Bakgrund: Diabetes typ 1 är en kronisk och obotlig sjukdom som påverkar olika aspekter i livet. Egenvården är en stor del av personernas vardag och kräver ett stort ansvarstagande. Unga vuxna lever i en komplex tid med ständiga förändringar och ska samtidigt utföra självhanteringsuppgifter relaterat till diabetes. Syfte: Syftet med studien var att beskriva unga vuxnas erfarenheter av egenvård vid diabetes typ 1. Metod: Metoden som användes var en allmän litteraturöversikt med induktiv ansats som baserades på åtta kvalitativa respektive två kvantitativa originalstudier. Materialet analyserades utifrån Fribergs fyra analyssteg och resultat diskuterades utifrån Dahlberg och Segestens teori om hälsa och vårdande. Sökningen genomfördes i två akademiska databaser CINAHL och PubMed med sökorden “young adult”, "emerging adult”, “experience”, "patient attitudes", "perception”, "self-care, "self-management" och "diabetes mellitus, type 1”. Resultat: Litteraturöversikten resulterade i fyra teman. Första temat “Att ha sin sjukdom som ständig följeslagare”, belyser hur unga vuxna uppfattar sina liv i förhållande till diabetes och att aldrig kunna bli fria från den, då de ständigt blir påminda om dess existens. Andra temat “Att hantera egenvård”, sammanfattar unga vuxnas egenvård genom användning av diverse diabetesteknologier och strategier som de utvecklat. Unga vuxna ville ha kontroll över sjukdomen genom att vara proaktiva.Tredje temat “Balansera mellan sjukdom och normalt liv”, präglas av balansen mellan självhantering i vardagslivet och hur unga vuxna hanterar den. Självhanteringsuppgifter kunde medvetet förbises för att bevara en känsla av normalitet i sociala sammanhang. Sista temat “Stöd från omgivningen”, tar upp det stöd som unga vuxna behöver för att hantera sin egenvård. Stödet kunde vara ett lyssnade öra och uppmuntrande ord från föräldrar, vänner och vårdgivare. Slutsats: Unga vuxna lever i en komplex tid med många övergångar som påverkar självhanteringen. Att bli självständiga och axla det större ansvaret kan vara påfrestande för sin hälsa och de behöver stöd från familj, vänner och vårdgivare för att nå en optimal blodglukosnivå. Sjuksköterskor behöver arbeta utifrån ett personcentrerat förhållningssätt och bygga en tillitsfull vårdrelation för att öka delaktigheten hos de unga vuxna. / Background: Type 1 diabetes is a chronic and incurable disease that affects various aspects of life. Self-care is a big part of the daily routine for individuals with diabetes and requires a big responsibility. Young adults live in a complex time with constant changes and must also carry out self-management tasks related to diabetes. Aim: The aim of the study was to describe young adults´ experiences of self-care in type 1 diabetes. Method: The method used was a literature review with an inductive approach based on eight qualitative and two quantitative original studies. The material was analyzed using Friberg's four analytical steps, and the results were discussed based on Dahlberg and Segesten's theory of health and caring. The search was conducted in two academic databases, CINAHL and PubMed, using the search terms "young adult", "emerging adult", "experience", "patient attitudes", "perception", "self-care", "self-management" and "diabetes mellitus, type 1". Results: The literature review resulted in four themes. The first theme "Having one's illness as a constant companion" highlights how young adults perceive their lives in relation to diabetes and the fact that they can never be free from it, as they are constantly reminded of its existence. The second theme "Managing self-care" summarizes young adults' self-care through the use of various diabetes technologies and strategies that they have developed. Young adults wanted to have control over their disease by being proactive. The third theme "Balancing between disease and normal life" is characterized by the balance between self-management in daily life and how young adults handle it. Self-management tasks could be deliberately overlooked to preserve a sense of normality in social situations. The fourth theme "Support from the surrounding environment" addresses the support that young adults need to manage their self-care. The support could be a listening ear and encouraging words from parents, friends and healthcare providers. Conclusions: Young adults are living in a complex time with many transitions that affect self-management. Becoming independent and taking on greater responsibilities can be stressful for their health, and they need support from family, friends, and caregivers to achieve optimal blood glucose levels. Nurses need to work from a person-centered approach and build a trusting care relationship to increase the involvement of young adults.

Bakgrund: I Sverige drabbas cirka 900 barn per år av diabetes mellitus typ 1. Kunskapen om behandling och medicin tekniska framsteg har utvecklats under årens gång vilket har förenklat dessa patienters möjligheter till egenvård Tidigare forskning påvisar en brist på stöd i skolverksamheten och hos hälso - och sjukvårdspersonal för barn med diabetes typ 1. Barn och ungdomar med diabetes har ett krav på att kunna sköta och behandla sin sjukdom självständigt mer än de krav som ställs på deras “friska” skolkamrater och vänner. Syftet med denna studie är att beskriva barns upplevelser av diabetes mellitus typ 1 i det dagliga livet. Metod: Litteraturstudie i form av en kvalitativ metaetnografi. Resultat: Tre huvudtema framkom och totalt åtta subtema. Huvudtema: Känslomässig reaktion av sjukdomen. Subtema: Att uppleva svåra känslor vid diagnostillfället, Oro för komplikationer och behandling och Känslan av att vara annorlunda, Huvudtema: Att vara kontrollerad av sjukdomen. Subtema: Känslan av att vara begränsad och Att förändras för att passa in. Huvudtema: Att behöva stöd. Subtema: Skolpersonalens betydelse, Betydelsen av familjens stöd och Sjukvårdspersonalens betydelse. Slutsats: Resultatet tyder på en önskan om förståelse och stöd från omgivningen, att bli sedd som en person och inte diagnos. / Background: In Sweden, approximately 900 children are affected by diabetes mellitus type 1 per year. Knowledge of treatment and advances in medical technology have developed over the years, which has simplified these patients' opportunities for self-care Previous research shows a lack of support in school activities and among health care professionals for children with diabetes type 1. Children and young people with diabetes must be able to manage and treat their disease independently more than those placed on their "healthy" schoolmates and friends. This study describes children's experiences of diabetes mellitus type 1 in daily life. Aim: The purpose of this study is to describe children's experiences of diabetes mellitus type 1 in daily life. Method: A literature study in the form of a qualitative metasynthesis in line with the research process. Results: Main theme: Emotional reaction to the disease. Subtheme: Experiencing difficult feelings at diagnosis, Worry about complications and treatment and The feeling of being different, Main theme: Being controlled by the disease. Subtheme: The feeling of being limited and Changing to fit in. Main theme: Needing support. Subtheme: The importance of school staff, The importance of family support and The importance of healthcare staff Conclusion: The result indicates a desire for understanding and support from those around them, to be seen as a person and not their diagnosis.

