8 research outputs found
Marked intrafamilial variability of exocrine and endocrine pancreatic phenotypes due to a splice site mutation in GATA6
The objective of this study was to describe the clinical characteristics of syndromic neonatal
diabetes in a family with a GATA6 mutation. A girl, currently aged 12 years 3 months, was born with
intrauterine growth retardation: weight 1600 g (–4.3 SDS) at term. After birth, foramen ovale and
patent ductus arteriosus (PDA) were diagnosed by echocardiography. Diabetes was diagnosed on
the 9th day after birth. Exocrine pancreatic insufficiency was clinically diagnosed at about 2 years
of age and pancreatic agenesis was revealed later by magnetic resonance imaging. Her father had
undergone surgery during infancy for PDA and had developed insulin dependent diabetes at
12 years of age. Ultrasound revealed a thin pancreas with normal length and anatomical structure.
He has subclinical exocrine pancreatic insufficiency, low insulin needs and no late complications of
diabetes up to the age of 40 years. Sequencing of GATA6 identified a heterozygous splicing
mutation, 1136-2A>G, in the girl and her father. Testing of the paternal grandparents showed that
the mutation was likely to have arisen de novo in the father. Identification of a GATA6 mutation
explains the cardiac anomalies and diabetes in this family. This case highlights the marked intrafamilial
variability of both exocrine and endocrine pancreatic phenotypes in patients with GATA6
mutations.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site
Glycaemic control among Bulgarian children and adolescents with type 1 diabetes – an impact of the social status and the educational level of the parents
Achievement of optimal glycaemic control in children and adolescents with type 1 diabetes depends on the knowledge of the patients and their parents about the control of the disease and the family support. The aim of this study was to investigate the importance of the social standard of the families determined by the employment of the parents and their educational qualification on the control of diabetes. Two consecutive national multi-centre cross-sectional studies of patients with type 1 diabetes, aged 0–19 years, for HbA1c were conducted in 2012 and in 2014. The first study included 829 patients (422 boys, 407 girls), and the second - 498 patients; 281 patients participated in both studies. The patients whose parents are with primary education showed the highest level of HbA1c in both studies: 9.73% ± 2.38% and 9.27% ± 1.54% in the first, and the second study, respectively. The patients whose parents have university education achieved the best control: HbA1c is 8.45% ± 1.76% and 7.84% ± 1.24%, respectively. The cohorts of diabetic patients whose parents have secondary (p = 0.035) and university education (p < 0.001) showed significant reduction of HbA1c in the second study compared to the first one. The patients in families with unemployed parents or families in which only the mother is employed showed the highest levels of HbA1c. Our results underline the importance of the educational qualification and the social standard of the family for the proper control of this chronic disease
Glycemic control in type 1 diabetes mellitus among Bulgarian children and adolescents: the results from the first and the second national examination of HbA1c
The standardized hemoglobin A1c (HbA1c) test is an essential tool to evaluate the glycaemic control and the diabetes care. The aim of our study was to evaluate and compare the actual HbA1c level in a cohort of Bulgarian patients with type 1 diabetes aged 0–19 years in two consecutive national studies, in 2012 and 2014. We used a standardized method for HbA1c high performance liquid chromatography (HPLC). Тhe survey was conducted in 11 paediatric endocrinology practices in Bulgaria. Overall 829 patients with type 1 diabetes participated in the first study, 422 boys and 407 girls, aged 11.9 ± 4.2 years. The second study included 498 patients: 261 boys and 237 girls, aged 11.6 ± 4.1 years. The mean HbA1c level for the patients studied in 2014 (8.42 ± 1.69%) was significantly lower compared to that in the patients studied in 2012 (8.93 ± 1.98%, p < 0.001). Significantly more patients in the second study (36%) showed optimal control with HbA1c < 7.5% (p < 0.05) compared to those from the first one (24.9%). Teenagers in both studies had higher HbA1c levels compared to the other age groups: 9.19 ± 2.11% in 2012 and 8.8 ± 1.87% in 2014. We found significant differences in the HbA1c levels between the different centres in Bulgaria (from 7.92% to 9.95% in 2012 and from 7.42% to 9.13% in 2014). All age groups, except the teenagers showed improvement in the glycemic control in the second study as a result of continuous and structured education of the patients and their families
Glycemic control in type 1 diabetes mellitus among Bulgarian children and adolescents: the results from the first and the second national examination of HbA 1c
Glycaemic control among Bulgarian children and adolescents with type 1 diabetes – an impact of the social status and the educational level of the parents
Possibilities and challenges of a large international benchmarking in pediatric diabetology—The SWEET experience
Possibilities and challenges of a large international benchmarking in pediatric diabetology-The SWEET experience
Aim: Despite the existence of evidence-based guidelines for the care of
children with diabetes, widespread gaps in knowledge, attitude, and
practice remain. The purpose of this paper is to present a review of
benchmarking practices and results of this process within SWEET,
moreover focusing on current challenges and future directions.
Methods: Biannually, members electronically transfer de-identified
clinic data for 37 parameters to the SWEET database. Each center
receives benchmarking and data validation reports.
Results: In 2015, 48 centers have contributed data for 20 165 unique
patients (51.6% male). After exclusion for missing data 19 131 patients
remain for further analysis. The median age is 14.2 years, with a median
diabetes duration 4.8 years; 96.0% of patients have type 1, 1.1% type
2, and 2.9% other diabetes types. Data completeness has increased over
time. In 2015, median HbA1c of all patients’ (diabetes type 1) medians
was 7.8% (61.7 mmol/mol) with 39.1%, 41.4%, and 19.4% of patients
having HbA1c < 7.5% (58 mmol/mol), 7.5%-9% (58-75 mmol/mol) and >9%
(75 mmol/mol), respectively. Although HbA1c has been stable over time
[7.7%-7.8% (60.7-61.7 mmol/mol)], there remains wide variation
between centers. Fourteen centers achieve a median HbA1c < 7.5% (58
mmol/mol).
Conclusions: Our vision is that the participation in SWEET is
encouraging members to deliver increasingly accurate and complete data.
Dissemination of results and prospective projects serve as further
motivation to improve data reporting. Comparing processes and outcomes
will help members identify weaknesses and introduce innovative
solutions, resulting in improved and more uniform care for patients with
diabetes