Diabetes Complications in Childhood Diabetes-New Biomarkers and Technologies

FGF-23 protects cell function and viability in murine pancreatic islets challenged by glucolipotoxicity

The fibroblast growth factor FGF-23 is a member of the FGF-15/19 subfamily with hormonal functions. Besides its well-known role for bone mineralization, FGF-23 is discussed as a marker for cardiovascular disease. We investigated whether FGF-23 has any effects on the endocrine pancreas of mice by determining insulin secretion, electrical activity, intracellular Ca²⁺, and apoptosis. Acute application of FGF-23 (10 to 500 ng/ml, i.e., 0.4 to 20 nM) does not affect insulin release of murine islets, while prolonged exposure leads to a 21% decrease in glucose-stimulated secretion. The present study shows for the first time that FGF-23 (100 or 500 ng/ml) partially protects against impairment of insulin secretion and apoptotic cell death induced by glucolipotoxicity. The reduction of apoptosis by FGF-23 is approximately twofold higher compared to FGF-21 or FGF-15/19. In contrast to FGF-23 and FGF-21, FGF-15/19 is clearly pro-apoptotic under control conditions. The beneficial effect of FGF-23 against glucolipotoxicity involves interactions with the stimulus-secretion cascade of beta-cells. Electrical activity and the rise in the cytosolic Ca²⁺ concentration of islets in response to acute glucose stimulation increase after glucolipotoxic culture (48 h). Co-culture with FGF-23 further elevates the glucose-mediated effects on both parameters. Protection against apoptosis and glucolipotoxic impairment of insulin release by FGF-23 is prevented, when calcineurin is inhibited by tacrolimus or when c-Jun N-terminal kinase (JNK) is blocked by SP600125. In conclusion, our data suggest that FGF-23 can activate compensatory mechanisms to maintain beta-cell function and integrity of islets of Langerhans during excessive glucose and lipid supply.

In vivo confocal microscopy study of corneal nerve alterations in children and youths with Type 1 diabetes

OBJECTIVE

To determine whether children and youths with Type 1 diabetes (T1D) have early alterations of the corneal subbasal nerve plexus detectable with in vivo confocal microscopy (IVCM) and to investigate the role of longitudinally measured major risk factors for diabetes complications associated with these alterations.

METHODS

One hundred and fifty children and youths with T1D and 51 age-matched controls were enrolled and underwent IVCM. Corneal nerve fiber length (CNFL), corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal fiber total branch density (CTBD), and corneal fiber fractal dimension (CNFrD) were measured. Risk factors for diabetes complications (blood pressure, BMI, HbA1c, lipoproteins, urinary albumin-creatinine ratio) were recorded at IVCM and longitudinally since T1D onset. Unpaired t-test was used to compare variables between the groups. Multiple regression models were calculated using IVCM parameters as dependent variables and risk factors as independent variables.

RESULTS

All IVCM parameters, except CTBD, were significantly lower in the T1D patients. Glycometabolic control (HbA1c, visit-to-visit HbA1c variability, and mean HbA1c), and blood pressure were inversely correlated with IVCM parameters. Multiple regression showed that part of the variability in CNFL, CNFD, CTBD, and CNFraD was explained by HbA1c, blood pressure percentiles and age at IVCM examination, independent of diabetes duration, BMI percentile and LDL cholesterol. Comparable results were obtained using the mean value of risk factors measured longitudinally since T1D onset.

CONCLUSIONS

Early signs of corneal nerve degeneration were found in children and youths with T1D. Glycometabolic control and blood pressure were the major risk factors for these alterations.

Risk factors of ocular morbidity among under-five years old children in Khartoum State- Sudan- 2020

BACKGROUND AND AIMS

Visual impairment in early childhood can significantly affect the development of visual, motor, and cognitive function and potentially lead to long-term adverse psychosocial consequences. This study aimed to identify the risk factors of ocular morbidity among under 5-year old children in Khartoum State, Sudan.

