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  • 1.
    de Beaufort, Carine E.
    et al.
    Pediat Clin, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg.
    Lange, Karin
    Dept Med Psychol, Hannover Medical School, Hannover, Germany.
    Swift, Peter G. F.
    Childrens Hosp, Leicester Royal Infirmary, Leicester, England..
    Åman, Jan
    Örebro University Hospital. Dept Pediat, Örebro University Hospital, Örebro, Sweden.
    Cameron, Fergus
    Dept Endocrinol & Diabet, Royal Childrens Hosp, Parkville Vic, Australia.
    Castano, Luis
    Endocrinol & Diabet Res Grp, Hosp Cruces, Univ Basque Country, Baracaldo, Spain.
    Dorchy, Harry
    Diabetol Clin, Univ Hosp Reine Fabiola, Brussels, Belgium.
    Fisher, Lynda K.
    Dept Endocrinol & Diabet, Childrens Hosp Los Angeles, Los Angeles CA, USA..
    Hoey, Hilary
    Natl Childrens Hosp, Univ Dublin Trinity Coll, Dublin, Ireland.
    Kaprio, Eero
    Dept Paediat, Peijas Hosp, Helsinki, Finland.
    Kocova, Mirjana
    Dept Endocrinol & Genet, Univ Pediat Clin, Skopje, Macedonia.
    Neu, Andreas
    Clin Children & Adolescence, Univ Tubingen, Tubingen, Germany.
    Njolstad, Pal R.
    Dept Clin Med, Univ Bergen, Bergen, Norway; Dept Pediat, Haukeland Hosp, Bergen, Norway.
    Phillip, Moshe
    Natl Ctr Childhood Diabet, Schneiders Med Ctr Israel, Petah Tiqwa, Israel.
    Schoenle, Eugen
    Dept Diabet & Endocrinol, Univ Childrens Hosp, Zurich, Switzerland.
    Robert, Jean J.
    Dept Childhood & Adolescent Diabet, Hop Necker Enfants Malad, Paris, France.
    Urukami, Tatsuhiko
    Sch Med, Nihon Univ, Tokyo, Japan.
    Vanelli, Maurizio
    Pediat Clin, Ctr Diabetol, Parma, Italy.
    Danne, Thomas
    Krankenhaus Bult, Hannover, Germany.
    Barrett, Tim
    Inst Child Hlth, Univ Birmingham, Birmingham, England; Birmingham Childrens Hosp, Univ Birmingham, Birmingham, England.
    Chiarelli, Franco
    Pediat Clin, Osped Policlin, Chieti, Italy.
    Aanstoot, Henk J.
    Ctr Pediat & Adolescent Diabet Care & Res, Rotterdam, Netherlands.
    Mortensen, Henrik B.
    Herlev Hosp, Dept Pediat, Herlev, Denmark; Fac Hlth Sci, Univ Copenhagen, Copenhagen, Denmark.
    Metabolic outcomes in young children with type 1 diabetes differ between treatment centers: the Hvidoere Study in Young Children 20092013In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 14, no 6, p. 422-428Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether center differences in glycemic control are present in prepubertal children <11yr with type 1 diabetes mellitus. Research Design and Methods: This cross-sectional study involved 18 pediatric centers worldwide. All children, <11 y with a diabetes duration 12months were invited to participate. Case Record Forms included information on clinical characteristics, insulin regimens, diabetic ketoacidosis (DKA), severe hypoglycemia, language difficulties, and comorbidities. Hemoglobin A1c (HbA1c) was measured centrally by liquid chromatography (DCCT aligned, range: 4.4-6.3%; IFFC: 25-45mmol/mol). Results: A total of 1133 children participated (mean age: 8.0 +/- 2.1 y; females: 47.5%, mean diabetes duration: 3.8 +/- 2.1 y). HbA1c (overall mean: 8.0 +/- 1.0%; range: 7.3-8.9%) and severe hypoglycemia frequency (mean 21.7 events per 100 patient-years), but not DKA, differed significantly between centers (p<0.001 resp. p=0.179). Language difficulties showed a negative relationship with HbA1c (8.3 +/- 1.2% vs. 8.0 +/- 1.0%; p = 0.036). Frequency of blood glucose monitoring demonstrated a significant but weak association with HbA1c (r=-0.17; p<0.0001). Although significant different HbA1c levels were obtained with diverse insulin regimens (range: 7.3-8.5%; p<0.001), center differences remained after adjusting for insulin regimen (p<0.001). Differences between insulin regimens were no longer significant after adjusting for center effect (p=0.199). Conclusions: Center differences in metabolic outcomes are present in children <11yr, irrespective of diabetes duration, age, or gender. The incidence of severe hypoglycemia is lower than in adolescents despite achieving better glycemic control. Insulin regimens show a significant relationship with HbA1c but do not explain center differences. Each center's effectiveness in using specific treatment strategies remains the key factor for outcome.

