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Aims: The aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022. Materials and Methods: Two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person‐years were calculated by country/region, sex, age, and COVID‐19 pandemic period (pre‐COVID‐19 and pandemic). Results: The study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15–16.29) per 100,000 person‐years. Finland and high‐income North America had the highest IR, with 56.81 (95%CI, 55.91–57.73) and 28.77 (95%CI, 26.59–31.13) per 100,000 person‐years, respectively. The IR was 13.37 (95%CI, 10.60–16.88) per 100,000 person‐years in boys and 13.87 (95%CI, 11.51–16.70) per 100,000 person‐years in girls. There were statistically significant differences among different age ranges: 0–4 versus 5–9 and 10–14 years old (p < 0.001); 5–9 versus 15–19 (p < 0.001) and 10–14 versus 15–19 years old (p = 0.003). Finally, during the pandemic period (2020–2022), the IR was 24.84 (95%CI, 17.16–35.96) per 100,000 person‐years, which was higher but not significant compared with the prepandemic period (2017–2019) of 13.56 (95%CI, 7.49–24.56) per 100,000 person‐years (p = 0.090). Conclusions: The IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM. [ABSTRACT FROM AUTHOR]

Pathogenetic mechanisms of diabetic retinopathy are associated with the toxic effects of hyperglycemia and subsequent activation of stress-sensitive systems. The purpose was to determine the features of immune dysfunction in patients with diabetic retinopathy against the background of metabolic syndrome. Clinical and laboratory examinations of 130 patients with diabetic retinopathy have been carried out (70 insulin-dependent patients - group 1 and 60 insulin-independent patients - group 2). In determining the surveyed individuals' contents of the lymphocyte populations and subpopulations, the monoclonal antibodies were used to CD3+, CD4+, CD8+, CD19+, CD23+, CD25+, CD56+ in the reaction of indirect immunofluorescence with fluorescein-isothiocyanate labeled antibodies and indices were calculated - the ratio of the lymphocyte populations and subpopulations. The population and subpopulation composition of blood lymphocytes were studied, and the ratio of cellular factors of immunity in patients with diabetic retinopathy was calculated. The immune status of patients with diabetic retinopathy is characterized by more pronounced changes in insulin-dependent patients' cellular immunity - the activation of nonspecific killer immunity, suppressor potential and humoral immunity than in insulin-independent patients. The results allow the pathogenetic correction of diabetic retinopathy with the immune imbalance. [ABSTRACT FROM AUTHOR]

To compare pregnancy complications in pregnancies with and without pre-gestational diabetes mellitus (DM) managed in a multidisciplinary high-risk diabetes antenatal clinic. This screening cohort study was undertaken at a large maternity unit in the United Kingdom between January 2010 and December 2022. We included singleton pregnancies that booked at our unit at 11–13 weeks' gestation. Univariate and multivariate logistic regression analysis was carried out to determine risks of complications in pregnancies with type 1 and type 2 DM after adjusting for maternal and pregnancy characteristics. Effect sizes were expressed as absolute risks (AR) and odds ratio (OR) (95 % confidence intervals [CI]). The study population included 53,649 singleton pregnancies, including 509 (1.0 %) with pre-existing DM and 49,122 (99.0 %) without diabetes. Multivariate logistic regression analysis demonstrated that there was a significant contribution from pre-existing DM in prediction of adverse outcomes, including antenatal complications such as fetal defects, stillbirth, preterm delivery, polyhydramnios, preeclampsia and delivery of large for gestational age (LGA) neonates; intrapartum complications such as caesarean delivery (CS) and post-partum haemorrhage; and neonatal complications including admission to neonatal intensive care unit, hypoglycaemia, jaundice and hypoxic ischaemic encephalopathy (HIE). In particular, there was a 5-fold increased risk of stillbirth and HIE. The maternal and neonatal complications in pregnancies with pre-existing DM are significantly increased compared to those without DM despite a decade of intensive multidisciplinary antenatal care. Further research is required to investigate strategies and interventions to prevent morbidity and mortality in pregnancies with pre-gestational DM. [ABSTRACT FROM AUTHOR]

Abstract Background Dysbiotic gut microbiome, genetically predisposed or chemically disrupted, has been linked with insulin-dependent diabetes (IDD) including autoimmune type 1 diabetes (T1D) in both humans and animal models. However, specific IDD-inducing gut bacteria remain to be identified and their casual role in disease development demonstrated via experiments that can fulfill Koch’s postulates. Results Here, we show that novel gut pathobionts in the Muribaculaceae family, enriched by a low-dose dextran sulfate sodium (DSS) treatment, translocated to the pancreas and caused local inflammation, beta cell destruction and IDD in C57BL/6 mice. Antibiotic removal and transplantation of gut microbiota showed that this low DSS disrupted gut microbiota was both necessary and sufficient to induce IDD. Reduced butyrate content in the gut and decreased gene expression levels of an antimicrobial peptide in the pancreas allowed for the enrichment of selective members in the Muribaculaceae family in the gut and their translocation to the pancreas. Pure isolate of one such members induced IDD in wildtype germ-free mice on normal diet either alone or in combination with normal gut microbiome after gavaged into stomach and translocated to pancreas. Potential human relevance of this finding was shown by the induction of pancreatic inflammation, beta cell destruction and IDD development in antibiotic-treated wildtype mice via transplantation of gut microbiome from patients with IDD including autoimmune T1D. Conclusion The pathobionts that are chemically enriched in dysbiotic gut microbiota are sufficient to induce insulin-dependent diabetes after translocation to the pancreas. This indicates that IDD can be mainly a microbiome-dependent disease, inspiring the need to search for novel pathobionts for IDD development in humans. Video Abstract

