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Biomedical subjects

J Jos

Publications and source records attributed to J Jos.

At least 19 recordsLinked to original sources
PubMed1998

Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group.

OBJECTIVE: To determine on a large scale the multiple medical and nonmedical factors that influence glycemic control in the general population of children with diabetes, we performed a nationwide French cross-sectional study. RESEARCH DESIGN AND METHODS: We enrolled 2,579 patients aged 1-19 years with type 1 diabetes of > 1 year's duration. The study was center based: 270 centers were identified, 206 agreed to participate, and 147 included at least 90% of their patients. Questionnaires were completed by physicians interviewing patients and family, and HbA1c measurements were centralized. To identify explanatory variables for HbA1c level and frequency of severe hypoglycemia, we performed multiple regression analysis using all the quantitative variables collected and stepwise logistic regression for the qualitative variables. RESULTS: Mean HbA1c value for the whole population was 8.97 +/- 1.98% (normal 4.7 +/- 0.7% [SD]). Only 19 children (0.7%) had ketoacidosis during the 6 months before the study, whereas 593 severe hypoglycemia events occurred in 338 children (13.8%). Control was better in university-affiliated hospitals and centers following > 50 patients, reflecting the importance of access to experienced diabetologists. Children had a mean of 2.3 injections, allegedly performed 2.8 glucose measurements per day, and were seen an average of 4.6 times per year at the center. In the multiple regression analysis, 94% of the variance of HbA1c was explained by our pool of selected variables, with the highest regression coefficient between HbA1c and age (Rc = 0.43, P < 0.0001), then with daily insulin dosage per kilogram (Rc = 0.28, P < 0.0001), mother's age (Rc = 0.26, P < 0.0001), frequency of glucose measurements (Rc = 0.21, P < 0.0001), and diabetes duration (Rc = 0.14, P < 0.0001). Logistic regression identified quality of family support and dietary compliance, two related qualitative and possibly subjective variables, as additional explanatory determinants of HbA1c. The frequency of severe hypoglycemia was 45 per 100 patient-years and correlated with diabetes duration, but not with HbA1c levels or other variables. CONCLUSIONS: Although overall results remain unsatisfactory, 33% of studied French children with type 1 diabetes had HbA1c < 8%, the value obtained in Diabetes Control and Complications Trial adolescents treated intensively. Diabetes management in specialized centers should be encouraged.

Adolescent↗
PubMed1997

[Insulin-dependent diabetes mellitus in children and in adolescents: value of pedopsychiatric follow-up].

UNLABELLED: To assess the type of mental disorders met in the medical follow-up of insulin-dependent diabetic children (IDDM) and adolescents and their relationships with metabolic control (HbA1C) in young IDDM patients who consult in a department of child psychiatry. POPULATION AND METHODS: Twenty boys and 37 girls (mean age: 14.7 +/- 4.1 years and mean duration of IDDM: 5.6 +/- 4.3 years were followed during 1 year by the same child psychiatrist (mean duration of follow-up: 22 months). They were assessed with several clinical interviews (mean: three by subject); mental disorders were classified according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition revised (DSM III-R). RESULTS: The study showed the importance of emotional disorders, 30 patients presenting at least an anxiety disorder and 17 an affective disorder, 11 a major depressive disorder and eight a dysthymic disorder. The most frequent anxiety disorders were phobias and overanxious disorders. Two patients had an anorexia nervosa, one a bulimia nervosa and nine an eating disorder not otherwise specified. There were ten diagnoses of disruptive behaviour disorders, one toxic substance abuse and 11 adaptation disorders. Seven subjects had a reading and writing learning disorder, three a coordination disorder and three a borderline IQ. Familial factors seemed very important. Nine patients had a parent-child problem, four sibling rivalry disorder and two an attachment disorder. Family problems (conflicts, separations, economical difficulties...) were found in 63% of cases. The mother or the father had mental disorders in 24 cases (42%). The diabetic patients with mental disorders had poor metabolic control (HbA1C = 9.9 +/- 2.4%) and ten subjects (18%) had already somatic complications. Some mental disorders were significantly associated with high HbA1C. The poorer metabolic controls were observed for eating disorders. Somatic complications were associated only with IDDM duration. CONCLUSIONS: This study shows the presence of typical DSM III-R mental disorders in IDDM children and adolescents, principally emotional disorders, and their association with a higher somatic risk, maximum for eating disorders. It shows the interest of collaboration between diabetologist and child psychiatrist. The exact prevalence of these disorders should be assessed by epidemiological studies.

