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WANG YY, YING HM, TIAN F, QIAN XL, Zhou ZF. Three months use of Hybrid Closed Loop Systems improves glycated hemoglobin levels in adolescents and children with type 1 diabetes: A meta-analysis. PLoS One 2024; 19:e0308202. [PMID: 39133688 PMCID: PMC11318905 DOI: 10.1371/journal.pone.0308202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Longer outpatient studies have demonstrated that hybrid closed loop (HCL) use has led to a concomitant reduction in glycated hemoglobin(HbA1c) by 0.3%-0.7%. However, reports have also indicated that HbA1c levels are not declined in the long-term use of HCL. Therefore, we wonder that 3 months use of HCL could improve glycated hemoglobin levels in adolescents and children with T1D. METHODS Relevant studies were searched electronically in the Cochrane Library, PubMed, and Embase utilizing the key words "Pediatrics or Child or Adolescent", "Insulin Infusion Systems" and "Diabetes Mellitus" from inception to 17th March 2024 to evaluate the performance of HCL on HbA1c in adolescents, and children with T1D. RESULTS Nine studies involving 927 patients were identified. Three months use of HCL show a beneficial effect on HbA1c management (p <0.001) as compared to standard of care in adolescents and children with T1D, without evidence of heterogeneity between articles (I2 = 40%, p = 0.10). HCL did significantly increase the overall average percentage of hypoglycemic time between 70 and 180 mg/dL (TIR) (p <0.001; I2 = 51%). HCL did not show a beneficial effect on hypoglycemic time <70 mg/dL and <54 mg/dL (p >0.05). The overall percentage of hyperglycemic time was significantly decreased in HCL group compared to the control group when it was defined as >180 mg/dL (p <0.001; I2 = 83%), >250 mg/dL (p = 0.007, I2 = 86%) and >300 mg/dL (p = 0.005; I2 = 76%). The mean glucose level was significantly decreased by HCL (p <0.001; I2 = 58%), however, no significant difference was found in coefficient of variation of sensor glucose (p = 0.82; I2 = 71%) and daily insulin dose (p = 0.94; I2 <0.001) between the HCL group and the control group. CONCLUSIONS HCL had a beneficial effect on HbA1c management and TIR without increased hypoglycemic time as compared to standard of care in adolescents and children with T1D when therapy duration of HCL was not less than three months. TRIAL NUMBER AND REGISTRY URL CRD42022367493; https://www.crd.york.ac.uk/PROSPERO, Principal investigator: Zhen-feng Zhou, Date of registration: October 30, 2022.
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Affiliation(s)
- Yuan-yuan WANG
- Department of Endocrinology, Xixi Hospital of Hangzhou (Affiliated Hangzhou Xixi Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang Province, Hangzhou, China
| | - Hui-min YING
- Department of Endocrinology, Xixi Hospital of Hangzhou (Affiliated Hangzhou Xixi Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang Province, Hangzhou, China
| | - Fang TIAN
- Department of Endocrinology, Xixi Hospital of Hangzhou (Affiliated Hangzhou Xixi Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang Province, Hangzhou, China
| | - Xiao-lu QIAN
- Department of Endocrinology, Xixi Hospital of Hangzhou (Affiliated Hangzhou Xixi Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang Province, Hangzhou, China
| | - Zhen-feng Zhou
- Department of Anesthesiology, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People’s Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, China
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Aouchiche K, Bernoux D, Baechler Sadoul E, Haine E, Joubert F, Epstein S, Faure Galon N, Dalla-Vale F, Combe JC, Samper M, Simonin G, Castets S, Marquant E, Vergier J, Reynaud R. Impact of continuous glucose monitoring on everyday life of young children with type 1 diabetes and their parents: An evaluation of 114 families. Prim Care Diabetes 2024; 18:91-96. [PMID: 38000979 DOI: 10.1016/j.pcd.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/08/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION The prevalence of type 1 diabetes is increasing worldwide. The advent of new monitoring devices has enabled tighter glycemic control. AIM To study the impact of glucose monitoring devices on the everyday life of young children with type 1 diabetes (T1D) and their parents. METHODS A questionnaire was addressed to parents of children with T1D under the age of 6 years with an insulin pump treated in one of the hospitals of the ADIM network in France between January and July 2020. RESULTS Among the 114 families included in the study, 53% of parents (26/49) woke up every night to monitor blood glucose levels when their child had flash glucose monitoring (FGM), compared with 23% (13/56) of those whose child had continuous glucose monitoring (CGM). Overall, 81% of parents (86/108) found that glucose monitoring improved their own sleep and parents whose child had CGM were significantly more likely to report improved sleep (86% vs 73%, p = 0.006). Forty-nine percent of parents (55/113) declared that they (in 87% of cases, the mother only) had reduced their working hours or stopped working following their child's T1D diagnosis. Maternal unemployment was significantly associated with the presence of siblings (p = 0.001) but not with glycemic control (p = 0,87). Ninety-eight percent of parents (105/107) think that glucose monitoring improves school integration. CONCLUSION In these families of children with T1D, new diabetes technologies reduced the burden of care but sleep disruption remained common. Social needs evaluation, particularly of mothers, is important at initial diagnosis of T1D in children.
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Affiliation(s)
- K Aouchiche
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France.
