Geographic Distribution and Neuropathology of Elaeophora schneideri in Shiras Moose (Alces alces shirasi) in Idaho, USA.

Elaeophorosis, infection by the filarial worm Elaeophora schneideri, is a parasitic disease of wild ungulates in North America; however, our understanding of the relevance of E. schneideri to moose (Alces alces) morbidity and mortality is incomplete. Between March 2020 and July 2022, necropsy and histopathology were performed on 61 Shiras moose (Alces alces shirasi) in Idaho, US. Among the 41 adults (greater than 1 yr old), 21 moose were from northern Idaho, and 20 were from southeastern Idaho. Elaeophorosis was diagnosed in 24% (10 of 41). All 10 infected moose were from southeastern Idaho; none of the 21 moose from northern Idaho were infected. No juvenile moose (nine from northern and 11 from southeastern Idaho) were infected. Microfilariae were detected histologically in 9 of 10 infected moose, most consistently in brain tissue associated with lesions indicative of ischemic injury to the neuroparenchyma attributed to occlusion of arterioles and capillaries by microfilariae or fibrin thrombi, including edema, necrosis, and glial nodules. Microfilariae found in other tissues of the head, including the eye, tongue, and pinnae of some animals, as well as in lung, heart, liver, and kidney, typically were associated with inflammation. Three of the 10 infected moose had cropped ears attributed to elaeophorosis, and four exhibited abnormal behavior, which may have been due to neuropathology associated with E. schneideri microfilariae in the brain.

Investigation of laboratory methods for characterization of aquatic viruses in fish infected experimentally with infectious salmon anemia virus.

Rapid growth in aquaculture has resulted in high-density production systems in ecologically and geographically novel conditions in which the emergence of diseases is inevitable. Well-characterized methods for detection and surveillance of infectious diseases are vital for rapid identification, response, and recovery to protect economic and food security. We implemented a proof-of-concept approach for virus detection using a known high-consequence fish pathogen, infectious salmon anemia virus (ISAV), as the archetypal pathogen. In fish infected with ISAV, we integrated histopathology, virus isolation, whole-genome sequencing (WGS), electron microscopy (EM), in situ hybridization (ISH), and reverse transcription real-time PCR (RT-rtPCR). Fresh-frozen and formalin-fixed tissues were collected from virus-infected, control, and sham-infected Atlantic salmon (Salmo salar). Microscopic differences were not evident between uninfected and infected fish. Viral cytopathic effect was observed in cell cultures inoculated with fresh-frozen tissue homogenates from 3 of 3 ISAV-infected and 0 of 4 uninfected or sham-infected fish. The ISAV genome was detected by shotgun metagenomics in RNA extracted from the medium from 3 of 3 inoculated cell cultures, 3 of 3 infected fish, and 0 of 4 uninfected or sham-infected fish, yielding sufficient coverage for de novo assembly. An ISH probe against ISAV revealed ISAV genome in multiple organs, with abundance in renal hematopoietic tissue. Virus was detected by RT-rtPCR in gill, heart, kidney, liver, and spleen. EM and metagenomic WGS from tissues were challenging and unsuccessful. Our proof-of-concept methodology has promise for detection and characterization of unknown aquatic pathogens and also highlights some associated methodology challenges that require additional investigation.

Tulathromycin and Diclazuril Lack Efficacy against Theileria haneyi, but Tulathromycin Is Not Associated with Adverse Clinical Effects in Six Treated Adult Horses.

Equine theileriosis, caused by Theileria haneyi and Theileria equi, leads to anemia, exercise intolerance, and occasionally, death. Theileriosis-free countries prohibit the importation of infected horses, resulting in significant costs for the equine industry. Imidocarb dipropionate is the only treatment for T. equi in the United States, but lacks efficacy against T. haneyi. The goal of this study was to assess the in vivo efficacy of tulathromycin and diclazuril against T. haneyi. Fourteen T. haneyi-infected horses were utilized. Six were treated with eight weekly 2.5 mg/kg doses of tulathromycin. Three were treated daily for eight weeks with 2.5 mg/kg diclazuril. Three were pre-treated with 0.5 mg/kg diclazuril daily for one month to determine whether low-dose diclazuril prevents infection. Following infection, the dose was increased to 2.5 mg/kg for eight weeks. Two infected horses remained untreated as controls. The horses were assessed via nested PCR, physical exams, complete blood counts, serum chemistry panels, and cytology. Tulathromycin and diclazuril failed to clear T. haneyi and the treated and control groups exhibited similar parasitemia and packed cell volume declines. To obtain additional safety data on tulathromycin use in adult horses, necropsy and histopathology were performed on tulathromycin-treated horses. No significant lesions were detected.

