Um problema para profissionais que atendem crianças com doenças crônicas é o de encontrar técnicas de atendimento que motivem o tratamento, evite as complicações da doença e mantenham a qualidade de vida dos pacientes. Psicólogos, inseridos no âmbito hospitalar, que participam de programas de atendimento para crianças com Diabetes Mellitus tipo 1 (DM1), se deparam com o sofrimento das mesmas, angústia dos pais e preocupação das equipes de saúde, principalmente quando há baixa adesão ao tratamento. Diante dos riscos de complicações graves que rodeiam essa patologia; das dificuldades no atendimento psicológico de crianças com doenças crônicas e da tendência ao uso de jogos na área da saúde; desenvolveu-se o Gamellito Adventures, um jogo digital para crianças e adolescentes com DM1. Este jogo (game) propõe aos jogadores a realização de cuidados de automonitorização, aplicação de insulina, alimentação e atividade física em um personagem com DM1. Ao considerar esse contexto, temse como objetivo apresentar Gamellito Adventures, como um dispositivo mediador na intervenção da psicologia em crianças com DM1 e realizar um estudo clínico para avaliar os alcances de sua utilização jogo, a partir de conceitos winnicottianos que enfocam o brincar e os objetos transicionais. Trata-se de uma pesquisa clínicoqualitativa que se dotou do método clínico e teve como coleta de dados entrevistas com os pais, consulta de prontuário médico e a técnica do Desenho-Estória com Tema e a utilização do próprio game como mediador e instrumento de coleta no atendimento. Participaram deste estudo cinco crianças com diagnóstico de DM1 na faixa etária de sete a onze anos, sendo quatro meninas e um menino, atendidos no Ambulatório de Especialidades do Hospital Universitário da Universidade Estadual de Londrina. Foram realizadas duas sessões com os responsáveis, entrevista inicial e devolutiva, e quatro sessões com cada criança, sendo que a primeira e última foram aplicados os Desenhos-Estórias com Tema. As demais sessões foram explorados os recursos do game, dos cuidados básicos, minigames e quizzes. Os resultados evidenciaram que a utilização do Gamellito Adventures o faz um potente recurso terapêutico em sessão de atendimento psicológico de crianças com DM1. Os aspectos clínicos comuns percebidos nos estudos de caso foram: as questões maternas que envolvem os pacientes com DM1, o sentimento de se perceber diferente em relação a outras crianças em relação ao seu estado crônico, a dificuldade de simbolização, as passagens ao ato e a negação da doença. Em relação aos aspectos do jogo, o estudo dos casos possibilitou entender que o Gamellito Adventures se fez um disparador para a fala da criança em relação à sua doença e na medida em que favorece a simbolização, é mediador para estabelecer a transferência, a aproximação do conhecimento e a responsabilização, elementos essenciais para melhorar a adesão ao tratamento. O Gamellito Adventures dá subsídios para que a criança se sinta identificada ao personagem e possa, então, falar sobre ela e sua relação com o DM1 e passar da posição de alguém sempre cuidada para um agente ativo: e cuidador / A problem for professionals who treat children with chronic diseases is to find care techniques that motivate treatment, avoid complications of the disease and maintain the quality of life of patients. Psychologists in the hospital who participate in care programs for children with Type 1 Diabetes Mellitus (T1DM) are faced with their suffering, parents\' anguish and concern of health teams, especially when there is low adherence to treatment. Faced with the risks of serious complications surrounding this pathology; the difficulties in the psychological care of children with chronic diseases and the tendency to use games in the health area; developed the Gamellito Adventures, a digital game for children and adolescents with T1DM. In considering this context, we aim to present Gamellito Adventures as a mediator device in the intervention of psychology in children with T1DM and conduct a clinical study to evaluate the scope of their game use, based on Winnicottian concepts that focus on playing and the transitional objects. It is a clinical-qualitative research that was endowed with the clinical method and had as data collection interviews with the parents, consultation of medical records and the technique of Drawing-Story with Theme and the use of Gamellito Adventures itself as mediator and instrument collection. Five children with DM1 diagnosed in the seven to eleven years age group, four girls and one boy, attended the Specialized Ambulatory of the University Hospital of the State University of Londrina (AEHU / UEL). Two sessions were carried out with those responsible, initial and