Eating disorders in adolescent girls with insulin-dependent diabetes mellitus: a population-based case-control study

In this study the prevalence of eating disorders in a population-based cohort of 89 female patients with type 1 diabetes, 14-18 y of age, was compared with that in age-matched healthy controls. Of all diabetic girls in the study area, 92% participated in the study. The majority were treated with multiple insulin injections and the mean HbA1c of the participants was 8.4%. On average, diabetic girls were 6.8 kg heavier than the controls. A two-stage design was used. The first consisted of a validated self-report questionnaire, the Eating Disorder Inventory (EDI). Girls who had high scores were then interviewed about eating habits and mental health using a semistructured interview, the BAB-T (Assessment of Anorexia-Bulimia - Teenager version). No cases of anorexia or bulimia nervosa were found, but 15 diabetic patients (16.9%) compared with 2 control girls (2.2%), p<0.01, had disturbed eating behaviour according to the questionnaire. In 6 of these 15 diabetic girls an eating disorder was confirmed at the interview, mainly binge eating and self-induced vomiting. None of the control girls showed an eating disorder. Overweight diabetic girls scored higher on EDI than non-overweight diabetic girls (chi2 = 4.9; p = 0.038). No relationships were found between EDI scores and metabolic control (HbA1c), dose of insulin, frequency of hypoglycaemia or diabetic ketoacidosis.     

Triple diabetes: coexistence of type 1 diabetes mellitus and a novel mutation in the gene responsible for MODY3 in an overweight adolescent

Abstract:  We report an interesting and unique case of an overweight adolescent with a novel mutation of the maturity-onset diabetes of the young (MODY)3 gene [hepatocyte nuclear factor-1 alpha (HNF-1α)] and positive islet cell autoantibodies. The patient is a 17-yr-old Caucasian female, who was diagnosed with type 2 diabetes mellitus, treated with metformin and glipizide, with poor control for 18 months prior to being referred to the Endocrinology clinic. Family history was strongly positive for type 2 diabetes (father, paternal aunts, uncles, and grandmother). All were diagnosed at age 40–50 and treated with oral hypoglycemic agents. The patient's body mass index was 36.4 kg/m². She had no acanthosis nigricans. Initial hemoglobin A1c was 11.9%, with fasting glucose of 234 mg/dL and fasting insulin 10.7 μU/mL. She was started on insulin therapy (0.6 units/kg/d), resulting in good glycemic control. Oral hypoglycemic agents were discontinued. Immunologic studies showed positive islet cell (29 U/mL, normal <1.0) and glutamic acid decarboxylase-65 (0.9 U/mL, normal <0.5) antibodies. Sequencing for HNF-1α gene revealed a nucleotide A to G substitution (ACC to GCC), resulting in a missense mutation, T196A. To our knowledge, T196A has not been previously reported. The coexistence of type 1 diabetes autoimmunity and a mutation in the gene responsible for MODY3 in this overweight patient is intriguing and might explain the early onset of progressive insulinopenia compared with the later age of diabetes onset of the earlier generation in the family.     

Urinary growth hormone excretion in post-menarcheal adolescent girls with type 1 diabetes

The aim of the present study was to compare measurements of urinary growth hormone (GH), serum insulinlike growth factor I (IGF-I) and IGF binding protein 3 (IGFBP3) between two groups of post-menarcheal girls, 13–18 y of age, one comprising 64 type 1 diabetic patients and the other 64 healthy girls matched for age and stage of puberty. GH was determined on two occasions in nocturnal urine samples by using a modification of an immunoradiometric method for serum. Significantly higher urinary GH concentrations but lower IGF-I and IGFBP3 levels were found in diabetic girls than in controls ( p < 0:001). A significant correlation was found between urinary GH concentrations and the daily dose of insulin (U kg ⁻¹) ( r = 0:426, p = 0:003). Urinary GH concentrations were also significantly related to HbA1c ( r = 0:380, p = 0:003). In conclusion, disturbances of the GH-IGF-I axis may be evaluated by the use of non-invasive urinary GH measurements, which is a simple alternative to frequent sampling of serum GH. Increased GH secretion seems to be related to a great need for insulin and poor metabolic control. More knowledge about underlying causal factors in the disturbed GH-IGF-I axis is required.     