Diagnosis, treatment, and outcome of four dogs with alveolar echinococcosis in the northwestern United States.

OBJECTIVE: To describe the clinical disease, diagnostic findings, medical management, and outcome in dogs with alveolar echinococcosis (AE). ANIMALS: 4 dogs with naturally occurring AE. PROCEDURES: Medical records were retrospectively reviewed from 2020 to 2022 to identify dogs diagnosed with AE. Signalment, case history, clinical signs, imaging and pathological laboratory findings, treatment, and clinical outcome were reported. RESULTS: All dogs developed systemic clinical illness and weight loss. Abdominal ultrasonography revealed multifocal to coalescent cystic masses of variable size distributed throughout the liver in all cases. Evaluation of aspirated hepatic cyst contents included membranous parasite structures and calcareous corpuscles. Echinococcus multilocularis was confirmed via PCR from hepatic cyst fluid in 3 of 4 cases. Treatment included systemic benzimidazole and praziquantel administration, 1 or more instances of ultrasound-guided cyst drainage in all cases, with ethanol ablation (percutaneous aspiration-injection-reaspiration) in 2 cases, and surgical resection in 1 case. Two of 4 dogs were euthanized within 5 months of diagnosis. One of these dogs was necropsied and had nearly complete obliteration of the hepatic parenchyma by multilocular cystic masses. One dog is still alive, and 1 dog has been lost to follow-up. CLINICAL RELEVANCE: This series of cases highlighted the diagnostic findings and therapeutic intervention in 4 dogs with AE. This was the first report of medical management incorporating the percutaneous aspiration-injection-reaspiration method used in humans. Reports of canine AE are rare in the US, so this series serves to help raise awareness of hepatic AE in the northwestern US.

Viral replication site distribution for rabbit hemorrhagic disease virus 2 in formalin-fixed, paraffin-embedded tissues via in situ hybridization.

We made 2 Z-based in situ hybridization (ISH) probes for the detection of rabbit hemorrhagic disease virus 2 (RHDV2; Lagovirus GI.2) nucleic acid in formalin-fixed, paraffin-embedded tissues from European rabbits (Oryctolagus cuniculus) that had died during an outbreak of RHD in Washington, USA. One probe system was made for detection of negative-sense RNA (i.e., the replicative intermediate RNA for the virus), and the other probe system was constructed for detection of genomic and mRNA of the virus (viral mRNA). Tissue sets were tested separately, and the viral mRNA probe system highlighted much broader tissue distribution than that of the replicative intermediate RNA probe system. The latter was limited to liver, lung, kidney, spleen, myocardium, and occasional endothelial staining, whereas signal for the viral mRNA was seen in many more tissues. The difference in distribution suggests that innate phagocytic activity of various cell types may cause overestimation of viral replication sites when utilizing ISH of single-stranded, positive-sense viruses.

Detection of rabbit hemorrhagic disease virus 2 in formalin-fixed, paraffin-embedded tissues via in situ hybridization.

Formalin-fixed, paraffin-embedded tissues from European rabbits (Oryctolagus cuniculus) that succumbed to rabbit hemorrhagic disease virus 2 (RHDV2; Lagovirus GI.2) during the 2019 outbreak in Washington, USA, were utilized for in situ hybridization via RNAscope (ACDBio). This detection method was both sensitive and specific, with no staining in tissues from RHDV- (Lagovirus GI.1) and RHDV2-negative rabbits, and only slight background staining of RHDV-positive rabbits; RHDV2-positive tissues had bright-red cytoplasmic staining. Although much of the viral mRNA detection was consistent with previously described antigen detection via immunohistochemistry of the liver, lungs, and spleen, there was also significant glomerular staining in the kidneys, and endothelial staining within blood vessels of almost all organs. We validated the RNAscope technique for detection of RHDV2 mRNA in formalin-fixed, paraffin-embedded tissues, with increased sensitivity from previous techniques, and identified additional affected cell types that may contribute to the understanding of pathogenesis.

Generalized cutaneous urticaria associated with Giardia infection in a five-month old puppy.