devolution interview, and four sessions with each child, the first and last one being applied the Theme-Story Drawings. The other sessions explored the features of Gamellito Adventures, basic care, minigames and quizzes. The results showed that the use of Gamellito Adventures makes it a powerful therapeutic resource in the psychological treatment session of children with T1DM. The common clinical aspects perceived in the case studies were: the maternal issues involving patients with T1DM, the feeling of perceiving themselves differently in relation to other children in relation to their chronic state, the difficulty of symbolization, the passage to the act and the denial of the disease. Regarding the aspects of the game, the study of the cases made it possible to understand that the Gamellito Adventures was a trigger for the speech of the child in relation to its disease and insofar as it favors symbolization, it mediates to establish the transference, the approximation of the knowledge and accountability, essential elements to improve adherence to treatment. Gamellito Adventures gives the child the ability to feel identified and can then talk about her and her relationship with T1DM and move from the position of someone always \"cared for\" to an active agent: and caregiver

O objetivo geral deste trabalho foi avaliar a presença de sintomas depressivos e as possíveis influências do Diabetes Mellitus tipo I (DM1) na qualidade de vida de adolescentes com esta doença. Para alcançar tal objetivo foram avaliados adolescentes com DM1 (58) e sem DM1 (61) completando um total de 119 adolescentes avaliados; de ambos os sexos. Os locais de coleta de dados foram o Ambulatório de Endocrinologia da Criança e do Adolescente (ECA) do Hospital das Clínicas da Faculdade de Medicina da USP (HCRP-USP) para os adolescentes diabéticos e para os não diabéticos o colégio público regular Escola Municipal de Ensino Fundamental Prof. Raul Machado, no município de Ribeirão Preto-SP. Foram utilizados dois instrumentos para coleta de dados, o The World Health Organization Quality of Life-Bref (Whoqol-bref); instrumento de Qualidade de Vida; e o Inventário de Depressão de Beck; instrumento que avalia sintomas depressivos. Os dados coletados foram organizadas em banco de dados no programa estatístico Stata, versão 12.0, e analisadas a partir de técnicas de estatística descritiva e inferencial. Os resultados desta pesquisa mostraram que, nas avaliações de qualidade de vida, quando não há presença de sintomas depressivos em comparação com o grupo sem diabetes, o grupo de diabéticos apresenta pior qualidade de vida nos domínios físico, social, ambiente e satisfação, todavia, quando há presença destes sintomas, a qualidade de vida é pior nos dois grupos. Conclui-se que o DM1 e a presença de sintomas depressivos, ambos interferem na qualidade de vida dos indivíduos em que acomete, nem sempre de forma igual. Desta maneira, foi possível compreender a importância do olhar ao adolescente com e sem a doença, afim de observar as peculiaridades dos indivíduos nesta fase da vida / The aim of this study was to assess the presence of depressive symptoms and the possible influences of type I diabetes mellitus (DM1) the quality of life of adolescents with this disease. To achieve this goal were evaluated adolescents with type 1 diabetes (58) and without DM1 (61) for a total of 119 adolescents evaluated; of both sexes. Data collection sites were the Endocrinology Clinic of Child and Adolescent (ECA) of the Hospital of the Faculty of Medicine, USP (HCRP-USP) for diabetic patients and nondiabetic patients regular public school Municipal School Elementary Education Prof. Raul Machado, in Ribeirão Preto-SP. Two instruments for data collection were used, The World Health Organization Quality of Life-Bref (WHOQOL-BREF); Quality of Life instrument; and the Beck Depression Inventory; instrument that assesses depressive symptoms. The collected data were organized in a database using Stata, version 12.0, and analyzed from descriptive and inferential statistical techniques. Our results show that in life quality assessments where there is presence of depressive symptoms compared with the group without diabates, the group of diabetics has worse quality of life in the physical, social, environment and satisfaction, however, when there is presence of these symptoms, quality of life is worse in both groups. It is concluded that the presence of DM1 and depressive symptoms, both interfere with the quality of life of individuals in that affects not always equal. In this way it was possible to understand the importance of looking adolescents with and without the disease in order to observe the peculiarities of individuals at this stage of life.

