Polyglandular type I autoimmune syndrome]

Two HLA-identical sisters have developed the full picture of type I polyglandular autoimmune syndrome over a period of 12 years. Both girls have hypoparathyroidism and Addison's disease. One of them additionally developed diabetes mellitus, hypergonadotropic hypogonadism and hypothyroidism. Autoantibodies to the adrenal, parathyroid and thyroid glands are present in both patients, as well as antinuclear antibodies. HLA associations have been described recently for the type I polyglandular autoimmune syndrome, but this could not be confirmed in the present two cases. Although we assume that the same genetic defect is present in both girls, additional factors to the genetic disposition are important for the clinical expression of the disease. The linkage of the disease-causing gene with the HLA region is not very close.     

Addisonian crisis precipitated by thyroxine therapy: a complication of type 2 autoimmune polyglandular syndrome

Hypothyroidism is a common condition. Rarely, it may occur in combination with autoimmune failure of other endocrine glands (autoimmune polyendocrinopathy syndrome type 2, previously known as Schmidt's syndrome). In such cases, restoring normal thyroid function may precipitate adrenal failure. Clinicians should have a high index of suspicion for this condition in patients with Addison's disease, those with a family history of autoimmune endocrine gland failure, patients with one autoimmune endocrine disease who develop nonspecific or serious illness, and patients with type 1 diabetes mellitus whose insulin requirements drop without obvious explanation.     

Hypophosphataemic Osteomalacia and Fanconi Syndrome of Adult Onset with Dominant Inheritance: POSSIBLE RELATIONSHIP WITH DIABETES MELLITUS

Adult-onset osteomalacia with multiple renal tubular defectsand generalized amino-aciduria is uncommon, and where familialit is characteristically an autosomal recessive disorder. Thispaper describes a kindred in which the syndrome has appearedin four successive generations, apparently inherited in a dominantmanner, and possibly associated with diabetes mellitus. Theproposita had hypophosphataemia, renal glycosuria, proteinuriaand generalized aminoaciduria, and at the age of 22 developedsymptoms of osteomalacia which responded to treatment with oralphosphate. Her father had been similarly affected: renal glycosuriawas first noted when he was 24, and 12 years later he developeddiabetes mellitus from which he died. One sister, aged 31, hasrenal glycosuria, aminoaciduria and hypophosphataemia withoutbone disease. In the three preceding generations at least sevenother individuals had crippling bone disease and profound muscleweakness of early adult onset; in four, preter-minal polydipsiawas recorded, and others had renal glycosuria or diabetes mellitus.Three of the five children in the latest generation have slightproteinuria but no other detectable abnormality. The possibleassociation between these renal tubular defects and diabetesmellitus is discussed.     

POLYSEROSITIS AS A RARE COMPONENT OF POLYGLANDULAR AUTOIMMUNE SYNDROME TYPE II

Polyglandular autoimmune (PGA) syndromes (types I and II) may affect various endocrine and non-endocrine organs in the body. In the commoner PGA type II, primary adrenal insufficiency, autoimmune thyroid disease and type I diabetes mellitus are the most frequent manifestations. Serositis with pericardial or pleural involvement is not a well known component of the disease. Here, we report a 21-year-old man who first presented with a pleuropericardial effusion and Graves' disease, and who then developed type I diabetes mellitus.     

Prevalence of IgA antitissue transglutaminase antibodies in children with type 1 diabetes mellitus

