Aim: To investigate the quality of life and the social life situation, with special focus on the consequenses of fear of hypoglycemia (FoH), in Islet transplanted patients. Method: 11 patients were included, four women and seven men, who have been Islet tranplanted at Uppsala University Hospital during the years 2001-2009. Two questionaires, Short Form 36 (SF-36) and the Swedish version Hypoglycemia Fear Survey (Swe-HFS) were used to investigate the quality of life, in relation to fear of hypoglycemia. Also, telephone interviews were conducted to investigate the patients social life situation in relation to FoH, after Islet transplantation and were analysed using content analysis method. Results: The mean value for quality of life was lower than that in the normal population. Three out of ten patients experienced FoH. Three predominant themes were revealed, one theme associated with pre- transplant, was “Struggle for control of Social Life Situation” and two themes associated with post-transplant, were “Regain power and controll of  Social Life Situation” and “At Peace with the balance between the Present and the Future”. Conclusion: The patients experienced improved control over social life situation and quality of life in relation to FoH may been improved following islet tranplantation. / Syfte: Att undersöka ö-cellstransplanterade patienters livskvalitet och sociala livssituation med speciellt fokus på oro/rädsla för hypoglykemi. Metod: I studien inkluderades 11 patienter, fyra kvinnor och sju män, vilka genomgått ö-cellstransplantation vid Akademiska Sjukhuset i Uppsala under perioden 2001-2009. Två frågeformulär, Short Form 36 (SF-36) och den svenska versionen av Hypoglycemia Fear Survey (Swe-HFS) användes för att undersöka patienternas livskvalitet relaterat till oro/rädsla för hypoglykemi. Telefonintervjuer genomfördes för att undersöka patienternas sociala livssituation efter genomgången ö-cellstransplantation relaterat till oro/rädsla för hypoglykemi och analyserats med innehållsanalys. Resultat: Medelvärdet för hälsorelaterad livskvalitet var lägre jämfört med normalbefolkningen och tre av tio deltagare upplevde oro/rädsla för hypoglykemi. Tre övergripande teman med koppling till social livssituation identifierades, ett tema före genomgången ö-cellstransplantation, var ”Kampen om kontroll över social livssituation”, och två teman efter genomförd transplantation, var ”Återtagande av makt och kontroll över social livssituation” samt ”Tillfreds med balans mellan nuet och framtiden”. Konklusion: Patienterna upplevde att kontrollen över den sociala livssituationen och livskvalitet i relation till oro/rädsla för hypoglykemi förbättrades efter genomgången ö-cellstransplantation.

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]

Background: Changing service demands require United Kingdom ambulance services to redefine their role and response strategies, in order to reduce unnecessary Emergency Department attendances. Treat and Refer guidelines have been developed with this aim in mind. However, these guidelines have been developed in the absence of reliable evidence or guiding mid-range theory. This has resulted in inconsistencies in clinical practice. One condition frequently included in Treat and Refer guidelines is hypoglycaemia. Therefore this thesis aimed to investigate prehospital hypoglycaemic emergencies in order to develop an evidence base for future interventions and guideline development. Research approach: A pragmatic and inductive applied health services research approach was employed. Multiple methods were used in a sequential explanatory design. Three linked studies were undertaken with the results of previous studies informing the development of the next. Study one: A scoping review of prehospital treatment of hypoglycaemic events. Aims: i) To describe the demographics of the patient population requiring ambulance service assistance for hypoglycaemic emergencies; ii) To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA), experience repeat hypoglycaemic events (RHE) after being treated in the prehospital environment. Methods: A scoping literature review was conducted using an overlapping retrieval strategy that included both published and unpublished