Type 1 Diabetes Mellitus In Patients Research Articles

Risk of Type 1 Diabetes Mellitus in Patients with Atopic Dermatitis: A Nationwide Population-Based Cohort Study

Introduction: Atopic dermatitis (AD) is a disease frequently occurring in children. The immune response is characterized by T-helper (Th)-2-dependent inflammation. Type 1 diabetes mellitus (T1DM) is an autoimmune disease that destroys pancreatic islet beta cells. In contrast, it is mainly mediated by a Th-1-dependent response. An inverted association has been hypothesized between T1DM and AD since Th1 and Th2 responses are mutually inhibitory. Methods: Data was retrieved from a nationwide healthcare database in Taiwan. A logistic regression model was used to evaluate the association of T1DM in patients with AD within a year. A Cox proportional hazards analysis was used to evaluate the subsequent risk of developing T1DM 1 year after AD diagnosis. Results: We identified 396,461 patients with AD and 1,585,844 age- and sex-matched controls. During the first year of follow-up, after adjusting variates, the association between T1DM and AD showed no statistical differences (odds ratio: 1.40; 95% confidence interval [CI]: 0.83–2.38, p = 0.207). After excluding those T1DM cases within 1 year of AD diagnosis and those with a follow-up duration of less than 1 year, AD did not significantly increase the risk of T1DM (hazard ratio [HR]: 1.02; 95% CI, 0.83–1.25, p = 0.843). Conclusions: Our study revealed that there was no significant association between AD and T1DM in the first year after AD diagnosis, and there was no increased risk of T1DM in AD patients in the average 5-year follow-up in our study.

Combined Hypophysitis and Type 1 Diabetes Mellitus Related to Immune Checkpoint Inhibitors.

The occurrence of multiple endocrinopathies due to immune checkpoint inhibitors (ICIs) is a relatively common adverse event. However, the occurrence of a combination of hypophysitis and type 1 diabetes mellitus (T1DM) is extremely rare, and its clinical features are unclear. We comparatively analyzed the clinical features of this combination and each individual ICI-induced endocrinopathy. We reported 3 cases that we encountered and reviewed previously reported cases of patients with combined hypophysitis and T1DM due to ICIs. Anti-programmed cell death-1 (anti-PD-1) antibodies were prescribed to all 3 cases. The duration from ICI initiation to the onset of endocrine disease was 12 to 48 weeks. Several human leukocyte antigen (HLA) haplotypes that have disease susceptibility to hypophysitis were detected in all 3 patients. With the 17 previously reported cases, combined endocrinopathies were more common in men (85%). The onset age was in the 60s for both combined and single endocrinopathies. Anti-PD-1 antibodies were used in most of the cases (90%). The time from ICI initiation to the onset of endocrinopathies was 24 (8-76) weeks for hypophysitis and 32 (8-76) weeks for T1DM in patients with combined endocrinopathies, which was not significantly different from that for each single endocrinopathy. We presented 3 cases of patients with combined endocrinopathies of hypophysitis and T1DM that may have been caused by anti-PD-1 antibodies. There was no difference in the time from ICI initiation to the onset of endocrinopathies between combined and single endocrinopathies. Further case accumulation and pathogenic investigations are required.

Impacts of glycemic variability on the relationship between time in range and estimated glycated hemoglobin in patients with type 1 diabetes mellitus

Objective: This study is to investigate the relationship between time in range (TIR) and glucose management indicator (GMI), and the impact of glycemic variability (GV) on their relationship in patients with type 1 diabetes mellitus (T1DM). Methods: The CGM data were collected from a multicenter randomized clinical trial of adults (≥18 years old) with T1DM, including 83 T1DM patients, respectively from the Third Affiliated Hospital of Sun Yat-sen University (72 cases), Drum Tower Hospital Affiliated to Nanjing University School of Medicine (2 cases), and the First Affiliated Hospital of University of Science and Technology of China (9 cases). All subjects wore the iProTM2 system for 14 days at baseline (0-2 weeks), 3 months (12-14 weeks), and 6 months (24-26 weeks). Data derived from iProTM2 sensor was used to calculate CGM parameters. Correlation between TIR and GMI was explored according to different stratification of glycemic variability assessed by glucose coefficient of variation (CV). Predicted TIR in the fixed GMI value was calculated via the linear regression equations performed in the respective interquartile group of CV. Results: From November 2017 to June 2021, a total of 233 CGM data were collected with 83 collected from baseline, 80 from the 3-month follow-up, 70 from the 6-month follow-up. Patients including 27 males had a median (Q1, Q3) age of 30.69 (25.22, 38.43) years, with a diabetes duration of 10.05(4.46, 13.92) years. The median (Q1, Q3) and effective wearing time of available CGM data was 13.92 (13.02, 14.00) days and 91.61% (84.96%, 95.94%), and the value of TIR, GMI and CV was 60.34%±13.03%, 7.14%±0.61% and 41.01%±7.64%, respectively. There was a strong negative correlation between TIR and GMI (r=-0.822, P<0.001). Multiple linear regression analysis showed that the predictive value of TIR calculated from a given GMI was 8.352% higher when CV was up to standard (36%) than that when CV was down to standard. Based on the multiple linear regression equations generated from quartiles of CV, the predicted TIR value was decreased across the ascending quartiles with 69.98 % in the lowest quartile of CV (≤35.91%), 64.57 % in 25th-50th quartile of CV (35.91%<CV≤40.08%), 60.96% in 50th-75th quartile of CV (40.08%<CV≤45.86%) and 56.44% in the highest quartile of CV (>75th quartile, CV>45.86%) when GMI was set as 7%. Conclusions: There is a strong correlation between TIR and GMI in adult patients with T1DM in patients with type 1 diabetes mellitus. CV influenced the relationship between TIR and GMI.