Biallelic loss-of-function variants in SMPD4 cause a rare and severe neurodevelopmental disorder with progressive congenital microcephaly and early death. SMPD4 encodes a sphingomyelinase that hydrolyses sphingomyelin into ceramide at neutral pH and can thereby affect membrane lipid homeostasis. SMPD4 localizes to the membranes of the endoplasmic reticulum and nuclear envelope and interacts with nuclear pore complexes (NPC). We refine the clinical phenotype of loss-of-function SMPD4 variants by describing five individuals from three unrelated families with longitudinal data due to prolonged survival. All individuals surviving beyond infancy developed insulin-dependent diabetes, besides presenting with a severe neurodevelopmental disorder and microcephaly, making diabetes one of the most frequent age-dependent non-cerebral abnormalities. We studied the function of SMPD4 at the cellular and organ levels. Knock-down of SMPD4 in human neural stem cells causes reduced proliferation rates and prolonged mitosis. Moreover, SMPD4 depletion results in abnormal nuclear envelope breakdown and reassembly during mitosis and decreased post-mitotic NPC insertion. Fibroblasts from affected individuals show deficient SMPD4-specific neutral sphingomyelinase activity, without changing (sub)cellular lipidome fractions, which suggests a local function of SMPD4 on the nuclear envelope. In embryonic mouse brain, knockdown of Smpd4 impairs cortical progenitor proliferation and induces premature differentiation by altering the balance between neurogenic and proliferative progenitor cell divisions. We hypothesize that, in individuals with SMPD4-related disease, nuclear envelope bending, which is needed to insert NPCs in the nuclear envelope, is impaired in the absence of SMPD4 and interferes with cerebral corticogenesis and survival of pancreatic beta cells. [ABSTRACT FROM AUTHOR]

In Bangladesh, diabetes mellitus is a substantial public health concern, and its prevalence is rising steadily. Many other mechanisms can cause diabetes in childhood; most children develop type 1 diabetes mellitus primarily due to immune system-mediated ß cell death, while type 2 diabetes mellitus is characterized by insulin resistance-related ß cell failure. The long-term effects of micro and macrovascular illnesses impose a tremendous strain on those frequently affected early in middle age. The increased prevalence of diabetes in children and the excessive morbidity linked to its effects highlight the significance of preventive measures for future generations. It is essential to look into the possibilities for improvement in school-oriented diabetes management interventions. Consistent engagement and communication on diverse theoretical concepts, performing exploratory assessments to guide interventions, and conducting an operational valuation are necessary to enhance these programs. Furthermore, it is required to identify the significant challenge of the general food milieu and its influence on children's diets with more participation from related parties like families, stores, and supermarkets. The fast urbanization of Bangladesh may affect the local population's way of living, there may be a genetic predisposition to diabetes in the country, or both could be responsible for the growth in childhood diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: Dysbiotic gut microbiome, genetically predisposed or chemically disrupted, has been linked with insulin-dependent diabetes (IDD) including autoimmune type 1 diabetes (T1D) in both humans and animal models. However, specific IDD-inducing gut bacteria remain to be identified and their casual role in disease development demonstrated via experiments that can fulfill Koch's postulates. Results: Here, we show that novel gut pathobionts in the Muribaculaceae family, enriched by a low-dose dextran sulfate sodium (DSS) treatment, translocated to the pancreas and caused local inflammation, beta cell destruction and IDD in C57BL/6 mice. Antibiotic removal and transplantation of gut microbiota showed that this low DSS disrupted gut microbiota was both necessary and sufficient to induce IDD. Reduced butyrate content in the gut and decreased gene expression levels of an antimicrobial peptide in the pancreas allowed for the enrichment of selective members in the Muribaculaceae family in the gut and their translocation to the pancreas. Pure isolate of one such members induced IDD in wildtype germ-free mice on normal diet either alone or in combination with normal gut microbiome after gavaged into stomach and translocated to pancreas. Potential human relevance of this finding was shown by the induction of pancreatic inflammation, beta cell destruction and IDD development in antibiotic-treated wildtype mice via transplantation of gut microbiome from patients with IDD including autoimmune T1D. Conclusion: The pathobionts that are chemically enriched in dysbiotic gut microbiota are sufficient to induce insulin-dependent diabetes after translocation to the pancreas. This indicates that IDD can be mainly a microbiome-dependent disease, inspiring the need to search for novel pathobionts for IDD development in humans. BraSzCKLkea6-Duo39HsMT Video Abstract [ABSTRACT FROM AUTHOR]

The recent increase in life expectancy has resulted in an increase in the number of older adults with diabetes mellitus. In addition to type 2 diabetes, in which aging is a well‐known risk factor, individuals with type 1 and other types of diabetes are also increasing owing to longevity in the general population and improved prognosis of the disease and comorbidities. Insulin‐dependent state in type 1 diabetes and other types of diabetes, such as diabetes after pancreatectomy, inevitably requires insulin treatment for survival; however, daily injection of insulin is often hampered in older adults due to impaired cognitive function or limited activities of daily living. In this review, we aimed to discuss the current situation of insulin‐dependent diabetes mellitus in older adults and highlight future prospects. Geriatr Gerontol Int 2022; 22: 549–553. [ABSTRACT FROM AUTHOR]

Introduction: Research objectives of present study were to examine sex and age-related specifics of diabetic retinopathy according to the therapy approach and duration of diabetes mellitus. The study also aimed to determine the association between the presence of diabetic retinopathy and diabetes duration as a prognostic factor of retinopathy progression in such patients. Materials and Methods: The study was designed as a retrospective study and included 289 patients with diabetic retinopathy, who were treated at the Department of Ophthalmology of the General Hospital “Dr. Josip Benčević” in Slavonski Brod during the period from 2019 to 2020. Results: 176 patients were treated with oral antidiabetic drugs (OAD), while 113 patients were insulin-dependent. The median age of patients treated with OAD was 77 years. Diabetic retinopathy was present in 35 (19.9%) patients, of whom 33 (18.8%) had non-proliferative diabetic retinopathy, while 2 patients (1.1%) had proliferative diabetic retinopathy. The median age of the insulin-dependent patients was 79 years. Diabetic retinopathy was present in 54 patients (47.8%), non-proliferative diabetic retinopathy was diagnosed in 51 patients (45.1%), while proliferative diabetic retinopathy was diagnosed in only 3 (2.7%) patients. There was a significant difference between the presence of diabetic retinopathy and diabetes duration (P

