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Ludvigsson J, Olsen Faresjö Å. The importance of factors early in life for development of eating disorders in young people, with some focus on type 1 diabetes. Eat Weight Disord 2024; 29:5. [PMID: 38198020 PMCID: PMC10781866 DOI: 10.1007/s40519-023-01633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024] Open
Abstract
AIM Eating disorders have a serious impact on quality of life, especially when combined with Type 1 diabetes. We investigated eating disorders in relation to factors early in life with some focus on Type 1 diabetes. METHODS Out of 21,700 children born 1st of Oct 1997-1st of Oct 1999 17,055 (78.6%) were included in ABIS (All Babies in southeast Sweden) and 16,415 had adequate questionnaires. ICD-10 diagnosis from The National Patient Register was merged with the ABIS data. RESULTS In total 247 individuals, 19 boys (7.7%) and 219 girls (92.3%) out of 16,415 (1.5%) developed eating disorders (EDs), 167 (1.0%) Type 1 diabetes of whom 7 (4.2%) also got eating disorders (ED) (OR 3.25 (1.47-7.28); p = 0.04), all of them years after diagnosis of Type 1 diabetes. EDs was associated with high parental education especially in fathers (OR 1.65 (1.09-2.50); p = 0.02) and to at birth anxiety, and depression among mothers. There was no association with the duration of breastfeeding. CONCLUSIONS Eating disorders are common in girls, with increased risk in high-educated but psychologically vulnerable families. Prevalence is increased in type 1 diabetes. Even modern diabetes treatment needs to be completed with psychological support. LEVEL OF EVIDENCE Level III: Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- J Ludvigsson
- Crown Princess Victoria Children's Hospital and Div of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden.
| | - Å Olsen Faresjö
- Division of Society and Health/Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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2
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Tatovic D, McAteer MA, Barry J, Barrientos A, Rodríguez Terradillos K, Perera I, Kochba E, Levin Y, Dul M, Coulman SA, Birchall JC, von Ruhland C, Howell A, Stenson R, Alhadj Ali M, Luzio SD, Dunseath G, Cheung WY, Holland G, May K, Ingram JR, Chowdhury MMU, Wong FS, Casas R, Dayan C, Ludvigsson J. Safety of the use of Gold Nanoparticles conjugated with proinsulin peptide and administered by hollow microneedles as an immunotherapy in Type 1 diabetes. Immunotherapy Advances 2022; 2:ltac002. [PMID: 35919496 PMCID: PMC9327128 DOI: 10.1093/immadv/ltac002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Antigen-specific immunotherapy is an immunomodulatory strategy for autoimmune diseases, such as type 1 diabetes, in which patients are treated with autoantigens to promote immune tolerance, stop autoimmune β-cell destruction and prevent permanent dependence on exogenous insulin. In this study, human proinsulin peptide C19-A3 (known for its positive safety profile) was conjugated to ultrasmall gold nanoparticles (GNPs), an attractive drug delivery platform due to the potential anti-inflammatory properties of gold. We hypothesised that microneedle intradermal delivery of C19-A3 GNP may improve peptide pharmacokinetics and induce tolerogenic immunomodulation and proceeded to evaluate its safety and feasibility in a first-in-human trial. Allowing for the limitation of the small number of participants, intradermal administration of C19-A3 GNP appears safe and well tolerated in participants with type 1 diabetes. The associated prolonged skin retention of C19-A3 GNP after intradermal administration offers a number of possibilities to enhance its tolerogenic potential, which should be explored in future studies
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Affiliation(s)
- D Tatovic
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | | | - J Barry
- Midatech Pharma PLC, Cardiff, UK
| | | | | | - I Perera
- Midatech Pharma PLC, Cardiff, UK
| | - E Kochba
- NanoPass Technologies Ltd., Nes Ziona, Israel
| | - Y Levin
- NanoPass Technologies Ltd., Nes Ziona, Israel
| | - M Dul
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
| | - S A Coulman
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
| | - J C Birchall
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
| | - C von Ruhland
- Central Biotechnology Services, Cardiff University, Cardiff, UK
| | - A Howell
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - R Stenson
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - M Alhadj Ali
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - S D Luzio
- Swansea Trials Unit, Swansea University Medical School, UK
| | - G Dunseath
- Swansea Trials Unit, Swansea University Medical School, UK
| | - W Y Cheung
- Diabetes Research Unit Cymru, Institute for Life Sciences, Swansea University, Swansea, UK
| | - G Holland
- Swansea Trials Unit, Swansea University Medical School, UK
| | - K May
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - J R Ingram
- Division of Infection & Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - M M U Chowdhury
- Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK
| | - F S Wong
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - R Casas
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - C Dayan
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - J Ludvigsson
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences and Crown Princess Victoria Children´s Hospital, Linköping University, Linköping, Sweden
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3
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Rathsman B, Haas J, Persson M, Ludvigsson J, Svensson AM, Lind M, Andersson Franko M, Nyström T. LDL cholesterol level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes mellitus: A nationwide cohort study. J Intern Med 2021; 289:873-886. [PMID: 33283333 PMCID: PMC8247303 DOI: 10.1111/joim.13212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Microvascular complications are common in people with diabetes, where poor glycaemic control is the major contributor. The aim of this study was to explore the association between elevated LDL cholesterol levels and the risk of retinopathy or nephropathy in young individuals with type 1 diabetes. METHODS This was a nationwide observational population-based cohort study, including all children and adults with a duration of type 1 diabetes of ≤ 10 years, identified in the Swedish National Diabetes Register between 1998 and 2017. We calculated the crude incidence rates with 95% confidence intervals (CIs) and used multivariable Cox regression to estimate crude and adjusted hazard ratios (HRs) of retinopathy or nephropathy in four LDL cholesterol categories: <2.6 (Reference), 2.6-3.4, 3.4-4.1 and > 4.1 mmol L-1 . RESULTS In total, 11 024/12 350 (retinopathy/nephropathy, both cohorts, respectively) children and adults (median age 21 years, female 42%) were followed up to 28 years from diagnosis until end of study. Median duration of diabetes when entering the study was 6 and 7 years in the retinopathy and nephropathy cohort, respectively. Median LDL cholesterol was 2.4 mmol L-1 , and median HbA1c level was 61 mmol mol-1 (7.7 %). After multivariable adjustment, the HRs (95% CI) for retinopathy in individuals with LDL cholesterol levels of 2.6-3.4, 3.4-4.1 or > 4.1 mmol L-1 were as follows: 1.13 (1.03-1.23), 1.16 (1.02-1.32) and 1.18 (0.99-1.41), compared with the reference. The corresponding numbers for nephropathy were as follows: 1.15 (0.96-1.32), 1.30 (1.03-1.65) and 1.41 (1.06-1.89). CONCLUSIONS Young individuals with type 1 diabetes exposed to high LDL cholesterol levels have an increased risk of retinopathy and nephropathy independent of glycaemia and other identified risk factors for vascular complications.
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Affiliation(s)
- B Rathsman
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - J Haas
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - M Persson
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden.,Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet, Stockholm, Sweden
| | - J Ludvigsson
- Division of Paediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Crown Princess Victoria Children's Hospital, Linköping, Sweden
| | - A-M Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
| | - M Lind
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - M Andersson Franko
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - T Nyström
- From the, Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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4
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Knobler R, Arenberger P, Arun A, Assaf C, Bagot M, Berlin G, Bohbot A, Calzavara-Pinton P, Child F, Cho A, French LE, Gennery AR, Gniadecki R, Gollnick HPM, Guenova E, Jaksch P, Jantschitsch C, Klemke C, Ludvigsson J, Papadavid E, Scarisbrick J, Schwarz T, Stadler R, Wolf P, Zic J, Zouboulis C, Zuckermann A, Greinix H. European dermatology forum - updated guidelines on the use of extracorporeal photopheresis 2020 - part 1. J Eur Acad Dermatol Venereol 2020; 34:2693-2716. [PMID: 33025659 PMCID: PMC7820969 DOI: 10.1111/jdv.16890] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/06/2020] [Indexed: 01/01/2023]
Abstract
Background Following the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T‐cell lymphoma published in 1983, this technology has received continued use and further recognition for additional earlier as well as refractory forms. After the publication of the first guidelines for this technology in the JEADV in 2014, this technology has maintained additional promise in the treatment of other severe and refractory conditions in a multi‐disciplinary setting. It has confirmed recognition in well‐known documented conditions such as graft‐versus‐host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection including lung, heart and liver and to a lesser extent inflammatory bowel disease. Materials and methods In order to further provide recognized expert practical guidelines for the use of this technology for all indications, the European Dermatology Forum (EDF) again proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. All authors had the opportunity to review each contribution as it was added. Results and conclusion These updated 2020 guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion. The guidelines are divided in two parts: PART I covers cutaneous T‐cell lymphoma, chronic graft‐versus‐host disease and acute graft‐versus‐host disease while PART II will cover scleroderma, solid organ transplantation, Crohn's disease, use of ECP in paediatrics practice, atopic dermatitis, type 1 diabetes, pemphigus, epidermolysis bullosa acquisita and erosive oral lichen planus.
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Affiliation(s)
- R Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - P Arenberger
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - A Arun
- FRCPath, The Rotherham NHA Foundation Trust, Rotherham, UK
| | - C Assaf
- Department of Dermatology and Venerology, Helios Klinikum Krefeld, Krefeld, Germany
| | - M Bagot
- Hospital Saint Louis, Université de Paris, Paris, France
| | - G Berlin
- Department of Clinical Immunology and Transfusion Medicine, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A Bohbot
- Onco-Hematology Department, Hautepierre Hospital, Strasbourg, France
| | | | - F Child
- FRCP, St John's Institution of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Cho
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - L E French
- Department of Dermatology, University Hospital, München, Germany
| | - A R Gennery
- Translational and Clinical Research Institute, Newcastle University Great North Children's Hospital Newcastle upon Tyne, Newcastle University, Newcastle upon Tyne, UK
| | - R Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - H P M Gollnick
- Dept. Dermatology & Venereology, Otto-von-Guericke University, Magdeburg, Germany
| | - E Guenova
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - P Jaksch
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - C Jantschitsch
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Klemke
- Hautklinik Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - J Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - E Papadavid
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - T Schwarz
- Department of Dermatology, University Clinics Schleswig-Holstein, Kiel, Germany
| | - R Stadler
- University Clinic for Dermatology Johannes Wesling Medical Centre, UKRUB, University of Bochum, Minden, Germany
| | - P Wolf
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - J Zic
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - A Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - H Greinix
- Division of Haematology, LKH-Univ. Klinikum Graz, Medical University of Graz, Graz, Austria
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5
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Knobler R, Arenberger P, Arun A, Assaf C, Bagot M, Berlin G, Bohbot A, Calzavara-Pinton P, Child F, Cho A, French LE, Gennery AR, Gniadecki R, Gollnick HPM, Guenova E, Jaksch P, Jantschitsch C, Klemke C, Ludvigsson J, Papadavid E, Scarisbrick J, Schwarz T, Stadler R, Wolf P, Zic J, Zouboulis C, Zuckermann A, Greinix H. European dermatology forum: Updated guidelines on the use of extracorporeal photopheresis 2020 - Part 2. J Eur Acad Dermatol Venereol 2020; 35:27-49. [PMID: 32964529 PMCID: PMC7821314 DOI: 10.1111/jdv.16889] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
Abstract
Background Following the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T‐cell lymphoma published in 1983, this technology has received continued use and further recognition for additional earlier as well as refractory forms. After the publication of the first guidelines for this technology in the JEADV in 2014, this technology has maintained additional promise in the treatment of other severe and refractory conditions in a multidisciplinary setting. It has confirmed recognition in well‐known documented conditions such as graft‐vs.‐host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection including lung, heart and liver and to a lesser extent inflammatory bowel disease. Materials and methods In order to further provide recognized expert practical guidelines for the use of this technology for all indications, the European Dermatology Forum (EDF) again proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. All authors had the opportunity to review each contribution as it was added. Results and conclusion These updated 2020 guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion. The guidelines were divided into two parts: PART I covers Cutaneous T‐cell lymphoma, chronic graft‐vs.‐host disease and acute graft‐vs.‐host disease, while PART II will cover scleroderma, solid organ transplantation, Crohn’s disease, use of ECP in paediatric patients, atopic dermatitis, type 1 diabetes, pemphigus, epidermolysis bullosa acquisita and erosive oral lichen planus.
