This study examined how children and adolescents with type 1 diabetes mellitus' (T1DM) glucose levels during and prior to academic performance impact the outcome on a variety of reading, writing, and mathematics tasks. The study sample was selected from a larger study. Participants wore a continuous glucose monitor for approximately six days and complete a neurobehavioral evaluation that consisted of a variety of tasks including tasks that assessed basic reading skills, reading fluency, reading comprehension, math fact fluency, math calculation, math problem solving, spelling, and writing fluency. Results indicated that individuals who experience extreme glucose levels (e.g. hyperglycemia or hypoglycemia) perform worse on spelling accuracy tasks. Additionally, when an individual is hyperglycemic his or her reading and writing fluency skills decrease. Moreover, poor glucose control prior to academic performance increased individual's risk for exhibiting impaired performance on reading and mathematics tasks. Overall, the study results suggest that one's glucose levels prior to and during academic performance potentially impact overall execution of reading, writing, and mathematics abilities. Therefore, these findings support the need to move beyond consideration of only overall glucose levels and review temporal influence of glucose levels on academic performance to track fluctuations on academic performance and determine necessary accommodations to buffer glycemic dysregulation effects. In particular, individuals whose glucose levels are frequently within the hyperglycemic range are at greatest risk for performing below their optimal level.

Background and Objective: Type 1 diabetes mellitus (T1DM) is one of the most common pediatric chronic illnesses. Youth with T1DM have been shown to be at risk for internalizing problems and obtaining insufficient sleep. An emerging body of literature has demonstrated the feasibility and potential benefit of increasing sleep duration as a strategy to improve psychological outcomes in nondiabetic school age populations. The current study seeks to investigate the relationship between sleep and internalizing symptoms and empirically examine the effect of a sleep extension intervention on internalizing symptoms in youth with T1DM. Methods: The sample consisted of 106 youth with T1DM (mean age = 13.5 ± 2.1 years) who were part of a larger study recruited over a three-year period. Participants were 52.8% male and 50.9% identified as non-white. The primary outcome measure was the Behavior Assessment System for Children, Second Edition (BASC-2), both parent and self-report. Other behavioral and sleep measures included actigraphy, sleep diary, the School Sleep Habits Survey (SSHS), Pediatric Symptoms Checklist (PSC), and the Child Sleep Habits Questionnaire (CSHQ). Participants were randomly assigned to either the Sleep Extension condition (n = 50), in which they were asked to extend their sleep duration, or the Fixed Sleep Duration condition (n = 56), in which they were asked to maintain the same amount of sleep as their baseline. Results: Average sleep durations varied across measures, with all values falling in the lower range or below national recommendations. More than a third (34.5%) of the sample had elevated scores for internalizing problems based on parent report, and 17.7% were elevated based on self-report. Pearson correlations indicated that parent reported sleep duration was negatively related to self-reported anxiety, r(106) = -0.237, p = 0.018, as well as parent-reported depression, r(106) = -0.218, p = 0.028, and emotional self-control, r(106) = -0.232, p = 0.018. No other measure of sleep duration was significantly correlated with internalizing symptoms. Secondary analyses of measures of sleep quality including sleep efficiency (SE), wake after sleep onset (WASO), and sleepiness, were significantly related to internalizing problems based on both parent and self-report (all p < 0.05), whereas more variability in sleep duration (CV) was related to higher self-reported depression, r(106) = 0.210, p = 0.033. Following the sleep intervention, participants in the Sleep Extension condition increased their average sleep duration by 26.71 minutes based on actigraphy, while participants in the Fixed Sleep duration decreased by 0.14 minutes from pre- to post-intervention. Participants in the Sleep Extension condition had significantly lower scores on the BASC-2 Internalizing Problems Composite than participants in the Fixed Sleep Duration condition following the intervention, after controlling for sex and baseline internalizing symptoms, F(1, 98) = 4.18, p = 0.044. On average, the Internalizing Problems Composite score of participants in the Sleep Extension condition decreased by almost half a standard deviation (4.65 ± 6.41 points), compared to a decrease of 2.31 ± 6.59 points for participants in the Fixed Sleep Duration condition. There were no significant effects for self-report. Conclusions: Youth with T1DM obtained insufficient sleep and experienced high rates of internalizing symptoms. The results also suggest that relations between sleep and internalizing symptoms exist; however, these associations may be more driven by other aspects of sleep rather than actual sleep loss, such as nighttime sleep disturbance, daytime sleepiness, and variability of the sleep schedule. The findings further indicated that a sleep extension intervention was effective in increasing sleep duration, as well as reducing parent-reported internalizing symptoms in a sample of children and adolescents with T1DM. This intervention has the potential to be utilized as a cost effective, and relatively easy to implement method for reducing internalizing symptoms in youth with T1DM.