Giardia cysts are commonly encountered in fecal examinations of dogs; intestinal infections can be asymptomatic or cause diarrhea but have not been previously associated with urticaria. A five-month old dalmatian puppy presented with a one-week history of cutaneous urticaria and pruritis. Wheals were most prominent on the head, abdomen, and inguinal region. A fecal flotation was performed to rule out internal parasites as a cause of hypersensitivity. Fecal float yielded many Giardia cysts, and treatment for giardiasis with fenbendazole was initiated. Urticaria improved drastically within a day after treatment initiation and completely resolved by the completion of the treatment regimen. No Giardia cysts were detected on the follow up fecal flotation three days later, and fecal Giardia antigen testing was negative at this time. No additional changes in management, housing, food, or environment were noted and the puppy has remained without additional clinical signs for three months following initial presentation.

Clinical and pathologic findings in an outbreak in rabbits of natural infection by rabbit hemorrhagic disease virus 2 in the northwestern United States.

Rabbit hemorrhagic disease virus 2 (RHDV2) causes an often-fatal disease of rabbits that has resulted in outbreaks in rabbitries in Europe, Africa, Australia, and Asia. RHD has historically been characterized as a foreign animal disease in the United States. In July 2019, RHDV2 was detected in rabbits on Orcas Island along the northwestern coast of Washington (WA) State following reports of deaths in multiple feral and domestic rabbits. We document and highlight here the unique clinical presentation and gross and histologic lesions observed in this recent WA outbreak. Affected rabbits died without premonitory signs or displayed hyporexia and/or lethargy for ≤1 d prior to death. The most consistent pathologic finding was random, multifocal hepatocellular necrosis, often with concurrent multifocal-to-diffuse splenic necrosis. The lack of significant clinical signs in conjunction with the random distribution of hepatic necrosis in the WA outbreak contrasts with previous reports of RHDV2 disease progression.

A recombinant bovine herpesvirus-4 vectored vaccine delivered via intranasal nebulization elicits viral neutralizing antibody titers in cattle.

Recombinant herpesvirus vaccine vectors offer distinct advantages in next-generation vaccine development, primarily due to the ability to establish persistent infections to provide sustainable antigen responses in the host. Recombinant bovine herpesvirus-4 (BoHV-4) has been previously shown to elicit protective immunity in model laboratory animal species against a variety of pathogens. For the first time, we describe the induction of antigen-specific immune responses to two delivered antigens in the host species after intranasal nebulization of recombinant BoHV-4 expressing the chimeric peptide containing the bovine viral diarrhea virus (BVDV) glycoprotein E2 and the bovine herpesvirus 1 (BoHV-1) glycoprotein D (BoHV-4-A-CMV-IgK-gE2gD-TM). In this study, four cattle were immunized via intranasal nebulization with the recombinant BoHV-4 construct. Two of the cattle were previously infected with wild-type BoHV-4, and both developed detectable serologic responses to BVDV and BoHV-1. All four immunized cattle developed detectable viral neutralizing antibody responses to BVDV, and one steer developed a transient viral neutralizing response to BoHV-1. Approximately one year after immunization, immunosuppressive doses of the glucocorticoid dexamethasone were administered intravenously to all four cattle. Within two weeks of immunosuppression, all animals developed viral neutralizing antibody responses to BoHV-1, and all animals maintained BVDV viral neutralizing capacity. Overall, nebulization of BoHV-4-A-CMV-IgK-gE2gD-TM persistently infects cattle, is capable of eliciting antigen-specific immunity following immunization, including in the presence of pre-existing BoHV-4 immunity, and recrudescence of the virus boosts the immune response to BoHV-4-vectored antigens. These results indicate that BoHV-4 is a viable and attractive vaccine delivery platform for use in cattle.

Gene gun DNA immunization of cattle induces humoral and CD4 T-cell-mediated immune responses against the Theileria parva polymorphic immunodominant molecule.

Theileria parva kills over one million cattle annually in sub-Saharan Africa. Parasite genetic complexity, cellular response immunodominance, and bovine MHC diversity have precluded traditional vaccine development. One potential solution is gene gun (GG) immunization, which enables simultaneous administration of one or more DNA-encoded antigens. Although promising in murine, porcine, and human vaccination trials, bovine GG immunization studies are limited. We utilized the model T. parva antigen, polymorphic immunodominant molecule (PIM) to test bovine GG immunization. GG immunization using a mammalian codon optimized PIM sequence elicited significant anti-PIM antibody and cell-mediated responses in 7/8 steers, but there was no difference between immunized and control animals following T. parva challenge. The results suggest immunization with PIM, as delivered here, is insufficient to protect cattle from T. parva. Nonetheless, the robust immune responses elicited against this model antigen suggest GG immunization is a promising vaccine platform for T. parva and other bovine pathogens.

