Nonpharmacological management and psychosocial support for children and adolescents with type 1 diabetes

Compared to that in the Caucasian population, type 1 diabetes mellitus (T1DM) incidence rates are very low in Koreans. Therefore, compared to the recent development of pharmacological therapy applicable to Korean children with T1DM, interest in nonpharmacological therapy and psychosocial support systems remains low, as is the development of Korean-style T1DM education programs for therapeutic application. Children who have been newly diagnosed with diabetes are placed in completely new environments for treatment. For appropriate control of diabetes, patients have to self-monitor blood glucose levels and inject insulin several times a day and must use extreme self-control when they eat foods to avoid increases in blood glucose levels. Blood glucose excursions resulting from impaired pancreatic β cell functions cause mental stress due to vague fears of chronic complications of diabetes. In addition, children with diabetes cannot be excluded from the substantial amount of studies required of Korean adolescents, and the absolute shortage of time for ideal control of diabetes adds to their mental stress. Many of these patients are psychologically isolated in school where they spend most of their time, and they are not appropriately considered or supported with respect to blood glucose control in many cases. In this respect, this author will introduce some of the newest views on nonpharmacological therapy and psychosocial support systems that account for important parts of T1DM management and seek measures to apply them in conformity with the social characteristics of Korea

Combined Etanercept, GAD-alum and vitamin D treatment : an open pilot trial to preserve beta cell function in recent onset type 1 diabetes

Aim We aimed to study the feasibility and tolerability of a combination therapy consisting of glutamic acid decarboxylase (GAD‐alum), Etanercept and vitamin D in children and adolescents with newly diagnosed with type 1 diabetes (T1D), and evaluate preservation of beta cell function. Material and Methods Etanercept Diamyd Combination Regimen is an open‐labelled multi‐centre study pilot trial which enrolled 20 GAD antibodies positive T1D patients (7 girls and 13 boys), aged (mean ±SD): 12.4 ± 2.3 (8.3–16.1) years, with a diabetes duration of 81.4 ± 22.1 days. Baseline fasting C‐peptide was 0.24 ± 0.1 (0.10–0.35) nmol/l. The patients received Day 1‐450 Vitamin D (Calciferol) 2000 U/d per os, Etanercept sc Day 1‐90 0.8 mg/kg once a week and GAD‐alum sc injections (20 μg, Diamyd™) Day 30 and 60. They were followed for 30 months. Results No treatment related serious adverse events were observed. After 6 months 90‐min stimulated C‐peptide had improved in 8/20 patients and C‐peptide area under the curve (AUC) after Mixed Meal Tolerance Test in 5 patients, but declined thereafter, while HbA1c and insulin requirement remained close to baseline. Administration of Etanercept did not reduce tumour necrosis factor (TNF) spontaneous secretion from peripheral blood mononuclear cells, but rather GAD65‐induced TNF‐α increased. Spontaneous interleukin‐17a secretion increased after the administration of Etanercept, and GAD65‐induced cytokines and chemokines were also enhanced following 1 month of Etanercept administration. Conclusions Combination therapy with parallel treatment with GAD‐alum, Etanercept and vitamin D in children and adolescents with type 1 diabetes was feasible and tolerable but had no beneficial effects on the autoimmune process or beta cell function.Funding Agencies|Barndiabetesfonden (Swedish Child Diabetes Foundation); Diabetesfonden (Swedish Diabetes Association); FORSS (the Research Council of Southeast Sweden); ALF (Region Ostergotland); Diamyd Medical</p