Parental Stress among Parents of Children with Type 1 Diabetes Mellitus: A Review

@#This review provides an overview of the evidence which concerns the parental stress of children with type 1 diabetes mellitus. Articles for this review were collected using the Science Direct, CINAHL, PsycINFO, Medline, Scopus, EBSCO, Springer, Ovid, PubMed, Google Scholar, and Cochrane Library. In total, 38 articles were relevant to this review. The findings of the reviewed studies provide an exciting opportunity to advance our knowledge for a different aspect of parental stress which is related to the disease and predictor’s factor contributes to parental stress. This review sheds new light on developing the educational programs to reduce the level of parental stress and to help them to cope positively with this disease.

Capillary versus Serum b-hydroxybutyrate in Pediatric Diabetic Ketoacidosis

Objective:To find the strength of agreement between point-of-care and serum β-hydroxybutyrate. Methods: 236 paired samples (capillary β-hydroxybutyrate by a point ofcare device and serum β-hydroxybutyrate by colorimetric enzymatic estimation) sampleswere collected from 26 children aged <13 years admitted with diabetic ketoacidosis. Inbornerrors of metabolism and septic shock were excluded. Results: Capillary β-hydroxybutyrateshowed excellent agreement with serum â-hydroxybutyrate with mean (SD) bias of 0.027(0.78); 95% limit of agreement -1.51, 1.56 and intraclass correlation 96.1% (95%CI 95%–97%, P<0.001). An increase in the bias noted for value above 5 mmol/L (P<0.001) (serummeasurements were higher than capillary point-of-care measure-ments). Capillary â-hydroxybutyrate correlated significantly with blood pH, anion gap,bicarbonate and carbondioxide levels on blood gas analysis (P<0.05). Conclusions: Capillary β-hydroxybutyrateestimation is a valid method for monitoring of ketonemia in pediatric diabetic ketoacidosis

Increased PIT1 and PIT2 Expression in Streptozotocin (STZ)-induced Diabetic Mice Contributes to Uptake of iAs(V) / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>This study aimed to investigate the susceptibility of mice with streptozotocin(STZ)-induced diabetes mellitus (TIDM) to the uptake of pentavalent inorganic arsenic (iAsV) and the possible molecular mechanism.</p><p><b>METHODS</b>TIDM was induced in mice by STZ. TIDM and normal mice were treated with 15.0 mg/kg Na2HAsO4·12H2O by intragastric administration. Then, the concentrations of arsenic in various tissues were measured by atomic fluorescence spectrometry. The gene expression levels of Pit1 and Pit2 were quantified by real-time RT-PCR, and their protein levels were detected by Western blotting in mouse heart, kidney, and liver tissues.</p><p><b>RESULTS</b>The concentrations of arsenic in STZ-induced TIDM mouse tissues were higher at 2 h after intragastric administration of Na2HAsO4·12H2O. Compared with the levels in normal mice, PIT1 and PIT2, which play a role in the uptake of iAsV, were upregulated in the livers and hearts of TIDM mice. PIT1 but not PIT2 was higher in TIDM mouse kidneys. The upregulation of Pit1 and Pit2 expression could be reversed by insulin treatment.</p><p><b>CONCLUSION</b>The increased uptake of iAsV in TIDM mouse tissues may be associated with increased PIT1 and/or PIT2 expression.</p>

Lung Function in Sudanese Children and Adolescents with Type 1 Diabetes Mellitus.

