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Robust evidence exists regarding initiation, intensification or modification of treatments. Recommendations to de-escalate therapy are lacking, specifically in diabetes. A successful treatment de-intensification reduces overtreatment, polypharmacy, and risk of adverse effects. To encompass current recommendations for deprescribing common drugs and create a consensus among health professionals. We reviewed four databases for deprescribing approaches published between 2010 and 2022. Articles were divided into different groups of drugs (for uric-acid, hypoglycemic, lipid-lowering, and psychotropic drugs). Hypoglycemic agents: strategies were limited to newer agents and insulin regimens for elderly individuals. Reducing insulin was associated with 1.1% reduction of A1c over time. SGLT2i and GLP-1RAs dose reduction depends on adverse events. Lipid-lowering agents : studies show that patients with very low cholesterol have fewer cardiovascular events without associated increased risk. Antihypertensive agents : Younger patients, lower systolic blood pressure, and few comorbidities are ideal characteristics for discontinuation. Uric acid therapy: we found no recommendation for dose de-escalation. Poor treatment adherence is associated with episodes of gout and deforming arthritis in the long term. Deprescribing hypoglycemic, statins, antihypertensives, and urate-lowering agents may be feasible in selected patients, but periodic surveillance is important. More evidence is necessary to support this decision entirely. [ABSTRACT FROM AUTHOR]

Introduction: Changes in lifestyle can significantly affect the management of good glycemic control and target values of blood pressure and lipids. Objective: To determine the achievement of target values of glycated hemoglobin (HbA1c), blood pressure and lipids, in participants with type 2 diabetes, who used a proper diet and controlled physical activity. Method: The study was a prospective study, conducted on participants with type 2 diabetes, from 01 October 2012 until 31 October 2013, at the Primary Health Center Banja Luka, by 60 family medicine teams. At the beginning of the study, all participants had individual counseling on lifestyle changes, eating habits, and regulation of body weight. Results: The study included 591 participants with the type 2 diabetes. At the beginning of the study, 49.92% of participants adhered to the proper diet, and at the end 76.65% of them (p

Background: Although compliance with all self-care behaviors is necessary for successful management of diabetes, patients with diabetes often refuse favorable self-care. This article is aimed to test the effects of a theory-related intervention to conduce self-aid adherence and metabolic curb in patients having type-2 diabetes. Methods: In this randomized controlled trial, 80 patients suffering from type-2 diabetes were arbitrarily allotted to intervention and control group. The intervention group attended six sessions in a batch and one-on-one consultation and received an education on self-efficacy and outcome expectations on improving the strategies. Self-efficacy, outcome expectations, self-care behaviors and HbA1c were measured and compared in two groups in the starting, after three and six-months of the interventions. “Intention to treat” analysis was used. Data were analyzed using t test and ANOVA for repeated measures. Results: Mean score of self-efficacy, outcome expectations and self-care behaviors revealed significant differences between two groups in the results of three and six months after the intervention (P < 0.01). A major fall in HbA1c was noted in the intervention group. The mean scores of the HbA1c showed a significant difference between two groups, six months after the intervention (P < 0.05). After the intervention diet, physical activity and foot care improved significantly in the intervention group (P < 0.001). No significant improvement occurred in self-monitoring of blood glucose and medication adherence between two groups after the intervention Conclusion: It is concluded that implementing educational interventions based on the self-efficacy model and related strategies can be effective for patients with type-2 diabetes and is recommended to be used for patient education in the field of metabolic control.

Maple Syrup Urine disease (MSUD) is caused by the deficiency of the branched chain 2-ketoacid dehydrogenase complex. Type I diabetes mellitus (TIDM) is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. A case with both MSUD and TIDM has not been reported previously. In this study, we presented a patient with both MSUD and TIDM, dietary management and the follow up period. Dietary management could be difficult in the presence of two disorders affecting more than one macronutrient component such as both carbohydrate and protein. Our patient had good metabolic control in the follow-up period. Treatment was successful with intensive insulin, frequent feeding and a leucine restricted diet.

Abstract Aims Intensification of type 2 diabetes (T2DM) treatment with GLP‐1 receptor agonists (GLP‐1RAs) promotes weight loss. We aimed to determine the synergistic effect of behavioural programmes on body weight on top of GLP‐1RA treatment. Materials and methods We retrospectively analysed the time course of 328 individuals with T2DM starting GLP‐1RA treatment because of insufficient metabolic control. In 29, a structured programme of elementary nutritional counselling was also implemented (elementary nutritional education [ENE]‐5 group sessions), whereas 53 entered a programme of cognitive‐behavioural treatment (CBT‐12 group sessions). Both programmes were completed within 6 months of switching to GLP‐1RAs. Data of body weight and metabolic control were followed up to 2 years as part of regular follow‐up. Weight loss targets (≥10% and ≥5%) and metabolic target (HbA1c

