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Gutiérrez-Domingo T, Farhane-Medina NZ, Villaécija J, Vivas S, Tabernero C, Castillo-Mayén R, Luque B. Effectiveness of Mindfulness-Based Interventions with Respect to Psychological and Biomedical Outcomes in Young People with Type 1 Diabetes: A Systematic Review. Healthcare (Basel) 2024; 12:1876. [PMID: 39337217 PMCID: PMC11430895 DOI: 10.3390/healthcare12181876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/28/2024] [Accepted: 09/01/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Type 1 diabetes is a chronic disease especially affecting young people. Mindfulness-based psychological interventions might reduce emotional symptoms post-diagnosis, but the evidence is limited. OBJECTIVES This systematic review aimed to evaluate the effectiveness of mindfulness interventions on psychological well-being and biomedical variables in young people with type 1 diabetes. METHODS A systematic review of trials was conducted that involved a bibliographic search in electronic databases (Web of Science, MEDLINE, SciELO, Scopus, PsycINFO, and Cochrane Library) considering studies published between 2013 and 2024. RESULTS A total of 434 records were identified, of which 252 underwent selection according to title and abstract, leaving 32 that were evaluated for eligibility and 7 included in this review. From Google Scholar, six more studies were identified and evaluated, and two were selected. Finally, nine studies were subjected to full reading and a detailed analysis of the inclusion criteria. A total of 66.6% of the studies were evaluated as having a methodological quality of moderate or optimal, but the samples analysed tended to be small, and only two articles carried out short-term follow-up evaluations. CONCLUSIONS Mindfulness-based interventions, upon reviewing the preliminary results, may be posited as a viable strategy to enhance psychological (anxiety, diabetes distress, perceived stress, depression, self-efficacy, psychological well-being, and quality of life) and biomedical outcomes (glycaemic control, blood glucose levels, and diastolic blood pressure) for type 1 diabetes in young people. Although promising, further research is required to improve the quality, methodology, and design of studies.
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Affiliation(s)
- Tamara Gutiérrez-Domingo
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Naima Z. Farhane-Medina
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Joaquín Villaécija
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Sebastián Vivas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Carmen Tabernero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Reina Sofia University Hospital, 14071 Córdoba, Spain
- Department of Psychology, University of Salamanca, 37007 Salamanca, Spain
- Institute of Neurosciences of Castilla y León (INCYL), University of Salamanca, 37007 Salamanca, Spain
| | - Rosario Castillo-Mayén
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Bárbara Luque
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
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James S, Cudizio L, Ng SM, Lyons S, Maruthur NM, Araszkiewicz A, Gomber A, Snoek F, Toft E, Weissberg-Benchell J, de Beaufort C. Transition between paediatric and adult diabetes healthcare services: An online global survey of healthcare professionals' experiences and perceptions. Diabetes Res Clin Pract 2024; 214:111768. [PMID: 38971378 DOI: 10.1016/j.diabres.2024.111768] [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: 04/05/2024] [Revised: 06/22/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Youth with diabetes should transition from paediatric to adult diabetes services in a deliberate, organized and cooperative way. We sought to identify healthcare professionals' (HCPs) experiences and perceptions around transition readiness planning, policies and procedures, and the actual transfer to adult services. METHODS Data were collected via an online global survey (seven language options), broadly advertised by the International Society for Pediatric and Adolescent Diabetes (ISPAD), European Association for the Study of Diabetes (EASD), team members and partners, via newsletters, websites, e-mails and social media. RESULTS Respondents (n = 372) were mainly physicians (74.5 %), practicing in government funded (59.4 %), paediatric (54.0 %), metropolitan settings (85.8 %) in Europe (44.9 %); 37.1 % in low and middle-income countries (LMICs). Few centers used a transition readiness checklist (32.8 %), provided written transition information (29.6 %), or had a dedicated staff member (23.7 %). Similarly, few involved a psychologist (25.8 %), had combined (35.2 %) or transition/young person-only clinics (34.9 %), or a structured transition education program (22.6 %); 49.8 % advised youth to use technology to assist the transfer. Most (91.9 %) respondents reported barriers in offering a good transition experience. Proportionally, more respondents from LMICs prioritised more funding (p = 0.01), a structured protocol (p < 0.001) and education (p < 0.001). CONCLUSION HCPs' experiences and perceptions related to transition vary widely. There is a pressing need for an international consensus transition guideline.
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Affiliation(s)
- Steven James
- University of the Sunshine Coast, Petrie, University of Melbourne, Parkville, and Western Sydney University, Campbelltown, Australia.
| | | | - Sze May Ng
- Edge Hill University, Liverpool, and Mersey and West Lancashire Teaching Hospitals National Health Service Trust, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Lyons
- Baylor College of Medicine, Houston, United States
| | - Nisa M Maruthur
- Johns Hopkins University School of Medicine, Baltimore, United States
| | | | | | - Frank Snoek
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Toft
- Karolinska Institute, Solna, and Ersta Hospital, Stokholm, Sweden
| | | | - Carine de Beaufort
- University of Luxembourg, Luxembourg, and Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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Perry L, Dunbabin J, Xu X, James S, Lowe J, Acharya S, Steinbeck KS. Service use and glycaemic control of young people with type 1 diabetes transitioning from paediatric to adult care: a 5-year study. Intern Med J 2024; 54:1164-1173. [PMID: 38573020 DOI: 10.1111/imj.16387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Regular contact with specialist care has been linked to better diabetes outcomes for young people with type 1 diabetes (YPwT1D), but evidence is limited to population-based service usage and outcomes. AIMS This observational 5-year study sought to capture YPwT1D living in the study catchment area (covering metropolitan, regional and rural Australia) as they transitioned to adult-based diabetes healthcare services and to describe their glycaemic control and complication rates, service usage and associated factors. METHODS Records between 2010 and 2014 in a public healthcare specialist diabetes database were extracted, care processes and outcomes were described, and associations were sought between episodes of care (EOC) and potentially predictive variables. RESULTS Annual cohort numbers increased yearly, but without significant differences in demographic characteristics. Each year around 40% had no reported planned specialist care, and the average number of planned EOC decreased significantly year on year. Overall, mean HbA1c levels also reduced significantly, but with higher values recorded for those living in non-metropolitan than metropolitan areas (achieving significance in 3 out of 5 years). Diabetes complication assessments were only reported in 37-46%, indicating one in five with retinopathy and hypertension affecting one in three to five young people. CONCLUSIONS Findings highlight the importance of investment to address the specific needs of adolescents and young adults and demonstrate the need for better support during these vulnerable early years, particularly for non-metropolitan residents. This will entail changes to funding mechanisms, the health workforce and infrastructure, and new models of care to provide equity of access and quality of specialist care.
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Affiliation(s)
- Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- South Eastern Sydney Local Health District, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Janet Dunbabin
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Xiaoyue Xu
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Steven James
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Julia Lowe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shamasunder Acharya
- Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Katharine S Steinbeck
- Discipline of Paediatrics and Child Health, University of Sydney, Camperdown, New South Wales, Australia
- The Sydney Children's Hospital Network, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Buchmann M, Tuncer O, Auzanneau M, Eckert AJ, Rosenbauer J, Reitzle L, Heidemann C, Holl RW, Thamm R. Incidence, prevalence and care of type 1 diabetes in children and adolescents in Germany: Time trends and regional socioeconomic situation. JOURNAL OF HEALTH MONITORING 2023; 8:57-78. [PMID: 37408713 PMCID: PMC10318564 DOI: 10.25646/11439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/21/2023] [Indexed: 07/07/2023]
Abstract
Background Trends over time and possible socio-spatial inequalities in the incidence and care of type 1 diabetes mellitus (T1D) in children and adolescents are important parameters for the planning of target-specific treatment structures. Methodology The incidence and prevalence of type 1 diabetes, diabetic ketoacidosis and severe hypoglycaemia as well as the HbA1c value are presented for under 18-year-olds based on data from the nationwide Diabetes Prospective Follow-up Registry (DPV) and the diabetes registry of North Rhine-Westphalia. Indicators were mapped by sex over time between 2014 and 2020, and stratified by sex, age and regional socioeconomic deprivation for 2020. Results In 2020, the incidence was 29.2 per 100,000 person-years and the prevalence was 235.5 per 100,000 persons, with the figures being higher in boys than in girls in either case. The median HbA1c value was 7.5%. Ketoacidosis manifested in 3.4% of treated children and adolescents, significantly more often in regions with very high (4.5%) deprivation than in regions with very low deprivation (2.4%). The proportion of severe hypoglycaemia cases was 3.0%. Between 2014 and 2020, the incidence, prevalence and HbA1c levels changed little, while the proportions of ketoacidosis and severe hypoglycaemia decreased. Conclusions The decrease in acute complications indicates that type 1 diabetes care has improved. Similar to previous studies, the results suggest an inequality in care by regional socioeconomic situation.