literature. Findings: Twenty-three papers and other relevant material were included. Hypoglycaemia related ambulance calls account for 1.3% to 5.2% of ambulance calls internationally. Transportation rates varied between studies (25%-73%). Repeat hypoglycaemic emergencies are experienced by 2-7% of patients within 48 hours. There was insufficient detail to determine any relationship between repeat events and OHA. The low quality of included papers means that the results should be cautiously interpreted. The safety of leaving patients on OHA at home post hypoglycaemic emergency is unknown. Consequently patients taking OHAs who experience a hypoglycaemic emergency should be transported to hospital for observation. There was a lack of knowledge about the Scottish demographics of the patient population. Study two: A retrospective cross-sectional observational study of diabetes related emergency calls. Aims: To investigate i) the patient demographics and characteristics of hypoglycaemia related emergency calls; ii) the incidence of repeat hypoglycaemic events; and iii) the factors associated with emergency calls that result in individuals being left at home. Methods: A retrospective observational cross-sectional study conducted using Medical Priority Dispatch System® call data from West of Scotland Ambulance Control Centre over a 12 month period. Data were extracted on age, gender, dispatch code, time of call, deprivation category, and immediate outcome (home or hospital). Multiple regression analysis was used to determine predictors of remaining at home. Findings: 1319 calls for hypoglycaemia were received. Patient demographics were similar to the scoping review findings. Most patients remained at home (N = 916 vs N = 380; p < .001). RHE’s were experience by 3.1% within 48 hours, and 10.6% within two weeks. The most significant independent predictor for patients remaining at home was a prior call to the ambulance service (OR of 2.4 [95%CI 1.5 to 3.7]). Patients’ reasons for remaining at home and the causes of subsequent severe events are unknown. It is likely that non-clinical factors may explain some of this behaviour. Study 3: Investigating patients’ experiences of prehospital hypoglycaemic care. Aim: To investigate the experiences of patients who are attended by ambulance clinicians for a hypoglycaemic emergency. Methods: In-depth interviews with adults with diabetes who had recently experienced a hypoglycaemic emergency treated by ambulance clinicians. Participants were recruited from Greater Glasgow and Clyde and Lanarkshire Health Board areas. Data were analysed using Framework Analysis. Findings: Twenty six patients were interviewed. Three key themes were developed. Firstly, an explanation for help seeking behaviour; patients’ impaired awareness of hypoglycaemia as well as the inability of friends and relatives to cope can contribute to an ambulance call-out. Secondly, the perceptions of ambulance service care; patients felt the service provided was good; however ambulance clinicians’ advice was inconsistent. Thirdly, the influences on uptake of follow-up care; patient preferences for follow-up care were influenced by previous experiences of home, hospital and primary care. Post-hoc analysis identified three psychological theories that may explain these findings and provide a useful basis for intervention development: Common Sense Model (Leventhal et al, 1998); Health Belief Model (Rosenstock, 1966); Ley’s cognitive hypothesis model of communication (Ley and Llewelyn, 1995; 1981). Conclusion: Most people treated for severe hypoglycaemia by ambulance clinicians remain at home and do not follow-up their care. A few experience repeat hypoglycaemic emergencies. Key causal, but modifiable factors, contributing to this include:- impaired awareness of hypoglycaemia; inconsistent delivery of ambulance clinician referral advice; and patients’ perceptions of the costs and benefits of follow-up care. Ambulance services cannot address all these factors in isolation. The studies in this thesis have generated an evidence base and identified plausible candidate theories. This will support the future development of novel interventions to improve severe hypoglycaemic emergency follow-up.

