Magister Chirurgiae Dentium (MChD) / Diabetes Mellitus (DM) is a well-known risk factor for Periodontal disease. Research has established that the prevalence of Periodontal disease is directly related to the glycaemic control of DM in adults and only a few research studies explore this prevalence in diabetic children and adolescents in South Africa. The aim of this study is to determine the periodontal health status of diabetic patients which include children and adolescents attending the Paediatric Diabetic Clinic at Tygerberg Hospital and compare periodontal status with diabetic control. cross-sectional study was employed to determine periodontal status and data relating to the HbA1c% level, the type and duration of DM, the body mass index (BMI) percentile, age, sex, and puberty and treatment regimens were collected from patient records and entered into data collection sheets.

Abstract: Purpose: Effective interventions are needed to help adolescents with T1D develop independent self-management skills to prevent commonly observed deterioration of disease self-management resulting in poor health outcomes. Using a prospective RCT design, we assessed the impact of a nurse-led education program based on motivational interviewing (MI) in youth with Type 1 diabetes (T1D). Design and methods: After parental consent and youth assent, we prospectively randomized 66 adolescents 13-18 years old with T1D to either usual care (every 3 months visit with pediatric endocrinologist) or usual care supplemented by 2 in-person and 4 follow-up phone calls with a nurse educator in a pediatric endocrinology clinic of the University Hospital Farhat Hached, Sousse, Tunisia. We used MI sessions to support youth general and disease specific self-management skills. Outcomes were change, between baseline and 6 months, in TRAQ (a validated measure of youth self-management) scores and HbA1c values. Results: Mean TRAQ scores (based on a 5-point Likert scale) increased by 1.44 points (s.d. = 0.56) in the Intervention Group versus 0.26 points (s.d.= 0.34) in the control group (p < 0.001). The mean HbA1C value decreased in the intervention group by 0.95 units versus a decrease of 0.12 units in the control group (p=0.047). Conclusion: We found that a brief, nurse-led MI-based educational intervention, integrated into specialty pediatric care, resulted in a significant improvement in both self-reported self-management skills and in HbA1c values. Trial registration: Registered in ClinicalTrials.gov Identifier: NCT04798937

Since the initial characterization of the human glucose transporter GLUT1, it has been observed that the presence of intracellular sugar stimulates the unidirectional rate of sugar uptake by a kinetic phenomenon known as trans-acceleration. Both GLUTs 1 and 3 catalyze transacceleration, while both GLUTs 2 and 4 do not. Although the basis for trans-acceleration is unknown, potential explanations include the requirement of a modulating cofactor, cellular context, or that the behavior is an artifact of imperfect transport measurements. This thesis examines whether trans-acceleration is a sequence-specific property intrinsic to the transporter. A method for detecting trans-acceleration in mammalian cells at physiologic temperature was developed through transport of two different glucose analogs. Homology-scanning mutagenesis was employed to exchange transmembrane domains (TMs) of GLUTs 1 and 4, and thereby test for accelerated-exchange loss- or gain-of-function. This approach was extended to GLUTs 2 and 3. The catalytic rates of these chimeric proteins were determined through transport measurements and expression measured by cell-surface biotinylation. These studies show that the sequence of putative scaffolding domain TM6 is both necessary and sufficient for trans-acceleration in scaffolds of GLUT1, GLUT2, and GLUT4. The substitution of TM6 sequence between these transporters has no effect on the turnover under exchange conditions, yet profoundly modifies turnover in the absence of intracellular sugar. We propose that the sequence-specific interaction of TM6 with other TMs structurally restrains relaxation of the empty carrier in GLUTs which catalyze trans-acceleration, and that binding of intracellular sugar affects these interactions to reduce the overall duration of the transport cycle. In addition, our model suggests that the substrate binding constant and rate of carrier relaxation are inter-dependent. In this model, the dissociation constant determined by substrate binding and dissociation rates at the endofacial sugar binding site must be larger than the equivalent constant at the exofacial site in order for trans-acceleration to occur.

Purpose: The aim of this study was to determine whether glycemic control is different between subjects who screened negative for Celiac Disease (CD) compared to subjects who screened positive for CD among subjects with autoimmune insulin-dependent diabetes. Also, this study investigated if the presence of specific beta cell autoantibodies, GAD65, Islet cell antibodies or both, could predict the risk for positive CD screening. METHODS/PROCEDURES: A retrospective cohort study of an existing clinical care data was obtained from the Clinical Data Warehouse (CDW) in Boston Medical Center (BMC) for the period between January 2000 and November 2015. The exposed cohort included those who screened positive for CD, while the non-exposed cohort included subjects who screened negative for CD. The following data was collected and included in the analysis: demographic variables, A1C levels, Diabetic Ketoacidosis (DKA) events, diabetes-associated antibodies, CD screening tests, and CD biopsy results. Longitudinal data for each subject was obtained from the CDW. RESULTS: The prevalence of potential CD in this study was 8.8%, while the prevalence of biopsy confirmed CD was 4.4%. Mean A1C level for subjects who screened negative for TTG was 8.9% (CI 8.3 - 9.6), while mean A1C levels for subjects who screened positive for TTG was 7.9% (CI 6.8 - 9.0) after adjusting for confounders using the mixed-effect model. This difference was not statistically significant. Moreover, diabetes-associated antibodies did not predict the risk for positive TTG screening. CONCLUSION: The glycemic control for subjects who screened negative for CD was found to be similar to subjects who screened positive for CD. However, further studies with higher power and larger sample size are needed to confirm the findings of this study. / 2017-11-03T00:00:00Z