Background: Maternal phenylketonuria (mPKU) is a pathologic condition occurring in the fetus of a mother with PKU that is caused by prolonged elevated intrauterine blood phenylalanine (Phe) levels, which can lead to congenital abnormalities and mental retardation of newborns. Management of PKU during pregnancy can be challenging as protein substitutes may exacerbate nausea, vomiting, and gastrointestinal symptoms. Aim: To report the successful management of four PKU pregnant women. Methods: The patients were administered with prolonged-release amino acid supplementation and were recommended to follow a strict diet. Blood Phe concentration, adherence to diet, and occurrence of adverse events were monitored. Results: All patients achieved safe levels of blood Phe concentration (120-360 µmol/L) since preconception and during pregnancy (mean Phe concentration values of 143.34 ± 137.59, 226.48 ± 194.57, 186.68 ± 133.67, and 187.47 ± 42.59 µmol/L). During the first trimester of pregnancy, all patients manifested gastrointestinal symptoms such as nausea, gastrointestinal reflux, and abdominal bloating, which were managed by either changing protein substitute or extending the time window between different meals and amino acid mixtures administration. The four women continued their pregnancies without experiencing further complications and delivered neonates with normal growth parameters and no malformations. Conclusion: Findings of this case series suggest that the intake of a prolonged-release amino acid mixture in granules is well tolerated by pregnant PKU patients, eventually leading to good metabolic control and fetal growth within normal ranges., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Phenylketonuria (PKU) is an autosomal recessive metabolic disorder characterized by increased phenylalanine (Phe) concentrations in the blood and brain. Despite wide agreement on treatment during childhood, recommendations for adults are still controversial., Objective: To assess the impact of a 4-week increase in Phe intake (simulating normal dietary Phe consumption) on cognition, mood, and depression in early-treated adults with PKU in a double-blind, randomized controlled trial (RCT)., Methods: In a single-site crossover trial, 30 adult patients with classical PKU diagnosed at birth were recruited. All patients underwent a 4-week period of oral Phe administration (1500-3000 mg Phe/d) and a 4-week placebo period in a randomly assigned order with age, sex, and place of usual medical care as stratification factors. Analyses were based on the intention-to-treat (ITT) and per protocol (PP) approach to claim noninferiority (noninferiority margin -4%), with working memory accuracy as the primary endpoint and additional cognitive domains, mood, and depression as secondary endpoints., Results: For the primary endpoint, a 4-week increase of Phe intake was noninferior to placebo with respect to working memory accuracy in both the ITT [point estimate 0.49; lower limit 95% confidence interval (CI): -1.99] and the PP analysis (point estimate -1.22; lower limit 95% CI: -2.60). Secondary outcomes (working memory reaction time, manual dexterity, mood, and depression) did not significantly differ between the Phe and placebo period, except for sustained attention (point estimate 31.0; lower limit 95% CI: 9.0). Adverse events were more frequent during the Phe than during the placebo period (95% CI: 1.03, 2.28, P = 0.037)., Conclusions: In early-treated adult patients with PKU, a 4-week high Phe intake was noninferior to continuing Phe restriction regarding working memory accuracy, and secondary outcomes did not differ except for sustained attention. Longer-term RCTs are required to determine whether low Phe levels need to be maintained throughout different periods of adulthood. This trial was registered at the clinicaltrials.gov as NCT03788343., Competing Interests: Conflict of interest The authors report no conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

• Dried blood spot home monitoring is associated with increased biochemical control. • Monitoring frequency is positively correlated with biochemical control. • Younger patients' BCAA levels are more sensitive to increased monitoring. • Number of hospitalizations decreases throughout the life of the patient. Branched-chain amino acid (BCAA) concentrations must be tracked and maintained within an optimal range to minimize disease phenotypes in patients with maple syrup urine disease (MSUD). In 2014, the Hospital for Sick Children (SickKids) implemented a dried blood spot (DBS) home monitoring system, allowing patients to track BCAA concentrations without the inconvenience of having to travel to the hospital. We conducted a retrospective chart review study (n = 15) to assess the impacts of DBS monitoring implementation on biochemical control. Furthermore, we explored relationships among various MSUD patient parameters, including monitoring frequency, age, biochemical control, and hospitalizations. There was a 35% increase in the proportion of LEU concentrations that met recommended targets post-DBS monitoring implementation. Monitoring frequency was positively associated with better biochemical control in the newborn period (r = 0.68, p = 0.046). Frequency of hospital visits decreased steadily throughout life. DBS monitoring has resulted in a sharp increase in monitoring frequency, which is further correlated with biochemical control. Younger patients are more likely to visit the hospital and respond better to increased monitoring efforts. We recommend that DBS monitoring be adopted by other centers more broadly to improve metabolic control in MSUD patients. [ABSTRACT FROM AUTHOR]

This cross-sectional, convenience sampling study examined the relationship between diabetes-related factors, family functioning, and health-related quality of life (HRQOL) in 100 Turkish adolescents with type 1 diabetes mellitus (T1DM). The mean adolescent age was 14.65 ± 1.13 years. Quality of life was assessed using the Kiddo-KINDL generic HRQOL scale. Family functioning was assessed using the McMaster Family Assessment Device. The findings revealed that the participants had moderately high HRQOL. In terms of family functioning, general family functions subscale appeared healthy whereas affective involvement subscale appeared unhealthy. Results revealed that HbA1c was significantly negatively correlated with HRQOL. The full model of the socio-demographic, diabetes-related variables and general family functions to predict the total quality of life in children with T1DM was statistically significant. The overall multivariate model accounted for 58% of the variance of the total HRQOL. Regression analyses revealed that the levels of HbA1c and family functioning were significantly negatively related with HRQOL. The relationships between family functioning and HRQOL in adolescents with T1DM were unclear in Turkish sample. This research addressed this gap of knowledge, and provided a greater insight for practitioners working with adolescents with T1DM. [ABSTRACT FROM AUTHOR]

Metabolons are dynamic associations of enzymes catalyzing consecutive reactions within a given pathway. Association results in enzyme stabilization and increased metabolic efficiency. Metabolons may use cytoskeletal elements, membranes and membrane proteins as scaffolds. The effects of glucose withdrawal on a putative glycolytic metabolon/F-actin system were evaluated in three Saccharomyces cerevisiae strains: a WT and two different obligate fermentative (OxPhos-deficient) strains, which obtained most ATP from glycolysis. Carbon source withdrawal led to inhibition of fermentation, decrease in ATP concentration and dissociation of glycolytic enzymes from F-actin. Depending on the strain, inactivation/reactivation transitions of fermentation took place in seconds. In addition, when ATP was very low, green fluorescent protein-labeled F-actin reorganized from highly dynamic patches to large, non-motile actin bodies containing proteins and enzymes. Glucose addition restored fermentation and cytoskeleton dynamics, suggesting that in addition to ATP concentration, at least in one of the tested strains, metabolon assembly/disassembly is a factor in the control of the rate of fermentation. Image 1 [ABSTRACT FROM AUTHOR]

