ABSTRACT
Patients with insulin-treated type 1 diabetes (T1D) are exposed to hypoglycaemia, which may be serious. Serious cognitive impairment (including coma and seizure) that requires the help of a third party is a medical emergency. Besides the intravenous injection of glucose by a health care provider, its treatment consists of the subcutaneous or intramuscular injection of glucagon which may be performed by a family member. However, such an injection is not easy and puts off some people, which retards the initiation of a potentially life-saving therapy. The intranasal administration of 3 mg glucagon has been shown as efficacious as the subcutaneous or intramuscular injection of 1 mg glucagon in controlled studies carried out in both adult and youth patients with T1D. Stimulation and real-life studies among caregivers, patients and acquaintances showed a preference for nasal glucagon because of its easy and quick use. The launch of nasal glucagon (Baqsimi®) offers new perspectives for the ambulatory emergency management of severe hypoglycaemia and hypoglycaemic coma with a special obvious advantage in children.
La personne avec un diabète de type 1 (DT1) traité par insuline est exposée à un risque d'hypoglycémie, parfois grave. L'hypoglycémie sévère qui désigne tout trouble cognitif grave (y compris coma, convulsion) nécessitant l'intervention d'un tiers est une urgence médicale. Outre l'injection de glucose par voie intraveineuse, réservée à un personnel de santé, le traitement consiste en l'injection de glucagon par voie sous-cutanée ou intramusculaire qui peut être réalisée par un membre de l'entourage. Cependant, cette injection n'est pas aisée et rebute certaines personnes, ce qui retarde la mise en route d'un traitement potentiellement salvateur. L'administration nasale de glucagon 3 mg s'est avérée aussi performante que l'injection sous-cutanée ou intramusculaire de 1 mg dans des études contrôlées réalisées chez des patients DT1 adultes ou enfants/adolescents. Des études de simulation et de vraie vie réalisées auprès de soignants, de patients et de connaissances ont montré une préférence pour la forme nasale en raison de sa facilité et rapidité d'utilisation. La commercialisation du glucagon nasal (Baqsimi®) offre de nouvelles perspectives pour le traitement d'urgence ambulatoire de l'hypoglycémie sévère et du coma, avec un avantage particulièrement évident chez les enfants.
Subject(s)
Diabetes Mellitus, Type 1 , Hypoglycemia , Adolescent , Adult , Blood Glucose , Child , Coma/chemically induced , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Glucagon/adverse effects , Glucagon/therapeutic use , Humans , Hypoglycemia/chemically induced , Hypoglycemic Agents/adverse effects , InsulinABSTRACT
The continuous and multidisciplinary care of children with type 1 diabetes contributes improving their quality of life. Nevertheless, psychological follow-up issues among parents of a diabetic child are less developed in studies. At present, there is a need to develop research on psychological parental adjustment in order to identify risk and protective factors for understanding the parental experience and improving the initiatives to prevent the parental distress. Our results argue for a crucial role of intolerance of uncertainty in parental concerns. This study supports the continuous psychological follow-up of parents in close collaboration with medical teams.
La prise en charge continue et pluridisciplinaire des enfants atteints de diabète de type 1 contribue à l'amélioration de leur qualité de vie. Cependant, les enjeux du suivi psychologique des parents d'un enfant diabétique sont moins développés dans les travaux de la littérature. À l'heure actuelle, il est nécessaire de réaliser des recherches portant sur l'ajustement psychologique parental afin d'identifier les facteurs de risque et de protection dans la compréhension du vécu des parents dans le but d'améliorer les initiatives de prévention de la détresse parentale. Nos résultats plaident pour un rôle non négligeable du facteur d'intolérance à l'incertitude au maintien des inquiétudes parentales. Cette étude confirme l'intérêt d'un suivi psychologique continu des parents en étroite collaboration avec les équipes médicales.
Subject(s)
Diabetes Mellitus, Type 1 , Adaptation, Psychological , Child , Emotional Adjustment , Humans , Parents , Prospective Studies , Quality of Life , Stress, PsychologicalABSTRACT
These last few years, new advances in technologies and modern insulin regimens have improved diabetes care for children and adolescents and have led to the definition of new therapeutic goals.
Au cours de ces dernières années, les nouvelles avancées technologiques et thérapeutiques ont marqué la prise en charge du diabète de l'enfant et de l'adolescent amenant ainsi à définir de nouveaux objectifs thérapeutiques.
