduce glucose exposure and lower the risk of complications and hospital admissions, which are associated with high healthcare costs. All of this can be achieved while minimizing the risk of hypoglycemia and improving quality of life for people with diabetes. Wider application of CGM can also bring considerable benefits for women with diabetes during pregnancy and their children, as well as providing support for acute care of hospital inpatients who experience the adverse effects of hyperglycemia following admission and surgical procedures, as a consequence of treatment-related insulin resistance or reduced insulin secretion. By tailoring the application of CGM for daily or intermittent use, depending on the patient profile and their needs, one can ensure the cost-effectiveness of CGM in each setting. In this article we discuss the evidence-based benefits of expanding the use of CGM technology to include all people with diabetes, along with a diverse population of people with non-diabetic glycemic dysregulation.
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Affiliation(s)
- Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Dzida
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Malgorzata Mysliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Dorota Bomba-Opon
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
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2
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Svensson J, Ibfelt EH, Carstensen B, Neu A, Cinek O, Skrivarhaug T, Rami-Merhar B, Feltbower RG, Castell C, Konrad D, Gillespie K, Jarosz-Chobot P, Marčiulionytė D, Rosenbauer J, Bratina N, Ionescu-Tirgoviste C, Gorus F, Kocova M, de Beaufort C, Patterson CC. Age-period-cohort modelling of type 1 diabetes incidence rates among children included in the EURODIAB 25-year follow-up study. Acta Diabetol 2023; 60:73-82. [PMID: 36205797 DOI: 10.1007/s00592-022-01977-x] [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: 07/26/2022] [Accepted: 09/15/2022] [Indexed: 01/07/2023]
Abstract
AIMS Specific patterns in incidence may reveal environmental explanations for type 1 diabetes incidence. We aimed to study type 1 diabetes incidence in European childhood populations to assess whether an increase could be attributed to either period or cohort effects. METHODS Nineteen EURODIAB centres provided single year incidence data for ages 0-14 in the 25-year period 1989-2013. Case counts and person years were classified by age, period and cohort (APC) in 1-year classes. APC Poisson regression models of rates were fitted using restricted cubic splines for age, period and cohort per centre and sex. Joint models were fitted for all centres and sexes, to find a parsimonious model. RESULTS A total of 57,487 cases were included. In ten and seven of the 19 centres the APC models showed evidence of nonlinear cohort effects or period effects, respectively, in one or both sexes and indications of sex-specific age effects. Models showed a positive linear increase ranging from approximately 0.6 to 6.6%/year. Centres with low incidence rates showed the highest overall increase. A final joint model showed incidence peak at age 11.6 and 12.6 for girls and boys, respectively, and the rate-ratio was according to sex below 1 in ages 5-12. CONCLUSION There was reasonable evidence for similar age-specific type 1 diabetes incidence rates across the EURODIAB population and peaks at a younger age for girls than boys. Cohort effects showed nonlinearity but varied between centres and the model did not contribute convincingly to identification of environmental causes of the increase.
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Affiliation(s)
- J Svensson
- Diabetes Technology Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
| | - E H Ibfelt
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - B Carstensen
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - A Neu
- University Children´S Hospital, Tübingen, Germany
| | - O Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - T Skrivarhaug
- Division of Adolescent and Paediatric Medicine, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - B Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - R G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - C Castell
- Department of Health, Government of Catalonia, Barcelona, Spain
| | - D Konrad
- Division of Paediatric Endocrinology and Diabetology and Children's Research Center, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - K Gillespie
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - P Jarosz-Chobot
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - D Marčiulionytė
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Microbiology and Virology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - J Rosenbauer
- German Diabetes Center, Institute of Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - N Bratina
- Diabetes & Metabolic Diseases, Department of Endocrinology, University Children's Hospital, Ljubljana, Slovenia
| | - C Ionescu-Tirgoviste
- National Institute of Diabetes Nutrition and Metabolic Diseases, NC Paulescu, Bucharest, Romania
| | - F Gorus
- Diabetes Research Center, Brussels Free University - Vrije Universiteit Brussel, Brussels, Belgium
| | - M Kocova
- Department of Endocrinology and Genetics, University Children's Hospital, Skopje, North Macedonia
| | - C de Beaufort
- Department of Paediatric Diabetes and Endocrinology, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - C C Patterson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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3
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Cengiz E, Danne T, Ahmad T, Ayyavoo A, Beran D, Ehtisham S, Fairchild J, Jarosz-Chobot P, Ng SM, Paterson M, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1277-1296. [PMID: 36537533 DOI: 10.1111/pedi.13442] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Eda Cengiz
- University of California San Francisco (UCSF) Pediatric Diabetes Program, UCSF School of Medicine, San Francisco, California, USA
| | - Thomas Danne
- Auf Der Bult, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Tariq Ahmad
- Pediatric Endocrinology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Ahila Ayyavoo
- Department of Pediatrics, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine University of Geneva and Geneva University Hospitals, Faculty of Medicine Diabetes Centre, Geneva, Switzerland
| | - Sarah Ehtisham
- Division of Pediatric Endocrinology, Mediclinic City Hospital, Dubai, UAE
| | - Jan Fairchild
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, Australia
| | | | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Southport, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Megan Paterson
- John Hunter Children's Hospital, HRMC, New South Wales, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
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4
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Czupryniak L, Dzida G, Fichna P, Jarosz-Chobot P, Gumprecht J, Klupa T, Mysliwiec M, Szadkowska A, Bomba-Opon D, Czajkowski K, Malecki MT, Zozulinska-Ziolkiewicz DA. Ambulatory Glucose Profile (AGP) Report in Daily Care of Patients with Diabetes: Practical Tips and Recommendations. Diabetes Ther 2022; 13:811-821. [PMID: 35278195 PMCID: PMC8991298 DOI: 10.1007/s13300-022-01229-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/08/2022] [Indexed: 12/01/2022] Open
Abstract
The ambulatory glucose profile (AGP) is now established as the standardised, practical one-page report for graphically presenting a summary of glycaemic control status in patients with diabetes who use continuous glucose monitoring (CGM) systems as part of their daily diabetes care. The AGP report provides both a visual and a statistical summary of the glucose metrics that, as agreed in the 2019 international consensus for assessing glycaemic control, should be analysed in all people with diabetes who are using CGM systems. The AGP report can be analysed in a systematic fashion to understand current glycaemic control and to monitor, in real time, the impact of adjustments to therapy in both type 1 diabetes and type 2 diabetes. Here we provide a practical guide to the glycaemic measures that are summarised in the AGP Report and illustrate the essential components of an AGP review in a series of hypothetical, real-world, patient-centred case studies (see Supplementary Materials).
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Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Dzida
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata Mysliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Dorota Bomba-Opon
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
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5
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Kaminska H, Wieczorek P, Zalewski G, Malachowska B, Kucharski P, Fendler W, Szarpak L, Jarosz-Chobot P. Reference Ranges of Glycemic Variability in Infants after Surgery—A Prospective Cohort Study. Nutrients 2022; 14:nu14040740. [PMID: 35215390 PMCID: PMC8878403 DOI: 10.3390/nu14040740] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to define reference ranges of glycemic variability indices derived from continuous glucose monitoring data for non-diabetic infants during post-operative intensive care treatment after cardiac surgery procedures. We performed a prospective cohort intervention study in a pediatric intensive care unit (PICU). Non-diabetic infants aged 0–12 months after corrective cardiovascular surgery procedures were fitted upon arrival to the PICU with a continuous glucose monitoring system (iPro2, Medtronic, Minneapolis, MN, USA). Thirteen glycemic variability indices were calculated for each patient. Complete recordings of 65 patients were collected on the first postoperative day. During the first three postsurgical days 5%, 24% and 43% of patients experienced at least one hypoglycemia episode, and 40%, 10% and 15%—hyperglycemia episode, respectively, in each day. Due to significant differences between the first postoperative day (mean glycemia 130 ± 31 mg/dL) and the second and third day (105 ± 18 mg/dL, 101 ± 22.2 mg/dL; p < 0.0001), we proposed two separate reference ranges—for the acute and steady state patients. Thus, for individual glucose measurements, we proposed a reference range between 85 and 229 mg/dL and 69 and 149 mg/dL. For the mean daily glucose level, ranges between 122 and 137 mg/dL and 95 and 110 mg/dL were proposed. In conclusion, rt-CGM revealed a very high likelihood of hyperglycemia in the first postsurgical day. The widespread use of CGM systems in a pediatric ICU setting should be considered as a safeguard against dysglycemic episodes; however, reference ranges for those patients should be different to those used in diabetes care.
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Affiliation(s)
- Halla Kaminska
- Department of Children’s Diabetology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence:
| | - Pawel Wieczorek
- Pediatric Intensive Care Unit (PICU), John Paul II Upper Silesian Health Centre in Katowice, 40-752 Katowice, Poland;
| | - Grzegorz Zalewski
- Department of Pediatric Cardiac Surgery, John Paul II Upper Silesian Child Health Center in Katowice, 40-752 Katowice, Poland;
| | - Beata Malachowska
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.M.); (P.K.); (W.F.)
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Przemyslaw Kucharski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.M.); (P.K.); (W.F.)
- Institute of Applied Computer Science, Lodz University of Technology, 90-537 Lodz, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.M.); (P.K.); (W.F.)
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02155, USA
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Przemyslawa Jarosz-Chobot
- Department of Children’s Diabetology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
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6
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Zmysłowska A, Jakiel P, Gadzalska K, Majos A, Płoszaj T, Ben-Skowronek I, Deja G, Glowinska-Olszewska B, Jarosz-Chobot P, Klonowska B, Kowalska I, Mlynarski W, Mysliwiec M, Nazim J, Noczynska A, Robak-Kontna K, Skala-Zamorowska E, Skowronska B, Szadkowska A, Szypowska A, Walczak M, Borowiec M. Next- generation sequencing is an effective method for diagnosing patients with different forms of monogenic diabetes. Diabetes Res Clin Pract 2022; 183:109154. [PMID: 34826540 DOI: 10.1016/j.diabres.2021.109154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 08/12/2021] [Revised: 11/13/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022]
Abstract
AIM Monogenic diabetes (MD) represents 5-7% of antibody-negative diabetes cases and is a heterogeneous group of disorders. METHODS We used targeted next-generation sequencing (NGS) on Illumina NextSeq 550 platform involving the SureSelect assay to perform genetic and clinical characteristics of a study group of 684 individuals, including 542 patients referred from 12 Polish Diabetes Centers with suspected MD diagnosed between December 2016 and December 2019 and their 142 family members (FM). RESULTS In 198 probands (36.5%) and 66 FM (46.5%) heterozygous causative variants were confirmed in 11 different MD-related genes, including 31 novel mutations, with the highest number in the GCK gene (206/264), 22/264 in the HNF1A gene and 8/264 in the KCNJ11 gene. Of the 183 probands with MODY1-5 diabetes, 48.6% of them were diagnosed at the pre-diabetes stage and most of them (68.7%) were on diet only at the time of genetic diagnosis, while 31.3% were additionally treated with oral hypoglycaemic drugs and/or insulin. CONCLUSIONS In summary, the results obtained confirm the efficacy of targeted NGS method in the molecular diagnosis of patients with suspected MD and broaden the spectrum of new causal variants, while updating our knowledge of the clinical features of patients defined as having MD.