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Affiliation(s)
- Maike Buchmann
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Oktay Tuncer
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Marie Auzanneau
- Ulm University, Institute for Epidemiology and Medical Biometry, ZIBMT
- German Center for Diabetes Research (DZD), München-Neuherberg
| | - Alexander J. Eckert
- Ulm University, Institute for Epidemiology and Medical Biometry, ZIBMT
- German Center for Diabetes Research (DZD), München-Neuherberg
| | - Joachim Rosenbauer
- German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometrics and Epidemiology
- German Center for Diabetes Research (DZD), München-Neuherberg
| | - Lukas Reitzle
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Christin Heidemann
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Reinhard W. Holl
- Ulm University, Institute for Epidemiology and Medical Biometry, ZIBMT
- German Center for Diabetes Research (DZD), München-Neuherberg
| | - Roma Thamm
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
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Muacevic A, Adler JR. Laser Treatment Modalities for Diabetic Retinopathy. Cureus 2022; 14:e30024. [PMID: 36348830 PMCID: PMC9637280 DOI: 10.7759/cureus.30024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/07/2022] [Indexed: 11/15/2022] Open
Abstract
Diabetes is a chronic progressive metabolic disorder that is caused by the body's inability to regulate blood glucose levels. If uncontrolled, it can lead to various complications. Among its various complications, long-term diabetes leads to diabetic retinopathy (DR). It is a disease involving blood vessels and the destruction of retinal nerves. It is usually classified into two types: proliferative diabetic retinopathy (PDR) and nonproliferative diabetic retinopathy (NPDR). It progresses and causes loss of vision. The leading cause of loss of vision is diabetic macular edema (DME). The argon laser is used as a modality in the management of PDR. There are various types of laser photocoagulation, such as peripheral retinal laser photocoagulation, focal macular laser photocoagulation, and grid photocoagulation. DR results in various adverse consequences such as vitreous hemorrhage, fibrosis, traction, detachment of the retina, and glaucoma. To assess DR, a detailed fundus examination with a slit lamp biomicroscope needs to be done. Seven-standard field stereoscopic-color fundus photography needs to be done for documentation and follow-up. Patients with diabetes mellitus (DM) type 1 have a greater risk of suffering from DR. Another major complication of the condition is DME, which is characterized by an increase in the permeability of vessels and the thickening of the central part of the retina along with the accumulation of hard exudates on the macula. This article discusses various laser therapy modalities for the treatment of DR, their types, mechanisms, and aims. Clinical features of DR include abnormal dilatation of capillaries, and outpouchings in the form of microaneurysm from the capillary wall are one of the earliest and most dangerous changes; later, non-perfusion of the retina occurs, which is associated with cotton wool spots and blot hemorrhages. In patients suffering from PDR and maculopathy, peripheral retinal laser photocoagulation is used as a mode of intervention.
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Liu H, Li T, Yu H, Li J, Tan H, Yu Y. How to Achieve Sufficient Endogenous Insulin Suppression in Euglycemic Clamps Assessing the Pharmacokinetics and Pharmacodynamics of Long-Acting Insulin Preparations Employing Healthy Volunteers. Front Pharmacol 2022; 13:899798. [PMID: 35935883 PMCID: PMC9354408 DOI: 10.3389/fphar.2022.899798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
The therapeutic effect of basal insulin analogs will be sustained at a rather low insulin level. When employing healthy volunteers to assess the pharmacokinetics (PK) and pharmacodynamics (PD) of long-acting insulin preparations by euglycemic clamp techniques, endogenous insulin cannot be ignored and sufficient endogenous insulin inhibition is crucial for the PD and/or PK assessment. This study aimed to explore a way to sufficiently inhibit endogenous insulin secretion. Healthy Chinese male and female volunteers were enrolled. After a subcutaneous injection of insulin glargine (IGlar) (LY2963016 or Lantus) (0.5 IU/kg), they underwent a manual euglycemic clamp for up to 24 h where the target blood glucose (BG) was set as 0.28 mmol/L below the individual’s baseline. Blood samples were collected for analysis of PK/PD and C-peptide. The subjects fell into two groups according to the reduction extent of postdose C-peptide from baseline. After matching for the dosage proportion of Lantus, there were 52 subjects in group A (C-peptide reduction<50%) and 26 in group B (C-peptide reduction≥50%), respectively. No significant difference was detected in age, body mass index, the proportion of Latus treatment and female participants. A lower basal BG was observed in group B compared to group A (4.35 ± 0.26 vs. 4.59 ± 0.22 mmol/L, p < 0.05). The clamp studies were all conducted with high quality (where BG was consistently maintained around the target and exhibited a low variety). The binary logistic regression analysis indicated low basal BG as an independent factor for the success of sufficient endogenous insulin suppression. In conclusion, setting a lower sub-baseline target BG (e.g., 10% instead of 5% below baseline) might be an approach to help achieve sufficient endogenous insulin suppression in euglycemic clamps with higher basal BG levels (e.g., beyond 4.60 mmol/L).
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Affiliation(s)
- Hui Liu
- General Practice Ward, General Practice Medical Center, Sichuan University West China Hospital, Chengdu, China
| | - Ting Li
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, China
| | - Hongling Yu
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, China
| | - Jiaqi Li
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, China
| | - Huiwen Tan
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, China
| | - Yerong Yu
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, China
- *Correspondence: Yerong Yu,
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Taylor GS, Shaw A, Smith K, Capper TE, Scragg JH, Cronin M, Bashir A, Flatt A, Campbell MD, Stevenson EJ, Shaw JA, Ross M, West DJ. Type 1 diabetes patients increase CXCR4 + and CXCR7 + haematopoietic and endothelial progenitor cells with exercise, but the response is attenuated. Sci Rep 2021; 11:14502. [PMID: 34267242 PMCID: PMC8282661 DOI: 10.1038/s41598-021-93886-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/25/2021] [Indexed: 01/01/2023] Open
Abstract
Exercise mobilizes angiogenic cells, which stimulate vascular repair. However, limited research suggests exercise-induced increase of endothelial progenitor cell (EPCs) is completely lacking in type 1 diabetes (T1D). Clarification, along with investigating how T1D influences exercise-induced increases of other angiogenic cells (hematopoietic progenitor cells; HPCs) and cell surface expression of chemokine receptor 4 (CXCR4) and 7 (CXCR7), is needed. Thirty T1D patients and 30 matched non-diabetes controls completed 45 min of incline walking. Circulating HPCs (CD34+, CD34+CD45dim) and EPCs (CD34+VEGFR2+, CD34+CD45dimVEGFR2+), and subsequent expression of CXCR4 and CXCR7, were enumerated by flow cytometry at rest and post-exercise. Counts of HPCs, EPCs and expression of CXCR4 and CXCR7 were significantly lower at rest in the T1D group. In both groups, exercise increased circulating angiogenic cells. However, increases was largely attenuated in the T1D group, up to 55% lower, with CD34+ (331 ± 437 Δcells/mL vs. 734 ± 876 Δcells/mL p = 0.048), CD34+VEGFR2+ (171 ± 342 Δcells/mL vs. 303 ± 267 Δcells/mL, p = 0.006) and CD34+VEGFR2+CXCR4+ (126 ± 242 Δcells/mL vs. 218 ± 217 Δcells/mL, p = 0.040) significantly lower. Exercise-induced increases of angiogenic cells is possible in T1D patients, albeit attenuated compared to controls. Decreased mobilization likely results in reduced migration to, and repair of, vascular damage, potentially limiting the cardiovascular benefits of exercise.Trial registration: ISRCTN63739203.