Subject(s)
Diabetes Mellitus, Type 1 , Hypoglycemic Agents , Insulin , Adolescent , Child , Diabetes Mellitus, Type 1/drug therapy , Humans , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic useABSTRACT
OBJECTIVES: Information on the efficacy of GH treatment in short SGA children starting their treatment in adolescence is limited. Therefore, adult height (AH), total height gain, and pubertal height gain were evaluated in short SGA children who started GH treatment at pubertal onset. PATIENT AND METHODS: Growth data of 47 short SGA adolescents (22 boys) who started GH treatment at pubertal onset (PUB group) were compared with results from 27 short SGA patients (11 boys) who started GH therapy at least 1 year before pubertal onset (PrePUB group). RESULTS: The PUB group achieved a mean (±SD) total height gain of 0.8 ± 0.7 SDS and an AH of -2.5 ± 0.7 SDS after 4.1 ± 1.1 years of GH treatment with a dosage of 41.8 ± 8.4 µg/kg/day. These results were comparable with those in the PrePUB group, which was treated for a longer duration (5.8 ± 2.1 years), resulting in a total height gain of 1.1 ± 0.7 SDS and an AH of -2.1 ± 1.0 SDS. Multiple regression analysis showed a significantly lower height gain in pubertal patients, females, and patients weighing less at start of GH treatment. An AH above -2 SDS and above the parent-specific lower limit of height was, respectively, reached in 28% and 70% of PUB and 44% and 67% of PrePUB patients (NS). AH SDS was positively correlated with the height SDS at start of GH. CONCLUSIONS: Short SGA adolescents starting GH therapy at an early pubertal stage have a modest and variable height gain. A normal AH can be expected in one third of the patients, especially in those with a smaller height deficit at onset of GH treatment.
ABSTRACT
Defining reference range is an essential tool for diagnostic. Age and sexe influences on thyroid hormone levels have been already discussed. In this study, we are defining a new pediatric reference range for TSH, FT3 and FT4 for Cobas C6000 analyzer. To do so, we have taken in account 0 to 18 year old outclinic patients. During the first year of life, thyroid hormone levels change dramatically before getting stabilized around 3 years old. We also compared our results to those obtained in a Canadian large-scale prospective study (the CALIPER initiative).
L'établissement de valeurs de référence thyroïdiennes pédiatriques est un élément essentiel dans l'aide au diagnostic des dysfonctionnements thyroïdiens chez l'enfant et l'adolescent. L'influence de l'âge et du sexe sur les concentrations des hormones thyroïdiennes a de nombreuses fois été évoquée. Dans cette étude, nous définissons un nouvel intervalle de référence pédiatrique pour la TSH, la FT3 et la FT4 sur l'analyseur Cobas C6000 (Roche). Pour ce faire, nous avons collecté les données des patients ambulants de 0 à 18 ans de notre institution. Au cours de la première année, les valeurs d'hormones thyroïdiennes fluctuent fortement avant de se stabiliser vers l'âge de 3 ans. Nous comparons également nos résultats à ceux d'une étude prospective de grande ampleur menée au Canada (étude CALIPER). e.
Subject(s)
Thyroid Hormones/blood , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Reference Values , Retrospective StudiesABSTRACT
Neonatal hyperthyroidism is a rare pathology, most often the consequence of Graves' disease in the mother. Around 0.2% of pregnant women have Graves disease and 1 to 2% of newborns of mother with Graves' disease. This article will describe the case of 4 newborns who have been diagnosed and treated in CHU-NDB between 2007 and 2011. The second part will focus on the new recommendations about the management of these young patients from foetal period to birth.