Intravenous glucagon in a deliberate insulin overdose in an adolescent with type 1 diabetes mellitus

Massive insulin overdose may be associated with unpredictable and prolonged hypoglycemia. Concerns surrounding the potential provocation of insulin release from beta cells have previously prevented the use of intravenous glucagon as an adjunct to infusion of dextrose in this situation. We describe the case of a 15‐yr‐old boy with type 1 diabetes mellitus (T1DM) who presented with profound hypoglycemia following an overdose of an unknown quantity of premixed insulin. Owing to an increasing dextrose requirement and a dependence on hourly intramuscular glucagon injections, a continuous intravenous infusion of glucagon was commenced which successfully avoided the requirement for central venous access or concentrated dextrose infusion. Nausea was managed with anti‐emetics. Intramuscular and subcutaneous glucagon is effective in the management of refractory and severe hypoglycemia in youth with both T1DM and hyperinsulinism. Concerns regarding the precipitation of rebound hypoglycemia with the use of intravenous glucagon do not relate to those with T1DM. This treatment option may be a useful adjunct in the management of insulin overdose in youth with T1DM and may avoid the requirement for invasive central venous access placement.     

Sulfonylurea challenge test in subjects diagnosed with type 1 diabetes mellitus

Background: Patients with early onset diabetes because of defects in glucose‐stimulated insulin secretion (GSIS) may respond better to sulfonylureas than insulin treatment. Such patients include those with monogenic disorders, who can be differentiated from autoimmune type 1 diabetes mellitus (T1DM) by genetic testing. Genetic testing is expensive and unknown defects in GSIS would not be diagnosed. Aims: We propose a sulfonylurea challenge test to identify patients who have been clinically diagnosed with T1DM, but those who maintain a preferentially sulfonylurea‐responsive insulin secretion. Materials & Methods: A total of 3 healthy controls, 2 neonatal diabetes mellitus (NDM) subjects, 3 antibody‐positive (Ab+T1DM), and 12 antibody‐negative (Ab?T1DM) subjects with type 1 diabetes, were given an intravenous bolus of glucose followed by an oral dose of glipizide. Results: Healthy controls showed a robust C‐peptide increase after both glucose and glipizide, but NDM subjects showed a large increase in C‐peptide only following glipizide. As expected, 2 of 3 Ab+T1DM, as well as 11 of 12 Ab?T1DM showed no response to either glucose or glipizide. However, 1 Ab?T1DM and 1 Ab+T1DM showed a small C‐peptide response to glucose and a marked positive response to glipizide, suggesting defects in GSIS rather than typical autoimmune diabetes. Discussion: These data demonstrate the feasibility of the sulfonylurea challenge test, and suggest that responder individuals may be identified. Conclusions: We propose that this sulfonylurea challenge test should be explored more extensively, as it may prove useful as a clinical and scientific tool.     

Neurocognitive functioning in preschool‐age children with type 1 diabetes mellitus

Patiño‐Fernández AM, Delamater AM, Applegate EB, Brady E, Eidson M, Nemery R, Gonzalez‐Mendoza L, Richton S. Neurocognitive functioning in preschool‐age children with type 1 diabetes mellitus. Neurocognitive functioning may be compromised in children with type 1 diabetes mellitus (T1DM). The factor most consistently implicated in the long‐term neurocognitive functioning of children with T1DM is age of onset. The pediatric literature suggests that glycemic extremes may have an effect on the neurocognitive functioning of children, but findings are mixed. The purpose of this study was to compare the neurocognitive functioning of young children with T1DM diagnosed before 6 yr of age and healthy children (i.e., without chronic illness). Additionally, in the children with T1DM, we examined the relationship between their neurocognitive functioning and glycemic control. Sixty‐eight (36 with T1DM and 32 without chronic illness) preschool‐age children (M age = 4.4 yr ) were recruited and administered a battery of instruments to measure cognitive, language, and fine motor skills. Children with T1DM performed similar to the healthy controls and both groups' skills fell in the average range. Among children with diabetes, poor glycemic control [higher hemoglobin A1c (HbA1c)] was related to lower general cognitive abilities (r = ?0.44,p < 0.04), slower fine motor speed (r = ?0.64,p < 0.02), and lower receptive language scores (r = ?0.39,p < 0.04). Such findings indicate that young children with T1DM already demonstrate some negative neurocognitive effects in association with chronic hyperglycemia.     