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Affiliation(s)
- Guy S Taylor
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andy Shaw
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kieran Smith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tess E Capper
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Jadine H Scragg
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Michael Cronin
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Ayat Bashir
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anneliese Flatt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew D Campbell
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Emma J Stevenson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James A Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Ross
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Daniel J West
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
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Liu CF, Chen SC, Chen KJ, Liu L, Chen YP, Kang EYC, Liu PK, Yeung L, Wu WC, Lai CC, Lo FS, Wang NK. Higher HbA1c may reduce axial length elongation in myopic children: a comparison cohort study. Acta Diabetol 2021; 58:779-786. [PMID: 33587176 PMCID: PMC8487071 DOI: 10.1007/s00592-020-01631-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/31/2020] [Indexed: 01/19/2023]
Abstract
AIMS To compare the annual axial length (AL) changes in myopic children with type 1 diabetes mellitus (T1DM) and those without diabetes. METHODS There are two groups of myopic children in this retrospective cohort study. Group 1 consisted of myopic children with T1DM (44 eyes of 22 patients). Group 2 comprised age-matched myopic children without diabetes (44 eyes of 22 children). These two groups were compared with regard to their baseline clinical characteristics. A generalized estimating equations (GEE) model was also used to determine the most likely factor that contributed to the results. RESULTS The average ages of group 1 and group 2 were 14.8 and 14.6 years, respectively. Children in group 1 had significantly slower annual AL changes (0.051 mm/year vs 0.103 mm/year; 50.5% slower, P = 0.011) and shorter baseline AL (23.97 vs 25.19 mm, P < 0.001) than those in group 2. GEE also showed that serum glycated hemoglobin (HbA1c) level (B = -0.023, P = 0.039) was the most important factor in reducing AL elongation in group 1 myopic children. CONCLUSIONS Long-term higher HbA1c level may reduce AL elongation. A strict blood sugar control strategy in clinical practice is warranted to axial myopia progression in T1DM children.
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Affiliation(s)
- Chun-Fu Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- Program in Molecular Medicine, National Yang Ming University, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Chieh Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Jen Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Laura Liu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yen-Po Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Ophthalmology, Tucheng Municipal Hospital, New Taipei City, Taiwan
| | - Eugene Yu-Chuan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York, USA
| | - Ling Yeung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Fu-Sung Lo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Division of Pediatric Endocrinology and Genetics, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York, USA.
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Katz ML, Kaushal T, Guo Z, Cheema A, Gerrard R, Laffel LM. Adolescent and Parent Perceptions of Long-Term Type 1 Diabetes Complications. Diabetes Spectr 2021; 34:52-59. [PMID: 33627994 PMCID: PMC7887537 DOI: 10.2337/ds20-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS Conversations about diabetes complications with adolescents and parents can be difficult and emotionally charged. To better inform conversations between providers and families, we sought adolescent and parent perspectives regarding their knowledge of long-term complications (LTCs), where they receive this information, and what they would like to learn from clinicians. METHODS Adolescents with type 1 diabetes and parents of adolescents with type 1 diabetes participated in semistructured interviews querying knowledge of LTCs, sources of information, and preferred ways for providers to discuss LTCs. Interview transcripts were coded and categorized into central themes by content analysis. RESULTS Participants included 22 adolescents (17.4 ± 1.7 years of age, diabetes duration 9.7 ± 4.0 years) and 25 parents (41-60 years of age, 84% mothers). Five themes related to complications were identified: 1) "Limited Adolescent Knowledge of Complications," 2) "Discussing Complications Is Important but Not Now or Not for Me," 3) "Outside Sources Overestimate Risk," 4) "Avoid Scare Tactics" and 5) "Emphasize Prevention." Adolescent and parent perspectives were similar, although parents showed greater understanding of complications. CONCLUSION When discussing complications, individualized, factual, positive, and prevention-focused conversations may be better received by adolescents with type 1 diabetes and their families.
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Salvy SJ, Carandang K, Vigen CL, Concha-Chavez A, Sequeira PA, Blanchard J, Diaz J, Raymond J, Pyatak EA. Effectiveness of social media (Facebook), targeted mailing, and in-person solicitation for the recruitment of young adult in a diabetes self-management clinical trial. Clin Trials 2020; 17:664-674. [PMID: 32627589 DOI: 10.1177/1740774520933362] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Research is needed to identify promising recruitment strategies to reach and engage diverse young adults in diabetes clinical research. The aim of this study was to examine the relative strengths and weaknesses of three recruitment strategies used in a diabetes self-management clinical trial: social media advertising (Facebook), targeted mailing, and in-person solicitation of clinic patients. METHODS Strategies were compared in terms of (1) cost-effectiveness (i.e. cost of recruitment/number of enrolled participants), (2) ability to yield participants who would not otherwise be reached by alternative strategies, and (3) likelihood of participants recruited through each strategy to adhere to study procedures. We further explored the appeal (overall and among age and gender subgroups) of social media advertisement features. RESULTS In-person recruitment of clinic patients was overall the most cost-effective strategy. However, differences in demographic, clinical, and psychosocial characteristics of participants recruited via different strategies suggest that the combination of these approaches yielded a more diverse sample than would any one strategy alone. Once successfully enrolled, there was no difference in study completion and intervention adherence between individuals recruited by the three recruitment strategies. CONCLUSIONS Ultimately, the utility of a recruitment strategy is defined by its ability to effectively attract people representative of the target population who are willing to enroll in and complete the study. Leveraging a variety of recruitment strategies appears to produce a more representative sample of young adults, including those who are less engaged in diabetes care.
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Affiliation(s)
- Sarah-Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | | | - Cheryl Lp Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | | | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jesus Diaz
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
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11
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Bronner MB, Peeters MAC, Sattoe JNT, van Staa A. The impact of type 1 diabetes on young adults' health-related quality of life. Health Qual Life Outcomes 2020; 18:137. [PMID: 32398086 PMCID: PMC7218580 DOI: 10.1186/s12955-020-01370-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/17/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Young adulthood is a challenging period for people with diabetes mellitus type 1 (T1DM) as they are facing multiple life transitions while managing a demanding disease. This poses a risk for impaired health-related quality of life (HRQOL). We assessed HRQOL in a cohort of young adults with T1DM in the Netherlands, and compared outcomes with those of Dutch norm groups of healthy young adults and young adults with a chronic disease. METHODS We analyzed data collected in a larger evaluation study on transitional care for young adults with T1DM in a nationwide sample in the Netherlands, including twelve participating hospitals. These data had been obtained from online questionnaires completed by young adults with T1DM after they had transferred to adult care. HRQOL was self-reported with the Pediatric Quality of Life Inventory for young adults (PedsQL-YA). RESULTS One hundred and sixty-five young adults with T1DM participated (44.2% response); and they scored significantly worse than did healthy peers on all domains of HRQOL, except social functioning. Particularly, functioning at school or work was worse than that of the norm group. The study group's HRQOL-scores were comparable to norm scores of young adults with chronic diseases, although the physical and social functioning of young people with T1DM was better. One quarter (26.1%) of all young adults with T1DM reported fatigue. CONCLUSIONS During transition to adulthood, young adults with T1DM struggle to maintain a balance between the demands of managing a disease and their life. Many of them encounter problems at work or school, and suffer from fatigue. These findings underscore the need to regularly assess HRQOL, and to discuss work- and education-related issues in clinical practice.