The management of diabetes mellitus in an insulin-dependent patient is challenging in the setting of concomitant antibody-mediated-insulin hypersensitivity. We report a case of a 62-year-old woman with pre-existing type 2 diabetes mellitus of 10 years duration who developed type 3 hypersensitivity reaction to insulin analogue detemir, and subsequently, severe diabetic ketoacidosis (DKA). She was C-peptide negative and was diagnosed with insulin-dependent diabetes. Despite increasing dose adjustments, insulin-meal matching, and compliance with insulin, she experienced episodes of unexpected hyperglycaemia and hypoglycaemia. The development of rash after detemir initiation and rapid progression to DKA suggests an aberrant immune response leading to the insulin allergy and antibody-induced interference with insulin analogues. Glycaemic control in the patient initially improved after being started on subcutaneous insulin infusion pump with reduced insulin requirements. However, after a year on pump therapy, localised insulin hypersensitivity reactions started, and glycaemic control gradually deteriorated. [ABSTRACT FROM AUTHOR]

The management of diabetes mellitus in an insulin-dependent patient is challenging in the setting of concomitant antibody-mediated-insulin hypersensitivity. We report a case of a 62-year-old woman with pre-existing type 2 diabetes mellitus of 10 years duration who developed type 3 hypersensitivity reaction to insulin analogue detemir, and subsequently, severe diabetic ketoacidosis (DKA). She was C-peptide negative and was diagnosed with insulin-dependent diabetes. Despite increasing dose adjustments, insulin-meal matching, and compliance with insulin, she experienced episodes of unexpected hyperglycaemia and hypoglycaemia. The development of rash after detemir initiation and rapid progression to DKA suggests an aberrant immune response leading to the insulin allergy and antibody-induced interference with insulin analogues. Glycaemic control in the patient initially improved after being started on subcutaneous insulin infusion pump with reduced insulin requirements. However, after a year on pump therapy, localised insulin hypersensitivity reactions started, and glycaemic control gradually deteriorated.

It remains debatable whether vitamin D plays any role as a risk factor for type 1 diabetes mellitus (T1DM). We have summarized the effect of circulating 25-hydroxy vitamin D [25(OH)D] concentration on the risk of developing T1DM via a dose-response meta-analysis. We undertook a database search on PubMed, Embase, and Cochrane Library from inception to January 2020. A meta-analysis based on random-effects model was applied. Subgroup analysis and meta-regression were performed to inspect the source of heterogeneity. Dose-response data were examined using the generalized least squares trend estimation method. This study was registered with the PROSPERO (ID: CRD42020166174). In total, 16 studies including 10,605 participants (3913 case patients) were included. The pooled odds ratios (OR) and 95% confidence intervals (95% CI) for the highest versus the lowest 25(OH)D concentration was 0.39 (0.27, 0.57), with a high heterogeneity (I2 = 76.7%, P < 0.001). Meta-regression analysis identified latitude (P = 0.02), adjustment for gender (P = 0.001), and 25(OH)D stratification (P < 0.001) as sources of heterogeneity. Furthermore, the nonlinear dose-response analysis determined the OR (95% CI) of T1DM to be 0.91 (0.90, 0.93) per 10 nmol/L increase in the 25(OH)D concentration. A 'U'-shaped association was found between serum 25(OH)D concentration and risk of T1DM. The present study highlights the significant inverse association between the circulating 25(OH)D concentration and the risk of T1DM. [ABSTRACT FROM AUTHOR]

Background: Brown adipose tissue (BAT) is essential to maintain body temperature. Its ability to convert chemical energy in glucose and free fatty acids to heat is conferred by a unique protein, UCP‐1. BAT activity is greatest in children and adolescents, declining through adulthood. Blood glucose concentrations outside the normal nondiabetic range are common in type 1 diabetes and hyperglycaemia leads to insulin resistance in muscle and white adipose tissue, but whether this applies to BAT, is not known. Method: To investigate the effect of type 1 diabetes on BAT activity, we measured the supraclavicular temperature of 20 children with type 1 diabetes and compared them to 20 age‐matched controls, using infrared thermography. Results: The diabetes group had lower stimulated supraclavicular temperatures (diabetes group: 35.03 (34.76–35.30)°C; control group: 35.42 (35.16–35.69)°C; p = 0.037) and a reduced response in relative temperature following cold stimulation, after adjusting for BMI (diabetes group: 0.11 (0.03–0.18)°C; control group: 0.22 (0.15–0.29)°C; p = 0.034). In the diabetes group, there was no association between glycaemic measures and supraclavicular temperatures, but the method of insulin delivery may significantly affect the change in supraclavicular temperature with stimulation (injections: 0.01 (−0.07–0.09)°C; pump: 0.15 (0.04–0.26)°C; p = 0.028). Conclusions: While further work is needed to better understand the glucose‐insulin‐BAT relationship, one possible explanation for the reduced supraclavicular temperature is that exogenous, unlike endogenous, insulin, is not suppressed by the activity of the sympathetic nervous system, preventing lipolysis‐driven activation of BAT. [ABSTRACT FROM AUTHOR]