The association of celiac disease with type 1 diabetes mellitus is known, but the evolution of celiac disease is most frequently asymptomatic, without any clinical signs. Thus, diagnosis is impossible to make in the absence of serological tests. Our study aimed to determine the prevalence and the efficiency of IgA antitissue transglutaminase antibodies in the screening of celiac disease in children with type 1 diabetes mellitus. Method: During the course of 2008–2009, we performed an analytical clinical study that included the determination of IgA antitissue transglutaminase antibodies in a group of 119 children with type 1 diabetesmellitus. Fifty‐seven percent of the subjects were male and 43% were female, with a mean age of 11±4 years. Results: By evaluating IgA antitissue transglutaminase antibodies, we obtained a prevalence of 9.2% in children with type 1 diabetes mellitus, with a sensitivity and specificity of 80 and 82.6%, respectively. Conclusions: There is an increased prevalence of IgA antitissue transglutaminase antibodies, which suggests the need to use this method as an effective first‐line test in the screening of celiac disease in children with type 1 diabetes mellitus. J. Clin. Lab. Anal. 25:156–161, 2011. © 2011 Wiley‐Liss, Inc.     

Technology and pregnancy

The World Health Organisation projects that the number of diabetes-related deaths will double between the years 2005 and 2030. An important method for reducing the number of new cases of diabetes is by screening for and controlling glucose in women with gestational diabetes, the form of diabetes that afflicts up to 10% of the pregnant population. Uncontrolled gestational diabetes mellitus results in an increased risk of complications due to maternal hyperglycaemia and the resultant fetal hyperinsulinaemia. These complications include macrosomia and an increased risk of metabolic disorders including diabetes later in the child's life. Advances in the treatment of gestational diabetes have shown promising results in minimising fetal complications; they have also helped to slow the vicious cycle of women who contract gestational diabetes mellitus producing children with a high risk of developing diabetes later in life. A comprehensive literature review with an emphasis on technology has resulted in the following collection of papers relating to pregnancy and diabetes. Last year there were several technological advances in glucose monitoring. This year the applications of telemedicine in the treatment of gestational diabetes and the use of ultrasound for early detection of the disease have been at the forefront. The authors aimed to include articles that were not only relevant to the field of diabetes technology in pregnancy, but that also improved treatment and advanced understanding. The study design and results were also carefully examined in considering the articles. The selected articles contain findings that provide new techniques for diagnosing gestational diabetes mellitus as well as provide additional treatment methods for those affected by the disease.     

The young adult with diabetes: impact of the disease on marriage and having children

To investigate the impact of insulin-dependent diabetes mellitus on marriage and having children we studied 50 young adults (aged 20-35 yr) with onset of the disease less than 20 yr. The subjects studied (37 women and 13 men) included 17 single, 26 married, and 7 divorced/separated diabetic patients. Twenty-two spouses of the 26 married diabetic patients also participated in the study. A 35-item questionnaire was developed with a 4-point Likert scale format for responses and administered separately to the patients and their spouses. None of the young adults in this study had made a conscious decision to remain unmarried, but 14 of 50 had decided not to have children. Onset of diabetes before 9 yr was associated with a significantly higher marriage rate than later onset of diabetes. Although onset of the disease after age 13 yr was more often associated with a decision to remain childless compared with earlier onset, this difference was not significant. Both men and women with diabetes found that the disease had an impact on certain aspects of their marital life, at times leading to friction and causing a financial burden. Whereas spouses were perceived to be very supportive, there was disagreement between young diabetic subjects and their spouses as to the impact of the disease on family activities and finances, the partners with diabetes perceiving a greater effect on these aspects of their lives than did their spouses.     

Seasonality of births and childhood inflammatory bowel disease

PURPOSE: In some geographical areas, including Slovakia, children with diabetes mellitus type 1 are born more often in summer than in late autumn and winter. Does this also apply to another autoimmune disorder - inflammatory bowel disease - in Slovakia? BASIC PROCEDURES: The month of birth was recorded for 30 boys and 36 girls with Crohn disease and 23 boys and 40 girls with ulcerative colitis. The monthly numbers of births were adapted to the length of the given month, divided by the number of boys or girls born in the whole Slovak children population in the same calendar month in comparable years, transformed to moving averages from three successive values each, and expressed as the fraction of the yearly total, which was equal to 1. According to the null hypothesis, there should be equal probability (1/12) of being born in any month. The significance of departures from this value was evaluated with cosinor regression using two sinusoidal functions with period lengths of 12 and 6 months. The most illustrative measure is the relation of the corridor of 95% confidence for the total approximating function to the midline estimating statistic of rhythm (the mesor) (1/12). Significant departures up or down are recognized as nonoverlapping of the mesor straight line by the confidence corridor. MAIN FINDINGS: These were similar to those reported for childhood diabetes mellitus type 1. In our sample of Crohn disease, the number of births was markedly higher between June and October and lower between December and March. In ulcerative colitis, there was a slight increase between June and August and a decrease between December and February. PRINCIPAL CONCLUSIONS: The seasonal effect on births of children with later childhood-onset Crohn disease is similar to that described for diabetes mellitus type 1, i.e., maximal frequency of births in summer.     

