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

Om konsten att samverka - En fallstudie av samverkan mellan AIC och Försörjningsenheten i Södra Innerstaden i Malmö.

We wanted to use this paper to something important, something real that someone needs and wants to read. After having sent a request to all social services in the City of Malmö, we had contact with a section that had an idea that we would look at their collaboration. This study concerns how collaboration may look like and how it might change to achieve results. Social Services exist to help the client. Can we achieve this through collaboration? To find out this our purpose was; To explore how the collaboration processes is between AIC and Försörjningsenheten of Södra Innerstaden in Malmö to have "the client in focus"? We used an exploratory consisting of a semi quantitative questionnaire. We assumed from the survey results when we designed the questions to our semi-structured interviews, which became our second method. We interviewed six members in the different units. Then we analyzed the results based on eight different themes, a theoretical method of interaction in three stages, and the definitions of terms. We found that it was hard for them to interact when they have different conditions. And that they are not in the same house, that they have different function in society, and that interaction is based on cooperation. It is difficult to work because it depends on people and what happens when individuals are replaced

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

Risk of Diabetes Among Young Adults Born Preterm in Sweden

OBJECTIVE-Previous studies have suggested that preterm birth is associated with diabetes later in life. These studies have shown inconsistent results for late preterm births and have had various limitations, including the inability to evaluate diabetic outpatients or to estimate risk across the full range of gestational ages. Our objective was to determine whether preterm birth is associated with diabetes medication prescription in a national cohort of young adults. RESEARCH DESIGN AND METHODS-This was a national cohort study of 630,090 infants born in Sweden from 1973 through 1979 (including 27,953 born preterm, gestational age < 37 weeks), followed for diabetes medication prescription in 2005-2009 (ages 25.5-37.0 years). Medication data were obtained from all outpatient and inpatient pharmacies throughout Sweden. RESULTS-Individuals born preterm, including those born late preterm (gestational age 35-36 weeks), had modestly increased odds ratios (ORs) for diabetes medication prescription relative to those born full term, after adjusting for fetal growth and other potential confounders. Insulin and/or oral diabetes medications were prescribed to 1.5% of individuals born preterm compared with 1.2% of those born full term (adjusted OR 1.13 [95% CI 1.02-1.26]). Insulin without oral diabetes medications was prescribed to 1.0% of individuals born preterm compared with 0.8% of those born full term (1.22 [1.08-1.39]). CONCLUSIONS-Preterm birth, including late preterm birth, is associated with a modestly increased risk of diabetes in young Swedish adults. These findings have important public health implications given the increasing number of preterm births and the large disease burden of diabetes, particularly when diagnosed in young adulthood

Insulin secretion in patients with latent autoimmune diabetes (LADA): half way between type 1 and type 2 diabetes: action LADA 9

Background: The study of endogenous insulin secretion may provide relevant insight into the comparison of the natural history of adult onset latent autoimmune diabetes (LADA) with types 1 and 2 diabetes mellitus. The aim of this study was to compare the results of the C-peptide response to mixed-meal stimulation in LADA patients with different disease durations and subjects with type 2 and adult-onset type 1 diabetes. Methods: Stimulated C-peptide secretion was assessed using the mixed-meal tolerance test in patients with LADA (n = 32), type 1 diabetes mellitus (n = 33) and type 2 diabetes mellitus (n = 30). All patients were 30 to 70 years old at disease onset. The duration of diabetes in all groups ranged from 6 months to 10 years. The recruitment strategy was predefined to include at least 10 subjects in the following 3 disease onset categories for each group: 6 to 18 months, 19 months to 5 years and 5 to 10 years. Results: At all time-points of the mixed-meal tolerance test, patients with LADA had a lower stimulated C-peptide response than the type 2 diabetes group and a higher response than the type 1 diabetes group. The same results were found when the peak or area under the C-peptide curve was measured. When the results were stratified by time since disease onset, a similar pattern of residual insulin secretory capacity was observed. Conclusions: The present study shows that the magnitude of stimulated insulin secretion in LADA is intermediate between that of type 1 and type 2 diabetes mellitus

Choices For Everyone? - A Critical Analysis on Conditionality in Cash Transfers

The use of conditional cash transfers (CCTs) as means of combating poverty has increased considerably the past decade. CCTs are safety net programs that transfer cash to targeted poor households, often to the mothers, on the condition that those households make pre-specified investments in the human capital of their children. The conditions are often criticised because the conditions only applies to the targeted poor that receive the grants, unlike laws that applies to everyone. Conditions are imposed on the recipients even if there are, for example compulsory school attendance laws. In this way it implies that recipients are irrational or incapable of acting in their own best interests. This thesis critically analyzes the aspects of conditionality in cash transfers. The analysis is based on a research overview that brings up important aspects that relate to the discussion on conditionality in cash transfer programs, and a theoretical framework consisting of two contrasting theories; paternalism and the capabilities approach which represents two ends in how poor people should be perceived and how development should be carried out. Part of the analysis places conditional cash transfers (CCTs) within the bigger picture of development thinking today. The thesis concludes that there is a need to accurately examine whether unconditional cash transfers (UCTs) is an alternative to CCTs in order for us to go beyond political standpoints in this discussion and instead be able to lean against adequate research. There is also a great need to get a deeper understanding about the realities and priorities of the poor