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To examine the prevalence of eating disorder symptoms (EDS) in 16 years and older individuals with insulin-dependent diabetes including both clinical and subclinical eating disorder symptoms. We searched PubMed, Embase, Scopus, PsycINFO, and CINAHL databases to discover studies reporting prevalence of eating disorder symptoms in patients with insulin-dependent diabetes (both type 1 and type 2). We performed a meta-analysis to estimate the pooled prevalence of eating disorder symptoms and an independent meta-analysis to estimate the prevalence of insulin omission. A total of 45 studies were included in the meta-analysis of eating disorder symptoms. Diabetes Eating Problem Survey (DEPS-R) was the most frequently used screening tool (in 43 % of studies, n = 20). The pooled prevalence of eating disorder symptoms was 24 % (95 % CI 0.21–0.28), whereas in studies using DEPS-R, it was slightly higher, 27 % (95 % CI 0.24–0.31), with the prevalence ratio (PR) of 1.1. The prevalence differed between screening tools (χ2 = 85.83, df = 8, p <.0001). The sex distribution was associated with the observed prevalences; in studies with a higher female prevalence (>58 %), the pooled eating disorder symptom prevalence was higher [30 % (95 % CI 0.26–0.34) vs. 18 % (95 % Cl 0.14–0.22), PR 1.7]. The prevalence of insulin omission was 21 % (95 % CI 0.13–0.33). Eating disorder symptoms and insulin omission are common in patients with insulin-dependent diabetes regardless of age. DEPS-R is the most used screening tool. Studies with a higher proportion of female participants report higher prevalence rates. [Display omitted] • Eating disorder symptoms affect 24 % of patients with insulin-dependent diabetes. • DEPS-R is the most used tool to screen eating disorders in patients with diabetes. • Prevalence of insulin omission in adults with insulin-dependent diabetes is 21 %. [ABSTRACT FROM AUTHOR]

Objective: Having a rapid and low cost diagnostic approach in assessment of fetal wellbeing is an important goal for prenatal care process. The aim of this study was to determine the diagnostic value of rapid biophysical profile (rBPP) in comparison to biophysical profile (BPP). Materials and methods: In this study 142 pregnant women with insulin-dependent diabetes referred to Besat Hospital (Sanandaj, Iran) were evaluated in terms of fetal health. Age, gestational age and non-stress test (NST) data of patients were collected. The fetuses were evaluated using the standard BPP and selected rBPP methods. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated. The receiver operating characteristic (ROC) curve was plotted. The data were analyzed in Stata 14 software, using appropriate statistical analyses. Results: The mean ± standard deviation (SD) of maternal age and gestational age of the studied subjects were 30.6 ± 6.3 and 35.6 ± 1.5 weeks, respectively. The frequency of normal cases were 126 (88.7%) in the BPP method and 121 (85.2%) in the rBPP method. The results showed that sensitivity, specificity, PPV and NPV of rBPP in this study were 56.2%, 90.5%, 42.8% and 94.2%, respectively. The area under the ROC curve was 73.3%. Pearson Test showed a significant correlation between scores obtained through BPP and rBPP methods (p < 0.001). Conclusion: Considering the high profile of the sensitivity and PPV of the RBPP method compared to BPP, rBPP method has a better capacity to discriminate non-distressed fetuses from distress-exposed fetuses. It can also be used as a quick and easy method in crowded centers with limited evaluation tests, where not much skill is needed.

Eating disorders are becoming an increasingly common problem. This problem becomes particularly dangerous when it concerns specific groups in which the occurrence of any nutritional irregularities constitutes a serious threat to health and even life. This is the case for diabulimia, which I will present in more detail in this article. Personality predispositions and socio-cultural factors are determined as the main risk factors of development of eating disorders, inclusive diabulimia. [ABSTRACT FROM AUTHOR]

Background: Self-efficacy is a crucial factor in controlling adolescents with insulin-dependent diabetes mellitus (IDDM). Subsequently the negative behavioral reactions such as aggression adversely affect on self-efficacy. Therefore, interventions are essential to reduce the aggression and to improve the self- efficacy in these patients. Aim: To determine the efficacy of the modified "aggression replacement training" program on self-efficacy of adolescents with insulin-dependent diabetes. Methods: In this clinical trial, 70 adult subjects with IDDM who were referred to Parsian Diabetes clinic of Mashhad in 2014 were divided into two groups of intervention and control. The intervention program, including three aspects including: anger control training, social skills training and moral reasoning training was performed in five sessions, each 1.5-2 hours. A five-day interval was between the sessions and each group consisted of 8-10 individuals. The self-management standard questionnaire of “insulin-dependent diabetes management self-efficacy scale (IDMSE)” was filled before the intervention and two months afterwards. Data were analyzed using SPSS version 11.5 with paired and Independent t-tests. Results: In this study, 38.5 and 61.5 percent of the subjects were boys and girls, respectively with total mean age of 15.9±2. The self-efficacy of the subjects before the intervention was not significantly different within the groups (p=0/57). Nevertheless in post-intervention assessment, the self-efficacy of the Intervention group significantly increased (49.0±11.1) compared to the control group (33.7±5.5) (p

Wolcott-Rallison syndrome is a rare disease presenting with insulin-dependent diabetes mellitus (DM) before 6 months old, skeletal dysplasia after 6 months old, and liver failure. Other manifestations are renal failure, microcephaly, epilepsy, central hypothyroidism, neutropenia, and dental and dermal problems. The cases were 2 patients from 2 different states of Iran (Khoozestan and Fars) who had developed DM before 6 months old. The first one was a 7-month-old infant who was healthy; in the genetic study (screening), autosomal recessive pattern and novel deletion in EIF2AK3 were reported; her sister had died at 5.5 years old due to diabetic ketoacidosis (DKA) that was associated with liver and renal failure. The second patient had developed DKA at 45 days old, which was associated with mild acute tubular necrosis and abnormal coagulation tests at onset clinical presentation, which were then resolved. He was treated with insulin, and at follow-up, the laboratory data are normal; in the genetic study, EIF2AK3 nonsense homozygous mutation was diagnosed. Genetic study of patients with insulindependent DM before 6 months old, especially those with DKA and associated with or without other disorders; attention to novel deletion of in EIF2AK3 gene; screening for skeletal dysplasia after 1 year old; and renal, liver, pancreatic, and thyroid function tests are recommended. [ABSTRACT FROM AUTHOR]