METHODS

A cross-sectional study was conducted in three tertiary eye care hospitals in Khartoum State, Sudan. The study included 391 children under the age of 5 years. The parent(s) were interviewed using a precoded, pretested, closed-ended questionnaire that included questions regarding socio-demographic profile and possible risk factors. Data were analyzed using Statistical Package for the Social Sciences (version 21.0). A P-value of less than .05 was regarded as significant.

RESULTS

There was a significant association between participants with diabetes mellitus and poor vision (P-value <.001). Two-thirds of participants (57%) with visual impairment had mothers, who reportedly attended antenatal care services regularly (P-value .001), revealing a significant statistical association. Maternal diseases, specifically diabetes, was identified as a risk factor for poor visual acuity in their offspring (P-value <.001). A significant relation was revealed between family history of eye disease and the degree of relationship to the affected participant (P-value <.001). There was an association between watching TV and current visual acuity (P-value <.001); as well as using mobile phones and current visual acuity (P-value <.001). Multilinear analysis revealed the stronger influence of TV watching rather than the use of mobile phones (P-value <.001).

CONCLUSIONS

Diabetes, diabetic mothers, a family history of ocular morbidity, watching television, and using mobile phones emerged as significant risk factors of ocular morbidity among children under the age of 5 years in this study. Many of these risk factors are either modifiable or controllable ocular morbidities among under-five children can be reduced with suitable interventions.

Validation Study and Outcomes of the Diabetes Quality of Life in Youth Instrument in Haitian Youth With Type 1 Diabetes Residing in Haiti

OBJECTIVES

Health-related quality of life (HRQL) in type 1 diabetes is a critical health outcome but has not been studied in many low-income countries. In this study we evaluated the validity of 2 HRQL instruments, measured the HRQL and explored the association between HRQL and glycemic control.

METHODS

This was a cross-sectional study of Haitian youth with diabetes between 0 and 25 years of age and living in Haiti. We administered the 51-item Diabetes Quality of Life in Youth (DQOLY) questionnaire and the EuroQol Visual Analogue Scale (EQ-VAS). Psychometric analyses evaluated internal consistency and construct validity of the DQOLY and its 21-item short form, the DQOLY-SF. Linear regression was used to identify predictors of HRQL and glycated hemoglobin (A1C).

RESULTS

In 85 youth (59% female; mean age, 17.5 years; mean diabetes duration, 3.7 years; mean A1C, 11.3%), DQOLY and DQOLY-SF had adequate internal consistency with Cronbach's alpha values of 0.86 and 0.84, respectively. Confirmatory factor analysis revealed adequate validity for the DQOLY-SF and DQOLY Satisfaction subscale. HRQL, as measured using the DQOLY-SF, was 62±16 (mean ± standard deviation) out of 100. Mean EQ-VAS score was 78±24 out of 100. Older age (p=0.004), female sex (p=0.02) and lower socioeconomic status (SES) (p=0.03) were risk factors for lower DQOLY score, and older age (p=0.02) and marginally female sex (p=0.06) for lower DQOLY-SF score. No predictors of EQ-VAS were identified. HRQL measures were not associated with glycemic control.

CONCLUSIONS

The DQOLY-SF and DQOLY Satisfaction subscale are valid measures of HRQL in Haitian youth with diabetes. HRQL is low and was worse in older, female and low-SES youth, but was not associated with glycemic control.

Sugar sweetened beverage consumption is positively associated with Klotho levels at two years of age in LatinX youth

Background

Klotho is an anti-aging protein mainly expressed in the kidneys with a smaller amount expressed in adipose tissue. Klotho effects include roles in reducing oxidative stress, insulin signaling, adipogenesis and glucose metabolism. Few studies have investigated the role of dietary factors such as sugar sweetened beverages (SSBs) on serum α-klotho levels in young children.

Methods

Data was collected from 60 low-income Latina pregnant women and their infants in San Francisco from birth until 2 years of life and examined for associations between dietary factors and child secreted α-klotho protein levels at 2 years.