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Affiliation(s)
- A Zmysłowska
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland.
| | - P Jakiel
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | - K Gadzalska
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | - A Majos
- Department of General and Transplant Surgery, Medical University of Lodz, Lodz, Poland
| | - T Płoszaj
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | - I Ben-Skowronek
- Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - G Deja
- Department of Children's Diabetology, Medical University of Silesia in Katowice, Poland
| | - B Glowinska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland
| | - P Jarosz-Chobot
- Department of Children's Diabetology, Medical University of Silesia in Katowice, Poland
| | - B Klonowska
- Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland
| | - I Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
| | - W Mlynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - M Mysliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - J Nazim
- Department of Pediatric Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - A Noczynska
- Department of Pediatric Endocrinology and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | - K Robak-Kontna
- Outpatient Clinic for Pediatric Diabetology, Regional Children's Hospital in Bydgoszcz, Bydgoszcz, Poland
| | - E Skala-Zamorowska
- Department of Children's Diabetology, Medical University of Silesia in Katowice, Poland
| | - B Skowronska
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | - A Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - A Szypowska
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - M Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - M Borowiec
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
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7
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Kaminska H, Szarpak L, Kosior D, Wieczorek W, Szarpak A, Al-Jeabory M, Gawel W, Gasecka A, Jaguszewski MJ, Jarosz-Chobot P. Impact of diabetes mellitus on in-hospital mortality in adult patients with COVID-19: a systematic review and meta-analysis. Acta Diabetol 2021; 58:1101-1110. [PMID: 33778910 PMCID: PMC8005367 DOI: 10.1007/s00592-021-01701-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) has spread worldwide since the beginning of 2020, placing the heavy burden on the health systems all over the world. The population that particularly has been affected by the pandemic is the group of patients suffering from diabetes mellitus. Having taken the public health in considerations, we have decided to perform a systematic review and meta-analysis of diabetes mellitus on in-hospital mortality in patients with COVID-19. METHODS A systematic literature review (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane) including all published clinical trials or observational studies published till December 10, 2020, was performed using following terms "diabetes mellitus" OR "diabetes" OR "DM" AND "survival" OR "mortality" AND "SARS-CoV-2" OR "COVID-19". RESULTS Nineteen studies were included out of the 7327 initially identified studies. Mortality of DM patients vs non-DM patients was 21.3 versus 6.1%, respectively (OR = 2.39; 95%CI: 1.65, 3.64; P < 0.001), while severe disease in DM and non-DM group varied and amounted to 34.8% versus 22.8% (OR = 1.43; 95%CI: 0.82, 2.50; P = 0.20). In the DM group, the complications were observed far more often when compared with non-DM group, both in acute respiratory distress (31.4 vs. 17.2%; OR = 2.38; 95%CI:1.80, 3.13; P < 0.001), acute cardiac injury (22.0% vs. 12.8%; OR = 2.59; 95%CI: 1.81, 3.73; P < 0.001), and acute kidney injury (19.1 vs. 10.2%; OR = 1.97; 95%CI: 1.36, 2.85; P < 0.001). CONCLUSIONS Based on the findings, we shall conclude that diabetes is an independent risk factor of the severity of COVID-19 in-hospital settings; therefore, patients with diabetes shall aim to reduce the exposure to the potential infection of COVID-19.
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Affiliation(s)
- Halla Kaminska
- Department of Pediatrics and Children's Diabetology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Silesia, Poland
| | - Lukasz Szarpak
- Maria Sklodowska-Curie Bialystok Oncology Center, Ogrodowa 12 str., 15-027, Bialystok, Poland.
- Polish Society of Disaster Medicine, Warsaw, Poland.
| | - Dariusz Kosior
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
- Department of Cardiology and Hypertension With Electrophysiological Lab, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Wojciech Wieczorek
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Wladyslaw Gawel
- Department of Surgery, The Silesian Hospital in Opava, Opava, Czech Republic
| | - Aleksandra Gasecka
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, The Netherlands
- 1St Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Przemyslawa Jarosz-Chobot
- Department of Pediatrics and Children's Diabetology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Silesia, Poland
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8
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Topor-Madry R, Wojtyniak B, Strojek K, Rutkowski D, Bogusławski S, Ignaszewska-Wyrzykowska A, Jarosz-Chobot P, Czech M, Kozierkiewicz A, Chlebus K, Jędrzejczyk T, Mysliwiec M, Polanska J, Wysocki MJ, Zdrojewski T. Prevalence of diabetes in Poland: a combined analysis of national databases. Diabet Med 2019; 36:1209-1216. [PMID: 30889281 DOI: 10.1111/dme.13949] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Accepted: 03/15/2019] [Indexed: 12/15/2022]
Abstract
AIMS To assess the number of people with diabetes in Poland using combined national sources and to evaluate the usefulness of data from an insurance system for epidemiological purposes. METHODS The data were collected from four sources: 1) 2013 all-billing records of the national insurance system comprising people of all age groups undergoing procedures or receiving services in primary healthcare, specialist practices and hospitals and also those receiving drugs; 2) an epidemiological study, NATPOL, that involved the assessment of people with undiagnosed diabetes; 3) the RECEPTOmetr Sequence study on prescriptions; and 4) regional child diabetes registries. RESULTS In 2013, 1.76 million people (0.98 million women and 0.79 million men) had medical consultations (coded E10-E14) and 2.13 million people (1.19 million women and 0.94 million men) purchased drugs or strip tests for diabetes. A total of 0.04 million people who used medical services did not buy drugs. In total, the number of people with diabetes in the insurance system was 2.16 million (1.21 million women and 0.95 million men), which corresponds to 6.1% (95% CI 6.11-6.14) of women and 5.1% (95% CI 5.12-5.14) of men. Including undiagnosed cases, the total number of people with diabetes in Poland was 2.68 million in 2013. CONCLUSION The estimated prevalence of diabetes (diagnosed and undiagnosed cases) in Poland is 6.97%. Data from the national insurance system with full coverage of the population can be treated as a reliable source of information on diseases with well-defined diagnosis and treatment methods, combined with an assessment of the number of undiagnosed individuals.
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Affiliation(s)
- R Topor-Madry
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow
| | - B Wojtyniak
- National Institute of Public Health - National Institute of Hygiene, Warsaw
| | - K Strojek
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice
| | | | | | | | - P Jarosz-Chobot
- Department of Children's Diabetology, Medical University of Silesia, Katowice
| | - M Czech
- Medical University in Warsaw, Warsaw
| | | | - K Chlebus
- Department of Cardiology, Clinical Center of Cardiology, Medical University of Gdansk, Gdansk
| | - T Jędrzejczyk
- Department of Preventive Medicine and Medical Education, Medical University of Gdansk, Gdansk
| | - M Mysliwiec
- Chair of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Gdansk
| | - J Polanska
- Data Mining Group, Silesian University of Technology, Gliwice, Poland
| | - M J Wysocki
- National Institute of Public Health - National Institute of Hygiene, Warsaw
| | - T Zdrojewski
- Department of Preventive Medicine and Medical Education, Medical University of Gdansk, Gdansk
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Danne T, Phillip M, Buckingham BA, Jarosz-Chobot P, Saboo B, Urakami T, Battelino T, Hanas R, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:115-135. [PMID: 29999222 DOI: 10.1111/pedi.12718] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [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: 03/22/2018] [Accepted: 07/01/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Thomas Danne
- Kinder- und Jugendkrankenhaus AUF DER BULT, Diabetes-Zentrum für Kinder und Judendliche, Hannover, Germany
| | - 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
| | - Bruce A Buckingham
- Department of Pediatric Endocrinology, Stanford University, Stanford, California
| | | | - Banshi Saboo
- Department of Endocrinology, DiaCare - Advance Diabetes Care Center, Ahmedabad, India
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Tadej Battelino
- Department Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, University de Chile, Santiago, Chile
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10
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Chobot A, Polanska J, Brandt A, Deja G, Glowinska-Olszewska B, Pilecki O, Szadkowska A, Mysliwiec M, Jarosz-Chobot P. Updated 24-year trend of Type 1 diabetes incidence in children in Poland reveals a sinusoidal pattern and sustained increase. Diabet Med 2017; 34:1252-1258. [PMID: 28257151 DOI: 10.1111/dme.13345] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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] [Accepted: 02/27/2017] [Indexed: 12/11/2022]
Abstract
AIMS To present the incidence trend for Type 1 diabetes in Polish children aged 0-14 years, updated using data collected during 2005-2012, and assess the reliability of the predictive model constructed previously using the 1989-2004 database. METHODS Children aged < 15 years with newly diagnosed Type 1 diabetes are recorded prospectively (EURODIAB criteria) in several regional registers in Poland. Age- and gender-standardized incidence rates for Type 1 diabetes were calculated per 100 000 persons/year. Incidence rates were analysed in terms of the dependency on age, gender, geographical region and population density. Incidence rate trends over time were modelled using generalized linear models. RESULTS The mean standardized incidence for 1989-2012 was 12.72 per 100 000 persons/year [95% confidence interval (CI), 11.35 to 14.21]. Over the 24-year observation period, the incidence increased from 5.36 to 22.74 per 100 000 persons/year. The lowest incidence rate was in children aged 0-4 years (8.35, 95% CI 7.27 to 9.57 per 100 000 persons/year). There was no difference between genders, or urban and rural regions. Incidence rates were higher in northern compared with southern Poland [14.04 (95% CI 12.59 to 15.63) vs. 11.94 (95% CI 10.62 to 13.39) per 100 000 persons/year]. The new data corrected the earlier predictive model by changing the estimates of some factors related to patient age, gender and their interactions with the remaining factors. The incidence rate shows periodic 5.33-year fluctuations. The periodicity component allows for a more accurate prediction of the incidence rate over time. CONCLUSIONS This cohort study reveals a sustained increase in Type 1 diabetes incidence in Polish children aged 0-14 years with regular, sinusoidal fluctuations and a slight levelling off in past few years. It is of concern that are the highest increases in incidence are found in children aged 0-4 years.
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Affiliation(s)
| | - J Polanska
- Silesian University of Technology, Gliwice
| | - A Brandt
- Medical University of Gdansk, Gdansk
| | - G Deja
- Medical University of Silesia, Katowice
| | | | - O Pilecki
- Provincial Children's Hospital, Bydgoszcz
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11
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Fendler W, Madzio J, Kozinski K, Patel K, Janikiewicz J, Szopa M, Tracz A, Borowiec M, Jarosz-Chobot P, Mysliwiec M, Szadkowska A, Hattersley AT, Ellard S, Malecki MT, Dobrzyn A, Mlynarski W. Differential regulation of serum microRNA expression by HNF1β and HNF1α transcription factors. Diabetologia 2016; 59:1463-1473. [PMID: 27059371 PMCID: PMC4901123 DOI: 10.1007/s00125-016-3945-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 12/31/2015] [Accepted: 03/10/2016] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS We aimed to identify microRNAs (miRNAs) under transcriptional control of the HNF1β transcription factor, and investigate whether its effect manifests in serum. METHODS The Polish cohort (N = 60) consisted of 11 patients with HNF1B-MODY, 17 with HNF1A-MODY, 13 with GCK-MODY, an HbA1c-matched type 1 diabetic group (n = 9) and ten healthy controls. Replication was performed in 61 clinically-matched British patients mirroring the groups in the Polish cohort. The Polish cohort underwent miRNA serum level profiling with quantitative real-time PCR (qPCR) arrays to identify differentially expressed miRNAs. Validation was performed using qPCR. To determine whether serum content reflects alterations at a cellular level, we quantified miRNA levels in a human hepatocyte cell line (HepG2) with small interfering RNA knockdowns of HNF1α or HNF1β. RESULTS Significant differences (adjusted p < 0.05) were noted for 11 miRNAs. Five of them differed between HNF1A-MODY and HNF1B-MODY, and, amongst those, four (miR-24, miR-27b, miR-223 and miR-199a) showed HNF1B-MODY-specific expression levels in the replication group. In all four cases the miRNA expression level was lower in HNF1B-MODY than in all other tested groups. Areas under the receiver operating characteristic curves ranged from 0.79 to 0.86, with sensitivity and specificity reaching 91.7% (miR-24) and 82.1% (miR-199a), respectively. The cellular expression pattern of miRNA was consistent with serum levels, as all were significantly higher in HNF1α- than in HNF1β-deficient HepG2 cells. CONCLUSIONS/INTERPRETATION We have shown that expression of specific miRNAs depends on HNF1β function. The impact of HNF1β deficiency was evidenced at serum level, making HNF1β-dependent miRNAs potentially applicable in the diagnosis of HNF1B-MODY.
