Dysphagia in patients with Duchenne muscular dystrophy evaluated with a questionnaire and videofluorography

Purpose. To investigate swallowing problems in patients with Duchenne muscular dystrophy (DMD) using a questionnaire and videofluorography (VF).

Method. A questionnaire survey was performed of swallowing-related symptoms and VF in 31 male patients with DMD (mean age 19.9 years, range 9 - 26 years). The relationships among age, frequency of symptoms and VF abnormalities were analysed using Spearman's rank correlation. The differences in VF abnormalities among different food textures were analysed with the Kruskal - Wallis test.

Results. Symptoms related to pharyngeal phase dysfunction were more frequent than those related to oral and oesophageal phases. Coughing while eating was seen in 71% of the patients, choking while eating in 32% and the need to clear the throat in 26%. VF abnormalities were observed in 30 patients (96.8%). Common VF abnormalities included pooling in the valleculae (90.3%) and in the pyriform sinus (90.3%). Pharyngo-oral regurgitation was seen in 35.5% of the patients. Pooling in the pyriform sinus after repeated swallowing seen in VF correlated significantly with symptoms related to the pharyngeal phase (Spearman's rho 0.356 - 0.544).

Conclusion. Because oropharyngeal dysphagia in DMD was evident in teenage patients as well as those without clinical symptoms, VF is recommended in patients with DMD.     

Intra- and inter-rater reliability of the Sollerman hand function test in patients with chronic stroke

Purpose.?To examine whether the Sollerman hand function test is reliable in a test-retest situation in patients with chronic stroke.

Method.?Three independent examiners observed each patient at three experimental sessions; two days in week 1 (short-term test-retest) and one day in week 4 (long-term test-retest). A total of 24 patients with chronic stroke (mean age; 59.7 years, mean time since stroke onset 29.6 months) participated. The examiners simultaneously assessed the patients' ability to perform 20 subtests. Both ordinal data (generalized kappa) and total sum scores (Spearman's rank correlation coefficient (Spearman's rho), intra class correlation coefficient (ICC_{2, 1}) and mean differences) were used in the statistical analysis.

Results.?There was agreement (kappa ≥ 0.4) between the examiners for 15 out of the 20 subtests. Using total sum scores, the agreement within the examiners, both short- and long-term, was higher than 0.96 (for Spearman's rho and ICC, respectively). The mean differences were 0.29 – 1.0/80 points within each examiner. Agreement between the examiners at each session was higher than 0.96 (Spearman's rho) and 0.92 (ICC), respectively. Systematic differences (p < 0.05) were, however, found between examiners A and B/C for all sessions.

Conclusions.?The Sollerman hand function test seems to be a reliable test in patients with chronic stroke, but we recommend that the same examiner evaluates a patient's hand function pre- and post-treatment.     

Pharynx and oesophagus evaluation during the swallow using helical computerized tomography

Purpose:?Videofluorography (VF) and endoscopy are commonly used for dynamic imaging (DI) of pharyngeal swallowing but do not offer transverse plane (TP) information. The aim of the present study was to evaluate helical computerized tomography (HCT) to measure the DI capability pharyngeal swallowing in the TP.

Methods:?The HCT scan technique used was a single-slice cine mode with scan times of 100?ms. All 15 subjects were studied supine during dry swallow, swallowing of barium sulphate jelly and 3, 10, 15 or 20?ml of a 40% barium sulphate solution. Nine subjects repeated the test twice at more than 1 week's interval to determine the test-retest reliability.

Results:?Swallowing leads to closure of the vocal folds, pharyngeal constriction and narrowing of the piriform sinuses allowing jelly passage between the sinuses. Laryngeal elevation then occurrs with the opening of the pharyngoesophageal segment (PES). Swallowing a bolus of 20?ml produced the maximum anteroposterior and transverse diameters as well as the maximum opening area of the PES. The test-retest intraclass correlation coefficients with liquid deglutition ranged from 0.86 to 0.98.

Conclusions:?This study shows that HCT enables visualization of TP of PES complementing VF or endoscopic swallowing studies.     

