OBJECTIVE -The objective of this study was to determine whether earlier diagnosis of diabetes in prospectively followed autoantibody-positive children lowered onset morbidity and improved the clinical course after diagnosis. RESEARCH DESIGN AND METHODS -The Diabetes Autoimmunity Study in theYoung (DAISY) follows genetically at-risk children for the development of diabetes. Increased genetic risk is identified by family history of type 1 diabetes or expression of diabetes-associated HLA genotypes. Of the 2,140 prospectively followed children, 112 have developed islet autoantibodies and 30 have progressed to diabetes. Diabetes onset characteristics and early clinical course of these 30 children followed to diabetes were compared with those of 101 age-and sex-matched children concurrently diagnosed with diabetes in the community.RESULTS -Pre-diabetic children followed to diabetes were less often hospitalized than the community cases (3.3 vs. 44%; P Ͻ 0.0001). They had a lower mean HbA 1c at onset (7.2 vs. 10.9%; P Ͻ 0.0001) and 1 month after diagnosis (6.9 vs. 8.6%; P Ͻ 0.0001) but not after 6 months of diabetes. The mean insulin dose was lower in the DAISY group at 1 (0.30 vs. 0.51 U ⅐ kg Ϫ1 ⅐ day Ϫ1; P ϭ 0.003), 6 (0.37 vs. 0.58; P ϭ 0.001), and 12 months (0.57 vs. 0.72; P ϭ 0.03). There was no difference in growth parameters between the two groups. Comparisons limited to children with a family history of type 1 diabetes in both groups showed a similar pattern.CONCLUSIONS -Childhood type 1 diabetes diagnosed through a screening and follow-up program has a less severe onset and a milder clinical course in the first year after diagnosis. Diabetes Care 27:1399 -1404, 2004T ype 1 diabetes affects ϳ15-30 million people globally and 1.4 million in the U.S. (1,2). The incidence is increasing by 3-5% per year (3,4), especially among young children (5-9). Type 1 diabetes is responsible for significant morbidity, premature mortality (10), and financial burden (11). The disease usually is preceded by a preclinical period lasting months to years. Pre-diabetes can often be detected by the presence of autoantibodies to islet antigens such as GAD65, insulin, and IA-2 that are highly predictive of type 1 diabetes risk in children with (12) and without (13) a first-degree type 1 diabetic relative.In the absence of effective prevention, screening for pre-diabetes is currently not recommended outside of research studies. To date, interventions applied after the development of islet autoantibodies have been unsuccessful in slowing progression to diabetes (14,15). Several ongoing cohort studies (16 -19) follow high-risk children from birth to determine environmental triggers of type 1 diabetes. Interventions based on avoidance of these triggers before the onset of autoimmunity could be effective in preventing type 1 diabetes.One of these projects, Diabetes Autoimmunity Study in the Young (DAISY) (16,19), intensively follows two groups of children at increased risk for the development of diabetes: young first-degree relatives and infa...
At the time of initial diagnosis, uninsured patients were more likely to present with DKA than insured patients. Furthermore, when the uninsured subjects presented with DKA, the condition tended to be more severe and life-threatening. A potential explanation is that uninsured subjects may delay seeking timely medical care, thereby presenting more critically ill, whereas insured subjects may have their T1DM diagnosed earlier.
ObjectiveThis study analyzed pediatric subjects at the time of initial diagnosis of type 1 diabetes (T1DM) with two objectives: 1) to determine the incidence and severity of diabetic ketoacidosis (DKA), and 2) to stratify these subjects according to insurance status.MethodsThe subject population included all children less than 18 years who presented with new onset T1DM from January 2002 to December 2003 and were subsequently followed at the Barbara Davis Center. The insurance status was collected on all subjects, and the initial pH was collected on subjects who presented to an emergency department and/or were admitted to the hospital.Results359 patients presented with new onset T1DM. Forty-three (12.0%) of these children had no insurance. One hundred two (28.4%) subjects presented with DKA. When stratified by insurance status, 26 (60.5%) of the 43 uninsured subjects presented with DKA compared to only 76 (24.1%) of the 316 insured subjects, p≤0.001, OR=1.5. Further stratification based on pH severity revealed that uninsured subjects tended to present with more severe DKA than subjects with insurance, p=0.09 (borderline significant chi-square test for trend). The proportions among the most life-threatening DKA (most severe pH ≤ 6.90) included 7 (26.9%) of 26 uninsured subjects compared to 7 (9.2%) of 76 insured subjects, p=0.04.ConclusionAt the time of initial diagnosis, patients without insurance were more likely to present with DKA than subjects with insurance. Furthermore, when the uninsured subjects presented with DKA, the condition tended to be more severe and life-threatening, as indicated by a lower initial pH. A potential explanation is that subjects without insurance may delay seeking timely medical care and therefore present more critically ill, whereas subjects with insurance may have their T1DM diagnosed earlier.
aration and activated with lipopolysaccharide (LPS, 100 ng/mL) in presence and absence of mevalonate (250µM) and monocyte cytokines were assayed by sandwich ELISA. The coefficient of variation of the hsCRP and monocyte cytokine assays were ≤10%. There were no differences in age, gender, BMI, lipoprotein levels and inflammatory markers in the two groups at baseline. As expected, S-40 therapy resulted in a significant lowering of LDL cholesterol levels at both 4 and 8 weeks compared to placebo (34% reduction at 8 weeks, p≤0.0005). S-40 therapy also significantly decreased hsCRP levels at 4 and 8 weeks compared to placebo (36% median reduction at 8 weeks, p≤0.0005). Furthermore S-40 therapy compared to placebo resulted in a significant reduction in LPS-activated monocytic release of IL-6 and TNF at both 4 and 8 weeks (% median reduction at 8 weeks for IL-6 and TNF 55% and 39% respectively, p≤0.025). S-40 therapy failed to affect monocyte IL-1b release. In addition to there being no correlation between LDL cholesterol reduction and CRP reduction with S-40, co-incubation of monocytes with mevalonate did not reverse the inhibition of IL-6 and TNF seen with S-40. Thus, we show, for the first time, a direct anti-inflammatory effect of S-40 therapy on hsCRP and monocyte IL-6 and TNF in patients with MS. This has major implications in forestalling cardiovascular disease in this high risk group.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.