Assessment of the diet of male adolescents suffering from type 1 diabetes.

INTRODUCTION: Currently, 5-10% of diabetes patients are teenagers. During this period the influence of peers and observation of their eating habits plays a significant role. Unfortunately, they differ from the principles of proper nutrition, which according to the PTD Diabetes Poland should be introduced as an element of proper metabolic compensation. Aim of the study: To assess the condition and dietary habits of male adolescents with type 1 diabetes and to compare their eating habits to generally accepted standards. MATERIAL AND METHODS: The study participants include 20 boys, aged 14.6 ±1.58 years, with type 1 diabetes mellitus treated with a personal insulin pump who were diagnosed using ISPAD criteria. In the study anthropometric and questionnaire methods were used, as well as body composition analysis. RESULTS: In most of the examined subjects, the assessment of nutritional status indicates a proper proportion of adipose tissue (14.72 ±6.25%, 8.71 ±4.10 kg per kg) and muscle mass in the body (28.2 ±6.93 kg). Unfortunately in a significant group of adolescents, the diet is not properly balanced. Particularly the common problem is the excess of total carbohydrates, including simple sugars. CONCLUSIONS: To sum up, despite systematic education of proper nutrition on glycemic control and prevention of acute and chronic complications, the eating habits of male adolescents differ from those of proper nutrition. Additionally, it should be noted that despite the proper results of the body composition analysis, there is a problem with an erroneously balanced diet.

Alcohol and cigarette use among adolescents with type 1 diabetes.

In this study, we compare the prevalence of alcohol and cigarette use among Polish adolescents with type 1 diabetes mellitus (T1DM) (n = 209), aged 15-18 years, with that of a large cohort of their healthy peers, using standardized questionnaire used in the European School Survey Project on Alcohol and Drugs (ESPAD). The lifetime, previous year, and past 30-day prevalence of alcohol consumption was high among adolescents with T1DM but lower than in the controls (82.8 vs 92.0%, 71.7 vs 85.6%, and 47.5 vs 69.7%, respectively, p < 10-5). The lifetime and 30-day prevalence of cigarette use was also lower among patients than the controls (54.6 vs 65.5%, p = 0.001 and 27.3 vs 35.9%, p = 0.012, respectively). Patients who admitted smoking exhibited worse metabolic control than non-smokers (p < 0.0001) and had a higher chance of developing diabetic ketoacidosis. The incidence of severe hypoglycemia was higher among those who reported getting drunk in the previous 30 days (p = 0.04) and lifetime smoking (p = 0.01). CONCLUSIONS: Although alcohol and cigarette consumption is lower than in controls, it is common among teenagers with type 1 diabetes, effecting metabolic control and causing the risk of acute diabetes complications. Better prevention strategies should be implemented in this group of patients in their early teen years. What is Known: • Substance use remains a significant cause of morbidity and mortality among teenagers with type 1 diabetes. • Current medical literature contains inconsistent data on the prevalence of alcohol and cigarette use among adolescents with type 1 diabetes, mostly due to methodological problems with conducting such surveys. What is New: • Methodological approach: we used a validated questionnaire from the European School Survey Project on Alcohol and Other Drugs (ESPAD) and compared the results to a large national control group of 12,114 healthy students who took part in ESPAD in 2011.

Breaking the Taboo: Illicit Drug Use among Adolescents with Type 1 Diabetes Mellitus.

BACKGROUND: The aim of the study was to explore the prevalence of illicit drug use in a group of Polish adolescents with type 1 diabetes (DM1) in comparison with a national cohort of their healthy peers. METHODS: Two hundred and nine adolescents with DM1, aged 15-18 years, were studied in 2013 with an anonymous questionnaire prepared for the European School Survey Project on Alcohol and Other Drugs (ESPAD). The control group was a representative sample of 12114 students at the same age who took part in ESPAD in 2011. Metabolic control was regarded as good if self-reported HbA1c was <8% or poor if HbA1c was ≥8%. RESULTS: Lifetime prevalence of illicit drug use was lower among adolescents with DM1 than in the control group [58 (28%) versus 5524 (46%), p = 10(-5)]. Cannabis preparations were the most frequently used substances [38 (18.3%) versus 3976 (33.1%), p = 10(-5)], followed by tranquilizers, sedatives, and amphetamine. Lifetime and last 12-month use of cannabis were associated with poorer glycemic control (HbA1c ≥ 8%), p < 0.01 and 0.02, respectively. CONCLUSIONS: Adolescents with DM1 report using illicit drugs to a lesser extent than their healthy peers. The use of cannabis is associated with a poorer metabolic control in teens with DM1.