Visual disability rates in a ten-year cohort of patients with anterior visual pathway meningiomas

Abstract

Purpose: To examine the visual outcome of anterior visual pathway meningioma (AVPM) patients followed for at least one year. Methods: Data were collected on demographics, clinical course and management. Visual disability was classified at the first and last examination as follows: I – no visual disability; II – mild visual defect in one eye; III – mild visual defect in both eyes; IV – loss of driver’s license; V – legally blind. Results: Eight-one AVPM patients had their tumor originate in the clinoid process in 23 (28%), sphenoid-wing area in 18 (22%), cavernous sinus in 15 (19%), tuberculum sellae in 8 (10%), and mixed in 17 (21%). On last examination, 46 patients (57%) had good visual acuity in one or both eyes (Class I or II) and 17 (21%) were mildly affected in both eyes. The rate of Class IV disability was 16%, and Class V disability was 6%. Conclusions: Attention needs to be addressed to the considerable proportion of patients with AVPM (22% in this study) who may lose their driver’s license or become legally blind. Occupational therapists should play an important role in the multidisciplinary management of those patients to help them adapt to their new physical and social situation.

• Implications for Rehabilitation

• Anterior visual pathway meningiomas (AVPMs) are commonly not life-threatening but they can lead to profound visual disability, especially when the tumor originates in the tuberculum sellae and cavernous sinus.

• Particular attention should be paid to visual acuity and visual field deficits, as these can profoundly affect the patient’s quality of life including ability to drive and activities of daily living.

• The interdisciplinary management of patients with AVPM should include the neurosurgeon, neuro-ophthalmologist and occupational therapist. Also, early intervention by the occupational therapist can help patients adapt to their current physical and social situation and return to everyday tasks more rapidly.

     

Determining the Efficacy of the Chin-Down Maneuver Following Esophagectomy With Fiberoptic Endoscopic Evaluation of Swallowing

ObjectivesTo clarify the reliability of fiberoptic endoscopic evaluation of swallowing (FEES) compared to videofluoroscopic swallowing studies (VFSSs). Second, we explored the effect of the chin-down maneuver in the presence or absence of vocal fold paralysis (VFP) using FEES in patients with 3-field lymphadenectomy (3FL) postesophagectomy.DesignRetrospective data collection from FEES and VFSS.SettingDysphagic clinics in the ear, nose, and throat department.ParticipantsPatients (N=15) underwent esophagectomy with 3FL at the Department of Gastroenterologic Surgery, during a period of 12 months.InterventionsThe patients underwent FEES and VFSS with neutral and chin-down maneuvers 2 weeks postoperatively. Two raters of speech pathology blindly scored aspiration, penetration, delayed initiation, and pharyngeal clearance in the pyriform sinus and vallecula, respectively, from recorded movie clips of both examinations, using the penetration aspiration scale (PAS) and modified Hyodo FEES rating scale.Main Outcome MeasuresThe intrarater and interrater correlation coefficients of each parameter examined with FEES. Statistical comparison of each parameter between FEES and VFSS and of each parameter evaluated using FEES between 2 maneuvers with or without VFP.ResultsThe intrarater and interrater correlation coefficients of the PAS and pyriform sinus examined with FEES were both statistically consistent between the 2 raters. The PAS and pyriform sinus evaluated using FEES were significantly correlated with those evaluated in a VFSS (P<.05). The 2 parameters evaluated using FEES were significantly (P<.05) improved with the chin-down maneuver compared to the neutral maneuver, especially in VFP patients.ConclusionFEES performed postesophagectomy with 3FL for evaluation of aspiration is as reliable statistically as VFSSs. The chin-down maneuver is especially useful for reducing the PAS score and pyriform sinus in VFP patients.     

Upper limb sensorimotor function and functional performance in patients with rheumatoid arthritis

Purpose. Although sensorimotor deficits have been identified in isolated upper limb joints of patients with rheumatoid arthritis (RA), relatively little is known about the presence or consequences of sensorimotor deficits in the upper limb as a whole. To address this, we compared sensorimotor and functional performance in multiple upper limb joints of patients with RA and healthy subjects.

Methods. Global upper limb strength, proprioception (joint position sense) and the time taken to perform 2 common functional daily activities (dressing and eating) were estimated in 31 RA patients and 18 healthy subjects. Disability, pain and clinical disease activity were also assessed in the RA patients.

Results. The RA patients were weaker (mean difference 280N, 95% Confidence Interval 172 to 389; P < 0.001), had poorer functional performance (6 sec, CI 8.1 – 23.9; P < 0.001), hand grip strength (117 mmHg, CI 61 – 173; P < 0.001) and proprioceptive acuity (2°, CI 0.4 – 3.5; P < 0.05) than the healthy subjects. Upper limb functional performance and disability in the RA patients were inversely associated with global upper limb (r = ?0.54 to ?0.36) and hand grip strength (r = ?0.51 to ?0.32) but not proprioception (r = 0.55 – 0.11).

