Dr. Frank Frick für Psychologie heute, 10/2006 Ist Medizin nur für die Kranken da? Auch Gesunde bedienen sich zunehmend an Medikamenten wie Ritalin oder Prozac, die eigentlich der Behandlung von Aufmerksamkeitsstörungen und Depressionen vorbehalten sein sollten. Und vielleicht werden Magnetstimulationsgeräte fürs Gehirn schon bald als Kick für Partys gehandelt. Doch ist „Hirndoping&
Pdi_125_3.qxdShort Poster Presentations
Linkoping University, Linkoping, Sweden, 7First Department of Transplantation of neuroprotective choroid plexus
Pediatrics, Semmelweis University, Budapest, Hungary, 8Department epithelium prevents diabetes in the nod mouse
of Pediatrics, University of Tartu, Tartu, Estonia, 9Department ofDiabetes and Endocrinology, University Campus Bio-Medico, Rome, R. B. Elliott, S. Skinner, P. Tan, N. Beckman & M. Geaney Italy, 10Department of Pediatric Endocrinology/Diabetology, University Living Cell Technologies, Auckland, New Zealand Children’s Hospital, Zurich, Switzerland, 11Department of Internal Introduction: The islets of Langerhans are enveloped in Schwann
Medicine II, Hospital Universitario Clinico San Carlos, Madrid, Spain, cells which are the early target of islet auto-immunity. The islets 12Department of Internal Medicine, S. Michele Hospital, Cagliari, Italy, also contain a profuse network of other neural elements. Neu- 13Department of Pediatrics, 2nd Medical School, Charles University, rotrophins are secreted by choroid plexus (CP) epithelium and we Prague, The Czech Republic, 14Department of Endocrinology for have demonstrated* that these secretions are able to prevent exper- Children and Adolescents, UM Wroclaw, Poland, 15Department of imental neural damage in vitro (serum deprivation or malonate in Epidemiology and Health Promotion, Nutrition Unit, National Public culture) in a dose dependent fashion, and from quinolinic acid and Health Institute, Helsinki, Finland; 16Pediatrics Epidemiology Unit, hypoxic ischemia in vivo. In vitro we have demonstrated* the University of South Florida, Tampa, Florida, USA beneficial effect of CP culture supernatant on survival and function Introduction: Increased weight in infancy and rapid linear growth
of porcine islets in long term culture. We therefore hypothesized and weight gain subsequently have been shown to be risk factors that CP epithelial secretions might salvage islets subjected to a for childhood type 1 diabetes (T1D). The highest incidence of T1D number of insults, including aggressive autoimmunity.
has been observed in Northern Europe (NE), whereas the rates are Methods: Female diabetic mice at the age of 30 days were trans-
moderate or low in Central and Southern Europe (CSE) except for planted IP with alginate encapsulated neonatal porcine choroid Sardinia. This study aimed at comparing birth size and postnatal plexus epithelial clusters derived by collagenase digestion, and sub- sequent culture in vitro with frequent media changes for three days Methodology: TRIGR is an international intervention study explor-
in groups of 6–7 animals given 3 different escalating doses (500, ing whether weaning to a highly hydrolyzed formula decreases the 1000, 2000). Litter mates were given empty microcapsules. Diabetes cumulative incidence of preclinical and clinical T1D in young chil- incidence (blood glucose consistently >15 mM) was studied in all dren at increased risk. The trial is running in 15 countries. This study cohort includes children born in NE (n = 78–363 at various Results: There was a highly significant, dose independent protective
time points) or in CSE (n = 24–278). Our analyses are based on effect on diabetes incidence of the CP transplants*. The control growth data up to the age of 2 years.
group reached the maximum diabetes incidence of 53% by day 156 Results: The newborn infants in NE were heavier (p < 0.001) but
of life, whereas the maximum diabetes incidence of 27% was not shorter (p = 0.007) than their peers in CSE. The NE children seen in the experimental group until day 230. CP transplants given remained heavier than those from CSE at all time points (p ≥ 0.04) after diabetes had occurred in the control group were ineffectual.
but at the age of 2 years. The former group was also taller than the Conclusion: It is likely that the protection afforded by CP is capable
latter group starting from the age of 3 months up to 18 months of of offsetting damage caused by immune attack of islets. CP age (p ≥ 0.03). The NE boys were heavier (p ≥ 0.04) at all time points intraperitoneal transplants could provide a novel, minimally during the follow-up, while that was true up to the age of 9 months invasive means of preventing Type 1 diabetes in humans, in those (p ≥ 0.05) among girls. NE girls were marginally taller than their deemed to be at high risk. That neuroprotection is likely to be the peers from CSE only at 6 and 18 months, whereas the NE boys were mechanism of action of these cells casts new light on the possible taller (p ≥ 0.05) at all time points but 6 months.
Conclusions: The young children in NE were shorter but heavier at
*original data will be presented in detail.
birth than their counterparts in CSE. The NE children remainedheavier over the first 18 months of life, and they became taller thantheir CSE peers already at the age of 3 months. These differencesin early growth pattern may contribute to the high incidence of T1D Birth size and postnatal growth in young offspring in
European families with at least one family member
affected by type 1 diabetes
Perinatal risk factors for childhood type 1 diabetes in
M. Knip1, C. de Beaufort2, G. Jan Bruining3, L. Castano4, T. Danne5, western Australia – a population based study
J. Ludvigsson6, L. Madacsy7, A. Ormisson8, P. Pozzilli9, E. Schoenle10, (1980–2002)
M. Serrano-Rios11, M. Songini12, J. Vavrinec13, R. B. Wasikowa14, A. Haynes1,2, C. Bower2, M. K. Bulsara2,3, T. W. Jones1,2 & E. A. Davis1,2 S. M. Virtanen15, D. Cuthbertson16, H. K. Åkerblom1 & the TRIGR 1Department of Endocrinology & Diabetes, Princess Margaret Hospital, Perth, 2Centre for Child Health Research, The University of 1Hospital for Children and Adolescents, University of Helsinki, Western Australia, Telethon Institute of Child Health Research, Perth, Helsinki, Finland, 2Clinique Pediatrique Luxemburg, GD de Luxemburg, 3School of Population Health, The University of Western Australia, Luxemburg, 3Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands, 4Hospital de Cruces, Barakaldo, Spain,5Diabetes-Zentrum für Kinder und Jugendliche, Kinderkrankenhaus Introduction: The relationship between perinatal factors and type 1
auf der Bult, Hannover, Germany, 6Division of Pediatrics, Department diabetes (T1DM) remains unclear, with several studies reporting of Molecular & Clinical Medicine, Faculty of Health Sciences, inconsistent findings. No such studies have yet been performed in Short Poster Presentations
Western Australia (WA) where complete, population-based data are are associated with an increased frequency of children born with available on all children diagnosed with T1DM under the age of 15 IAA and IA-2Ab. Prospective analysis will determine whether these years. Perinatal data collection on all births, including data on neighborhoods are also at increased risk for later development of maternal health and socio-demographic factors, has been manda- tory in WA since 1980.
Aim: This study aimed to investigate potential perinatal risk factors
for childhood T1DM in WA, using a complete population-based Variation in physical activity lies with the child, not
cohort, from 1980 to 2002.
Methodology: Perinatal data were obtained from the Midwives’
his environment. Evidence for an ‘activitystat’ in young
Notification System, on all live births in WA from 1980 to 2002 (n children: the EarlyBird diabetes study
= 559,134) and record linkage performed to identify the cases. Cases T. J. Wilkin, K. M. Mallam, B. S. Metcalf, A. N. Jeffery & L. D. Voss born between 1980 and 2002 and diagnosed with T1DM, under the Dept of Endocrinology & Metabolism, Peninsula Medical School, age of 15 years, in WA between 1985 and 2003 (n = 909), were iden- tified using the prospective population-based diabetes register at Background: Children’s physical activity (PA) is important in rela-
Princess Margaret Hospital, which has a case ascertainment rate of tion to diabetes risk, but there is little understanding of its control.
Aims: To establish whether a child’s overall PA is greater where there
Results: After adjusting for year of birth, birth weight and gesta-
tional age, the incidence increased by an average of 9% for each 5 Methodology: Accelerometers recorded weekly PA in two groups of
year increase in maternal age at delivery (Incidence rate ratio (IRR) healthy children: Group 1: 215 9-year-olds from three schools (S) 1.09 (95%CI: 1.03–1.17), p = 0.005). After adjusting for maternal differing widely in timetabled physical education (PE) (S1 = 9.0 age at delivery, gestational age and year of birth, the incidence h/week, S2 = 2.2 and S3 = 1.8). Group 2: 300 of the EarlyBird increased by an average of 16% for every 500 g increase in birth cohort examined at 5 y and again at 6 y.
weight (IRR 1.16 (95%CI: 1.07–1.25), p < 0.001). After adjusting Results: Group 1: school-time PA was predictably higher in S1 (B:
for maternal age at delivery, birth weight and year of birth, the inci- S1 = 18.6, S2 = 12.5, S3 = 11.0, G: S1 = 16.9, S2 = 9.7, S3 = 11.4 dence decreased with increasing gestational age [IRR 0.82 (95%CI: PA units/wk, p < 0.001). However, what PA the children from S2 0.75–0.90), p < 0.001]. Additional data on maternal medical and S3 lacked in school, they made up for out of school (B: S1 = history, pregnancy complications and socioeconomic status will be 16.1, S2 = 26.6, S3 = 22.8, G: S1 = 13.6, S2 = 22.7, S3 = 22.6 units/wk, p < 0.001). Indeed, <1% of the variance in PA could be Conclusion: After adjusting for confounding variables, the incidence
explained by the five-fold difference in timetabled PE. Group 2: of T1DM increased significantly with increasing maternal age at weekday/weekend day and year-on-year correlations were high delivery, higher birth weight and lower gestational age.
(r = 0.43–0.56). Furthermore, over 90% of the PA counts lost by car transport to school were ‘recovered’ during the rest of the day(walkers 37.56, car 37.60 units/wk, p = 0.97). Finally, the weekly PA Neighborhood genetic and environmental factors and
recorded by Group 2 children in Plymouth was within 1% of that number of newborns born with cord blood
recorded by age-matched children in Glasgow.
Conclusions: The data point to consistency in PA among young chil-
dren, irrespective of daily routine or culture. Further, almost all the Department of Clinical Sciences, Malmö, Sweden variation in PA lies with the child, rather than his/her environment,which may have important implications for plans to increase pro- Introduction: Genetic factors are important in the development of
vision. The correlations in PA within groups over time and the sim- islet autoimmunity and type 1 diabetes (TID). HLA-DQB1*02 is ilarities between groups, despite differing opportunity, suggest that associated with GAD65Ab and HLA-DQB1*0302 with IA-2Ab PA is under biological, rather than environmental, control.
and IAA. The role of environmental triggers however is unknown
but perinatal factors are considered important.
Aim: To examine whether prevalence of high risk T1D-HLA geno-
type and reported maternal infections in municipalities are inde- Parental body mass index (BMI) is closely related to
pendently related to frequency of newborns with autoantibodies.
the BMI in children and adolescents with type 1
Methodology: In all, 24 732 newborns born to healthy mothers in
the south of Sweden were included. Dried blood spots were pre- B. Aschemeier, T. Danne, U. Rischer & S. Glinda pared from the newborn and the address of the mother was Kinderkrankenhaus auf der Bult, Diabetes-Zentrum, Hannover, obtained from a registration form. Prevalence of high risk T1D- HLA in municipalities was estimated from frequency of newbornswith the high risk HLA-DQB1*02/0302 genotype. Reported mater- Introduction: The excessive weight gain of children and adolescents
nal infections during pregnancy were taken from psychosocial ques- with type 1 diabetes is a frequent finding.
tionnaires filled out by mothers. Poisson regression tested whether Aim: We tested the hypothesis that there is an influence of parental
neighborhood factors were associated with frequency of newborns BMI and analyzed the contribution of further diabetes and non- Results: Neighborhood genetic and environmental factors were
Methodology: The association between the age and gender adjusted
not related to frequency of GAD65Ab positive children. Frequency SDS of BMI of children and adolescents with type 1 diabetes of IA-2Ab or IAA positive children however was positively associ- treated in a regional referral center, clinical data, and the parental ated with both prevalence of DQB1*02/0302 (p = 0.006) and BMI were examined in a retrospective cross-sectional analysis by mothers reporting gastroenteritis (p = 0.01). Number of younger logistic multiple regression statistics.
mothers (<30 years) was also associated with increased autoanti- Results: A representative sample of 251 patients (3–21 ys) with a
body frequency (p = 0.04). Multivariate analysis showed both HLA mean diabetes duration of 5.4 ± 3.3 ys (mean ± SD) exhibited a sig- and reported gastroenteritis to be significant (ps < 0.01).
nificant increase of body weight of 0.9 ± 0.9 SDS. A tendency Conclusion: High risk HLA and gastroenteritis in the neighborhood
towards higher SDS (0.9 ± 1.0) in girls (n = 119) compared to boys Short Poster Presentations
(0.8 ± 0.8 p = 0.2) was observed particularly in pubertal girls (n = W. Mlynarski, K. Wyka, A. Szadkowska, B. Mianowska & J. Bodalski 86, SDS: 1.0 ± 1.0) compared to prepubertal girls (0.7 ± 0.8 p < Department of Pediatrics Medical University of Lodz, Poland 0.05). In contrast, the pubertal boys (n = 80) demonstrated a lower Introduction: Recent studies have reported that free fatty acids
SDS (0.8 ± 0.8) compared to prepubertal ones (0.9 ± 0.8). Fathers (FFA) affect insulin secretion by specific receptors, e.g. CD36 and who were overweight (BMI > 25 kg/m_ n = 167) increased the odds GRP40. Moreover, in vitro studies have revealed that high FFA ratio for obesity in children by 1.8 (95%CI: 1.06–3.1 p < 0.05).
level may induce apoptosis of the pancreatic beta cells. On the other Maternal obesity (BMI > 30 kg/m_ n = 40) increased the odds ratio hand, the accelerator hypothesis suggests that adipose tissue and/or even to 2.9 (95%CI = 1.42–6.11 p < 0.05). We found a direct posi- lipids metabolism may contribute to the pathogenesis of type 1 tive correlation of maternal BMI to the BMI of their diabetic chil- dren in both sexes, while the paternal BMI increased the risk only Aim: Thus, to determine whether the residual insulin secretion in
for prepubertal girls (p < 0.000). Diabetes related factors such as children with type 1 diabetes is related to FFA serum level we diabetes duration, glycaemic control or mode of therapy showed no recruited 178 diabetic patients (mean age 10.8 yrs; M/F 99/79).
association. Furthermore, it had no influence on the results if the Methodology: In all individuals the fasting C-peptide and FFA
children were living in urban or rural regions.
serum levels were measured at the onset and after 6 months of the Conclusion: The risk of overweight and obesity in children and
adolescents with type 1 diabetes is primarily dependent on familiar Results: 34 (19.1%) of the patients had the C-peptide level above
factors and particularly maternal obesity. Methods to prevent an lower limit of normal range (>0.28 pmol/ml) at both time-points.
excessive weight gain in pediatric diabetes patients should focus also FFA level at onset was significantly higher as compared to the level after 6 month of follow-up (38.4 ± 29.4 vs. 28.9 ± 23.1 mg/dl; p = 0.0003). However, both values were positively correlated (r = 0.31,p = 0.0008). Interestingly, negative correlation was found between Higher body mass index at diagnosis of type 1 diabetes
FFA and C-peptide measurements at 6th month (r = -0.19, p = 0.01 in younger children
and r = -0.18, p = 0.02 for FFA at onset and at 6th month, respec- S. L. Clarke, A. Sambavisan, A. Chan, J. M. Cusumano, C. T. Cowell, tively). Moreover, when the C-peptide level was treated as a binom- inal variable (above and below 0.28 pmol/ml) higher levels of FFA Institute of Endocrinology and Diabetes, The Children’s Hospital at were observed in children with C-peptide deficiency at both time- Westmead, Sydney, New South Wales, Australia points (41.1 vs 29.9 mg/dl, p = 0.03 and 31.0 vs 23.7 mg/dl, p = 0.1).
No relation of FFA with age at onset, gender, insulin requirement The accelerator hypothesis states that overweight in childhood brings earlier the diagnosis of type 1 diabetes. It may also suggest Conclusion: Obtained results, which link the FFA acids with resid-
that younger children may be more overweight than older children ual insulin secretion in type 1 diabetes, may serve as further evi- dence supporting the accelerator hypothesis.
Aim: To determine whether BMI standard deviation score (SDS)
was higher in younger children at diagnosis and if so, whether that
continued after five years of diabetes.
Methods: We analyzed the baseline weight and height measurements
TRMA, a novel aetiology to diabetes in childhood
at 1–12 months post diagnosis to allow for the regain of any lost weight prior to diagnosis; and at five years duration. Weight, height Dept. of Pediatrics, Glostrup University Hospital, Denmark & Kennedy and BMI SDS were compared between three age categories. SDS for age and gender were derived from CDC 2000 growth data.
Introduction: In Denmark most children with diabetes have
type 1 diabetes, but other more rare types of diabetes also exist.
Thiamine Responsive Megaloblastic Anaemia (TRMA) is a rare autosomal recessive condition, including megaloblastic anemia, Baseline
non-autoimmune diabetes mellitus and sensorineural deafness. We describe 3 cases of TRMA in children from two consanguineous Pakistani families, who were apparently not related.
Aim: To raise the awareness of other more seldom types of diabetes
which especially occur in immigrant, consanguineous families.
Methodology: In our clinic 3 cases of TRMA have been diagnosed.
Two children, who were cousins, came from the same consan- guineous family from Pakistan. Their parents were siblings, and married to their first cousins. The last child came from another con- After 5 years of diabetes, the BMI SDS fell significantly in the sanguineous family, not related to the first family, but coming from youngest group (p = 0.0004), but had increased significantly in the older groups (p = 0.032, p < 0.0001).
All children were diagnosed at a young age, 10 months, 12 Conclusions: At diagnosis BMI SDS was higher in younger children
months and 8 weeks, and all had diabetes, severe megaloblastic but after five years diabetes duration BMI SDS was not significantly anemia, failure to thrive and sensorineural deafness. Due to the different between younger and older children. This suggests the complex of symptoms TRMA was suspected, and a genetic evalu- younger children had a relative deceleration in growth possibly fol- lowing an acceleration prior to onset of diabetes.
Results: All children were homozygous and the parents heterozy-
gous for a previously reported mutation 196G > T, leading to a pre-
mature stop (E66X) in the SLC19A2 gene. The gene is located on
chromosome 1q23.2–23.3 and encodes a high-affinity thiamine Free fatty acids level at onset of type 1 diabetes:
transporter. The result is an abnormal thiamine transportation.
further evidence supporting the accelerator hypothesis
Thiamine in high doses (100–200 mg/day) reversed the anemia in Short Poster Presentations
all patients. After a short treatment period two of the patients treating hospitals. Patients who had an HbA1c value >7.5% in 2003 stopped insulin treatment, while the third remained on insulin treat- and managed to reduce it with 1% point in a year were selected for ment, but had a 50% reduction in daily insulin requirement. All the study. All HbA1c values used in this study were measured at the children remained deaf, and have received a cochlea implant.
same laboratory with the DCCT standard.
Conclusion: TRMA is a rare, autosomal recessive disease, including
Results: The benchmarking was based on 1129 patients in 2003,
megaloblastic anemia, diabetes and deafness. The disease should 1417 patients in 2004. In 2004 mean HbA1c for the total group was especially be suspected in immigrant consanguineous families.
8.1%. 152 patients with a mean age of 13.4 years (3.7–20.4) wereincluded in the study according to the inclusion criteria. Further results are given in the table.
Conclusion: Insulin dose, BMI and the proportion of patients using
CSII and MDI treatment of type 1 diabetic children
an insulin pump were significantly raised in 2004 compared to 2003.
under the age of 10: 5 years follow up
Higher insulin dosages and increased use of pumps were the main A. Szypowska, E. Pankowska, M. Lipka, H. Trippenbach-Dulska, factors we could identify having importance for better glycemic Department of Diabetology, Neonatology and Birth Defects MedicalUniversity of Warsaw, Poland Clinical characteristics
Introduction: Continuous subcutaneous insulin infusion (CSII) is an
alternative method of insulin administration in patients with type 1 diabetes. The guidelines of its use in young children are still being Aim: The aim of this study was to evaluate and compare the
outcome of type 1 diabetic children under the age of 10 treated with CSII therapy with a control group treated with multiple daily injec- Number of blood glucose measurements/week tion (MDI) for a period of 5 years.
Methodology: The study was conducted during years 2000–2004.
234 patients (128b, 108 g) of an outpatient clinic of Medical Uni-
versity Department of Diabetology in Warsaw, with a history of Treatment with insulin glargine (Lantus) of children
type 1 diabetes for at least 6 months were followed. This group and adolescents with type 1 diabetes
treated with CSII included 163 subjects (81b, 83 g) with mean age – 7.46 ± 2.4 (2.3–10 ys), mean duration of diabetes – 3.26 ± 1.7 2nd Pediatric Clinic, Medical University, Bialystok, Poland (0.5–9 ys) and mean duration of CSII therapy – 1.96 ± 0.3 (0.5– Objectives: New therapies for treatment of type 1 diabetes should
4.2 ys). The group treated with MDI therapy included 71 subjects improve control without increasing the number of hypoglycemic (37b, 25 g), mean age – 8.57 ± 2.24 (2.3–10 ys), mean duration of episodes which are a significant cause of psychological and physical diabetes – 3.21 ± 2.35 (0.5–9 ys).
fear in patients. Previous studies suggested that hypoglycemia may Results: The average HbA1c values were significantly lower in CSII
be closely linked to the high variability observed with traditional vs MDI patients (2000: 8.07 ± 1.21% vs 8.49 ± 1.36%; 2001: 7.78 ± basal insulin preparations such as NPH insulin. Further, NPH 1.21% vs 8.66 ± 1.67%; 2002: 7.53 ± 1.03 vs 7.81 ± 0.98%; 2003: 7.38± insulin is often administered twice daily and patients with dawn phe- 0.96% vs 7.8 ± 1.28%, 2004: 7.23 ± 0.94 vs 7.86 ± 1.23 p < 0.005).
nomenon need additional injection with short acting insulin at 3 a.m.
The overweight in pumps users was not observed and the average Aim: The aim of the study was to determine if the addition of
BMI in both groups was 16.2 ± 1.3 kg/m2. No statistically insulin glargine (Lantus) could improve glycemic control and avoid significant difficulties were noted in mean insulin requirement an additional injection at 3.00 a.m. in children and adolescents with between CSII and MDI groups during follow up period (2000: 0.5 ± 0.22 j/kg/d vs 0.58 ± 0.27 j/kg/d, 2001: 0.55 ± 0.2 j/kg/d vs Materials and methods: 83 patient with type 1 diabetes (41 F and
0.6 ± 0.29 j/kg/d, 2002: 0.6 ± 0.22 j/kg/d vs 0.65 ± 0.3 j/kg/d, 2003: 42 M) mean age of 14.45 years (5–18.8) and diabetes duration of 0.64 ± 0.22 j/kg/d vs 0.71 ± 0.49 j/kg/d, 2004: 0.71 ± 0.19 j/kg/d vs 5.85 years (0.5–12.9) were transferred from NPH insulin to Lantus and maintained the treatment for at least six months. The starting Conclusion: The pump therapy is more effective than pen therapy
dose of insulin glargine at bedtime was 80–100% of the previous in young diabetic children, provides good and sustained metabolic total dose of basal insulin. The doses of glargine and prandial control without increasing of body mass index.
insulins were adjusted according to fasting, postprandial glycemiaand glycemia at 3.00 a.m.
Results: Mean HbA1c levels at baseline, after 3 and 6 months
Under dosage of insulin seems to be an important
were 8.3%, 7.99% and 7.5% (p < 0.05 vs. baseline) respectively. The reason for not reaching treatment goals for Norwegian
dose of glargine insulin was 0.24 IU/kg (27% of daily insulin dose).
children with diabetes
Episodes of severe hypoglycemia were not registered. The incidenceof nocturnal hypoglycemia and early morning hyperglycemia J. R. Larsen, C. Brunborg, H. D. Margeirsdottir, K. Dahl-Jorgensen & tended to decrease. We also observed that patients with dawn phe- the Norwegian Study Group of Childhood Diabetes nomenon (78%) did not need additional insulin injections at 3.00 Ullevaal University Hospital, Pediatrics, Oslo, Norway a.m. to have good fasting glycemia (almost 50% of them) or doses Introduction: Twenty-three percent of the patients in a nationwide
of short acting insulin insulin were significantly lower. BMI did not benchmarking study of children with diabetes obtained the goal for change (19.88 kg/m2 at baseline vs. 19.42 kg/m2 after 6 months).
Conclusion: These results show that treatment with a basal bolus
Aim: To identify patients who managed to get significantly better
insulin glargine is effective and well tolerated in type 1 diabetic glycemic control from 2003 to 2004 and characterize them.
patients. Insulin glargine significantly improves metabolic control, Methodology: Data concerning treatment, acute and chronic com-
reduces nocturnal hypoglycemic and hyperglycemic episodes and is plications in children with diabetes are collected yearly from the not associated with weight gain. The insulin analogue glargine Short Poster Presentations
(Lantus) is a valuable tool to obtain a basal insulin supplementa- the beginning of therapy and on the 6th month Childhood Behav- tion in patients with type 1 diabetes.
ior Check List (CBCL), self-esteem and quality of life scoring wereevaluated. Hb A1c, height SDS, BMI, BMI SDS and insulin dosages were evaluated at delta Hb A1c, the beginning and on the The use of insulin glargine in pre-pubertal children on
3 ¥ daily insulin regimen – a randomized cross-over
Results: Mean age of the patients was 15.2 years (6.3–22.3 years)
and the mean duration of diabetes was 7.1 years (1.2–18 years).
There was no difference in BMI, BMI SDS, the total insulin dosage E. E. Reiterer, K. Ong, F. Regan, C. Acerini & D. Dunger and basal insulin dosage at the beginning and on the 6th month of University Department of Pediatrics, Addenbrooke’s Hospital, therapy in the two groups. There was a significant decrease in HbA1c in both of the groups on the 6th month of therapy (p < Introduction: Insulin glargine is increasingly used in children with
0.05) but no difference was found between delta Hb A1c at the end type 1 diabetes mellitus (T1DM) on multiple injection therapy (4 + of the 62.37 p = 0.78). Self-esteem of ± 2.72; group 2: -0.46th month injections/day) to reduce nocturnal hypoglycemia and to improve (group 1: -0.58 the patients did not show any difference between blood glucose control. However many younger children will only the two groups but there was a significant difference in the behav- accept less intensive insulin regimens.
ioral issues of the patients at the beginning and at the end of the Aim: We investigated the effects of glargine on hypoglycemic
6th month. CBCL scores decreased in both of the groups at the end events and glucose control in pre-pubertal children when combined of the sixth month but not statistically significantly. There was no with various insulin combinations given 3 ¥ daily (morning/ difference in the self esteem of the two groups at the beginning and on the 6th month. Anxiety of the patients decreased in the first Methodology: 17 pre-pubertal children with T1DM (7 girls),
group at the end of the sixth month (p = 0.049) according to quality median age 10.2 years (range 6–12.4), HbA1c 8.8% (6.8–11.5) took part in an open-label, randomised, cross-over study. After a 2-week Conclusion: As a result, glargine insulin helps to provide a better
run-in period (with NPH pre-bed), every child received 3 different metabolic control albeit nutrition and the difference in behavioral 3-week treatment blocks in randomised order. All the treatment issues is statistically significant and carb counting helps to decrease blocks included: insulin aspart pre-tea, and glargine pre-bed. The different morning insulins were: Block 1: actrapid only, Block 2:actrapid + NPH, Block 3: aspart + NPH. A continuous glucose monitor (CGMS, Minimed) was applied at the end of the run-in Impact of regular physical activity on metabolic
and each 3-week glargine treatment block.
control and cardiovascular risk factors in children
Results: Mean pre-breakfast glucose levels were lower in the 3
with type 1 diabetes – a large multicentre study
glargine blocks (p < 0.05), and showed lower variance (p < 0.05) A. Herbst1, K. O. Schwab2, T. Kapellen3 & R. W. Holl4 for the compared to the run-in period. Mean day-time blood sugars and number of day-time hypoglycemia episodes did not differ signifi- 1Department of Pediatrics, University of Bonn, 2University of Freiburg, cantly between treatment blocks and run-in. Night-time prolonged 3University of Leipzig, 4Institute for Biomedical Engineering, University hypoglycemic episodes (<3.5 mmol/l for >60 mins) were less common in Block 3 (14.9% of 47 nights) than in the run-in (33.3%;p < 0.05); Block 1 (21.9%) and Block 2 (38.3%) did not differ com- Introduction: Physical activity has been shown to have a positive
pared to run-in. Total daily insulin doses were 8–15% lower on each effect on glycaemic control in type 1 diabetes.
of the 3 glargine treatment blocks compared to the run-in period Aim: To evaluate the influence of the frequency of regular physical
activity on HbA1c, BMI, plasma lipids and blood pressure in a Conclusion: In pre-pubertal children on a 3 ¥ daily insulin regimen,
large cohort of children with type 1 diabetes.
insulin glargine (pre-bed) is as effective as conventional insulin, and Methodology: Anonymous data of 18.392 pediatric patients (age
results in lower and less variable morning glucose levels. When 0.2–19.9 years; 8828 girls) with type 1 diabetes were provided by the taking insulin glargine pre-bed, the morning insulin combination of Pediatric Quality Initiative (DPV), including data from 179 centers a short-acting analogue + NPH was associated with reduced noc- in Germany and Austria. Patients were grouped by the frequency of their regular physical activity per week (FRPA) as follows:FRPA0 = none, FRPA1 = 1–2¥/week, FRPA2 = >2¥/week.
Results: Frequency of regular physical activity was 0–9 (mean 1.26)
The effect of insulin glargine and nutritional model on
times/ week. Multiple regression analysis revealed that FRPA was metabolic control, behavior, self-esteem and quality of
one of the most important factors influencing HbA1c, LDL, HDL, life in type 1 diabetes mellitus
triglycerides (TG) and diastolic blood pressure. High FRPA corre-lated with low HbA1c (p < 0.0001) in both sexes and in all age D. Goksen, M. Buyukinan, S. Darcan, B. Ozbaran & M. Coker groups. In the FPRA1 group HbA1c was lower than in the FRPA0 group, but in the FRPA2 group HbA1c was not lower than in the Introduction: Nutritional model and the type of insulin used affect
FPRA1 group. We found a significant negative correlation between the metabolic control, quality of life, behavior problems and self- Cholesterol, LDL, TG and diastolic blood pressure and FRPA and a significant positive correlation between HDL and FRPA. In girls, Aim: To evaluate the effects of glargine insulin and nutritional
but not in boys, high FRPA was associated with low BMI-SDS (p model on metabolic control and quality of life.
< 0.0001). Rate of severe hypoglycemia (defined by unconsciousness Methodology: Thirty eight children (19 girls, 19 boys) with type 1
or seizures) did not correlate to FRPA.
diabetes were included. The patients were assigned to 2 groups Conclusion: Regular physical activity represents one of the most
according to their nutritional model. First group (n = 14) were important factors influencing the metabolic control and cardiovas- changed to carbohydrate counting and the second group (n = 24) cular risk factors in children with T1DM. Frequency of the regular stayed with the same nutrional model as before (calories). Both physical activity has an important impact on lipid profils and dias- groups started to use insulin glargine and rapid acting insulin. At tolic blood pressure. Concerning the HbA1c, regularity of physical Short Poster Presentations
activity seems to be more important than frequency. The risk for (T1D). We and others have shown that adjunctive therapy with met- severe hypoglycemia is not elevated even in children frequently per- formin moderately improves A1c in these subjects. The objective of this study was to determine if the addition of a potent insulinsensitizer, the thiazolidinedione pioglitazone (PIO), to standard therapy also leads to improved metabolic control in pubertal T1D What is the relationship between the frequency
patients with IR.
Methodology: We conducted a 2 site, randomized, placebo-
of self-monitoring of blood glucose (SMBG) and
controlled, double-blind 6 month trial of 30 mg PIO versus placebo metabolic control? Effects of age, gender, mode of
(PLAC) in 38 adolescents with T1D, high insulin requirements (>0.9 insulin therapy
U/kg/day) and suboptimal metabolic control (HbA1c > 7.5%). We R. W. Holl, R. Lepler, H. Haberland, U. Krause, A. Herbst, V. Wagner, contacted each subject by telephone at least weekly to adjust insulin J. Rosenbauer & B. Rami for the DPV-Wiss Study Group doses to target blood sugars of 4–8 mmol/L.
Ulm, Hamburg, Berlin, Bonn, Lübeck, Düsseldorf, Wien (Germany / Results: There was 1 dropout. 2 subjects withdrew [severe hypo-
glycemia (PIO); elevated hepatic enzymes (PLAC)].
Introduction: Repeated daily blood glucose measurements and
Baseline characteristics of patients who completed the study appropriate dose-adjustments are considered a major part of modern intensified insulin therapy. However, few studies have addressed the question whether more frequent SMBG is actually related to better metabolic control in pediatric patients with type-1 Aim: Evaluate the relationship between SMBG and metabolic
Methodology: The DPV-Science-Database is a multicentre docu-
mentation initiative as a basis for quality management in routine
After 6 months both groups had significantly lower A1c levels (p < care. Data are recorded locally by a dedicated computer software 0.05); (mean change in A1c in PIO group – 0.4 ± 0.9 vs – 0.5 ± 1.2% program, anonymized and transferred for central analysis. This in the PLAC group), without significant differences between groups.
report is based on pediatric patients (age <18 years) with type-1 dia- Insulin dose was unchanged. The PIO group demonstrated a small betes. By March 2005, 17940 patients from 166 centers in Germany decrease in cholesterol and LDL, compared to an increase in the and Austria were available for analysis (mean age at onset: 8.0 years, PLAC group (p < 0.05). BMI SDS increased by 0.3 in PIO group, mean chronological age: 12.8 years, 48% female). HbA1c was math- and remained unchanged in the PLAC group (p = 0.01).
ematically standardized to the DCCT normal range based on local Conclusion: Unlike previous studies using metformin, adjunctive
therapy with PIO was not effective in improving metabolic control Results: On average, patients measured 30.9 blood glucose values
in adolescents with T1D. The effect on lipid profile, despite per week. The frequency of SMBG increased during recent years increased BMI SDS, in these patients may suggest potential (1995: 23, 2004: 34), was higher in younger patients (<5 years: 39, 15–18 years: 27) and in patients on intensified insulin therapy (4+injections/day, 32 versus 28), and girls measured slightly more BGvalues compared to boys (all p < 0.0002). A multiple regression model (GLM) was used to evaluate the relationship between the fre- Glimepiride (GLIM) vs metformin (MET) as
quency of glucose testing and metabolic control. Overall, HbA1caveraged 8.4%. After correction for age, gender, duration of dia- monotherapy in pediatric subjects with T2DM: a single
betes, injection frequency, dose and preparation of insulin, year of blind comparison study
observation and center, there was a highly significant relationship M. Gottschalk1, T. Danne2, J. Cara3, A. Vlajinic4 & M. Issa4 between the frequency of SMBG and better metabolic control (p < 1University of California, San Diego Medical Center, San Diego, CA, 0.0001). One additional BG measurement per day improved HbA1c 2Kinderkrankenhaus auf der Bult, Hannover, Germany, 3Children’s by 0.27%. This effect was more pronounced in older subjects and Hospital of Michigan, Detroit, MI, 4sanofi-aventis, Bridgewater, NJ in patients on intensified insulin therapy or insulin pump therapy.
Introduction: Glimepiride (GLIM) with its favorable efficacy and
In contrast, the rate of severe hypoglycemia did not improve with safety profile in adults may be an appropriate alternative for initial more frequent blood glucose testing.
therapy in pediatric patients with T2DM.
Conclusion: This observational study on a large cohort of subjects
Methodology: A 26 wk randomized, single blind, parallel-group,
demonstrates that under real-life conditions patients who measure forced-titration study compared the efficacy and safety of GLIM blood glucose more frequently display better metabolic control, and metformin (MET) therapy in 263 T2DM pts age 9 to 17 inad- especially in older subjects on intensified insulin therapy.
equately controlled (A1C > 7.1% but <12.0) with diet & exerciseonly &/or failed oral monotherapy. Pts were randomized to GLIM 1 mg qd & titrated every 4 wks to 2 mg, 4 mg, and 8 mg qd, respec- Does the addition of pioglitazone to insulin improve
tively to achieve FBG <7.0 mmol/L (126 mg/dL) or MET 500 mg bid metabolic control in youth with type 1 diabetes and
titrated to 1000 mg bid if mean SMBG > 7.0 mmol/L (126 mg/dL).
insulin resistance? A randomized placebo-controlled
Results: Baseline demographics were similar: mean age 13.8 yrs;
66% female; >50% tanner stage £3; mean A1C 8.5%; median BMIGLIM 30.4 kg/m2 (range 14.5–70.5) & MET 31.2 kg/m2 (range V. Zdravkovic1, E. Cummings2, D. Daneman1 & J. Hamilton1 17.2–62.9). Mean last dose of GLIM was 3.8 mg & 1408 mg for 1Hospital for Sick Children, Toronto, ON, Canada, 2IWK Health Centre, MET. At wk 24, mean A1C was 7.99% & 7.83% and mean SMBG was 9.0 mmol/L (161 mg/dL) & 8.4 mmol/L (152 mg/dL) for GLIM Introduction: Insulin resistance (IR) during puberty may cause dete-
& MET groups, respectively. Similar percentage of pts achieved rioration of metabolic control in adolescents with type 1 diabetes A1C <7% (42% GLIM vs 48% MET, p = 0.3468). Incidence of Short Poster Presentations
ADRs was low with headache, diarrhea, & nausea occurring most frequently in the MET group. Incidence of hypoglycemia Effects of rosiglitazone on intracellular antioxidant
[<2.8 mmol/L (50 mg/dL)] was similar in each group [4.9% (7/142) pts enzyme production in adolescents and young adults
GLIM vs 4.2% (6/142) MET, p < 0.7464]. One severe hypoglycemia with early diabetic angiopathy
event [<2.0 mmol/L (36 mg/dL)] occurred in each group. Lipid D. Di Marzio, A. Mohn, F. Cipollone, A. Mezzetti & F. Chiarelli Department of Pediatrics, University of Chieti, Chieti, Italy Conclusion: GLIM & MET are safe and effective for the treatment
of pediatric pts with T2DM.
Introduction: Defective intracellular antioxidant enzyme production
(IAP) has been recently demonstrated in adults with diabetic
Aim: The objective is to evaluate the effects of rosiglitazone, one of
the thiazolidinediones, on IAP in adolescents and young adults with type 1 diabetes mellitus (T1DM) and early signs of retinopathy and Methodology: Prospective, matched case-control study conducted
between November 2003 and December 2004 among 16 adolescents (age 16–21 years) with T1DM and early signs of angiopathy, 16 *Adjusted means from analysis of covariance (ANCOVA) patients (age 16–22 years) with T1DM, without diabetic angiopa-thy and 13 healthy volunteers (age 17–23 years). Skin fibroblastswere obtained by skin biopsies from the anterior part of forearmand cultured in Dulbecco’s modified Eagle’s medium. Activity of CuZnSuperoxide-dismutase (SOD), MnSOD, catalase (CAT) and Oxidative stress, DNA damage and DNA repair
glutathione-peroxidase (GPX) and mRNA expression were mea- capacity in children with type 1 diabetes mellitus and
sured before and after 6 months of treatment with rosiglitazone;in both occasions antioxidant enzyme activity was evaluated at dif- Crohn disease
ferent glucose concentrations (5 mmol/l and 22 mmol/l). Adoles- J. Varvarovska, R. Stetina*, R. Pomahacova, J. Sykora, J. Racek, cents and young adults with diabetic angiopathy were treated with rosiglitazone (4 mg daily) for 6 months.
Charles University Hospital, Alej Svobody 80, 304 60 Plzeò, Czech Results: In normal glucose concentrations, CuZnSOD (0.56 ± 0.23
U/mg protein; 4.7 ± 1.5 mRNA/GAPDH), MnSOD (0.32 ± 0.08; Introduction: Oxidative stress (OS) occurs in conjunction with dia-
0.9 ± 0.4), CAT (0.39 ± 0.12; 4.6 ± 1.4), and GPX (0.53 ± 0.15; 2.6 betes mellitus (DM) and chronic inflammatory state represented by ± 0.9) activity and mRNA expression were not different among the Crohn disease (CD). OS results in damage to lipids, proteins and three groups (values of diabetics with angiopathy). In high glucose Aim: To study the intensity of oxidative stress, degree of DNA
increased similarly in all groups (in angiopathics: 0.99 ± 0.32; 10.0 damage and DNA repair in a group of children with diabetes mel- ± 3.4). CAT and GPX activity and mRNA did not increase in high litus type 1 (T1DM) and CD. These results were compared with glucose conditions only in the adolescents with diabetic angiopathy those derived from healthy children.
(0.39 ± 0.11; 4.7 ± 1.3 and 0.55 ± 0.16; 2.7 ± 0.9, respectively).
Methodology: 20 T1DM children (8 girls, 12 boys, average age 13.26
MnSOD did not change in any group. Treatment with rosiglitazone ± SD 2.98 years, average T1DM duration 2.94 ± 2.72 years, mean in adolescents with diabetic angiopathy was able to restore CAT and HbA1c 9.50 ± SD 2.52%-DCCT) and 17 CD children (7 girls, 10 GPX activity and mRNA expression after exposure to high glucose boys, average age 14.29 ± SD 2.52 years, average disease duration 3 concentrations. Markers of oxidative stress (MDA, FPLP, MCP-1 ± 1.43 years, PCDAI index 35.69 ± 16.60) were randomly chosen and 8-isoprostanes PGF2a) were significantly reduced after treat- from a list of those treated at the Department of Pediatrics, Uni- versity Hospital in Plzen. Investigated markers of OS were: super- Conclusion: Adolescents and young adults with early signs of dia-
oxide dismutase (SOD), glutathione peroxidase (GPx), plasma betic angiopathy have defective intracellular antioxidant enzyme antioxidant capacity (AOC), reduced glutathione (GSH) and mal- production and activity; treatment with rosiglitazone is able to sub- ondialdehyde (MDA). Breaks in DNA chains due to OS were inves- stantially improve activity and production of these enzymes in skin tigated within peripheral lymphocytes using comet assay technique (DNAsb). Lymphocyte capacity to repair damaged DNA (DNArc)was also assessed using the modified comet asssay. DNRI indexexpressed the relationship DNRI = DNArc/DNAsb. Results were compared with a group of 11 healthy children of similar age and Risk factors of prehypertension in type 1 diabetic
sex (5 girls, 6 boys, average age 13.73 ± SD 3.80).
children and adolescents
Results: There were no significant differences between children with
I. Pietrzak, A. Szadkowska, B. Mianowska, E. Czerniawska & T1DM and CD in terms of disease duration and examined para- meters. Children with T1DM compared with healthy children had Department of Pediatrics, Medical University of Lodz, Poland lower SOD (p < 0.001), lower GSH (p < 0.05) and higher DNArc(p < 0.05), CD children had only SOD significantly lower (p < 0.05) Introduction: The Fourth Report on the Diagnosis, Evaluation, and
Treatment of High Blood Pressure in Children and Adolescents Conclusion: Children with T1DM demonstrated more intensive
2004 includes the new term – prehypertension. Prehypertension is oxidative stress compared with healthy children than the CD group.
an indication of increased risk for developing hypertension and Comparison of T1DM children versus CD children did not show requires therapeutic lifestyle changes.
Aim: The aim of the study was to evaluate the selected factors influ-
Acknowledgement: Supported by the grant IGA MZ CR NR7919-
encing the prevalence of prehypertension in T1DM children and Short Poster Presentations
Methodology: 82 T1DM patients (46 male), aged 12–18.9 years,
tematic screening is important and feasible. Early intervention with diabetes duration of 0.5–17.2 years, without evidence of should be considered in all patients at risk. So far few patients are arterial hypertension were recruited. In patients 24-hour automatic treated with statins and anti-hypertensive drugs.
blood pressure (BP) monitoring was performed. The individualswith >40% of systolic BP (SBP) and/or diastolic BP (DBP) ≥95th percentile were defined as hypertensive, >40% of SBP and/or Retinopathy in young adults with type 1 childhood-
DBP ≥120/80 mmHg but <95th percentile – as prehypertensive. BMI and daily dose of insulin (DDI) were calculated. Insulin resistance onset diabetes. A Spanish multicenter study
(M index) was estimated by using euglycemic-hyperinsulinemic M. Oyarzábal1, I. Rica2, M. J. Lopez2, M. Rodríguez4, R. Barrio5, clamp. Power spectral analysis of heart rate variation was M. Gussinyé6, F. Hermoso7, C. Luzuriaga8, A. Gomez-Gila9, I. Gonzalez10, M. Chueca1, A. Sola1 & S. Berrade11 Results: None of the study patients had hypertension. In 30 indi-
Pediatric Diabetic Units: Pamplona, 2Bilbao, 3Valencia, 4Zaragoza, viduals (36.6%) prehypertension was diagnosed. In the table we Madrid, 6Barcelona, 7Valladolid, 8Santander, 9Sevilla, 10Madrid compared selected risk factors of the patients with normal and ele- Introduction: Diabetic retinopathy (DR) is the most frequent and
vated BP. Normal blood pressure Prehypertension p Age (years) an early-onset microvascular complication in type 1 diabetes. It is 16.1 ± 0.24 17.2 ± 0.33 0.013 Duration of diabetes (years) 5.2 ± 0.5 the main cause of blindness in western countries. Its detection using 6.4 ± 0.7 0.19 BMI (SDS) 0.48 ± 0.14 0.68 ± 0.19 0.40 DDI (U/kg) sensitive methods is relatively easy and it can be reversible in early 0.80 ± 0.03 0.87 ± 0.04 0.2 HbA1c (%) 7.9 ± 0.20 7.4 ± 0.26 0.14 phases. Quality of metabolic control and puberty have a great influ- HDL-cholesterol (mg/dl) 58 ± 2 55 ± 3 0.30 M index (mg/kg/min) ence in DR appearance and progression (DCCT).
6.68 ± 0.41 6.35 ± 0.5 0.63 LF/HF ratio 0.77 ± 0.05 1.03 ± 0.07 0.005 Objectives: To estimate DR prevalence in diabetic young adults
Conclusion: Prehypertension is common in T1DM children and
whose evolution is controlled in 10 Spanish Pediatric Diabetic adolescents. The prevalence of prehypertension is connected with Units. Inclusion criteria comprised to have patients’ recent data the shift of the sympathovagal balance toward sympathetic of their medical records (from our pediatric or adult units). To analyze metabolic control influence (HbA1c) during puberty as well Acknowledgement: Supported by Medical University of Lodz – 502-
as evolution time until DR appearance.
Subjects and methods: A total of 474 diabetic young adults (218
males /256 females) with an average age of 22.3 ± 4.6 years; age at
onset 9.3 ± 3.9 years and a mean follow-up of 13 ± 5.6 years were
included in the study. Patients had to have regular ophthalmologi- High prevalence of cardiovascular risk factors, as
cal examinations: funduscopy (83%), retinography (11%) and/or defined by ADA in 2005, in Norwegian children and
angiography (6%) with at least one exploration available in the adolescents with type-1 diabetes
last year. DR classification according to the ISPAD Consensus H. D. Margeirsdòttir, J. R. Larsen, N. C. Øverby, C. Brunborg, Guidelines (2000) was used in this study. Puberty HbA1c values are L. F. Andersen, K. Lande, P. Thorsby, K. Dahl-Jørgensen & the expressed in mean SDS. Student t-test and logistic regression (OR) Norwegian Study Group for Childhood Diabetes statistical analysis were performed.
Pediatric Dept and Centre for Medical Statistics Ullevaal University Results: We have observed DR in 54 (11.4%) patients. Forty-six
Hospital, Clinical Chemistry Dept and Hormone Laboratory, Aker patients (85%), in an early stage and with a mean evolution time of University Hospital, Institute of Nutrition, UiO, Norway 14 ± 42.3 years (10–17 years range). Patients who have DR, had asignificant worse metabolic control (HbA1c SDS: +10.25 ± 2.9 vs Introduction: The risk of dying of CVD before the age of 40 is
+7.05 ± 2.76; p = 0.000), with a clear influence of puberty (HbA1c 20 fold increased in patients with type-1 diabetes compared to SDS: + 9.75 ± 3.45 vs +7.07 ± 3.36; p = 0.000). There are no signif- icant differences in prepuberal metabolic control (HbA1c SDS: 7.35 Aim: To evaluate the CVD risk factors in Norwegian children and
± 2.46 vs 6.39 ± 2.82; p = 0.32). Patients who have HbA > adolescents with type-1 diabetes according to the new ADA defin- have 4.0 (OR) times more risk of suffering DR with 95% CI itions [Diabetes Care 28 (suppl 1): 21–24)].
(2.23–7.24). Diabetes evolution time is significantly higher in Methodology: CVD risk factors were examined in a national
patients with DR (17.9 vs. 12.1 years; p = 0.000).
prospective quality study. All diabetic children in Norway are Conclusions:
treated at the pediatric clinics of the government hospitals. In 2004, • We have found relatively low retinopathy prevalence in our pop- 23 clinics (of 25) participated with 1417 patients.
ulation, clearly lower than in former studies of our own group, Results: The HbA1c was >7.5% in 64% of the patients. The LDL-
as well as in other experiences recently published.
cholesterol was >2.6 mmol/l in 42% and the HDL-cholesterol was • Poor metabolic control during puberty and disease evolution time <1.1 mmol/l in 5%. 3% reported smoking (8.8% of those ≥15 years).
are relevant factors in DR appearance. Thus, trying to reach the The blood pressure (systolic and/or diastolic) was above the 90th best possible metabolic control at this age in our patients has to percentile by age, gender and height in 7% and above the 95th be one of the main objectives of pediatric diabetologists.
percentile in 3%. 1% of the patients had persistent microalbu- • It is necessary to unify systematic ophthalmological examinations minuria. 0.2% of the patients got statin treatment and 0.3% anti- and HbA1c laboratory technique validation in future studies to hypertensive treatment. About 55% reported watching TV more know the real prevalence of this complication and to assess its than 2 hours each day. Obesity was present in 4.4% of the patients.
29% had a positive family history (1. and 2. degree relatives) of oneor more of the following: type-2 diabetes, heart attack and/or stroke before the age of 60. Dietary habits were evaluated in a group of9–10 and 12–13 year old. Dietary fat was >30% of caloric intake in Risk factors analysis of diabetic polyneuropathy in
82% and 85%, saturated fat >10% in 94% and 97% and fiber intake children above 10 years of age
<25 g/daily in 94% and 92%, respectively.
M. Wysocka-Mincewicz, B. Emeryk-Szajewska & J. Zajaczkowska Conclusion: Approximately 90% of the Norwegian pediatric type-1
Pediatric Department of Children Memorial Health Institute, Warsaw, diabetic patients had at least one of these CVD risk factors. Sys- Short Poster Presentations
Introduction: Pathogenesis of diabetic neuropathy is multifactorial,
legs, in two subject reduced reflexes in legs and arms). Eight (8.2%) but the prevailing theory implicates persistent hyperglycemia as the patients had diabetic polyneuropathy defined as abnormalities in nerve conduction tests in at least two nerves and clinical signs or Aim: The aim of the study was to establish the influence different
symptoms. 16 (16.5%) patients had subclinical polyneuropathy factors have on risk of diabetic polyneuroapthy development in defined as abnormalities in at least two nerves without signs or symptoms. Abnormalities in conduction tests in 27.8% of diabetic Methodology: 97 children with type 1 diabetes (55 girls, 42 boys,
children in peroneal nerves, 22.7% in sural, 17.5% in sensory ulnar, mean age 15.4 ± 2.16 years, mean duration of diabetes 8.11 ± 2.9 14.4% in median motor, 7.2% in ulnar motor, 6.2% in median years, mean age in onset 7.16 ± 2.96 years, mean HbA1c 8.58 ± sensory and 5.1% in tibial nerves were detected.
1.06%) at least 10 years old and with at least 3 years duration of Conclusion: The study revealed clinical signs in a quarter of the
diabetes, were included in the study. Nerve conduction studies of studied population of diabetic children. The diabetic polyneuropa- the median, ulnar, tibial and peroneal motor nerves, and median, thy was diagnosed in a quarter of the studied population. The per- ulnar and sural sensory nerves were performed with standard centage of sensory nerve abnormalities did not differ from motor surface stimulating and recording techniques. The sensory and nerves. The impairments in sural and peroneal nerves in legs were motor amplitude, velocity and latency were detected. 24 children the most frequent. Poor metabolic control and duration of diabetes were diagnosed with diabetic polyneuropathy defined as impaired were significantly different in diabetic children with and without at least two parameters of conduction tests in at least two periph- eral nerves (16 children with subclinical diabetic polyneuropathy,and 8 children with diabetic polineuropathy with clinical signs).
Influence of age, mean (for whole diabetes duration) and actual Subclinical hearing deficits in children and
HbA1c, duration of diabetes, age at onset of diabetes, height, mean adolescents with type 1 diabetes
and actual BMI, treatment method (conventional, intensive, con- M. Wysocka-Mincewicz, K. Kochanek, M. Mueller-Malesinska, tinuous subcutaneous insulin infusion), and hypoglycemic episodes H. Trippenbach-Dulska, E. Pankowska & A. Pilka in history. A model of logistic regression analysis was performed.
Pediatric Department The Children’s Memorial Health Institute, Results: The logistic regression analysis revealed that the statistical
significant factors were mean HbA1c, duration of diabetes, height,hypoglycemic episodes in history and mean BMI [Chi2 (5) = 23.12].
Introduction: Hearing disturbances are one of the latest complica-
In the population studied, the mean duration of diabetes (OR 1.36, tions of type 1 diabetes, but electrophysiological methods gave the p < 0.005, ±95%CI 1096–1697), mean HbA1c (OR 1.91, p < 0.05, opportunity to detect subclinical defects early.
±95%CI 1072–3411), hypoglycemic episodes in history (OR 2.11, p Aim: The aim of the study was to detect the early impairments of
< 0.05, ±95%CI 1005–4433) were the most significant risk factors.
hearing, and to establish the risk factors of this dysfunction.
In this population of children the height was statistically significant Methodology: 87 children with type 1 diabetes (mean age 15.46 ±
but seemed to be a factor of low impact (OR 1.06, p < 0.05, ±95%CI 2.17 SD years, mean duration of diabetes 8.14 ± 2.75 SD years) at least 10 years old and with at least 3 years duration of diabetes, Conclusion: Long-term metabolic control, duration of diabetes
were included in the study. The following were done in the course and hypoglycemic episodes in diabetes history were the strongest of the study: otorhinolaryngologic examination, tonal, impedance, risk factors for developing polyneuropathy. The influence of hypo- and verbal audiometry, auditory brainstem responses (ABR), glycemic episodes on peripheral nerves function is very interesting DPOAE. In ABR latency of wave I, III, V, and intervals I-III, III- V and I-V were analyzed.
Results: In the studied population, abnormalities in ABR in 34.9%
were detected. The results of ABR were not related with age, age Prevalence of diabetic polyneuropathy in children with
at onset, mean and actual HbA1c. Wave latencies in ABR were type 1 diabetes
significantly correlated with duration of diabetes (wave I latency M. Wysocka-Mincewicz, B. Emeryk-Szajewska, p < 0.01, wave III latency p < 0.005, wave V latency p < 0.05). Sig- H. Trippenbach-Dulska, E. Pankowska & J. Zajaczkowska nificant differences between subgroups of different treatment Pediatric Department The Children’s Memorial Health Institute, methods in interpeak latency III-V (p < 0.05) were detected. More intensive method of treatment had a positive influence on the decreasein latencies of evoked potentials. When analyzing the presently used Introduction: Neuropathy is a common and serious late complica-
method of treatment, significant differences in interpeak latencies tion of diabetes mellitus in adults, but its prevalence in children is I-III and III-V between the subgroups were observed.
Conclusion: Abnormalities in ABR were diagnosed in over one third
Aim: The aim of this study was to establish the prevalence of clin-
of the studied population. The increase of ABR latency depends ical and subclinical polyneuropathy in children with type 1 diabetes, on longer duration of diabetes. The study revealed that auditory and identify the independent risk factors in the development of this evoked potentials in the subgroups that were treated with more functional methods (intensive, and CSII) had a more normal shape Methodology: 97 children with type 1 diabetes (55 girls, 42 boys,
than those in the subgroups treated with conventional and multiple mean age 15.4 ± 2.16 years, mean duration of diabetes 8.11 ± 2.9 injection, even though there weren’t any differences in metabolic years, mean age in onset 7.16 ± 2.96 years, mean HbA1c 8.58 ± control between the subgroups. The authors consider it a favorable 1.06%) at least 10 years old and with at least 3 years duration of diabetes, were included in the study. Nerve conduction studies ofthe median, ulnar, tibial and peroneal motor nerves, and median, ulnar and sural sensory nerves were performed with standard surface Prevalence of type 2 diabetes and MODY in children
stimulating and recording techniques. The motor and sensoryamplitude, velocity, and latency were detected.
and adolescents. A state-wide study in Baden-
Results: Clinical signs were detected in 24 (25.5%) diabetic children
(in 9, abnormality in sensory thresholds, in 13, reduced reflexes of A. Neu1, L. Feldhahn2, S. Ehehalt1, R. Hub1 & M. B. Ranke1 Short Poster Presentations
1University Children’s Hospital, Tuebingen, 2Children’s Hospital, triglyceride buffering capacity will paradoxically increase, with falling rather than rising IR. The rise in adiposity, fall in IR andrise in HDL-C reported here are consistent with the hypothesis. The Introduction: In contrast to North America, Japan and few
rise in glucose was unexpected, and possibly related to an indepen- European countries, prevalence data for childhood type 2 diabetes dent loss of beta cells. These observations are novel, represent sub- and maturity onset diabetes of the young (MODY) have not been stantial metabolic remodeling in pre-pubertal children, and need explanation to establish whether they are physiological and pro- Aim: To estimate the prevalence of childhood type 2 diabetes and
grammed, or pathological and ultimately harmful. They should MODY for the age group 0–20 years in Baden-Wuerttemberg (BW) also be taken into account when interpreting the response to child- hood interventions designed to reduce IR.
Methodology: In 2004, we conducted a state-wide survey of all chil-
dren’s hospitals in BW (n = 32), all diabetologists (n = 122) and all
departments of internal medicine (n = 164). In addition, in the dis-
trict of Tuebingen, all family doctors (n = 121) were included in the Pediatric prevention of metabolic syndrome and type 2
diabetes in obese children and adolescents – when to
Results: 530 institutions were surveyed, responses of 445 were suit-
able for analysis. Our findings showed that in 11.0% (49/445) of all B. Skowronska, P. Fichna, W. Stankiewicz & K. Majewska institutions, patients aged 0–20 years are treated for type 2 dia- Department of Pediatric Endocrinology and Diabetes, Poznan betes or MODY. 55 patients with type 2 diabetes (mean age 15.8 University of Medical Sciences, Poland years) and 57 patients with MODY (mean age 14.0 years) were reg-istered. Most of these patients (56/112) were treated in pediatric Introduction: The risk of type 2 diabetes mellitus is correlated with
departments or by diabetologists in private consultancies. In the BMI positively. There are natural steps in progress of obesity in data from the district which we used as a random sample, we found young patients: a) overweight, b) simple obesity, c) obesity with that none of the type 2 patients in this age group had been treated insulin resistance, d) with insulin resistance and impaired glucose by any of the 121 general practitioners; and only 1 patient with tolerance, e) metabolic syndrome, f) type 2 diabetes.
MODY had been treated in a private practice. Prevalence of type 2 Aim: 1) To evaluate the prevalence of metabolic syndrome and dia-
diabetes was calculated as being 2.36/100 000; and the prevalence of betes type 2 in obese children. 2) To compare the stage of obesity MODY was calculated as 2.45/100 000, respectively, for the studied and the insulin secretion in relation to age, gender and sexual Conclusion: The calculated prevalence figures indicate the lower
Methodology: Study comprises 140 obese, 12 overweight and 14
limit for the prevalence of type 2 diabetes and MODY in childhood nonobese children, aged 4 to 18 years. BMI-SD and Tanner stage and adolescence. At present the frequency of these diabetes types were estimated in all patients. OGTT, insulin measures, HOMA-IR is lower than in North America, they are, however, more frequent and QUICKI indexes were performed. Triglycerides, cholesterol than in other European countries. This epidemiological study is the and blood pressure results were adjusted for age and sex. ANOVA first population-based survey for type 2 diabetes and MODY in test and Pearson’s correlations were applied in statistics.
Results: Fasting glycemia was found as dependent on age (p < 0.02)
and Tanner’s stages (p < 0.013), without gender and obesity influ-
ence. Fasting insulinemia depended on age (p < 0.004), puberty (p
< 0.009) and on the progress of obesity (p < 0.006) but not on sex.
Metabolic remodeling in pre-pubertal children
HOMA-IR and QUICKI were depending on age (p < 0.002, p < – testing the lipid flux hypothesis
0.001), puberty (p < 0.009, p < 0.001) and on the stage of obesity (p < 0.009, p < 0.001) respectively. BMI-SD correlated positively Peninsula Medical School, Plymouth, UK with fasting insulinemia (p < 0.006), glycemia after 2 hours ofOGTT (p < 0.02), triglycerides (p < 0.018), systolic (p < 0.001) and Introduction: The behavior of insulin resistance (IR) and its meta-
diastolic (p < 0.003) blood pressure. 13.2% of patients had impaired bolic correlates in response to changes in body fat has not been well glucose tolerance and 1.3% – diabetes type 2. The prevalence of the characterised in children. Frayn’s lipid flux hypothesis proposes that metabolic syndrome was 31% in obese subjects.
adipose tissue buffers the flux of fatty acids in circulation by ‘trap- Conclusion: The prevalence of disorders in glucose metabolism,
ping’ them, thus increasing triglyceride clearance.
insulin secretion and metabolic syndrome is high among obese Aim: To test this hypothesis by examining trends in adiposity, IR
children and it increases in parallel to obesity. Biomarkers of an and metabolic risk in healthy pre-pubertal children.
increased risk of metabolic complications are already present in the Methodology: EarlyBird is a prospective, non-intervention cohort
youngest patients. It suggests, that prophylactic intervention against study documenting physical, metabolic and lifestyle development of type 2 diabetes should be started at the earliest stage of obesity and 300 children from school entry at 5 yrs. Data were obtained from 230 children (130 boys, 100 girls) who attended at 5, 6, 7 and 8 yrs.
Measures included adiposity (sum of skinfolds), IR (HOMA-IR),triglycerides, HDL cholesterol (HDL-C), beta-cell function Commencement of gluten-free diet in children with
Results: In both genders, adiposity rose progressively and signifi-
type 1 diabetes mellitus and celiac disease increases
cantly from 5–8 yr (+18%, p < 0.001), while IR unexpectedly fell body mass index and insulin requirement
(-24%, p < 0.05). Consistent with falling IR, HDL-C rose (+17%, p S. M. Ng1, N. Lek1, S. F. Annan2, S. C. Wong1, M. Didi1 & J. C. Blair1 < 0.001) and triglycerides fell (-8%, ns). Fasting glucose rose (+12% 1Endocrinology Department, 2Dietetic Department, Royal Liverpool or 0.5 mmol, p < 0.001), while HOMA-beta fell (-35%, p < 0.001).
Children’s Hospital Alder Hey, Liverpool UK Conclusion: Weight gain is normally associated with rising IR – but
only when existing adipocytes are further filled, losing their buffer-
Introduction: The incidence of celiac disease (CD) is increased in
ing capacity. Frayn’s lipid flux hypothesis, on the other hand, envis- children with type 1 diabetes Mellitus (T1DM). However, the ages that if the increase in adiposity is due to new adipose cells, benefit of a gluten-free diet (GFD) remains unclear.
Short Poster Presentations
Aim: To assess effects of GFD on growth, body mass index (BMI),
glycemic control and insulin requirement in children with T1DM Mummy I feel invisible: living with a brother or sister
who has diabetes
Methodology: Retrospective study of the effect of GFD on height
SDS, BMI SDS, mean HbA1c, mean insulin requirement and The Children’s Hospital at Westmead, Sydney, NSW, Australia dietetic input was performed in children with T1DM and CD diag-nosed following screening and intestinal biopsy.
Introduction: A diagnosis of Diabetes affects all family members,
Results: 350 children with T1DM were screened for CD. Twelve
yet most attention has been given to the child with Diabetes. In con- (3.4%, 5 M) were diagnosed with CD and commenced on GFD trast there has been very little research focusing on siblings. Siblings within 4 weeks of diagnosis. We report data from 11 patients, 44.1 have very real concerns about their brother or sister with diabetes, ± 12.3 weeks following introduction of GFD. Mean age of diag- often different concerns from their parents. This qualitative study nosis of T1DM was 5.5 ± 4.5 years and for CD 10.7 ± 3.3 years.
represents an attempt to achieve a broad perspective and under- BMI SDS, insulin requirement and dietetic input were increased sig- standing of effects on the well child and family relations by con- nificantly after introduction of GFD but there was no change in ducting in-depth interviews with siblings and their parents.
Methodology: Qualitative data was collected to determine the
impact for children when a sibling has been diagnosed with Dia-
Table 1. Characteristics of patients before and after introduction of GFD betes. A semi structured interview guide was used to assist with data collection. A sample of 32 participants, including children and their parents were interviewed. This allowed for multiple data sources to be incorporated into the study design. The Non-Numerical Unstructured Data Indexing Searching And Theorising (NUD.IST) program successfully facilitated data analysis.
Results: Earlier researchers relied on anecdotal reports, case studies
and retrospective designs. In this study the qualitative data allowed the researchers to gain first hand knowledge regarding the actionsand reactions of children to their siblings with Diabetes in the Conclusion: Our data do not demonstrate any short term clinical
context of their daily lives. Findings suggest that children can have benefits of GFD. GFD may improve carbohydrate absorption either enhanced or strained experiences from living with a sibling resulting in increased BMI and insulin requirement.
who has Diabetes. The in-depth interviews show well children canexperience stress and a sense of being forgotten in comparison to their sibling with Diabetes. In contrast the study also uncovered that Beneficial long-term effects of motivational
many children experience closeness, maturity and improved health.
interviewing (MI) in adolescents with insulin
Conclusion: The research findings have implications for how broth-
dependent diabetes mellitus: a multicenter randomised
ers and sisters are educated and strongly indicate the need for controlled trial
including all family members from the point of diagnosis.
S. Channon1, M. V. Huws-Thomas2, S. Rollnick3, K. Hood3, R. L. Cannings3 & J. W. Gregory2 1Department of Child Clinical Psychology, 2University Hospital ofWales Departments of Child Health and General Practice, 3Cardiff Art therapy groups for children with diabetes and their
N. Mor, R. Ofan, P. Lilos, E. Mittleman & M. Phillip
Introduction: MI is a counseling approach promoting behavior
Institute for Endocrinology and Diabetes, National Center for change. We have previously shown a non-significant (p = 0.09) trend Childhood Diabetes, Schneider Children’s Medical Center of Israel, to improvements in HbA1c after a one-year MI intervention with adolescents.
Aims: To evaluate the effect of MI on psychosocial variables at the
Introduction: Art Therapy is a therapeutic method which aids in
end of the 12-month intervention and the long-term effects on connecting the child to his inner world through artistic creation.
HbA1c one year after the intervention was completed.
Through their drawings children can non-verbally express and work Method: We recruited 70 teenagers (mean age 15.3 years) to an RCT
of an MI intervention versus counseling support. HbA1c and a Aim: 1. To renew the children’s sense of control over their lives and
range of psychosocial variables were measured at baseline, at the to better process the emotions that the illness evokes. 2. To improve end of the one-year intervention and one year later.
parents’ quality of life by allowing them to express their feelings Results: There were no demographic differences between the two
verbally and artistically in group sessions.
groups at baseline. At 12 months the MI group had improved Methodology: 12 two-hour meetings, two groups, 4–6 participants
quality of life, lowered anxiety, more positive well being, placed in each group. A parents’ group took place separately at the same higher importance in controlling their diabetes and had a more pos- time. Diabetes Quality of Life questionnaires were given to children itive belief system that their actions would prevent complications and parents at beginning and end of complete sessions. Qualitative (all p < 0.01). After 24 months there was a significant difference in analysis was done of the children’s artistic creations.
HbA1c between the two groups over time, after adjusting for base- Results: The children’s creative products revealed the ‘emotional
inner world’ regarding daily handling of routine diabetes care, and Conclusion: MI produces a significant improvement in HbA1c one
provide an opportunity to vent these emotions. The simultaneous year after the end of the intervention. This was preceded by posi- group sessions enabled a better understanding of each family’s tive changes in quality of life, well-being and personal models of dynamics. Parents’ Diabetes Quality of Life questionnaires revealed diabetes at the end of the intervention. The potential of MI as an statistically significant areas: improved happiness quotient (p = effective and deliverable intervention in improving outcomes is 0.01); less frustration and restlessness (p = 0.03); more positive daily life experiences (p = 0.01) post group sessions.
Short Poster Presentations
Conclusion: Art Therapy groups enable children with diabetes and
their families in an out-patient setting, using a demographic ques- their parents to express their inner feelings through non-verbal tionnaire which included information about their disease as well. A media in a secure and empathetic environment. The group process behavioral check list for children and Arabic Childhood Depression enables them to develop a more in-depth understanding of positive Inventory (ACDI) were used. These are translated, validated and coping methods, and gives them a renewed sense of control over their lives. Enabling parents to meet and share their feelings and Results: The mean age of the children was 9.1 years (SD 4.26), and
fears has been proven as being a contributing factor to the improved their mean duration of diabetes was 7.4 years (SD 4.8). Sixty one quality of their own lives. These groups are recommended as an reported mild depression. There was no sex difference, and no sta- integral part of care in childhood diabetes centers.
tistically significant relation to metabolic control (p > 0.5). Hyper-activity was found in 65.4% and was significantly increased in children with poor metabolic control (p = 0.001). Similar positiveassociation was found with aggressive behavior (p > 0.005), con- Psychological reactions to type 1 diabetes in children
centration and attention (p < 0.001). Several somatic symptoms were reported; dizziness and abdominal pain were the commonest Department of Pediatrics, Farwania Hospital, Safat, State of Kuwait (62.1, 35.4% respectively). Duration of the disease was not associ- Introduction: The incidence of type 1 diabetes is increasing in
ated with an increased risk for any abnormal reactions (p > 0.05).
Kuwait. Treatment of the disease puts an enormous burden on both Conclusion: This is the first study on the psychological conse-
the child and his family and may put them at increased risk for psy- quences of diabetes in children in our community. High prevalence chological difficulties. Therefore it is important to deal with the of depression, aggressive behavior, hyperactivity and poor attention effect of the disease on family function and the child’s psychologi- were found. Poor metabolic control is associated as an increased risk for all, except depression. Further controlled studies are needed Aim: To assess the psychological reactions to type 1 diabetes in chil-
to confirm the direct effect of diabetes on these abnormalities.
dren and the effect of metabolic control.
Methodology: Children (n = 240) with type 1 diabetes participated
in the study. Trained psychologists interviewed the children and
PARTNERSHIP FOR EDUCATION AND RESEARCH ABOUT RESPONSIBLE LIVING INSTITUTO BRASILEIRO DE DEFESA DO CONSUMIDOR MAPEO EDUCACIÓN Y CONSUMO SUSTENTABLE: propuesta de São Paulo, Brasil 1 APROXIMACIÓN CONCEPTUAL AL CONSUMO SUSTENTABLE “Sin una producción más limpia y un consumo más responsable, es imposible avanzar en dirección a una economia de bajo carbono, en direcc