1
|
den Brok EJ, Svensson CH, Panagiotou M, van Greevenbroek MMJ, Mertens PR, Vazeou A, Mitrakou A, Makrilakis K, Franssen GHLM, van Kuijk S, Proennecke S, Mougiakakou S, Pedersen-Bjergaard U, de Galan BE. The effect of bolus advisors on glycaemic parameters in adults with diabetes on intensive insulin therapy: A systematic review with meta-analysis. Diabetes Obes Metab 2024; 26:1950-1961. [PMID: 38504142 DOI: 10.1111/dom.15521] [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: 01/10/2024] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/21/2024]
Abstract
AIM To conduct a systematic review with meta-analysis to provide a comprehensive synthesis of randomized controlled trials (RCTs) and prospective cohort studies investigating the effects of currently available bolus advisors on glycaemic parameters in adults with diabetes. MATERIALS AND METHODS An electronic search of PubMed, Embase, CINAHL, Cochrane Library and ClinicalTrials.gov was conducted in December 2022. The risk of bias was assessed using the revised Cochrane Risk of Bias tool. (Standardized) mean difference (MD) was selected to determine the difference in continuous outcomes between the groups. A random-effects model meta-analysis and meta-regression were performed. This systematic review was registered on PROSPERO (CRD42022374588). RESULTS A total of 18 RCTs involving 1645 adults (50% females) with a median glycated haemoglobin (HbA1c) concentration of 8.45% (7.95%-9.30%) were included. The majority of participants had type 1 diabetes (N = 1510, 92%) and were on multiple daily injections (N = 1173, 71%). Twelve of the 18 trials had low risk of bias. The meta-analysis of 10 studies with available data on HbA1c showed that the use of a bolus advisor modestly reduced HbA1c compared to standard treatment (MD -011%, 95% confidence interval -0.22 to -0.01; I2 = 0%). This effect was accompanied by small improvements in low blood glucose index and treatment satisfaction, but not with reductions in hypoglycaemic events or changes in other secondary outcomes. CONCLUSION Use of a bolus advisor is associated with slightly better glucose control and treatment satisfaction in people with diabetes on intensive insulin treatment. Future studies should investigate whether personalizing bolus advisors using artificial intelligence technology can enhance these effects.
Collapse
Affiliation(s)
- Elisabeth J den Brok
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Cecilie H Svensson
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
| | - Maria Panagiotou
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | | | - Peter R Mertens
- Department of Kidney and Hypertension Diseases, Diabetology and Endocrinology, Otto-Von-Guericke-Univeristat Magdeburg, Magdeburg, Germany
| | | | - Asimina Mitrakou
- Diabetes Center, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gregor H L M Franssen
- University Library, Department Education, Content & Support, Maastricht University, Maastricht, The Netherlands
| | - Sander van Kuijk
- Clinical epidemiology & Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Stavroula Mougiakakou
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Lausanne, Denmark
| | - Bastiaan E de Galan
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Ulriksdotter J, Sukakul T, Bruze M, Mowitz M, Ofenloch R, Svedman C. Contact Allergy to Allergens in the Swedish Baseline Series Overrepresented in Diabetes Patients with Skin Reactions to Medical Devices - A Retrospective Study from Southern Sweden. Acta Derm Venereol 2024; 104:adv19676. [PMID: 38551376 PMCID: PMC11000652 DOI: 10.2340/actadv.v104.19676] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 04/02/2024] Open
Abstract
Allergic contact dermatitis is reported among individuals using continuous glucose monitoring systems and insulin pumps. The aim of this study was to describe contact allergy patterns for allergens in the Swedish baseline series and medical device-related allergens among users. Contact allergy to baseline series allergens and isobornyl acrylate was compared between diabetes patients and dermatitis patients patch-tested at the Department of Occupational and Environmental Dermatology during 2017 to 2020. Fifty- four diabetes patients and 2,567 dermatitis patients were included. The prevalence of contact allergy to fragrance mix II and sesquiterpene lactone mix was significantly higher in diabetes patients compared with dermatitis patients. Of the diabetes patients 13.0% and of the dermatitis patients 0.5% tested positive to sesquiterpene lactone mix (p < 0.001). Of the diabetes patients 7.4% and of the dermatitis patients 2.3% tested positive to fragrance mix II (p = 0.041). Of the diabetes patients 70.4% tested positive to medical device-related allergens. Of the diabetes patients 63.0% and of the dermatitis patients 0.2% were allergic to isobornyl acrylate (p < 0.001). In conclusion, not only medical device-related contact allergies, but also contact allergy to baseline series allergens (fragrance mix II and sesquiterpene lactone mix), is overrepresented in diabetes patients who use medical devices.
Collapse
Affiliation(s)
- Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden; Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden .
| | - Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Robert Ofenloch
- Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
3
|
Hussein S, Jespersen LN, Ingersgaard MV, Skovby P, Grabowski D. Trying to be like everybody else: A qualitative study revealing the importance of social contexts and illness representations among adolescents with type 1 diabetes and their parents. Chronic Illn 2024; 20:37-48. [PMID: 36760087 DOI: 10.1177/17423953231155287] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Type 1 diabetes is one of the most common chronic conditions in young children and adolescents. During the period of adolescence, young people with diabetes often struggle with self-management and have compromised health-related quality of life. This often leads to familial conflicts affecting all family members negatively. The aim of this study is to provide qualitative insight into the everyday life of families with adolescents with type 1 diabetes. METHODS The data consisted of participatory family workshops conducted using interactive dialogue tools. The total number of participants was 33 (adolescents n = 13, parents n = 20). The adolescents were between 15 and 17 years. The data were analyzed using systematic text condensation. RESULTS The results showed two main themes. The first theme, Diabetes-friendly and unfriendly social contexts, highlighted how the (dis)comfortability of disclosing diabetes was a significant factor in achieving optimal metabolic control. For parents, it affected their perception of social support. The second theme, incongruent illness representations among family members, dealt with the extended family conflict during the period of adolescence. DISCUSSION Insights from our study could help healthcare professionals apply a family-centered approach minimizing family conflict and supporting metabolic control when consulting families with adolescents with type 1 diabetes.
Collapse
Affiliation(s)
- Sana Hussein
- Department of Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Louise Norman Jespersen
- Department of Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Marianne Vie Ingersgaard
- Department of Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Pernille Skovby
- Herning Hospital, Region of Central Jutland, Herning, Denmark
| | - Dan Grabowski
- Department of Health Promotion Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| |
Collapse
|
4
|
Anwar A, Faisal F, Elahi W, Illahi A, Alam SM, Adnan STA, Batool SA, Bhagwandas S, Hashmi AA. Correlation of Blood Urea and Creatinine Levels With Thiamin Levels in Type 1 and Type 2 Diabetic Patients. Cureus 2024; 16:e57022. [PMID: 38681462 PMCID: PMC11046357 DOI: 10.7759/cureus.57022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Serum urea and creatinine levels are the most commonly recognized parameters for evaluating renal impairment in patients with diabetes mellitus (DM). Therefore, this study evaluated the correlation between urea and creatinine levels and thiamin levels in patients with type 1 DM (T1DM) and type 2 DM (T2DM). Methods This multi-center, cross-sectional study was conducted at diabetic outpatient clinics in Karachi. The duration of the study was six months, from 1st January 2023 to 30th June 2023. A total of 60 patients were enrolled and divided into two groups, i.e., T1DM and T2DM, each containing 30 patients of both genders between the ages of 24 and 42 years. Demographic data and biochemical variables, such as urea, creatinine, random blood sugar, fasting blood sugar, hemoglobin A1c, and serum thiamin levels, were assessed. The Mann-Whitney U test and independent t-test were used to associate the means between the two study groups. The chi-square test and Spearman's correlation coefficient were used to determine the associations between the variables and T1DM and T2DM. Results The study results revealed that patients with T2DM had a significantly higher frequency of hypertension (p = 0.039), neuropathy (p = 0.038), and coronary artery disease (p = 0.010) than those with T1DM, in both genders. The level of serum thiamin was found to be significantly higher (p < 0.001) in T2DM (14.8 ± 4.82) than in T1DM patients (7.34 ± 1.90). Similarly, serum creatinine was higher in T2DM than in T1DM patients (0.83 ± 0.12 vs. 0.76 ± 0.17, p = 0.025). Moreover, the correlation of urea and creatinine with thiamin levels in T1DM and T2DM patients revealed that in T1DM and T2DM patients, urea and creatinine showed an insignificant positive correlation with thiamin levels. Conclusion We found a significantly higher level of serum creatinine and thiamin levels in T2DM patients than in T1DM; however, there was no significant correlation between urea and creatinine levels and thiamin status in T1DM and T2DM patients. Therefore, we conclude that although serum urea, creatinine, and serum thiamin are important disease biomarkers in diabetic patients, there is no correlation between them.
Collapse
Affiliation(s)
- Adnan Anwar
- Physiology, Hamdard College of Medicine and Dentistry, Karachi, PAK
- Internal Medicine, Essa General Hospital, Karachi, PAK
| | | | - Wajeeha Elahi
- Nephrology, Hamdard University Hospital, Karachi, PAK
| | - Ahsan Illahi
- Community Medicine, Field Epidemiology Training Program, Sindh Government Hospital, Karachi, PAK
| | | | | | - Syed Asra Batool
- Medicine, Hamdard College of Medicine and Dentistry, Karachi, PAK
| | | | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| |
Collapse
|
5
|
Hellstrand Tang U, Scandurra I, Sundberg L, Annersten Gershater M, Zügner R. Patients' Expectations of Evidence-Based Service at the Pharmacy Regarding Information on Self-Care of the Feet for Persons with Diabetes at Risk of Developing Foot Ulcers - A Cross-Sectional Observational Study in Sweden. Patient Prefer Adherence 2023; 17:3557-3576. [PMID: 38169667 PMCID: PMC10758569 DOI: 10.2147/ppa.s435632] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Self-care of the feet is one of the cornerstones in the prevention of diabetic foot ulcers (DFU). Often, individuals with diabetes seek help at the pharmacy, but it is still unclear whether the service meets their expectations and needs. The aims were to explore patients' expectations of support from the pharmacy regarding self-care of their feet and explore how patients with diabetes felt that they managed the self-care of their feet. Patients and Methods The included participants (n = 17), aged 70 ± 9 years, answered surveys regarding their expectations of support from the pharmacy related to self-care of the feet and how they felt that they managed the self-care of their feet. By using software, MyFoot Diabetes, they assessed their risk of developing DFU (ranging from 1 = no risk to 4 = DFU). In addition, a healthcare professional assessed the risk grade. Results Sixteen patients had not received any information from the pharmacy regarding how to take care of their feet. Several suggestions for ways the pharmacy could help patients with diabetes to take care of their feet were registered. They included having the necessary skills and competence, giving advice regarding self-care, giving information regarding the products they market and have for sale and giving advice on ointments/creams. The participants gave several examples of how they self-managed their feet: by wearing shoes indoors and outdoors, wearing socks and compression stockings as often as possible, being physically active, inspecting their feet, being aware of the fact that their feet have no problems, washing, moisturising their feet, cutting their nails and finally seeking help to prevent DFU. Conclusion The participants thought that they should receive competent information from the personnel at the pharmacy to improve the self-care of their feet, eg, being given information about which ointments/creams to use. Clinical Trial NCT05692778.
Collapse
Affiliation(s)
- Ulla Hellstrand Tang
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabella Scandurra
- Centre of Empirical Research in Information Systems, Örebro University, Örebro, Sweden
| | | | | | - Roland Zügner
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
6
|
Niazi SK. Anti-Idiotypic mRNA Vaccine to Treat Autoimmune Disorders. Vaccines (Basel) 2023; 12:9. [PMID: 38276668 PMCID: PMC10819008 DOI: 10.3390/vaccines12010009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
The 80+ existing autoimmune disorders (ADs) affect billions with little prevention or treatment options, except for temporary symptomatic management, leading to enormous human suffering and a monumental financial burden. The autoantibodies formed in most ADs have been identified, allowing the development of novel anti-idiotypic antibodies to mute the autoantibodies using vaccines. Nucleoside vaccines have been successfully tested as antigen-specific immunotherapies (ASI), with mRNA technology offering multi-epitope targeting to mute multiple autoantibodies. This paper proposes using mRNA technology to produce anti-idiotypic antibodies with broad effectiveness in preventing and treating them. This paper delves into the state-of-the-art mRNA design strategies used to develop novel ASIs by selecting appropriate T cell and B cell epitopes to generate anti-idiotypic antibodies. The low cost and fast development of mRNA vaccines make this technology the most affordable for the global control of ADs.
Collapse
Affiliation(s)
- Sarfaraz K Niazi
- College of Pharmacy, University of Illinois, Chicago, IL 60012, USA
| |
Collapse
|
7
|
Jelleryd E, Brorsson AL, Smart CE, Käck U, Lindholm Olinder A. Carbohydrate Counting, Empowerment and Glycemic Outcomes in Adolescents and Young Adults with Long Duration of Type 1 Diabetes. Nutrients 2023; 15:4825. [PMID: 38004219 PMCID: PMC10675281 DOI: 10.3390/nu15224825] [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] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
The complex treatment for diabetes type 1 (T1D) includes insulin dosing for every meal, which requires education and experience to achieve optimal outcomes. Advanced carbohydrate counting (ACC) is the recommended method. We studied ACC as part of a standard treatment with the aim to explore its associations with glycemic control and empowerment in adolescents and young adults. We used national registry data on glycemic outcomes, a study-specific questionnaire regarding the use of ACC and the Gothenburg Young Persons Empowerment Scale (GYPES) to measure empowerment. A total of 111 participants (10-28 years of age, diabetes duration >9 years, mean HbA1c of 55.4 mmol/mol) answered the questionnaire. We found that most participants (79.3%) who learn ACC, at onset or later, continue to use the method. A higher level of empowerment was associated with lower HbA1c (p = 0.021), making patient empowerment an important factor in achieving optimal glycemic outcomes. No associations were found between ACC and empowerment or glycemic outcomes. A mixed strategy, only using ACC sometimes when insulin dosing for meals, was associated with the lowest empowerment score and highest HbA1c and should warrant extra education and support from the diabetes team to reinforce a dosing strategy.