Bakgrund Rädsla för hypoglykemi hos föräldrar med barn som har diabetes mellitus typ 1 är ett folkhälsoproblem. Hypoglykemi är en vanlig komplikation vid insulinbehandling och kan leda till allvarliga konsekvenser om det inte behandlas. Detta kan skapa en stor rädsla hos föräldrarna som gör allt för att förhindra att det inträffar. Det finns därför ett behov av att sammanställa aktuell forskning för att öka vårdpersonalens kunskap och förståelse för föräldrars rädsla för hypoglykemi hos barn med diabetes mellitus typ 1. Syfte Syftet med denna litteraturöversikt var att belysa hur föräldrar upplevde att leva med rädsla för hypoglykemi när barnet hade diabetes mellitus typ 1. Metod En icke-systematisk litteraturöversikt som baserades på 14 vetenskapliga originalartiklar med både en kvantitativ och kvalitativ ansats har skrivits. De vetenskapliga artiklarna inhämtades från PubMed och CINAHL med hjälp av olika sökordskombinationer, samt att en artikel hittades via manuell sökning. De vetenskapliga artiklarna har genomgått kvalitetsgranskning utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Resultatet sammanställdes och analyserades utifrån integrerad dataanalys. Resultat I sammanställningen av resultatet identifierades två huvudteman: “Rädslans påverkan på föräldrars livskvalitet” samt “Rädslans påverkan på föräldrars sjukdomshantering”. Resultatet visade att föräldrars rädsla var ett omfattande problem som baserades på en bristande kunskap från vården vid diagnostiseringen. Det resulterade i att föräldrarna själva skapade hanteringsstrategier för att undvika att barnet skulle få hypoglykemi. Slutsats Litteraturöversikten belyste hur föräldrar upplevde att leva med rädsla för hypoglykemi när barnet hade diabetes mellitus typ 1. Rädslan hade en stor påverkan på föräldrarnas liv och rädslan berodde på flera faktorer. Föräldrarna lindrade sin rädsla genom att utveckla egna hanteringsstrategier. Sjuksköterskor med rätt kunskap kan minska föräldrarnas rädsla och förbättra deras hantering av barnets sjukdom, vilket minskar långsiktiga komplikationer. / Background Fear of hypoglycemia among parents of children with diabetes mellitus type 1 is a public health concern. Hypoglycemia is a common complication of insulin therapy and could lead to serious consequences if left untreated. This creates a great fear in parents who do everything to prevent it from happening. Therefore, there is a need to gather and compile current research to increase healthcare professionals’ knowledge and understanding of parents’ fear of hypoglycemia when the child diabetes mellitus type 1. Aim The aim of this literature review was to elucidate how parents experienced living with fear of hypoglycemia when their child had diabetes mellitus type 1. Method A non-systematic literature review based on 14 scientific original articles with quantitative and qualitative approaches has been written. The scientific articles were collected from PubMed and CINAHL using combinations of search terms. One article was found through manual search. The scientific articles underwent quality assessment based on Sophiahemmet University’s criteria for scientific classification and quality. The results were gathered and analyzed using integrated data analysis. Results In aggregating the results, two main themes were identified: “The impact of fear on parents’ quality of life”, and “The impact of fear on parents’ disease management”. The results showed that parental fear was a significant issue, based on a lack of knowledge from healthcare professionals at the time of diagnosis. This resulted in parents creating their own management strategies to avoid their child experiencing hypoglycemia. Conclusions The literature review highlighted how parents experienced living with fear of hypoglycemia when the child had diabetes mellitus type 1. The fear had a substantial impact on the parents’ lives and the fear was due to various factors. The parents alleviated their fear by developing their own coping strategies. Nurses with appropriate knowledge can reduce parents’ fear and enhance the management of children’s illness, thereby reducing long term complications.

