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See detailAssociation between age, IL-10, IFNγ, stimulated C-peptide and disease progression in children with newly diagnosed Type 1 diabetes
Kaas, A.; Pfleger, C.; Kharagjitsingh, A.V. et al

in Diabetic Medicine : A Journal of the British Diabetic Association (2011)

AIMS: The relation of disease progression and age, serum interleukin 10 (IL-10) and interferon gamma (IFNγ) and their genetic correlates were studied in paediatric patients with newly diagnosed Type 1 ... [more ▼]

AIMS: The relation of disease progression and age, serum interleukin 10 (IL-10) and interferon gamma (IFNγ) and their genetic correlates were studied in paediatric patients with newly diagnosed Type 1 diabetes. METHODS: Two hundred and twenty-seven patients from the Hvidoere Study Group were classified in four different progression groups as assessed by change in stimulated C-peptide from 1 to 6 months. CA repeat variants of the IL-10 and IFNγ gene were genotyped and serum levels of IL-10 and IFNγ were measured at 1, 6 and 12 months. RESULTS: IL-10 decreased (P < 0.001) by 7.7% (1 month), 10.4% (6 months) and 8.6% (12 months) per year increase in age of child, while a twofold higher C-peptide concentration at 1 month (p = 0.06), 6 months (P = 0.0003) and 12 months (P = 0.02) was associated with 9.7%, 18.6% and 9.7% lower IL-10 levels, independent of each other. IL-10 concentrations did not associate with the disease progression groups. By contrast, IFNγ concentrations differed between the four progression groups at 6 and 12 months (P = 0.02 and P = 0.01, respectively); patients with rapid progressing disease had the highest levels at both time points. Distribution of IL-10 and IFNγ genotypes was equal among patients from the progression groups. CONCLUSION: IL-10 serum levels associate inversely with age and C-peptide. As age and C-peptide also associate, a triangular association is proposed. Genetic influence on IL-10 production seems to be masked by distinct disease mechanisms. Increased serum IFNγ concentrations associate with rapid disease progression. Functional genetic variants do not associate with a single progression pattern group, implying that disease processes override genetically predisposed cytokine production. [less ▲]

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See detailAre family factors universally related to metabolic outcomes in adolescents with type 1 diabetes?
Cameron, F. J.; Skinner, T. C.; De Beaufort, Carine UL et al

in Diabetic Medicine : A Journal of the British Diabetic Association (2008), 25(4), 463-468

Aims: To assess the importance of family factors in determining metabolic outcomes in adolescents with Type 1 diabetes in 19 countries. Methods: Adolescents with Type 1 diabetes aged 11-18 years, from 21 ... [more ▼]

Aims: To assess the importance of family factors in determining metabolic outcomes in adolescents with Type 1 diabetes in 19 countries. Methods: Adolescents with Type 1 diabetes aged 11-18 years, from 21 paediatric diabetes care centres, in 19 countries, and their parents were invited to participate. Questionnaires were administered recording demographic data, details of insulin regimens, severe hypoglycaemic events and number of episodes of diabetic ketoacidosis. Adolescents completed the parental involvement scale from the Diabetes Quality of Life for Youth - Short Form (DQOLY-SF) and the Diabetes Family Responsibility Questionnaire (DFRQ). Parents completed the DFRQ and a Parental Burden of Diabetes score. Glycated haemoglobin (HbA1c) was analysed centrally on capillary blood. Results: A total of 2062 adolescents completed a questionnaire, with 2036 providing a blood sample; 1994 parents also completed a questionnaire. Family demographic factors that were associated with metabolic outcomes included: parents living together (t = 4.1; P < 0.001), paternal employment status (F = 7.2; d.f. = 3; P < 0.001), parents perceived to be over-involved in diabetes care (r = 0.11; P < 0.001) and adolescent-parent disagreement on responsibility for diabetes care practices (F = 8.46; d.f. = 2; P < 0.001). Although these factors differed between centres, they did not account for centre differences in metabolic outcomes, but were stronger predictors of metabolic control than age, gender or insulin treatment regimen. Conclusions: Family factors, particularly dynamic and communication factors such as parental over-involvement and adolescent-parent concordance on responsibility for diabetes care appear be important determinants of metabolic outcomes in adolescents with diabetes. However, family dynamic factors do not account for the substantial differences in metabolic outcomes between centres. © 2008 The Authors. [less ▲]

