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Multiple sources of burden for youth with type 1 diabetes (T1D) impact key outcomes including quality of life, self‐management, and glycemic control. Professional diabetes organizations recommend diabetes care providers screen for psychosocial and behavioral challenges and implement strategies to support youth with T1D. The purpose of this article is to review the literature and recommend practical strategies medical providers can use for screening and behavioral support for youth with diabetes and their families. As part of their routine medical care, diabetes care providers are well‐positioned to identify and intervene to address emotional distress related to the burdens of living with diabetes. In collaboration with multidisciplinary team members, including psychologists and mental health professionals, medical providers may be able to successfully implement brief behavioral strategies for screening and providing emotional support. [ABSTRACT FROM AUTHOR]

O artigo tem como objetivo principal caracterizar os perfis glicêmicos domiciliares de pacientes com diabetes mellitus tipo1, a partir de um esquema de monitorização proposto, e adotá-los como estratégia de ajuste nas doses de insulina. Foram realizados 3259 testes, 781 antes do café, 752 antes do almoço, 765 antes do jantar, 740 antes de deitar e 221 pela madrugada. A média das glicemias nestes períodos ultrapassaram os limites superiores satisfatórios em 6,87%, 3,83%, 11,37%, 30,50% e 19,28% respectivamente. Estes dados forneceram subsídios para ajustes nos esquemas insulinoterápicos. Os níveis HbA1c não mudaram de forma significante com os ajustes realizados porém, foram mantidos em 10%.El objetivo principal de este artículo consiste en caracterizar los perfiles glicémicos domiciliares de los pacientes con diabetes mellitus tipo 1, a partir de un esquema propuesto de monitorización, para aplicarlo como estrategia, en los ajustes de las dosis de insulina. Fueron realizados 3.259 tests, de los cuales 781se hicieron antes del desayuno, 752 se realizaron antes del almuerzo, 765 antes de la merienda, 740 se hicieron antes de dormir y los 221 se hicieron en la madarugada. La media de las glicemias en estos períodos ultrapasaron los límites superiores satisfactorios em 6,8%, 3,83%, 11,37%, 30,50% y 19,28% respectivamente. Estos datos ofrecieron subsidios para poder ajustar los esquemas insulinoterápicos. Los niveles de HbA1c no variaron de forma significativa com los ajustes realizados y se mantuvieron em 10%.The goal of this paper is to characterize the glycemic profiles of patients with type 1 diabetes mellitus like a strategy in insulin adjustments. A total of 3259 tests were realized being 781 before breakfast, 752 before lunch, 765 before dinner and 740 before bed and 221 in the dawn. The average of the blood glucose tests in these periods oversteped the superior limits in 6,87%, 3,83%, 11,37%, 30,50% e 19,28% respectively. These data gave the conditons to make the insulin adjustments. The HbA1c levels evidenced that there was no significant statistical difference in the metabolic control, but they remained in 10%.

En las investigaciones biomédicas se precisa la utilización de los animales de laboratorio como biomodelos naturales o inducidos de diversas enfermedades o procesos morbosos, los cuales ayudan al estudio y la comprensión de la patogenia, fisiología y posibilidades de tratamiento de las mismas. En la endocrinología se utilizan para estudiar estos aspectos de las enfermedades de origen autoinmune o no relacionadas con este sistema, como la diabetes mellitus, disfunciones tiroideas, trastornos de la reproducción y del metabolismo, entre otras, además de constituir un arma importante para investigar las interrelaciones hormonales que ocurren en los individuos normales o enfermos. Se realizó una amplia revisión bibliográfica sobre el tema para brindar una información detallada sobre los modelos animales de diabetes mellitus tipo 1 utilizados en las investigaciones biomédicas, que comprendiera los que se obtienen de forma espontánea e inducida, así como la influencia sobre ellos, de los factores ambientales. Se concluyó que resulta de vital importancia para el logro de las investigaciones básicas in vivo mantener un control estricto de las condiciones ambientales en las que desarrollamos nuestras investigaciones y ampliar nuestros conocimientos sobre el tema.In biomedical research, it is necessary the use of laboratory animals as natural or induced models of different diseases or morbid processes that make easy the study and understanding of the pathogeny, physiology and possibilities of treatment of them. In endocrinology, they are utilized to study the aspects of the diseases of autoimmune origin or of those not related to this system, such as diabetes mellitus, thyroid dysfunctions, reproduction and metabolism disorders, among others. Besides, they are also an important tool to investigate the hormonal interrelations occurring in normal or sick individuals. A wide bibliographic review on this topic was made to give a detailed information about the animal models of type I diabetes mellitus used in biomedical research, including those obtained in a spontaneous or induced way, as well as the influence of the environmental factors on them. It was concluded that it is very important for the achievement of the basic research in vivo to maintain a strict control of the environmental conditions under which we develop our investigations and to improve our knowledge on this topic.