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Affiliation(s)
- R Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - P Arenberger
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - A Arun
- FRCPath, The Rotherham NHA Foundation Trust, Rotherham, United Kingdom
| | - C Assaf
- Department of Dermatology and Venerology, Helios Klinikum Krefeld, Krefeld, Germany
| | - M Bagot
- Hospital Saint Louis, Université de Paris, Paris, France
| | - G Berlin
- Department of Clinical Immunology and Transfusion Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A Bohbot
- Onco-Hematology Department, Hautepierre Hospital, Strasbourg, France
| | | | - F Child
- FRCP, St John's Institution of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Cho
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - L E French
- Department of Dermatology, University Hospital, München, Germany
| | - A R Gennery
- Translational and Clinical Research Institute Newcastle University Great North Children's Hospital Newcastle upon Tyne, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - R Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Canada
| | - H P M Gollnick
- Department Dermatology & Venereology Otto-von-Guericke University, Magdeburg, Germany
| | - E Guenova
- Faculty of Biology and Medicine, University of Lausanne and Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - P Jaksch
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - C Jantschitsch
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Klemke
- Hautklinik Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - J Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - E Papadavid
- National and Kapodistrian University of Athens, Athens, Greece
| | - J Scarisbrick
- University Hospital Birmingham, Birmingham, United Kingdom
| | - T Schwarz
- Department of Dermatology, University Clinics Schleswig-Holstein, Kiel, Germany
| | - R Stadler
- University Clinic for Dermatology Johannes Wesling Medical Centre, UKRUB, University of Bochum, Minden, Germany
| | - P Wolf
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - J Zic
- Vanderbilt University Medical Center Department of Dermatology, Nashville, Tennessee, USA
| | - C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - A Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - H Greinix
- LKH-Univ. Klinikum Graz, Division of Haematology, Medical University of Graz, Graz, Austria
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6
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Jasem D, Majaliwa ES, Ramaiya K, Najem S, Swai ABM, Ludvigsson J. Incidence, prevalence and clinical manifestations at onset of juvenile diabetes in Tanzania. Diabetes Res Clin Pract 2019; 156:107817. [PMID: 31425767 DOI: 10.1016/j.diabres.2019.107817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 01/04/2023]
Abstract
UNLABELLED Better knowledge on incidence, prevalence and clinical manifestations is needed for planning diabetes care in Sub Saharan Africa. AIMS To find a crude incidence/prevalence of diabetes in children and young adults in a low resource setting, classify the diabetes and audit the health record keeping. METHODS A retrospective observational study based on medical recordings 2010-2016. Target population was children and adolescent registered in Changing Diabetes in Children (CDiC) or Life for a Child (LFAC) programs for children with T1DM and diagnosed at 5 diabetes clinics in three geographical regions of Tanzania. 604 patients' files were available from five hospitals. RESULTS 336/604 files covered patients <15 years of age at diagnosis. The prevalence of diabetes <15 years of age ranged from 10.1 to 11.9 per 100,000 children and the annual incidence 1.8-1.9/100,000 children, with peak incidence at 10-14 years. A lot of data were missing. The great majority of the patients presented with typical signs and symptoms of T1D, 83.7% with plausible ketoacidosis (DKA). CONCLUSIONS Diabetes incidence and prevalence is still low. T1D seems to dominate with very high frequency of DKA at diagnosis. Increased awareness of diabetes both in health care and community is needed.
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Affiliation(s)
- D Jasem
- Div of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - E S Majaliwa
- Department of Paediatric and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - K Ramaiya
- Department of Internal Medicine, Hindu Mandal Hospital, Dar Es Salaam, Tanzania
| | - S Najem
- Div of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A B M Swai
- Tanzania Diabetes Association, Dar es Salaam, Tanzania
| | - J Ludvigsson
- Div of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Crown Princess Victoria Children's Hospital, University Hospital, Region Östergötland, Linköping, Sweden.
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7
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Abstract
The incidence of type 1 diabetes (T1D) has increased explained by changes in environment or lifestyle. In modern society dissemination of heavy metals has increased. As the autoimmune process usually starts already, we hypothesized that exposure to toxic metals during fetal life might contribute to development of T1D in children. We analysed arsenic (AS), aluminium (Al), cadmium (Cd), lithium (Li), mercury (Hg), lead (Pb), in cord blood of 20 children who later developed T1D (probands), and in 40 age-and sex-matched controls. Analysis of heavy metals in cord blood was performed by ALS Scandinavia AB (Luleå, Sweden) using the ‘ultrasensitive inductively coupled plasma sector field mass spectrometry method’ (ICP-SFMS) after acid digestion with HNO3. Most children had no increased concentrations of the metals in cord blood. However, children who later developed T1D had more often increased concentrations (above limit of detection; LOD) of aluminium (p = 0.006) in cord blood than the non-diabetic controls, and also more often mercury and arsenic (n.s). Our conclusion is that exposure to toxic metals during pregnancy might be one among several contributing environmental factors to the disease process if confirmed in other birth cohort trials.
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Affiliation(s)
- J Ludvigsson
- Department of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, Linköping, Sweden
| | - P Andersson-White
- Crown Princess Victoria Children's Hospital, Region Östergötland. Linköping Sweden
| | - C Guerrero-Bosagna
- IFM Biology, Linköping, University; Linköping university, Linköping, Sweden
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8
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Persson M, Becker C, Elding Larsson H, Lernmark Å, Forsander G, Ivarsson SA, Ludvigsson J, Samuelsson U, Marcus C, Carlsson A. The Better Diabetes Diagnosis (BDD) study - A review of a nationwide prospective cohort study in Sweden. Diabetes Res Clin Pract 2018; 140:236-244. [PMID: 29626585 DOI: 10.1016/j.diabres.2018.03.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/08/2017] [Accepted: 03/29/2018] [Indexed: 12/26/2022]
Abstract
The incidence of type 1 diabetes (T1D) in Sweden is one of the highest in the world. However, the possibility of other types of diabetes must also be considered. In addition, individuals with T1D constitute a heterogeneous group. A precise classification of diabetes is a prerequisite for optimal outcome. For precise classification, knowledge on the distribution of genetic factors, biochemical markers and clinical features in individuals with new onset of diabetes is needed. The Better Diabetes Diagnosis (BDD), is a nationwide study in Sweden with the primary aim to facilitate a more precise classification and diagnosis of diabetes in order to enable the most adequate treatment for each patient. Secondary aims include identification of risk factors for diabetes-related co-morbidities. Since 2005, data on almost all children and adolescents with newly diagnosed diabetes in Sweden are prospectively collected and including heredity of diabetes, clinical symptoms, levels of C peptide, genetic analyses and detection of autoantibodies. Since 2011, analyses of HLA profile, autoantibodies and C peptide levels are part of clinical routine in Sweden for all pediatric patients with suspected diagnosis of diabetes. In this review, we present the methods and main results of the BDD study so far and discuss future aspects.
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Affiliation(s)
- M Persson
- Department of Medicine, Clinical Epidemiology, Karolinska University Hospital, Stockholm, Sweden.
| | - C Becker
- Department of Clinical Chemistry, Skåne University Hospital, Malmö, Sweden
| | - H Elding Larsson
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
| | - Å Lernmark
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
| | - G Forsander
- Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and the Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S A Ivarsson
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
| | - J Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - U Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - C Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Pediatrics, Stockholm, Sweden
| | - A Carlsson
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
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Chisalita SI, Ludvigsson J. Insulin-Like Growth Factor-1 at Diagnosis and during Subsequent Years in Adolescents with Type 1 Diabetes. J Diabetes Res 2018; 2018:8623560. [PMID: 29744370 PMCID: PMC5883934 DOI: 10.1155/2018/8623560] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) in adolescents is associated with alterations in the insulin-like factor system probably caused both by a deranged metabolism and insulinopenia in the portal vein. OBJECTIVE To study how the circulating IGF-1 is affected at diagnosis and during subsequent years in adolescents with T1D. METHODS Ten girls and ten boys with type 1 diabetes (T1D), aged 13.0 ± 1.4 (mean ± SD) years at diagnosis, took part in the study. Blood samples were drawn at diagnosis and after 3, 9, 18, and 48 months. HbA1c, total IGF-1, and C-peptide were measured. RESULTS At diagnosis, the patients had high HbA1c, low IGF-1, and measurable C-peptide. After the start of insulin treatment, maximal improvement in glycemic control and IGF-1 occurred within 3 months and then both tended to deteriorate, that is, HbA1c to increase and IGF-1 to decrease. C-peptide decreased with time, and after 4 years, half of the patients were C-peptide negative. At diagnosis, C-peptide correlated positively to IGF-1 (r = 0.50; p < 0.03). C-peptide correlated negatively with insulin dose (U/kg) after 18 and 48 months from diagnosis (r = -0.48; p < 0.03 and r = -0.72; p < 0.001, resp.). CONCLUSIONS In conclusion, our results show that in newly diagnosed adolescents with type 1 diabetes and deranged metabolism, the IGF-1 level is low and rapidly improves with insulin treatment but later tends to decrease concomitantly with declining endogenous insulin secretion.
