Diagnosis Of Insulin-dependent Diabetes Mellitus Research Articles

Peripheral edema in a child with a new diagnosis of insulin-dependent diabetes mellitus

Peripheral or generalized edema is an uncommon complication of insulin therapy in diabetes mellitus. The exact cause is yet not known. It is transient and self-limiting in nature. However, diuretics and aldosterone antagonists have been used in some cases. We report the case of a 14-year-old boy with newly diagnosed Type 1 diabetes who developed edema after the commencement of insulin therapy. Other causes of edema were excluded from the study. The child was managed conservatively and edema seemed to start decreasing after 72 h and completely disappear in 2 weeks.

A Unique Case of Atezolizumab-Induced Autoimmune Diabetes

Immunotherapy is a novel treatment that can cause autoimmune diabetes in rare cases. More cases occur following use of the inhibitor to the protein programmed cell death-1 rather than the inhibitor to programmed cell death-ligand 1. We report a unique case of autoimmune diabetes following atezolizumab use. A 55-year-old, Aboriginal Australian female with no prior history of diabetes was commenced on atezolizumab for recurrent squamous cell lung carcinoma. Two months following its commencement, there was the onset of fatigue, polyuria, polydipsia, and new hyperglycemia. Subsequently she was found to have a borderline-low C peptide level of 0.6 nmol/L (reference range is 0.5 to 1.0 nmol/L), and positive zinc transporter-8 antibodies. Following the diagnosis of autoimmune diabetes, 5 units of glargine insulin was commenced which maintained euglycemia and resolved her symptoms of hyperglycemia. There are few case reports of atezolizumab-induced autoimmune diabetes. We present the first case associated with zinc transporter-8 antibodies, and a unique case of autoimmune diabetes in a patient of Aboriginal Australian background.

Psychotropic drug use following venous thromboembolism versus diabetes mellitus in adolescence or young adulthood: a Danish nationwide cohort study

ObjectivesCritical and chronic illness in youth such as diabetes can lead to impaired mental health. Despite the potentially traumatic and life-threatening nature of venous thromboembolism (VTE), the long-term mental health...

Factors Influencing Length of Stay after Elective Bowel Resection within an Enhanced Recovery Protocol

A multimodality approach to enhance surgical recovery after bowel surgery decreases the LOS. The surgical approach, participation in ambulation, insulin-dependent diabetes mellitus, and COPD influenced the overall LOS. Increasing use of morphine equivalents and developing a complication increased mLOS beyond the ACSRC preoperative risk estimates.

Screening of ZnT8 autoantibodies in the diagnosis of autoimmune diabetes in a large French cohort

Aim of the studyEvaluate the added value of screening anti-ZnT8 antibodies (ZnT8A) in addition to the classical anti-GAD (GADA) and anti-IA-2 (IA-2A) antibodies for the diagnosis of type-1 diabetes (T1D) within a large cohort of both children and adults. Materials and methodsRetrospective 2-year study including 516 patients (215 children, 301 adults) who had blood tests at diabetes onset and/or for diabetes classification. ZnT8A, GADA, and IA-2A were analyzed in all samples. ResultsAmong those individuals included, 142 (28%) were ZnT8A-positive. A total of 228/516 suffered from T1D, of whom 110 (48%) were ZnT8A-positive and 166 (73%) GADA and/or IA-2A positive. When adding ZnT8A to GADA/IA-2A, 184 (81%) patients were positive for ≥1 Ab. Regarding the 122 patients at T1D onset, 75 (61%) were positive for ZnT8A and the proportion of patients with T1D with ≥1 Ab reached 89%. The highest prevalence of ZnT8A was observed in children aged 6–10years. Fourteen of the 124 patients positive for ZnT8A with a known clinical diagnosis suffered from a disease other than T1D. ConclusionsZnT8A should be included in routine evaluation at diabetes onset and is a valuable biological marker to classify newly-diagnosed diabetics. The predictive value in our high-risk subjects has to be confirmed.

