The Assessment of Autoimmunological Status and Prevalence of Different Forms of Celiac Disease among Children with Type 1 Diabetes Mellitus and Celiac Disease

This study aims to assess the autoimmunological status and forms of celiac disease (CD) among children with type 1 diabetes mellitus (T1DM). The study group comprises 27 patients at the mean age of 12.30 years (±SD 3.12). The measurement of the level of diabetes-specific antibodies and organ-specific antibodies was gained at the T1DM-onset and repeated annually. The following risk factors influencing time of CD diagnosis were analyzed: age, sex, T1DM duration, autoantibodies, and HLA-haplotype. The prevalence of antibodies was GADA-74%, IAA-63%, IA2A-67%, ATA-11%, and ATG-4%. The intestinal biopsy revealed in 19% no changes and in 77% stage 3 (Marsh scale). In most cases, no clinical manifestation of CD was observed. The diagnosis of Hashimoto's disease was made twice. The negative correlation between the age at T1DM-onset and the interval between onset of T1DM and CD (r = −0.35, p < .05) was noted. The high-comorbidity ratio of CD and thyroiditis with T1DM demands regular screening tests especially in the first years after T1DM-onset

Severe hypertriglyceridemia in the course of ketoacidosis in a patient with newly diagnosed type 1 diabetes mellitus

BACKGROUND: One of the most serious complications in delayed diagnosis of DKA is hypertriglyceridemia (HTG), Prevalence of mild hypertriglyceridemia is found in about 50% of patients with diabetic ketoacidosis (DKA). Prevalence of severe hypertriglyceridemia [TG &gt; 22.4 mmol/L (&gt; 1959 mg/dL)] was found in about 1–8% of adults with DKA, but few data have been reported in children with severity ranging from asymptomatic to severe acute pancreatitis.CASE PRESENTATION: A 2-year-old-girl with a 2 weeks history of generalized weakness, polydipsia, polyuria, and vulvar candidiasis was admitted to the Intensive Care Unit with clinical signs of DKA. Our patient was met the diagnostic criteria for DKA (pH 7.1, HCO3- 8.8 mmol/L, BE -21.1 mmol/L), glucose level of &gt; 22 mmol/L (556 mg/dl). Initial biochemical analysis showed hyperlipidemia [TG 11470 mg/dL (131.1 mmol/L)], amylase 28 U/L. Her blood demonstrated a grossly lipemic appearance and her lipemic condition disturbed the results of other biochemical blood investigations. The objective of this case report is to present and describe the clinical features, laboratory investigations, case management, and natural course of hypertriglyceridemia in a 2-year-old girl with DKA.CONCLUSIONS: Lipemia secondary to severe HTG may exist in new-onset T1DM with DKA. Diabetic lipemia can be caused not only by profound insulin deficiency. An additional factor which should be taken into consideration in very young children is breastfeeding, which is associated with increased mean total cholesterol (TC) and LDL levels. Moreover, severe hypertriglyceridemia may result in mutations of genes encoding lipoprotein lipase (LPL)

Wrodzony hiperinsulinizm — próba optymalizacji diagnostyki i leczenia u polskich pacjentów

