Triad of markers for identifying children at high risk of developing insulin-dependent diabetes mellitus

A longitudinal investigation was conducted from 1977 to 1984 on 178 families in which one or more of the children had insulin-dependent diabetes mellitus. Of 351 nondiabetic sibs followed up for an average of 54 months, ten have, thus far, become diabetic. Eight sibs were HLA identical to their diabetic proband and nine had HLA-DR3 and/or HLA-DR4. Islet cell surface antibody and islet cell cytoplasmic antibody were found from two to 74 months before the onset of clinical diabetes in 100% and 90%, respectively, of the children. A decrease in insulin secretion was observed in all of these children on entry into the study and was detected in the absence of elevated plasma glucose concentrations. The data suggest that the triad of HLA identity, pancreatic islet cell antibodies, and depressed insulin secretion identifies those sibs who are at high risk of developing insulin-dependent diabetes mellitus.     

Blood Glutathione in Various Phases of Insulin-dependent Diabetes Mellitus in Children

Reduced glutathione (GSH) in whole blood was studied in 15 insulin-dependent juvenile diabetic patients at onset of diabetes (group A). In 5 of these patients the blood GSH concentration was followed during the first month after onset. The blood GSH content was also analyzed in 16 children with insulin-dependent diabetes mellitus (IDDM) with a duration of diabetes of more than 2 years (group B), and in a control group of 76 healthy children (group C). The GSH levels in groups A, B and C were 48.3 ± 5.7, 47.1 ± 4.6 and 47.6 ± 4.3 mg/100 ml erythrocytes, respectively. Thus, there were no significant differences between the patients and the control group. In group A, there were no significant differences in blood GSH values at onset and 1 month later.     

Height at diagnosis of insulin dependent diabetes in patients and their non-diabetic family members

Height at the onset of insulin dependent diabetes mellitus was evaluated in 200 newly diagnosed children, 187 non-diabetic siblings, and 169 parents. Diabetic children 5-9 years of age at diagnosis were consistently taller than the national average. Non-diabetic siblings of the same age were also tall. Diabetic children aged 14 or over at diagnosis were short, while their siblings and parents were of normal height. Diabetic children positive for islet cell antibodies were taller than those without islet cell antibodies. No association between height and HLA antigens was found. Non-diabetic siblings at high risk for the disease were closer in height to the diabetic children than were the lower risk, non-diabetic siblings. Siblings, particularly those under 10, were also significantly more obese than the general population. Deviations in growth in patients with insulin dependent diabetes mellitus appear to be related to age at diagnosis and a factor(s) not related to parental height.     

Diabetes in Western Australian children: descriptive epidemiology

The prevalence and incidence of diabetes mellitus in the age group zero to 14 years in Western Australia were determined from a survey by means of Schools Health Services. Additional information from the State's computer-linked hospital records system, the State's only children's hospital, diabetic clinics and physicians enabled virtually complete ascertainment of cases of childhood diabetes. Only 60% of school-age diabetic children were known to school nurses before the survey, but the nurses were able to identify two-thirds of the remainder during the survey. Among non-Aboriginal children, the prevalence of diabetes in the age group zero to 14 years was 0.59 per 1000 children and the incidence was 12.3 per 100,000 children per year. These rates are somewhat lower than those that have been reported from the United Kingdom and North America, and substantially lower than the rates that were reported from Scandinavia. All but one of the diabetic children who were identified required insulin and were assumed to be insulin-dependent. An excess of boys was found. None of 8715 Aboriginal or part-Aboriginal children had insulin-dependent diabetes mellitus, which indicates that this racial group has a low prevalence of this condition. In case--control studies, which used questionnaires for parents, no significant trends were found in relation to the history of immunizations or of specific viral illnesses except for a past history of varicella which was less frequent in diabetic children. A past history of established breast-feeding (of more than one week) was less frequent in diabetic children, as was the ingestion of vitamin C supplements before the onset of diabetes. Some evidence for a seasonality of onset was obtained. The diabetic children were absent from school for more days and had more admissions to hospital than did non-diabetic children. The majority of diabetic children were prescribed insulin twice a day or more often (84%); performed home blood-glucose monitoring (74%); and attended hospital diabetic clinics (91%).     

