Insulin-dependent Diabetes Mellitus Group Research Articles

Diabetes status and postoperative complications for patients receiving open rotator cuff repair

Background Diabetic patients are known to have poor wound healing and worse outcomes following surgeries. The purpose of this study is to evaluate diabetes status and complications for patients receiving open rotator cuff repair. Methods Patients undergoing open rotator cuff repair from 2006 to 2018 were identified in a national database. Patients were stratified into 3 cohorts: no diabetes mellitus, non-insulin dependent diabetes mellitus (NIDDM), and insulin dependent diabetes mellitus (IDDM). Differences in demographics, comorbidities, and complications were assessed with the use of bivariate and multivariate analyses. Results Of 7678 total patients undergoing open rotator cuff repair, 6256 patients (81.5%) had no diabetes, 975 (12.7%) had NIDDM, and 447 (5.8%) had IDDM. Bivariate analyses revealed that IDDM patients had increased risk of mortality, extended length of stay, and readmission compared to non-diabetic patients ( p < 0.05 for all). IDDM patients had higher risks of major complications and readmission relative to NIDDM patients ( p < 0.05 for both). On multivariate analysis, there were no differences in any postoperative complications between the non-diabetic, NIDDM, and IDDM groups. Discussion Diabetes does not affect postoperative complications following open rotator cuff repairs. Physicians should be aware of this finding and counsel their patients appropriately. Level of Evidence: III

Abstract 11580: Platelet Activity and Cardiovascular Events in Patients with Diabetes and Peripheral Artery Disease: Findings from the American Heart Association Cardiometabolic Health Strategically Focused Research Network

Introduction: Peripheral artery disease (PAD) and diabetes mellitus (DM) are significant risk factors for atherothrombosis. Platelets mediate atherothrombosis and are therapeutic targets in PAD and DM. We investigated the relationships between PAD, DM, platelet activity, and cardiovascular risk. Methods: The Platelet Activity and Cardiovascular Events (PACE) study enrolled 289 PAD patients undergoing lower extremity revascularization (LER). Prior to LER, platelet activity was measured via light transmission aggregometry in response to submaximal ADP, collagen (coll), serotonin (ser), epinephrine (epi), and arachidonic acid (AA). Patients were followed for a median of 18 months for the composite of major adverse cardiac or limb events (MACLE; MI, stroke, death, major amputation, and limb revascularization). Results: There were 93 (32%) patients with insulin-dependent DM (IDDM), 60 (21%) with non-insulin dependent DM (NIDDM), and 136 (47%) without-DM. Patients with IDDM were more likely than those without DM to be female, non-white, and Hispanic, and to have history of coronary artery disease, heart failure, and critical limb ischemia (P<0.05 for all). Use of antiplatelet therapy was similar across groups. Maximum platelet aggregation was highest in the IDDM group in response to multiple agonists ( Figure) . MACLE occurred in 51%, 57%, and 69% of the without-DM, NIDDM, and IDDM groups, respectively (P=0.02). Compared to subjects without DM, only those with IDDM were at increased risk of MACLE after multivariable adjustment (aHR 1.6 [95% CI 1.02-2.4]; P=0.04) ( Figure ). After further adjustment for platelet aggregation, the association between IDDM and MACLE was no longer statistically significant (1.4 [0.9-2.3]; P=0.17); platelet aggregation mediated 24% of the excess MACLE risk in individuals with IDDM. Conclusions: In patients with PAD, IDDM is associated with increased platelet activity that mediates, in part, the risk for incident cardiac and limb events.

Impact of Diabetes Mellitus on Postoperative Complications Following Laparoscopic Hysterectomy for Benign Indications

Background: Current research pertaining to minimally invasive gynecologic surgical outcomes in the context of diabetes mellitus (DM) is limited. This study seeks to evaluate the association between DM and postoperative complications following laparoscopic hysterectomy for benign indications. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was utilized. We identified laparoscopic hysterectomies completed for benign indications from 2007 to 2016 using current procedural terminology codes. Complications were evaluated by DM status: non-insulin-dependent DM (NIDDM), insulin-dependent DM (IDDM), and non-DM. Postoperative complications were evaluated utilizing univariate and multivariate analyses. Results: We identified 56,640 laparoscopic hysterectomies. Though both the IDDM and NIDDM cohorts had an increased incidence of postoperative complications compared to the non-diabetes cohort. The IDDM group had the highest incidence of all 3 cohorts. Compared to non-DM, the IDDM group had higher odds of reintubation (OR 4.23; 95% CI 1.59–11.19), urinary tract infection (OR 1.45; 95% CI 1.022–2.069), and extended length of stay (OR 1.75; 95% CI 1.36–2.26). Conclusion: Both NIDDM and IDDM were independent risk factors for postoperative complications after laparoscopic hysterectomy. However, the IDDM cohort had the highest odds of complications. Diabetic patients should be carefully counseled regarding their elevated risk of perioperative complications.

