Diabetes mellitus in childhood: an emerging condition in the 21st century

Anti-Diabetic Activities of Hydro-Methanolic Crude Extract and Solvent Fractions of Heteromorpha arborescens (Apiaceae) Leaves in Mice

Background

Heteromorpha arborescens has been used to treat diabetes traditionally. There was no in vivo study to support the claim. This study aimed to confirm anti-diabetic activity of 80% methanol in water extract and solvent fractions of H. arborescens leaves in mice.

Methods

H. arborescens leaves were macerated and extracted in 80% methanol in water. Hydro-methanol extract of H. arborescens leaves were tested in mice models. Overnight fasted mice were randomly divided into five groups for normoglycemic and glucose-loaded models as a negative control, positive control, and three tested groups, whereas, in streptozotocin-induced diabetic models, the mice were grouped into six groups each comprised six mice: diabetic negative control and normal negative control groups treated with 10 mL/kg distilled water, diabetic positive control group treated with Glibenclamide 5 mg/kg and three diabetic tested groups treated with extract at 100, 200, and 400 mg/kg doses. A one-way ANOVA was performed to analyze the data, and the post hoc Tukey's test was utilized for multiple comparisons. The P-value <0.05 was considered statistically significant.

Results

Hydro-methanol extract of H. arborescens leaves at 400 mg/kg in normoglycemic mice significantly lowered blood glucose levels (BGLs) (P< 0.01). Mice with oral glucose-loaded test lowered BGLs at dosages of 200 mg/kg (P < 0.05) and 400 mg/kg (P < 0.01) respectively. Single-dose of ethyl acetate, n-hexane fractions and hydro-methanol extract at 100 mg/kg, 400 mg/kg and 200 mg/kg reduced BGLs (P < 0.05, P < 0.001, and P < 0.01) respectively. BGL drops in diabetic mice given daily repeated doses of 200 mg/kg of hydro-methanol extract and 400 mg/kg of ethyl acetate fraction (P < 0.001). Diabetic mice gained weight at a 400 mg/kg hydro-methanol extract and ethyl acetate fraction (P < 0.05 and P < 0.01) respectively. Hydro-methanol extract and ethyl acetate fraction and at 200 mg/kg decreased total cholesterol, triglycerides, and low-density lipoprotein and increased high-density lipoprotein (P < 0.001).

Conclusion

80% methanol in water extract and solvent fractions of H. arborescens leaves showed anti-diabetic effects and significantly reduced hyperlipidemia in diabetics, this study supported the traditional usage of H. arborescens for treating diabetes; however, species variation could also limit such a straightforward extrapolation of the findings of this study in humans.

COMPLEXITY OF PEDIATRIC CHRONIC DISEASE: CROSS-SECTIONAL STUDY WITH 16,237 PATIENTS FOLLOWED BY MULTIPLE MEDICAL SPECIALTIES

Objective:

To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient.

Methods:

We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications.

Results:

Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties.

Conclusions:

The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

Skim milk powder with high content of Maillard reaction products affect weight gain, organ development and intestinal inflammation in early life in rats

BACKGROUND

The intestinal tract is important for development of immune tolerance and disturbances are suggested to trigger autoimmune disorders. The aim of this study was to explore the effect of Maillard products in skim milk powder obtained after long storage, compared to fresh skim milk powder.

METHODS

Young rats were weaned onto a diet based on skim milk powder with high concentration of Maillard products (HM-SM, n = 18) or low (C-SM, n = 18) for one week or four weeks. Weekly body weight and feed consumption were noted. At the end, organ weights, intestinal histology, permeability and inflammatory cytokines were evaluated.

RESULTS

Rats fed with HM-SM had after one week, 15% less weight gain than controls, despite equal feed intake. After one week thymus and spleen were smaller, intestinal mucosa thickness was increased and acute inflammatory cytokines (IL-17, IL-1β, MCP-1) were elevated. After four weeks, cytokines associated with chronic intestinal inflammation (fractalkine, IP-10, leptin, LIX, MIP-2, RANTES and VEGF) were increased in rats fed with HM-SM compared to C-SM.

CONCLUSION

High content of Maillard products in stored milk powder caused an intestinal inflammation. Whether this is relevant for tolerance development and future autoimmune diseases remains to be explored.

Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

PURPOSE

The purpose of this study was to determine the level of adherence and the factors associated with adherence to diabetes care recommendations among type 1 diabetic children and adolescents at two urban diabetes clinics in Kampala, Uganda.

RESEARCH DESIGN AND METHODS

A facility-based cross-sectional study was carried out among 200 children and adolescents with type 1 diabetes at two major diabetes clinics in Kampala. Caretakers of the children and adolescents were interviewed using pretested questionnaires to provide information on sociodemographic characteristics, diabetes care, knowledge, attitudes, and adherence to diabetes care recommendations in type 1 diabetes. Prevalence rate ratios (PRRs) at the 95% confidence interval (CI) were used to establish the factors associated with adherence using modified Poisson regression, with robust standard errors. The data were analyzed by using STATA Version 13.0.

RESULTS

The overall prevalence of adherence to diabetes care recommendations was at 37%. However, evaluating adherence to specific treatment parameters showed that 52%, 76.5%, and 29.5% of the children and adolescents adhered to insulin, blood glucose monitoring, and dietary recommendations, respectively. In the final adjusted model, active diet monitoring (adjusted PRR [APRR]: 1.95; 95% CI: 1.01, 3.78), being under care of a sibling (APRR: 1.66; 95% CI: 1.61, 1.71), being under care of a married caretaker (APRR: 1.10; 95% CI: 1.05, 1.14) and a separated or divorced caretaker (APRR: 1.60; 95% CI: 1.12, 2.27), taking three or less tests of blood glucose per day (APRR: 0.63; 95% CI: 0.42, 0.95), and having a caretaker with poor knowledge about diabetes (APRR: 0.49; 95% CI: 0.43, 0.57) and who is inactive in supervision of insulin injections (APRR: 0.58; 95% CI: 0.56, 0.60) were associated with adherence to type 1 diabetes care recommendations.

CONCLUSION

Adherence to type 1 diabetes care recommendations is still low among this population. The results suggest that reinforcing caretaker involvement could be vital in improving adherence to diabetes care recommendations in this population.