Conclusions. Compared to healthy subjects, patients with RA had global upper limb sensorimotor deficits. Weakness contributes to poor upper limb function and disability in patients with RA, although the clinical importance of proprioception is unclear.     

Clinical and cardiac features of patients with subarachnoid haemorrhage presenting with out-of-hospital cardiac arrest

Background

Subarachnoid haemorrhage (SAH) is known as one of the aetiologies of out-of-hospital cardiac arrest (OHCA). However, the mechanisms of circulatory collapse in these patients have remained unclear.

Methods and results

We examined 244 consecutive OHCA patients transferred to our emergency department. Head computed tomography was performed on all patients and revealed the existence of SAH in 14 patients (5.9%, 10 females). Among these, sudden collapse was witnessed in 7 patients (50%). On their initial cardiac rhythm, all 14 patients showed asystole or pulseless electrical activity, but no ventricular fibrillation (VF). Return of spontaneous circulation (ROSC) was obtained in 10 of the 14 patients (14.9% of all ROSC patients) although all resuscitated patients died later. The ROSC rate in patients with SAH (71%) was significantly higher than that of patients with either other types of intracranial haemorrhage (25%, n = 2/8) or presumed cardiovascular aetiologies (22%, n = 23/101) (p < 0.01). On electrocardiograms, ST-T abnormalities and/or QT prolongation were found in all 10 resuscitated patients. Despite their electrocardiographic abnormalities, only 3 patients showed echocardiographic abnormalities.

Conclusions

The frequency of SAH in patients with all causes of OHCA was about 6%, and in resuscitated patients was about 15%. The initial cardiac rhythm revealed no VF even though half had a witnessed arrest. A high ROSC rate was observed in patients with SAH, although none survived to hospital discharge.     

Ablation of Polymorphic Ventricular Tachycardias in Patients with Structural Heart Disease

Background and Objectives: Monomorphic ventricular premature beats (VPB) originating from the Purkinje network can induce polymorphic ventricular tachycardia (PMVT) and ventricular fibrillation (VF) storm. We hereby report the results of targeted ablation to treat PMVT/VF storms initiated by monomorphic VPB in seven patients with structural heart disease and left ventricular (LV)‐dysfunction (n = 4 with coronary artery disease (CAD), n = 2 with chronic and remote myocarditis, n = 1 after aortic valve replacement). Methods and Results: Pace‐mapping and activation mapping was used to identify optimal ablation targets. Earliest activation during mapping was found midseptal of LV in three patients, midinferoseptal of LV in two patients. One patient with myocarditis showed earliest activation at free wall of right ventricle, the other one basal midseptal of LV. Local ventricular electrograms at the successful ablation sites were preceded by short, high frequency, low amplitude potentials by 22–90 ms (median 35 ms). The same local potentials were seen in sinus rhythm. Cycle lengths of VT ranged between 200 and 360 ms (median 245 ms). A median of nine radiofrequency (RF)‐ablations (range 3–19) were necessary to abolish all local Purkinje potentials at the site of earliest activation. Two patients with CAD died due to refractory heart failure. The other five patients had no recurrence of PMVT and VF during follow up (median 10 months, range 1–27 months). Conclusion: The distal Purkinje network plays an important role in triggering PMVT/VF in patients with structural heart disease. Ablation of the triggering VPB originating from the Purkinje arborization is feasible; prevents recurrence in a long‐term follow up; and is potentially life saving in patients with severe LV‐dysfunction after myocardial infarction, in patients after aortic valve replacement, or in patients with myocarditis particularly when medical treatment, including antiarrhythmic drugs, failed to suppress electrical storms.     

Quality of life of patients with Duchenne muscular dystrophy: from adolescence to young men

Purpose: This study investigated quality of life (QOL) in adolescent and young men with Duchenne muscular dystrophy (DMD).

Methods: Health-related QOL and global QOL were assessed with the Short Form 36 (SF-36) and World Health Organization Quality of Life-BREF (WHOQOL-BREF). Associations between functional status and QOL were assessed.

