Diabetes mellitus in Adults - Aspects of Incidence, Autoimmunity and C-peptide

Type 1 and type 2 diabetes increase worldwide, leading to a heavy burden of disease and its complications. All 1666 adults aged 18-100 years with new onset diabetes in Kronoberg during 3 years were registered, and type of diabetes classified by pancreatic autoantibodies and C-peptide. Annual incidences of both type 1 and type 2 diabetes were higher than previously described (27.1/100 000 and 378/100 000). Type 1 incidence was bimodal with peaks in 0-19 and 50-80 years. Patients with latent auto-immune diabetes (LADA) were treated either with insulin or conventionally (diet ± oral hypoglycaemic agents). Beta cell function (glucagon-stimulated Cpeptide)and metabolic control (HbA1c) were followed for 36 months. LADA patients treated with insulin did not demonstrate better preservation of beta cell function but had a better metabolic control compared to those on conventional treatment. Adult type 1 patients with long duration (n=40)were examined for pancreatic antibodies, residual C-peptide, and other autoantibodies and complications, with focus on complications from the connective tissues. After 20-30 years duration of diabetes, 20% of type 1 patients had detectable pancreatic autoantibodies, 23% had still detectable C-peptide. Complications from the connective tissues were as common as retinopathy and increased with duration

β-cell function and metabolic control in latent autoimmune diabetes in adults with early insulin versus conventional treatment: a 3-year follow-up

Objectives: The optimal treatment of latent autoimmune diabetes in adults (LADA) is not established. We explored whether early insulin treatment, which has shown beneficial effects in rodents and in human pilot studies, would result in better preservation of beta-cell function or metabolic control, compared with conventional treatment. Subjects and methods: Glucagon-stimulated C-peptide and HbAlc were evaluated at baseline and after 12, 24 and 36 months in 37 patients recently diagnosed with diabetes, aged >= 30 years, non-insulin-requiring and GADAb and/or ICA positive. Twenty patients received early insulin and 17 received conventional treatment (diet +/- oral hypoglycaemic agents (OHA), metformin, some and/or sulfonylurea) and insulin when necessary. Results: Level of metabolic control, HbAlc, was preserved in the early insulin treated, while it significantly deteriorated in the conventionally treated. There was no significant difference between the groups in C-peptide after 12, 24 or 36 months, or in the decline of C-peptide. Only baseline C-peptide predicted a C-peptide of >= 0.5 nmol/l at 36 months. Gender, body mass index, antibody titres or HbAlc did not influence the levels of C-peptide or HbAlc at baseline or end-of-study, or the decline in C-peptide. Among the diet +/- OHA-treated, 5/17 (30%) developed insulin dependency during the follow-up. No major hypoglycaemic events occurred. Conclusions: Early insulin treatment in LADA leads to better preservation of metabolic control and was safe. Superior preservation of C-peptide could not be significantly demonstrated. Only baseline level of C-peptide significantly influenced C-peptide level after 3 years. Further studies exploring the best treatment in LADA are warranted. European Journal of Endocrinology 164 239-24

Levels of C-peptide, body mass index and age, and their usefulness in classification of diabetes in relation to autoimmunity, in adults with newly diagnosed diabetes in Kronoberg, Sweden

Objective: C-peptide is a main outcome measure in treatment trials of diabetes. C-peptide also has a role in the classification of diabetes, which is often difficult in adults and this is also increasingly recognised in adolescents and elders. Aim: We aimed to describe the levels of C-peptide in relation to age and body mass index (BMI) in a large population-based cohort of adults with newly diagnosed diabetes and compare the capabilities of C-peptide, age and BMI to discriminate between autoimmune and non-autoimmune diabetes. Subjects and methods: Blood samples from 1180 patients were analysed regarding islet cell antibody, glutamic acid decarboxylase antibody and fasting C-peptide (FCP). Receiver operating characteristics (ROC) curves were analysed to check the ability of age, BMI and C-peptide to discriminate between autoantibody-positive (Ab(+)) and -negative (Ab(-)) diabetes. Results: Mean FCP was 0.73 +/- 0.5 (range 0.13-1.80) nmol/l in the Ab(+) and 1.42 +/- 0.9 (range 0.13-8.30) nmol/l in the Ab(-). FCP was 0.02 nmol/l higher per year increase in age at diagnosis of diabetes. Mean BMI was 26.0 +/- 4.8 (range 18.0-39.0) kg/m(2) in the Ab(+) and 28.9 +/- 5.3 (range 15.5-62.6) kg/m(2) in the Ab(-). FCP increased with age also within each BMI group. The highest area under the curve (AUC) in the ROC analysis was found for C-peptide, followed by age and BMI (0.78, 0.68 and 0.66 respectively). Conclusions: At diagnosis of diabetes, C-peptide was superior to age and BMI in discriminating between autoimmune and non-autoimmune diabetes. C-peptide increased significantly with BMI and age, latter also within each BMI group. Most of the adults had normal or high levels of C-peptide at presentation of diabetes among the autoimmune patients