  Introduction: Congenital hyperinsulinism of Infancy (CHI) comprises heterogenic defects of insulin secretion with diverse molecular aetiology, histological features, severity of symptoms, and response to pharmacotherapy. The study aimed to establish the first clinical characteristics of Polish patients with CHI and to propose a novel clinical algorithm allowing the prioritisation of genetic and radiology studies, based on patient’s characteristics and response to pharmacotherapy. Material and methods: Thirty-one patients with CHI were recruited from five reference centres in Poland. Clinical and biochemical parameters were statistically evaluated and compared to those of a control group (n = 30). Results: CHI predisposes to increased birth weight (p = 0.004), lower Apgar score (p = 0.004), perinatal complications (74%), and neurological implications (48%). Diagnostic process and therapy were inconsistent. A trial of pharmacotherapy was applied in 21 patients (68%), and diagnostic imaging with 18F-L-DOPA PET was performed in only 3. Eighteen patients (58%) were surgically treated, including 8 infants (44%) aged less than 2 months. Depending on the type of resection, further hypoglycaemia was observed postoperatively in 50% (n = 9) and hyperglycaemia in 39% (n = 7) of cases. Based on foregoing results, a clinical algorithm was proposed. Conclusions: Standardisation of clinical management with the use of pharmacotherapy, genetic screening, and diagnostic imaging will allow the optimisation of therapy and minimisation of treatment complications. (Endokrynol Pol 2015; 66 (4): 322–328)    Wstęp: Wrodzony hiperinsulinizm (CHI) obejmuje heterogenną grupę zaburzeń sekrecji insuliny przez komórki β trzustki i charakteryzuje się zróżnicowaną etiologią molekularną, obrazem histopatologicznym, nasileniem objawów oraz odpowiedzią na leczenie farmakologiczne. Celem pracy było stworzenie charakterystyki klinicznej polskich pacjentów z wrodzonym hiperinsulinizmem oraz podjęcie próby stworzenia algorytmu diagnostyczno-terapeutycznego, umożliwiającego priorytetyzację badań genetycznych i obrazowych w zależności od obrazu klinicznego, wyników badań laboratoryjnych oraz odpowiedzi na leczenie farmakologiczne. Materiał i metody: Do badania włączono 31 pacjentów z rozpoznaną hipoglikemią w przebiegu hiperinsulinizmu z 5 ośrodków w Polsce. Analizę danych klinicznych oraz parametrów biochemicznych pacjentów hipoglikemią odniesiono do 30-osobowej grupy kontrolnej. Wyniki: Pacjenci z CHI charakteryzowali się znacznie wyższą masą urodzeniową (p = 0,004), niższą oceną uzyskaną w okołoporodowej skali Apgar (p = 0,004), częstszymi komplikacjami okołoporodowymi (74%) oraz powikłaniami neurologicznymi (48%). Przeprowadzona w badanej grupie diagnostyka była niespójna. U 21 pacjentów (68%) włączono leczenie za pomocą Diazoksydu, a u 3 pacjentów (9,7%) wykonano diagnostykę obrazową przy użyciu 18F-L-DOPA PET. Wśród 18 (58%) pacjentów leczonych chirurgicznie u 8 (44%) resekcję wykonano w wieku poniżej 2. miesiąca życia. Pooperacyjnie w zależności od typu wykonanej operacji obserwowano hipoglikemię u 50% (n = 9), a hiperglikemię u 39% (n = 7). Na podstawie uzyskanych wyników zaproponowano pierwszy w Polsce algorytm diagnostyczno- terapeutyczny. Wnioski: Ujednolicenie schematu postępowania diagnostycznego-terapeutycznego z wykorzystaniem wszystkich dostępnych metod umożliwi zapobieganie kolejnym epizodom choroby, oraz zminimalizuje komplikacje wynikające z leczenia. (Endokrynol Pol 2015; 66 (4): 322–328)

Differential regulation of serum microRNA expression by HNF1β and HNF1α transcription factors.

We aimed to identify microRNAs (miRNAs) under transcriptional control of the HNF1β transcription factor, and investigate whether its effect manifests in serum.This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text via the publisher's site.Published (Open Access

Reference Ranges of Glycemic Variability in Infants after Surgery&mdash;A Prospective Cohort Study

We aimed to define reference ranges of glycemic variability indices derived from continuous glucose monitoring data for non-diabetic infants during post-operative intensive care treatment after cardiac surgery procedures. We performed a prospective cohort intervention study in a pediatric intensive care unit (PICU). Non-diabetic infants aged 0&ndash;12 months after corrective cardiovascular surgery procedures were fitted upon arrival to the PICU with a continuous glucose monitoring system (iPro2, Medtronic, Minneapolis, MN, USA). Thirteen glycemic variability indices were calculated for each patient. Complete recordings of 65 patients were collected on the first postoperative day. During the first three postsurgical days 5%, 24% and 43% of patients experienced at least one hypoglycemia episode, and 40%, 10% and 15%&mdash;hyperglycemia episode, respectively, in each day. Due to significant differences between the first postoperative day (mean glycemia 130 &plusmn; 31 mg/dL) and the second and third day (105 &plusmn; 18 mg/dL, 101 &plusmn; 22.2 mg/dL; p &lt; 0.0001), we proposed two separate reference ranges&mdash;for the acute and steady state patients. Thus, for individual glucose measurements, we proposed a reference range between 85 and 229 mg/dL and 69 and 149 mg/dL. For the mean daily glucose level, ranges between 122 and 137 mg/dL and 95 and 110 mg/dL were proposed. In conclusion, rt-CGM revealed a very high likelihood of hyperglycemia in the first postsurgical day. The widespread use of CGM systems in a pediatric ICU setting should be considered as a safeguard against dysglycemic episodes; however, reference ranges for those patients should be different to those used in diabetes care