Objectives: To study celiac‐specific antibody status over 3 years in patients with type 1 diabetes and biopsy‐proven celiac disease (T1D + CD). Furthermore, to determine clinical differences after diagnosis between patients reaching constant antibody‐negativity (Ab‐neg) and staying antibody‐positive (Ab‐pos). Methods: A total of 608 pediatric T1D + CD patients from the multicenter DPV registry were studied longitudinally regarding their CD specific antibody‐status. Differences between Ab‐neg (n = 218) and Ab‐pos (n = 158) patients 3 years after biopsy were assessed and compared with 26 833 T1D patients without CD by linear and logistic regression adjusted for age, gender, diabetes duration and migration background. Results: Thirty‐six percent of T1D + CD patients reached and sustained antibody‐negativity 3 years after CD diagnosis. The median time until patients returned to Ab‐neg was 0.86 (0.51;1.16) years. Three years after diagnosis, HbA1c was lowest in Ab‐neg and highest in Ab‐pos patients compared to T1D‐only patients (adjusted mean (95%CI): 7.72 (7.51‐7.92) % vs 8.44 (8.20‐8.68) % vs 8.19 (8.17‐8.21) %, adjusted P < 0.001, respectively). Total cholesterol, LDL‐cholesterol and frequency of dyslipidemia were significantly lower in Ab‐neg compared to T1D‐only patients (167 (161‐173) mg/dl vs 179 (178‐179) mg/dl, P < .001; 90 (84‐96) mg/dl vs 99 (98‐99) mg/dl, P =.005; 15.7 (10.5‐22.9) % vs 25.9 (25.2‐26.6) %, P =.017). In longitudinal analyses over 6 years after diagnosis, a constantly higher HbA1c (P < .001) and a lower height‐SDS (P =.044) was observed in Ab‐pos compared to Ab‐neg patients. Conclusion: Only one third of T1D + CD patients reached constant Ab‐negativity after CD diagnosis. Achieving Ab‐negativity after diagnosis seems to be associated with better metabolic control and growth, supposedly due to a higher adherence to therapy in general. [ABSTRACT FROM AUTHOR]

Objective: Adequate glycemic control in children with type 1 diabetes reduces the risk of future complications. Identifying factors affecting haemoglobin A1c (HbA1c) is crucial to management of metabolic control. We aimed to identify possible socioeconomic predictors of poor metabolic control this patient group in Jordan, a developing country with limited resources. Methods: Medical charts of children with type 1 diabetes attending the pediatric endocrine clinics in two major diabetes centers were reviewed. HbA1c ≥7.5% (58 mmol/mol) was considered to reflect poor metabolic control. Logistic regression analysis was performed to identify predictors of poor glycemic control. The association between socioeconomic characteristics and metabolic control was evaluated using multiple correspondence analysis (MCA). Results: Two hundred and fifty-nine children were enrolled in the study. One fifth of the patients (20.5%) achieved HbA1c <7.5%. Patients with dietary non-compliance [odds ratio (OR): 3.533, confidence interval (CI): 1.803 - 6.926; p<0.001], and those who were overweight (OR: 3.869, CI: 1.218 - 12.294; p=0.022) were more likely to have poor metabolic control. Children whose mothers had a bachelor's degree or higher were less likely to have poor metabolic control compared to children whose mothers had only elementary education (OR: 0.241, CI: 0.079 - 0.734; p=0.012). MCA revealed an association between low socioeconomic status and poor metabolic control. Children with deceased mothers had significantly higher HbA1c of 10.6±1.86% compared to an average of 8.7±1.45% for the rest of participants (p=0.005). Conclusion: Low socioeconomic status, lower levels of maternal education and maternal death were associated with poor metabolic control. Identifying children with these risk factors might play an important role in optimizing metabolic control and provide better diabetes care. [ABSTRACT FROM AUTHOR]

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ankara Medical Journal is the property of Yildirim Beyazit Üniversity and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Effective education is considered essential for people with type 1 diabetes mellitus (T1DM) to adhere to a complex and long‐term medical regimen and to delay or prevent the onset of diabetes‐related complications. Objective: We compared the effect of a compact, cost‐effective, education program (CEPT1) vs a long‐term program on the metabolic control of children and adolescents with T1DM. Methods: Young people aged 8 to 21 years with T1DM were randomized to a short‐term (experimental) or an extensive education program (control). The experimental group participated in three sessions of 90 minutes, with one session per week, containing five short videos. The control group attended an extended program delivered through 45‐minute PowerPoint lectures, with one class every 3 months. The primary outcome was change in glycated hemoglobin A1c (HbA1c) levels from baseline to endpoint (baseline, 3, 6, 9, and 12 months). Results: In total, 62 patients were randomized to the experimental (CEPT1) (n = 32) or control (n = 30) groups. Both groups showed comparable improvement in HbA1c levels at the end of 12 months (P = .183). In a per‐protocol analysis, the mean HbA1c level reduction was −2.3% (−2.6, −2.0) in the experimental group and − 1.8% (−2.0, −1.5) in the control group (P = .008). Conclusion: CEPT1 was comparable with an extensive education program in reducing HbA1c levels. In a per‐protocol analysis, the CEPT1 was more effective than the control program in reducing HbA1c levels. CEPT1 is a simple and cost‐effective tool that can equally be used in settings with limited resources and specialized centers. [ABSTRACT FROM AUTHOR]

Determine the correlation of quality of life (QoL) and the impact on the metabolic control of patients with type 2 diabetes mellitus (T2DM). An observational study was conducted at the outpatient consulting service in a specialized hospital in Santo Domingo, DR. We used a non-probabilistic, convenience sampling strategy, and the World Health Organization Quality of Life (WHOQOL-BREF) short form questionnaire was applied. The patients presented lower impact in QoL domains was: pain ( x ¯ = 29.07, SD = 3.04) and negative feelings ( x ¯ = 28.70, SD = 3.33). We found there is a negative correlation between the psychological domains and the fasting glycemia (r ho = −0.192, p < 0.05), also between the summary of all domains of QoL and metabolic control, HbA1C (r ho = −0.205, p < 0.05), and fasting glycaemia (r ho = −0.214, p < 0.05). There was a significant difference in the physical domains F (1, 131) = 9.73, p = 0.002, η2 = 0.069, indicating that men (M = 14.81) have a higher physical QoL than women (M = 13.72). Given the evidence of the impact of metabolic control and the different domains to QoL, it is necessary to consider these aspects in the treatment plan of patients with diabetes, to ensure adequate management and control of future complications. [ABSTRACT FROM AUTHOR]

