Studies demonstrate short-wavelength cone pathway dysfunction in patients with diabetes and no clinically visible DR. Poor glycemic control, as measured by hemoglobin A1c (HbA1c), is a strong risk factor for DR. We hypothesized that raised HbA1c was associated with short-wavelength cone sensitive visual evoked potential (S-VEP) and electroretinogram (sERG) dysfunction. Forty adolescents with diabetes and 39 controls were tested using the S-VEP. Latencies to a short-wavelength stimulus were delayed in patients at low contrasts. Patient S-VEP latencies were not associated with HbA1c when controlling for age and time since diagnosis. Twenty-one adolescents with diabetes and 19 controls were tested using the sERG. Implicit times of the b-wave were delayed but not associated with HbA1c when controlling for time since diagnosis.Patient PhNR amplitudes were reduced. A one-unit increase in HbA1c was associated with a 15% sERG PhNR amplitude reduction (p=0.004). The sERG PhNR may be a potential biomarker for DR.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2010. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / Typescript. Vita. Includes bibliographical references (leaves 146-172). Also available on the Internet.

School plays critical roles in facilitating and inhibiting the safety, development, and well-being of adolescents with T1DM. However, their school-based lived experiences have been under-investigated. This study aimed to explore those experiences for adolescents with T1DM in Taiwan. In conducting the study, Heidegger’s hermeneutic phenomenological approach was used. Fourteen Taiwanese adolescents with T1DM were enrolled between June 2009 and July 2010 through purposive snowball sampling. Data were collected using audio-recorded, semi-structured interviews and analyzed using the hermeneutic circle and West’s (1998) structural analysis steps, supported by qualitative analysis software NVivo 9.0. Reflective journaling, peer debriefing, memo writing, and member checking were performed to enhance the trustworthiness of the findings. Six interrelated themes were identified in the adolescents’ school-based lived experiences. They are (a) the same and different, (b) covert and overt, (c) hyper- and hypoglycemia, (d) independent and dependent, (e) derailing and being on track, and (f) dark clouds and silver lining. In the stressful context of school, the adolescents’ diabetes self-management is challenged. Multiple factors, including unaccepted disease identity; social anxiety and pressure; intrusive, ignorant school personnel and classmates; and transition to independent self-management threaten the adolescents’ health and well-being at school. To optimize diabetes self-management effectiveness, interventions should include the adolescents and their parents, classmates, and school personnel to ease burdens that the adolescents bear. Future interventions should also facilitate the adolescents’ autonomy, self-efficacy, diabetes knowledge and self-management, and capacity to alleviate social pressure. / text