An evaluation of attention deficit hyperactivity disorder and specific learning disorder in children born to diabetic gravidas: a case control study

Objective: Children born after risky pregnancies are known to have an increased disposition to neurodevelopmental disorders. The purpose of our study was to investigate the relationship between diabetic pregnancy and attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD). Methods: One hundred thirty-seven children of mothers with diabetic pregnancies and 128 children of mothers without a history of diabetic pregnancy were enrolled. Forty-nine of the case group had a history of insulin-dependent diabetes mellitus (IDDM) and 88 of gestational diabetes mellitus (GDM). All participants were evaluated using The Kiddie Schedule for Affective Disor-ders and Schizophrenia for School-Age Children (6-18) (K-SADS PL), the Wechsler Intelligence Scale for Children-Revised (WISC-R), and the SLD Battery. The results were then subjected to statistical analysis. Results: A statisti-cally significant difference was determined between the case and control groups in terms of levels of diagnosis of ADHD and SLD. Significant differences were determined between verbal/performance/total IQ scores when IDDM and GDM were compared with the control group. When the IDDM and GDM subgroups were compared among themselves, no significant difference was determined between verbal/performance/total IQ scores. Significant varia-tion was observed between the IDDM and GDM groups in terms of ADHD and SLD diagnoses. IQ scores decreased as fasting blood sugar increased in all parameters. Conclusion: Significantly, more diagnoses of ADHD and SLD were observed in children born to diabetic mothers compared to those of non-diabetic mothers. Further, wide-ranging studies on the subject of the effect of diabetic pregnancy and blood sugar control on infant neurodevel-opmental disorders are now needed.

Evaluation of salivary albumin in diabetic children

Aim: To evaluate salivary albumin in insulin-dependent diabetes mellitus (IDDM) patients and to compare with the healthy nondiabetic control group. Study Design: The study consisted of 30 IDDM patients and 30 age- and sex-matched healthy controls. All the subjects were subjected to salivary albumin estimations. The salivary albumin estimations were done by bromocresol green (BCG) dye method, end point. All the estimations were performed using an AutoAnalyzer. Results: The results showed elevated levels of salivary albumin in the IDDM group compared to the healthy controls. Conclusion: The salivary albumin can be used to assess the metabolic status of the diabetic subjects since it showed increased levels compared to the healthy controls. Salivary parameters can act as adjuncts in assessing the overall metabolic status of the patient.

Absence of occult hepatitis B virus infection in sera of diabetic children and adolescents following hepatitis B vaccination

Background The prevalence of occult hepatitis B (HB) infection (OBI) in HB-vaccinated diabetic children has not yet been tested. Here, we aimed to determine the prevalence of OBI among HB-vaccinated children and adolescents with insulin-dependent diabetes mellitus (IDDM).Results Eighty-seven (51.2%) children had a titer for antibodies to HB surface antigen (anti-HBs) of <10 IU/L. These included 44 (70%) IDDM children and 43 (40.2%) healthy children. Eighty-three (48.8%) children had an anti-HBs titer of ≥10 IU/L; they included 19 (30%) with IDDM and 64 (59.8%) healthy children. None of the enrolled children (n = 170) were reactive for total antibody to HB core antigen (anti-HBc) as determined by enzyme-linked immunosorbent assay. HB virus DNA was not detected in HB-vaccinated IDDM or healthy children and adolescents.Method An amount of 170 HBsAg-negative sera samples from HB-vaccinated children and adolescents was included. They were classified into the IDDM group (n = 63) and the healthy control group (n = 107). HBsAg, anti-HBc, and anti-HBs were tested by enzyme-linked immunosorbent assay, and HB virus DNA was tested by nested polymerase chain reaction using 3 pairs of surface, core, and X genes.In Conclusion Primary HB vaccination confers long-term protection against OBI in Egyptian diabetic children and adolescents. However, the number of cases tested in this study was relatively low, and further studies and long-term follow-up of large populations are needed to draw solid and convincing conclusions.