| | - D Bernoux
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - E Baechler Sadoul
- Nice-Lenval University Hospital, Department of Pediatrics, 57 Avenue de la Californie, Nice, France
| | - E Haine
- Nice-Lenval University Hospital, Department of Pediatrics, 57 Avenue de la Californie, Nice, France
| | - F Joubert
- Avignon Hospital, Department of Pediatrics, 305 Rue Raoul Follereau, 84902 Avignon, France
| | - S Epstein
- Aubagne Hospital, Department of Pediatrics, 179 Av des Sœurs Gastine, 13677 Aubagne, France
| | - N Faure Galon
- Aix-en-Provence Pertuis Hospital, Department of Pediatrics, Avenue des Tamaris, Aix-en Provence, France
| | - F Dalla-Vale
- Montpellier University Hospital, Department of Pediatrics, Arnaud De Villeneuve Hospital, 371 avenue Doyen Gaston Giraud, 34295 Montpellier, France; Saint-Pierre Institute, Department of Pediatrics, 371 Avenue de l'évêché de Maguelone, 34250 Palavas-les-Flots, France
| | - J C Combe
- Hyères hospital, Depatment of Pediatrics, Bd Maréchal Juin, 83400 Hyères, France
| | - M Samper
- Pediatric Val Pré Vert Rehabilitation and Recuperative Care Facilities, 929 route de Gardanne, 13105 Mimet, France
| | - G Simonin
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - S Castets
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - E Marquant
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - J Vergier
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - R Reynaud
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
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Mutluer T, Aslan Genç H, Demir T, Demirel Ç, Bakır ÇN, Necef I, Muradoğlu S, Yeşiltepe Mutlu G, Hatun Ş. The effect of problem-solving skills on blood glucose regulation and disease management in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2023; 36:949-956. [PMID: 37623928 DOI: 10.1515/jpem-2023-0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES This cross-sectional study examined the relationship between problem-solving skills, glucose regulation, and disease management in children with type 1 diabetes mellitus (T1DM) as well as the role of depression in this association. METHODS The participants (n=54) were recruited from a diabetes camp. Problem-solving inventory (PSI), Beck depression inventory (BDI), and diabetes self-management profile (DSMP) were administered as tests. Forty-six participants who have been diagnosed with T1DM for at least a year and completed the survey were included in the analyses. Participants were categorized into high and low depression groups based on the median split. Student's t-test was used to detect demographic differences in groups. Linear regression models were used to examine the association between PSI, HbA1c, and DSMP. Regressions for PSI and DSMP were repeated in low and high-depression groups. RESULTS Of the 46 participants with T1DM, 52 % were female, with a mean age of 13.96 ± 1.94 (range 10-17). Avoidant and monitoring style of problem solving as well as the total score of PSI significantly predicted HbA1c levels. Impulsive and avoidant style of problem solving, problem-solving confidence, and total scores of PSI significantly predicted DSMP (p<0.05). The high depression group had a significantly higher DSMP score than the low depression group (p=0.001), with no difference in HbA1c levels (p=0.968). When the DSMP regressions were repeated, no significant associations were seen in the low depression group. Avoidant style of problem solving, problem-solving confidence, and the total score of PSI significantly predicted DSMP in the high depression group (p<0.005). CONCLUSIONS Problem solving-skills are essential in children with T1DM for a successful disease management. Depression modulates the association between the problem-solving and self-management profile.
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Affiliation(s)
- Tuba Mutluer
- Department of Child and Adolescent Psychiatry and Mental Health, Koç University School of Medicine, Istanbul, Türkiye
| | - Herdem Aslan Genç
- Department of Child and Adolescent Psychiatry and Mental Health, Koç University School of Medicine, Istanbul, Türkiye
| | - Tuana Demir
- Koç University School of Medicine, Istanbul, Türkiye
| | - Çağrı Demirel
- Koç University School of Medicine, Istanbul, Türkiye
| | | | - Işıl Necef
- Department of Child Psychology, Koç Üniversitesi Hastanesi, Istanbul, Türkiye
| | - Serra Muradoğlu
- Department of Child Psychology, Koç Üniversitesi Hastanesi, Istanbul, Türkiye
| | - Gül Yeşiltepe Mutlu
- Department of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Türkiye
| | - Şükrü Hatun
- Department of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Türkiye
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Hill H, Klaar P, Espes D. Real-life data of hypoglycemic events in children and adolescents with type 1 diabetes. BMJ Open Diabetes Res Care 2023; 11:e003485. [PMID: 37739421 PMCID: PMC10533671 DOI: 10.1136/bmjdrc-2023-003485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Hypoglycemia composes an always present risk in the treatment of type 1 diabetes (T1D) and can be a fatal complication. Many studies on hypoglycemic events are based on self-reported data or focused on the aggregated time below range. We have processed continuous glucose monitoring (CGM) data in children and adolescents with T1D in order to examine all occurring hypoglycemic events. RESEARCH DESIGN AND METHODS CGM data (mean 168±3 days) from 214 children and adolescents with T1D were analyzed using computer-based algorithms. Patients were divided into three groups based on estimated HbA1c (eHbA1c): (1) ≤48 mmol/mol (n=58); (2) 49-64 mmol/mol (n=113); (3) ≥65 mmol/mol (n=43). The groups were compared concerning descriptive data and CGM metrics with emphasis on the frequency of hypoglycemic events. RESULTS Only one self-reported event of severe hypoglycemia was registered, while 54 390 hypoglycemic events (<3.9 mmol/L (<70 mg/dL)) were identified from CGM data out of which 11 740 were serious (<3.0 mmol/L (<54 mg/dL)). On average there were 1.5±0.1 hypoglycemic events per 24 hours out of which 1.2±0.1 were mild (3.0-3.9 mmol/L) and 0.3±0.02 serious. Group 1 had a higher frequency of both total and mild hypoglycemic events compared with both groups 2 and 3. However, the frequency of serious hypoglycemic events was similar in all groups. A negative correlation was observed for eHbA1c and total daily and mild hypoglycemic events (r=-0.57 and r=-0.66, respectively, p<0.0001), whereas for serious hypoglycemic events there was only a borderline significance (r=-0.13, p=0.05). CONCLUSIONS This study shows that hypoglycemic events are a frequent phenomenon in children and adolescents with T1D, occurring regardless of overall metabolic control. Although patients with an HbA1c ≤48 mmol/mol had a higher frequency of mild hypoglycemic events there was no increase in serious hypoglycemic events.
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Affiliation(s)
- Henrik Hill
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Daniel Espes
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Science for Life Laboratory, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
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The Advanced Diabetes Technologies for Reduction of the Frequency of Hypoglycemia and Minimizing the Occurrence of Severe Hypoglycemia in Children and Adolescents with Type 1 Diabetes. J Clin Med 2023; 12:jcm12030781. [PMID: 36769430 PMCID: PMC9917934 DOI: 10.3390/jcm12030781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Hypoglycemia is an often-observed acute complication in the management of children and adolescents with type 1 diabetes. It causes inappropriate glycemic outcomes and may impair the quality of life in the patients. Severe hypoglycemia with cognitive impairment, such as a convulsion and coma, is a lethal condition and is associated with later-onset cognitive impairment and brain-structural abnormalities, especially in young children. Therefore, reducing the frequency of hypoglycemia and minimizing the occurrence of severe hypoglycemia are critical issues in the management of children and adolescents with type 1 diabetes. Advanced diabetes technologies, including continuous glucose monitoring and sensor-augmented insulin pumps with low-glucose suspension systems, can reduce the frequency of hypoglycemia and the occurrence of severe hypoglycemia without aggravating glycemic control. The hybrid closed-loop system, an automated insulin delivery system, must be the most promising means to achieve appropriate glycemic control with preventing severe hypoglycemia. The use of these advanced diabetes technologies could improve glycemic outcomes and the quality of life in children and adolescents with type 1 diabetes.