Type 1 diabetes (T1D) is an autoimmune disorder, targeting the β-cells of the pancreas. Processes occurring in the gut and pancreas are inferred to be involved. The pre-diabetic expression signature in these tissues is largely uncharacterized. HYPOTHESIS: Spontaneous models of T1D, the LEW.1AR1/Ztm-iddm rat (LEW-DP) and BioBreeding diabetes-prone rat (BBdp) exhibit a distinct transcriptional signature prior to T1D onset. Transcriptional profiling was used to elucidate the expression signatures of the LEW-DP gut and BBdp pancreas. The LEW-DP gut displayed decreased expression of markers of anti-inflammatory M2 macrophages. The LEW-DP rats showed an upregulation of markers of pro-inflammatory signaling when fed a diabetes-promoting cereal diet compared with LEW-DP rats fed a protective hydrolyzed casein diet. Prospective pancreatectomy was used to analyze T1D development in the BBdp rat. Significant upregulation of β-cell markers Reg3α, Reg3β, and Trim26 was observed in pre-diabetic rats. Thus, it was shown that environment modifies the transcriptional program and the transcriptional profile is programmed early to affect T1D development.

Cardiovascular complications represent the leading cause of death in chronic kidney disease (CKD) patients. Significant renal mass reduction induced by 5/6 subtotal nephrectomy (Nx) animal model leads to a chain of events that culminates in hypertension and CKD. The renin angiotensin (Ang) system (RAS) is known to be dysregulated, specifically Ang type 1 receptor (AT1R) plays a major role in development and progression of the disease. However, conflicting results have been reported on intrarenal AT1R levels, and the impact of antihypertensive drugs on RAS signaling is divergent. We hypothesize that PET imaging will be able to quantify kidney AT1R expression reliably in healthy and disease states. The broad objectives of this research project were: (i) to develop a positron emission tomography (PET) probe capable of detecting changes in the AT1R binding in the kidney; (ii) to elucidate the nature/temporal role of renal AT1R in Nx rat model of CKD; and (iii) to explore the predictive value of non-invasive PET imaging of AT1R to guide the use of antihypertensive therapy in preventing the progression of the disease. The novel selective AT1R PET radioligand [18F]FPyKYNE-losartan was successfully used with PET in detecting renal AT1Rs at early and late stages of the CKD. The PET results correlated well with in vitro [125I]-[Sar1, Ile8]Ang II autoradiography. Over the time-course of the study (10-20 weeks), the Nx rats exhibited renal impairment, proteinuria and sustained hypertension. Echocardiography indicated the development of cardiac hypertrophy most likely secondary to the hyperdynamic circulation. These abnormalities were associated with increasing plasma and kidney levels of Ang II, and compensatory downregulation of renal AT1Rs. ACEI enalapril attenuated renal impairment, hypertension and prevented progression of cardiac hypertrophy in Nx rats. This was successfully accomplished through reduction of systemic and kidney Ang II, and consequent normalization of renal AT1R as measured by PET (and autoradiography). The non-dihydropyridine CCB diltiazem also reduced blood pressure but did not normalize renal AT1R expression. Diltiazem induced elevation in Ang II levels in plasma, kidney and heart, associated with exacerbation of renal and cardiac dysfunction, and no change in AT1R renal expression. This outcome adds value to the use of [18F]FPyKYNE-losartan PET for determination of receptor abnormalities with progression of the disease and monitoring of therapy.