Collapse
Affiliation(s)
- Elisabeth Jelleryd
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Women’s Health and Allied Health Professionals Theme, Medical Unit Clinical Nutrition, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Anna Lena Brorsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 14152 Stockholm, Sweden;
| | - Carmel E. Smart
- Department of Endocrinology, John Hunter Children’s Hospital, Newcastle, NSW 2305, Australia;
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2300, Australia
| | - Ulrika Käck
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Sachs’ Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Sachs’ Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
| |
Collapse
|
8
|
Dan AO, Bălășoiu AT, Puiu I, Tănasie AC, Târtea AE, Sfredel V. Retinal Microvascular Alterations in a Patient with Type 1 Diabetes Mellitus, Hemoglobin D Hemoglobinopathy, and High Myopia-Case Report and Review of the Literature. Diagnostics (Basel) 2023; 13:2934. [PMID: 37761301 PMCID: PMC10527753 DOI: 10.3390/diagnostics13182934] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Type 1 diabetes mellitus (type 1 DM) is one of the most prevalent endocrinological diseases among children and young adults, with a growing incidence rate reaching up to 2.9 new cases per year per 100,000 persons below 15 years of age. We report a rare case of a 20-year-old female patient with type 1 DM, hemoglobin D (HbD) heterozygote variant and high myopia of -10.00 spheric diopters, and describe the retinal microvascular alterations visible on OCT angiography (angio-OCT). The patient also presented with a severe stature deficit (less than three standard deviations) and delayed puberty, which could not be explained only by suboptimal glycemic control and indicated possible hypopituitarism. HbA1c level evaluated with the high-performance liquid chromatography (HPLC) method was 6.5%, a falsely low value due to HbD hemoglobinopathy. On ophthalmic evaluation, the angio-OCT scan showed the following retinal microvascular alterations in the right eye (RE): the FAZ (Foveal Avascular Zone) area was 0.39 mm2, the FAZ perimeter was 2.88 mm, and the circularity index was 0.58. The following alterations were shown in the left eye (LE): the FAZ area was 0.34 mm2, the FAZ perimeter was 3.21 mm, and the circularity index was 0.41. Clinicians should consider high-performance retinal screening methods such as angio-OCT evaluation for young type 1 DM patients, especially for those with associated pathologies like high myopia and hemoglobinopathies. Moreover, multiple evaluation methods of HbA1c values are mandatory as hemoglobinopathies can interfere with the accuracy of HbA1c assay methods.
Collapse
Affiliation(s)
- Alexandra Oltea Dan
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andrei Theodor Bălășoiu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ileana Puiu
- Department of Pediatrics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andreea Cornelia Tănasie
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Elena Târtea
- Department of Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Veronica Sfredel
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| |
Collapse
|
9
|
Cyranka K, Matejko B, Juza A, Kieć-Wilk B, Cohen O, Malecki MT, Klupa T. Quality of life in the course of a one-year use of an advanced hybrid closed-loop system in adults with type 1 diabetes previously naïve to advanced diabetes technology. Front Endocrinol (Lausanne) 2023; 14:1210756. [PMID: 37654566 PMCID: PMC10466125 DOI: 10.3389/fendo.2023.1210756] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Aim To evaluate the effect of a one-year use of an advanced hybrid closed-loop (AHCL) system on the quality of life, level of anxiety, and level of self-efficacy in adults with type 1 diabetes (T1D) previously treated with multiple daily injections (MDI) and naïve to advanced diabetes technology. Methods A total of 18 participants of a previously published 3-month randomized trial (10 men, 8 women; age 40.9 ± 7.6 years) who were switched directly from MDI/BMG to AHCL completed 12 months of MiniMed 780G™system use (a 3-month randomized trial followed by a 9-month follow-up phase). At month 6 of the study, patients were switched from the sensor GS3 (Continuous Glucose Monitoring) system, powered by Guardian™ Sensor 3) to GS4. Quality of life was assessed using the Polish validated version of the 'QoL-Q Diabetes' questionnaire. The level of anxiety was evaluated with the use of the State-Trait Anxiety Inventory (STAI). Self-efficacy was assessed with the General Self-Efficacy Scale (GSES). Results were obtained at baseline and at the end of the study. Results Significant increase in QoL was reported in the global score (p=0.02, Cohen d=0.61) and in as many as 11 out of 23 analyzed areas of life: being physically active (p=0.02, Cohen d = 0.71); feeling well (p<.01, Cohen d = 0.73); feeling in control of my body (p<.01, Cohen d = 0.72); looking good (p<.01, Cohen d = 1.07); working (p<.01, Cohen d = 1.12); sleeping (p=0.01, Cohen d = 0.66); eating as I would like (p<.01, Cohen d = 0.79); looking after or being useful to others (p= 0.02, Cohen d = 0.65); being active with pets/animals (p<.01, Cohen d = 0.95); being spontaneous (p=0.02, Cohen d = 0.67); and doing "normal" things (p=0.02, Cohen d = 0.67). Both state (p=0.04, Cohen d = 0.56) and trait (p=0.02, Cohen d = 0.60) anxiety decreased while the general self-efficacy increased (p=0.03, Cohen d = 0.76). No participant stopped the use of the pump. Conclusion Adult patients with T1D previously treated with MDI and naïve to modern technologies experienced significant improvement in their psychological well-being after transitioning to the AHCL system after 12 months of treatment.
Collapse
Affiliation(s)
- Katarzyna Cyranka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Anna Juza
- Clinical Provincial Hospital of Frederic Chopin No. 1 in Rzeszów, Rzeszów, Poland
- College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | | | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| |
Collapse
|
10
|
Zong S, Vinke AM, Du P, Hoffmann C, Mané-Damas M, Molenaar PC, Damoiseaux JGMC, Losen M, Rouhl RPW, Martinez-Martinez P. Anti-GAD65 autoantibody levels measured by ELISA and alternative types of immunoassays in relation to neuropsychiatric diseases versus diabetes mellitus type 1. Front Neurol 2023; 14:1111063. [PMID: 37305746 PMCID: PMC10248002 DOI: 10.3389/fneur.2023.1111063] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Background Anti-GAD65 autoantibodies (GAD65-Abs) may occur in patients with epilepsy and other neurological disorders, but the clinical significance is not clear-cut. Whereas high levels of GAD65-Abs are considered pathogenic in neuropsychiatric disorders, low or moderate levels are only considered as mere bystanders in, e.g., diabetes mellitus type 1 (DM1). The value of cell-based assays (CBA) and immunohistochemistry (IHC) for GAD65-Abs detection has not been clearly evaluated in this context. Objective To re-evaluate the assumption that high levels of GAD65-Abs are related to neuropsychiatric disorders and lower levels only to DM1 and to compare ELISA results with CBA and IHC to determine the additional value of these tests. Methods 111 sera previously assessed for GAD65-Abs by ELISA in routine clinical practice were studied. Clinical indications for testing were, e.g., suspected autoimmune encephalitis or epilepsy (neuropsychiatric cohort; n = 71, 7 cases were initially tested positive for GAD65-Abs by ELISA), and DM1 or latent autoimmune diabetes in adults (DM1/LADA cohort (n = 40, all were initially tested positive)). Sera were re-tested for GAD65-Abs by ELISA, CBA, and IHC. Also, we examined the possible presence of GAD67-Abs by CBA and of other neuronal autoantibodies by IHC. Samples that showed IHC patterns different from GAD65 were further tested by selected CBAs. Results ELISA retested GAD65-Abs level in patients with neuropsychiatric diseases was higher than in patients with DM1/LADA (only retested positive samples were compared; 6 vs. 38; median 47,092 U/mL vs. 581 U/mL; p = 0.02). GAD-Abs showed positive both by CBA and IHC only if antibody levels were above 10,000 U/mL, without a difference in prevalence between the studied cohorts. We found other neuronal antibodies in one patient with epilepsy (mGluR1-Abs, GAD-Abs negative), and in a patient with encephalitis, and two patients with LADA. Conclusion GAD65-Abs levels are significantly higher in patients with neuropsychiatric disease than in patients with DM1/LADA, however, positivity in CBA and IHC only correlates with high levels of GAD65-Abs, and not with the underlying diseases.
Collapse
Affiliation(s)
- Shenghua Zong
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Anita M. Vinke
- Department of Neurology, Maastricht University Medical Center (MUMC +), Maastricht, Netherlands
| | - Peng Du
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Carolin Hoffmann
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
- Algarve Biomedical Center, Algarve Biomedical Center Research Institute, Faro, Portugal
| | - Marina Mané-Damas
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Peter C. Molenaar
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | | | - Mario Losen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Rob P. W. Rouhl
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
- Department of Neurology, Maastricht University Medical Center (MUMC +), Maastricht, Netherlands
- Academic Centre for Epileptology Kempenhaeghe/MUMC+, Maastricht, Netherlands
| | - Pilar Martinez-Martinez
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| |
Collapse
|
11
|
Fatani B, Alfhaed NK, Alkhemshi AA, Alomireeni AA, Albarrak MS, Alquhayz MF, Alzahrani SG. Behavioral Changes in Patients With Diabetes During the COVID-19 Pandemic in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e34956. [PMID: 36938276 PMCID: PMC10019933 DOI: 10.7759/cureus.34956] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
On March 2, 2020, the first case of coronavirus disease 2019 (COVID-19) was dedicated in Saudi Arabia. The government established partial quarantine, and all precautions were mandatory on March 23, 2020. This in turn forced people to spend more time at home, leading to changes in the physical activity and dietary habits of individuals. In this study, we aimed to assess the behavioral changes of Saudi diabetic individuals during the COVID-19 pandemic and measure the effectiveness of the behavioral changes of Saudi diabetic individuals during the COVID-19 pandemic on the control of the glucose level. A cross-sectional study was conducted through an online questionnaire sent to diabetic patients in Riyadh, Saudi Arabia. Participants ranging from 18 years old and above of both genders were selected. Diabetic patients (type 1 and 2) were included. All collected data for this study were analyzed using Stata 17 (StataCorp LLC, College Station, Texas, USA). A total of 223 people responded. For 45% of individuals, doctor visits significantly decreased (p<0.05), and the percentage of doctor visits also decreased for individuals who previously visited their doctor more regularly. Furthermore, the number of hours spent on tablets increased significantly during COVID-19 (p<0.05). Our findings demonstrate that there are no significant changes in lifestyle factors or glycemic control during the pandemic compared with the pre-pandemic year in individuals with diabetes. However, the rate of patient visits to the doctor was lower than pre-pandemic, with an increase in the rate of physical activity.
Collapse
Affiliation(s)
- Bader Fatani
- Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
| | - Nawaf K Alfhaed
- Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
| | - Aseel A Alkhemshi
- Medicine and Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Aseel A Alomireeni
- Medicine and Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Maha S Albarrak
- Medicine and Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Mohammed F Alquhayz
- Medicine and Surgery, College of Medicine, King Saud University, Riyadh, SAU
| | - Saeed G Alzahrani
- Public Health, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| |
Collapse
|
12
|
Małachowska M, Gosławska Z, Rusak E, Jarosz-Chobot P. The role and need for psychological support in the treatment of adolescents and young people suffering from type 1 diabetes. Front Psychol 2023; 13:945042. [PMID: 36687959 PMCID: PMC9845699 DOI: 10.3389/fpsyg.2022.945042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Psychological support might be perceived as one of the most important factors in the treatment of people suffering from type 1 diabetes, particularly among vulnerable groups such as adolescents and young people. Problems arising from extreme pressure put on young patients, high expectations, and specific limitations associated with diabetes often reflect in negative wellbeing and affect patients' behavior, resulting in lower self-esteem, mood swings, depression, or even eating disorders. Therefore, the need for a more holistic approach to the treatment of diabetes and caring about psychological support can be observed, which may contribute to better functioning and management of the disease. Differentiation of certain approach methods such as the positive approach (PA) discussed in the text may help young patients in motivation and coping with their disease as well as accepting limitations caused by type 1 diabetes. This would decrease the risk of potential revolt against medical recommendations, common for patients at the mentioned age, and help raise awareness of the problem. Maintaining life balance through undertaking regular physical activities and being open to new strategies such as telenursing can also result in the improvement of glycemic control. The studies presented have proven the great effectiveness of personalized care adjusted to the patient with psychological support, as well as the invaluable role of education in diabetes, which includes not only standard procedures such as calculating an appropriate insulin dose but also the invention of effective coping mechanisms, which influence patients' performance and wellbeing.
Collapse
Affiliation(s)
- Magdalena Małachowska
- Students' Scientific Association at the Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland,Faculty of Medicine, The Medical University of Warsaw, Warsaw, Poland,*Correspondence: Magdalena Małachowska ✉
| | - Zuzanna Gosławska
- Department of Clinical Endocrinology, Independent Public Health Care Central Clinical Hospital of the Medical University, Łódź, Poland
| | - Ewa Rusak
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | | |
Collapse
|
13
|
Muacevic A, Adler JR, Al Otaiby A, Al Wraidat M, Nashwan AJ. Optic Neuritis in a Child With Poorly Controlled Type 1 Diabetes Mellitus: A Case Report. Cureus 2023; 15:e33474. [PMID: 36751258 PMCID: PMC9900420 DOI: 10.7759/cureus.33474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
Type 1 diabetes stands among the most prevalent endocrinological diseases in the pediatric age group. The incidence rate continues to rise globally. Optic neuritis has been described in the literature in association with type 2 diabetes; however, cases of optic neuritis with type 1 diabetes are very few. Here we describe a rare case of a 15-year-old patient with type 1 diabetes mellitus presenting with optic neuritis. Due to the hyperglycemia that steroids can induce in some patients, management with steroids can be difficult. A multidisciplinary team approach is required to ensure that these patients' optic neuritis is properly handled while avoiding steroid side effects.
