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The results of study on thyroid autoimmunity and its clinical importance gained during 11-year follow-up of 47 adults with type 1 diabetes mellitus (DM1) are presented. The study proved the preponderance of women among subject affected with thyroid autoimmunity, the autoantibodies against thyroid gland (T-Ab) were significantly more often detected in women compared to men (68% vs. 32%, p < 0.05). Also, serious forms of thyroid autoimmunity manifested with persistence of both T-Ab, faster development of subclinical hypothyroidism (TSH > 4.5 mIU/l in 100% within 4 years after first detection of T-Ab positivity, and within 8 years after DM1 manifestation, respectively), and diffuse hypoechogenic pattern at thyroid gland ultrasonography (USG) were significantly more often observed in women compared to men (45% vs. 12%, p < 0.01). These patients often had small thyroid gland (77% of subjects had volume below 25th percentile of control subjects at the 11th year of follow-up) and presence of thyreopathy in the first degree relatives. No difference between men and women was observed in persistence of thyroid peroxidase autoantibodies (anti-TPO) solely (20% vs. 23%); milder clinical course of thyroid disease was observed in these subjects (the fist detection of TSH > 4.5 mIU/l in the 9th year of follow-up). These patients had varied findings at USG examination with focally/diffuse hypoechogenic/ non-homogenous thyroid gland, and 50% of subjects had thyroid gland volume above 95th percentile in the 11th year of follow-up. Among subjects without thyroid autoimmunity men prevailed (68% vs. 32% women, p < 0.01), and in the 11th year of follow-up the USG finding was often abnormal (thyroid gland volume above 95th percentile of the controls in more than 60% of subjects, trend towards nodulisation). Except for 1 subject, TSH did not exceed 4.5 mIU/l. These results obtained from the Czech population constitute the basis for our recommendation to screen regularly markers of thyroid autoimmunity in patients with DM1. Ultrasonographic examination, that is able to detect sings of thyroid immunopathy in many subjects before first manifestation of T-Ab, is the most sensitive according to both our experience and the published data. For clinical practice, determination of TSH once a year in all DM1 subjects, and of anti-TPO in DM1 women in fertile age is recommended. Ultrasonographic examination should be carried out in case of pathologic results of these tests.
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PMID:[Thyroid autoimmunity in adults with diabetes mellitus type 1. Own experience gained by 11-year monitoring]. 1706 95

The object of this review is to provide the definitions and criteria for diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS), and convey current knowledge of the causes of permanent disability or mortality from complications of these conditions, of the risk factors for DKA and HHS, and of early indicators and contemporary treatment of suspected cerebral edema. The frequency of DKA at onset of type 1 diabetes mellitus (DM1) varies from 10-70%, depending on availability of health care and frequency of diabetes. At the onset of type 2 diabetes (DM2), DKA occurs in 5-52%. One study reported HHS in approximately 4% of new patients with DM2. Recurrent DKA rates are equally dependent on variability in medical services and socio-economic circumstances, and are estimated to be eight episodes per 100 patient years, with 20% of patients accounting for 80% of the episodes. Mortality for each episode of DKA internationally varies from 0.15-0.31%, with idiopathic cerebral edema accounting for two-thirds or more of this mortality. Other causes of death or disability include untreated DKA or HHS, hypokalemia, hypophosphatemia, hypoglycemia, other intracerebral complications, peripheral venous thrombosis, mucormycosis, rhabdomyolysis, acute pancreatitis, acute renal failure, sepsis, aspiration pneumonia, and other pulmonary complications. Population-based studies from the UK, Australia, the USA, and Canada report cerebral edema incidence in DKA of 0.5-2.0%. Published information does not support the notion that treatment factors are causal in cerebral edema. Younger age, greater severity of acidosis, degree of hypocapnia, and severity of dehydration have been suggested as risk factors in several studies. Bimodal distribution of the time of onset of cerebral edema and wide variation in brain imaging findings suggest the variability and likely multiple causation of the clinical picture. Functional brain scanning has indicated that DKA is accompanied by increased cerebral blood flow suggesting that the predominant mechanism of edema formation is a vasogenic process. A method of monitoring for diagnostic and major and minor signs of cerebral edema has been proposed and tested which indicates that intervention will be required in five individuals to provide early intervention for a single case of cerebral edema. The preferred intervention of mannitol infusion has typically been accompanied by intubation and hyperventilation, but recent evidence indicates outcome is adversely affected by aggressive hyperventilation. The prevention of DKA and HHS at the onset of diabetes mellitus requires a high degree of awareness and suspicion by primary care providers; prevention of recurrent DKA necessitates a diligent team effort.
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PMID:Hyperglycemic crises and their complications in children. 1731 23