Factors Affecting Glycemic Control in Type-1 Diabetes Mellitus in Patients Visiting Newly Established Diabetic OPD at Tertiary Car Hospital Hyderabad Sindh

Background: Patients worldwide are affected by diabetes mellitus (DM), one of the most frequent diseases in the world. Various organs and systems in the body are affected by diabetic complications, which can be either microvascular or macrovascular in nature. Finding out and preventing these variables is critical to improving the quality of life for diabetics. Objective: To assess the poor glycemic control and its association with affected factors it in our diabetes population. Material and Methods: This Observational study was conducted on 80 patients in the Department of Pediatric (Unit II), Liquate University Hospital, Jamshoro/Hyderabad for six months from 1st January to 30th June 2021. Diabetic children between the ages of 1 and 15 who had Type-1DM and were on insulin therapy at LUMHS Hospital Jamshoro/Hyderabad were eligible for inclusion. Using a pre-tested structured questionnaire, we asked particular questions of each child after they had been inspected and their family history was gathered. Data was analyzed using SPSS version 26.0 Results: A total of 80 patients were enrolled in this study. Table: 1 shows the age and gender profile of the children. The most of the children were in the age group 5 to 12 years, with a p-value of 0.0001. As demonstrated in Table 2, the Subject had Polyuria, Polydipsia, Polyphagia, Fatigability and weight loss due to Diabetic ketoacidosis, the prevalence of consanguinity in the family, average monthly earnings, and the cost of insulin and glucose control. Table 3 shows weight and height. Graph I (p=0.0001) reveal that 14 (17.5%), 17 (21.2%), and 49 (61.2%) participants had good, fair, or poor glycemic control, respectively. Conclusion: Uncontrolled diabetes and complications are linked to poor insulin adherence, which is the mainstay of treatment. It is suggested that this topic be explored further. Keywords: Factors affecting, Glycemic Control, Type-1 Diabetes Mellitus, Complications, Insulin

169-LB: Type 1 Diabetes Mellitus and Stiff-Person Syndrome

Introduction: Type 1 diabetes mellitus (T1DM) is often associated with other autoimmune diseases. One of them is Stiff-Person Syndrome (SPS), a rare neurological disorder characterized by muscle spasms and progressive muscle stiffness, which most often affects females. Glutamic acid decarboxylase antibodies (anti-GAD) are associated with the pathogenesis of this disease as well as T1DM. These antibodies cause a deficit in the synthesis of γ-aminobutyric acid (GABA) that is essential both in the function as neurotransmitter and in the secretion of insulin in pancreatic β cells. Clinical case: We present the case of a 32-year-old female patient diagnosed with T1DM at 18 years old. Currently under intensive functional insulin therapy and flash glucose monitoring (FGM). Since 2019 with subcutaneous insulin infusion system. At the age of 26, the patient reports dystonia in the left lower limb with subsequent involvement of the contralateral lower limb, upper limbs, trunk and face. Collaboration was made with the Neurology department. Among the laboratory findings, of note: positive serum anti-GAD65 (5437 U/mL; &amp;lt;1) and positive cerebrospinal fluid anti-GAD65 (126.23 U /mL; &amp;lt;1). The diagnosis of SPS was made. The patient started human immunoglobulin therapy with progressive clinical improvement. Estimated HbA1c from FGM was 6,8 % at February, 2021. Discussion: The association between T1DM and SPS is frequent. In this case, a patient with a known history of T1DM was presented, but cases of diagnosis of T1DM in patients with SPS have also been described. About 43% of patients have T1DM at the time of diagnosis of SPS. Anti-GAD are involved in the pathophysiology of these two diseases and anti-GAD titers are much higher in cases of association with SPS (about 50 to 100 times). In the treatment of patients with T1DM, physicians should be alert to the onset of other autoimmune diseases and active surveillance is essential for early diagnosis. Disclosure C. A. Araújo: None. C. Baptista: None. I. Paiva: None. A. Morgadinho: None.