Monozygous twins with hypothyroidism and diabetes mellitus

Monozygous twins with diabetes mellitus and autoimmune hypothyroidism are described. The onset of the hypothyroidism was simultaneous, but one twin had had insulin-dependent diabetes mellitus for 9 years while the other twin developed insulin-independent diabetes concurrently with the hypothyroidism. Two other siblings had diabetes mellitus and one of them had a goitre, possibly lymphadenoid. The aetiology of autoimmune hypothyroidism is discussed, and evidence is presented which supports suggestions that diabetes mellitus may be an autoimmune disease.     

小儿新发1型糖尿病酮症酸中毒与小儿应激性高血糖的临床诊断与鉴别

目的 探讨小儿新发1型糖尿病酮症酸中毒与小儿应激性高血糖的临床诊断与鉴别方法.方法 选取2008年6月至2011年6月在我院接受治疗的35例1型糖尿病酮症酸中毒患儿为DKA组;选取同期在我院接受治疗的30例应激性高血糖患儿为SHG组,观察两组生化指标及鉴别情况,并与同期在我院正常体检的30例受检儿童生化指标进行比较分析.结果 DKA组和SHG组即时血糖(RBG)、空腹血糖(FBG)均较对照组有明显升高,组间比较差异有统计学意义(P均＜0.01);DKA组HbA1c水平显著高于SHG组和对照组,组间比较差异有统计学意义(P＜0.05),而SHG组HbAc水平与对照组相当,组间比较差异无统计学意义(P＞0.05);DKA患儿均需长期依赖胰岛素治疗才可控制血糖,而SHG组无需长期依赖胰岛素治疗.结论 应激性高血糖和糖尿病酮症酸中毒临床表现均为高血糖(BG)症状,HbA1c和是否长期依赖胰岛素治疗可作为鉴别SHG和DKA的良好指标,值得临床借鉴采用.     

儿童1型糖尿病32例临床分析

目的: 探讨儿童1型糖尿病(type1 diabetesmellitus,T1-DM)的临床特点,以提高对儿童1型糖尿病的诊治和管理水平。方法: 回顾分析32例1型糖尿病患儿的临床资料,并观察10例糖尿病酮症酸中毒(diabetes ketoaacdosis,DKA)患儿的诊治效果。结果: 10例儿童1型糖尿病首发症状为酮症酸中毒,4例以呼吸道感染、3例以呕吐、1例以腹痛为首发表现;小剂量胰岛素短时静脉滴注治疗DKA效果好。结论: 儿童1型糖尿病起病往往隐匿,临床表现不典型,以酮症酸中毒及呼吸、消化系统疾病为首发表现就诊者,易误诊误治;胰岛素治疗有效。     

Insulin pump treatment in insulin-dependent diabetes mellitus. Children, adolescents, and young adults

Twenty-four children, teenagers, and young adults (8 to 26 years old) with insulin-dependent diabetes mellitus were treated with continuous subcutaneous insulin infusion (CSII). Criteria for using CSII included persistent high glycohemoglobin (GHb) values and/or wide swings in blood glucose values despite arduous efforts to improve glycemia. Thirty percent discontinued CSII. Improvement was significant by three months for GHb and blood glucose values, but plateaued thereafter. Only three patients attained a normal GHb value. No predictors for degree of control were identified. Diabetic ketoacidosis did not occur more frequently with CSII. Electromechanical problems with the devices, patient errors, or local skin problems occurred in 50% of patients, although none produced ketoacidosis or severe hypoglycemia. Dietary noncompliance and decreased intensive home monitoring were contributory factors. Better ways to predict success or failure are needed if normalization or even near-normalization is a goal of CSII in younger patients with insulin-dependent diabetes mellitus followed up in a nonresearch setting.     

Lack of effect of glibenclamide on insulin requirements and diabetic control in persons with insulin-dependent diabetes

The addition of the sulphonylurea agent, glibenclamide, to the insulin therapy of six patients with insulin-dependent diabetes mellitus was studied in a double-blind cross-over trial. The subjects produced no measurable plasma C-peptide after stimulation with glucagon, weighed within 10% of their ideal body weight and required approximately 1 U/kg per day of insulin. After one month of close supervision while the patients were being managed with diet and insulin therapy alone, glibenclamide, three times a day, or a placebo, was added to the therapy for one month. After a further one-month control period, the alternate agent was administered for one month. No change in the insulin requirement or the glycosylated haemoglobin levels, or in the 24-hour profiles of the plasma glucose and free insulin levels in response to a standard diet, was observed at the end of each treatment period. This study suggests that any enhancement of insulin sensitivity by sulphonylurea treatment in persons with insulin-dependent diabetes mellitus is only minor and clinically-unimportant.     