Adolescent↗
PubMed1997

Insulin responses to intravenous glucose, intravenous arginine and a hyperglycaemic clamp in ICA-positive subjects with different degrees of glucose tolerance.

The relationship between altered insulin secretion and impaired glucose tolerance was studied in 32 non-obese subjects aged 14-49 years with islet-cell antibodies (ICA) and fasting blood glucose below 7.9 mmol/l, using oral (OGTT) and intravenous (IVGTT) glucose tolerance tests. Glucose tolerance was normal in 19 subjects, impaired (IGT) in 4 and satisfied diabetic criteria in 9. Fifteen of these subjects and 8 ICA-negative controls also underwent a hyperglycaemic clamp (10 mmol/l) and a glucose-potentiated IV arginine bolus. Acute insulin response to IVGTT and insulin and C-peptide responses to the hyperglycaemic clamp and the arginine bolus were dramatically lower (p < 0.001) in diabetic and IGT subjects than in ICA-positive patients with normal glucose tolerance and control subjects. Insulin responses to the three tests were inversely correlated with plasma glucose levels and the area under the curve of OGTT. The correlations between the degree of glucose tolerance and insulin responses to IVGTT, the hyperglycaemic clamp and the arginine bolus were virtually identical. It is concluded that insulin responses to the three stimuli were severely altered in ICA-positive patients with impaired glucose tolerance or asymptomatic diabetes, normal in normotolerant ICA-positive subjects, and correlated with glucose tolerance.

Administration, Oral↗
PubMed1996

[Growth of children with insulin-dependent diabetes. Study of 104 cases].

BACKGROUND: Results of studies of growth in children with diabetes mellitus are still conflicting. In a cross-sectional and longitudinal study, statural growth was analysed in a sample of diabetic children in order to specify its characteristics and relationship with various factors. POPULATION AND METHODS: One hundred and four children (53 girls and 51 boys) with insulin-dependent diabetes for more than 3 years have been studied (age at onset and duration of diabetes, respectively, 6.4 +/- 4.1 and 8.5 +/- 4.8 in girls; 6.1 +/- 3.9 and 7.9 +/- 3.9 in boys; m +/- SD). A control group included 51 boys (age: 8.9 +/- 2.9) and 49 girls (age: 9.3 +/- 2.7). Data were collected every three months. Hemoglobin A1c was measured using high performance liquid chromatography (normal range: 5.0 +/- 1.0%; m +/- 2 DS). RESULTS: At diagnosis, height (evaluated in SD) did not differ between diabetic children and controls. Three years before the onset of diabetes, boys were taller compared to controls (1.02 +/- 0.20 vs 0.41 +/- 0.17; P < 0.05; m +/- SEM). Children five years after the onset of disease were overweight compared to controls (girls: 0.96 +/- 0.16 vs 0.00 +/- 0.20; boys: 0.59 +/- 0.16 vs -0.04 +/- 0.15; P < 0.01; m +/- SEM). Longitudinal study showed a progressive decrease of mean growth velocity starting at least 2 years before the onset of diabetes and proceeding until the end of growth. From diagnosis to the end of height development, there was a growth loss of 0.66 SD in girls (p < 0.01) and 0.69 SD in boys (p < 0.05). This alteration of growth affected more clearly children who became diabetic before the onset of puberty, especially those with early-onset diabetes and bad metabolic control. Growth changes for the first 5 years of diabetes were significantly and negatively correlated with mean hemoglobin A1c levels (r = -0.57). Growth changes from the onset of diabetes to the end of growth were correlated with age at diagnosis, (boys: r = 0.73; girls: r = 0.37). During puberty, girls exhibited a reduced growth spurt, especially when they were overweight and received too low doses of insulin. CONCLUSIONS: On the whole, diabetic children were growing in normal range. Growth was adversely and mainly affected by early-onset diabetes, a long duration of disease, many years of poor metabolic control and, especially in adolescent girls, low doses of insulin and weight excess.

Adolescent↗
PubMed1995

Eating and emotional disorders in adolescent obese girls with insulin-dependent diabetes mellitus.