Results: All domains of the SF-36 were below Taiwan norms (effect size: ?14.2 to ?0.5), especially Physical Function, Role Physical, and Social Function. Three of the four domains of the WHOQOL-BREF were below Taiwan norms (effect size: ?2.0 to ?0.7). The Physical Function of the SF-36 was moderately correlated with functional status (mobility, basic activities of daily living, and arm function). The Social Function of the SF-36 and Social Relationships of the WHOQOL-BREF were also moderately correlated with functional status (impairment, basic activities of daily living, and arm function).

Conclusion: The adolescent and young men with DMD had poor health-related and global QOL. Poor QOL was related to both physical condition and social health. We suggest that rehabilitation programs focus on using assistive devices to facilitate arm function and encouraging participation in social activities to improve the QOL of patients with DMD.

• Implications for rehabilitation

• Duchenne muscular dystrophy (DMD) is a progressive muscle weakness disease that not only impacts physical health but also leads to poor quality of life in many domains.

• A valuable rehabilitation goal for patients with DMD is to encourage participation in social activities. Medical care and educational programs should plan a formal transition processes for patients with DMD from pediatric to adult care to maximum their quality of life.

• Arm function is associated with many domains of global quality of life, so a key element in improving quality of life may be to improve arm function.

     

The Orpington Prognostic Scale for patients with stroke: Reliability and pilot predictive data for discharge destination and therapeutic services

Purpose.?To determine the inter-rater and test-retest reliability of the Orpington Prognostic Scale (OPS) in patients with stroke. Pilot data were gathered to evaluate its predictive validity for discharge destination and therapeutic services required on discharge.

Method.?Ninety-four consecutive patients, admitted to hospital due to stroke participated. Pairs of physiotherapists (PT) and occupational therapists (OT) assessed patients using the OPS on days 7 and 14 post stroke. For inter-rater reliability, one rater performed the OPS while the other observed, each scoring the scale independently. For test-retest reliability, two different raters tested the subjects separately within the same day. Data were gathered on the discharge destination and the number of follow-up services prescribed.

Results.?The inter-rater reliability as measured by the intraclass correlation coefficient (ICC) was 0.99 (95% CI 0.97 – 0.99). For test-retest reliability, the ICC was 0.95 (95% CI 0.90 – 0.98). The accuracy for predicting discharge to home using OPS ? 5.0 was 65% (95% CI 0.52 – 0.76). OPS scores were not related to number of follow-up services prescribed.

Conclusions.?Despite high inter-rater and test-retest reliability, the OPS has limited predictive accuracy for discharge destination and is a poor predictor of follow-up services.     

Eccentric calf muscle training in athletic patients with Achilles tendinopathy

Purpose. To evaluate the effects of eccentric strengthening exercises (ESE) in athletic patients with Achilles tendinopathy.

Methods. Forty-five athletic patients (29 men, average age 26 years ± 12.8, range 18 – 42; 16 women, average age 28 years ± 13.1, range 20 – 46; average height: 173 ± 16.8, range 158 – 191; average weight 70.8 kg ± 15.3, range 51.4 – 100.5) with a clinical diagnosis of unilateral tendinopathy of the main body of the Achilles tendon completed the VISA-A questionnaire at first attendance and at their subsequent visits. The patients underwent a graded progressive eccentric calf strengthening exercises programme for 12 weeks.

Results. The mean pre-management VISA-A scores of 36 (SD 23.8; 95% CI: 29 – 46) improved to 52 (SD 27.5; 95% CI: 41.3 – 59.8) at the latest follow up (p = 0.001). Twenty seven of the 45 patients responded to the eccentric exercises. Of the 18 patients who did not improve with eccentric exercises, 5 (mean age: 33 years) improved with two peritendinous aprotinin and local anaesthetic injections. 10 of the 18 patients (9 men, mean age 35 years; 1 woman aged 40 years) who did not improve with eccentric exercises and aprotinin injections proceeded to have surgery. The remaining three patients (3 women, mean age 59.6 years) of the 18 non-responders to eccentric exercises and aprotinin injections declined surgical intervention.

Conclusions. ESE in athletic patients provide comparable clinical outcome compared to our previous results in non-athletic patients. ESE are a viable option for the management of AT in athletes, but, in our hands, only around 60% of our athletic patients benefited from an intensive, heavy load eccentric heel drop exercise regimen alone. If ESE fail to improve the symptoms, aprotinin and local anaesthetic injections should be considered. Surgery is indicated in recalcitrant cases after 3 to 6 months of non operative management.     