Introduction: Diabetes mellitus is an incurable, widespread disease increasing globally. 2017 there were 425 million people with the diagnosis, and circa 10% of these have type 1 diabetes mellitus. Diabetes mellitus is a disease which requires a lot of self-management. Living with a chronic disease may impact the patient’s mental and psychosocial health. Aim: The aim of this literature review was to describe how living with type 1 diabetes mellitus may affect the patient’s psychosocial health.  Method: The study was conducted as a literature review using Polit and Beck’s (2017) nine steps. Data was collected using two databases, PubMed and CINAHL. The articles chosen were critiqued according to Polit and Beck’s (2017, p. 102-109) “Guide to an Overall Critique of a Qualitative Research Report” and “Guide to an Overall Critique of a Quantitative Research Report”. Twelve articles in total were chosen for the result, six quantitative and six qualitative.  Results: Two main themes and seven subthemes were developed based on the results. Conclusion: Healthcare professionals did not take these patients’ psychosocial health into consideration. Many patients also felt that they could not self-manage their disease in public due to others’ perception of them. This could result in complications.

O objetivo geral deste trabalho foi avaliar a presença de sintomas depressivos e as possíveis influências do Diabetes Mellitus tipo I (DM1) na qualidade de vida de adolescentes com esta doença. Para alcançar tal objetivo foram avaliados adolescentes com DM1 (58) e sem DM1 (61) completando um total de 119 adolescentes avaliados; de ambos os sexos. Os locais de coleta de dados foram o Ambulatório de Endocrinologia da Criança e do Adolescente (ECA) do Hospital das Clínicas da Faculdade de Medicina da USP (HCRP-USP) para os adolescentes diabéticos e para os não diabéticos o colégio público regular Escola Municipal de Ensino Fundamental Prof. Raul Machado, no município de Ribeirão Preto-SP. Foram utilizados dois instrumentos para coleta de dados, o The World Health Organization Quality of Life-Bref (Whoqol-bref); instrumento de Qualidade de Vida; e o Inventário de Depressão de Beck; instrumento que avalia sintomas depressivos. Os dados coletados foram organizadas em banco de dados no programa estatístico Stata, versão 12.0, e analisadas a partir de técnicas de estatística descritiva e inferencial. Os resultados desta pesquisa mostraram que, nas avaliações de qualidade de vida, quando não há presença de sintomas depressivos em comparação com o grupo sem diabetes, o grupo de diabéticos apresenta pior qualidade de vida nos domínios físico, social, ambiente e satisfação, todavia, quando há presença destes sintomas, a qualidade de vida é pior nos dois grupos. Conclui-se que o DM1 e a presença de sintomas depressivos, ambos interferem na qualidade de vida dos indivíduos em que acomete, nem sempre de forma igual. Desta maneira, foi possível compreender a importância do olhar ao adolescente com e sem a doença, afim de observar as peculiaridades dos indivíduos nesta fase da vida / The aim of this study was to assess the presence of depressive symptoms and the possible influences of type I diabetes mellitus (DM1) the quality of life of adolescents with this disease. To achieve this goal were evaluated adolescents with type 1 diabetes (58) and without DM1 (61) for a total of 119 adolescents evaluated; of both sexes. Data collection sites were the Endocrinology Clinic of Child and Adolescent (ECA) of the Hospital of the Faculty of Medicine, USP (HCRP-USP) for diabetic patients and nondiabetic patients regular public school Municipal School Elementary Education Prof. Raul Machado, in Ribeirão Preto-SP. Two instruments for data collection were used, The World Health Organization Quality of Life-Bref (WHOQOL-BREF); Quality of Life instrument; and the Beck Depression Inventory; instrument that assesses depressive symptoms. The collected data were organized in a database using Stata, version 12.0, and analyzed from descriptive and inferential statistical techniques. Our results show that in life quality assessments where there is presence of depressive symptoms compared with the group without diabates, the group of diabetics has worse quality of life in the physical, social, environment and satisfaction, however, when there is presence of these symptoms, quality of life is worse in both groups. It is concluded that the presence of DM1 and depressive symptoms, both interfere with the quality of life of individuals in that affects not always equal. In this way it was possible to understand the importance of looking adolescents with and without the disease in order to observe the peculiarities of individuals at this stage of life.