  • 2.
    Hjern, Anders
    et al.
    Natl Board Hlth & Welf, Ctr Epidemiol, Stockholm, Sweden; Uppsala Univ, Dept Childrens & Womens Hlth, Uppsala, Sweden.
    Söderström, Ulf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Parental country of birth is a major determinant of childhood type 1 diabetes in Sweden2008In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 9, no 1, p. 35-39Article in journal (Refereed)
    Abstract [en]

    Objective: To test the hypothesis that the risk of childhood diabetes type 1 increases with migration from a low to a high incidence region.

    Methods: Register study of a national cohort of 783 547 children born between 1987 and 1993 who remained in Sweden in 2002, including 3225 children with childhood type 1 diabetes identified in hospital discharge data. Logistic regression analysis was used to test the hypotheses.

    Results: Offspring of two parents born in very low (Asia excluding Middle East and Latin America) and low (southern and eastern Europe and the Middle East) incidence regions had the lowest adjusted odds ratios (ORs) of childhood type 1 diabetes; 0.21 (0.11-0.41) and 0.37 (0.29-0.48), respectively, compared with the Swedish majority population. When one parent was born in a low incidence country and one parent was Swedish born, the adjusted ORs increased but remained lower than the Swedish majority population.

    Conclusions: Parental country of birth is an important determinant of childhood type 1 in Sweden. Heritable factors seem most likely to explain this pattern.

  • 3.
    Jørgenrud, Benedicte
    et al.
    Department of Pediatric Research, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway; Hormone Laboratory, Department of Medical Biochemistry, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Stene, Lars C
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
    Tapia, German
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
    Bøås, Håkon
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
    Pepaj, Milaim
    Hormone Laboratory, Department of Medical Biochemistry, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Berg, Jens P
    Division of Diagnostic and Intervention, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Thorsby, Per M
    Hormone Laboratory, Department of Medical Biochemistry, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Orešič, Matej
    Systems Medicine Department, Steno Diabetes Centre, Gentofte, Denmark; VTT Technical Research Centre of Finland, Espoo, Finland.
    Hyötyläinen, Tuulia
    Systems Medicine Department, Steno Diabetes Centre, Gentofte, Denmark; VTT Technical Research Centre of Finland, Espoo, Finland.
    Rønningen, Kjersti S
    Department of Pediatric Research, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Longitudinal plasma metabolic profiles, infant feeding, and islet autoimmunity in the MIDIA study2017In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 18, no 2, p. 111-119Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim of this study was to investigate the longitudinal plasma metabolic profiles in healthy infants and the potential association with breastfeeding duration and islet autoantibodies predictive of type 1 diabetes.

    METHOD: Up to four longitudinal plasma samples from age 3 months from case children who developed islet autoimmunity (n = 29) and autoantibody-negative control children (n = 29) with the HLA DR4-DQ8/DR3-DQ2 genotype were analyzed using two-dimensional gas chromatography coupled to a time-of-flight mass spectrometer for detection of small polar metabolites.

    RESULTS: Plasma metabolite levels were found to depend strongly on age, with fold changes varying up to 50% from age 3 to 24 months (p < 0.001 after correction for multiple testing). Tyrosine levels tended to be lower in case children, but this was not significant after correction for multiple testing. Ornithine levels were lower in case children compared with the controls at the time of seroconversion, but the difference was not statistically significant after correcting for multiple testing. Breastfeeding for at least 3 months as compared with shorter duration was associated with higher plasma levels of isoleucine, and lower levels of methionine and 3,4-dihydroxybutyric acid at 3 months of age.

    CONCLUSIONS: Plasma levels of several small, polar metabolites changed with age during early childhood, independent of later islet autoimmunity status and sex. Breastfeeding was associated with higher levels of branched-chain amino acids, and lower levels of methionine and 3,4-dihydroxybutyric acid.