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Affiliation(s)
- Simona I. Chisalita
- Department of Endocrinology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - J. Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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10
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Jennersjö P, Ludvigsson J, Länne T, Nystrom FH, Östgren CJ. Pedometer-determined physical activity level and change in arterial stiffness in Type 2 diabetes over 4 years. Diabet Med 2016; 33:992-7. [PMID: 26227869 DOI: 10.1111/dme.12873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/30/2022]
Abstract
AIM To explore prospectively the correlation between the level of pedometer-determined physical activity at the start of the study and the change in pulse wave velocity from baseline to 4 years later in people with Type 2 diabetes. METHODS We analysed data from 135 men and 53 women with Type 2 diabetes, aged 54-66 years. Physical activity was measured with waist-mounted pedometers on 3 consecutive days and the numbers of steps/day at baseline were classified into four groups: <5000 steps/day, 5000-7499 steps/day, 7500-9999 steps/day and ≥10 000 steps/day. Pulse wave velocity was measured using applanation tonometry over the carotid and femoral arteries at baseline and after 4 years. RESULTS The mean (±sd; range) number of steps/day was 8022 (±3765; 956-20 921). The participants with the lowest level of physical activity had a more pronounced increase in the change in pulse wave velocity compared with the participants with the highest. When change in pulse wave velocity was analysed as a continuous variable and adjusted for sex, age, diabetes duration, HbA1c , BMI, systolic blood pressure, pulse wave velocity at baseline, β-blocker use, statin use, unemployment, smoking and diabetes medication, the number of steps/day at baseline was significantly associated with a less steep increase in change in pulse wave velocity (P=0.005). Every 1000 extra steps at baseline corresponded to a lower increase in change in pulse wave velocity of 0.103 m/s. CONCLUSIONS We found that a high level of pedometer-determined physical activity was associated with a slower progression of arterial stiffness over 4 years in middle-aged people with Type 2 diabetes.
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Affiliation(s)
- P Jennersjö
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - J Ludvigsson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - T Länne
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - F H Nystrom
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - C J Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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11
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Canova C, Pitter G, Ludvigsson J, Romor P, Zanier L, Zanotti R, Simonato L. Risks of hospitalization and drug consumption associated with Coeliac Disease in a birth cohort study. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Carlsson E, Ludvigsson J, Huus K, Faresjö M. High physical activity in young children suggests positive effects by altering autoantigen-induced immune activity. Scand J Med Sci Sports 2015; 26:441-50. [PMID: 25892449 DOI: 10.1111/sms.12450] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 12/16/2022]
Abstract
Physical activity in children is associated with several positive health outcomes such as decreased cardiovascular risk factors, improved lung function, enhanced motor skill development, healthier body composition, and also improved defense against inflammatory diseases. We examined how high physical activity vs a sedentary lifestyle in young children influences the immune response with focus on autoimmunity. Peripheral blood mononuclear cells, collected from 55 5-year-old children with either high physical activity (n = 14), average physical activity (n = 27), or low physical activity (n = 14), from the All Babies In Southeast Sweden (ABIS) cohort, were stimulated with antigens (tetanus toxoid and beta-lactoglobulin) and autoantigens (GAD65 , insulin, HSP60, and IA-2). Immune markers (cytokines and chemokines), C-peptide and proinsulin were analyzed. Children with high physical activity showed decreased immune activity toward the autoantigens GAD65 (IL-5, P < 0.05), HSP60 and IA-2 (IL-10, P < 0.05) and also low spontaneous pro-inflammatory immune activity (IL-6, IL-13, IFN-γ, TNF-α, and CCL2 (P < 0.05)) compared with children with an average or low physical activity. High physical activity in young children seems to have positive effects on the immune system by altering autoantigen-induced immune activity.
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Affiliation(s)
- E Carlsson
- The Biomedical Platform, Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Jönköping, Sweden.,Division of Medical Diagnostics, Ryhov County Hospital, Jönköping, Sweden
| | - J Ludvigsson
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Östergötland County Council, Linköping, Sweden
| | - K Huus
- CHILD Research Group, Department of Nursing, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - M Faresjö
- The Biomedical Platform, Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Jönköping, Sweden.,Division of Medical Diagnostics, Ryhov County Hospital, Jönköping, Sweden
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13
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Lauria A, Barker A, Schloot N, Hosszufalusi N, Ludvigsson J, Mathieu C, Mauricio D, Nordwall M, Van der Schueren B, Mandrup-Poulsen T, Scherbaum WA, Weets I, Gorus FK, Wareham N, Leslie RD, Pozzilli P. BMI is an important driver of β-cell loss in type 1 diabetes upon diagnosis in 10 to 18-year-old children. Eur J Endocrinol 2015; 172:107-13. [PMID: 25378371 DOI: 10.1530/eje-14-0522] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Body weight-related insulin resistance probably plays a role in progression to type 1 diabetes, but has an uncertain impact following diagnosis. In this study, we investigated whether BMI measured at diagnosis was an independent predictor of C-peptide decline 1-year post-diagnosis. DESIGN Multicentre longitudinal study carried out at diagnosis and up to 1-year follow-up. METHODS Data on C-peptide were collected from seven diabetes centres in Europe. Patients were grouped according to age at diagnosis (<5 years, n=126; >5 years <10 years, n=295; >10 years <18 years, n=421; >18 years, n=410). Linear regression was used to investigate whether BMI was an independent predictor of change in fasting C-peptide over 1 year. Models were additionally adjusted for baseline insulin dose and HbA1c. RESULTS In individuals diagnosed between 0 and 5 years, 5 and 10 years and those diagnosed >18 years, we found no association between BMI and C-peptide decline. In patients aged 10-18 years, higher BMI at baseline was associated with a greater decline in fasting C-peptide over 1 year with a decrease (β 95% CI; P value) of 0.025 (0.010, 0.041) nM/kg per m(2) higher baseline BMI (P=0.001). This association remained significant after adjusting for gender and differences in HbA1c and insulin dose (β=0.026, 95% CI=0.0097, 0.042; P=0.002). CONCLUSIONS These observations indicate that increased body weight and increased insulin demand are associated with more rapid disease progression after diagnosis of type 1 diabetes in an age group 10-18 years. This should be considered in studies of β-cell function in type 1 diabetes.
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Affiliation(s)
- A Lauria
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - A Barker
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - N Schloot
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - N Hosszufalusi
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - J Ludvigsson
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - C Mathieu
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - D Mauricio
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - M Nordwall
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
| | - B Van der Schueren
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - T Mandrup-Poulsen
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
| | - W A Scherbaum
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - I Weets
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
| | - F K Gorus
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
| | - N Wareham
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - R D Leslie
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - P Pozzilli
- Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartment EndocrinologyHospital Arnau de Vilanova, Lleida, SpainPediatric ClinicVrinnevi Hospital, Norrköping, SwedenDepartment of Biomedical SciencesUniversity of Copenhagen, Copenhagen, DenmarkDepartment of EndocrinologyDiabetes and Rheumatology, Heinrich Heine University, Dusseldorf, GermanyDiabetes Research Center and Academic Hospital (UZ Brussel)Vrije Universiteit Brussel (VUB), Brussel, BelgiumBelgian Diabetes Registry (BDR)Brussels, BelgiumCentre of DiabetesBlizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UKDepartment of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden Department of Endocrinology and DiabetesUniversity Campus Bio-Medico, Via Alvaro del Portillo, Rome 21 00128, ItalyMRC Epidemiology UnitCambridge, UKInstitute for Clinical DiabetologyGerman Diabetes Centre, Leibniz-Institute for Diabetes Research and Clinic for Metabolic Diseases Heinrich Heine University, Dusseldorf, GermanySemmelweis University3rd Department of Internal Medicine, Linkoping University, Linkoping, SwedenDivision of PediatricsDepartment of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SwedenLaboratory for Experimental Medicine and EndocrinologyKatholieke Universiteit Leuven, Leuven, BelgiumDepartme
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Knobler R, Berlin G, Calzavara-Pinton P, Greinix H, Jaksch P, Laroche L, Ludvigsson J, Quaglino P, Reinisch W, Scarisbrick J, Schwarz T, Wolf P, Arenberger P, Assaf C, Bagot M, Barr M, Bohbot A, Bruckner-Tuderman L, Dreno B, Enk A, French L, Gniadecki R, Gollnick H, Hertl M, Jantschitsch C, Jung A, Just U, Klemke CD, Lippert U, Luger T, Papadavid E, Pehamberger H, Ranki A, Stadler R, Sterry W, Wolf IH, Worm M, Zic J, Zouboulis CC, Hillen U. Guidelines on the use of extracorporeal photopheresis. J Eur Acad Dermatol Venereol 2014; 28 Suppl 1:1-37. [PMID: 24354653 PMCID: PMC4291097 DOI: 10.1111/jdv.12311] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND After the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease. MATERIALS AND METHODS In order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. RESULTS AND CONCLUSION These guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion.
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Affiliation(s)
- R Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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15
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Svensson M, Ramelius A, Nilsson AL, Delli AJ, Elding Larsson H, Carlsson A, Forsander G, Ivarsson SA, Ludvigsson J, Kockum I, Marcus C, Samuelsson U, Örtqvist E, Lernmark Å. Antibodies to influenza virus A/H1N1 hemagglutinin in Type 1 diabetes children diagnosed before, during and after the SWEDISH A(H1N1)pdm09 vaccination campaign 2009-2010. Scand J Immunol 2014; 79:137-48. [PMID: 24313339 DOI: 10.1111/sji.12138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/18/2013] [Indexed: 12/18/2022]
Abstract
We determined A/H1N1-hemagglutinin (HA) antibodies in relation to HLA-DQ genotypes and islet autoantibodies at clinical diagnosis in 1141 incident 0.7-to 18-year-old type 1 diabetes patients diagnosed April 2009-December 2010. Antibodies to (35) S-methionine-labelled A/H1N1 hemagglutinin were determined in a radiobinding assay in patients diagnosed before (n = 325), during (n = 355) and after (n = 461) the October 2009-March 2010 Swedish A(H1N1)pdm09 vaccination campaign, along with HLA-DQ genotypes and autoantibodies against GAD, insulin, IA-2 and ZnT8 transporter. Before vaccination, 0.6% patients had A/H1N1-HA antibodies compared with 40% during and 27% after vaccination (P < 0.0001). In children <3 years of age, A/H1N1-HA antibodies were found only during vaccination. The frequency of A/H1N1-HA antibodies during vaccination decreased after vaccination among the 3 < 6 (P = 0.006) and 13 < 18 (P = 0.001), but not among the 6 < 13-year-olds. HLA-DQ2/8 positive children <3 years decreased from 54% (15/28) before and 68% (19/28) during, to 30% (9/30) after vaccination (P = 0.014). Regardless of age, DQ2/2; 2/X (n = 177) patients had lower frequency (P = 0.020) and levels (P = 0.042) of A/H1N1-HA antibodies compared with non-DQ2/2; 2/X (n = 964) patients. GADA frequency was 50% before, 60% during and 51% after vaccination (P = 0.009). ZnT8QA frequency increased from 30% before to 34% during and 41% after vaccination (P = 0.002). Our findings suggest that young (<3 years) along with DQ2/2; 2/X patients were low responders to Pandemrix(®) . As the proportion of DQ2/8 patients <3 years of age decreased after vaccination and the frequencies of GADA and ZnT8QA were enhanced, it cannot be excluded that the vaccine affected clinical onset of type 1 diabetes.