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Litmanovitch E, Geva R, Leshem A, Lezinger M, Heyman E, Gidron M, Yarmolovsky J, Sasson E, Tal S, Rachmiel M. Missed meal boluses and poorer glycemic control impact on neurocognitive function may be associated with white matter integrity in adolescents with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1141085. [PMID: 37091855 PMCID: PMC10113499 DOI: 10.3389/fendo.2023.1141085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
Background The notion that pediatric type 1 diabetes impacts brain function and structure early in life is of great concern. Neurological manifestations, including neurocognitive and behavioral symptoms, may be present from childhood, initially mild and undetectable in daily life. Despite intensive management and technological therapeutic interventions, most pediatric patients do not achieve glycemic control targets for HbA1c. One of the most common causes of such poor control and frequent transient hyperglycemic episodes may be lifestyle factors, including missed meal boluses. Objective The aim of this study was to assess the association between specific neurocognitive accomplishments-learning and memory, inhibition ability learning, and verbal and semantic memory-during meals with and without bolusing, correlated to diffusion tensor imaging measurements of major related tracts, and glycemic control in adolescents with type 1 diabetes compared with their healthy siblings of similar age. Study design and methods This is a case-control study of 12- to 18-year-old patients with type 1 diabetes (N = 17, 8 male patients, diabetes duration of 6.53 ± 4.1 years) and their healthy siblings (N = 13). All were hospitalized for 30 h for continuous glucose monitoring and repeated neurocognitive tests as a function of a missed or appropriate pre-meal bolus. This situation was mimicked by controlled, patient blinded manipulation of lunch pre-meal bolus administration to enable capillary glucose level of <180 mg/dl and to >240 mg/d 2 hours after similar meals, at a similar time. The diabetes team randomly and blindly manipulated post-lunch glucose levels by subcutaneous injection of either rapid-acting insulin or 0.9% NaCl solution before lunch. A specific neurocognitive test battery was performed twice, after each manipulation, and its results were compared, along with additional neurocognitive tasks administered during hospitalization without insulin manipulation. Participants underwent brain imaging, including diffusion tensor imaging and tractography. Results A significant association was demonstrated between glycemic control and performance in the domains of executive functions, inhibition ability, learning and verbal memory, and semantic memory. Inhibition ability was specifically related to food management. Poorer glycemic control (>8.3%) was associated with a slower reaction time. Conclusion These findings highlight the potential impairment of brain networks responsible for learning, memory, and controlled reactivity to food in adolescents with type 1 diabetes whose glycemic control is poor.
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Affiliation(s)
- Edna Litmanovitch
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Ronny Geva
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
- Department of Psychology, The Developmental Neuropsychology Lab, Bar Ilan University, Ramat Gan, Israel
| | - Avital Leshem
- Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Be'er Ya'akov, Israel
| | - Mirit Lezinger
- Pediatric Neurology and Epilepsy Department, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
| | - Eli Heyman
- Pediatric Neurology and Epilepsy Department, Shamir (Assaf Harofeh) Medical Center, Be’er Ya’akov, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maor Gidron
- Department of Psychology, The Developmental Neuropsychology Lab, Bar Ilan University, Ramat Gan, Israel
| | - Jessica Yarmolovsky
- Department of Psychology, The Developmental Neuropsychology Lab, Bar Ilan University, Ramat Gan, Israel
| | - Efrat Sasson
- Radiology Department, Shamir (Assaf Harofeh) Medical Center, Be'er Ya'akov, Israel
| | - Sigal Tal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Radiology Department, Shamir (Assaf Harofeh) Medical Center, Be'er Ya'akov, Israel
| | - Marianna Rachmiel
- Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Be'er Ya'akov, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Marianna Rachmiel,
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S230-S253. [PMID: 36507640 PMCID: PMC9810473 DOI: 10.2337/dc23-s014] [Citation(s) in RCA: 81] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Abraham MB, Karges B, Dovc K, Naranjo D, Arbelaez AM, Mbogo J, Javelikar G, Jones TW, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1322-1340. [PMID: 36537534 PMCID: PMC10107518 DOI: 10.1111/pedi.13443] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mary B Abraham
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Discipline of Pediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Diana Naranjo
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Ana Maria Arbelaez
- Division of Endocrinology and Diabetes, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joyce Mbogo
- Department of Pediatric and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Ganesh Javelikar
- Department of Endocrinology and Diabetes, Max Super Speciality Hospital, New Delhi, India
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Discipline of Pediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Parent-Child Conflict Moderates the Relationship Between Executive Functioning and Child Disruptive Behaviors in Youth with T1D. J Clin Psychol Med Settings 2022; 29:357-364. [PMID: 34985630 PMCID: PMC9893479 DOI: 10.1007/s10880-021-09838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/04/2023]
Abstract
Executive function (EF) skills, parent-child conflict, and high blood glucose (BG) may impact child externalizing behaviors. We examined these child and parent factors in families of 5-9 year olds with recent-onset type 1 diabetes (T1D). Parents (N = 125) reported child EF, child externalizing behaviors, and conflict regarding T1D-specific tasks. We used self-monitoring BG uploads to calculate the percentage of time children had high BG (> 180 mg/dl). We entered data into a moderated path analysis using MPlus8. The path analysis revealed a positive direct effect for parent-reported child EF and child externalizing behavior (p < .01). Further, T1D-specific conflict moderated the positive association between parent-reported child EF and child externalizing behaviors (p < .05). Early screening of child EF, externalizing behavior, and family conflict may be particularly important in the recent-onset period of T1D. The introduction of T1D-related conflict after diagnosis may impact child externalizing behavior and limited child EF skills that pre-date diagnosis.
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Glaser N, Chu S, Weiner J, Zdepski L, Wulff H, Tancredi D, ODonnell ME. Effects of TRAM-34 and minocycline on neuroinflammation caused by diabetic ketoacidosis in a rat model. BMJ Open Diabetes Res Care 2022; 10:10/3/e002777. [PMID: 35584854 PMCID: PMC9119135 DOI: 10.1136/bmjdrc-2022-002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) causes acute and chronic neuroinflammation that may contribute to cognitive decline in patients with type 1 diabetes. We evaluated the effects of agents that reduce neuroinflammation (triarylmethane-34 (TRAM-34) and minocycline) during and after DKA in a rat model. RESEARCH DESIGN AND METHODS Juvenile rats with DKA were treated with insulin and saline, either alone or in combination with TRAM-34 (40 mg/kg intraperitoneally twice daily for 3 days, then daily for 4 days) or minocycline (45 mg/kg intraperitoneally daily for 7 days). We compared cytokine and chemokine concentrations in brain tissue lysates during DKA among the three treatment groups and in normal controls and diabetic controls (n=9-15/group). We also compared brain inflammatory mediator levels in these same groups in adult diabetic rats that were treated for DKA as juveniles. RESULTS Brain tissue concentrations of chemokine (C-C) motif ligand (CCL)3, CCL5 and interferon (IFNγ) were increased during acute DKA, as were brain cytokine composite scores. Both treatments reduced brain inflammatory mediator levels during acute DKA. TRAM-34 predominantly reduced chemokine concentrations (chemokine (C-X-C) motif ligand (CXCL-1), CCL5) whereas minocycline had broader effects, (reducing CXCL-1, tumor necrosis factor (TNFα), IFNγ, interleukin (IL) 2, IL-10 and IL-17A). Brain inflammatory mediator levels were elevated in adult rats that had DKA as juveniles, compared with adult diabetic rats without previous DKA, however, neither TRAM-34 nor minocycline treatment reduced these levels. CONCLUSIONS These data demonstrate that both TRAM-34 and minocycline reduce acute neuroinflammation during DKA, however, treatment with these agents for 1 week after DKA does not reduce long-term neuroinflammation.