Blood glucose levels fluctuate considerably in diabetic patients with reduced secretion of endogenous insulin. We previously reported that glucagon is secreted excessively in these patients and that taurine increases glucagon secretion in vitro. Therefore, we hypothesized that glucose tolerance would further deteriorate when taurine was administered to diabetic mice incapable of insulin secretion. We generated four groups of streptozotocin (STZ)-treated C57BL/6J mice (STZ-mice): STZ-mice without taurine treatment (STZ-Con), STZ-mice treated with 0.5% (w/v) taurine (STZ-0.5% Tau), STZ-mice treated with 1% (w/v) taurine (STZ-1% Tau), and STZ-mice treated with 2% (w/v) taurine (STZ-2% Tau). Mice were treated for 4 weeks, and then, we evaluated glucose tolerance, pancreatic β-cell area and α-cell area, pancreatic insulin and glucagon content, and daily blood glucose variability. As a result, following the administration of taurine, glucose tolerance improved, both pancreatic β- and α-cell area increased, and both insulin and glucagon content increased. In the 1% taurine administration group, blood glucose variability decreased. These unexpected results suggest that taurine improves glucose tolerance, in spite of its subsequent increased glucagon production, partly by increasing pancreatic β-cells and insulin production in vivo. [ABSTRACT FROM AUTHOR]

Background Obesity not only increases the chances of developing diabetes—one of the top causes of death in the United States—but it also results in further medical complications. Objective To compare the 6-month and 1-year postoperative remission rates of type 2 diabetic (T2D) patients after bariatric surgery based on preoperative glycosylated hemoglobin (A1C) stratification and pharmacologic therapy: insulin-dependent diabetic (IDD) versus noninsulin-dependent diabetic (NIDD). Setting Academic hospital, United States. Methods We retrospectively analyzed a prospectively maintained database of 186 obese patients with a diagnosis T2D who had undergone either a sleeve gastrectomy or a Roux-en-Y gastric bypass surgery at our hospital. Results At 6 months (n = 180), patients who were stratified by preoperative A1C levels (<6.5; ≥6.5 to<8; ≥8) had 70.5%, 51.7%, and 30.0% remission rates ( P <.001) and at 1 year (n = 118) patients had 72.0%, 54.0%, and 42.8% remission rates ( P = .053 ), respectively. When patients were substratified by preoperative pharmacologic therapy, IDD and NIDD patients had different remission rates within the same A1C level. At 6-months follow-up within A1C ≥6.5 to<8 (IDD versus NIDD), the remission rate was 23.5% versus 64.1% (odds ratio [OR]: .173, confidence interval [CI]: .0471, .6308, P = .0079), and within A1C ≥8 the remission was 24.0% versus 37.5% (OR: .5263, CI: .2115, 1.3096, P = .1676), respectively. At 1-year follow-up within A1C ≥6.5 to<8, the remission rate was 30.0% versus 62.9% (OR: .2521, CI: .0529, 1.2019, P = .0838), and within A1C ≥8 the remission was 31.4% versus 61.9% (OR: .2821, CI: .0908, .8762, P = .0286), respectively. Furthermore, when IDD patients were compared between A1C ≥6.5 to<8 and A1C ≥8 the remission rates were nearly identical, and for NIDD patients A1C was not significantly associated with remission regardless of the level, except at 6 months. Conclusion While a difference was observed between overall A1C levels—the lower the A1C level, the higher the remission rate—IDD patients had lower remission rates than NIDD patients irrespective of A1C levels; further, IDD patients performed similarly across A1C levels. [ABSTRACT FROM AUTHOR]

Introduction Type 1 diabetes mellitus (T1DM) is an autoimmune disease that impacts roughly 200,000 youths in the United States. Many patients have limited access to specialist care. Therefore, general pediatricians are expected to be skilled in the management of diabetes. Recent studies suggest that an educational gap exists for general practitioners regarding diabetes care. Team-based learning (TBL), an active, learner-centered method of teaching, has been shown to be an effective tool in adult learning and teaching. Here, we outline a TBL activity focused on the education of pediatric residents in the comprehensive management of T1DM. Methods Learners prepare in advance by reading through a review article on T1DM. They are formed into groups and work through the readiness assurance process first, followed by application exercises. The application exercises focus on choosing and applying an insulin regimen to a patient with a new diagnosis of T1DM, including modification of this regimen based on blood sugar trends, management of diabetes ketoacidosis, and recognition and management of hypoglycemia. Results Learners showed improvement in their readiness assurance testing, from 81.4% individually to 91% as a group. Eighty percent of learners agreed or strongly agreed this was an effective method for improving diabetes skills and knowledge, and the learning process engaged them. Discussion TBL may be a valuable educational strategy to enhance knowledge of T1DM care for general pediatricians. Future studies focusing on longitudinal educational outcomes would be beneficial.

Introduction: Insulin-dependent diabetes has been considered a scuba diving contraindication. This is currently being reconsidered for well-controlled diabetes. We developed a real-time continuous glucose monitor (CGM) to check glycemia, or blood glucose (BG), during diving, both for prospective studies and to increase diabetic diver safety, allowing for real-time control of glycemia and hypoglycemia prevention. To ensure CGM measurement accuracy we tested the method under hyperbaric conditions. Materials and methods: Two experienced diabetic divers were studied during a one-week diving cruise. BG was monitored every five minutes on every dive, by a dedicated CGM, and values were visible to the divers throughout their dives. The mean of relative difference (MRD) between CGM and capillary blood glucose was calculated. Measurement accuracy was assessed according to ISO guideline 15197 and by Clarke Error Grid (CEG) analysis. Results: Both divers showed gradual BG decrease during diving. Hyperbaric chamber accuracy tests showed two of 26 MRD values (7.7%) slightly exceeding the ISO-15197 allowed difference (5%). However, our data suggest that this discrepancy may have been an artefact. Discussion: Our data (even limited to two subjects only) agree with the current literature showing that also in our investigated subjects diving does not imply significant risks of hypoglycemia. The use of a real-time CGM by diabetic divers during their dives can provide immediate information on BG values and trends, thus significantly improving diving safety. The accuracy tests comparing continuous glucose monitoring (CGM) and capillary blood glucose measurement (CBM) data recorded under hyperbaric conditions showed that data recorded under pressure are very close to the ISO-15197 and CEG acceptable limits. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to assess the indirect costs of six major autoimmune diseases including seropositive rheumatoid arthritis, other types of rheumatoid arthritis, psoriasis, multiple sclerosis, Type 1 diabetes, and ulcerative colitis.Methods: Relevant data for 2012 on sick leave and short- and long-term work disabilities were obtained from the Social Insurance Institution in Poland. Indirect costs were estimated using the human capital approach based on gross domestic product per capita, gross value added per worker, and gross income per worker in Poland in 2012 and expressed in euro.Results: We recorded data on the total number of 45,500 patients. The total indirect costs were EUR 146,862,569; 353,683,508; and 108,154,271, calculated using gross domestic product, gross value added, and gross income, respectively.Conclusions: Considering only data on absenteeism collected by the Social Insurance Institution in Poland, we can conclude that the selected autoimmune diseases are associated with great indirect costs. [ABSTRACT FROM AUTHOR]

