Psychological factors associated with self-management among adolescents with Type 1 diabetes: a review

This review aims to synthesise the literature examining the psychosocial variables related to self-management (insulin adherence, non-adherence and administration, blood sugar monitoring, dietary behaviour, exercise behaviour) in adolescents with type 1 diabetes.
A systematic search of three electronic databases was carried out and, after the application of eligibility criteria, 21 articles were assessed for quality prior to data extraction. Numerous psychological factors were found to be associated with self-management; however, correlations were typically small to moderate. The strongest associations were found between social anxiety and diet (among males); greater intrinsic motivation, conscientiousness and diet; and extraversion and exercise.

Serum Fatty Acid Binding Protein 4 (FABP4) Predicts Pre-eclampsia in Women with Type 1 Diabetes

Objective: To examine the association between fatty acid binding protein 4 (FABP4) and pre-eclampsia risk in women with type 1 diabetes.
Reesearch Design and Methods: Serum FABP4 was measured in 710 women from the Diabetes and Pre-eclampsia Intervention Trial (DAPIT) in early pregnancy and in the second trimester (median 14 and 26 weeks gestation, respectively).
Results: FABP4 was significantly elevated in early pregnancy (geometric mean 15.8 ng/mL [interquartile range 11.6–21.4] vs. 12.7 ng/mL [interquartile range 9.6–17]; P < 0.001) and the second trimester (18.8 ng/mL [interquartile range 13.6–25.8] vs. 14.6 ng/mL [interquartile range 10.8–19.7]; P < 0.001) in women in whom pre-eclampsia later developed. Elevated second-trimester FABP4 level was independently associated with pre-eclampsia (odds ratio 2.87 [95% CI 1.24, 6.68], P = 0.03). The addition of FABP4 to established risk factors significantly improved net reclassification improvement at both time points and integrated discrimination improvement in the second trimester.
Conclusions: Increased second-trimester FABP4 independently predicted pre-eclampsia and significantly improved reclassification and discrimination. FABP4 shows potential as a novel biomarker for pre-eclampsia prediction in women with type 1 diabetes.

Knowledge and awareness of type 1 diabetes among primary school initial teacher trainees

Autocuidado dos adolescentes com diabetes mellitus tipo 1: responsabilidade no controlo da doença

Enquadramento: A diabetes mellitus tipo 1 (DM1) é uma doença cada vez mais prevalente na adolescência. Intervir no autocuidado é determinante para a gestão da doença. Objetivos: Determinar a responsabilidade dos adolescentes com DM1 nos papéis de autocuidado; analisar a relação da responsabilidade dos adolescentes com DM1 nos papéis de autocuidado com a idade e o género. Metodologia: Estudo descritivo-analítico e transversal. Participaram 51 adolescentes entre os 12 e os 18 anos seguidos em hospitais distritais da zona centro de Portugal. Foi aplicada uma escala de responsabilidade nos papéis de autocuidado, constituída por 15 itens distribuídos por 4 dimensões: manutenção da saúde; controlo da doença; diagnóstico, tratamento e medicação na DM1; e participação em serviços de saúde. Resultados: A maioria dos adolescentes assume responsabilidade própria elevada. O género não influencia a responsabilidade global, os rapazes evidenciam maior nível de responsabilidade na gestão de administração de insulina. Conclusão: Os adolescentes assumem responsabilidade própria no controlo da doença, evidencia-se responsabilidade partilhada com os pais ou outros no global e na participação em serviços de saúde.

Parents’ experiences during the transition from childhood to adolescence with Type 1 Diabetes: Parent-child relationships and support received during this time and clinical research portfolio

Background: Type 1 Diabetes (T1D) management often worsens as children become adolescents. This can be a difficult time for parents as they hand over responsibility of diabetes management to their adolescent. Objectives: To look at the experiences of parents with a child with T1D as they move to adolescence and take more responsibility for their diabetes management. To find out about parents’ experience of support during this transition. Subjects: Three parents of adolescents with T1D. Participants were recruited from the NHS Highland Paediatric Diabetes Service. Methods: Participants took part in a one-to-one semi-structured interview with a researcher. Interpretative Phenomenological Analysis was used to analyse the interviews and find common themes across the interviews. Results: Participants experienced worry throughout their child’s transition to adolescence. They found it difficult to let their child take responsibility for their diabetes but acknowledged that their involvement caused tensions with their adolescent. Participants’ experience was that there were a number of practical adjustments to be made with a diagnosis of T1D and educating the network around their child was important. The participants reported that the diagnosis of T1D had an impact on the whole family and not just the child with the diagnosis. The parents felt well supported medically but said that the amount of time before their first clinic appointment felt too long. All participants had concerns about their adolescent moving to the adult diabetic service. Conclusions: Participants experienced worry relating to aspects of their adolescents T1D that they could not control, but were aware of the tensions caused by trying to keep elements of control. Areas of future research were identified.

