Retinitis pigmentosa. A mimic of neurologic disease

Six patients with various forms of retinitis pigmentosa who were misdiagnosed as having neurologic disease are presented. In five of the patients, visual field defects were misinter-preted as being secondary to a neurologic rather than a retinal problem. In two patients, optic nerve drusen, which accompanied the retinal degeneration, were mistaken for papilledema. Since the diagnosis of retinitis pigmentosa is not always obvious on ophthalmoscopy, the clinician must be aware of the various manifestations of this disorder and be able to distinguish visual field defects on a retinal from a neurologic basis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26648/1/0000191.pd

Longitudinal evaluation of cognitive functioning in young children with type 1 diabetes over 18 months

OBJECTIVE: Decrements in cognitive function may already be evident in young children with type 1 diabetes (T1D). Here we report prospectively acquired cognitive results over 18 months in a large cohort of young children with and without T1D. METHODS: 144 children with T1D (mean HbA1c: 7.9%) and 70 age-matched healthy controls (mean age both groups 8.5 years; median diabetes duration 3.9 yrs; mean age of onset 4.1 yrs) underwent neuropsychological testing at baseline and after 18-months of follow-up. We hypothesized that group differences observed at baseline would be more pronounced after 18 months, particularly in those T1D patients with greatest exposure to glycemic extremes. RESULTS: Cognitive domain scores did not differ between groups at the 18 month testing session and did not change differently between groups over the follow-up period. However, within the T1D group, a history of diabetic ketoacidosis (DKA) was correlated with lower Verbal IQ and greater hyperglycemia exposure (HbA1c area under the curve) was inversely correlated to executive functions test performance. In addition, those with a history of both types of exposure performed most poorly on measures of executive function. CONCLUSIONS: The subtle cognitive differences between T1D children and nondiabetic controls observed at baseline were not observed 18 months later. Within the T1D group, as at baseline, relationships between cognition (VIQ and executive functions) and glycemic variables (chronic hyperglycemia and DKA history) were evident. Continued longitudinal study of this T1D cohort and their carefully matched healthy comparison group is planned

A Web-Based Study of the Relationship of Duration of Insulin Pump Infusion Set Use and Fasting Blood Glucose Level in Adults with Type 1 Diabetes

Background: To evaluate the impact of infusion set use duration on glycemic control, we conducted an Internet-based study using the T1D Exchange's online patient community, Glu (myGlu.org). Subjects and Methods: For 14 days, 243 electronically consented adults with type 1 diabetes (T1D) entered online that day's fasting blood glucose (FBG) level, the prior day's total daily insulin (TDI) dose, and whether the infusion set was changed. Results: Mean duration of infusion set use was 3.0 days. Mean FBG level was higher with each successive day of infusion set use, increasing from 126?mg/dL on Day 1 to 133?mg/dL on Day 3 to 147?mg/dL on Day 5 (P<0.001). TDI dose did not vary with increased duration of infusion set use. Conclusions: Internet-based data collection was used to rapidly conduct the study at low cost. The results indicate that FBG levels increase with each additional day of insulin pump infusion set use.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140356/1/dia.2014.0336.pd

Pediatric diabetes consortium T1D New Onset ( NeOn ) study: clinical outcomes during the first year following diagnosis

Objective There have been few prospective, multicenter studies investigating the natural history of type 1 diabetes ( T1D ) from the time of diagnosis. The objective of this report from the Pediatric Diabetes Consortium ( PDC ) T1D New Onset ( NeOn ) study was to assess the natural history and clinical outcomes in children during the first year after diagnosis of T1D . Research design and methods: Clinical measures from the first year following diagnosis were analyzed for 857 participants (mean age 9.1 yr, 51% female, 66% non‐Hispanic White) not participating in an intervention study who had a HbA1c result at 12 months. Results Mean HbA1c ± SD was 102 ± 25 mmol/mol (11.4 ± 2.3%) at diagnosis, 55 ± 12 mmol/mol (7.2 ± 1.1%) at 3 months, 56 ± 15 mmol/mol (7.3 ± 1.3%) at 6 months and 62 ± 16 mmol/mol (7.8 ± 1.5%) at 12 months from diagnosis. A severe hypoglycemic ( SH ) event occurred in 31 (4%) participants (44 events, 5.2 events per 100 person‐years). Diabetic ketoacidosis ( DKA ) not including diagnosis occurred in 10 (1%) participants (13 events, 1.5 events per 100 person‐years). Conclusions After onset of T1D , mean HbA1c reaches its nadir at 3–6 months with a gradual increase through 12 months. SH and DKA are uncommon but still occur during the first year with T1D . Data from large cohorts, such as the PDC T1D NeOn study, provide important insights into the course of T1D during the first year following diagnosis, which will help to inform the development of models to target future interventions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107374/1/pedi12068.pd