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Affiliation(s)
- Madelon B Bronner
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Mariëlle A C Peeters
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jane N T Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands. .,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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12
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Serag H, El Wakeel L, Adly A. Coenzyme Q10 administration has no effect on sICAM-1 and metabolic parameters of pediatrics with type 1 diabetes mellitus. INT J VITAM NUTR RES 2020; 91:315-324. [PMID: 31942840 DOI: 10.1024/0300-9831/a000636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Endothelial dysfunction (ED) plays a key role in the development and progression of microvascular and macrovascular complications in pediatrics with type 1 diabetes mellitus (T1DM). Coenzyme Q10 (CoQ10) is a nutraceutical with a known anti-inflammatory and anti-oxidant activity. This study was conducted to evaluate the potential effect of CoQ10 on ED and various metabolic parameters. Methods: This prospective randomized open-label pilot study was conducted on 49 T1DM pediatric patients. Seven healthy non-diabetic pediatric subjects who didn't receive treatment were included as a control group. Eligible patients were randomly allocated into either group I (n = 25); received 100 mg of CoQ10 in addition to standard treatment or group II (n = 24); received standard treatment only. The levels of; soluble intracellular adhesion molecule-1 (sICAM-1), glycated hemoglobin (HbA1c), fasting blood glucose (FBG), lipid profile, serum creatinine and liver function tests were assessed for both groups at baseline and after 3 months of treatment. Results: At baseline, compared to an age-matched healthy control group sICAM-1 levels were significantly elevated in group II diabetic patients (276.5 (231.6-320.66) vs 221.8 (177.9-267.1 ng/ml), p = 0.042. After 3 months of treatment no significant difference was observed in sICAM-1, HbA1c, FBG, lipid profile, serum creatinine and liver function tests between the two study groups. A positive correlation was found between sICAM-1 and HbA1c throughout the study (r = 0.308, p = 0.0054). Conclusion: Administration of CoQ10 for 3 months in T1DM pediatric patients was well tolerated but had no favorable effect on ED or metabolic parameters.
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Affiliation(s)
- Heba Serag
- Department of Clinical Pharmacy, Faculty of Pharmacy Ain Shams University, Cairo, Egypt
| | - Lamia El Wakeel
- Department of Clinical Pharmacy, Faculty of Pharmacy Ain Shams University, Cairo, Egypt
| | - Amira Adly
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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13
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Blair J, McKay A, Ridyard C, Thornborough K, Bedson E, Peak M, Didi M, Annan F, Gregory JW, Hughes D, Gamble C. Continuous subcutaneous insulin infusion versus multiple daily injections in children and young people at diagnosis of type 1 diabetes: the SCIPI RCT. Health Technol Assess 2019; 22:1-112. [PMID: 30109847 DOI: 10.3310/hta22420] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The risk of developing long-term complications of type 1 diabetes (T1D) is related to glycaemic control and is reduced by the use of intensive insulin treatment regimens: multiple daily injections (MDI) (≥ 4) and continuous subcutaneous insulin infusion (CSII). Despite a lack of evidence that the more expensive treatment with CSII is superior to MDI, both treatments are used widely within the NHS. OBJECTIVES (1) To compare glycaemic control during treatment with CSII and MDI and (2) to determine safety and cost-effectiveness of the treatment, and quality of life (QoL) of the patients. DESIGN A pragmatic, open-label randomised controlled trial with an internal pilot and 12-month follow-up with 1 : 1 web-based block randomisation stratified by age and centre. SETTING Fifteen diabetes clinics in hospitals in England and Wales. PARTICIPANTS Patients aged 7 months to 15 years. INTERVENTIONS Continuous subsutaneous insulin infusion or MDI initiated within 14 days of diagnosis of T1D. DATA SOURCES Data were collected at baseline and at 3, 6, 9 and 12 months using paper forms and were entered centrally. Data from glucometers and CSII were downloaded. The Health Utilities Index Mark 2 was completed at each visit and the Pediatric Quality of Life Inventory (PedsQL, diabetes module) was completed at 6 and 12 months. Costs were estimated from hospital patient administration system data. OUTCOMES The primary outcome was glycosylated haemoglobin (HbA1c) concentration at 12 months. The secondary outcomes were (1) HbA1c concentrations of < 48 mmol/mol, (2) severe hypoglycaemia, (3) diabetic ketoacidosis (DKA), (4) T1D- or treatment-related adverse events (AEs), (5) change in body mass index and height standard deviation score, (6) insulin requirements, (7) QoL and (8) partial remission rate. The economic outcome was the incremental cost per quality-adjusted life-year (QALY) gained. RESULTS A total of 293 participants, with a median age of 9.8 years (minimum 0.7 years, maximum 16 years), were randomised (CSII, n = 149; MDI, n = 144) between May 2011 and January 2015. Primary outcome data were available for 97% of participants (CSII, n = 143; MDI, n = 142). At 12 months, age-adjusted least mean squares HbA1c concentrations were comparable between groups: CSII, 60.9 mmol/mol [95% confidence interval (CI) 58.5 to 63.3 mmol/mol]; MDI, 58.5 mmol/mol (95% CI 56.1 to 60.9 mmol/mol); and the difference of CSII - MDI, 2.4 mmol/mol (95% CI -0.4 to 5.3 mmol/mol). For HbA1c concentrations of < 48 mmol/mol (CSII, 22/143 participants; MDI, 29/142 participants), the relative risk was 0.75 (95% CI 0.46 to 1.25), and for partial remission rates (CSII, 21/86 participants; MDI, 21/64), the relative risk was 0.74 (95% CI 0.45 to 1.24). The incidences of severe hypoglycaemia (CSII, 6/144; MDI, 2/149 participants) and DKA (CSII, 2/144 participants; MDI, 0/149 participants) were low. In total, 68 AEs (14 serious) were reported during CSII treatment and 25 AEs (eight serious) were reported during MDI treatment. Growth outcomes did not differ. The reported insulin use was higher with CSII (mean difference 0.1 unit/kg/day, 95% CI 0.0 to 0.2 unit/kg/day; p = 0.01). QoL was slightly higher for those randomised to CSII. From a NHS perspective, CSII was more expensive than MDI mean total cost (£1863, 95% CI £1620 to £2137) with no additional QALY gains (-0.006 QALYs, 95% CI -0.031 to 0.018 QALYs). LIMITATIONS Generalisability beyond 12 months is uncertain. CONCLUSIONS No clinical benefit of CSII over MDI was identified. CSII is not a cost-effective treatment in patients representative of the study population. FUTURE WORK Longer-term follow-up is required to determine if clinical outcomes diverge after 1 year. A qualitative exploration of patient and professional experiences of MDI and CSII should be considered. TRIAL REGISTRATION Current Controlled Trials ISRCTN29255275 and EudraCT 2010-023792-25. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 42. See the NIHR Journals Library website for further project information. The cost of insulin pumps and consumables supplied by F. Hoffman-La Roche AG (Basel, Switzerland) for the purpose of the study were subject to a 25% discount on standard NHS costs.