O presente estudo teve como objetivo relacionar os níveis de indicadores sanguíneos energéticos e de cálcio na ocorrência de afecções uterinas, mastite clínica e mastite subclínica em vacas de raça Holandesa. A presença de mastite foi monitorada através do California Mastitis Test (CMT) e da contagem de células somáticas, para a identificação de mastite subclínica, e do Teste da Caneca de Fundo Preta (TCFP), para identificação de mastite clínica. A presença das afecções uterinas foi identificada mediante exame clínico. Foram feitas coletas de sangue para a determinação dos níveis de cálcio (Ca), glicose e β-hidroxi-butirato (BHB). O CMT foi realizado nas duas primeiras semanas após o parto, o TCFP foi realizado conforme a rotina de ordenha, estabelecida pela propriedade, e as coletas de sangue foram realizadas na semana anterior ao parto e duas coletas até os 21 dias posteriores ao parto. A ocorrência de hipocalcemia subclínica foi determinada quando o Ca no soro atingiu valores ≤ 8,00 mg/dL, hipoglicemia com valores de glicose ≤ 50 mg/dL e hipercetonemia com valores de BHB ≥ 1,2 mmol/L. Nas vacas com mastite clínica foi realizado tratamento conforme estabelecido pelo protocolo de ordenha e tratamentos da fazenda. Os dados de mastite subclínica obtidos através do teste de CMT, por quarto mamário, foram validados através de cultura microbiológica realizada em laboratório de referência e em laboratório na fazenda para identificar crescimento bacteriano, bem como através da contagem de células somáticas (CCS) e da contagem bacteriana total (CBT). Não foi encontrada relação significativa entre a hipocalcemia subclínica, a hipoglicemia e a hipercetonemia com afecções uterinas e da glandula mamária nas vacas após o parto. / This study aimed to relate the levels of energy and calcium in the occurence of both uterine diseases, clinic and subclinic mastitis in Holstein cows. The presence of mastitis was monitored through California Mastitis Test (CMT) and the counting of somatic cells (CSC), for the identification of subclinic mastitis, and strip cup test, for the identification of clinic mastitis. The presence of uterine disorders was identified by clinical examination. Blood collections were made for determining calcium, glicose and β-hydroxy-butyrate (BHB). CMT was realized in the first two weeks after calving, BBMT was realized according to the routine of milking settled by the farm and the blood collections were made in the week before the calving and also two collections were made after it. The occurrence of subclinic hypocalcemia was determined when serum Ca reached ≤ 8,00 mg/dL, hypoglycemia with glucose values ≤ 50 mg/dL and hyperketonemia values with BHB BHB ≥ 1,2 mmol/L. Data of clinic mastitis were obtained through the identification of altered milk in BBMT and subsequently realized treatment as settled by the milking protocol and treatments of the farm. Data of subclinic mastitis were obtained through CMT test, for mammary quarter, and validated by microbiological culture in reference laboratory, culture in the farm for identifying the bacterial growth, counting of somatic cells (CSC) and total bacterial counting (TBC). It was not identified in the study any relationship between subclinical hypocalcemia and uterine and mammary gland diseases in cows after calving.

O presente estudo teve como objetivo relacionar os níveis de indicadores sanguíneos energéticos e de cálcio na ocorrência de afecções uterinas, mastite clínica e mastite subclínica em vacas de raça Holandesa. A presença de mastite foi monitorada através do California Mastitis Test (CMT) e da contagem de células somáticas, para a identificação de mastite subclínica, e do Teste da Caneca de Fundo Preta (TCFP), para identificação de mastite clínica. A presença das afecções uterinas foi identificada mediante exame clínico. Foram feitas coletas de sangue para a determinação dos níveis de cálcio (Ca), glicose e β-hidroxi-butirato (BHB). O CMT foi realizado nas duas primeiras semanas após o parto, o TCFP foi realizado conforme a rotina de ordenha, estabelecida pela propriedade, e as coletas de sangue foram realizadas na semana anterior ao parto e duas coletas até os 21 dias posteriores ao parto. A ocorrência de hipocalcemia subclínica foi determinada