The Greek family system when a child has diabetes mellitus type 1

Aim: To depict the characteristic ways that families who have a child suffering from diabetes and face difficulties with metabolic control function. In addition, to reveal the ways that this functioning is related to metabolic control problems. Methods: Qualitative methods were used, including an in-depth interview and observation of 30 Greek families having one child suffering from diabetes mellitus type 1 and facing difficulties with metabolic control. An average of 10 meetings were conducted with each family, including separate meetings with each individual family member, the parental couple and the family as a whole. Methods were based on thematic categories provided by the model of the "psychosomatic family". Results: The presence of the disease and the requirements of the treatment regimen seemed to be associated with certain family characteristics: enmeshed relationships, ambiguous roles and rules, break down of hierarchy, coalition between mother and patient, absence of father's involvement and "infantilization" of the suffering child. Also in such families, healthy siblings are assigned parental roles and, finally, the families present signs of social exclusion.

Conclusion: The study provides important findings concerning the psychological characteristics of the families under study. The present ways of functioning are associated with the difficulties families face when coping with the treatment regimen.     

Changes in food habits in families with a newly diagnosed child with type 1 diabetes mellitus

Dietary recommendations for children with type 1 diabetes mellitus (DM) are in line with the recommendations for the general population and applicable to the whole family. We review what is known about the food habits of non-diabetic family members and present original data on dietary changes in families with a child with DM. Some studies suggest that family members eat mostly the same food as the affected child. In a Finnish study of siblings of children with DM, favourable changes were observed after diagnosis in the type of milk and fat used. In a study of young children with DM, family members increased their consumption of skim milk, low-fat cheese and low-fat cold meat cuts. The consumption frequencies of fruit and vegetables increased. In conclusion, family members of a child with DM are willing to change their food habits towards the recommended diet. Dietary advice should be directed to the whole family from the very beginning.     

The changing presentation of children with newly diagnosed type 1 diabetes mellitus

Abstract: Although it is known that the incidence of type 1 diabetes mellitus (DM) in childhood is progressively increasing, it is less clear whether the presentation of newly diagnosed DM is changing. The aim of this study was to establish whether any biochemical or clinical presentation parameters have altered over time.
A retrospective study was performed comparing newly diagnosed children with DM in two 24 month time intervals, 8 yrs apart (1988–89 and 1995–96). Fifty-seven children were diagnosed with type 1 DM in 1988–89 and 70 children in 1995–96. At presentation, children born in the later cohort had a higher pH (p < 0.001) and lower serum glucose (p < 0.05). Although the frequency of diabetic ketoacidosis (DKA) was higher in the 1988/89 cohort (63% vs. 42% in 1995/96) the absolute number of children with DKA in each time interval was similar (33 subjects in 1988–89 vs. 30 subjects in 1995/96). Islet cell antibody (ICA) levels were very different between the two cohorts; higher antibody levels were found in the 1988/89 group (p < 0.01). DKA was also associated with higher ICA titres (p < 0.05). Hospital admission stay decreased from 6.5 DS to 3.4 DS over the 8-year period (p < 0.0001).
At our institution, the presentation of children with type 1 D M is changing with many more children diagnosed before developing DKA. We speculate that a new environmental factor(s) may be responsible for the absolute increase in patients presenting without DKA, while older etiologies (both genetic and environmental) are responsible for the steady, unchanging number of patients with a more severe presentation. Greater awareness of diabetes in children is not the factor contributing to earlier diagnosis before DKA develops.     

初发1型糖尿病患儿酮症酸中毒的调查

目的调查初发1型糖尿病患儿酮症酸中毒(DKA)的发生情况。方法以224例初发1型糖尿病患儿为研究对象,进行回顾性分析,分为DKA组和未合并DKA组,各112例。DKA组患儿根据年龄分为≥5岁组(65例)和5岁组(47例),并根据酸中毒情况分为轻度(26例)、中度(29例)、重度(57例)3组。分析DKA发生的影响因素以及不同年龄DKA患儿的临床及实验室特点。结果 224例初发1型糖尿病患儿中最常见的症状为多饮(86.2%)、多尿(78.6%)及体重下降(57.1%)。与未合并DKA患儿比较,DKA组5岁、低收入、父母教育程度高中及以下所占的比例均较高,随机血糖、Hb A1C水平较高,pH、HCO_3~-及C肽水平更低,差异均具有统计学意义(P0.05)。≥5岁组与5岁组的轻、中、重度DKA所占比例的差异无统计学意义(P0.05)。与5岁组相比,≥5岁组DKA患儿的症状持续时间较长,随机血糖较低,HbA1C、C肽水平较高,差异具有统计学意义(P0.05)。结论 1型糖尿病患儿DKA发生率高,DKA的发生与年龄、父母文化程度及家庭收入有关。     