Epidemiologic Association between Inflammatory Bowel Diseases and Type 1 Diabetes Mellitus: a Meta-Analysis.

Patients with inflammatory bowel diseases (IBD) are at high risk of developing several autoimmune diseases. However, the epidemiological connection between IBD and type 1 diabetes mellitus (T1DM) remains controversial. This meta-analysis aimed to determine the association between the two diseases. A literature search was performed using Medline, Embase, and Central databases from inception to December 31, 2019. Studies evaluating the prevalence of T1DM in patients with IBD and controls were included. Statistical analysis was performed with a random effects model using the generic inverse variance method. After the literature research, five cross-sectional studies and one case-control study met the inclusion criteria. A total of 45,103 participants with Crohn's disease (CD) and 76,046 with ulcerative colitis (UC) were included. The pooled odds ratios (ORs) of T1DM were 1.16 (confidence interval [95% CI]: 0.87-1.55) in patients with CD and 1.20 (95% CI: 0.90-1.59) in patients with UC compared with the control groups. Significant heterogeneity was observed (CD: I 2 =70% and UC: I 2 =80%) in the complete analysis. Subgroup analysis stratified by study region was performed. Recalculated results indicated a positive association between CD and TD1M in Northern Europe with an OR of 1.65 (95% CI: 1.43-1.90; I 2 =0%). Patients with UC in Israel were at a higher risk of developing T1DM with an OR of 1.70 (95% CI: 1.38-2.09; I 2 =0%). The complete meta-analysis suggests no association between IBD and T1DM. However, the subgroup analysis indicated that patients with CD or UC from specific regions may be at a higher risk of developing T1DM than those without IBD.

Incidence of Type 1 diabetes mellitus and effect on mortality in young patients with congenital heart defect – A nationwide cohort study

Background1% of all live born children are born with a congenital heart defect (CHD) and currently 95% reach adulthood. Type 1 diabetes mellitus (T1DM) is an autoimmune disease that can develop due to i.e. heredity, exposure to infections and stress-strain. The incidence of T1DM in patients with CHD is unknown and we analysed the risk of developing T1DM for patients with CHD, and how this influences mortality. MethodsBy combining registries, the incidence of T1DM and the mortality was analysed in patients with CHD by birth cohort (1970–1993, 1970–1984 and 1984–1993) matched with population-based controls matched for sex, county and year of birth without CHD and followed from birth until a maximum of 42 years. Results221 patients with T1DM among 21,982 patients with CHD and 1553 patients with T1DM among 219,816 matched controls were identified. The hazard ratio (HR) for developing T1DM was 1.50 (95%, CI 1.31–1.73) in patients with CHD compared to the controls and the first birth cohort (1970–1984) had the highest risk for T1DM, HR 1.87 (95%, CI 1.56–2.24). After onset, mortality risk was 4.21 times higher (95%, CI 2.40–7.37) in patients with CHD and T1DM compared to controls with T1DM. ConclusionFrom a nationwide cohort of patients with CHD and controls, the incidence of developing T1DM was 50% higher in patients with CHD, showing a significant increase in risk among birth cohort 1970–1984. The combination of CHD and T1DM was associated with a 4-fold increase in mortality compared to controls with only T1DM.

Hyperglycemic hyperosmolar state in an adolescent with type 1 diabetes mellitus.

SummaryHyperglycemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) are the most severe acute complications of diabetes mellitus (DM). HHS is characterized by severe hyperglycemia and hyperosmolality without significant ketosis and acidosis. A 14-year-old Japanese boy presented at the emergency room with lethargy, polyuria and polydipsia. He belonged to a baseball club team and habitually drank sugar-rich beverages daily. Three weeks earlier, he suffered from lassitude and developed polyuria and polydipsia 1 week later. He had been drinking more sugar-rich isotonic sports drinks (approximately 1000–1500 mL/day) than usual (approximately 500 mL/day). He presented with HHS (hyperglycemia (1010 mg/dL, HbA1c 12.3%) and mild hyperosmolality (313 mOsm/kg)) without acidosis (pH 7.360), severe ketosis (589 μmol/L) and ketonuria. He presented HHS in type 1 diabetes mellitus (T1DM) with elevated glutamate decarboxylase antibody and islet antigen 2 antibody. Consuming beverages with high sugar concentrations caused hyperglycemia and further exacerbates thirst, resulting in further beverage consumption. Although he recovered from HHS following intensive transfusion and insulin treatment, he was significantly sensitive to insulin therapy. Even the appropriate amount of insulin may result in dramatically decreasing blood sugar levels in patients with T1DM. We should therefore suspect T1DM in patients with HHS but not those with obesity. Moreover, age, clinical history and body type are helpful for identifying T1DM and HHS. Specifically, drinking an excess of beverages rich in sugars represents a risk of HHS in juvenile/adolescent T1DM patients.Learning points:Hyperglycemic hyperosmolar state (HHS) is characterized by severe hyperglycemia and hyperosmolality without significant ketosis and acidosis.The discrimination between HHS of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in initial presentation is difficult.Pediatrician should suspect T1DM in patients with HHS but not obesity.Age, clinical history and body type are helpful for identifying T1DM and HHS.Children with T1DM are very sensitive to insulin treatment, and even appropriate amount of insulin may result in dramatically decreasing blood sugar levels.

Autoimmunity and intestinal colonization by Candida albicans in patients with type 1 diabetes at the time of the diagnosis

Purpose Type 1 diabetes mellitus (T1DM) is a chronic and immune-mediated disease, which is characterized by the progressive destruction of pancreatic beta cells. T1DM precipitates in genetically susceptible individuals through environmental factors. In this study, we aimed to evaluate the impact of autoimmunity and intestinal colonization of Candida albicans on the development of T1DM.Methods Forty-two patients newly diagnosed with T1DM and 42 healthy subjects were included in this monocentric study. The basic and clinical characteristics of the patients were recorded. T1DM-, thyroid-, and celiac-associated antibodies were evaluated. Stool cultures for C. albicans were performed to assess whether or not gut integrity was impaired in patients with T1DM.Results The evaluation of T1DM- and thyroid-associated antibodies showed that the prevalences of islet cell antibodies and antithyroperoxidase positivity were higher in the study patients than in the patients in the control group. Furthermore, the direct examination and culture of fresh stool samples revealed that 50% of the patients with T1DM and 23.8% of the control subjects had fungi (C. albicans).Conclusion Through this study, we suggest that the presence of intestinal C. albicans colonization at the time of the diagnosis of T1DM may indicate impairment of normal intestinal microbiota. We also suggest that there may be a tendency of T1DM in patients with a high prevalence of intestinal C. albicans.

Differences in incidence of diabetic retinopathy between type 1 and 2 diabetes mellitus: a nine-year follow-up study

Background/aimsTo determine the incidence of any diabetic retinopathy (any-DR), sight-threatening diabetic retinopathy (STDR) and diabetic macular oedema (DMO) and their risk factors in type 1 diabetes mellitus (T1DM) over a...

Trends in childhood type 1 diabetes mellitus incidence in Beijing from 1995 to 2010: a retrospective multicenter study based on hospitalization data.

The incidence of type 1 diabetes mellitus (T1DM) is increasing rapidly worldwide for children of every age group. A retrospective analysis of hospital registration data from five tertiary hospitals in Beijing, China, identified 485 patients (210 boys, 275 girls) younger than 15 years of age with newly diagnosed T1DM between 1995 and 2010. From 1995 to 2010, the incidence of T1DM in patients <15 years of age ranged from 0.935-3.26 per 100,000 per year. During this period, the average age-standardized incidence rate was 1.7 per 100,000 per year, and the average annual increase in T1DM incidence was 4.36%. The highest rate increases occurred in boys and in patients <5 years of age. For both genders and all age groups, T1DM incidence increased at an accelerated rate after 2006. By 2020, the incidence of T1DM among children in Beijing is projected to increase by a factor of 1.69. The incidence of T1DM among patients younger than 15 years of age in Beijing increased from 1995 to 2010, with rates growing at an accelerated pace since 2006. Based on recent trends, we project continued rapid growth in the number of new childhood T1DM cases in Beijing.