Diabetes and chronic kidney disease (CKD) consistently rank among the top ten conditions in prevalence and mortality in the United States. Insulin-dependent diabetes (IDD) and CKD each increase the risk of skeletal fractures and fracture-related mortality. However, it remains unknown whether these conditions have interactive end-organ effects on the skeleton. We hypothesized that combining IDD and CKD in mice would cause structural and mechanical bone alterations that are more deleterious compared to the single disease states. Female C57BL6/J mice were divided into four groups: 1) N = 12 Control (CTRL), 2) N = 10 Streptozotocin-induced IDD (STZ), 3) N = 10 Adenine diet-induced CKD (AD), and 4) N = 9 Combination (STZ+AD). STZ administration resulted in significantly higher blood glucose, HbA1c (p < 0.0001), and glucose intolerance (p < 0.0001). AD resulted in higher blood urea nitrogen (p = 0.0002) while AD, but not STZ+AD mice, had high serum parathyroid hormone (p < 0.0001) and phosphorus (p = 0.0005). STZ lowered bone turnover (p = 0.001). Trabecular bone volume was lowered by STZ (p < 0.0001) and increased by AD (p = 0.003). Tissue mineral density was lowered by STZ (p < 0.0001) and AD (p = 0.02) in trabecular bone but only lowered by STZ in cortical bone (p = 0.002). Cortical porosity of the proximal tibia was increased by AD, moment of inertia was lower in both disease groups, and most cortical properties were lower in all groups vs CTRL. Ultimate force, stiffness, toughness, and total displacement/strain were lowered by STZ and AD. Fracture toughness was lower by AD (p = 0.003). Importantly, Cohen's D indicated that STZ+AD most strongly lowered bone turnover and mechanical properties. Taken together, structural and material-level bone properties are altered by STZ and AD while their combination resulted in greater detriments, indicating that improving bone health in the combined disease state may require novel interventions. • IDD and CKD can be reliably induced together in C57BL/6 mice. • STZ and STZ+AD mice demonstrate persistent hyperglycemia and glucose intolerance. • AD, but not STZ+AD mice, show hyperparathyroidism and increased serum phosphorus. • STZ+AD mice have detriments in bone turnover, structural, and mechanical properties. • The magnitude of changes in skeletal properties were frequently greatest in STZ+AD. [ABSTRACT FROM AUTHOR]

Introduction: Immune checkpoint inhibitor-associated diabetes mellitus (ICI-DM) is a rare adverse event. In this study, we characterize clinical outcomes of patients with ICI-DM and evaluate survival impact of this complication on melanoma patients. Research design & methods: We conducted a retrospective review of 76 patients diagnosed with ICI-DM from April 2014 to December 2020. Results: 68% of patients presented in diabetic ketoacidosis, 16% had readmissions for hyperglycemia, and hypoglycemia occurred in 70% of patients after diagnosis. Development of ICI-DM did not impact overall survival or progression-free survival in melanoma patients. Conclusion: Development of ICI-DM is associated with long-term insulin dependence and pancreatic atrophy; the use of diabetes technology in this patient population can help improve glycemic control.

Nivolumab, a blockade of programmed cell death 1, is now administrated for advanced malignant melanomas. Nivolumab-associated adverse events include organ-specific autoimmune disorders; autoimmune thyroid disease, vitiligo and insulin-dependent diabetes. However, predisposed persons are currently unknown. Here, we report serological aggravation of autoimmune thyroid disease in two cases receiving nivolumab: one with Hashimoto disease and another with probable subclinical Hashimoto disease. We should verify if nivolumab-related hypothyroidism and hyperthyroidism are predisposed to occur in euthyroid individuals with subclinical autoimmune thyroid disease. [ABSTRACT FROM AUTHOR]

Background and purpose: Adolescents with diabetes are faced with some constraints and may show some negative reactions such as aggressive behavior. These behaviors increase the level of glycosylated hemoglobin in these patients. It is important to assess some interventions that reduce aggression and improve glycosylated hemoglobin level in diabetic adolescents. This study aimed at determining the effect of implementation of the modified aggression replacement training program (ART) on glycosylated hemoglobin levels in adolescents with insulin-dependent diabetes. Materials and methods: A clinical trial was conducted in 70 adolescents suffering insulin-dependent diabetes attending Parsian Diabetes clinic in Mashhad, 2014. They were divided into two groups: a control (n= 35) and intervention (n= 35) group. The intervention program comprised five sessions of 1.5-2 hours. The sessions were held at five days intervals and each group consisted of 8-10 individuals. Glycosylated hemoglobin tests were performed before the intervention and two months later. Data was analyzed in SPSS by student t-test and Chi-square test. Results: Before the intervention the glycosylated hemoglobin levels were not significantly different between the two groups (P=0.457). But in post-intervention phase, the glycosylated hemoglobin levels decreased significantly in intervention group (8.7±1.4) compared to the control group (9.6±1.5) (P<0.017). Conclusion: The modified ART could be effective in reducing glycosylated hemoglobin levels in adolescents with insulin-dependent diabetes. Therefore, it is recommended as part of a comprehensive treatment for diabetes. [ABSTRACT FROM AUTHOR]