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Affiliation(s)
- M Svensson
- Department of Clinical Sciences Malmö, Skåne University Hospital SUS, Lund University, Malmö, Sweden
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16
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Barker A, Lauria A, Schloot N, Hosszufalusi N, Ludvigsson J, Mathieu C, Mauricio D, Nordwall M, Van der Schueren B, Mandrup-Poulsen T, Scherbaum WA, Weets I, Gorus FK, Wareham N, Leslie RD, Pozzilli P. Age-dependent decline of β-cell function in type 1 diabetes after diagnosis: a multi-centre longitudinal study. Diabetes Obes Metab 2014; 16:262-7. [PMID: 24118704 DOI: 10.1111/dom.12216] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/14/2013] [Accepted: 09/14/2013] [Indexed: 01/12/2023]
Abstract
AIMS C-peptide secretion is currently the only available clinical biomarker to measure residual β-cell function in type 1 diabetes. However, the natural history of C-peptide decline after diagnosis can vary considerably dependent upon several variables. We investigated the shape of C-peptide decline over time from type 1 diabetes onset in relation to age at diagnosis, haemoglobin A1c (HbA1c) levels and insulin dose. METHODS We analysed data from 3929 type 1 diabetes patients recruited from seven European centres representing all age groups at disease onset (childhood, adolescence and adulthood). The influence of the age at onset on β-cell function was investigated in a longitudinal analysis at diagnosis and up to 5-years follow-up. RESULTS Fasting C-peptide (FCP) data at diagnosis were available in 3668 patients stratified according to age at diagnosis in four groups (<5 years, n = 344; >5 years < 10 years, n = 668; >10 years < 18 years, n = 991; >18 years, n = 1655). FCP levels were positively correlated with age (p < 0.001); the subsequent decline in FCP over time was log-linear with a greater decline rate in younger age groups (p < 0.0001). CONCLUSIONS This study reveals a positive correlation between age at diagnosis of type 1 diabetes and FCP with a more rapid decline of β-cell function in the very young patients. These data can inform the design of clinical trials using C-peptide values as an end-point for the effect of a given treatment.
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Affiliation(s)
- A Barker
- Department MRC Epidemiology Unit, Cambridge Institute of Public Health, Cambridge, UK
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17
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Abstract
AIM The aim of this study was to examine mortality in patients with both type 1 diabetes (T1D) and coeliac disease (CD). METHODS Between 1969 and 2008, we identified individuals with CD through biopsy reports from all pathology departments (n = 28) in Sweden. T1D was defined as a diagnosis of diabetes recorded in the Swedish National Patient Register between 1964 and 2009 in individuals aged ≤ 30 years. During follow-up, we identified 960 patients with both T1D and CD. For each individual with T1D and CD, we selected up to five subjects with T1D alone (i.e. no CD), matched for sex, age and calendar period of diagnosis, as the reference group (n = 4608). Using a stratified Cox regression analysis with CD as a time-dependent covariate, we estimated the risk of death in patients with both T1D and CD compared with those with T1D alone. RESULTS Stratifying for time since CD diagnosis, CD was not a risk factor for death in patients with T1D during the first 5 years after CD diagnosis [hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.43-1.73], but thereafter the HR for mortality increased as a function of follow-up time (5 to < 10 years, HR 1.44, 95% CI 0.74-2.79; 10 to <15 years, HR 1.88, 95% CI 0.81-4.36). Having a CD diagnosis for ≥ 15 years was associated with a 2.80-fold increased risk of death in individuals with T1D (95% CI 1.28-6.12). CONCLUSION A diagnosis of CD for ≥ 15 years increases the risk of death in patients with T1D.
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Affiliation(s)
- K Mollazadegan
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
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18
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Jonsdottir B, Andersson C, Carlsson A, Delli A, Forsander G, Ludvigsson J, Marcus C, Samuelsson U, Ortqvist E, Lernmark A, Ivarsson SA, Larsson HE. Thyroid autoimmunity in relation to islet autoantibodies and HLA-DQ genotype in newly diagnosed type 1 diabetes in children and adolescents. Diabetologia 2013; 56:1735-42. [PMID: 23666211 DOI: 10.1007/s00125-013-2934-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/22/2013] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to investigate, in children newly diagnosed with type 1 diabetes: (1) the prevalence of autoantibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TGAb); and (2) the association between TPOAb, TGAb or both, with either islet autoantibodies or HLA-DQ genes. METHODS Blood samples from 2,433 children newly diagnosed with type 1 diabetes were analysed for TPOAb and TGAb in addition to autoantibodies against arginine zinc transporter 8 (ZnT8RA), tryptophan zinc transporter 8 (ZnT8WA), glutamine zinc transporter 8 (ZnT8QA), glutamic acid decarboxylase (GADA), insulin (IAA), insulinoma-associated protein-2 (IA-2A), HLA-DQA-B1 genotypes, thyroid-stimulating hormone (TSH) and free thyroxine (T4). RESULTS At type 1 diabetes diagnosis, 12% of the children had thyroid autoantibodies (60% were girls; p < 0.0001). GADA was positively associated with TPOAb (p < 0.001) and with TGAb (p < 0.001). In addition, ZnT8A was associated with both TPOAb (p = 0.039) and TGAb (p = 0.015). DQB1*05:01 in any genotype was negatively associated with TPOAb (OR 0.55, 95% CI 0.37, 0.83, p value corrected for multiple comparisons (p c) = 0.012) and possibly with TGAb (OR 0.55, 95% CI 0.35, 0.87, p c = 0.07). Thyroid autoimmunity in children newly diagnosed with type 1 diabetes was rarely (0.45%) associated with onset of clinical thyroid disease based on TSH and free T4. CONCLUSIONS/INTERPRETATION GADA and ZnT8A increased the risk for thyroid autoimmunity at the time of clinical diagnosis of type 1 diabetes, while HLA-DQB1*05:01 reduced the risk. However, the associations between thyroid autoimmunity and HLA-DQ genotype were weak and did not fully explain the co-occurrence of islet and thyroid autoimmunity.
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Affiliation(s)
- B Jonsdottir
- Department of Clinical Sciences, Skåne University Hospital SUS, Malmö, Sweden.
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19
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Pihl M, Akerman L, Axelsson S, Chéramy M, Hjorth M, Mallone R, Ludvigsson J, Casas R. Regulatory T cell phenotype and function 4 years after GAD-alum treatment in children with type 1 diabetes. Clin Exp Immunol 2013; 172:394-402. [PMID: 23600827 DOI: 10.1111/cei.12078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2013] [Indexed: 01/13/2023] Open
Abstract
Glutamic acid decarboxylase (GAD)(65) formulated with aluminium hydroxide (GAD-alum) was effective in preserving insulin secretion in a Phase II clinical trial in children and adolescents with recent-onset type 1 diabetes. In addition, GAD-alum treated patients increased CD4(+) CD25(hi) forkhead box protein 3(+) (FoxP3(+)) cell numbers in response to in-vitro GAD(65) stimulation. We have carried out a 4-year follow-up study of 59 of the original 70 patients to investigate long-term effects on the frequency and function of regulatory T cells after GAD-alum treatment. Peripheral blood mononuclear cells were stimulated in vitro with GAD65 for 7 days and expression of regulatory T cell markers was measured by flow cytometry. Regulatory T cells (CD4(+) CD25(hi) CD127(lo)) and effector T cells (CD4(+) CD25(-) CD127(+)) were further sorted, expanded and used in suppression assays to assess regulatory T cell function after GAD-alum treatment. GAD-alum-treated patients displayed higher frequencies of in-vitro GAD(65) -induced CD4(+) CD25(+) CD127(+) as well as CD4(+) CD25(hi) CD127(lo) and CD4(+) FoxP3(+) cells compared to placebo. Moreover, GAD(65) stimulation induced a population of CD4(hi) cells consisting mainly of CD25(+) CD127(+) , which was specific of GAD-alum-treated patients (16 of 25 versus one of 25 in placebo). Assessment of suppressive function in expanded regulatory T cells revealed no difference between GAD-alum- and placebo-treated individuals. Regulatory T cell frequency did not correlate with C-peptide secretion throughout the study. In conclusion, GAD-alum treatment induced both GAD(65) -reactive CD25(+) CD127(+) and CD25(hi) CD127(lo) cells, but no difference in regulatory T cell function 4 years after GAD-alum treatment.
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Affiliation(s)
- M Pihl
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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20
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Pham MN, Kolb H, Battelino T, Ludvigsson J, Pozzilli P, Zivehe F, Roden M, Mandrup-Poulsen T, Schloot NC. Fasting and meal-stimulated residual beta cell function is positively associated with serum concentrations of proinflammatory cytokines and negatively associated with anti-inflammatory and regulatory cytokines in patients with longer term type 1 diabetes. Diabetologia 2013; 56:1356-63. [PMID: 23494449 DOI: 10.1007/s00125-013-2883-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/14/2013] [Indexed: 01/01/2023]
Abstract
AIMS/HYPOTHESIS Cytokines may promote or inhibit disease progression in type 1 diabetes. We investigated whether systemic proinflammatory, anti-inflammatory and regulatory cytokines associated differently with fasting and meal-stimulated beta cell function in patients with longer term type 1 diabetes. METHODS The beta cell function of 118 patients with type 1 diabetes of duration of 0.75-4.97 years was tested using a standardised liquid mixed meal test (MMT). Serum samples obtained at -5 to 120 min were analysed by multiplex bead-based technology for proinflammatory (IL-6, TNF-α), anti-inflammatory (IL-1 receptor antagonist [IL-1RA]) and regulatory (IL-10, TGF-β1-3) cytokines, and by standard procedures for C-peptide. Differences in beta cell function between patient groups were assessed using stepwise multiple regression analysis adjusting for sex, age, duration of diabetes, BMI, HbA1c and fasting blood glucose. RESULTS High fasting systemic concentrations of the proinflammatory cytokines IL-6 and TNF-α were associated with increased fasting and stimulated C-peptide concentrations even after adjustment for confounders (p < 0.03). Interestingly, increased concentrations of anti-inflammatory/regulatory IL-1RA, IL-10, TGF-β1 and TGF-β2 were associated with lower fasting and stimulated C-peptide levels (p < 0.04), losing significance on adjustment for anthropometric variables. During the MMT, circulating concentrations of IL-6 and TNF-α increased (p < 0.001) while those of IL-10 and TGF-β1 decreased (p < 0.02) and IL-1RA and TGF-β2 remained unchanged. CONCLUSIONS/INTERPRETATION The association between better preserved beta cell function in longer term type 1 diabetes and increased systemic proinflammatory cytokines and decreased anti-inflammatory and regulatory cytokines is suggestive of ongoing inflammatory disease activity that might be perpetuated by the remaining beta cells. These findings should be considered when designing immune intervention studies aimed at patients with longer term type 1 diabetes and residual beta cell function.