Neonatal diabetes mellitus: A rare but important diagnosis in the critically ill infant.

Diabetes mellitus is a heterogeneous disorder that may occur at any age. Neonatal diabetes mellitus, defined as hyperglycaemia presenting within the first 6 weeks of life in term infants, is a rare disorder that may result in permanent or transient diabetes mellitus. Although reported in paediatric diabetes literature, there are no reports of this condition in emergency medicine journals and these children may present to emergency departments with a picture mimicking sepsis. We report the case of a 5-week-old infant with diabetes mellitus who presented with diabetic ketoacidosis and review the literature surrounding this rare condition.     

Immunosuppression in autoimmune disease: the double-edged sword

We have developed a protocol of prophylactic cyclosporin A administration which confers complete and permanent protection against insulin-dependent diabetes mellitus in diabetes-prone BioBreeding rats. Spontaneous insulin-dependent diabetes mellitus developed in about 50% of BioBreeding rats, between 10 and 18 weeks of age. Prophylactic cyclosporin A (10 mg/kg/day p.o.), started at 6 weeks of age and terminated at 21 weeks of age, completely prevented insulin-dependent diabetes mellitus: 0% (0/25) cyclosporin A-treated compared to 46% (11/24) control rats developed insulin-dependent diabetes mellitus (p less than 0.001). Protection against insulin-dependent diabetes mellitus was lifelong, provided cyclosporin A prophylaxis was initiated when insulitis was minimal or absent, and pancreatic insulin content was normal. Cyclosporin A prophylaxis initiated later, but still before the onset of clinical symptoms (8-9 weeks), and terminated at 22-23 weeks, was only partially effective; 5/20 (25%) of cyclosporin A-treated rats developed insulin-dependent diabetes mellitus, compared to 60% (12/20) of controls (p less than 0.05). Cyclosporin A prophylaxis started at the appropriate time (6 weeks) but terminated prematurely (17-19 weeks of age) was not effective; insulin-dependent diabetes mellitus developed in 20% (3/15), compared to 50% (7/14) controls (p greater than 0.05); insulin-dependent diabetes mellitus developed after cessation of therapy. We conclude that effective and permanent moderate-dose cyclosporin A prophylaxis of insulin-dependent diabetes mellitus in BioBreeding rats requires (1) early initiation of treatment, when islet morphology and hormone content are still normal; and (2) prolonged treatment, with continuation of prophylaxis past the end of the at-risk period.(ABSTRACT TRUNCATED AT 250 WORDS)     

Puppy power

Dogs have been used for many years to help people who are blind or have hearing loss. Now they are being trained to help people with medical conditions such as cancer, diabetes, seizures, Addison's disease and narcolepsy.     

A history of diabetes: from antiquity to discovering insulin

This article, the first of a three-part series, gives a historical account of events for diabetes, dating from antiquity and its first recording in the Ebers Papyrus--an Egyptian document circa 1500 BC. This article describes initial thoughts that diabetes was linked to an alimentary complaint, and concludes with the discovery of it being a chronic systemic disease. It highlights the discoveries and also includes details of the failed attempts to locate the cause and identify a solution to the ancient mysterious disease which became known to all as diabetes mellitus. Early remedies and treatments are included. The article tells how for many centuries individuals suffered from the debilitating complaint with very little offered in terms of treatment or relief. Eventually the pancreas was identified as the causative organ and, some time later, animal experimentation resulted in the abstraction of the substance insulin. The article concludes with Frederick Banting and John Macleod being awarded the Nobel Prize in 1923 for their revolutionary discovery of insulin.     