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-06-12T17:33:35Z No. of bitstreams: 1 KellySilva.pdf: 1053190 bytes, checksum: 14ae6885897006b813bbfa8df8168e7c (MD5) / Made available in DSpace on 2017-06-12T17:33:35Z (GMT). No. of bitstreams: 1 KellySilva.pdf: 1053190 bytes, checksum: 14ae6885897006b813bbfa8df8168e7c (MD5) Previous issue date: 2016-07-25 / Diabetes Mellitus (DM) is a heterogeneous group of metabolic disorders that have in common hyperglycemia. Diabetics under treatment with insulin therapy must embrace responsibility of the control and management of their condition on a daily basis; in this context the congnitive theory of self efficacy (SE) proposed by Bandura can be considered a decisive factor in achieving behavioral goals of diabtes, resulting in improvements to self-care and glycemic control. The research here presented aimed to analyse the self efficacy to the treatment of patients with diabetes mellitus type 1 and 2 in insulin therapy and its correlaton with sociodemographic and clinical variables. To that end, we conducted and analytical study of cross-sectional, with quantitative approach and sample consisting on 134 patients with DM type 1 and 2 in insulin therapy at University Hospital's Endocrinology Clinic - Unit President Dutra (HUUPD) of São Luís-MA. For data collection, we used two instruments: identification data with open and closed questions related to sociodemographic and clinical variables and the Insulin Management Diabetes Self Efficacy (IMDSES), Brazilian version. The search resulted 3.07 global media, on the scale of self efficacy, the areas that stood out with the highest and lowest average respectively were the general management domain (3.38) and the diet field (2.90). We have found the following significant correlations: marital status (widowed had more SE in the diet), education (the higher the education, the better the SE in the management, control and correction of glycemia), treatment with diet and insulin (higher SE in the diet), absence of dyslipidemia (increased SE to the overall management of diabtes) and age (higher SE for older in the diet). It was concluded that there are factors relates to socioeconomic and clinical features that interfare in self efficacy of patients with Diabetes mellitus type 1 e 2 in insulin therapy, against the desease. / O Diabetes Mellitus (DM) é um grupo heterogêneo de distúrbios metabólicos que apresentam em comum a hiperglicemia, resultado de defeitos na ação da insulina, na secreção de insulina ou em ambas. Os diabéticos que fazem tratamento com insulinoterapia devem assumir a responsabilidade do controle e gestão de sua condição no dia a dia. Nesse contexto, a teoria cognitiva da autoeficácia (AE) proposta por Bandura pode ser considerada um fator decisivo para atingir as metas comportamentais do diabetes, resultando em melhorias para o autocuidado e controle glicêmico. A pesquisa que se apresenta, teve como objetivo analisar a autoeficácia do tratamento dos portadores de diabetes mellitus tipo 1 e 2 em insulinoterapia e a sua correlação com as variáveis sociodemográficas e clínicas. Para tanto, foi realizado um estudo analítico de corte transversal, com abordagem quantitativa e amostra de 134 portadores de DM tipo 1 e 2 em insulinoterapia, atendidos no Ambulatório de Endocrinologia do Hospital Universitário - Unidade Presidente Dutra (HUUPD) de São Luís-MA. Para a coleta de dados, utilizaram-se dois instrumentos: dados de identificação com questões abertas e fechadas referente às variáveis sociodemográficas e clínicas e o Insulin Management Diabetes Self Efficacy (IMDSES), versão brasileira. A pesquisa resultou média global de 3,07 na escala de autoeficácia, os domínios que se destacaram com maior e menor média respectivamente foram o domínio administração geral (3,38) e o domínio dieta (2,90). Encontraram-se as seguintes correlações significativas: estado civil (viúvos tinham maior AE na dieta), escolaridade (quanto maior a escolaridade, melhor a AE na administração, controle e correção da glicemia), tratamento com dieta e insulina (maior AE na dieta), ausência de dislipidemia (maior AE para o manejo geral do diabetes) e idade (maior AE para os mais velhos na dieta). Concluiu-se que existem fatores relacionados às características socioeconômicas e clínicas que interferem na autoeficácia do portador de Diabetes mellitus tipo 1 e 2 em Insulinoterapia, frente à doença.