Se realizó un estudio retrospectivo de tipo analítico, en el Hospital Docente Pediátrico del Cerro, en un período de 10 años, del 15 de enero de 1989 al 15 de enero de 1999, con el objetivo de identificar el comportamiento de las alteraciones en la maduración ósea y el crecimiento en niños con diabetes mellitus insulinodependiente, y determinar la relación entre los factores seleccionados. El universo estuvo conformado por todos los niños diabéticos insulinodependientes atendidos en el servicio, quedando constituida la muestra por 45 pacientes. Las variables seleccionadas fueron: edad al inicio de la enfermedad, tiempo de evolución, esquema terapéutico, dosis de insulina, y control metabólico. Se detectó que el 82,2 % de lo niños estudiados no presentaron ninguna afectación, mientras que el 15,6 % presentó afectación en la maduración y el 2,2 % en la maduración y el crecimiento. No se diagnosticó ningún caso con afectación solamente en el crecimiento. Las variables que mostraron relación fueron la edad de inicio de la enfermedad menor de 5 años, tiempo de evolución de más de 10 años, esquemas inadecuados, dosis de insulina insuficiente y mal control metabólico. El comportamiento de las alteraciones en la maduración ósea y el crecimiento fueron poco frecuentes, coincidiendo con los datos de la literatura revisada, que incluye a estas complicaciones como excepcionales.The authors made a retrospective and analytical study in the Children Teaching Hospital of Cerro Municipality, from January 15, 1989, to January 15, 1999, to identify the behaviour of the alterations in bone maturation and growth in insulin-dependent diabetes mellitus children, and to determine the relation among the selected factors. The group was composed of all insulin-dependent sick children seen in our service. The sample included 45 patients. The selected variables were: age at onset of the disease, evolution time, therapeutical scheme, insulin dose and metabolic control. It was oberved that 82,2 % of the studied children had no alterations, while 15,6 % had problems with maturation and 2,2 % in both, maturation and growth. There was not any case with alteration only in growth. The related variables were: age at onset of the disease of less than 5 years, evolution time of more than 10 years, unsuitable schemes, insufficient insulin dose and a poor metabolic control. The alterations in bone maturation and growth were not frequent, coinciding with the data found in the reviewed literature, where these complications are included as something exceptional.

OBJECTIVE: To estimate the incidence rate of type 1 diabetes in the urban area of Santiago, Chile, from March 21, 1997 to March 20, 1998, and to assess the spatio-temporal clustering of cases during that period. METHODS: All sixty-one incident cases were located temporally (day of diagnosis) and spatially (place of residence) in the area of study. Knox's method was used to assess spatio-temporal clustering of incident cases. RESULTS: The overall incidence rate of type 1 diabetes was 4.11 cases per 100,000 children aged less than 15 years per year (95% confidence interval: 3.06--5.14). The incidence rate seems to have increased since the last estimate of the incidence calculated for the years 1986--1992 in the metropolitan region of Santiago. Different combinations of space-time intervals have been evaluated to assess spatio-temporal clustering. The smallest p-value was found for the combination of critical distances of 750 meters and 60 days (uncorrected p-value = 0.048). CONCLUSIONS: Although these are preliminary results regarding space-time clustering in Santiago, exploratory analysis of the data method would suggest a possible aggregation of incident cases in space-time coordinates.OBJETIVO: Estimar a taxa de incidência de diabetes tipo 1 na área urbana de Santiago, Chile, entre os dias 21 de março de 1997 e 20 de março 1998, assim como a avaliação do agrupamento espaço-temporal dos casos incidentes no período. MÉTODOS: Foram localizados 61 casos incidentes no tempo (dia do diagnóstico) e no espaço (lugar de residência) na área do estudo. O método de Knox foi usado para avaliar o agrupamento dos casos no espaço e no tempo. RESULTADOS: A taxa de diabetes tipo 1 foi estimada em 4,11 casos por 100.000 menores de 15 anos por ano (Intervalo de confiança 95%: 3,06 -- 5,14). Essa taxa de incidência parece ter aumentado desde a última estimativa realizada na região metropolitana de Santiago, nos anos 1986-1992. Foram construídas diferentes combinações de intervalos de espaço e tempo para determinar a agregação espaço-temporal dos casos incidentes. A quase significativa agregação de casos foi detectada usando as distâncias críticas de 750 m e 60 dias (valor p não corrigido = 0,048). CONCLUSÕES: Embora o estudo só mostre resultados preliminares do agrupamento espaço-temporal dos casos de diabetes tipo 1, em Santiago, a análise dos dados sugere uma possível agregação de casos incidentes nas coordenadas de espaço e tempo.