Anti-müllerian hormone, inhibin B and antral follicle count as markers of premature ovarian failure in women with type I diabetes mellitus

Objective: To evaluate the different markers of ovarian reserve (AMH-Inhibin B , FSH and antral follicle count (AFC) in insulin dependent diabetes mellitus ( IDDM). Methods: We studied 30 patients with IDDM as study groups (10cases>32 years group IV and 20 cases 32 years group II) and 20 healthy women as control groups (8 cases >32 years group III and 12 cases 32 years group I . Serum levels of FSH, LH, inhibin B and AMH were measured at (days 1-7) of menstrual cycle and AFC was done by trans vaginal ultrasound. Results: AMH levels were lower in IDDM patients than in controls > 32 years (2.35 2.2 versus 7.79 difference in the levels of FSH .. AFC is valuable for the diagnoses of premature ovarian failure in IDDM. 1.73 p0.000). Also IDDM groups showed lower levels of inhibin B. While there is no Conclusion: Compared with FSH (AMH and inhibin B) are more valuable for the diagnosis of premature ovarian aging in IDDM patients which developed earlier decline in the ovarian follicle pool compared with the healthy women and also AMH is more valuable than AFC for detection of premature ovarian failure in IDDM.

A re‐evaluation of the influence of maternal insulin‐dependent diabetes on fetal nuchal translucency thickness and first‐trimester maternal serum biochemical markers of aneuploidy

To evaluate the influence of maternal insulin-dependent diabetes mellitus (IDDM) on maternal serum free ß-hCG, pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency (NT) thickness from 11 weeks to 13 weeks 6 days of gestation in a large cohort of women screened prospectively for chromosomal anomalies. Information on maternal IDDM status, maternal serum biochemical marker levels and fetal NT were collected from the prenatal screening computer records. On total, the control group included 83,972 and the IDDM group included 489 pregnancies. The median-corrected free β-hCG and PAPP-A, expressed as MoM, and fetal NT, expressed as delta values, in the IDDM and non-IDDM groups were compared. There were no significant differences between the IDDM and non-IDDM groups in median-corrected free β-hCG (IDDM 1.01 MoM, non-IDDM 1.01 MoM; p = 0.970), or mean delta NT (IDDM 0.00 mm, non-IDDM 0.02 mm; p = 0.412). However, the median-corrected PAPP-A was significantly lower (IDDM 0.88 MoM, non-IDDM 1.03 MoM; p < 0.0001). In pregnancies with maternal IDDM, first-trimester screening for chromosomal defects does not require adjustments for the measured fetal NT and maternal serum free ß-hCG. However, for PAPP-A the 15% reduction is large enough to require correction in the calculation of risks for chromosomal defects.

Bone Mineral Density, Osteocalcin, and Bone‐specific Alkaline Phosphatase in Patients with Insulin‐dependent Diabetes Mellitus

The aims of this study were to evaluate the prevalence of osteopenia and the relationships between osteocalcin (OC), bone alkaline phosphatase (bALP), and bone mineral density (BMD) in patients with insulin-dependent diabetes mellitus (IDDM). A group of 18 patients (median age 47, range 36-51) with uncomplicated IDDM (Group A) were matched by sex, age, and body mass index with 21 healthy control volunteers (Group B). All subjects underwent osteodensitometry with measurement of BMD at the lumbar spine and femoral neck. Osteopenia was present in 11 (61.1%) and 2 (9.5%) of Group A and B patients (P= 0.01), respectively. Both OC (28.4 +/- 16.4 versus 41.2 +/- 14.6 ng/mL; P= 0.005) and bALP (51.3 +/- 11.8 versus 61.7 +/- 10.6 U/L; P= 0.006) serum levels were significantly lower in patients with IDDM. BMD did not correlate with either OC or bALP. In conclusion, osteopenia is common among patients with IDDM, but the relationship between bone formation markers and BMD is still unclear.

