A Multicenter Screening Study

Background In cystic fibrosis, highly variable glucose tolerance is suspected. However, no study provided within-patient coefficients of variation. The main objective of this short report was to evaluate within-patient variability of oral glucose tolerance. Methods In total, 4,643 standardized oral glucose tolerance tests of 1,128 cystic fibrosis patients (median age at first test: 15.5 [11.5; 21.5] years, 48.8% females) were studied. Patients included were clinically stable, non-pregnant, and had at least two oral glucose tolerance tests, with no prior lung transplantation or systemic steroid therapy. Transition frequency from any one test to the subsequent test was analyzed and within-patient coefficients of variation were calculated for fasting and two hour blood glucose values. All statistical analysis was implemented with SAS 9.4. Results A diabetic glucose tolerance was confirmed in 41.2% by the subsequent test. A regression to normal glucose tolerance at the subsequent test was observed in 21.7% and to impaired fasting glucose, impaired glucose tolerance or both in 15.2%, 12.0% or 9.9%. The average within-patient coefficient of variation for fasting blood glucose was 11.1% and for two hour blood glucose 25.3%. Conclusion In the cystic fibrosis patients studied, a highly variable glucose tolerance was observed. Compared to the general population, variability of two hour blood glucose was 1.5 to 1.8-fold higher

Symptoms of Eating Disorders and Depression in Emerging Adults with Early-Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control

BACKGROUND: This study analyzed the prevalence of and association between symptoms of eating disorders and depression in female and male emerging adults with early-onset, long-duration type 1 diabetes and investigated how these symptoms are associated with metabolic control. METHODS: In a nationwide population-based survey, 211 type 1 diabetes patients aged 18-21 years completed standardized questionnaires, including the SCOFF questionnaire for eating disorder symptoms and the Patient Health Questionnaire (PHQ-9) for symptoms of depression and severity of depressive symptoms (PHQ-9 score). Multiple linear and logistic regression models were used to analyze the association between eating disorder and depressive symptoms and their associations with HbA1c. RESULTS: A total of 30.2% of the women and 9.5% of the men were screening positive for eating disorders. The mean PHQ-9 score (standard deviation) was 5.3 (4.4) among women and 3.9 (3.6) among men. Screening positive for an eating disorder was associated with more severe depressive symptoms among women (βwomen 3.8, p<0.001). However, neither eating disorder symptoms nor severity of depressive symptoms were associated with HbA1c among women, while HbA1c increased with the severity of depressive symptoms among men (βmen 0.14, p=0.006). CONCLUSIONS: Because of the high prevalence of eating disorder and depressive symptoms, their interrelationship, and their associations with metabolic control, particularly among men, regular mental health screening is recommended for young adults with type 1 diabetes

Carbohydrate intake and insulin requirement in children, adolescents and young adults with cystic fibrosis-related diabetes: A multicenter comparison to type 1 diabetes

Background & aims: In cystic fibrosis-related diabetes (CFRD), energy needs differ from type 1 (T1D) or type 2 diabetes, and endogenous insulin secretion is not totally absent. We analyzed whether daily carbohydrate intake, its diurnal distribution and insulin requirement per 11 g of carbohydrate differ between CFRD and T1D. Methods: Anonymized data of 223 CFRD and 36,780 T1D patients aged from 10 to <30 years from the multicenter diabetes registry DPV were studied. Carbohydrate intake and insulin requirement were analyzed using multivariable regression modeling with adjustment for age and sex. Moreover, carbohydrate intake was compared to the respective recommendations (CFRD: energy intake 130% of general population with 45% carbohydrates; T1D: carbohydrate intake 50% of total energy). Results: After demographic adjustment, carbohydrate intake (238 +/- 4 vs. 191 +/- 1 g/d, p < 0.001) and meal-related insulin (0.52 +/- 0.02 vs. 0.47 +/- 0.004 IU/kg*d, p = 0.001) were higher in CFRD, whereas basal insulin (0.27 +/- 0.01 vs. 0.38 +/- 0.004 IU/kg*d, p < 0.001) and total insulin requirement per 11 g of carbohydrate (1.15 +/- 0.06 vs. 1.70 +/- 0.01 IU/d, p < 0.001) were lower compared to T1D. CFRD patients achieved 62% [Q(1);Q(3): 47; 77] of recommended carbohydrate intake and T1D patients 60% [51; 71] of age- and gender-specific recommended intake (p < 0.001). CFRD and T1D patients had a carbohydrate intake below healthy peers (79% [58; 100] and 62% [52; 74], p < 0.001). The circadian rhythm of insulin sensitivity persisted in CFRD and the diurnal distribution of carbohydrates was comparable between groups. Conclusions: In pediatric and young adult patients, carbohydrate intake and insulin requirement differ clearly between CFRD and T1D. However, both CFRD and T1D patients seem to restrict carbohydrates. (C) 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved

Diabetes in cystic fibrosis : multicenter screening results based on current guidelines

Background: Published estimates on age-dependent frequency of diabetes in cystic fibrosis (CF) vary widely, and are based mostly on older data. However, CF treatment and prevention of comorbidities changed over recent years. In many studies, definition of cystic fibrosis-related diabetes (CFRD) is not in line with current guideline recommendations. Therefore, we evaluated age-dependent occurrence of glucose abnormalities and associated risk factors in CF patients who participated in a multicenter screening program using oral glucose tolerance tests (OGTT). Methods: Between 2001 and 2010, 43 specialized CF centers from Germany and Austria serially performed 5,179 standardized OGTTs in 1,658 clinically stable, non-pregnant CF patients with no prior steroid medication or lung transplantation. Age-dependent occurrence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG+IGT, one (DGT) or two consecutive (CFRD) diabetic OGTTs was analyzed, using Kaplan Meier curves. Cox proportional-hazards models were created to elucidate the influence of sex or underweight. Results: At baseline/last OGTT, median age was 15.9 years/18.2 years and 30.6%/31.8% of patients were underweight. 25% of patients showed IFG at age 14.3 years; IGT at age 16.3 years; IFG+IGT combined at age 17.7 years. DGT was observed in 25% of patients at age 22.6 years; CFRD at age 34.5 years. Females had a 3.54 [95% CI 1.23–10.18] times higher risk for CFRD; risk for DGT was 2.21 [1.22–3.98] times higher. Underweight was a risk factor for IGT (HR [95% CI]: 1.38 [1.11–1.71]) and IFG+IGT (1.43 [1.11–1.83]), and in males also for DGT (1.49 [1.09–2.04]). Conclusions/Significance: If confirmation of diabetes by a second test is required, as recommended in current guidelines, age at CFRD diagnosis was higher compared to most previous studies. However, known risk factors for glucose abnormalities in CF were confirmed. Confirmation of diabetic OGT by a repeat test is important for a consistent diagnosis of CFRD

Lower Frequency of Insulin Pump Treatment in Children and Adolescents of Turkish Background with Type 1 Diabetes: Analysis of 21,497 Patients in Germany

Icks A, Razum O, Rosenbauer J, et al. Lower Frequency of Insulin Pump Treatment in Children and Adolescents of Turkish Background with Type 1 Diabetes: Analysis of 21,497 Patients in Germany. Diabetes Technology &amp; Therapeutics. 2012;14(12):1105-1109.Aim: This study investigated insulin pump therapy in pediatric patients with type 1 diabetes and Turkish origin compared with those without migration background in Germany. Subjects and Methods: Using a nationwide documentation program, we estimated the prevalence of insulin pump therapy in patients <20 years of age with Turkish origin and those without migration background. Logistic regression was used to adjust for age, sex, diabetes duration, body mass index SD score (BMI-SDS), glycated hemoglobin, number of outpatient visits, number of daily blood glucose self-measurements, and area-based socioeconomic conditions. Results: In 1,695 pediatric type 1 diabetes patients with Turkish background and 19,802 patients without migration background (respectively: 51.2% and 53.0% boys; mean age, 12.4 +/- 4.1 and 12.6 +/- 4.2 years; mean diabetes duration, 4.7 +/- 3.9 and 5.3 +/- 4.0 years), fully adjusted prevalences of insulin pump therapy were 18.5% and 30.9%, respectively (odds ratio 0.51, 95% confidence interval 0.43-0.60, P < 0.001). Age, sex, BMI-SDS, outpatient visits, and blood glucose self-control were significantly associated with the prevalence of insulin pump therapy but did not alter the difference substantially. Conclusions: The prevalence of insulin pump therapy is roughly half among pediatric diabetes patients with Turkish background compared with those without migration background. Several covariates could not explain this difference. Individual characteristics or access barriers within the healthcare system may play a role. Further research is needed

Impact of Maternal Country of Birth on Type-1-Diabetes Therapy and Outcome in 27,643 Children and Adolescents from the DPV Registry

