There is strong evidence that skeletal muscle health is compromised in persons with type 1 diabetes mellitus (T1D). These impairments include reduced strength, mitochondrial dysfunction, and decreased satellite cell (SC) content. Maintaining healthy muscle requires successful muscle repair. Preclinical models of T1D consistently show impaired muscle regeneration. To date, the impact of T1D on human skeletal muscle repair has not been established; however, attenuated repair would account for the reduced functional capacity and premature institutionalization that often characterizes those with diabetes. The purpose of this study was to determine the impact of T1D on the recovery of skeletal muscle function, morphology, and ultrastructure after 300 unilateral eccentric contractions (90°/s) of the knee extensors. Eighteen men and women (18-30 years old) with (n=9) and without (n=9) T1D performed the exercise protocol. Pre-damage, and at 48- and 96-hours post-damage, subjects gave a blood sample and vastus lateralis biopsy, and performed a maximal isometric knee extension. Given the sex-specific differences in muscle damage, control and T1D men and women were analyzed together and separately. Force production and recovery were comparable between control and T1D men and women. Exercise-related increases in creatine kinase activity and ultrastructural damage were also comparable between groups. There was a trend towards T1D men having more type 2 fast-twitch muscle fibers than T1D women (p=0.055). While baseline SC content was not different between groups, proliferating SC content was trending lower at 48-, and higher at 96-hours post-damage in T1D women compared to controls (p=0.07). In those with T1D, there was no correlation between muscle damage and HbA1c, but HbA1c was strongly correlated with vigorous physical activity (r=0.881, p=0.002). Contrary to preclinical studies, our data is the first to show that skeletal muscle repair is largely unaltered in otherwise healthy young adults with T1D. We attribute these differences to glycemic control and speculate that muscle repair is unaffected if individuals are optimally managing their diabetes. Considering the exercise-related dysglycemia seen in T1D, our results emphasize a need to define the dose of physical activity required for those with diabetes to properly regulate their blood glucose levels. We expect that this would in turn, improve skeletal muscle health and ultimately, extend the healthy lifespan of those living with T1D. / Thesis / Master of Science in Medical Sciences (MSMS) / Type 1 diabetes mellitus (T1D) is a chronic disease where the body does not make enough insulin to control blood glucose levels. Overtime, unstable blood glucose levels can damage major organ systems, including skeletal muscle. Skeletal muscle plays a pivotal role in regulating our physical and metabolic capacities. In those with T1D, exercise-mediated improvements in muscle health have been shown to delay health complications. However, we do not know how diabetic skeletal muscle repairs from exercise in humans. In this thesis, we investigated the ability of skeletal muscle to recover from damaging exercise in young adults with T1D. For the first time, we showed that skeletal muscle repair was similar between otherwise healthy young adults with T1D and those without diabetes. Our findings suggest that persons with T1D can engage in high levels of physical activity without compromising their muscle health. Further studies are needed to understand how exercise type, intensity, and duration impact glycemic control in men and women with T1D.

Föräldrar till barn med typ 1 diabetes mellitus (T1DM) genomgår en rad olika förändringar när deras barn insjuknar. Insjuknandet går fort och föräldrarna hinner inte bli förberedda på det som komma skall. De tvingas utan förvarning hantera de emotionella, psykologiska och fysiologiska förändringar som sjukdomen för med sig. Föräldrarna försöker hantera situationen och genomför på kort tid livsstilsförändringar kring kost, motion, läkemedelshantering, blodsockermätning och hantera medicinteknisk utrustning. Dessutom påverkas den sociala support de tidigare hade, deras egna arbetssituation kan komma att förändras. De ska fortsätta att se syskonen till det insjuknade barnet samtidigt som de ska vårda sitt sjuka barn dygnet runt, året ut och livet ut. Förändringarna och den nya livssituationen kan vara mycket ansträngande för föräldrarna och de riskerar sin egna hälsa för att vårda sitt barn. Syftet med studien var att belysa föräldrars upplevelser att leva med ett barn med typ 1 diabetes. Metoden i litteraturstudien bygger på 12 artiklar. Både kvalitativa och kvantitativa artiklar som belyser området vilka alla sammanställts och bildar resultatet. Tre huvudteman framkom i resultatet: Föräldrarnas tankar och känslor, Vikten av social support och Föräldrarnas egna hälsorisk. Subteman som kom fram under föräldrars tankar och känslor var normalisering, att ha kontroll, oro och rädsla, sorg, mödrar kontra fäder. Det framkom inom vikten av social support tre subteman: diabetsteam/ sjukvården, skola/ barnomsorg samt support från vänner och familj. Subteman under föräldrarnas egna hälsorisk berör sömnbrist och utbrändhet. I studiens resultat framkommer att föräldrarna är oroliga över den bristfälliga kunskap skolan har kring deras barns T1DM. Att föräldrarna saknar stöttning från sjukvården till att nå riktlinjerna för en bra metabol kontroll. Det framkom att sjukvården har en viktig uppgift att bidra med kunskap och information. Det framkom också att diabetesteam bör beakta vad som kan ligga bakom problemet till brister i egenvården. Egenvårdsbalansen bör upprättas på ett mer långsiktigt och konstruktivt sätt än om sjuksköterskan bara inriktar sig på att åtgärda problem. Sjuksköterskans roll bör vara av hjälpande, vägledande, lärande, motiverande, fysiskt eller psykologiskt stödjande funktion eller att bidra till ett sammanhang som stödjer utveckling för föräldrarna till barn med T1DM.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 152-175).

