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1. Dietary patterns during pregnancy and maternal and birth outcomes in women with type 1 diabetes: the Environmental Determinants of Islet Autoimmunity (ENDIA) study

Author

Thomson, Rebecca L., Brown, James D., Oakey, Helena, Palmer, Kirsten, Ashwood, Pat, Penno, Megan A. S., McGorm, Kelly J., Battersby, Rachel, Colman, Peter G., Craig, Maria E., Davis, Elizabeth A., Huynh, Tony, Harrison, Leonard C., Haynes, Aveni, Sinnott, Richard O., Vuillermin, Peter J., Wentworth, John M., Soldatos, Georgia, and Couper, Jennifer J.

Published
2024
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2. Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes

Author

Phillip, Moshe, Achenbach, Peter, Addala, Ananta, Albanese-O’Neill, Anastasia, Battelino, Tadej, Bell, Kirstine J., Besser, Rachel E. J., Bonifacio, Ezio, Colhoun, Helen M., Couper, Jennifer J., Craig, Maria E., Danne, Thomas, de Beaufort, Carine, Dovc, Klemen, Driscoll, Kimberly A., Dutta, Sanjoy, Ebekozien, Osagie, Larsson, Helena Elding, Feiten, Daniel J., Frohnert, Brigitte I., Gabbay, Robert A., Gallagher, Mary P., Greenbaum, Carla J., Griffin, Kurt J., Hagopian, William, Haller, Michael J., Hendrieckx, Christel, Hendriks, Emile, Holt, Richard I. G., Hughes, Lucille, Ismail, Heba M., Jacobsen, Laura M., Johnson, Suzanne B., Kolb, Leslie E., Kordonouri, Olga, Lange, Karin, Lash, Robert W., Lernmark, Åke, Libman, Ingrid, Lundgren, Markus, Maahs, David M., Marcovecchio, M. Loredana, Mathieu, Chantal, Miller, Kellee M., O’Donnell, Holly K., Oron, Tal, Patil, Shivajirao P., Pop-Busui, Rodica, Rewers, Marian J., Rich, Stephen S., Schatz, Desmond A., Schulman-Rosenbaum, Rifka, Simmons, Kimber M., Sims, Emily K., Skyler, Jay S., Smith, Laura B., Speake, Cate, Steck, Andrea K., Thomas, Nicholas P. B., Tonyushkina, Ksenia N., Veijola, Riitta, Wentworth, John M., Wherrett, Diane K., Wood, Jamie R., Ziegler, Anette-Gabriele, and DiMeglio, Linda A.

Published
2024
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3. Islet autoantibodies as precision diagnostic tools to characterize heterogeneity in type 1 diabetes: a systematic review

Author

Felton, Jamie L., Redondo, Maria J., Oram, Richard A., Speake, Cate, Long, S. Alice, Onengut-Gumuscu, Suna, Rich, Stephen S., Monaco, Gabriela S. F., Harris-Kawano, Arianna, Perez, Dianna, Saeed, Zeb, Hoag, Benjamin, Jain, Rashmi, Evans-Molina, Carmella, DiMeglio, Linda A., Ismail, Heba M., Dabelea, Dana, Johnson, Randi K., Urazbayeva, Marzhan, Wentworth, John M., Griffin, Kurt J., and Sims, Emily K.

Published
2024
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4. Correction to: Consensus guidance for monitoring individuals with islet autoantibody‑positive pre‑stage 3 type 1 diabetes

Author

Phillip, Moshe, Achenbach, Peter, Addala, Ananta, Albanese‑O’Neill, Anastasia, Battelino, Tadej, Bell, Kirstine J., Besser, Rachel E. J., Bonifacio, Ezio, Colhoun, Helen M., Couper, Jennifer J., Craig, Maria E., Danne, Thomas, de Beaufort, Carine, Dovc, Klemen, Driscoll, Kimberly A., Dutta, Sanjoy, Ebekozien, Osagie, Larsson, Helena Elding, Feiten, Daniel J., Frohnert, Brigitte I., Gabbay, Robert A., Gallagher, Mary P., Greenbaum, Carla J., Griffin, Kurt J., Hagopian, William, Haller, Michael J., Hendrieckx, Christel, Hendriks, Emile, Holt, Richard I. G., Hughes, Lucille, Ismail, Heba M., Jacobsen, Laura M., Johnson, Suzanne B., Kolb, Leslie E., Kordonouri, Olga, Lange, Karin, Lash, Robert W., Lernmark, Åke, Libman, Ingrid, Lundgren, Markus, Maahs, David M., Marcovecchio, M. Loredana, Mathieu, Chantal, Miller, Kellee M., O’Donnell, Holly K., Oron, Tal, Patil, Shivajirao P., Pop‑Busui, Rodica, Rewers, Marian J., Rich, Stephen S., Schatz, Desmond A., Schulman‑Rosenbaum, Rifka, Simmons, Kimber M., Sims, Emily K., Skyler, Jay S., Smith, Laura B., Speake, Cate, Steck, Andrea K., Thomas, Nicholas P. B., Tonyushkina, Ksenia N., Veijola, Riitta, Wentworth, John M., Wherrett, Diane K., Wood, Jamie R., Ziegler, Anette‑Gabriele, and DiMeglio, Linda A.

Published
2024
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5. Abatacept for Delay of Type 1 Diabetes Progression in Stage 1 Relatives at Risk: A Randomized, Double-Masked, Controlled Trial

Author

Russell, William E, Bundy, Brian N, Anderson, Mark S, Cooney, Laura A, Gitelman, Stephen E, Goland, Robin S, Gottlieb, Peter A, Greenbaum, Carla J, Haller, Michael J, Krischer, Jeffrey P, Libman, Ingrid M, Linsley, Peter S, Long, S Alice, Lord, Sandra M, Moore, Daniel J, Moore, Wayne V, Moran, Antoinette M, Muir, Andrew B, Raskin, Philip, Skyler, Jay S, Wentworth, John M, Wherrett, Diane K, Wilson, Darrell M, Ziegler, Anette-Gabriele, Herold, Kevan C, and Group, Type 1 Diabetes TrialNet Study