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See detailIncidence and trends of Childhood Type 1 diabetes worldwide 1990-1999
De Beaufort, Carine UL

in Diabetic Medicine : A Journal of the British Diabetic Association (2006), 23(8), 857-866

AIM: To examine incidence and trends of Type 1 diabetes worldwide for the period 1990-1999. METHODS: The incidence of Type 1 diabetes (per 100 000/year) was analysed in children aged <or= 14 years from ... [more ▼]

AIM: To examine incidence and trends of Type 1 diabetes worldwide for the period 1990-1999. METHODS: The incidence of Type 1 diabetes (per 100 000/year) was analysed in children aged <or= 14 years from 114 populations in 112 centres in 57 countries. Trends in the incidence of Type 1 diabetes were analysed by fitting Poisson regression models to the dataset. RESULTS: A total of 43,013 cases were diagnosed in the study populations of 84 million children. The age-adjusted incidence of Type 1 diabetes among 112 centres (114 populations) varied from 0.1 per 100,000/year in China and Venezuela to 40.9 per 100,000/year in Finland. The average annual increase in incidence calculated from 103 centres was 2.8% (95% CI 2.4-3.2%). During the years 1990-1994, this increase was 2.4% (95% CI 1.3-3.4%) and during the second study period of 1995-1999 it was slightly higher at 3.4% (95% CI 2.7-4.3%). The trends estimated for continents showed statistically significant increases all over the world (4.0% in Asia, 3.2% in Europe and 5.3% in North America), except in Central America and the West Indies where the trend was a decrease of 3.6%. Only among the European populations did the trend in incidence diminish with age. CONCLUSIONS: The rising incidence of Type 1 diabetes globally suggests the need for continuous monitoring of incidence by using standardized methods in order to plan or assess prevention strategies. [less ▲]

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See detailClinical and laboratory features of type 1 diabetic children at the time of diagnosis
Levy-Marchal, C.; Papoz, L.; De Beaufort, Carine UL et al

in Diabetic Medicine : A Journal of the British Diabetic Association (1992), 9

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See detailContinuous subcutaneous insulin infusion (CSII) versus conventional insulin injection therapy in newly diagnosed diabetic children : a randomised prospective trial
De Beaufort, Carine UL; Houtzagers, C.M.G.J.; Bruining, G.J. et al

in Diabetic Medicine : A Journal of the British Diabetic Association (1989), 6

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See detailInsulin antibodies in diabetic children before treatment: A marker for islet B-cell destruction?
De Beaufort, Carine UL; Binder, C.; Bruining, G. J. et al

in Diabetic Medicine : A Journal of the British Diabetic Association (1988), 5(5), 441-443

Insulin antibodies were measured in the sera of 28 newly diagnosed diabetic children (age 8.0 ± 4.0 (±SD) years) prior to insulin therapy and after 3, 6, 9, and 12 months. The levels at diagnosis and ... [more ▼]