It has been suggested that breastfeeding is a protective factor against Type 1 DM due to anti-infection properties or delay in exposure to other agents in the diet. A descriptive study was carried out using data from the Cuban National Registry of Childhood-Onset Diabetes Mellitus (CNRDM). The goal of the study was to determine the frequency and duration of breast-feeding in Cuban children with Type 1 DM. Four hundred and eighty-six children were registered in the CNRDM between January 1, 1988, and December 31, 1993. Breast-feeding data was obtained from two hundred and sixty three (54.1%) of the total registered children. Of these children, two hundred and one (76.4%) were breastfed. The median duration of breast-feeding was three months (Total range 144 months). No statistically significant association was found between the mean age at DM or the clinical profile at diagnosis and the breast-feeding duration groups (p >0.05, respectively). In conclusion, Cuban children with Type 1 DM have relatively low frequency of breast-feeding. When breast-feeding is studied without stratifying for different types of breast-feeding (e.g. exclusive and non-exclusive), there is no association found with the age at DM diagnosis or the clinical profiles at diagnosis.Há evidências de que o aleitamento materno age como um fator protetor contra o DM Tipo 1 devido a propriedades antiinfecciosas ou porque retarda a exposição a outros agentes na dieta. Foi realizado um estudo descritivo com dados do Registro Nacional Cubanas de Diabetes Mellitus na Infância (CNRDM). O objetivo desse estudo era determinar a freqüência e duração do aleitamento materno em crianças cubanas com DM Tipo 1. Quatrocentas e oitenta e seis crianças foram cadastradas no CNRDM entre 1 de janeiro de 1988 e 31 de dezembro de 1993. Os dados sobre aleitamento materno foram obtidos de duzentas e sessenta e três crianças (54.1%) do total registrado. Dessas crianças, duzentas e uma (76.4%) foram amamentadas. A duração média do aleitamento materno foi de (3) meses (Variação total entre 1 e 44 meses). Não foi encontrada nenhuma diferença estatisticamente significante entre a idade média de início e os grupos de duração do aleitamento materno (p >0.05). Concluindo, as crianças cubanas com DM Tipo 1 apresentam uma freqüência relativamente baixa tanto do aleitamento materno exclusivo como não exclusivo. Quando o aleitamento materno é estudado sem estratificação em diferentes tipos (ex. exclusivo e não exclusivo), não encontra-se associação com a idade ou perfil clínico no momento do diagnóstico.

Se analiza la estrategia terapéutica actual en el diabético insulinodependiente. Se insiste en la necesidad de lograr la normoglicemia como criterio de control metabólico expresado en valores normales de hemoglobina glicolisada o Hb Alc trimestral. Se debe enfatizar en la educación diabetológica reforzándola en cada consulta y reevaluando cada cierto tiempo. El cumplimiento de la dieta es fundamental. Debemos utilizar insulina altamente purificada con esquemas insulínicos principalmente basados en mezclas de insulinas o regímenes de múltiples dosis de insulina. Es necesario lograr el monitoreo glicémico por el paciente. La práctica sistemática del ejercicio físico diario o tres veces a la semana es importante. Es preciso tratar de localizar y estudiar los posibles grupos de riesgo a desarrollar esta enfermedadThe present therapeutic estrategy for the insulin-dependent diabetic is analyzed. It is stressed the need of attaining normoglycaemia as a criterion of metabolic control expressed in normal values of glycosylated hemoglobin or HB Alc quarterly. Emphasis shoud be made on the education received by the diabetic patients in connection with the disease, reinforcing it at every office visit, and reevaluating it periodically. Being on a diet is very important, too. We should use highly purified insulin with insulin schemes based mainly on mixtures of insulins or regimes of multiple doses of insulin. It is necessary that the patient attains the glycaemic control. We should try to locate and study the possible risk groups that may develop this disease

The authors compared, in the context of diabetic retinopathy, alternative methods of quantifying the extent to which disease progression in one eye increases the risk of subsequent progression in the other eye. Data were gathered on 478 US patients with insulin-dependent diabetes mellitus who participated in the 1983–1988 Sorbinil Retinopathy Trial and were followed up for a median of 41 months. During that time, diabetic retinopathy progressed in 93 right eyes and 77 left eyes. Crude incidence rates of progression for right eyes were 7.7 times higher after the left eye had progressed and, for left eyes, were 4.4 times higher after the right eye had progressed. In eye-specific proportional hazards models that adjusted for increasing rates of progression over time and for baseline risk factors, the comparable relative risks associated with progression in the other eye were 2.6 (95% confidence interval (Cl): 1.5, 4.7) for right eyes and 1.4 (95% Cl: 0.72, 2.9) for left eyes. Two alternative proportional hazards models that included data on both eyes and accounted for their correlation produced estimated relative risks of 1.9 (95% Cl: 1.2, 2.9) and 2.7 (95% Cl: 1.8, 3.5), respectively. The more complex models for joint survival integrate information on both eyes and provide more stable estimates than do separate analyses of right or left eyes. Am J Epidemiol 2000; 151: 965-74. [ABSTRACT FROM PUBLISHER]

Background: The aim of this study was to determine whether detectable periodontal destruction and alterations in the salivary status were present with duration of diabetes in children with type 1 insulin-dependent diabetes mellitus (type 1 DM) as compared to healthy controls. Methods: Sixteen newly diagnosed children with DM (group 1), 16 children with type 1 DM of long duration (group 2), and 16 healthy children (group 3) participated in the study. Periodontal health was assessed by plaque index, gingival index, bleeding on probing, and periodontal probing depths. The flow rate, pH, buffering capacity, and peroxidase activities of stimulated saliva were determined. The data were analyzed by Kruskall-Wallis, Student t test, and Pearson's correlation analysis. Results: The mean values for fasting blood glucose levels for the diabetic groups were significantly higher than for the controls. The mean values for salivary buffering capacities and salivary pH from the diabetic groups were significantly lower than for the controls. The plaque index values for the diabetic groups were significantly higher than for the controls. The mean gingival index value for group 1 was significantly lower than for group 2. The mean periodontal probing depths for group 1 were similar to those of the non-DM controls, but the mean periodontal probing depths for group 2 were significantly greater than for both the non-DM controls and group 1. Group 1 had significantly greater bleeding on probing scores than did the other groups (P <0.05). Conclusion: The glycemic status of the diabetic subjects affects the periodontal probing depths, salivary pH, buffering capacity, and peroxidase activity. [ABSTRACT FROM AUTHOR]