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Immunology, Clinical Research, Clinical Trials and Supportive Activities, Diabetes, Nutrition, Prevention, 6.1 Pharmaceuticals, Metabolic and endocrine, Humans, Abatacept, Diabetes Mellitus, Type 1, Immunosuppressive Agents, T-Lymphocytes, Regulatory, Glucose, Type 1 Diabetes TrialNet Study Group, Medical and Health Sciences, Endocrinology & Metabolism, Biomedical and clinical sciences, Health sciences
Abstract

ObjectivePrevious studies showed that inhibiting lymphocyte costimulation reduces declining β-cell function in individuals newly diagnosed with type 1 diabetes. We tested whether abatacept would delay or prevent progression of type 1 diabetes from normal glucose tolerance (NGT) to abnormal glucose tolerance (AGT) or to diabetes and the effects of treatment on immune and metabolic responses.Research design and methodsWe conducted a phase 2, randomized, placebo-controlled, double-masked trial of abatacept in antibody-positive participants with NGT who received monthly abatacept/placebo infusions for 12 months. The end point was AGT or diabetes, assessed by oral glucose tolerance tests.ResultsA total of 101 participants received abatacept and 111 placebo. Of these, 81 (35 abatacept and 46 placebo) met the end point of AGT or type 1 diabetes diagnosis (hazard ratio 0.702; 95% CI 0.452, 1.09; P = 0.11) The C-peptide responses to oral glucose tolerance tests were higher in the abatacept arm (P < 0.03). Abatacept reduced the frequency of inducible T-cell costimulatory (ICOS)+ PD1+ T-follicular helper (Tfh) cells during treatment (P < 0.0001), increased naive CD4+ T cells, and also reduced the frequency of CD4+ regulatory T cells (Tregs) from the baseline (P = 0.0067). Twelve months after treatment, the frequency of ICOS+ Tfh, naive CD4+ T cells, and Tregs returned to baseline.ConclusionsAlthough abatacept treatment for 1 year did not significantly delay progression to glucose intolerance in at-risk individuals, it impacted immune cell subsets and preserved insulin secretion, suggesting that costimulation blockade may modify progression of type 1 diabetes.

Published
2023

6. Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine

Author

Tobias, Deirdre K., Merino, Jordi, Ahmad, Abrar, Aiken, Catherine, Benham, Jamie L., Bodhini, Dhanasekaran, Clark, Amy L., Colclough, Kevin, Corcoy, Rosa, Cromer, Sara J., Duan, Daisy, Felton, Jamie L., Francis, Ellen C., Gillard, Pieter, Gingras, Véronique, Gaillard, Romy, Haider, Eram, Hughes, Alice, Ikle, Jennifer M., Jacobsen, Laura M., Kahkoska, Anna R., Kettunen, Jarno L. T., Kreienkamp, Raymond J., Lim, Lee-Ling, Männistö, Jonna M. E., Massey, Robert, Mclennan, Niamh-Maire, Miller, Rachel G., Morieri, Mario Luca, Most, Jasper, Naylor, Rochelle N., Ozkan, Bige, Patel, Kashyap Amratlal, Pilla, Scott J., Prystupa, Katsiaryna, Raghavan, Sridharan, Rooney, Mary R., Schön, Martin, Semnani-Azad, Zhila, Sevilla-Gonzalez, Magdalena, Svalastoga, Pernille, Takele, Wubet Worku, Tam, Claudia Ha-ting, Thuesen, Anne Cathrine B., Tosur, Mustafa, Wallace, Amelia S., Wang, Caroline C., Wong, Jessie J., Yamamoto, Jennifer M., Young, Katherine, Amouyal, Chloé, Andersen, Mette K., Bonham, Maxine P., Chen, Mingling, Cheng, Feifei, Chikowore, Tinashe, Chivers, Sian C., Clemmensen, Christoffer, Dabelea, Dana, Dawed, Adem Y., Deutsch, Aaron J., Dickens, Laura T., DiMeglio, Linda A., Dudenhöffer-Pfeifer, Monika, Evans-Molina, Carmella, Fernández-Balsells, María Mercè, Fitipaldi, Hugo, Fitzpatrick, Stephanie L., Gitelman, Stephen E., Goodarzi, Mark O., Grieger, Jessica A., Guasch-Ferré, Marta, Habibi, Nahal, Hansen, Torben, Huang, Chuiguo, Harris-Kawano, Arianna, Ismail, Heba M., Hoag, Benjamin, Johnson, Randi K., Jones, Angus G., Koivula, Robert W., Leong, Aaron, Leung, Gloria K. W., Libman, Ingrid M., Liu, Kai, Long, S. Alice, Lowe, Jr, William L., Morton, Robert W., Motala, Ayesha A., Onengut-Gumuscu, Suna, Pankow, James S., Pathirana, Maleesa, Pazmino, Sofia, Perez, Dianna, Petrie, John R., Powe, Camille E., Quinteros, Alejandra, Jain, Rashmi, Ray, Debashree, Ried-Larsen, Mathias, Saeed, Zeb, Santhakumar, Vanessa, Kanbour, Sarah, Sarkar, Sudipa, Monaco, Gabriela S. F., Scholtens, Denise M., Selvin, Elizabeth, Sheu, Wayne Huey-Herng, Speake, Cate, Stanislawski, Maggie A., Steenackers, Nele, Steck, Andrea K., Stefan, Norbert, Støy, Julie, Taylor, Rachael, Tye, Sok Cin, Ukke, Gebresilasea Gendisha, Urazbayeva, Marzhan, Van der Schueren, Bart, Vatier, Camille, Wentworth, John M., Hannah, Wesley, White, Sara L., Yu, Gechang, Zhang, Yingchai, Zhou, Shao J., Beltrand, Jacques, Polak, Michel, Aukrust, Ingvild, de Franco, Elisa, Flanagan, Sarah E., Maloney, Kristin A., McGovern, Andrew, Molnes, Janne, Nakabuye, Mariam, Njølstad, Pål Rasmus, Pomares-Millan, Hugo, Provenzano, Michele, Saint-Martin, Cécile, Zhang, Cuilin, Zhu, Yeyi, Auh, Sungyoung, de Souza, Russell, Fawcett, Andrea J., Gruber, Chandra, Mekonnen, Eskedar Getie, Mixter, Emily, Sherifali, Diana, Eckel, Robert H., Nolan, John J., Philipson, Louis H., Brown, Rebecca J., Billings, Liana K., Boyle, Kristen, Costacou, Tina, Dennis, John M., Florez, Jose C., Gloyn, Anna L., Gomez, Maria F., Gottlieb, Peter A., Greeley, Siri Atma W., Griffin, Kurt, Hattersley, Andrew T., Hirsch, Irl B., Hivert, Marie-France, Hood, Korey K., Josefson, Jami L., Kwak, Soo Heon, Laffel, Lori M., Lim, Siew S., Loos, Ruth J. F., Ma, Ronald C. W., Mathieu, Chantal, Mathioudakis, Nestoras, Meigs, James B., Misra, Shivani, Mohan, Viswanathan, Murphy, Rinki, Oram, Richard, Owen, Katharine R., Ozanne, Susan E., Pearson, Ewan R., Perng, Wei, Pollin, Toni I., Pop-Busui, Rodica, Pratley, Richard E., Redman, Leanne M., Redondo, Maria J., Reynolds, Rebecca M., Semple, Robert K., Sherr, Jennifer L., Sims, Emily K., Sweeting, Arianne, Tuomi, Tiinamaija, Udler, Miriam S., Vesco, Kimberly K., Vilsbøll, Tina, Wagner, Robert, Rich, Stephen S., and Franks, Paul W.