Bakgrund: I Sverige insjuknar cirka 1100 personer årligen i diabetes mellitus typ 1 [DMT1] vilket ställer höga krav på individen vad gäller kost, träning och insulinbehandling. Unga kvinnor med DMT1 lider ökad risk att utveckla ett stört ätbeteende vilket kan leda till kontinuerligt försummande av insulinbehandlingen för att gå ned i vikt (diabulimi). Diabulimi är ett komplext sjukdomstillstånd som är svårt att upptäcka i ett tidigt stadie och svårt att behandla på ett optimalt sätt. Syfte: Att beskriva unga kvinnor med diabulimis upplevelser i sitt sjukdomstillstånd utifrån deras egna berättelser. Metod: En kvalitativ innehållsanalys tillämpades på sju bloggar vilka söktes fram med sökmotorn Google. Bloggarna var skrivna av kvinnor som lever eller har levt med diabulimi. Upplevelser av att leva med sjukdomen eftersöktes i deras bloggar. Analysen resulterade i två huvudteman och fyra subteman. Resultat: De huvudteman som framkom i analysen var ”Självbild” och ”(O)Kunskap”. De olika temana redovisar olika upplevelser av att leva med diabulimi. Slutsats: En förändrad självbild och ett förändrat beteende upplevs av personer med diabulimi samt att det finns brist på kunskap och förståelse om sjukdomen inom sjukvården och i samhället Klinisk betydelse: Studien kan leda till en större förståelse för personer med diabulimi vilket leder till att sjuksköterskan kan ge ett bättre bemötande och bättre omvårdnad. / Background: In Sweden approximately 1100 persons every year get sick in diabetes mellitus type 1 [DMT1] every year which puts high pressure on the individual when it comes to food, exercise and insulin treatment. Young women with DMT1 have a higher risk of developing a harmful eating behaviour which can lead to habitually omitting insulin to lose weight (diabulimia). Diabulimia is a complex illness that is hard to discover in an early stage and difficult to treat in an optimal way. Aim: Describing young diabulimic womens experiences in their illness from their own personal stories. Method: A qualitative content analysis was applied on seven blogs which were found using the search engine Google. The blogs were written by women with personal experience of living with diabulimia. Their blogs were searched for experiences of the illness. The analysis resulted in two main themes and four subthemes Result: The main themes that were found in the analysis was ”self-image”, and "Lack of knowledge”. The themes represented different experiences of living with diabulimia. Conclusion: A change in self-image and behaviour is experienced by individuals with diabulimia, they also experience a lack of knowledge and understanding in the healthcare system and the society. Clinical implication: The study can lead to a greater understanding of people living with diabulimia which could improve the nurse’s approach and nursing.

Bakgrund: Idag lever ca: 450 000 personer med diabetes i Sverige och det gör sjukdomen till en av de stora folksjukdomarna. Diabetes mellitus typ 1 är en kronisk autoimmun sjukdom och drabbar framförallt unga människor. I Sverige lever ungefär 7000 barn med sjukdomen och varje år insjuknar ca: 700 barn under 15 år. Detta gör sjukdomen till en av de vanligaste kroniska sjukdomarna hos barn i Sverige. Syfte: Syftet med denna litteraturstudie var att beskriva föräldrars upplevelse av att leva med ett barn (0–13 år) med diabetes mellitus typ 1. Samt att beskriva datainsamlingsmetoderna i de inkluderade artiklarna. Metod: En deskriptiv litteraturstudie som inkluderade 11 vetenskapliga artiklar varav nio artiklar av kvalitativ ansats, en av kvantitativ ansats och en mixad studie. Dessa analyserades objektivt av båda författarna. Sökningarna skedde i PubMed och Cinahl. Resultat: Resultatet visar att föräldrar upplevde en stor påfrestning och livsomställning när ens barn drabbades av diabetes. De upplevde en känsla av ständig oro och de hade svårt att överlåta ansvaret till någon annan. Stöd och information upplevdes som bristfällig vid olika situationer men ett diabetesteam eller en mentor upplevdes som positivt. Datainsamlingsmetoderna i de inkluderade artiklarna var till största delen intervjuer förutom en som tillämpat frågeformulär. Slutsatser: Föräldrar upplevde ständig oro, brist på stöd och information. Med rätt stöd och information skulle föräldrars oro minskas och det skulle även kunna stärka barnets egenvårdsförmåga. / Background: Today live about 450 000 people with diabetes in Sweden and it makes the disease one of the major diseases. Diabetes mellitus type 1 is a chronic autoimmune disease primarily affects young people. In Sweden live about 7000 children with the disease and fall ill every year approximately 700 children under 15 years. This makes the disease one of the most common chronic diseases in children in Sweden. Aims: The purpose of this study was to describe parents' experience of living with a child (0-13 years) with type 1 diabetes mellitus and to describe the data collection methods of the included articles. Methods: A descriptive literature study, which included 11 scientific articles, nine articles of qualitative approach, one quantitative and one mixed study. These were analyzed objectively by both authors. The searches took place in PubMed and Cinahl. Results: The results show that parents experienced stress and life adjustment when child get diabetes. They felt a sense of worry and they found it difficult to assign responsibility to someone else. Support and information perceived as flawed in different situations, but a healthcare team or a mentor perceived as positive. Data collection methods in the included articles were mostly interviews except one who applied the questionnaire. Conclusions: Parents experienced constant worry, lack of support and information. With the right support and information would reduce parents' anxiety and it could also strengthen the child's self-care ability.

Introduction: The main goal of the diabetes mellitus type 1 (DM type 1) therapy is the achievement of the best compensation of this disease. One of the tools to attain this compensation is the correctly carried out self-monitoring, from which can be the right dose of the Insulin derived. To estimate the correct dose of the Insulin is the essential knowledge of the actual dietary records, especially the amount of the carbohydrates. The thorough dietary record is in this case another tool how to significantly improve the compensation of DM type 1. Objective: The main objective of this thesis was the description of the influence of the dietary record for the compensation of DM type 1. As the evaluating parameters were set the value of HbA1c before-and-after the observation and the glycemia variability during the observation. The observation had been provided during one month where in the beginning of the observation all patients took part in the educative stay. Methods: The examined sample included in total 34 persons, but 2 of them were excluded for health reasons. The final examined sample was consist of 32 persons, out of them 18 females and 14 males, which suffer from DM type 1. The average age of these patients was 36,6 years ± 12,6, where the average lasting of DM type 1 was 14,9 years ± 9,9. In...