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Affiliation(s)
- Joanne Blair
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andrew McKay
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Colin Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Keith Thornborough
- Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Emma Bedson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Matthew Peak
- Department of Research, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Mohammed Didi
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Francesca Annan
- Paediatric and Adolescent Division, University College Hospital, London, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Carrol Gamble
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
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Kamaleldeen EB, Mohammad HA, Mohamed EF, Askar AG. Microvascular complications in children and adolescents with type 1 diabetes mellitus in Assiut governorate, Egypt. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2018. [DOI: 10.1016/j.epag.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Marcovecchio ML, Chiesa ST, Armitage J, Daneman D, Donaghue KC, Jones TW, Mahmud FH, Marshall SM, Neil HAW, Dalton RN, Deanfield J, Dunger DB, Acerini C, Ackland F, Anand B, Barrett T, Birrell V, Campbell F, Charakida M, Cheetham T, Chiesa S, Cooper C, Doughty I, Dutta A, Edge J, Gray A, Hamilton-Shield J, Mann N, Marcovecchio ML, Rayman G, Robinson JM, Russell-Taylor M, Sankar V, Smith A, Thalange N, Yaliwal C, Benitez-Aguirre P, Cameron F, Cotterill A, Couper J, Craig M, Davis E, Donaghue K, Jones TW, Verge C, Bergman P, Rodda C, Clarson C, Curtis J, Daneman D, Mahmud F, Sochett E, Marshall S, Armitage J, Bingley P, Van’t Hoff W, Dunger D, Dalton N, Daneman D, Neil A, Deanfield J, Jones T, Donaghue K, Baigent C, Emberson J, Flather M, Bilous R. Renal and Cardiovascular Risk According to Tertiles of Urinary Albumin-to-Creatinine Ratio: The Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT). Diabetes Care 2018; 41:1963-1969. [PMID: 30026334 DOI: 10.2337/dc18-1125] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/17/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Baseline data from the Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT) indicated that tertiles of urinary albumin-to-creatinine ratios (ACRs) in the normal range at age 10-16 years are associated with risk markers for diabetic nephropathy (DN) and cardiovascular disease (CVD). We aimed to determine whether the top ACR tertile remained associated with DN and CVD risk over the 2-4-year AdDIT study. RESEARCH DESIGN AND METHODS One hundred fifty adolescents (mean age 14.1 years [SD 1.6]) with baseline ACR in the upper tertile (high-ACR group) recruited to the AdDIT trial, who remained untreated, and 396 (age 14.3 years [1.6]) with ACR in the middle and lower tertiles (low-ACR group), who completed the parallel AdDIT observational study, were evaluated prospectively with assessments of ACR and renal and CVD markers, combined with carotid intima-media thickness (cIMT) at baseline and end of study. RESULTS After a median follow-up of 3.9 years, the cumulative incidence of microalbuminuria was 16.3% in the high-ACR versus 5.5% in the low-ACR group (log-rank P < 0.001). Cox models showed independent contributions of the high-ACR group (hazard ratio 4.29 [95% CI 2.08-8.85]) and HbA1c (1.37 [1.10-1.72]) to microalbuminuria risk. cIMT change from baseline was significantly greater in the high- versus low-ACR group (mean difference 0.010 mm [0.079], P = 0.006). Changes in estimated glomerular filtration rate, systolic blood pressure, and hs-CRP were also significantly greater in the high-ACR group (P < 0.05). CONCLUSIONS ACR at the higher end of the normal range at the age of 10-16 years is associated with an increased risk of progression to microalbuminuria and future CVD risk, independently of HbA1c.
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Affiliation(s)
| | - Scott T. Chiesa
- National Centre for Cardiovascular Prevention and Outcomes, University College London, London, U.K
| | - Jane Armitage
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Denis Daneman
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kim C. Donaghue
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, University of Sydney, Camperdown, New South Wales, Australia
| | - Timothy W. Jones
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Farid H. Mahmud
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sally M. Marshall
- Institute of Cellular Medicine (Diabetes), Faculty of Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne, U.K
| | - H. Andrew W. Neil
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K
| | - R. Neil Dalton
- Guy’s and St Thomas’ National Health Service Foundation Trust, London, U.K
| | - John Deanfield
- National Centre for Cardiovascular Prevention and Outcomes, University College London, London, U.K
| | - David B. Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, U.K
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
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16
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Nomogram for prediction of non-proliferative diabetic retinopathy in juvenile-onset type 1 diabetes: a cohort study in an Asian population. Sci Rep 2018; 8:12164. [PMID: 30111889 PMCID: PMC6093915 DOI: 10.1038/s41598-018-30521-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/01/2018] [Indexed: 12/18/2022] Open
Abstract
The need for screening for retinopathy in patients with type 1 diabetes mellitus (T1DM) has been emphasised, but diagnostic delays were reported when screening was done at fixed intervals. To establish an individualised risk-prediction model to assist screening non-proliferative diabetic retinopathy (NPDR) in T1DM, we performed a retrospective cohort study enrolling participants in the Chang Gung Juvenile Diabetes Eye Study. There were 413 patients with 12 381 records analysed from 2005 to 2015. A time-dependent Cox proportional hazard analysis was used to evaluate the risks of NPDR development and a nomogram with risk-stratification indicators was established based on the results. During 97 months of follow-up, 43 of 413 patients (10.4%) developed NPDR. Male sex (HR: 0.4, 95% CI: 0.19–0.85), age 5–14 years at onset of T1DM (6.38, 2.41–16.87), duration of diabetes (1.57, 1.41–1.75), and hemoglobin A1c level (1.56, 1.35–1.80) were independently associated with NPDR. Using the nomogram offers a quick method in the clinical setting to interpret the risk of NPDR development. Based on its weighting, each of the independent factors is allocated a score, and the total points indicate the probabilities of NPDR occurring within 6 months, 1 year, and 3 years.
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17
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Elbarbary NS, Ismail EAR, El-Naggar AR, Hamouda MH, El-Hamamsy M. The effect of 12 weeks carnosine supplementation on renal functional integrity and oxidative stress in pediatric patients with diabetic nephropathy: a randomized placebo-controlled trial. Pediatr Diabetes 2018; 19:470-477. [PMID: 28744992 DOI: 10.1111/pedi.12564] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/16/2017] [Accepted: 06/27/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Oxidative stress is a significant contributor to the pathogenesis of diabetic nephropathy. Carnosine is a natural radical oxygen species scavenger. We investigated the effect of carnosine as an adjuvant therapy on urinary albumin excretion (UAE), the tubular damage marker alpha 1-microglobulin (A1M), and oxidative stress in pediatric patients with type 1 diabetes and nephropathy. METHODS This randomized placebo-controlled trial included 90 patients with diabetic nephropathy, despite oral angiotensin-converting enzyme inhibitors (ACE-Is), who were randomly assigned to receive either 12 weeks of carnosine 1 g/day (n = 45), or matching placebo (n = 45). Both groups were followed-up with assessment of hemoglobin A1c (HbA1c), UAE, A1M, total antioxidant capacity (TAC) and malondialdhyde (MDA). RESULTS Baseline clinical and laboratory parameters were consistent between carnosine and placebo groups (P > .05). After 12 weeks, carnosine treatment resulted in significant decrease of HbA1c (8.2 ± 2.1% vs 7.4 ± 1.3%), UAE (91.7 vs 38.5 mg/g creatinine), A1M (16.5 ± 6.8 mg/L vs 9.3 ± 6.6 mg/L), MDA levels (25.5 ± 8.1 vs 18.2 ± 7.7 nmol/mL) while TAC levels were increased compared with baseline levels (P < .001) and compared with placebo (P < .001). No adverse reactions due to carnosine supplementation were reported. Baseline TAC was inversely correlated to HbA1c (r = -0.58, P = .04) and A1M (r = -0.682, P = .015) among carnosine group. CONCLUSIONS Oral supplementation with L-Carnosine for 12 weeks resulted in a significant improvement of oxidative stress, glycemic control and renal function. Thus, carnosine could be a safe and effective strategy for treatment of pediatric patients with diabetic nephropathy.
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Affiliation(s)
| | | | - Abdel Rahman El-Naggar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Modern technology and Information University, Cairo, Egypt
| | - Mahitab Hany Hamouda
- Department of Clinical Pharmacy, Faculty of Pharmacy, Modern technology and Information University, Cairo, Egypt
| | - Manal El-Hamamsy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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18
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Role of neopterin as a biochemical marker for peripheral neuropathy in pediatric patients with type 1 diabetes: Relation to nerve conduction studies. Int Immunopharmacol 2018; 59:68-75. [PMID: 29627577 DOI: 10.1016/j.intimp.2018.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/17/2018] [Accepted: 03/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neopterin, a marker of inflammation and cellular immune response, is elevated in conditions of T-cell or macrophages activation. Diabetic peripheral neuropathy (DPN) is associated with inflammatory/immune processes and therefore, we hypothesized that neopterin could be used as a marker of neuropathy in type 1 diabetes mellitus (T1DM). AIM To measure neopterin levels in children and adolescents with T1DM and assess its possible relation to DPN and nerve conduction studies (NCS). METHODS Sixty patients aged ≤18 years and >5 years disease duration were subjected to neurological assessment by neuropathy disability score (NDS) and NCS for median, ulnar, posterior tibial and common peroneal nerves. Mean fasting blood glucose, lipid profile, HbA1c, high sensitivity C-reactive protein (hs-CRP) and serum neopterin levels were assessed. Patients were compared with 30 age- and sex-matched healthy controls. RESULTS The frequency of DPN according to NDS was 40 (66.7%) patients out of 60 while NCS confirmed that only 30 of those 40 patients had this complication (i.e. 50% out of the total studied patients). Neopterin levels were significantly higher in patients with DPN than those without (median [IQR], 53.5 [35-60] nmol/L versus 17 [13-32] nmol/L) and healthy controls (5.0 [3.2-7.0] nmol/L) (p < 0.001). Significant positive correlations were found between neopterin levels and HbA1c (r = 0.560, p = 0.005), serum creatinine (r = 0.376, p = 0.003), total cholesterol (r = 0.405, p = 0.026) and hs-CRP (r = 0.425, p = 0.012) among patients with DPN. Neopterin levels were positively correlated to motor latency of tibial and common peroneal nerves as well as motor and sensory latencies of median and ulnar nerves. Logistic regression analysis revealed that neopterin was a significant independent variable related to DPN (Odds ratio, 2.976). Neopterin cutoff value 32 nmol/L could differentiate patients with and without DPN with 100% sensitivity and 96.7% specificity. CONCLUSIONS Neopterin could be used as an early reliable serum biomarker for DPN in pediatric patients with T1DM.