Renal transplantation in patients with insulin-dependent diabetes mellitus.

Forty patients (including 37 juvenile diabetic patients) with insulin-dependent diabetes mellitus and end-stage renal failure received 42 renal allografts during the interval from June 1970 to December 1975. Of the 30 patients who are alive (between six and 72 months after transplantation; average, 29 months), 19 have been fully rehabilitated. Gangrene of peripheral extremities occurred in 30% of the survivors. The use of "pretreated" cadaveric kidneys in the diabetic patient may become an attractive alternative to grafts from living related donors. Renal transplantation with living related and pretreated cadaveric donor kidneys is the treatment of choice and is superior to dialysis in the insulin-dependent diabetic patient with end-stage renal disease.     

Type I (insulin dependent) diabetes: a disease of slow clinical onset?

Type I (insulin dependent) diabetes is usually believed to present acutely and it is assumed that metabolic decompensation is sudden. In a prospective family study, however, 10 of 13 subjects developing the disease showed progressive or intermittent development of hyperglycaemia over many months and the others had non-specific symptoms over a long period. All were first degree relatives of a child with type I diabetes; 10 were siblings (aged 5-24) and three were parents (aged 45-58). All possessed HLA-DR4 or DR3, or both, and all but two had been positive for islet cell antibodies for six to 86 months before diagnosis. Ten had non-specific symptoms for two to 14 months before the onset of thirst and polyuria; one remained asymptomatic even when insulin became necessary. Six subjects had an oral glucose tolerance test before clinical onset, of whom five were diabetic by World Health Organisation criteria four, four, six, seven, and 21 months before insulin was needed. Nine showed random blood glucose concentrations above the 97.5th centile (6.3 mmol/l) six to 34 months (median 12) before diagnosis. Two others had a glucose tolerance test result compatible with diabetes but had not reached the stage of needing insulin. Hyperglycaemia is often of insidious onset in type I diabetes, even in children and young adults. Diagnosis will inevitably be late if considered only when acute symptoms of thirst and polyuria develop.     

Somatostatin analogue, octreotide, reduces increased glomerular filtration rate and kidney size in insulin-dependent diabetes

To determine whether treatment with a somatostatin analogue can reduce kidney hyperfiltration and hypertrophy in insulin-dependent diabetes mellitus, we studied 11 patients with insulin-dependent diabetes mellitus and glomerular hyperfiltration. The patients were assigned randomly to receive continuous subcutaneous infusion of either octreotide, 300 micrograms/24 h (five patients) or placebo (six patients) for 12 weeks. At baseline, mean glomerular filtration rate and mean total kidney volume were not significantly different in the two groups. However, after 12 weeks of treatment, the mean glomerular filtration rate was significantly lower in the octreotide group (136 mL/min per 1.73 m2; range, 91 to 158 mL/min per 1.73 m2) than in the placebo group (157 mL/min per 1.73 m2; range, 138 to 184 mL/min per 1.73 m2). Furthermore, the mean total kidney volume was significantly lower after treatment in the octreotide group (379 mL/1.73 m2; range, 307 to 454 mL/1.73 m2) than in the placebo group (389 mL/1.73 m2; range, 347 to 465 mL/1.73 m2). Glycemic control did not change significantly in either group. We conclude that subcutaneous infusion of octreotide for 12 weeks reduces increased glomerular filtration rate and kidney size in patients with insulin-dependent diabetes mellitus despite the fact that glycemic control remains unchanged.     