Collapse
|
14
|
Kurpiewska E, Ciężki S, Jamiołkowska-Sztabkowska M, Polkowska A, Starosz A, Grubczak K, Moniuszko M, Bossowski A, Głowińska-Olszewska B. Excessive BMI is associated with higher C-peptide level at recognition but also with its greater loss in two years clinical observation in children with new onset type 1 diabetes. Front Immunol 2023; 14:1176403. [PMID: 37180128 PMCID: PMC10174309 DOI: 10.3389/fimmu.2023.1176403] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
Introduction The prevalence of obesity in general pediatric population increases without sparing children with T1D. We intended to find factors associated with the possibility of preserving endogenous insulin secretion in individuals with long-standing T1D. At onset, higher BMI is associated with higher C-peptide level, which may indicate to be one of the favorable factors involved in preserving residual β-cell function. The study determines the influence of BMI on C-peptide secretion in children newly diagnosed with T1D in two years observation. Methods We assessed the possible relationship between selected pro- and anti-inflammatory cytokines, body mass at recognition and β-cell function status. 153 pediatric patients with newly diagnosed T1D were divided into quartiles according to BMI-SDS index. We separated a group consisted of patients with BMI-SDS >1. Participants were followed up for two years and examined for changes in body weight, HbA1c, and insulin requirement. C-peptide was assessed at baseline and after two years. We evaluated the patients' levels of selected inflammatory cytokines at baseline. Results Subjects with higher BMI-SDS presented higher serum C-peptide levels and lower insulin requirements at diagnosis than children with lower body weight. The two-year follow-up showed that C-peptide levels of obese patients dropped more rapidly than in children with BMI-SDS within normal limits. The group with BMI-SDS >1 showed the greatest decrease in C-peptide level. Despite statistically insignificant differences in HbA1c at diagnosis between the study groups, in the fourth quartile and BMI-SDS >1 groups, HbA1c as well as insulin requirements increased after two years. The levels of cytokines varied the most between BMI-SDS <1 and BMI-SDS >1 groups and were significantly higher within BMI-SDS >1 group. Discussion Higher BMI, associated with enhanced levels of inflammatory cytokines, relates to preservation of C-peptide at T1D recognition in children but is not beneficial in the long term. A decrease in C-peptide levels combined with an increase in insulin requirements and in HbA1c among patients with high BMI occur, which may indicate a negative effect of excessive body weight on the long term preservation of residual β-cell function. The process seems to be mediated by inflammatory cytokines.
Collapse
Affiliation(s)
- Emilia Kurpiewska
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Sebastian Ciężki
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Milena Jamiołkowska-Sztabkowska
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Agnieszka Polkowska
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Aleksandra Starosz
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Białystok, Poland
| | - Kamil Grubczak
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Białystok, Poland
| | - Marcin Moniuszko
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Białystok, Poland
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Białystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, Białystok, Poland
- *Correspondence: Barbara Głowińska-Olszewska,
| |
Collapse
|
15
|
Grabia M, Markiewicz-Żukowska R, Socha K, Polkowska A, Zasim A, Boruch K, Bossowski A. Prevalence of Metabolic Syndrome in Relation to Cardiovascular Biomarkers and Dietary Factors among Adolescents with Type 1 Diabetes Mellitus. Nutrients 2022; 14:nu14122435. [PMID: 35745165 PMCID: PMC9228781 DOI: 10.3390/nu14122435] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 12/18/2022] Open
Abstract
The occurrence of metabolic syndrome (MetS) significantly affects the course of diabetes mellitus (DM), resulting in deterioration of insulin sensitivity and metabolic control, as well as many cardiometabolic complications. The aim of the study was to investigate the relationships between cardiovascular biomarkers, nutritional status, dietary factors and the occurrence of MetS among 120 participants from northeast Poland (adolescents with type 1 DM and healthy peers). MetS was assessed using several criteria: nutritional status by anthropometric measurements, body composition analysis by bioelectrical impedance, and diet using a food diary and questionnaire. MetS was diagnosed in every third diabetic. Compared to healthy peers, MetS patients had higher total body fat (26% vs. 14%, p < 0.001) and visceral fat (77 cm2 vs. 35 cm2, p < 0.001), and lower total antioxidant status (1.249 mmol/L vs. 1.579 mmol/L, p < 0.001). Additionally, their diet was rich in saturated fatty acids, but low in dietary fiber as well as mono- and polyunsaturated fatty acids. The group of diabetics reported many inappropriate eating behaviors. The combination of those with the presence of an excessive content of visceral fat tissue and abnormal values of MetS components may negatively affect metabolic control, thus accelerating the development of cardiometabolic complications.
Collapse
Affiliation(s)
- Monika Grabia
- Department of Bromatology, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Białystok, Mickiewicza 2D Street, 15-222 Białystok, Poland; (M.G.); (K.S.)
| | - Renata Markiewicz-Żukowska
- Department of Bromatology, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Białystok, Mickiewicza 2D Street, 15-222 Białystok, Poland; (M.G.); (K.S.)
- Correspondence: ; Tel.: +48-85-748-5469
| | - Katarzyna Socha
- Department of Bromatology, Faculty of Pharmacy with the Division of Laboratory Medicine, Medical University of Białystok, Mickiewicza 2D Street, 15-222 Białystok, Poland; (M.G.); (K.S.)
| | - Agnieszka Polkowska
- Clinic of Paediatrics, Endocrinology, Diabetology with Subdivision of Cardiology, Children’s University Clinical Hospital in Białystok, 15-274 Białystok, Poland; (A.P.); (A.Z.); (A.B.)
| | - Aneta Zasim
- Clinic of Paediatrics, Endocrinology, Diabetology with Subdivision of Cardiology, Children’s University Clinical Hospital in Białystok, 15-274 Białystok, Poland; (A.P.); (A.Z.); (A.B.)
| | - Karolina Boruch
- Clinic of Paediatrics, Rheumatology, Immunology and Bone Metabolic Diseases, Children’s University Clinical Hospital in Białystok, 15-274 Białystok, Poland;
| | - Artur Bossowski
- Clinic of Paediatrics, Endocrinology, Diabetology with Subdivision of Cardiology, Children’s University Clinical Hospital in Białystok, 15-274 Białystok, Poland; (A.P.); (A.Z.); (A.B.)
| |
Collapse
|
16
|
Kofoed P, Timm S. The impact of COVID-19 lockdown on glycaemic control and use of health services among children followed at a Danish diabetes clinic. Acta Paediatr 2022; 111:368-375. [PMID: 34586678 PMCID: PMC8653272 DOI: 10.1111/apa.16128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022]
Abstract
Aim During COVID‐19 restrictions, the paediatric clinic only accepted essential outpatient visits, schools closed, sports activities and social life were limited. Most employees worked at home. This quasi‐experiment evaluates how this affected glycaemic control and use of health services among children with diabetes. Methods Paired t‐tests were used to compare HbA1c‐values before, during and after lockdown. Sub‐analyses were stratified by pre‐lockdown HbA1c‐values. Results Overall mean HbA1c decreased from 58.3 to 56.9 mmol/mol (p = 0.025) from pre‐ to post‐lockdown, a decrease also seen during the same season the previous year. HbA1c decreased by −4.2 mmol/mol (p = 0.002) for patients with pre‐lockdown HbA1c > 59 mmol/mol, but increased slightly by 0.8 mmol/mol (p = 0.176) for patients with HbA1c < 52 mmol/mol. HbA1c measured 8 months post‐lockdown increased again, most pronounced for patients with lowest HbA1c. During lockdown, virtual contacts increased from 0.1 to 0.5 contacts/patient/month and stayed post‐lockdown at 0.3 contacts/patient/month. Conclusion Compared to 2019, overall the COVID‐19 restrictions did not influence the glycaemic control negatively. However, patients with pre‐lockdown HbA1c < 52 mmol/mol experienced a deterioration, whereas those with HbA1c > 59 mmol/mol experienced an improvement. Less stress and more contact with parents may contribute to the last‐mentioned finding. The lockdown enforced more virtual contacts between patients and the clinic.
Collapse
Affiliation(s)
- Poul‐Erik Kofoed
- Department of Paediatrics and Adolescent Medicine Lillebaelt HospitalUniversity Hospital of Southern Denmark Kolding Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Signe Timm
- Department of Regional Health Research University of Southern Denmark Odense Denmark
- Research unit Lillebaelt HospitalUniversity Hospital of Southern Denmark Kolding Denmark
| |
Collapse
|
17
|
Ciężki S, Kurpiewska E, Bossowski A, Głowińska-Olszewska B. Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children - From Disease Pathogenesis to Complications. Front Endocrinol (Lausanne) 2022; 13:890833. [PMID: 35784568 PMCID: PMC9243381 DOI: 10.3389/fendo.2022.890833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children's population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.
Collapse
|
18
|
Alarcón-Gómez J, Chulvi-Medrano I, Martin-Rivera F, Calatayud J. Effect of High-Intensity Interval Training on Quality of Life, Sleep Quality, Exercise Motivation and Enjoyment in Sedentary People with Type 1 Diabetes Mellitus. Int J Environ Res Public Health 2021; 18:ijerph182312612. [PMID: 34886337 PMCID: PMC8656786 DOI: 10.3390/ijerph182312612] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/07/2021] [Accepted: 11/25/2021] [Indexed: 12/18/2022]
Abstract
(1) Background: Type 1 diabetes mellitus (T1DM) people’s health-related quality of life (HRQoL) is affected by glycemic control. Regular exercise is strongly recommended to these patients due to its cardiovascular and metabolic benefits. However, a large percentage of patients with T1DM people present a sedentary behavior because of the fear of a post-exercise hypoglycemia event, lack of time, lack of motivation and the complicated management of exercise, glycemic and insulin dose interaction. High-intensity interval training (HIIT) is an efficient and safe methodology since it prevents hypoglycemia and does not require much time, which are the main barriers for this population to doing exercise and increasing physical conditioning. (2) Methods: Nineteen sedentary adults (37 ± 6.5 years) with T1DM, were randomly assigned to 6 weeks of either HIIT (12-16-20 × 30-s intervals interspersed with 1-min rest periods) performed thrice weekly, or to the control group, which did not train. HRQoL, sleep quality, exercise motivation and enjoyment were measured as psychological variables. (4) Results: HRQoL improved in physical and social domains, PF (1.9%); PR (80.3%); GH (16.6); SF (34.1%). Sleep quality improved in the HIIT group by 21.4%. Enjoyment improved by 7% and intrinsic motivation was increased by 13%. (5) Conclusions: We suggest that the 6-week HIIT program used in the present study is safe, since no severe hypoglycemia were reported, and an effective strategy in improving HRQoL, sleep quality, exercise motivation and enjoyment which are important psychological well-being factors in T1DM people.
Collapse
Affiliation(s)
- Jesús Alarcón-Gómez
- Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain;
| | - Iván Chulvi-Medrano
- UIRFIDE Sport Performance and Physical Fitness Research Group, University of Valencia, 46010 Valencia, Spain;
| | - Fernando Martin-Rivera
- Research Group in Prevention and Health in Exercise and Sport, University of Valencia, 46010 Valencia, Spain
- Correspondence: or
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
| |
Collapse
|
19
|
Resurrección DM, Navas-Campaña D, Gutiérrez-Colosía MR, Ibáñez-Alfonso JA, Ruiz-Aranda D. Psychotherapeutic Interventions to Improve Psychological Adjustment in Type 1 Diabetes: A Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph182010940. [PMID: 34682687 PMCID: PMC8535719 DOI: 10.3390/ijerph182010940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 12/18/2022]
Abstract
Background: International clinical practice guidelines highlight the importance of improving the psychological and mental health care of patients with Type 1 diabetes mellitus (T1DM). Psychological interventions can promote adherence to the demands of diabetes self-care, promoting high quality of life and wellbeing. Methods: A systematic review was carried out to determine whether psychological treatments with a specific focus on emotional management have an impact on glycemic control and variables related to psychological adjustment. Comprehensive literature searches of PubMed Medline, Psycinfo, Cochrane Database, Web of Science, and Open Grey Repository databases were conducted, from inception to November 2019 and were last updated in December 2020. Finally, eight articles met inclusion criteria. Results: Results showed that the management of emotions was effective in improving the psychological adjustment of patients with T1DM when carried out by psychologists. However, the evidence regarding the improvement of glycemic control was not entirely clear. When comparing adolescent and adult populations, findings yielded slightly better results in adolescents. Conclusions: More rigorous studies are needed to establish what emotional interventions might increase glycemic control in this population.
Collapse
Affiliation(s)
- Davinia M. Resurrección
- Department of Psychology, Universidad Loyola Andalucía, 41704 Seville, Spain; (D.M.R.); (D.N.-C.); (J.A.I.-A.); (D.R.-A.)
| | - Desirée Navas-Campaña
- Department of Psychology, Universidad Loyola Andalucía, 41704 Seville, Spain; (D.M.R.); (D.N.-C.); (J.A.I.-A.); (D.R.-A.)
| | - Mencía R. Gutiérrez-Colosía
- Department of Psychology, Universidad Loyola Andalucía, 41704 Seville, Spain; (D.M.R.); (D.N.-C.); (J.A.I.-A.); (D.R.-A.)