Background: Diabetes Mellitus Type 1 (DMT1) is a chronic, debilitating and multifactor disease that is emerging as an important health problem in Sudan. The aim of this study was to investigate the lung functions in Sudanese children and adolescents as well as to explore the effects of duration, age, gender and insulin dose on the pulmonary functions. Methods: This is a hospital-based controled study conducted in the diabetic center of Wad Madani Pediatrics Hospital. A total of 80 males and 80 females with DMT1 and matching healthy controls were included. Spirometry was performed on a microspirometer (compact hand instrument, Switzerland, 2000). Results: Our data revealed that children with diabetes showed significantly lower mean values of Forced Expiratory Volume in First Second (FEV1), Forced Vital Capacity (FVC) and Peak Expiratory Flow Rate (PEFR), except the ratio FEV1/FVC that has shown a significant increase compared with the healthy controls. Male patients with diabetes demonstrated a greater increase in FEV1, FVC and PEFR than the females, but the ratio FEV1/FVC was increased in both equally and significant correlations between FEV1, FVC, PEFR and age, gender, duration dose of insulin were found in patients with diabetes. Conclusion: The actual lung function data among Type 1 diabetic children and adolescents showed significantly lower values of FVC, FEV1, and PEFR with increased FEV1 and FVC compared to the predicted lung function data which indicated a restrictive pattern.

Does Protein Distribution Affect Blood Glucose in Type I Diabetes Mellitus? A Case Report

Introduction: Type I diabetes mellitus patients often complain of hunger and suboptimal blood glucose levels. Proper protein distribution might help to improve glucose control and ultimately, carbohydrate distribution. Case presentation: A nine-year-old boy (herein the patient) newly diagnosed with Type I diabetes mellitus with diabetic ketoacidosis, presented nocturia, polydipsia, loss of weight and lethargy. During admission, the patient was dehydrated and had decompensate metabolic acidosis with glycated hemoglobin (HbA1c) 14.5%, random blood sugar 26.2 mmol/dL, and ketone 3.2 mmol/dL. The patient was started on insulin therapy and referred to a dietitian on the 2nd day of admission. Although patient complied with the dietitian's plan, his glucose level remained suboptimal and he complained of hunger immediately after meals. Insulin dose and activity level remained same at this moment. Whilst keeping the protein intake constant, protein exchanges were redistributed into snacks and main meals. The patient felt satiety and his blood glucose started to optimise. Pairing protein-rich foods with carbohydrates can help to slow the rise in blood glucose because protein causes slower stomach emptying and helps prevent sharp spikes in blood glucose and takes the edge off hunger. Conclusion: This reported case showed proper protein distribution with even carbohydrate distribution can help to improve glucose control and satiety in type I diabetic mellitus. It is recommended that further investigations be conducted to provide more concrete evidence on the role of protein distribution in blood glucose control of type I diabetes mellitus.

A Case of Bilateral Diabetic Papillopathy Related to Rapid Hemoglobin A1c Decrease in Type I Diabetes Mellitus

PURPOSE: To report a case of bilateral diabetic papillopathy related to rapid hemoglobin A1c (HbA1c) decrease in a type I diabetic patient. CASE SUMMARY: A 39-year-old female who was diagnosed with type I diabetes mellitus for the first time at this hospital was presented to our clinic for evaluation of diabetic retinopathy. There were no subjective symptoms, including blurred vision or visual defect. Her best corrected visual acuity in both eyes was 1.0, but her fundus resembled mild nonproliferative diabetic retinopathy. When diagnosed with type I diabetes mellitus, her HbA1c was 15.3%. She used insulin to control her blood glucose and her HbA1c reached 7.3% two months after controlling the blood glucose. Three months after her diabetic diagnosis, there were no differences in subjective symptoms and best corrected visual acuity. Fundus examination showed optic disc swelling in both eyes. To evaluate for the etiology of optic disc swelling, we did the examinations of the optic disc, fundus, and brain magnetic resonance imaging. No specific signs were observed. We diagnosed diabetic papillopathy and observed the patient without any treatments. Her optic disc swelling showed gradual improvement. CONCLUSIONS: This case shows that the rapid HbA1c decrease in type I diabetes mellitus is related to the occurrence of bilateral diabetic papillopathy. This supports previous studies that estimated that the rapid HbA1c decrease in type I diabetes mellitus in response to insulin treatment is one of the risk factors for bilateral diabetic papillopathy.