Reduced growth hormone secretion improves insulin sensitivity in adolescent girls with type 1 diabetes

The aims of the present study were to compare nocturnal growth hormone (GH) secretion, insulin requirements and insulin sensitivity on two occasions in six adolescent girls with type 1 diabetes when the GH secretion was reduced one night by an oral dose of 100 mg of pirenzepine at bedtime. The mean nocturnal intravenous insulin infusion required to maintain a normal constant blood glucose concentration between 24:00 and 07:00 was 53% higher during the night on placebo ( p = 0.0212). During the night on pirenzepine, the serum GH area under the curve (AUC) was reduced in all patients to a mean concentration which was 50.1% (15-78%) of that during the night without pirenzepine ( p = 0.0036). The nocturnal urinary GH excretion was also reduced in all of the investigated patients ( p = 0.0229). Insulin sensitivity in the morning, measured by the euglycaemic hyperinsulinaemic glucose clamp, increased significantly from 115±51mg m^-2 min^-1 after the night on placebo to 205±67 mg m^-2 min^-1 after the night on pirenzepine ( p = 0.0161). No side-effects were observed during the pirenzepine night. Negative correlations were found between the nocturnal serum GH AUC and the insulin-stimulated glucose metabolism ( r = 0.65, p = 0.0241) and between the nocturnal urinary GH excretion and the insulin-stimulated glucose metabolism ( r = -0.77, p = 0.0054). In conclusion, the present study shows a relation between GH secretion and insulin resistance in adolescent girls with type I diabetes. The administration of pirenzepine acutely reduces GH secretion and improves insulin sensitivity.     

Insulin resistance at diagnosis in Japanese children with type 2 diabetes mellitus

Background: Insulin resistance at diagnosis was investigated in Japanese children with type 2 diabetes mellitus (T2DM). Methods: A total of 160 children with T2DM were divided into groups on the basis of percent overweight at time of diagnosis: group A (n= 28), <20%; group B (n= 55), 20–39%; group C (n= 37), 40–59%; group D (n= 40), ≥60%. Indicators of insulin resistance at diagnosis were compared among the four patient groups, and also between the children with T2DM and the 201 age‐matched normal Japanese children. Results: There were no significant differences in plasma glucose (PG) levels among the four patient groups. The mean concentration of fasting plasma immunoreactive insulin (IRI) was significantly higher in group D than in groups A and B (39.2 µU/mL vs 16.2 µU/mL and 24.1 µU/mL, P < 0.05, respectively). The mean homeostasis model assessment (HOMA‐R) was significantly higher in group D than in all the other three groups (17.6 vs 7.8, 10.8 and 12.7, P < 0.05, respectively). The indicators HOMA‐R and fasting IRI were significantly higher in each diabetes group, even in non‐obese group A, than in normal children (P < 0.01, respectively). Conclusions: Japanese children with T2DM had insulin resistance at diagnosis regardless of percent overweight, and the degree of insulin resistance gradually increased with rise in percent overweight.     

Possible effect of leptin on renal magnesium excretion in adolescent patients with type 1 diabetes

