Satisfactory Metabolic Control Research Articles

Phenylalanine-Free Infant Formula in Patients with Phenylketonuria: A Retrospective Study.

The long-term efficacy and use of phenylalanine-free infant amino acid formula (PFIF) is understudied. This retrospective, longitudinal study evaluated PFIF (PKU Start: Vitaflo International) in children with phenylketonuria, collecting data on metabolic control, growth, dietary intake, and symptoms and the child's experience with PFIF. Twenty-five children (12 males, 48%) with a median age of 3.6 years (2.0-6.2 years) were included. During 24 months follow-up, children maintained normal growth and satisfactory metabolic control. The protein intake from protein substitutes increased from 2.7 at 6 months to 2.8 g/kg/day at 24 months, while natural protein decreased from 0.6 to 0.4 g/kg/day. By 24 months, most children (n = 16, 64%) had stopped PFIF, while nine (36%) continued with a median intake of 450 mL/day (Q1:300 mL, Q3: 560 mL). Children who continued PFIF after 24 months of age had higher energy and fat intakes with higher weight/BMI z-scores compared with those who stopped earlier (p < 0.05). Constipation was reported in 44% of infants but improved with age. Initial difficulty with PFIF acceptance was reported in 20% of infants but also improved with time. Prolonged use of PFIF in pre-school children may contribute to poor feeding patterns and overweight; thus, replacing the majority of the protein equivalent provided by PFIF with a weaning protein substitute by 12 months and discontinuing PFIF before 2 years is recommended.

Glycemic control versus quality of life in a cohort of diabetic children from South Kerala

Background: Assessment of HRQOL (Health related quality of life) in clinical practice is important to determine the course of the disease, early recognition of problems and the type of insulin therapy that would be adequate to maintain satisfactory metabolic control with less impact on HRQOL in every patient. Methods: A cross-sectional analytical study was conducted in the tertiary care hospital in Kerala. All children’s who aged 4-18 years with type 1 diabetes mellitus (DM) attending pediatric OPD in a tertiary care hospital in Kerala were included. The study period was 18 months. PedsQL diabetes module 3.0 (pediatric quality of life inventory 3.0 diabetes module) and PedsQL generic core module 4 (pediatric quality of life inventory 4.0 generic core scale) were used as tools. Results: The study population included 30 children with type 1 DM. The average duration of diabetes was 5.60±2.990 years. Based on HbA1c level, 16 [53.3%] children had well controlled diabetes and 14 [46.7%] had poorly controlled diabetes. Eighteen [80%] patients had complications in the form diabetic ketoacidosis or hypoglycemia in the past 1 year. Diabetes specific quality of life mean scores were [child report and parent proxy report] 88.4 and 85.9 for poorly controlled diabetes group and 94.4 and 93.0 for well controlled group respectively which showed a significant difference (p value 0.004). Children with better glycemic control also showed better generic score (p value-0.004). Conclusions: Metabolic control, measured by HbA1c value, was significantly associated with QoL in patients with diabetes. Good glycemic control is associated with better quality of life and less diabetes related symptoms.

Feasibility and efficacy of combined pancreatic islet-lung transplantation in cystic fibrosis-related diabetes–PIM study: A multicenter phase 1–2 trial

Cystic fibrosis‐related diabetes (CFRD) is a common complication of cystic fibrosis (CF), and restoring metabolic control in these patients may improve their management after lung transplantation. In this multicenter, prospective, phase 1–2 trial, we evaluate the feasibility and metabolic efficacy of combined pancreatic islet‐lung transplantation from a single donor in patients with CFRD, terminal respiratory failure, and poorly controlled diabetes. Islets were infused via the portal vein under local anesthesia, 1 week after lung transplantation. At 1 year, the primary outcome was transplant success as evaluated by a composite score including four parameters (weight, fasting glycemia, HbA1c, and insulin requirements). Ten participants (age: 24 years [17–31], diabetes duration: 8 years [4–12]) received a combined islet‐lung transplant with 2892 IEQ/kg [2293–6185]. Transplant success was achieved in 7 out of 10 participants at 1‐year post transplant. Fasting plasma C‐peptide increased from 0.91 μg/L [0.56–1.29] to 1.15 μg/L [0.77–2.2], HbA1c decreased from 7.8% [6.5–8.3] (62 mmol/mol [48–67]) to 6.7% [5.5–8.0] (50 mmol/mol [37–64]), with 38% decrease in daily insulin doses. No complications related to the islet injection procedure were reported. In this pilot study, combined pancreatic islet‐lung transplantation restored satisfactory metabolic control and pulmonary function in patients with CF, without increasing the morbidity of lung transplantation.