- Correspondence: ; Tel.: +34-95564-1600
| | - Joaquín A. Ibáñez-Alfonso
- Department of Psychology, Universidad Loyola Andalucía, 41704 Seville, Spain; (D.M.R.); (D.N.-C.); (J.A.I.-A.); (D.R.-A.)
- Human Neuroscience Lab, Universidad Loyola Andalucía, 41704 Seville, Spain
| | - Desireé Ruiz-Aranda
- Department of Psychology, Universidad Loyola Andalucía, 41704 Seville, Spain; (D.M.R.); (D.N.-C.); (J.A.I.-A.); (D.R.-A.)
| |
Collapse
|
20
|
Pillokeit N, Grzella S, Zgoura P, Westhoff T, Viebahn R, Schenker P. Challenges Associated with Pancreas and Kidney Retransplantation-A Retrospective Analysis. J Clin Med 2021; 10:3634. [PMID: 34441932 DOI: 10.3390/jcm10163634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Simultaneous pancreas and kidney transplantation (SPK) is an accepted treatment for diabetic patients with renal failure, and is associated with increased survival and quality of life for recipients. There are only a few publications on the outcomes of simultaneous pancreas–kidney retransplantation (Re-SPK) after previous SPK and the loss of function of both grafts. A total of 55 patients with type 1 diabetes mellitus underwent pancreas retransplantation at our center between January 1994 and March 2021. Twenty-four of these patients underwent Re-SPK after a previous SPK. All 24 operations were technically feasible. Patient survival rate after 3 months, 1 year, and 5 years was 79.2%, 75%, and 66.7%, respectively. The causes of death were septic arterial hemorrhage (n = 3), septic multiorgan failure (n = 2), and was unknown in one patient. Pancreas and kidney graft function after 3 months, 1 year, and 5 years were 70.8% and 66.7%, 66.7% and 62.5%, and 45.8% and 54.2%, respectively. Relaparotomy was performed in 13 out of 24 (54.2%) patients. The results of our study show that Re-SPK, after previously performed SPK, is a technical and immunological challenge, associated with a significantly increased mortality and complication rate; therefore, the indication for Re-SPK should be very strict. Careful preoperative diagnosis is indispensable.
Collapse
|
21
|
Staub K, Abrams P. Novel presentation of autoimmune polyglandular syndrome II in a child with simultaneous Addison's disease, type 1 diabetes, and Hashimoto's thyroiditis: A case report. Clin Case Rep 2021; 9:e04453. [PMID: 34457274 PMCID: PMC8380072 DOI: 10.1002/ccr3.4453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 11/06/2022] Open
Abstract
Providers should remain vigilant of autoimmune polyglandular syndrome type II in the context of persistent low blood sugar in type I diabetes. Correction of adrenal insufficiency is key for regulation of blood sugar and thyroid function.
Collapse
Affiliation(s)
- Kayla Staub
- St. Luke's Clinical Heath CampusTemple University School of MedicineBethlehemPAUSA
| | - Pamela Abrams
- Center for Diabetes and EndocrinologySt. Luke's University Health NetworkCenter ValleyPAUSA
| |
Collapse
|
22
|
Özcan B, Delhanty PJD, Huisman M, Visser JA, Neggers SJ, van der Lely AJ. Overweight and obesity in type 1 diabetes is not associated with higher ghrelin concentrations. Diabetol Metab Syndr 2021; 13:79. [PMID: 34294136 PMCID: PMC8296697 DOI: 10.1186/s13098-021-00699-4] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several studies have demonstrated suppressed levels of acylated (AG) and unacylated ghrelin (UAG) in patients with type 2 diabetes. However, the role of these hormones in type 1 diabetes has not been extensively studied. This study assessed the relationship between AG and UAG levels and body composition in patients with type 1 diabetes. METHODS We selected eighteen patients with type 1 diabetes and divided them into two groups: non-obese (BMI < 25 kg/m2) and overweight (BMI ≥ 25 kg/m2). Demographics, parameters of body composition and serum parameters including AG and UAG, were assessed. RESULTS The patients with a BMI ≥ 25 kg/m2 were older and had a longer duration of diabetes. AG and UAG levels were not significantly different between non-obese and overweight groups (mean AG non-obese ± SD: 44.5 ± 29.4 pg/ml and mean UAG non-obese 42.4 ± 20.7 pg/ml vs mean AG overweight ± SD: 46.1 ± 29.6 pg/ml and mean UAG overweight 47.2 ± 18.2 pg/ml). AG/UAG ratios did not discriminate between these groups. There was a positive association of insuline dose/kg bodyweight with BMI (r2 = 0.45, p = 0.002). CONCLUSIONS Surprisingly, unlike non-diabetics and in T2D, we did not observe a difference in plasma levels of AG and UAG between normal weight and overweight adult type 1 diabetics. However, we did observe a positive correlation between BMI and insuline dose/kg bodyweight, suggesting that exogenous insulin is more important than the ghrelin system in the development of obesity in type 1 diabetes.
Collapse
Affiliation(s)
- Behiye Özcan
- Departments of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Patric J D Delhanty
- Departments of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Martin Huisman
- Departments of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jenny A Visser
- Departments of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sebastian J Neggers
- Departments of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aart Jan van der Lely
- Departments of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| |
Collapse
|
23
|
Azhar M, Hammami M, Musmar A, Bromer M. Glycogen Hepatopathy: A Reversible yet Relapsing Cause of Hepatitis in Type 1 Diabetics. Cureus 2021; 13:e13441. [PMID: 33763324 PMCID: PMC7982004 DOI: 10.7759/cureus.13441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/19/2021] [Indexed: 12/04/2022] Open
Abstract
Glycogen hepatopathy (GH), a rare glycogen storage disease caused by genetic or acquired overactivation of hepatic glycogen synthesis enzymes, can mimic non-alcoholic fatty liver disease (NAFLD). We describe a case of biopsy-proven GH in an adult with type 1 diabetes mellitus (DM). A 33-year-old Honduran woman with a 25-year history of type 1 DM complicated by gastroparesis, multiple episodes of diabetic ketoacidosis (DKA) and hypoglycemia, and recurrent pancreatitis was referred for abnormal liver enzymes. Family history was negative for liver disease. There was no history of alcohol or recreational drug use. Patients' medications included insulin and thyroxine. Physical exam showed hepatomegaly but no stigmata of chronic liver disease. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) had ranged from 100's to over 7000 U/L while alkaline phosphatase (ALP) was elevated to over 400 IU/L. Albumin, total bilirubin, platelets, international normalized ratio (INR), eosinophils, viral hepatitis panel, antinuclear antibody (ANA), smooth muscle antibody (Ab), anti-liver-kidney microsomal (LKM) Ab, celiac serologies, ceruloplasmin, alpha 1 antitrypsin, iron studies, and acetaminophen levels were all normal. An abdominal ultrasound showed "fatty liver" and an atrophic pancreas. CT abdomen showed hepatomegaly. The common bile duct (CBD) was found to be normal on endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP). A liver biopsy was pursued eventually, demonstrating glycogenotic hepatocytes. GH is frequently misdiagnosed as NAFLD, a more common liver disease that occurs in association with diabetes While GH is known to be reversible, NAFLD has been known to progress to advanced liver disease, ranging from cirrhosis to hepatocellular carcinoma. Definite diagnosis often requires liver biopsy because of overlapping clinical and radiographical pictures. Elevation of both glucose and insulin levels in the setting of fragile DM control is thought to play a role via overstimulation of glycogen synthesis. Recommended treatment is stable "tight" glycemic control; pancreatic transplantation has resulted in sustained GH remission in two case reports. The required degree of stability and tightness of glucose control is not yet known. An increased awareness of GH is needed in an attempt to prevent delay in diagnosis, in a condition with an otherwise unknown incidence.
Collapse
Affiliation(s)
- Mishah Azhar
- Internal Medicine, Florida Atlantic University, Boca Raton, USA
| | | | - Ahmad Musmar
- Internal Medicine, Florida Atlantic University, Boca Raton, USA
| | - Matthew Bromer
- Gastroenterology, Bethesda Hospital East, Boynton Beach, USA
| |
Collapse
|
24
|
Canecki Varzic S, Steiner K, Gradinjan Centner M, Grgurevic M, Cigrovski Berkovic M, Klobucar Majanovic S, Radman M, Milicevic T, Rahelic D, Bilic Curcic I. Assessment of FreeStyle Libre Flash Glucose Monitoring System Implementation in Real Life Clinical Setting: A Prospective Observational Study. Diagnostics (Basel) 2021; 11:305. [PMID: 33668675 DOI: 10.3390/diagnostics11020305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In this study, we investigated the effectiveness of FreeStyle Libre Flash Glucose Monitoring (FGM) implementation in a real life clinical setting with the emphasis on the effect of initial education on the use of the FGM system. Methods: This prospective observational study included 425 diabetes type 1 subjects followed up for 3 to 12 months (320 were followed up to 3 months, 267 up to 6 months and 147 up to period of one year). An FGM sensor was placed at study entry and all participants were educated through a period of 5 days on sensor usage and self-management of glycemia with follow up visits every 3 months. Results: HbA1c values significantly decreased from baseline (T0) to 3 months (T3) (p < 0.001), with a drop from 7.48% ± 0.1% to 7.30 ± 0.1%. There was no change in time spent in hypoglycemia from T3 to T12, although there was a decreasing trend present. The change in HbA1c values in the entire cohort was driven by change in the subgroup of patients with HbA1c ≥7% with a drop from 8.22% ± 1.14% to 7.68% ± 1.26% (p < 0.0001) in the first 3 months. Also, in individuals performing SMBG less than 5 times per day, there was a steady decrease in HbA1c levels up to 6 months (p < 0.05 and p < 0.001, respectively) as opposed to those who performed SMBG ≥5 times per day. Conclusions: The improvement in HbA1c was mainly driven by the increase in the number of scans per day. The subjects with poorer glycemic control and those who seldom performed SMBG benefited the most.
Collapse
|
25
|
Van Ryckeghem L, Franssen WMA, Verbaanderd E, Indesteege J, De Vriendt F, Verwerft J, Dendale P, Bito V, Hansen D. Cardiac Function is Preserved in Adolescents With Well-Controlled Type 1 Diabetes and a Normal Physical Fitness: A Cross-sectional Study. Can J Diabetes 2021:S1499-2671(21)00017-4. [PMID: 33773936 DOI: 10.1016/j.jcjd.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/07/2021] [Accepted: 01/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Cardiovascular diseases and exercise intolerance elevate mortality in type 1 diabetes (T1D). Left ventricular systolic and diastolic function are already affected in T1DM adolescents, displaying poor glycemic control (glycated hemoglobin [A1C]>7.5%) and exercise intolerance. We investigated to the extent to which left ventricular function is affected by disease severity/duration and whether this is related to exercise capacity. METHODS Transthoracic echocardiography was performed in 19 T1DM adolescents (14.8±1.9 years old, A1C 7.4±0.9%) and 19 controls (14.4±1.3 years old, A1C 5.3±0.2%), matched for age and Tanner stage. Diastolic and systolic (ejection fraction [EF]) function were assessed. Cardiopulmonary exercise testing was used to evaluate exercise capacity, as measured by peak oxygen uptake (VO2peak). RESULTS VO2peak and left ventricular systolic and diastolic function were similar in both groups. Within the T1D group, EF was negatively associated with disease duration (r=-0.79 corrected for age, standardized body mass index, glucose variability and VO2peak; p=0.011). Regression analyses revealed that 37.6% of the variance in EF could be attributed to disease duration. CONCLUSIONS Although left ventricular systolic and diastolic function are preserved in T1D with adequate exercise capacity, disease duration negatively affects EF. The detrimental effects of T1D seem to be driven by disease duration, rather than by disease severity, at least during adolescence. Young T1D patients may, therefore, benefit from cardiovascular evaluation in order to detect cardiovascular abnormalities early in the disease course, and therefore, improve long-term cardiovascular health.
Collapse
|
26
|
Šuláková T, Strnadel J, Pavlíček J, Poláková R, Seeman T, Feber J. Early Vascular Aging in Children With Type 1 Diabetes and Ambulatory Normotension. Front Pediatr 2021; 9:764004. [PMID: 34988037 PMCID: PMC8721847 DOI: 10.3389/fped.2021.764004] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Preliminary data suggest that target organ damage (TOD) and early vascular aging (EVA) may occur in children with normal blood pressure (BP). Objectives: To analyze TOD and EVA in normotensive (BP <95th percentile on ambulatory BP monitoring) type 1 diabetes children (T1D) in comparison to healthy controls (C). Subjects: 25 T1D aged 13.9 ± 2.6 years and 22 C aged 14.0 ± 3.4 years. Methods: We analyzed age- and height-related pulse wave velocity (PWV) Z-scores and expected PWV based on age, height, and mean arterial pressure (MAP). Expected vascular age based on measured PWV was calculated from pooled pediatric and adult PWV norms. Left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR) were obtained as markers of TOD. Results: T1D and C groups did not differ in anthropometry, ambulatory, LVMI, and ACR. However, median age- and height-related PWV Z-scores were higher in T1D compared to C (1.08 vs. 0.57, p = 0.006; 0.78 vs. 0.36, p = 0.02, respectively). Mean (±SD) difference between measured and expected PWV was 0.58 ± 0.57 in T1D vs. 0.22 ± 0.59 in C, p = 0.02. The mean (±SD) difference between chronological and expected vascular age was 7.53 ± 7.74 years in T1D vs. 2.78 ± 7.01 years in C, p = 0.04. Conclusion: Increased arterial stiffness and increased intraindividual differences between expected and measured PWV as well as between chronological and expected vascular age indicate that EVA may develop in T1D children even at normal ambulatory BP levels.