quando o Ca no soro atingiu valores ≤ 8,00 mg/dL, hipoglicemia com valores de glicose ≤ 50 mg/dL e hipercetonemia com valores de BHB ≥ 1,2 mmol/L. Nas vacas com mastite clínica foi realizado tratamento conforme estabelecido pelo protocolo de ordenha e tratamentos da fazenda. Os dados de mastite subclínica obtidos através do teste de CMT, por quarto mamário, foram validados através de cultura microbiológica realizada em laboratório de referência e em laboratório na fazenda para identificar crescimento bacteriano, bem como através da contagem de células somáticas (CCS) e da contagem bacteriana total (CBT). Não foi encontrada relação significativa entre a hipocalcemia subclínica, a hipoglicemia e a hipercetonemia com afecções uterinas e da glandula mamária nas vacas após o parto. / This study aimed to relate the levels of energy and calcium in the occurence of both uterine diseases, clinic and subclinic mastitis in Holstein cows. The presence of mastitis was monitored through California Mastitis Test (CMT) and the counting of somatic cells (CSC), for the identification of subclinic mastitis, and strip cup test, for the identification of clinic mastitis. The presence of uterine disorders was identified by clinical examination. Blood collections were made for determining calcium, glicose and β-hydroxy-butyrate (BHB). CMT was realized in the first two weeks after calving, BBMT was realized according to the routine of milking settled by the farm and the blood collections were made in the week before the calving and also two collections were made after it. The occurrence of subclinic hypocalcemia was determined when serum Ca reached ≤ 8,00 mg/dL, hypoglycemia with glucose values ≤ 50 mg/dL and hyperketonemia values with BHB BHB ≥ 1,2 mmol/L. Data of clinic mastitis were obtained through the identification of altered milk in BBMT and subsequently realized treatment as settled by the milking protocol and treatments of the farm. Data of subclinic mastitis were obtained through CMT test, for mammary quarter, and validated by microbiological culture in reference laboratory, culture in the farm for identifying the bacterial growth, counting of somatic cells (CSC) and total bacterial counting (TBC). It was not identified in the study any relationship between subclinical hypocalcemia and uterine and mammary gland diseases in cows after calving.

Orientador: Marcio Alberto Torsoni / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T22:25:41Z (GMT). No. of bitstreams: 1 Santos_GustavoAparecidodos_M.pdf: 1529206 bytes, checksum: e9aae5229598f14274aea766dccadceb (MD5) Previous issue date: 2013 / Resumo: A hipoglicemia endotóxica tem papel importante na sobrevivência de ratos e pacientes com sepse. O hipotálamo e uma importante área no sistema nervoso central que regula a homeostase energética. Estudos recentes têm demonstrado à importante papel da proteína quinase ativada por AMP (AMPK) no controle da homeostase glicêmica, sendo um importante sensor energético ativado quando a uma diminuição de disponibilidade energética como é observado na hipoglicemia, e por controlar importantes estímulos que visão restabelecer a glicemia como a modulação da produção de glicose hepática. Até o momento não existem estudos que investiguem o papel da AMPK hipotalâmica na endotoxemia e na hipoglicemia associada a essa enfermidade. Por isso o objetivo do nosso estudo foi o de avaliar a participação das citocinas inflamatórias e da AMPK hipotalâmica na redução da resposta contrarregulatória hepática durante a endotoxemia promovida por LPS. Para isso foram utilizados camundongos (Swiss) e camundongos com mutação no receptor TLR4 (C3H/HeJ) e seus controles selvagens (Wild type (C3H/HeN)) ambos os animais receberam LPS (1mg/Kg) ou salina intraperitonealmente ou/e AICAR por via intracerebroventricular e após os tempos pré-estabelecidos obtivemos os resultados que mostram que a administração periférica de LPS induz o aumento nas citocinas TNF? e IL?, ocorreu a desfosforilação da AMPK hipotalâmica e menor fosforilação da sua proteína alvo a ACC se comparado ao grupo controle; desfosforilação da AMPK hepática e ACC hepática, aumento da fosforilação da STAT3 hipotalâmica e hepática, aumento da fosforilação a TAK1 hipotalâmica e quantidade da