Aims/hypothesis. The overall increase in proteolytic activity in diabetes is known to be associated with the development and progression of vascular complications. Our aim was to investigate in detail the molecular nature of this activity in the plasma of Type 1 diabetic subjects. Methods. Plasma of both diabetic and control subjects was subjected to various purification procedures (ion exchange and affinity chromatography, HPLC, immunoprecipitation, electrophoresis, immunoblot and mass analyses) to identify the proteins of interest. Biological activities were measured on specific substrates. Results. In diabetic but not normal plasma we identified the presence of two heat shock proteins, Grp94 (Glucose-regulated protein94) and HSP70. The higher-than-normal proteolytic activity of Grp94 was: (i) directed against casein, but not against endogenous plasma proteins; (ii) fully and specifically inhibited only by anti-Grp94 polyclonal antibodies; and (iii) coupled with low-level ATPase activity. In addition, ATP binding to Grp94 was able to modulate proteolytic activity. We found that Grp94 in plasma circulates only as high molecular mass homo- and hetero-complexes, the latter mostly formed with IgG to which Grp94 is also linked by tenacious binding. Proteolytically-active Grp94 was purified by immunoprecipitation, which co-immunoprecipitated α1antitrypsin. Conclusion/interpretation. Our results show the unexpected extracellular location and characteristic biological function of Grp94 even at a late stage of disease. These findings have physiopathological relevance for predicting activation of both autoimmune and inflammatory processes potentially associated with vascular complications. [ABSTRACT FROM AUTHOR]

Background: Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non-diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women. Methods: Thirty-three (13 diabetic and 20 non-diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non-diabetics was 29.5 ± 7.1 (SD) and 27.0 ± 7.3 years, respectively. The following parameters were assessed at Ramfjord's reference teeth: plaque index (PI), gingival inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL). Results: Diabetic subjects had significantly (P<0.001) higher PI (1.4S ± 0.69) and GI (1.77 ± 0.44) scores than non-diabetics (PI = 0.63 ± 0.38; GI = 0.93 ± 0.48). Mean PD for diabetics (2.95 = 0.69 mm) was significantly different (P <0.024) from that of non-diabetics (2.44 ± 0.32 mm). Although mean GM location was coronal to the cemento-enamel junction (CEJ) in both groups, gingival margins were at a more apical position (P<0.001] in the diabetics (-0.20 ± 1.24 mm) compared to non-diabetics (-1.75 ± 0.53 mm]. Mean CAL values also varied significantly (P<0.001) between diabetics (2.60 ± 1.54 mm) and non-diabetics (0.68 ± 0.65 mm). Significant differences were seen For GI (P<0.001), PD (P = 0.005), GM location (P<0.001), and CAL (P<0.001) when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI (P= 0.001). Conclusions: The results of this study demonstrate that periodontal inflammation and destruction are increased in pregnant diabetics as compared to non-diabetic pregnant patients. These findings may have implications for diabetic control and, hence, maternal and fetal outcomes in pregnant diabetic patients. [ABSTRACT FROM AUTHOR]

Background: Poor metabolic control of diabetes mellitus (DM) has often been associated with the severity of periodontal disease. The aim of this report is to present a 9-year-old female with localized aggressive periodontitis who had a history of type 1 DM and the outcome of her treatment. Methods: The patient had received medical, clinical, and radiographic periodontal examinations. Peripheral blood analysis was done as well. She had non-surgical periodontal treatment, and medical management of her diabetes was performed at the same time. She was followed longitudinally for 5 years. Results: Medical examination revealed no pathological findings except for growth retardation. Laboratory tests showed that she had poor metabolic control, with 497 mg/dl fasting blood glucose and 15.6% HbA1c. The random migration and neutrophil chemotaxis were significantly reduced. Periodontal treatment and metabolic control of her diabetes resulted in significant improvement in her periodontal condition. No incipient periodontal breakdown was observed around the teeth after 5 years from baseline. Conclusions: This report proves the efficiency of periodontal therapy in the prevention of future periodontal breakdown in a systemically compromised patient. It seems that in certain individuals who are predisposed to the aggressive forms of periodontitis, clinical and medical examinations and intervention to the systemic condition, in combination with periodontal treatment, are important in the management of these individuals. [ABSTRACT FROM AUTHOR]

