Autoanticuerpos anti-insulina en la diabetes tipo 1 / Anti-insulin autoantibodies in type 1 diabetes

Introducción: Los autoanticuerpos anti-insulina (AAI) representan un marcador serológico de la diabetes tipo 1 (DT1). El significado clínico de los AAI aún no ha sido determinado en la población cubana. Objetivo: Determinar el valor clínico de AAI en pacientes con DT1. Métodos: Se determinaron los niveles séricos de AAI por el ensayo inmuno-adsorbente ligado a enzima (ELISA) en 33 pacientes adultos con DT1, 78 pacientes con otras condiciones endocrinas (CEE) como diabetes tipo 2, tiroiditis de Hashimoto e hiperinsulinemia, y 49 controles normales (CN). El valor de corte se determinó con el análisis de las curvas características operativas del receptor (COR) (ROC por sus siglas en inglés). Se utilizaron pruebas no paramétricas para comparar los niveles de AAI de pacientes con DT1, CEE y CN, y determinar la correlación entre AAI y la edad. Resultados: El valor de corte óptimo de AAI para DT1 fue el índice de 1,05, con sensibilidad de 45,5 por ciento, especificidad de 81,6 por ciento, razón de verosimilitud positiva de 2,47, y razón de verosimilitud negativa de 0,67. Los niveles de AAI en DT1 (índice de 0,97) fueron significativo, más altos que los de CN (índice de 0,70; p=0,020) y los de CEE (índice de 0,63; p= 0,009). Los niveles de AAI resultaron inversamente proporcionales a la edad en pacientes diabéticos ( =-0,252; p=0,030). Conclusiones: Los pacientes con DT1 se distinguieron por niveles más altos de AAI, aunque la presencia de estos anticuerpos no fue exclusiva de DT1. Los niveles de AAI dependieron de la edad en los pacientes diabéticos(AU)

Introduction: Anti-insulin autoantibodies (AAI) represent a serological marker of type 1 diabetes (T1D). The clinical significance of AAIs has not yet been determined in the Cuban population. Objective: To determine the clinical value of AAI in patients with T1D. Methods: AAI serum levels were determined by enzyme-linked immunosorbent assay (ELISA) in 33 adult patients with T1D, 78 patients with other endocrine conditions (CEE) such as type 2 diabetes, Hashimoto's thyroiditis, and hyperinsulinemia, and 49 normal controls (CN). The cut-off value was determined by receiver operating characteristic (ROC) curve analysis. Nonparametric tests were used to compare the AAI levels of patients with T1D, CEE, and CN, and to determine the correlation between AAI and age. Results: AAI optimal cut-off value for T1D was the index of 1.05, with 45.5 percent of sensitivity, 81.6 percent specificity, 2.47 positive likelihood ratio, and 0.67 negative likelihood ratio. AAI levels in DT1 (index of 0.97) were significant, higher than those of CN (index of 0.70; p= 0.020) and CEE levels (index of 0.63; p= 0.009). AAI levels were inversely proportional to age in diabetic patients (ρ = -0.252; p=0.030). Conclusions: Patients with T1D were distinguished by AAI higher levels, although the presence of these antibodies was not exclusive to T1D. AAI levels depended on age in diabetic patients(AU)

Changes of thyroid hormone level in type 1 diabetic children complicated with ketoacidosis / 中华全科医师杂志