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Affiliation(s)
- M N Pham
- Institute for Clinical Diabetology at the German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
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Chéramy M, Hampe CS, Ludvigsson J, Casas R. Characteristics of in-vitro phenotypes of glutamic acid decarboxylase 65 autoantibodies in high-titre individuals. Clin Exp Immunol 2013; 171:247-54. [PMID: 23379430 DOI: 10.1111/cei.12026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2012] [Indexed: 01/29/2023] Open
Abstract
Previous studies have indicated phenotypical differences in glutamic acid decarboxylase 65 autoantibodies (GADA) found in type 1 diabetes (T1D) patients, individuals at risk of developing T1D and stiff-person syndrome (SPS) patients. In a Phase II trial using aluminium-formulated GAD(65) (GAD-alum) as an immunomodulator in T1D, several patients responded with high GADA titres after treatment, raising concerns as to whether GAD-alum could induce GADA with SPS-associated phenotypes. This study aimed to analyse GADA levels, immunoglobulin (Ig)G1-4 subclass frequencies, b78- and b96·11-defined epitope distribution and GAD(65) enzyme activity in sera from four cohorts with very high GADA titres: T1D patients (n = 7), GAD-alum-treated T1D patients (n = 9), T1D high-risk individuals (n = 6) and SPS patients (n = 12). SPS patients showed significantly higher GADA levels and inhibited the in-vitro GAD(65) enzyme activity more strongly compared to the other groups. A higher binding frequency to the b78-defined epitope was found in the SPS group compared to T1D and GAD-alum individuals, whereas no differences were detected for the b96·11-defined epitope. GADA IgG1-4 subclass levels did not differ between the groups, but SPS patients had higher IgG2 and lower IgG4 distribution more frequently. In conclusion, the in-vitro GADA phenotypes from SPS patients differed from the T1D- and high-risk groups, and GAD-alum treatment did not induce SPS-associated phenotypes. However, occasional overlap between the groups exists, and caution is indicated when drawing conclusions to health or disease status.
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Affiliation(s)
- M Chéramy
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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22
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Andersson C, Vaziri-Sani F, Delli A, Lindblad B, Carlsson A, Forsander G, Ludvigsson J, Marcus C, Samuelsson U, Ivarsson S, Lernmark A, Larsson HE. Triple specificity of ZnT8 autoantibodies in relation to HLA and other islet autoantibodies in childhood and adolescent type 1 diabetes. Pediatr Diabetes 2013; 14:97-105. [PMID: 22957668 DOI: 10.1111/j.1399-5448.2012.00916.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 06/08/2012] [Accepted: 07/06/2012] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To establish the diagnostic sensitivity of and the relationships between autoantibodies to all three Zinc transporter 8 (Zinc transporter 8 autoantibody to either one, two, or all three amino acid variants at position 325, ZnT8A) variants to human leukocyte antigen (HLA)-DQ and to autoantibodies to glutamic acid decarboxylase (GADA), insulinoma-associated protein 2 (IA-2A), and insulin (IAA). METHODS We analyzed 3165 patients with type 1 diabetes (T1D) in the Better Diabetes Diagnosis study for HLA-DQ genotypes and all six autoantibodies (ZnT8RA, arginine 325 Zinc transporter 8 autoantibody; ZnT8WA, tryptophan 325 Zinc transporter 8 autoantibody; ZnT8QA, glutamine 325 Zinc transporter 8 autoantibody; GADA, IA-2A, and IAA). RESULTS ZnT8A was found in 65% of the patients and as many as 108 of 3165 (3.4%) had 1-3 ZnT8A alone. None had ZnT8QA alone. Together with GADA (56%), IA-2A (73%), and IAA (33%), 93% of the T1D patients were autoantibody positive. All three ZnT8A were less frequent in children below 2 yr of age (p < 0.0001). All three ZnT8A were associated with DQA1-B1*X-0604 (DQ6.4) and DQA1-B1*03-0302 (DQ8). ZnT8WA and ZnT8QA were negatively associated with DQA1-B1*05-02 (DQ2). CONCLUSIONS Analysis of ZnT8A increased the diagnostic sensitivity of islet autoantibodies for T1D as only 7% remained islet autoantibody negative. The association between DQ6.4 and all three ZnT8A may be related to ZnT8 antigen presentation by the DQ6.4 heterodimer.
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Affiliation(s)
- C Andersson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden.
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Samuelsson U, Lindblad B, Carlsson A, Forsander G, Ivarsson S, Kockum I, Lernmark Å, Marcus C, Ludvigsson J. Residual beta cell function at diagnosis of type 1 diabetes in children and adolescents varies with gender and season. Diabetes Metab Res Rev 2013; 29:85-9. [PMID: 23081842 PMCID: PMC3644881 DOI: 10.1002/dmrr.2365] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 09/07/2012] [Accepted: 10/11/2012] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are seasonal variations and gender differences in incidence of type 1 diabetes (T1D), metabolic control and responses to immune interventions at onset of the disease. We hypothesized that there are seasonal and gender differences in residual insulin secretion already at diagnosis of T1D. METHODS In 2005, a national study, the Better Diabetes Diagnosis, was started to classify all newly diagnosed children and adolescents with diabetes. About 95% (3824/4017) of the patients were classified as T1D, and our analyses are based on the patients with T1D. RESULTS C-peptide was lower in younger children, 0-10 years of age (0.23 ± 0.20 nmol/L) than in older children, 11-18 years of age (0.34 ± 0.28 nmol/L) (p < 0.000 ). There was a seasonal variation in non-fasting serum C-peptide, significantly correlated to the seasonal variation of diagnosis (p < 0.01). Most children were diagnosed in January, February and March as well as in October when C-peptide was highest, whereas fewer patients were diagnosed in April and May when serum C-peptide was significantly lower (p < 0.01). The seasonal variation of C-peptide was more pronounced in boys than in girls (p < 0.000 and p < 0.01, respectively). Girls had higher C-peptide than boys (p < 0.05), especially in early puberty. CONCLUSIONS Both seasonal and gender differences in residual beta cell function exist already at diagnosis of T1D. These observations have consequences for treatment and for randomizing patients in immune intervention clinical trials.
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Affiliation(s)
- U Samuelsson
- Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes, Research Center, Linköping University Hospital, Linköping, Sweden.
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Ludvigsson J. Novel therapies in the management of type I diabetes mellitus. Panminerva Med 2012; 54:257-270. [PMID: 23123577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Development of insulin pumps and glucose sensors together with sophisticated algoritms and connections leading to closed loop systems will probably soon improve and facilitate treatment for many patients with Type 1 diabetes (T1D). However, the burden for patients will not disappear completely, and such therapy will still require both competence and motivation of patients. Therefore the final goal should be either to cure the disease via replacement therapy (transplantions) or stop the destructive process, preserve residual insulin secretion or even improve via beta cell regeneration. This will give a milder disease, a more stable metabolism, simpler treatment and perhaps even cure. It is neither necessary nor even plausible that Type 1 diabetes has one single cause or pathogenesis. Infections may be one causal factor, and vaccinations will then turn the increasing incidence downwards. We will also soon know whether it is possible to prevent some cases of T1D by avoiding cow's milk in the early nutrition. It is possible that probiotics can influence the gut flora so that the gut permeability is normlized and maturation of the immune system is improved which may also contribute to less incidence of Type 1 diabetes. However, for those who already have got the disease we need interventions to preserve exisiting beta cell function and facilitate regeneration of beta-cells. Broader immunosuppressive therapies have been disappointing. Phase III studies using monocloncal antiCD3 antibodies have recently failed, but one dose regimen showed promising effect in patients aged 8-20 years. Therefore furthers studies are needed. Autoantigen treatment is a promising concept, and has the great advantage of being easy, practical with no adverse events. Diapep277 has shown some positive results in adults with good C-peptide, and glutamic acid decarboxylase (GAD)-alum has given quite impressive results in children aged 10-20 years, even though the results from studies differ. It is time to start combination therapies where auto-antigen/s, alone or in combination, are used together with other agents such as Vitamin D and anti-inflammatory drugs. We need to learn how to treat subgroups of patients. Gradually a more individualized treatment may become successful.
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Affiliation(s)
- J Ludvigsson
- Division of Pediatrics, Department of Clinical of Experimental Medicine, Linköping University, Linköping, Sweden.
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Abstract
AIM The balance between T helper cell subsets is an important regulator of the immune system and is often examined after immune therapies. We aimed to study the immunomodulatory effect of glutamic acid decarboxylase (GAD) 65 formulated with aluminium hydroxide (GAD-alum) in children with Type 1 diabetes, focusing on chemokines and their receptors. METHODS Blood samples were collected from 70 children with Type 1 diabetes included in a phase II clinical trial with GAD-alum. Expression of CC chemokine receptor 5 (CCR5) and CCR4 was analysed on CD4+ and CD8+ lymphocytes after in vitro stimulation with GAD(65) using flow cytometry, and secretion of the chemokines CCL2, CCL3 and CCL4 was detected in peripheral blood mononuclear cell supernatants with Luminex. RESULTS Expression of Th1-associated CCR5 was down-regulated following antigen challenge, together with an increased CCR4/CCR5 ratio and CCL2 secretion in GAD-alum-treated patients, but not in the placebo group. CONCLUSION Our results suggest that GAD-alum treatment has induced a favourable immune modulation associated with decreased Th1/Tc1 phenotypes upon antigen re-challenge, which may be of importance for regulating GAD(65) immunity.
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Affiliation(s)
- S Axelsson
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Jennersjö P, Ludvigsson J, Länne T, Nystrom FH, Ernerudh J, Östgren CJ. Pedometer-determined physical activity is linked to low systemic inflammation and low arterial stiffness in Type 2 diabetes. Diabet Med 2012; 29:1119-25. [PMID: 22364114 DOI: 10.1111/j.1464-5491.2012.03621.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to explore the association between pedometer-determined physical activity versus measures of obesity, inflammatory markers and arterial stiffness in people with Type 2 diabetes. METHODS We analysed data from 224 men and 103 women with Type 2 diabetes, aged 54-66 years. Physical activity was measured with waist-mounted pedometers during three consecutive days and the number of steps/day were calculated and classified in four groups: < 5000 steps/day, 5000-7499 steps/day, 7500-9999 steps/day and ≥ 10000 steps/day. Blood samples were analysed for lipids, HbA(1c), inflammatory markers including C-reactive protein and interleukin-6. Nurses measured blood pressure and anthropometrics. Aortic pulse wave velocity was measured with applanation tonometry over the carotid and femoral arteries. RESULTS Mean steps/day was 7683 ± 3883 (median 7222, interquartile range 4869-10,343). There were no differences in age, diabetes duration, blood pressure, lipids or glycaemic control between the four groups of pedometer-determined physical activity. Subjects with higher steps/day had lower BMI (28.8 vs. 31.5 kg/m(2), P < 0.001), waist circumference (101.7 vs. 108.0 cm, P < 0.001), lower levels of C-reactive protein (1.6 vs. 2.6 mg/l, P = 0.007), lower levels of interleukin-6 (1.9 vs. 3.8 pg ml, P < 0.001) and lower pulse wave velocity (10.2 vs. 11.0 m/s, P = 0.009) compared with less physically active people. CONCLUSIONS We conclude that physical activity measured with pedometer was associated not only with less abdominal obesity, but also with decreased systemic low-grade inflammation as well as with low arterial stiffness, in people with Type 2 diabetes.