Background: Insulin-dependent or Type 1 diabetes mellitus (IDDM) has been associated with an increased severity of periodontal disease. Because periodontal ligament (PDL) cells play a significant role in maintenance and regeneration of mineralized tissue, the success of procedures, such as guided tissue regeneration, is directly related to the ability of these cells to augment mineralized tissue. The objective of this study was to examine the ability of PDL cells from long-standing IDDM patients to form mineralized tissue and to determine whether these cells would exhibit altered responses to exogenously added growth factors.Methods: PDL cells were isolated from 4 patients with IDDM treated with insulin for at least 5 years and from systemically healthy donors. The cell isolates were tested for their ability to form mineralized nodules in vitro and to express alterations in alkaline phosphatase activity in response to exogenously added growth factors (transforming growth factor-beta (TGF-beta), platelet-derived growth factor-BB (PDGF-BB), and insulin-like growth factor-1 (IGF-1). Alkaline phosphatase activity was determined spectrophotometrically.Results: Although all PDL cell isolates formed mineralized nodules in vitro, PDL cells from diabetics formed mineralized nodules more slowly than did the controls. Alkaline phosphatase activity was not altered by exposure of diabetic PDL cells to TGF-beta for 9 days. In contrast, non-diabetic isolates exhibited increased levels of activity with increasing concentrations, from 0.5 to 1.0 ng/ml. Alkaline phosphatase activity was significantly higher in non-diabetic, but not in diabetic, cell isolates exposed to TGF-beta at 1.0 ng/ml, when compared to non-treated controls. Diabetic cell isolates exhibited significantly lower alkaline phosphatase activity than the non-diabetic isolates when exposed to either TGF-beta, PDGF-BB, IGF-1 or a combination of PDGF-BB and IGF-1.Conclusions: These results suggest that the populations of PDL cells in insulin-dependent diabetics may be altered in their ability to form mineralized tissue and to respond to growth factors, functions affecting the maintenance and regeneration of the periodontium. [ABSTRACT FROM AUTHOR]

Background: The periodontal disease status of 320 dentate adults, diagnosed 23.7 years previously with Type 1 insulin dependent diabetes mellitus, was evaluated. These patients had been monitored at 2-year intervals as part of a large University of Pittsburgh longitudinal study assessing the medical complications associated with insulin dependent diabetes. Methods: During one of their regularly scheduled medical examinations, a group of 320 adult dentate subjects (mean age of 32.1 years) received a periodontal examination as part of a comprehensive oral health assessment. The oral health assessment collected data regarding demographics, oral health behaviors, tooth loss, coronal and root caries, salivary functions, and soft tissue pathologies. For the periodontal assessments, 3 facial sites (mesial, mid-cervical, distal) of the teeth in the right maxillary/left mandibular or left maxillary/right mandibular quadrants were evaluated for calculus, bleeding on probing (BOP) and loss of gingival attachment (LOA). Results: Attachment loss was significantly greater for older patients whereas BOP and calculus levels were relatively constant across age categories. Univariate analyses of factors possibly related to extensive periodontal disease (LOA ≥4 mm for at least 10% of sites examined) indicated an association with older age; lower income and education; past and current cigarette smoking; infrequent visits to the dentist; tooth brushing less than once per day; older age of onset; longer duration of diabetes; and the diabetic complication of neuropathy. A multivariate regression model of all possibly significant factors found current cigarette use (odds ratio [OR] = 9.73), insulin dependent diabetes onset after 8.4 years of age (OR = 3.36), and age greater than 32 years (OR = 3.00) explained the majority of the extensive periodontal disease in this group of diabetic patients. Conclusions: Management and prevention of extensive periodontal disease for Type 1 diabetic patients should include strong recommendations to discontinue cigarette smoking. [ABSTRACT FROM AUTHOR]

THIS STUDY EXAMINED FOR 3 YEARS the changes in periodontal status and the possible correlations with selected subgingival microbiota and diabetic conditions in a group of 16 insulin-dependent diabetes mellitus (IDDM, JD) patients as compared with their 16 healthy cohabiting siblings (HS). JD patients were monitored every 3 months for levels of glycosylated hemoglobin (HbA1C). Clinical and microbiological parameters were measured 6 weeks before drawing blond to determine levels of HbA1C. Periodontal parameters were measured at baseline (T0), year 2 (T2), year 3 (T3) and included: probing depth (PD), attachment level (AL), sulcus bleeding index (SBI), and plaque index (PI). Two sites in each patient were selected for microbial samples: a mesio-facial aspect of the maxillary right first molar (defined as constant site, CS) and a site with the greatest probing depth (defined as deepest site, DS). Microbial samples were analyzed by culture techniques. No significant differences in clinical parameters were found between diabetics and healthy siblings at any examination. The SBI in the non-diabetic group at T2 and at T3 was significantly lower than at baseline. PD and AL of constant sites in the diabetic group at T3 were significantly higher than baseline. There was a significant increase in Prevotella intermedia at T3 as compared with baseline for deepest sites in the diabetic group. Cluster analysis revealed, in a former study, two clusters (IV and V) at baseline which were significantly different from the overall mean regarding composition of Porphyromonas gingivalis and Capnocytophaga spp. They were not significantly different for periodontal parameters from T0 to T3. These data would suggest no significant differences in clinical parameters between the diabetics and non-diabetic siblings throughout this 3-year longitudinal study. [ABSTRACT FROM AUTHOR]

