The Usefulness of Genotyping of Celiac Disease-Specific HLA among Children with Type 1 Diabetes in Various Clinical Situations.

Aim: The aim of the study was to determine the usefulness of HLA DQ2/DQ8 genotyping in children with T1D in various clinical situations: as a screening test at the diabetes onset, as a verification of the diagnosis in doubtful situations, and as a test estimating the risk of CD in the future. Materials and methods. Three groups of patients with T1D were included: newly diagnosed (n = 92), with CD and villous atrophy (n = 92), with CD and villous atrophy (n = 92), with CD and villous atrophy (n = 30), and with potential CD (n = 23). Genetic tests were performed (commercial test, PCR, and REX), and clinical data were collected. Results: The results of genetic tests confirmed the presence of DQ2/DQ8 in 94% of children with diabetes (group I) and in 100% of children with diabetes and CD (groups II and III, respectively). Comparative analysis of the HLA DQ2/DQ8 distribution did not show any differences. Allele DRB1∗04 (linked with HLA DQ8) was significantly less common in children with diabetes and CD (group I versus groups II and III, 56.5% vs. 24.5%; p = 0.001). The probability of developing CD in DRB1∗04-positive patients was 4 times lower (OR 0.25; 95% CI 0.118-0.529; p = 0.001). The probability of developing CD in DRB1∗04-positive patients was 4 times lower (OR 0.25; 95% CI 0.118-0.529; p = 0.001). The probability of developing CD in DRB1∗04-positive patients was 4 times lower (OR 0.25; 95% CI 0.118-0.529. Conclusions: Genotyping HLA DQ2/DQ8 as a negative screening has limited use in assessing the risk of CD at the diabetes onset and does not allow to verify the diagnosis of CD in doubtful situations. The presence of the DRB1∗04 allele modulates the risk of CD and significantly reduces it and can predict a potential form.

The usefulness of the FlashStyle Libre system in glycemic control in children with type 1 diabetes during summer camp.

THE AIM OF THE STUDY: was to evaluate the usefulness of Flash FreeStyle Libre in glycemic control in children during summer camp on the basis of the participants' completed questionnaire and on the basis of the assessment o the suitability of the system performed by medical staff based on a comparative analysis: glycemia by sensor and glucometer. MATERIAL AND METHODS: A study using the new Flash FreeStyle Libre glycemic control system was conducted at a seaside summer camp for children with diabetes at the seaside. The study included 75 children (32 boys and 43 girls), in mean 13.4 (SD 4.6) years old, with an average duration of diabetes of 6.5 (SD 4.5) years and mean HbA1c of 7.81% (SD 2.05). All camp participants were provided with Libre sensors, however, routine glucose control measurements with therapeutic decisions was made using traditional glucose meters. On the last day of the camp, after the removal of the sensors, a satisfaction survey was conducted to assess with a new self-monitoring method and a comparative analysis of the glucose results from the sensor with the personal glucose meters - MARD, MAD, and clinical errors on the Clarke Error Grid were calculated. RESULTS: In the Libre user's survey, wearing comfort and ease of installation were described as very good / good by 86% and 94% of the respondends, respectively. Ease of reading blood glucose by scan was positively evaluated by 92% of the respondents, 95% of the subjects did not report any side effects. The sensor remained intact for 14 days in 46 children (62%), which value was the basis for the statistical calculations. Comparative analysis of glucose results obtained from Libre measurements performed with glucose meters (3143 measurements) showed a relatively good MARD index - 18.22% on average, with a large individual variation (6.36-29.51%). Clarke Error Grid showed that 75.2% (2309) of the results were in Zone A (Acceptable Errors) and 95.81% (3012) in Zone A and B (Non-Negative Errors). CONCLUSION: Libre user's satisfaction survey revealed that most of the respondents rated the cooperation with Flash FreeStyle Libre positively. The relatively good results of Libre in comparison with glucose meters have confirmed the usefulness of this method of monitoring glucose in summer camps for children with diabetes.

Differential sequential patterns supporting insulin therapy of new-onset type 1 diabetes.

BACKGROUND: In spite of numerous research efforts on supporting the therapy of diabetes mellitus, the subject still involves challenges and creates active interest among researchers. In this paper, a decision support tool is presented for setting insulin therapy in new-onset type 1 diabetes. METHODS: The concept of differential sequential patterns (DSPs) is introduced with the aim of representing deviations in the patient's blood glucose level (BGL) and the amount of insulin injections administered. The decision support tool is created using data mining algorithms for discovering sequential patterns. RESULTS: By using the DSPs, it is possible to support the physician's decisionmaking concerning changing the treatment (i.e., whether to increase or decrease the insulin dosage). The other contributions of the paper are an algorithm for generating DSPs and a new method for evaluating nocturnal glycaemia. The proposed qualitative evaluation of nocturnal glycaemia improves the generalization capabilities of the DSPs. CONCLUSIONS: The usefulness of the proposed approach was evident in the results of experiments in which juvenile diabetic patients actual data were used. It was confirmed that the proposed DSPs can be used to guide the therapy of numerous juvenile patients with type 1 diabetes.

[Frequency and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes]. / Ocena stanu klinicznego i czestosci wystepowania kwasicy ketonowej u dzieci ze swiezo rozpoznana cukrzyca typu 1.

INTRODUCTION: Diabetic ketoacidosis (DKA) is still the most dangerous acute complication of type 1 diabetes mellitus (T1DM). It is a life-threatening condition requiring intensive treatment. DKA may be the first symptom of previously undiagnosed diabetes, especially in children. AIM OF THE STUDY: Assessment of the incidence and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes. MATERIAL AND METHODS: We analyzed 535 medical files of children (aged 9 months to 17 years, mean age 4.41-9.96, 261 girls (48%)) hospitalized from 2006 to 2009 because of the newly diagnosed type 1 diabetes mellitus. DKA was diagnosed (according to ISPAD) in children with pH <7.3, blood glucose level >11 mmol/L (>200 mg/dL) and/or blood concentration of bicarbonate <15 mmol/L with ketonuria. Severe DKA was diagnosed in children with pH <7.2. RESULTS: DKA was diagnosed in 123 patients (23%) (63 girls (51%)). The mean age of children with DKA was significantly lower than the age of the children without DKA (9.05-4.45 vs 9.48-4.39 years; p<0.001). Mean pH was 7.21-1.03 (min. 6,82; max. 7,30). In 32.5% of children with DKA severe ketoacidosis (pH -7.2) was observed. The prevalence of acidosis was higher in the 0-4 age group compared to children over 4 years (28 vs. 22%, p<0.001). Neither sex, nor symptoms duration were associated with the development of DKA. Polyuria (95%), polydipsia (95%), weight loss (85%) and abdominal pain (50%) were the most common symptoms reported by patients. CONCLUSIONS: Despite the typical symptomatology of type 1 diabetes mellitus, about 1/4 of newly diagnosed diabetes in children is accompanied by ketoacidosis. The risk of acidosis is greater in younger children.