Insulin antibodies were measured in the sera of 28 newly diagnosed diabetic children (age 8.0 ± 4.0 (±SD) years) prior to insulin therapy and after 3, 6, 9, and 12 months. The levels at diagnosis and after 12 months were compared to endogenous insulin production at onset and after 12 to 14 months. Endogenous insulin production was evaluated through the measurement of 24-h urinary C-peptide excretion, fasting plasma C-peptide levels and plasma C-peptide levels after glucagon stimulation. Insulin antibodies were detected in 29% of the patients (8 out of 28). In all but one patient antibodies binding porcine and human insulin were detected. No relationship was found between the presence of antibodies binding human or porcine insulin at diagnosis and age. After 1 year 27 out of 28 patients presented insulin antibodies. No relationship was found between the presence of insulin antibodies before therapy and 1 year after therapy. Insulin antibodies prior to diagnosis showed no relationship with the urinary C-peptide excretion at diagnosis (with antibodies 67 ± 27%, without antibodies 76 ± 11%). However, after 1 year significantly lower urinary C-peptide excretions were found in patients with insulin antibodies prior to therapy (with antibodies, 17 ± 7%, without antibodies, 31 ± 5%, p < 0.02). Peak plasma C-peptide levels after 1 year were possibly lower in patients with insulin antibodies before treatment (with antibodies 0.17 ± 0.06 nmol/l, without antibodies 0.26 ± 0.04 nmol/l, p < 0.1). Fasting C-peptide levels did not differ significantly between the two groups after 1 year of therapy (with antibodies 0.11 ± 0.03 nmol/l, without antibodies 0.14 ± 0.02 nmol/l). Thus, insulin auto-antibodies may be a marker for islet B-cell destruction in Type 1 diabetes. [less ▲]

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See detailContinuous subcutaneous insulin infusion in children
De Beaufort, Carine UL; Bruining, G. J.

in Diabetic Medicine : A Journal of the British Diabetic Association (1987), 4(2), 103-108

Insulin-dependent diabetes mellitus usually presents in childhood. Since it is generally accepted that persisting metabolic derangements contribute to the development of micro- and macrovascular ... [more ▼]

Insulin-dependent diabetes mellitus usually presents in childhood. Since it is generally accepted that persisting metabolic derangements contribute to the development of micro- and macrovascular complications, a primary aim of the management of children with diabetes is to achieve near normalization of metabolism. In adults continuous subcutaneous insulin infusion (CSII) has been used to optimize control. Despite a reluctance amongst paediatricians to use CSII in children, several studies with pumps have been performed in adolescents. The results of these studies are contradictory with respect to acceptability and achieved metabolic control. Thus, some authors report a near normalization of blood glucose concentrations, whereas others only find a temporary improvement. Patient selection seems to account for many of these differences. This suggests that methods ought to be developed to predict success or failure of CSII in a particular adolescent patient. For diabetic toddlers with their age-specific problems CSII may be a therapy of choice. So far, good acceptability and improved metabolic control are reported in this group. More studies are needed to confirm this. It is important that the diabetic clinic as well as the patient is organized to a high standard before starting CSII. Home blood glucose measurements, education, and a 24-h telephone service are essential factors for the management of diabetic children, treated conventionally or with CSII. [less ▲]

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See detailQuantitative sensory examination in diabetic children: Assessment of thermal discrimination
Heimans, J. J.; Bertelsmann, F. W.; De Beaufort, Carine UL et al

in Diabetic Medicine : A Journal of the British Diabetic Association (1987), 4(3), 251-253

Vibration perception thresholds (VPTs) and thermal discrimination thresholds (TDTs) were investigated in 55 insulin-dependent diabetic children aged 11.3 ± 3.9 years (mean ± SD) and in 81 controls. There ... [more ▼]

Vibration perception thresholds (VPTs) and thermal discrimination thresholds (TDTs) were investigated in 55 insulin-dependent diabetic children aged 11.3 ± 3.9 years (mean ± SD) and in 81 controls. There was no significant difference in VPTs between the two groups. TDTs were significantly higher in the group of diabetic children (p < 0.03). Eight diabetic children had abnormal thermal sensation and one child had abnormal vibratory sensation. TDT correlated positively with duration of diabetes mellitus (r = 0.25; p < 0.05). Both investigations can be carried out easily and are unobtrusive, which is an important advantage in the examination of children. [less ▲]

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