Results

Mean α-klotho levels were 1782.96 ± 874.56 pg/mL at 2 years of age. Any consumption of SSBs was independently associated with increased α-klotho levels (Beta = 682.79, 95%CI 67.50, 1298.09; p = 0.03). Household income ranging from $25,000 to $50,000 was also correlated to higher levels of α-klotho in children compared with lower income levels (<$25,000) (Beta = 1613.35, 95%CI 527.37, 2699.33; p = 0.005).

Conclusions

The positive association between SSB intake and α-klotho levels at 2 years may reflect higher phosphate levels consistent with SSB intake. Higher socioeconomic status may be a proxy for reduced stress exposure in children, also associated with higher α-klotho levels. Future studies should evaluate the early impact of exposures to SSBs, stress and accelerated aging in children.

Nursing of Gastrointestinal Peristalsis Function Recovery after Abdominal Mirror Surgery for Rectal Cancer Patients Based on Intelligent Electronic Medicine

In recent years, with the rapid development of colorectal surgery technology and laparoscopic instruments, laparoscopic radical resection of colorectal cancer has been widely used. Although laparoscopic surgery has the characteristics of small trauma, less blood loss, less hospitalization days, and low incidence of adverse reactions such as incision infection, it is still inevitable to have different degrees of gastrointestinal dysfunction after surgery. This paper mainly studies the recovery nursing of gastrointestinal peristalsis after abdominal mirror in rectal cancer patients based on intelligent electronic medicine. In this paper, an intelligent medical monitoring system is designed for the posterior care of rectal cancer patients with abdominal mirror image, which can realize the collection and transmission of wireless sign parameters of postoperative rectal cancer patients and improve the efficiency of postoperative monitoring in medical work. All parameter data are sent to the Lora base station in real time via Lora wireless communication, which is then uploaded to the medical monitoring platform. The experimental results showed that the first postoperative exhaust time of the treatment group using the intelligent medical monitoring system was significantly shortened, and the difference was statistically significant (P < 0.05). The first defecation time was shortened, and the difference was statistically significant (P < 0.05). The recovery time of total fluid diet was shortened, and the difference was statistically significant (P < 0.05). The above results indicate that the intelligent medical monitoring device designed in this paper has positive significance for improving the work efficiency of the hospital, the clinical experience of patients after abdominal mirror surgery for rectal cancer, and the real-time monitoring of signs of patients in intensive care.

Role of sodium-glucose cotransporter 2 inhibition to mitigate diabetic kidney disease risk in type 1 diabetes

Diabetic kidney disease (DKD) is a common complication of type 1 diabetes (T1D) and a major risk factor for premature death from cardiovascular disease (CVD). Current treatments, such as control of hyperglycaemia and hypertension, are beneficial, but only partially protect against DKD. Finding new, safe and effective therapies to halt nephropathy progression has proven to be challenging. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated, in addition to glycaemic lowering, impressive protection against DKD and CVD progression in people with type 2 diabetes. Although these beneficial cardiorenal effects may also apply to people with T1D, supporting data are lacking. Furthermore, the increased rates of euglycaemic diabetic ketoacidosis may limit the use of this class in people with T1D. In this review we highlight the pathophysiology of DKD in T1D and the unmet need that exists. We further detail the beneficial and adverse effects of SGLT2 inhibitors based on their mechanism of action. Finally, we balance the effects in people with T1D and indicate future lines of research.

The comorbidity of increased arterial stiffness and microalbuminuria in a survey of middle-aged adults in China

BACKGROUND

Increased arterial stiffness (iAS) and microalbuminuria (MAU), which may occur simultaneously or separately in the general population and share similar risk factors, are markers of macro- and microvascular injuries. Our research investigated the comorbidity of iAS and MAU in the middle-aged population and examined the heterogeneous effects of metabolic risk factors on iAS and MAU.