Anti-GAD Antibody in Patients with Adult-Onset Diabetes in Korea

Background: It is well known that the clinical characteristics of diabetes mellitus in Korean people are different from those of Western people. The purpose of this study was to investigate the prevalence of the anti-GAD antibody (GADA) in a large number of Korean patients with adult-onset diabetes. Methods: The GADA was measured by radioimmunoassay for 11,472 adult-onset diabetic patients who visited the Asan Medical Center from 1998 to 2007. According to the fasting C-peptide levels, we classified the patients into an insulin dependent diabetes mellitus group (IDDM; C-peptide < 0.6 ng/mL) and non-insulin dependent diabetes mellitus group (NIDDM; C-peptide ≥ 1.0 ng/mL). Other clinical and laboratory data were obtained from medical records. Results: Among the 11,147 diabetic patients, 9,250 patients were classified as NIDDM, 922 patients were classified as IDDM and 975 patients excluded. Within the latter group 472 patients were to absolute insulin deficient (C-peptide < 0.1 ng/mL). The prevalence of GADA was 2 2.0% in the IDDM group and 4.7% in the NIDDM group. GADA was more prevalent in younger-onset NIDDM patients (25~40 years of age; 12.4%) than in older-onset NIDDM patients (≥ 40 years of age; 3.8%). The GADA-positive NIDDM patients had lower C-peptide and BMI levels, and higher rates of typical diabetic symptoms and insulin treatment. Conclusion: The prevalence of GADA in Korean patients with IDDM and NIDDM was lower than that reported in Western populations. It is thus suggested that autoimmunity is a rarer cause of diabetes in Korean people. However, since over 10% of younger-onset NIDDM patients were positive for GADA, routine GADA measurement in such patients is recommended. (Korean Diabetes J 33:16-23, 2009)

Nutritional Intake of Children and Adolescents with Insulin-Dependent Diabetes Mellitus in Crete, Greece

Background/Aims: The incidence of childhood insulin-dependent diabetes mellitus (IDDM) is rapidly increasing in Greece. The aim of this study was to examine nutrient patterns of children and adolescents with IDDM in Crete. Methods: A case-control survey of eating habits was conducted among 41 children and adolescents, aged 6–17 years, with IDDM (cases) and healthy sex- and age-matched controls, recruited from Heraklion University Hospital and the village of Rouvas, Crete, respectively. Dietary data was based on 24-hour recall records. Results: Dietary intake was similar between the groups. Both groups exceeded the recommendations for total and saturated fat and consumed lower than recommended amounts of dietary fibre and total carbohydrates. Children with IDDM consumed more dairy products and vegetables and less meats and cereals. Vegetables were consumed by a relatively high proportion of children and adolescents in both groups, but there was a higher proportion of fruit consumers amongst the IDDM group. For those who ate fruit and vegetables, intake approximated current recommendations of 400 g/day. Conclusions: The need to increase complex carbohydrates and reduce the consumption of total and saturated fat, in order to approach the traditional dietary pattern of Crete for this population, should be addressed via appropriate nutrition education programmes.

The influence of maternal insulin‐dependent diabetes on fetal nuchal translucency thickness and first‐trimester maternal serum biochemical markers of aneuploidy

To evaluate the influence of maternal insulin dependent diabetes mellitus (IDDM) on maternal serum free beta-hCG, PAPP-A and fetal nuchal translucency (NT), thickness at 11 to 13(+6) weeks of gestation in a large cohort of women screened prospectively for chromosomal anomalies. Information on maternal IDDM status, maternal serum biochemical marker levels and fetal NT were collected from the prenatal screening computer records in two first-trimester screening centres. In total the control group included 33 301 pregnancies of which 16 366 had NT and maternal serum biochemistry results and 16 305 with NT only. The IDDM group included 195 pregnancies of which 79 had NT and maternal serum biochemistry results and 127 with NT only. The median maternal weight corrected free beta-hCG and PAPP-A, expressed as multiple of the median (MoM), and fetal NT, expressed as delta values, in the IDDM and non-IDDM groups were compared. There were no significant differences between the IDDM and non-IDDM groups in median maternal weight corrected free beta-hCG (IDDM 0.87 MoM, 95% Confidence Interval 0.75 to 1.16 MoM, non-IDDM 1.00 MoM), median maternal weight corrected PAPP-A (IDDM 1.02 MoM, 95% Confidence Interval 0.83 to 1.05 MoM, non-IDDM 1.01 MoM), or mean delta NT (IDDM 0.0358 mm, non-IDDM 0.0002 mm). In pregnancies with maternal IDDM, first-trimester screening for chromosomal defects does not require adjustments for the measured fetal NT. However, more data are required before the possible reduction in maternal serum free beta-hCG and the reduction of PAPP-A suggested by the published world series can be considered sufficiently important to take into account in the calculation of risks for chromosomal defects.