Students´ breakfast habits : A survey of 5th graders´ breakfast habits

Bakgrund Av många anses frukosten vara den viktigaste måltiden under dagen. Med en energi- och näringsrik frukost får eleverna bättre förutsättningar till att öka koncentrationen och prestationen i skolan. Syfte Syftet med studien var att undersöka barn i årskurs 5 och deras frukostvanor, om det var skillnad mellan de som hade undervisning i hem- och konsumentkunskap (HKK) och de som inte haft HKK, om det var någon skillnad mellan flickor och pojkar, vilka livsmedel eleverna valde att äta till frukost och hur de kände när de åt respektive inte åt frukost. Metod Studien genomfördes i form av en pappersenkät med fem frågor på två olika skolor i Sverige under våren 2020. Urvalet var ett bekvämlighetsval. Enkätsvaren lades in i Google Sheets och Excel och analyserades med hjälp av Chi-två-test och analystabeller. Resultat I studien deltog 183 respondenter. Studien visade att 73% av eleverna åt frukost varje dag och att det var 1 % som aldrig åt frukost. Det var ingen skillnad i frukostfrekvens mellan flickor och pojkar. Det var fler som åt frukost varje dag av de som hade haft HKK jämfört med de som inte hade haft HKK. Vanligaste livsmedlet till frukost var mjukt bröd. Vanligaste känsloordet när respondenterna åt frukost var att de kände sig glad medan det vanligaste ordet när de inte åt frukost var att de kände sig hungrig. Slutsats Det var fler som åt frukost dagligen av elever som hade fått undervisning i HKK. HKK är ett viktigt ämne som behöver få mer undervisningstid och då framförallt med de yngre eleverna för att tidigt ge dem kunskap om en bra kosthållning, så att de utifrån det kan göra val som är välgrundade.Background Breakfast is often considered to be the most important meal of the day. A nutritious energy boosting breakfast provides a better basis for students’ academic performance and concentration. Objective The purpose of this study was to examine the breakfast habits of 5th grade students: if there was any difference between students who had been taught home economics and those that had not, if there was any difference between boys and girls, what they ate, and how students felt if they ate breakfast or not. Method This study was based on a paper survey consisting of five questions which was distributed during spring of 2020 to two schools in different regions of Sweden. The survey was administered as a convenience sample. Survey results were entered in Google Sheets and Excel and analyzed with Chi-squared tests and coded to analysis tables. Results The total number of participants was 183 students. Results from the study showed that 73 % of students ate breakfast daily and that 1 % never ate breakfast. There was no difference between the proportion of boys and girls that ate breakfast. Students who had studied home economics ate breakfast more frequently than those that had not. The most common breakfast food was bread. The most common word used by respondents to describe how they felt when they ate breakfast was the word “happy”. The word most frequently used to describe how they felt when they did not eat breakfast was “hungry”. Conclusion Students who had studied home economics ate breakfast daily more frequently than students that had not. Home economics is a crucial subject in which more teaching is needed primarily for younger students, so that they can learn the importance of healthy eating habits early on and make well-grounded choices