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Affiliation(s)
- Wojciech Fendler
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland.
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 36/50 Sporna Str., 91-738, Lodz, Poland.
| | - Joanna Madzio
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland
- Studies in Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Kamil Kozinski
- Laboratory of Cell Signalling and Metabolic Disorders, Nencki Institute of Experimental Medicine, Polish Academy of Sciences, Warsaw, Poland
| | - Kashyap Patel
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Justyna Janikiewicz
- Laboratory of Cell Signalling and Metabolic Disorders, Nencki Institute of Experimental Medicine, Polish Academy of Sciences, Warsaw, Poland
| | - Magdalena Szopa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Adam Tracz
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Maciej Borowiec
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | | | - Malgorzata Mysliwiec
- Department of Paediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Szadkowska
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Sian Ellard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Agnieszka Dobrzyn
- Laboratory of Cell Signalling and Metabolic Disorders, Nencki Institute of Experimental Medicine, Polish Academy of Sciences, Warsaw, Poland
| | - Wojciech Mlynarski
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland
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12
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Braun M, Tomasik B, Wrona E, Fendler W, Jarosz-Chobot P, Szadkowska A, Zmysłowska A, Wilson J, Mlynarski W. The Stricter the Better? The Relationship between Targeted HbA1c Values and Metabolic Control of Pediatric Type 1 Diabetes Mellitus. J Diabetes Res 2016; 2016:5490258. [PMID: 26881252 PMCID: PMC4736392 DOI: 10.1155/2016/5490258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/14/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It remains unclear how HbA1c recommendations influence metabolic control of paediatric patients with type 1 diabetes mellitus. To evaluate this we compared reported HbA1c with guideline thresholds. MATERIALS AND METHODS We searched systematically MEDLINE and EMBASE for studies reporting on HbA1c in children with T1DM and grouped them according to targeted HbA1c obtained from regional guidelines. We assessed the discrepancies in the metabolic control between these groups by comparing mean HbA1c extracted from each study and the differences between actual and targeted HbA1c. RESULTS We included 105 from 1365 searched studies. The median (IQR) HbA1c for the study population was 8.30% (8.00%-8.70%) and was lower in "6.5%" than in "7.5%" as targeted HbA1c level (8.20% (7.85%-8.57%) versus 8.40% (8.20%-8.80%); p = 0.028). Median difference between actual and targeted HbA1c was 1.20% (0.80%-1.70%) and was higher in "6.5%" than in "7.5%" (1.70% (1.30%-2.07%) versus 0.90% (0.70%-1.30%), resp.; p < 0.001). CONCLUSIONS Our study indicates that the 7.5% threshold results in HbA1c levels being closer to the therapeutic goal, but the actual values are still higher than those observed in the "6.5%" group. A meta-analysis of raw data from national registries or a prospective study comparing both approaches is warranted as the next step to examine this subject further.
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Affiliation(s)
- Marcin Braun
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Bartlomiej Tomasik
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Ewa Wrona
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Wojciech Fendler
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Przemyslawa Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetology, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Agnieszka Zmysłowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Jayne Wilson
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston, Birmingham B15 2TT, UK
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
- *Wojciech Mlynarski:
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13
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Patterson CC, Gyürüs E, Rosenbauer J, Cinek O, Neu A, Schober E, Parslow RC, Joner G, Svensson J, Castell C, Bingley PJ, Schoenle E, Jarosz-Chobot P, Urbonaité B, Rothe U, Kržišnik C, Ionescu-Tirgoviste C, Weets I, Kocova M, Stipancic G, Samardzic M, de Beaufort CE, Green A, Soltész G, Dahlquist GG. Seasonal variation in month of diagnosis in children with type 1 diabetes registered in 23 European centers during 1989-2008: little short-term influence of sunshine hours or average temperature. Pediatr Diabetes 2015; 16:573-80. [PMID: 25316271 DOI: 10.1111/pedi.12227] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 07/16/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The month of diagnosis in childhood type 1 diabetes shows seasonal variation. OBJECTIVE We describe the pattern and investigate if year-to-year irregularities are associated with meteorological factors using data from 50 000 children diagnosed under the age of 15 yr in 23 population-based European registries during 1989-2008. METHODS Tests for seasonal variation in monthly counts aggregated over the 20 yr period were performed. Time series regression was used to investigate if sunshine hour and average temperature data were predictive of the 240 monthly diagnosis counts after taking account of seasonality and long term trends. RESULTS Significant sinusoidal pattern was evident in all but two small centers with peaks in November to February and relative amplitudes ranging from ± 11 to ± 38% (median ± 17%). However, most centers showed significant departures from a sinusoidal pattern. Pooling results over centers, there was significant seasonal variation in each age-group at diagnosis, with least seasonal variation in those under 5 yr. Boys showed greater seasonal variation than girls, particularly those aged 10-14 yr. There were no differences in seasonal pattern between four 5-yr sub-periods. Departures from the sinusoidal trend in monthly diagnoses in the period were significantly associated with deviations from the norm in average temperature (0.8% reduction in diagnoses per 1 °C excess) but not with sunshine hours. CONCLUSIONS Seasonality was consistently apparent throughout the period in all age-groups and both sexes, but girls and the under 5 s showed less marked variation. Neither sunshine hour nor average temperature data contributed in any substantial way to explaining departures from the sinusoidal pattern.
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Affiliation(s)
- C C Patterson
- Centre of Excellence for Public Health Northern Ireland, Queen's University Belfast, Belfast, UK
| | - E Gyürüs
- Department of Paediatrics, Pécs University, Pecs, Hungary
| | - J Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - O Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - A Neu
- Pediatric Endocrinology & Diabetes, University Children's Hospital, Tübingen, Germany
| | - E Schober
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - R C Parslow
- Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - G Joner
- Department of Pediatrics, Ullevål University Hospital, Oslo, Norway
| | - J Svensson
- Department of Paediatrics, Herlev University Hospital, Copenhagen, Denmark
| | - C Castell
- Public Health Agency, Department of Health, Government of Catalonia, Barcelona, Spain
| | - P J Bingley
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - E Schoenle
- Department of Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - P Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, Katowice, Poland
| | - B Urbonaité
- Institute of Endocrinology, Lithuanian University of Health Science, Kaunas, Lithuania
| | - U Rothe
- Department for Epidemiology and Health Care Research, Technical University of Dresden, Dresden, Germany
| | - C Kržišnik
- Department of Pediatrics, University Children's Hospital, Ljubljana, Slovenia
| | - C Ionescu-Tirgoviste
- Nutrition and Metabolic Diseases Clinic, N Paulescu Institute of Diabetes and Metabolic Diseases, Bucharest, Romania
| | - I Weets
- Diabetes Research Center, Brussels Free University, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Kocova
- Department of Endocrinology and Genetics, University Children's Hospital, Skopje, Macedonia
| | - G Stipancic
- Department of Paediatrics, University Hospital Sestre Milosrdnice, Zagreb, Croatia
| | - M Samardzic
- Department of Endocrinology and Diabetes, University Children's Hospital, Podgorica, Montenegro
| | - C E de Beaufort
- Department of Paediatric Diabetes and Endocrinology, Centre Hospitalier de Luxembourg, Luxembourg
| | - A Green
- Odense Patient data Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - G Soltész
- Department of Paediatrics, Pécs University, Pecs, Hungary
| | - G G Dahlquist
- Department of Clinical Science, University of Umeå, Umeå, Sweden
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14
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Buraczewska M, Szymanska E, Brandt A, Jarosz-Chobot P, Sykut-Cegielska J, Barg E, Borowiec M, Młynarski W, Myśliwiec M. Congenital hyperinsulinism in Polish patients--how can we optimize clinical management? Endokrynol Pol 2015; 66:322-8. [PMID: 26323469 DOI: 10.5603/ep.2015.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Congenital hyperinsulinism of Infancy (CHI) comprises heterogenic defects of insulin secretion with diverse molecular aetiology, histological features, severity of symptoms, and response to pharmacotherapy. The study aimed to establish the first clinical characteristics of Polish patients with CHI and to propose a novel clinical algorithm allowing the prioritisation of genetic and radiology studies, based on patient's characteristics and response to pharmacotherapy. MATERIAL AND METHODS Thirty-one patients with CHI were recruited from five reference centres in Poland. Clinical and biochemical parameters were statistically evaluated and compared to those of a control group (n = 30). RESULTS CHI predisposes to increased birth weight (p = 0.004), lower Apgar score (p = 0.004), perinatal complications (74%), and neurological implications (48%). Diagnostic process and therapy were inconsistent. A trial of pharmacotherapy was applied in 21 patients (68%), and diagnostic imaging with 18F-L-DOPA PET was performed in only 3. Eighteen patients (58%) were surgically treated, including 8 infants (44%) aged less than 2 months. Depending on the type of resection, further hypoglycaemia was observed postoperatively in 50% (n = 9) and hyperglycaemia in 39% (n = 7) of cases. Based on foregoing results, a clinical algorithm was proposed. CONCLUSIONS Standardisation of clinical management with the use of pharmacotherapy, genetic screening, and diagnostic imaging will allow the optimisation of therapy and minimisation of treatment complications.
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Affiliation(s)
- Marta Buraczewska
- Medical University of Gdansk, Department and Clinic of Pediatrics, Diabetology and Endocrinology, Gdansk, Poland.
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15
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Neu A, Lange K, Barrett T, Cameron F, Dorchy H, Hoey H, Jarosz-Chobot P, Mortensen HB, Robert JJ, Robertson K, de Beaufort C. Classifying insulin regimens--difficulties and proposal for comprehensive new definitions. Pediatr Diabetes 2015; 16:402-6. [PMID: 25865149 DOI: 10.1111/pedi.12275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 11/29/2022] Open
Abstract
Modern insulin regimens for the treatment of type 1 diabetes are highly individualized. The concept of an individually tailored medicine accounts for a broad variety of different insulin regimens applied. Despite clear recommendations for insulin management in children and adolescents with type 1 diabetes there is little distinctiveness about concepts and the nomenclature is confusing. Even among experts similar terms are used for different strategies. The aim of our review--based on the experiences of the Hvidoere Study Group (HSG)--is to propose comprehensive definitions for current insulin regimens reflecting current diabetes management in childhood and adolescence. The HSG--founded in 1994--is an international group representing 24 highly experienced pediatric diabetes centers, from Europe, Japan, North America and Australia. Different benchmarking studies of the HSG revealed a broad variety of insulin regimens applied in each center, respectively. Furthermore, the understanding of insulin regimens has been persistently different between the centers since more than 20 yr. Not even the terms 'conventional' and 'intensified therapy' were used consistently among all members. Besides the concepts 'conventional' and 'intensified', several other terms for the characterization of insulin regimens are in use: Basal Bolus Concept (BBC), multiple daily injections (MDI), and flexible insulin therapy (FIT) are most frequently used, although none of these expressions is clearly or consistently defined. The proposed new classification for insulin management will be comprehensive, simple, and catchy. Currently available terms were included. This classification may offer the opportunity to compare therapeutic strategies without the currently existing confusion on the insulin regimen.