Objective: To establish the prevalence of sensorineural hearing loss (SNHL), as well as the predisposing risk factors, in children and adolescents with type 1 diabetes mellitus (T1DM) attending the Service of Endocrino-Pediatrics and Otolaryngology Department of the "Dr. José Eleuterio González" University Hospital and the Materno-Infantil Hospital, from January 2011 to December 2012. Material and methodsL A total of 84 children with T1DM, with ages between 6 and 18 years old, were studied. Values of glycated hemoglobin (HbA1c) were assessed and Tonal audiometry and Speech audiometry tests were performed. Results: A total of 84 patients with a diagnosis of T1DM were studied, out of which 12 (14.3%) presented SNHL. Fifty percent of patients with hearing loss were in the age range of 10-13 years old. Regarding time of evolution with the disease (T1DM), 33% of patients with more than 5 years with T1DM presented SNHL, and nearly 88.9% of the patients with less than 5 years with T1DM presented normal hearing (p = 0.011). Moreover, 65.47% of the patients presented complications due to poor glycemic control at some point in the evolution of their disease. All (100%) diabetic patients with SNHL and 91% of the patients without SNHL had HbA1c values greater than 6%. In patients with hearing impairments, 83.3% suffered mild and 16.4% suffered moderate hearing loss. Most presented bilateral hearing loss, with the right ear dominating. Acute frequencies, mainly 8000 kHz, were the most affected. Conclusion: SNHL prevalence among our diabetic population was 14.3%, which indicates that a sixth of our diabetic type 1 population will develop SNHL. According to the results obtained, SNHL is more frequent among patients who have had T1DM for more than 5 years. Nevertheless, more studies are required to confirm that there is a relation between time spent with the disease and SNHL. [ABSTRACT FROM AUTHOR]

Aims: Insulin degludec is a new-generation ultra-long-acting basal insulin which offers a significantly more predictable glucose-lowering effect than other long-acting insulin analogues. The aim of this study was to compare the effect of treatment with insulin degludec and long-acting insulin analogues glargine and detemir in type 1 diabetic (T1D) patients by means of a systematic review and meta-analysis. Methods: The following electronic databases were searched up to January 2014: MEDLINE, EMBASE and The Cochrane Library. Additional references were obtained from the reviewed articles. There were included randomised controlled trials of at least 12-week duration with basal-bolus regimen therapies in T1D patients. Results: Current analysis included four studies involving 1,846 T1D patients. The combined data from all trials showed a statistically significant reduction in the basal insulin dose (MD −0.042, 95 % CI −0.067 to −0.018, p = 0.001) and the total daily insulin dose (MD −0.072, 95 % CI 0.016 to −0.027, p = 0.002) in the degludec group compared to other long-acting analogues. There was also a significant reduction of nocturnal hypoglycaemia in the degludec group compared to the controls (rate ratio 0.697, 95 % CI 0.617-0.786, p = 0.000). There were no differences between the groups in terms of glycated haemoglobin values, fasting plasma glucose (FPG) and adverse events. Conclusions: Basal-bolus treatment with insulin degludec was superior to long-acting insulin analogues detemir and glargine in reducing the rate of nocturnal hypoglycaemia. In comparison with other long-acting analogues, treatment with insulin degludec was safe and patients obtained similar metabolic control expressed by HbA1c and FPG levels with the added benefit of a reduced basal and total insulin dose. [ABSTRACT FROM AUTHOR]

Abstract: For more than half a century glucagon has been used as a critical care medicine in the treatment of life-threatening hypoglycemia. It is commercially supplied as a lyophilized powder intended to be solubilized in dilute aqueous hydrochloric acid immediately prior to administration. We have envisioned a “ready-to-use” glucagon as a drug of more immediate and likely use. Through a series of iterative changes in the native sequence we have identified glucagon analogs of appreciably enhanced aqueous solubility at physiological pH, and of chemical stability suitable for routine medicinal use. The superior biophysical properties were achieved in part through adjustment of the isoelectric point by use of a C-terminal Asp-Glu dipeptide. The native glutamines at positions 3, 20 and 24 as well as the methionine at 27 were substituted with amino acids of enhanced chemical stability, as directed by a full alanine scan of the native hormone. Of utmost additional importance was the dramatically enhanced stability of the peptide when Ser16 was substituted with alpha,aminoisobutyric acid (Aib), a substitution that stabilizes peptide secondary structure. The collective set of changes yield glucagon analogs of comparable in vitro and in vivo biological character to native hormone but with biophysical properties much more suitable for clinical use. [Copyright &y& Elsevier]

Our objective is focused on studying self-concept and adaptation to the process of disease in diabetic pediatric patients. The assessment tools used were an ad-hoc self-report for the socio-demographic and illness variables, the questionnaire of self-concept Garley (CAG), and the questionnaire of adaptive response to the disease in diabetic patients. The sample consisted of 23 subjects evaluated at a single time of measurement, all of them children and adolescents aged between 8 and 16 years of age. The results show that about 50% of the children and adolescents with type I diabetes had a low self-concept in most of the studied dimensions, being especially significant that about 30% of the studied children have a very low self-concept. Moreover, most of the subjects presented a little adaptive behavior before their illness. [ABSTRACT FROM AUTHOR]

Objective: Using claims data from an integrated payer-provider, we compared costs incurred by patients with insulin-dependent diabetes mellitus (IDDM) who received Hospital Inpatient/Observation/EmeRgency Department care (HIghER care) for diabetes-related events with those who did not receive such care to identify a target population for interventions in future studies., Methods: A retrospective study pooled real-world claims data for IDDM (type 1 or type 2) between July 1, 2018, and June 30, 2019. Medical claims were used to calculate the total and diabetes-related allowed medical costs to the enterprise and per member per month costs., Results: Medical and prescription drug coverage from 19 378 members was analyzed. Only 8.4% of the IDDM population received HIghER care but incurred 20% of medical expenses and nearly 40% of diabetes-related medical costs. For HIghER care patients, medical spending was higher in every inpatient and outpatient category (Wilcoxon 2-sample tests, all P < .0001). Non-diabetes-related prescription drug costs were greater in this group (Wilcoxon test, Z = 2.2879, P = .0221), whereas diabetes-related prescription drug costs were higher for non-HIghER care (Wilcoxon test, Z = -9.5918, P < .0001). In a longitudinal study of 29 602 patients over 24 months, previous-year receipt of HIghER care was a significant predictor of HIghER care the subsequent year (odds ratio, 3.28)., Conclusion: Medical spending for patients receiving HIghER care was disproportionately high and greater in every inpatient and outpatient category. HIghER care receipt the previous year was highly predictive of HIghER care episodes the following year., (Copyright © 2022 AACE. Published by Elsevier Inc. All rights reserved.)