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Affiliation(s)
- Nicole Glaser
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, California, USA
| | - Steven Chu
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, California, USA
| | - Justin Weiner
- Department of Physiology and Membrane Biology, UC Davis, Davis, California, USA
| | - Linnea Zdepski
- Department of Physiology and Membrane Biology, UC Davis, Davis, California, USA
| | - Heike Wulff
- Department of Pharmacology, UC Davis, Davis, California, USA
| | - Daniel Tancredi
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, California, USA
| | - Martha E ODonnell
- Department of Physiology and Membrane Biology, UC Davis, Davis, California, USA
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Dogra V, Mittal B, Senthil Kumaran S, Nehra A, Sagar R, Gupta A, Kalaivani M, Gupta Y, Tandon N. Evaluation of Cognitive Deficits in Adults with Type 1 Diabetes Stratified by the Age of Diabetes Onset: A Cross-Sectional Study. Adv Ther 2022; 39:1711-1723. [PMID: 35182367 DOI: 10.1007/s12325-022-02063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/26/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Type 1 diabetes (T1DM) is associated with cognitive deficits, and age at diagnosis is thought to play a substantial role. However, there are limited data for the cognitive performance in young adults, in relation to the age of diabetes onset. The lack of information is particularly striking in the context of developing regions. METHODS This cross-sectional study was performed from August 2018 to July 2020. We included adult participants with T1DM, stratified by the age of diabetes onset (till 6 years of age, between 7 to 12 years of age, and 13 to < 18 years of age) and compared them with the control group (no diabetes or pre-diabetes). We filled a structured case record proforma for all participants and recorded relevant socio-demographic and medical details. Detailed neuropsychological assessment with 13 psychological tests representing four cognitive domains was carried-(1) attention, working memory and executive functions; (2) learning and memory; (3) visuoperceptual functions; and (4) information processing speed. RESULTS We evaluated 100 individuals, 73 (men 48.0%) with T1DM and 27 (men 51.9%) without T1DM. After adjustment for age, gender and education, the mean differences in composite Z scores (for the four cognitive domains) between participants with T1DM and without T1DM were 0.08 for attention, working memory and executive functions (p = 0.614); 0.07 for learning and memory (p = 0.694); 0.05 for visuoperceptual (p = 0.784); and 0.22 for information processing speed (p = 0.305). No significant differences were found for the three subgroups of individuals with T1DM, when compared with the control group. Effect size (Cohen's d) for the individual tests (n = 13) ranged from - 0.36 to + 0.39, and none of the comparisons were statistically significant. Amongst the participants with T1DM, higher education had a significant positive association with three of the four cognitive domains evaluated. CONCLUSIONS To conclude, our findings suggest minimal differences in the cognitive functioning of patients with T1DM with different age of onset of diabetes compared to healthy controls, when evaluated in early adulthood. This is possibly the first study from South Asia with an in-depth and comprehensive assessment of cognitive functions in patients with T1DM, using a detailed neuropsychological battery.
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12
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Cacciatore M, Grasso EA, Tripodi R, Chiarelli F. Impact of glucose metabolism on the developing brain. Front Endocrinol (Lausanne) 2022; 13:1047545. [PMID: 36619556 PMCID: PMC9816389 DOI: 10.3389/fendo.2022.1047545] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Glucose is the most important substrate for proper brain functioning and development, with an increased glucose consumption in relation to the need of creating new brain structures and connections. Therefore, alterations in glucose homeostasis will inevitably be associated with changes in the development of the Nervous System. Several studies demonstrated how the alteration of glucose homeostasis - both hyper and hypoglycemia- may interfere with the development of brain structures and cognitivity, including deficits in intelligence quotient, anomalies in learning and memory, as well as differences in the executive functions. Importantly, differences in brain structure and functionality were found after a single episode of diabetic ketoacidosis suggesting the importance of glycemic control and stressing the need of screening programs for type 1 diabetes to protect children from this dramatic condition. The exciting progresses of the neuroimaging techniques such as diffusion tensor imaging, has helped to improve the understanding of the effects, outcomes and mechanisms underlying brain changes following dysglycemia, and will lead to more insights on the physio-pathological mechanisms and related neurological consequences about hyper and hypoglycemia.
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13
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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14
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Ribeiro ACAF, Batista TH, Ferrari MS, Giusti-Paiva A, Vilela FC. The accentuation in post-traumatic stress disorder-like symptoms induced by diabetes in rats is not associated with a further increase in astrocyte activation in the hippocampus. Neurosci Lett 2021; 762:136174. [PMID: 34400287 DOI: 10.1016/j.neulet.2021.136174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Individuals with post-traumatic stress disorder (PTSD) show increased rates of several serious metabolic diseases. However, little is known about pre-existing metabolic diseases and the development of PTSD. Therefore, we aimed to evaluate the course of post-traumatic stress disorder (PTSD) development in rats with preexisting diabetes. In addition, we quantified glial fibrillary acidic protein (GFAP) in the hippocampus of the experimental animals. For this, we used male Wistar rats and divided them into two groups: saline and alloxan (150 mg/Kg, i.p.). The animals were weighed, and plasma glucose was measured after 48 h of diabetes induction by alloxan. The animals were either exposed to inescapable footshocks or not, followed by social isolation. After 14 days, the animals were re-exposed to the box, and the freezing time was evaluated for 10 min. Over the following days, the animals were tested on the open field, social interaction and forced swimming tests. In another group of animals, elevated plus maze and object recognition tests were performed. Our results demonstrated that animals with diabetes had more pronounced PTSD-like symptoms as a reduction in social interaction, an increase in immobility time in forced swimming, a reduction in permanence in the open arms of the elevated plus maze, and a deficit in the object recognition index more accentuated. However, this did not reflect astrocyte activation in the hippocampus. In conclusion, diabetes accentuates post-traumatic stress disorder-like symptoms but not astrocyte activation in the hippocampus.