MyD88 hipotalâmica proteínas da via do TLR4 se comparado ao grupo controle, também foi observado aumento na fosforilação da JNK hepática, redução da ingestão alimentar, redução da glicemia basal e um possível aumento na captação de glicose observada pelo teste de tolerância à glicose nos animais que receberam LPS, também foi observado à diminuição da quantidade e expressão da proteína PEPCK e diminuição da G6Pase resultado que corroborou o resultado da diminuição da produção de glicose hepática observada no teste de tolerância ao piruvato (PTT). A redução na glicemia nos animais nos gerou uma hipótese de que esse efeito pode ter a participação da insulina onde observamos um significativo aumento nos níveis séricos deste hormônio, a ativação farmacológica da AMPK hipotalâmica reduziu o efeito hipoglicemiante do LPS, onde também observamos que a ativação farmacológica da AMPK inibiu a diminuição das proteínas PEPCK e G6Pase deflagrado pelo LPS sugerindo que a um controle hipotalâmico através da AMPK sobre a secreção de glicose. Nos animais mutantes do receptor TLR4 (C3H/HeJ) não houve diminuição da glicemia e desfosforilação da AMPK hipotalâmica e diminuição da PEPCK hepática como observamos nos animais Wild type (C3H/HeN). Mostrando que o receptor TLR4 possui uma atividade intrínseca na indução à hipoglicemia e desfosforilação da AMPK. Os dados do nosso trabalho mostram que a endotoxemia ocasionada pela administração de LPS exerce uma importante modulação da ação da AMPK hipotalâmica, modulação negativa da ingestão e glicemia plasmática, alem de inibir a produção de glicose e expressão e quantidades de proteínas neoglicogênicas e ativação de vias inflamatórias mostrando que a sepse e/ou endotoxemia por LPS leva a severos danos na homeostase glicêmica, contudo também mostramos que a ativação da AMPK hipotalâmica consegue minimizar os efeitos oriundos da endotoxemia, mostrando que mecanismos que atuem sobre a ativação da AMPK hipotalâmica podem contribuir para o tratamento da Sepse/endotoxemia / Abstract: Endotoxic hypoglycaemia has an important role in the survival rates of septic patients. Currently, the hypothalamus is the main area of the brain that regulates glycemic homeostasis. Previous studies have demonstrated that hypothalamic AMP-activated protein kinase (AMPK) activity is sufficient for nutrient-sensing mechanisms to modulate glucose production. However, the role of hypothalamic AMPK in hypoglycaemia associated with endotoxemia is unknown. The aims of this study were to examine hypothalamic AMPK dephosphorylation in lipopolysaccharide (LPS) treated mice and to determine whether pharmacological AMPK activation could reduce the effects of endotoxemia on the liver metabolism of glucose. Fasted Swiss mice and C3H/HeJ (TLR4-receptor mutant) and C3H/HeN (wild type) mices received intraperitoneal injections of LPS (1mg/kg). LPS-treated mice showed reduced food intake and diminished basal glycemia, increased serum TNF? and IL1? levels and hypothalamic p-TAK and TLR4/MyD88 association. These effects were accompanied by hypothalamic AMPK/ACC dephosphorylation and reduction of glucose production in the liver. Interestingly, the LPS treated mice liver also showed diminished expression of PEPCK/G6Pase and reduction in p-FOXO1, p-AMPK, p- STAT3 and p-JNK level. In contrast, the pharmacological hypothalamic AMPK activation blocked the effects of LPS on the hypothalamic AMPK phosphorylation, liver PEPCK expression and glucose production. Furthermore, the effects of LPS were TLR4-dependent because no effect on hypothalamic AMPK phosphorylation, liver PEPCK expression and basal glycemia was detected in C3H/HeJ (TLR4- receptor mutant) mice. These results suggest that hypothalamic AMPK activity may be an important pharmacological target to control glucose homeostasis during endotoxemia / Mestrado / Clinica Medica / Mestre em Ciências

