C-PEPTIDE IN JUVENILE DIABETICS BEYOND THE POSTINITIAL REMISSION PERIOD Relation to Clinical Manifestations at Onset of Diabetes, Remission and Diabetic Control

Abstract Ludvigsson, J., Heeling, L. G., Larsson, Y. and Leander, E. (Department of Paediatrics, Linköping University, Sweden, Novo Research Institute, Copenhagen, Denmark, Department of Mathematics, Linköping University, Sweden). C-peptide in juvenile diabetics beyond the postinitial remission period.—Relation to clinical manifestations at onset of diabetes, remission and diabetic control. Acta Paediatr Scand, 66:177, 1977.—A group of 58 diabetics, age 6–17 years and with a duration of diabetes of 3–14 years was studied in order to show whether the nature of the clinical manifestations and the treatment at the onset of the disease are related to the subsequent C-peptide production and also whether remaining C-peptide production is related to better diabetic control. The relations between a number of clinical and laboratory variables were analysed including the degree of ketosis and the insulin dose given at onset of diabetes, the incidence of postinitial remission period, the fasting C-peptide level after the remission period, the level of insulin antibodies and the actual diabetic control expressed as the degree of glucosuria in the patients' urine tests at home. Multiple regression analysis was the main method used. Postinitial remission was positively correlated to initial insulin dose and negatively correlated to duration of ketonuria at onset. C-peptide, which was found in 24.1% of the patients was positively correlated to age at onset and initial insulin dose, but negatively correlated to ketonuria at onset. Diabetic control was positively correlated to insulin dose at onset and to C-peptide level, but negatively correlated to insulin antibodies. It could further be shown that patients who had received a more vigorous treatment immediately at onset had both a higher incidence of postinitial remission and a better diabetic control. The results suggest that an early diagnosis followed by rapid normalization of the metabolism at the onset of juvenile diabetes increase the possibility of preservation of some of the endogenous insulin production, which seems to facilitate diabetic control.     

Diabetes mellitus in Danish cystic fibrosis patients: prevalence and late diabetic complications

Lanng S, Thorsteinsson B, Lund-Andersen C, Nerup J, Schiatz PO, Koch C. Diabetes mellitus in Danish cystic fibrosis patients: prevalence and late diabetic complications. Acta Pzdiatr 1994;83: 72–7. Stockholm. ISSN 0803–5253.
The prevalences of impaired glucose tolerance (IGT), diabetes mellitus and late diabetic complications were studied in all Danish cystic fibrosis (CF) patients. A total of 311 CF patients were identified with an estimated ascertainment rate above 98%. Glucose tolerdnce was classified in 278 (89%) patients: the prevalences of IGT and diabetes mellitus were 13.7% (38 patients) and 14.7% (41 patients), respectively, with no sex differences. The prevalence of diabetes mellitus increased with age but not with the severity of CF as compared with age- and sex-matched non-diabetic CF patients. Diabetes was diagnosed at a median age of 20 years (range 3–40 years) and the duration of diabetes was 1.7 years (0.1–17 years). Twenty-eight of the diabetic patients (70%) were trcated with insulin, on average 20 (4–90) IU per day. Late diabetic complications were identified in 4 patients (10%) with a duration of diabetes mellitus of 1–17 years: background retinopathy (2 patients), diabetic nephropathy (1 patient), microalbuminuria (1 patient) and neuropathy (2 patients). Thus diabetic CF patients are probably not less prone to develop late diabetic complications than patients with other types of diabetes of equally long duration and comparable glycemic control.     

Annotation Microvascular complications of insulin-dependent diabetes: Risk factors, screening and intervention

The ability to detect subclinical signs of the microvascular complications of diabetes during adolescence and our increased understanding of risk factors for their development provide an opportunity to prevent irreversible organ damage. Glycaemic control makes a major contribution to the risk and progression of microvascular complications. However, the unique psychological and physiological changes of childhood and adolescence present a considerable challenge for those attempting to reduce the burden of adult microvascular disease.     