Coexistence of type 1 diabetes mellitus and spinal muscular atrophy in an 8-year-old girl: a case report.

The spinal muscular atrophy is a rare autosomal recessive genetic disease characterized by the progressive loss of muscular strength. In its natural course the disease leads to death. Diabetes mellitus type 1 is an autoimmune metabolic disorder characterized by the disturbed insulin synthesis. This is a case report of an 8-year-old girl suffering from Werdnig Hoffman disease in whom DM1 was diagnosed. The unspecific clinical manifestation and diagnostic difficulties are presented in this paper. To the authors' knowledge, this is the first publication concerning the co-existence of these two medical conditions.

Multicenter cross-sectional analysis of values of glycated haemoglobin (HbA1c) in Polish children and adolescents with long-term type 1 diabetes in Poland: PolPeDiab study group.

INTRODUCTION: Glycated haemoglobin is currently a golden standard of evaluation of metabolic control of diabetes. According to the Evidence based Medicine data, better metabolic control of diabetes decreases the prevalence of chronic complications. AIM OF THE STUDY: to analyse HbA1c in children with a longer duration of type 1 diabetes mellitus (t1DM). MATERIAL AND METHODS: We analysed an epidemiological database (2006-2009) of 7783 HbA1c values of 996 children (465 girls) with t1DM treated at three academic centres (Gdansk, Lódz, Katowice) in Poland. the mean age was 13.04±3.43 years and the mean duration of diabetes was 6.93±2.33 years. RESULTS: the overall mean HbA1c was 7.6±1.5% (by age groups: 7.0±0.8%, 2-5 yrs; 7.1±1.0%, 6-10 yrs; 7.8±1.7%, 11-19 yrs) without gender-related differences. HbA1c increased significantly with increasing age and t1DM duration. HbA1c values differed significantly between the centres. A group of 455 (55.7%) children reached a stable course of diabetes with HbA1c <7.5%, and 110 (13.5%) had HbA1c levels >9%. The mean HbA1c ?6.5% was found in 150 children (18.4%). CONCLUSIONS: In more than 50% of Polish children with longer t1DM duration, the international target of glycaemic control (HbA1c) is achieved; however, only 18% of them reached Polish national target. Age, t1DM duration and centre-specific factors influence the HbA1c values.

[Prognostic factors of celiac disease occurrence in type 1 diabetes mellitus children]. / Czynniki prognostyczne choroby trzewnej u dzieci z cukrzyca typu 1.

INTRODUCTION: Discussion on the frequency of coexistent celiac disease and type 1 diabetes mellitus (DM1) as well as an attempt to standardize diagnostic methods of celiac disease detection among DM1 children have been performed. OBJECTIVES: To assess the incidence of celiac disease among DM1 children in the Pomeranian region of Poland followed by analysis of the putative prognostic factors for celiac disease development in this particular group of children. MATERIALS AND METHODS: 70 children aged 9.47+/-4.59 (group 1) de novo diagnosed with DM1 and 223 children aged 10.20+/-3.87 with long-standing diabetes mellitus type 1 (4.47+/-3.16 years from the diagnosis) were enrolled in the study. All the patients had C-peptide, HbA1c, CRP, TSH, fT4, fT3, urinary albumin secretion rate, IgA, level of antigliadin antibodies (AGA), anti-tissue transglutaminase (TGA) IgA and IgG antibodies (ELISA), anti-endomysium (EmA) IgA and IgG antibodies (immunofluorescence) and anti-tyreoglobulin antibodies (TG), anti-thyroid peroxidase (TPO) antibodies (ELISA) evaluated. All the patients had jejunal biopsy and thyroid ultrasound examination. RESULTS: 5.7% of group 1 patients were diagnosed with celiac disease based on the positive jejunal biopsy in comparison with 9.4% in the group 2. TGA antibodies were present in 9.52% of group 2, AGA in 7.62%, EmA in 6.19%. 10% of group 1 children had autoimmune thyroiditis versus 24.2% of group 2 children. The group of children with coincident long-lasting DM1 and celiac disease (group A) was characterized by significantly earlier age at diagnosis (p=0.003), higher HbA(1)c (p=<0.001), CRP (p<0.001) and elevated urine albumin secretion in relation to children without celiac disease and autoimmune thyroiditis (group B). Serologic test detecting TGA antibodies was found to be the most sensitive (95.2%) for the detection of celiac disease among DM1 children, while the lowest sensitivity was obtained in the case of the EmA antibody test (61.9%). CONCLUSIONS: The celiac disease morbidity confirmed by jejunal biopsy is high among DM1 children (9.4%). The assessment of the serum TGA appears to be the most sensitive screening marker for the celiac disease detection in DM1 children.