1163-P: Prognostic Factors in Type 2 Diabetic Patients Diagnosed with COVID-in a Latin American Hospital

Background: To determine the factors associated with mortality in adult patients diagnosed with type 2 diabetes hospitalized for COVID-in a hospital of Latin America. Methods: Prospective cohort study from June 2020-june 2021. Patients with a diagnosis of type 2 diabetes older than 18 years with a confirmed diagnosis of COVID-infection were included. Results: A total of 813 adults were included. The mean age was 61.2 years, 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%) . A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the Intensive Care Unit and 377 (46.4%) died. The requirement for ventilatory support, increased lung involvement, comorbidities and inflammatory markers were associated with mortality. Admission to the intensive care unit and the need for mechanical ventilation increased 1.39 (95% CI: 1.13 to 1.69) and 1.97 (95% CI: 1.69 to 2.29) the mortality. Those patients whose glycosylated hemoglobin on admission was greater than 10%, for every 1% increase above 10%, this increased the risk of death by 32% (RR: 1.32 95% CI: 1.25 to 1.38) . Conclusion: The mortality found in our study was associated with age, poor control of type 2 diabetes and respiratory compromise. Ensuring a satisfactory metabolic control of the patient with type 2 diabetes would decrease complications related to COVID-infection. Disclosure H. Moreno Parra: None.

P1121TOTAL PLASMA EXCHANGE (TPE) AND CITRATE CRRT IN A LOW-WEIGHT PEDIATRIC PATIENT WITH MACROPHAGE ACTIVATION SYNDROME (MAS): FEASIBILITY AND COMPLEXITIES OF BOTH TREATMENTS

Abstract Background and Aims Low-weight extracorporeal pediatric dialysis treatments remain a challenge due to their clinical and technical complexity. Apart from some metabolic congenital disorders, the usual indications for CRRT in early pediatric patients and newborns are the same as for adults with acute kidney injury (AKI). But the implementation of TPE is still in the anecdotal stage. Method Clinical case: a 7-month female infant, weighing 5.7kg, in the neonatal intensive care unit with fever, lymphadenopathy, hepatosplenomegaly, pancytopenia, hyperferritinemia, hypertriglyceridemia, was diagnosed as having macrophage activation syndrome (MAS). She developed AKI and acute respiratory distress syndrome (ARDS), due to sepsis. Because of oliguria, ruling out administration of drugs and parental nutrition, and fluid overload (more than 20% of her body-weight), CRRT was started. Results CRRT lasted 22 days in continuous venovenous hemodiafiltration (CVVHDF), with regional citrate anticoagulation (Table 1). Mean filter patency: 26±17h. 43% of treatments were interrupted after CVC failure, 21% after clinical procedures, 7% after filter coagulation. There was in this case no citrate accumulation and satisfactory metabolic and electrolyte control were obtained (Figure 1). After treatment of MAS failed with both i.v. immunoglobulins and corticosteroids, we considered TPE as a rescue therapy for the disease, even though we could not find a similar experience reported in the literature in such a small infant. We performed 3 TPE sessions, with heparin anticoagulation (Table 1), non-consecutively, with CRRT in between. Conclusion The treatments were well tolerated, resulting in a large decrease in triglycerides and ferritin (MAS index, Figure 2). Despite the death of the patient after ARDS worsened, we showed that even in a small critically ill infant, complex depurative treatments such as total plasma exchange are feasible. Highly skilled nephrologists and dialysis nurses are mandatory for treatment management.