Tyrimo tikslas – ištirti sąsajas tarp paauglių, sergančių cukriniu diabetu, psichosocialinio prisitaikymo ir tėvų pastangų kontroliuoti savo vaikų ligą. Tyrime dalyvavo 11–16 metų paaugliai, kurie serga cukriniu diabetu ilgiau nei vienerius metus, ir jų tėvai (vienas iš tėvų). Iš viso buvo apklausti 73 paaugliai (36 vaikinai ir 37 merginos) ir 73 jų tėvai (21 vyras ir 52 moterys). Paauglių psichosocialinis prisitaikymas buvo matuojamas R. Goodman Galių ir Sunkumų klausimynu, kurį sudaro 25 teiginiai apie teigiamas ir neigiamas savybes, iš kurių susideda 6 klausimyno skalės: socialumas, hiperaktyvumas, emociniai simptomai, elgesio problemos, problemos su bendraamžiais ir bendra sunkumų skalė. Tėvų ligos kontrolė buvo matuojama L. Gonder-Frederick Hipoglikemijos baimės klausimynu (tėvų versija), kurį sudaro 26 teiginiai apie tėvų, kurių vaikai serga cukriniu diabetu, elgesį, kad išvengtų hipoglikemijos ir nerimavimus, kad jų vaiką gali ištikti hipoglikemija; ir vertinama glikemijos kontrolė, kurią parodo glikuoto hemoglobino koncentracija kraujyje. Tyrimo rezultatai parodė, kad vaikinų ir merginų psichosocialinis prisitaikymas skiriasi. Vaikinų grupėje labiau išreikštas socialumas susijęs su didesnes tėvų hipoglikemijos baime, o labiau išreikštos elgesio problemos susijusios su mažesne tėvų hipoglikemijos baime. Merginų grupėje psichosocialinis prisitaikymas su tėvų hipoglikemijos baime nesusijęs. Vaikinų ir merginų geresnė glikemijos kontrolė susijusi su didesne tėvų... [toliau žr. visą tekstą] / The aim of the study was to assess the relationships between psychosocial functioning in youth with type 1 diabetes mellitus, parental fear of hypoglycemia and glycemic control. The subject of the study was 11-16 years-old youths with type 1 diabetes mellitus diagnosed more than 1 year ago and one of their parents. Overall there were 73 youth (36 boys and 37 girls) and 73 their parents (21 men and 52 women). Psychosocial functioning was assessed with Strengths and Difficulties Questionnaire of R. Goodman. It has 25 items about good and bad habits which turn into 6 scales: prosocial, hyperactivity, emotional symptoms, conduct problems, peer problems and total difficulties. Parental fear of hypoglycemia was assessed with Hypoglycemia Fear Survey (patent version) of L. Gonder-Frederick. It has 26 items about parent’s behavior in order to avoid hypoglycemia and worries of child having a low. Glycemic control was evaluated by glycated hemoglobin concentration. The results of the study showed that psychosocial functioning is different in boys and girls. Higher prosocial in boys was related to higher parental fear of hypoglycemia, higher conduct problems was related to lower parental fear of hypoglycemia. No relations were found in girls psychosocial functioning and parental fear of hypoglycemia. Greater glycemic control was related to higher parental fear of hypoglycemia in both boys and girls. Higher hiperaktivity, emotional symptoms, conduct problems and total difficulties in... [to full text]

La transplantation d’îlots chez des sujets diabétiques permet la normalisation de leur glycémie mais nécessite l’utilisation d’immunosuppresseurs. Afin d’éliminer l’utilisation de ceux-ci, une capsule d’alginate capable d’immunoprotéger l’îlot a été proposée. Cependant, un problème persiste : la survie de l’implant est limitée. Deux moyens afin d’améliorer ce facteur seront présentés dans ce mémoire: l’utilisation d’alginate purifié et la co-encapsulation des îlots avec des cellules canaliculaires pancréatiques. La première étude rapporte un aspect nouveau : les effets directs de l’alginate non-purifié, versus purifié, sur la survie d’îlots encapsulés. Ceci est démontré in vitro sur la viabilité à long terme des îlots, leur fonction et l’incidence de leur mort cellulaire par apoptose et nécrose. Ces investigations ont permis de conclure que l’alginate purifié permet de maintenir à long terme une meilleure survie et fonction des îlots. De plus, cette étude ajoute un autre rôle aux contaminants de l’alginate en plus de celui d’initier la réaction immunitaire de l’hôte; celle-ci étant indirectement reliée à la mort des îlots encapsulés. La deuxième étude consiste à déterminer les impacts possibles d’une co-encapsulation d’îlots de Langerhans avec des cellules canaliculaires pancréa-tiques. Les résultats obtenus démontrent que cette co-encapsulation n’améliore pas la survie des îlots microencapsulés, par des tests de viabilité et de morts cellulaires, ni leur fonction in vivo testée par des implantations chez un modèle murin immmunodéficient. Pour conclure, la survie des îlots encapsulés peut être améliorée par la purification de l’alginate mais reste inchangée lors d’une co-encapsulation avec des cellules canaliculaires pancréatiques. / Islets transplantation can normalize glycaemia in diabetic patients but only with the use of immunosuppressive drugs. The elaboration of an alginate microcapsule to immunoprotect the islets has been developed to overcome the use of those harmful drugs. However, one problem still subsists: the limited survival of the transplant. Two different aspects to overcome this problem will be discussed in this thesis: the use of purified alginate and the co-encapsulation of islets with pancreatic duct cells. The first study investigated a new proposition: the direct effects of non-purified alginate, compared to the purified one, on the survival of encapsulated islets. This was demonstrated by in vitro studies on the islets long-term viability, function and the incidence of their death by apoptosis and necrosis. These investigations helped us to conclude that purified alginate can maintain a better long-term survival and function of encapsulated islets. This investigation also demonstrated that alginate contaminants have a direct influence on encapsulated cells besides their role in immune cell activation; which have an indirect implication in the encapsulated islets death. The second study investigated the possible effects of pancreatic duct cells when co-encapsulated with islets of Langerhans. The results showed no significant effects on the viability of co-encapsulated islets, by viability and cellular death assays, and neither on their function in vivo tested with implantations in a mouse immmunodeficient model. To conclude, alginate purification appeared to improve the survival of encapsulated islets while pancreatic duct cells failed to do the same.