INTRODUÇÃO: O diabetes tipo 1 autoimune (DM1A) está associado a alterações na imunidade inata e adaptativa. A agressão autoimune, órgão específica, determina a destruição das células beta do pâncreas e a deficiência da produção de insulina. O infiltrado inflamatório do tipo linfomononuclear, configurando a insulite, e a escassez ou a ausência das células ?, definem o quadro histológico do DM1A. Os autoanticorpos contra antígenos das células beta, que geralmente se desenvolvem na fase pré-clínica, conferem predisposição para DM1A. No entanto, é difícil definir quando e quais indivíduos progredirão para o diabetes manifesto, justificando a busca de outros biomarcadores que auxiliem nas indicações de tratamentos preventivos. Nesse contexto, sabe-se que os microRNAs (miRNAs), pequenos RNAs que atuam pós transcrição, desempenham papel crucial na regulação de genes, integrando fatores genéticos e ambientais e influenciando o funcionamento de órgãos e tecidos de maneira pontual ou sistêmica. OBJETIVOS: avaliar o envolvimento biológico e a relevância da expressão de miRNAs na resposta imunológica e na função das células ? na patogênese do DM1A. MÉTODOS: analisamos o perfil dos miRNAs séricos em 4 grupos, a saber: pacientes portadores de DM1A, até 6 meses do diagnóstico (DM1A recente), (n=30); pacientes portadores de DM1A com duração de 2-5 anos (DM1A 2-5)(n=26) e indivíduos com autoanticorpos pancreáticos positivos sem diabetes (AcP) (n=25), os quais foram comparados aos indivíduos controles saudáveis(n= 29). A expressão dos microRNAs foi obtida com ensaios individuais TaqMan® MicroRNA Assays 5x primers e TaqMan MicroRNA Human Array Card A, (Applied Biosystems- Forster City CA, USA) constituído por 377 alvos e 4 endógenos. Os dados de expressão foram analisados no Software Cloud, (Thermo Fisher Scientific) e no programa Limma (Linear Models for Microarray and RNA-Seq Data). RESULTADOS: Não houve diferença nas características demográficas, como idade, cor auto referida e sexo entre os grupos (p > 0,05). Pacientes portadores de DM1A (recente e com duração de 2-5 anos), diferiram do grupo controle pelos valores elevados de glicose, hemoglobina glicada, títulos de autoanticorpos pancreáticos, e menores de peptídeo C (p < 0,05) e foram semelhantes entre si. Os portadores de autoanticorpos (AcP) tinham características intermediárias entre os grupos: menores valores de HbA1c e de anticorpo anti-tirosina-fosfatase (anti-IA2) e maiores de peptídeo C em relação aos dois grupos com diabetes. Diferiram dos controles apenas pelos maiores títulos de anticorpo anti-insulina (IAA) e anti-descarboxilase do ácido glutâmico 65 (anti-GAD65). A frequência dos alelos HLA de risco para diabetes (-DR3 ou -DR4 e -DQ2 ou DQ-8) decresceu dos grupos DM1A recente e DM 2-5 para AcP e controles. Foram avaliados 135 miRNAs que estavam expressos em 20% ou mais das amostras dos quatro grupos analisados. Maior expressão foi observada em 13, 4 e 33 miRNAs dos grupos AcP, DM1A recente e DM1A 2-5 respectivamente e menor em 11, 7 e 31 miRNAs destes grupos. Destes, 4 miRNAs foram diferencialmente expressos nos grupos AcP, DM1A recente e DM1A 2-5 em relação ao grupo controle. Os miRNAs: miR -16, miR-195 e miR-454, relacionados com regeneração endócrina do pâncreas, efeito anti-inflamatório e resposta à injúria da célula ? estavam diminuídos nestes 3 grupos. O miR-200a, implicado em apoptose das células beta, estava aumentado nos grupos AcP e DM1A recente e diminuído nos pacientes com maior duração do diabetes (DM1A 2-5), possivelmente devido à escassez destas células. Outros 8 miRNAs apresentaram expressão diferente da do grupo controle em dois dos grupos avaliados, e tendência semelhante no terceiro grupo, sendo 4 deles elevados (miR-193a-5p, miR- 323-3p, miR-423-5p, e miR-92a) e 4, diminuídos (miR-191, miR-19a, miR- 376a, miR-590-5p) ou neutralidade no 3º grupo (miR-15b, miR-100, miR-181a e miR-483-5p) Resposta antagônica foi observada para o miR-25 e miR-485- 3p, diminuídos no grupo AcP e aumentados no DM1A 2- 5. Tais miRNAs estão relacionados com resposta imunológica, secreção de insulina, lesão de células ? e glicotoxicidade, à semelhança do observado para o miR-101-3p, validado por ensaios individuais numa casuística maior. CONCLUSÃO: nossos dados sugerem que miRNAs circulantes podem estar envolvidos na patogênese do DM1A / INTRODUCTION: Autoimmune type 1 diabetes (T1D) is associated with changes in innate and adaptive immunity. The organ-specific autoimmune aggression determines the destruction of beta-cells in the pancreas and the deficient insulin production. The inflammatory infiltration of the lymphomononuclear type, configuring the insulite, and the scarcity or the absence of the beta cells, define the histological picture of T1D. Autoantibodies against beta-cell antigens, which usually develop in the preclinical phase, confer predisposition to T1D. However, it is difficult to define when and which individuals will progress to overt diabetes, justifying the search for other biomarkers that could be indicative of preventive treatments. In this context, it is known that the microRNAs (miRNAs) - small RNAs that act post transcription - play a crucial role in regulating genes and in integrating genetic and environmental factors, influencing the function of organs and tissues in a punctual or systemic way. OBJECTIVES: to evaluate the biological involvement and relevance of miRNA expression in the immune response and ?