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Affiliation(s)
- Ana Cláudia A F Ribeiro
- Programa de Pós-Graduação em Biociências Aplicadas à Saúde, Universidade Federal de Alfenas (Unifal-MG), Alfenas, Brazil; Instituto de Ciências Biomédicas, Universidade Federal de Alfenas (Unifal-MG), Alfenas, Brazil
| | - Tatiane H Batista
- Instituto de Ciências Biomédicas, Universidade Federal de Alfenas (Unifal-MG), Alfenas, Brazil
| | - Mariela S Ferrari
- Instituto de Ciências Biomédicas, Universidade Federal de Alfenas (Unifal-MG), Alfenas, Brazil
| | - Alexandre Giusti-Paiva
- Programa de Pós-Graduação em Biociências Aplicadas à Saúde, Universidade Federal de Alfenas (Unifal-MG), Alfenas, Brazil; Instituto de Ciências Biomédicas, Universidade Federal de Alfenas (Unifal-MG), Alfenas, Brazil
| | - Fabiana C Vilela
- Programa de Pós-Graduação em Biociências Aplicadas à Saúde, Universidade Federal de Alfenas (Unifal-MG), Alfenas, Brazil; Instituto de Ciências Biomédicas, Universidade Federal de Alfenas (Unifal-MG), Alfenas, Brazil.
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15
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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16
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Glaser N, Chu S, Hung B, Fernandez L, Wulff H, Tancredi D, ODonnell ME. Acute and chronic neuroinflammation is triggered by diabetic ketoacidosis in a rat model. BMJ Open Diabetes Res Care 2020; 8:e001793. [PMID: 33318070 PMCID: PMC7737057 DOI: 10.1136/bmjdrc-2020-001793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/21/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cognitive decline is common in patients with type 1 diabetes and has been attributed to the effects of chronic hyperglycemia and severe hypoglycemia. Diabetic ketoacidosis (DKA) has only recently been suspected to be involved in causing cognitive decline. We hypothesized that DKA triggers both acute and chronic neuroinflammation, contributing to brain injury. RESEARCH METHODS AND DESIGN We measured concentrations of cytokines, chemokines and matrix metalloproteinases (MMP) in serum and brain tissue lysates in juvenile rats during and after DKA (during acute DKA, 24 hours and 7 days after DKA), and compared these to healthy controls and hyperglycemic controls. We also measured cytokine, chemokine and MMP concentrations in serum and brain tissue of adult rats (70 days) that had experienced DKA as juveniles and compared these measurements to those of adult diabetic rats without exposure to DKA. RESULTS During acute DKA in the juvenile rats, serum concentrations of CCL3, tumor necrosis factor (TNF)-α, interleukin (IL)-1ß and MMP-9 were significantly increased. Serum concentrations of IL-2 and IL-17A increased 7 days after DKA recovery. In brain tissue lysates, concentrations of CCL3, CCL5, interferon (IFN)-γ and MMP-9 were significantly elevated during acute DKA. In adult rats that had DKA as juveniles (28 days previously), serum concentrations of IL-1ß and brain concentrations of IL-10 and IL-12p70 were elevated in comparison to diabetic rats without prior DKA. Composite scores for highly correlated cytokines and chemokines (mean z-scores for IL-10, IL-1ß, TNF-α, IL-17A, IFN-γ, CXCL-1 and CCL5) were also significantly elevated in adult rats with prior DKA. CONCLUSIONS These data confirm that DKA causes acute systemic inflammation and neuroinflammation in a rat model. Importantly, the neuroinflammatory response triggered by DKA is long-lasting, suggesting the possibility that DKA-induced chronic neuroinflammation could contribute to long-term cognitive decline in individuals with diabetes.
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Affiliation(s)
- Nicole Glaser
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Steven Chu
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Benjamin Hung
- Department of Physiology and Membrane Biology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Luis Fernandez
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Heike Wulff
- Department of Pharmacology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Daniel Tancredi
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Martha E ODonnell
- Department of Physiology and Membrane Biology, University of California Davis School of Medicine, Sacramento, California, USA
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17
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Ma WX, Tang J, Lei ZW, Li CY, Zhao LQ, Lin C, Sun T, Li ZY, Jiang YH, Jia JT, Liang CZ, Liu JH, Yan LJ. Potential Biochemical Mechanisms of Brain Injury in Diabetes Mellitus. Aging Dis 2020; 11:978-987. [PMID: 32765958 PMCID: PMC7390528 DOI: 10.14336/ad.2019.0910] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/10/2019] [Indexed: 01/07/2023] Open
Abstract
The goal of this review was to summarize current biochemical mechanisms of and risk factors for diabetic brain injury. We mainly summarized mechanisms published in the past three years and focused on diabetes induced cognitive impairment, diabetes-linked Alzheimer’s disease, and diabetic stroke. We think there is a need to conduct further studies with increased sample sizes and prolonged period of follow-ups to clarify the effect of DM on brain dysfunction. Additionally, we also think that enhancing experimental reproducibility using animal models in conjunction with application of advanced devices should be considered when new experiments are designed. It is expected that further investigation of the underlying mechanisms of diabetic cognitive impairment will provide novel insights into therapeutic approaches for ameliorating diabetes-associated injury in the brain.
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Affiliation(s)
- Wei-Xing Ma
- 1Department of Pharmaceutical, University of North Texas Health Science Center, Fort Worth, Texas, USA.,2Chemical Engineering Institute, Qingdao University of Science and Technology, Qingdao, Shandong, China.,3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Jing Tang
- 3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Zhi-Wen Lei
- 3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Chun-Yan Li
- 1Department of Pharmaceutical, University of North Texas Health Science Center, Fort Worth, Texas, USA.,4Shantou University Medical College, Shantou, Guangdong, China
| | - Li-Qing Zhao
- 3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Chao Lin
- 3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Tao Sun
- 3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Zheng-Yi Li
- 3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Ying-Hui Jiang
- 3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Jun-Tao Jia
- 3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Cheng-Zhu Liang
- 3Technological Center, Qingdao Customs, Qingdao, Shandong, China
| | - Jun-Hong Liu
- 2Chemical Engineering Institute, Qingdao University of Science and Technology, Qingdao, Shandong, China
| | - Liang-Jun Yan
- 1Department of Pharmaceutical, University of North Texas Health Science Center, Fort Worth, Texas, USA
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18
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Nevo-Shenker M, Phillip M, Nimri R, Shalitin S. Type 1 diabetes mellitus management in young children: implementation of current technologies. Pediatr Res 2020; 87:624-629. [PMID: 31715623 DOI: 10.1038/s41390-019-0665-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/29/2019] [Accepted: 10/13/2019] [Indexed: 12/11/2022]
Abstract
The use of advanced technologies for diabetes management is on the rise among pediatric patients with type 1 diabetes (T1D). Continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring, predictive low glucose suspend, hybrid closed-loop insulin delivery systems-all enable better diabetes management and glycemic control. However, when used by children, and especially very young children, specific aspects must be taken into consideration, including technical parameters, ease of use, parental stress, and satisfaction. The unique characteristics of T1D in children aged <6 years are reviewed and studies of the pros and cons of different technologies in this specific age group are presented. Addressing such issues when implementing advanced technologies among very young children with T1D will enable better diabetes management and will hopefully ease a tremendous burden of both children and families.
