Objective: To define the prevalence of auto antibodies (Ab) to different organs in young patients with type 1 diabetes (type 1DM). Methods: Ab to thyroid, celiac and adrenal disease was analyzed in 831 type 1 DM patie...Objective: To define the prevalence of auto antibodies (Ab) to different organs in young patients with type 1 diabetes (type 1DM). Methods: Ab to thyroid, celiac and adrenal disease was analyzed in 831 type 1 DM patients. Results: Hundred twenty-three (14.8%) had positive thyroid Ab. The risk of developing thyroid Ab was increased in girls (HR 2.3;95% CI 1.6 - 3.2, p < 0.0001). Thirty-three (3.9%) patients had positive endomysium Ab (3.1% in girls and 3.5% in boys, p = NS). Adrenal Ab was detected in 5 patients. The DQA1*0301-DQB1*0301 haplotype was more prevalent in patients with thyroid Ab (p = 0.0281);DQA1*301-DQB1*302 and DQA1*501-DQB1*201 in patients with endo- mysium Ab (p = 0.0251 and p < 0.0001). All patients with adrenal Ab were DQA1*301-DQB1*302 positive. Conclusions: Type 1D patients should be screened annually for thyroid autoimmunity and celiac disease. The DQA1*0301-DQB1*0301 haplotype seems to confer susceptibility to thyroid autoimmunity, DQA1*301-DQB1*302 and DQA1*501-DQB1*201 to celiac disease and DQA1*301-DQB1*302 to adrenal autoimmunity.展开更多
The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications(retinopathy, neuropathy, nephropathy, cardiov...The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications(retinopathy, neuropathy, nephropathy, cardiovascular disease, etc.) by maintaining blood glucose concentrations close to normal level. Glycated hemoglobin levels(Hb A1c) provide a good criterionof overall glycemic control. The Hvidoere Study Group(HSG) on Childhood Diabetes, founded in 1994, is an international group representing about twenty highly experienced pediatric centers from Europe, North America, Japan and Australia. Four international comparisons of metabolic control(1995, 1998, 2005,2009) have been performed. The one center that has consistently had the lowest Hb A1 c values(approximate7.3% or 56.3 mmol/mol) is my center in Brussels. This is more often obtained with a twice-daily free-mixed regimen with additional supplemental fast insulins ad hoc. The so-called "Dorchy's recipes" are summarized.The conclusion is that the number of daily insulin injections, 2 or ≥ 4, or the use of pumps, by itself does not necessarily give better results. Intensified therapy should not depend upon the number of insulin doses per day, by syringe, pen or pump but rather should be redefined as to intent-to-treat ascertainment(i.e., goals). When there are no mutually agreed upon goals for BG and/or Hb A1 c, when there is insufficient education and psychosocial support by the medical team or at home, there is likely to be poor outcomes,as shown by the HSG. One of our recipes is not to systematically replace rapid-acting human insulins by fast-acting analogues. Because the multicenter studies of the HSG, performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of Hb A1 c are very different, diabetes treatment teams should individually explore the reasons for failure,without any prejudice or bias. Any dogmatism must be avoided. Treatment cost vs results must also be taken into account.展开更多