Komplikacije tipa 1 dijabetesa melitusa kod dece

The World Health Organization has defined Diabetes mellitus as a disorder of metabolism of various causes, due to lack of secretion and / or action of insulin, with long-term hyperglycemia and altered metabolism of sugars, proteins and fats. Diabetes mellitus is the most widespread chronic non-infectious disease, with an increase in the frequency in childhood that could be the epidemic of the 21st century. The incidence is rapidly increasing in the world, while in the last thirty years in Serbia there has been an increase in the number of patients - especially in the group of small and preschool children. Exposure to the genetic, immune and environmental factors plays an important role in the etiology of the disease, but the underlying mechanisms remain unknown. Weeks before the final diagnosis, weakness, irresistible hunger, weight loss, increased thirst, pronounced diuresis, drying of the mucous membranes, skin pruritus and blurred vision could be present. Inadequate glycemic control and unregulated lipid status of children with type 1 diabetes are compatible with numerous complications and a higher risk of cardiovascular, peripheral vascular and cerebrovascular diseases. The therapy consists of insulin therapy, adequate daily physical activity, a variety of diets, overcoming stressful life situations and maintaining satisfactory metabolic control. By using intensive insulin therapy, the best control of the disease is achieved, while the frequency of possible complications is reduced.

Effect of Telehealth System on Glycemic Control in Children and Adolescents with Type 1 Diabetes

Objective:A close diabetes team-patient relationship is required for establishing satisfactory metabolic control. The purpose of this study was to investigate the effect of a telehealth system on diabetes control.Methods:The study was carried out between June 2015 and January 2016 at the Gazi University Faculty of Medicine, Pediatric Endocrinology Department. The telehealth system was developed by the diabetes team. The demographic characteristics, frequency of use and hemoglobin A1c (HbA1c) changes of type 1 diabetic (T1DM) patients using this communication network were analysed.Results:Eighty two patients [43 (52.4%) females, mean (±standard deviation) age 10.89±4 years] used the telehealth system. Fourteen (17.1%) of the cases were on pump therapy and 59 (72.0%) were counting carbohydrates. The individuals with diabetes or their families preferred WhatsApp communication. Whatsapp provided a means for instant messaging in most instances (57.3%), contact with diabetes education nurse (32.9%) and consultation with the diabetes team about insulin doses and blood glucose regulation (42.7%). HbA1c values after six months were significantly lower in patients/parents calling frequently (p<0.001) compared with HbA1c values recorded at the beginning of the study.Conclusion:Increase in frequency of counselling by the diabetes team led to improved blood glucose control in T1DM patients. A telehealth system is useful for early detection of the need for changes in treatment and for intervention. It also promoted better self care.

Reproductive experience of women living with phenylketonuria

IntroductionMany women with PKU are well-informed about the risks of maternal PKU but there are several barriers to achieving satisfactory metabolic control before and during pregnancy. Many studies have documented the outcome of maternal PKU infants, but very little has been reported about the experiences of women of reproductive age with PKU, particularly about their psychosexual development, pre-conception, pregnancy and postnatal experience. MethodsIn the UK, in a subsection of an online questionnaire conducted by the National Society for PKU (NSPKU) about living with PKU, women aged 18 years and over completed 9 closed questions about their pre-conception, pregnancy and post-natal experiences and an open-ended question on their reproductive health. Results300 women aged 18 years and over with PKU completed this questionnaire with 37% (n = 111/300) of women already having children. 56% (n = 71/128) of pregnancies were planned and a further 18% (n = 23/128) of women had both planned and unplanned pregnancies. Most women (73%, n = 200/273) expressed concerns, fears and distress about pregnancy and two thirds of women who had at least one pregnancy stated that having PKU made pregnancy more stressful and difficult. 60% (n = 164/273) were concerned that they may cause harm to a baby, 58% (n = 159/273) worried about their ability to manage a strict diet during pregnancy, 54% (n = 147/273) had anxiety about their ability to maintain blood Phe within target range, and 48% (n = 132/273) feared having an unplanned pregnancy.Postnatally, 48% (n = 45/93) had low mood or sadness, 41% (n = 38/93) were depressed, 34% (n = 32/93) felt unable to cope, 33% (n = 31/93) said they could not manage their PKU and care for their baby, 14% (n = 13/93) struggled with child care needs and 4% (n = 4/94) worried they might hurt themselves or their baby through being unable to manage their diet. ConclusionsMany women with PKU have unmet sexual and reproductive health needs. Pregnancy fears are prominent from adolescence onwards and for some women overarching concerns about their ability to cope with pregnancy led to a decision not to have children. Interventions are needed to reduce the psychological impact of the risk of maternal PKU syndrome and assist with safe pregnancies. Post-natal experiences of women with PKU give rise to concern.

Patient preferences for treatment in type 2 diabetes: the Italian discrete-choice experiment analysis.