Objective The aim of this observational study was to analyse snacking pattern and satisfaction with snacking, and to associate snacking patterns with metabolic control and quality of life in people with diabetes type 1 and 2 on insulin therapy. Methods In 2017, 390 people with diabetes were interviewed in a university outpatient department: 132 diabetes type 1 (56.1y, diabetes duration 24.2y, HbA1c 7.0%), 89 diabetes type 2/biphasic insulin (72.8y, diabetes duration 22.0y, HbA1c 7.1%) and 169 diabetes type 2/prandial insulin (66.7y, diabetes duration 20.5y, HbA1c 7.0%). Standardised questionnaires were used to assess eating patterns, satisfaction with snacking, treatment satisfaction and quality of life. Results The far majority snacked regardless of diabetes type and type of insulin therapy (70.5% type 1, 80.9% type 2/biphasic insulin, 74.6% type 2/prandial insulin) and liked to do so or did not mind (type 1 diabetes 79.5%, type 2 diabetes/biphasic insulin 84.8%, type 2 diabetes/prandial insulin 83.5%). Snacking because of recommendations of healthcare professionals was rare (10.8% type 1 diabetes, 8.2% type 2 diabetes/biphasic insulin, 9.4% type 2 diabetes/prandial insulin). Snacking and not snacking participants did not differ in respect to HbA1c, quality of life or treatment satisfaction. Conclusions Snacking seems to be a common habit in individuals with diabetes and most of them like to snack. Snacking is not associated with better or worse metabolic control or quality of life. The decision to snack or not to snack can be left to the individual and integrated into the therapy without danger for the glycaemic control. [ABSTRACT FROM AUTHOR]

Aim: This paper presents an implementation study following previous research including a randomised controlled trial (RCT) of hospital-based home care (HBHC), referring to specialist care in a home-based setting. The aim was to evaluate whether the effects sustained when rolled out into wider practice.Methods: In 2013-2014, 42 children newly diagnosed type 1 diabetes were included in the study at a university hospital in Sweden and followed for two years. Measurements of child safety, effects of services, resource use and service quality were included. Descriptive statistics were used to present the results and then discussed in relation to the same intervention of HBHC previously evaluated in an RCT.Results: Shorter in-hospital stay was partially implemented but increased support after discharge by the diabetes nurse was not. The results indicated that the implemented HBHC was equally effective in terms of child outcomes two years from diagnosis but less effective in terms of parents' outcome. The results furthermore indicated that the quality of services decreased.Conclusion: The suggested overall conclusion was that the implemented HBHC services were safe but had become less effective, at least in relation to the HBHC provided under controlled circumstances. [ABSTRACT FROM AUTHOR]

The results of two large multicentric, observational and cross-sectional studies (the DIAINFORM study and BALI study) reflecting routine clinical practice for insulin treatment in type 2 diabetes mellitus in the Czech Republic were published recently. In this commentary, we analyze these results and compare them with the findings of similar studies conducted in other countries within the last decade. The analysis focuses on achievement of glycated hemoglobin goals, insulin dosage and frequency of hypoglycemia. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a common chronic disease that requires a long‐term regimen. However, the management of diabetes by telenursing is limited and inconclusive. Objectives: To determine the effectiveness of telenursing on control in diabetes. We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs). Methods: We searched electronic databases, including PubMed, Embase, Web of Science and Cochrane Library. Studies comparing telenursing with usual care in diabetes patients were included. Results: A total of 17 randomized controlled trials were identified. Glycated hemoglobin (HbA1c) dates were pooled using a random effects meta‐analysis method, followed by subgroup analyses to examine heterogeneity. The meta‐analysis showed that the use of telenursing (vs. usual care) was associated with a significant reduction in HbA1c levels compared to usual care, with a pooled 0.68% (95% CI: 0.33–1.03, p = 0.0001; I2 = 95%). For the secondary outcome, the SMD of body mass index (BMI) was −0.25% (95% CI: −0.81 to 0.32%, p = 0.39), with no statistically significant change; the fasting blood sugar (FBS) SMD was −0.19% (95% CI: 0.20 to 1.01, p = 0.003), with a statistically significant change; the total cholesterol (TC) SMD was −0.09% (95% CI: −0.03 to 0.21, p = 0.12), with no statistically significant change. Conclusions: Telenursing, as a useful tool for patient education and behavioral interventions, can help diabetes patients to improve their glycemic control. However, more studies on up‐to‐date and cost‐effective technologies are needed. [ABSTRACT FROM AUTHOR]

Skeletal muscle satellite cells (SMSCs), the major stem cells responsible for the regeneration of skeletal muscle, are normally cell cycle arrested but differentiate to generate myocytes upon muscle damage, forming new myofibers along with self-renewing stem cells in preparation for subsequent injury. In this study, we investigated which factors stimulate the proliferation and differentiation of SMSCs and found that pyruvate, the end product of glycolysis, stimulates their differentiation. Pyruvate antagonizes the effects of hypoxia on preferential self-renewal of SMSCs through dephosphorylation or activation of pyruvate dehydrogenase (PDH), which mediates opening of the gateway from glycolysis to the tricarboxylic acid (TCA) cycle by producing acetyl coenzyme A from pyruvate. PDH kinase 1, highly expressed under hypoxia, is down-regulated under normoxic conditions, leading to an increase in dephosphorylated PDH. Conditional deletion of PDH in SMSCs affects cell divisions generating myocytes and subsequent myotube formation, inefficient skeletal muscle regeneration upon injury, and aggravated pathogenesis of a dystrophin-deficient mouse model of Duchenne muscular dystrophy. Thus, the flow from glycolysis to the TCA cycle mediated by PDH plays a pivotal role in the differentiation of SMSCs, which is critical for the progression of skeletal muscle regeneration.--Hori, S., Hiramuki, Y., Nishimura, D., Sato, F., Sehara-Fujisawa, A. PDH-mediated metabolic flow is critical for skeletal muscle stem cell differentiation and myotube formation during regeneration in mice. [ABSTRACT FROM AUTHOR]

Objective: To identify the epidemiological characteristics in patients of the diabetes club of the Hospital Básico de Paute, Ecuador. Materials and methods: This was a descriptive and crosssectional study in patients with diabetes mellitus type 2 of the Hospital Básico de Paute diabetes club, during the period January to August 2018, a questionnaire validated by 2 experts in diabetes mellitus was used, the following data was recorded: age, sex, ethnicity, educational status, occupation, used drugs and anthropometric data. Results: Out of the 80 patients evaluated, 73.8% (n=59) were female, with a predominance of subjects >70 years (41.3%, n=33), with only primary education (62.5%; n=50), and housewives (67.5%; n=54), the majority were obese (56.3%; n=45) with a predominance of weight disorders in women (overweight: 35.6% and obesity: 32.5%). 50% of the patients received combined pharmacological therapy, being metformin the most used antidiabetic drug (92.5%), followed by sulfonylureas (35%); while ACE inhibitors were the most antihypertensive used with 33.8%. Conclusion: Patients from the Hospital Básico de Paute diabetes club are predominantly women, older adults, with a low educational level and whose prevalence of obesity and overweight is very high; most of them receive antidiabetic pharmacotherapy, with metformin as the main drug used. [ABSTRACT FROM AUTHOR]