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Affiliation(s)
- A Neu
- Children's Hospital, University Hospital Tuebingen, Germany
| | - K Lange
- Department of Medical Psychology OE5430, Hannover Medical School, Germany
| | - T Barrett
- Institute of Child Health, University of Birmingham, UK
| | - F Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia
| | - H Dorchy
- Clinique de Diabetologie, Hopital Universitaire des Enfants, Brussels, Belgium
| | - H Hoey
- Department of Paediatrics, University of Dublin, Trinity College, Ireland
| | - P Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, Katowice, Poland
| | - H B Mortensen
- Faculty of Health Science, University of Copenhagen, Denmark
| | - J-J Robert
- Department of Diabetes in Children and Adolescents, Hôpital Necker - Enfants Malades, Paris, France
| | - K Robertson
- Department of Paediatrics, DCRTD, Kuwait.,Department of Diabetes, Royal Hospital for Sick Children, Glasgow, UK
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16
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Chobot A, Polanska J, Deja G, Jarosz-Chobot P. Incidence of type 1 diabetes among Polish children ages 0-14 years from 1989-2012. Acta Diabetol 2015; 52:483-8. [PMID: 25381194 DOI: 10.1007/s00592-014-0682-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/27/2014] [Indexed: 12/17/2022]
Abstract
AIMS The incidence of pediatric type 1 diabetes mellitus (T1DM) in Poland is intermediate relative to the rest of the world. T1DM prevalence in the region of Silesia approximates national estimates for all of Poland. This epidemiologic study aimed to analyze the changes in incidence rates of T1DM among children ages 0-14 years from 1989 to 2012 in this region. METHODS Data collection methods for the registry followed EURODIAB criteria. To estimate overall population size, data from the Central and regional Statistical Office in Katowice were used. T1DM incidence rates/100,000 children ages 0-14 years/annum and their 95 % CI were calculated for all children and in age subgroups (0-4, 5-9, 10-14 years). For comparative analysis incidence rates were age and sex standardized to the population of Poland in 2005. For statistical analyses open source R Bioconductor software was used. RESULTS During this 24-year period, 2,215 new cases (1,146 boys) were diagnosed. The standardized incidence rate rose about 7 % annually. The mean standardized incidence rates estimated in four 6-year time periods (1989-1994, 1995-2000, 2001-2006, 2007-2012) separately showed significant increases from 5.80/100,000/year (1989-1994) through 10.44/100,000/year (1995-2000) and 15.05/100,000/year (2001-2006) to 18.94/100,000/year (2007-2012). From 1989 to 2012, the greatest relative rise in annual incidence (/100,000/year) was among the very young: 2.58-14.00 (0-4 years); 4.96-19.43 (5-9 years); 8.84-22.15 (10-14 years). The highest average annual increment of the incidence rate was in the middle age subgroup (5-9 years). No significant sex difference was observed. CONCLUSIONS The overall incidence rate increased 3.8 times, suggesting an epidemic of pediatric T1DM in Silesia, Poland. These temporal changes confirm that Poland currently has one of the highest incidence rates of pediatric T1DM in Europe.
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Affiliation(s)
- Agata Chobot
- Clinical Hospital No 1, 3-go Maja 13-15, Zabrze, Poland,
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17
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Korzeniowska K, Ramotowska A, Szypowska A, Szadkowska A, Fendler W, Kalina-Faska B, Młynarski W, Jarosz-Chobot P, Myśliwiec M. How does autoimmune thyroiditis in children with type 1 diabetes mellitus influence glycemic control, lipid profile and thyroid volume? J Pediatr Endocrinol Metab 2015; 28:275-8. [PMID: 25210750 DOI: 10.1515/jpem-2013-0455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 08/14/2014] [Indexed: 11/15/2022]
Abstract
AIM To investigate whether autoimmune thyroiditis (AIT) in children with type 1 diabetes mellitus (DM1) has any influence on glycemic control, lipid profile or thyroid volume. METHODS A total of 330 patients with DM1 and AIT (DM1+AIT group) were compared with 309 children with DM1 without AIT (control group). Patients were treated in four Polish academic pediatric diabetes centers from 2008 to 2012: Warsaw, Lodz, Katowice and Gdansk. All patients underwent measurements of thyroid-stimulating hormone (TSH), free thyroxine, anti-thyroid peroxidase (anti-TPO) antibody, anti-thyroglobulin (anti-TG) antibody and HbA1c levels, and thyroid ultrasound examination. RESULTS Among AIT+DM1 patients, 62% (n=205) were female, whereas in the control group 60.8% (n=188) were male (p<0.0001). Children with AIT+DM1 had lower a BMI-SDS (mean difference of -0.5, 95% CI -0.68 to -0.33; p<0.0001), had a higher SDS thyroid volume (0.27, 95% CI 0.03-0.51; p=0.014) and needed less insulin (-0.15, 95% CI -0.20 to -0.11 U/kg body weight per day; p<0.0001) in comparison with the control group. AIT patients had higher HbA1c levels (0.66, 95% CI 0.36%-0.96%, p<0.0001), lower HDL-cholesterol levels (-3.68, 95% CI -1.41 to -5.94 mg/dL, p=0.002) and higher triglyceride levels (7.16, 95% CI 1.22-13.10 mg/dL, p=0.02). Patients with positive anti-TPO and anti-TG antibodies were older (by 1.95 years, 95% CI 0.98-2.92 years, p=0.006) and had longer DM1 duration (by 1.64 years, 95% CI 0.76-2.52 years, p=0.006). Presence of anti-TPO antibodies was associated with higher TSH levels (odds ratio 2.34, 95% CI 1.36-4.04; p=0.007). CONCLUSION AIT accompanying DM1 is associated with worse glycemic control and lipid profile as well as a lower daily insulin requirement. The female gender is more likely to develop AIT and hypothyroidism.
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Machnica L, Deja G, Polanska J, Czupryniak L, Szymanska-Garbacz E, Loba J, Jarosz-Chobot P. Blood pressure disturbances and endothelial dysfunction markers in children and adolescents with type 1 diabetes. Atherosclerosis 2014; 237:129-34. [PMID: 25238220 DOI: 10.1016/j.atherosclerosis.2014.09.006] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 07/16/2014] [Accepted: 09/07/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Being the earliest step on the way to atherosclerosis, endothelial dysfunction is particularly escalated in diabetes. This study aimed at assessing endothelial dysfunction and blood pressure disturbances in young patients with type 1 diabetes mellitus (T1DM) and defining their interrelations. METHODS The study group comprised 52 children and adolescents aged 14.07 ± 3.03 years, with T1DM duration 5.13 ± 2.18 years. 20 healthy controls with similar age and sex distribution were included. Chosen serum biochemical markers of endothelial damage: intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), sE-selectin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) as well as ambulatory blood pressure monitoring (ABPM) were performed in all subjects. RESULTS Patients with T1DM displayed significantly higher concentrations of chosen markers of endothelial dysfunction compared to controls (sVCAM-1 (ng/ml): 951.56 ± 330.68 vs. 710.35 ± 162.12, TNF-α (pg/ml): 16.63 ± 8.32 vs. 9.41 ± 4.23, IL-6 (pg/ml): 3.38 ± 1.31 vs. 2.45 ± 0.81; p < 0.05). Within the study group subjects with an abnormal ABPM reading had significantly higher concentrations of sE-selectin compared with subjects with normal ABPM (in ng/ml: 45.71 ± 15.63 vs. 32.42 ± 11.95; p < 0.01). The study revealed a significant positive correlation between sE-selectin and systolic as well as diastolic pressure loads during the day period (respectively: r = 0.46, r = 0.60; p < 0.01). CONCLUSIONS Endothelium dysfunction may be present early in the course of T1DM in children and adolescents. It seems to be related with blood pressure disturbances which highlights the need to intensify treatment in this group of patients.
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Affiliation(s)
- L Machnica
- Upper-Silesia Child Health Center, ul. Medykow 16, 40-752 Katowice, Poland.
| | - G Deja
- Dept. of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, ul. Medykow 16, 40-752 Katowice, Poland
| | - J Polanska
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, ul. Akademicka 16, 44-101 Gliwice, Poland
| | | | | | | | - P Jarosz-Chobot
- Dept. of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, ul. Medykow 16, 40-752 Katowice, Poland
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Danne T, Bangstad HJ, Deeb L, Jarosz-Chobot P, Mungaie L, Saboo B, Urakami T, Battelino T, Hanas R. ISPAD Clinical Practice Consensus Guidelines 2014. Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2014; 15 Suppl 20:115-34. [PMID: 25182312 DOI: 10.1111/pedi.12184] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 02/03/2023] Open
Affiliation(s)
- Thomas Danne
- Kinder- und Jugendkrankenhaus auf der Bult, Diabetes-Zentrum für Kinder und Judendliche, Hannover, Germany
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Deja G, Borowiec M, Fendler W, Pietrzak I, Szadkowska A, Machnica L, Polanska J, Mlynarski W, Jarosz-Chobot P. Non-dipping and arterial hypertension depend on clinical factors rather than on genetic variability of ACE and RGS2 genes in patients with type 1 diabetes. Acta Diabetol 2014; 51:633-40. [PMID: 24562335 PMCID: PMC4127442 DOI: 10.1007/s00592-014-0568-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/31/2014] [Indexed: 11/29/2022]
Abstract
The aim of our study was to characterize the association of clinical and genetic risk factors such as: ACE genotype (rs17997552, rs1800764, rs4459609) and RGS2 (rs2746071) with the development of hypertension (HT) and non-dipping phenomenon in patients with type 1 diabetes mellitus (T1DM). A total of 238 adolescents and young adults with T1DM-103 females and 135 males, aged 8-30 years (mean 17.35 ± 5.2) with diabetes duration 1-26 years (mean 7.72 ± 6.2), with mean HbA1c (IFCC) 58 ± 15 mmol/mmol-were subjected to 24-h ambulatory blood pressure measurements (ABPM). The results of the ABPM were analyzed in association with the polymorphisms of ACE and RGS2 genes and clinical data of patients. HT was recognized in 65 (27 %) and non-dipping in 111 (46.63 %) patients. In the multivariate analysis of factors predisposing to HT, the variables that remained significant were the following: male sex (OR 1.62; 95 % CI 1.171-2.250), non-dipping (OR 1.40; 95 % CI 1.03-1.90) and total cholesterol level (OR 1.01; 95 % CI 1.005-1.021). The only factor influencing non-dipping was the duration of diabetes-OR 1.09 (95 % CI 1.04-1.14). The patients displaying non-dipping have a twice increased risk of development of HT (OR 2.17; 95 % CI 1.21-3.89). There was no association between disturbances of blood pressure (BP) and genotypes of ACE: rs17997552, rs1800764, rs4459609 and RGS2: rs2746071. Clinical rather than genetic risk factors seem to be connected with BP disturbances in young patients with T1DM. Although we have identified representative groups of HT versus non-HT and dipping versus non-dipping subjects, the effect of genetic predisposition to the development of higher BP is too weak to be statistically significant.