Several drug classes are now available to achieve a satisfactory metabolic control in patients with type 2 diabetes (T2DM), but patients' preferences may differ. In a discrete-choice experiment, we tested T2DM patients' preferences for recent antidiabetic drugs, in the event that their treatment might require intensification. The following attributes were considered: (a) route of administration; (b) type of delivery; (c) timing; (d) risk of adverse events; (e) effects on body weight. Twenty-two possible scenarios were built, transferred into 192 paired choices and proposed to 491 cases naïve to injectable treatments and 171 treated by GLP-1 receptor agonists (GLP-1RAs). Analyses were performed by descriptive statistics and random effects logit regression model. Preferences according to dosing frequency, risk of nausea and urinary tract infections (UTls) were similar across groups, age, sex and BMI. Administration route and delivery type accounted for 1/3 of relative importance; the risk of UTIs, nausea and dosing frequency for ≈ 20% each, and weight loss for only 6%. Two significant interactions emerged (p < 0.01): type of delivery × group, and weight change × BMI class. Irrespective of previous treatment, the three preferred choices were injectable, coupled with weekly dosing and a ready-to-use device (first two choices). In a regression model, being naïve or non-naïve changed the ranking of preferences (p < 0.001), and the order was systematically shifted towards injectable medications in non-naïve subjects. Easy-to-deliver, injectable treatment is preferred in T2DM, independently of treatment history, and previous experience with GLP-1RAs strengthens patients' willingness to accept injectable drugs.

Sense of coherence, self-esteem, and health locus of control in subjects with type 1 diabetes mellitus with/without satisfactory metabolic control.

Despite intensive training, a few individuals with Type 1 diabetes mellitus (T1DM) fail to reach the desired metabolic targets. To evaluate the association between disease-related emotional and cognitive aspects and metabolic control in subjects with T1DM. Health locus of control (HLOC), sense of coherence (SOC), and self-esteem were assessed in T1DM subjects using validated questionnaires. Sixty-seven consecutive subjects who did not attain the desired HbA1c target (mean HbA1c, 8.3% [67mmol/mol]) were compared with 30 cases in satisfactory metabolic control (HbA1c levels <7%-53mmol/mol). In the overall population, SOC was negatively associated with BMI and average HbA1c, as was the association of self-esteem with HbA1c. Subjects attaining the desired metabolic target were characterized by higher SOC scores, higher Internal HLOC and prevalent Internal vs. Powerful-others HLOC. Compared to subjects in good metabolic control, subjects with unsatisfactory control had lower scores of SOC, Internal HLOC and Self-esteem, with no difference in Powerful others, or Chance HLOC. In the same group, SOC in the upper tertile was significantly associated with self-esteem (OR 1.35; 95% CI 1.08-1.69) and PHLOC (OR 1.24; 95% CI 1.03-1.49), after adjustment for age, sex, educational level, and comorbidities. Patients who fail to reach a satisfactory metabolic control tend to rely on significant others, trusting in the physicians' skills or on the efficiency of the health-care system. Strategies aimed at increasing self-efficacy and SOC, based on personal ability, are eagerly awaited to help patients improve diabetes care.

Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundDiabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health apps.ObjectiveThe aim of our study was to evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist DM patients in treatment.MethodsWe conducted searches in the electronic databases MEDLINE (Pubmed), Cochrane Register of Controlled Trials (CENTRAL), and LILACS (Latin American and Caribbean Health Sciences Literature), including manual search in references of publications that included systematic reviews, specialized journals, and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, patients with DM, and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager software version 5.3.ResultsThe literature search identified 1236 publications. Of these, 13 studies were included that evaluated 1263 patients. In 6 RCTs, there were a statistical significant reduction (P<.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (mean difference, MD −0.44; CI: −0.59 to −0.29; P<.001; I²=32%).The evaluation favored the treatment in patients who used apps without significant heterogeneity.ConclusionsThe use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care by contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly by reducing their fear of not knowing how to deal with potential hypoglycemic episodes that may occur.