Students´ breakfast habits : A survey of 5th graders´ breakfast habits

Bakgrund Av många anses frukosten vara den viktigaste måltiden under dagen. Med en energi- och näringsrik frukost får eleverna bättre förutsättningar till att öka koncentrationen och prestationen i skolan. Syfte Syftet med studien var att undersöka barn i årskurs 5 och deras frukostvanor, om det var skillnad mellan de som hade undervisning i hem- och konsumentkunskap (HKK) och de som inte haft HKK, om det var någon skillnad mellan flickor och pojkar, vilka livsmedel eleverna valde att äta till frukost och hur de kände när de åt respektive inte åt frukost. Metod Studien genomfördes i form av en pappersenkät med fem frågor på två olika skolor i Sverige under våren 2020. Urvalet var ett bekvämlighetsval. Enkätsvaren lades in i Google Sheets och Excel och analyserades med hjälp av Chi-två-test och analystabeller. Resultat I studien deltog 183 respondenter. Studien visade att 73% av eleverna åt frukost varje dag och att det var 1 % som aldrig åt frukost. Det var ingen skillnad i frukostfrekvens mellan flickor och pojkar. Det var fler som åt frukost varje dag av de som hade haft HKK jämfört med de som inte hade haft HKK. Vanligaste livsmedlet till frukost var mjukt bröd. Vanligaste känsloordet när respondenterna åt frukost var att de kände sig glad medan det vanligaste ordet när de inte åt frukost var att de kände sig hungrig. Slutsats Det var fler som åt frukost dagligen av elever som hade fått undervisning i HKK. HKK är ett viktigt ämne som behöver få mer undervisningstid och då framförallt med de yngre eleverna för att tidigt ge dem kunskap om en bra kosthållning, så att de utifrån det kan göra val som är välgrundade.Background Breakfast is often considered to be the most important meal of the day. A nutritious energy boosting breakfast provides a better basis for students’ academic performance and concentration. Objective The purpose of this study was to examine the breakfast habits of 5th grade students: if there was any difference between students who had been taught home economics and those that had not, if there was any difference between boys and girls, what they ate, and how students felt if they ate breakfast or not. Method This study was based on a paper survey consisting of five questions which was distributed during spring of 2020 to two schools in different regions of Sweden. The survey was administered as a convenience sample. Survey results were entered in Google Sheets and Excel and analyzed with Chi-squared tests and coded to analysis tables. Results The total number of participants was 183 students. Results from the study showed that 73 % of students ate breakfast daily and that 1 % never ate breakfast. There was no difference between the proportion of boys and girls that ate breakfast. Students who had studied home economics ate breakfast more frequently than those that had not. The most common breakfast food was bread. The most common word used by respondents to describe how they felt when they ate breakfast was the word “happy”. The word most frequently used to describe how they felt when they did not eat breakfast was “hungry”. Conclusion Students who had studied home economics ate breakfast daily more frequently than students that had not. Home economics is a crucial subject in which more teaching is needed primarily for younger students, so that they can learn the importance of healthy eating habits early on and make well-grounded choices

Students´ breakfast habits : A survey of 5th graders´ breakfast habits

Bakgrund Av många anses frukosten vara den viktigaste måltiden under dagen. Med en energi- och näringsrik frukost får eleverna bättre förutsättningar till att öka koncentrationen och prestationen i skolan. Syfte Syftet med studien var att undersöka barn i årskurs 5 och deras frukostvanor, om det var skillnad mellan de som hade undervisning i hem- och konsumentkunskap (HKK) och de som inte haft HKK, om det var någon skillnad mellan flickor och pojkar, vilka livsmedel eleverna valde att äta till frukost och hur de kände när de åt respektive inte åt frukost. Metod Studien genomfördes i form av en pappersenkät med fem frågor på två olika skolor i Sverige under våren 2020. Urvalet var ett bekvämlighetsval. Enkätsvaren lades in i Google Sheets och Excel och analyserades med hjälp av Chi-två-test och analystabeller. Resultat I studien deltog 183 respondenter. Studien visade att 73% av eleverna åt frukost varje dag och att det var 1 % som aldrig åt frukost. Det var ingen skillnad i frukostfrekvens mellan flickor och pojkar. Det var fler som åt frukost varje dag av de som hade haft HKK jämfört med de som inte hade haft HKK. Vanligaste livsmedlet till frukost var mjukt bröd. Vanligaste känsloordet när respondenterna åt frukost var att de kände sig glad medan det vanligaste ordet när de inte åt frukost var att de kände sig hungrig. Slutsats Det var fler som åt frukost dagligen av elever som hade fått undervisning i HKK. HKK är ett viktigt ämne som behöver få mer undervisningstid och då framförallt med de yngre eleverna för att tidigt ge dem kunskap om en bra kosthållning, så att de utifrån det kan göra val som är välgrundade.Background Breakfast is often considered to be the most important meal of the day. A nutritious energy boosting breakfast provides a better basis for students’ academic performance and concentration. Objective The purpose of this study was to examine the breakfast habits of 5th grade students: if there was any difference between students who had been taught home economics and those that had not, if there was any difference between boys and girls, what they ate, and how students felt if they ate breakfast or not. Method This study was based on a paper survey consisting of five questions which was distributed during spring of 2020 to two schools in different regions of Sweden. The survey was administered as a convenience sample. Survey results were entered in Google Sheets and Excel and analyzed with Chi-squared tests and coded to analysis tables. Results The total number of participants was 183 students. Results from the study showed that 73 % of students ate breakfast daily and that 1 % never ate breakfast. There was no difference between the proportion of boys and girls that ate breakfast. Students who had studied home economics ate breakfast more frequently than those that had not. The most common breakfast food was bread. The most common word used by respondents to describe how they felt when they ate breakfast was the word “happy”. The word most frequently used to describe how they felt when they did not eat breakfast was “hungry”. Conclusion Students who had studied home economics ate breakfast daily more frequently than students that had not. Home economics is a crucial subject in which more teaching is needed primarily for younger students, so that they can learn the importance of healthy eating habits early on and make well-grounded choices