Children diagnosed with type 1 diabetes: a randomized controlled trial comparing hospital versus home-based care

Aim: To compare two different regimens for children diagnosed with type 1 diabetes: hospital‐based care or hospital‐based home care (HBHC), referring to specialist care in a home‐based setting. Method: The trial took place in Sweden with a randomized controlled design and included 60 children, aged 3–15 years. After 2–3 days with hospital‐based care, children were randomized to either continued hospital‐based care or to HBHC for 6 days. The primary outcome was the child’s metabolic control after 2 years. Secondary outcomes were set to evaluate the family and child situation as well as the healthcare services. This article presents data 6 months after diagnosis. Results: Results showed equivalence between groups in terms of metabolic control, insulin dose, parents’ employment and working hours as well as parents’ and significant others’ absence from work related to the child’s diabetes. Parents in the HBHC were more satisfied with the received health care and showed less subsequent healthcare resource use. The level of risk for the family’s psychosocial distress assessed at diagnosis was associated with the subsequent use of resources, but not with metabolic control. Conclusion: HBHC was found to be an equally safe and effective way of providing care as hospital‐based care at the onset of type 1 diabetes for children who are medically stable.     

Attained education and self-assessed health later in life when diagnosed with diabetes in childhood: a population-based study

Wennick A, Hallström I, Lindgren B, Bolin K. Attained education and self‐assessed health later in life when diagnosed with diabetes in childhood: a population‐based study. Background: Previous studies have reported conflicting findings on academic achievement in children with type 1 diabetes, and generally lower self‐assessed health status among respondents with diabetes. Objective: Thus, in this study, using the theoretical framework of the human‐capital model, a population‐based survey data set for Sweden, and explanatory variables following predictions from theory and previous empirical human‐capital studies, individuals diagnosed with diabetes before the age of 19 were examined whether they differ from the general population at the same age concerning (i) educational level attained and (ii) self‐assessed health later in life. Special attention was devoted to the association between education and health. Subjects: A set of pooled cross‐sectional population survey data complemented with register data, comprising 20 670 individuals (of whom 106 individuals were diagnosed with diabetes), aged 19–38 yr, from 1988 to 2000, was created from the Swedish Biennial Survey of Living Conditions. Method: The influence of childhood diabetes was analyzed using multiple regression analysis, controlling for educational level, wage, sex, age, marital status, and parental ethnicity. Results: Childhood diabetes was associated with lower levels of attained education and self‐assessed health in comparison with the general population. More educated individuals reported better health, though. Conclusions: In terms of the rapid increase in the incidence of diabetes in many countries, it is important to bear in mind that investments made both in education and in health, early in life, may facilitate the capability of the individual to experience healthy time later in life.     

1型糖尿病儿童情绪障碍对照研究

目的 探讨1型糖尿病儿童情绪障碍的发生率及其特点.方法 2005年7月至2006年1月在北京儿童医院糖尿病门诊随访的1型糖尿病患儿90例,以儿童焦虑性情绪障碍筛查表(SCARED)及儿童抑郁障碍自评量表(DSRSC)为工具,评估糖尿病患儿及193例对照组儿童的情绪状况,任一量表分≥划界分者视为情绪障碍.结果 (1)对照组共检出情绪障碍48例,检出率24.9%,搪尿病组共检出情绪障碍34例,检出率37.8%.经X2检验差异有统计学意义(X2=4.969,P=0.026),其中焦虑症状阳性在对照组检出43例,检出率22.3%,在糖尿病组检出32例,检出率35.6%,差异有统计学意义(X2=5.554,P=0.018).抑郁症状阳性(15.6%vs9.3%)及焦虑抑郁共存(13.3%vs 6.7%)两组差异无统计学意义.(2)两组情绪障碍的构成特点相似,焦虑症状阳性者多于抑郁症状阳性.(3)以不同年龄组进行比较,糖尿病组在15～17岁组情绪障碍的检出率最高(55.9%),显著高于对照组(31.9%)(X2=0.532,P=0.019),结论 1型糖尿病患儿是情绪障碍的高危人群,焦虑症状是情绪障碍的主要表现,年龄的增长可能是该群体并发情绪障碍的危险因素.     