Subject(s)
Graves Disease/complications , Hyperthyroidism/etiology , Pregnancy Complications/physiopathology , Female , Humans , Hyperthyroidism/physiopathology , Hyperthyroidism/therapy , Infant, Newborn , Male , Pregnancy , Pregnancy Complications/epidemiologyABSTRACT
UNLABELLED: Since heterozygous familial hypercholesterolemia (HeFH) is a disease that exposes the individual from birth onwards to severe hypercholesterolemia with the development of early cardiovascular disease, a clear consensus on the management of this disease in young patients is necessary. In Belgium, a panel of paediatricians, specialists in (adult) lipid management, general practitioners and representatives of the FH patient organization agreed on the following common recommendations. 1. Screening for HeFH should be performed only in children older than 2 years when HeFH has been identified or is suspected (based on a genetic test or clinical criteria) in one parent.2. The diagnostic procedure includes, as a first step, the establishment of a clear diagnosis of HeFH in one of the parents. If this precondition is satisfied, a low-density-lipoprotein cholesterol (LDL-C) levelabove 3.5 mmol/L (135 mg/dL) in the suspected child is predictive for differentiating affected from non-affected children. 3. A low saturated fat and low cholesterol diet should be started after 2 years, under the supervision of a dietician or nutritionist.4. The pharmacological treatment, using statins as first line drugs, should usually be started after 10 years if LDL-C levels remain above 5 mmol/L (190 mg/dL), or above 4 mmol/L (160 mg/dL) in the presence of a causative mutation, a family history of early cardiovascular disease or severe risk factors. The objective is to reduce LDL-C by at least 30% between 10 and 14 years and, thereafter, to reach LDL-C levels of less than 3.4 mmol/L (130 mg/dL). CONCLUSION: The aim of this consensus statement is to achieve more consistent management in the identification and treatment of children with HeFH in Belgium.
Subject(s)
Hyperlipoproteinemia Type II/therapy , Adult , Cardiology/methods , Child , Consensus Development Conferences as Topic , Decision Making , Female , Gastroenterology/methods , General Practice/methods , Guidelines as Topic , Heterozygote , Humans , Hyperlipoproteinemia Type II/diet therapy , Hyperlipoproteinemia Type II/genetics , Lipids/chemistry , Male , Nutritional Sciences , Pediatrics/methods , Young AdultABSTRACT
The gynaecological issues encountered in children and teenagers lay at the intersection of paediatric endocrinology and gynaecology. More than ten years ago, an outpatient clinic in paediatric endocrinology and gynaecology has been created. Here, we review the last 6 years. 214 girls were included, considering only the first visit for each patient. Collected data are initial concern for this consultation, age at first consultation and confirmed or suspected diagnosis. A classification is done according to the initial concern of patients in six categories. Principal queries concern pubertal development, precocious pilosity or abnormalities in menstrual cycles. Vulvovaginitis and morphologic abnormalities are also frequently encountered. This consultation suggests a paediatric approach with a child feeling confident and a gynaecological examination with a specialist knowing the anatomy particularities and the development of the children. This article focuses on the importance of specific gynaecological examination in children and reviews the main diseases encountered.
Subject(s)
Endocrinology , Gynecological Examination , Gynecology , Pediatrics , Referral and Consultation , Adolescent , Adolescent Health Services/organization & administration , Ambulatory Care Facilities/organization & administration , Belgium/epidemiology , Child , Child Health Services/organization & administration , Child, Preschool , Endocrine System Diseases/diagnosis , Female , Genital Diseases, Female/diagnosis , Genital Diseases, Female/epidemiology , Gynecological Examination/methods , Gynecological Examination/standards , Gynecological Examination/statistics & numerical data , Humans , Infant , Menstruation Disturbances/diagnosis , Menstruation Disturbances/epidemiology , Physical Examination/statistics & numerical data , Retrospective Studies , Vaginal Diseases/diagnosis , Vaginal Diseases/epidemiology , Vulvar Diseases/diagnosis , Vulvar Diseases/epidemiology , Young AdultABSTRACT
Congenital Isolated hypogonadotropic hypogonadism (CIHH) is caused by an inherited mechanism of impairment of the pituitary-gonadal axis, interfering with gonads' control. Currently, different forms of HHCI with (Kallmann syndrome or KS) or without anosmia-hyposmia are known. There are six forms of KS already described but in several cases no genetic mutation is found. The genetic anomalies already described are: KAL1 (locus Xp23) coding for anosmine-1, KAL-2 or FGFRI (8p11. locus 2 - p11.1) coding for Fibroblast Growth Factor Receptor 1 (FGFR1), KAL4 or PROk2 (locus 3p21.1) and KAL3 or ProKR2 (locus 20p13) coding respectively for the Prokinecitin-2 and its receptor, KAL5 or CHD7 (locus_8q12.1) coding for a chromodomain helicase DNA-binding protein-7 gene (CHD7) and lastly KAL6 or FGF8 (10Q 24 loci) coding for Fibroblast Growth Factor 8. The other genetic anomalies without anosmia are less frequent. These are associated either with Gnrhl gene (8p2-11. 2), GnRHR (4q21.2), GPR54 (19p13),TAC3R or neurokinine receptor 3 (4 q 25), LH (19q13.32) or FSH (11p13). The isolated congenital hypogonadotrophic hypogonadism phenotype is variable depending on gender, the importance of the deficit, and ultimately, according to a specific regulatory mechanism of the axis, affected by an inherited genetic anomaly. In this review, we describe the essential aspects of the different phenotypes and genotypes of HHCI, in order to assess clinicians an early disease's diagnosis and management.