Estrategias para la prevención de la diabetes mellitus tipo 1 / Strategies for the prevention of type I diabetes mellitus

La diabetes mellitus tipo 1, muestra una fase progresiva crónica prolongada y predecible en la actualidad en la mayoría de los individuos. Los recientes avances en la comprensión de la etiología autoinmune de la diabetes tipo 1, justifican la aplicación de novedosos métodos de intervención inmunológicos. El propósito de este trabajo es revisar los aspectos más relevantes en relación con la prevención de la diabetes mellitus tipo I y las posibles estrategias. Las medidas de intervención incluyen métodos inmunológicos: deprivación de proteínas de origen bovino, plasmaféresis, insulinoterapia temprana, administración de insulina y de antígeno GAD por vía oral; empleo de agentes inmunosupresores, inmunomoduladores o inmunoterapias semiespecíficas. Se ha utilizado tratamientos no inmunológicos: empleo de medicamentos antinflamatorios no esteroideos o antioxidantes, previo al inicio de la intolerancia a la glucosa y de la presencia de complicaciones vasculares. En la actualidad, se están realizando diferentes ensayos sobre posibles tratamientos preventivos de la diabetes mellitus tipo 1, aunque ninguno de ellos muestra seguridad y eficacia de forma convincente, el empleo racional de nuevos y potentes medicamentos inmunosupresores o inmunomodulares, constituye un atractivo proceder en la verdadera prevención del desarrollo y progresión del proceso autoinmunológico que caracteriza a esta enfermedad en individuos considerados de alto riesgo

Type I diabetes mellitus shows long chronic progressive phase that is now predictable in most of individuals. Recent advances in the understanding of autoimmune etiology of this type of diabetes warrant the implementation of novel methods of immunological interventions. This paper was aimed at reviewing the most relevant aspects on the prevention of type I diabetes mellitus and probable strategies. The intervention measures covered the following immunological methods: deprivation of bovine proteins, plasmapheresis, insulin-based therapy, oral administration of insulin and GAD antigen; use of immunosupressors, immunomodulators and semi-specific immunotherapies. Non-immunological treatments have been used such as use of non-steroidal anti-inflammatory or antioxidant drugs prior to onset of intolerance to glucose, and the presence of vascular complications. Several trials on possible preventive treatments for type I diabetes mellitus are being performed, but none of them has been so far enough safe and efficient in a convincing way; the rational use of new and potent immunosuppresors or immunomodulators is an attractive procedure to prevent the development and progression of the autoimmune process that characterizes this disease in high risk individuals

PEFR, FEF25-75 and MVV In Type-1 Diabetic Male And Their Relationships With HbA1c.

Background: Diabetes mellitus is a chronic and debilitating disease. Its complications give rise to microvascular, macrovascular and neuropathic diseases which affect eyes, kidneys, heart, blood vessels and also lungs. So, there may be a relationship between type-1 diabetes and reduced lung function. Objectives: To observe PEFR, FEF25-75 and MVV and their relationship with HbA1c in type- 1 diabetic male in Bangladesh. Methods: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Dhaka between 1st January and 31st December 2009. A total 30 type-1 diabetic male subjects, age 18-30 years were taken as study group. Another 30 apparently healthy age, sex, BMI and socioeconomic status matched non-diabetic persons were also included as control. For assessment of lung function PEFR, FEF25-75 and MVV of all the subjects were measured by a digital spirometer. Again, to observe glycemic control serum blood glucose and glycosylated hemoglobin (HbA1c) levels of diabetic patients were also measured by usual laboratory technique. Data were analyzed by unpaired‘t’ test and Pearson’s correlation coefficient test. Results: PEFR (p<0.001), FEF25-75 (p<0.001), and MVV (p <0.001) were significantly lower in type-1 diabetic patients in comparison to those of apparently healthy non-diabetic male. Again, their PEFR (p < 0.05), FEF25-75 (p>0.05), and MVV (p<0.05) were negatively correlated with HbA1c. Conclusion: The lung functions were lower in type-1 diabetic male in comparison to those of non-diabetic counterpart and this reduction is mainly due to poor glycemic control.