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Affiliation(s)
- P Jennersjö
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Hanberger L, Samuelsson U, Berterö C, Ludvigsson J. The influence of structure, process, and policy on HbA(1c) levels in treatment of children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2012; 96:331-8. [PMID: 22326692 DOI: 10.1016/j.diabres.2012.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 01/08/2012] [Accepted: 01/10/2012] [Indexed: 12/18/2022]
Abstract
AIMS To identify factors which improve glycaemic control measured as HbA(1c) in children and adolescents with diabetes treated at paediatric departments. METHODS Through data from the Swedish paediatric diabetes quality registry, SWEDIABKIDS, five centres respectively with the lowest, highest, and largest decrease in centre mean HbA(1c) (Low, High, Decrease HbA(1c) centres) were identified. Diabetes team members completed questionnaires (109 of 128 responded) and reported team structure, process and policy. Open-ended questions were analysed with summative content analysis. RESULTS Compared to the High HbA(1c) centres, the Low and Decrease HbA(1c) centres showed higher compliance with guidelines, although they had shorter professional experience and lower proportion of special diabetes-educated team members. A clear message was given and the centres aimed at a lower HbA(1c) target value. Team members were devoted, had a positive attitude and perception of a well-functioning team. Trends for higher mean insulin dose and larger centre size were found. High HbA(1c) centres gave a vague message and had a perception of lack of cooperation in the team. CONCLUSIONS Team members' policy and approaches affect glycaemic control in children and adolescents. Team members need to be aware of their approach and of the importance of using resources within the team.
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Affiliation(s)
- L Hanberger
- Department of Clinical and Experimental Medicine, Linköping University, Sweden.
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Leslie RD, Ludvigsson J. The viral aetiology of diabetes: a tribute to Keith Taylor (1929-2012). Diabet Med 2012; 29:419. [PMID: 22409517 DOI: 10.1111/j.1464-5491.2012.03614.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lahdenperä AI, Hölttä V, Ruohtula T, Salo HM, Orivuori L, Westerholm-Ormio M, Savilahti E, Fälth-Magnusson K, Högberg L, Ludvigsson J, Vaarala O. Up-regulation of small intestinal interleukin-17 immunity in untreated coeliac disease but not in potential coeliac disease or in type 1 diabetes. Clin Exp Immunol 2012; 167:226-34. [PMID: 22235998 DOI: 10.1111/j.1365-2249.2011.04510.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Up-regulation of interleukin (IL)-17 in small intestinal mucosa has been reported in coeliac disease (CD) and in peripheral blood in type 1 diabetes (T1D). We explored mucosal IL-17 immunity in different stages of CD, including transglutaminase antibody (TGA)-positive children with potential CD, children with untreated and gluten-free diet-treated CD and in children with T1D. Immunohistochemistry was used for identification of IL-17 and forkhead box protein 3 (FoxP3)-positive cells and quantitative polymerase chain reaction (qPCR) for IL-17, FoxP3, retinoic acid-related orphan receptor (ROR)c and interferon (IFN)-γ transcripts. IL-1β, IL-6 and IL-17 were studied in supernatants from biopsy cultures. Expression of the apoptotic markers BAX and bcl-2 was evaluated in IL-17-stimulated CaCo-2 cells. The mucosal expression of IL-17 and FoxP3 transcripts were elevated in individuals with untreated CD when compared with the TGA-negative reference children, children with potential CD or gluten-free diet-treated children with CD (P < 0·005 for all IL-17 comparisons and P < 0·01 for all FoxP3 comparisons). The numbers of IL-17-positive cells were higher in lamina propria in children with CD than in children with T1D (P < 0·05). In biopsy specimens from patients with untreated CD, enhanced spontaneous secretion of IL-1β, IL-6 and IL-17 was seen. Activation of anti-apoptotic bcl-2 in IL-17-treated CaCo-2 epithelial cells suggests that IL-17 might be involved in mucosal protection. Up-regulation of IL-17 could, however, serve as a biomarker for the development of villous atrophy and active CD.
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Affiliation(s)
- A I Lahdenperä
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Ludvigsson J, Carlsson A, Forsander G, Ivarsson S, Kockum I, Lernmark A, Lindblad B, Marcus C, Samuelsson U. C-peptide in the classification of diabetes in children and adolescents. Pediatr Diabetes 2012; 13:45-50. [PMID: 21910810 DOI: 10.1111/j.1399-5448.2011.00807.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To report C-peptide results in newly diagnosed patients and the relation to clinical diagnosis of diabetes. METHODS A nation-wide cohort, the Better Diabetes Diagnosis study was used to determine serum C-peptide at diagnosis in 2734 children and adolescents. Clinical data were collected at diagnosis and follow-up. C-peptide was determined in a validated and controlled time-resolved fluoroimmunoassay. RESULTS The clinical classification of diabetes, before any information on human leukocyte antigen, islet autoantibodies, or C-peptide was received, was type 1 diabetes (T1D) in 93%, type 2 diabetes (T2D) in 1.9%, maturity onset diabetes of the young (MODY) in 0.8%, secondary diabetes (0.6%), while 3.3% could not be classified. In a random, non-fasting serum sample at diagnosis, 56% of the patients had a C-peptide value >0.2 nmol/L. Children classified as T2D had the highest mean C-peptide (1.83 + 1.23 nmol/L) followed by MODY (1.04 ± 0.71 nmol/L) and T1D (0.28 ± 0.25 nmol/L). Only 1/1037 children who had C-peptide <0.2 nmol/L at diagnosis was classified with a type of diabetes other than T1D. Predictive value of C-peptide >1.0 nmol/L for the classification of either T2D or MODY was 0.46 [confidence interval 0.37-0.58]. CONCLUSIONS More than half of children with newly diagnosed diabetes have clinically important residual beta-cell function. As the clinical diagnosis is not always straightforward, a random C-peptide taken at diagnosis may help to classify diabetes. There is an obvious use for C-peptide determinations to evaluate beta-cell function in children with diabetes.
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Affiliation(s)
- J Ludvigsson
- Division of Pediatrics and Diabetes Research Center, Department of Clinical and Experimental Medicine, Linköping University Hospital, Linköping, Sweden.
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Carlsson A, Kockum I, Lindblad B, Engleson L, Nilsson A, Forsander G, Karlsson AK, Kernell A, Ludvigsson J, Marcus C, Zachrisson I, Ivarsson SA, Lernmark A. Low risk HLA-DQ and increased body mass index in newly diagnosed type 1 diabetes children in the Better Diabetes Diagnosis study in Sweden. Int J Obes (Lond) 2011; 36:718-24. [PMID: 21712811 PMCID: PMC3192932 DOI: 10.1038/ijo.2011.122] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective Type 1 diabetes and obesity has increased in childhood. We therefore tested the hypothesis that type 1 diabetes HLA-DQ risk genotypes may be associated with an increased body mass index (BMI). Design The type 1 diabetes high risk HLA-DQ A1*05:01-B1*02:01/A1*03:01-B1*03:02 genotype along with lower risk DQ genotypes were determined at the time of clinical onset by PCR and hybridization with allele-specific probes. Body mass index was determined after diabetes was stabilized. Subjects A total of 2403 incident type 1 diabetes children below 18 years of age were ascertained in the Swedish national Better Diabetes Diagnosis (BDD) studybetween May 2005 to September 2009. All children classified with type 1 diabetes including positivity for at least one islet autoantibody were investigated. Results Overall, type 1 diabetes HLA-DQ risk was negatively associated with BMI (p<0.0008). The proportion of the highest risk A1*05:01-B1*02:01/A1*03:01-B1*03:02 genotype decreased with increasing BMI (p<0.0004). However, lower risk type 1 diabetes DQ genotypes were associated with an increased proportion of patients who were overweight or obese (p<0.0001). Indeed, the proportion of patients with the low risk A1*05:01-B1*02:01/A1*05:01-B1*02:01 genotype increased with increasing body mass index (p<0.003). The magnitude of association on the multiplicative scale between the A1*05:01-B1*02:01/A1*05:01-B1*02:01 genotype and increased body mass index was significant (p<0.006). The odds ratio in patients with this genotype of being obese was 1.80 (95% CI 1.21–2.61; p<0.006). The increased proportion of overweight type 1 diabetes children with the A1*05:01-B1*02:01 haplotype was most pronounced in children diagnosed between 5 and 9 years of age. Conclusions Susceptibility for childhood type 1 diabetes was unexpectedly found to be associated with the A1*05:01-B1*02:01/A1*05:01-B1*02:01 genotype and an increased BMI. These results support the hypothesis that overweight may contribute to the risk of type 1 diabetes in children positive for HLA-DQ A1*05:01-B1*02:01.