Long‐term mental wellbeing of adolescents and young adults diagnosed with venous thromboembolism: results from a multistage mixed methods study

Background Critical and chronic illness in youth can lead to impaired mental wellbeing. Venous thromboembolism (VTE) is a potentially traumatic and life-threatening condition. Nonetheless, the long-term mental wellbeing of adolescents and young adults (AYAS) with VTE is unclear. Objectives To investigate the long-term mental wellbeing of AYAS (aged 13-33years) diagnosed with VTE. Methods We performed a multistage mixed method study based on data from the Danish nationwide health registries, and semistructured interviews with 12 AYAS diagnosed with VTE. An integrated mixed methods interpretation of the findings was conducted through narrative weaving and joint displays. Results The integrated mixed methods interpretation showed that the mental wellbeing of AYAS with VTE had a chronic perspective, with a persistently higher risk of psychotropic drug purchase among AYAS with a first-time diagnosis of VTE than among sex-matched and age-matched population controls and AYAS with a first-time diagnosis of insulin-dependent diabetes mellitus. Impaired mental wellbeing was largely connected to a fear of recurrence and concomitant uncertainty. Therefore, it was important for the long-term mental wellbeing to navigate uncertainty. The perceived health threat played a more profound role in long-term mental wellbeing than disease severity, as the potential life threat was the pivot which pointed back to the initial VTE and forward to the perception of future health threat and the potential risk of dying of a recurrent event. Conclusion Our findings show that the long-term mental wellbeing of AYAS diagnosed with VTE is negatively affected, and highlights these patients' need for adequate support.

Stimulated and Unstimulated Saliva Glucose Levels in Children Suffer Insulin-Dependent Diabetes Mellitus

Objectives: Occurrence insulin dependent diabetes mellitus (IDDM) or Type 1 DM is growing worldwide. Checking serum glucose is necessary for management of DM. Serum glucose assessment involves needle puncture or venipuncture. The aim of this study was to assess the salivary glucose level in monitoring glycaemia in children with IDDM. Methods: Serum as well as stimulated and unstimulated saliva were collected from 34 IDDM and 34 non-diabetic subjects. Serum and saliva glucose levels were measured by GOD-POP. For the statistical analysis of student’s t-test, Pearson correlation test and Receiver operating characteristic (ROC) analysis was used. Results: Stimulated and unstimulated salivary levels of glucose were significantly higher in children with IDDM compared to control subjects. Serum glucose concentration correlates with stimulated (r = 0.407; P = 0.005), but not with unstimulated salivary concentration of glucose (r = 0.189; P = 0.145). Serum HbA1c correlates with unstimulated (r = 0.404; P = 0.001), but not with stimulated salivary concentration of HbA1c (r = 0.0.95; P = 0.526). The cut-off value of stimulated and unstimulated salivary glucose for the diagnosis of IDDM were 2.15 mg/dL and 1.05 mg/dL, respectively. Conclusions: It seems that saliva glucose is higher in Type 1 diabetic mellitus subjects and checking of glucose in saliva may be applied as an index of DM.

Ophthalmic disorder in patients with latent autoimmune diabetes in adult

It is well known that about 90% of all cases of diabetes mellitus (DM) are type 2, which is characteristic for adults aged above 40 years. Ten percent is represented by type 1 DM, typical for children and young. Adult's onset diabetes represent a heterogeneous mixture of type 1 and type 2 DM, often difficult to differentiate between, those patients may have actually latent autoimmune diabetes in adults (LADAs), where beta-cell destruction is less aggressive, leading to a slower development of insulin dependency. Studies indicated that antibodies against glutamic acid decarboxylase 65 (GAD 65) are good marker for diagnosis of autoimmune diabetes in adults who are not responding to oral hypoglycemic and may be at risk for getting complications namely increased risk of diabetic retinopathy. GAD 65 is mainly expressed in beta-cells of Langerhans but also in nonbeta-cells. GAD is an enzyme required for gama-aminobutyric acid (GABA) synthesis that acts as neurotransmitter in neurons of central nervous system and in pancreatic islets. GABA is probably involved in controlling the release of insulin from secretary granules.

Evaluation of the role of type I interferon to the development of type 1 diabetes. (BA3P.131)

Abstract Our goal is to identify the earliest immunologically relevant events that trigger autoimmune diabetes. The first detectable inflammatory signature in the NOD mouse is the upregulation of type I interferons and an interferon-inducible gene signature. We reason that understanding the early interferon signature may provide targets for the prevention, treatment, or diagnosis of autoimmune diabetes. The two ubiquitous interferon receptors (IFNAR and IFNGR) upregulate hundreds genes, some shared and some unique to each receptor. We backcrossed the type I interferon receptor onto NOD background to determine the relative contribution of IFNAR-inducible transcripts in type I diabetes induction. In our specific pathogen-free colony, NOD.IFNAR-/- mice developed diabetes at a decreased rate and penetrance from littermate controls. This reduction in incidence was gender independent and NOD.IFNAR heterozygous mice developed diabetes normally. There was a reduction in the number of the immunological infiltrates in the islets of Langerhans of NOD.IFNAR-/- mice from 4-8 wks of age as detected by flow cytometry and immunofluorescence. Concomitantly, there was a reduction in inflammatory gene expression in NOD.IFNAR-/- when compared to controls. Additionally, analysis of the NOD.IFNGR-/- mice showed a decrease in penetrance and kinetics of type I diabetes. Based on this data, we hypothesize that IFNAR and IFNGR induce a common genetic signature that is required for type I diabetes to proceed.