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Affiliation(s)
- Michal Nevo-Shenker
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Moshe Phillip
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Revital Nimri
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Shalitin
- The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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20
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Cameron FJ, Northam EA, Ryan CM. The effect of type 1 diabetes on the developing brain. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:427-436. [PMID: 30987935 DOI: 10.1016/s2352-4642(19)30055-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 12/25/2022]
Abstract
The effect of type 1 diabetes on the developing brain is a topic of primary research interest. A variety of potential dysglycaemic insults to the brain can cause cellular and structural injury and lead to altered neuropsychological outcomes. These outcomes might be subtle in terms of cognition but appear to persist into adult life. Age and circumstance at diagnosis appear to play a substantial role in potential CNS injury. A history of diabetic ketoacidosis and chronic hyperglycaemia appear to be more injurious than previously suspected, whereas a history of severe hypoglycaemia is perhaps less injurious. Neurocognitive deficits manifest across multiple cognitive domains, including executive function and speed of information processing. Some evidence suggests that subtle brain injury might directly contribute to psychological and mental health outcomes. Impaired executive function and mental health, in turn, could affect patients' adherence and the ability to make adaptive lifestyle choices. Impaired executive functioning creates a potential feedback loop of diabetic dysglycaemia leading to brain injury, further impaired executive function and mental health, which results in suboptimal adherence, and further dysglycaemia. Clinicians dealing with patients with suboptimal glycaemic outcomes should be aware of these potential issues.
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Affiliation(s)
- Fergus J Cameron
- The Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, VIC, Australia; The Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Elisabeth A Northam
- The School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Christopher M Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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21
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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22
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Abraham MB, Jones TW, Naranjo D, Karges B, Oduwole A, Tauschmann M, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:178-192. [PMID: 29869358 DOI: 10.1111/pedi.12698] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/28/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Mary B Abraham
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Division of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Division of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Diana Naranjo
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | | | - Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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23
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Broadley MM, White MJ, Andrew B. Executive function is associated with diabetes-specific disordered eating in young adults with type 1 diabetes. J Psychosom Res 2018; 111:1-12. [PMID: 29935740 DOI: 10.1016/j.jpsychores.2018.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/28/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Disordered eating behavior in young adults with type 1 diabetes is overrepresented and associated with significant negative health consequences. Thus, determining the key correlates of these behaviors is essential. The aim of the present study was to determine the association between executive function and disordered eating in young adults with type 1 diabetes, relative to a control group without diabetes. METHODS 74 young adults with type 1 diabetes and 201 demographically similar control participants completed an online survey containing the Eating Disorders Examination Questionnaire (EDE-Q), Diabetes Eating Problems Survey- Revised (DEPS-R), Behavior Rating Inventory of Executive Function- Adult version, Depression Anxiety and Stress Scales, and 3 subscales of the Family Environment Scale (independence, control, and cohesion). RESULTS Hierarchical multiple regressions showed that lower executive function was associated with significantly greater disordered eating (as measured by the DEPS-R) over and above psychological and family functioning in the type 1 diabetes group (ΔR2 = 0.056, β = 0.366, p = .031). The same relationship was not found when disordered eating was measured by the EDE-Q in either the diabetes group (ΔR2 = 0.049, β = 0.342, p = .054), or the control group (ΔR2 = 0.010, β = 0.136, p = .100). CONCLUSIONS Executive function may play a greater role in the development and/or maintenance of disordered eating in groups with type 1 diabetes relative to those without. This relationship may contribute to the over-representation of eating problems in this clinical group, and may represent a target for prevention or intervention.
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Affiliation(s)
- Melanie M Broadley
- Queensland University of Technology, School of Psychology and Counselling, 170 Victoria Park Rd, Kelvin Grove, QLD 4059, Australia; Institute of Health and Biomedical Innovation, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia.
| | - Melanie J White
- Queensland University of Technology, School of Psychology and Counselling, 170 Victoria Park Rd, Kelvin Grove, QLD 4059, Australia; Institute of Health and Biomedical Innovation, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia
| | - Brooke Andrew
- Queensland University of Technology, School of Psychology and Counselling, 170 Victoria Park Rd, Kelvin Grove, QLD 4059, Australia; Institute of Health and Biomedical Innovation, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia
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24
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He J, Ryder AG, Li S, Liu W, Zhu X. Glycemic extremes are related to cognitive dysfunction in children with type 1 diabetes: A meta-analysis. J Diabetes Investig 2018; 9:1342-1353. [PMID: 29573221 PMCID: PMC6215942 DOI: 10.1111/jdi.12840] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 02/22/2018] [Accepted: 03/13/2018] [Indexed: 12/18/2022] Open
Abstract
Aims/Introduction To examine the magnitude and pattern of cognitive dysfunction in children with type 1 diabetes, and the possible effects associated with other disease variables, such as early onset diabetes, severe hypoglycemia and hyperglycemia. Materials and Methods We carried out a meta‐analysis using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. We searched MedLine, Embase and PsycINFO to identify studies on cognitive function in children with type 1 diabetes that were published up until 30 September 2016. Effect sizes understood as the standardized mean differences between groups with diabetes and control groups (i.e., Hedges’ g) were calculated to quantify the extent of cognitive dysfunction in those groups consisting of children with diabetes. Results A total of 19 studies met our inclusion criteria, comprising 1,355 participants with type 1 diabetes and 696 controls. Compared with non‐diabetic controls, children with type 1 diabetes showed a significantly poorer cognitive performance overall (g = −0.46), as well as specific deficits in full‐scale intelligence (g = −1.06), attention (g = −0.60) and psychomotor speed (g = −0.46). Glycemic extremes were associated with poorer overall cognition (g = −0.18), as well as slightly lower performance in memory (g = −0.27). Conclusions We found that type 1 diabetes was associated with cognitive dysfunction characterized by a lowered intelligence, diminished attention and a slowing of psychomotor speed. Glycemic extremes, which are described as a period of high glucose levels and severe hypoglycemia, were related to cognitive dysfunction in children with type 1 diabetes.
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Affiliation(s)
- Jing He
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute of Central South University, Changsha, China
| | - Andrew G Ryder
- Center for Clinical Research in Health & Department of Psychology, Concordia University, Montreal, Quebec, Canada.,Culture and Mental Health Research Unit & Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Shichen Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute of Central South University, Changsha, China
| | - Wanting Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute of Central South University, Changsha, China
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute of Central South University, Changsha, China
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25
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Abstract
OBJECTIVE The aims of the study were to examine the current evidence for executive function (EF) performance differences between groups with type 1 diabetes mellitus (T1DM) and nondiabetic control groups during adolescence and early adulthood and to explore the relationships between EF and diabetes-related risk factors. METHODS A systematic review of the literature examining EF performance in groups with T1DM was conducted according to the PRISMA guidelines. Electronic database searches for published and unpublished literature yielded a final set of 26 articles after application of inclusion and exclusion criteria. A meta-analysis was conducted on a subset of these articles (n = 17) comparing EF performance in T1DM and control groups, across a total sample size of 1619. RESULTS Sixteen of 26 studies found significantly lower EF on at least one task in groups with T1DM. Meta-analyses of the performance difference between T1DM groups and control groups without diabetes showed that inhibition (g = -0.28, p < .001), working memory (g = -0.34, p < .001), set-shifting (g = -0.31, p = .012), and overall EF performance across these domains (g = -0.42, p < .001) were all significantly lower in groups with T1DM. Performance on specific EF domains also seemed to be differentially associated with early age of diabetes onset, chronic hyperglycemia and its complications, and severe hypoglycemia. CONCLUSIONS T1DM and its associated risk factors are related to subtle impairments across the inhibition, working memory, and set-shifting domains of EF. Lower EF may be a key factor contributing to behavioral and clinical problems experienced by individuals with T1DM.