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Affiliation(s)
- G Deja
- Department of Pediatrics, Pediatric Endocrinology and Diabetology, Medical University of Silesia, Medykow 16 Str., 40-752, Katowice, Poland,
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Fendler W, Małachowska B, Baranowska-Jazwiecka A, Borowiec M, Wyka K, Malecki MT, Jarosz-Chobot P, Mysliwiec M, Mlynarski W. Population-based estimates for double diabetes amongst people with glucokinase monogenic diabetes, GCK-MODY. Diabet Med 2014; 31:881-3. [PMID: 24660669 DOI: 10.1111/dme.12449] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- W Fendler
- Department of Paediatrics, Oncology, Haematology and Diabetology
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22
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Tracz A, Madzio J, Gnys P, Malachowska B, Borowiec M, Wyka K, Jarosz-Chobot P, Mysliwiec M, Szadkowska A, Mlynarski W, Fendler W. Genetic variability of GCKR alters lipid profiles in children with monogenic and autoimmune diabetes. Exp Clin Endocrinol Diabetes 2014; 122:503-9. [PMID: 24918535 DOI: 10.1055/s-0034-1375648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Mutations in the glucokinase (GCK) gene are associated with altered blood glucose and lipid concentrations. Our aim was to assess the effects on HbA1c and serum lipid levels of single nucleotide polymorphisms (SNPs) in 2 genes encoding proteins that interact with glucokinase: glucose-6-phospatase catalytic subunit 2 (G6PC2) and glucokinase regulatory protein (GCKR). METHODS The study group included 129 children with GCK-MODY from the Polish Registry of Monogenic Diabetes and 395 with type 1 diabetes (T1DM), in whom we genotyped 2 SNPs in G6PC2 (rs560887) and GCKR (rs1260326). Lipid concentrations were assessed in fasting serum samples. RESULTS Total and HDL cholesterol concentrations were significantly lower in the GCK-MODY group than in patients with T1DM (167.5±32.5 mg/dl vs. 174.4±31.1 mg/dl, p=0.0435 and 48.42±14.3 mg/dl vs. 58.7±12.7 mg/dl, p<0.0001, respectively). No differences in genotype distributions were found except for underrepresentation of GCKR TT homozygotes among GCK-MODY patients (10.9% in GCK-MODY vs. 17.7% in T1DM, p=0.0651). GCKR genotypes showed significant associations with lipid profiles and HbA1c levels, whereas no such associations were noted for G6PC2. After adjustment for confounders, TT homozygotes were shown to have higher total cholesterol and marginally higher LDL cholesterol and triglyceride levels (p=0.0245, p=0.0657 and p=0.0550, respectively). The difference between TT homozygotes and other genotypes was similar in magnitude within the GCK-MODY and T1DM groups. No significant interactions between the type of diabetes and the GCKR or G6PC2 genotype were detected. CONCLUSIONS Individuals who are homozygous TT at rs1260326 of the GCKR gene have higher triglyceride, total and LDL cholesterol levels regardless of the presence of GCK mutations.
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Affiliation(s)
- A Tracz
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - J Madzio
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - P Gnys
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - B Malachowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - M Borowiec
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - K Wyka
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - P Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetes, Silesian Medical University of Katowice, Poland
| | - M Mysliwiec
- Department of Pediatrics, Oncology, Hematology and Endocrinology, Medical University of Gdansk, Poland
| | - A Szadkowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - W Mlynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - W Fendler
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
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Stanczyk J, Chobot A, Polanska J, Jarosz-Chobot P. Patients with type 1 diabetes transition from pediatric to adult care in Poland—an example from Silesia. Int J Diabetes Dev Ctries 2014. [DOI: 10.1007/s13410-013-0182-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Korzeniowska K, Jarosz-Chobot P, Szypowska A, Ramotowska A, Fendler W, Kalina-Faska B, Szadkowska A, Mlynarski W, Mysliwiec M. L-thyroxine stabilizes autoimmune inflammatory process in euthyroid nongoitrous children with Hashimoto's thyroiditis and type 1 diabetes mellitus. J Clin Res Pediatr Endocrinol 2013; 5:240-4. [PMID: 24379033 PMCID: PMC3890223 DOI: 10.4274/jcrpe.1136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/22/2013] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To investigate if L-thyroxine (T4) treatment may influence the clinical course of autoimmune thyroiditis (AIT) or prevent progression to subclinical or overt hypothyroidism in euthyroid nongoitrous pediatric patients with type 1 diabetes mellitus (T1DM) and AIT. METHODS The study was performed in four Polish pediatric diabetes centers. Of 330 children with T1DM and AIT followed between 2008 and 2012, 101 received L-T4 and 160 underwent clinical observation for 24 months. Thyroid stimulating hormone (TSH), free T4 (fT4), anti thyroid peroxidase antibody (anti-TPO), anti thyroglobulin antibody (anti-TG), glycosylated hemoglobin (HbA1c) levels, and lipid profile were assessed in all patients. Ultrasonographic evaluation was also performed in all children at each examination. RESULTS Patients treated with thyroid hormones had higher TSH levels (3.99; interquantile 3.5 to 4.52 vs. 2.09 mIU/L; interquantile 1.55 to 3.06; pp<0.0001). A fall in TSH level (0.87 mIU/L 95% CI 0.43-1.30; pp<0.0001) was documented after the first year of treatment. FT4 level did not differ between the groups at baseline (p=0.7434), but rose in the treatment group and fell in the control group [mean difference 0.78 95% CI-0.22-1.53 pmol/L (p=0.02) after 12 months and 0.98 95% CI 0.04-1.76 (p=0.005) after 24 months]. Higher levels of anti-TPO were initially found in the treated patients (pp<0.0001) and significantly decreased over the 24-month period (pp<0.0001). Children in the treatment group had higher anti-TG levels (pp<0.0001), which showed a borderline decrease (p=0.08) in time. In the control group, anti-TG levels rose marginally (p=0.06) during the study. CONCLUSIONS The data demonstrate that treatment with L-T4 in euthyroid pediatric patients with T1DM and AIT stabilizes autoimmune inflammation in the thyroid gland and is to be recommended as soon as the diagnosis is established.
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Affiliation(s)
- Katarzyna Korzeniowska
- Medical University of Gdansk, Department of Pediatrics, Diabetology and Endocrinology, Gdansk, Poland. E-mail:
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Borowiec M, Fendler W, Dusatkova P, Antosik K, Pruhova S, Cinek O, Mysliwiec M, Jarosz-Chobot P, Malecki MT, Mlynarski W. HbA1c-based diabetes diagnosis among patients with glucokinase mutation (GCK-MODY) is affected by a genetic variant of glucose-6-phosphatase (G6PC2). Diabet Med 2012; 29:1465-9. [PMID: 22486180 DOI: 10.1111/j.1464-5491.2012.03671.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Genetic variation at the rs560887 locus of the glucose-6-phosphatase, catalytic 2 gene (G6PC2) is known to affect regulation of fasting glycaemia. We determined the rs560887 genotype of patients with monogenic diabetes and glucokinase gene mutations (GCK-MODY) and correlated the genotypes with HbA(1c) levels. METHODS Patients from families with GCK-MODY were recruited from two large cohorts from Poland (n = 128) and the Czech Republic (n = 154). Genotypes at the rs560887 polymorphic site in G6PC2 were examined using real-time quantitative polymerase chain reaction. The effect of rs560887 genotype on age at diagnosis of GCK-MODY and initial HbA(1c) levels were evaluated separately within both cohorts. Following that, a meta-analysis of rs560887 genotype-HbA(1c) associations of both Polish and Czech cohorts was performed to confirm homogeneity of findings and validate cohort-specific results. RESULTS GG homozygosity at rs560887 was associated with marginally elevated HbA(1c) levels (P = 0.07 in both cohorts). The effects observed in both groups were very homogeneous (Q = 0.18; P = 0.68). Meta-analysis showed that GG homozygosity at rs560887 was associated with mean HbA(1c) levels higher by 2.4 mmol/mol (0.24%), 95% CI 0.5-4.4 mmol/mol (0.05-0.44%) than in individuals with other genotypes. Additionally, meta-analysis of both cohorts showed that GG homozygous individuals had higher odds of reaching the 48 mmol/mol (6.5%) diagnostic threshold of diabetes; (odds ratio 1.90; 95% CI 1.07-3.36; P = 0.03). No such effects were observed for age at diagnosis of diabetes. CONCLUSIONS Variation at the rs560887 locus of G6PC2 is associated with worse glycated haemoglobin levels in individuals with GCK mutations; GG homozygotes are more likely to meet diagnostic criteria for diabetes based on HbA(1c) level.
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Affiliation(s)
- M Borowiec
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Poland
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Fendler W, Borowiec M, Baranowska-Jazwiecka A, Szadkowska A, Skala-Zamorowska E, Deja G, Jarosz-Chobot P, Techmanska I, Bautembach-Minkowska J, Mysliwiec M, Zmyslowska A, Pietrzak I, Malecki MT, Mlynarski W. Prevalence of monogenic diabetes amongst Polish children after a nationwide genetic screening campaign. Diabetologia 2012; 55:2631-2635. [PMID: 22782286 PMCID: PMC3433657 DOI: 10.1007/s00125-012-2621-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/24/2012] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to study dynamic changes in the prevalence of different types of diabetes in paediatric populations in Poland, with a specific focus on monogenic diabetes (MD). METHODS Using epidemiologic data (PolPeDiab Collaboration) and nationwide genetic test results (TEAM Programme), we compared the prevalence of type 1, type 2 and cystic fibrosis-related diabetes (CFRD) and MD. Genetically confirmed MD included MODY, neonatal diabetes and Wolfram and Alström syndromes. The study covered all children aged 0-18 years treated for diabetes between 2005 and 2011 in three regions, inhabited by 23.7% (1,989,988) of Polish children, with a low prevalence of childhood obesity (<5%). RESULTS The prevalence of type 1 diabetes showed a continuous increase, from 96 to 138/100,000 children. The prevalence of type 2 diabetes and CFRD also increased, from 0.3 to 1.01/100,000 children and from 0.1 to 0.95/100,000 children, respectively. The prevalence of MD was stable at between 4.2 and 4.6/100,000 children, accounting for 3.1-4.2% of children with diabetes, with glucokinase (GCK)-MODY being the most frequent type, amounting to 83% of patients with MD. The percentage of positive test results decreased with the number of referrals, suggesting that children with the highest probability of MD were referred initially, followed by those with a less clear-cut phenotype. The prevalence of neonatal diabetes equalled 1 in 300,000 children. CONCLUSIONS/INTERPRETATION The prevalence of MD in a paediatric population with a low prevalence of obesity remains stable and is nearly fivefold higher than that of type 2 diabetes and CFRD, justifying a need for increased access to genetic diagnostic procedures in diabetic children.
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Affiliation(s)
- W Fendler
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna Str., 91-738, Lodz, Poland
| | - M Borowiec
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna Str., 91-738, Lodz, Poland
| | - A Baranowska-Jazwiecka
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna Str., 91-738, Lodz, Poland
| | - A Szadkowska
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna Str., 91-738, Lodz, Poland
| | - E Skala-Zamorowska
- Department of Paediatrics, Endocrinology and Diabetes, Silesian Medical University of Katowice, Katowice, Poland
| | - G Deja
- Department of Paediatrics, Endocrinology and Diabetes, Silesian Medical University of Katowice, Katowice, Poland
| | - P Jarosz-Chobot
- Department of Paediatrics, Endocrinology and Diabetes, Silesian Medical University of Katowice, Katowice, Poland
| | - I Techmanska
- Department of Paediatrics, Oncology, Haematology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - J Bautembach-Minkowska
- Department of Paediatrics, Oncology, Haematology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - M Mysliwiec
- Department of Paediatrics, Oncology, Haematology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - A Zmyslowska
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna Str., 91-738, Lodz, Poland
| | - I Pietrzak
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna Str., 91-738, Lodz, Poland
| | - M T Malecki
- Department of Metabolic Diseases, Collegium Medicum Jagiellonian University of Cracow, Cracow, Poland
| | - W Mlynarski
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna Str., 91-738, Lodz, Poland.