The hyperinsulinemic euglycemic clamp (HEC) combined with indirect calorimetry (IC) is used for estimation of insulin-stimulated substrate utilization. Calculations are based on urinary urea nitrogen excretion (UE), which is influenced by correct urine collection. The aims of our study were to improve the timing of urine collection during the clamp and to test the effect of insulin on UE in patients with type 1 diabetes (DM1; n=11) and healthy subjects (C; n=11). Urine samples were collected (a) over 24 h divided into 3-h periods and (b) before and during two-step clamp (1 and 10 mIU.kg(-1).min(-1); period 1 and period 2) combined with IC. The UE during the clamp was corrected for changes in urea pool size (UEc). There were no significant differences in 24-h UE between C and DM1 and no circadian variation in UE in either group. During the clamp, serum urea decreased significantly in both groups (p<0.01). Therefore, UEc was significantly lower as compared to UE not adjusted for changes in urea pool size both in C (p<0.001) and DM1 (p<0.001). While UE did not change during the clamp, UEc decreased significantly in both groups (p<0.01). UEc during the clamp was significantly higher in DM1 compared to C both in period 1 (p<0.05) and period 2 (p<0.01). The UE over 24 h and UEc during the clamp were statistically different in both C and DM1. We conclude that urine collection performed during the clamp with UE adjusted for changes in urea pool size is the most suitable technique for measuring substrate utilization during the clamp both in DM1 and C. Urine collections during the clamp cannot be replaced either by 24-h sampling (periods I-VII) or by a single 24-h urine collection. Attenuated insulin-induced decrease in UEc in DM1 implicates the impaired insulin effect on proteolysis.
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PMID:Urinary urea nitrogen excretion during the hyperinsulinemic euglycemic clamp in type 1 diabetic patients and healthy subjects. 1755 77

The incidence of type 1 diabetes (DM1) varies greatly among different nations and ethnic groups. Precise mapping of DM1 incidence and its trends is useful in the study of the interaction of genetic and non-genetic factors which influence the manifestation and course of the disease. Important progress has been made in the understanding of the mechanisms of autoimmune diabetes by the study of genes and autoimmune forms of monogenetic diabetes.
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PMID:[New knowledge in the heredity of autoimmune diabetes. 1st part--Monogenetically determined types of autoimmune diabetes]. 1770 29

The aim of this study was to evaluate the efficacy of long-acting insulin analogue glargine (G) changing from NPH in basal-bolus therapy for Japanese children and adolescents with type 1 diabetes mellitus (DM1). Thirty patients (11 M, 19 F) with DM1 aged 13.3 +/- 4.5 years were included in the study. Mean fasting blood glucose level was significantly decreased (baseline: 142.5 +/- 39.3 vs 127.1 +/- 24.0, 129.0 +/- 29.1, 121.1 +/- 26.0 mg/dl at 3, 6, 12 months, respectively, p <0.01), and mean HbA(1c) was significantly decreased (baseline: 8.06 +/- 0.85 vs 7.69 +/- 0.89, 7.57 +/- 0.93, 7.36 +/- 0.95%, at 3, 6, 12 months, respectively, p <0.01) after changing to G from NPH. Severe hypoglycemia rarely occurred during the study period. In conclusion, basal-bolus therapy using G resulted in improved overall glycemic control with a low risk of severe hypoglycemia in Japanese pediatric patients with DM1.
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PMID:Usefulness of the long-acting insulin analogue glargine in basal-bolus therapy for Japanese children and adolescents with type 1 diabetes mellitus. 1784 43

External respiratory mechanics was studied in 141 patients with type 1 diabetes mellitus (DM1) and 36 healthy controls using computed analysis of flow-volume loop and total body plethysmography. The DM1 patients were divided into 4 groups: group 1 consisted of patients without clinical signs of microangiopathic complications; groups 2 and 3 consisted of patients with initial and advanced manifestations of late diabetic syndrome (LDS), respectively; group 4 consisted of patients suffering from severe endocrinopathy with end-stage chronic renal failure. The velocity and volume parameters in groups 1 and 2 did not differ significantly from those in the controls. Significant reduction in the vital capacity, forced expiratory volume in one second, and total lung capacity was noted in patients with advanced LDS and uremia. Forced expiratory volume in one second decreased in proportion to reduction in lung vital capacity, which did not cause Tiffno index to leave the reference range. The authors came to the conclusion that DMI causes restrictive ventilatory defect, associated with advanced clinical manifestations of microangiopathic alterations.
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PMID:[The condition of external respiratory mechanics in patients with type 1 diabetes]. 1803 70