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26
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Almeida MC, Claudino DA, Grigolon RB, Fleitlich-Bilyk B, Claudino AM. Psychiatric disorders in adolescents with type 1 diabetes: a case-control study. ACTA ACUST UNITED AC 2018; 40:284-289. [PMID: 29412336 PMCID: PMC6899402 DOI: 10.1590/1516-4446-2017-2259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/03/2017] [Indexed: 01/09/2023]
Abstract
Objectives: To study the prevalence of psychiatric disorders in adolescents with and without type 1 diabetes, the factors associated with its presence, and to test the reliability of a screening tool for use in clinical settings. Methods: Eighty-one adolescents were enrolled in this case-control study, including 36 diabetic participants and 45 controls. Clinical and sociodemographic data were collected and psychiatric symptoms and diagnoses were obtained from adolescents and their parents using a screening tool (Strengths & Difficulties Questionnaire) and a semi-structured interview (Development and Well-Being Assessment). Results: Psychiatric disorders were identified in 22.2% of the sample (30.56% among diabetic adolescents vs. 15.56% of controls: OR = 2.39, 95%CI 0.82-6.99; p = 0.11). Overweight (body mass index percentile ≥ 85) was the only factor associated with psychiatric disorder (OR = 3.07; 95%CI 1.03-9.14; p = 0.04). Compared to the semi-structured interview, the screening instrument showed 80% sensitivity, 96% specificity, 88.9% positive predictive value and 92.3% negative predictive value for the presence of psychiatric diagnoses in adolescents. Conclusion: Psychiatric morbidity was high in this sample of adolescents, especially among those with diabetes. Routine use of the Strengths and Difficulties Questionnaire can help with early detection of psychiatric disorders in this at-risk group.
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Affiliation(s)
- Mireille C Almeida
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Denise A Claudino
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ruth B Grigolon
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Bacy Fleitlich-Bilyk
- Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (IPQ-FMUSP), São Paulo, SP, Brazil
| | - Angélica M Claudino
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Pierce JS, Aroian K, Caldwell C, Ross JL, Lee JM, Schifano E, Novotny R, Tamayo A, Wysocki T. The Ups and Downs of Parenting Young Children With Type 1 Diabetes: A Crowdsourcing Study. J Pediatr Psychol 2017; 42:846-860. [PMID: 28369409 DOI: 10.1093/jpepsy/jsx056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/07/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives Parenting young children with type 1 diabetes (YC-T1D) entails pervasive challenges; parental coping may influence child and parent outcomes. This study used a qualitative descriptive design to describe these challenges comprehensively to inform the user-centered design of an Internet coping resource for parents. Methods A "Parent Crowd" of 153 parents of children with T1D onset at ≤ 5 years old submitted textual responses online to open-ended questions about parenting YC-T1D. Systematic coding organized responses into domains, themes, and examples. A supplemental focus group of racial/ethnic minority parents enhanced the sample's diversity and validated findings from the Parent Crowd. Results Similar domains and themes emerged from responses of crowdsourcing and focus group participants. In each domain, parenting YC-T1D was challenging, but there was also substantial evidence of positive coping strategies and adaptability. Conclusions The study yielded rich data to inform user-centered design of an Internet resource for parents of YC-T1D.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tim Wysocki
- Nemours Children's Health System, Jacksonville, FL
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29
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Histological and cognitive alterations in adult diabetic rats following an episode of juvenile diabetic ketoacidosis: Evidence of permanent cerebral injury. Neurosci Lett 2017; 650:161-167. [DOI: 10.1016/j.neulet.2017.04.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/03/2017] [Accepted: 04/18/2017] [Indexed: 01/26/2023]
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Seke Etet PF, Farahna M, Satti GMH, Bushara YM, El-Tahir A, Hamza MA, Osman SY, Dibia AC, Vecchio L. Garcinia kola seeds may prevent cognitive and motor dysfunctions in a type 1 diabetes mellitus rat model partly by mitigating neuroinflammation. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2017; 14:/j/jcim.2017.14.issue-3/jcim-2016-0167/jcim-2016-0167.xml. [PMID: 28889733 DOI: 10.1515/jcim-2016-0167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/21/2017] [Indexed: 01/06/2023]
Abstract
Background We reported recently that extracts of seeds of Garcinia kola, a plant with established hypoglycemic properties, prevented the loss of inflammation-sensible neuronal populations like Purkinje cells in a rat model of type 1 diabetes mellitus (T1DM). Here, we assessed G. kola extract ability to prevent the early cognitive and motor dysfunctions observed in this model. Methods Rats made diabetic by single injection of streptozotocin were treated daily with either vehicle solution (diabetic control group), insulin, or G. kola extract from the first to the 6th week post-injection. Then, cognitive and motor functions were assessed using holeboard and vertical pole behavioral tests, and animals were sacrificed. Brains were dissected out, cut, and processed for Nissl staining and immunohistochemistry. Results Hyperglycemia (209.26 %), body weight loss (-12.37 %), and T1DM-like cognitive and motor dysfunctions revealed behavioral tests in diabetic control animals were not observed in insulin and extract-treated animals. Similar, expressions of inflammation markers tumor necrosis factor (TNF), iba1 (CD68), and Glial fibrillary acidic protein (GFAP), as well as decreases of neuronal density in regions involved in cognitive and motor functions (-49.56 % motor cortex, -33.24 % medial septal nucleus, -41.8 % /-37.34 % cerebellar Purkinje /granular cell layers) were observed in diabetic controls but not in animals treated with insulin or G. kola. Conclusions Our results indicate that T1DM-like functional alterations are mediated, at least partly, by neuroinflammation and neuronal loss in this model. The prevention of the development of such alterations by early treatment with G. kola confirms the neuroprotective properties of the plant and warrant further mechanistic studies, considering the potential for human disease.