  • 4.
    Kaas, Anne
    et al.
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Andersen, Marie Louise Max
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Fredheim, Siri
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Hougaard, Philip
    Department of Statistics, University of Southern Denmark, Odense, Denmark.
    Buschard, Karsten
    Bartholin Institute, Rigshospitalet, Copenhagen, Denmark.
    Petersen, Jacob Steen
    Diabetes Biology and Pharmacology, Novo Nordisk A/S, Måløv, Denmark.
    de Beaufort, Carine
    Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg.
    Robertson, Kenneth J.
    Department of Paediatrics, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland, United Kingdom.
    Hansen, Lars
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Mortensen, Henrik B.
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Nielsen, Lotte B.
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Proinsulin, GLP-1, and glucagon are associated with partial remission in children and adolescents with newly diagnosed type 1 diabetes2012In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 13, no 1, p. 51-58Article in journal (Refereed)
    Abstract [en]

    Objective: Proinsulin is a marker of beta-cell distress and dysfunction in type 2 diabetes and transplanted islets. Proinsulin levels are elevated in patients newly diagnosed with type 1 diabetes. Our aim was to assess the relationship between proinsulin, insulin dose-adjusted haemoglobin A1c (IDAA1C), glucagon-like peptide-1 (GLP-1), glucagon, and remission status the first year after diagnosis of type 1 diabetes.

    Methods: Juvenile patients (n = 275) were followed 1, 6, and 12 months after diagnosis. At each visit, partial remission was defined as IDAA1C = 9%. The patients had a liquid meal test at the 1-, 6-, and 12-month visits, which included measurement of C-peptide, proinsulin, GLP-1, glucagon, and insulin antibodies (IA).

    Results: Patients in remission at 6 and 12 months had significantly higher levels of proinsulin compared to non-remitting patients (p < 0.0001, p = 0.0002). An inverse association between proinsulin and IDAA1C was found at 1 and 6 months (p = 0.0008, p = 0.0022). Proinsulin was positively associated with C-peptide (p < 0.0001) and IA (p = 0.0024, p = 0.0068, p < 0.0001) at 1, 6, and 12 months. Glucagon (p < 0.0001 and p < 0.02) as well as GLP-1 (p = 0.0001 and p = 0.002) were significantly lower in remitters than in non-remitters at 6 and 12 months. Proinsulin associated positively with GLP-1 at 1 month (p = 0.004) and negatively at 6 (p = 0.002) and 12 months (p = 0.0002).

    Conclusions: In type 1 diabetes, patients in partial remission have higher levels of proinsulin together with lower levels of GLP-1 and glucagon compared to patients not in remission. In new onset type 1 diabetes proinsulin level may be a sign of better residual beta-cell function.

  • 5.
    Lodefalk, Maria
    et al.
    Pediatric Endocrinology and Diabetes Unit, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Gastrointestinal symptoms in adolescents with type 1 diabetes2010In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 11, no 4, p. 265-70Article in journal (Refereed)
    Abstract [en]

    Objective: To compare the prevalence of gastrointestinal (GI) symptoms in adolescents with and without type 1 diabetes (T1DM) and to relate the symptoms in patients to demographic, socioeconomic, diabetes-specific variables, and food habits.

    Method: In a population-based, cross-sectional setting, 173 adolescents with T1DM and 160 matched controls completed a questionnaire. Moreover, 13 patients and 1 control were excluded due to having a GI disorder.

    Results: Moreover, 75% of patients and 77% of controls reported at least one GI symptom (ns). More girls than boys reported symptoms. Reflux episodes were more prevalent in patients with poorer socioeconomic status. Poor appetite, loss of weight, an uncomfortable feeling of fullness, swallowing difficulties, and nausea were more prevalent in patients smoking daily compared with patients not smoking daily. Vomiting was more prevalent in patients with duration of diabetes >7 yr, and patients with reflux episodes had higher glycated hemoglobin (HbA1c). Belching and early satiety were more prevalent in patients with an irregular meal pattern.

    Conclusions: GI symptoms in adolescents are common, but the prevalence is not increased in those with T1DM. GI symptoms in adolescents with T1DM are associated with female sex, poorer socioeconomic status, daily cigarette smoking, longer duration of diabetes, poorer metabolic control, and an irregular meal pattern.

  • 6.
    Särnblad, Stefan
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Berg, Lars
    Department of Medicine, Södra Älvsborg Hospital, Borås, Sweden.
    Detlofsson, Ingalill
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Jönsson, Åsa
    Swedish Diabetes Association, Stockholm, Sweden.
    Forsander, Gun
    Department of Pediatrics, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Diabetes management in Swedish schools: a national survey of attitudes of parents, children, and diabetes teams2014In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 15, no 8, p. 550-556Article in journal (Refereed)
    Abstract [en]

    Background: Parents of children with type 1 diabetes often raise complaints about self-care support during school time. The aim of this study was to investigate attitudes to diabetes care in school reported by children with type 1 diabetes, their parents, and their diabetes teams.

    Method: Children who had completed preschool class or at least one grade in the nine-year compulsory school system were invited to participate. Data were collected using separate questionnaires for the children and their parents. In addition, the members of the diabetes team answered a separate questionnaire. All pediatric diabetes centers in Sweden were invited to participate in the study.