Three cases of glycogenic hepatopathy mimicking acute and relapsing hepatitis in type I diabetes mellitus

Glycogenic hepatopathy (GH) is an uncommon cause of serum transaminase elevation in type I diabetes mellitus (DM). The clinical signs and symptoms of GH are nonspecific, and include abdominal discomfort, mild hepatomegaly, and transaminase elevation. In this report we describe three cases of patients presenting serum transaminase elevation and hepatomegaly with a history of poorly controlled type I DM. All of the cases showed sudden elevation of transaminase to more than 30 times the upper normal range (like in acute hepatitis) followed by sustained fluctuation (like in relapsing hepatitis). However, the patients did not show any symptom or sign of acute hepatitis. We therefore performed a liver biopsy to confirm the cause of liver enzyme elevation, which revealed GH. Clinicians should be aware of GH so as to prevent diagnostic delay and misdiagnosis, and have sufficient insight into GH; this will be aided by the present report of three cases along with a literature review.

FVC, FEV1 And FEV1/FVC% In Type-1 Diabetic Male And Their Relationships With HbA1c.

Background: Diabetes mellitus is a chronic and debilitating disease. Its complications give rise to micro and macrovascular diseases which affect eyes, kidneys, heart, blood vessels, nerves and also lungs. There may be a relationship between type-1 diabetes and reduced lung function. Objectives: To observe FVC, FEV1, FEV1/FVC % and their relationship with HbA1C in type-1 diabetic male in Bangladesh. Methods: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Dhaka from January to December 2009. A total number of 60 male subjects, from 18-30 years of age was taken and was divided into control and study groups. Among them study group was consisted of 30 type-1 diabetic male patients. Control group was consisted of 30 apparently healthy age, sex, BMI and socioeconomic status matched non-diabetic subjects. All the subjects belonged to lower socio-economic status. For assessment of lung function, FVC, FEV1, FEV1/FVC % of all the subjects were measured. All of theses tests were done by spirometric method by using a digital Spirometer. Again, to observe glycemic control of blood, glycosylated hemoglobin (HbA1c) levels of diabetic patients were also measured by usual laboratory technique. Data were analyzed by Independent-Samples ‘t’ test and Pearson’s correlation coefficient test as applicable. Results: FVC (p <0.001), FEV1 (p < 0.001), and FEV1/FVC% (p < 0.05) were significantly lower in type- 1 diabetic patients in comparison to those of apparently healthy non-diabetic male. Again FVC and FEV1 had significant (p < 0.001) negative correlation but FEV1/FVC% had non-significant positive correlation with HbA1c. Conclusion: Impairment of some lung functions may be found in type-1 diabetic male which may be due to poor glycemic control.

The use of stem cells for the treatment of autoimmune diseases

Autoimmune diseases constitute a heterogeneous group of conditions commonly treated with anti-inflammatory, immunosuppressant and immunomodulating drugs, with satisfactory results in most cases. Nevertheless, some patients become resistant to conventional therapy. The use of high doses of drugs in such cases results in the need for bone marrow reconstitution, a situation which has stimulated research into the use of hematopoietic stem cells in autoimmune disease therapy. Stem cell transplantation in such diseases aims to destroy the self-reacting immune cells and produce a new functional immune system, as well as substitute cells for tissue damaged in the course of the disease. Significant results, such as the reestablishment of tolerance and a decrease in the recurrence of autoimmune disease, have been reported following stem cell transplantation in patients with autoimmune disease in Brazil and throughout the world. These results suggest that stem cell transplantation has the potential to become an important therapeutic approach to the treatment of various autoimmune diseases including rheumatoid arthritis, juvenile idiopathic arthritis, systemic lupus erythematosus, multiple sclerosis, systemic sclerosis, Crohn's disease, autoimmune blood cytopenias, and type I diabetes mellitus.