Subject(s)
Hypogonadism/congenital , Hypogonadism/genetics , Diagnosis, Differential , Genetic Counseling , Humans , Hypogonadism/diagnosis , Hypogonadism/therapyABSTRACT
OBJECTIVES: The treatment of brain tumors in childhood is frequently complicated by growth retardation with a high proportion of irradiation (Irr)-induced GH deficiency (GHD) resulting in reduced adult final height (AFH) even after GH therapy (GHT). In order to optimize future GHT protocols, more information on the factors influencing the growth response to GH in these children is needed. This retrospective study evaluated AFH and influencing auxological and treatment factors of a standardized daily biosynthetic GHT in childhood survivors of brain tumors with documented GHD after brain Irr. DESIGN AND METHODS: From the Belgian GH Registry, 57 children survivors of a brain tumor outside the hypothalamo-pituitary area with available AFH were stratified into two groups depending on cranial (C-Irr; n=25) or craniospinal (CS-Irr; n=32) Irr. RESULTS: In the C-Irr patients, results showed an AFH of -0.8 (-2.5, 1.4) SDS (median (range)) and in the CS-Irr patients, results showed a significantly (P<0.001) lower AFH of -1.8 (-4.2, 0.0) SDS. AFH SDS corrected for mid-parental height (MPH) in the C-Irr group was -0.5 (-2.2, 0.9) and -1.5 (-3.6, 0.0) SDS in the CS-Irr group. AFH was positively correlated with age at end of tumor therapy, height SDS at start GHT, height gain SDS first year GHT, and negatively correlated with CS-Irr. CONCLUSIONS: GHT failed to restore adult height to MPH in nearly half of Irr-induced GHD patients for brain tumor, especially those receiving CS-Irr, irradiated at a younger age or shorter at start GHT.
Subject(s)
Body Height/drug effects , Brain Neoplasms/radiotherapy , Human Growth Hormone/deficiency , Human Growth Hormone/therapeutic use , Hypopituitarism/etiology , Pituitary Gland/radiation effects , Radiotherapy/adverse effects , Adolescent , Adult , Age Factors , Belgium , Body Height/radiation effects , Chi-Square Distribution , Child , Child, Preschool , Databases, Factual , Female , Humans , Infant , Male , Patient Selection , Pituitary Gland/physiopathology , Regression Analysis , Retrospective Studies , Sex Factors , Statistics, Nonparametric , SurvivorsABSTRACT
BACKGROUND/AIMS: Few data are available about parental concerns and psychosocial functioning of young children born small for gestational age (SGA) treated with growth hormone (GH). The present study focused on the perception of short stature and the concerns and expectations of the parents regarding GH treatment. METHODS: Forty prepubertal short SGA children, randomized into a GH-treated and a GH-untreated group, and their parents were evaluated by a questionnaire and a semi-structured interview at start and after 2 years of follow-up. RESULTS: Before start, 85% of the parents were concerned about short stature, 76% expected an increase in adult height of > or =10 cm and 81% expected a positive impact on well-being. Half of the parents expressed fears regarding GH treatment. After 2 years, more parents of treated children reported obvious growth and physical changes, and fewer parents reported teasing because of short stature. An improvement of well-being was reported by half of the parents of treated and untreated children. Fears about GH treatment disappeared almost completely. CONCLUSION: The perspective of GH treatment induced major adult height expectations. In treated children, the physical effects of GH treatment became obvious, teasing because of short stature decreased and initial concerns about short stature and GH therapy decreased.