Transplantation of the islets of Langerhans is a promising technique for restoring the impairedinsulin production in brittle type 1 diabetics. The downside is that the patient will have to takeimmunosuppressant drugs in order to protect the islet cells from the immune system. Donorsare also sparse, making the quest of finding sufficient amounts of islets for transplantationhard. Encapsulation of the islets of Langerhans has been proposed as a means of protectingthe cells from the immune system taking away the need for immunosuppresives. The mostcommon encapsulation technique is extravascular capsules, which are categorized into micro-and macrocapsules. The microcapsules hold only one or a small set of islet whereas themacrocapsules hold a large quantity of islets.This thesis investigates the encapsulation impact on the beta-cells rapid insulin response torising plasma glucose levels. This was done by simulating the glucose-insulin system inMATLAB with included encapsulation of the islets. Two current macro-encapsulation set upswere used in the model, Beta-Air and ViaCyte devices, and they were compared against anormal case. The results showed that the Beta-Air device would not be able to restorenormoglycemia in a T1DM patient but rather showed a delay in insulin response, while theViaCyte device could mimic the normal case well.

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.

Levels of circulating large extracellular vesicles (L-EVs) are increased in individuals with type 1 diabetes mellitus (T1DM) and associated with increased cardiovascular risk. T1DM in pregnancy induces vascular injury leading to adverse maternal and neonatal outcomes. Conversely, exercise has been shown to improve cardiovascular and metabolic health in pregnancy and may represent a non-pharmacological approach to improving pregnancy outcomes. Assessment of vascular health may aid in the identification of individuals at risk of complications and allow for intervention with strategies to improve the maternal vasculature. Unfortunately, there is a paucity of strategies for assessing vascular health in pregnant women. L-EVs are membrane-encapsulated particles released from stressed/injured cells. They are emerging biomarkers of vascular health. The purpose of this thesis was to assess the impact of T1DM and pregnancy on L-EV levels and protein composition, the relationship between L-EVs and pregnancy outcomes and the effect of exercise on L-EV levels. In aim #1, I observed that high levels of L-EVs are predictive of adverse pregnancy outcomes. In aim # 2, I examined the protein composition of circulating L-EVs in hypertensive, diabetic and healthy mice models. Diabetes-enriched proteins were involved in inflammation, SNARE signaling and NAD+ biogenesis. The changes were found in L-EV protein content were consistent with proteins associated with inflammation, cytoskeletal organization, and angiogenesis. Finally, in aim #3, I examined the changes in plasma L-EVs after an acute bout of moderate-intensity aerobic exercise in healthy pregnant and non-pregnant women. I observed that circulating L-EVs significantly decreased after the acute exercise only in non-pregnant individuals. Taken together, my thesis work advances knowledge on L-EVs in T1DM, pregnancy, and hypertension and sets the stage for future work on L-EVs as predictive biomarkers, for molecular profiling, and for monitoring of vascular health interventions in pregnancy.