Measurement of IgG levels can serve as a biomarker in newly diagnosed diabetic children

This study was undertaken to determine humoral immune response to the presence of anti-immunoglobulin antibodies in children with newly diagnosed type 1 diabetes mellitus, using as a target cow immunoglobulins, in an attempt to elucidate further complex immuno-pathogenetic interactions of the disease. Serum immunoglobulin G (IgG) concentrations were measured by ELISA in 30 children with type 1 diabetes mellitus and 30 healthy matched normal children. It was found that normal children had a mean IgG level of 7.41 mg/ml while diabetic individuals had a mean IgG level of 8.52 mg/ml (p<0.00004). On the contrary, the mean level of IgG in diabetic sera after purification from anti-cow immunoglobulins was determined to be 7.52 mg/ml. Therefore, there was no significant difference in IgG level in patients with type 1 diabetes mellitus after removal of anti-cow immunoglobulin antibodies compared to normal children (p<0.58). Visualization of IgG and immuno-precipitation confirm that anti-cow immunoglobulins antibodies, which were unrelated to antigen, were co-precipitated with the antigen-antibody complex. A circulating immunoglobulin reacting with other immunoglobulins is thus present in children with type 1 diabetes and may well play a part in the complex immuno-pathogenetic interactions.     

Linking research and innovative clinical practice: the story of diabetes mellitus.

Research into diabetes mellitus and the clinical practice of diabetology are a fascinating illustration how the accumulation of knowledge leads to changing scientific theories and paradigms. The pivotal point in the history of diabetes, the discovery of insulin and its introduction to treatment, was one of the most spectacular events in medicine. Later, diabetes care provided, among other developments, models for multidisciplinary approach to treatment and the blueprint for community-based epidemiological studies. The history of diabetology also illustrates the role of chemistry, and later laboratory medicine, in the management of disease. This article is an introduction to the special issue of Clinical Chemistry and Laboratory Medicine, focused on diabetes mellitus and its complications.     

Autoantibody "subspecificity" in type 1 diabetes: risk for organ-specific autoimmunity clusters in distinct groups

OBJECTIVE: Autoimmune thyroid disease (AIT), celiac disease, and Addison's disease are characterized by the presence of autoantibodies: thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in AIT, tissue transglutaminase antibody (TTGAb) in celiac disease, and 21-hydroxylase antibody (21-OHAb) in Addison's disease. The objective of this study was to define the prevalence of these autoantibodies and clinical disease in a population with type 1 diabetes. RESEARCH DESIGN AND METHODS: We screened 814 individuals with type 1 diabetes for TPOAb, TGAb, TTGAb, and 21-OHAb. Clinical disease was defined by chart review. Factors related to the presence of autoimmunity and clinical disease including age at onset of type 1 diabetes, duration of diabetes, age at screening, sex, and the presence of autoantibodies were reviewed. RESULTS: The most common autoantibodies expressed were TPOAb and/or TGAb (29%), followed by TTGAb (10.1%) and 21-OHAb (1.6%). Specific HLA DR/DQ genotypes were associated with the highest risk for expression of 21-OHAb (DRB1*0404-DQ8, DR3-DQ2) and TTGAb (DR3-DQ2- DR3-DQ2). The expression of thyroid autoantibodies was related to 21-OHAb but not to TTGAb. The presence of autoantibodies was associated with and predictive of disease. CONCLUSIONS: In this large cohort of individuals with type 1 diabetes, the expression of organ-specific autoantibodies was very high. The grouping of autoantibody expression suggests common factors contributing to the clustering.     