Perdas gestacionais, malformações, restrição de crescimento intrauterino (IUGR) são associadas a gestações diabéticas. Para ampliar o conhecimento nesse tema, nosso grupo desenvolveu um modelo de gestação complicada por diabetes tipo 1 em camundongos que, nessa tese, foi utilizado para analisar o ciclo estral, desenvolvimento fetal e organização placentária. O diabetes foi induzido por aloxana e estudado em dois períodos 30-50D (curto prazo) e 90-110D (longo prazo). Placentas e fetos foram coletados, pesados, e submetidos a técnicas moleculares, bioquímicas e morfológicas. Detectaram-se alterações no perfil temporal do ciclo estral. O grupo 30-50D apresentou altas taxas de perdas embrionárias e IUGR, e o 90-110D malformações, mortes fetais, IUGR e aumento no peso placentário. As placentas diabéticas apresentaram aumento e desorganização da zona juncional, redução do labirinto e vasodilatação. A expressão dos colágenos I e III aumentou e a do V diminuiu em 30-50D, porém, a deposição destes aumentou concomitante com a redução da atividade da MMP9. A deposição dos colágenos III e V e a atividade da MMP2 aumentaram em 90-110D. Nossos resultados reiteram a importância do fator temporal nas complicações do diabetes sobre a gestação. / Gestational loss, malformations and intrauterine growth restriction (IUGR) are often associated with pregnancies. To increase the knowledge about this topic, our group has developed a model of pregnancy complicated by type 1 diabetes in mice. In this study, was analyzed the estrous cycle and the fetal and placental development. For this, diabetes was induced by alloxan and studied in two time-periods 30-50D (short term) and 90-110D (long term). Placentas and fetuses were collected, weighed and analyzed by biochemical, morphological and molecular procedures. We detected changes in the temporal profile of the estrous cycle. The 30-50D group showed high rates of embryonic loss and IUGR whereas malformations, fetal death, IUGR and increased placental weight was detected in 90-110D. Increase and disorganization of junctional zone, reducing labirinth and vasodilation characterize diabetic placentas. The expression of collagen I and III was increased whereas collagen V decreased in the 30-50D. The deposition of this collagen, however increased concomitant with the reduction of MMP9 activity. In 90-110D deposition of collagen III and V and the MMP2 activity was increased. Together, our results reinforce the relevance of the time factor in the complications of diabetes on pregnancy.

<p><strong>Syfte:</strong> Att undersöka hur kvinnor med diabetes typ-1 upplever informationen före och i samband med graviditet samt omvårdnaden i samband med graviditet. <strong>Metod:</strong> Semistrukturerade intervjuer med sju kvinnor genomfördes och innehållet analyserades med tematisk analysmetod för att få fram kategorier och subkategorier. <strong>Resultat:</strong> Majoriteten av kvinnorna fick information gällande graviditet i samband med behandlingen av sin diabetessjukdom av hälsovården innan de blev gravida. Många av kvinnorna upplevde att fokus under graviditeten låg på blodsockerkontrollerna och att barnmorskorna på specialistmödravården fokuserade på diabetessjukdomen och glömde mödravården. Informationen på specialistmödravården upplevdes som bristande eller saknades helt och kvinnorna valde att söka information själva. Omvårdnaden och mottagandet var bra på specialistmödravården fastän det framkom att väntetiderna ibland var långa och att personalen var ostrukturerad. <strong>Slutsats:</strong> De flesta kvinnorna upplever att informationen på specialistmödravården är bristande eller att den kommer för sent, medan de upplever att omvårdnaden i de flesta fall är bra. Vi anser att det finns utrymme för förbättringar genom att exempelvis utforma en broschyr med information gällande graviditet i samband med diabetes typ-1. Vi tycker att det är viktigt att vårdpersonalen förklarar för kvinnorna hur de kan minimera riskerna och poängtera att många kvinnor med diabetes typ-1 idag får friska barn.</p> / <p><strong>Aim:</strong> To investigate how women with diabetes type-1 experienced information before and during pregnancy and nursing care during pregnancy. <strong>Method:</strong> Semi-structured interviews with seven women were carried out and the content was analyzed with a thematic analysis to generate categories and subcategories. <strong>Result:</strong> The majority of the women received information about pregnancy associated with diabetes type-1 in health care before they became pregnant. Many women felt that the focus during pregnancy was on blood sugar control and that the focused on diabetes and forgot about maternity care. The information received was seen as inadequate or missing entirely, and the women chose to seek information themselves. The care was good although it appeared that the waiting times were long and the staff was unstructured. <strong>Conclusion:</strong> Most women feel that the information is inadequate or that it comes too late, while they experience that the care in most cases is good. We believe that there is room for improvement, for example by designing a brochure with information regarding pregnancy associated with diabetes type-1. We think it is important that health professionals explain to women how they can minimize risks and point out that many women with diabetes type-1 have healthy children.</p>