Assessment and optimization of Theileria parva sporozoite full-length p67 antigen expression in mammalian cells.

Delivery of various forms of recombinant Theileria parva sporozoite antigen (p67) has been shown to elicit antibody responses in cattle capable of providing protection against East Coast fever, the clinical disease caused by T. parva. Previous formulations of full-length and shorter recombinant versions of p67 derived from bacteria, insect, and mammalian cell systems are expressed in non-native and highly unstable forms. The stable expression of full-length recombinant p67 in mammalian cells has never been described and has remained especially elusive. In this study, p67 was expressed in human-derived cells as a full-length, membrane-linked protein and as a secreted form by omission of the putative transmembrane domain. The recombinant protein expressed in this system yielded primarily two products based on Western immunoblot analysis, including one at the expected size of 67 kDa, and one with a higher than expected molecular weight. Through treatment with PNGase F, our data indicate that the larger product of this mammalian cell-expressed recombinant p67 cannot be attributed to glycosylation. By increasing the denaturing conditions, we determined that the larger sized mammalian cell-expressed recombinant p67 product is likely a dimeric aggregate of the protein. Both forms of this recombinant p67 reacted with a monoclonal antibody to the p67 molecule, which reacts with the native sporozoite. Additionally, through this work we developed multiple mammalian cell lines, including both human and bovine-derived cell lines, transduced by a lentiviral vector, that are constitutively able to express a stable, secreted form of p67 for use in immunization, diagnostics, or in vitro assays. The recombinant p67 developed in this system is immunogenic in goats and cattle based on ELISA and flow cytometric analysis. The development of a mammalian cell system that expresses full-length p67 in a stable form as described here is expected to optimize p67-based immunization.

Serum antibodies from a subset of horses positive for Babesia caballi by competitive enzyme-linked immunosorbent assay demonstrate a protein recognition pattern that is not consistent with infection.

Tick-borne pathogens that cause persistent infection are of major concern to the livestock industry because of transmission risk from persistently infected animals and the potential economic losses they pose. The recent reemergence of Theileria equi in the United States prompted a widespread national survey resulting in identification of limited distribution of equine piroplasmosis (EP) in the U.S. horse population. This program identified Babesia caballi-seropositive horses using rhoptry-associated protein 1 (RAP-1)-competitive enzyme-linked immunosorbent assay (cELISA), despite B. caballi being considered nonendemic on the U.S. mainland. The purpose of the present study was to evaluate the suitability of RAP-1-cELISA as a single serological test to determine the infection status of B. caballi in U.S. horses. Immunoblotting indicated that sera from U.S. horses reacted with B. caballi lysate and purified B. caballi RAP-1 protein. Antibody reactivity to B. caballi lysate was exclusively directed against a single ∼50-kDa band corresponding to a native B. caballi RAP-1 protein. In contrast, sera from experimentally and naturally infected horses from regions where B. caballi is endemic bound multiple proteins ranging from 30 to 50 kDa. Dilutions of sera from U.S. horses positive by cELISA revealed low levels of antibodies, while sera from horses experimentally infected with B. caballi and from areas where B. caballi is endemic had comparatively high antibody levels. Finally, blood transfer from seropositive U.S. horses into naive horses demonstrated no evidence of B. caballi transmission, confirming that antibody reactivity in cELISA-positive U.S. horses was not consistent with infection. Therefore, we conclude that a combination of cELISA and immunoblotting is required for the accurate serodiagnosis of B. caballi.

Gender differences in the relationship between parental report of self-regulation skills and adolescents' management of type 1 diabetes.

OBJECTIVE: To examine the extent to which self-regulation skills of adolescents with type 1 diabetes (T1D), including executive functioning and emotion regulation, relate to treatment adherence and glycemic control. METHOD: Participants were 109 adolescents aged 12-18 yr with TID and their primary caregiver who attended an outpatient appointment at a pediatric endocrinology clinic. Parents and adolescents completed a measure of treatment adherence. Parents completed a self-regulation measure while a glycemic control measure [i.e., hemoglobin A1c (HbA1c)] was collected. RESULTS: For boys, executive functioning and emotion regulation deficits were significantly associated with worse treatment adherence and glycemic control. Further analyses indicated that emotion regulation was the primary self-regulation measure related to treatment adherence and glycemic control. No significant associations were found for girls. CONCLUSION: For adolescent boys, the ability to cope with various stressors and emotions may be as important as higher-order thinking skills for maximizing treatment adherence and diabetes control. Clinical implications and potential mechanisms by which emotion regulation skills relate to adolescent boys' diabetes treatment management are discussed.