Hereditary haemochromatosis in a man of Pakistani descent

A 35-year-old Pakistani man, resident in the UK, was referred to his local hospital because of general malaise, weight loss and mildly deranged liver function tests. His medical history included a recent diagnosis of insulin-dependent diabetes mellitus, and previous investigations for testicular atrophy and azoospermia. He drank no alcohol. Clinical examination was unremarkable. Specifically, there were no cutaneous stigmata of chronic liver disease, and abdominal palpation was unremarkable with no hepatosplenomegaly. Blood tests showed deranged liver enzymes: ALT was 92 U/l (normal range <40 U/l), alkaline phosphatase was 155 U/l (normal range <125 U/l). Serum albumin was normal at 39 g/l, bilirubin normal at 8 μmol/l. Subsequent serological testing for hepatitis B, hepatitis C and autoimmune liver disease was all negative, but his serum ferritin was grossly elevated at 3985 μg/l (normal range 30–365 μg/l) and his iron transferrin saturation was 89% (20–50%). Liver ultrasound scanning was normal but liver biopsy revealed severe (Grade 4) liver cell siderosis with the appearances of haemochromatosis with extensive fibrosis (Figure 1). Figure 1. Liver biopsy: ( A ) hematoxylin and eosin staining showing iron (staining brown) within hepatocytes and fibrosis. ( B ) Perls staining showing severe liver cell siderosis. There is striking blue staining of granular iron deposits within hepatocytes, outlining the bile canaliculi. In view of the new diagnosis of haemochromatosis and his previous fertility problems, his pituitary function was assessed. He had normal …

Simultaneous Kidney-Pancreas Transplantation for End-Stage Renal Disease Patients with Insulin-Dependent Diabetes and Detectable C-Peptide

Introduction There is controversy regarding the place of simultaneous pancreas-kidney (SPK) transplantation in end-stage renal disease (ESRD) patients with insulin-dependent diabetes mellitus (IDDM) and detectable c-peptide. We sought to compare outcomes of recipients with and without pretransplantation c-peptide. Methods This retrospective single-center review included consecutive primary SPK transplantations performed between September 2007 and May 2010. Demographic characteristics and outcomes were compared between recipients with and without pretransplantation c-peptide. Results Seven of 25 (28%) consecutive SPK transplant recipients with a diagnosis of IDDM and ESRD had detectable c-peptide prior to transplantation. The mean c-peptide level was 6.3 ± 6.1 ng/mL. For those recipients with and without c-peptide, mean age at diagnosis of IDDM (12.4 ± 7.8 vs 17.1 ± 6.6 years; P = not significant [NS]), duration of IDDM prior to transplantation (30 ± 10 vs 23 ± 9 years; P = NS), and body mass index (25.9 ± 4.5 vs 26.7 ± 4.5 kg/m 2; P = NS) were equivalent between the groups. With a median follow-up of 17 months (range, 3–35 months) there was 1 graft loss (due to cardiovascular death) among the 25 patients. At the most recent follow-up, for recipients with and without c-peptide, both the mean serum creatinine (1.3 ± 0.6 vs 1.0 ± 0.2 ng/mL; P = NS) and the mean HbA1c level (5.3 ± 0.4 vs 5.3 ± 0.5; P = NS) were equivalent between the groups. Conclusion For nonobese ESRD patients diagnosed with IDDM at a young age, the presence of detectable c-peptide should not influence the decision to proceed with SPK transplantation.

A 5-yr follow-up nerve conduction study for the detection of subclinical diabetic neuropathy in children with newly diagnosed insulin-dependent diabetes mellitus