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Patterson CC, Gyürüs E, Rosenbauer J, Cinek O, Neu A, Schober E, Parslow RC, Joner G, Svensson J, Castell C, Bingley PJ, Schoenle E, Jarosz-Chobot P, Urbonaité B, Rothe U, Krzisnik C, Ionescu-Tirgoviste C, Weets I, Kocova M, Stipancic G, Samardzic M, de Beaufort CE, Green A, Dahlquist GG, Soltész G. Trends in childhood type 1 diabetes incidence in Europe during 1989-2008: evidence of non-uniformity over time in rates of increase. Diabetologia 2012; 55:2142-7. [PMID: 22638547 DOI: 10.1007/s00125-012-2571-8] [Citation(s) in RCA: 310] [Impact Index Per Article: 25.8] [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] [Received: 12/30/2011] [Accepted: 04/02/2012] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to describe 20-year incidence trends for childhood type 1 diabetes in 23 EURODIAB centres and compare rates of increase in the first (1989-1998) and second (1999-2008) halves of the period. METHODS All registers operate in geographically defined regions and are based on a clinical diagnosis. Completeness of registration is assessed by capture-recapture methodology. Twenty-three centres in 19 countries registered 49,969 new cases of type 1 diabetes in individuals diagnosed before their 15th birthday during the period studied. RESULTS Ascertainment exceeded 90% in most registers. During the 20-year period, all but one register showed statistically significant changes in incidence, with rates universally increasing. When estimated separately for the first and second halves of the period, the median rates of increase were similar: 3.4% per annum and 3.3% per annum, respectively. However, rates of increase differed significantly between the first half and the second half for nine of the 21 registers with adequate coverage of both periods; five registers showed significantly higher rates of increase in the first half, and four significantly higher rates in the second half. CONCLUSIONS/INTERPRETATION The incidence rate of childhood type 1 diabetes continues to rise across Europe by an average of approximately 3-4% per annum, but the increase is not necessarily uniform, showing periods of less rapid and more rapid increase in incidence in some registers. This pattern of change suggests that important risk exposures differ over time in different European countries. Further time trend analysis and comparison of the patterns in defined regions is warranted.
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Affiliation(s)
- C C Patterson
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science Block B, Grosvenor Road, Belfast, BT12 6BJ, UK.
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Chobot AP, Haffke A, Polanska J, Halaba ZP, Deja G, Jarosz-Chobot P, Pluskiewicz W. Quantitative ultrasound bone measurements in pre-pubertal children with type 1 diabetes. Ultrasound Med Biol 2012; 38:1109-1115. [PMID: 22542259 DOI: 10.1016/j.ultrasmedbio.2012.02.012] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 02/08/2012] [Accepted: 02/16/2012] [Indexed: 05/31/2023]
Abstract
This case-control study aimed to assess bone status in children with type 1 diabetes mellitus (T1DM). Fifty-seven pre-pubertal patients (37 boys, aged 7.9 ± 2.5 years, T1DM duration 3.1 ± 1.6 years) and 171 age-matched healthy controls (111 boys) were studied. Quantitative ultrasound (QUS) was used to measure amplitude dependent speed of sound (Ad-SoS) at hand phalanges (expressed as standard deviation score [SDS]). Anthropometric and disease-related data (including mean HbA(1c) from whole T1DM duration [T], last year [Y], examination day [D]) were collected. Mean Ad-SoS SDS in patients -0.13 ± 1.32 (95% confidence interval [CI] -0.48, 0.22) was similar to that of controls. Subgroups discriminated according to HbA(1c) D, Y and T (cut-off 7.0%) did not differ regarding analyzed parameters. In patients, Ad-SoS SDS was comparable for both genders. Multivariable stepwise regression analysis showed significant negative influence of diabetes duration on Ad-SoS SDS. QUS findings in pre-pubertal children with T1DM do not differ from those in healthy children. Disease duration seems to affect negatively Ad-SoS SDS. However, independent prospective studies are needed to elucidate the true associations.
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Affiliation(s)
- Agata P Chobot
- Department of Paediatrics, Clinical Hospital No. 1, Zabrze, Poland.
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Di Iorio CT, Carinci F, Brillante M, Azzopardi J, Beck P, Bratina N, Cunningham SG, De Beaufort C, Debacker N, Jarosz-Chobot P, Jecht M, Lindblad U, Moulton T, Metelko Z, Nagy A, Olympios G, Pruna S, Roder M, Skeie S, Storms F, Massi Benedetti M. Cross-border flow of health information: is 'privacy by design' enough? Privacy performance assessment in EUBIROD. Eur J Public Health 2012; 23:247-53. [DOI: 10.1093/eurpub/cks043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kaminska-Winciorek G, Deja G, Polanska J, Jarosz-Chobot P. The role of selected metalloproteinases in cheiroarthropathy in children with type 1 diabetes - a pilotage study. Int J Clin Pract 2012; 66:374-7. [PMID: 22248162 DOI: 10.1111/j.1742-1241.2011.02702.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 01/30/2023] Open
Abstract
BACKGROUND Metalloproteinases of the external matrix play an important role in ethiopatogenesis of diabetic complications especially in microangiopathy and also in fibrosing processes with occurrence the cheiroarthropathy, but clinical data are insufficient. AIMS The aim of the study was to assess the influence of metalloproteinases such as gelatinase A (MMP2) and gelatinase B (MMP9), and their tissue inhibitors (TIMP2, TIMP9) in ethiopathogenesis of cheiroatrhopathy in children with diabetes type 1. MATERIALS AND METHODS Forty one children were observed in average age of 14.98 years (±3.03 years), with the average duration of diabetes 6.78 years (±3.21 years), and with average HbA1c within all diabetes duration time 7.1% (6.47-7.5%). In all patients, the occurrence of cheiroarthropathy was checked, and concentration of metalloproteinase's and their inhibitors in serum were measured using ELISA method. Probe was divided into two groups because of presence of cheiroarthropathy. The comparing analysis of these two groups was conducted, and the correlation between metalloproteinase's concentration and their tissue inhibitors with selected parameters was done. RESULTS When comparing group with cheiroarthropathy (n = 19) with the group without cheiroarthropathy (n = 22), the statistically significant elevated levels of metalloproteinase's were proved such as: MMP2 - 202 ng/ml (193-207) vs. 138 ng/ml (130-158), p < 0.001; MMP9 - 462 ng/ml (426-505) vs. 288 ng/ml (251-313), 0.001; TIMP2 - 182 ng/ml (177-190) vs. 104 ng/ml (88-165), p < 0.001); TIMP9 - 85 ng/ml (68-95) vs. 55 ng/ml (50-60), p < 0.001. There was no correlation between occurrence of cheiroarthropathy and age of the diabetes onset, duration of diabetes, grade of metabolic compensation, insulin dosages, weight and height. CONCLUSION In children with long-term diabetes, although relatively metabolic compensation, the cheiroarthropathy has been occurred accompanying by elevated concentrations of metalloproteinase's and their tissue inhibitors. The presence of cheiroarthropathy could be treated as a simple test to identification the patients endangered to develop chronic vascular complication.
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Fendler W, Borowiec M, Antosik K, Szadkowska A, Deja G, Jarosz-Chobot P, Mysliwiec M, Wyka K, Pietrzak I, Skupien J, Malecki MT, Mlynarski W. HDL cholesterol as a diagnostic tool for clinical differentiation of GCK-MODY from HNF1A-MODY and type 1 diabetes in children and young adults. Clin Endocrinol (Oxf) 2011; 75:321-7. [PMID: 21521320 DOI: 10.1111/j.1365-2265.2011.04052.x] [Citation(s) in RCA: 19] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Confirmation of monogenic diabetes caused by glucokinase mutations (GCK-MODY) allows pharmacogenetic intervention in the form of insulin discontinuation. This is especially important among paediatric and young adult populations where GCK-MODY is most prevalent. METHODS The study evaluated the utility of lipid parameters in screening for patients with GCK-MODY. Eighty-nine children with type 1 diabetes and 68 with GCK-MODY were screened for triglyceride (TG), total and HDL cholesterol levels. Standardization against a control group of 171 healthy children was applied to eliminate the effect of development. Clinical applicability and cut-off value were evaluated in all available patients with GCK-MODY (n = 148), hepatocyte nuclear factor 1-alpha-MODY (HNF1A MODY) (n = 37) or type 1 diabetes (n = 221). RESULTS Lower lipid parameter values were observed in GCK-MODY than in patients with type 1 diabetes. Standard deviation scores were -0·22 ± 2·24 vs 1·31 ± 2·17 for HDL cholesterol (P < 0·001), -0·16 ± 2·14 vs 0·60 ± 1·77 for total cholesterol (P = 0·03) and -0·57 ± 0·97 vs-0·22 ± 0·97 for TG (P = 0·05). Validation analysis confirmed that HDL cholesterol was the best parameter for GCK-MODY selection [sensitivity 87%, specificity 54%, negative predictive value (NPV) 86%, positive PV 56%]. A threshold HDL concentration of 1·56 mm offered significantly better diagnostic efficiency than total cholesterol (cut-off value 4·51 mm; NPV 80%; PPV 38%; P < 0·001). TG did not offer a meaningful cut-off value. CONCLUSIONS HDL cholesterol levels measured in individuals with likely monogenic diabetes may be useful in screening for GCK-MODY and differentiation from T1DM and HNF1A-MODY, regardless of treatment or metabolic control.
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Affiliation(s)
- Wojciech Fendler
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
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Borowiec M, Antosik K, Fendler W, Deja G, Jarosz-Chobot P, Mysliwiec M, Zmyslowska A, Malecki M, Szadkowska A, Mlynarski W. Novel glucokinase mutations in patients with monogenic diabetes - clinical outline of GCK-MD and potential for founder effect in Slavic population. Clin Genet 2011; 81:278-83. [PMID: 21348868 DOI: 10.1111/j.1399-0004.2011.01656.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Glucokinase (GCK) gene mutations are the causative factor of GCK-MD (monogenic diabetes) characterized by a mild clinical phenotype and potential for insulin withdrawal. This study presents the results of a nationwide genetic screening for GCK-MD performed in Poland. A group of 194 patients with clinical suspicion of GCK-MD and 17 patients with neonatal diabetes were subjected to GCK sequencing. Patients negative for GCK mutations were subjected to multiplex ligation-dependent probe amplification (MLPA) to detect deletions or insertions. A total of 44 GCK heterozygous mutations were found in 68 probands (35%). Among those, 20 mutations were novel ones: A282fs, D198V, E158X, G246V, G249R, I348N, L165V, L315Q, M115I, N254S, P284fs, Q338P, R377L, R43C, R46S, S212fs, S212P, T255N, V406A and Y214D. No abnormalities were detected in MLPA analysis. Homozygous D278E mutation was found in one patient with neonatal diabetes. The most frequently observed combinations of symptoms typical for GCK-MD were mild diabetes and/or fasting hyperglycaemia (98.3%), positive C-peptide at diagnosis (76%) and dominant mode of inheritance (59%). This study outlines numerous novel mutations of the GCK gene present in white Caucasians of Slavic origin. Thorough clinical assessment of known factors associated with GCK-MD may facilitate patient selection.