Disposal of injection material used for the treatment of hepatitis C: comparison with insulin-dependent diabetes and thromboembolism

The survey conducted in the Provence-Alpes-Cote d'Azur region in France in 1999 showed that 38% of patients infected with the hepatitis C virus (HCV) receiving interferon injections in their home were aware of the recommendations concerning the disposal of injection material and that 41% of the needles were discarded with household waste after use. The purpose of our study conducted in the Centre region of France was to ascertain how injection material used by HCV-positive patients for interferon treatment are disposed of in comparison with material used by patients injecting insulin for insulin-dependent diabetes mellitus (IDDM) or low-molecular-weight heparin (LMWH) for thromboembolism. A questionnaire to be completed by patients was proposed to HCV-positive patients attending hepatogastroenterology clinics in the Centre region hepatitis C network for therapeutic follow-up (N=113 patients) between October 2001-January 2002. The same questionnaire was proposed to patients attending follow-up consultations for insulin-dependent diabetes mellitus (N=85 patients) or thromboembolism (N=23 patients) between March-June 2002. Significantly more patients stated they were aware of recommendations for disposal of injection material in the HCV group (89%) than in the IDDM (67%) or LMWH (26%) groups (P<0.01). Injection material was discarded with household waste less often by patients in the HCV group (6%) than in the IDDM (32%) or LMWH (29%) groups (P<0.001) and more often collected in a safety box prior to incineration (73% in the HCV group versus 63% and 14% in the IDDM and LMWH groups respectively). The safety box was discarded with household garbage more often by patients in the IDDM (54%) or LMWH (50%) groups than in the HCV group (0%) (P<0.001). Equivalent proportions of the patients said they recapped the needle after use (HCV 83%; IDDM 93%; LMWH 84%). Information concerning use of safety boxes for disposal of injection material should be provided to patients in order to comply with regulatory recommendations on proper disposal of used injection material. Moreover, the habit of recapping needles (89% of all patients in this study) is still widespread.

Ultrastructural mucosal alterations and increased intestinal permeability in non-celiac, type I diabetic patients

Background. Increased intestinal permeability was described in several intestinal auto-immune conditions. There are very few and contradictory reports about type I diabetes mellitus, an auto-immune condition sometimes associated with celiac disease. Aims. To investigate intestinal permeability in type I diabetes mellitus patients with no concomitant celiac disease, with a comparison to ultra-structural aspects of duodenal mucosa. Patients. 46 insulin dependent diabetes mellitus, non-celiac, patients (18 females and 28 males, mean age 15.8±5.3 [S.D.] years) were enrolled. The mean duration of the disease was 5.7 years. Methods. The morphological aspect of the small bowel mucosa, at standard light microscopy and electron transmission microscopy, along with intestinal permeability (by lactulose/mannitol test) were studied. Lactulose and mannitol urinary excretion were determined by means of high performance anion exchange chromatography–pulsed amperometric detection. Results. The lactulose/mannitol ratio was 0.038 [0.005−0.176] (median and range) in 46 patients compared to 0.014 [0.004−0.027] in 23 controls: insulin dependent diabetes mellitus group values being significantly higher than those of the controls ( P<0.0001, Mann–Whitney test). Eight insulin dependent diabetes mellitus patients underwent endoscopy and biopsies were analysed by means of light microscopy and transmission electron microscopy. At the light microscopy level, none of the biopsy samples showed any sign of atrophy nor inflammation, whereas transmission electron microscopy analysis showed remarkable ultra-structural changes in six out of the eight patients. Four parameters were evaluated: height and thickness of microvilli, space between microvilli and thickness of tight junctions. Conclusions. This alteration of intestinal barrier function in non-celiac type I diabetes mellitus, frequently associated with mucosal ultra-structural alterations, could suggest that a loss of intestinal barrier function can be a pathogenetic factor in a subset of insulin dependent diabetes mellitus patients.

Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus

Background context Prior studies have documented an increased complication rate in diabetics treated by lumbar decompression. Despite the assumption that this risk would be exacerbated in larger fusion procedures, a recent study found no such increased risk. Purpose To clarify the perioperative risk for patients with diabetes mellitus undergoing instrumented lumbar fusion as compared with controls. To identify differences, if any exist, between patients with insulin-dependent diabetes mellitus (IDDM) and non–insulin-dependent diabetes (NIDDM). Study design/setting This is a retrospective case-control study designed to examine the risk of perioperative complications in patients with diabetes mellitus treated by lumbar instrumentation and fusion. This study analyzed 94 diabetic patients and 43 controls treated by posterior lumbar instrumentation and fusion. Outcome was assessed based on the occurrence of perioperative complications. Complications were classified as major or minor. Methods Hospital and office records were reviewed for 94 diabetics (51 NIDDM, 43 IDDM) and 43 controls matched for age, sex and procedure with the IDDM group. The groups were compared for demographic characteristics, surgical data, perioperative complications and fusion rate. Results The NIDDM, IDDM and control groups were equivalent with regard to age, gender, nicotine use, fusion levels, operative time and estimated blood loss. There was a significant difference in complication rate between the NIDDM (53%) and IDDM (56%) groups versus controls (21%). There was a significant increase in complications with multilevel fusion in all groups and with increased operative time in the IDDM group. There was a significantly greater nonunion rate in the NIDDM (22%) and IDDM (26%) groups as compared with controls (5%). Conclusions Patients with both IDDM and NIDDM have a significantly increased risk of perioperative complications as compared with controls when treated by lumbar instrumentation and fusion.

Characteristics and habits of parents of children with insulin-dependent diabetes mellitus

The aim of this case-control study conducted in Belgrade during 1994-1997 was to investigate whether parental demographic characteristics and habits are associated with insulin-dependent diabetes mellitus (IDDM). Case group comprised 105 children up to 16 years old with IDDM and control group comprised 210 children with skin diseases. Cases and controls were individually matched by age (+/- one year), sex and place of residence (Belgrade). According to chi 2 test results, children with IDDM significantly had five or more family members and they also significantly more frequently had poor socio-economic status than their controls. Higher education of fathers was significantly more frequently reported in diabetic children, in comparison with their controls. Parents of diabetic children were significantly more frequently occupationally exposed to radiation, petroleum, and its derivates, organic solvents, dyes and lacquers. During pregnancy mothers of diabetic children significantly more frequently smoked cigarettes and consumed coffee, coca-cola, alcohol and foods containing nitrosamines. Fathers of diabetic children more frequently consumed alcohol.

Signal-averaged electrocardiogram in children and adolescents with insulin-dependent diabetes mellitus.

We report on the potential usefulness of the signal-averaged electrocardiogram (SA-ECG) in young patients with insulin-dependent diabetes mellitus (IDDM) to predict subclinical cardiovascular complications. Sixteen patients with IDDM and 18 age-matched healthy subjects were studied. The IDDM group included 4 males and 12 females, aged 7 to 20 y (mean 14.2 +/- 3.8 y, +/- SD). The duration from the onset of IDDM to the study ranged from 1.2 to 9.8 y (mean 5.4 +/- 3.8 y), and HbAlc value ranged from 6.6 to 12.4% (mean, 10.0 +/- 1.8%). SA-ECG was recorded and analyzed using the methods described by Simson. Values of filtered QRS duration (f-QRS), root mean square voltage (RMS), the duration of low amplitude signal (LAS) and late duration (LD) were calculated and compared between the groups. These parameters were not significantly different between the IDDM and control groups. However, in patients with poor glycemic control (HbAlc >10%), f-QRS was long and RMS was significantly low (p < 0.05, each) compared with the control group. Three patients with IDDM were positive for ventricular late potentials, although none had ventricular tachyarrhythmia. None of the control subjects showed ventricular late potentials. Certain parameters of SA-ECG showed abnormal values in IDDM patients with poor glycemic control. Thus, SA-ECG is a potentially useful and non-invasive method for the assessment of subclinical cardiac impairment in diabetic children and adolescents.

Signal‐averaged electrocardiogram in children and adolescents with insulin‐dependent diabetes mellitus