Obstetric and perinatal outcomes in pregnancies complicated by diabetes, and control pregnancies, in Kronoberg, Sweden

Background: Diabetes during pregnancy is an increasingly common metabolic disorder, associated with significantly increased risks for both mother and child. Aim of this study was to compare maternal and perinatal outcomes in women with pregestational (PDM) type 1 (T1DM), type 2 diabetes (T2DM), gestational diabetes mellitus (GDM) and compare these to pregnancies not complicated with diabetes. This study also evaluated a specifically organized care-model mostly involving specialist diabetes nurses. Methods: Retrospective population-based records review 2009-2012. Rates of maternal (preeclampsia, pre-term delivery, cesarean section (CS)) and fetal outcomes (large for gestational age (LGA), macrosomia, congenital malformations/intrauterine death) were assessed and potential predisposing or contributing factors as maternal age, ethnicity, obesity, weight gain, parity, HbA1c levels, insulin types and doses. Results: Among 280 pregnancies 48 were PDM, 97 GDM and 135 without diabetes. Within the group with diabetes, early-pregnancy BMI was higher (p = 0.0001), pregnancy weight gain lower (11.1 ± 6.7 kg vs 13.1 ± 7.1 kg, p = 0.005), more delivered preterm (p = 0.0001), by CS (p = 0.05), and had more LGA neonates (p = 0.06) than the group without diabetes. Among pregnancies with diabetes, GDM mothers gained less weight (9.9 kg vs 13.5 kg) (p = 0.006), and rates of CS (p = 0.03), preterm deliveries (p = 0.001) and LGA (p = 0.0001) were not increased compared to PDM; More T1DM infants were LGA, 60% vs. 27% in T2DM. In pregnancies with diabetes obesity, excessive weight gain and multiparity were associated with increased risk of LGA neonates, and mother's type of diabetes and gestational week were associated with higher rates of CS. Conclusion: Weight gain during pregnancy was lower in pregnancies with diabetes and prevalence of LGA, CS and preterm deliveries in GDM was not elevated, also for T2DM, except increased prevalence of LGA in T1DM that warrants increased clinical attention, indicating that this model of antenatal diabetes care may have contributed to improved maternal and fetal outcomes

Soluble CD163 was linked to galectin-3, diabetic retinopathy and antidepressants in type 1 diabetes

OBJECTIVE: Depression has been associated with diabetic retinopathy and increased plasma levels of galectin-3, a lectin expressed in activated macrophages. Increased levels of sCD163, the soluble form of a macrophage expressed scavenger receptor involved in several inflammatory processes, have been demonstrated in the vitreous of the eye in type 1 diabetes (T1D) patients with severe diabetic retinopathy. The aim was to explore whether circulating sCD163 was associated with diabetic retinopathy, depression, and/or galectin-3 in T1D patients, controlling for gender, metabolic factors, other diabetes complications, life style, and medication.DESIGN: Cross sectional.METHODS: Two hundred and eighty-seven T1D patients, men 56%, age 18-59 years, diabetes duration ≥1 year, were consecutively recruited from one specialist diabetes clinic. Depression was assessed by Hospital Anxiety and Depression Scale-depression subscale. Blood samples, anthropometrics and blood pressure were collected, supplemented with data from electronic medical records and the Swedish National Diabetes Registry. High plasma sCD163 was defined as ≥ 0.575 mg/l (corresponding to the 80th percentile) and high plasma galectin-3 as ≥4.659 µg/l (corresponding to the 95th percentile).RESULTS: The prevalence of depression was 10%, antidepressant medication 8%, diabetic retinopathy 72%, high sCD163 20%, and high galectin-3 5%. High galectin-3 (AOR 9.7), antidepressants (AOR 3.8), diabetic retinopathy (AOR 2.4), and systolic blood pressure (per mm Hg) (AOR 1.03) were associated with high sCD163.CONCLUSIONS: This is the first study to show that circulating sCD163 was independently associated with galectin-3, the use of antidepressants, and diabetic retinopathy, in patients with T1D. Depression was not associated with sCD163