Response of circulating ghrelin levels to insulin therapy in children with newly diagnosed type 1 diabetes mellitus

Ghrelin is secreted primarily by the stomach, although other tissues such as the pancreas synthesize a minor proportion. The discovery of a new cell type that produces ghrelin in the human pancreas and that this organ expresses GHS-R opens new perspectives in the understanding of the control of glucose metabolism. We have studied 22 children with newly diagnosed type 1 diabetes mellitus at four different points: at diagnosis before insulin therapy, after 48-60 h of insulin therapy, and after 1 and 4 mo of insulin treatment. At each point circulating levels of ghrelin, leptin, IGF-I, IGF binding protein (IGFBP)-1, IGFBP-2, IGFBP-3, and glucose were determined. Ghrelin levels were significantly decreased at diagnosis (573 +/- 68 pg/mL, p < 0.01) compared with controls (867 +/- 38 pg/mL) and remained decreased after insulin therapy (d 2: 595 +/- 68 pg/mL; 1 mo: 590 +/- 61 pg/mL; 4 mo: 538 +/- 67 pg/mL) with no differences before or after insulin treatment. There was a negative correlation between ghrelin levels and body mass index at all of the study points, whereas a negative correlation between ghrelin and glucose concentrations was only observed after insulin therapy. No correlation between ghrelin and HbA1c was found at any point. A positive correlation between ghrelin and IGFBP-1 was found after insulin therapy, but no correlation with other members of the IGF system or leptin was found. In conclusion, these data could indicate a possible link between glucose concentrations and ghrelin; hence, the persisting low ghrelin levels in diabetic children may suggest a defensive mechanism against hyperglycemia.     

Low levels of vitamin D in North Indian children with newly diagnosed type 1 diabetes

Borkar VV, Devidayal, Verma S, Bhalla AK. Low levels of vitamin D in North Indian children with newly diagnosed type 1 diabetes. Background: To find out whether vitamin D levels are lower in children with newly diagnosed type 1 diabetes (T1D) as compared to non‐diabetic subjects. Methods: Plasma levels of vitamin D (25‐OHD) were measured by high performance liquid chromatography (HPLC) in 50 children aged between 6 and 12 yr within a week of diagnosis of T1D, and in 50 healthy children. Results: The mean levels of vitamin D were significantly lower in patients as compared to their controls [20.02 ± 10.63 ng/mL (50.05 ± 26.57 mmol/L) vs. 26.16 ± 12.28 ng/mL (65.4 ± 30.7 mmol/L), p‐value 0.009]. Twenty‐nine (58%) children in the study group were vitamin D deficient (25‐OHD level < 20 ng/mL or < 50 mmol/L) as compared to only 16 (32%) in the control group. Overall, 43 (86%) diabetic and 38 (76%) healthy children were either vitamin D deficient or insufficient. Conclusion: These results suggest that vitamin D levels are low at the onset of T1D, and they strongly support the need for further clinical studies to prospectively evaluate the effect of vitamin D supplementation on T1D rates in this patient population.     

Autoimmune characteristics in Japanese children diagnosed with type 1 diabetes before 5 years of age

Background:  Several studies have shown that the autoimmune features in young children with type 1 diabetes differ from those in older pediatric patients as well as adults. The purpose of the present study was to examine the prevalence of β-cell autoantibodies, glutamic acid decarboxylase antibodies (GADA), and antibodies to the protein tyrosine phosphatase-related molecule IA-2 (IA-2A), at the time of diagnosis in Japanese children with type 1 diabetes who were younger than 5 years at diagnosis.
Methods:  Subjects consisted of 23 Japanese children (nine boys, 14 girls), 3.1 ± 1.3 years of age at diagnosis (range, 1.1–4.8 years). The majority had severe metabolic decompensation accompanied by complete absence of β-cell function at diagnosis. We found 41.7% to have suffered viral infections before disease onset.
Results:  The prevalence of antibodies to GAD and IA-2 at diagnosis in these subjects was significantly lower than those in older patients diagnosed after 5 years of age (31.6 % vs 86.3% and 47.1% vs 82.5%, P  < 0.0001 and P  = 0.0064, respectively). Among 17 patients in whom both antibodies were measured, only two (11.8%) had both GADA and IA-2A, three (17.6%) had GADA alone, six (35.3%) had IA-2A alone, and six (35.3%) had neither GADA nor IA2-A.
Conclusions:  Non-autoimmune mechanisms or age-related differences in autoimmunity could be involved in the pathogenesis of diabetes in young patients.