An Outbreak of Food‐borne Illness Due to Methomyl Contamination

Abstract

Background.?On December 26, 2002, 124 dinners took ill while eating lunch at a seafood restaurant in the town of Chiching in Kaohsiung municipality of Taiwan. Sixty‐nine people were sent to the emergency departments of the Municipal Chiching Hospital and Yuan's General Hospital. Methods.?We analyzed the clinical symptoms, detailed food history, and ingested amount of each food from 59 hospitalized adult patients and identified the source of the outbreak. Results.?The median latency period from beginning eating to first symptoms was 5 min. Twenty‐six symptoms and signs were recorded. The most commonly reported clinical effects were general weakness (84%), ataxia (82%), dizziness (82%), vomiting (80%), sweating (75%), floating sensation (71%), headache (69%), dyspnea (69%), and blurred vision (67%). Thirty‐one patients had residual symptoms 7 days after ingestion. Of the six residual symptoms reported, the most frequent ones were dizziness (40%), poor appetite and dry mouth (11%), and gastrointestinal disturbance (11%). The presence of residual symptoms correlated with the severity of the initial complaints (p < 0.01). Almost all patients ate cooked rice (93%) and leaf vegetable stir‐fried with crab claw (93%). The amount of each food eaten by the patients was not associated with the severity of symptoms (p > 0.05). High levels of methomyl in leaf vegetables of “leaf vegetables stir‐fried with crab claws” (380 ppm) and fried mussels (1113 ppm) were found by the Food Inspection Center at the Department of Health. The food history and chemical analysis of the poison indicated methomyl was the cause of this outbreak. Twenty‐four patients recovered completely within 7 days. Conclusion.?Food‐related methomyl intoxication produced a rapid onset of significant clinical toxicity in 124 individuals. Based on the analysis of 55 adult patients, the most common effects were gait ataxia, dizziness, generalized weakness, and vomiting.     

Evaluating the population with intellectual disability unable to comply with routine dental treatment using the International Classification of Functioning,Disability and Health

Purpose.?The aim of this study was to investigate the use of general anaesthesia (GA) among patients with intellectual disability (ID) in relation to the International Classification of Functioning (ICF).

Method.?Twenty-seven ICF codes related to the tolerance of the dental treatment were chosen. The sample consisted of 100 children with ID divided into two groups (50 patients in whom routine dental treatment had been accomplished and 50 patients who had been treated under GA). Differences between the groups were analysed using the chi-square test, bivariate correlation and multiple logistic regression analysis.

Results.?The GA group showed higher levels with regard to the following codes: b117 – intellectual function, b2801 – pain in head and neck, d310 – communication, d530 – toileting, d540 – dressing, e310 – immediate family, e5400 – transportation services and e5850 – education and training services. The severity of ID significantly correlated with the ‘Activities and Participation’ codes. Three predictors of GA treatment were identified: ‘Pain in head and neck’ (p < 0.001), ‘Transportation services, systems and policies’ (p < 0.05) and ‘Education and training services, systems and policies’ (p < 0.05).

Conclusions.?The use of GA increases with the severity of ID. Acute and painful conditions result in more frequent use of GA. Unfavourable environmental factors present barrier to routine dental management.     

A comparison of swallowing dysfunction in Becker muscular dystrophy and Duchenne muscular dystrophy

Purpose: Swallowing dysfunction has been reported in Duchenne muscular dystrophy (DMD), but has not been studied in Becker muscular dystrophy (BMD). The aims of this study were to report the characteristics of swallowing dysfunction in BMD compared with DMD.

Materials and methods: The study participants were 18 patients with BMD and 18 patients with DMD. All the patients were examined using videofluorography during swallowing of 5?mL of fluid. The penetration–aspiration scale (P–A scale) and the videofluorographic dysphagia scale (VDS) were used to evaluate dysphagia.

Results: Swinyard functional ability stage was not significantly different between the BMD and DMD groups. Rate of aspiration, P–A scale score, and total VDS score did not differ across groups, but the VDS item score for laryngeal elevation was lower in the BMD group than in the DMD group (median scores 4.5 and 9, respectively; p?r?=?0.78, p?Conclusion: Patients with BMD have swallowing problems similar to those observed in patients with DMD when matched according to physical functional status. These patients should be evaluated and followed-up for the duration of their disease.

• Implications for rehabiliation

• Dysphagia is one of the most critical problems in patients with progressive neuromuscular disease but dysphagia in patients with Becker muscular dystrophy (BMD) was not well known.