In der Literatur wird von einem kontinuierlichen, weltweiten Anstieg der Inzidenz des Typ 1 Diabetes mellitus unter Kindern und jungen Erwachsenen, insbesondere in der Altersgruppe der unter 20-Jährigen, berichtet. Die multizentrische Studie EURODIAB untersuchte in den Jahren 1989-2003 die Inzidenz des Typ 1 Diabetes in 17 europäischen Ländern und bestätigte mit deren Ergebnissen diese weltweite Tendenz. Die Akzelerator Hypothese von Wilkin aus dem Jahr 2001 sieht die Ursache hierfür durch einen übermäßigen Gewichtsanstieg bedingt, da auch die Inzidenz übergewichtiger Kinder innerhalb der letzten Jahre zugenommen hat. Demnach sei die Anzahl Betroffener insgesamt gleich, jedoch in jungen Jahren (bis 15 Jahre) erhöht. Folglich sei Übergewicht mit Insulinresistenz ein Triggerfaktor für eine raschere Progression der Erkrankung und würde zu einem vorzeitigen klinischen Ausbruch des Typ-1-Diabetes beitragen. Im Rahmen dieser Dissertation verglichen wir anthropometrische Geburtsdaten von 1.117 Kindern mit Typ 1 Diabetes mellitus, deren Erstmanifestation zwischen 1988 und April 2013 lag, mit einer Kontrollgruppe, die bezüglich Geschlecht, Alter und Schwangerschaftswoche angepasst wurde (n=54.344). Des Weiteren wurden die Kinder mit Diabetes entsprechend ihres Alters bei Manifestation bestimmten Gruppen zugeordnet: G1:0-4,9 Jahre; G2:5 9,9 Jahre; G3:10-20 Jahre. Diese Unterteilung wurde vorgenommen, um festzustellen, ob Kinder, bei denen eine Diabetes Erkrankung früher klinisch manifest wird, zur Geburt bzw. zum Zeitpunkt der Diagnosestellung einen höheren Gewichts SDS aufweisen als Kinder, welche erst in späteren Jahren betroffen sind. Zusätzlich wurden Verlaufsdaten des BMI SDS von 540 Studienkindern vor, zu und nach Manifestation ermittelt und mit einer gesunden Kontrollpopulation (n=134.249) verglichen. Hierbei zeigten Kinder und Jugendliche mit Typ 1 Diabetes im Vergleich zu Stoffwechselgesunden signifikant erhöhte Geburtsgewicht SDS Werte. Es konnte jedoch keine signifikante Abhängigkeit zwischen einer vorzeitigen Diabetes-Manifestation und einem erhöhten Geburtsgewichts bzw. einem erhöhten BMI SDS zum Zeitpunkt der Manifestation gezeigt werden. Ebenso blieb der laut Wilkin zu erwartende Gewichtsanstieg 4 Jahre vor Ausbruch der Erkrankung aus. Kinder mit Diabetes verlieren, wie erwartet, zur Manifestation an Gewicht und erreichen nach ungefähr einem Jahr ihr Ausgangsgewicht. In den Folgejahren sind Kinder mit Typ 1 Diabetes signifikant schwerer als die Kontrollgruppe. Aufgrund dieser Ergebnisse müssen wir die von Wilkin postulierte „Akzelerator Hypothese“ widerlegen.