Lipid peroxidation and erythrocyte membrane permeability in children and adolescents with diabetes mellitus type 1

The content of malonic dialdehyde (MDA) in erythrocytes and blood plasma as well as the specificity of erythrocyte membrane permeability (EMP) was studied in case of children and teenagers with insulin-dependent diabetes mellitus (IDDM) with respect to a duration and compensation degree of the disease. Eighty-seven children and teenagers with IDDM, aged 7 to 16, and 23 age-matching healthy children and teenagers were examined. The MDA content in erythrocytes and plasma of sick children was found to be increasing yet at the disease onset and did not depend on a duration and compensation degree of diabetes. Erythrocytes of sick children had a lower resistance to the hemolytic action of urea and a higher permeability. As the disease duration was increasing, there was a higher EMP observed at earlier diabetes stages and its decrease with the progressing of diabetes.     

The presence of family history and the development of type 2 diabetes mellitus risk factors in rural children.

Type 2 diabetes mellitus is reaching epidemic proportions among children and adolescents. School health fairs offer an opportunity to identify children with risk factors for the development of type 2 diabetes mellitus. This study identified selected risk factors (i.e., high-risk racial/ethnic group, obesity, elevated blood pressure, elevated casual blood glucose, elevated total cholesterol, and the presence of acanthosis nigricans) for development of type 2 diabetes mellitus in rural children with or without a family history of diabetes during annual school health fairs. Of the children screened, 40% (673) presented with two or more of the identified risk factors for type 2 diabetes mellitus. The presence of multiple risk factors in participants reporting a positive family history of diabetes mellitus versus those with no family history was not statistically significant. Based on the study results, factors other than family history may be more predictive for the development of type 2 diabetes mellitus in rural school children.     

以皮肤病变为首发表现的糖尿病误诊分析

目的 探讨以皮肤病变为首发表现的糖尿病的临床特点。以期能为早期诊断糖尿病提供线索。方法 总结分析以皮肤病变为首发表现的13例糖尿病的临床资料。结果 所有病例首疹就诊均误诊，主要是对糖尿病的皮肤病变缺乏认识，对无糖尿病典型表现的患忽视了检查血糖。结论 临床上糖尿病的皮肤病变较常见。对有反复真菌感染，化脓性皮肤病，顽固性皮肤瘙痒的中老年人，应重视血糖测定。避免误诊糖尿病。     

小儿糖尿病的家庭护理干预效果观察与分析

[目的]探讨并分析小儿糖尿病家庭护理干预的效果。[方法]随机将糖尿病患儿82例分为对照组40例与干预组42例,对照组按常规治疗和护理,干预组在常规治疗和护理的基础上给予系统全面而个性化的家庭护理干预,半年后对两组患儿的糖化血红蛋白值(HbA1C)、饮食控制、遵医嘱用药、规律锻炼、自我监测等方面进行评价。[结果]干预组患儿的HbA1C与对照组比较,差异有统计学意义(P<0.01)。饮食控制、遵医嘱用药、规律锻炼、自我监测指标执行情况均高于对照组,差异有统计学意义(P<0.01)。[结论]正确家庭护理干预可有效控制小儿糖尿病病情,减少并发症发生。     

Peptic ulcer in patients with diabetes mellitus

It is well recognized that diabetes mellitus develop a variety of complications during the course of disease, such as diabetic triopathy. After one to two decades of overt disease, approximately 30-60% of diabetics develop clinical signs of visceral autonomic neuropathy. Peptic ulcer patients with diabetes mellitus have these complicated backgrounds. The prevalence of peptic ulcer disease in asymptomatic diabetic patients was reported as 5.3% to 7.3% in Japan. We evaluated the efficacy of Helicobacter pylori eradication therapy in peptic ulcer patients with non-insulin dependent diabetes mellitus. The cure rate of peptic ulcer and gastritis score at 8 weeks after eradication therapy is similar with non-diabetic patients. Our data suggests that the eradication of Helicobacter pylori becomes a first therapy in peptic ulcer patients with non-insulin dependent diabetes mellitus.