Published
2023
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7. Disease-modifying therapies and features linked to treatment response in type 1 diabetes prevention: a systematic review

Author

Felton, Jamie L., Griffin, Kurt J., Oram, Richard A., Speake, Cate, Long, S. Alice, Onengut-Gumuscu, Suna, Rich, Stephen S., Monaco, Gabriela S. F., Evans-Molina, Carmella, DiMeglio, Linda A., Ismail, Heba M., Steck, Andrea K., Dabelea, Dana, Johnson, Randi K., Urazbayeva, Marzhan, Gitelman, Stephen, Wentworth, John M., Redondo, Maria J., and Sims, Emily K.

Published
2023
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8. Imatinib therapy for patients with recent-onset type 1 diabetes: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial

Author

Gitelman, Stephen E, Bundy, Brian N, Ferrannini, Ele, Lim, Noha, Blanchfield, J Lori, DiMeglio, Linda A, Felner, Eric I, Gaglia, Jason L, Gottlieb, Peter A, Long, S Alice, Mari, Andrea, Mirmira, Raghavendra G, Raskin, Philip, Sanda, Srinath, Tsalikian, Eva, Wentworth, John M, Willi, Steven M, Krischer, Jeffrey P, Bluestone, Jeffrey A, Group, Gleevec Trial Study, Barr, Mayalin, Buchanan, Jeanne, Cabbage, Joanne, Coleman, Peter, De La Vega, Monica, Evans-Molina, Carmella, Ferrara, Christine, Healy, Felicity, Higgins, Laurie, Hildinger, Megan, Jenkins, Margaret, Bryant, Nora Kayton, Kinderman, Amanda, Koshy, Nisha, Kost, Brianne, Krishfield, Suzanne, Kucheruk, Olena, Lindsley, Karen, Mantravadi, Manasa, Mesfin, Shelley, Michels, Aaron, Migre, Mary Ellen, Minnock, Pantea, Mohammed-Nur, Elham, Nelson, Jennifer, Nursing, Ashvin, O'Donnell, Ryan, Olivos, Diana, Parker, Melissa, Redl, Leanne, Reed, Nicole, Resnick, Brittany, Sayre, Peter, Serti, Elisavet, Sims, Emily, Smith, Karen, Soppe, Carol, Stuart, Fiona, Szubowicz, Sarah, Tansey, Michel, Terrell, Jennifer, Tersey, Sarah, Torok, Christine, Watson, Kelly, Wesch, Rebecca, Willi, Steven, and Woerner, Stephanie

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Patient Safety, Diabetes, Clinical Research, Prevention, Clinical Trials and Supportive Activities, Infectious Diseases, 6.1 Pharmaceuticals, Metabolic and endocrine, Adolescent, Adult, Biomarkers, Blood Glucose, Diabetes Mellitus, Type 1, Double-Blind Method, Female, Follow-Up Studies, Humans, Imatinib Mesylate, Male, Middle Aged, Prognosis, Protein Kinase Inhibitors, Young Adult, Gleevec Trial Study Group, Medical Biochemistry and Metabolomics, Public Health and Health Services, Clinical sciences, Medical biochemistry and metabolomics
Abstract

BackgroundType 1 diabetes results from autoimmune-mediated destruction of β cells. The tyrosine kinase inhibitor imatinib might affect relevant immunological and metabolic pathways, and preclinical studies show that it reverses and prevents diabetes. Our aim was to evaluate the safety and efficacy of imatinib in preserving β-cell function in patients with recent-onset type 1 diabetes.MethodsWe did a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial. Patients with recent-onset type 1 diabetes (

Published
2021

9. Parental experiences of using continuous glucose monitoring in their young children with early-stage type 1 diabetes: a qualitative interview study.

Author

Roberts, Alison G., Tully, Alexandra S., Binkowski, Sabrina K., Bebbington, Keely R., Penno, Megan A. S., Anderson, Amanda J., Craig, Maria E., Colman, Peter G., Huynh, Tony, McGorm, Kelly J., Soldatos, Georgia, Vuillermin, Peter J., Wentworth, John M., Davis, Elizabeth A., Couper, Jennifer J., and Haynes, Aveni

Published
2024
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10. Women with type 1 diabetes exhibit a progressive increase in gut Saccharomyces cerevisiae in pregnancy associated with evidence of gut inflammation

Author

Bandala-Sanchez, Esther, Roth-Schulze, Alexandra J., Oakey, Helena, Penno, Megan A.S., Bediaga, Naiara G., Naselli, Gaetano, Ngui, Katrina M., Smith, Alannah D., Huang, Dexing, Zozaya-Valdes, Enrique, Thomson, Rebecca L., Brown, James D., Vuillermin, Peter J., Barry, Simon C., Craig, Maria E., Rawlinson, William D., Davis, Elizabeth A., Harris, Mark, Soldatos, Georgia, Colman, Peter G., Wentworth, John M., Haynes, Aveni, Morahan, Grant, Sinnott, Richard O., Papenfuss, Anthony T., Couper, Jennifer J., and Harrison, Leonard C.