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Affiliation(s)
- M Borowiec
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
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Jarosz-Chobot P, Polanska J, Szadkowska A, Kretowski A, Bandurska-Stankiewicz E, Ciechanowska M, Deja G, Mysliwiec M, Peczynska J, Rutkowska J, Sobel-Maruniak A, Fichna P, Chobot A, Rewers M. Rapid increase in the incidence of type 1 diabetes in Polish children from 1989 to 2004, and predictions for 2010 to 2025. Diabetologia 2011; 54:508-15. [PMID: 21165594 PMCID: PMC3034048 DOI: 10.1007/s00125-010-1993-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Accepted: 09/23/2010] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS We analysed the temporal changes in the incidence of childhood type 1 diabetes and its demographic determinants in Poland from 1989 to 2004, validating the model with data from 1970 to 1989. We also estimated a predictive model of the trends in childhood diabetes incidence for the near future. METHODS Children under 15 years with newly diagnosed type 1 diabetes mellitus and drawn from seven regional registries in Poland were ascertained prospectively using the Epidemiology and Prevention of Diabetes study (EURODIAB) criteria. The type 1 diabetes incidence rates (IRs) were analysed in dependency of age, sex, seasonality, geographical region and population density. Time trends in IR were modelled using several approaches. RESULTS The average incidence, standardised by age and sex, for 1989 to 2004 was 10.2 per 100,000 persons per year and increased from 5.4 to 17.7. No difference was found between boys and girls, or between urban and rural regions. In children above 4 years, IR was significantly higher in the population of northern Poland than in that of the country's southern part, as well as in the autumn-winter season, this finding being independent of child sex. Based on the trend model obtained, almost 1,600 Polish children aged 0 to 14 years are expected to develop type 1 diabetes in 2010, rising to more than 4,800 in 2025. The estimates suggest at least a fourfold increase of IR between 2005 and 2025, with the highest dynamics of this increment in younger children. CONCLUSIONS/INTERPRETATION These estimates show that Poland will have to face a twofold higher increase in childhood type 1 diabetes than predicted for the whole European population. The dramatic increase could have real downstream effects on Poland's healthcare system.
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Affiliation(s)
- P Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, Medykow 16 Str., 40-752, Katowice, Poland.
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Cardwell CR, Stene LC, Joner G, Bulsara MK, Cinek O, Rosenbauer J, Ludvigsson J, Svensson J, Goldacre MJ, Waldhoer T, Jarosz-Chobot P, Gimeno SG, Chuang LM, Roberts CL, Parslow RC, Wadsworth EJ, Chetwynd A, Brigis G, Urbonaite B, Sipetic S, Schober E, Devoti G, Ionescu-Tirgoviste C, de Beaufort CE, Stoyanov D, Buschard K, Radon K, Glatthaar C, Patterson CC. Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies. Int J Epidemiol 2010; 40:363-74. [DOI: 10.1093/ije/dyq207] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Chobot AP, Haffke A, Polanska J, Halaba ZP, Deja G, Jarosz-Chobot P, Pluskiewicz W. Bone status in adolescents with type 1 diabetes. Diabetologia 2010; 53:1754-60. [PMID: 20454951 DOI: 10.1007/s00125-010-1782-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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] [Received: 01/10/2010] [Accepted: 03/31/2010] [Indexed: 11/28/2022]
Abstract
AIMS The aim of the study was to investigate the potential negative impact of type 1 diabetes on bone status of adolescents. Bone status in adolescents with type 1 diabetes was assessed by means of quantitative ultrasound (QUS) and the influence of metabolic control and other disease-related and growth variables was analysed. METHODS Group I consisted of 99 pubertal (Tanner > or = 2) adolescents (49 female), aged 14.3 +/- 2.5 years, diabetes duration 4.6 +/- 2.3 years. Controls (group II) were 297 children, matched by sex and age, from a healthy population. The influence of glycated haemoglobin (current: HbA(1c)D; last year's mean: HbA(1c)Y; whole duration mean: HbA(1c)T), diabetes duration, percentage of life with disease and daily insulin requirement (DIR) on amplitude dependent speed of sound (Ad-SoS) at distal phalanges was studied. RESULTS In comparison to the control group, adolescents with type 1 diabetes presented significantly higher BMI SDS (0.82 [95% CI 0.54, 1.10] vs -0.06 [95% CI -0.16, 0.04] p < 0.001) and lower Ad-SoS SDS (-0.34 [95% CI -0.57, -0.11] vs -0.03 [95% CI -0.15, 0.08], p < 0.05). No correlation between Ad-SoS SDS and sex, DIR or diabetes duration was observed. The lower Ad-SoS SDS reflects reduced bone status, and the reduction was significantly more marked in those patients whose HbA(1c)T was higher than 7.0% when compared with those whose HbA(1c)T was lower. CONCLUSIONS Bone status of adolescents with type 1 diabetes mellitus assessed with QUS differs from that of healthy peers and is dependent on long-term metabolic control.
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Affiliation(s)
- A P Chobot
- Department of Paediatrics, Clinical Hospital No. 1, 3-go Maja 13-15, 41-800 Zabrze, Poland.
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Jarosz-Chobot P, Deja G, Polanska J. Epidemiology of type 1 diabetes among Silesian children aged 0-14 years, 1989-2005. Acta Diabetol 2010; 47:29-33. [PMID: 19183839 DOI: 10.1007/s00592-009-0094-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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: 03/09/2008] [Accepted: 12/23/2008] [Indexed: 11/30/2022]
Abstract
The aim of this study was to estimate the present Polish incidence rate of diabetes mellitus type 1 in children aged 0-14. The research was conducted between 1989 and 2005 among the children of Upper Silesia region (Poland), being the part of the EURODIAB program, according to all criteria of this project. During this period, 1,385 new cases (720 boys) of diabetes mellitus type 1 were recognized. The analysis of the standardized incidence rates performed after dividing into shorter periods (1989-1994, 1995-1999, 2000-2005) showed a sharp increase from 5.80/10(5)/year through 9.54/10(5)/year to 15.26/10(5)/year, respectively, in the periods. Analysis of age subgroups showed the greatest increase in the incidence rate among the younger children: 3.59 times for children aged 0-4, 3.40 times for children aged 5-9 and 2.08 times for children aged 10-14. No significant difference of incidence rate between boys and girls was established. Such high increase of incidence rate of diabetes mellitus type 1 (above 260%) noted since 1989 shows a secular trend of an epidemic of diabetes mellitus type 1 in Poland and a conversion from countries with the lower incidence rates in Europe to the countries with the highest incidence rates.
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Affiliation(s)
- Przemyslawa Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, Medykow 16 Str., 40-752, Katowice, Poland.
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Abstract
OBJECTIVES The purpose of this study is to evaluate the practices of diabetes health care providers concerning the transition from pediatric to adult diabetes care. The information presented here may help increase awareness of the organization of transitional care for young people with diabetes and prevent the loss of follow-up during this vulnerable period in their lives. METHODS A questionnaire with an explanatory letter was sent to all members (n = 578) of the International Society for Pediatric and Adolescent Diabetes (ISPAD). A follow-up mailing was sent 4 months later. RESULTS In total, 92 questionnaires (16%) from members representing 36 countries were included in the analysis. In 76% of the centers, youth are seen until the age of 18 yr; 36% of the pediatric centers see adults > 25 yr; 30% report children under the age of 16 receive follow up from adult diabetologists or internists. About half of the programs already have a structured transition process usually targeting youth 16-25 yr of age. The majority of responders propose that preparation for transition starts at least 1 yr prior to leaving the pediatric center. CONCLUSION Youth with type 1 diabetes often struggle to keep diabetes management a priority and find it challenging to maintain optimal metabolic control. When they graduate from pediatric care, some of these young people opt out of care altogether, only to resurface in the medical system when they develop complications which may have been prevented. Our survey of diabetes health care professionals in 36 countries worldwide shows that the actual transition practices in many places are far from optimal and require improvement. Transitional care should start early and strategies should promote uninterrupted, comprehensive, and accessible adult care.
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Cardwell CR, Stene LC, Joner G, Bulsara MK, Cinek O, Rosenbauer J, Ludvigsson J, Jané M, Svensson J, Goldacre MJ, Waldhoer T, Jarosz-Chobot P, Gimeno SGA, Chuang LM, Parslow RC, Wadsworth EJK, Chetwynd A, Pozzilli P, Brigis G, Urbonaite B, Sipetic S, Schober E, Devoti G, Ionescu-Tirgoviste C, de Beaufort CE, Stoyanov D, Buschard K, Patterson CC. Maternal age at birth and childhood type 1 diabetes: a pooled analysis of 30 observational studies. Diabetes 2010; 59:486-94. [PMID: 19875616 PMCID: PMC2809958 DOI: 10.2337/db09-1166] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim if the study was to investigate whether children born to older mothers have an increased risk of type 1 diabetes by performing a pooled analysis of previous studies using individual patient data to adjust for recognized confounders. RESEARCH DESIGN AND METHODS Relevant studies published before June 2009 were identified from MEDLINE, Web of Science, and EMBASE. Authors of studies were contacted and asked to provide individual patient data or conduct prespecified analyses. Risk estimates of type 1 diabetes by maternal age were calculated for each study, before and after adjustment for potential confounders. Meta-analysis techniques were used to derive combined odds ratios and to investigate heterogeneity among studies. RESULTS Data were available for 5 cohort and 25 case-control studies, including 14,724 cases of type 1 diabetes. Overall, there was, on average, a 5% (95% CI 2-9) increase in childhood type 1 diabetes odds per 5-year increase in maternal age (P = 0.006), but there was heterogeneity among studies (heterogeneity I(2) = 70%). In studies with a low risk of bias, there was a more marked increase in diabetes odds of 10% per 5-year increase in maternal age. Adjustments for potential confounders little altered these estimates. CONCLUSIONS There was evidence of a weak but significant linear increase in the risk of childhood type 1 diabetes across the range of maternal ages, but the magnitude of association varied between studies. A very small percentage of the increase in the incidence of childhood type 1 diabetes in recent years could be explained by increases in maternal age.
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Affiliation(s)
- Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
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Minkina-Pedras M, Jarosz-Chobot P, Polanska J, Kalina MA, Marcinkowski A, Malecka-Tendera E. Prospective assessment of continuous subcutaneous insulin infusion therapy in young children with type 1 diabetes. Diabetes Res Clin Pract 2009; 85:153-8. [PMID: 19539392 DOI: 10.1016/j.diabres.2009.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 12/28/2008] [Revised: 05/15/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022]
Abstract
The study assessed 3.5-year treatment with continuous subcutaneous insulin infusion (CSII) in well-controlled children with duration of type 1 diabetes mellitus longer than 1 year. Following groups were observed: the CSII group-40 children and the multiple injections (MDI) group-36 patients (age-matched, the mean of 6.5+/-2.1 and 7.1+/-1.8 years, respectively). At the onset of the follow-up both groups were comparable in age, HbA1c, daily insulin requirement (DIR), body weight, height and BMI. They were followed from the start, and every 6 months in relation to DIR, HbA1c, acute complications (DKA, hypoglycaemia) and physical development. Mean HbA1c and DIR for the whole study period were lower in the CSII versus MDI group (6.90+/-0.54 vs 7.22%+/-0.16 and 0.75+/-0.16 vs 0.88+/-0.13 U/kg/d; p<0.05). HbA1c was lower in the CSII versus MDI group in months 6 and 42 (6.95 vs 7.29%, and 6.91 vs 7.43%, respectively; p<0.05). DIR was significantly lower at most intervals in the CSII group. No significant differences regarding number of complications and anthropometry were found. CSII allows for near-normal metabolic control and lower insulin requirement comparing to the MDI method. CSII is safe treatment, assuring harmonious child's development.