To investigate the changes of peripheral nerve conduction in children with insulin-dependent diabetes mellitus (IDDM) prospectively from diagnosis and to know how those results were related to clinical risk factors. A total of 37 patients (14 males and 23 females) aged 3-19 yr (mean 12.0 ± 3.7) with newly diagnosed IDDM underwent bilateral nerve conduction studies (NCS) of median, ulnar, posterior tibial, peroneal, and sural nerves annually for 5 yr. In all, 12 patients (32.4%) showed electrophysiological evidence of polyneuropathy in at least two different nerves including the sural nerve at the diagnosis of IDDM; 20 patients (54%) had multiple (≥2) abnormalities in parameters of NCS. The most common abnormal parameters at the diagnosis were conduction velocities of peroneal motor and sural nerves. In sequential NCS over 5 yr, the percentage of abnormal nerve conduction velocities rose except within the sural nerve. Poor metabolic control, height, duration of diabetes, and older age of onset were related to the changes of parameters of NCS over 5 yr. Among those risk factors, the duration of diabetes and sustained hyperglycemia affected the parameters of NCS more frequently than others. Children with IDDM frequently have nerve conduction abnormalities without clinical neuropathy at initial diagnosis. The frequency of abnormalities of any attribute of nerve conduction increased over the 5 yr follow-up. The duration of diabetes and poor glycemic control proved to be more important risk factors over 5 yr as related to the development of subclinical neuropathy.

Complement-dependent antibody mediated cytotoxicity (C'AMC) in patients with newly diagnosed insulin-dependent diabetes mellitus.

Serum activities of complement-dependent antibody mediated cytotoxicity (C'AMC) were determined in 36 consecutive patients with newly diagnosed insulin-dependent diabetes mellitus (IDDM). The sequential exposure of 51Cr labeled neonatal rat islet cells to patient serum and rabbit complement revealed the presence of C'AMC in 28 IDDM subjects. The C'AMC titres ranged between 1:4 and 1:512 and were not related to the C'AMC activity of a given sample as measured at a standard dilution (1:4). In comparison to the clinical characteristics of 21 IDDM patients with negative C'AMC, higher C'AMC titres (greater than or equal to 1:32) were associated with a lower mean age at diagnosis of IDDM (12.2 +/- 2.1 vs. 19.0 +/- 2.3 years; p less than 0.05), with a higher frequency of infections up to 6 months prior to diagnosis (6 out of 11 vs. 3 out of 21 patients; p less than 0.05) and, although statistically not significant, a preponderance of female sex together with a decreased frequency of HLA-DR4. In contrast, fasting C-peptides levels, HLA-DR3 antigen frequency and Coxsackie B1-6 virus antibody titres were not related to the C'AMC titres. It is concluded that (1) C'AMC titration is superior to the detection of initial C'AMC levels for evaluating the strength of the complement-dependent humoral immune response towards islet cell surface (auto)antigen(s), and (2) infectious agents may be involved in eliciting a C'AMC response.

Prognostic implications of diabetes phenotyping: new concepts for an old disease

Dr. Daniele: The case record presented here is that of D.S., a woman who is now 35 years. Her case report begins when she was 14 years (1987) at which time she underwent screening for diabetes because of her obesity (weight 95 kg, BMI 36 kg/m) and her family history of diabetes (mother and maternal grandmother). Based on her fasting glucose level (160 mg/dl), she was diagnosed with diabetes mellitus. At that time, her level of HbA1c was 7.8%. D.S. began treatment with a low calorie diet with which she obtained a moderate weight reduction (about 10–15 kg). During the following years, she has had several weight fluctuations until she reached 67 kg in 1995. Throughout that period, she had several medical visits, but there is no available information regarding her glucose levels. At 22 years of age (1996), she was admitted into the hospital following a hyperglycemic crisis, accompanied by polyuria and polydipsia. This hospitalization resulted in the diagnosis of insulin-dependent diabetes mellitus and subsequently, she began insulin treatment. On that occasion, diabetic retinopathy was found. The following years she saw an improvement in her glucose levels (HbA1c 6.5%) but a worsening of the retinopathy (diffuse microaneurysms, microhemorthages, and hard exudates) that required bilateral laser therapy. Concurrently, she developed a peripheral motor and sensory neuropathy, and then microalbuminuria but with preserved renal function. She continued insulin with four daily injections and maintained good metabolic control (HbA1c 6.5–7%), although her body weight rose continuously until she again reached 95 kg in 2000. In 2003, her HbA1c levels increased (7.8%) and she gained an additional 5 kg.

Immunological Markers in the Diagnosis and Prediction of Autoimmune Type 1a Diabetes

In BriefSeveral autoantibodies are associated with autoimmune type 1 diabetes. Measurements of islet autoantibodies can assist in the diagnosis of autoimmune diabetes, and the detection of islet autoantibodies in nondiabetic individuals indicates a significantly increased risk for the subsequent development of type 1 diabetes. When preventive therapies for type 1 diabetes become available, islet autoantibody screening of the general pediatric population should be considered to identify at-risk individuals.

Pancreas after kidney transplantation.