BACKGROUND: Hypomagnesaemia and hyperleptinemia are common in patients with diabetes. Moreover, it has been demonstrated that leptin stimulates diuresis and natriuresis. The aim of this study was to evaluate the relationship between serum leptin, serum magnesium (Mg) and urinary Mg/urinary creatinine levels in patients with type 1 diabetes. METHODS: Serum leptin and Mg and urinary Mg/urinary creatinine levels were measured in 67 patients with diabetes (33 girls and 34 boys). The age, diabetes duration, anthropometric and metabolic parameters of the subjects were matched between girls and boys. The relation of serum leptin levels to serum and urinary Mg/urinary creatinine levels was assessed. RESULTS: Serum leptin levels of girls with diabetes were higher than those of the boys (14 +/- 5.3 microg/L vs 5.8 +/- 1.5 microg/L, P < 0.001, respectively). The differences for serum Mg and for urinary Mg/urinary creatinine levels were not significant between girls and boys with diabetes. Leptin levels were correlated with urinary Mg/urinary creatinine levels in both girls and boys (r = 0.39, P = 0.02 and r = 0.37, P = 0.03, respectively). In a multivariate regression model, leptin emerged as independent correlates for mean urinary Mg/urinary creatinine in both girls and boys with the total variance explained being 14%, and 15%, respectively. CONCLUSION: The data suggest that serum leptin might be related to increased urinary Mg loss in patients with type I diabetes.     

不同病程的1型糖尿病患儿血清细胞因子的变化

目的　了解不同病程的 1型糖尿患儿血清细胞因子的变化。方法　第 1组为新诊断 1型糖尿病患儿 2 6例。第 2组为病程 >3年、长期治疗不伴其他疾病的 1型糖尿病 2 0例。第 3组 :因身材矮小但无慢性疾病的患儿为正常对照组 30例。以放射免疫分析法 (RIA)或酶联免疫吸附法 (ELISA)法检测血清白细胞介素(IL) 1β、2、4、12 ,肿瘤坏死因子 α(TNF α) ,干扰素 γ(IFN γ)水平 ,计算Th1、Th2来源细胞因子比值。 结果　第1组IL 1β较第 3组显著增高 ,第 2组IL 1β水平下降 ;第 1、2组IL 4水平低于第 3组 ,第 1、2组间IL 4比较无显著性差异。第 1、2组IL 2 /IL 4、IFN γ/IL 4较第 3组升高 ;第 1、2组比较无显著差异。第 1组IL 2明显低于第 3组 ,第 2组IL 2明显增高。IL 12、IFN γ和TNF α水平于各组间均无显著差异。结论　 1.IL 1β、IL 2水平与病程有关。 2 .IFN γ/IL 4、IL 12 /IL 4未随病程延长而改变 ,以Th1来源的细胞因子占优势 ,提示糖尿病患儿免疫系统本身存在Th1优势的倾向     

Improved glycemic control in adolescents with type 1 diabetes mellitus who attend diabetes camp.

OBJECTIVE: Diabetes camp has become a common part of medical practice worldwide. Although patients' knowledge and self-management of diabetes may improve after camp, improved glycated hemoglobin A1c (HbA1c) levels have not been consistently demonstrated. RESEARCH DESIGN AND METHODS: We performed a retrospective study of medical records at the Children's Medical Center Dallas Endocrinology Center for adolescents with type 1 diabetes aged 12-18 yr. We compared patients who did (n = 77) or did not (n = 106) attend Camp Sweeney, a regional 20-d diabetes camp. Some patients (n = 82) and their parents also completed measures of adherence, depression, and quality of life. RESULTS: HbA1c decreased over time in patients who attended diabetes camp {mean [+/-standard deviation (SD)] at baseline, (T1) = 8.6% (+/-1.8%) and at follow-up, (T2) = 8.3% (+/-1.6%)}, whereas it increased in those who did not attend [mean (+/-SD) at T1 = 8.4% (+/-2.1%) and at T2 = 8.9% (+/-2.3%)] (p < 0.005). Seven months after camp (T3), there were still significant differences in HbA1c between the camp and control groups (p = 0.04), with the difference because of persistent improvement for girls but not for boys. Patients' adherence (p < 0.05) and adjustment (p < 0.05) improved by parental report in those who attended camp; parents of patients who did not attend did not report the change. CONCLUSIONS: Attending Camp Sweeney is associated with improved glycemic control and parent-reported adherence and adjustment in adolescents with type 1 diabetes. Additional studies are needed to determine whether these findings can be generalized to other diabetes camps.     