Background About 7000 children and teenagers live with type 1 diabetes in Sweden. Parents take a big responsibility when it comes to their child's diabetes care. Nurses play an important role when it comes to supporting parents during this time. In order to increase knowledge about how nurses can develop their support for this group, it’s important to study parents' experiences of living with and supporting their teenager with the disease.Aim The aim of this study was to investigate parents' experiences of being a parent to a teenager with type 1 diabetes.Method A qualitative literature review method was chosen to investigate parents' experiences of being a parent to a teenager with type 1 diabetes. The literature review included nine scientific articles from CINAHL and PUBMED.Results Two main themes emerged: (1) Concerned parents and (2) Lack of knowledge about diabetes and diabetes management. Parents felt that they did not have time to take care of their own well-being which resulted in mental illness among many parents. Most parents experience difficulties in handing over the responsibility of the diabetes care to their teenager,as they are worried about what the future. Most parents feel insecure in several daily situations, showing evidence of a lack of knowledge.Conclusion Nurses need to focus more on caring for parents. It is important that the nurse pays attention to parents' need for support. By involving parents in the care, a good relationship is created between the nurses and the parents. / I denna litteraturstudie undersöks upplevelser av att vara förälder till en tonåring med diabetes typ 1. Diabetes typ 1 drabbar till största del barn och ungdomar, och att drabbas av en kronisk sjukdom i tonåren är en utmaning för de flesta. Genom att analysera tidigare forskning om föräldrars upplevelser visades två huvudteman kring att föräldrar känner oro och uppleverokunskap. Resultatet visade att när ett barn eller tonåring drabbas av diabetes typ 1 spelar föräldrarna en central roll i vårdandet, de är ofta närvarande och får ta det största ansvaret till en början. Föräldrar upplever ofta sjukdomshanteringen som krävande och stressande, vilket påverkar föräldrarnas psykiska mående. Daglig ångest och oro plågar många tonåringar och föräldrar som lever med diabetessjukdomen nära, tonåringar upplever ofta skamkänslor vilket upprör föräldrarna. Psykisk ohälsa bland föräldrar är vanlig, speciellt hos mödrar då det största ansvaret ofta läggs på dom när det kommer till att hantera diabetessjukdomen. En stor oro över att deras tonåring ska drabbas av lågt blodsocker påverkade många föräldrar, denna oro gör det svårt att släppa kontrollbehoven. Konflikter mellan tonåring och förälder var vanlig då föräldrar upplever tonåringen som krävande och svårhanterad. När ens barn blir tonåring vill de gärna ta eget ansvar, över sitt liv men också över sin sjukdom. Föräldrar berättar att det är väl medvetna om att tonåringen kommer klara det och att överlämningen av ansvaret måste ske, men är oroliga över vissa situationer en tonåring kan hamna i. Föräldrar upplevde också en rädsla över dagliga situationer som rörde diabetessjukdomen, vilket kunde förklaras med okunskap och osäkerhet hos föräldrarna. Föräldrar hade önskat en mer lättillgänglig källa att hitta snabb och lätt information på, då de upplever att information de tidigare fått inte uppfattats ordentligt på plats. Sjuksköterskor behöver hitta en bra balans av att vårda tonåringen i samband med föräldrarna. Resultatet visar att föräldrarna behöver stöd och hjälp, det är sjuksköterskans ansvar att se till att föräldrarna får ordentligt med stöd under denna stressiga tid.

Bakgrund: Fysisk aktivitet vid diabetes typ 1 är viktig. Den kan förbättra blodsockerkontrollen över tid. Det har uttryckts ett behov av vidare studier för att undersöka vilket stöd diabetiker får från sjukvården gällande fysisk aktivitet. Det behöver även undersökas om personer med diabetes upplever rädsla för att vara fysiskt aktiva på grund av risken för hypoglykemi.    Syfte: Syftet med denna kvalitativa studie är att via intervjuer undersöka vilket stöd individer med nydiagnostiserad diabetes typ 1 upplever att de får från sjukvården gällande fysisk aktivitet. Studien ska även belysa vilka erfarenheter patienter med diabetes typ 1 har gällande rädsla kopplad till fysisk aktivitet samt vad de anser skulle kunna minska den rädslan.    Metod: I studien användes en kvalitativ deskriptiv design och datainsamlingen genomfördes med fem semistrukturerade intervjuer. Databearbetningen gjordes med kvalitativ innehållsanalys.   Resultat: Upplevelserna av råden från sjukvården gällande fysisk aktivitet skiljde sig mellan de intervjuade. För dem som haft diabetes kortast tid framstod råden som bra men generella, medan de som levt med sin diabetes en längre tid tyckte att råden var mer individanpassade. Mer individanpassade råd önskades. Ingen av de intervjuade uttryckte specifik rädsla för att vara fysiskt aktiv.   Konklusion: Råden diabetiker får från sjukvården är bra men otillräckliga. I framtiden skulle det behövas mer stöd kring fysisk aktivitet i form av träningsspecifika råd och uppmuntran. / Background: For people diagnosed with type 1 diabetes physical activity is important. It can improve glucose control over time. A need for further research about the support diabetics receive from healthcare professionals regarding physical activity has been expressed. There is also a need for investigating if diabetics experience fear of being physically active due to the risk of hypoglycemia.    Purpose: The purpose of this qualitative study is to explore, through interviews, what support individuals with newly diagnosed type 1 diabetes receive from healthcare professionals regarding physical activity, and how they experience this support. The study will also illustrate what experiences people with type 1 diabetes have regarding fear of being physically active as well as what they believe can reduce that potential fear.   Method: The study used a qualitative descriptive design, and data collection was conducted through five semi-structured interviews. Qualitative content analysis was used to process the data.   Results: The interviewees’ experiences of the advice from healthcare professionals regarding physical activity was inconsistent. For those who have lived with diabetes for a shorter period of time, the advice was considered good but quite general. Those who have lived with their diabetes for a longer period of time thought that the advice was more individualized. More individualised advice was requested. None of the interviewees expressed specific fear of being physically active.   Conclusion: The advice diabetics receives from healthcare professionals is considered good but insufficient. In the future more support will be needed regarding physical activity in the form of exercise-specific advice and encouragement.