Depression in type 1 diabetes was associated with high levels of circulating galectin-3

Objective: Neuroinflammatory responses are implicated in depression. The aim was to explore whether depression in patients with type 1 diabetes (T1D) was associated with high circulating galectin-3, controlling for metabolic variables, s-creatinine, life style factors, medication, and cardiovascular complications.Design: Cross-sectional.Methods: Participants were T1D patients (n=283, 56% men, age 18-59 years, diabetes duration ≥1 year). Depression was assessed by Hospital Anxiety and Depression Scale-depression subscale. Blood samples, anthropometrics and blood pressure were collected, supplemented with data from medical records and the Swedish National Diabetes Registry. Galectin-3 ≥2.562 µg/l, corresponding to the 85th percentile, was defined as high galectin-3.Results: Median (quartile1, quartile3) galectin-3 (µg/l) was 1.3 (0.8, 2.9) for the 30 depressed patients, and 0.9 (0.5, 1.6) for the 253 non-depressed, P = 0.009. Depression was associated with high galectin-3 in all the 283 patients (Adjusted odds ratio (AOR) 3.5), in the 161 men (AOR 3.4), and in the 122 women (AOR 3.9). HbA1c, s-lipids, s-creatinine, blood pressure, obesity, smoking, physical inactivity, cardiovascular complications, and drugs (antihypertensive, lipid lowering, oral antidiabetic drugs, and antidepressants) were not associated with high galectin-3.Conclusions: This is the first study to show an association between depression and galectin-3. Depression was the only explored parameter associated with high circulating galectin-3 levels in 283 T1D patients. High galectin-3 levels might contribute to the increased risk for Alzheimer's disease, cardiovascular and all-cause mortality observed in persons with depression. Potentially, in the future, treatment targeting galactin-3 might improve the prognosis for patients with high galectin-3 levels

Admission glucose level was associated with increased short-term mortality and length-of-stay irrespective of diagnosis, treating medical specialty or concomitant laboratory values

Background: Glucose is a routine emergency sample. General guidelines for inpatient hyperglycemia are scarce, except in myocardial infarction, stroke, and perioperative/ICU. Previous studies found admission glucose associated with increased mortality in specific conditions. Scandinavian data, and for general patients, are scarcer. We investigated admission glucose levels, 30-day mortality, and length-of-stay (LoS), in a Swedish hospital. Methods: From 8146 emergency visits data regarding age, gender, dates of admission, discharge and death, diagnoses, admission p-glucose, s-sodium, s-potassium, b-hemoglobin, b-WBC and s-CRP, was collected, and for 6283 information regarding diagnosis of diabetes the previous 5 years. Visits were grouped in hypoglycemia (≤4.0), normoglycemia (>4.0–≤7.0), modest (>7.0–≤11.1) and severe hyperglycemia (>11.1) mmol/l. Results: Short-term mortality was 1.5% in the normoglycemic, 2.6% in the hypoglycemic, 4.0–4.5% in modest and severe hyperglycemia, p < 0.001; Cox proportional hazard ratios (HR) for groups of patients without/with diabetes were 6.8; 1; 3.4; 4.4/7.3; 3.9; 4.0; 2.1 compared to the normoglycemic without diabetes (p 0.0001–0.05); adjusted for age, and concurrent levels of sodium, potassium, Hb, WBC and CRP 1.51 (1.07–2.1, p 0.02) with modest hyperglycemia, and 1.08 (0.60–1.95, p 0.80) in severe hyperglycemia. Mean LoS was 1.2 and 1.7 days longer with modest and severe hyperglycemia. Conclusions: Short-term mortality increased substantially with admission hypo- and hyperglycemia for patients both with and without diabetes, irrespective of treating medical specialty, main discharge diagnosis, or concurrent laboratory values. Patients with diabetes (16%) were older, with higher glucose levels at admission, and with a different pattern of the association of admission glucose and mortality