An increased albumin excretion rate (AER) is associated with impaired glucose tolerance and diabetes mellitus in some populations, but data on Americans of Northern European origin are lacking. In 1986–1987, AER and creatinine clearance were measured in 455 adults in a survey of the population of Wadena, Minnesota. Thirty-five subjects (8%) had an AER ≥ 15 μg/minute, and eight of these had overt proteinuria (AER ≥ 175 μg/minute). AER and creatinine clearance were uncorrelated except when AER was increased. Unadjusted mean AER in a stratified random sample of adults (n = 374) was 3.6 μg/minute. Adjusted values for 277 subjects with normal glucose tolerance and for 80 subjects with impaired glucose tolerance were very similar (3.8 and 3.7 μg/minute, respectively), whereas mean AER was 5.4 μg/minute for persons with non-insulin-dependent diabetes mellitus (NIDDM) who were not taking insulin and 9.4 μg/minute for persons with NIDDM who were taking insulin (p < 0.0001). After adjustment for age, mean creatinine clearance was unrelated to glucose tolerance. Systolic blood pressure was a major determinant of increased AER (p < 0.0001) and lowered creatinine clearance (p = 0.0011), independently of diabetes. AER was stable over 5 years among the 321 cases who were not taking insulin and were not severely hypertensive. The decrease in creatinine clearance was greater in ex-smokers and current smokers than in nonsmokers. The authors conclude that hypertension and NIDDM were independently associated with the risk of kidney damage in this population, as indicated by a higher AER. High-normal blood pressure, but not impaired glucose tolerance, was associated with microalbuminuria. These relatively mild changes may reflect an ethnically based resistance to the damaging effects of hyperglycemia on the kidney. Smoking may accelerate the aging-related decline in glomerular filtration rate. Am J Epidemiol 1997; 145: 91–102. [ABSTRACT FROM AUTHOR]

Glycosylated hemoglobin is an indicator of long-term glycemic control and a strong predictor of diabetic complications. This paper provides a comprehensive description of glycemic control (total glycosylated hemoglobin (GHb)) up to 4.5 years duration of diabetes by age, duration, and sex in a population-based cohort (n = 507) aged less than 20 years followed from diagnosis of Type 1 diabetes in Wisconsin during 1987–1994. Important aspects of demographics and diabetes care are described to allow comparison with other populations. Since large variations between laboratories are known to exist in the measurement of GHb, levels are also interpreted relative to the frequency of short-term complications. GHb increased after diagnosis, but leveled off after 2–3 years. Peak GHb values occurred in the age group 12–15 years. The within-individual standard deviation in GHb between tests, adjusted for age and duration, was 1.6%. The mean GHb at last testing was 11.3%, with a standard deviation across individuals of 2.9%. The majority (74%) of individuals saw a diabetes specialist at least once. The mean number of insulin injections per day increased from 2.2 to 2.5 across the 4.5-year duration, and the insulin dose increased from 0.6 to 0.9 units per day per kg body weight. Despite the quite satisfactory level of care, 38% of subjects had GHb levels associated with significant short-term complications. Am J Epidemiol 1996; 144: 954-61. [ABSTRACT FROM AUTHOR]

Patients' perceptions of the extent to which their health care needs have been met may affect compliance with prescribed health behaviors and related health outcomes. The authors examined the relationships of "patient request fulfillment" to patient compliance, glycemic control, and several other health care outcomes in 51 adult outpatients with insulin-dependent diabetes mellitus. On average, patients retrospectively cited 4.5 long-term requests, of which over three-fourths were fulfilled. Fulfillment of these requests was significantly associated with patient satisfaction, perceived health status, fewer insulin reactions, and greater insulin injection time reliability (p less than 0.05), but not with several other measures of compliance. Higher patient request fulfillment at single visits was correlated, as hypothesized, with subsequent reduction in glycosylated hemoglobin, but this association was not statistically significant. These results suggest that patient request fulfillment is associated with several aspects of health behavior and health status in adults with insulin-dependent diabetes. Further studies are needed to confirm these observations and determine whether strategies to enhance patient request fulfillment can enhance health care outcomes. [ABSTRACT FROM AUTHOR]

Se determinó la actividad del sistema complemento en 26 pacientes adultos que se hallaban en la fase terminal de la nefropatía diabética. En estos pacientes se observó una disminución significativa (pThe activity of the complement system was determined in 26 adult patients that were suffering from end-stage diabetic nephropathy. In these patients, it was observed a significant reduction (p