-cell function in the pathogenesis of T1D. METHODS: we analyzed the profile of serum miRNAs of 4 groups, namely: patients with T1D up to 6 months after diagnosis (recent T1D), (n = 30); patients with T1D lasting 2-5 years (T1D 2- 5) (n = 26) and individuals expressing pancreatic autoantibodies without diabetes (AbP) (n = 25), which were compared to healthy controls (n = 29). Expression of the microRNAs was obtained with individual assays TaqMan® MicroRNA Assays 5x primers and TaqMan MicroRNA Human Array Card A (Applied Biosystems-Forster City CA, USA), consisting of 377 targets and 4 endogenous. The expression data was analyzed in the Cloud Software (Thermo Fisher Scientific) and Limma (Linear Models for Microarray and RNASeq Data) program. RESULTS: There was no difference in demographic characteristics, such as age, self-reported color, and sex among groups (p > 0.05). Patients with T1D (both recent and 2-5 years), similar to each other, differed from the control group by high glucose, glycated hemoglobin levels, pancreatic autoantibody titers, and lower C peptide values (p < 0.05) . Pancreatic autoantibodies (AbP) carriers had intermediate characteristics among the groups: lower HbA1c and anti-tyrosine phosphatase antibody (anti- IA2) values and higher C-peptide levels than the two groups with diabetes. They differed from controls only by the higher titers of anti-insulin (IAA) and anti-decarboxylase of glutamic acid 65 (anti-GAD65) autoantibodies. The frequency of high risk HLA alleles for diabetes (-DR3 or -DR4 and -DQ2 or DQ- 8) decreased from the recent T1D and T1D 2-5 groups to the AbP and controls. We evaluated 135 miRNAs that were expressed in 20% or more of the samples from the four groups analyzed. Higher expression was observed in 13, 4 and 33 miRNAs of the Abp, recent T1D and T1D 2-5 groups respectively and lower in 11, 7 and 31 miRNAs of these groups. Of these, 4 miRNAs were differentially expressed in the AbP, recent T1D and T1D 2-5 groups in relation to the control group.The miRNAs: miR -16, miR-195 and miR-454, related to endocrine regeneration of the pancreas, anti-inflammatory effect and response to beta-cell injury were decreased in these 3 groups. miR-200a, implicated in beta-cell apoptosis, was increased in the recent and decreased AbP and T1D groups in patients with longer duration of diabetes (T1D 2-5y), possibly due to the shortage of these cells. Another eight miRNAs showed different expression of the control group in two of the evaluated groups, and a similar trend in the third group, four of them high (miR-193a-5p, miR-323-3p, miR-423-5p, and miR- 92a ) and four, decreased (miR-191, miR-19a, miR-376a, miR-590-5p) or neutrality in the 3rd group (miR-15b, miR-100, miR-181a and miR-483-5p) was observed for miR-25 and miR-485-3p, decreased in the AbP group and increased in T1D 2-5y. Such miRNAs are related to immune response, insulin secretion, ?-cell damage and glycotoxicity, similar to that observed for the miR- 101-3p, validated by individual trials in a larger cohort. CONCLUSION Our data suggests that circulating miRNAs may be involved in the pathogenesis of T1D

Introdução: O processo educativo e de suporte deve ser permanente e compartilhado, tendo o indivíduo com diabetes como o centro de toda a ação. A automonitorização glicêmica é, em geral, a primeira prática de autocuidado ensinada à criança com diabetes mellitus tipo 1 (DM1) em seu processo de autonomia no manejo da doença. Objetivos: Geral: Avaliar a efetividade da oficina educativa no desempenho da técnica de monitorização glicêmica capilar em crianças escolares com diagnóstico de DM1; Específicos: Verificar os Índices de Conformidade do procedimento da técnica de monitorização glicêmica das crianças escolares com DM1 antes e após serem submetidas à oficina educativa e comparar os Índices de Conformidade, pré- e pós-oficina, da técnica de automonitorização glicêmica das crianças com DM1 que serão submetidas à oficina educativa. Método: Trata-se de um estudo quantitativo, quase-experimental, pré-teste e pós-teste. Participaram do estudo 33 crianças escolares, de 6 a 11 anos, com DM1 há mais de um ano, usuárias de dois ambulatórios infantis de endocrinologia de um complexo hospitalar do município de São Paulo. Após a concordância dos pais e o assentimento da criança, foram assinados, respectivamente, o Termo de Consentimento Livre e Esclarecido e o Termo de Assentimento. A coleta de dados foi realizada por meio do emprego dos seguintes instrumentos: 1) Dados sociodemográficos; 2) Perfil de monitorização glicêmica e 3) Passos da técnica de monitorização glicêmica, antes da oficina educativa. Os instrumentos 2 e 3 foram reaplicados um mês e meio após o término da oficina. Resultados: Verificou-se que houve resultados estatísticos significativos para três passos da técnica de automonitorização glicêmica: trocar a lanceta do lancetador (p=0,021), pressionar o local de punção (p=0,057) e desprezar o material utilizado em recipiente adequado para perfurocortantes (p=0,004). A oficina educativa também foi eficaz para provocar mudança de comportamento nas crianças, uma vez que elas conseguiram sair de uma média de conformidade de 5,3 passos corretos da técnica de monitorização, para 6,58 passos, ou seja, passaram a executar um passo a mais em conformidade em relação ao que vinham realizando. Conclusão: A oficina educativa, por meio de atividades lúdicas, foi uma ferramenta eficaz para melhorar o desempenho da execução da técnica de automonitorização glicêmica capilar realizada por crianças escolares com DM1. / Introduction: In the case of diabetes, care must be patient-centered and the educational process and support must be permanent and shared. Blood glucose monitoring is generally the first practice of self-care taught to children with diabetes mellitus type 1 (DM1) to grant them autonomy to manage their disease. Objectives: General: To evaluate the effectiveness of the educational workshop on the performance of the capillary blood glucose monitoring technique in school children diagnosed with DM1; Specific: To check Compliance Indices