Objective:To investigate the changes of thyroid hormone level in children with type 1 diabetic mellitus (T1DM) complicated with ketoacidosis.Methods:Sixty-seven children with acute T1DM and ketoacidosis admitted in Department of Endocrinology, Shanxi Children′s Hospital from December 2017 to December 2020 were enrolled as acidosis group; and 44 T1DM children without ketoacidosis at admission served as control group. According to blood gas analysis, in acidosis patients there were 22 cases in mild group (pH<7.3), 16 cases in moderate group (pH<7.2) and 29 cases in severe group (pH<7.1). Serum levels of triiodothyronine (T 3), thyroxine (T 4), free T 3(FT 3), free T 4(FT 4), thyroid stimulating hormone (TSH) were measured in all patients at admission and recovery, retrospectively. Patients in the acidosis group at acute stage were treated with balanced fluid infusion, insulin infusion and eritone. Results:The serum levels of T 3 [0.48(0.19, 0.67)nmol/L vs. 0.97(0.74, 1.18)nmol/L, Z=-5.97, P<0.001], T 4 [(49.99±26.06) nmol/L vs. (73.48±23.32)nmol/L, t=4.68, P<0.001], FT 3 [1.80(1.24, 2.51) pmol/L vs. 3.31(2.56, 3.98) pmol/L, Z=-6.15, P<0.001], FT 4 [9.74 (7.21, 12.85)pmol/L vs. 14.54 (11.29, 16.75)pmol/L, Z=-5.23, P<0.001] and TSH [0.86(0.31, 1.81) mIU/L vs. 1.92(1.01, 3.56)mIU/L, Z=-4.19, P<0.001] in acidosis group at acute stage were significantly lower than those in the control group. In acidosis group at recovery stage serum levels of T 3 [1.58 (1.25, 1.86)nmol/L], T 4 [(92.52±27.03) nmol/L], FT 3 [5.03(4.15, 5.78) pmol/L], FT 4 [15.94 (14.40, 18.38)pmol/L], and TSH [2.21(1.58, 3.16)mIU/L] were significantly higher than those at acute stage ( Z=-6.96, t=-11.34, Z=-7.00, Z=-6.39, Z=-5.28,all P<0.001). There was an decreasing trend of T 3 and FT 3 levels from mild group [0.60 (0.47, 0.78)nmol/L, 2.20(1.47, 2.89) pmol/L], moderate group [0.36(0.18, 0.64)nmol/L, 1.90(1.11, 2.31)pmol/L] to severe acidosis group [0.35(0.16, 0.54) nmol/L, 1.48(1.08, 1.89)pmol/L](T 3: Z=-3.44, P=0.001; Z=-3.97, P<0.001; Z=-5.63, P<0.001;FT 3: Z=-3.44, P=0.001; Z=-4.13, P<0.001; Z=-5.86, P<0.001). Compared to control group serum T 4 and FT 4 levels in moderate group [(47.34±29.89)nmol/L and 9.75(5.74,12.29)pmol/L] and severe group [(44.08±22.27)nmol/L and 8.82 (6.40, 9.89)pmol/L] were significantly decreased (T 4: t=3.66, t=5.01,all P<0.001; FT 4: Z=-3.40, P=0.001; Z=-5.73, P<0.001). The TSH level in severe acidosis group [0.63 (0.27, 1.33)mIU/L] was lower than that in the control group ( Z=-4.23, P<0.001). At the recovery stage the serum levels of T 3 [1.69 (1.22, 1.87)nmol/L,1.68 (1.24, 1.84)nmol/L,1.55(1.25, 1.86) nmol/L], FT 3 [5.27 (4.37, 5.76)pmol/L,4.32(4.17, 5.73)pmol/L,5.04(3.81, 5.79)pmol/L], T 4 [(87.41±18.40)nmol/L,(90.02±30.41)nmol/L,(97.34±30.10)nmol/L] and FT 4 [16.05(14.23, 17.71) pmol/L,15.26(14.40, 16.11)pmol/L,16.88(13.98, 18.89) pmol/L] in the mild, moderate and severe acidosis groups were higher than those in the control group (T 3: Z=-4.55, Z=-3.87, Z=-4.93,all P<0.001;FT 3: Z=-4.72, Z=-3.72, Z=-4.52,all P<0.001;T 4: t=-2.01, P=0.047; t=-2.15, P=0.034; t=-3.88, P<0.001;FT 4: Z=-2.21, P=0.027; Z=-0.84, P=0.399; Z=-2.67, P=0.008); while there was no significant difference in TSH levels [2.28(1.88, 3.16)mIU/L, 2.19(1.26, 3.57) mIU/L, 2.18(1.36, 3.09) mIU/L] between mild, moderate, severe acidosis groups and the control group (all P>0.05). Conclusions:Thyroid function in T1DM children complicated with ketoacidosis is decreased significantly with the aggravation of acidosis. After correction of ketoacidosis, the level of thyroid function can basically return to normal.