A possible etiologic role of enteroviruses for type 1 diabetes has been researched for 40 years, but evidence to date is inconclusive. This article summarizes new evidence from Cuban research supporting a role for enteroviruses, both in preclinical stages of autoimmune reactions against pancreatic β cells and at clinical onset, in a population with low type 1 diabetes incidence. Possible pathogenetic mechanisms are also discussed, such as acute cytolytic damage and molecular mimicry. Although direct causal effects of enteroviruses in type 1 diabetes are difficult to demonstrate, arguments supporting their role in type 1 diabetes pathogenesis should not be ignored; and confirmation could contribute to development of more effective preventive strategies. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the effect of α-lipoic acid (ALA) on the occurrence of diabetic macular edema. Methods: Randomized, double-blind, placebo-controlled, multicenter, multinational study. Patients were randomized to the treatment group with 600 mg ALA per day or the placebo group. Every 6 months stereo fundus photographs, HbA1c levels, and an ophthalmological examination were documented. The primary endpoint was the occurrence of clinically significant macular edema (CSME) within a follow-up period of 2 years. Results: We randomized 235 patients with type II diabetes mellitus into the treatment group (mean age 58.0 years) and 232 into the placebo group (mean age 57.9 years). Mean HbA1c level was 8.1, with no significant differences between the treatment (mean 8.2, SD ± 1.35) and placebo groups (mean 8.1, SD ± 1.29). HbA1c values remained constant over time. In the treatment and placebo groups, 84 and 86 patients (35.7 and 37.1%) had insulin-dependent diabetes mellitus (IDDM) with a median duration of diabetes of 9.3 versus 9.0 years in the placebo group. Visual acuity remained unchanged during the entire trial. Concerning the primary endpoint, the study provided a negative result, i.e. 26/235 patients in the treatment group and 30/232 patients in the placebo group developed CSME. Confirmatory intention-to-treat analysis of the primary endpoint revealed no statistically significant difference between groups (log-rank test, p = 0.7108, HR = 0.9057 with CI = 0.5355-1.5317). Median follow-up was identical (2.00 years). Conclusions: A daily dosage of 600 mg ALA does not prevent the occurrence of CSME in IDDM patients. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article discusses the management of the psychosocial issues surrounding families with diabetes. It explains the challenges associated with parent a child with diabetes, including the additional parenting responsibilities posed by diabetic children. The importance of balancing between self-care and independence among adolescents with diabetes is emphasized. In addition, the article offers ideas on addressing childhood depression, disordered eating and family stress in relation to pediatric diabetes.

Lee S-S, Han H-H, Kim H. A 5-yr follow-up nerve conduction study for the detection of subclinical diabetic neuropathy in children with newly diagnosed insulin-dependent diabetes mellitus. Pediatric Diabetes 20XX: 00: 000-000 Objective: To investigate the changes of peripheral nerve conduction in children with insulin-dependent diabetes mellitus (IDDM) prospectively from diagnosis and to know how those results were related to clinical risk factors. Methods: A total of 37 patients (14 males and 23 females) aged 3-19 yr (mean 12.0 ± 3.7) with newly diagnosed IDDM underwent bilateral nerve conduction studies (NCS) of median, ulnar, posterior tibial, peroneal, and sural nerves annually for 5 yr. Results: In all, 12 patients (32.4%) showed electrophysiological evidence of polyneuropathy in at least two different nerves including the sural nerve at the diagnosis of IDDM; 20 patients (54%) had multiple (≥2) abnormalities in parameters of NCS. The most common abnormal parameters at the diagnosis were conduction velocities of peroneal motor and sural nerves. In sequential NCS over 5 yr, the percentage of abnormal nerve conduction velocities rose except within the sural nerve. Poor metabolic control, height, duration of diabetes, and older age of onset were related to the changes of parameters of NCS over 5 yr. Among those risk factors, the duration of diabetes and sustained hyperglycemia affected the parameters of NCS more frequently than others. Conclusions: Children with IDDM frequently have nerve conduction abnormalities without clinical neuropathy at initial diagnosis. The frequency of abnormalities of any attribute of nerve conduction increased over the 5 yr follow-up. The duration of diabetes and poor glycemic control proved to be more important risk factors over 5 yr as related to the development of subclinical neuropathy. [ABSTRACT FROM AUTHOR]

Type 1 diabetes mellitus (TID) is an autoimmune genetic disease with unidentified environmental agents affecting its pathogenesis. Susceptibility is determined by the interaction of MHC and non-MHC genes in the thymus, primarily by the IDDM1 locus, which is extremely polymorphic and thus generates multitudes of predisposing and protective haplotypes for binding self-peptides. By presenting these peptide antigens to immature T-cells for activation and selection, most autoreactive cells will be deleted, but inefficient presentation and subsequent deficiencies of non-MHC genes allow some cells to escape to the periphery and to be eliminated by anergy or regulatory T-cells. T-cell dysregulation to a Th1 response with secretion of inflammatory cytokines promotes a self-perpetuating autoimmune cascade leading to overt disease unless blocked by suppressive cytokines from Th2-type cells. Since autoantibodies reflect target-cell destruction, early insulin autoantibodies may be transient due to benign insulitis induced by insulin or proinsulin. Multiple autoantibodies denote epitope spreading to cryptic autoantigens, likely involving posttranslational variants. Thus, the resulting T1D development requires coordinated abnormal variations, and this requirement limits its occurrence to a small minority of susceptible individuals. [ABSTRACT FROM AUTHOR]