Scheuing N, Wiegand S, Baechle C, et al. Impact of Maternal Country of Birth on Type-1-Diabetes Therapy and Outcome in 27,643 Children and Adolescents from the DPV Registry. PLoS ONE. 2015;10(8): e0135178.Objective To study the impact of maternal country of birth on type-1-diabetes (T1D) therapy and outcome. Study Design and Methods 27,643 T1D patients aged <= 20 years with documented maternal country of birth from the multicenter German/Austrian diabetes patient registry (DPV) were analyzed. Patients were categorized based on their mother's origin: Germany/Austria (reference), Turkey, Southern Europe, and Eastern Europe. To compare BMI standard deviation score (BMI-SDS), diabetes therapy and outcome between groups, multivariable regression was applied with adjustments for age, sex and duration of diabetes. Based on observed marginal frequencies, adjusted estimates were calculated. Linear regression was used for continuous data, logistic regression for binary data and Poisson regression for count data. All statistical analyses were performed using SAS 9.4. Significance was set at a two-tailed p<0.05. Results 83.3% of patients were offspring of native mothers. A Turkish, Southern or Eastern European background was documented in 2.4%, 1.7% and 4.3% of individuals. After demographic adjustment, patients with migration background had a higher mean BMI-SDS (Turkey, Southern Europe or Eastern Europe vs. Germany/Austria: 0.58 +/- 0.03, 0.40 +/- 0.04, or 0.37 +/- 0.02 vs. 0.31 +/- 0.01; +/- SE) and a lower use of insulin pumps (26.8%, 27.9%, or 32.6% vs. 37.9%) compared to offspring of native mothers. Mean HbA1c was worst in individuals of Turkish mothers (Turkey vs. Germany/Austria: 69.7 +/- 0.7 vs. 66.6 +/- 0.1 mmol/mol; +/- SE). Patients of Eastern European descent had an increased rate of severe hypoglycemia (22.0 +/- 0.13 vs. 16.13 +/- 0.02 events per 100 patient-years) and ketoacidosis was more prevalent in offspring of Turkish or Southern European mothers (7.50 +/- 0.10, or 7.13 +/- 0.11 vs. 6.54 +/- 0.02 events per 100 patient-years). Patients of Turkish descent were more often hospitalized (57.2 +/- 2.7 vs. 48.5 +/- 0.4 per 100 patient-years). All differences were significant. Conclusion The differences in diabetes therapy and outcome among patients with distinct migration background suggest that specific challenges have to be considered in clinical care

High variability in oral glucose tolerance among 1,128 patients with cystic fibrosis : a multicenter screening study

Background: In cystic fibrosis, highly variable glucose tolerance is suspected. However, no study provided within-patient coefficients of variation. The main objective of this short report was to evaluate within-patient variability of oral glucose tolerance. Methods: In total, 4,643 standardized oral glucose tolerance tests of 1,128 cystic fibrosis patients (median age at first test: 15.5 [11.5; 21.5] years, 48.8% females) were studied. Patients included were clinically stable, non-pregnant, and had at least two oral glucose tolerance tests, with no prior lung transplantation or systemic steroid therapy. Transition frequency from any one test to the subsequent test was analyzed and within-patient coefficients of variation were calculated for fasting and two hour blood glucose values. All statistical analysis was implemented with SAS 9.4. Results: A diabetic glucose tolerance was confirmed in 41.2% by the subsequent test. A regression to normal glucose tolerance at the subsequent test was observed in 21.7% and to impaired fasting glucose, impaired glucose tolerance or both in 15.2%, 12.0% or 9.9%. The average within-patient coefficient of variation for fasting blood glucose was 11.1% and for two hour blood glucose 25.3%. Conclusion: In the cystic fibrosis patients studied, a highly variable glucose tolerance was observed. Compared to the general population, variability of two hour blood glucose was 1.5 to 1.8-fold higher

Characteristics of the study population.

<p>¹ Data are presented as n, mean (SD), and %</p><p>^2/3 p-value of t-test/Fisher’s exact test for comparison of male and female patients</p><p>Characteristics of the study population.</p

Multiple linear regression models for the association between depression severity (dependent variable) and SCOFF positive screening results for eating disorders.

<p>Data are presented as regression coefficient β (95% CI) with p-value. Model 1: SCOFF (ED) (unadjusted). Model 2: Model 1 + age + diabetes duration. Model 3: Model 2 + BMI + socioeconomic status + family structure/residence^#</p><p>Multiple linear regression models for the association between depression severity (dependent variable) and SCOFF positive screening results for eating disorders.</p