Feeding of sorghum with a high level of tannin (high-tannin sorghum) to rats caused changes in gene expression in parotid glands similar to isoproterenol treatment. Within 3 days the parotid glands were enlarged about 3-fold and a series of proline-rich proteins were increased about 12-fold. Unlike isoproterenol treatment, no changes were observed in the submandibular glands, and a Mr 220,000 glycoprotein in parotid glands was not induced. Amino acid analyses, electrophoretic patterns, and cell-free translations of mRNAs all confirmed that the proline-rich proteins induced by feeding high-tannin sorghum were identical to those induced by isoproterenol treatment. Binding curves for proline-rich proteins to tannins showed affinities 10-fold greater than bovine serum albumin and tannins.A series of unusual proteins containing 25-45% proline have been isolated from human and rat salivary glands and the secretions of salivary glands (1-6). Two families of either acidic or basic proline-rich proteins (PRPs) are commonly found, with variations in glycosylation and phosphorylation. The phosphorylated PRPs are postulated to be involved in dental repair (7) because these substances have a very high affinity for hydroxyapatite. The functions of the basic PRPs, which have isoelectric points of >10 (8), are unknown.The condensed tannins (proanthocyanidins, oligomers of flavan-3-ols) present in many plant tissues characteristically bind and precipitate proteins (9). This astringency of the tannins, which are rich in phenolic groups, apparently protects the plant tissue against ingestion by some insects (10) and seed-eating birds (11). Seeds of bird-resistant cultivars of sorghum, a major cereal of the semi-arid tropics, contain a high level of tannin (high-tannin sorghum), which diminishes the nutritional value of the grain by inhibiting protein digestion (12) and possibly by other mechanisms. In studies designed to define the interaction of tannins and proteins, Hagerman and Butler (13) were able to demonstrate that tannins have an unusually high affinity for proteins rich in proline. Because the gastrointestinal tractspecifically the oral cavity-is a source of PRPs, Hagerman and Butler (13) proposed that salivary PRPs could possibly interact with tannins and serve to protect dietary proteins and digestive enzymes.In this study we report on the dramatic effects on rat parotid glands of feeding high-tannin sorghum. High-tannin sorghum ingestion mimics some of the phenotypic changes observed after treatment of rats with the a-agonist isoproterenol (6,8 Feeding Trials. Sprague-Dawley male rats (70 g) (Murphy Breeding Laboratories, Plainfield, IN) were maintained on Purina Lab Chow for 3-6 days before initiating the feeding trials. Sorghum grains were ground and incorporated into diets of the following composition (% of diet): sorghum, 92.6; corn oil, 2.0; minerals (AIN-76), 3.5; vitamins (AIN-76), 1.0; lysine HCI, 0.75; choline chloride, 0.14; and butylated hydroxytoluene, 0.01. Feed and water were provided ad lib. I...
Our study suggests telemedicine is equivalent to in-person visits to maintain A1C, whereas families increase the number of visits in line with ADA recommendations. Patients and families miss less school and work. Decreased financial burden and increased access may improve overall diabetes care and compliance for rural patients. Further study is needed to detect long-term differences in complications screenings and the financial impact of telemedicine on pediatric diabetes care.
BackgroundThe International Society for Pediatric and Adolescent Diabetes (ISPAD) and the American Diabetes Association (ADA) have established a hemoglobin A1c (A1c) target of less than 7.5% for adolescents with type 1 diabetes (T1D). However, many adolescents are unaware of their A1c target, and little data exist on how knowledge of this A1c target affects the actual A1c they achieve. We sought to evaluate the relationship between awareness of the A1c target and the actual A1c achieved in adolescents with T1D.MethodsIn a cohort of 240 adolescents with T1D age 13–19 years, we measured A1c and administered a questionnaire to assess their knowledge of the ISPAD guideline for A1c target.ResultsOf the total cohort, 42 subjects (18%) had an A1c below target and 198 subjects (82%) had an A1c above target. Almost all subjects (98%) reported that they were told their A1c target by a healthcare provider, and most of those (88%) claimed to know their A1c target, but few (8%) were correct. More subjects with actual A1c below 7.5% thought their A1c goal was lower than the ISPAD target, compared to subjects with A1c above target (75% vs. 59%, p = 0.07), although this did not achieve statistical significance.ConclusionIn this cohort of adolescents with T1D, there was a trend toward a lower achieved A1c in those with a lower perceived A1c goal. Further studies should focus on identification of factors influencing an adolescent’s ability to achieve a lower A1c.
OBJECTIVE Insulin is a commonly used, high-risk medication in the inpatient setting. Incorrect insulin administration can lead to preventable hypoglycemic events, which are a significant morbidity in inpatient diabetes care. The goal of this intervention was to decrease preventable insulin-related hypoglycemic events in an inpatient setting in a tertiary care pediatric hospital. METHODS Methods included the institution of several interventions such as nursing and physician education, electronic medical record order sets, electronic communication note templates, and the development of new care guidelines. RESULTS After the institution of multiple interventions, the rate of preventable hypoglycemic events decreased from 1.4 preventable events per 100 insulin days to 0.4 preventable events per 100 insulin days. CONCLUSIONS Through the use of a multi-interventional approach with oversight of a multidisciplinary insulin safety committee, a sustained decreased rate of severe preventable hypoglycemic events in hospitalized pediatric patients receiving insulin was achieved.
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