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Affiliation(s)
- A Carlsson
- Department of Pediatrics, Skåne University Hospital SUS, Lund, Sweden
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Ludvigsson J, Hjorth M, Chéramy M, Axelsson S, Pihl M, Forsander G, Nilsson NÖ, Samuelsson BO, Wood T, Aman J, Ortqvist E, Casas R. Extended evaluation of the safety and efficacy of GAD treatment of children and adolescents with recent-onset type 1 diabetes: a randomised controlled trial. Diabetologia 2011; 54:634-40. [PMID: 21116604 DOI: 10.1007/s00125-010-1988-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 10/29/2010] [Indexed: 01/12/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate the safety and efficacy of alum formulated glutamic acid decarboxylase GAD(65) (GAD-alum) treatment of children and adolescents with type 1 diabetes after 4 years of follow-up. METHODS Seventy children and adolescents aged 10-18 years with recent onset type 1 diabetes participated in a phase II, double-blind, randomised placebo-controlled clinical trial. Patients identified as possible participants attended one of eight clinics in Sweden to receive information about the study and for an eligibility check, including a medical history. Participants were randomised to one of the two treatment groups and received either a subcutaneous injection of 20 μg of GAD-alum or placebo at baseline and 1 month later. The study was blinded to participants and investigators until month 30. The study was unblinded at 15 months to the sponsor and statistician in order to evaluate the data. At follow-up after 30 months there was a significant preservation of residual insulin secretion, as measured by C-peptide, in the group receiving GAD-alum compared with placebo. This was particularly evident in patients with <6 months disease duration at baseline. There were no treatment-related serious adverse events. We have now followed these patients for 4 years. Overall, 59 patients, 29 who had been treated with GAD-alum and 30 who had received placebo, gave their informed consent. RESULTS One patient in each treatment group experienced an episode of keto-acidosis between months 30 and 48. There were no treatment-related adverse events. The primary efficacy endpoint was the change in fasting C-peptide concentration from baseline to 15 months after the prime injection for all participants per protocol set. In the GAD-alum group fasting C-peptide was 0.332 ± 0.032 nmol/l at day 1 and 0.215 ± 0.031 nmol/l at month 15. The corresponding figures for the placebo group were 0.354 ± 0.039 and 0.184 ± 0.033 nmol/l, respectively. The decline in fasting C-peptide levels between day 1 and month 1, was smaller in the GAD-alum group than the placebo group. The difference between the treatment groups was not statistically significant. In those patients who were treated within 6 months of diabetes diagnosis, fasting C-peptide had decreased significantly less in the GAD-alum group than in the placebo-treated group after 4 years. CONCLUSION/INTERPRETATION Four years after treatment with GAD-alum, children and adolescents with recent-onset type 1 diabetes continue to show no adverse events and possibly to show clinically relevant preservation of C-peptide. TRIAL REGISTRATION ClinicalTrials.gov NCT00435981 FUNDING The study was funded by The Swedish Research Council K2008-55X-20652-01-3, Barndiabetesfonden (The Swedish Child Diabetes Foundation), the Research Council of Southeast Sweden, and an unrestricted grant from Diamyd Medical AB.
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Affiliation(s)
- J Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-58185, Linköping, Sweden.
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Cardwell CR, Stene LC, Joner G, Bulsara MK, Cinek O, Rosenbauer J, Ludvigsson J, Svensson J, Goldacre MJ, Waldhoer T, Jarosz-Chobot P, Gimeno SG, Chuang LM, Roberts CL, Parslow RC, Wadsworth EJ, Chetwynd A, Brigis G, Urbonaite B, Sipetic S, Schober E, Devoti G, Ionescu-Tirgoviste C, de Beaufort CE, Stoyanov D, Buschard K, Radon K, Glatthaar C, Patterson CC. Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies. Int J Epidemiol 2010; 40:363-74. [DOI: 10.1093/ije/dyq207] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Cattaneo A, Monasta L, Stamatakis E, Lioret S, Castetbon K, Frenken F, Manios Y, Moschonis G, Savva S, Zaborskis A, Rito AI, Nanu M, Vignerová J, Caroli M, Ludvigsson J, Koch FS, Serra-Majem L, Szponar L, van Lenthe F, Brug J. Overweight and obesity in infants and pre-school children in the European Union: a review of existing data. Obes Rev 2010; 11:389-98. [PMID: 19619261 DOI: 10.1111/j.1467-789x.2009.00639.x] [Citation(s) in RCA: 237] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998-2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20-30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.
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Affiliation(s)
- A Cattaneo
- Health Services Research, Epidemiology and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy.
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Cardwell CR, Stene LC, Joner G, Davis EA, Cinek O, Rosenbauer J, Ludvigsson J, Castell C, Svensson J, Goldacre MJ, Waldhoer T, Polanska J, Gimeno SGA, Chuang LM, Parslow RC, Wadsworth EJK, Chetwynd A, Pozzilli P, Brigis G, Urbonaite B, Sipetić S, Schober E, Ionescu-Tirgoviste C, de Beaufort CE, Stoyanov D, Buschard K, Patterson CC. Birthweight and the risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies using individual patient data. Diabetologia 2010; 53:641-51. [PMID: 20063147 DOI: 10.1007/s00125-009-1648-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 12/10/2009] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS We investigated whether children who are heavier at birth have an increased risk of type 1 diabetes. METHODS Relevant studies published before February 2009 were identified from literature searches using MEDLINE, Web of Science and EMBASE. Authors of all studies containing relevant data were contacted and asked to provide individual patient data or conduct pre-specified analyses. Risk estimates of type 1 diabetes by category of birthweight were calculated for each study, before and after adjustment for potential confounders.Meta-analysis techniques were then used to derive combined ORs and investigate heterogeneity between studies. RESULTS Data were available for 29 predominantly European studies (five cohort, 24 case-control studies), including 12,807 cases of type 1 diabetes. Overall, studies consistently demonstrated that children with birthweight from 3.5 to 4 kg had an increased risk of diabetes of 6% (OR 1.06 [95% CI 1.01-1.11]; p=0.02) and children with birthweight over 4 kg had an increased risk of 10% (OR 1.10 [95% CI 1.04-1.19]; p=0.003), compared with children weighing 3.0 to 3.5 kg at birth. This corresponded to a linear increase in diabetes risk of 3% per 500 g increase in birthweight (OR 1.03 [95% CI 1.00-1.06]; p=0.03). Adjustments for potential confounders such as gestational age, maternal age, birth order, Caesarean section, breastfeeding and maternal diabetes had little effect on these findings. CONCLUSIONS/INTERPRETATION Children who are heavier at birth have a significant and consistent, but relatively small increase in risk of type 1 diabetes.
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Affiliation(s)
- C R Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK,
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Koch FS, Ludvigsson J, Sepa A. Parents' Psychological Stress Over Time may Affect Children's Cortisol at Age 8. J Pediatr Psychol 2010; 35:950-9. [DOI: 10.1093/jpepsy/jsp132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- J Ludvigsson
- Department of Clinical and Experimental Medicine, Linköping University, Sweden.
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Swartling U, Helgesson G, Hansson MG, Ludvigsson J. Split views among parents regarding children's right to decide about participation in research: a questionnaire survey. J Med Ethics 2009; 35:450-455. [PMID: 19567697 DOI: 10.1136/jme.2008.027383] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Based on extensive questionnaire data, this paper focuses on parents' views about children's right to decide about participation in research. The data originates from 4000 families participating in a longitudinal prospective screening as 1997. Although current regulations and recommendations underline that children should have influence over their participation, many parents in this study disagree. Most (66%) were positive providing information to the child about relevant aspects of the study. However, responding parents were split about whether or not children should at some point be allowed decisional authority when participating in research: 41.6% of the parents reported being against or unsure. Those who responded positively believed that children should be allowed to decide about blood-sampling procedures (70%), but to a less extent about participation (48.5%), analyses of samples (19.7%) and biological bank storage (15.4%). That as many as possible should remain in the study, and that children do not have the competence to understand the consequences for research was strongly stressed by respondents who do not think children should have a right to decide. When asked what interests they consider most important in paediatric research, child autonomy and decision-making was ranked lowest. We discuss the implications of these findings.
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Affiliation(s)
- U Swartling
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, SE-581 85 Linkoping, Sweden.
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Abstract
It is rather difficult to draw conclusions from reported C-peptide values, as the methods for determination differ, and C-peptide may be measured in serum or in urine with the patient fasting or after stimulation. We have followed prospectively 49 children with IDDM with regular determinations of serum C-peptide fasting and after a standardized breakfast. A subgroup of seven patients have been studied more thoroughly with 24-hour-profile of serum C-peptide, C-peptide excretion in urine, and stimulation by i.v. glucose + i.v. arginine. Our results indicate that the stimulation of the beta cells usually reaches a maximum around a blood glucose level of 10-12 mmol/l leading to a curve linear relationship between serum C-peptide and blood glucose. Thus a simple quotient is not so useful but the degree of stimulation should be stated and actual blood glucose value noticed. Stimulation with a standardized breakfast gives roughly the same information as maximal stimulation with i.v. glucose + arginine, and little extra information is found by a 24-hour-profile. Urinary C-peptide may give valuable information if it is related to the actual degree of metabolic balance. It can be of special interest in patients with very low serum C-peptide levels.
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Hedman M, Faresjö M, Axelsson S, Ludvigsson J, Casas R. Impaired CD4 and CD8 T cell phenotype and reduced chemokine secretion in recent-onset type 1 diabetic children. Clin Exp Immunol 2009; 153:360-8. [PMID: 18803760 DOI: 10.1111/j.1365-2249.2008.03720.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Although the role of the T cell-mediated autoimmune reaction in type 1 diabetes (T1D) is conclusive, studies including data from human circulating CD4(+) and CD8(+) lymphocytes subsets during the disease onset and posterior development are scarce. Further, chemokines and chemokine receptors are key players in the migration of pathogenic T cells into the islets of non-obese diabetic mice developing T1D, but few studies have investigated these markers in human T1D patients. We studied the expression of T helper 1 (Th1)- and Th2-associated chemokine receptors, and the two isoforms of CD45 leucocyte antigen on CD4(+) and CD8(+) lymphocytes from T1D and healthy children, as well as the secretion of chemokines in cell supernatants in peripheral blood mononuclear cells. Our results showed increased expression of CCR7 and CD45RA and reduced CD45RO on CD8(+) cells among recent-onset T1D patients. The percentages of CD4(+) cells expressing CXC chemokine receptor 3 (CXCR3), CXCR6 and CCR5, and the secretion of interferon-gamma-induced protein-10, monocyte chemoattractant protein-1, macrophage inflammatory protein (MIP)-1alpha and MIP-1beta was lower among diabetics. Low expression of Th1-associated receptors and secretion of chemokines, together with an increased amount of CD8(+) cells expressing CD45RA and CCR7 in T1D patients therefore might represent suboptimal Th function in T1D, leading to impaired T cytotoxic responses or alternatively reflect a selective recruitment of Th1 cells into the pancreas.
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Affiliation(s)
- M Hedman
- Division of Pediatrics and Diabetes Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Ludvigsson J. Adequate doses of autoantigen administered using the appropriate route may create tolerance and stop autoimmunity. Diabetologia 2009; 52:175-6. [PMID: 19005640 DOI: 10.1007/s00125-008-1211-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 10/24/2008] [Indexed: 01/12/2023]
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Resic-Lindehammer S, Larsson K, Ortqvist E, Carlsson A, Cederwall E, Cilio CM, Ivarsson SA, Jönsson BA, Larsson HE, Lynch K, Neiderud J, Nilsson A, Sjöblad S, Lernmark A, Aili M, Bååth LE, Carlsson E, Edenwall H, Forsander G, Granstro BW, Gustavsson I, Hanås R, Hellenberg L, Hellgren H, Holmberg E, Hörnell H, Ivarsson SA, Johansson C, Jonsell G, Kockum K, Lindblad B, Lindh A, Ludvigsson J, Myrdal U, Neiderud J, Segnestam K, Sjöblad S, Skogsberg L, Strömberg L, Ståhle U, Thalme B, Tullus K, Tuvemo T, Wallensteen M, Westphal O, Aman J. Temporal trends of HLA genotype frequencies of type 1 diabetes patients in Sweden from 1986 to 2005 suggest altered risk. Acta Diabetol 2008; 45:231-5. [PMID: 18769865 DOI: 10.1007/s00592-008-0048-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 07/14/2008] [Indexed: 01/24/2023]
Abstract
The aim of this study was to compare the frequency of human leukocyte antigen (HLA) genotypes in 1-18-year-old patients with type 1 diabetes newly diagnosed in 1986-1987 (n = 430), 1996-2000 (n = 342) and in 2003-2005 (n = 171). We tested the hypothesis that the HLA DQ genotype distribution changes over time. Swedish type 1 diabetes patients and controls were typed for HLA using polymerase chain reaction amplification and allele specific probes for DQ A1* and B1* alleles. The most common type 1 diabetes HLA DQA1*-B1*genotype 0501-0201/0301-0302 was 36% (153/430) in 1986-1987 and 37% (127/342) in 1996-2000, but decreased to 19% (33/171) in 2003-2005 (P \ 0.0001). The 0501-0201/0501-0201 genotype increased from 1% in 1986-1987 to 7% in 1996-2000 (P = 0.0047) and to 5% in 2003-2005 (P > 0.05). This study in 1-18-year-old Swedish type 1 diabetes patients supports the notion that there is a temporal change in HLA risk.