Background: Since March 2020, health systems around the world shifted to virtual care approaches as social distancing measures were recommended to stem the spread of SARS-COV-2, the virus responsible for the COVID-19 pandemic. For children and families living with type 1 diabetes, virtual consultations in pediatric diabetes care were rare prior to the pandemic but became the norm since the start of the pandemic. Data regarding glycemic outcomes and comorbidities in children living with type 1 diabetes mellitus (T1DM) during the pandemic are limited, and there is a need for these data to drive future care models design and delivery. Aim & Methods: The aim of this project was to assess the association of the COVID-19 pandemic with measures of glycemic control (HbA1c), hyperglycemia, hypoglycemia, diabetic ketoacidosis (DKA) and hospitalization for the period spanning March 2020-2021 at McMaster Children’s Hospital, a tertiary pediatric academic center in Hamilton, Ontario, Canada. Data from the onset of virtual care were compared with data from two years pre-pandemic. Results: The COVID-19 pandemic was not associated with changes in HbA1c (MD -0.14, p=0.058), hospitalization (OR 0.57, p=0.068), or hypoglycemia (OR 1.11, p=0.484), but was significantly associated with the increase in reported hyperglycemia (OR 1.38, p=0.003) and reduction in DKA presentation (OR 0.30, p=0.009). Conclusions: Glycemic control was stable during the early stages of the COVID-19 pandemic, when virtual and hybrid care models prevailed in diabetes care. These results suggest that patients and their families were able to adapt to the uncertain circumstances of the pandemic. Virtual consultations for pediatric diabetes did not hinder glycemic control, and likely aided in the maintenance of diabetes management. Longitudinal studies are necessary before virtual consultations should be recommended to replace in-person clinic visits, but the initial data seem encouraging. / Thesis / Master of Science (MSc) / The COVID-19 pandemic restricted face-to-face healthcare-based interactions to limit the spread of the virus. These restrictions posed as a challenge for children and youth with type 1 diabetes mellitus (T1DM), who relied exclusively on in-person clinic visits as part of their care regimen pre-pandemic. In this retrospective study, we assessed the association of the first year of the COVID-19 pandemic with measures of glycemic control (HbA1c), diabetic ketoacidosis (DKA), hospitalization, hyperglycemia, and hypoglycemia, compared to two years pre-pandemic. We determined that children living with type 1 diabetes had no deterioration of glycemic control measures, apart from an increase in hyperglycemia, during the first 12 months of the pandemic. This study provides insights into health outcomes of children living with T1DM in the early stages of the pandemic and offers a roadmap to guide the further avenues of exploration needed to assess the full impact of the pandemic on this population.

Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 5 uppsatser.

Type I Diabetes Mellitus (T1DM) is a major health problem and a burden for affected young individuals, as well as for society. It is among the most prevalent paediatric disorders, affecting an estimated 1.7 per 100 children and adolescents. Given the complexity of diabetes treatment regimens, it is not surprising that children, adolescents, and their families often have difficulty adhering to these regimens. Studies have found that the overall adherence rate among children and adolescents with diabetes is about 50%. It has also been found that adherence to T1DM often tends to decrease when the adolescent begins to assume most of the responsibility for managing the disease and the parents‟ role starts to decline. However, literature indicates that adolescent patients‟ adherence is poor and an important strategy to improving their metabolic control is to increase self-care. The most common age of onset for T1DM is between 10-14 years. The adolescent population is highly neglected in current research on diabetes, because the focus tends to favour children and not adolescents. It is widely recognised that glycaemic control in adolescents is complex, challenging and dependent on interconnected relationships between numerous inputs at individual, family, community and health service levels. Optimal care of adolescents with diabetes has not been subjected to rigorous scientific studies, and research results related to optimal glycaemic control are conflicting. Development and continuous evaluation of best practices pertaining to diabetes mellitus remains one of the major objectives of diabetes care, possibly allowing a delay in and/or prevention of later complications. Research indicates that adolescence is the one age group where there has been no discernible improvement in health over the last 20 years. A great number of research studies on the subject of diabetes are done globally, but less literature, especially in the South African context, can be found that focuses on and explain the experiences of adolescents with T1DM with regard to their treatment adherence. This qualitative study explored the experiences of adolescents with T1DM. A purposive sample (n=7) of young adolescents between the ages of 13 and 15 willingly participated in the research study to explore and describe their experiences with managing their treatment regimen. In-depth interviews were conducted to collect rich descriptive data, followed by participants‟ verbal reflections once a week for the duration of a month. After the in-depth interviews and weekly reflections, the researcher held a focus group interview with all the participants. Transcribed data were analysed by means of thematic analysis from which themes and subthemes were derived. The participants expressed both positive and negative emotions associated with their diabetes; they experienced a lack of understanding by significant others because of a lack of knowledge, interest or support regarding their diabetes; they mentioned that they continually need age-appropriate support and parental involvement, even though they manage diabetes through their own processes; and lastly, participants struggled with a fear of friends‟ and peers‟ perceptions. From the findings it is clear that in order to cope, the adolescents need not only medical treatment and education about diabetes (T1DM), but emotional support, supervision and repeated reinforcement to achieve effective self-management. The basic suggestion is that diabetes care for children and young people should include routine assessment of the psychological and social pressures on the adolescent and the family so that strategies can be put in place to give support and education as needed and as appropriate. The researcher also recommends that school personnel must be educated about diabetes so that they can understand the changing medical and psychosocial needs of the adolescent and can help him/her to participate fully in all the available work, sport, and leisure activities. Models of legislation and training programmes for school staff specifically addressing the needs of children with diabetes in school have been developed in a number of countries such as Greece, Germany, Italy, Poland, Spain, Sweden, the UK and the USA. These programmes should be considered as an example to other countries. These best practices can serve as a foundation for national improvement. / MA (Psychology), North-West University, Potchefstroom Campus, 2015