Magister Chirurgiae Dentium (MChD) / Chronic inflammation of the periodontium is known as periodontal disease. The inflammation can be contained only within gingival connective tissue or can progress, leading to the loss of gingival connective tissue and alveolar bone. Lately, periodontal disease is considered as a co-morbidity of diabetes mellitus (Polak, Sanui et al., 2020). Though studies that have assessed the relationship of periodontal status with the glycemic control in type 1 diabetes mellitus adolescents, such studies have not been conducted in South Africa.

Thesis advisor: Judith A. Vessey / Significance of Problem: Emerging adults (ages 18-30) with type 1 diabetes (T1D) are a specific group that experiences worse glycemic control, more frequent severe hypoglycemia and more frequent diabetic ketoacidosis (DKA) than any other age group. The multiple transitions and stressors associated with the developmental stage of emerging adulthood can magnify and exacerbate the diabetes specific emotional burden of living with T1D, resulting in increased diabetes distress (DD). However, there is no measure of DD specific to the developmental stage of emerging adulthood. Purpose: The purpose of this program of research is to explicate the need for a developmental stage-specific measure of DD, as well as to develop, refine and psychometrically validate a new measure of DD in emerging adults. Method: This multi-phase study employed methods grounded in both item response theory (Rasch analysis) and classical test theory to reduce, refine and validate a new measure of DD in emerging adulthood, entitled the Problem Areas in Diabetes-Emerging Adult version (PAID-EA). In phase 1, data were collected from emerging adults with T1D using a cross-sectional online survey strategy. Rasch methodology was used to reduce and refine the PAID-EA. In phase 2, an additional cross-sectional online survey was conducted using the refined PAID-EA. Classical test theory-based approaches were employed to examine the psychometric properties of the refined measure. Finally, the relationships between scores on the PAID-EA and related constructs and clinical variables were explored. Conclusions: Collectively, this work advances the science by providing insight into how the challenges of emerging adulthood impact life with T1D during this developmental stage and providing a new measure to accurately and validly capture this experience for both clinical and research purposes. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

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Type 1 Diabetes (T1D) is a complex autoimmune disorder in which T cells destroy the pancreatic islets, leading to a loss of insulin production and hyperglycemia. The disease incidence has increased globally over the last decades, primarily in individuals with low to moderate genetic risk. There is evidence that environmental factors play a role alongside genetic risk to trigger the disease. An environmental factor that has global influence is adoption of the Western diet, characterized by increased consumption of n-6 fatty acids, including linoleic acid (LA), and decreased consumption of n-3 fatty acids. Increased n-6/n-3 ratios are associated with enhanced susceptibility to autoimmune diseases. We sought to understand how linoleic acid affects the survival and function of T cells from the non-obese diabetic (NOD) mouse, a model for T1D. We found that linoleic acid's presence during in vitro activation of T cells led to an increased expansion of the cells in culture. Additionally, CD4+ and CD8+ T cells activated in linoleic acid's presence produced increased levels of pro-diabetogenic cytokines, including Interleukin-21 (IL-21) and Interferon-gamma (IFN-γ). In contrast, linoleic acid reduced IL-10-producing CD4+ T cells, which are protective in T1D, significantly changing the balance between pro-and anti-inflammatory T cell subsets. Gene expression analysis of T cells exposed to linoleic acid during in vitro activation revealed decreased gene expression of lipid-regulated transcription factors, peroxisome proliferator-activated receptors (PPAR), PPARα and PPARγ. These data suggest a role for these transcription factors and their associated pathways in linoleic acid-mediated T cell functions. Finally, we tested whether the T cell fatty acid response is regulated by the cytokine IL-7, which modulates T cell immunometabolism. However, our data did not reveal a prominent role for IL-7 in regulating the T cell response to linoleic acid. Together, these studies add to evidence that fatty acids present in the microenvironment can directly alter T cell functions and that changes in dietary components may contribute to enhanced T1D susceptibility.