Published
2022
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12. Transcription Factor 7-Like 2 (TCF7L2) Gene Polymorphism and Progression From Single to Multiple Autoantibody Positivity in Individuals at Risk for Type 1 Diabetes

Author

Redondo, Maria J, Steck, Andrea K, Sosenko, Jay, Anderson, Mark, Antinozzi, Peter, Michels, Aaron, Wentworth, John M, Atkinson, Mark A, Pugliese, Alberto, Geyer, Susan, and Group, the Type 1 Diabetes TrialNet Study

Subjects
Biomedical and Clinical Sciences, Health Sciences, Prevention, Genetics, Autoimmune Disease, Nutrition, Diabetes, Aetiology, 2.1 Biological and endogenous factors, Metabolic and endocrine, Adolescent, Adult, Antibody Specificity, Autoantibodies, Autoimmunity, Child, Child, Preschool, Cohort Studies, Diabetes Mellitus, Type 1, Disease Progression, Female, Gene Frequency, Genetic Predisposition to Disease, Humans, Infant, Male, Middle Aged, Obesity, Overweight, Polymorphism, Single Nucleotide, Risk Factors, Transcription Factor 7-Like 2 Protein, Young Adult, Type 1 Diabetes TrialNet Study Group, Medical and Health Sciences, Endocrinology & Metabolism, Biomedical and clinical sciences, Health sciences
Abstract

ObjectiveThe type 2 diabetes-associated alleles at the TCF7L2 locus mark a type 1 diabetes phenotype characterized by single islet autoantibody positivity as well as lower glucose and higher C-peptide measures. Here, we studied whether the TCF7L2 locus influences progression of islet autoimmunity, from single to multiple (≥2) autoantibody positivity, in relatives of patients with type 1 diabetes.Research design and methodsWe evaluated 244 participants in the Type 1 Diabetes TrialNet Pathway to Prevention study with confirmed single autoantibody positivity at screening and Immunochip single nucleotide polymorphism data (47.5% male; median age 12.8 years, range 1.2-45.9; 90.2% white). We analyzed risk allele frequency at TCF7L2 rs4506565 (in linkage disequilibrium with rs7903146). Altogether, 62.6% participants carried ≥1 risk allele. Univariate and multivariable Cox proportional hazards models and Kaplan-Meier statistical methods were used.ResultsDuring follow-up (median 5.2 years, range 0.2-12.6), 62% of the single autoantibody-positive participants developed multiple autoantibody positivity. In the overall cohort, the TCF7L2 locus did not significantly predict progression to multiple autoantibody positivity. However, among single GAD65 autoantibody-positive participants (n = 158), those who carried ≥1 risk allele had a lower rate of progression to multiple autoantibody positivity (hazard ratio [HR] 0.65, P = 0.033) than those who did not, after adjustment for HLA risk haplotypes and age. Among subjects who were either IA-2 or insulin autoantibody positive only, carrying ≥1 TCF7L2 risk allele was not a significant factor overall, but in overweight or obese participants, it increased the risk of progression to multiple autoantibody positivity (HR 3.02, P = 0.016) even with adjustment for age.ConclusionsThe type 2 diabetes-associated TCF7L2 locus influences progression of islet autoimmunity, with differential effects by autoantibody specificity and interaction by obesity/overweight.

Published
2018

15. Imatinib therapy for patients with recent-onset type 1 diabetes: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial

Author

Barr, Mayalin, Blanchfield, J Lori, Bluestone, Jeffrey A, Buchanan, Jeanne, Bundy, Brian N, Cabbage, Joanne, Coleman, Peter, De La Vega, Monica, DiMeglio, Linda A, Evans-Molina, Carmella, Felner, Eric I, Ferrannini, Ele, Ferrara, Christine, Gaglia, Jason L, Gitelman, Stephen E, Gottlieb, Peter A, Healy, Felicity, Higgins, Laurie, Hildinger, Megan, Jenkins, Margaret, Kayton Bryant, Nora, Kinderman, Amanda, Koshy, Nisha, Kost, Brianne, Krischer, Jeffrey P, Krishfield, Suzanne, Kucheruk, Olena, Lim, Noha, Lindsley, Karen, Long, S Alice, Mantravadi, Manasa, Mari, Andrea, Mesfin, Shelley, Michels, Aaron, Migre, Mary Ellen, Minnock, Pantea, Mirmira, Raghavendra G, Mohammed-Nur, Elham, Nelson, Jennifer, Nursing, Ashvin, O'Donnell, Ryan, Olivos, Diana, Parker, Melissa, Raskin, Philip, Redl, Leanne, Reed, Nicole, Resnick, Brittany, Sanda, Srinath, Sayre, Peter, Serti, Elisavet, Sims, Emily, Smith, Karen, Soppe, Carol, Stuart, Fiona, Szubowicz, Sarah, Tansey, Michel, Terrell, Jennifer, Tersey, Sarah, Torok, Christine, Tsalikian, Eva, Watson, Kelly, Wentworth, John M, Wesch, Rebecca, Willi, Steven, Woerner, Stephanie, and Willi, Steven M

Published
2021
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16. Early Dysglycemia Is Detectable Using Continuous Glucose Monitoring in Very Young Children at Risk of Type 1 Diabetes.

Author

Haynes, Aveni, Tully, Alexandra, Smith, Grant J., Penno, Megan A.S., Craig, Maria E., Wentworth, John M., Huynh, Tony, Colman, Peter G., Soldatos, Georgia, Anderson, Amanda J., McGorm, Kelly J., Oakey, Helena, Couper, Jennifer J., Davis, Elizabeth A., Barry, Simon C., Hamilton-Williams, Emma, Harrison, Leonard C., Kim, Ki Wook, Morahan, Grant, and Rawlinson, William D.