Insulin signaling in the brain plays a critical role in metabolic control and cognitive function. Targeting insulinergic pathways in the central nervous system via peripheral insulin administration is feasible, but associated with systemic effects that necessitate tight supervision or countermeasures. The intranasal route of insulin administration, which largely bypasses the circulation and thereby greatly reduces these obstacles, has now been repeatedly tested in proof-of-concept studies in humans as well as animals. It is routinely used in experimental settings to investigate the impact on eating behavior, peripheral metabolism, memory function and brain activation of acute or long-term enhancements in central nervous system insulin signaling. Epidemiological and experimental evidence linking deteriorations in metabolic control such as diabetes with neurodegenerative diseases imply pathophysiological relevance of dysfunctional brain insulin signaling or brain insulin resistance, and suggest that targeting insulin in the brain holds some promise as a therapy or adjunct therapy. This short narrative review gives an overview over recent findings on brain insulin signaling as derived from human studies deploying intranasal insulin, and evaluates the potential of therapeutic interventions that target brain insulin resistance. [ABSTRACT FROM AUTHOR]

Since they lack insulin-producing β -cells, patients with type 1 diabetes mellitus (T1DM) need to supply their body with insulin from external sources to manage their blood glucose (BG) concentration and mitigate the long-term effects of chronically increased BG levels. The common way of dosing insulin in T1DM is basal bolus therapy. In this method, patients continuously supply their body with a small amount of insulin that is meant for keeping their BG level more or less constant in case no large disturbances occur. Bolus insulin (which makes up roughly 30–60% of the total insulin amount) on the other hand is used to counterbalance such disturbances. The biggest perturbation of BG is caused by meals that can lead to large postprandial glucose excursions. By far, the most common approach to determine bolus insulin requirements in T1DM is known as Advanced Carbohydrate Counting (ACC). In ACC the bolus insulin amount is determined proportional to the estimated carbohydrate content of the ingested meal. Even though this semi-heuristic approach has proven very valuable in daily practice, its use is not without pitfalls. In this paper we discuss the background, implicit assumptions and limitations of ACC from an engineering perspective and show how concepts from the fields of data-based modeling and control have been successfully used to facilitate the computation of bolus insulin requirements. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Metabolic control is a collection of tests and studies related to diabetes performed on a daily basis for 2 to 3 months. Self-efficacy means the belief of an individual in him/herself to successfully perform a particular behavior and expect the associated results. The present study aimed to investigate the relationship between metabolic control and selfefficacy in diabetic patients in Qom, Iran. Materials and Methods: This cross-sectional study was conducted on a total 325 patients with type II diabetes who referred to Diabetic Community in Qom through simple random sampling. Demographic information and standard self-efficacy in diabetic management questionnaires were used in this study. Fasting blood sugar (FBS) and hemoglobin A1c (HbA1c) data sheet was used based on the last 3-month test results. Finally, the data were analyzed by SPSS software (version 20) using descriptive indices and analytical tests. Results: The obtained results of this study showed that there was a significant reverse correlation between the mean score of self-efficacy with the mean scores of FBS and HbA1c. There was also a significant difference in self-efficacy scores in terms of gender (P<0.05). According to the results, self-efficacy showed predictive power of FBS and HbA1C reported as 22% and 18%, respectively. Conclusion: The obtained results of this study showed that self-efficacy was at a moderate level among the patients. The levels of FBS and HbA1c did not indicate the optimal control of diabetes. It should be noted that there was a significant reverse correlation between self-efficacy with FBS and HbA1c, indicating that FBS and HbA1c levels decrease with the increase of self-efficacy score. [ABSTRACT FROM AUTHOR]

To compare growth and glycemic control in children with type 1 diabetes and silent celiac disease treated with a gluten-free diet for 1 year with those of similar age and gender with type 1 diabetes but without celiac disease, 16 type 1 diabetes patients with silent celiac disease were enrolled and each celiac disease-positive case was matched for age, sex, and duration of diabetes with two type 1 diabetes controls with negative serologic markers of celiac disease. All 16 children with positive celiac disease serology had histologic features consistent with celiac disease despite the absence of symptoms. The mean growth and metabolic control values were similar between children with type 1 diabetes and celiac disease and those with type 1 diabetes but without celiac disease. This study seems to suggest that the early diagnosis of celiac disease and initiation of a gluten-free diet may prevent further deterioration in the nutritional status of children with type 1 diabetes and celiac disease and may reduce the prospect of celiac disease complications without any impact on type 1 diabetes control. [ABSTRACT FROM AUTHOR]

Background: The benefits and risks of continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) in patients with Type 1 diabetes mellitus (T1DM) who fast during Ramadan are not known.Methods: Systematic review and meta-analysis of observational studies conducted in PubMed, Embase (Ovid), and the Cochrane Library. Quality of included studies was assessed using the ROBINS-I tool for risk of bias assessment and analyses were performed using RevMan version 5.1.Results: From 709 records, 306 full text studies were assessed. After exclusions, the final analysis included a total of 9 studies. Heterogeneity for outcomes was I2 = 0%. There was no significant difference for the change in glycemic control (HbA1c) between CSII and MDI (P > 0.05). There was no change in weight or the lipid profile in patients with T1DM on MDI during Ramadan. There were insufficient data to assess the impact on glucose profiles and the incidence of hypoglycemia or diabetic ketoacidosis (DKA) in patients on CSII or MDI during Ramadan.Conclusions: Studies assessing the effect of CSII or MDI in patients with T1DM who fast during Ramadan are limited to observational studies and show no difference in the change in HbA1c, weight or lipids during Ramadan. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effectiveness of a comprehensive care program to achieve and maintain goals in patients with type 2 diabetes.Methods: The CAIPaDi program includes 9 interventions delivered in 7 h. It seeks to achieve metabolic goals, identify and resolve barriers that would make implementation difficult, and provide self-efficacy and empowerment to patients by identifying personal profiles to establish individualized strategies. The program consists of a 4 intervention visits (1, 2, 3, and 4 months) and two follow up visits (12 and 24 months). Outcomes are compared between every visit. Main outcome was the attainment of the USA National Committee for Quality Assurance treatment goals.Results: 1104 patients completed the first 4 visits, 545 the 12 month evaluation, and 218 the 24 month evaluation. After the conclusion of the four monthly sessions, 80.6% had HbA1c <7%, 72.1% had BP <130/80 mmHg and 71.6% had LDL- cholesterol <100 mg/dl. After twelve months, the percentage of goals achieved were 65.9%, 67.7% and 43.3% respectively (p < 0.001). For the 2-year evaluation the percentages were 61.0%, 70.6%, and 40.8% respectively (p < 0.001). All patients had renal, eye, foot and dental evaluations. Empowerment and quality of life showed significant changes; anxiety and depression scores remained low at annual follow-ups.Conclusions: The CAIPaDI program results in sustained improvement and maintenance of treatment goals. [ABSTRACT FROM AUTHOR]