OBJECTIVE: To study eating and emotional disorders in adolescent insulin-dependent diabetic (IDDM) girls. METHODS: 98 adolescent girls, aged 13-19 years, were studied: 15 obese and 37 non-obese IDDM girls, 22 obese non-diabetic and 24 non-obese girls, DSM-III-R eating disorders (anorexia nervosa, bulimia nervosa, eating disorders NOS) and eating habits (snacking, sweet compulsions) were evaluated by a semi-structured diagnostic interview (Kiddie-SADS-E and Eating Habits Interview). Emotional disorders were assessed using self-questionnaires (State-Trait Anxiety Inventory for Children, Beck Depression Inventory, Coopersmith Self-Esteem Inventory). Psychological characteristics were correlated with BMI and, for IDDM girls, with HbA1C. RESULTS: IDDM and non-diabetic obese girls showed high rates of eating disorders NOS (sub-clinical bulimia: 60 and 41%, respectively) and they had more extra-snacks than non-obese girls, suggesting that obesity was the main risk factor for additional eating disorders. However, non-obese IDDM girls had more eating disorders NOS (sub-clinical bulimia: 27%) than did the normal girls (4%). Three IDDM girls had typical bulimia nervosa, while none of the non-diabetic did. The risk of depression was increased by both IDDM and obesity (16 and 18% dysthymia, respectively; 8% in normal girls); both factors cumulated in obese IDDM girls (47% dysthymia). Obesity was linked to marked changes in self-esteem scores and mild effects on anxiety. IDDM had little effect on anxiety and none on self-esteem; it even seemed to preserve the self-esteem of obese girls. Patients with bulimia nervosa had poorer metabolic control than other girls with IDDM. There was no correlation between HbA1C and eating or emotional disorders. CONCLUSIONS: Adolescent IDDM girls are at increased risk of eating and emotional disorders. Obesity appears to be an important factor for psychiatric complications; more obese IDDM girls suffered from eating disorders NOS sub-clinical bulimia), dysthymia, anxiety disorders, depression and low self-esteem (Family Satisfaction SEI sub-score) than did non-obese IDDM girls.

Adolescent↗
PubMed1995

Cyclosporin A does not delay insulin dependency in asymptomatic IDDM patients.

OBJECTIVE: To measure the effects of cyclosporin A (CyA) with no insulin therapy on glucose tolerance and beta-cell function in the preclinical phase of insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: beta-cell responses to the intravenous glucose tolerance test (IVGTT), hyperglycemic clamp, intravenous arginine, and intravenous glucagon were evaluated before and after a 6-month course of CyA in seven patients (mean age 19.6 years) with asymptomatic IDDM. RESULTS: Initial insulin secretory responses were severely decreased when the patients were compared with eight healthy control subjects: IVGTT (1 + 3 min): 106 +/- 16 vs. 884 +/- 190 pmol/l (P < 0.001); hyperglycemic clamp: 102 +/- 16 vs. 310 +/- 42 pmol/l (P < 0.001); intravenous arginine: 346 +/- 72 vs. 1104 +/- 168 pmol/l (P < 0.01); and intravenous glucagon: 170 +/- 37 vs. 247 +/- 35 pmol/l (NS). The beta-cell responses remained markedly abnormal after 6 months of CyA, although the response to intravenous glucose and oral glucose tolerance tests improved in three subjects. All the patients became insulin-dependent after 5-36 months. CONCLUSIONS: CyA alone is not a suitable treatment for asymptomatic IDDM. Earlier identification of subjects with substantial beta-cell secretory capacity and newer nontoxic intervention strategies are required for the prevention of IDDM.

Adolescent↗
PubMed1993

Improvement of diabetic control and acceptability of a three-injection insulin regimen in diabetic adolescents. A multicenter controlled study.