Se estudiaron 66 sujetos ICA +: 21 diabéticos tipo 1, 24 diabéticos clasificados inicialmente como de tipo 2 y 21 familiares de primer grado de diabéticos tipo 1, se compararon con 101 individuos ICA -: 20 diabéticos tipo 2, 20 FPG, 21 niños y 40 adultos controles no diabéticos para analizar si la respuesta inmunológica a H. pylori está asociada con anticuerpos antiislotes pancreáticos (ICA). Los ICA se determinaron por el método de inmunofluorescencia indirecta con incubación prolongada y los niveles de anticuerpos (IgG) contra H. pylori (HP), por un ELISA utilizando un kit comercial. Se observó frecuencia de anticuerpos (IgG) contra H. pylori del 38,0 % (25/66) en los sujetos ICA + y del 39,6 % (40/101) en los ICA-. No se halló correlación entre la presencia de anticuerpos (IgG) contra H. pylori y los ICA en los grupos estudiados. No hubo diferencias en relación con la presencia de anticuerpos IgG contra H. pylori entre la DM y los controles (47,7 % [31/65] vs. 40,9 % [25/61]). Se encontró alto porcentaje de anticuerpos (IgG) contra H. pylori en los diabéticos tipo 1 (33 %, 7/21) en relación con los controles (14 %, 3/21), pero sin diferencias significativas. Existe mayor frecuencia de anticuerpos contra Helicobacter en los controles adultos, en comparación con los niños (55 %, 22/40 vs. 14 %, 3/21, p = 0,0025). La frecuencia de anticuerpos contra H. pylori está mucho más elevada en los controles adultos quizá por la mayor posibilidad de exposición a reinfecciones. A pesar de estos resultados, no excluimos que la infección por H. pylori esté relacionada con la diabetes tipo 1, porque algunos estudios sugieren que la IgG contra H. pylori no persiste por largo tiempo.66 ICA-positive patients were studied: 21 type 1 diabetics, 24 diabetics initially classified as type 2 and 21 first-degree relatives of type 1 diabetics. They were compared with 101 ICA-negative patients: 20 type 2 diabetics, 20 first-degree relatives, 21 children and 40 non-diabetic adult controls to analyze if the immunolgical response to H. pylori is associated with islet cell antibodies (ICA). The ICA were determined by the indirect immunofluorescence method with prolongued incubation and the levels of antibodies (IgG) versus H. pylori (HP) by an ELISA using a commercial kit. It was observed a frequency of antibodies (IgG) versus H. pylori of 38.0 % (25/66) in ICA-positive patients and of 39.6 % (40/101) in ICA-negative patients. No correlation was found between the presence of antibodies (IgG) versus H.pylori and the ICA in the studied groups. There were no differences as regards the presence of IgG anitbodies versus H. pylori between diabetes mellitus and the controls (47.7 % [31/65] vs. 40.9 % [ 25/61]). It was observed a high percentage of antibodies (IgG) vs. H. pylori in type 1 diabetics (33 %, 7/21) in relation to the controls (14 %, 3/21), but with no significant differences. The frequence of antibodies vs. Helicobacter in adult controls is higher than in children (55 %, 22/40 vs. 3/21, p=0.0025). The frequency of antibodies vs. H. pylori is much more elevated in the adult controls may be because of the greater possibility of exposure to reinfections. In spite of these results, we do not exclude the idea that the infection due to H. pylori is related to type I diabetes, since some studies suggest that IgG versus H. pylori does not persist for a long time.

Se realizó un estudio transversal en 32 diabéticos tipo 1 con 10 o más años de evolución, con edades entre 17 y 40 años, para conocer la frecuencia de disfunción ventricular izquierda (DVI) subclínica y sus factores asociados. Se excluyeron los pacientes que presentaban valvulopatía, cardiopatía isquémica, hipertensión arterial y otras enfermedades que provocan miocardiopatía. A todos se les realizó una historia clínica completa y se les indicó: glucemia en ayunas, hemoglobina glucosilada (HbA1), colesterol total, triglicéridos totales, lipoproteína de alta densidad (HDL-colesterol), excreción urinaria de albúmina (EUA), velocidad de conducción nerviosa motora y sensitiva en los miembros inferiores, electrocardiograma y ecocardiograma a modo M, bidimensional y con Doppler pulsado. Para el diagnóstico ecocardiográfico de DVI se adoptaron los criterios propuestos por la Sociedad Americana de Ecocardiografía. Se comprobó DVI en el 34,3 %. Se observaron alteraciones estructurales cardíacas en el 18,75 %. Se presentó neuropatía periférica en 8/11 pacientes con DVI (72,7 %). Los niveles de EUA fueron significativamente mayores en los afectados de DVI (233,4 ± 176 mg/L). El engrosamiento de septum interventricular y de la pared posterior fue significativamente mayor en pacientes con DVI. Se concluyó que la DVI es una complicación frecuente en el diabético tipo 1, lo que obliga a su búsqueda sistemática en este grupo de pacientesA cross-sectional study of 32 type 1 diabetics aged 17-40 years, with 10 or more years of diabetes profession was conducted to find out the frequency of subclinical left ventricular dysfunction (LVD) and its associated factors. Those patients presenting with valvulopathy, ischemic heart disease, blood hypertension and other diseases leading to myocardiopathy, were excluded. Their complete medical histories were made and they were indicated the following: glycemia in fasting conditions, glycosylated hemoglobin, total cholesterol, total triglycerides, high density lipoprotein, urine excretion of albumin, speed of motor and sensitive nerve conduction in lower limbs, electrocardiogram and pulsed Doppler bidimensional M mode echocardiography. For the echocardiographic diagnosis of left ventricular dysfunction, the criteria submitted by the American Society of Echocardiography were adopted. LVD was confirmed in 34.3 % of patients. Structural cardiac abnormalities were observed in 18.75% of cases; peripheral neuropathy was found in 8 of 11 patients with LVD (72.7%); the levels of urine excretion of albumin were significantly higher in those affected by LVD(233.4±176 mg/L).The thickening of the interventricular septum and the posterior wall was markedly greater in patients with LVD. It was concluded that LVD is a frequent complication in type 1 diabetics, which makes it necessary to systematically look for this disorder in this group of patients