Collapse
Affiliation(s)
- Terezie Šuláková
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia.,Medical Faculty University of Ostrava, Ostrava, Czechia
| | - Jiří Strnadel
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia.,Medical Faculty University of Ostrava, Ostrava, Czechia
| | - Jan Pavlíček
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia.,Medical Faculty University of Ostrava, Ostrava, Czechia
| | - Radka Poláková
- Centre of Excellence IT4Innovations, Institute for Research and Applications of Fuzzy Modeling, University of Ostrava, Ostrava, Czechia
| | - Tomáš Seeman
- Department of Pediatrics, University Hospital Motol, Prague, Czechia.,Second Medical Faculty Charles University, Prague, Czechia.,Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximillians University, Munich, Germany
| | - Janusz Feber
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
27
|
C.B.B. Veiby N, Simeunovic A, Heier M, Brunborg C, Saddique N, Moe MC, Dahl‐Jørgensen K, Margeirsdottir HD, Petrovski G. Venular oxygen saturation is increased in young patients with type 1 diabetes and mild nonproliferative diabetic retinopathy. Acta Ophthalmol 2020; 98:800-807. [PMID: 32410388 DOI: 10.1111/aos.14462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/08/2020] [Accepted: 04/18/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To clarify how early in the development of diabetic retinopathy (DR) can oxygen (O2 ) saturation changes be detected. METHODS Retinal oximetry was performed in a cross-sectional study, involving 14- to 30-year-old individuals: 185 with type 1 diabetes (T1D) and 94 controls. The subjects were divided into four groups according to the grade of DR. One-way ANOVA and post hoc tests were used to test for differences in the mean O2 saturations between the groups. RESULTS Fifty-eight (31 %) of the T1D patients had nonproliferative DR. There was no significant difference in O2 saturations between controls and T1D patients with no DR. Arteriolar and venular O2 saturations in T1D patients were significantly higher in moderate/severe DR than in no DR (p = 0.009 and p > 0.001), while venular O2 saturation was significantly higher in mild DR than in no DR (p = 0.013). CONCLUSION Increase in venular O2 saturation could not be detected before mild retinopathy had developed, and the retinal O2 saturation increase was measurable on the venular side first. Our results suggest that the increase in O2 saturation is likely a consequence of DR.
Collapse
Affiliation(s)
- Nina C.B.B. Veiby
- Center for Eye Research Department of Ophthalmology Oslo University Hospital Oslo Norway
| | - Aida Simeunovic
- Department of Paediatrics and adolescent Medicine Akershus University Hospital Lorenskog Norway
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
- Oslo Diabetes Research Centre Oslo Norway
| | - Martin Heier
- Oslo Diabetes Research Centre Oslo Norway
- Department of Paediatrics Oslo University Hospital Oslo Norway
| | - Cathrine Brunborg
- Oslo Centre of Biostatistics and Epidemiology Oslo University Hospital Oslo Norway
| | - Naila Saddique
- Center for Eye Research Department of Ophthalmology Oslo University Hospital Oslo Norway
| | - Morten C. Moe
- Center for Eye Research Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - Knut Dahl‐Jørgensen
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
- Oslo Diabetes Research Centre Oslo Norway
- Department of Paediatrics Oslo University Hospital Oslo Norway
| | - Hanna D. Margeirsdottir
- Oslo Diabetes Research Centre Oslo Norway
- Department of Paediatrics Oslo University Hospital Oslo Norway
| | - Goran Petrovski
- Center for Eye Research Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| |
Collapse
|
28
|
Jamiołkowska-Sztabkowska M, Głowińska-Olszewska B, Łuczyński W, Konstantynowicz J, Bossowski A. Regular physical activity as a physiological factor contributing to extend partial remission time in children with new onset diabetes mellitus-Two years observation. Pediatr Diabetes 2020; 21:800-807. [PMID: 32277567 DOI: 10.1111/pedi.13018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/03/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Beneficial effects of physical activity (PA) are confirmed in patients with all types of long-lasting diabetes. The possibility of PA to be a factor prolonging remission phase in children with new-onset type 1 diabetes (T1D) has not yet been thoroughly studied. OBJECTIVE The aim of the study was to elucidate the influence of regular PA on prevalence of partial remission (PR), metabolic control, daily insulin requirement (DIR), and C-peptide secretion in children newly diagnosed with T1D. METHODS A total of 125 children diagnosed with T1D were studied prospectively for 2 years. Patients were controlled every 3 months and advised with PA according to ISPAD recommendations. Anthropometric parameters, HbA1c, C-peptide level and DIR were analyzed. Patients' PA level was assessed using a self-designed questionnaire. RESULTS We classified 43% of participants as physically-active. In this group, lower HbA1c after 2 years, lower DIR after 3, 6 months, and after 2 years (all P < .05) were found. At discharge from hospital, the prevalence of DIR < 0.5 U/kg/24 h with near normoglycemia was similar in both groups. Then, we observed higher PR prevalence in active group lasting over time and resulting in 44% vs 13% after 2 years (P < .001). C-peptide after 2 years was comparable in both groups, with higher prevalence of clinically significant levels (>0.2 nmoL/L) in active group: 79.6% vs 61.4% (P = .029). CONCLUSIONS These data support the view that regular PA may essentially contribute to extending PR time in pediatric diabetes, and may therefore lead to a better long-term metabolic control of the disease.
Collapse
Affiliation(s)
- Milena Jamiołkowska-Sztabkowska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland.,Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland
| | - Włodzimierz Łuczyński
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland.,Department of Medical Simulations, Medical University of Bialystok, Bialystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
29
|
Lejk A, Myśliwiec M, Myśliwiec A. Can athletes with type 1 diabetes use supplementation? Pediatr Endocrinol Diabetes Metab 2020; 26:97-103. [PMID: 32564585 DOI: 10.5114/pedm.2020.95626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
From year to year, we observe constantly growing revenue from the sale of supplements and functional food for athletes. The increased interest in their use raises many questions concerning the choice of products, portions, in addition in the case of athletes with type 1 diabetes - how they affect the level of glycaemia. In the group of people under 18 with diagnosed type 1 diabetes, the properly selected supplementation, which will not cause undesirable effects, is even more important. This publication aims to summarize the current reports on nutrients that come from: the present scientific knowledge, information on the labels, and information available on the websites of the most popular companies producing nutrients on the Polish market.
Collapse
|
30
|
Alsalman D, Bu Ali ZM, Alnosaier ZF, Alotaibi NA, Alanzi TM. Gamification for Diabetes Type 1 Management: A Review of the Features of Free Apps in Google Play and App Stores. J Multidiscip Healthc 2020; 13:425-432. [PMID: 32523349 PMCID: PMC7236238 DOI: 10.2147/jmdh.s249664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/19/2020] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The objective of this study was to review most of the existing free m-Health applications (Apps) that use the gamification approach to manage diabetes type 1 in both App and Google Play stores. METHODS Free mobile health applications "apps" that were related to diabetes mellitus have been identified in both App and Google Play stores. In order to cover all the mentioned applications, the following keywords, "game for type 1 diabetes" and "gamification for type 1 diabetes" were used in English and Arabic languages. All applications that were collected in the inclusion process were carefully analyzed, and the game name, game description, game features, game mechanics, game themes, and operating systems were recorded. RESULTS A total of eight gamified applications related to type 1 diabetes were identified. Seven of these applications were in English language and only one application was in Arabic language. The applications were categorized into three main categories based on the theme of the application. The categories were taking care of a character, quizzes, and the storytelling theme. Moreover, there was no application that included the social networking feature. CONCLUSION This study highlighted the most important features of the free mobile health applications "apps" for diabetes type 1 available in Google Play and App stores that can contribute to enhance the self-management of the diabetes condition by patients in Saudi Arabia. The identified applications have important characteristics that can be used in the future for the care and self-control of type 1 diabetic patients in Saudi Arabia.
Collapse
Affiliation(s)
- Demah Alsalman
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zahra M Bu Ali
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zainab F Alnosaier
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Norah A Alotaibi
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Turki M Alanzi
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
31
|
Koebnick C, Imperatore G, Jensen ET, Stafford JM, Shah AS, Mottl AK, Bell RA, Dabelea D, Liese AD, Marcovina SM, D'Agostino RB, Urbina EM, Lawrence JM. Progression to hypertension in youth and young adults with type 1 or type 2 diabetes: The SEARCH for Diabetes in Youth Study. J Clin Hypertens (Greenwich) 2020; 22:888-896. [PMID: 32297456 PMCID: PMC7383720 DOI: 10.1111/jch.13849] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/10/2020] [Accepted: 02/29/2020] [Indexed: 12/12/2022]
Abstract
Central obesity may contribute to the development of hypertension in youths with diabetes. The SEARCH for Diabetes in Youth Study followed 1518 youths with type 1 diabetes (T1D) and 177 with type 2 diabetes (T2D) diagnosed when <20 years of age for incident hypertension. Incident hypertension was defined as blood pressure ≥95th percentile (or ≥130/80 mm Hg) or reporting antihypertensive therapy among those without hypertension at baseline. Poisson regression models were stratified by diabetes type and included demographic and clinical factors, clinical site, and waist‐to‐height ratio (WHtR). Youths with T2D were more likely to develop hypertension than those with T1D (35.6% vs 14.8%, P < .0001). For each 0.01 unit of annual increase in WHtR, adjusted relative risk for hypertension was 1.53 (95% CI 1.36‐1.73) and 1.20 (95% CI 1.00‐1.43) for youths with T1D and T2D, respectively. Effective strategies targeted toward reducing central obesity may reduce hypertension among youths with diabetes.
Collapse
Affiliation(s)
- Corinna Koebnick
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeanette M Stafford
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amy S Shah
- Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, OH, USA
| | - Amy K Mottl
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Ronny A Bell
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Santica M Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA, USA
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| |
Collapse
|
32
|
Slavcheva-Prodanova O, Konstantinova M, Tsakova A, Savova R, Archinkova M. Bone Health Index and bone turnover in pediatric patients with type 1 diabetes mellitus and poor metabolic control. Pediatr Diabetes 2020; 21:88-97. [PMID: 31599085 DOI: 10.1111/pedi.12930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/23/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is a need for a non-invasive, affordable, and reliable method for bone health screening in pediatric patients at risk. OBJECTIVE To assess Bone Health Index (BHI) in pediatric patients with type 1 diabetes (T1D) and its relation to bone metabolism, age at onset, duration, control, and insulin dose. SUBJECTS AND METHODS Left-hand radiographs were obtained from 65 patients with T1D, mean age 11.23 ± 3.89 years, mean disease duration 5.23 ± 3.76 years and mean glycosylated hemoglobin (HbA1c)-83 mmol/mol (9.7%). Blood and 24 hours urine samples were collected for bone and mineral metabolism assessment. BoneXpert was used to determine BHI, Bone Health Index standard deviation score (BHI SDS), and bone age. RESULTS Mean BHI SDS was -1.15 ± 1.19 (n = 54). In 20.37% (n = 11) BHI SDS was < -2SD with mean value -2.82 ± 0. 69, P < .001. These patients had lower levels of beta cross laps (0.77 ± 0.33 ng/mL vs 1.17 ± 0.47 ng/mL), osteocalcin (47.20 ± 14.07 ng/mL vs 75.91 ± 32.08 ng/mL), serum magnesium (0.79 ± 0.05 mmol/L vs 0.83 ± 0.06 mmol/L) and phosphorus (1.48 ± 0.29 mmol/L vs 1.71 ± 0.28 mmol/L) but higher ionized calcium (1.29 ± 0.04 mmol/L vs 1.26 ± 0.05 mmol/L), P < .05, compared to patients with BHI SDS in the normal range. We found a positive correlation between BHI SDS and age at manifestation (r = 0.307, P = 0.024) and a negative one with disease duration (r = -0.284, P = .038). No correlations were found with HbA1c, insulin dose, height, weight, BMI. CONCLUSIONS To the best of our knowledge, this is the first study to assess bone health in pediatric patients with T1D using BHI. We found significantly decreased cortical bone density and bone turnover in 20.37%. Earlier age at onset and diabetes duration may have a negative impact on cortical bone density in patients with poor control. Longitudinal studies are needed to follow changes or to assess future interventions.