Services and cost of hospitalization for children and adolescents with insulin-dependent diabetes mellitus in New South Wales

Data on services for Australian children and adolescents with diabetes are limited. The purpose of the present study was to examine the availability, utilization and some of the costs of services for persons of less than 20 years of age with insulin-dependent diabetes mellitus in New South Wales, and to make recommendations for future services. The numbers of prevalent and incident cases of insulin-dependent diabetes mellitus in the zero- to 19-years' age-group in each of the health regions of the State were estimated using data from the insulin-dependent diabetes mellitus register of the Southern Metropolitan Health Region. Information on the available services for young persons with diabetes was obtained from doctors and diabetes educators around the State, and on the utilization of services in the Southern Metropolitan Health Region from interviewing the families of persons whose names are listed in the diabetes register. An estimated range of the annual direct cost of hospital admissions for diabetes in the zero- to 19-years' age-group in New South Wales was calculated by use of the data collected from the diabetes register, the hospital separation data from the NSW Department of Health, the NSW Department of Health estimated bed-day cost and the estimated average cost of a bed day for diabetic patients at The Children's Hospital Camperdown. Services for children and adolescents with insulin-dependent diabetes mellitus in this State are most comprehensive in central Sydney. However, even these excellent services are not utilized fully by the children and their families. The annual cost of hospitalization for diabetes in the zero- to 19-years' age-group in New South Wales is estimated to be approximately +1.5 million. There needs to be an equally high standard of care for all diabetic children in the State; however, the utilization of services, as well as the services themselves, need to be improved and the cost-effectiveness of new services needs to be evaluated.     

糖尿病合并肺结核57例临床分析

目的探讨糖尿病合并肺结核的临床特点、诊断和治疗方法。方法将57例糖尿病合并肺结核患者作为观察组,并选择同期单纯肺结核患者57例作为对照组。结果观察组治疗2个月末痰菌阴转33例(76.74%),对照组治疗2个月末痰菌阴转28例(84.85%),两组相比差异有统计学意义(P<0.05)。治疗5个月末观察组痰菌阴转率为100%,对照组阴转率为100%(P>0.05),观察组治疗1年总有效48例(84.21%),空洞闭合率29.41%(10/34),对照组治疗1年总有效57例(100%),空洞闭合率为50.00%(5/10)(P>0.05)。结论糖尿病合并肺结核两者有相互不利影响,患者应积极控制血糖,早期行抗结核治疗,能有效改善预后并预防并发症的发生。     

ICA512 and insulin-dependent diabetes mellitus

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Is a random urinary albumin concentration a useful screening test in insulin-treated diabetic patients?

The debate continues on how to screen for microalbuminuria in clinical practice in patients with insulin-dependent diabetes mellitus. Our study assesses the value of a spot morning urine specimen obtained at a clinic visit. In 1984, as part of a randomised survey of our diabetes clinic, 43 of 249 patients with insulin treated diabetes mellitus, were found to have microalbuminuria (urinary albumin concentration 35-300 ug ml^p-1) on a spot morning urine sample. These subjects were compared with an age-matched control group from the 1984 cohort who did not have microalbuminuria. Eight years later, in the group with microalbuminuria, 10 had died compared to six in the control group (p=0.17) with 62.5% of all deaths being from cardiovascular disease. In the group with microalbuminuria, 10 of 27 still had incipient nephropathy while five had progressed to nephropathy. In the group without microalbuminuria only three of 33 patients had progressed to microalbuminuria while none had progressed to nephropathy. In conclusion a spot morning urine sample is a useful screening test to identify patients at risk of progression to nephropathy.     

Autoantibodies,human T lymphotropic virus type 1 and type 1 diabetes mellitus in Jamaicans

The clinical characteristics, autoantibody profiles and seroprevalence of human T lymphotropic virus Type 1 (HTLV-1) were assessed in 30 Jamaican patients with Type 1 diabetes mellitus. Two hundred and fifty-two blood donors and 108 patients with Graves' disease were included as controls for the HTLV-1 component of the study. The mean age of onset of diabetes mellitus was 20.5 +/- 9.2 years and the mean duration of diabetes mellitus was 10.5 +/- 6.1 years. The remarkable clinical data included an absence of other associated organ-specific autoimmune diseases, and clinical evidence and history of congenital rubella in one patient. Islet cell cytoplasmic antibodies (ICA) were absent but 17% (5/30) of the diabetic patients tested positive for glutamic acid decarboxylase (GAD) antibodies. No other organ-specific autoantibodies were detected but non-organ-specific autoantibodies were present in 9 (30%) of the sera of diabetic patients. The seroprevalence of HTLV-1 in the patients with diabetes mellitus was significantly higher than that in the healthy controls (17% (5/30) versus 4% (11/252), p = 0.05). Autoantibodies were found in the sera of 4/5 (80%) of the diabetic patients who were positive for HTLV-1. None of the patients with onset of diabetes mellitus below age 15 years was HTLV-1 positive. The likely polyaetiological nature of Type 1 diabetes mellitus in Jamaicans is being further investigated at the molecular level.     

