The association between Type 1 Diabetes Mellitus (T1DM) and obesity (Ob) is no longer unexpected due to unhealthy lifestyle mostly in adolescents. We compared clinical-biochemical characteristics, ...adherence to the Mediterranean Diet (MD), lifestyle habits and physical fitness across different weight categories of T1DM adolescents from Campania Region. As second aim, we assessed the relationship among lifestyle and physical fitness in these patients.
74 adolescents (35M; 39F; 13–18 y), with T1DM diagnosed at least 6 mo before the study, were enrolled at the Regional Center for Pediatric Diabetology of Vanvitelli University of Naples. Height, weight, Body Mass Index (BMI), BMI z-score, and Clinical Biochemical health-related parameters were determined. MD adherence, physical activity (PA) amount and sedentary habits were assessed by questionnaires. Handgrip strength, 2-Min Step test (2-MST) cardiorespiratory endurance and Timed up and go test (TUG) for agility and balance were used for physical fitness evaluation.
Our sample included 22 normal weight (NW), 37 overweight (OW) and 15 with Obese (Ob) adolescents. Across the three groups, adolescents showed similar Clinical-Biochemical parameters, MD adherence, PA amount, mostly walking (9.3 h/w), daily video exposure (8.5 h/d) and similar handgrip or 2-MST performance. Better performance was observed in NW compared to OW or Ob for TUG (7 vs 8 vs 9 s; p < 0.05). A positive correlation was found between TUG test and BMI, while no correlation was found between HbA1c (glycated haemoglobin) and BMI z score or 2-MST.
T1DM adolescents did not meet the recommendations for active lifestyle, despite a medium/good adherence to MD, in particular in NW and OW youths. Sedentary habits correlated with a poor HbA1c. Further, reduced agility and balance were observed in adolescents with obesity compared to NW participants.
Future research should be aimed to examine wider samples and to design health promotion interventions for T1DM adolescents.
Abstract
Objective
The aim of this study was to report nationwide data of the prevalence of disordered eating behaviors (DEBs) in adolescents with type 1 diabetes (T1D) and to evaluate a ...multidimensional model of eating problems, analyzing how psychopathological problems are associated with DEBs and with metabolic control.
Methods
This study was carried out using a cross-sectional design with a sample of 1,562 patients with T1D (812 male), aged 11–19 years. Participants were recruited from multiple pediatric diabetes centers (N = 30) located in northern, central, and southern Italy, and they individually completed the Diabetes Eating Problem Survey–Revised (DEPS-r) and the Youth Self-Report (YSR). Sociodemographic and clinical data were also gathered. Multiple-group structural equation modeling was used to investigate the relationships between internalizing/externalizing symptoms, DEBs, and glycosylated hemoglobin (HbA1c) values.
Results
A total of 29.7% of the participants reported DEBs (DEPS-r scores ≥20), 42.4% reported insulin manipulation (IM). The prevalence of DEBs was higher for female participants (p ≤ .001). The model explains 37% of the variance in disordered eating, 12% in IM, and 21% in HbA1c values. Body mass index, externalizing symptoms, and internalizing symptoms were significantly and positively associated with DEBs, which in turn were significantly and positively associated with HbA1c values (all p ≤ .001). Externalizing (p ≤ .001) and internalizing (p ≤ .01) symptoms were also directly associated with HbA1c values.
Conclusion
Given the relevant prevalence of DEBs, their significant positive association with psychopathological symptoms, and their relationship with worse diabetes outcomes, regular psychological screening and support is needed to ensure the best care of adolescents with T1D.
Glycemia following pizza consumption is typically managed with a dual-wave insulin bolus. This study evaluated the effect of a simple bolus on glycemia following consumption of traditionally prepared ...pizzas with long (24 h) or short (8 h) dough fermentation periods.
On two separate evenings, children with type 1 diabetes (
= 38) receiving sensor-integrated pump therapy consumed traditionally prepared pizza with either short (pizza A) or long (pizza B) dough fermentation, and blood glucose was monitored over 11 h. A simple insulin bolus was administered 15 min preprandially. The carbohydrate and amino acid contents of the two types of pizza were analyzed by liquid chromatography and high-resolution mass spectrometry (LC-HRMS).
The mean (±standard deviation) time in range 3.9-10.0 mmol/L was 73.2% ± 23.2%, and 50.8% ± 26.7% of glucose measurements were within the range 3.9-7.8 mmol/L. However, during the 2 h after bolus administration, the mean time in range 3.9-7.8 mmol/L was significantly greater with pizza B than with pizza A (73.3% ± 31.5% vs. 51.8% ± 37.4%, respectively,
= 0.009), and the time in hyperglycemia (>10 mmol/L) was significantly shorter (mean percentage 6.1% ± 19.0% vs. 17.7% ± 29.8%, respectively,
= 0.019). LC-HRMS analysis showed that long fermentation was associated with a lower carbohydrate content in the pizza, and a higher amino acid content.
Glycemia following consumption of traditionally prepared pizza can be managed using a simple bolus 15 min before eating. Glycemic control can be further improved by increasing the dough fermentation time.
NCT03748251, Clinicaltrials.gov.
Choosing the right infusion set site can be an important factor in obtaining good glycemic control, especially in very young children. In an attempt to identify the best infusion site, we performed a ...crossover study in six preschool children with type 1 diabetes using insulin pump therapy.
We enrolled six patients 5.2±0.7 years old (range, 4-6 years), with type 1 diabetes for more than 1.5 years, using insulin pump therapy for at least 6 months. For each patient, body mass index, glycated hemoglobin, and all data downloaded from the system were evaluated on two occasions: the first with the infusion set placed on the buttock and the second on the abdomen, each for 3 days. The order of infusion set placement was randomized. Mean capillary blood glucose, mean continuous glycemia, mean area under the curve (AUC) using the trapezoidal rule for both >140 mg/dL and <70 mg/dL, insulin daily dose, carbohydrate/insulin ratio, total basal insulin, total bolus insulin, and mean amplitude of glucose excursions (MAGE) were evaluated.
Mean glycemic values, mean AUC >140 mg/dL, and MAGE were significantly lower when the infusion set was placed on the buttock versus the abdomen (144.6±31.9 mg/dL vs. 166.0±34.8 mg/dL P=0.000, 28.4±18.3% vs. 48.8±28.2% P=0.000, and 32±10 vs. 60±15 mg/dL P<0.001, respectively), whereas mean AUC <70 mg/dL was higher (1.47±2.77% vs. 0.87±1.03% P<0.001).
The present findings suggest that preschool children with type 1 diabetes using insulin pump therapy could benefit from inserting the infusion set in the buttock instead of the abdomen.
Aim: People around the world are consuming much more sodium than is physiologically necessary. A
number of studies suggest that dietary sodium intake is related to weight gain. The aim of our study ...was to
evaluate in a population of children and adolescents with type 1 diabetes mellitus, possible correlations
between the urinary sodium excretion (UNa24h), indirect marker of sodium intake, and both duration of
diabetes and BMI z-score. Moreover, we also evaluated the correlation between UNa24h and duration of
diabetes according with the presence/absence of overweight/obesity.
Research Design and Methods: Children and adolescents aged between 4 and 18 years with type 1 diabetes
were consecutively enrolled from Regional Center for Pediatric Diabetes in Naples. Urinary sodium
concentrations were tested in three 24 h urine samples of 68 individuals (204 tests).
Results: Mean UNa24h was 141.3±68.2 mmol/24h corresponding to 8.1±3.9 gr of NaCl intake. Seventyfive percent of subjects aged between 4 and 6 years, 95% of subjects aged between 7 and 10 years and
79.5% of subjects aged between 11 and 18 years consume more salt of the LARN’s advice.
Urinary sodium excretion increased in relation to the increase of duration, in years, of diabetes (p=0.0027).
No statistically significant relationship is between UNa24h (mmol/24h) and zBMI (p=0.705).
Conclusions: This study shows that young patients with type 1 diabetes have high levels of UNa24h. Given
the close correlation between the UNa24h and salt intake we can conclude that they take more salt with their
diet. High salt intake is not related to overweight but to diabetes duration.
Whether differences in outcomes of calcium-free vs. calcium-containing phosphate binder treatments can be amplified by concurrent treatment with a calcium-sensing receptor agonist or vitamin D ...remains to be elucidated.
A post-hoc analysis of the INDEPENDENT study, an open-label randomized controlled trial designed to evaluate the impact of sevelamer (SV) vs. calcium salts (CS) on survival in incident dialysis patients.
We recruited 466 middle-aged men and women. Cinacalcet (CC) and vitamin D (VD) were administered to a portion of patients as part of their routine care. We tested the impact of CC and VD on survival in the overall and in both treatment arms of the original study cohort. Overall SV, but not CC or VD, administration was associated with a survival benefit (mean follow-up: 28 (10) months). However, a significant (p = 0.006) interaction of SV and CC on mortality was observed. CC use was associated with improved survival if administered in combination with SV (HR 0.34, 95% CI 0.14 - 0.81, p = 0.01 for subjects receiving or not CC) but not CS (HR 1.28, 95% CI 0.82 - 2.00; p = 0.26 for subjects receiving or not CC). No effect on mortality or interaction of phosphate binder use with VD was noted.
Though hypothesis generating, these results lend support to the idea that use of a CC may increase survival in incident hemodialysis patients when used with a calcium-free phosphate binder.
BACKGROUNDWhen very low doses of insulin are used insulin dilution, a procedure prone to errors, is recommended. CASE PRESENTATIONWe managed a neonate with pancreas agenesis with insulin pump therapy ...from the first days of life to 16 months of age without insulin dilution. Predictive low glucose suspend mode first and then closed loop control were used. No episodes of severe hypoglycemia were observed. CONCLUSIONSThough limited to a single patient with pancreas agenesis we believe that the use of pump should be warranted in patients with permanent neonatal diabetes mellitus and intestinal malabsorption, even with undiluted insulin.
Vascular calcifications have been previously shown to be an independent predictor of mortality in dialysis patients and a similar association has been shown for arterial stiffness. Nonetheless, the ...relationship between vascular calcifications and pulse wave velocity (PWV) have so far been little explored. The goal of this study is to verify the correlation among vascular calcifications and rigidity of arterial wall in patients at dialysis start. Accordingly, we investigated the association between aortic PWV and coronary calcification measured by computed tomography (TC-score) in 105 adult incident hemodialysis patients. PWV resulted increased in patients with the higher TC-score values; indeed, at univariate analysis PWV directly correlated with age (p=0.016), presence of diabetes (p<0.0001), serum phosphorus (p=0.0066), C-reactive protein (CRP) (p=0.046), LDL-cholesterol (p=0.043), TC-score (p<0.0001), and inversely correlated with systolic blood pressure (p=0.036). At multivariate analysis, age, diabetes, serum phosphorus, CRP, LDL-cholesterol and vascular calcifications were determinants of arterial stiffening. Using the table “two for two”, we showed 6 false negative patients (high TC-score and low PWV) and 12 false positive patients (low TC-score and high PWV). The sensibility was 76% and the specificity 85%; the accuracy was 83%, the predictor positive value was 61% and the predictor negative value was 92%. Overall, a strong association between TC-score and PWV was seen.
PDF