OBJECTIVE: To compare the effectiveness and acceptability of a three-injection insulin regimen with the conventional two-injection therapy in an unselected population of diabetic adolescents. RESEARCH DESIGN AND METHODS: Some 205 patients aged 10-18 yr with IDDM, who were previously treated with two daily insulin injections, were included without any selection into a randomized trial. They were either switched to three (regular prebreakfast, regular prelunch, and [regular+ultralente] predinner) or remained on two ([regular+intermediary] prebreakfast and predinner) subcutaneous injections. They were evaluated after 1 yr of treatment. The major criteria of outcome of efficacy were the concentration of GHb, the frequency of severe hypoglycemia and DKA, and body weight. RESULTS: Of the patients, 82% accepted the three-injection regimen, and 83% accepted the two-injection regimen. At entry into the trial, no significant differences appeared between the two treatment groups nor among patients refusing the allocated regimen. Significant explanatory variables predicting initial diabetes control were duration of disease and adherence to diet. GHb, decreased from 9.8 +/- 0.1 to 9.3 +/- 0.2% (P < 0.05) in the three-injection group, whereas it increased from 9.5 +/- 0.3 to 9.8 +/- 0.3% (P < 0.05) in the two-injection group, resulting in a modest (0.75%) but significant difference (P < 0.05) between GHb change in the two groups. The difference reached 1.4% (P < 0.0002) in patients with GHb > 11.2% at entry. The frequency of hypoglycemia and DKA was similar in the two groups. None of the parameters known to potentially influence glycemic control changed during the trial, and, therefore, the improvement of GHb could be attributed to the pattern of daily insulin distribution per se. CONCLUSIONS: In the general diabetic adolescent population, the efficacy of a three-injection regimen is somewhat superior to that of a conventional two-injection regimen, particularly in patients previously poorly controlled. The acceptability of this regimen being excellent, its increased use should be considered in this age-group.

Adolescent↗
PubMed1991

DNA polymorphism analysis of HLA class II genes in unrelated children and in first-degree relatives with type I diabetes.

Eighty unrelated diabetic children, seventy healthy controls and hundred and ten affected and unaffected first-degree relatives of twenty multiplex families were investigated by restriction fragment length polymorphism analysis of HLA class II genes using five probe/enzyme systems: DRB and DQB/Taq I, DRB and DQB/EcoRI and DQB/BamHI according to standard procedures described in the 10th Histocompatibility Workshop protocol. Comparison between the unrelated diabetic patients and the controls confirmed the positive association of type 1 diabetes with DR3(w17)DQw2 Dw24 or Dw25 and DR4DQw8 and the negative association with DR2(w15)DQw6, DR4DQw7 and DR7DQw2 haplotypes. In multiplex families, similar allele associations were found and the distinction between haplotypes present in diabetic patients and those that segregated to healthy family members allowed to observe striking differences between the "affected" and "unaffected" haplotypes, particularly for the subtypes of DR3(w17) DQw2, DR4DQw3 and DR2DQw1 haplotypes. Heterozygous siblings who carried both DR3DQw2 and DR4DQw8 subtypes disclosed a highly increased risk and more than 80% of DR3/DR4 affected siblings received a paternal DR4DQw8 together with a maternal DR3DQw2. These observations indicate that several genetic aspects influence susceptibility to type 1 diabetes: 1) some particular HLA class II subsets; 2) the parental origin of the predisposing genes; 3) the synergistic effect of both haplotypes, in particular DR3DQw2 and DR4DQw8. These results may help to better specify susceptibility markers for risk prediction in siblings.

Adolescent↗
PubMed1991

[Injections without needles in the treatment of insulin-dependent diabetes].

Jet injectors, which force a fluid under considerable pressure through a very small opening, have recently become available for subcutaneous administration of insulin. Use of the new devices introduced on the market is neither simpler nor more complicated than use of a syringe. Although jet injectors are highly attractive to both patients and parents, they can be used in only a limited range of diabetics. Main limitations to more widespread use include: 1) the small capacity of the devices which cannot inject more than 20 units of 40 unit/ml insulin; 2) modifications in the pharmacokinetic effects of insulins, especially long-acting insulins; 3) the high price of the injectors. Young children, who often find it difficult to accept injections, may be the main potential target for jet injector therapy. A trial period at home should always be scheduled before considering the purchase of a jet injector.

Adolescent↗
PubMed1990

[Antioxidant enzymes in insulin-dependent diabetes in the child and adolescent].

Superoxide dismutase, glutathione peroxidase and glutathione reductase activities were measured in erythrocytes of 214 young patients with insulin-dependent diabetes and 37 healthy subjects with similar age and sex distribution. The diabetic patients were divided into groups and subgroups according to sex, age, duration of disease, existence of diabetes complications and family history of atherogenic risks. Data analysis was performed by comparing enzyme activities in subgroups according to the degree of diabetes control and the plasmatic level of various lipid fractions. Results showed that superoxide dismutase, glutathione peroxidase and glutathione reductase activities in young diabetic patients were similar to those in controls, except for patients with retinopathy, whose glutathione peroxidase activity was decreased. This last finding might suggest that there is a relationship between the development of diabetic microvascular complications and the accumulation of free radicals and peroxide lipids.