of the blood glucose monitoring technique of school children with DM1 before and after being subjected to the educational workshop and to compare Compliance Indices, pre- and post-workshop, of the glucose monitoring technique of children with DM1 to be submitted to the educational workshop. Method: This is a quantitative quasi-experimental pretest and posttest study. The study included 33 school children, 6-11 years of age, with DM1 for more than a year, attended at two endocrinology pediatric clinics of a hospital complex in São Paulo. The Informed Consent Form and the Child Assent Form were signed by parents and children, respectively, upon agreeing with the protocol. Data collection was conducted through the use of the following instruments: 1) sociodemographic data; 2) glycemic profile monitoring and 3) steps for the glucose monitoring technique before the educational workshop. Steps 2 and 3 were reapplied six weeks after the end of the workshop. Results: We found that there were statistical significant results for three steps of the self-monitoring blood glucose technique: replacing the lancet of the lancing device (p = 0.021), press the puncture site (p = 0.057) and dispose of the material used in a suitable container for needles and other sharps (p = 0.004). The educational workshop was also effective to promote behavior changes in children, as they were able to move from an average of 5.3 correct steps in the compliance monitoring technique, to 6.58 steps. Therefore, they started to perform one more step correctly than they had previously done. Conclusion: The educational workshop using play activities was an effective tool to improve the performance of the capillary blood glucose monitoring technique performed by school children with DM1.

INTRODUÇÃO: O diabetes mellitus tipo 1 (DM1) e a doença celíaca (DC) são doenças de origem autoimune, com padrão genético similar e terapias embasadas em alterações dietéticas distintas; ou seja, monitorização da ingestão de carboidratos nas refeições no DM1 e dieta livre de glúten na DC.OBJETIVO: O objetivo deste estudo foi comparar o estado nutricional, o consumo alimentar, a saúde óssea e a qualidade de vida em indivíduos com associação com duas doenças crônicas. PACIENTES E MÉTODOS: Os voluntários portadores de DM1, DC e indivíduos hígidos foram recrutados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e divididos conforme os grupos: DMDC (portadores de DM1 e DC), DM (portadores de DM1), DC (portadores de DC) e GC (indivíduos hígidos). Utilizamos a bioimpedância octopolar para aferir a área de gordura visceral e a densitometria de corpo inteiro para estimar o total de gordura corporal e a densidade mineral óssea; o índice de massa corporal (IMC) e a circunferência da cintura também foram empregados para avaliação nutricional, além de exames laboratoriais. Verificou-se o consumo alimentar pelo registro alimentar de três dias e a qualidade de vida pelo questionário SF-36. RESULTADOS: Foram incluídos no estudo sessenta indivíduos controlados segundo sexo, idade, índice de massa corporal (IMC) distribuídos em quatro grupos conforme diagnóstico prévio. Houve predomínio do sexo feminino (80%) e o tempo de diagnóstico de DM foi semelhante entre os grupos DMDC e DM; no entanto, a duração da DC foi significativamente maior no grupo DC comparado ao DMDC (p = 0,0015). Em relação ao IMC, os participantes foram classificados como dentro da normalidade ou pré-obesidade e em 53,3% deles observamos aumento da circunferência da cintura. A porcentagem média de massa gorda e a área de gordura corporal foi semelhante entre os grupos e não representou aumento de risco de doenças associadas à obesidade. O consumo diário de macronutrientes foi semelhante ao padrão de referência para a população adulta; mas a ingestão de fibras, cálcio e vitamina D foi menor que a recomendada. Os parâmetros descritos para saúde óssea e as medidas laboratoriais de vitaminas e minerais foram homogêneas entre os grupos, com exceção da concentração sérica de ácido fólico e de magnésio naqueles com DC e DM1, respectivamente. A análise do SF-36 evidenciou diferença significativa entre os grupos DM e GC no domínio estado geral de saúde e vitalidade. A presença de complicações relacionadas ao diabetes foi associada a menor escore no domínio limitação emocional. CONCLUSÃO: A ingestão dietética habitual de macronutrientes e micronutrientes dos portadores de diabetes mellitus tipo 1 e doença celíaca foi semelhante aos demais grupos e não houve associação com indicadores laboratoriais de deficiências nutricionais. Além disso, a presença das duas doenças não acarretou prejuízo adicional ao metabolismo ósseo e não impactou na qualidade de vida / BACKGROUND: Type 1 diabetes mellitus (T1DM) and celiac disease (CD) are autoimmune diseases, they have similar genetic patterns and their therapies are based upon different dietary changes. Monitoring of carbohydrate intake per meal is recommended to patients with DM1, whereas a gluten-free diet, for those with CD.OBJECTIVE: The aim of the study was to compare the nutritional status, food intake, bone health and quality of life of individuals with the association of the two chronic diseases. PATIENTS AND METHODS: Volunteers with T1DM, CD and healthy subjects were recruited at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo divided into four different groups: patients with type 1 diabetes and celiac disease (DMDC group), only T1DM (DM group), only CD (DC group) and healthy controls (GC group). We used the octopolar bioimpedance to measure the area of visceral fat and whole-body densitometry to assess total body fat and bone mineral density; while nutritional status was determined by body mass index (BMI), waist circumference and general laboratory