Copyright of Wiener Klinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Wiener Klinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Prevention and treatment of diabetes have an economic burden for the society. Treatment of diabetes is accompanied by the willingness of the patients to control their diabetes. This study aimed to show the effects of intervention based on the transtheoretical model on physical activity and metabolic control of diabetic women. Methods: This was a randomized control trial study which conducted on 98 diabetics women (48: intervention and 50: control) in two health centers in Qazvin, Iran. Patients of each center were placed in intervention group and control group randomly. Data collection tool was a questionnaire, consisting of demographic characteristics, the determination of physical activity (GPAQ) and a questionnaire about TTM constructs in physical activity behavior. The HbA1c determined by blood test. Educational intervention design based on the results of the questionnaire and data analysis and then implemented to the intervention group. Data related to post-test collected three months after the end of the intervention and then measured the HbA1c level. Data analyzed using SPSS software version 19. Results: There was no a significant difference before intervention in demographic variables, the amount of physical activity, HbA1c and constructs model in both groups. There was a significant difference after intervention in the mean constructs model of intervention group than control group (P<0.05). Moreover, there was a significant difference in the mean physical activity of intervention group than control group. While there was no a significant difference in HbA1c level in both groups. Conclusion: Transtheoretical model-based intervention required more consideration in increasing physical activity in chronic diseases. The implementation of similar interventions with more sample size is a necessity in both genders. [ABSTRACT FROM AUTHOR]

Secretagogin (SCGN) is a calcium sensor protein enriched in neuroendocrine cells in general and pancreatic β-cells in particular. SCGN regulates insulin secretion through several Ca2+-dependent interactions. Recent studies implicate SCGN in the β-cell physiology and extracellular insulin function, making it an intriguing candidate in diabetes research. Here, we propose a conjoining theme of diversified SCGN function in diabetes pathology. In our opinion, SCGN is an attractive therapeutic candidate ascribed by its role in β-cell maintenance and neuronal functions and in the efficacy of insulin. To scrutinize the therapeutic prospects of SCGN, we abridge putative diabetes-related properties of SCGN and put forth strategies to determine the precise role of SCGN in the pathogenesis/preclusion of diabetes. Highlights Secretagogin (SCGN) is a calcium sensor protein with the highest expression in pancreatic β-cells to regulate insulin expression and secretion. Diabetic patients have reduced SCGN levels. In mice, lack of SCGN causes glucose intolerance and pancreatic β-cell depletion, while exogenous injection impedes these symptoms. Several brain regions express SCGN for an unidentified purpose. In the hypothalamus, SCGN regulates CRH release to manifest stress response and activate HPA axis of systemic metabolic control. A consolidated understanding of diverse SCGN expression/function is lacking. We present a comprehensive view of current knowledge in the field and discuss future directions to resolve the opacity in perplexing diabetes nexus and imminent therapeutic prospects. [ABSTRACT FROM AUTHOR]

Abstract The present study evaluated the effect of age on glucose tolerance and cardiac function and assessed the relationship between metabolic control and cardiac function and performance. Thirty-four healthy women aged 40 to 81 years were divided into two age groups: younger (≤50 years of age, N = 19) and older (≥60 years of age, N = 15). Participants performed an oral glucose tolerance test and a graded cardiopulmonary exercise test with non-invasive haemodynamic measurements. Compared to younger, older women demonstrated significantly higher 2-hour glucose (4.67 ± 1.01 vs 6.08 ± 1.54 mmol/l, P < 0.01), but lower peak exercise O 2 consumption (1.96 ± 0.44 vs 1.38 ± 0.26 l/min, P < 0.01) and cardiac power output (4.06 ± 0.76 vs 3.35 ± 0.73 W, P = 0.01). When data from all study participants were combined, there was a significant negative relationship between 2-hour glucose and peak cardiac power (r = −0.39, P = 0.02), and peak O 2 consumption (r = −0.40, P = 0.02). The strength of these relationships was affected by age, with moderate negative relationship identified between 2-hour glucose and peak cardiac power output in younger compared to older participants (r = −0.38, P = 0.11 vs. r = −0.09, P = 0.75). Metabolic control and cardiac function decline with age. The lack of relationship between glucose control and cardiac power may suggest that metabolic control does not influence cardiac function and performance in older women. Highlights • Age is the major risk factor for development of cardiovascular and metabolic diseases. • Cardiac function and glucose control decline with age. • Cardiac function is not associated with glucose control in older women. [ABSTRACT FROM AUTHOR]

Adolescents with type 1 diabetes may be at elevated risk for somatic problems. This study used cross‐sectional, baseline data from an intervention to examine if problems with executive function (EF) were associated with greater somatic problems independent of poor adherence and disease severity in adolescents with type 1 diabetes and above target glycemic control. In addition, it examined whether certain types of EF skills, that is, metacognitive and behavior regulation, accounted for variance in somatic problems. Ninety‐three adolescents completed a glycated hemoglobin (HbA1c) blood test and parents completed adherence, somatic problems, and EF questionnaires, which measured metacognitive, behavior regulation, and global EF. Greater somatic problems had significant bivariate associations with greater global (r = 0.42, P < 0.01), metacognitive (r = 0.43, P < 0.01), and behavior regulation EF problems (r = 0.31, P < 0.01), worse adherence (r = −0.39, P < 0.01), and poorer metabolic control (r = 0.26, P < 0.05). However, when adherence, metabolic control, and EF subscales were examined together in the same model, only greater global EF problems (b = 0.15, P < 0.01) and metacognitive EF problems (b = 0.16, P < 0.01) were independently associated with greater somatic problems; behavior regulation EF problems were not independently associated with greater somatic problems when controlling for adherence. Metacognitive EF problems may predict somatic problems in adolescents with above target glycemic control above and beyond physical symptoms related to disease management, underscoring the importance of proper assessment and treatment of these distinct somatic problems. [ABSTRACT FROM AUTHOR]