Clinical Islet Transplantation: Where Do We Stand on? / 대한이식학회지

Islet transplantation had been suggested as a potential treatment modality for type I diabetes mellitus for the last two decades. The methods for the islet isolation and purification were developed. In 2000, the excellent clinical outcomes from the Edmonton group were reported. And various basic researches were performed for the elucidation of the mechanism of initial islet loss. Although the Edmonton protocol, which had initially raised hopes that all the technical and immunologic problems would be solved, recently revealed as a limited success within the selective cases and short-term follow-up, these inspirations led us to the subsequent clinical or basic research of islet transplantation. As a result, many clinical trials and studies have been attempted for the establishment of the optimal immune suppression regimen, the prevention from islet loss in the process of isolation, and the improvement of the intraportal engraftment. This article reviews the history and the recent progress and possible strategies for the clinical islet transplantation.

The Usefulness of Measuring Urinary Proteins by SDS-PAGE in Children with Type I DM without Overt Proteinuria / 대한신장학회잡지

BACKGROUND: The present study was done to evaluate the usefulness of SDS-PAGE in measuring glomerular proteins and tubular proteins in patients with type I DM without overt proteinuria. METHODS: The study population consisted of 76 children with type I DM who have been participated in the Taegu Diabetic Camp from 1997 to 2000. We measured urine albumin, NAG, beta2-microglobulin, creatinine level in urine samples collected for 12 hours in 22 children and simultaneously we analyzed urinary proteins by SDS-PAGE. In remainder 54 children, we measured urine albumin, NAG, creatinine level in random morning urines and urinary proteins by SDS-PAGE. RESULTS: In 22 of 76 children, urinary albumin-to-creatinine ratio (mg/mg), NAG (U/g) and beta2-microglobulin (microgram/g) were 0.021, 2.99 and 170.2, respectively. Positive correlation between urine albumin and NAG was statistically significant (r=0.51, p< 0.05). No significant relations between urinary proteins, such as albumin, NAG, beta2-microglobulin, and clinical characteristics, such as age, duration of illness, HbA1c, were observed. In diagnosing `microalbuminuria', sensitivity of SDS-PAGE was 63% and band of tubular proteins was not detected in any children. CONCLUSION: We thought that SDS-PAGE could be one of useful methods in diagnosing early stage of diabetic nephropathy. The more large scale study is necessary.

Research advancement of the stem cells of the bone marrow interstitial substance differentiating into islet cells / 介入放射学杂志

Type I diabetes mellitus (T_1DM) is a chronic metabolic disease liable to teenagers all over the world. Its mechanism is due to the attack of auto-immune system on the body's own islet cells leading to hyperglycemia with great damages to the body. The implantation of islet cells is an effective way of curing T_1DM. The authors reviewed in detail the research advancement of islet cell source from stem cells of the bone marrow interstitial substance.

INTRACEREBRAL PANCREAS ISLET TRANSPLANTATION FOR THE TREATMENT OF TYPE I DIABETES MELLITUS / 中华内分泌代谢杂志

Ten cases of type I diabetes mellitus were treated with intracerebral pancreas islet transplantation. In 7 cases insulin has been totally stopped for 2 to 13 months, in other 2 cases the dosages of insulin had a decrease of 37% and 64% than that before transplantation respectively, and good control was achieved in those 9 patients. Only one case had not any improvement. The results showed that it is an effective therapy for type I diabetes mellitus and indicated that the pancreas islet was survived in patient's cerebrum and secreted insulin. No evidence of immunological rejection was found. Long-term follow-up is necessary to find how long the allogenic graft can survive.