Type 1 diabetes patients born to immigrants to Sweden increase their native diabetes risk and differ from Swedish patients in HLA types and islet autoantibodies

To determine whether type 1 diabetes mellitus (T1DM) patients, having parents who immigrated to Sweden, have increased T1DM risk before 18 yr compared with countries of origin. We also determined whether they have different human leukocyte antigen (HLA) genetic markers and islet autoantibodies at diagnosis compared with Swedish patients. A total of 1988 (53% males) newly diagnosed and confirmed T1DM patients <18 yr registered within the Better Diabetes Diagnosis (BDD) study (May 2005 to September 2008) were included. Participants were classified into three groups: Swedish, non-Swedish, and Mixed-origin patients according to country of origin of two generations (parents and grandparents). These groups were compared with respect to T1DM HLA markers and islet autoantibodies [glutamic acid decarboxylase autoantibodies (GAD65Ab), insulin autoantibodies (IAA), and islet antigen-2 autoantibodies (IA-2Ab)]. Only 30 (1.5%) patients were born outside Sweden. Swedish patients constituted 66%, non-Swedish patients 8%, Mixed origins 17%, and 9% were of uncertain origin. Confirmed T1DM in patients within the study was 22 (95% CI: 21-23) patients/10(5)/yr rate for Swedish patients compared with 14 (95% CI: 13-15) among non-Swedish patients. The HLA-DQ8 haplotype (p < 0.0001) and DQ2/8 genotype (p < 0.02) predominated among Swedish compared with non-Swedish patients. In contrast, DQ2 was the most frequent haplotype among non-Swedish patients [OR = 1.5 (95% CI: 1.0-2.0), p < 0.04]. Multiple (≥2) autoantibodies (p < 0.04) and specifically IA-2Ab (p < 0.001) were most prevalent among the Swedish patients. Multiple autoantibodies were associated with DQ8 among the Swedish patients only (p < 0.001). Patients born to parents who had immigrated to the high T1DM incidence environment of Sweden have, compared with Swedish patients, more frequent HLA-DQ2 genetic markers and are diagnosed more often with GAD65Ab.

Care of the Pediatric Cardiac Surgery Patient—Part 1

1% of all live born children are born with a congenital heart defect (CHD) and currently 95% reach adulthood. Type 1 diabetes mellitus (T1DM) is an autoimmune disease that can develop due to i.e. heredity, exposure to infections and stress-strain. The incidence of T1DM in patients with CHD is unknown and we analysed the risk of developing T1DM for patients with CHD, and how this influences mortality.By combining registries, the incidence of T1DM and the mortality was analysed in patients with CHD by birth cohort (1970–1993, 1970–1984 and 1984–1993) matched with population-based controls matched for sex, county and year of birth without CHD and followed from birth until a maximum of 42 years.221 patients with T1DM among 21,982 patients with CHD and 1553 patients with T1DM among 219,816 matched controls were identified. The hazard ratio (HR) for developing T1DM was 1.50 (95%, CI 1.31–1.73) in patients with CHD compared to the controls and the first birth cohort (1970–1984) had the highest risk for T1DM, HR 1.87 (95%, CI 1.56–2.24). After onset, mortality risk was 4.21 times higher (95%, CI 2.40–7.37) in patients with CHD and T1DM compared to controls with T1DM.From a nationwide cohort of patients with CHD and controls, the incidence of developing T1DM was 50% higher in patients with CHD, showing a significant increase in risk among birth cohort 1970–1984. The combination of CHD and T1DM was associated with a 4-fold increase in mortality compared to controls with only T1DM.

Clustering of cases of type 1 diabetes mellitus occurring 2-4 years after vaccination is consistent with clustering after infections and progression to type 1 diabetes mellitus in autoantibody positive individuals.

We previously analyzed data from a hemophilus vaccine trial and identified clusters of extra cases of type 1 diabetes mellitus (T1DM) caused by the vaccine that occurred between 36 and 48 months after immunization. Published reports indicate clustering of cases of T1DM occurring approximately 2-4 years after mumps infection. Others have reported a 2-4 year delay between the onset of autoantibodies and the development of T1DM. We attempted to determine whether similar clustering of cases of T1DM occurred after immunization with vaccines other than hemophilus. We searched MEDLINE and reviewed references from published papers to find databases on the incidence of T1DM and then searched MEDLINE to determine whether changes in immunization occurred in these regions during the times the incidence of DM was being recorded. Distinct rises in the incidence of T1DM occurred 2-4 years following the introduction of the MMR and pertussis vaccines. A drop in the incidence of T1DM was detected between 3-4 years following discontinuation of pertussis and BCG vaccines. The identification of clusters of cases of T1DM occurring in consistent temporal time periods allowed a link between the hemophilus vaccine and T1DM to be established. The current findings indicate the there are also clusters of cases of T1DM occurring 2-4 years post-immunization with the pertussis, MMR, and BCG vaccine. The data are consistent with the occurrence of clusters following mumps infection and the progression to T1DM in patients with antipancreatic autoantibodies.