This study examined nonverbal intelligence and scholastic achievement in children with type 1 diabetes. In a retrospective case–control study, 69 children (35 males) ages 5–10 years with type 1 diabetes and 69 healthy controls matched to patients by age, gender and socioeconomic status were compared according to their performance on Raven's Coloured Progressive Matrices and their scholastic grades. No differences in nonverbal intelligence and grades were observed between children with type 1 diabetes and healthy control subjects. Raven's Coloured Progressive Matrices scores inversely correlated with duration of illness both in children with early onset of type 1 diabetes and poor metabolic control. Possible explanations of the results and implications are discussed. [ABSTRACT FROM AUTHOR]

Problem Statement: Although there is progress in understanding the impact of obesity and Type 1 diabetes in children, are not fully understood whether these conditions are associated with cardiac autonomic modulation. Purpose: To evaluate the effects of the sedentary lifestyle in the HRV of children with DM 1 or obese. Approach: After performing the ethical procedures, we applied the International Questionnaire of Physical Activity (IPAQ - C), short version, adapted for children and adolescents. We selected male children aged 6 to 12 years, classified as eutrophic (n = 8), diabetic (n = 8) and / or obese (n = 8). They were then submitted to anthropometric and cardiometabolic evaluations and an aerobic capacity test (Shuttle Run Test). Subsequently, the children were submitted to the 6-minute walk test (6-MWT) to record HRV in response to exercise. Results: The parameters of heart rate variability were reduced in DM 1 and obese when compared with eutrophic children (p <0.001). Analysis of heart rate variability in the time domain in the exercise of eutrophic, obese and DM1 children through the cardiac interval, standard deviation, variance and RMSSD were reduced in DM 1 and obese when compared to eutrophic children (p <0.001). The components of low and high frequency by the frequency domain at exercise were reduced in DM1 and obese when compared with eutrophic children (p <0.001). We found positive and significant moderate to very strong correlations between IPAQ and HRV parameters. We also observed moderate to strong correlation between obesity evaluated by Z-score and HRV. There was not correlations between glycemic control infer by Hb1Ac and HRV data. In addition, a very strong association was found between the IPAQ parameters and the cardiac vagal tone assessed by the RMSSD (p <0.0001). Conclusion: The level of physical activity showed a strong association with HRV, with lower levels in the obese and DM 1 group. [ABSTRACT FROM AUTHOR]

Polymalic acid (PMA) is a linear anionic polyester composed of L-malic acid monomers, which have potential applications as drug carriers, surgical suture, and biodegradable plastics. In this study, a novel strain of Aureobasidium pullulans var. melanogenum GXZ-6 was isolated and identified according to the morphological observation and deoxyribonucleic acid internal-transcribed spacer sequence analysis, and the product of PMA was characterized by FT-IR, 13C-NMR, and 1H-NMR spectra. The PMA titer of GXZ-6 reached 62.56 ± 1.18 g L−1 with productivity of 0.35 g L−1 h−1 using optimized medium with addition of metabolic intermediates (citrate and malate) and inhibitor (malonate) by batch fermentation in a 10-L fermentor. Besides that the malate for PMA synthesis in GXZ-6 might mainly come from the glyoxylate cycle, based on results, citrate, malate, malonate, and maleate increased while succinate and fumarate inhibited the production of PMA, which was different from that of other A. pullulans. This study provided a potential strain and a simple metabolic control strategy for high-titer production of PMA and shared novel information on the biosynthesis pathway of PMA in A. pullulans. [ABSTRACT FROM AUTHOR]

The main neurological, cognitive, and behavioural consequences of phenylketonuria have been eradicated thanks to new-born screening and Phe-restricted diet therapy. However, the effects of high phenylalanine levels during adolescence and adulthood on neurocognitive functions remain a concern. This systematic review aimed at collecting clinical data suggesting the safest metabolic target for early treated PKU during the second decade of life. Twenty studies met the inclusion criteria for full-text review. Relevant studies included papers that (a) examined the relationship between metabolic control and neurocognitive functions during adolescence or (b) investigated the impact of metabolic control in adolescence on adult outcomes. Most studies showed a positive correlation between metabolic control during adolescence and neurocognitive outcomes across ages. This was true both for IQ and executive functions, although data on executive functions were less clear, and it remains to be established whether they are more vulnerable to Phe than IQ. Taken together present evidence confirm brain vulnerability to Phe during adolescence and suggests that low average Phe levels and low Phe fluctuations should be maintained throughout life. While results are fully compatible with current European recommendations, clinical and methodological limitations coupled with remarkable interindividual variability prevented a clear identification of a safe threshold for Phe blood levels during adolescence. [ABSTRACT FROM AUTHOR]

Background Children with type-1 diabetes face not only short- term complications but also long-term microvascular and macrovascular complications. Therefore, a continuing medical care and education to reach blood glucose near normal range is abso- lutely required. An addition of behavioral educational intervention to intensive diabetes management resulted in improved metabolic control and quality of life. Objective To determine the effects of a structured educational intervention to parents and patients with type-1 diabetes mellitus on their knowledge and patient metabolic control. Methods In this interventional study with pretest-posttest design at Department of Child Health, Medical School, University of Indo- nesia, a total of 21 patients with the age between 8 and 18 years and their parents were assigned to follow a structured educational program over period of 6 months. During the 6 intervention ses- sions, some procedures were applied: obtaining HbA1c at initial, 3 rd and 6 th month using HPLC procedure, classroom teaching pro- gram, small group discussions, role-playing and pre-posttests. Results The mean HbA1c level in the 21 children and adoles- cents at initial, 3 rd and 6 th month were 10.05% (SD 2.67%), 10.28% (SD 2.23%) and 10.01% (SD 2.67%), which showed no significant changes (P>0.05). After 6 educational sessions, the result showed significant changes in both parents’ (P