After three decades of controversy surrounding the therapeutic validity of pancreas transplantation, the procedure has become accepted as the preferred treatment for patients with insulin-dependent diabetes mellitus (IDDM) and advanced diabetic nephropathy with end-stage renal disease (ESRD) and for

Surviving chronic physical illness: psychosocial outcome in adult life

Recent advances in physical treatments have changed the implications of receiving a diagnosis of chronic physical illness in childhood. Individuals with disorders such as diabetes, cystic fibrosis, renal failure, and...

Association of HLA class II alleles with different subgroups of diabetes mellitus in Eastern India identify different associations with IDDM and malnutrition-related diabetes.

Genetic studies of Malnutrition related diabetes are few. We have analyzed HLA class II gene polymorphism in different types of diabetes mellitus patients from Cuttack in Eastern India. Patients with insulin-dependent diabetes mellitus (IDDM), non-insulin-dependent diabetes mellitus (NIDDM) and malnutrition-related diabetes mellitus (MRDM), which is subdivided into protein-deficient diabetes mellitus (PDDM) and fibrocalculous pancreatic diabetes (FCPD), were studied and their associations with autoantibody markers. IDDM and PDDM were associated with DR3 and DQ2 but not DR4 and DQ8. FCPD was positively associated with DQ9 (A*0201-B*0303). The association of DQ9 with FCPD suggests differences in the genetic background for susceptibility between IDDM and MRDM in the Cuttack population. There is no association seen between HLA-DR-DQ and NIDDM patients from Eastern India. Clinical classification of diabetes into IDDM, NIDDM and MRDM does not identify the underlying pathological mechanisms. Presence of autoantibodies to IDDM autoantigens in clinical MRDM and NIDDM identifies the slow-onset form of IDDM. Due to the absence of autoantibody assays for diagnosis of IDDM in India, slow onset IDDM is not diagnosed and the patients are classified as NIDDM or MRDM. Our study demonstrates that the presence of GAD65 antibody and DR3-DQ2 positivity in MRDM and NIDDM patients in Eastern India would suggest the presence of slow-onset IDDM. Our data would indicate alternatively that MRDM can coexist with IDDM in these patients and malnutrition could be one of the reasons for the slower onset in IDDM-prone individuals.

Prevalence of IgA-antiendomysium and IgA-antigliadin autoantibodies at diagnosis of insulin-dependent diabetes mellitus in Swedish children and adolescents.

This study was conducted to investigate the prevalence of celiac disease (CD) in children and adolescents at diagnosis of insulin-dependent diabetes mellitus (IDDM) before insulin treatment was started. At diagnosis of IDDM, and before treatment was started, 115 children and adolescents were screened for IgA- antiendomysium (EMA) and IgA-antigliadin antibodies (AGA). Those found to be EMA-positive and/or AGA-positive were investigated further with intestinal biopsy. Of the 115 patients, 2 had known CD at diagnosis of IDDM; of the remainder of patients, 6% (7/113) were found to be EMA-positive and 9% (10/113) were found to have AGA levels above normal. Of the 6 patients who underwent biopsy, 5 manifested villous atrophy. In addition, 2 patients with high EMA and AGA antibody titers refused biopsy, and 4 patients with low EMA and/or AGA titers were found to have normal titers at control before biopsy decision. Because the prevalence of CD at diagnosis of IDDM would seem to be 6% to 8%, screening for CD seems to be justified among patients with newly diagnosed IDDM.

急性すい炎を契機にインスリン依存型糖尿病を発症した１例

Impaired glucose tolerance is a well-known complication of acute pancreatitis. However, transition from acute pancreatitis to insulin-dependent diabetes mellitus (IDDM) is rare. Recently we encountered a case of IDDM due to diabetic ketoacidosis (DKA) subsequent to acute pancreatitis. We report the present case and also discuss several studies on this pathological condition. The patient was a 38-year-old woman who visited a nearby hospital with high fever and epigastric pain. Hematological and X-ray examinations indicated that the patient was suffering from acute pancreatitis. On the sixth hospital day, she was transferred to this hospital due to hyperglycemia, consciousness disorder and metabolic acidosis. Insulin therapy and continuous hemodialysis were effective in the improvement of these symptoms. However, insulin therapy was necessary after the amelioration of the pancreatitis. Although the patient has a family history of diabetes mellitus, she has no past history of this disease and her HbAlc level was within the normal range. Furthermore, her blood glucose level was normal at the onset of the pancreatitis. A diagnosis of IDDM was made because the blood and urinary C-peptide levels measured at the onset of DKA were low, and the β cell functions were suppressed.