Subjects
CONTINUOUS glucose monitoring, TYPE 1 diabetes, DISEASE progression, AUTOIMMUNITY, EXPERIMENTAL design
Abstract

OBJECTIVE: Continuous glucose monitoring (CGM) can detect early dysglycemia in older children and adults with presymptomatic type 1 diabetes (T1D) and predict risk of progression to clinical onset. However, CGM data for very young children at greatest risk of disease progression are lacking. This study aimed to investigate the use of CGM data measured in children being longitudinally observed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study from birth to age 10 years. RESEARCH DESIGN AND METHODS: Between January 2021 and June 2023, 31 ENDIA children with persistent multiple islet autoimmunity (PM Ab+) and 24 age-matched control children underwent CGM assessment alongside standard clinical monitoring. The CGM metrics of glucose SD (SDSGL), coefficient of variation (CEV), mean sensor glucose (SGL), and percentage of time >7.8 mmol/L (>140 mg/dL) were determined and examined for between-group differences. RESULTS: The mean (SD) ages of PM Ab+ and Ab− children were 4.4 (1.8) and 4.7 (1.9) years, respectively. Eighty-six percent of eligible PM Ab+ children consented to CGM wear, achieving a median (quartile 1 [Q1], Q3) sensor wear period of 12.5 (9.0, 15.0) days. PM Ab+ children had higher median (Q1, Q3) SDSGL (1.1 [0.9, 1.3] vs. 0.9 [0.8, 1.0] mmol/L; P < 0.001) and CEV (17.3% [16.0, 20.9] vs. 14.7% [12.9, 16.6]; P < 0.001). Percentage of time >7.8 mmol/L was greater in PM Ab+ children (median [Q1, Q3] 8.0% [4.4, 13.0] compared with 3.3% [1.4, 5.3] in Ab− children; P = 0.005). Mean SGL did not differ significantly between groups (P = 0.10). CONCLUSIONS: CGM is feasible and well tolerated in very young children at risk of T1D. Very young PM Ab+ children have increased SDSGL, CEV, and percentage of time >7.8 mmol/L, consistent with prior studies involving older participants. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Diabetes Complications among Inpatients with Childhood and Young Adult–Onset Type 1 and 2 Diabetes.

Author

Hawke, Kate, Ng, Soong Zheng, Anderson, Jessica, Dharmaputra, Raymond, Hogg, Prue, Titmuss, Angela, Sinha, Ashim, McLean, Anna, and Wentworth, John M.

Subjects
TYPE 1 diabetes, HOSPITAL patients, TYPE 2 diabetes, DISEASE complications, CHILDREN, ADULTS
Abstract

Aims. To assess morbidity among young people with diabetes presenting to a regional hospital in Northern Australia and compare the risk of complications among those living with type 2 diabetes (T2D) versus type 1 diabetes (T1D). Materials and Methods. A cross‐sectional study of young people with T1D or T2D (diagnosed age 1–25 years) presenting to a regional Northern Australian hospital with any condition from 2015 to 2019. Demographics, cardiometabolic comorbidities, and diabetes‐related complications were collected from individual medical records and compared between those with T1D and T2D. Results. Among 357 young people (192 had T2D, 165 T1D), the mean age was 22 years, the mean duration of diabetes was 6.7 years, 52% were Aboriginal or Torres Strait Islander, and 28% lived remotely. Cardiometabolic comorbidities (obesity, hypertension, and dyslipidaemia) and diabetes‐related complications (microalbuminuria, amputation, and elevated non‐alcoholic fatty liver disease score) were more prevalent in those with T2D compared to T1D, despite shorter disease duration and lower median HbA1c. When adjusted for age, sex, and BMI, the odds ratio (95% CI) for microalbuminuria was 4.8 (1.83–12.8) with T2D compared to T1D. Conclusion. In a cohort of young people with diabetes in Northern Australia, the prevalence of diabetes‐related complications was higher among those with T2D than T1D. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Baricitinib and β-Cell Function in Patients with New-Onset Type 1 Diabetes

Author

Waibel, Michaela, primary, Wentworth, John M., additional, So, Michelle, additional, Couper, Jennifer J., additional, Cameron, Fergus J., additional, MacIsaac, Richard J., additional, Atlas, Gabby, additional, Gorelik, Alexandra, additional, Litwak, Sara, additional, Sanz-Villanueva, Laura, additional, Trivedi, Prerak, additional, Ahmed, Simi, additional, Martin, Francis J., additional, Doyle, Madeleine E., additional, Harbison, Jessica E., additional, Hall, Candice, additional, Krishnamurthy, Balasubramanian, additional, Colman, Peter G., additional, Harrison, Leonard C., additional, Thomas, Helen E., additional, and Kay, Thomas W.H., additional

Published
2023
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22. Proinsulin C-peptide is an autoantigen in people with type 1 diabetes

Author

So, Michelle, Elso, Colleen M., Tresoldi, Eleonora, Pakusch, Miha, Pathiraja, Vimukthi, Wentworth, John M., Harrison, Leonard C., Krishnamurthy, Balasubramanian, Thomas, Helen E., Rodda, Christine, Cameron, Fergus J., McMahon, Jacinta, Kay, Thomas W. H., and Mannering, Stuart I.