Background: Our hypothesis was that a modified diet would improve blood glucose control with beneficial impact on weight management and overall health in established diabetes. Objective: This prospective interventional study investigated the clinical effect of an Okinawan-based Nordic diet on anthropometry, metabolic control, and health-related quality of life (HRQoL) in Scandinavian type 2 diabetes patients. Design: Food was prepared and delivered to 30 type 2 diabetes patients. Clinical information along with data on HRQoL, blood samples, and urine samples were collected during 12 weeks of diet interventions, with follow-up 16 weeks after diet completion. Results: After 12 weeks of dietary intervention, a reduction in body weight (7%) (p

Background and Objectives: Diabetes mellitus is among the most common causes of mortality in the world and an important risk factor for chronic kidney disease, foot amputation, ischemic heart disease and blindness among older adults. Diabetic patients mostly develop hyperlipidemia, which can result in cardiovascular diseases. Patient’s knowledge, attitude and practices toward diet are the core center for diabetes control and affect their metabolic control and complications. In the present study, we measured nutritional knowledge, attitude and practices and their relations to serum lipids, HbA1C, and fasting blood glucose in diabetic patients of Boirahmad County, southwest of Iran, where many people encounter increasing prevalence of diabetes. Materials and Methods: 198 IDDM patients from the rural and urban areas of Boirahmad County were invited to the health centers to be checked for their fasting blood glucose, serum total cholesterol, serum HDL cholesterol, serum triglyceride and also serum glycosylated hemoglobin. Their knowledge, attitude, and practices toward the diabetic diet were assessed using a validated questionnaire. The obtained scores were classified into three categories (Poor, average, and Good) to show their knowledge, attitude and practice levels, and the serum parameters were compared between the levels to show the relevancies. Results: Our data showed that the patients’ knowledge and attitude on diabetic nutrition are mostly at the average level (79.3% and 47.1%, respectively) but their practice scores are mostly at the poor level (43.8%), and just a minor proportion of the patients are at the appropriate levels (15.3, 33, and 23.1% of knowledge, attitude and practices, respectively). In addition, we found a significant reverse relationship between the patients’ nutritional knowledge and serum HbA1C (p=0.003), and also between their attitude and serum triglyceride (p

Aim: To compare metabolic control and complications in people with type 2 diabetes in Nauru and the Solomon Islands before and after a project intervention. Methods: This follow-up study compared metabolic control and complications in a cohort of 216 people with diabetes (81 from Nauru and 135 from the Solomon Islands) at baseline and 15 months following a project intervention (upgrading and equipping the existing diabetes centres, and providing training and clinical support systems) aimed at improving the quality of clinical diabetes care. Subjects were screened using a standardised protocol which gathered information on demographics, treatment, physical and biochemical parameters and their outcomes. Results: At follow-up, glycaemic control had improved and mean HbA1c had decreased in study participants in both Nauru (mean difference (MD) = −0.9 ± 2.3%) and the Solomon Islands (MD = −0.6 ± 1.4%), P

Beata Kowalewska,1 Katarzyna Zorena,2 Małgorzata Szmigiero-Kawko,3 Piotr Wąż,4 Małgorzata Myśliwiec3 1Department of Tropical Medicine and Epidemiology, Institute of Maritime and Tropical Medicine, 2Department of Immunology and Environmental Microbiology, 3Clinic of Paediatrics, Diabetology and Endocrinology, 4Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland Objective: To conduct qualitative and quantitative assessment of yeast-like fungi in the feces of children and adolescents with type 1 diabetes mellitus (T1DM) with respect to their metabolic control and duration of the disease.Materials and methods: The studied materials included samples of fresh feces collected from 53 children and adolescents with T1DM. Control group included 30 age- and sex-matched healthy individuals. Medical history was taken and physical examination was conducted in the two study arms. Prevalence of the yeast-like fungi in the feces was determined as well as their amounts, species diversity, drug susceptibility, and enzymatic activity.Results: The yeast-like fungi were found in the samples of feces from 75.4% of T1DM patients and 70% controls. In the group of T1DM patients, no correlation was found between age (Rs=0.253, P=0.068), duration of diabetes (Rs=−0.038, P=0.787), or body mass index (Rs=0.150, P=0.432) and the amount of the yeast-like fungi isolated in the feces. Moreover, no correlation was seen between the amount of the yeast-like fungi and glycated hemoglobin (Rs=0.0324, P=0.823), systolic blood pressure (Rs=0.102, P=0.483), or diastolic blood pressure (Rs=0.271, P=0.345).Conclusion: Our research has shown that children and adolescents with T1DM show higher species diversity of the yeast-like fungi, with Candida albicans being significantly less prevalent versus control subjects. Moreover, fungal species in patients with T1DM turn out to be more resistant to antifungal treatment. Keywords: children, diabetes mellitus type 1, yeast-like fungi, drug susceptibility, metabolic control, duration of the disease

The purpose of this study was to evaluate the consequences of non-linear changes in phosphocreatine (PCr) and pH during incremental calf exercise on estimates of ADP and cytosolic free energy of ATP hydrolysis (delta GATP). Six subjects performed incremental plantar flexion exercise on a treadle ergometer while muscle P(i) metabolism (PCr, P(i), ATP) and pH were followed using 31P-nuclear magnetic resonance spectroscopy. Changes in ADP and delta GATP were estimated with the assumption that there was equilibrium of the creatine kinase reaction and homogeneous tissue metabolite pools. All six subjects showed a threshold for onset of cellular acidosis that occurred on average at 47.3 +/- 12.7% of peak work rate (PWR). In five of the six subjects, PCr and P(i) showed accelerated rates of change above the threshold for onset of cellular acidosis. In all six subjects, ADP, when correctly calculated considering changes in pH, rose in a curvilinear fashion that was well described by a Michaelis-Menten hyperbola through 60-100% of PWR, with a mean apparent Michaelis-Menten constant of 43.1 +/- 17.1 microM ADP and a predicted maximal oxidative rate at PCr = 0, which was 241 +/- 94% of PWR. delta GATP rose linearly with work rate from -62.9 +/- 1.8 kJ/mol during unloaded treadling to -55.0 +/- 1.8 kJ/mol at PWR. If we assume a linear O2 uptake-to-work rate relationship, these results are most consistent with control of respiration being exerted through delta GATP under these conditions (incremental exercise by human calf muscle).(ABSTRACT TRUNCATED AT 250 WORDS)