A1C Variability and the Risk of Microvascular Complications in Type 1 Diabetes: Data from the Diabetes Control and Complications Trial

OBJECTIVE—Debate remains as to whether short- or long-term glycemic instability confers a risk of microvascular complications in addition to that predicted by mean glycemia alone. In this study, we analyzed data from the Diabetes Control and Complications Trial (DCCT) to assess the effect of A1C variability on the risk of retinopathy and nephropathy in patients with type 1 diabetes

Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications

Aims  The Michigan Neuropathy Screening Instrument (MNSI) is used to assess distal symmetrical peripheral neuropathy in diabetes. It includes two separate assessments: a 15‐item self‐administered questionnaire and a lower extremity examination that includes inspection and assessment of vibratory sensation and ankle reflexes. The purpose of this study was to evaluate the performance of the MNSI in detecting distal symmetrical peripheral neuropathy in patients with Type 1 diabetes and to develop new scoring algorithms. Methods  The MNSI was performed by trained personnel at each of the 28 Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications clinical sites. Neurologic examinations and nerve conduction studies were performed during the same year. Confirmed clinical neuropathy was defined by symptoms and signs of distal symmetrical peripheral neuropathy based on the examination of a neurologist and abnormal nerve conduction findings in ≥ 2 anatomically distinct nerves among the sural, peroneal and median nerves. Results  We studied 1184 subjects with Type 1 diabetes. Mean age was 47 years and duration of diabetes was 26 years. Thirty per cent of participants had confirmed clinical neuropathy, 18% had ≥ 4 and 5% had ≥ 7 abnormal responses on the MNSI questionnaire, and 33% had abnormal scores (≥ 2.5) on the MNSI examination. New scoring algorithms were developed and cut points defined to improve the performance of the MNSI questionnaire, examination and the combination of the two. Conclusions  Altering the cut point to define an abnormal test from ≥ 7 abnormal to ≥ 4 abnormal items improves the performance of the MNSI questionnaire. The MNSI is a simple, non‐invasive and valid measure of distal symmetrical peripheral neuropathy in Type 1 diabetes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92152/1/j.1464-5491.2012.03644.x.pd

Diabetes control and the influence of family functioning

Background: The link between glycaemic control of type 1 diabetes and family functioning is complex, with the existing literature largely focussing upon the association between clear patterns of disturbances in family functioning and suboptimal diabetic control. The more subtle changes to family function that might influence the degree of successful management of a child's diabetes have been less well studied. Methods: This study sought to explore whether suboptimal glycaemic control was associated with variations in family functioning that might not in themselves prompt concern in routine clinic review. The project focussed on families attending for routine follow-up in specialist paediatric diabetes clinics in the North East of England. Mother and child participants provided demographic information and completed the Family Adaptation and Cohesion Evaluation Scale (FACES IV), and the quality of their glycaemic control was assessed using the mean HbA1c value for each child over the last year. Families with clear emotional or family difficulties, or where the level of control was causing clear concern were excluded (as were families where there was major physical or a member with significant learning disabilities). The sample was divided into two groups; families whose children were in optimal glycaemic control of their diabetes, and families where the glycaemic control was suboptimal. Results: Whatever the degree of control, nearly all the mothers and index children reported functioning within the balanced range. The mothers of children with optimal glycaemic control reported their family to be more cohesive and expressed greater satisfaction with family life than mothers whose child's glycaemic control was suboptimal. The children with suboptimal diabetic control also tended to view their family life as more chaotic. Discussion: Despite the challenges most families cope reasonably well with the issues that managing type 1 diabetes in a child bring. However suboptimal control tends to be associated with some unhelpful family issues, and the implications for intervention are discussed. Conclusions: Suboptimal control, when it is present, prompts exploration of a wide range of factors. Assessment of family functioning should be part of this process, even if there is no evidence of major family difficulties because subtle distortions in functioning can significantly influence glycaemic control, especially in early adolescence

Why exercise is important for someone with diabetes

Unlike medication, exercise is low cost and side-effect free. Those with diabetes who don’t exercise are three times more likely to have poor diabetes control and more likely to suffer related complications

Impact of Diabetes and Its Treatment on Cognitive Function Among Adolescents Who Participated in the Diabetes Control and Complications Trial

OBJECTIVE—The purpose of this study was to evaluate whether severe hypoglycemia or intensive therapy affects cognitive performance over time in a subgroup of patients who were aged 13–19 years at entry in the Diabetes Control and Complications Trial (DCCT)