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Pourabbasi A, Tehrani-Doost M, Qavam SE, Arzaghi SM, Larijani B. Association of diabetes mellitus and structural changes in the central nervous system in children and adolescents: a systematic review. J Diabetes Metab Disord 2017; 16:10. [PMID: 28271054 PMCID: PMC5335845 DOI: 10.1186/s40200-017-0292-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/10/2017] [Indexed: 12/15/2022]
Abstract
Background The relationship between diabetes and academic performance have been of great interest to researchers during the year to date. Many studies have been conducted to discover this relationship during three recent decades. But, evaluation of the structural changes of brain in the context of diabetes is of paramount importance especially in children and adolescents. Methods This study is a systematic review conducted to investigate the structural changes in the central nervous system in children and adolescents living with diabetes. Among about 500 papers published in this area in Pubmed and SCOPUS, 13 articles in the field of assessing structural changes in the central nervous system in children and adolescents with diabetes mellitus were entered into the evaluation process. Results As can be seen in these studies, a huge proportion of structures of the central nervous system have been affected by diabetes that include different areas of gray and white matters. In the majority of these studies, it has become clear that high glycemic changes, especially recurrent hyperglycemic attacks are very seriously associated with structural changes in the brain. Conclusion It seems the findings of this review can positively aid other researchers to develop medical guidelines to prevent or resolve the brain changes in central nervous structure and consequently cognitive impairments in children and adolescents.
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Affiliation(s)
- Ata Pourabbasi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Tehrani-Doost
- Department of Psychiatry, Rouzbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soqra Ebrahimi Qavam
- Faculty of psychology and education, Allameh Tabataba'ee university, Tehran, Iran
| | - Seyed Masoud Arzaghi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology & Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Shari'ati Hospital, North Kargar St., Tehran, Iran
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Farahna M, Seke Etet PF, Osman SY, Yurt KK, Amir N, Vecchio L, Aydin I, Aldebasi YH, Sheikh A, Chijuka JC, Kaplan S, Adem A. Garcinia kola aqueous suspension prevents cerebellar neurodegeneration in long-term diabetic rat - a type 1 diabetes mellitus model. JOURNAL OF ETHNOPHARMACOLOGY 2017; 195:159-165. [PMID: 27825990 DOI: 10.1016/j.jep.2016.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 08/04/2016] [Accepted: 11/02/2016] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The development of compounds able to improve metabolic syndrome and mitigate complications caused by inappropriate glycemic control in type 1 diabetes mellitus is challenging. The medicinal plant with established hypoglycemic properties Garcinia kola Heckel might have the potential to mitigate diabetes mellitus metabolic syndrome and complications. AIM OF THE STUDY We have investigated the neuroprotective properties of a suspension of G. kola seeds in long-term type 1 diabetes mellitus rat model. MATERIALS AND METHODS Wistar rats, made diabetic by single injection of streptozotocin were monitored for 8 months. Then, they were administered with distilled water or G. kola oral aqueous suspension daily for 30 days. Body weight and glycemia were determined before and after treatment. After sacrifice, cerebella were dissected out and processed for stereological quantification of Purkinje cells. Histopathological and immunohistochemical analyses of markers of neuroinflammation and neurodegeneration were performed. RESULTS Purkinje cell counts were significantly increased, and histopathological signs of apoptosis and neuroinflammation decreased, in diabetic animals treated with G. kola compared to diabetic rats given distilled water. Glycemia was also markedly improved and body weight restored to non-diabetic control values, following G. kola treatment. CONCLUSIONS These results suggest that G. kola treatment improved the general condition of long-term diabetic rats and protected Purkinje cells partly by improving the systemic glycemia and mitigating neuroinflammation.
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Affiliation(s)
- Mohammed Farahna
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia.
| | - Paul F Seke Etet
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Sayed Y Osman
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia; Department of Biochemistry and Molecular Biology, Faculty of Science and Technology, Al-Neelain University, Khartoum, Sudan
| | - Kıymet K Yurt
- Department of Histology and Embryology, Medical Faculty, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Naheed Amir
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE
| | - Lorella Vecchio
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Isınsu Aydin
- Department of Histology and Embryology, Medical Faculty, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Yousef H Aldebasi
- Department of Optometry, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Azimullah Sheikh
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE
| | - John C Chijuka
- Department of Optometry, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Süleyman Kaplan
- Department of Histology and Embryology, Medical Faculty, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Abdu Adem
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE.
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34
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Properties of Na,K-ATPase in cerebellum of male and female rats: effects of acute and prolonged diabetes. Mol Cell Biochem 2016; 425:25-36. [DOI: 10.1007/s11010-016-2859-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/22/2016] [Indexed: 02/07/2023]
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Abo-el-Asrar M, Andrawes NG, Rabie MA, El-Gabry DA, Khalifa AG, El-Sherif M, Abdel Aziz K. Cognitive functions in children and adolescents with early-onset diabetes mellitus in Egypt. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 7:21-30. [DOI: 10.1080/21622965.2016.1224186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Nevine G. Andrawes
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Menan A. Rabie
- Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina Aly El-Gabry
- Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdel-Gawad Khalifa
- Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mariam El-Sherif
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Karim Abdel Aziz
- Psychiatry Department, College of Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
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Franchini S, Comegna L, Prezioso G, Blasetti A. Hypoglycemia in children with type 1 diabetes: unawareness is a concrete risk. Curr Med Res Opin 2016; 32:1487-91. [PMID: 27142345 DOI: 10.1080/03007995.2016.1185400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- S Franchini
- a Department of Pediatrics , University of Chieti , Chieti , Italy
| | - L Comegna
- a Department of Pediatrics , University of Chieti , Chieti , Italy
| | - G Prezioso
- a Department of Pediatrics , University of Chieti , Chieti , Italy
| | - A Blasetti
- a Department of Pediatrics , University of Chieti , Chieti , Italy
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37
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Abstract
Hypoglycemia and fear of hypoglycemia limit appropriate glycemic control in many children and adolescents with type 1 diabetes. Traditional approaches to the prevention of hypoglycemia including patient education about modifiable risk factors for hypoglycemia (changes in insulin, diet, and exercise) and frequency of self glucose monitoring remain important for hypoglycemia prevention. Continuous glucose monitoring systems with or without a partial closed-loop control of insulin infusion have been very useful in the prevention of hypoglycemia. Oral carbohydrate and parenteral glucagon continue to be the mainstays of hypoglycemia treatment. In the future, we can look forward to regulatory approval of closed-loop insulin delivery and glucose monitoring systems to facilitate euglycemia, as well as glucagon administered by the intranasal route to treat hypoglycemia.
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Affiliation(s)
- Dayna E McGill
- MassGeneral Hospital for Children, Joslin Diabetes Center, Harvard Medical School, 5th Floor, Pediatrics, 175 Cambridge Street, Boston, MA, 02114, USA
| | - Lynne L Levitsky
- Division of Pediatric Endocrinology, MassGeneral Hospital for Children, Harvard Medical School, 5th Floor, Pediatrics, 175 Cambridge Street, Boston, MA, 02114, USA.
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