A First Evaluation of OMNI®, A New Device for Continuous Renal Replacement Therapy

Background: Omni® (B. Braun, Germany) is a new-generation, continuous renal replacement therapy (CRRT) machine designed to improve user interface, minimize downtime and optimize renal dose delivery. It was never tested in humans. Methods: We used Omni® to provide CRRT in 10 critically ill patients. We collected therapy data, metabolic parameters and evaluated user's satisfaction with a survey. Results: CRRT was delivered using Omni® in CVVH-heparin (6 patients) and CVVHD-citrate (4 patients) modes for a total duration of 617.7 h. No adverse event was observed. The mean filter life was 22.8 (CVVH-heparin) and 33.5 (CVVHD-citrate) h. Alarms-related downtime corresponded to 5.9% of total therapy time. Delivered renal dose was 96.6% of prescribed. Satisfactory metabolic control and fluid removal were achieved. Overall, users evaluated interface, design and usability as excellent. Conclusion: CRRT in CVVH-heparin and CVVHD-citrate modes was provided using Omni® in a safe and efficient way for 10 critically ill patients. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=451053.

Ten years of specialized adult care for phenylketonuria - a single-centre experience.

BackgroundSpecialized adult care of phenylketonuria (PKU) patients is of increasing importance. Adult outpatient clinics for inherited errors of metabolism can help to achieve this task, but experience is limited. Ten years after establishment of a coordinated transition process and specialised adult care for inherited metabolic diseases, adult PKU care was evaluated with respect to metabolic control, therapy satisfaction, life satisfaction, sociodemographic data, economical welfare as well as pregnancy outcome.MethodsAll PKU patients transferred from paediatric to adult care between 2005 and 2015 were identified. A retrospective data analysis and a cross-sectional survey in a sub-cohort of 30 patients including a questionnaire for assessing quality of life (FLZm) were performed as a single-centre investigation at the metabolic department of the University Hospital Leipzig, Germany. For statistical analysis, Mann-Whitney-U-test, t-test for independent samples, ANOVA and chi square test were used as appropriate.Results96 PKU patients (56 females/40 males; median age 32 years, range 18–62) were included. In the last 3-year period, 81 % of the transferred patients still kept contact to the adult care centre. Metabolic control was stable over the evaluation period and dried blood phenylalanine concentrations mostly remained within the therapeutic range (median 673.0 μmol/l, range 213.0–1381.1). Sociodemographic data, economical welfare and life satisfaction data were comparable to data from the general population. However, differences could be revealed when splitting the cohort according to time of diagnosis and to management during childhood. 83 % of the PKU adults were satisfied with the transition process and current adult care. 25 completed pregnancies were supervised; three newborns, born after unplanned pregnancy, showed characteristic symptoms of maternal PKU syndrome.ConclusionsContinuous care for adult PKU patients in a specialized outpatient clinic is successful, leading to good to satisfactory metabolic control and social outcomes. Uninterrupted good metabolic treatment throughout childhood and adolescence positively influences educational, professional and economic success in later life. Further effort in specialized paediatric and adult metabolic care is needed to prevent loss of follow-up and to support the recommended life-long treatment and/or care.

Effect of age, sex and the insulin regiment on insulin needs in children and adolescents suffering from diabetes mellitus type 1

INTRODUCTION: The purpose of this study was to generate insulin dose (ID) percentiles for children and adolescents with type 1 diabetes mellitus (DM1) having the opportunity to assess this important parameter in relation to age and sex. Individual intensive substitution of insulin is vital for achieving optimum metabolic control in children and adolescents suffering from type 1 diabetes. AIM OF THE STUDY: The aim of this study is: to examine the basic factors which determine daily insulin needs; to establish average insulin doses of the examinees of different ages and sexes and to present them in the form of figures - percentile tables. METHODS: Medical documentation of 100 examinees (55 girls and 45 boys), ages 2-18 were analyzed at the Children's University Hospital in Belgrade in the period between August 1994 and August 2002. All the examinees achieved a satisfactory metabolic control of diabetes after the period of the remission of the disease. The examinees had the conventional insulin therapy (KITh) and intensive therapy (IITh), and they were all using humane insulins. RESULTS: On the basis of the data analysis it has been established that the average insulin dose at ages 3-9 is 0.8 IJ/kg/24h in both sexes, and that from the age of 10 the need for insulin considerably increases with metabolic control deteriorating at the same time. Insulin needs are the greatest during adolescence, especially in girls (1.20 IJ/kg/24h). The ranges of insulin doses show that every child needs an individual approach and estimate of insulin needs. CONCLUSION: It has been concluded that daily insulin needs grow with the growth of chronological age (0.8 before adolescence and 1.16 IJ/kg/24h in adolescence) and that girls get greater insulin doses than boys, especially during adolescence. Insulin needs shown in percentiles (P5 - P95) and presented in the form of figures enable fast and simple visualization of the range of insulin doses at different ages (figures 2 and 3). It is evident that there is a considerable deterioration of metabolic control during adolescence.