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Affiliation(s)
- Mariola Minkina-Pedras
- Department of Paediatric Endocrinology and Diabetes, Upper Silesia Centre for Child's Health, Katowice, Poland.
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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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Abstract
BACKGROUND The dramatic increase in the incidence of diabetes mellitus type 1 (DMT1) in all countries of Central and Eastern Europe seems to be correlated with the rapid transformations of the political, economical, and social conditions. The aim of this study was to analyze the increase of DMT1 incidence vs. changes of parameters describing economical conditions, medical care standards, and level of hygiene. MATERIALS AND METHODS The study was based on the Upper Silesia, Poland, prospective register of DMT1 cases, a part of the EURODIAB program. The analyzed parameters were number of salmonellosis, taeniasis, diarrhea, and diarrhea in children aged 0 - 2 yr, alimentary toxicosis, neonatal mortality rate, average male and female life expectancy, gross domestic product (GDP), and accessibility to the water supply and sewage lines. RESULTS The dynamics of incidence increase has been very high: from 4.71/100 000 (1989) to 15.20/100 000 (2002); average increase per year is 7.52%. The statistically significant positive associations between DMT1 incidence and average male and female life expectancy, GDP, and accessibility of the water supply and sewage systems as well as the negative association for both neonatal mortality rate and nursery attendance were observed. No significant correlation was found between DMT1 and incidence rates of chosen diseases. CONCLUSIONS Currently, Poland and its part, Upper Silesia, belong to regions with high DMT1 incidence in children. The change from low to high incidence of DMT1 over the past 14 yr corresponded to profound social and economical transformations. Our observations confirm the importance of environmental factors in the aetiopathogenesis of DMT1. The state of hygiene and the state of the health of the society influence its susceptibility to DMT1.
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Affiliation(s)
- Przemyslawa Jarosz-Chobot
- Department of Pediatric Endocrinology and Diabetes, Medical University of Silesia, Katowice, Poland.
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Machnica L, Osior A, Jarosz-Chobot P, Deja G, Polanska J, Otto-Buczkowska E. An analysis of the prevalence of thyroid autoantibodies: thyroid peroxidase antibodies (ATA) and thyroglobulin antibodies (ATG) in children with newly diagnosed diabetes mellitus type 1 during 2000-2004 in the Upper Silesia region, Poland. Acta Diabetol 2008; 45:37-40. [PMID: 17932620 DOI: 10.1007/s00592-007-0017-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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] [Received: 02/21/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
Abstract
The aim of this study was to evaluate the prevalence of thyroid autoantibodies and clinical significance of thyroid autoimmunity in children with the diagnosis of diabetes mellitus type 1. The study group comprised 222 children all with newly diagnosed diabetes mellitus type 1 (122 boys) with a mean age 9.92 +/- 4.5 years, who were admitted to a regional diabetes division in 2000-2004. Assessment of ATA and ATG were performed and two emerging groups-ATA/ATG (+) and ATA/ATG (-) were compared, including anthropometric data, HbA1C, plasma lipids, TSH, fT4. Positive antibodies titre was found in 27 (12.16%) of the children. Apart from older age in the antibody positive group (11.67 vs. 9.67 years, p < 0.05), there were no significant differences among these groups regarding other clinical and laboratory characteristics. Concluding, the presence of thyroid autoantibodies in 12.16% of subjects with newly diagnosed diabetes confirms the necessity of screening of all children, especially adolescents from the time of diagnosis of diabetes mellitus type 1 onwards. No association between existence of autoantibodies and the clinical status of a child at the presentation of diabetes was demonstrated by this study.
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Affiliation(s)
- L Machnica
- Central Clinical Hospital of Medical University of Silesia, Katowice, Poland
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Otto-Buczkowska E, Jarosz-Chobot P, Minkina-Pedras M, Deja G, Kalina-Faska B. [Coexistance of autoimmunological diseases with type 1 diabetes mellitus in young patients based on literature and own experience]. Przegl Lek 2008; 65:140-144. [PMID: 18624123] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Patients with autoimmune type 1 diabetes mellitus have often, besides immune diabetic markers, also other organ-specific antibodies. In many diabetic patients autoimmune thyroid diseases, i.e. Hashimoto thyroiditis and Grave's disease, with silent clinical course can be diagnosed. Because 50% of children with diabetes and significant titres of thyroid autoantibodies (ATA) develop thyroid problems within 3-4 years, examinations of thyroid antibodies should be performed yearly. In cases of significant antibody titres, thyroid function tests and ultrasound assessment are recommended in order to minimize the risk of undiagnosed hypothyroidism in these patients. Coeliac is an other disease commonly coexisting with type 1 diabetes mellitus and autoimmune thyroid diseases. It is recommended that screening for coeliac disease should be part of the routine investigation for all patients. Potential benefits of treatment coeliac disease is more prevalent in individuals with type 1 diabetes mellitus, and when untreated is associated with a number of medical complications, including poor glycaemic control. Identification of patients with coeliac has been facilitated in recent years by serological screening. Initial normal screening does not exclude coeliac and repeated screening is indicated, a positive IgA antibody test to tTG is a more sensitive parameter than EmA for silent coeliac disease in patients with diabetes. Confirmatory small bowel biopsy, however, remains necessary for diagnosis as some patients with positive antibodies may be without histological changes.
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Deja G, Jarosz-Chobot P, Polanska J. The rate of improvement in metabolic control in children with diabetes mellitus type 1 on insulin glargine depends on age. Exp Clin Endocrinol Diabetes 2007; 115:662-8. [PMID: 18058601 DOI: 10.1055/s-2007-984444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 10/22/2022]
Abstract
BACKGROUND To evaluate the changes in the glycemic profile and metabolic control after introducing glargine in children with DMT1 in a one-year follow up. METHODS 70 children (36 boys) at the average age of 12.03+/-2.50 with the mean diabetes duration of 3.35+/-2.19 years were observed. Glargine was substituted for NPH in children treated with multiple daily injections. RESULTS The analysis showed the differences in the dynamics of changes in mean glycemia based on home blood glucose monitoring and HbA1c between prepubertal children (Group 1) and teenagers (Group 2). A significant reduction in mean glycemia from baseline to 12 months was observed at all chosen points in Group 2: fasting glycemia (125+/-27 mg/dl vs 117+/-17 mg/dl,p<0.05), bedtime glycemia (128+/-24 mg/dl vs. 117+/-20 mg/dl,p=0.001) and 3 a.m. glycemia (143+/-47 mg/dl vs. 90+/-25 mg/dl,p<0.001). A significant decrease in mean glycemia in Group 1 was observed from the beginning of treatment only at bedtime (0-12 months:129+/-27 mg/dl vs. 112+/-25 mg/dl,p=0.001) and at 3 am with the delay (6-12 months:122+/-36 mg/dl vs. 90+/-22 mg/dl,p<0.05). A significant improvement in HbA1c between baseline and 12 months was observed in both groups but with different dynamics of changes: 6.91+/-0.77% vs. 6.59+/-0.65% (p<0.05) and 7.44+/-1.26% vs. 7.18+/-1.58% (p=0.001) respectively in the groups. A trend towards decreasing the number of hypoglycemic episodes and no changes in BMI and insulin requirement were noted. CONCLUSIONS Introduction of glargine provides diabetic children with a better stabilization of the daily glycemic profile even in the cases of baseline good metabolic control. The rate of reaching the target in a long-term observation depends on age. A slower reduction of glycemia observed in smaller subjects suggests a great individuality in the regimen of diabetic children.
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Affiliation(s)
- G Deja
- The Department of Pediatric, Endocrinology & Diabetes, The Medical University of Silesia, Katowice, Poland.
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Jarosz-Chobot P, Nowakowska M, Polanska J. Seeking the Factors Predisposing to Local Skin Inflammatory State Development in Children with Type 1 Diabetes (T1DM) Treated with Continuous Subcutaneous Insulin Infusion (CSII). Exp Clin Endocrinol Diabetes 2007; 115:179-81. [PMID: 17427107 DOI: 10.1055/s-2007-970593] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 10/23/2022]
Abstract
UNLABELLED The often CSII treatment complication is local skin infection. The aim of the study was to analyze chosen factors predisposing to this complication. MATERIAL AND METHODS We observed 40 children aged 1.9-15.6, suffering from diabetes for 0.1-12 and treated by CSII for 0.01-4.4 years in whom HbA1c, BMI, injection site and catheter insertion duration, catheter colonization, skin flora and Staphylococcus aureus carrier state were analyzed. The catheter cultures were prepared with Maki method. The skin and nasal vestibule swab were taken to detect local flora. RESULTS In the culture of 43 catheters (Maki method) a positive growth (>10 cfu) was detected in 9 (21%), homogeny culture of coagulase-negative staphylococci in 7 and mixed culture (both S.epidermidis and S.aureus) in two cases. Skin inflammation of the injection site was observed in a total of 10 children (25%), in two of whom catheter culture was positive. A statistically significant relation between the presence of bacteria in the catheter and on the skin around the injection site was found. Among the examined parameters, the relation between the catheter colonization and HbA1c, female sex and BMI were observed. CONCLUSIONS Metabolic control, female sex and BMI influence the development of a skin inflammatory state in patients treated with CSII. S.aureus carrier state has no impact either on catheter colonization or the development of an infection. However, bacteria skin occurrences can predispose to catheter colonization by the strain as well as to developing an inflammation.
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Affiliation(s)
- P Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, Katowice, Poland.
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Jarosz-Chobot P. [Overweight - problem in pediatric patients. Part II. Weight gain in insulin treatment of adolescent diabetic girls]. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2003; 7:63-7. [PMID: 12818151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Adolescents with type 1 diabetes mellitus, especially diabetic pubertal girls, have been found to be more prone to high body mass index than their non-diabetic peers. It is an important problem because it has been associated with risk of cardiovascular complications and other. The study was performed in 93 diabetic girls aged from 14 to 18 years, duration of diabetes varied from 6.4 to 7.7 years. The control group consisted of 75 non diabetic girls matched for age. Girls with type 1 diabetes are more overweight than their peers. In the non diabetic subjects BMI was 20.60+/-0.24 kg/m2, in the diabetic girls BMI was significantly higher, mean 22.70+/-0.23 kg/m2, which indicates a need of more effective prevention of obesity in diabetic children and adolescents, especially in pubertal girls.
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Jarosz-Chobot P, Otto-Buczkowska E, Malanowicz B, Wiedermann G. [Use of pre-mixed insulins in diabetes treatment of young patients]. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2003; 4:113-6. [PMID: 12818106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
UNLABELLED The aim of the study was to analyse the administration of pre-mixed insulins in the young. We studied 46 type I (insulin-dependent) diabetic subjects aged from 2.5 to 9 years with diabetes duration from 1 to 10 years in a period of 3 years. 19 patients were treated with Novo Nordisk insulins and 27 patients with Lilly pre-mixed insulins during 10-38 months. CONCLUSIONS We suggest using pre-mixed insulins in diabetes of the young in: 1. A group of small children, where we resign from strict glycaemic control because of the risk of hypoglycaemia; 2. Patients with small insulin requirement and stabile diabetes, including diabetics in partial remission; 3. Patients who do not cooperate with diabetic team.
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