Collapse
Affiliation(s)
- Olga Slavcheva-Prodanova
- Department of Endocrinology, Diabetes and Genetics, University Children's Hospital, Medical University - Sofia, Bulgaria
| | - Maia Konstantinova
- Department of Endocrinology, Diabetes and Genetics, University Children's Hospital, Medical University - Sofia, Bulgaria
| | - Adelina Tsakova
- Central Clinical Laboratory, Alexandrovska Hospital, Medical University - Sofia, Bulgaria
| | - Radka Savova
- Department of Endocrinology, Diabetes and Genetics, University Children's Hospital, Medical University - Sofia, Bulgaria
| | - Margarita Archinkova
- Department of Endocrinology, Diabetes and Genetics, University Children's Hospital, Medical University - Sofia, Bulgaria
| |
Collapse
|
33
|
Głowinska-Olszewska B, Borysewicz-Sańczyk H, Sawicka B, Klonowska B, Charemska D, Żelazowska-Rutkowska B, Bossowski A. Does Hashimoto's Thyroiditis Increase the Risk of Cardiovascular Disease in Young Type 1 Diabetic Patients? Front Endocrinol (Lausanne) 2020; 11:431. [PMID: 32793113 PMCID: PMC7393727 DOI: 10.3389/fendo.2020.00431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/04/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Immunological and hormonal disorders have undoubted influence on the development of atherosclerotic process. Autoimmune diseases accompanying type 1 diabetes (T1D) may additionally accelerate atherosclerosis progression and increase the risk of cardiovascular events in the future. The influence of subclinical hypothyroidism on the cardiovascular system, in particular, has recently aroused great interest. The aim of our study was to assess intima-media thickness (cIMT) of common carotid arteries and the occurrence of classical atherosclerosis risk factors together with selected new biomarkers of cardiovascular diseases in young patients with type 1 diabetes mellitus coexisting with Hashimoto's disease (HD). Patients and Methods: The study included 50 adolescents and young adults with T1D with mean age 17.1 ± 3 years, with mean diabetes duration of 10.5 ± 3.3 years, including 20 patients with diagnosed HD: T1D and HD(+), and 30 patients with no additional diseases: T1D and HD(-). Twenty-two healthy, age-matched volunteers formed control group (C). We analyzed mean HbA1c value from all years of disease, BMI, blood pressure, lipids, new biomarkers of atherosclerosis (hsCRP, adiponectin, myeloperoxidase, NT-proBNP peptide, vitamin D), and cIMT of common carotid arteries. Results: In the group of patients with T1D and HD(+), significantly higher BMI was found: 23.3 ± 4.4 vs. 21.28 ± 2.9 in group HD(-) and 19.65 ± 2.4 kg/m2 in group C (p = 0.003), and higher waist circumference: 79 ± 10.9 vs. 75.10 ± 7.6 in group HD(-) vs. 69.0 ± 7.4 cm in group C (p < 0.001). The mean value of HbA1c was higher in group T1D and HD(+): 8.8% than in group HD(-): 8.1% (p = 0.04). Significantly higher concentration of hsCRP and lower vitamin D were observed in T1D and HD(+) in comparison to T1D and HD(-) and the control group. The IMT index in the HD(+) group was 0.46 ± 0.05 mm and was comparable to the HD(-) group but significantly higher than in healthy controls: 0.41 ± 0.03 mm (P < 0.05). Conclusions: Young patients with type 1 diabetes mellitus and with coexisting Hashimoto's thyroiditis have a higher BMI, a higher waist circumference, and a higher HbA1c value, which altogether may cause faster development of macroangiopathy in the near future. Additional risk for cardiovascular disease may result from low vitamin D and increased hsCRP concentration in this group of patients. Coexistence of Hashimoto's thyroiditis did not significantly affect the cIMT value in the studied population.
Collapse
Affiliation(s)
- Barbara Głowinska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Białystok, Białystok, Poland
- *Correspondence: Barbara Głowinska-Olszewska
| | - Hanna Borysewicz-Sańczyk
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Beata Sawicka
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Bożenna Klonowska
- Department of Clinical Pediatrics, Faculty of Medical Sciences, Specialist Children's Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Dorota Charemska
- Department of Clinical Pediatrics, Faculty of Medical Sciences, Specialist Children's Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | | | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Białystok, Białystok, Poland
| |
Collapse
|
34
|
Głowińska-Olszewska B, Szabłowski M, Panas P, Żoła̧dek K, Jamiołkowska-Sztabkowska M, Milewska AJ, Kadłubiska A, Polkowska A, Łuczyński W, Bossowski A. Increasing Co-occurrence of Additional Autoimmune Disorders at Diabetes Type 1 Onset Among Children and Adolescents Diagnosed in Years 2010-2018-Single-Center Study. Front Endocrinol (Lausanne) 2020; 11:476. [PMID: 32849272 PMCID: PMC7424019 DOI: 10.3389/fendo.2020.00476] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/17/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives: The prevalence of type 1 diabetes mellitus (T1D) in children is growing, but its relation to other autoimmune disorders that coexist since the onset of diabetes is not recognized. The objective of this study was to assess the incidence of T1D and the prevalence of autoimmune illnesses additionally coexisting since the diabetes mellitus onset in children during a period of 9 years' observation. Methods: In this retrospective study, the incidence rate (IR) of the T1D was calculated as the total number of all cases that were newly diagnosed per 100,000 population people between 0 and 18 years of age. The selected age groups (0-4, 5-9, 10-14, and 15-18 years) were examined, respectively. The studied group included 493 children (264 [53.55%] boys) between 0 and 18 years old newly diagnosed with T1D in one of the Polish centers in the years 2010-2018. Other autoimmune illnesses diagnoses were obtained from medical records taken from the first hospital treatment, when T1D was recognized. Results: The annual standardized IR of T1D increased from 19.2/100,000 in year 2010 to 31.7/100,000 in 2018 (1.7-fold over 9 years' observation), with an increase in the incidence rate ratio (IRR) by 4% per year. The highest growth in IR was recorded in 5- to 9-year-olds (from 19.61 in 2010 to 43.45 in 2018). In 61 (12.4%) of the studied group, at least one additional autoimmune disease was diagnosed. The prevalence doubled from 10.4% in the year 2010 to 20.8% in the year 2018. Autoimmune thyroid illnesses were found in 37 children (7.5%); their incidence increased from 6.3% to almost 2-fold, 12.5%, in 2018. In 26 children (5.3%), celiac disease was recognized; the prevalence increased from 4.2 to 9.8% in the study period. The prevalence of additional autoimmune thyroid disease was higher in glutamic acid decarboxylase-positive antibodies (χ2 = 3.4, p = 0.04) patients, the oldest age group (15-18 years) (χ2 =7.1, p = 0.06), and in girls (χ2 =7.1, p = 0.007). Conclusions:The standardized IR of T1D in children increased 1.7-fold over the 9-year observation period, and IRR increased 4% per year. Additional autoimmunity represents a significant comorbidity in patients with new-onset T1D. The number of children diagnosed with additional autoimmune diseases that accompany T1D is rapidly growing in all age groups throughout recent years.
Collapse
Affiliation(s)
- Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
- *Correspondence: Barbara Głowińska-Olszewska
| | - Maciej Szabłowski
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Patrycja Panas
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Karolina Żoła̧dek
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Milena Jamiołkowska-Sztabkowska
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Białystok, Poland
| | - Anna Justyna Milewska
- Department of Statistics and Medical Informatics, Medical University of Bialystok, Białystok, Poland
| | - Anna Kadłubiska
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Agnieszka Polkowska
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Włodzimierz Łuczyński
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
- Department of Medical Simulations, Medical University of Bialystok, Białystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
| |
Collapse
|
35
|
Kleisarchaki AN, Papadopoulou-Legbelou K, Kotanidou EP, Kotanidis CP, Eboriadou-Petikopoulou M, Galli-Tsinopoulou A. Could vitamin D deficiency influence left heart ventricular geometry in youngsters with type 1 diabetes mellitus? Hippokratia 2019; 23:9-14. [PMID: 32256032 PMCID: PMC7124876] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Experimental and clinical studies have shown the cardio-protective, anti-inflammatory, and anti-atherosclerotic actions of vitamin D. MATERIAL AND METHODS We aimed to investigate a possible correlation between vitamin D status and heart geometry using echocardiographic parameters of the left ventricle in youngsters with type 1 diabetes mellitus (T1D). Seventy-eight pediatric patients (aged 13.47 ± 2.86 years) with T1D of more than two years duration and 74 healthy controls (aged 12.04 ± 2.79 years) were enrolled in this case-control study. Anthropometric parameters were recorded, vitamin D and parathormone serum levels were measured, and trans-thoracic echocardiographic study was performed. RESULTS Vitamin D deficiency was found in 74 % T1D patients and in 72 % of the controls, while parathormone levels were normal in both groups. T1D patients presented significantly higher values of interventricular septal thickness at diastole (IVSD) compared to controls (0.76 ± 0.16 cm vs 0.71 ± 0.14 cm, p =0.043). All other echocardiographic parameters did not exhibit significant differences between patients and controls. The diastolic function of the left ventricle (LV) was normal in both groups. After sub-grouping, the participants according to the deficiency or not of vitamin D, only patients with T1D and low vitamin D levels had increased values of IVSD compared to controls (0.78 ± 0.17 vs 0.71 ± 0.14, p =0.008). Patients with T1D and normal vitamin D levels presented similar values of IVSD compared to controls (0.71 ± 0.12 vs 0.73 ± 0.15, p =NS). CONCLUSIONS Children and adolescents with T1D and normal vitamin D levels do not exhibit changes in LV dimensions or diastolic function, except for increased IVSD, compared to controls. Larger and longitudinal studies are required to confirm and consolidate this finding. HIPPOKRATIA 2019, 23(1): 9-14.
Collapse
Affiliation(s)
- A N Kleisarchaki
- 4 Department of Paediatrics, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - K Papadopoulou-Legbelou
- 4 Department of Paediatrics, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - E P Kotanidou
- 4 Department of Paediatrics, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - C P Kotanidis
- 4 Department of Paediatrics, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - M Eboriadou-Petikopoulou
- 4 Department of Paediatrics, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Galli-Tsinopoulou
- 4 Department of Paediatrics, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| |
Collapse
|
36
|
Piechowiak K, Szypowska A. Physiological factors influencing diabetes control in type 1 diabetes children with insulin pumps from diagnosis. Diabetes Metab Res Rev 2019; 35:e3086. [PMID: 30325106 DOI: 10.1002/dmrr.3086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/09/2017] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to identify the physiological factors influencing diabetes control in children with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion (CSII) from diabetes diagnosis. METHODS This study focused on 163 children (81 boys) initiated with CSII within 2 weeks after T1D recognition and treated for at least 3 years. We analysed fasting C-peptide, GADA, ICA, IA2A, BMI z-score, total daily dose, and basal insulin. Patients were divided into groups according to their metabolic control: 7.5% > HbA1c ≥ 7.5% at the end of the study. RESULTS At the end of the follow-up, patients with HbA1c <7.5%, had a lower HbA1c level at diagnosis (11.7% vs 12.6%; P = 0.018), lower HbA1c level at both the first-year (6.7% vs 7.3%; P = 0.000) and the second-year (6.8% vs.7.7%; P = 0.000) follow-up, and a lower GADA level (P = 0.001). A multiple logistic regression analysis showed that HbA1c at diagnosis (P = 0.012), HbA1c at first year (P = 0.000), HbA1c at second year (P = 0.000), age at diagnosis (P = 0.047), GADA (P = 0.031), and basal insulin at third year (P = 0.032), influenced HbA1c <7.5% at the third year of follow-up. At the end of the study, 76% of patients started with CSII at the age <10 years and 49% of subjects initiated with CSII at the age ≥10 years achieved HbA1c ≤7.5%. CONCLUSIONS This study shows that for those who initiated CSII at T1D onset, younger age, less intense autoimmune process, a low HbA1c at recognition, and good diabetes control during the first year of treatment were associated with long-term optimal glycaemic control.
Collapse
|
37
|
Putarek K, Banfic L, Pasalic M, Krnic N, Spehar Uroic A, Rojnic Putarek N. Arterial stiffness as a measure of cardiovascular risk in obese adolescents and adolescents with diabetes type 1. J Pediatr Endocrinol Metab 2018; 31:1315-1323. [PMID: 30433871 DOI: 10.1515/jpem-2018-0137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/08/2018] [Indexed: 01/03/2023]
Abstract
Background Cardiovascular disease (CVD) is the end result of vascular aging and atherosclerosis, having its origins in childhood. The aim of our study was to compare arterial stiffness (AS) and intima-media thickness (IMT) as markers of an early vascular damage between obese adolescents, adolescents with diabetes type 1 (T1D) and lean control subjects. Methods We analyzed AS and IMT in 68 obese adolescents (13.27±2.31 years), 42 adolescents with T1D (14.95±2.35 years) lasting over 5 years and 38 controls (15.02±1.94 years). AS (measured by pulse wave velocity [PWV], arterial compliance [AC] and β-stiffness) and IMT were assessed using an e-tracking ultrasound method. Results A significant difference between the groups was found for AC (p=0.022) and PWV (p=0.010), with the lowest compliance and higher velocities in T1D patients. When corrected for age, the difference in AC among the groups did not reach a statistical difference (p=0.059). Correlation analysis in the obese adolescents showed lower AC in females (p=0.041), with higher systolic blood pressure (SBP) (p=0.032). In T1D adolescents, disease duration was the strongest determinant of AS (AC p=0.028, β p=0.029 and PWV p=0.003), followed by body mass index (BMI; PWV p=0.008; β p=0.033), SBP (AC p<0.001; PWV p=0.023), diastolic BP (AC p=0.049; PWV p=0.048) and HbA1c (PWV p=0.048). No significant correlations were found for AS measures or IMT with sex, age, BMI, Tanner stage or BP levels in controls. Conclusions Early vascular damage is more pronounced in T1D adolescents than in obese or lean adolescents, which may emphasize the impact of hyperglycemia as a major threat for cardiovascular health.