Self-care practice and glycaemic control amongst adults with diabetes at the Jimma University Specialized Hospital in south-west Ethiopia: A cross-sectional study

BackgroundThe main goal in diabetes care is to improve the patient's quality of life, to maintain satisfactory metabolic control and to retain minimal complications caused by diabetes mellitus (DM). Thus, this study has assessed self-care practice and glycaemic control amongst adults with diabetes mellitus.SettingA facility-based study amongst the diabetic follow-up clinic at Jimma University Specialized Hospital in Ethiopia.MethodsA cross-sectional study was conducted from 01 April to 30 April 30 2010. A total of 343 diabetic patients were selected using a systematic sampling method. The data were collected by structured questionnaires and a medical card review; anthropometric measurement was done by trained nurses.ResultsThe study showed that 53% of the respondents had diabetes related knowledge. The study also found that 64% of the respondents were physically less active, and 17% of the respondents were walking on foot for less than 30 minutes per a day. Only 18.1% of the respondents were able to control their Fasting Blood Sugar (FBS) to level below 126 mg/dL.ConclusionThe present study illustrates that the level of knowledge about diabetes and self-care practices amongst diabetic patients were meager. In addition, it showed that respondents’ level of physical activity, their educational status, and the dose of oral hypoglycaemic agents taken by the respondents significantly affected glycaemic control.

Bilateral Simultaneous Laparoscopic Adrenalectomy in Cushing's Syndrome: Safe, Effective, and Curative

Surgical morbidity and mortality rates are high in patients with Cushing's syndrome. Nevertheless, simultaneous bilateral laparoscopic adrenalectomy (LA) is feasible in these patients with less morbidity and good long-term results. Consecutive 22 patients who underwent LA for Cushing's syndrome between 2003 and 2010 in our institute were retrospectively studied. Ninteen patients underwent bilateral simultaneous and three underwent unilateral LA. Seven patients had Cushing's syndrome after failed pituitary surgery and five each had ectopic adrenocorticotrophic hormone dependent syndrome and bilateral macronodular hyperplasia respectively. LA was bilaterally done by lateral transabdominal adrenalectomy in 15 patients and retroperitoneal endoscopic adrenalectomy in 4 on the right side. Mean operative time for simultaneous bilateral cases was 199.45±72.43 minutes with mean blood loss of 72.72±48.6 mL. Patients were fit for discharge by the fifth postoperative day from the surgical aspect. Surgical complication rate was 26% that included wound infections in two, port site hernia, pleural effusion, and atelectasis in one each. One patient died of sepsis (5% mortality). Satisfactory metabolic control was achieved in all observable patients in the long term although Addisonian crisis and Nelson syndrome were seen in 26% and 15% respectively. LA has all advantages of minimal access surgery in patients with Cushing's syndrome who are immunocompromised and at high risk of delayed wound healing and infections. Magnification decreases the risk of retained adrenal remnants. Despite advances in minimal access surgery, perioperative morbidity continues to be significant for the procedure.

Dental caries and adolescents with type 1 diabetes

The aim of this study was to determine the prevalence of dental caries in adolescents with type 1 diabetes mellitus (DM). A clinical examination was carried out on 259 adolescents with type 1 DM as compared with 259 age- and sex-matched metabolically healthy controls. The DM cases were characterised by postprandial blood glucose and HBA1c levels, duration of the diseases, age at onset and level of control. Dental caries was assessed using the DMFT index. Data were analysed by Shapiro-Wilk's W, ANOVA, Student's t and Tukey's posthoc test. An intact dentition was found in none of the DM patients. DM adolescents had a higher mean DMFT score (p <0.001), fewer decayed (p <0.0001), and more filled (p <0.001) teeth than in the controls. In the well-controlled DM adolescents, the mean number of decayed (D) teeth was lower (p <0.0001) and the number of filled(F) teeth was higher than in patients with poorer glycaemic control. Early onset of DM was related to fewer decayed and filled teeth, but only if the oral hygiene was adequate (p <0.0001). Poor glycaemic control and the early onset of DM may increase the risk of dental caries, but appropriate oral hygiene together with satisfactory metabolic control may prevent the development of dental caries in adolescents with type 1 DM.