We report on the potential usefulness of the signal‐averaged electrocardiogram (SA‐ECG) in young patients with insulin‐dependent diabetes mellitus (IDDM) to predict subclinical cardiovascular complications. Sixteen patients with IDDM and 18 age‐matched healthy subjects were studied. The IDDM group included 4 males and 12 females, aged 7 to 20 y (mean 14.2 ± 3.8 y, ±SD). The duration from the onset of IDDM to the study ranged from 1.2 to 9.8 y (mean 5.4 ± 3.8 y), and HbA1c value ranged from 6.6 to 12.4% (mean, 10.0 ± 1.8%). SA‐ECG was recorded and analyzed using the methods described by Simson. Values of filtered QRS duration (f‐QRS), root mean square voltage (RMS), the duration of low amplitude signal (LAS) and late duration (LD) were calculated and compared between the groups. These parameters were not significantly different between the IDDM and control groups. However, in patients with poor glycemic control (HbA1c &gt; 10%), f‐QRS was long and RMS was significantly low (p &lt; 0.05, each) compared with the control group. Three patients with IDDM were positive for ventricular late potentials, although none had ventricular tachyarrhythmia. None of the control subjects showed ventricular late potentials. Conclusion: Certain parameters of SA‐ECG showed abnormal values in IDDM patients with poor glycemic control. Thus, SA‐ECG is a potentially useful and non‐invasive method for the assessment of subclinical cardiac impairment in diabetic children and adolescents.

Association between atopic dermatitis and insulin-dependent diabetes mellitus: a case-control study

Up to two-thirds of children with atopic dermatitis have IgE-mediated allergic reactions and a Th2 immune reactivity pattern with low production of interferon gamma and high production of interleukin 4 after allergen stimulation of T lymphocytes. Insulin-dependent diabetes mellitus (IDDM) seems to be associated with a Th1 immune reactivity pattern. We therefore postulated that these diseases may be inversely associated. We designed a case-control study including 920 children with IDDM, registered in the Danish Registry for Childhood Diabetes, and a sample of 9732 non-diabetic children registered in the Danish Medical Birth Registry. The children were aged 3-15 years. Information on atopic dermatitis was obtained by questionnaires. The cumulative incidence of atopic dermatitis up to age 15 years was 13.1% among children with IDDM and 19.8% in non-diabetic children (p<0.0001). Among children who developed IDDM, the incidence of atopic dermatitis was significantly lower than in the controls before onset of IDDM (73 cases in 5314 person-months vs 1375 in 57432 person-months; odds ratio 0.49 [0.39-0.63]). After onset of IDDM, diabetic and non-diabetic groups did not differ in incidence of atopic dermatitis (1.36 [0.89-2.07]). Our findings may be explained by different acquired or inherited reactivity patterns associated with atopic dermatitis (Th2) and IDDM (Th1). The results do not allow us to find out whether early development of atopic dermatitis reduces the risk of IDDM, or a propensity for IDDM reduces the risk of early-onset atopic dermatitis.

Relationship between metabolic glycaemic control and platelet content of glutathione and its related enzymes, in insulin-dependent diabetes mellitus

The relationship between glycaemic metabolic control and intracellular concentration of reduced glutathione (GSH) and related enzymes GSH-peroxidase (GSH-Px), GSH-reductase (GSH-Red), GSH-transferase (GSH-Tr), glucose-6-P-dehydrogenase (G6PDH), and thioltransferase (TT) in patients with insulin-dependent diabetes mellitus (IDDM) is controversial. Choosing platelets as cell model (as commonly done in previous studies), the aim of this study was to relate the platelet content of GSH and related enzymes to glycaemic metabolic control, expressed as glycated haemoglobin (HbA1c), as well as to presence of retinopathy and nephropathy in 114 IDDM patients. As compared to controls, both GSH and GSH-Red (geometric means (95% CI)) were significantly increased in platelets of diabetic patients: 3.3 (0.7–9.6) vs. 2.4 (0.8–7.6) mmol 10 −9 platelets; P=0.01 for GSH, and 30.6 (14.7–61.6) vs. 22.2 (8.7–52.2) mU 10 −9 platelets, P=0.0002 for GSH-Red, and TT activity was marginally decreased in the IDDM group ( P=0.06). While no clear relationship was present between GSH-related enzymes and HbA1c, a trend was present toward a non-linear relation between HbA1c and GSH, being significantly related by a parabolic curve ( P=0.002). As compared to patients with normoalbuminuria ( n=88), diabetic patients with increased urinary albumin excretion rate ( n=26) had a significant decrease in platelet TT concentration (3.2 (0.9–6.7) vs. 5.1 (1.9–18.7) mU 10 −9 platelets; P=0.0002), whereas retinopathy was not associated to modifications in GSH or in the enzymatic pattern. In summary: (a) platelet GSH and GSH-Red are increased in IDDM, while other enzymes are unmodified; (b) GSH seems to be related to metabolic control according to non-linear parabolic curve; (c) presence of increased albuminuria is associated to a selective decrease in platelet TT content.