Collapse
Affiliation(s)
- Kresimir Putarek
- Department of Cardiovascular Diseases, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Ljiljana Banfic
- Department of Cardiovascular Diseases, Zagreb University Hospital Centre, School of Medicine, Zagreb, Croatia
| | - Marijan Pasalic
- Department of Cardiovascular Diseases, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Nevena Krnic
- Department of Paediatric Endocrinology and Diabetes, Zagreb University Hospital Centre, School of Medicine, Zagreb, Croatia
| | - Anita Spehar Uroic
- Department of Paediatric Endocrinology and Diabetes, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Natasa Rojnic Putarek
- Department of Paediatric Endocrinology and Diabetes, Zagreb University Hospital Centre, School of Medicine, Zagreb, Croatia
| |
Collapse
|
38
|
Mueller-Godeffroy E, Vonthein R, Ludwig-Seibold C, Heidtmann B, Boettcher C, Kramer M, Hessler N, Hilgard D, Lilienthal E, Ziegler A, Wagner VM. Psychosocial benefits of insulin pump therapy in children with diabetes type 1 and their families: The pumpkin multicenter randomized controlled trial. Pediatr Diabetes 2018; 19:1471-1480. [PMID: 30302877 DOI: 10.1111/pedi.12777] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/28/2018] [Accepted: 09/04/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Continuous subcutaneous insulin infusion (CSII) is on the rise among pediatric patients with type 1 diabetes mellitus. Metabolic effects alone cannot explain this rising popularity. From the patient's perspective, the main benefits of CSII may be found in subjective psychosocial health outcomes (patient-reported outcomes [PRO]). SUBJECTS AND METHODS In a multicenter open randomized controlled trial, children and adolescents aged 6 to16 years currently treated with multiple daily injections (MDI) were randomized 1:1, stratified by center, to either starting with CSII immediately after the baseline interview or to continuing MDI while waiting 6 months for transmission to CSII. The primary outcomes were patient-reported diabetes-specific health-related quality of life (DHRQOL) and diabetes burden of the main caregiver. Secondary outcomes were caregiver stress, fear of hypoglycemia, satisfaction with treatment, and HbA1c. RESULTS Two-hundred and eleven patients were randomized between February 2011 and October 2014, and 186 caregivers and 170 patients were analyzed using the intention-to-treat principle for primary outcomes. Children 8 to 11 years in the CSII group reported improved DHRQOL at follow-up compared to MDI (median difference [MD] 9.5, 95% confidence interval [CI] 3.6-16.7, P = 0.004). There were no treatment differences in the adolescent age-group 12 to 16 years (MD 2.7; 95% CI -3.2-9.5; P = 0.353). The main caregivers of the CSII group reported a significant decline of overall diabetes burden at follow-up compared to the MDI group (MD 0; 95% CI -1-0; P = 0.029). Secondary PROs also were in favor of CSII. CONCLUSIONS CSII has substantial psychosocial benefits. PROs demonstrate these benefits. Registered as NCT01338922 at clinicaltrials.gov.
Collapse
Affiliation(s)
| | - Reinhard Vonthein
- Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center Schleswig-Holstein, Luebeck, Germany.,Center for Clinical Trials, University of Luebeck, Luebeck, Germany
| | | | - Bettina Heidtmann
- Catholic Children's Hospital, Wilhelmstift gGmbH, Department of Endocrinology and Diabetology, Hamburg, Germany
| | - Claudia Boettcher
- Division of Pediatric Endocrinology and Diabeteology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Frankfurt, Germany
| | - Miriam Kramer
- Division of Pediatric Endocrinology and Diabeteology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Frankfurt, Germany
| | - Nicole Hessler
- Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Doerte Hilgard
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke gGmbH, Herdecke, Germany.,Pediatric and Adolescent Medical Practice, Witten, Germany
| | - Eggert Lilienthal
- Department of Pediatrics, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Ziegler
- Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center Schleswig-Holstein, Luebeck, Germany.,Center for Clinical Trials, University of Luebeck, Luebeck, Germany.,School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Verena M Wagner
- Department of Pediatric and Adolescent Medicine, University of Luebeck, Luebeck, Germany.,Pediatric and Adolescent Medical Practice, 18055 Rostock, Germany
| | | |
Collapse
|
39
|
Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | | | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
- Tomasz Klupa, MD, PhD, Department of Metabolic Diseases, Jagiellonian University, 15 Kopernika St, 31-501 Kraków, Poland.
| |
Collapse
|
40
|
Starčević K, Filipović N, Galan A, Micek V, Gudan Kurilj A, Mašek T. Hepatic Lipogenesis and Brain Fatty Acid Profile in Response to Different Dietary n6/n3 Ratios and DHA/EPA Supplementation in Streptozotocin Treated Rats. Mol Nutr Food Res 2018; 62:e1701007. [PMID: 29579359 DOI: 10.1002/mnfr.201701007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/07/2018] [Indexed: 11/06/2022]
Abstract
SCOPE We investigated the interaction between streptozotocin (STZ)-induced diabetes and dietary n6/n3 ratio, and its influence on lipogenesis. METHODS AND RESULTS The animals were treated with STZ and fed with different dietary n6/n3 ratios: 1, 7, and 60, or supplemented with DHA/EPA. Gene expression was assessed by RT-PCR and protein expression by western blotting and immunohistochemistry. Fatty acid profile was determined by GC-MS. Pancreas and liver histology were assessed by hematoxylin and eosin (H&E) staining. STZ-induced characteristic changes in all STZ treated groups, including: increased blood glucose, decreased body mass, increased lipid peroxidation and CD36 expression, decreased 16:1n7 and 18:1n7, increases in 20:3n6, decreases in phospholipid (PL) content of 20:4n6, as well as decreases in the expression of SREBP1c, Δ-9-desaturase (Δ9D), and Δ-5-desaturase (Δ5D). Additionally, other changes occurred that were dependent on the n6/n3 ratio. Among the diabetic groups, the lower n6/n3 ratio caused higher lipid peroxidation and CD36 expression, a greater decrease in 20:4n6 and decreased Δ6-desaturase (Δ6D) expression, while the higher n6/n3 ratio caused increased partitioning of 20:4n6 into hepatic neutral lipids (NL), a decrease in 20:5n3 content, and increased β-oxidation. CONCLUSION Presented data suggest that the n6/n3 ratio could significantly influence lipogenesis, lipid peroxidation, and β-oxidation in STZ-induced diabetes, which could have clinical significance.
Collapse
Affiliation(s)
- Kristina Starčević
- Department of Animal Husbandry, University of Zagreb, Faculty of Veterinary Medicine, 10000, Zagreb, Croatia
| | - Natalija Filipović
- Department of Anatomy, Histology and Embryology, University of Split, School of Medicine, 21000, Split, Croatia
| | - Asier Galan
- VetMedZg ERA Chair project, University of Zagreb, Faculty of Veterinary Medicine, 10000, Zagreb, Croatia
| | - Vedran Micek
- Institute for Medical Research and Occupational Health, 10000, Zagreb, Croatia
| | - Andrea Gudan Kurilj
- Department of Veterinary Pathology, University of Zagreb, Faculty of Veterinary Medicine, 10000, Zagreb, Croatia
| | - Tomislav Mašek
- Department of Animal Nutrition and Dietetics, University of Zagreb, Faculty of Veterinary Medicine, 10000, Zagreb, Croatia
| |
Collapse
|
41
|
Abstract
Aim To estimate the proportion of diabetic patients on insulin, who interrupt fasting during Ramadan, and describe the reported reasons of this interruption. Design This is a national observational survey of diabetic patients treated with insulin and fasting during the month of Ramadan 2013, proposed to all endocrinologists willing to participate. Consecutive patients were included until the required sample size, estimated at 498 patients, was obtained. Conducted among patients recruited by endocrinologists during the month following Ramadan 2013. Results Five hundred twenty-six (526) patients were included, of which 51 (9.7%) had type 1 diabetes. The mean age was 36.8 ± 11.6 and 58.3 ± 10.0 years for type 1 and type 2 diabetes, respectively. The proportions of male subjects were 62.8% and 57.5% for type 1 and type 2 diabetes, respectively. The mean duration of diabetes was 11.0 ± 8.8 and 14.4 ± 7.9 years for type 1 and type 2 diabetes, respectively. During Ramadan, more than 55% (54.9% and 55.8% for type 1 and type 2 diabetes, respectively) of patients were treated with insulin analog and over a third with mixed insulin. In this study population, 71.5% reported having fasted without interruption during the month of Ramadan. The average number of non-fasted days was 3.0 ± 6.7, mainly due to hypoglycemic episodes. Conclusion According to this observational survey conducted in Tunisia, most patients with diabetes treated with insulin (insulin in more than half of the cases) were able to fast without interruption during Ramadan.
Collapse
Affiliation(s)
- Mohamed Abid
- Department of Endocrinology, Hedi Chaker Hospital, Sfax
| | - Mohamed Hsairi
- Department of Epidemiology, Salah Azaiz Institute, Tunis
| | - Mouna Elleuch
- Department of Endocrinology, Hedi Chaker Hospital, Sfax
| | | |
Collapse
|
42
|
Valitsky M, Hoffman A, Unterman T, Bar-Tana J. Insulin sensitizer prevents and ameliorates experimental type 1 diabetes. Am J Physiol Endocrinol Metab 2017; 313:E672-E680. [PMID: 28270441 DOI: 10.1152/ajpendo.00329.2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/29/2016] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 01/12/2023]
Abstract
Insulin-dependent type-1 diabetes (T1D) is driven by autoimmune β-cell failure, whereas systemic resistance to insulin is considered the hallmark of insulin-independent type-2 diabetes (T2D). In contrast to this canonical dichotomy, insulin resistance appears to precede the overt diabetic stage of T1D and predict its progression, implying that insulin sensitizers may change the course of T1D. However, previous attempts to ameliorate T1D in animal models or patients by insulin sensitizers have largely failed. Sensitization to insulin by MEthyl-substituted long-chain DICArboxylic acid (MEDICA) analogs in T2D animal models surpasses that of current insulin sensitizers, thus prompting our interest in probing MEDICA in the T1D context. MEDICA efficacy in modulating the course of T1D was verified in streptozotocin (STZ) diabetic rats and autoimmune nonobese diabetic (NOD) mice. MEDICA treatment normalizes overt diabetes in STZ diabetic rats when added on to subtherapeutic insulin, and prevents/delays autoimmune T1D in NOD mice. MEDICA treatment does not improve β-cell insulin content or insulitis score, but its efficacy is accounted for by pronounced total body sensitization to insulin. In conclusion, potent insulin sensitizers may counteract genetic predisposition to autoimmune T1D and amplify subtherapeutic insulin into an effective therapeutic measure for the treatment of overt T1D.
Collapse
Affiliation(s)
- Michael Valitsky
- Department of Human Nutrition and Metabolism, Hebrew University Medical School, Jerusalem, Israel
| | - Amnon Hoffman
- Institute for Drug Research, Hebrew University Faculty of Medicine, Jerusalem, Israel; and
| | - Terry Unterman
- Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Jacob Bar-Tana
- Department of Human Nutrition and Metabolism, Hebrew University Medical School, Jerusalem, Israel;
| |
Collapse
|
43
|
Sokołowska M, Chobot A, Jarosz-Chobot P. The honeymoon phase - what we know today about the factors that can modulate the remission period in type 1 diabetes. Pediatr Endocrinol Diabetes Metab 2017; 22:66-70. [PMID: 28329775 DOI: 10.18544/pedm-22.02.0053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Certain patients with type 1 diabetes (T1DM), often shortly after initiating the treatment, may require smaller doses of insulin. This phenomenon is commonly referred to as the remission or honeymoon phase. In majority the remission is partial, but in very rare cases complete remission might occur. Recent studies have enlightened that an appropriate treatment and follow-up during the honeymoon could potentially enable the prolongation of this period for years or even permanently stop the destruction of the remaining ß cells, hence the renewal of interest on the subject. On average, the remission usually appears approximately 3 months after the insulin therapy was started. The duration of the partial remission ranges from 1 month up to 13 years, with an average of 9.2 months. Various clinical and metabolic factors have been analysed to assess whether they are influencing the remission rate and the duration of the honeymoon period. However, the degree of their influence is still a point of discussion. Also, new potential factors are investigated. This article gives an up-to-date status on recent papers concerning remission in T1DM.
Collapse
Affiliation(s)
- Magdalena Sokołowska
- Department of Pediatrics, The Upper Silesian Child Health Center, Katowice, Poland
| | - Agata Chobot
- Department of Pediatric Gastroenterology and Hepatology, Clinical Hospital No 1, Zabrze, Poland
| | - Przemysława Jarosz-Chobot
- Department of Children's Diabetology, School of Medicine in Katowice, Medical University Of Silesia, Katowice, Poland
| |
Collapse
|
44
|
Kuźmiuk A, Marczuk-Kolada G, Łuczaj-Cepowicz E, Obidzińska M, Chorzewska E, Wasilczuk U, Kierklo A, Szajda SD. [Importance of dental care to maintain oral health of children and youth with type 1 diabetes]. Med Pr 2017; 69:37-44. [PMID: 29063912 DOI: 10.13075/mp.5893.00554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Dental care for children and youth with type 1 diabetes should rely on reliable examination of the oral cavity, early treatment of dental caries and maintenance of the treatment results. This can be achieved through regular control visits consistent with the standards, and also through following the recommendations for prevention of dental caries and periodontal disease. The aim of the study was to investigate whether dental care allows to preserve good oral health of children and youth with type 1 diabetes. MATERIAL AND METHODS The study included 60 patients with type 1 diabetes, aged 7-17 years, and 30 healthy children and youth within the same age range. There were evaluated intensity of caries, the effectiveness of conservative treatment, periodontal health and oral hygiene. RESULTS The results of examinations showed significantly lower caries prevalence and better periodontal health in the children and youth with type 1 diabetes. The effectiveness of conservative treatment was significantly higher among patients with mixed dentition. There was no significant difference in oral hygiene between the compared groups. CONCLUSIONS Diabetes is a risk factor for oral diseases, so children and youth with type 1 diabetes should be provided with special preventive care and curative measures. The main goal of the insulin-dependent diabetes care program is to early classify them to highrisk groups to improve general oral health and thus improve the quality of life. Proper dental care for children and yuoth with type 1 diabetes is a condition to maintain oral health. Med Pr 2018;69(1):37-44.