An increased frequency of allergic reactions to latex has been reported in specific populations with chronic latex exposure. However, relevance of latex allergy to children and adolescents with type I diabetes mellitus (DM1) has not been studied yet. The aim of the studty is to assess latex allergy risk in children and adolescents with DM1. Thirty-nine children with DM1 and 35 controls were enrolled. In a case-control study, we applied to all subjects a standard questionnaire, and specific Immunoglobulin E (IgE) concentrations for latex, common aeroallergens, and food-allergens were measured in serum samples. Latex exposure rates by means of medical procedures, operations, and latex glove usage were not different between DM1 and controls. Symptoms due to latex exposure were not determined in both groups. Three (7.7%) subjects in DM1 tested positive for latex-specific antibodies (LSIE), whereas no subject in controls. Diabetics that tested positive for latex-specific antibodies had the disease for three, 5 and 8 years. Nine (23.1%) of diabetics, and two (5.7%) of controls were atopic (p = 0.04). In our investigation, we found that children and adolescents with DM1 are not a risk group for latex allergy, and LSIE in children with DM1 was not accompanied by symptoms of latex allergy, or, presumably, increased risk of latex anaphylaxis.
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PMID:Latex allergy risk assessment in children and adolescents with type I diabetes mellitus. 1807 23

This article presents an introduction to diabetes and the problems associated with diabetes as well as scientific evidence on how to prevent or retard chronic complications diabetes causes by means of optimizing a diabetes sufferer's metabolic control. The authors make reference to one of the most important studies by The Diabetes Control and Complications Trial-DCCT which has signified a before and an after in the treatment of type 1 diabetes mellitus (DM1). Focusing on the treatment of diabetes with continuous subcutaneous insulin injection (CSII), the authors describe 1) Patients who are candidates for this treatment according to scientific associations; 2) Characteristics and functioning methods for insulin delivery systems as well as the different models of insulin delivery systems, catheters, needles and commercial inserting mechanisms presently available in Spain. The authors report on the experiences that the diabetes team at the Barcelona "Hospital Clinic" have with CSII therapy The authors describe the structure of a Therapeutic Educational Program directed at patients suffering from DM1 who are candidates for CSII therapy the process which these patients follow and the results of this program, evaluated after two years of follow-up study.
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PMID:[Therapeutic education regarding type 1 diabetes (DM1)]. 1827 93

Vaccination with polysaccharide pneumococcal vaccine "Pneumo 23" (Sanofi Pasteur, France) was performed in 31 children with type 1 diabetes mellitus (DM1) as well as in 19 children with respiratory tract diseases (asthma, chronic pneumonia), which formed comparison group. Fourty-three unvaccinated children with DM1 were included in the control group. Dynamics of IgG levels to mixture of pneumococcal polysaccharides (PS) included in the vaccine as well as to PS of serotypes 3, 6B, 9N, 23F, and to cell wall polysaccharides of Streptococcus pneumoniae were assessed. Using ELISA method, significant increase of IgG levels to mixture of PS and to PS of pneumococcal serotype 3 was detected. Although intensity of immune response to vaccination in children with respiratory diseases was significantly higher compared to children with DM1 (mean geometric titer of antibodies, proportion of patients with high antibody titers, and with 4-fold seroconversion). Development of methods to strengthen immune response in children with DM1 vaccinated against pneumococcal infection is required.
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PMID:[Effect of vaccination against pneumococcal infection in children with type 1 diabetes mellitus]. 1827 39

The increased prevalence of coeliac disease (CD) among children with type 1 diabetes mellitus (DM1) implies that there is more than a simple association. A link between the gut immune system and DM1 has been suggested both in animal models and in humans. We review the literature on the epidemiology and genetic and clinical aspects shared by these two diseases and speculate on the role of gluten on the possible relationship between CD and DM1, on the basis of recent animal and human studies. The data suggest a failure in oral tolerance mechanisms in DM1 other than that in CD. It remains to be understood why only a small proportion of patients with DM1 proceed to the production of coeliac-associated antibodies and to overt enteropathy.
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PMID:Update on coeliac disease and type 1 diabetes mellitus in childhood. 1834 Oct 84


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