Healing of chronic necrobiosis lipoidica lesions in a Type 1 diabetic patient after pancreas-kidney transplantation: A case report

Necrobiosis lipoidica (NL) is a degenerative disease of dermal connective tissue of unknown etiology characterized by erythematous plaques preferentially localized to distal extremities. Skin lesions show a chronic relapsing nature. NL is often associated with diabetes mellitus and satisfactory treatment options are lacking. We describe the spontaneous healing of NL lesions after pancreas and kidney transplantation in a Type 1 diabetic patient with chronic NL recalcitrant to a variety of standard treatments. The 31-yr-old male patient had experienced NL lesions for more than 15 yr; despite various systemic and topical treatments, the skin lesions had pregressively enlarged. Because of end-stage renal disease, a simultaneous pancreas and kidney transplantation was performed and immunosuppressive therapy with tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisone was started. Pancreatic transplantation maintained satisfactory metabolic control with no need of exogenous insulin. After transplantation, skin lesions slowly healed without any specific treatment, leaving residual areas of fibrotic scars. A skin biopsy confirmed the absence of typical NL lymphocytic and histiocytic inflammatory response. Clinical remission of NL lesions may probably be explained by the concomitant effect of multiple-drug regimen for immunosuppression (TAC, MMF, and prednisone) and improved skin microcirculation secondary to the good metabolic control provided by pancreas transplantation.

Diet, self-management and metabolic control in Norwegian teenagers with type 1 diabetes

Background: Nutritional recommendations for people with diabetes have changed in the past 15-20 years, and few studies have focused on dietary management in adolescents with diabetes. Objective: To study dietary intake, metabolic control and self-management among teenagers with type 1 (insulin-dependent) diabetes. Design: A quantitative food frequency questionnaire and an additional questionnaire were used to study dietary intake, self-management and lifestyle factors, including smoking habits, among 49 teenagers aged 13_/ 19 years. Height, weight, glycosylated haemoglobin (HbA1c), total cholesterol and HDL cholesterol were also measured. Results: The participants had five meals daily. Frequent meals seemed to have an impact on glycaemic control. The boys’ energy intake from fat was very high, and there was a high intake of saturated fat. Fibre intake was lower than recommended, while sugar consumption was satisfactory. The girls had lower intake of vitamin D, c alcium, magnesium and iron than recommended. Median HbA1c was 8.6%. Those who measured their blood glucose less than daily had poorer glucose control than those who measured it at least three times a day. The prevalence of overweight was high. Conclusions: Few teenagers had satisfactory metabolic control. Frequent meals and regular glucose monitoring seemed to have an impact on blood glucose control. The results also indicate that fat quality and intake of micronutrients should be emphasized. Keywords: diet; diabetes; HbA1c; IDDM; self-management.

Role of metabolic control on diabetic nephropathy

OBJECTIVE: The aim of this investigation was studying the influence of glucose metabolic control on diabetic nephropathy. The authors observed the effect of acarbose, insulin, and both drugs on the metabolic control and development of mesangial enlargement of kidney glomeruli in alloxan-diabetic rats. METHODS: Five groups of Wistar rats were used: normal rats (N), non-treated alloxan-diabetic rats (D), alloxan-diabetic rats treated with acarbose (AD), alloxan-diabetic rats treated with insulin (ID), and alloxan-diabetic rats treated with insulin plus acarbose (IAD). The following parameters were evaluated: body weight; water and food intake; diuresis; blood and urine glucose levels; and the kidney lesions: mesangial enlargement and tubule cell vacuolization. Renal lesions were analysed using a semi-quantitative score 1, 3, 6, 9, and 12 months after diabetes induction. RESULTS: Diabetic rats showed a marked increase of glycemia, urinary glucose levels, diuresis, water and food intake, and weight loss, while the treated diabetic rats showed significant decreased levels of these parameters. The most satisfactory metabolic control was that of diabetic rats treated with acarbose + insulin. There was a significant mesangial enlargement in diabetic rats compared to normal rats from the third up to the 12th month after diabetes induction, with a significant difference between the animals treated with acarbose + insulin and non-treated diabetic rats. A difference between the animals treated with acarbose or insulin alone and non-treated diabetics rats was not seen. CONCLUSIONS: The authors discuss the results stressing the role of diabetic metabolic control in the prevention of diabetic nephropathy.