Subject(s)
Body Height , Human Growth Hormone/therapeutic use , Infant, Small for Gestational Age/growth & development , Perception , Psychomotor Performance , Child , Child, Preschool , Female , Humans , Infant, Newborn , Infant, Small for Gestational Age/psychology , Male , Parents/psychology , Patient Satisfaction , Social BehaviorABSTRACT
We present the experience of the Citadelle Hospital (Liege, B) in the diagnosis, treatment and follow-up of medulloblastoma in children. A retrospective study of 10 cases of medulloblastoma was performed. Five years after diagnosis, the event-free survival was 77%.
Subject(s)
Brain Neoplasms/surgery , Medulloblastoma/surgery , Adolescent , Belgium , Brain Neoplasms/diagnosis , Brain Neoplasms/genetics , Chemotherapy, Adjuvant , Child , Child Development , Child, Preschool , Diagnosis, Differential , Disease-Free Survival , Female , Follow-Up Studies , Humans , Infant , Intracranial Hypertension/surgery , Male , Medulloblastoma/diagnosis , Medulloblastoma/genetics , Neoplasm Recurrence, Local/pathology , Radiotherapy, Adjuvant , Remission Induction , Retrospective Studies , Treatment OutcomeABSTRACT
The present study aimed to investigate the effects of leptin and ghrelin on pulsatile pulsatile gonadotrophin-releasing hormone (GnRH) secretion in vitro with emphasis on neuropeptide mediators and changes between prepuberty (15 days) and sexual maturity (50 days) in the male rat. When hypothalamic explants were studied 90 min after an intraperitoneal injection of leptin, ghrelin or agouti-related protein (AgRP) at 15 days, the GnRH interpulse interval (IPI) was significantly increased by ghrelin and AgRP and decreased by leptin. At 50 days, an increase in GnRH IPI was also caused by ghrelin and AgRP. When the peptides were directly incubated with the explants, the effects of leptin and AgRP in vitro were consistent with those seen after in vivo administration. By contrast, ghrelin resulted in a reduction of GnRH IPI and this was observed at 15 days only. To delineate the neuropeptide mediators of leptin and the effects of ghrelin in the hypothalamus, various hypothalamic neuropeptides and antagonists were used in vitro. At 15 days, the GnRH IPI was significantly decreased after incubation with cocaine and amphetamine-regulated transcript (CART), alpha-melanocyte-stimulating hormone, corticotrophin-releasing factor (CRF) and neuropeptide Y (NPY). The reduction of GnRH IPI caused by leptin was partially prevented by either an anti-CART antiserum or SHU 9119, a melanocortin MC3/MC4 receptor antagonist or a CRF receptor antagonist. The NPY-Y5 receptor antagonist did not influence the effects of leptin whereas that antagonist totally prevented the decrease in GnRH IPI caused by ghrelin. The ghrelin-induced reduction of GnRH IPI was partially prevented by SHU 9119. When used alone, SHU 9119 or a CRF-receptor antagonist resulted in increased GnRH IPI at 50 days while they had no effects at 15 days. The NPY-Y5 receptor antagonist resulted in increased GnRH IPI at 15 and 50 days. In conclusion, leptin and ghrelin show opposing effects on pulsatile GnRH secretion after administration in vivo whereas they both have stimulatory effects in vitro. Such effects involve consistently the anorectic peptides CART and CRF for leptin that are mainly active at 15 days. The melanocortigenic system appears to mediate the effects of both leptin and ghrelin. The effects of ghrelin also involve NPY receptors and operate effectively before and at sexual maturity.