Radio observational constraints on Galactic 3D-emission models

(Abridged) We constrain simulated all-sky maps in total intensity, linear polarization, and rotation measure (RM) by observations. We test a number of large-scale magnetic field configurations and take the properties of the warm interstellar medium into account. From a comparison of simulated and observed maps we are able to constrain the regular large-scale Galactic magnetic field in the disk and the halo of the Galaxy. The local regular field is 2 microG and the average random field is about 3 microG. The known local excess of synchrotron emission originating either from enhanced CR electrons or random magnetic fields is able to explain the observed high-latitude synchrotron emission. The thermal electron model (NE2001) in conjunction with a proper filling factor accounts for the observed optically thin thermal emission and low frequency absorption by optically thick emission. A coupling factor between thermal electrons and the random magnetic field component is proposed, which in addition to the small filling factor of thermal electrons increases small-scale RM fluctuations and thus accounts for the observed depolarization at 1.4 GHz. We conclude that an axisymmetric magnetic disk field configuration with reversals inside the solar circle fits available observations best. Out of the plane a strong toroidal magnetic field with different signs above and below the plane is needed to account for the observed high-latitude RMs. Our preferred 3D-model fits the observations better than other models over a wide frequency range.Comment: 20 pages, 19 figures, accepted for publication in A&A, for full resolution version see ftp://ftp.mpifr-bonn.mpg.de/outgoing/p098wre/sun-etal.pd

Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141963/1/jper0611.pd

Clinical outcomes in youth beyond the first year of type 1 diabetes: Results of the Pediatric Diabetes Consortium (PDC) type 1 diabetes new onset (NeOn) study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138914/1/pedi12459.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138914/2/pedi12459_am.pd

Cognitive functioning in young children with type 1 diabetes

OBJECTIVE: To assess cognitive functioning in children with type 1 diabetes (T1D) and examine whether glycemic history influences cognitive function. RESEARCH DESIGN AND METHODS: Neuropsychological evaluation of 216 children (healthy controls, n = 72; T1D, n = 144) ages 4-10yrs across five DirecNet sites. Cognitive domains included IQ, Executive Functions, Learning and Memory, and Processing Speed. Behavioral, mood, parental IQ data and T1D glycemic history since diagnosis were collected. RESULTS: The cohorts did not differ in age, gender or parent IQ. Median T1D duration was 2.5yrs and average onset age was 4yrs. After covarying age, gender, and parental IQ, the IQ and the Executive Functions domain scores trended lower (both p = .02, not statistically significant adjusting for multiple comparisons) with T1D relative to controls. Children with T1D were rated by parents as having more depressive and somatic symptoms (p < 0.001). Learning and memory (p = 0.46) and processing speed (p = 0.25) were similar. Trends in the data supported that the degree of hyperglycemia was associated with Executive Functions, and to a lesser extent, Child IQ and Learning and Memory. CONCLUSIONS: Differences in cognition are subtle in young children with T1D within 2 years of onset. Longitudinal evaluations will help determine whether these findings change or become more pronounced with time

Gender differences in diabetes self-care in adults with type 1 diabetes: Findings from the T1D Exchange clinic registry

Aims To evaluate gender differences in diabetes self-care components including glycemic, blood pressure and lipid control, utilization of diabetes technologies and acute diabetes complications in adults with type 1 diabetes. Methods A total of 9,481 participants >18 years were included in the analysis, 53% were female. Variables of interest included glycemic control measured by HbA1c, systolic/diastolic blood pressures, presence of dyslipidemia, insulin delivery modality, and rates of acute complications. Results Glycemic control was similar in women and men (mean HbA1c in both groups: 8.1% ± 1.6% (64 ± 16 mmol/mol), (p = 0.54). More women used insulin pump therapy (66% vs. 59%, p < 0.001) but use of sensor technology was similar (p < = 0.42). Women had higher rates of diabetic ketoacidosis (DKA) (5% vs. 3%, p < 0.001) and eating disorders (1.7% vs. 0.1%, p < 0.001). Severe hypoglycemia rates were not different between men and women (p = 0.42). Smoking (6% vs 4%, p < 0.001), systolic (125 ± 14.2 vs. 121 ± 14.4, p < 0.001) and diastolic blood pressure (73.3 ± 9.5 vs. 72.2 ± 9.3, p < 0.001) and rate of dyslipidemia (28% vs. 23%, p < 0.001) were higher in men. Conclusion While glycemic control in type 1 diabetes was similar regardless of gender, rates of DKA and eating disorders were higher in women while rates of smoking, hypertension and dyslipidemia were higher in men