BACKGROUND Alopecia areata(AA)is an inflammatory disease with autoimmune,environmental,and inherited components directed at the hair follicle,either limited to patchy hair loss over the scalp(Focalis,AF),total loss of...BACKGROUND Alopecia areata(AA)is an inflammatory disease with autoimmune,environmental,and inherited components directed at the hair follicle,either limited to patchy hair loss over the scalp(Focalis,AF),total loss of scalp hair(Totalis,AT),or total loss of both scalp and body hair(Universalis,AU).Despite multiple treatment modalities,no therapy exists.Vitamin D deficiency in patients with AA/AT/AF influences disease severity and duration,inversely correlating with inflammation histologically.CASE SUMMARY Three girls presented with AT(P1),AU(P2),and AF(P3)at the ages of 1,5,and 5 years,respectively.For P1-P2,all available treatments implemented for 2 years had failed.We started an initial 6-mo repletion with oral cholecalciferol 2000/4000 IU/d,with no apparent effect.Then we attempted immunomodulation using oral calcitriol and its analog paricalcitol.On calcitriol,0.5 mcg/d P1 regrew hair within 6 mo.After 4 years,a relapse with loss of eyebrow hair was resolved after doubling the calcitriol dose to 0.5 mcg×2/d;the results have been maintained for 6 years to date.On calcitriol,0.25 mcg×3/d P2 led to the development of asymptomatic hypercalcemia-hypercalciuria,which was immediately resolved by switching to paricalcitol 2 mcg×3/d;mild tolerable hypercalciuria was maintained.Hair regrowth was observed at 6 mo,stabilizing only as fur at 12 mo.AF in P3 was resolved completely within 3 mo on a daily high dose(8000 IU)of cholecalciferol.CONCLUSION Vitamin D may have immunomodulating therapeutic impact on AT/AU/AF,which needs to be explored with further pilot clinical trials.展开更多
Background: Increased glomerular filtration rate (GFR) commonly develops in early diabetes and is closely correlated with the development of diabetic nephropathy. Objective: The aim was to study the relationship betwe...Background: Increased glomerular filtration rate (GFR) commonly develops in early diabetes and is closely correlated with the development of diabetic nephropathy. Objective: The aim was to study the relationship between GFR, C-peptide level and other parameters at diagnosis of Type 1 diabetes. Methods: We determined GFR, Cpeptide level, glycated hemoglobin (HbA1c), body mass index (BMI) SDS and loss of weight at diagnosis of Type 1 diabetes in 495 children (231 females). Linear and multiple regression analysis was used to test for the associations between GFR and other parameters. Results: In the 495 patients, GFR median (interquartile range) was increased vs normal values (p = 0.0001). GFR was significantly negatively correlated with age (p < 0.001) and C-peptide level (p = 0.001), and positively correlated with weight loss (p = 0.02). The multiple regression analysis showed that age (p = 0.001) and C-peptide level (p = 0.05) were independently and negatively related to GFR. Conclusions: This study shows that, at onset of Type 1 diabetes, higher the GFR, younger the age and lower the C-peptide level are. The role of this hyperfiltration in the development of later nephropathy and the putative preventive effect of C-peptide administration need to be evaluated.展开更多
文摘Objective: To define the prevalence of auto antibodies (Ab) to different organs in young patients with type 1 diabetes (type 1DM). Methods: Ab to thyroid, celiac and adrenal disease was analyzed in 831 type 1 DM patients. Results: Hundred twenty-three (14.8%) had positive thyroid Ab. The risk of developing thyroid Ab was increased in girls (HR 2.3;95% CI 1.6 - 3.2, p < 0.0001). Thirty-three (3.9%) patients had positive endomysium Ab (3.1% in girls and 3.5% in boys, p = NS). Adrenal Ab was detected in 5 patients. The DQA1*0301-DQB1*0301 haplotype was more prevalent in patients with thyroid Ab (p = 0.0281);DQA1*301-DQB1*302 and DQA1*501-DQB1*201 in patients with endo- mysium Ab (p = 0.0251 and p < 0.0001). All patients with adrenal Ab were DQA1*301-DQB1*302 positive. Conclusions: Type 1D patients should be screened annually for thyroid autoimmunity and celiac disease. The DQA1*0301-DQB1*0301 haplotype seems to confer susceptibility to thyroid autoimmunity, DQA1*301-DQB1*302 and DQA1*501-DQB1*201 to celiac disease and DQA1*301-DQB1*302 to adrenal autoimmunity.