Se realizó un estudio transversal en 32 diabéticos tipo 1 con menos de 10 años de evolución de la enfermedad, edades entre 17 y 40 años, para conocer la frecuencia de disfunción ventricular izquierda (DVI) subclínica y factores asociados a la misma. Se excluyeron los pacientes que presentaron valvulopatías, cardiopatía isquémica, hipertensión arterial y otras enfermedades que provocan miocardiopatías. Se les realizó una historia clínica completa y se les indicó: glucemia en ayunas, HbA1, colesterol total, triglicéridos totales, HDL-colesterol, excreción urinaria de albúmina (EUA), velocidad de conducción motora y sensitiva de los miembros inferiores, electrocardiograma y ecocardiograma modo M, bidimensional y con Doppler pulsado. Se adoptaron los criterios propuestos por la Sociedad Americana de Ecocardiografía para el diagnóstico ecocardiográfico de DVI. Se comprobó DVI en el 25 %. Las alteraciones estructurales cardíacas se observaron en el 6,2 %. La neuropatía periférica se presentó en 6 de 8 pacientes con DVI. Los niveles de EUA fueron significativamente mayores en los afectados de DVI (219,5 ± 170,2 mg/L vs. 66,9 ± 86,9 mg/L). En conclusión, se afirmó que la DVI es de observación relativamente frecuente en los diabéticos con menos de 10 años de evolución y los niveles de EUA pudieran constituir un marcador de riesgo para el desarrollo de esta complicación.A cross-sectional study in 32 type l diabetics aged 17-40 with less than 10 years of evolution of the disease was conducted to know the frequency of subclinical left ventricular dysfunction (LVD) and its associated factors. Patients with valvulopathies, ischemic heart disease, arterial hypertension and other diseases causing myocardiopathies, were excluded. Complete medical histories were obtained and fasting glycemia, HbAl, total cholesterol, total triglycerides, HDL-cholesterol, urinary excretion of albumin (USA), velocity of motor and sensitive conduction of the lower limbs, EKG and mode B bidemensional pulsed Doppler echocardiography were indicated. The criteria proposed by the American Society of Echocardiography for the echocardiographic diagnosis of LVD were adopted. LVD was proved in 25 %. The structural cardiac alterations were observed in 6.2 %. Peripheral neuropathy was observed in 6 of the 8 patients with LVD. The US levels were significantly higher in those affected with LVD (219.5 ± 170.2 mg/L vs 6.9 ± 86.9 mg/L). It was concluded that LVD appears commonly among diabetics with less than 10 years of evolution and that the US levels may be a risk marker for the development of this complication.

Objective: To trace new cases of insulin-dependent diabetes mellitus (IDDM) on an ongoing basis and to estimate the incidence rate and prevalence of IDDM in children 0-19 years of age. Research design and methods: The estimation of the prevalence and incidence rate of IDDM was based on, respectively, the prevalence and the rate of new users of insulin. The data were obtained from pharmacy, patient-based, drug dispensing histories in a well-defined population encompassing 257, 113 individuals in the Netherlands. Results: The IDDM incidence rate was estimated at 11.5 (CI95 6.6-17.8) per 100,000 person years in 1989-1990 in children 0-19 years of age. The prevalence was estimated at 11.0 (CI95 8.6-13.4) per 10,000 children 0-19 years of age. Discussion: The incidence rate is comparable to that found in a large, national survey among all paediatricians and internists in the Netherlands. The method offers ongoing monitoring of the incidence and prevalence of IDDM in children, 0-19 years of age, against low costs. The method is suitable for rapid and cost-efficient recruitment of cohorts of incident IDDM patients, which fosters research to identify and quantify the attribution of different types of aetiologic and prognostic factors of IDDM. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate the incidence rate of type 1 diabetes in the urban area of Santiago, Chile, from March 21, 1997 to March 20, 1998, and to assess the spatio-temporal clustering of cases during that period. METHODS: All sixty-one incident cases were located temporally (day of diagnosis) and spatially (place of residence) in the area of study. Knox's method was used to assess spatio-temporal clustering of incident cases. RESULTS: The overall incidence rate of type 1 diabetes was 4.11 cases per 100,000 children aged less than 15 years per year (95% confidence interval: 3.06--5.14). The incidence rate seems to have increased since the last estimate of the incidence calculated for the years 1986--1992 in the metropolitan region of Santiago. Different combinations of space-time intervals have been evaluated to assess spatio-temporal clustering. The smallest p-value was found for the combination of critical distances of 750 meters and 60 days (uncorrected p-value = 0.048). CONCLUSIONS: Although these are preliminary results regarding space-time clustering in Santiago, exploratory analysis of the data method would suggest a possible aggregation of incident cases in space-time coordinates.

OBJETIVO: O transplante de pâncreas (TP) é atualmente o único tratamento disponível capaz de estabelecer estado euglicêmico permanente e de independência da insulina nos portadores de Diabetes Mellitus Tipo 1. Neste estudo são apresentados os resultados do TP realizados em um centro paranaense. MÉTODO: De janeiro de 2001 até abril de 2003, foram realizados 24 transplantes de pâncreas-rim simultâneos (TPRS), e um Transplante de Pâncreas Isolado (TPI) no Hospital e Maternidade Angelina Caron. RESULTADOS: No seguimento de 8,2 meses (1-27), a taxa de sucesso para pâncreas e rim foi de 74 %. A sobrevida dos pacientes foi de 76 %. A principal causa de insucesso foi trombose pancreática em três casos (12%) e renal em dois (8%). Não ocorreu nenhum episódio de rejeição. Todos os doentes com enxertos funcionantes apresentam-se normoglicêmicos sem necessidade de insulina. CONCLUSÕES: O transplante simultâneo de rim e pâncreas éterapêutica com alto índice de sucesso para pacientes diabéticos com insuficiência renal terminal.