METHODS

We selected 11,911 individuals aged 45 to 60 years who underwent a health examination at the 3rd Xiangya Hospital between 2010 and 2014. Metabolic syndrome (MetS) was determined according to IDF/NHLBI/AHA-2009 criteria. Multinomial logistic regression was applied to evaluate the influence of MetS, components of MetS and clusters of MetS on the co-occurrence (MAU(+)/iAS(+)) or non-co-occurrence (MAU(+)/iAS(-) and MAU(-)/iAS(+)) of MAU and iAS.

RESULTS

Reference group was MAU(-)/iAS(-). A positive effect of MetS on the presence of MAU(+)/iAS(-), MAU(-)/iAS(+), or MAU(+)/iAS(+) is listed in ascending order based on odds ratios (ORs = 2.11, 2.41, 4.61, respectively; P < 0.05). Compared with MAU(+)/iAS(-), Elevated blood pressure (BP) (OR = 1.62 vs. 4.83, P < 0.05), triglycerides(TG) (OR = 1.20 vs. 1.37, P < 0.05) were more strongly associated with MAU(-)/iAS(+), whereas fasting blood glucose (FBG) was less associated (OR = 1.37 vs. 1.31, P < 0.05). Decreased high-density lipoprotein cholesterol(HDL-c) (OR = 1.84, P < 0.01) and elevated waist circumference(WC) (OR = 1.28 P < 0.01) were the most strongly associated with MAU(+)/iAS(-). Compared with the individuals without MetS, individuals with the elevated BP, FBG, TG and decreased HDL-c cluster had the greatest likelihood of presenting a MAU(-)/iAS(+) (OR = 5.98, P < 0.01) and MAU(+)/iAS(+) (OR = 13.17, P < 0.01), these likelihood was even greater than the cluster with simultaneous alteration in all five MetS components (OR = 3.89 and 10.77, respectively, P < 0.01), which showed the most strongly association with MAU(+)/iAS(+) (OR = 5.22, P < 0.01).

CONCLUSION

Based on the heterogeneous influences of MetS-related risk factors on MAU and iAS, these influences could be selectively targeted to identify different types of vascular injuries.

In vivo assessment of macula in eyes of healthy children 8 to 16 years old using optical coherence tomography angiography

The purpose of the present study was to investigate the vascular flow density (VD) of macular superficial (SCP), deep capillary plexus (DCP), and choriocapillaris and the size of the foveal avascular zone (FAZ) area in healthy children using optical coherence tomography angiography (OCTA). The potential associations of age, sex, intraocular pressure, body mass index, spherical equivalent, and axial length with OCTA parameters were also investigated. A total of 75 eyes from 75 healthy children were included for analysis, with the mean age 11.51 ± 1.91 years (range, 8–16 years). At the level of the SCP, mean VD and mean FAZ area were, respectively, 54.29 ± 2.25% and 0.290 ± 0.109 mm². At the level of the DCP and choriocapillaris, mean VD were 60.19 ± 1.76% and 66.58 ± 1.33%, respectively. After adjustment on the signal strength index, there was no significant correlation between age and all OCTA parameters. Intra-observer repeatability was 0.91, 0.82, and 0.88 in the SCP, DCP and choriocapillaris, respectively. In healthy eyes of children, only sex has a significant influence on the FAZ area. OCTA may provide a noninvasive and reliable approach for evaluating macular perfusion in children, although sex-related variations should be considered.