Collapse
Affiliation(s)
- Anna Kuźmiuk
- Uniwersytet Medyczny w Białymstoku / Medical University of Bialystok, Białystok, Poland (Zakład Stomatologii Dziecięcej / Department of Pediatric Dentistry).
| | - Grażyna Marczuk-Kolada
- Uniwersytet Medyczny w Białymstoku / Medical University of Bialystok, Białystok, Poland (Zakład Stomatologii Dziecięcej / Department of Pediatric Dentistry)
| | - Elżbieta Łuczaj-Cepowicz
- Uniwersytet Medyczny w Białymstoku / Medical University of Bialystok, Białystok, Poland (Zakład Stomatologii Dziecięcej / Department of Pediatric Dentistry)
| | - Marta Obidzińska
- Uniwersytet Medyczny w Białymstoku / Medical University of Bialystok, Białystok, Poland (Zakład Stomatologii Dziecięcej / Department of Pediatric Dentistry)
| | - Ewa Chorzewska
- Uniwersytet Medyczny w Białymstoku / Medical University of Bialystok, Białystok, Poland (Zakład Stomatologii Dziecięcej / Department of Pediatric Dentistry)
| | - Urszula Wasilczuk
- Uniwersytet Medyczny w Białymstoku / Medical University of Bialystok, Białystok, Poland (Zakład Stomatologii Dziecięcej / Department of Pediatric Dentistry)
| | - Anna Kierklo
- Uniwersytet Medyczny w Białymstoku / Medical University of Bialystok, Białystok, Poland (Zakład Propedeutyki Stomatologii / Department of Dentistry Propaedeutics)
| | - Sławomir Dariusz Szajda
- Uniwersytet Medyczny w Białymstoku / Medical University of Bialystok, Białystok, Poland (Klinika Psychiatrii / Psychiatry Clinic)
| |
Collapse
|
45
|
Staels F, Moyson C, Mathieu C. Metformin as add-on to intensive insulin therapy in type 1 diabetes mellitus. Diabetes Obes Metab 2017; 19:1463-1467. [PMID: 28318105 DOI: 10.1111/dom.12948] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/20/2016] [Revised: 03/06/2017] [Accepted: 03/13/2017] [Indexed: 12/16/2022]
Abstract
We aimed to evaluate the effect of adjuvant metformin to intensive insulin therapy in patients with type 1 diabetes mellitus (T1DM). A 10-year retrospective study in 2 cohorts was performed: the MET cohort (n = 181) consisted of patients with T1DM on adjuvant metformin for ≥6 months and the CTR cohort (n = 62) consisted of patients with T1DM who refused metformin (n = 25) or adhered to metformin for <6 months (n = 36). Data on glycated haemoglobin (HbA1c), body mass index (BMI) and daily insulin dose were recorded yearly. A third cross-sectional cohort, the REF cohort (n = 961), consisting of patients with T1DM not offered adjuvant metformin, was used as a reference for baseline comparison. At the study start, BMI was significantly higher and insulin doses were lower in patients in the MET cohort, while HbA1c levels were similar. In the first years of metformin therapy, small but non-significant decreases were seen in BMI and insulin dose in patients in the MET cohort, while after 10 years no persistent effect on HbA1c, insulin dose or BMI was seen. In conclusion, although metformin may have short-term effects on BMI and insulin dose when used as adjunct therapy in patients with T1DM, no long-term beneficial effects were observed when patients were followed for 10 years.
Collapse
Affiliation(s)
- Frederik Staels
- Department of Clinical and Experimental Medicine, Laboratory for Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Carolien Moyson
- Department of Clinical and Experimental Medicine, Laboratory for Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Chantal Mathieu
- Department of Clinical and Experimental Medicine, Laboratory for Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| |
Collapse
|
46
|
Andrawus E, Veildbaum G, Zemel E, Leibu R, Perlman I, Shehadeh N. Light Modulates Ocular Complications in an Albino Rat Model of Type 1 Diabetes Mellitus. Transl Vis Sci Technol 2017; 6:1. [PMID: 28685103 PMCID: PMC5497601 DOI: 10.1167/tvst.6.4.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 04/03/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The purpose of the study was to assess potential interactions of light exposure and hyperglycemia upon ocular complications in diabetic rats. METHODS Streptozotocin-induced (STZ-induced) diabetic rats (N = 39) and non-diabetic rats (N = 9) were distributed into eight groups according to the irradiance and color of the light phase during the 12/12-hour light/dark regime. Follow-up lasted 90 days and included assessment of cataract development and electroretinogram (ERG) recordings. Stress to the retina was also assessed by glial fibrillary acidic protein immunocytochemistry. RESULTS Cataract development was fast in diabetic rats that were exposed to unattenuated white light or to bright colored lights during the light phase. Diabetic rats that were kept under attenuated brown or yellow light during the light phase exhibited slower rate of cataract development. Electroretinogram responses indicated very severe retinal damage in diabetic rats kept under bright colored lights in the blue-yellow range or bright white light during the light phase. Electroretinogram damage was milder in rats kept under bright red light or attenuated yellow or brown light during the light phase. Glial fibrillary acidic protein expression in retinal Müller cells was consistent with ERG assessment of retinal damage. CONCLUSIONS Attenuating white light and filtering out short wavelengths have a protective effect on the eyes of diabetic rats as evident by slower rate of cataract formation and a smaller degree of retinal damage. TRANSLATIONAL RELEVANCE Our findings suggest that special glasses attenuating light exposure and filtering out short wavelengths (400-530 nm) may be beneficial for diabetic patients.
Collapse
Affiliation(s)
- Elias Andrawus
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gizi Veildbaum
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Rappaport Family Institute for Research in the Medical Sciences, Haifa, Israel
| | - Esther Zemel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Rappaport Family Institute for Research in the Medical Sciences, Haifa, Israel
| | - Rina Leibu
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Ido Perlman
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Rappaport Family Institute for Research in the Medical Sciences, Haifa, Israel
| | - Naim Shehadeh
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Rappaport Family Institute for Research in the Medical Sciences, Haifa, Israel.,Department of Pediatrics A and the Pediatric Diabetes Unit, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
47
|
Niedzwiecki P, Naskret D, Pilacinski S, Pempera M, Uruska A, Adamska A, Zozulinska-Ziolkiewicz D. The Higher the Insulin Resistance the Lower the Cardiac Output in Men with Type 1 Diabetes During the Maximal Exercise Test. Metab Syndr Relat Disord 2017; 15:252-257. [PMID: 28394194 DOI: 10.1089/met.2017.0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the hemodynamic parameters analyzed in bioimpedance cardiography during maximal exercise in patients with type 1 diabetes differing in insulin resistance. METHODS The study group consisted of 40 men with type 1 diabetes. Tissue sensitivity to insulin was assessed on the basis of the glucose disposal rate (GDR) analyzed during hyperinsulinemic-euglycemic clamp. Patients were divided into groups with GDR <4.5 mg/kg/min (G1 group-lower insulin sensitivity) and GDR ≥4.5 mg/kg/min (G2 group-higher insulin sensitivity). During the exercise test, the heart rate, systolic volume, cardiac output, cardiac index were measured by the impedance meter (PhysioFlow). RESULTS Compared with the G2 group, the G1 group had a lower cardiac output (CO): during exercise 8.6 (IQR 7.7-10.0) versus 12.8 (IQR 10.8-13.7) L/min; P < 0.0001, at the maximal effort 13.1 (IQR 12.2-16.7) versus 18.6 (IQR 16.9-20.2) L/min; P = 0.001, and during observation after exercise 8.4 (IQR 6.3-9.6) versus 11.9 (IQR 10.1-13.1) L/min; P < 0.0001. We noticed a positive correlation of GDR and cardiac output: during the exercise test (r = 0.63, P = 0.0002), at the maximal effort (Rs 0.56, P = 0.001), and during observation after the exercise test (r = 0.72, P < 0.0001). In multivariate logistic regression, cardiac output during exercise and during observation was associated with high GDR, regardless of the age and duration of diabetes [OR: 1.98 (95% CI 1.10-3.56), P = 0.02 and OR: 1.91 (95% CI 1.05-3.48), P = 0.03; respectively]. CONCLUSION In nonobese subjects with type 1 diabetes, with good metabolic control, insulin resistance is associated with cardiac hemodynamic parameters assessed during and after exercise. The higher the insulin resistance the lower the cardiac output during maximal exercise in men with type 1 diabetes.
Collapse
Affiliation(s)
- Pawel Niedzwiecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Dariusz Naskret
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Stanislaw Pilacinski
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Maciej Pempera
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | - Anna Adamska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences , Poznan, Poland
| | | |
Collapse
|
48
|
Kuwabara WMT, Curi R, Alba-Loureiro TC. Autophagy Is Impaired in Neutrophils from Streptozotocin-Induced Diabetic Rats. Front Immunol 2017; 8:24. [PMID: 28163707 PMCID: PMC5247474 DOI: 10.3389/fimmu.2017.00024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/06/2017] [Indexed: 01/14/2023] Open
Abstract
We tested the hypothesis that changes reported on functions of neutrophils from streptozotocin-induced diabetic rats involve autophagy impairment. Wistar rats were rendered diabetic by streptozotocin injection (65 mg/kg, i.v.), and the measurements were carried out 2 weeks afterward. Neutrophils were collected through intraperitoneal cavity lavage after 4 h of i.p. oyster glycogen type 2 injection. Neutrophils cultured with PMA (20 nM) for 1 h were used for analysis of plasma membrane integrity, DNA fragmentation, and mitochondrial depolarization by flow cytometry; expression of Atg5, Atg14, Beclin1, LC3BII, and Rab9 by RT-PCR; the contents of caspase 3, LC3BII/LC3BI, and pS6 by western blotting; ATP content by fluorescence essay; reactive oxygen species production by chemiluminescence (Luminol), and autophagy by immunofluorescence tracking LC3B cleavage. Herein, neutrophils from diabetic rats had high DNA fragmentation, depolarization of mitochondrial membrane, low content of ATP, and high content of cleaved caspase 3 after PMA stimulation. Neutrophils from diabetic rats also had low expression of LC3B, failed to increase the expression of Rab9 and Atg14 induced by PMA stimulation. Neutrophils from diabetic animals also had low cleavage of LC3BI to LC3BII and do not present punctate structures that label autophagosomal membranes after stimulus. The changes of neutrophil function reported in diabetic rats do involve impaired autophagy. The suppression of autophagy in neutrophils from diabetic rats may be associated with the activation of the mTOR signaling as indicated by the high content of pS6.
Collapse
Affiliation(s)
| | - Rui Curi
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo , São Paulo , Brazil
| | | |
Collapse
|
49
|
Brown MA, Davis CS, Fleming LW, Fleming JW. The role of Toujeo®, insulin glargine U-300, in the treatment of diabetes mellitus. J Am Assoc Nurse Pract 2016; 28:503-9. [PMID: 26990724 DOI: 10.1002/2327-6924.12357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/01/2016] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this article is to educate nurse practitioners about the role of Toujeo®, insulin glargine U-300 (Gla-300), which is a new option for the treatment of diabetes mellitus. DATA SOURCES A comprehensive literature search was conducted using MEDLINE with the key terms: insulin glargine 300, Toujeo, Gla-300, and EDITION for clinical trial data. Other resources included package inserts, drug information websites, and the World Health Organization (WHO). CONCLUSIONS Gla-300 appears to be a safe and effective option for basal insulin therapy. In clinical trials, it was shown to be equally efficacious as Gla-100 with fewer episodes of hypoglycemia and slightly less weight gain, and subjects receiving Gla-300 required approximately 10 units more basal insulin to obtain the same hemoglobin A1c (HbA1c) as subjects receiving Gla-100. IMPLICATIONS FOR PRACTICE This new basal therapy option represents a potential advantage for patients who require higher doses of insulin because of the higher concentration of Gla-300. The lower incidence of hypoglycemia and more predictable pharmacokinetics could offer a significant therapeutic benefit in difficult-to-control patients with diabetes mellitus. The biggest disadvantage of this product is the slightly higher insulin dosage that is required to improve and/or maintain patients' HbA1c.
Collapse
Affiliation(s)
- Meagan A Brown
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi
| | - Courtney S Davis
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi
| | - Laurie W Fleming
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi
| | - Joshua W Fleming
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi
| |
Collapse
|
50
|
Chałas R, Rudzka O, Wójcik-Chęcińska I, Vodanović M. The impact of type 1 diabetes on the development of the craniofacial mineralised tissues (bones and teeth): literature review. Folia Morphol (Warsz) 2016; 75:275-280. [PMID: 26806434 DOI: 10.5603/fm.a2016.0001] [Citation(s) in RCA: 7] [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] [Received: 09/20/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are many reports on the impact of diabetes on periodontium as well as the state of organs in diabetics; however, there is little research on the impact of the disease on morphological and anatomical changes in the mineralised tissues like teeth and craniofacial bones. The aim of this study was to present a review of literature on morphological and anatomical changes of mineralised tissues in the course of type 1 diabetes. MATERIALS AND METHODS A review of PubMed database was made using the keywords: morphological changes, anatomical changes, enamel hypoplasia, type 1 diabetes, induced diabetes and the names of individual anatomical and morphological structures of the teeth. RESULTS The analysis of experimental studies have shown that in induced type 1 diabetes in rats there is a substantial reduction in the thickness of the enamel and dentin, compared with the control group. The changes in the content of indivi-dual minerals in the tissues of the tooth have been shown - a decrease in the concentration of calcium and fluoride ions and an increase in the concentration of magnesium. In a study conducted on embryos of rats born of diabetic dams, defects were observed in enamel organ, which can cause delayed enamel hypo-plasia. Literature analysis revealed morphological disorders also in some clinical cases of patients with type 1 diabetes. CONCLUSIONS Type 1 diabetes mellitus as a metabolic disorder may affect changes in the structure of mineralised tissues, thereby increasing their susceptibility to caries development and orthognathic disorders.
Collapse
Affiliation(s)
- R Chałas
- Department of Conservative Dentistry and Endodontics, Medical University of Lublin, Poland.
| | | | | | | |
Collapse
|