Use of continuous glucose monitoring in young children with type 1 diabetes: implications for behavioral research.

OBJECTIVE: This study presents data on the use of continuous glucose monitoring (CGM) in young children with type 1 diabetes mellitus (T1DM). CGM provides moment-to-moment tracking of glucose concentrations and measures of intra- and interday variability, which are particularly salient measures in young children with T1DM. METHODS: Thirty-one children (mean age = 5.0 yr ) with T1DM wore the Medtronic Minimed CGM for a mean of 66.8 h. The CGM was inserted in diabetes clinics, and parents were provided brief training. RESULTS: Few difficulties were experienced and families cited the acceptability of CGM. Participants' CGM data are compared with self-monitoring blood glucose (SMBG) data as well as data from older children with T1DM to illustrate differences in methodology and variability present in this population. CGM data are used to calculate glucose variability, which is found to be related to diabetes variables such as history of hypoglycemic seizures. CONCLUSIONS: CGM is an acceptable research tool for obtaining glucose data in young children with T1DM and has been used previously in older children and adults. CGM may be particularly useful in young children who often experience more glucose variability. Data obtained via CGM are richer and more detailed than traditional SMBG data and allow for analyses to link blood glucose with behavior.

Brief report: normative data on a structured interview for diabetes adherence in childhood.

OBJECTIVE: This study provides normative data, divided by age and gender, for the Diabetes Self-Management Profile (DSMP), an empirically supported structured interview that assesses adherence with the type 1 diabetes treatment regimen. Despite wide use, normative data on the DSMP have yet to be reported. METHODS: The sample included 444 parents and 275 youth with type 1 diabetes. The DSMP was administered by a trained clinician. RESULTS: For both child and parent ratings of adherence, means and standard deviations for the overall sample and subdivision by gender and three age groups are presented for normative comparisons. Subscale data (e.g., glucose monitoring, diet, exercise) are similarly presented. Lower adherence scores were reported among older adolescents relative to preadolescents. CONCLUSIONS: The literature has lacked normative data on pediatric diabetes adherence. These data present means and standard deviations for parent and child ratings of regimen adherence from a relatively large sample of youth with diabetes that can be utilized for normative comparisons for clinical and research purposes.

Feeding problems reported by parents of young children with type 1 diabetes on insulin pump therapy and their associations with children's glycemic control.

OBJECTIVE: Previous research demonstrated high rates of perceived mealtime behavior problems in families of young children with type 1 diabetes who were managed with conventional therapy. Because of new insulin regimens that offer greater flexibility, reexamination of mealtime behaviors is required. We assessed parent-reported mealtime behaviors in a sample of young children using an insulin pump. An additional aim was to evaluate the associations of two measures of parental feeding behavior with children's glycemic control. METHODS: Primary caregivers of 31 young children (mean age = 5.0 +/- 1.3 yr) completed the Child Feeding Questionnaire (CFQ) and the Behavioral Pediatric Feeding Assessment Scale (BPFAS). Hemoglobin A1c (HbA1c) was used as a surrogate marker for children's glycemic control. RESULTS: Children had a mean HbA1c of 7.8 +/- 0.64%. Mean CFQ - Restriction and Pressure to Eat scores were 3.1 +/- 0.94 and 2.0 +/- 0.88, respectively (range = 1-5). Mean BPFAS - Parent and Child scores were 16.0 +/- 4.3 (range = 10-50) and 44.9 +/- 9.3 (range = 25-125), respectively. Positive correlations were found between children's HbA1c levels and caregivers' reporting of frequency of child mealtime behavior problems. CONCLUSIONS: Caregivers of young children on pump therapy report relatively low rates of mealtime behavior problems. However, correlations with children's HbA1c suggest that parent-child mealtime behaviors continue to relate to children's health outcomes. Research is needed to determine if changing mealtime interactions can improve children's glycemic control; items from the BPFAS and CFQ can offer targets to guide interventions.

Validity and reliability of an adolescent and parent rating scale of type 1 diabetes adherence behaviors: the Self-Care Inventory (SCI).

