Continuous glucose monitoring (CGM) is increasingly used to assess glucose control in diabetes. The objective was to examine how analysis of glucose data might improve our understanding of the role temporal glucose variation has on large-for-gestational-age (LGA) infants born to women with diabetes.
Functional data analysis (FDA) was applied to 1.68 million glucose measurements from 759 measurement episodes, obtained from two previously published randomized controlled trials of CGM in pregnant women with diabetes. A total of 117 women with type 1 diabetes (n = 89) and type 2 diabetes (n = 28) who used repeated CGM during pregnancy were recruited from secondary care multidisciplinary obstetric clinics for diabetes in the U.K. and Denmark. LGA was defined as birth weight =90th percentile adjusted for sex and gestational age.
A total of 54 of 117 (46%) women developed LGA. LGA was associated with lower mean glucose (7.0 vs. 7.1 mmol/L; P
In Finland the world-record for the highest incidence of type 1 diabetes has risen steeply over the past decades. However, after 2006 the incidence rate has plateaued. We showed earlier, that despite the strong genetic disease component, environmental factors are driving the increasing disease incidence.
Since vitamin D intake has increased considerably in the country since 2003, we analyzed how serum 25-hydroxyvitamin D (25[OH]D) concentration changed over time in healthy children, and the timely relation of these changes to disease incidence.
The birth cohort of the Finnish Type 1 Diabetes Prediction and Prevention project was used to explore longitudinal changes in serum 25-hydroxyvitamin concentrations. The sampling period was limited to children born from 1994 to 2004, with serum samples collected during 1998-2006 in the Turku area, Southwest Finland (60 ?N).
25(OH)D concentrations were measured every 3-6 months from birth, ages ranging from 0.3 to 12.2 years (387 subjects, 5334 measurements).
Serum 25(OH)D concentrations were markedly lower before 2003 than after (69.3 ? 1.0 nmol/L vs 84.9 ? 1.3 nmol/L, respectively, P
Serum levels of cholesterol, HDL-cholesterol, triglycerides, lipoprotein Lp(a), and the fibrinolysis factors tPA (tissue plasminogen activator) and PAI-1 activity (plasminogen activator inhibitor) were compared with sensory thresholds for vibration, electrical current perception, and pain in a population-based study comprising 239 patients with diabetes mellitus Type 1, aged 15-50 years. Univariate regression analyses (n = 180) showed significant correlations between elevated sensory thresholds and age, duration of diabetes, serum cholesterol and triglycerides, and HbA1c. In multivariate regression analysis, age, duration of diabetes, height, and serum triglycerides showed significant independent associations with five or six of the six measured sensory threshold variables. In addition there was a significant association between increased thresholds for vibration and Lp(a) levels. Thus, increased sensory thresholds for vibration, current perception, and pain in patients with Type 1 diabetes are associated with increased serum triglyceride levels, and Lp(a) levels are associated with increased threshold for vibration. Fibrinolytic activity is unrelated to these measures of nerve function in Type 1 diabetic patients.
Expression of human leukocyte antigen (HLA) class II molecules on islet endothelial cells is a central vascular event in the pathogenesis of Type 1 diabetes. Previous studies demonstrated the ability of other vascular endothelial cells to express HLA and thereby to process islet autoantigens on their surface. We investigated whether the HLA-DQ2/8 genotype, which confers the highest risk for Type 1 diabetes, is associated with early atherosclerosis in youths with this disease. Brachial artery endothelium-dependent, flow-mediated dilation (BA-FMD) and carotid artery intima-media thickness (CA-IMT), as well as markers of systemic inflammation [C-reactive protein (CRP), fibrinogen, and orosomucoid], HbA(1C), LDL, HDL, and total cholesterol, were assessed in 86 children and adolescents with Type 1 diabetes (mean age and diabetes duration, 15 and 7 yr, respectively) between 2004 and 2006. HLA genotypes were determined in dried blood spots by an oligoblot hybridization method. As a result, HLA-DQ2/8 was detected in 34 patients (DQ2/8). When this group was compared with the remaining patients (non-DQ2/8, n = 52), there were no differences in age, diabetes duration, HbA(1C), body mass index, inflammatory markers, and IMT (P > or = 0.4). In the DQ2/8 group, LDL-to-HDL ratio was elevated compared with that in the non-DQ2/8 group (1.8 vs. 1.3, respectively; P = 0.001), whereas FMD did not significantly differ between the groups (5.3% vs. 6.7%, respectively; P = 0.08). When patients were further categorized in relation to CRP (cut-off value, 1 mg/l), BA-FMD was significantly lower (3%, P or = 1 patients compared with the remaining three subgroups. These associations remained significant after adjustment for age, diabetes duration, and HbA(1C) by analysis of covariance. The brachial artery responses to nitroglycerine were similar in all subgroups. In conclusion, the diabetes-predisposing HLA-DQ2/8 genotype in children and adolescents with Type 1 diabetes interferes with endothelial and lipid-related mechanisms of early atherosclerosis, possibly in part through inflammatory pathways.
A total of 77 adults (48% women; age: 43.5Â±10.4; body mass index: 25.2Â±4.3kg/m(2); HbA(1c): 7.6Â±1.3%) with type 1 diabetes completed the questionnaire and an evaluation of their physical activity using an accelerometer (8.4Â±1.2 days) and cardiorespiratory fitness assessment (VO(2)(peak)). To evaluate the temporal stability of the questionnaire, a subgroup of 17 participants answered the BAPAD-1 scale on both visits required by the protocol (10Â±4 days).