文摘The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications(retinopathy, neuropathy, nephropathy, cardiovascular disease, etc.) by maintaining blood glucose concentrations close to normal level. Glycated hemoglobin levels(Hb A1c) provide a good criterionof overall glycemic control. The Hvidoere Study Group(HSG) on Childhood Diabetes, founded in 1994, is an international group representing about twenty highly experienced pediatric centers from Europe, North America, Japan and Australia. Four international comparisons of metabolic control(1995, 1998, 2005,2009) have been performed. The one center that has consistently had the lowest Hb A1 c values(approximate7.3% or 56.3 mmol/mol) is my center in Brussels. This is more often obtained with a twice-daily free-mixed regimen with additional supplemental fast insulins ad hoc. The so-called "Dorchy's recipes" are summarized.The conclusion is that the number of daily insulin injections, 2 or ≥ 4, or the use of pumps, by itself does not necessarily give better results. Intensified therapy should not depend upon the number of insulin doses per day, by syringe, pen or pump but rather should be redefined as to intent-to-treat ascertainment(i.e., goals). When there are no mutually agreed upon goals for BG and/or Hb A1 c, when there is insufficient education and psychosocial support by the medical team or at home, there is likely to be poor outcomes,as shown by the HSG. One of our recipes is not to systematically replace rapid-acting human insulins by fast-acting analogues. Because the multicenter studies of the HSG, performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of Hb A1 c are very different, diabetes treatment teams should individually explore the reasons for failure,without any prejudice or bias. Any dogmatism must be avoided. Treatment cost vs results must also be taken into account.
文摘BACKGROUND Alopecia areata(AA)is an inflammatory disease with autoimmune,environmental,and inherited components directed at the hair follicle,either limited to patchy hair loss over the scalp(Focalis,AF),total loss of scalp hair(Totalis,AT),or total loss of both scalp and body hair(Universalis,AU).Despite multiple treatment modalities,no therapy exists.Vitamin D deficiency in patients with AA/AT/AF influences disease severity and duration,inversely correlating with inflammation histologically.CASE SUMMARY Three girls presented with AT(P1),AU(P2),and AF(P3)at the ages of 1,5,and 5 years,respectively.For P1-P2,all available treatments implemented for 2 years had failed.We started an initial 6-mo repletion with oral cholecalciferol 2000/4000 IU/d,with no apparent effect.Then we attempted immunomodulation using oral calcitriol and its analog paricalcitol.On calcitriol,0.5 mcg/d P1 regrew hair within 6 mo.After 4 years,a relapse with loss of eyebrow hair was resolved after doubling the calcitriol dose to 0.5 mcg×2/d;the results have been maintained for 6 years to date.On calcitriol,0.25 mcg×3/d P2 led to the development of asymptomatic hypercalcemia-hypercalciuria,which was immediately resolved by switching to paricalcitol 2 mcg×3/d;mild tolerable hypercalciuria was maintained.Hair regrowth was observed at 6 mo,stabilizing only as fur at 12 mo.AF in P3 was resolved completely within 3 mo on a daily high dose(8000 IU)of cholecalciferol.CONCLUSION Vitamin D may have immunomodulating therapeutic impact on AT/AU/AF,which needs to be explored with further pilot clinical trials.
文摘Background: Increased glomerular filtration rate (GFR) commonly develops in early diabetes and is closely correlated with the development of diabetic nephropathy. Objective: The aim was to study the relationship between GFR, C-peptide level and other parameters at diagnosis of Type 1 diabetes. Methods: We determined GFR, Cpeptide level, glycated hemoglobin (HbA1c), body mass index (BMI) SDS and loss of weight at diagnosis of Type 1 diabetes in 495 children (231 females). Linear and multiple regression analysis was used to test for the associations between GFR and other parameters. Results: In the 495 patients, GFR median (interquartile range) was increased vs normal values (p = 0.0001). GFR was significantly negatively correlated with age (p < 0.001) and C-peptide level (p = 0.001), and positively correlated with weight loss (p = 0.02). The multiple regression analysis showed that age (p = 0.001) and C-peptide level (p = 0.05) were independently and negatively related to GFR. Conclusions: This study shows that, at onset of Type 1 diabetes, higher the GFR, younger the age and lower the C-peptide level are. The role of this hyperfiltration in the development of later nephropathy and the putative preventive effect of C-peptide administration need to be evaluated.