Utilidad de la prueba de tolerancia de comida mixta con Nutrial I para la evaluación de la función de las células beta en diabetes tipo 1 / Usefulness of the tolerance test of mixed food with Nutrial I for the assessment of beta cells function in diabetes type 1

RESUMEN Introducción: La prueba de tolerancia de comida mixta es considerada la prueba de oro para la medición de la producción de insulina endógena en pacientes con diabetes tipo 1. Objetivo: Determinar la utilidad de la prueba de tolerancia de comida mixta con Nutrial I para evaluar la función de las células ß en diabéticos tipo 1 de diagnóstico reciente y la relación de esa función con algunas características clínicas y bioquímicas. Métodos: Se estudiaron variables bioquímicas como la glucemia, hemoglobina glucosilada (HbA1c), péptido C y fracciones lipídicas. La prueba de tolerancia de comida mixta con Nutrial I se aplicó a 18 sujetos con diabetes tipo 1 de diagnóstico reciente y a 8 voluntarios con edades comprendidas entre 19 y 35 años. El consumo del suplemento Nutrial I se calculó según el peso del paciente. Se obtuvieron muestras para glucemia y péptido C a los -10, 0, 30, 60, 90 y 120 minutos. Resultados: Se observaron concentraciones elevadas de glucemia y disminuidas de péptido C durante la prueba de tolerancia de comida mixta en los diabéticos tipo 1 de diagnóstico reciente, en comparación con los voluntarios, así como, diferencias en las áreas bajo la curva de péptido C (AUC-pc) (p= 0,001). En los diabéticos tipo 1 de diagnóstico reciente se evidenció una correlación negativa entre el AUC-pc con los niveles de glucemia en ayunas (r= -0,747; p ( 0,0001) y la HbA1c (r= -0,535; p= 0,022). Por el contrario, se encontró una correlación positiva entre el AUC-pc y el péptido C en ayunas (r= 0,722; p= 0,001). El AUC-pc después de la prueba de tolerancia de comida mixta es mayor en los sujetos con glucemia en ayunas si GA < 7 mmol/L con respecto a los sujetos con glucemia en ayunas ( 7 mmol/L (p= 0,012). Conclusiones: El empleo del Nutrial I en la prueba de tolerancia de comida mixta fue útil en la evaluación de la función de las células β en diabéticos tipo 1 de diagnóstico reciente. Los valores bajos de glucemia en ayunas durante esta prueba son marcadores indirectos de una función residual de células ( más conservada en los diabéticos tipo 1 de diagnóstico reciente(AU)