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Dunger DB, Marcovecchio ML, Deanfield J. ACE Inhibitors and Statins in Adolescents with Type 1 Diabetes. N Engl J Med 2018; 378:580. [PMID: 29419270 DOI: 10.1056/nejmc1715763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - John Deanfield
- UCL Institute of Cardiovascular Science, London, United Kingdom
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20
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El-Samahy MH, Tantawy AAG, Adly AAM, Habeeb NM, Ismail EAR, Hamed GM, Eladawy R. Expression of CD4 + CD28 null T lymphocytes in children and adolescents with type 1 diabetes mellitus: Relation to microvascular complications, aortic elastic properties, and carotid intima media thickness. Pediatr Diabetes 2017; 18:785-793. [PMID: 28102614 DOI: 10.1111/pedi.12484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiovascular risk in type 1 diabetes mellitus (T1DM) is associated with endothelial dysfunction, inflammation, and altered immunity. CD4+ CD28null T-cells are a subset of long-lived cytotoxic CD4+ T-lymphocytes with proatherogenic and plaque-destabilizing properties. We hypothesized that the frequency of CD4+ CD28null T-cells may be altered in T1DM and related to vascular complications. AIM To assess the percentage of CD4+ CD28null T-lymphocytes in children and adolescents with T1DM and their relation to vascular structure and glycemic control. METHODS Totally 100 patients with T1DM were divided into 2 groups according to the presence of microvascular complications and compared with 50 healthy controls. CD4+ CD28null T-lymphocytes were analyzed using flow cytometry. Aortic elastic properties and carotid intima media thickness (CIMT) were assessed. RESULTS Aortic stiffness index and CIMT were significantly higher among patients compared with healthy controls while aortic strain and distensibility were decreased. The percentage of CD4+ CD28null T-cells was significantly higher in patients with and without microvascular complications compared with controls. High frequency of CD4+ CD28null T-cells was found among patients with microalbuminuria or peripheral neuropathy. Patients with CD4+ CD28null T-cells ≥10% had higher HbA1c, urinary albumin creatinine ratio, aortic stiffness, and CIMT. CD4+ CD28null T-cells were positively correlated to HbA1c, aortic stiffness index, and CIMT. CONCLUSIONS Changes in aortic elastic properties and increased CIMT among young patients with T1DM may enable the recognition of preclinical cardiac impairment. The correlation between CD4+ CD28null T-cells and assessed parameters of vascular structure highlights the role of altered immune response in the occurrence of diabetic vascular complications.
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Affiliation(s)
- Mona H El-Samahy
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Azza A G Tantawy
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amira A M Adly
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nevin M Habeeb
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman A R Ismail
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Gehan M Hamed
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rasha Eladawy
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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21
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Carlsen S, Skrivarhaug T, Thue G, Cooper JG, Gøransson L, Løvaas K, Sandberg S. Glycemic control and complications in patients with type 1 diabetes - a registry-based longitudinal study of adolescents and young adults. Pediatr Diabetes 2017; 18:188-195. [PMID: 26875589 DOI: 10.1111/pedi.12372] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The main aims of this study were to assess longitudinal glycemic control and the prevalence of retinopathy and nephropathy in young people (aged 14-30 yr) with type 1 diabetes in Norway. METHOD Data on 874 patients were obtained by linking two nationwide, population-based medical quality registries: The Norwegian Diabetes Register for Adults and The Norwegian Childhood Diabetes Registry. RESULTS Median age was 23 yr, median diabetes duration 9 yr and 51% were male. Median HbA1c increased through adolescence to peak at ages of 17 yr for females and 19 yr for males, females had higher HbA1c than males: 9.3% (78 mmol/mol) vs. 9.1% (76 mmol/mol). Subsequently, median HbA1c declined but was still >8% (>64 mmol/mol) for patients approaching 30 yr. Half of the patients aged 14-17 yr and 40% of patients aged 18-25 yr had HbA1c >9% (75 mmol/mol). Retinopathy was found in 16% and nephropathy in 13% of the population. Patients transferring from the pediatric department to adult care between the ages of 14 and 17 yr had higher median HbA1c and prevalence of late complications than those transferring at ages 18-22 yr. Less than 40% of patients with albuminuria were treated with ACE inhibitors or angiotensin II receptor blocker. CONCLUSION Our results demonstrate that treatment of adolescents and young adults with type 1 diabetes in Norway is not optimal, especially for patients in their late teens. We suggest that pediatricians and endocrinologists should critically assess the care offered to this group and consider new approaches to help them improve glycemic control.
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Affiliation(s)
- Siri Carlsen
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Torild Skrivarhaug
- Department of Paediatrics, Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Geir Thue
- Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - John G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway.,Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Lasse Gøransson
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Karianne Løvaas
- Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Primary Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
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22
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James S, Perry L, Gallagher R, Lowe J. Diabetes Educators' Intended and Reported Use of Common Diabetes-Related Technologies: Discrepancies and Dissonance. J Diabetes Sci Technol 2016; 10:1277-1286. [PMID: 27179011 PMCID: PMC5094322 DOI: 10.1177/1932296816646798] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Technology provides adjuvant and/or alternative approaches to care and may promote self-care, communication, and engagement with health care services. Common recent technologies for diabetes include continuous subcutaneous insulin infusions (insulin pumps), continuous glucose monitoring systems, smartphone and tablet applications, and telehealth (video conferencing). This study reports Australian diabetes educators' intentions and reported professional use of these technologies for people with type 1 diabetes, and factors predictive of this. METHODS An anonymous, web-based questionnaire based on the technology acceptance model was distributed to members of the Australian Diabetes Educators Association through their electronic newsletter. Exploratory factor analysis revealed a 5-factor solution comprising confidence and competence, improving clinical practice, preparation (intentions and training), ease of use, and subjective norms. Logistic regression analyses identified factors predicting intention and use of technology. RESULTS Respondents (n = 228) had high intentions to use technology. The majority reported using continuous subcutaneous insulin infusions, continuous glucose monitoring systems, and applications with patients, but usage was occasional. Confidence and competence independently predicted both intentions and use of all 4 technologies. Preparation (intentions and training) independently predicted use of each technology also. CONCLUSIONS Discrepancies and dissonance appear between diabetes educators' intentions and behavior (intentions to use and reported technology use). Intentions were higher than current use, which was relatively low and not likely to provide significant support to people with type 1 diabetes for disease management, communication, and engagement with health care services. Continuing education and experiential learning may be key in supporting diabetes educators to align their intentions with their practice.
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Affiliation(s)
- Steven James
- University of Technology Sydney, Ultimo, NSW, Australia
| | - Lin Perry
- University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Julia Lowe
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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23
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Kreider KE, Padilla BI. Type 1 diabetes & cardiovascular disease. Nurse Pract 2016; 41:18-25. [PMID: 27623295 DOI: 10.1097/01.npr.0000497007.02127.fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Individuals with type 1 diabetes mellitus (T1DM) have a high risk of developing cardiovascular disease (CVD), but some risk factors can be mediated by lifestyle modification and medication. NPs should understand evidence-based management approaches to counsel patients with T1DM on appropriate self-management interventions to reduce the likelihood of CVD.