Early prediction of autoimmune (type 1) diabetes

Underlying type 1 diabetes is a genetic aetiology dominated by the influence of specific HLA haplotypes involving primarily the class II DR-DQ region. In genetically predisposed children with the DR4-DQ8 haplotype, exogenous factors, yet to be identified, are thought to trigger an autoimmune reaction against insulin, signalled by insulin autoantibodies as the first autoantibody to appear. In children with the DR3-DQ2 haplotype, the triggering reaction is primarily against GAD signalled by GAD autoantibodies (GADA) as the first-appearing autoantibody. The incidence rate of insulin autoantibodies as the first-appearing autoantibody peaks during the first years of life and declines thereafter. The incidence rate of GADA as the first-appearing autoantibody peaks later but does not decline. The first autoantibody may variably be followed, in an apparently non-HLA-associated pathogenesis, by a second, third or fourth autoantibody. Although not all persons with a single type of autoantibody progress to diabetes, the presence of multiple autoantibodies seems invariably to be followed by loss of functional beta cell mass and eventually by dysglycaemia and symptoms. Infiltration of mononuclear cells in and around the islets appears to be a late phenomenon appearing in the multiple-autoantibody-positive with dysglycaemia. As our understanding of the aetiology and pathogenesis of type 1 diabetes advances, the improved capability for early prediction should guide new strategies for the prevention of type 1 diabetes.

Plasma copeptin in children and adolescents with type 1 diabetes mellitus in comparison to healthy controls

In a cohort of children and adolescents with type 1 diabetes mellitus the trial tested the hypothesis that copeptin levels are associated with kidney function, biometrical data and quality of diabetes control.

PATIENTS AND METHODS

A total of 141 subjects were recruited to participate in the trial: 80 patients with type 1 diabetes (13.0±3.4years, HbA1c 7.85±1.42%) and 61 healthy controls (12.4±2.8years). Clinical and socio-economic data were assessed. A sandwich immunoassay (B.R.A.H.M.S. GmbH/Thermo Fisher Scientific, Hennigsdorf/Berlin, Germany) was used for measuring plasma copeptin levels.

RESULTS

The mean concentration of copeptin in the diabetic patients was 4.75±3.46pmol/l. There was a strong inverse correlation between copeptin and GFR (r=-0.86, p=0.021), as well as with total cholesterol (r=-0.23, p=0.041), LDL-cholesterol (r=-0.24, p=0.036), but not with serum creatinine, albuminuria, HbA1c, blood glucose, MAGE, CRP, systolic or diastolic blood pressure or age, diabetes duration, weight, height and BMI. Comparing patients with a diabetes duration of ⩾7years (n=45) with those with a diabetes duration <7years (n=35), patients with a longer duration of diabetes had higher copeptin levels (5.24±2.26 vs 4.13±2.86, p=0.045). Performing multivariate analyses only GFR could be identified as a parameter associated with copeptin (R-square=0.05, β=-0.23, p=0.032). In the healthy controls mean copeptin concentration was 5.56±3.15pmol/l. The copeptin concentration and GFR were inversely correlated as well (r=-0.61, p=0.034). However, other correlation and multivariate analyses revealed no further significant results. Comparing patients with type 1 diabetes mellitus with the healthy controls, the diabetes patients revealed no significant difference with respect to copeptin (p=0.24), serum creatinine (49.8±11.9 vs 50.4±11.0μmol/l, p=0.53) or GFR (102.4±23.3 vs 104.5±19.1ml/min, p=0.47). On the other hand, patients with type 1 diabetes had lower concentrations of CRP (1.66±3.91 vs 3.21±3.04μg/ml, p=0,013), triglycerides (0.88±0.53 vs 1.13±0.60mmol/l, p=0.010), and a lower ratio of LDL-/HLD-cholesterol (1.73±0.69 vs 2.32±0.80, p<0.001), as well as lower body weight (51.3±18.0 vs 60.3±15.7kg, p=0.002) and BMI (19.7±3.8 vs 23.2±2.9kg/m(2), p<0.001). In contrast to the controls, the diabetes patients had higher blood glucose levels at the time of examination (8.2±3.8 vs 4.7±0.5mmol/l, p<0.001), higher HDL-cholesterol levels (1.59±0.34 vs 1.26±0.24mmol/l, p<0.001), as well as higher education and higher educational levels of the mothers.

CONCLUSIONS

The present trial revealed a clear association between GFR and copeptin in children and adolescents with type 1 diabetes mellitus. Hence, copeptin can be considered as a marker of renal function.