ABSTRACT Introduction: The tolerance test of mixed food is considered the gold standard for the measurement of endogenous insulin production in patients with diabetes type 1. Objective: To determine the usefulness of the tolerance test of mixed food with Nutrial I to assess the ß-cells function in patients with diabetes type 1 of recent diagnosis and the relation of this function with some clinical and biochemical characteristics. Methods: There were studied biochemical variables as the blood glucose, glycosylated haemoglobin (HbA1c), C-peptide and lipid fractions. The tolerance test of mixed food with Nutrial I was applied to 18 individuals with diabetes type 1 of recent diagnosis and in 8 volunteers aged between 19 and 35 years old. The consumption of Nutrial I supplement was calculated according to the weight of the patient. Samples were obtained for blood glucose and C-peptide at -10, 0, 30, 60, 90 and 120 minutes. Results: There were observed high concentrations of glycemia and decreased amounts of C-peptide during the tolerance test of mixed food in recently diagnosed type 1 diabetics in comparison with the volunteers, as well as differences in areas under the curve of C-peptide (AUC-pc) (p= 0.001). In the recently diagnosed type 1 diabetics was evident a negative correlation between the AUC-pc with fasting plasma glucose levels (r= -0,747; p(0.0001) and HbA1c (r= -0,535; p= 0.022). On the contrary, it was found a positive correlation between the AUC-pc and fasting C-peptide (r = 0.722; p = 0.001). The AUC-pc after the tolerance test of mixed food was greater in subjects with fasting blood glucose < 7 mmol/L with respect to the subjects with fasting blood glucose ( 7 mmol/L (p= 0.012). Conclusions: The use of Nutrial I in the tolerance test of mixed food was useful in the assessment of the role of the β-cells in patients with recently diagnosed diabetes type 1. Low values of fasting blood glucose during this test are indirect markers of a residual function of (cells more preserved in type 1 diabetics of recent diagnosis(AU)

Assessment of knowledge and skills of barangay health workers: Basis for diabetes education program for lay persons

@#This study aimed to determine the level of knowledge and skills of the barangay health workers (BHW) about diabetes management. A descriptive correlational design that included 121 BHWs in Bustos, Bulacan was utilized in the study. A test and skill demonstration checklist was utilized to determine the knowledge and skills of BHWs about diabetes management. Categorical variables such as the respondents' profile were described using frequencies and percentages. Continuous variables such as level of knowledge and skills were summarized using central tendency measures (mean) with standard deviation. Pearson correlation test for association was used to test for relationship between level of knowledge and skills. Pearson Chi square was used to test association between demographic variables and level of knowledge and skills. Ap value of <0.05 was considered significant in the analysis of the results. Results showed that the overall level of knowledge of the BHWs was satisfactory but varied in many aspects of diabetes management. The BHWs level of knowledge in determining signs and symptoms and diagnosis of diabetes was high but low in determining types of diabetes mellitus. The level of skills of the BHWs was high in blood pressure measurement but low in blood glucose monitoring. BHWs have varied knowledge and skills in diabetes care management. There is a need to train the BHWs further to develop their knowledge and skills. The nurse diabetes educators must provide diabetes education program for BHWs that are focused on competencies to deliver safe and appropriate health teaching activities utilizing the basic concepts and principles of diabetes management

Diabetes self-management education program (DSME) among adolescents with type 1 diabetes mellitus

@#<p style="text-align: justify;">The DSME program is aimed to educate adolescents about diabetes mellitus: disease process, survival skills, exercise management, drug management, diet management, prevent acute and chronic complications and optimize quality of life. This study utilized the quasi experimental pre and post-test design involving 15 adolescent patients with Type 1 Diabetes Mellitus. The DSME materials were composed of five modules that included topics in diabetes awareness, survival skills, exercise, drug and diet management. Knowledge, Fasting Blood Sugar (FBS), Random Blood Sugar (RBS) and waist and hip ratio (WHR) were tested. The Intervention phase was implemented in three months where each module was completed by patients in two weeks. Pre and post-test examinations were done after each module. Participants have very satisfactory knowledge in diabetes awareness, survival skills, exercise, drug management before and after the DSME program. However, participants knowledge in diet management were unsatisfactory before and after the DSME program. FBS were high but RBS levels and WHR were in normal levels before, during and after the DSME program. Knowledge scores were significantly different before and after the implementation of all the modules (Module 1 to Module 5) to the participants. RBS results were significantly different after the implementation of the Module 1- DM awareness and Module 5- diet management. However, no significant differences were obtained in the RBS results of the participants after the implementation of Module 2, 3, 4, and 5. No significant differences were also obtained in the WHR parameters of the participants in each of the implementation of DSME. No significant differences in the FBS results were obtained after the implementation of the DSME modules. The module type DSME is effective in increasing knowledge of the adolescent patients in diabetes and its management. The content of the diet management module needs to be strengthened and be tested again for its effectiveness in increasing knowledge of adolescent patients.</p>