The human being and other animals contain immensely complex biochemical processes that govern their function on a cellular level. It is estimated that several thousand small molecules (metabolites) are produced by various biochemical pathways in humans. Pathological processes can introduce perturbations in these biochemical pathways which can lead to changes in the amounts of some metabolites.Developments in analytical chemistry have made it possible measure a large number metabolites in a single blood sample, which gives a metabolic profile. In this thesis I have worked on establishing and understanding metabolic profiles from patients with rheumatoid arthritis (RA) and from animal models of the autoimmune diseases diabetes mellitus type 1 (T1D) and RA.Using multivariate statistical methods it is possible to identify differences between metabolic profiles of different groups. As an example we identified differences between patients with RA and healthy volunteers. This can be used to elucidate the biochemical processes that are active in a given pathological condition.Metabolite concentrations are affected by a many other things than the presence or absence of a disease. Both genomic and environmental factors are known to influence metabolic profiles. A main focus of my work has therefore been on finding strategies for ensuring that the results obtained when comparing metabolic profiles were valid and relevant. This strategy has included repetition of experiments and repeated measurement of individuals’ metabolic profiles in order to understand the sources of variation.Finding the most stable and reproducible metabolic effects has allowed us to better understand the biochemical processes seen in the metabolic profiles. This makes it possible to relate the metabolic profile differences to pathological processes and to genes and proteins involved in these.The hope is that metabolic profiling in the future can be an important tool for finding biomarkers useful for disease diagnosis, for identifying new targets for drug design and for mapping functional changes of genomic mutations. This has the potential to revolutionize our understanding of disease pathology and thus improving health care.

Syfte: Att undersöka hur kvinnor med diabetes typ-1 upplever informationen före och i samband med graviditet samt omvårdnaden i samband med graviditet. Metod: Semistrukturerade intervjuer med sju kvinnor genomfördes och innehållet analyserades med tematisk analysmetod för att få fram kategorier och subkategorier. Resultat: Majoriteten av kvinnorna fick information gällande graviditet i samband med behandlingen av sin diabetessjukdom av hälsovården innan de blev gravida. Många av kvinnorna upplevde att fokus under graviditeten låg på blodsockerkontrollerna och att barnmorskorna på specialistmödravården fokuserade på diabetessjukdomen och glömde mödravården. Informationen på specialistmödravården upplevdes som bristande eller saknades helt och kvinnorna valde att söka information själva. Omvårdnaden och mottagandet var bra på specialistmödravården fastän det framkom att väntetiderna ibland var långa och att personalen var ostrukturerad. Slutsats: De flesta kvinnorna upplever att informationen på specialistmödravården är bristande eller att den kommer för sent, medan de upplever att omvårdnaden i de flesta fall är bra. Vi anser att det finns utrymme för förbättringar genom att exempelvis utforma en broschyr med information gällande graviditet i samband med diabetes typ-1. Vi tycker att det är viktigt att vårdpersonalen förklarar för kvinnorna hur de kan minimera riskerna och poängtera att många kvinnor med diabetes typ-1 idag får friska barn. / Aim: To investigate how women with diabetes type-1 experienced information before and during pregnancy and nursing care during pregnancy. Method: Semi-structured interviews with seven women were carried out and the content was analyzed with a thematic analysis to generate categories and subcategories. Result: The majority of the women received information about pregnancy associated with diabetes type-1 in health care before they became pregnant. Many women felt that the focus during pregnancy was on blood sugar control and that the focused on diabetes and forgot about maternity care. The information received was seen as inadequate or missing entirely, and the women chose to seek information themselves. The care was good although it appeared that the waiting times were long and the staff was unstructured. Conclusion: Most women feel that the information is inadequate or that it comes too late, while they experience that the care in most cases is good. We believe that there is room for improvement, for example by designing a brochure with information regarding pregnancy associated with diabetes type-1. We think it is important that health professionals explain to women how they can minimize risks and point out that many women with diabetes type-1 have healthy children.