• Eighteen patients with BMD and 18 patients with Duchenne muscular dystrophy were examined with videofluorography.

• Patients with BMD have swallowing problems similar to those observed in patients with DMD.

     

Survival in patients with hypertension treated in primary care A population-based follow-up study in the Skaraborg Hypertension and Diabetes Project

Objective – To explore risk factors for all-cause mortality in patients with hypertension.

Design – Community-based cohort study.

Setting – Hypertension outpatient clinic in primary health care.

Subjects – Hypertensive men and women who consecutively underwent an annual follow-up during 1992–1993 (n=894).

Methods – Vital status was ascertained up to December 1999 by record linkage with national registers. Gender-specific predictors for mortality from baseline examination were analysed by Cox regression.

Main outcome measure – All-cause mortality.

Results – In both sexes all-cause mortality was predicted by fasting blood glucose (RR by 1 mmol L^?1: 1.2, CI: 1.1–1.3 in men; 1.2, 1.1–1.4 in women), and known type 2 diabetes (RR: 1.9, CI: 1.3–2.9 in men; 2.5, 1.7–3.9 in women). In men, furthermore, mortality was predicted by previous cardiovascular disease, left ventricular hypertrophy and microalbuminuria, whilst in women mortality was predicted by high blood pressure and dyslipidemia. In patients without known diabetes male gender was a strong predictor of mortality (RR: 2.0, CI: 1.4–2.9), whereas in patients with hypertension and type 2 diabetes combined, male gender was not associated with increased mortality (RR: 1.4, CI: 0.9–2.2).

Conclusion – Type 2 diabetes in hypertensive patients treated in primary care predicts mortality and dilutes gender difference in survival. For hypertensive patients general practitioners should be observant regarding disturbed glucose metabolism and regarding the associated major risk increase in women.     

Depressive symptoms in the congenital long QT syndrome

Background. A proportion of patients with congenital long QT syndrome (LQTS) experience potentially life-threatening cardiac arrhythmias.

Aim. To examine whether depressive symptoms are related to arrhythmic events among symptomatic and asymptomatic LQTS patients, and syncope events among their relatives not carrying the family's LQTS-causing mutation.

Methods. The participants were 569 molecularly defined LQTS mutation carriers and 622 non-carrier relatives from the Finnish LQTS registry. Depressive symptoms were self-rated with a revised version of the Beck Depression Inventory.

Results. LQTS patients with arrhythmic events scored higher on depressive symptoms than those without (P=0.011) or the control group (P=0.005). In addition, in the binary logistic regression analysis including symptomatic and asymptomatic LQTS mutation carriers, depressive symptoms showed an age- and sex-adjusted association of odds ratio (OR) 1.40 (95% confidence interval (CI) 1.12–1.74) with symptomatic status of LQTS. In similar analysis including non-carriers of the LQTS mutation, there was no association between depressive symptoms and history of syncope events OR 1.23 (95% CI 0.99–1.53).

Conclusion. Our results from this relatively large genotyped LQTS patient cohort indicate that depressive symptoms are associated with arrhythmic events in LQTS patients. Whether depressive symptoms are causally related to arrhythmias in LQTS remains uncertain.     

Five-year observation of the relationship between body mass index and glycated hemoglobin in children with Type 1 diabetes mellitus

Abstract

Background: Poor metabolic control is a well-recognized risk factor for cardiovascular disease. However, the relationship between such factor as body weight and metabolic control in children with diabetes mellitus type 1 (DM1) is unclear. The aim of this study was to examine the relationships between body weight, age, metabolic control, sex, and form of insulin therapy in children with DM1.

Methods: This was a retrospective study of children with DM1 treated at one diabetes center for a minimum of 5?years since diagnosis.

Results: Median body mass index standard deviation score (BMI-SDS) increased annually (p?=?.0042) on average 0.08?±?0.27 per year throughout the observation. As well HbA1c and daily dose insulin increased annually (p?p?p?=?.01895). No correlation between BMI-SDS and metabolic control (HbA1c) was found (R?=?0.09, p?=?.60).

Conclusions: Body weight appears to be more affected by non-diabetic factors (e.g. irregular eating and sedentary lifestyle) than by the clinical course of diabetes. Metabolic control and body weight must be maintained in all children with DM1 (males and females) to reduce their future risk of cardiovascular disease.