Influence of growth hormone receptor gene knockout in pancreaticβcells in STZ-induced type 1 diabetes in mice / 吉林大学学报(医学版)

Objective To investigate the influence of tissue-specific growth hormone receptor (GHR)deficiency in type 1 diabetes in the mice at the gene level using pancreaticβcells combined with streptozotocin (STZ)-induced type 1 diabetes model.Methods The experiment was divided into four groups:knockout mice group (LLc knockout group), using the homozygotes (LLc:LL+Cre) producted by pancreaticβ cell-specific expressed recombinant enzyme mice (RIP-Cre)and Cre-LoxP system modified GHR mice (Floxed,LL);LL control group, containing Floxed GHR allele homozygous mice (LL);LLc STZ group and LL STZ group (STZ was used for inducing type 1 diabetes model mice). The mice with feeding glucose≥25 mmol · L-1 were considered to be successful models.The Glucose Tolerance Test (GTT),pancreas tissue HE staining and immunohistochemistry were performed in the mice.Results The blood glucose of the mice in LL STZ group and LLc STZ group and LLc STZ group were increased after inj ection of STZ and the models achieved the diagnostic criteria for diabetes 1 6 d later.The results of GTT showed that compared with LLc control group and LLc knockout group, the blood glucose levels of the mice in LL STZ and LLc STZ groups were increased (P<0.05).There was no significant change of morphology and structure of islets between LL control group and LLc knockout group detected by HE staining. The immunohistochemistry results showed that the insulin level of the mice in LL STZ group was significantly reduced compared with LL control group;the insulin level of the mice in LLc STZ group was reduced compared with LLc control group.Conclusion Pancreaticβcell GHR gene knockout has no effect on the blood glucose and the function ofβcells in the mice with STZ-induced type 1 diabetes.

The changes in serum concentrations of the interferon-?-inducible protein 10(IP-10) in different types of diabetic patients and their significance / 中国糖尿病杂志

Objective To investigate the significance of serum IP-10 levels in different types of diabetic patients. Methods Serum IP-10 level in 78 cases with type 1 diabetes,49 cases with type 2 diabetes and 33 cases of healthy controls was measured with ELISA assays. Type 1 diabetic patients were divided into classic type 1 diabetes (n=39) and latent autoimmune diabetes in adults (LADA,n=39) according to their disease process,and they were also divided into autoimmune type 1 diabetes (n=58) and idiopathic type 1 diabetes (n=20).Type 2 diabetic patients,according to carotid intima-media thickness (IMT),were divided into patients with (n=24) or without atherosclerosis (n=25). Results 1) Serum IP-10 levels were not statistically different among type 1 diabetes,type 2 diabetes and healthy controls. 2) Serum IP-10 concentrations in autoimmune type 1 diabetes with positive islet autoantibody were higher than those in healthy controls(184.96?104.48pg/ml vs 146.10?74.61pg/ml,P=0.03);while there were no difference in type 1 diabetes with variable disease durations. 3) No difference in IP-10 levels was found between type 2 patients with(173.5?69.6pg/ml) and without atherosclerosis (188.5?79.7 pg/ml). Conclusions Serum IP-10 level is augmented in autoimmune type 1 diabetes.

Glycogen levels and energy status of the liver of fasting rats with diabetes types 1 and 2

Glycogen levels and the energy status of livers from fasting rats with diabetes types 1 and 2 were measured. After a 24 h fast, the hepatic glycogen levels of rats with diabetes1 and diabetes2 were, 18.7 and 2.6 times higher, respectively, than those of livers from the normal rats. In diabetes1 rats, the glycogen levels decreased when the fasting period was extended to 48 and 72 h. The opposite occurred with the control and diabetes2 rats. Consistently, glucose release by the perfused livers from diabetes1 rats was considerably higher during at least 60 minutes after initiating perfusion. The hepatic ATP content of diabetes1 rats was similar to that of the control rats; in diabetes2 rats, the hepatic ATP content was increased. It could be concluded that regulation of glycogen deposition and degradation in rats with diabetes1 differed markedly from that of rats with diabetes2 which, in turn, behaved similarly to normal healthy rats.