Diet, microbes and gut immune responses in the pathogenesis of experimental type 1 diabetes

Type 1diabetes (T1D) is an autoimmune disease, which is influenced by a variety of environmental factors including diet and microbes. These factors affect the homeostasis and the immune system of the gut. This thesis explored the altered regulation of the immune system and the development of diabetes in non-obese diabetic (NOD) mice. Inflammation in the entire intestine of diabetes-prone NOD mice was studied using a novel ex-vivo imaging system of reactive oxygen and nitrogen species (RONS), in relation to two feeding regimens. In parallel, gut barrier integrity and intestinal T-cell activation were assessed. Extra-intestinal manifestations of inflammation and decreased barrier integrity were sought for by studying peritoneal leukocytes. In addition, the role of pectin and xylan as dietary factors involved in diabetes development in NOD mice was explored. NOD mice showed expression of RONS especially in the distal small intestine, which coincided with T-cell activation and increased permeability to macromolecules. The introduction of a casein hydrolysate (hydrolysed milk protein) diet reduced these phenomena, altered the gut microbiota and reduced the incidence of T1D. Extra-intestinally, macrophages appeared in large numbers in the peritoneum of NOD mice after weaning. Peritoneal macrophages (PM) expressed high levels of interleukin-1 receptor associated kinase M (IRAK-M), which was indicative of exposure to ligands of toll-like receptor 4 (TLR-4) such as bacterial lipopolysaccharide (LPS). Intraperitoneal LPS injections activated T cells in the pancreatic lymph nodes (PaLN) and thus, therefore potentially could activate islet-specific T cells. Addition of pectin and xylan to an otherwise diabetes-retarding semisynthetic diet affected microbial colonization of newly-weaned NOD mice, disturbed gut homeostasis and promoted diabetes development. These results help us to understand how diet and microbiota impact the regulation of the gut immune system in a way that might promote T1D in NOD mice.

Alteration of the bone tissue material properties in type 1 diabetes mellitus: A Fourier transform infrared microspectroscopy study

International audience

Stable Incretin Mimetics Counter Rapid Deterioration of Bone Quality in Type 1 Diabetes Mellitus.

International audience

Use of GLP-1 mimetic in type 2 diabetes mellitus: is it the end of fragility fractures?

International audience

Eficacia de diferentes tratamientos intensivos en pacientes con diabetes mellitus tipo 1: Análisis de parámetros glucémicos, psicológicos y de calidad de vida

El gran avance que han experimentado los tratamientos intensivos insulínicos desde el punto de vista farmacológico y tecnológico ha aumentado por un lado la esperanza de vida de las personas con diabetes, pero por otro ha incrementado las exigencias en el autocuidado y en el nivel de compromiso. Esta mayor exigencia conlleva un reto para todos los profesionales implicados, el de encontrar el equilibrio entre el hecho de atender las necesidades médicas específicas del paciente con diabetes, sin detrimento de que éste pueda llevar una vida plena. Aunque se ha producido un aumento en el interés sobre la repercusión de estos tratamientos en las variables biomédicas, la cantidad de bibliografía existente sobre la respuesta psicosocial y la calidad de vida es escasa y poco concluyente. Con el objetivo de comparar el impacto de diversas terapias intensivas en la calidad de vida y otras variables psicológicas y biomédicas, se ha llevado a cabo este trabajo que se compone de dos estudios. En el primero se compara el impacto en variables de calidad de vida, psicológicas y biomédicas de tres tipos de terapias intensivas insulínicas (Múltiples dosis con insulinas humanas de acción intermedia, múltiples dosis con análogos de insulina de acción prolongada y terapia con infusión subcutánea continua de insulina) En el segundo estudio se persiguen cuatro objetivos. En primer lugar, si la terapia con infusión subcutánea continua de insulina (ISCI) junto a un sistema de monitorización continua de glucosa a tiempo real (MCG-TR) se asocia con mayores beneficios en el control glucémico y variables psicosociales que ISCI sin dicho sistema integrado. En segundo lugar, si el uso de la terapia ISCI junto al sistema MCG-TR a tiempo completo proporciona mayores beneficios en el control glucémico que ISCI y dicho sistema a tiempo parcial (15 días al mes) y si se produce un empeoramiento en dicha variable tras retirar el sistema a los 6 meses de tratamiento. En tercer lugar, se analiza si existen diferencias iniciales y a los 6 meses de tratamiento en las variables ansiedad, depresión y calidad de vida entre los pacientes en terapia con ISCI y MCG-TR que no perciben bien las hipoglucemias leves y los que sí las perciben. Por último, se estudia tanto la satisfacción de los pacientes con DM1 tratados con ISCI que deciden retomar el tratamiento integrado (ISCI y MCG-TR) a los 9 meses, como la de aquéllos tratados con ISCI que deciden no volver a recibir dicho tratamiento.