Aims: The general aims of this thesis were 1) To explore how non-western immigrant families’ different background and factors related to immigration and acculturation may affect the outcome of education and support in paediatric diabetes management; 2) To provide knowledge on how diabetes education and support for immigrant children and their families should be given to ensure them adequate competence in disease management and the children optimum metabolic control. Methods: The thesis comprises five studies carried out 2001-2006. Study I was based on national register data on metabolic control (N=977), questionnaires to all 20 Danish paediatric diabetes centres and structured interviews with 38 immigrant families. Study II was an intervention study including the development of guidelines and adapted educational material, followed by a re-education programme for 37 families. Study III was a case study of 11 Turkish and Kurdish children/families comprising data from medical records, a participant observation and qualitative interviews with the parents, one interpreter and three diabetes team members. Study IV included qualitative interviews with Arabic parents of 12 children, living as immigrants in Denmark and in Cairo/Egypt respectively. Study V comprised data on metabolic control and qualitative interviews with 11 young adult immigrants with type 1 diabetes since childhood or adolescence.Findings: The young immigrants were very unevenly distributed between the Danish paediatric centres. Most teams had little knowledge of and no special educational offers for immigrant families, just as the use of professional interpreters was limited. The immigrant parents had clearly different pre-conditions for diabetes education as compared with ethnic Danish parents, just as most had a low level of acculturation as evaluated by their need for an interpreter. Major differences were identified between the different ethnic groups and between the individual immigrants. The immigrant children and adolescents had different pre-conditions as compared to their parents; most, however, had non-optimum metabolic control. The design of an adapted educational programme could optimise the outcome of diabetes education, but was not sufficient to provide the families with competence in diabetes management and the children/ adolescents with good metabolic control of long duration. Many parents in particular experienced difficulty combining diabetes management with their principles relating to good parenthood. In addition, they appeared to be insecure and doubtful about the competence of the Danish health care professionals.Conclusions: A different ethno-cultural background is likely to create barriers to health education, learning and collaboration. The non-homogeneity of non-western immigrant families requires educational initiatives tailored to the pre-conditions and needs of the individual family members; adapted initiatives such as peer education are suggested. Special support for immigrant children and adolescents should be considered. A close, supportive and trust-filled relationship between the families and health care professionals is needed to facilitate learning, collaboration and good metabolic contro

The correct administration of insulin is a constant challenge for type 1 diabetics. The correct insulin regime leads to fewer complications and an easier way of life. The amount of insulin administered must take into account the meals eaten, previous administered insulin, exercise etc. A rapid process for determining insulin regimes that is accessible to type 1 diabetics will greatly reduce diabetic complications later in life. This study researches such a process. Software is developed to use the ets-concept to simulate blood glucose levels. From these simulations blood glucose characterisation can be done to propose insulin regimes. Data gathered in previous studies is used to verify the results of this process. These results are compared to factors that describe the accuracy of a person's blood glucose control. The effects the new regimes will have are used to make recommendations to the end-user. Accurate characterisation leads to insulin regImes that will Improve the control performance of type 1 diabetes. / Thesis (M.Ing. (Electronical Engineering)--North-West University, Potchefstroom Campus, 2008.

The correct administration of insulin is a constant challenge for type 1 diabetics. The correct insulin regime leads to fewer complications and an easier way of life. The amount of insulin administered must take into account the meals eaten, previous administered insulin, exercise etc. A rapid process for determining insulin regimes that is accessible to type 1 diabetics will greatly reduce diabetic complications later in life. This study researches such a process. Software is developed to use the ets-concept to simulate blood glucose levels. From these simulations blood glucose characterisation can be done to propose insulin regimes. Data gathered in previous studies is used to verify the results of this process. These results are compared to factors that describe the accuracy of a person's blood glucose control. The effects the new regimes will have are used to make recommendations to the end-user. Accurate characterisation leads to insulin regImes that will Improve the control performance of type 1 diabetes. / Thesis (M.Ing. (Electronical Engineering)--North-West University, Potchefstroom Campus, 2008.