Published
2018

24. List of Contributors

Author

Abramson, Jakub, primary, Ahmed, S. Sohail, additional, Alba, Marco A., additional, Ali, Youssif M., additional, Ambrus, Julian L., additional, Andersson Svärd, Agnes, additional, Aringer, Martin, additional, Assassi, Shervin, additional, Aung, Thanda, additional, Ayzenberg, Ilya, additional, Barker, Robert N., additional, Baxter, Alan G., additional, Betterle, Corrado, additional, Birlea, Stanca A., additional, Björkström, Niklas K., additional, Blair, Paul A., additional, Blüml, Stephan, additional, Bosch, Xavier, additional, Brodsky, Robert A., additional, Bryceson, Yenan T., additional, Burkett, Patrick R., additional, Bussel, James B., additional, Caricchio, Roberto, additional, Casciola-Rosen, Livia, additional, Caturegli, Patrizio, additional, Chaigne-Delalande, Benjamin, additional, Chalan, Paulina, additional, Chatenoud, Lucienne, additional, Cohen, Philip L., additional, Cooper, Megan A., additional, Coppieters, Ken, additional, Crystal, Ronald G., additional, Culton, Donna A., additional, Damato, Valentina, additional, Davidson, Anne, additional, Delfino, Lorenzo, additional, Delves, Peter J., additional, Di Dalmazi, Giulia, additional, Diamond, Betty, additional, Diaz, Luis A., additional, Falk, Ronald J., additional, Fritzler, Marvin J., additional, Gallucci, Stefania, additional, Gangaputra, Sapna, additional, Gelbman, Brian, additional, Gershwin, M. Eric, additional, Gery, Igal, additional, Getts, Daniel R., additional, Gold, Ralf, additional, Goldfarb, Yael, additional, Gong, Jing, additional, Gordon, Siamon, additional, Goronzy, Jörg J., additional, Greer, Judith M., additional, Guazzone, Vanesa A., additional, Guilherme, Luiza, additional, Hafler, David A., additional, Hahn, Bevra H., additional, Hamad, Abdel Rahim A., additional, Hamano, Hideaki, additional, Harrison, Leonard C., additional, Homann, Dirk, additional, Husebye, Eystein S., additional, Jennette, J. Charles, additional, Jones, Richard J., additional, Jordan, Margaret A., additional, Kalil, Jorge, additional, Kawa, Shigeyuki, additional, Kaya, Ziya, additional, Keller, Christian W., additional, King, Nicholas J.C., additional, Kitcharoensakkul, Maleewan, additional, Kiyosawa, Kendo, additional, Königs, Christoph, additional, Kronenberg, Mitchell, additional, Kuchroo, Vijay K., additional, Laurence, Arian, additional, Lee, Eun-Ju, additional, Lehmann, Helmar C., additional, Lernmark, Åke, additional, Lindbladh, Ida, additional, Liu, Zhi, additional, Ljunggren, Hans-Gustaf, additional, Lunardi, Claudio, additional, Lundin, Knut E.A., additional, Lünemann, Jan D., additional, Lunn, Michael P.T., additional, Lustig, Livia, additional, Mackay, Charles R., additional, Mackay, Ian R., additional, Malattia, Clara, additional, Martinez-Pomares, Luisa, additional, Martini, Alberto, additional, Mauri, Claudia, additional, McCombe, Pamela A., additional, Melchers, Fritz, additional, Mieli-Vergani, Giorgina, additional, Miller, Frederick W., additional, Miller, Stephen D., additional, Mizui, Masayuki, additional, Mjösberg, Jenny, additional, Münz, Christian, additional, Nijjar, Jagtar Singh, additional, Norris, David A., additional, Oleinika, Kristine, additional, Oppenheim, Joost J., additional, Pawlak, Mathias, additional, Peligero-Cruz, Cristina, additional, Peters, Anneli, additional, Peterson, Pärt, additional, Pitarokoili, Kalliopi, additional, Presotto, Fabio, additional, Puccetti, Antonio, additional, Rabb, Hamid, additional, Raczek, Patricia, additional, Rahman, M. Jubayer, additional, Ramos-Casals, Manuel, additional, Rose, Noel R., additional, Rosen, Antony, additional, Sadasivam, Mohanraj, additional, Schiffenbauer, Adam, additional, Schwaeble, Wilhelm J., additional, Sen, H. Nida, additional, Serota, Marc, additional, Sheikh, Kazim A., additional, Shoenfeld, Yehuda, additional, Shovman, Ora, additional, Sieper, Joachim, additional, Silverstein, Arthur M., additional, Sim, Robert B., additional, Smith, Kenneth G C, additional, Smolen, Josef S., additional, Sollid, Ludvig M., additional, Spiteri, Alanna, additional, Steinman, Lawrence, additional, Stone, John H., additional, Syrbe, Uta, additional, Tamhaney, Ami, additional, Tanaka, Atsushi, additional, Taneja, Veena, additional, Tarbell, Kristin V., additional, Tinazzi, Elisa, additional, Tiong, Benedict K., additional, Toh, Ban-Hock, additional, Tsokos, George C., additional, Tung, Kenneth S.K., additional, Varga, John, additional, Vergani, Diego, additional, Vickers, Mark A., additional, Viegas, Stuart, additional, Vincent, Angela, additional, von Herrath, Matthias, additional, Weetman, Anthony P., additional, Weinstock, Joel V., additional, Wentworth, John M., additional, Wesley, Sarah, additional, Weyand, Cornelia M., additional, Wingender, Gerhard, additional, Winter, Michael W., additional, Zanchetta, Renato, additional, and Zouali, Moncef, additional

Published
2020
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30. IL-18 Production from the NLRP1 Inflammasome Prevents Obesity and Metabolic Syndrome

Author

Murphy, Andrew J., Kraakman, Michael J., Kammoun, Helene L., Dragoljevic, Dragana, Lee, Man K.S., Lawlor, Kate E., Wentworth, John M., Vasanthakumar, Ajithkumar, Gerlic, Motti, Whitehead, Lachlan W., DiRago, Ladina, Cengia, Louise, Lane, Rachael M., Metcalf, Donald, Vince, James E., Harrison, Leonard C., Kallies, Axel, Kile, Benjamin T., Croker, Ben A., Febbraio, Mark A., and Masters, Seth L.

Published
2016
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31. Continuous glucose monitoring has an increasing role in pre-symptomatic type 1 diabetes: advantages, limitations, and comparisons with laboratory-based testing.

Author

Joshi, Kriti, Harris, Mark, Cotterill, Andrew, Wentworth, John M., Couper, Jennifer J., Haynes, Aveni, Davis, Elizabeth A., Lomax, Kate E., and Huynh, Tony

Subjects
TYPE 1 diabetes, AUTOANTIBODIES, GLUCOSE tolerance tests, GLUCOSE, DIABETIC acidosis, DEFICIENCY diseases
Abstract

Type 1 diabetes (T1D) is well-recognised as a continuum heralded by the development of islet autoantibodies, progression to islet autoimmunity causing beta cell destruction, culminating in insulin deficiency and clinical disease. Abnormalities of glucose homeostasis are known to exist well before the onset of typical symptoms. Laboratory-based tests such as the oral glucose tolerance test (OGTT) and glycated haemoglobin (HbA1c) have been used to stage T1D and assess the risk of progression to clinical T1D. Continuous glucose monitoring (CGM) can detect early glycaemic abnormalities and can therefore be used to monitor for metabolic deterioration in pre-symptomatic, islet autoantibody positive, at-risk individuals. Early identification of these children can not only reduce the risk of presentation with diabetic ketoacidosis (DKA), but also determine eligibility for prevention trials, which aim to prevent or delay progression to clinical T1D. Here, we describe the current state with regard to the use of the OGTT, HbA1c, fructosamine and glycated albumin in pre-symptomatic T1D. Using illustrative cases, we present our clinical experience with the use of CGM, and advocate for an increased role of this diabetes technology, for monitoring metabolic deterioration and disease progression in children with pre-symptomatic T1D. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Precision Diagnostics: Using Islet Autoantibodies to Characterize Heterogeneity in Type 1 Diabetes