Bilateral metabolic cataracts in 10-yr-old boy with newly diagnosed type 1 diabetes mellitus

Abstract:  Classic symptoms of diabetes mellitus in childhood prompting parents to seek medical attention include polydipsia, polyuria, polyphagia, weight loss and kussmal breathing. Cataracts with juvenile diabetes usually occur in patients with long-standing, poorly controlled diabetes (1, 2) . We describe a child in whom the acute loss of vision secondary to lenticular opacities was the initial sign of insulin-dependent diabetes mellitus.     

1型糖尿病患儿反复发生酮症酸中毒的原因

目的　分析 1型糖尿病患儿反复发生酮症酸中毒 (DKA)的原因。方法　回顾总结 2 0年来在我院诊治的 1型糖尿病患儿 85 0例次 ,其中因DKA住院 2 2 5例次 ,2次或 2次以上者 5 6例 ,131例次 ,将其分为前 10年和后 10年两组进行分析。结果　两组DKA患儿占总糖尿病人数比率及反复发生DKA人数相比有显著差异 ,后 10年显著少于前 10年 (P <0 .0 1)。在诱因方面感染占第 1位 ,平均 71.8% ;不控制饮食而暴饮暴食 19% ;因停用胰岛素 9.2 % ,两组相比无显著差异 (P >0 .0 5 )。结论　对糖尿病病人进行系统的管理和教育是降低DKA发生率的重要手段     

Use of complementary and alternative medicine in children with type 1 diabetes mellitus – prevalence, patterns of use, and costs

Background:  Complementary and alternative medicine (CAM) is increasingly used in adults and children. Studies on CAM in diabetes have mainly focused on the adult population and its use among children with type 1 diabetes has not been well characterized.
Objectives:  This study determines prevalence, parental reasons and motivations, perceived effectiveness, costs, and communication of CAM use. Moreover, caregiver-related variables associated with the use of CAM were investigated.
Methods:  A self-completed anonymous questionnaire was administered to parents of children with type 1 diabetes in four pediatric diabetes centers in Germany (Leipzig, Berlin, Stuttgart, and Bonn).
Results:  Two hundred and twenty eight (65.9%) of 346 families completed the survey. Mean age of the diabetic patients was 11.9 ± 3.8 yr. Forty two (18.4%) received one or more types of CAM, with the most common types being homeopathy (14.5%), vitamins and minerals (13.7%), modified diet (12.9%), aloe vera (7.3%), and cinnamon (5.6%). Users had a significantly higher family income and parental tertiary education (p < 0.05) and stated a significantly stronger interest in self-care (p < 0.01). Parents' motivations for using CAM were the hope for an improved well-being (92.1%), to try everything (77.8%), and assumption of fewer side effects (55.2%). Costs for the entire treatment varied between less than €100 and up to €5000, with mostly no reimbursement.
Conclusions:  Use of CAM in children with type 1 diabetes is less common than that documented for adults. Parents using CAM do not question the need for insulin. When using CAM, improved well-being and quality of life are important considerations where CAM can have a role.     

儿童1型糖尿病并甲状腺自身抗体异常的意义

目的 探讨儿童1型糖尿病(DM)并甲状腺自身抗体异常的临床意义。方法 应用酶联免疫吸附法(ELISA)及放射免疫法(RIA)测定11例1型DM患儿血清谷氨酸脱羧酶抗体(GADA)、胰岛素自身抗体(IAA)、胰岛细胞抗体(ICA)、甲状腺球蛋白抗体(TgAb)、甲状腺微粒体抗体(TMA)及甲状腺功能。结果 11例1型DM患儿中GADA、IAA、ICA阳性率分别为27.3％、63.6％、18.2％;TgAb、TMA阳性率分别为0％、27.3％,其中亚临床甲状腺功能低下(甲低)2例,发生率为18.2％。伴与不伴甲状腺自身抗体阳性两组1型DM患儿GADA、IAA、ICA阳性率分别为66.7％和12.5％、100％和50％、33.3％和12.5％,但无统计学差异(P>0.05)。结论 1型DM有相当高TMA阳性检出率和自身免疫性甲状腺疾病(AITD)发生率,并可能演变为自身免疫性多内分泌腺综合征(PAS),并甲状腺自身抗体异常的1型DM确实存在胰岛自身抗体高企。