tests. We assessed food intake by a three-day food record and quality of life using the SF-36 questionnaire. RESULTS: The study included sixty individuals controlled by sex, age, BMI and distributed in four groups according to previous diagnosis and there were sex female predominance (80%). The time of diagnosis of T1DM was similar between DMDC and DM groups; however the duration of CD was significantly higher in DC group compared to DMDC (p = 0.0015). The participants were classified as normal or overweight through BMI and 53.3% of them had increased waist circumference. The average percentage of fat mass and body fat area was similar in both groups and did not represent an increased risk of diseases associated with obesity. The macronutrients consumed were usually distributed according to the reference standard for the adult population; while fiber, calcium and vitamin D intake did not reach the daily recommendations. The parameters described for bone health and laboratory measures of vitamins and minerals were similar in all groups, except for serum concentration of folic acid that was lower in individuals with CD and magnesium in those with diabetes. The SF-36 analysis revealed significant differences between the DM and the control groups regarding general health and vitality. The presence of diabetes-related complications was associated with lower scores on the emotional limitation domain among patients with T1DM. CONCLUSION: The nutritional status, food intake, bone health and quality of life of individuals of DMDC group were similar to the others groups. This allowed us to conclude that the combination of the two chronic diseases with therapies based upon different dietary changes did not deteriorate the general state of health

A manutenção da célula de ilhotas in vitro aparece como uma estratégia atraente para aumentar o resultado do transplante de ilhotas pancreáticas. Entretanto, o destino das ilhotas em cultura é determinado pelo equilíbrio entre mediadores pró e antiapoptóticos. Nós mostramos anteriormente que os níveis de HSPB1 são aumentados pela prolactina (PRL) tanto nas células beta pancreáticas humanas quanto nas células de insulinoma murino MIN6. Além disso, mostramos que os efeitos pró- sobrevivência induzidos pela prolactina nas células beta pancreáticas são mediados pela HSPB1. Uma vez que o papel da HSPB1 nas células beta não foi estudado diretamente, procuramos explorar os mecanismos moleculares pelos quais a HSPB1 medeia a citoproteção da célula beta induzida pela PRL. Para isso, células MIN6 derivadas de um insulinoma de camundongo e cultura primária de ilhotas pancreáticas murinas (I), silenciadas ou superexpressando HSPB1 foram submetidas à privação de soro e então pré- tratadas na presença ou na ausência de PRL (300 ng / mL) e expostos a ou citocinas (IL-1&#946; (0,8 ng / mL), IFN-&#947; (4 ng / mL) e TNF-&#945; (8 ng / mL) por 16 ou 24 h. Após esses períodos de tempo foi avaliada a viabilidade celular. De fato, as células silenciadas para HSPB1 tiveram maiores porcentagens de morte celular em comparação aos controles. No entanto, a superexpressão de HSPB1 sozinha imita os efeitos citoprotectores da Prolactina em ambas as células MIN6 e nas culturas primárias das ilhotas. Estes resultados mostram o papel fundamental da HSPB1 no efeito citoprotetor inibindo a apoptose inducida pelo tratamento com citocinas pró-inflamatórias. Além disso, os lisados de células Min6 tratadas com citocinas na presença ou na ausência de PRL durante 6 h foram sujeitos a imunoprecipitação de HSPB1. Proteínas coimmunoprecipitadas separadaspor SDS-PAGE e posteriormente identificadas por nano-HPLC acoplado à espectrometria de massas. Células pré-tratadas com PRL apresentaram um enriquecimento de proteínas que coprescipitaram com HSPB1 relacionadas em processos de resistência ao estresse oxidativo, degradação proteica e metabolismo de carboidratos. Células MIN6, silenciadas ou superexpressando HSPB1 foram expostas á menadiona e peróxido de hidrogênio e parâmetros oxidativos foram analisados. O silenciamento de HSPB1 promoveu células mais sensíveis ao estresse oxidativo e levou a uma redução da capacidade antioxidante, enquanto que prolactina induziu citoproteção mediada por HSPB1 contra o estresse oxidativo. A superexpressão de HSPB1, no entanto, levou a efeitos opostos. O tratamento com PRL, o silenciamento ou superexpressão de HSPB1 não mudou a expressão de enzimas antioxidantes, mas os níveis proteicos de HSPB1 estão relacionados com a modulação da razão GSH/GSSG e a atividade de G6PD. Dado de estudos recentes reportam que o perfil respiratório das ilhotas prévias ao transplante pode predizer seu desempenho e que não se sabe nada sobre se a PRL poderia modular a função mitocondrial nas células beta; no presente projeto foi investigado se o tratamento hormonal poderia aumentar a eficiência mitocondrial das células beta. Observamos que o tratamento com citocinas pró-inflamatórias produziu uma diminuição na eficiência do consumo de oxigênio mitocondrial estar relacionado à síntese de ATP. Esses resultados foram significativamente revertidos a valores similares ao obtidos nas células submetidas Às condições de máxima viabilidade após o tratamento com PRL. Além disso, os resultados mostraram que os níveis elevados de HSPB1 medeiam este efeito, uma vez que a falta desta proteína anulou significativamente a recuperação da função mitocondrial induzida pelo tratamento hormonal. Visto que as taxas de síntese de ATP mitocondrial são as responsáveis pela elevação na sua concentração intracelular e que esse evento está diretamente relacionado com a secreção de insulina nas células beta, analisamos se diferentes níveis proteicos de HSPB1 poderia modificar a função secretora de células beta. Para isso foram