    Results: All Swedish children and adolescents with diabetes are treated at pediatric diabetes centers. Out of 44 eligible centers, 41 were able to participate. The questionnaires were completed by 317 children and adolescents and 323 parents. The mean age was 11.4 ± 2.7 years and HbA1c was 61.8 ± 12.4 mmol/mol (7.8 ± 1.1%). For 57% of the children, there was no member of staff at the school with principal responsibility to support diabetes self-care. A written action plan for hypoglycemia existed for 60% of the children. Twenty-one percent of the parents regularly gave less insulin than they calculated would be needed at breakfast because of fear of hypoglycemia during school time.

    Conclusions: Although Sweden has legislation underlining the specific need for diabetes care in school, this nationwide study demonstrates deficiencies in the support of self-care management. 

  • 7.
    Särnblad, Stefan
    et al.
    Örebro University, School of Medical Sciences. Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Åkesson, Karin
    Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden; Futurum-The Academy of Health and Care, Jönköping University, Jönköping, Sweden.
    Fernström, Lillemor
    Swedish Diabetes Association, Stockholm, Sweden.
    Ilvered, Rosita
    Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Forsander, Gun
    Institution of Clinical Sciences, Sahlgrenska Academy, Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden; The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Improved diabetes management in Swedish schools: results from two national surveys2017In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 8, no 6, p. 463-469Article in journal (Refereed)
    Abstract [en]

    Background: Support in diabetes self-care in school is essential to achieve optimal school performance and metabolic control. Swedish legislation regulating support to children with chronic diseases was strengthened 2009.

    Objective: To compare the results of a national survey conducted 2008 and 2015 measuring parents' and diabetes specialist teams' perceptions of support in school.

    Method: All pediatric diabetes centers in Sweden were invited to participate in the 2015 study. In each center, families with a child being treated for T1DM and attending preschool class or compulsory school were eligible. The parents' and the diabetes teams' opinions were collected in two separate questionnaires.

    Results: Forty-one out of 42 eligible diabetes centers participated and 568 parents answered the parental questionnaire in 2015. Metabolic control had improved since the 2008 survey (55.2 ± 10.6 mmol/mol, 7.2% ± 1.0%, in 2015 compared with 61.8 ± 12.4 mmol/mol, 7.8% ± 1.1% in 2008). The proportion of children with a designated staff member responsible for supporting the child's self-care increased from 43% to 59%, (P < .01). An action plan to treat hypoglycemia was present for 65% of the children in 2015 compared with 55% in 2008 (P < .01). More parents were satisfied with the support in 2015 (65% compared with 55%, P < .01).

    Conclusions: This study shows that staff support has increased and that more parents were satisfied with the support for self-care in school in 2015 compared with 2008. More efforts are needed to implement the national legislation to achieve equal support in all Swedish schools.

  • 8.
    Åman, Jan
    et al.
    Örebro University, School of Health and Medical Sciences.
    Skinner, T. C.
    de Beaufort, C. E.
    Swift, P. G. F.
    Aanstoot, H.-J.
    Cameron, F.
    Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood Diabetes2009In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 10, no 4, p. 234-239Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Hvidoere Study Group on Childhood Diabetes has demonstrated persistent differences in metabolic outcomes between pediatric diabetes centers. These differences cannot be accounted for by differences in demographic, medical, or treatment variables. Therefore, we sought to explore whether differences in physical activity or sedentary behavior could explain the variation in metabolic outcomes between centers. METHODS: An observational cross-sectional international study in 21 centers, with demographic and clinical data obtained by questionnaire from participants. Hemoglobin A1c (HbA1c) levels were assayed in one central laboratory. All individuals with diabetes aged 11-18 yr (49.4% female), with duration of diabetes of at least 1 yr, were invited to participate. Individuals completed a self-reported measure of quality of life (Diabetes Quality of Life - Short Form [DQOL-SF]), with well-being and leisure time activity assessed using measures developed by Health Behaviour in School Children WHO Project. RESULTS: Older participants (p < 0.001) and females (p < 0.001) reported less physical activity. Physical activity was associated with positive health perception (p < 0.001) but not with glycemic control, body mass index, frequency of hypoglycemia, or diabetic ketoacidosis. The more time spent on the computer (r = 0.06; p < 0.05) and less time spent doing school homework (r = -0.09; p < 0.001) were associated with higher HbA1c. Between centers, there were significant differences in reported physical activity (p < 0.001) and sedentary behavior (p < 0.001), but these differences did not account for center differences in metabolic control. CONCLUSIONS: Physical activity is strongly associated with psychological well-being but has weak associations with metabolic control. Leisure time activity is associated with individual differences in HbA1c but not with intercenter differences.

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