Subject(s)
Gonadotropin-Releasing Hormone/metabolism , Hypothalamus/metabolism , Leptin/physiology , Peptide Hormones/physiology , Sexual Maturation/physiology , Agouti-Related Protein , Analysis of Variance , Animals , Corticotropin-Releasing Hormone/metabolism , Female , Ghrelin , In Vitro Techniques , Intercellular Signaling Peptides and Proteins/physiology , Male , Nerve Tissue Proteins/metabolism , Periodicity , Rats , Rats, Wistar , Receptors, Melanocortin/physiology , Signal Transduction/physiology , Statistics, NonparametricABSTRACT
OBJECTIVE AND DESIGN: Children born small for gestational age (SGA) are not only at risk for short stature, but also for neurodevelopmental and behavioral problems. In this study, we analyzed the effects of high-dose GH therapy on cognitive development and psychosocial functioning in 34 prepubertal (3-8 years) short SGA children, equally randomized into a GH-treated group (TRG) and an untreated group (UTRG). METHODS: At start and after 2 years, children underwent standardized tests measuring the intellectual abilities (Wechsler Preschool and Primary Scale of Intelligence-Revised, or Wechsler Intelligence Scale for Children-Revised); their parents completed a standardized questionnaire evaluating psychosocial functioning (Child Behavior Checklist; CBCL). RESULTS: At start, total IQ scores were significantly (P < 0.05) lower in the SGA group than in the general population: 32% of the SGA patients had scores below 85. After 2 years, IQ scores remained unchanged in the TRG, but increased significantly (P < 0.05) in the UTRG. After exclusion of children with developmental problems, however, no significant changes in IQ scores occurred in the UTRG as well as the TRG. At baseline, 24% (8/34) children had problematic CBCL total problems scores, equally distributed among the two groups; no significant changes in the different subscale scores occurred after 2 years. CONCLUSION: No beneficial effect of 2 years of GH therapy on cognitive and behavioral profile could be observed in a cohort of rather young short SGA children presenting a variable degree of developmental delay and behavioral problems. Subsequent follow-up could reveal potential long-term effects of GH therapy on development and behavior.
Subject(s)
Child Development/drug effects , Cognition/drug effects , Developmental Disabilities/drug therapy , Human Growth Hormone/administration & dosage , Infant, Small for Gestational Age , Body Height , Child , Child Behavior , Child, Preschool , Cohort Studies , Educational Status , Female , Humans , Infant, Newborn , Intelligence Tests , Male , PsychologyABSTRACT
Prader Willi syndrome can be viewed as a physiopathological model of obesity. Such patients deserve specific management, preferably in a multidisciplinary setting. The paper reports on 6 patients followed in the paediatric endocrine service at the University of Liege.
Subject(s)
Patient Care Team , Prader-Willi Syndrome/therapy , Child , Humans , Prader-Willi Syndrome/diagnosis , Prader-Willi Syndrome/geneticsABSTRACT
AIMS/HYPOTHESIS: The incidence of type 1 diabetes varies according to age, sex and season of diagnosis. We investigated whether these and other clinical, biological and anthropometric parameters were correlated with residual beta cell function in newly diagnosed patients, since it is possible that the nature of external and/or genetic disease accelerators may be (partly) reflected in the inaugural disease presentation. MATERIALS AND METHODS: The correlates of random C-peptide levels sampled shortly after diagnosis (median [interquartile range]: 3 [0-14] days) were studied by multivariate analysis in 1,883 islet-antibody-positive diabetic patients aged <40 years who were diagnosed between 1989 and 2000. RESULTS: Higher C-peptide levels (above percentile 50 of patients) were associated with older age at diagnosis, female sex, diagnosis in the high-incidence season (October to March), less-decreased BMI (expressed as a standard deviation score), lower insulin requirements after stabilisation, lower prevalence of ketonuria and a less-increased glycaemia at diagnosis (all p < 0.001). C-peptide levels were not correlated with calendar year at diagnosis, duration of symptoms prior to diagnosis, HLA-DQ2/DQ8 genotype or islet antibody status. CONCLUSIONS/INTERPRETATION: Sex- and season-dependent differences in residual functional beta cell mass and/or insulin resistance have been identified at diagnosis of type 1 diabetes. They may reflect differences in disease-precipitating external or lifestyle factors and should be further investigated longitudinally in prediabetes to further identify putative aetiological factors, which may provide targets for prevention.
Subject(s)
C-Peptide/blood , Diabetes Mellitus, Type 1/blood , Adolescent , Adult , Age of Onset , Autoantibodies/blood , Belgium/epidemiology , Child , Child, Preschool , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/immunology , Female , HLA-DQ Antigens/blood , Humans , Infant , Male , Registries , Sex CharacteristicsABSTRACT
The management and follow up of diabetes in youth is a multidisciplinary challenge due to both short and long term objectives. Awareness of the feelings and problems faced by the families is critical. The experience of our team has started in the 1960s and is briefly described and updated in this article.