Author

Felton, Jamie, primary, Redondo, Maria Jose, additional, Oram, Richard A., additional, Speake, Cate, additional, Long, S. Alice, additional, Onengut-Gumuscu, Suna, additional, Rich, Stephen S., additional, Scavacini de Freitas Monaco, Gabriela, additional, Harris-Kawano, Arianna M., additional, Perez, Dianna L., additional, Saeed, Zeb I., additional, Hoag, Benjamin D., additional, Jain, Rashmi, additional, Evans-Molina, Carmella, additional, DiMeglio, Linda A., additional, Ismail, Heba M, additional, Dabelea, Dana, additional, Johnson, Randi K., additional, Urazbayeva, Marzhan, additional, Wentworth, John M., additional, Griffin, Kurt J., additional, and Sims, Emily K., additional

Published
2023
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33. Abatacept for Delay of Type 1 Diabetes Progression in Stage 1 Relatives at Risk: A Randomized, Double-Masked, Controlled Trial

Author

E. Russell, William, primary, Bundy, Brian N., primary, S. Anderson, Mark, primary, Cooney, Laura A., primary, Gitelman, Stephen E., primary, Goland, Robin S., primary, Gottlieb, Peter A., primary, J. Greenbaum, Carla, primary, Haller, Michael J., primary, Krischer, Jeffrey P, primary, Libman, Ingrid M., primary, Linsley, Peter S., primary, Alice Long, S., primary, Lord, Sandra M., primary, J. Moore, Daniel, primary, Moore, Wayne V, primary, Moran, Antoinette M., primary, Muir, Andrew B., primary, Raskin, Phillip, primary, Skyler, Jay S., primary, Wentworth, John M, primary, Wherrett, Diane K., primary, Wilson, Darrell M., primary, Ziegler, Anette-Gabriele, primary, and C. Herold, Kevan, primary

Published
2023
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36. Protocol for a nested case-control study design for omics investigations in the Environmental Determinants of Islet Autoimmunity cohort

Author

Oakey, Helena, Giles, Lynne C., Thomson, Rebecca L., Cao, Kim-Anh Lê, Ashwood, Pat, Brown, James D., Knight, Emma J., Barry, Simon C., Craig, Maria E., Colman, Peter G., Davis, Elizabeth A., Hamilton-Williams, Emma E., Harrison, Leonard C., Haynes, Aveni, Kim, Ki Wook, Mallitt, Kylie-Ann, McGorm, Kelly, Morahan, Grant, Rawlinson, William D., Sinnott, Richard O., Soldatos, Georgia, Wentworth, John M., Couper, Jennifer J., and Penno, Megan A. S.

Abstract

Background: The Environmental Determinants of Islet Autoimmunity (ENDIA) pregnancy-birth cohort investigates the developmental origins of type 1 diabetes (T1D), with recruitment between 2013 and 2019. ENDIA is the first study in the world with comprehensive data and biospecimen collection during pregnancy, at birth and through childhood from at-risk children who have a first-degree relative with T1D. Environmental exposures are thought to drive the progression to clinical T1D, with pancreatic islet autoimmunity (IA) developing in genetically susceptible individuals. The exposures and key molecular mechanisms driving this progression are unknown. Persistent IA is the primary outcome of ENDIA; defined as a positive antibody for at least one of IAA, GAD, ZnT8 or IA2 on two consecutive occasions and signifies high risk of clinical T1D. Method: A nested case-control (NCC) study design with 54 cases and 161 matched controls aims to investigate associations between persistent IA and longitudinal omics exposures in ENDIA. The NCC study will analyse samples obtained from ENDIA children who have either developed persistent IA or progressed to clinical T1D (cases) and matched control children at risk of developing persistent IA. Control children were matched on sex and age, with all four autoantibodies absent within a defined window of the case’s onset date. Cases seroconverted at a median of 1.37 years (IQR 0.95, 2.56). Longitudinal omics data generated from approximately 16,000 samples of different biospecimen types, will enable evaluation of changes from pregnancy through childhood. Conclusions: This paper describes the ENDIA NCC study, omics platform design considerations and planned univariate and multivariate analyses for its longitudinal data. Methodologies for multivariate omics analysis with longitudinal data are discovery-focused and data driven. There is currently no single multivariate method tailored specifically for the longitudinal omics data that the ENDIA NCC study will generate and therefore omics analysis results will require either cross validation or independent validation.KEY MESSAGESThe ENDIA nested case-control study will utilize longitudinal omics data on approximately 16,000 samples from 190 unique children at risk of type 1 diabetes (T1D), including 54 who have developed islet autoimmunity (IA), followed during pregnancy, at birth and during early childhood, enabling the developmental origins of T1D to be explored. The ENDIA nested case-control study will utilize longitudinal omics data on approximately 16,000 samples from 190 unique children at risk of type 1 diabetes (T1D), including 54 who have developed islet autoimmunity (IA), followed during pregnancy, at birth and during early childhood, enabling the developmental origins of T1D to be explored.

Published
2023
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40. A surge in serum mucosal cytokines associated with seroconversion in children at risk for type 1 diabetes.

Author

Harrison, Leonard C, Bandala‐Sanchez, Esther, Oakey, Helena, Colman, Peter G, Watson, Kelly, Kim, Ki Wook, Wu, Roy, Hamilton‐Williams, Emma E, Stone, Natalie L, Haynes, Aveni, Thomson, Rebecca L, Vuillermin, Peter J, Soldatos, Georgia, Rawlinson, William D, McGorm, Kelly J, Morahan, Grant, Barry, Simon C, Sinnott, Richard O, Wentworth, John M, and Couper, Jennifer J

Subjects
TYPE 1 diabetes, SEROCONVERSION, CYTOKINES, ENTEROVIRUSES, ISLANDS of Langerhans
Abstract