自发性2型糖尿病小鼠发病早期认知功能的研究

目的通过对自发性2型糖尿病小鼠发病早期认知功能的研究,探讨糖尿病脑病的发病机制。方法利用自发性2型糖尿病动物模型KK-Ay小鼠,动态研究其认知功能的变化,并进行脑组织形态学观察。结果在Morris水迷宫实验中,糖尿病小鼠在发病6周时已出现轻度认知功能障碍,在发病12周时认知功能障碍明显加重,游出时间、游出距离显著长于正常对照鼠(P<0.01)。光镜和电镜都观察到糖尿病小鼠脑组织形态学的变化,以电镜下超微结构的变化为主。发病12周时海马及颞叶神经元固缩、深染,核膜凹陷,核内染色质溶解,核糖体解聚,线粒体退变,内容物呈絮状,未观察到毛细血管基底膜增厚,管腔狭窄等血管病变。结论KK-Ay小鼠可以作为研究糖尿病脑病的一种较好的动物模型;高血糖等代谢因素可引起认知障碍的发生。     

慢性胰腺炎患者并发糖尿病的发生率及影响因素分析

目的观察慢性胰腺炎(chronic pancreatitis,CP)患者伴发糖尿病的发生率,探讨影响其发生的相关因素。方法分析笔者医院慢性胰腺炎患者的临床资料,检测伴发糖尿病患者的胰岛功能,通过寿命表法计算首次疼痛后糖尿病的累计发生率,以COX比例风险模型分析可能导致胰腺炎患者发生糖尿病的危险因素。结果入组病例共342例,首发年龄37.9±16.7岁,随访时间43.2±29.7个月;总糖尿病发生率16.1%(55/342)。内镜介入或外科手术治疗前33例已确诊,治疗后新发22例;两种糖尿病患者胰岛功能比较差异无统计学意义(P>0.05);其中25.5%(14/55)糖尿病发生于腹痛1年内;首次腹痛后1、3、5、10年内的累积糖尿病发生率分别为4.7%、6.3%、8.9%、19.8%;COX风险比例模型回归分析显示,治疗前糖尿病组中吸烟量>200年支(年支定义为每天吸烟支数×吸烟年数)、轻度腹痛、体重减轻、胰腺钙化为风险因素,风险比(HR)分别为3.3、5.3、2.4、2.1;新发糖尿病组中,吸烟量>200年支、持续或新发体重减轻、胰腺尾部或胰体尾部切除等因素为风险因素。风险比分别为2.9、2.7、7.1。结论吸烟量>200年支、胰腺钙化、轻度腹痛、体重减轻以及胰腺尾部或胰体尾部切除是CP患者伴发糖尿病的危险因素,对有这些情况的患者应注意发生糖尿病的可能。     

Incidence and prevalence of insulin-dependent diabetes mellitus in the zero- to 19-years' age-group in Sydney

A population-based register of cases of insulin-dependent diabetes mellitus in the zero- to 19-years' age-group was established in the Southern Metropolitan Health Region of Sydney. The aims of the register were to provide accurate incidence and prevalence data for comparison with those of studies from elsewhere in the world and to evaluate diabetes services, morbidity and compliance with self-care regimens. This article presents the incidence and prevalence data. In the Southern Metropolitan Health Region, the annual incidence of insulin-dependent diabetes mellitus per 100,000 population who were aged zero to 19 years, rose from 10.3 cases in 1984 to 14.8 cases in 1987, and in the zero- to 14-years' age-group, it rose from 13.6 cases per 100,000 population in 1984 to 19.4 cases per 100,000 population in 1987; the increases were not statistically significant. The prevalence in the zero- to 19-years' age-group was 0.80 cases per 1000 population, and in the zero- to 14-years' age-group, it was 0.74 cases per 1000 population on February 1, 1986. Age-specific incidence rates were calculated for the years 1984-1987. Incidence peaks occurred at the ages of six years, 10 years and 12-13 years.