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Affiliation(s)
- Kathryn Evans Kreider
- Kathryn Evans Kreider is an assistant professor at Duke University School of Nursing, Durham, N.C., and currently practices as an NP in Endocrinology at Duke University Medical Center. Blanca I. Padilla is an assistant professor at Duke University School of Nursing, Durham, N.C., and currently practices as an NP in Endocrinology at Duke University Medical Center
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24
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van der Heyden JC, Birnie E, Mul D, Bovenberg S, Veeze HJ, Aanstoot HJ. Increased skin autofluorescence of children and adolescents with type 1 diabetes despite a well-controlled HbA1c: results from a cohort study. BMC Endocr Disord 2016; 16:49. [PMID: 27613110 PMCID: PMC5017065 DOI: 10.1186/s12902-016-0129-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/16/2016] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Early identification of children and adolescents with type 1 diabetes at high risk for development of complications is important, as early intervention may prevent further deterioration. Here we investigate the applicability of assessing skin advanced glycation end products (sAGEs) by skin autofluorescence (SAF) as a potential surrogate risk marker. METHODS This study included a cross-sectional analysis of SAF in 77 patients with type 1 diabetes mellitus and 118 healthy controls across age categories (11-12, 13-14, 15-16, and 17-19 years old). In patients, the impact of current and historical glycated hemoglobin (HbA1c) values, age, and duration of diabetes on SAF was studied in a retrospective cohort study and analyzed with multivariable analyses. RESULTS SAF was significantly and similarly higher in patients when compared with controls across all age categories (P ≤0.009). For patients, age, duration of diabetes, and current and historical HbA1c were associated with SAF in univariate analysis. Multivariate analysis showed no association between HbA1c and SAF. A subgroup of patients with a HbA1c-within-target (≤7.5 %/59 mmol/mol) were observed to have high SAF. CONCLUSION Children and adolescents with type 1 diabetes show higher SAF than controls. The presumed correlation of high HbA1c with high SAF does not exist in all patients. Thus, use of this non-invasive measure may provide a surrogate marker for diabetic complications, additional to HbA1c.
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Affiliation(s)
- Josine C. van der Heyden
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, Netherlands
- Department of Pediatric Endocrinology, Sophia Children’s Hospital, Erasmus MC, University Medical Centre, Wytemaweg 80, 3015 CN Rotterdam, Netherlands
- Department of Pediatrics, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, Netherlands
| | - Erwin Birnie
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - Dick Mul
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, Netherlands
| | - Sarah Bovenberg
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, Netherlands
| | - Henk J. Veeze
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, Netherlands
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25
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James S, Perry L, Gallagher R, Lowe J. Diabetes Educators: Perceived Experiences, Supports and Barriers to Use of Common Diabetes-Related Technologies. J Diabetes Sci Technol 2016; 10:1115-21. [PMID: 27417141 PMCID: PMC5032969 DOI: 10.1177/1932296816660326] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Various technologies are commonly used to support type 1 diabetes management (continuous subcutaneous insulin infusion therapy, continuous glucose monitoring systems, smartphone and tablet applications, and video conferencing) and may foster self-care, communication, and engagement with health care services. Diabetes educators are key professional supporters of this patient group, and ideally positioned to promote and support technology use. The aim of this study was to examine diabetes educators' perceived experiences, supports, and barriers to use of common diabetes-related technologies for people with type 1 diabetes. METHODS This qualitative ethnographic study recruited across metropolitan, regional and rural areas of Australia using purposive sampling of Australian Diabetes Educators Association members. Data were collected by semistructured telephone interviews and analyzed using thematic analysis. RESULTS Participants (n = 31) overwhelmingly indicated that overall the use of technology in the care of patients with type 1 diabetes was burdensome for them. They identified 3 themes involving common diabetes-related technologies: access to technology, available support, and technological advances. Overall, these themes demonstrated that while care was usually well intentioned it was more often fragmented and inconsistent. Most often care was provided by a small number of diabetes educators who had technology expertise. CONCLUSIONS To realize the potential benefits of these relatively new but common diabetes technologies, many diabetes educators need to attain and retain the skills required to deliver this essential component of care. Furthermore, policy and strategy review is required, with reconfiguration of services to better support care delivery.
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Affiliation(s)
- Steven James
- University of Technology Sydney, Ultimo, NSW, Australia
| | - Lin Perry
- University of Technology Sydney/South East Sydney Local Health District, Prince of Wales Hospital, Randwick, NSW, Australia
| | | | - Julia Lowe
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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26
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El-Asrar MA, Elbarbary NS, Ismail EAR, Bakr AA. Circulating angiopoietin-2 levels in children and adolescents with type 1 diabetes mellitus: relation to carotid and aortic intima-media thickness. Angiogenesis 2016; 19:421-31. [PMID: 27236773 DOI: 10.1007/s10456-016-9517-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Angiopoietin-2 is a growth factor involved in the pathophysiology of vascular and inflammatory diseases such as arteriosclerosis. Carotid or aortic scans provide noninvasive screening tools for assessment of preclinical atherosclerosis in high-risk children. AIM We assessed serum angiopoietin-2 in children and adolescents with type 1 diabetes mellitus as a potential marker for vascular complications in relation to glycemic control, inflammation and vascular structure. METHODS Sixty patients with type 1 diabetes were divided into 2 groups according to the presence of micro-vascular complications and compared with 30 healthy controls. High-sensitivity C-reactive protein (hs-CRP), hemoglobin A1c (HbA1c), urinary albumin/creatinine ratio, serum angiopoietin-2, carotid and aortic intima-media thickness (CIMT and AIMT) were measured. RESULTS CIMT, AIMT and serum angiopoietin-2 levels were significantly increased in patients with and without micro-vascular complications compared with controls, and the highest levels were in patients with complications (p < 0.001). Angiopoietin-2 was higher in patients with microalbuminuria than normoalbuminuric group (p < 0.001). Fasting blood glucose, HbA1c, hs-CRP, CIMT and AIMT were independently related to angiopoietin-2 in multiple regression analysis. Disease duration, hyperglycemia, poor glycemic control, hypercholesterolemia, inflammation and angiopoietin-2 were independent factors contributing to atherosclerosis risk. CONCLUSION The relation between angiopoietin-2 and assessed parameters of vascular structure in type 1 diabetes reflects a state of endothelial injury and highlights the role of disturbed angiogenesis and vascular inflammation in the occurrence of diabetic complications.
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Affiliation(s)
| | | | | | - AlShaimaa Abo Bakr
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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27
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Gibson JM, McGinnigle S. Diabetes: Intravitreous ranibizumab for proliferative diabetic retinopathy. Nat Rev Endocrinol 2016; 12:130-1. [PMID: 26794438 DOI: 10.1038/nrendo.2016.1] [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: 11/10/2022]
Affiliation(s)
- Jonathan M Gibson
- School of Life and Health Sciences, University of Aston, Birmingham B4 7ET, UK
| | - Samantha McGinnigle
- School of Life and Health Sciences, University of Aston, Birmingham B4 7ET, UK
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28
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Martinov T, Spanier JA, Pauken KE, Fife BT. PD-1 pathway-mediated regulation of islet-specific CD4 + T cell subsets in autoimmune diabetes. ACTA ACUST UNITED AC 2016; 3. [PMID: 27656680 PMCID: PMC5027981 DOI: 10.14800/ie.1164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Type 1 diabetes (T1D) is a CD4+ T cell-driven autoimmune disease resulting from the destruction of insulin-producing pancreatic beta cells. Clinical evidence and studies in non-obese diabetic (NOD) mice suggest that insulin is a major autoantigen. With this in mind, we developed insulin B10-23:IAg7 tetramer reagents to track insulin-specific CD4+ T cells in mice and interrogated the role of Programmed death-1 (PD-1) for peripheral tolerance. PD-1 is a T cell inhibitory receptor necessary to maintain tolerance and prevent T1D in NOD mice. PD-1 pathway inhibitors are increasingly used in the clinic for treating malignancies, and while many patients benefit, some develop adverse autoimmune events, including T1D. We therefore sought to understand the role of PD-1 in maintaining islet-specific tolerance in diabetes-resistant strains. B6.g7 mice express the same MHC Class II allele as NOD mice, have predominantly naïve insulin-specific CD4+ T cells in the periphery, and remain diabetes-free even after PD-1 pathway blockade. Here, we examined the trafficking potential of insulin-specific CD4+ T cells in NOD and B6.g7 mice with or without anti-PD-L1 treatment, and found that PD-L1 blockade preferentially increased the number of CD44highCXCR3+ insulin-specific cells in NOD but not B6.g7 mice. Additionally, we investigated whether pancreatic islets in NOD and B6.g7 mice expressed CXCL10, a lymphocyte homing chemokine and ligand for CXCR3. Anti-PD-L1 treated and control NOD mice had detectable CXCL10 expression in the islets, while B6.g7 islets did not. These data suggest that islet tolerance may be in part attributed to the pancreatic environment and in the absence of pancreas inflammation, chemotactic cytokines may be missing. This, together with our previous data showing that PD-1 pathway blockade preferentially affects effector but not anergic self-specific T cells has implications for the use of checkpoint blockade in treating tumor patients. Our work suggests that determining tumor- and self-specific CD4+ T cell activation status (naïve, effector or anergic) prior to initiation of immunotherapy would likely help to stratify individuals who would benefit from this therapy versus those who might have adverse effects or incomplete tumor control.