Subject(s)
Child Welfare , Diabetes Mellitus/therapy , Patient Education as Topic , Child , Child, Preschool , Diabetes Mellitus/diagnosis , Diagnosis, Differential , Humans , Nutritional Status , Patient Care Team , Pediatrics , Social SupportABSTRACT
The management of adolescents with diabetes mellitus involves specific aspects at diagnosis and during follow-up. A type 2 diabetes should be excluded at diagnosis since this condition is increasingly observed in closed relationhip with the progression of obesity in young people. During initial education process, the parents should be involved while a specific space and time for interaction with the adolescents is required. During follow-up, all aspects of the adolescent process should be taken into account together with diabetes. This includes risk-taking or exploratory behaviours, feeling of being different, angryness and difficulties for the adolescents to consider the long-term complication risk. Special attention should be devoted to the transition towards adult care.
Subject(s)
Adolescent Behavior , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/therapy , Risk-Taking , Adolescent , Adolescent Health Services , Anger , Humans , Obesity/etiology , Obesity/prevention & control , Self ConceptABSTRACT
BACKGROUND: Children with type 1 diabetes should be encouraged to participate in physical activity because exercise can benefit insulin sensitivity and improve known risk factors for atherosclerosis. METHODS: Physical activity patterns of 127 children and adolescents with stable type 1 diabetes were investigated by 24 hour continuous heart rate monitoring. The percentage of heart rate reserve was used to measure the amounts of physical activity at different intensities. The results were compared with normative data. RESULTS: Diabetic preschoolchildren accumulated 192.7 (78.1), 39.1 (24.3), and 21.3 (9.4) minutes/day (mean (SD)) of light, moderate, and vigorous physical activity, respectively. At the same activity levels, diabetic schoolchildren accumulated 168.9 (76.7), 37.9 (15.9), and 19.0 (14.8) minutes/day, and diabetic teenagers accumulated 166.3 (67.5), 45.6 (26.9), and 25.2 (15.3) minutes/day. Diabetic schoolchildren were significantly more active than healthy peers when considering moderate activity; diabetic teenagers were significantly more active when considering moderate and vigorous activity. There was a negative correlation between the most recent glycated haemoglobin and the time spent in light activities in schoolchildren, and a negative correlation between mean glycated haemoglobin for one year and time spent in light and moderate activities in schoolchildren. CONCLUSION: The majority of our diabetic patients meet the classical paediatric guidelines for physical activity and compare favourably with their healthy peers.
Subject(s)
Diabetes Mellitus, Type 1/rehabilitation , Motor Activity/physiology , Adolescent , Age Factors , Child , Child, Preschool , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/physiopathology , Diabetes Mellitus, Type 1/psychology , Electrocardiography, Ambulatory , Exercise , Female , Glycated Hemoglobin/metabolism , Health Behavior , Heart Rate , Humans , Male , Time FactorsABSTRACT
Although the interactions between sex steroids and GnRH have been extensively studied, little is known about the mechanism of estradiol (E2) effects on GnRH secretion. In the present study, we used retrochiasmatic hypothalamic explants of 50-d-old male rats, and we observed that E2 significantly increased the glutamate-evoked GnRH secretion in vitro within 15 min in a dose-dependent manner. E2 also significantly increased the L-arginine-evoked GnRH secretion. E2 effects were time dependent because the initially ineffective 10(-9) M concentration became effective after 5 h of incubation. The E2 effects involved the estrogen receptor (ER) alpha because they were similarly obtained with the specific ER alpha agonist 1,3,5-tris(4-hydroxyphenyl)-4-propyl-1H-pyrazole. The use of glutamate receptor agonists and antagonists indicated that E2 effects on GnRH secretion evoked by both glutamate and L-arginine involved the 2-amino-3-hydroxy-5-methyl-4-isoxazol propionic acid/kainate receptors. Similar E2 effects on the kainate-evoked secretion were observed throughout development in both sexes. The observation of similar E2 effects using explants containing the median eminence alone indicated that the median eminence was a direct target for E2 rapid effects on the glutamate-evoked GnRH secretion. The signaling pathways involved in E2 effects included an increase in intracellular calcium and the activation of protein kinase A, protein kinase C, and MAPK. It is concluded that E2 can stimulate the glutamate- and nitric oxide-evoked GnRH secretion in vitro through a rapid pathway involving the ER and kainate receptor as well as through a slower mechanism responding to lower E2 concentrations.