Teores de glicogênio e os estados energéticos de fígados de ratos com diabete dos tipos 1 e 2 foram medidos. Após um jejum de 24 horas os teores de glicogênio de ratos com diabete1 e diabete2 foram, respectivamente 18,7 e 2,6 vezes superiores àqueles de fígados de animais controle. Em ratos com diabete1 o conteúdo de glicogênio diminuiu quando o período de jejum foi prolongado para 48 e 72 horas. O oposto ocorreu em ratos controle e ratos com diabete2. Consistentemente, a liberação de glicose por fígados em perfusão isolada obtidos de ratos com diabete1 foi consideravelmente maior durante ao menos 60 minutos após o início da perfusão. O conteúdo hepático de ATP de ratos com diabete1 foi similar àquele de ratos controle; em ratos com diabete2 o conteúdo hepático de ATP foi maior. Pode-se concluir que a regulação da deposição e degradação do glicogênio em ratos com diabete1 difere marcadamente daquela de ratos com diabete2, os quais, por seu turno, comportam-se similarmente a ratos normais e saudáveis.

Alteration of the plasma concentration of all-trans retinoic acid(ATRA) in type 1 diabetes mellitus / 中国糖尿病杂志

To study the abnormality of the plasma concentration of ATRA in T1DM patients.T1DM patients(n=26),T2DM patients(n=33) and healthy people(n=30) were enrolled.The plasma concentration of ATRA was determined by HPLC.Compared with T2DM patients and healthy people,the concentration of ATRA increased significantly in T1DM patients.

Manejo de la diábetes tipo 1 en el embarazo

El manejo inadecuado de la diabetes tipo 1 durante el embarazo puede conducir a un aumento en la tasa de morbimortalidad para ambos madre e hijos, lo cual implica un aumento del gasto en salud. La utilización apropiada de las guías de manejo preconcepcional y durante la gestación es una estrategia efectiva que limita las complicaciones de la diabetes tipo 1. En este artículo se describen las características de la paciente con diabetes tipo 1, las metas de cuidado preconcepcionales, los potenciales efectos adversos del embarazo en las diabéticas y las estrategias potenciales para la administración de insulina durante el embarazo.

Type 1 diabetes in pregnancy can result in significant short- and long-term morbidity to both mother and offspring if management is suboptimal. This morbidity imposes a considerable financial and health burden on the individual and society at large. Utilization of appropriate management guidelines of preconception and during pregnancy is an effective strategy to limit complications of type 1 diabetes and should therefore become the standard of care. The article, describe the feature of s type 1 diabetic patient, outline the goals of preconception care in this population, for the management of insulin administration in pregnancy.

Effects of anti-chemokine receptor-5 antibody on type 1 diabetes / 第二军医大学学报

Objective:To explore the anti-diabetogenic effect of antibody blocking portion of chemokine receptor-5 antibody(CCR5) molecule.Methods: The severe combined immunodeficient NOD(NOD.Scid) mice,injected i.p.with splenocytes from nonobese diabetic mouse,were randomly divided into 2 groups(8 of each group): anti-CCR5 Ab group and PBS group.The mice in anti-CCR5 Ab group were treated with a specific polyclonal antibody,targeting the first extracellular loop of CCR5,and PBS group was treated with PBS.Blood glucose levels were measured to observe the anti-diabetogenic effect of the antibody.Histological examination and ELISA analysis were also performed.Results: Within 70 d,all of the control mice developed diabetes while 5 of the 8 mice treated with anti-CCR5 Ab were diabetes-free.The difference of inflammation score between 2 groups was significant(P