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Affiliation(s)
- Sabina Resic-Lindehammer
- Department of Clinical Sciences, Unit of Diabetes and Celiac Disease, University Hospital MAS, CRC/Lund University, Ent 72 Bldg 91 Floor 10, 205 02 Malmö, Sweden.
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Akesson K, Carlsson A, Ivarsson SA, Johansson C, Weidby BM, Ludvigsson J, Gustavsson B, Lernmark A, Kockum I. The non-inherited maternal HLA haplotype affects the risk for type 1 diabetes. Int J Immunogenet 2008; 36:1-8. [PMID: 19055605 DOI: 10.1111/j.1744-313x.2008.00802.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim was to test the hypothesis that the human leucocyte antigen (HLA) haplotype that is not inherited from the mother, that is, the non-inherited maternal antigen (NIMA) affects the risk for type 1 diabetes (T1D). A total of 563 children with T1D and 286 non-diabetic control children from Sweden were genotyped for DRB1, DQA1 and DQB1 alleles. The frequency of positively (DR4-DQA1*0301-B1*0302 and DR3-DQA1*0501-B1*0201), negatively (DR15-DQ A1*0102-B1*0602) or neutrally (all other) T1D associated HLA haplotypes were compared between NIMA and non-inherited paternal antigen (NIPA). All comparisons were carried out between HLA-matched patients and controls. The frequency of positively associated NIMA was higher among both DR4/X-positive healthy individuals compared wit DR4/X-positive patients (P < 0.00003) and DR3/X-positive healthy individuals compared with DR3/X-positive patients (P < 0.009). No such difference was observed for NIPA. High-risk NIMA was increased compared to NIPA among healthy DR3/X- and DR4/X-positive children (P < 0.05). There was no difference in frequency of positively associated haplotypes between patient NIMA and NIPA. The NIMA but not the NIPA affects the risk for T1D, suggesting that not only the inherited but also non-inherited maternal HLA haplotypes, perhaps through microchimerism or other mechanisms, may influence the risk for the disease.
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Affiliation(s)
- K Akesson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Walldén J, Ilonen J, Roivainen M, Ludvigsson J, Vaarala O. Effect of HLA genotype or CTLA-4 polymorphism on cytokine response in healthy children. Scand J Immunol 2008; 68:345-50. [PMID: 18782261 DOI: 10.1111/j.1365-3083.2008.02144.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Type 1 diabetes (T1D) is considered to be a T-cell-mediated autoimmune disease in which genetic predisposition is affected by HLA class II alleles and polymorphisms in cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) gene. We tested the hypothesis whether these T1D-related gene polymorphisms modulate cytokine response and thus contribute to the development of autoimmunity. The study includes 67 non-diabetic children, typed for HLA class II alleles and CTLA-4 polymorphisms (+49A/G, CT60A/G, CTBC217_1C/T). We measured cytokine secretion of peripheral blood mononuclear cells after stimulation with tetanus toxoid (TT), polio virus, coxsackie virus B4, pertussis toxin (PT) and phytohemagglutinin (PHA). We saw higher IL-13 response to TT in individuals with DR3-DQ2 haplotype (P = 0.002). HLA class II protective haplotype, DR2-DQ6, showed association with increased production of IFN-gamma (P < 0.001) and IL-2 (P = 0.005) in response to polio virus. In children with the autoimmunity-related homozygous genotypes CTLA-4 +49G/G, CT60G/G and CTBC217_1T/T, we found enhanced PT- and PHA-induced IFN-gamma production (P < 0.05). The cytokine responses to studied antigens were weakly modified by HLA class II risk haplotypes, and children with T1D-associated HLA risk haplotypes are not specifically inclined to develop an immune response in general. Higher IFN-gamma and IL-2 response to enterovirus in children with HLA class II protective haplotype DR2-DQ6 could be of importance in the protection from T1D-associated enterovirus infections. All autoimmunity related CTLA-4 polymorphisms were associated with enhanced IFN-gamma. This suggests impaired downregulation of cellular immunity by these CTLA-4 polymorphisms.
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Affiliation(s)
- J Walldén
- Division of Pediatrics and Diabetes Research Center, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Koch F, Ludvigsson J, Sepa A. Body Dissatisfaction Measured with a Figure Preference Task and Self-Esteem in 8 Year Old Children—a Study within the ABIS-Project. Clinical medicine Pediatrics 2008. [DOI: 10.4137/cmped.s932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Body dissatisfaction has been related to low self-esteem and depression in adolescents. With regard to the current world wide rise in childhood obesity and common stigmatization of adults and children with obesity, easy to use and cost effective measurements of body dissatisfaction would be helpful in epidemiological research. In the current study, detailed data on body measurements with regard to perceived and ideal body size and body dissatisfaction, as measured with the figure preference task, are presented for a population based sample of 3837 children. Perceived body size correlations to weight, body mass index [BMI], and waist circumference were between 0.41 and 0.54; and to height between 0.12 and 0.21. Odds ratios for lower self-esteem increased with increase in body dissatisfaction. Gender differences in body dissatisfaction were present but not found in relation to self-esteem. It is concluded that the figure preference task yields valuable information in epidemiological studies of children as young as 7.5 years of age. It is argued, that the figure preference task is an additional measurement which theoretically relates to psychological stress in childhood.
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Affiliation(s)
- F.S. Koch
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden
| | - J. Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden
| | - A. Sepa
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden
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Danne T, Battelino T, Jarosz-Chobot P, Kordonouri O, Pánkowska E, Ludvigsson J, Schober E, Kaprio E, Saukkonen T, Nicolino M, Tubiana-Rufi N, Klinkert C, Haberland H, Vazeou A, Madacsy L, Zangen D, Cherubini V, Rabbone I, Toni S, de Beaufort C, Bakker-van Waarde W, van den Berg N, Volkov I, Barrio R, Hanas R, Zumsteg U, Kuhlmann B, Aebi C, Schumacher U, Gschwend S, Hindmarsh P, Torres M, Shehadeh N, Phillip M. Establishing glycaemic control with continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes: experience of the PedPump Study in 17 countries. Diabetologia 2008; 51:1594-601. [PMID: 18592209 DOI: 10.1007/s00125-008-1072-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 05/20/2008] [Indexed: 01/15/2023]
Abstract
AIMS/HYPOTHESIS To assess the use of paediatric continuous subcutaneous infusion (CSII) under real-life conditions by analysing data recorded for up to 90 days and relating them to outcome. METHODS Pump programming data from patients aged 0-18 years treated with CSII in 30 centres from 16 European countries and Israel were recorded during routine clinical visits. HbA(1c) was measured centrally. RESULTS A total of 1,041 patients (age: 11.8 +/- 4.2 years; diabetes duration: 6.0 +/- 3.6 years; average CSII duration: 2.0 +/- 1.3 years; HbA(1c): 8.0 +/- 1.3% [means +/- SD]) participated. Glycaemic control was better in preschool (n = 142; 7.5 +/- 0.9%) and pre-adolescent (6-11 years, n = 321; 7.7 +/- 1.0%) children than in adolescent patients (12-18 years, n = 578; 8.3 +/- 1.4%). There was a significant negative correlation between HbA(1c) and daily bolus number, but not between HbA(1c) and total daily insulin dose. The use of <6.7 daily boluses was a significant predictor of an HbA(1c) level >7.5%. The incidence of severe hypoglycaemia and ketoacidosis was 6.63 and 6.26 events per 100 patient-years, respectively. CONCLUSIONS/INTERPRETATION This large paediatric survey of CSII shows that glycaemic targets can be frequently achieved, particularly in young children, and the incidence of acute complications is low. Adequate substitution of basal and prandial insulin is associated with a better HbA(1c).
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Affiliation(s)
- T Danne
- Kinderkrankenhaus auf der Bult, Hanover, Janusz-Korczak-Allee 12, 30173 Hanover, Germany.
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Abstract
AIMS To compare levels of insulin antibodies in children and adolescents after initiation of insulin therapy using either insulin aspart (IAsp) or human insulin (HI) in combination with Neutral Protamine Hagedorn (NPH) insulin, and to investigate the relationships between insulin antibodies and HbA(1c) and insulin dose. METHODS IAsp-specific antibodies (IAsp-Ab) and antibodies cross-reacting with HI and IAsp (HI-cross-Ab) were analysed by radioimmunoassay at diagnosis of diabetes and every 3-6 months for 30 months. Seventy-two patients (HI = 30, IAsp = 42) with Type 1 diabetes, aged 2-17 years were included. Data on HbA(1c), insulin dose and serious adverse events (SAEs) were collected retrospectively. RESULTS IAsp-Ab levels remained low throughout the study. After 9 months, the level of HI-cross-Ab increased [mean (SD) HI, 48.8% (21.53); IAsp, 40.2% (17.92)] and remained elevated. Repeated measurement analysis of HI-cross-Ab levels showed no significant difference between treatments (P = 0.16). HI-cross-Ab were significantly associated with total insulin dose (U/kg) (P = 0.001) and time (P < 0.0001), but not with HbA(1c) (P = 0.24). Mean (+/- SD) HbA(1c) was similar at diagnosis (HI 9.5 +/- 1.97%; IAsp 9.6 +/- 1.62%); HbA(1c) then decreased and stabilized to about 6.0% in both groups. Few SAEs were reported, the majority being hypoglycaemic episodes. CONCLUSIONS Treatment with IAsp and with HI was associated with an increase in HI-cross-Ab in insulin-naive children, but this did not influence treatment efficacy or safety. These results support the safe use of IAsp in children and adolescents with Type 1 diabetes.
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Affiliation(s)
- H Holmberg
- Division of Paediatrics and Diabetes Research Centre, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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