Aortic Intima-Media Thickness and Mean Platelet Volume in Children With Type 1 Diabetes Mellitus

Background: Diabetes mellitus type 1 is the most common endocrine metabolic disorder occurring in childhood and adolescence due to the autoimmune destruction of pancreatic beta cells as a result of various environmental factors interacting with an underlying genetic predisposition. Diabetes is a risk factor for early onset atherosclerosis, and the high mortality rate seen in these patients is partially related to cardiovascular diseases. Objectives: This study was conducted to compare mean platelet volume as a marker of early atherosclerosis with aortic intima-media thickness in children with type 1 diabetes and to identify its correlation with known cardiovascular risk factors. Patients and Methods: The study included 27 patients between age range of 6 and 17 years that were diagnosed with type 1 diabetes and 30 healthy children of the same age range who did not have any chronic disease. In both groups, we used the color Doppler ultrasound to measure children’s aortic intima-media thickness and identify their mean platelet volumes. Results: There was no significant difference between the groups regarding gender distribution, age, High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL) cholesterol levels (P > 0.05). Also no significant difference could be documented between the patient and control groups regarding the aortic intima-media thickness and mean platelet volume (P > 0.05). However, there was a significant correlation between aortic intima-media thickness and mean platelet volume (r = 0.351; P < 0.05). Conclusions: In the present study, there was no evidence of early atherosclerosis in children with type 1 diabetes. However, mean platelet volume having a significant correlation with aortic intima-media thickness may be useful as an early marker of atherosclerosis.

Adherence to therapeuthic regimen and metabolic control of type 1 diabetes

Abstract Objectives: To assess the adherence to therapeutic regimen; to determine the Hemoglobin Glycation Index (HbA1c); to analyse the relationship that exists between the adherence to therapeutic regimen and metabolic control. Design: correlational analytical study, carried out according to a cross-sectional perspective. Participants: A non-probabilistic sample of 266 people with type 1 diabetes aged between 18 and 78 years old (mean M = 51.02 ± SD = 18.710), attending follow-up diabetes consultations. Mostly male individuals (51.88%), with low schooling level (50.75% had only inished elementar school). Measuring Instruments: We used the following data collection tools: a questionnaire on clinical and socio-demographic data, blood analysis of venous blood to determine the glycated hemoglobin level (HbA1c).Three self-report scales were used: Accession to Diabetes Treatment (Matos, 1999), Self-perception Scale (Vaz Serra, 1986) and Social Support Scale (Matos & Rodrigues, 2000). Results: In a sample in which the mean disease duration is 12.75 years, 69.17% of the sample run glycemic control tests between once a day and four times a year and 42.86% of them undergo insulin treatment. In the last 3 weeks, 26.32% of these people have experienced an average of 4.22 to 44.36%, hypoglycemic crises and experienced an average of 6.18 hyperglycemic crises. 57% of the individuals have showed a poor metabolic control (mean HbA1c higher than 7.5% (HbA1c mean M ≥ 7.50%). The mean psychosocial proile revealed individuals who show a decent self-esteem (M = 70.81) and acceptable social support (M = 58.89). Conclusions: The results suggest we should develop a kind of investigation that could be used to monitor the strenght of the mediation effect effect of the psychosocial predictive dimension of the adherence, since it has become essential to support a multidisciplinary approach which center lays in the promotion of a co-responsible self-management from the person who suffers from diabetes. This will enable a better quality of life; fewer years of people’s lives lost prematurely and a better health with less economical costs for citizens and healthcare systems.

Diabetes Mellitus tipo 1 em Odontopediatria

A Diabetes Mellitus é conhecida por uma doença metabólica caracterizada por um défice na ação ou secreção da insulina, na qual a consequência direta é o aparecimento de hiperglicemia, isto é, o nível de glicose apresentar valores elevados (Kidambi, 2008; Silva-Sousa, 2003). A DM1, especificamente, é apresentada como uma doença que é resultado da destruição das células beta do pâncreas, desenvolvendo assim, um défice na produção de insulina (Raymond et al., 2001). As complicações orais da DM1 incluem xerostomia, doença periodontal (gengivite e periodontite), abcessos dentários, perda de dentes, lesões de tecidos moles e síndrome de ardência oral. A complicação oral mais frequente da DM1 nas crianças é o aumento da sensibilidade à doença periodontal. A doença periodontal é caracterizada como uma reação inflamatória infecciosa dos tecidos gengivais (gengivite) ou do suporte dos dentes, ou seja, ligamento periodontal, cemento e osso alveolar (periodontite), podendo induzir um certo grau de resistência à insulina. Ambas as doenças resultam da interação entre microorganismos periodontais patogénicos. A avaliação e influência do controlo da doença é expressa pelos valores médios de hemoglobina glicosada (Hba1c) na saúde oral nas crianças e adolescentes com DM1. Vários estudos demonstraram que o controlo glicémico teve uma influencia sobre a saúde oral de crianças e adolescentes com DM1. Assim uma avaliação oral, deve fazer parte de procedimentos de rotina no atendimento de crianças e adolescentes com DM1. O dentista deve ser parte da equipa multidisciplinar que auxilia os indivíduos com DM1. O tratamento precoce numa população infantil com DM1, pode diminuir a severidade da doença periodontal. O presente trabalho tem por objectivo realizar uma revisão bibliográfica sobre a importância do estudo em crianças e adolescentes portadores de DM1 e doenças da cavidade oral, nomeadamente, a periodontite, e respetivas implicações.