Background/aim. The incidence of microvascular complications has been reported to be unchanged the last decades. However, in randomized clinical trials it has been shown that improved metabolic control can reduce the development of long term complications. It has been debated whether it is possible to achieve the same results in an unselected population. In a previous study we found a decreased incidence of overt nephropathy, but unchanged incidence of severe laser treated retinopathy in a population of patients with type 1 diabetes diagnosed in childhood. The aim of the present study was to investigate the incidence 10 years later in the same population and to analyse the importance of possible risk factors. In another previous study we found a high prevalence of subclinical neuropathy among young diabetic patients despite intensive insulin therapy since diagnosis. The aim of the present study was to examine if intensive treatment is more effective in preventing early diabetic complications other than neuropathy. The incidence of type 1 diabetes has doubled in Sweden the last decades. The reason must be environmental factors. These, as well as more intensive insulin regimens from onset of diabetes, might also lead to different disease process. We wanted to analyse if clinical characteristics at onset had changed the last 25 years and if there was any secular trend of C-peptide secretion. We also intended to investigate if longer persistence of C-peptide secretion could be of importance for prevention of long term complications. Methods. The whole study population consisted of all 478 patients with type 1 diabetes diagnosed before the age of 15 during the years 1961 - 2000, living in the catchment area of the Paediatric Clinic, University Hospital, Linköping, Sweden. For the statistical analysis the population was divided into five–year cohorts according to time of onset of diabetes. The cumulative proportion of severe retinopathy and overt nephropathy in 269 patients with onset of diabetes 1961 - 1985 was computed with survival analysis. Multivariable regression models were used to analyse the importance of metabolic control, diabetes duration, blood pressure, smoking, BMI, lipids and persisting C-peptide secretion. The prevalence of all grades of retinal changes, nephropathy and neuropathy, defined as abnormal nerve conduction, was estimated in the late 1990s in a subgroup of 80 children and adolescents with mean 13 years of diabetes duration. Clinical characteristics at onset, duration of partial remission and regularly measurements of fasting and stimulated C-peptide secretion the first five years after onset were analysed in 316 patients with onset of diabetes 1976 - 2000. Results. The cumulative proportion of severe laser treated retinopathy showed a significant declining trend the last decades. The decrease was significant between the oldest cohort with diabetes onset 1961 - 1965 and the cohorts with diabetes onset 1971 - 1975 and 1976 - 1980. The cumulative proportion of overt nephropathy also declined with a significant decrease between the oldest cohorts and all the following cohorts. After 25 years of diabetes duration it was 30% and 8% in the two oldest cohorts respectively and remained largely unchanged after 30 years. Diabetes duration and long term HbA1c were the only significant independent risk factors for both retinopathy and nephropathy. The risk of overt nephropathy increased substantially when HbA1c was above 8.5%, while the risk of severe retinopathy increased already when HbA1c exceeded 7.5%. The prevalence of neuropathy was 59%, of retinopathy 27% and of nephropathy 5% in the population of young patients after mean 13 years of diabetes duration. During the last 25 years the clinical characteristics at onset were unchanged as well as duration of partial remission and magnitude and persistence of C-peptide secretion. Conclusions. In this unselected population the cumulative proportion of severe retinopathy and overt nephropathy decreased over the last decades. Diabetic nephropathy has probably been prevented and not just postponed. Good glycaemic control was the most important factor to avoid complications, with the necessity of a lower level of HbA1c to escape retinopathy than nephropathy. Intensive insulin regimens from diabetes onset was not sufficient to entirely escape early diabetic complications after mean 13 years of diabetes duration, even if the prevalence of retinopathy and especially nephropathy was lower than usually reported. The clinical picture at onset of diabetes was unchanged the last 25 years. There was no secular trend of partial diabetes remission or C-peptide secretion during the first years after diagnosis.