Indiana University-Purdue University Indianapolis (IUPUI) / Type 1 diabetes (T1D) is a multifactorial disease involving genetic and environmental factors. One of the factors implicated in disease pathogenesis is early life viral infection. A typical immune response to viral infection includes production of type 1 interferons (IFN), such as IFN-α, which can induce stress in the pancreatic β-cells. Reactive oxygen species (ROS) accumulation occurs after exposure to other inflammatory cytokines, causing oxidative stress that may be linked to T1D pathogenesis. Therefore, we hypothesized that IFN-α may also elicit β-cell ROS accumulation. Our in vivo and in vitro experiments with human islets showed rapid and heterogenous ROS accumulation with IFN-α. Although T1D is characterized by autoimmune destruction of β-cells, some cells survive this persistent attack. We hypothesized that survival/ death of β-cells could be attributed to the ability to effectively mitigate ROS accumulation. One mechanism to mitigate ROS is autophagy, which degrades and recycles cellular components to promote cellular homeostasis. We observed an impairment in autophagy in β-cells of donors with T1D as well as in islets of diabetic non-obese diabetic (NOD) mouse model of autoimmune diabetes. Autophagic flux was also impaired in diabetic NOD mouse islets, further confirming impairment of autophagy. Interestingly, we observed an induction of autophagy after acute treatment with IFN-α both in vitro and in vivo, suggesting compensatory upregulation of autophagy to restore homeostasis. Similarly, we observed an increase in autophagosomes and telolysosomes in β-cells of normoglycemic autoantibody positive organ donors compared to nondiabetic organ donors. Together, these data implicate a defect in the final degradation step of autophagy involving lysosomes. Therefore, we analyzed the activity and expression of lysosomal cysteine protease Cathepsin H (CTSH, a T1D susceptibility locus), and found both to be increased in islets of pre-diabetic NOD mice. Together, these data support compensatory hyperactivation of lysosomal enzymes prior to overt diabetes, potentially to rid the cell of ROS and degradation-resistant oxidized proteins and lipids. We also observed that C57Bl/6J mice lacking a key autophagy enzyme, ATG7, in their β-cells, spontaneously developed hyperglycemia. Collectively, these data highlight the importance of -phagic degradation process in the pathogenesis of T1D. / 2022-12-28

No description available.

Type 1 diabetes mellitus (T1DM), a common, chronic disease, affects the patient as well as the family. It requires daily vigilance in blood sugar monitoring, dietary management and insulin administration. Research has examined the impact of T1DM on family adaptation and relationships. However, few current data describes parents' perceptions of challenges. The purpose of this study was to identify challenges and impact on the family perceived by parents raising children with T1DM. Using a qualitative descriptive design, 21 parents raising children with T1DM participated in audio-recorded focus groups. At the time of the interviews the children ranged in age from 2 to 17 years, with duration of diagnosis ranging from six months to 10 years. Seven major themes were identified, including issues regarding (a) children's behavior and development, (b) physical management of diabetes, (c) parenting challenges, (d) siblings and extended family, (e) friends and community, (f) school, and (g) health care system and diabetes organizations. Within each theme, numerous sub-themes were identified. The identification of challenges and unmet needs of families raising children with T1DM suggests health care and schools systems improve the services and support provided. Mental health issues should be managed. A follow-up plan should be in place at the time of hospital discharge, to include provider initiated contact as well as contact by another parent raising a child with T1DM.

The purpose of this study was to evaluate the effectiveness of a workshop/support group for parents raising children with type 1 diabetes mellitus (T1DM). Diagnosis of a chronic disease in a child generally arouses acute anxiety and stress in parents. Parental stress when raising a child with type 1 diabetes is often centered on worry about their child's health and parents' ability to maintain the care activities needed by these children. Parents are the primary caregivers of children with Type 1 diabetes, and the effect of stress on parents can impact the health of both children and parents. The present study examined parents of children with type 1 diabetes who attended four separate two hour support groups/workshops. The Pediatric Inventory for Parents (Streisand, 2001) measured parenting stress. The parents completed the Pediatric Inventory for Parents, at the beginning of the first workshop and again at the end of all the workshops. Parents also completed an open ended questionnaire at the end of each workshop. Parents responded positively to the workshops. Parents stated that hearing how others worked through difficult situations while raising their child with type 1 diabetes was helpful. In quantitative analyses, parents had lower mean scores, post- vs. pre- test on measures of stress related to emotional functioning, communication, medical care, and role function. Research shows that support groups that involve the entire family are most beneficial (McBroom & Enriquez, 2009). Nurse practitioners should consider sponsoring or becoming involved in workshops for parents raising children with type 1 diabetes.

Type 1 diabetes [T1D] is an autoimmune illness that results in insulin deficiency. Managing this illness during childhood requires maintaining blood glucose within a healthy range and is a constant challenge. This can result in increased stress for children and their caregivers. School attendance is one factor that may result in stress. Studies have highlighted the fact that teachers of students with T1D may receive little education regarding management of the disease and may be required to make accommodations which can result in confusion, miscommunication, and increased psychosocial stress. The goal of this research was to learn about the experiences of teachers of students with T1D, what is expected of them, what resources they have, and factors which they perceive as barriers or facilitators to education for students with T1D. Semi-structured interviews were conducted with two high school teachers in East Tennessee who had experience teaching students with T1D. The results of the interviews showed that teachers receive limited education regarding T1D, that they are expected to make accommodations such as having snacks on hand and allowing extra access to phones, and that there are perceived barriers to education of individuals with T1D due to the possibility of life-threatening events. The teachers reported that school nurses are involved in the care of students with T1D. Limitations of this study include that only two teachers were interviewed, and while the results are important to take into consideration, saturation was not reached. Future research could include more in-depth interviews or surveys with teachers, coaches, and school nurses.

No description available.