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De snelle technologische ontwikkelingen in de diabeteszorg zorgen voor betere uitkomsten, maar ook voor een toename van dataverkeer tussen patiënt en zorgverleners. De noodzaak voor die verbetering van uitkomsten wordt beschreven. De stappen die daartoe zijn gezet en die nog kunnen worden gezet, zijn aan de inzet van deze technologie verbonden. Daarbij moet en kan ook de diabeteszorg worden veranderd, waardoor er op nieuwe wijze continuïteit in contacten en coaching komt en traditionele zorg (3-4 x per jaar een consult) verandert naar nieuwe virtuele en automatische vormen. Daarvoor is een verandering nodig: in plaats van dat elk contact vanuit één patiënt of behandelaar wordt gestart, wordt op basis van de glucosedata populatiemanagement van diabetes verricht. Daarbij wordt op basis van zorggegevens een (continue) triage verricht en wordt direct persoonsgerichte zorg aangeboden aan mensen die problemen ervaren of risico hebben op problemen. De combinatie van diabetestechnologie en populatiemanagementmethoden wordt aan de hand van het ontwikkelde CloudCare-systeem toegelicht.

Introduction: Children with type 1 diabetes mellitus (T1DM) have to deal with a complex and demanding daily treatment regime which can have a negative impact on the quality of life (QoL) of these patients. The objective of the present study is to review studies that have compared generic quality of life of children and adolescents with T1DM with that of healthy peers. In addition, we will examine whether QoL differs between boys and girls, and across different developmental stages. Methods: A systematic literature search using PubMed was conducted for the years 2000 through May 2012. 17 studies were eligible for the current review. Effect sizes were computed to estimate the effects of having T1DM on QoL in children and adolescents. Results: Although individual studies reported small to moderate effect sizes on the distinct QoL-domains, the weighted effect sizes across all studies indicated no differences in QoL-domains between children and adolescents with T1DM and healthy controls. However, disease-specific problems were certainly present. Girls with T1DM reported lower generic and disease-specific QoL than boys with T1DM. Relationships between age and generic or disease-specific QoL remained unclear. Conclusions: Although children and adolescents with T1DM have to live with a demanding treatment regime, overall results revealed that their generic QoL is not impaired compared to healthy peers. However, disease-specific QoL problems, including a negative impact of diabetes on daily functioning, and diabetes-related worries were certainly present. Longitudinal research is needed in order to provide tailored care for children of all ages with T1DM.

Pancreatic agenesis is a rare condition, of which only a limited number of cases have been described. One recent paper reported a homozygous mutation in the pancreatic duodenal homeobox gene 1 (PDX-1) in a child with pancreatic agenesis. We report a 6-year-old boy with pancreatic agenesis, treated medically, without abnormalities in the PDX-1 gene coding sequence and with normal gastroduodenal endocrine cell distribution. Genes other than PDX-1 also appear to be involved in human pancreatic agenesis.

Type I diabetes mellitus results from the autoimmune destruction of insulin producing beta cells in the pancreas. Certain viral infections, especially those caused by coxsackie B viruses and related enteroviruses, have been associated with the development of type I diabetes. The sequence homology between the coxsackie B4 virus nonstructural protein 2C (CVB4 p2C) and the major diabetes autoantigen glutamic acid decarboxylase (GAD65) provides a basis for the hypothesis of molecular mimicry. In this study, we investigated the prevalence of antibodies directed against nonstructural enterovirus proteins. In addition, a correlation of antibodies against CVB4 p2C and GAD65was studied in diabetes patients and in healthy controls. Antibody reactivity against CVB proteins was detected by immunoprecipitation of [35S]‐methionine‐labelled viral proteins and GAD65antibodies were measured in a quantitative radio‐immunoassay. It was shown that antibodies raised against the nonstructural proteins of CVB4 are very common in the population and a high degree of heterotypic cross‐reactivity exists between different enterovirus types. CVB4 p2C‐specific antibodies were not only detectable in GAD65antibody‐positive diabetes patients but also in GAD65antibody‐negative healthy blood donors. Furthermore, GAD65antibodies could not be detected in p2C‐positive subjects who had various enterovirus infections, indicating that an antibody response to CVB4 p2C does not necessarily induce a cross‐reactive immune response against GAD65. A correlation was not found between antibodies against GAD65and p2C. J. Med. Virol. 59:256–261, 1999. © 1999 Wiley‐Liss, Inc.

The first large-scale (secondary) intervention trials have been initiated in first-degree family members of patients with insulin-dependent diabetes mellitus (IDDM). Within a few years, data from these studies may suggest that intervention is possible, thereby opening similar approaches in the general population. However, before large-scale intervention studies can be initiated, several problems need to be solved. One of these problems is the lack of knowledge on the natural course of β-cell autoimmunity. This review analyses this and other issues related to population-based prediction for IDDM. At present, no long-term follow-up studies are available in large-sized populations, but data show that prediction in the general population is both technically feasible and likely to have sufficient power to be useful in prevention trials. More data need to be generated, not only to determine which markers are most likely to give good prediction but also to obtain knowledge on the natural course, psychosocial impact and cost-effectiveness of screening.

Research has shown that taking care of a child with type 1 diabetes (T1DM) can be stressful for parents and could have a negative effect on the parent-child interaction. It is currently unclear whether this leads to suboptimal HbA1c levels and decreased quality of life (QoL).

Maturity-onset diabetes of the young (MODY) and type 2 diabetes are often misdiagnosed in children and adolescents.

In young children (0-7 years) with diabetes mellitus type 1 (T1DM), parents have full responsibility for the diabetesmanagement of their child. The tasks needed to achieve optimal blood glucose control may interfere with normal behavioral processes in childhood, which could negatively affect the parent-child interaction. Currently, there is no diabetes-specific observational rating scale to assess parent-child interaction. Therefore, the aim of this study was to develop and test an observational rating scale to assess the quality of diabetes-specific parent-child interactions.