The BAPAD-1 scale showed good internal validity with an inter-items correlation coefficient (Cronbach's correlation) of 0.85. The intraclass correlation coefficient for the two times the scales were completed was 0.80. The BAPAD-1 score was negatively correlated with both physical activity energy expenditure (r=-0.25; P=0.03) and VO(2)(peak) adjusted for gender and age (r=-0.27; P=0.02).
The BAPAD-1 scale is a reliable and valid tool for assessing salient barriers to physical activity. In future, this scale could be used to describe the factors accounting for physical activity, and for planning interventions aimed at promoting physical activity among adults with type 1 diabetes.
To study the humoral immune response to bovine serum albumin (BSA) and ovalbumin (OA) in children with newly diagnosed insulin-dependent diabetes mellitus (IDDM).
We examined serum samples from 505 children 0.8-14.9 years of age with newly diagnosed IDDM for antibodies to BSA and OA by enzyme-linked immunosorbent assay (ELISA). We also had two control groups: 85 unrelated control children (0.8-7.1 years of age) and 395 nondiabetic siblings (3.0-14.9 years of age). The specificity of antibodies detected in ELISA was confirmed by immunoblotting in a subset of sera with varying levels of antibodies.
Major advances have been made in the classification and genetics of monogenic diabetes in infancy.
The objective of the study was to characterize different forms of diabetes diagnosed during the first year of life.
Patients diagnosed with diabetes before the age of 1 year in 10 Finnish hospitals from 1980 to 2014 were included.
The study was conducted at Kuopio University Hospital and University of Eastern Finland.
Patients were identified through diagnosis-based searches from hospital registries including 93 children, of whom 64 participated.
DNA sample for sequencing, serum sample, and medical records interventions were included.
Incidence of diabetes during the first year of life, sequencing results, human leukocyte antigen (HLA) genotypes, and islet autoantibodies were measured.
The incidence of diabetes diagnosed during the first 12 months was 4.4/100 000/year. Three novel and 11 previously described mutations were found in 22 patients from 15 families in the KCNJ11, ABCC8, INS, GCK, FOXP, STAT3, and RFX6 genes. Positive islet autoantibodies were observed in 40.0% of the patients diagnosed during the first 0-6 months of life vs 70.8% of the patients diagnosed between ages of 7 to 12 months. A total of 85.7% of the patients carrying protective HLA genotypes were mutation-positive compared to 7.7% of the patients having high-risk genotypes (P = .001).
Mutations in the K-ATP channel and INS genes were the most common cause of early diagnosed monogenic diabetes. After 6 months of age, patients with diabetes had high HLA risk genotypes and islet autoantibodies, reflecting the autoimmune character of diabetes in that age group.
Parents of children with type 1 diabetes often raise complaints about self-care support during school time. The aim of this study was to investigate attitudes to diabetes care in school reported by children with type 1 diabetes, their parents, and their diabetes teams.
Children who had completed preschool class or at least one grade in the 9-yr compulsory school system were invited to participate. Data were collected using separate questionnaires for the children and their parents. In addition, the members of the diabetes team answered a separate questionnaire. All pediatric diabetes centers in Sweden were invited to participate in the study.
All Swedish children and adolescents with diabetes are treated at pediatric diabetes centers. Out of 44 eligible centers, 41 were able to participate. The questionnaires were completed by 317 children and adolescents and 323 parents. The mean age was 11.4?±?2.7?yr and hemoglobin A1c (HbA1c) was 61.8?±?12.4?mmol/mol (7.8?±?1.1%). For 57% of the children, there was no member of staff at the school with principal responsibility to support diabetes self-care. A written action plan for hypoglycemia existed for 60% of the children. Twenty-one percent of the parents regularly gave less insulin than they calculated would be needed at breakfast because of fear of hypoglycemia during school time.
Although Sweden has legislation underlining the specific need for diabetes care in school, this nationwide study demonstrates deficiencies in the support of self-care management.
OBJECTIVE: The aim of the present study was to investigate whether psycho-social variables, for example social support and task- and emotion-oriented coping would predict psychological and physical well being among young adults with diabetes. MATERIAL AND METHODS: Participants were 56 individuals in their twenties suffering from type 1 diabetes. Response rate was 78%. The participants came from the whole of Iceland, 64.3% from the Greater ReykjavÃk area and 33.9% from rural areas. One participant did not indicate his place of residence. Self-assessment scales were used to assess depression, anxiety, task-, avoidance- and emotion-oriented coping, social support and problems relating to diabetes. Additional information was obtained from patients' records concerning the results of blood glucose measurements (HbA1c). RESULTS: Good social support was related to less anxiety and depression and to less self-reported problems related to having diabetes. Emotion-oriented coping was related to not feeling well and task- oriented coping to feeling better. No relationship was found between psychosocial variables and blood glucose measurements and a limited relationship between self-reported problems related to having diabetes and these measurements. CONCLUSIONS: Social support and coping are strongly related to measurements of depression, anxiety and problems related to having diabetes in the present age group. The results indicate that it is very important to teach and strengthen usage, as possible, of task-oriented coping instead of emotion-oriented coping. The results also indicate that social support is highly important for young adults with diabetes type 1. It is clear that friends and family have to be more involved in the treatment and also more educated about the disease and the importance of giving the right kind of support.