calculados os índices de estímulo da secreção de insulina em resposta ao aumento da concentraçãode glicose no meio de cultura tanto em células parentais MIN6 como em culturas primárias de ilhotas pancreáticas murinas que foram submetidas ou não ao silenciamento ou superexpressão de HSPB1. Nossos resultados mostraram que nem a presença de citocinas, Prolactina, ou a ausência ou superexpressão de HSPB1 nas culturas celulares analisadas apresentaram diferença significativa em relação aos índices de estímulo da secreção e conteúdo de insulina. Esses resultados sugerem que nem a falta, nem a superexpressão de HSPB1 poderia alterar a função de célula beta. Nós mostramos a relevância da HSPB1 em ambos os efeitos pró- sobrevivência da PRL contra a morte da célula beta induzida tanto por citocinas quanto por indução de estresse oxidativo. Este último efeito poderia também estar relacionado com a participação da HSPB1 na recuperação da função mitocondrial observada após o tratamento hormonal corroborando assim parte dos resultados obtidos nos experimentos de immunoprecipitação. Finalmente, nossos resultados destacam a importância de mais estudos visando um entendimento mais profundo das funções da HSPB1 nas células beta, uma vez que elas poderiam levar à mitigação da morte da célula beta através da regulação positiva de uma via de proteção endógena, que não é dependente da modulação do sistema imunológico. / The success of islet transplantation has improved lately. Unfortunately, it is still compromised by cell loss. Maintaining islet cell in vitro appears as an attractive strategy to increase the outcome of pancreatic islet transplantation. However, islet fate in culture is determined by the balance between pro- and anti- apoptotic mediators. We have previously shown that Heat Shock Protein B1 (HSPB1) levels are increased by prolactin (PRL) on both human pancreatic beta cells and MIN6 murine insulinoma cells. Furthermore, we have demonstrated the prolactin-induced pro-survival effects on pancreatic beta-cells are mediated by HSPB1. Since HSPB1 role in beta cells has not been directly studied, we set out to explore the molecular mechanisms by which HSPB1 mediates PRL-induced beta cell cytoprotection. For this purpose, MIN6 insulinoma mouse cells and primary culture of murine pancreatic islets (I) wild type, HSPB1 silenced or overexpressing the chaperone were subjected to serum starvation and then pre-treated in the presence or in the absence of PRL (300 ng/mL) and exposed to or cytokines (IL-1&#946; (0,8 ng/mL), IFN-&#947; (4 ng/mL) and TNF-&#945; (8 ng/mL)) for 16 or 24h. Then, we analyse cell viability. HSPB1silenced cells presented higher percentages of cell death compared to controls. However, the overexpression of HSPB1, independently of hormonal treatment, was able mimic the cytoprotective effects of Prolactin. These results point at the key role of HSPB1 in the cytoprotective effect against proinflammatory cytokines-induced beta cell death. In addition, lysates from Min6 cells incubated for 6 hours in the presence of a cocktail of cytokines and/or PRL were subjected to HSPB1 immunoprecipitation. Co-precipitated proteins were identified by SDS-PAGE coupled to mass spectrometry. We found an enrichment of proteins relatedto signaling pathways involved in a response against oxidative and endoplasmic reticulum stress induction. Moreover, we also identified antiapoptotic effects and carbohydrate metabolism related proteins. Indeed, HSPB1 knockdown rendered cells more sensitive to oxidative stress and led to a reduced antioxidant capacity, while prolactin induced an HSPB1- mediated cytoprotection against ROS induced beta-cell apoptosis. One again, HSPB1 overexpression mimic PRL- induced cytoprotection. While hormonal treatment, HSPB1 silencing or overexpression did not change the expression of antioxidant enzymes; this conditions influenced reduced glutathione cell content and G6DP activity. Since recent studies have pointed that islets respiratory profile prior to transplantation may predict their performance; we also investigated whether PRL treatment could increase beta-cell mitochondrial efficiency. We observed a cytokine-induced increase of mitochondrial oxygen consumption rate not related to ATP synthesis, which was significantly decreased upon PRL treatment. HSPB1 was a key mediator of this effect since the lack of this protein significantly abrogated PRL-induced mitochondrial function recovery. The secretory function was then analysed in wild type MIN6 cells as well as in primary cultures of pancreatic islets either HSPB1 silenced or overexpressing the chaperone. Cells were subjected to serum starvation and then pre-treated in the presence or in the absence of PRL and exposed to cytokines for 16 or 24h. We didn´t found significant differences in both glucose induced-insulin secretion and insulin content between the hormonal treatment, HSPB1 silencing or overexpression. These results suggest that neither lack, nor overexpression of HSPB1 could alter beta cell function. Altogether our results have shown the importance of HSPB1 on PRL prosurvival effects as well as on maintenance of mitochondrial efficiency against both cytokine treatment and oxidative-stress-induced beta cell damage. These results are in accordance with the PRL-induced enrichment of HSPB1 interacting proteins displaying functions related to protein degradation, oxidative stress protection or mitochondrial carbohydrate metabolism.Finally, our results outline the importance of further studies aiming at a deeper understanding of HSPB1 functions on beta cells, since they could lead to the mitigation of beta cell death through the up-regulation of an endogenous protective pathway, which is not dependent on the modulation of the immune system.