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Affiliation(s)
- Tijana Martinov
- Center for Immunology, Department of Medicine, Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Justin A Spanier
- Center for Immunology, Department of Medicine, Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Kristen E Pauken
- Center for Immunology, Department of Medicine, Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Brian T Fife
- Center for Immunology, Department of Medicine, Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, MN, 55455, USA
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29
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Forlenza GP, Buckingham B, Maahs DM. Progress in Diabetes Technology: Developments in Insulin Pumps, Continuous Glucose Monitors, and Progress towards the Artificial Pancreas. J Pediatr 2016; 169:13-20. [PMID: 26547403 PMCID: PMC6214345 DOI: 10.1016/j.jpeds.2015.10.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/03/2015] [Accepted: 10/05/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center for Childhood Diabetes, University of
Colorado Denver, Aurora, CO
| | | | - David M. Maahs
- Barbara Davis Center for Childhood Diabetes, University of
Colorado Denver, Aurora, CO
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30
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Yang CJ, Lee JW, Chung JW. Influences of Diabetes on Hearing Recovery in Noise-Exposed Mice. J Audiol Otol 2015; 19:138-43. [PMID: 26771012 PMCID: PMC4704550 DOI: 10.7874/jao.2015.19.3.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/05/2015] [Accepted: 11/18/2015] [Indexed: 01/31/2023] Open
Abstract
Background and Objectives Many studies have reported an association between diabetes and hearing loss. However, these reports were mainly abstractive correlations between common hearing loss and the incidence of diabetes. Therefore, we evaluated the impact of diabetes on the occurrence of and recovery from noise-induced hearing loss. Materials and Methods We used 5-week-old C57BLKS/J-m wild type (+/+) and C57BLKS/J-db/db male mice as the control and diabetic groups, respectively. In one set of experiments, the hearing levels of control and diabetic mice were measured weekly for 7 weeks. In a second set of experiments, control and diabetic mice were exposed to broadband white noise of 110 dB SPL for 3 hours; hearing levels were analyzed before and immediately after exposure, 1, 3, and 5 days, and 1, 2, 3, and 4 weeks after the noise exposure. Results The hearing levels of the control group were better than those of the diabetic group at each weekly revision for 7 weeks at all auditory brainstem response frequencies (4, 8, 16, and 32 kHz). After noise exposure, both groups of mice showed an immediate increase in the hearing level threshold at all frequencies. Subsequent threshold recovery was seen in both groups with no difference in the hearing level recovery rates between the two groups. Conclusions Hearing level with aging becomes significantly impaired earlier in diabetic mice but hearing recovery after noise exposure is similar between diabetic and control mice.
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Affiliation(s)
- Chan Joo Yang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Won Lee
- Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Woo Chung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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31
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Long L, Wang J, Lu X, Xu Y, Zheng S, Luo C, Li Y. Protective effects of scutellarin on type II diabetes mellitus-induced testicular damages related to reactive oxygen species/Bcl-2/Bax and reactive oxygen species/microcirculation/staving pathway in diabetic rat. J Diabetes Res 2015; 2015:252530. [PMID: 25861655 PMCID: PMC4377542 DOI: 10.1155/2015/252530] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 12/22/2022] Open
Abstract
The goal of our study is to evaluate the effect of Scutellarin on type II diabetes-induced testicular disorder and show the mechanism of Scutellarin's action. We used streptozotocin and high-fat diet to establish type II diabetic rat model. TUNEL and haematoxylin and eosin staining were used to evaluate the testicular apoptotic cells and morphologic changes. Immunohistochemical staining was used to measure the expression level of vascular endothelial growth factor and blood vessel density in testes. Oxidative stress in testes and epididymis was tested by fluorescence spectrophotometer and ELISA. The expression of Bcl-2/Bax and blood flow rate in testicular vessels were measured by western blot and Doppler. Our results for the first time showed that hyperglycemia induced apoptotic cells and morphologic impairments in testes of rats, while administration of Scutellarin can significantly inhibit these damages. This effect of Scutellarin is controlled by two apoptotic triggers: ROS/Bcl-2/Bax and ROS/microcirculation/starving pathway.
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Affiliation(s)
- Lingli Long
- Translation Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Jingnan Wang
- Translation Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Xiaofang Lu
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Yuxia Xu
- Translation Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Shuhui Zheng
- Translation Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Canqiao Luo
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- *Canqiao Luo: and
| | - Yubin Li
- The Reproductive Center of the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
- *Yubin Li:
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James S, Perry L, Gallagher R, Lowe J, Dunbabin J, McElduff P, Acharya S, Steinbeck K. Service usage and vascular complications in young adults with type 1 diabetes. BMC Endocr Disord 2014; 14:39. [PMID: 24884679 PMCID: PMC4017963 DOI: 10.1186/1472-6823-14-39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have examined young adults with type 1 diabetes use of health services and the development of vascular complications. As part of the Youth Outreach for Diabetes (YOuR-Diabetes) project, this study identified health service usage, the prevalence and factors predictive of development of vascular complications (hypertension, retinopathy and nephropathy) in a cohort of young adults (aged 16-30 years) with type 1 diabetes in Hunter New England and the Lower Mid-North Coast area of New South Wales, Australia. METHODS A cross-sectional retrospective documentation survey was undertaken of case notes of young adults with type 1 diabetes accessing Hunter New England Local Health District public health services in 2010 and 2011, identified through ambulatory care clinic records, hospital attendances and other clinical records. Details of service usage, complications screening and evidence of vascular complications were extracted. Independent predictors were modelled using linear and logistic regression analyses. RESULTS A cohort of 707 patients were reviewed; mean (SD) age was 23.0 (3.7) years, with mean diabetes duration of 10.2 (5.8, range 0.2 - 28.3) years; 42.4% lived/ 23.1% accessed services in non-metropolitan areas.Routine preventative service usage was low and unplanned contacts high; both deteriorated with increasing age. Low levels of complications screening were found. Where documented, hypertension, particularly, was common, affecting 48.4% across the study period. Diabetes duration was a strong predictor of vascular complications along with glycaemic control; hypertension was linked with renal dysfunction. CONCLUSION Findings indicate a need to better understand young people's drivers and achievements when accessing services, and how services can be reconfigured or delivered differently to better meet their needs and achieve better outcomes. Regular screening is required using current best practice guidelines as this affords the greatest chance for early complication detection, treatment initiation and secondary prevention.
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Affiliation(s)
- Steven James
- Huntsville District Memorial Hospital, 100 Frank Miller Drive, Huntsville, Ontario P1H 1H7, Canada
| | - Lin Perry
- University of Technology, Sydney, 15 Broadway, Ultimo, New South Wales 2007, Australia
| | - Robyn Gallagher
- University of Technology, Sydney, 15 Broadway, Ultimo, New South Wales 2007, Australia
| | - Julia Lowe
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Janet Dunbabin
- University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales 2308, Australia
| | - Patrick McElduff
- University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales 2308, Australia
| | - Shamasunder Acharya
- Hunter New England Local Health District, New Lambton Heights, New South Wales 2305, Australia
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