浙江省1999～2004年新诊断儿童1型糖尿病流行病学特征及血脂水平

目的 探讨浙江省新诊断儿童1型糖尿病（DM）患儿流行病学特征及血脂特点。方法对1999年1月1日～2004年12月31日住院且为首次发病的101例1型DM患儿的年龄发病时间、出生时间、酮症酸中毒（DKA）及血脂特点进行回顾性分析。结果2004年新诊断的1型DM病人与总住院人数之比高于1999年；男童中12岁以上组病例所占同性别比例高于同年龄组女童（27．5％vs4．9％）.新诊断1型DM患儿出生于10月份至次年1月份者多于2～5月份出生者，同期发病的病例与总住院人数之比也明显升高。新诊断病例DKA组血糖和糖化血红蛋白（HbAlc）较非DKA组明显升高。两组总胆固醇（TC）和三酰甘油（TG）有显著性差异。血脂异常组与血脂正常组并DKA的比率有显著性差异，两组血糖、HbAlc和住院时间差异有显著性。结论儿童1型DM与总住院人数之比早逐年上升趋势；其发病可能与青春发育有关。初发1型DM患儿的DKA发生率又有回升。1型DM患儿TC、TG与血糖和HbAlc水平相关。     

Diabetic Children and Their Parents: Personality Correlates of Metabolic Control

ABSTRACT. Test measures of field-dependence-independence and impulsiveness-control were obtained from two groups of diabetic children and their parents, the children being in optimal (O, n=12) or poor (P, n=27) metabolic control and, according to the judgment of clinicians, showing optimal or poor psychological adaptation. Children of the O-group scored lower in impulsiveness and higher in realistic functioning than those of the P-group. Differences which parallelled these were found between the two groups of fathers. The P-group fathers were decidedly more field-dependent than their wives, while the opposite was found for the O-group. Group differences of the kind obtained were seen as possible determinants of disturbed family interaction or emotional stress in the child in the P-group and of autonomy and self-reliance in the child in the O-group. It is concluded that the role of fathers of diabetic children has been underestimated.     

Reversible Cataract as the Presenting Sign of Diabetes Mellitus: Report of Two Cases and Literature Review

Background

Type 1 diabetes mellitus (T1DM) is the most common form of diabetes in young children. Serious optic complications, e.g. diabetic retinopathy and diabetic cataract involvement, are not usually detected in T1DM patients at the onset of the disease.

Case Presentation

Two girls aged 11 years and 9 years were hospitalized in our unit in 2008 and 2009. They presented cataracts 1 and 6 months before the diagnosis of T1DM, respectively. After blood glucose level was controlled by insulin therapy, the cataract was resolved, totally in one and partly in the other girl. Meanwhile, visual acuity of both cases recovered, closely associated with fluctuation of plasma glucose level. In this study, we describe the symptoms, probable mechanism and treatment of diabetic cataract.

Conclusion

Early antihyperglycemic therapy and maintenance of stable blood glucose level may reverse acute diabetic cataract or prevent it from getting worse.     

情绪障碍对1型糖尿病儿童代谢控制及治疗依从性的影响

目的探讨情绪障碍对1型糖尿病儿童代谢控制及治疗依从性的影响。方法以儿童焦虑性情绪障碍筛查表及儿童抑郁障碍自评量表为工具,评估90例1型糖尿病患儿的情绪状况,任一量表分≥划界分者为情绪障碍组,余为情绪正常组。以糖化血红蛋白(HbAlc)为代谢控制的指标比较二组差异,并对患儿在血糖监测、饮食控制及运动3方面的治疗依从性进行比较。结果1.情绪障碍组HbAlc平均水平显著高于情绪正常组(8.82%±2.10%vs7.79%±1.53%,t=2.496P<0.05),HbAlc≤7.0%比例显著低于情绪正常组(26.5%vs41.1%,P<0.01)。2.情绪障碍组在血糖监测、饮食控制及运动3方面的治疗依从性均显著差于情绪正常组(Pa<0.01)。结论情绪障碍对1型糖尿病儿童代谢控制及治疗依从性有显著影响,伴情绪障碍者代谢控制状况及治疗依从性差。