Indiana University-Purdue University Indianapolis (IUPUI) / The link between volatile organic compounds (VOCs) from breath and various diseases and specific conditions has been identified since long by the researchers. Canine studies and breath sample analysis on Gas chromatography/ Mass Spectroscopy has proven that there are VOCs in the breath that can detect and potentially predict hypoglycemia. This project aims at developing a smart nanosensor system to detect hypoglycemia from human breath. The sensor system comprises of 1-Mercapto-(triethylene glycol) methyl ether functionalized goldnanoparticle (EGNPs) sensors coated with polyetherimide (PEI) and poly(vinylidene fluoride -hexafluoropropylene) (PVDF-HFP) and polymer composite sensor made from PVDF-HFP-Carbon Black (PVDF-HFP/CB), an interface circuit that performs signal conditioning and amplification, and a microcontroller with Bluetooth Low Energy (BLE) to control the interface circuit and communicate with an external personal digital assistant. The sensors were fabricated and tested with 5 VOCs in dry air and simulated breath (a mixture of air, small portion of acetone, ethanol at high humidity) to investigate sensitivity and selectivity. The name of the VOCs is not disclosed herein but these VOCs have been identified in-breath and are identified as potential biomarkers for other diseases as well. The sensor hydrophobicity has been studied using contact angle measurement. The GNPs size was verified using Ultra-Violent-Visible (UV-VIS) Spectroscopy. Field Emission Scanning Electron Microscope (FESEM) image is used to show GNPs embedded in the polymer film. The sensors sensitivity increases by more than 400\% in an environment with relative humidity (RH) of 93\% and the sensors show selectivity towards VOCs of interest. The interface circuit was designed on Eagle PCB and was fabricated using a two-layer PCB. The fabricated interface circuit was simulated with variable resistance and was verified with experiments. The system is also tested at different power source voltages and it was found that the system performance is optimum at more than 5 volts. The sensor fabrication, testing methods, and results are presented and discussed along with interface circuit design, fabrication, and characterization. / 2022-05-8

This thesis, entitled The Specific Needs of a Child with Type 1 Diabetes Mellitus in Primary School, is divided into two main parts. The theoretical part deals with the disease of diabetes mellitus, mainly type 1 diabetes mellitus and the specifics of childhood diabetes. In the practical part I focus on identifying the specific needs of children with type 1 diabetes mellitus attending the first level of primary school. Research information was obtained through interviews with parents of these children. The aim of the research was also to determine the level of satisfaction of parents with the schools' approach and whether and what they would like to change about the schools' approach. According to the responses, all school staff should know that a child is diabetic and be able to help them with hypoglycaemia. The child should be able to tell their classmates about the illness, respond to glycaemia at any time and contact parents if necessary. A negative experience associated with diabetes in the school environment was reported by 6 out of 15 children. In contrast, the same number of parents were satisfied with the approach and found nothing they wished to change. Parents would like teachers to be more empathetic and better educated. As a didactic output, an educational lecture was developed for...

Les diètes faibles en glucides (Low-Carbohydrate Diet [LCD]; moins de 30 % de l'énergie provenant des glucides) gagnent en popularité chez les personnes atteintes de diabète de type 1 (DbT1). Cependant, l’impact de ces diètes sur le contrôle glycémique et le risque cardiovasculaire (CV) est controversé. Objectif : Évaluer les associations entre le score LCD, le contrôle glycémique et des facteurs de risque CV chez les adultes atteints de DbT1 par le biais d’un registre de DbT1 au Québec (Canada). Méthodologie : Il s’agit d’une étude transversale des données du registre BETTER, utilisant les rappels alimentaires de 24 heures afin de calculer les scores LCD et incluant les données suivantes : mesures anthropométriques auto-rapportées ou mesurées (ex. tour de taille), questionnaires sur les antécédents d’épisodes d’hypoglycémies modérées (nombre d’épisodes dans le dernier mois) et sévères (présence d’au moins un épisode dans la dernière année), perception altérée des symptômes de l’hypoglycémie (score Clarke ≥4) et données biochimiques (HbA1c, cholestérol LDL et cholestérol non-HDL). Un score de 0 à 10 points a été attribué pour chaque macronutriment pour un total de 30 points. Pour les glucides, les participants avec l’apport le plus faible ont reçu 10 points, et l’attribution des points a été inversée pour les lipides et protéines, les participants ayant les apports les plus élevés recevant 10 points. Les participants ont été divisés en quartiles (Q) en fonction de leur score LCD. Résultats : 285 adultes (âgés de 48,2 ± 15,0 ans ; durée du DbT1 de 25,9 ± 16,2 ans) ont été inclus. Dans l’ensemble, les participants ont rapporté des apports faibles en glucides et en fibres et un apport élevé en lipides comparativement aux recommandations. L'apport moyen en glucides contribuait à 31,2 ± 6,9 % (Q1) à 56,5 ± 6,8 % de l'apport énergétique total (Q4). Par rapport au Q4, plus de personnes au Q1 ont signalé une HbA1c ≤ 7 % (Q1 : 53,4 % vs Q4 : 29,4 %; p = 0,011). Les participants au Q3 ont rapporté moins souvent d’avoir un antécédent d’hypoglycémie sévère que le Q1 (Q1 : 60,0 % vs Q3 : 31,0 %; p = 0,004). Il n’y avait aucune différence entre les quartiles pour la fréquence d’évènements d’hypoglycémies modérées, l’altération de la perception des symptômes de l’hypoglycémie et le profil lipidique : cholestérol LDL et cholestérol non-HDL. Conclusions : Les participants avec un faible apport en glucides sont plus nombreux à atteindre la cible d’HbA1c et moins nombreux à présenter des antécédents d’hypoglycémie sévère comparativement à ceux ayant un apport plus élevé en glucides. Cependant, la LCD n’est pas associée à une fréquence de l’hypoglycémie modérée, à une altération de la perception des symptômes de l’hypoglycémie, ni aux facteurs de risque CV. / Low-carbohydrate-diets (LCD; less than 30% of energy from carbohydrates) are gaining popularity in individuals with type 1 diabetes (T1D). However, the impact of such diet on glycemic control and cardiovascular (CV) risk factors is debated. Objective: To evaluate associations between LCD score, glycemic control and CV risk factors in adults with T1D using a registry in Québec (Canada). Research Design and Methods: This is a cross-sectional study using data from the BETTER registry, using 24-hour dietary recalls to calculate LCD scores and including the following data: self-reported or measured anthropometric data (e.g. waist circumference), questionnaires on history of moderate (number of episodes in the last month) and severe (experienced at least one episode in the last year) hypoglycemic episodes, impaired awareness of hypoglycemia (Clarke score ≥4) and biochemical data (HbA1c, LDL-cholesterol and non-HDL-cholesterol). A score of 0 to 10 points was given for each macronutrient for a total of 30 points. For carbohydrates, participants with the lowest intake received 10 points, and the point allocation was reversed for fat and protein, meaning participants with the highest intakes received 10 points. Participants were divided into quartiles (Q) based on LCD score. Results: 285 adults (aged 48.2 ± 15.0 years; T1D duration of 25.9 ± 16.2 years) were included. Overall, participants reported low carbohydrate and fiber intakes and high fat intake compared to recommendations. Mean carbohydrate intake ranged from 31.2 ± 6.9 % (Q1) to 56.5 ± 6.8 % of total energy (Q4). Compared to Q4, more people in Q1 reported HbA1c ≤7 % (Q1: 53.4 % vs Q4: 29.4 %; P = 0.011). Participants in Q3 reported less often having a history of severe hypoglycemia than Q1 (Q1: 60.0 % vs Q3: 31.0 %; P = 0.004). There were no differences between quartiles for frequency of moderate hypoglycemia events, impaired awareness of hypoglycemia and lipid profile: LDL-cholesterol and non-HDL-cholesterol. Conclusions: Participants with low carbohydrate intake are more likely to reach HbA1c target and less likely to have a history of severe hypoglycemia compared to those with a higher carbohydrate intake. However, LCD is not associated with moderate hypoglycemia frequency, impaired hypoglycemia awareness or CV risk factors.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19399号 / 医博第4050号 / 新制||医||1012(附属図書館) / 32424 / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 川口 義弥, 教授 小川 誠司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM