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H Dorchy

Publications and source records attributed to H Dorchy.

At least 37 records · Page 2Linked to original sources
PubMed2000

Insulin regimens and insulin adjustments in diabetic children, adolescents and young adults: personal experience.

Because recent multicenter studies, even those performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of glycated hemoglobin (HbA1c) are very different, diabetes treatment teams should individually explore the reasons for failure, without any prejudice or bias. The "good" treatment is signed by good HbA1c associated with good quality of life, and is not necessarily exportable without adjustment to the local way of life. HbA1c must be under 7%, if the upper normal limit is about 6%, which is possible, in our experience, even in diabetic children and adolescents. Our "recipes" are summarized. The number of daily insulin injections, 2 or 4, by itself does not necessarily give better results, but the 4-injection regimen allows greater freedom, taking into account that the proper insulin adjustment is difficult before adolescence. Successful glycemic control in young patients depends mainly on the quality and intensity of diabetes education. Any dogmatism must be avoided; only the objective result is important.

Adolescent↗
PubMed1999

[Screening, prediction and prevention of type 1 diabetes. Role of the Belgian Diabetes Registry].

Since 1989, all incident cases of type 1 diabetes mellitus and their first-degree relatives younger than 40 years are entered in the Belgian Diabetes Registry (BDR). The incidence of type 1 diabetes is 11.8/100,000 in subjects younger than 15 years and 8.9/100,000 in subjects aged 15 to 40 years. Before 15 years of age, the cases are evenly divided between males and females, whereas in the older group the male-to-female ratio is 1.7. The median duration of symptoms at diagnosis is 3 weeks in patients younger than 15 years versus 8 weeks in those aged 15 to 40 years. The data of the BDR suggest that type 1 diabetes may be more "aggressive" in children than in adults. Autoantibodies are detectable before and during the clinical onset of type 1 diabetes. Over 90% of patients with type 1 diabetes have at least one type of autoantibody directed to beta-cell antigens. However, the nature of biological markers present at clinical onset tends to vary with age. Detection of autoantibodies in first-degree relatives of patients allows to diagnose the disease at a preclinical stage and to evaluate relatively safe preventive interventions in high-risk subjects. Several international studies in this area have been started.

Adolescent↗
PubMed1998

Insulin management and metabolic control of type 1 diabetes mellitus in childhood and adolescence in 18 countries. Hvidøre Study Group on Childhood Diabetes.

Insulin regimens and metabolic control in children and adolescents with Type 1 diabetes mellitus were evaluated in a cross-sectional, non-population-based investigation, involving 22 paediatric departments, from 18 countries in Europe, Japan, and North America. Blood samples and information were collected from 2873 children from March to August 1995. HbA1c was determined once and analysed centrally (normal range 4.4-6.3%, mean 5.4%). Year of birth, sex, duration of diabetes, height, body weight, number of daily insulin injections, types and doses of insulin were recorded. Average HbA1c in children under 11 years was 8.3 +/- 1.3% (mean +/- SD) compared with 8.9 +/- 1.8% in those aged 12-18 years. The average insulin dose per kg body weight was almost constant (0.65 U kg(-1) 24 h(-1)) in children aged 2-9 years for both sexes, but there was a sharp increase during the pubertal years, particularly in girls. The increase in BMI of children with diabetes was much faster during adolescence compared to healthy children, especially in females. Sixty per cent of the children (n = 1707) used two daily insulin injections while 37% (n = 1071) used three or more. Of those on two or three injections daily, 37% used pre-mixed insulins, either alone or in combination with short- and intermediate-acting insulin. Pre-adolescent children on pre-mixed insulin showed similar HbA1c levels to those on a combination of short- and long-acting insulins, whereas in adolescents significantly better HbA1c values were achieved with individual combinations. Very young children were treated with a higher proportion of long-acting insulin. Among adolescent boys, lower HbA1c was related to use of more short-acting insulin. This association was not found in girls. We conclude that numerous insulin injection regimens are currently used in paediatric diabetes centres around the world, with an increasing tendency towards intensive diabetes management, particularly in older adolescents. Nevertheless, the goal of near normoglycaemia is achieved in only a few.

Adolescent↗
PubMed1998

Serum antioxidant status and oxidized LDL in well-controlled young type 1 diabetic patients with and without subclinical complications.

It has been suggested that oxidative stress may play an important role in the pathogenesis of diabetic complications because hyperglycemia may cause increased production of free radicals. However, studies on the antioxidant status of young type 1 diabetic patients are very scarce as well as the relationships of oxidative stress and the presence of subclinical complications. Therefore, it was decided to evaluate autoantibodies against LDL (o-LAB) and antioxidant status in relationship with glycated hemoglobin levels (HbA1c), lipoproteins and subclinical complications (retinopathy, neuropathy and nephropathy). The study included 110 young type 1 diabetic patients, with a median age of 15 years and a median diabetes duration of 5 years. The mean+/-S.E.M. of HbA1c levels was 7.1+/-0.2%. Subclinical complications were detected in 26 patients. Total antioxidant status (TAS), vitamin A or E were not decreased in the patients and no significant differences were noted between the different subgroups of patients classified according to their subclinical complications. HbA1c levels were not related to antioxidants. Autoantibodies against LDL-lipoproteins decreased with age and diabetes duration, as reported in healthy non diabetic subjects. In conclusion, in the diabetic patients with a more or less good diabetic control, increased lipid peroxidation or reduced lipid antioxidant defense could not be demonstrated, even for the patients with subclinical complications.

Adolescent↗
PubMed1998

Increased prevalence of abnormal immunoglobulin M, G, and A concentrations at clinical onset of insulin-dependent diabetes mellitus: a registry-based study. The Belgian Diabetes Registry.

In view of the reported association of insulin-dependent diabetes mellitus (IDDM) with viral infections, (non-) islet-specific immune changes, and partial immunodeficiencies, we used immunonephelometry to measure circulating levels of IgM, IgG, and IgA in a registry-based group of IDDM patients under age 40 years at clinical onset (n = 397) and in age-matched nondiabetic siblings (n = 316) and control subjects (n = 322). Overall, IgM and IgA concentrations were higher, and IgG concentrations lower, in patients than in control subjects or siblings (P < 0.001). In siblings, IgM concentrations were higher than in control subjects (P < 0.001). Using age-adjusted reference intervals, abnormal Ig concentrations were noted in 27% of the patients at onset versus only 10% of the siblings and 7% of the control subjects (P < 0.001). For onset between 20 and 40 years (n = 220), 30% of the patients presented either increased IgM levels (21%) or decreased IgG levels (11%). Both independent phenomena occurred regardless of diabetes-associated immune and genetic markers. In patients and siblings, IgM levels were positively correlated with pancreatic lipase activity. In diabetic children (0-9 years; n = 65), a subgroup presented increased IgA levels (15%) in association with the highest HLA DQ-linked genetic risk and elevated IgM levels. The changes in total Ig concentrations at onset were largely reversed under insulin therapy. They may reflect exposure to environmental triggers, such as viral infections, or to (relative) insulinopenia prior to clinical disease onset. Whatever their cause, different serum Ig levels exist in different age groups of recent-onset IDDM patients.

Adolescent↗
PubMed1997

[Well-being of insulin-dependent diabetics. Evaluation of 100 adolescents and young adults in relation to their metabolic control].

OBJECTIVE: The principal aim of therapeutic management of the child, adolescent and adult with type I diabetes is to avoid severe hypoglycemia and long-term complications, by maintaining blood glucose concentrations and thus glycated hemoglobin levels (HbA1c)-dose to the normal range. However, the therapeutic constraints should not decrease the quality of life and well-being of patients. Therefore, the purpose of the present study was to evaluate by a questionnaire the well-being of our autonomous diabetic adolescents and young adults in relationship with their HbA1c levels and other characteristics. PATIENTS AND METHODS: A total of 100 unselected subjects (73 men and 44 women), with a mean age of 21 years (14-38) and a mean diabetes duration of 12 years (0-26), were included in the study over a 3-month period. Mean age at onset of diabetes was 10 years. Twenty-five percent of the patients were of Moroccan origin. All the patients were autonomous for self-management and treatment. Their socioeconomic status was not different from that of the normal population. The mean annual HbA1c level in the 100 diabetic patients was 7.3 (4.7-11.7). Well-being was measured using a questionnaire developed by a working group of the World Health Organisation, International Diabetes Federation and St Vincent Declaration. The questionnaire included 4 subscales labelled depression, anxiety, energy and positive well-being. The measurement of all 4 subscales involved 22 items and allowed an estimation of general well-being. RESULTS: General well-being in women was not as good as in men due to a greater tendency toward depression. Well being was better in patients with a professional activity than in the others. Patients age, duration of diabetes, number of insulin injections, frequency of home blood glucose monitoring, presence of 1 or 2 subclinical complications, had no effect on well-being. On the other hand, well-being was negatively correlated with the HbA1c levels: higher the HbA1c, higher the anxiety and the depression, and lower the energy and the positive well-being. CONCLUSION: Well-being was mainly associated with HbA1c levels; it improved with better glucemic control.

Adolescent↗
PubMed1997

Improvement of the compliance with blood glucose monitoring in young insulin-dependent diabetes mellitus patients by the Sensorlink system.

Recently, Medisense has introduced the Sensorlink system as a tool for retrieving the 125 last results of home blood glucose monitoring stored in patient's Pen 2 or Companion 2, unknown to them. Therefore we decided to check the compliance of type I diabetic adolescents and young adults with home blood glucose monitoring (HBGM) by comparing the blood glucose values noted in their log book and those retrieved by the Sensorlink and to evaluate an eventual subsequent effect both on compliance and glycated haemoglobin (HbA1c). The study was carried out in 60 insulin-dependent diabetes mellitus (IDDM) patients (33 women and 27 men) chosen according to two criteria: (1) the use of a Medisense Pen 2 or Companion 2; (2) autonomous self-monitoring of blood glucose, i.e. without parental supervision. They were aged 21.3 +/- 6.3 years with a diabetes duration of 11.6 +/- 7.0 years. HbA1c was measured by an HPLC method (N: 4.4-6.0%) before and after the first use of the Sensorlink and HBGM data of the log books were recorded. After the first use of the Sensorlink, the patients were warned of the retrieving data. The 60 patients were divided into two groups (same mean age and diabetes duration), according to the mean level of HbA1c before Sensorlink: < or = 7% (good control; n = 33); > 7% (insufficient control; n = 27). Cheating was unrelated to sex and occurred in 36 patients (60%; aged: 19.3 +/- 4.7 years), up to 100% in 13 of them (22%); five patients had no log book (8%; aged: 24.0 +/- 5.0 years); 19 patients (32%; aged 24.4 +/- 7.9 years) didn't cheat at all. After the use of the Sensorlink system, cheating dramatically decreased to zero. The effect of the Sensorlink system on improvement of HbA1c was statistically significant in the 27 patients with insufficient control before Sensorlink, since mean HbA1c level decreased from 8.0 +/- 0.9% to 7.5 +/- 1.1% (P < 0.05). In conclusion, non compliance with HBGM occurs in 2/3 of adolescents and young adults with IDDM. The Sensorlink system puts an end to this phenomenon and allows significant reduction of HbA1c levels in patients with insufficient metabolic control.

Adult↗
PubMed1997

Glycated hemoglobin and related factors in diabetic children and adolescents under 18 years of age: a Belgian experience.

OBJECTIVE: To determine, in an unselected population of diabetic children and adolescents < 18 years of age, which HbA1c levels can be achieved, and to examine the relationships with insulin regimen, insulin dose, sex, diabetes duration, BM1, and frequency of home blood glucose monitoring (HBGM) and outpatient clinic attendance. RESEARCH DESIGN AND METHODS: A total of 144 unselected subjects (73 boys and 71 girls) aged 11.8 +/- 3.7 years (mean +/- SD) were included in the study over a 6-month period. They had diabetes durations ranging from 5 months to 15 years (4.0 +/- 3.0). They were followed by the same pediatric diabetologist and the same nurse. The yearly frequency of visits was 8.9 +/- 2.0, and the monthly frequency of HBGM was 111 +/- 27. Of the patients, 129 were treated with two daily insulin injections of an individualized mixture of rapid- and intermediate-acting insulins, and 15 adolescents were treated with four injections using the basal-bolus regimen. The patients were divided into two subgroups according to diabetes duration: < or = 2 years (n = 53) and > 2 years (n = 91), i.e., outside the honeymoon period. HbA1c was measured by a high-pressure liquid chromatography method (normal values 3.9-5.5%). RESULTS: The mean +/- SD HbA1c level in the 144 children and adolescents was 6.6 +/- 1.2% using our method. In 62% of the patients, it was possible to obtain an HbA1c level under the normal mean value plus 5 SD. HbA1c was not related to sex, number of insulin injections, or age, i.e., it was not poorer at adolescence. The mean daily insulin dose was 0.9 U/kg body wt, being lower during the first 2 years of diabetes and reaching 1 U at adolescence. HbA1c levels were lower during the first 2 years of diabetes (6.2 +/- 1.0%) than afterwards (6.9 +/- 1.2%), but the frequencies of outpatient visits and HBGM were higher. After 2 years, HbA1c was negatively correlated with the frequency of HBGM. The yearly incidence rate of severe hypoglycemic episodes was 0.2. After the age of 13 years, BM1 was significantly higher in girls and in adolescents on four daily injections. CONCLUSIONS: In nearly two-thirds of diabetic children and adolescents, it is possible to obtain HbA1c levels under the normal mean plus 5 SD, which is considered satisfactory and close to that of the adult cohort of the Diabetes Control and Complications Trial (DCCT) with intensive treatment. There is no difference between the children on only two daily insulin injections and the adolescents on four injections. After 2 years of diabetes, increased frequency of HBGM helps reduce HbA1c levels, taking into account the "intensive" education of the patients and their families. Adolescent girls on four injections must pay attention to the risk of becoming overweight.

Adolescent↗
PubMed1997

Associations of GAD65- and IA-2- autoantibodies with genetic risk markers in new-onset IDDM patients and their siblings. The Belgian Diabetes Registry.

OBJECTIVE: To investigate the association of GAD (65-kDa) autoantibodies (GAD65-Abs) and IA-2 autoantibodies (IA-2-Abs) with human leukocyte antigen (HLA)-DQ and insulin gene (INS) risk markers in patients with recent-onset IDDM and their siblings. RESEARCH DESIGN AND METHODS: Blood was sampled from 608 recent-onset IDDM patients and 480 siblings, aged 0-39 years and consecutively recruited by the Belgian Diabetes Registry, to determine GAD65- and IA-2-Ab (radiobinding assay), HLA-DQ- (allele-specific oligonucleotyping), and INS-genotypes (restriction fragment length polymorphism analysis; siblings, n = 439). RESULTS: At the onset of IDDM, GAD65-Abs were preferentially associated with two populations at genetic risk but only in the 20- to 39-year age-group: 1) their prevalence was higher in carriers of DQA1*0301-DQB1*0302 (88 vs. 73% in non[DQA1*0301-DQB1*0302], P = 0.001), and 2) an association was found in patients lacking this haplotype but carrying DQA1*0501-DQB1*0201, together with INS I/I (87 vs. 54% vs. non[INS I/I], P = 0.003). Siblings of IDDM patients also presented the association of GAD65-Abs with DQA1*0301-DQB1*0302 (13 vs. 2% non[DQA1*0301-DQB1*0302], P < 0.001), while associations with the second genetic risk group could not yet be assessed. At the onset of IDDM, IA-2-Ab prevalence was higher in carriers of DQA1*0301-DQB1*0302 (69 vs. 39% non[DQA1*0301-DQB1*0302], P < 0.001) but not of DQA1*0501-DQB1*0201 or INS I/I. This association was present in both the 0- to 19- and the 20- to 39-year age-groups. It was also found in siblings of IDDM patients (4 vs. 0% non[DQA1*0301-DQB1*0302], P < 0.001). CONCLUSIONS: Both GAD65- and IA-2-Abs exhibit higher prevalences in presence of HLA-DQ- and/or INS-genetic risk markers. Their respective associations differ with age at clinical onset, suggesting a possible usefulness in the identification of subgroups in this heterogeneous disease.

Adolescent↗
PubMed1997

[Glycosylated hemoglobin in nonselected under-18-year-old young diabetics. Comparison of 2 HPLC methods].

The aim of this study is to determine, in an unselected population of diabetic children and adolescents < 18 years of age, which HbA1c levels can be achieved, and to compare 2 different HPLC (High Performance Liquid Chromatography) methods. One hundred and fourty-four unselected subjects (73 boys and 71 girls), with a diabetes duration ranging from 5 months to 15 years were included. HbA1c was measured simultaneously in our hospital and at the Steno Institute in Danemark. The mean (SD) HbA1c levels in the 144 children and adolescents were 6.6 +/- 1.2% using our method (normal values: 3.9-5.5%), and 7.7 +/- 1.1% at the Steno Institute (normal values : 4.4-6.3%), with a mean difference of 1.1 +/- 0.4%. Therefore, one must be cautious when comparing HbA1c levels, even by HPLC, between laboratories. Moreover, the lack of HbA1c standardization makes difficult to define HbA1c thresholds in order to avoid diabetic complications. In more than 60% of the patients, it is possible to obtain an HbA1c level under the normal mean value plus 5 SD. In the other paediatric studies, HbA1c levels are higher, whatever the type of treatment.