The Stricter the Better? The Relationship between Targeted HbA1c Values and Metabolic Control of Pediatric Type 1 Diabetes Mellitus

Introduction. It remains unclear how HbA1c recommendations influence metabolic control of paediatric patients with type 1 diabetes mellitus. To evaluate this we compared reported HbA1c with guideline thresholds. Materials and Methods. We searched systematically MEDLINE and EMBASE for studies reporting on HbA1c in children with T1DM and grouped them according to targeted HbA1c obtained from regional guidelines. We assessed the discrepancies in the metabolic control between these groups by comparing mean HbA1c extracted from each study and the differences between actual and targeted HbA1c. Results. We included 105 from 1365 searched studies. The median (IQR) HbA1c for the study population was 8.30% (8.00%–8.70%) and was lower in “6.5%” than in “7.5%” as targeted HbA1c level (8.20% (7.85%–8.57%) versus 8.40% (8.20%–8.80%); p=0.028). Median difference between actual and targeted HbA1c was 1.20% (0.80%–1.70%) and was higher in “6.5%” than in “7.5%” (1.70% (1.30%–2.07%) versus 0.90% (0.70%–1.30%), resp.; p<0.001). Conclusions. Our study indicates that the 7.5% threshold results in HbA1c levels being closer to the therapeutic goal, but the actual values are still higher than those observed in the “6.5%” group. A meta-analysis of raw data from national registries or a prospective study comparing both approaches is warranted as the next step to examine this subject further

Impact of diabetes mellitus on in-hospital mortality in adult patients with COVID-19: a systematic review and meta-analysis

Background: The novel coronavirus disease 2019 (COVID-19) has spread worldwide since the beginning of 2020, placing the heavy burden on the health systems all over the world. The population that particularly has been affected by the pandemic is the group of patients suffering from diabetes mellitus. Having taken the public health in considerations, we have decided to perform a systematic review and meta-analysis of diabetes mellitus on in-hospital mortality in patients with COVID-19. Methods: A systematic literature review (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane) including all published clinical trials or observational studies published till December 10, 2020, was performed using following terms “diabetes mellitus” OR “diabetes” OR “DM” AND “survival” OR “mortality” AND “SARS-CoV-2” OR “COVID-19”. Results: Nineteen studies were included out of the 7327 initially identified studies. Mortality of DM patients vs non-DM patients was 21.3 versus 6.1%, respectively (OR = 2.39; 95%CI: 1.65, 3.64; P < 0.001), while severe disease in DM and non-DM group varied and amounted to 34.8% versus 22.8% (OR = 1.43; 95%CI: 0.82, 2.50; P = 0.20). In the DM group, the complications were observed far more often when compared with non-DM group, both in acute respiratory distress (31.4 vs. 17.2%; OR = 2.38; 95%CI:1.80, 3.13; P < 0.001), acute cardiac injury (22.0% vs. 12.8%; OR = 2.59; 95%CI: 1.81, 3.73; P < 0.001), and acute kidney injury (19.1 vs. 10.2%; OR = 1.97; 95%CI: 1.36, 2.85; P < 0.001). Conclusions: Based on the findings, we shall conclude that diabetes is an independent risk factor of the severity of COVID-19 in-hospital settings; therefore, patients with diabetes shall aim to reduce the exposure to the potential infection of COVID-19