Aims/Introduction: Autoantibodies to pancreatic islet antigens identify young children at high risk of type 1 diabetes. On a background of genetic susceptibility, islet autoimmunity is thought to be driven by environmental factors, of which enteric viruses are prime candidates. We sought evidence for enteric pathology in children genetically at‐risk for type 1 diabetes followed from birth who had developed islet autoantibodies ("seroconverted"), by measuring mucosa‐associated cytokines in their sera. Materials and Methods: Sera were collected 3 monthly from birth from children with a first‐degree type 1 diabetes relative, in the Environmental Determinants of Islet Autoimmunity (ENDIA) study. Children who seroconverted were matched for sex, age, and sample availability with seronegative children. Luminex xMap technology was used to measure serum cytokines. Results: Of eight children who seroconverted, for whom serum samples were available at least 6 months before and after seroconversion, the serum concentrations of mucosa‐associated cytokines IL‐21, IL‐22, IL‐25, and IL‐10, the Th17‐related cytokines IL‐17F and IL‐23, as well as IL‐33, IFN‐γ, and IL‐4, peaked from a low baseline in seven around the time of seroconversion and in one preceding seroconversion. These changes were not detected in eight sex‐ and age‐matched seronegative controls, or in a separate cohort of 11 unmatched seronegative children. Conclusions: In a cohort of children at risk for type 1 diabetes followed from birth, a transient, systemic increase in mucosa‐associated cytokines around the time of seroconversion lends support to the view that mucosal infection, e.g., by an enteric virus, may drive the development of islet autoimmunity. [ABSTRACT FROM AUTHOR]

Published
2023
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43. Decreased occurrence of ketoacidosis and preservation of beta cell function in relatives screened and monitored for type 1 diabetes in A ustralia and N ew Z ealand

Author

Wentworth, John M., primary, Oakey, Helena, additional, Craig, Maria E., additional, Couper, Jennifer J., additional, Cameron, Fergus J., additional, Davis, Elizabeth A., additional, Lafferty, Antony R., additional, Harris, Mark, additional, Wheeler, Benjamin J., additional, Jefferies, Craig, additional, Colman, Peter G., additional, and Harrison, Leonard C., additional

Published
2022
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45. Type 1 diabetes: a disease of developmental origins

Author

Phillips, Jessica E., Couper, Jennifer J., Penno, Megan A.S., Harrison, Leonard C., Anderson, Heather, Bandala‐Sanchez, Esther, Barry, Simon C, Baskerville, Tracey, Battersby, Rachel, Bediaga, Naiara G, Bezuidenhout, Debra, Brownrigg, Emma, Catteau, Jacki, Choo, Ace, Colman, Peter G, Cotterill, Andrew, Couper, Jennifer J, Craig, Maria E, Curran, Sheryl, Davis, Elizabeth A, Dodd, Jodie M, Edwards, Danielle, French, Jane, Gibson, Emily, Giles, Lynne C, Gwiazdzinski, Alison, Harris, Mark, Harrison, Leonard C, Haynes, Aveni, Hope, Christopher M, Hsieh, Cecilia, Huang, Dexing, Hu, William, Keytash, Azita, Krieg, Meredith, Law, Soi C, Lloyd‐Johnsen, Catherine, Morahan, Grant, Neale, Alana M, Ngui, Katrina, Papenfuss, Anthony T, Penno, Megan AS, Poth, Megan, Ramoso, Benjamin, Rawlinson, William D, Roberts, Alison, Sadlon, Timothy J, Schulze, Alexandra, Penington, Jocelyn Sietsma, Sinnott, Richard O, Spooner, Kelly, Stone, Natalie L, Thomson, Rebecca L, Toome, Sarah, Tully, Alexandra, Vuillermin, Peter J, Watson, Kelly, Wentworth, John M, and Wilson, Julianne

Published
2017
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49. A Long-Term Evaluation of Facebook for Recruitment and Retention in the ENDIA Type 1 Diabetes Pregnancy-Birth Cohort Study

Author

McGorm, Kelly J., Brown, James D., Thomson, Rebecca L., Oakey, Helena, Moore, Belinda, Hendry, Alexandra, Colman, Peter G., Craig, Maria E., Davis, Elizabeth A., Harris, Mark, Harrison, Leonard C., Haynes, Aveni, Soldatos, Georgia, Vuillermin, Peter, Wentworth, John M., Couper, Jennifer J., and Penno, Megan A. S.

Subjects
Endocrinology, Diabetes and Metabolism, education, Biomedical Engineering, Internal Medicine, Bioengineering, Original Articles
Abstract

Background: The Environmental Determinants of Islet Autoimmunity (ENDIA) study is an Australia-wide pregnancy-birth cohort study following children who have a first-degree relative with type 1 diabetes (ACTRN1261300794707). A dedicated ENDIA Facebook page was established in 2013 with the aim of enhancing recruitment and supporting participant retention through dissemination of study information. To measure the impact of Facebook, we evaluated the sources of referral to the study, cohort demographics, and withdrawal rates. We also investigated whether engagement with Facebook content was associated with specific post themes. Methods: Characteristics of Facebook versus conventional recruits were compared using linear, logistic, and multinomial logistic regression models. Logistic regression was used to determine the risk of study withdrawal. Data pertaining to 794 Facebook posts over 7.5 years were included in the analysis. Results: Facebook was the third largest source of referral (300/1511; 19.9%). Facebook recruits were more frequently Australian-born ( P < .001) enrolling postnatally ( P = .01) and withdrew from the study at a significantly lower rate compared with conventional recruits (4.7% vs 12.3%; P < .001) after a median of follow-up of 3.3 years. Facebook content featuring stories and images of participants received the highest engagement even though Conclusions: Facebook was a valuable recruitment tool for ENDIA. Compared with conventional recruits, Facebook recruits were three times less likely to withdraw during long-term follow-up and had different sociodemographic characteristics. Facebook content featuring participants was the most engaging. These findings inform social media strategies for future cohort and type 1 diabetes studies. Trial Registration: Australia New Zealand Clinical Trials Registry: ACTRN1261300794707.

Published
2022

50. Resolution of symptoms of binge eating disorder associated with semaglutide treatment for obesity and type 1 diabetes.

Author

Gong, Joanna Y. and Wentworth, John M.

Subjects
*OBESITY complications, *TYPE 1 diabetes, *SELF-evaluation, *WEIGHT loss, *MENTAL health, *GLYCOSYLATED hemoglobin, *BINGE-eating disorder, *DISEASE management, *HYPOGLYCEMIC agents, *ANXIETY, *DRUG approval, *DISEASE relapse, *ANTHROPOMETRY, *OBESITY, *MENTAL depression, *PSYCHOSOCIAL factors
Published
2024
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