Adolescent↗
PubMed1996

[Treatment of type 1 diabetes mellitus in children and adolescents].

Successful therapeutic management of the child and adolescent with diabetes mellitus requires insulin administration, dietary management, physical activity and fitness, without severe hypoglycaemia. The ultimate aim is to avoid long-term microvascular, renal and neurologic complications by maintaining blood glucose concentrations close to the normal range and HbA1c level of approximately 7%. This is possible with 2 daily injections of an individualized mixture of rapid-and intermediate-acting insulins in a syringe as well as with the basal-bolus regimen with pen injectors (rapid-acting insulin before the 3 main meals; intermediate- or long-acting insulin at bed time). A good metabolic control is linked to the quality and intensity of diabetes education by an experienced multidisciplinary team.

Adolescent↗
PubMed1996

[Erythrocyte and plasma antioxidant activity in diabetes mellitus type I].

OBJECTIVES: Some biologic parameters involved in cell defence against oxygen radicals (plasmatic vitamins C and E, erythrocyte glutathione peroxidase, glutathione reductase and superoxide dismutase) were measured in single blood samples from 119 diabetic infants, adolescents and young adults. METHODS: Data were studied in relation to residual insulin secretion determined by C peptide, level of metabolic control appreciated by glycosylated haemoglobin, lipid abnormalities and subclinical complications (retinopathy, neuropathy and nephropathy). RESULTS: There was no change in antioxidant parameters with insulin secretion. Patients with poor glycaemic control and high plasma lipids had higher levels of plasma vitamin E. Patients with nephropathy had lower plasma vitamin C levels and those with neuropathy showed lower erythrocyte glutathione peroxidase activity. Plasma vitamin C concentrations and erythrocyte glutathione reductase activities were negatively correlated with the age of the patients and the duration of the disease. CONCLUSION: Higher transport capacity of vitamin E probably explains the elevated levels of vitamin E observed in patients with high lipid levels and long lasting illness. The lower levels of vitamin C in the presence of nephropathy may be due to an increased renal excretion of this vitamin. The reduction of glutathione peroxidase, glutathione reductase activities and vitamin C levels confirms the existence of an oxidative stress in type I diabetes.

Adolescent↗
PubMed1996

Serum lipoprotein (a) in type 1 diabetic children and adolescents: relationships with HbA1c and subclinical complications.

UNLABELLED: In a population of 106 young type I diabetic patients, we evaluated whether a relationship exists between lipoprotein (Lp)(a) or apolipoproteins and the degree of metabolic control (HbA1c, fructosamine) or the subclinical complications. The patients were subdivided according to puberty and to the presence or not of subclinical complications (no complications [n = 32]; retinopathy at fluorescein angiography [n = 28]; neuropathy diagnosed by reduced peroneal motor nerve conduction velocity [n = 30]; nephropathy determined by presence of micro-albuminuria [n = 15]. Lp(a) concentrations were not significantly increased in the whole group of diabetic patients. There was no difference between girls and boys, nor between the prepubertal children and the others. There were no significant correlations between the markers of metabolic control and Lp(a). Nevertheless, if the diabetic patients were divided into two groups according to the levels of HbA1c (<7.6 or > or = 6% Hb), Lp(a) tends to be higher in the poorly controlled, but not to any significant degree. On the other hand, significant increases of total cholesterol, triglycerides, low density lipoprotein cholesterol and apolipoprotein B levels were observed in poorly controlled patients. Lp(a) concentrations were significantly lower in patients with subclinical neuropathy or nephropathy than in patients without these complications, but not in patients with retinopathy versus no retinopathy. These results are confirmed by categorical analysis (i.e. Lp(a) < or = 30 vs > 30 mg/dl). CONCLUSION: Lp(a) levels are not significantly increased in poorly controlled insulin-dependent diabetes mellitus patients. High controlled insulin-dependent diabetes mellitus patients. High levels of Lp(a), in young diabetic patients, are not markers for subclinical complications (retinopathy, neuropathy and nephropathy). On the contrary, low Lp(a) levels were found in subjects with subclinical neuropathy or nephropathy.

Adolescent↗