OBJECTIVE: Accurate assessment of diabetes regimen adherence behaviors in youth is a challenging endeavor and is limited by a paucity of empirically supported measures. The purpose of this research is to further demonstrate the validity and reliability of the Self-Care Inventory (SCI), a youth and parent report measure of adherence with diabetes self-care behaviors. The SCI was chosen given its ease of implementation, applicability to multiple diabetes regimens, and dual parent/youth formats. METHODS: Participants were 164 youth with type 1 diabetes and a parent. Measures were administered at regular office visits to a tertiary care diabetes clinic. RESULTS: The SCI has strong psychometric properties, including adequate internal consistency, parent-youth agreement, and test-retest agreement. Relations between the SCI and a structured interview of diabetes adherence (the Diabetes Self-Management Profile; DSMP) and hemoglobin A1c (HbA1c) were strong. CONCLUSIONS: In addition to demonstrating strong psychometrics, this research provides independent support for the SCI. Thus, the SCI is consistent with recent criteria proposed by Quittner et al. (Journal of Pediatric Psychology, 33, 916-936) for an empirically supported measure of regimen adherence. Although other methods of accessing adherence may provide more comprehensive assessments, the brevity, ease-of-implementation, and robustness for multiple regimens makes the SCI an ideal tool for clinicians and researchers.

Glycemic control in youth with type 1 diabetes: family predictors and mediators.

OBJECTIVE: This study examined predictive and mediated relationships among youth perception of critical parenting, Child Behavior Checklist Externalizing Subscale (CBCL) externalizing problem scores, adherence, and (hemoglobin A(1c) HbA(1c)), in youth with type 1 diabetes from low socioeconomic status families. METHODS: Caregiver/youth dyads (n = 120) completed diabetes specific measures of family functioning regarding diabetes management and structured adherence interviews. Parents completed the CBCL, while assays of youth HbA(1c) were performed. Analyses were conducted using hierarchical linear regression. RESULTS: Combined measures predicted 44% of the variance in HbA(1c). Adherence partially mediated critical parenting and HbA(1c), while critical parenting and adherence mediated CBCL externalizing problem scores and HbA(1c). CBCL externalizing problem scores did not mediate critical parenting and HbA1(c). CONCLUSIONS: The presence of youth perceptions of critical parenting and youth externalizing behavior problems may interfere with adherence, leading to increases in HbA(1c).

Observational assessment of family functioning in families with children who have type 1 diabetes mellitus.

OBJECTIVE: Children with type 1 diabetes mellitus have a complex treatment regimen that includes insulin therapy and dietary requirements (e.g., matching insulin and carbohydrate intake). Previous research has shown that parents of children with type 1 diabetes mellitus report significant mealtime challenges and higher parenting stress compared to parents of healthy controls. The objective of the current study was to compare family functioning in children with type 1 diabetes mellitus (ages 2-8) to a matched, healthy control sample. Sixty-six families (33 diabetes; 33 controls) participated in a home visit at which their evening meal was videotaped. Tapes were then coded using the McMaster Interaction Coding System to objectively assess family functioning. RESULTS: Results indicated that families in the diabetes group demonstrated significantly poorer family functioning in a majority of areas (communication, affect management, family roles, overall functioning) compared to the healthy control sample. Additionally, families with lower socioeconomic status and families of male children evidenced poorer overall family functioning for both groups. CONCLUSIONS: Results also suggest that family-focused interventions for young children with type 1 diabetes should include components targeting family functioning in the areas of communication, affect management, and family roles.

Metabolic control and nocturnal enuresis in children with type 1 diabetes.

This study examined the relationship between metabolic control and enuresis in youths with type 1 diabetes. Participants were 203 youths with type 1 diabetes at an outpatient pediatric diabetes clinic. Outcome measures included HbA(lc), nocturia, blood glucose, polydipsia, frequency of daytime urination, and diabetic ketoacidosis. The mean fasting blood glucose (FBG) level of children with enuresis (FBG = 192 mg/dl) was significantly higher than that of children without enuresis (FBG = 160 mg/dl, p = .03). Differences in HbA(lc) levels between children with enuresis and those without enuresis approached significance (9.2% vs. 8.6%, p = .07). Findings indicate that metabolic control indices (FBG, HbA(1c), polyuria, and polydipsia) are related to nocturnal enuresis in youths with type 1 diabetes. Further studies should determine the mechanism by which this relationship occurs to initiate appropriate interventions.