Adolescent↗
PubMed1988

[Comparison of 2 modes of treatment of diabetic ketoacidosis in children].

In two groups of children with diabetic ketoacidosis, the effects of intramuscular insulin injections associated with intensive rehydration and alkalisation were compared with low-dose continuous intravenous infusion associated with well-controlled fluid and electrolyte therapy. Although correction of ketoacidosis was as effective with both methods, the second appeared to offer several advantages: 1. More progressive normalization of metabolic parameters; 2. Reduced risks of hypoglycemia and hypokaliemia; 3. Easier control of the decrease in plasma glucose levels; 4. Better correction of hyponatremia; 5. More gradual increase in pH values. These results confirmed that low-dose continuous insulin infusion with proper monitoring of fluid and electrolyte replacement was a safe, simple and effective treatment of diabetic ketoacidosis in children.

Acid-Base Imbalance↗
PubMed1985

[Etiopathogenesis of celiac disease: the attraction and flimsiness of hypotheses].

The pathogenetic mechanisms which induce the intestinal lesions observed in coeliac disease are still unknown. The hypothesis of a primary intestinal peptidase deficiency has not been confirmed. The immunological theory is supported by a large number of findings, but it cannot explain all of the facts. The concept of a surface cell membrane abnormality aims at making up for the previous shortcomings, but it is based on very few unconfirmed data. Although the new pathogenetic theories for auto-immune diseases, and especially coeliac disease, are of considerable interest, experimental confirmation is eagerly awaited. Recently isolated pure toxic gliadin peptides may be of great value to test these new concepts in future research work.

Celiac Disease↗
PubMed1985

[Effect of metabolic control on plasma lipids and lipoproteins in insulin-dependent diabetes in children and adolescents].

Plasma triglycerides, total cholesterol, phospholipids, HDL-cholesterol, HDL-phospholipids, apolipoproteins A-I and B, haemoglobin AIc and C-peptide were measured in 113 children and adolescents (49 males and 64 females) with insulin-dependent diabetes. These patients were divided into four groups according to sex and age (more or less than 12 years old) and into three subgroups according to metabolic control. In female adolescents with poor control, triglycerides and apolipoprotein B were increased whereas HDL-cholesterol, HDL-phospholipids and (HDL/LDL + VLDL)-cholesterol were significantly decreased. In poorly-controlled male adolescents, similar changes were observed except for HDL-cholesterol and HDL-phospholipids which were not significantly decreased. In adolescents, haemoglobin AIc correlated directly with triglycerides, total cholesterol, phospholipids, apolipoprotein B and inversely with HDL-cholesterol, HDL-phospholipids and (HDL/LDL + VLDL)-cholesterol. In children aged less than 12 years, no significant change of HDL-cholesterol or apolipoprotein B was observed even in the poorly-controlled group.

Adolescent↗
PubMed1985

[Decrease of the cytotoxicity of gliadin fractions in the development of celiac disease. Organotypic culture study].

Observation up to adulthood of children with coeliac disease given again a normal diet had shown a clinical as well as histologic reduction in their sensitivity to gluten. From this fact a retrospective study was undertaken to appreciate whether this decreased sensitivity was also observed in vitro in a model of organotypic culture of intestinal mucosa obtained by biopsy, in the presence of gliadin toxic peptides. Twelve children had 2 cultures with a several year interval under normal diet. In 10 of them a decreased cytotoxic effect was observed. However, the explanation of this decrease remains difficult. It seems related neither to the age of the children, nor with the status of the mucosa at the time of in vitro testing, or to the duration of the gluten-containing diet. This study finally confirms that it is impossible to use organotypic cultures as an in vitro test for the diagnosis of coeliac disease.

Celiac Disease↗
PubMed1984

[Analysis of diabetic microangiopathy using retinal angiography in 82 children].

Between 1979 and 1983, 116 retinal fluorescein angiographies were performed in 82 insulin-dependent diabetic children aged from 8 to 19 years. Abnormalities were observed in 7% of children with diabetes of less than 5 years duration. Retinal lesions were present in 30% of children with disease of 5-60 years duration. Most of the lesions encountered were capillary dilatations, fluorescein leakages and microaneurysms. The incidence and severity of these lesions increased with the duration of diabetes. Most of them, even of early onset, proved irreversible. It is therefore important to monitor their development by frequent angiographies (every 2 years) and to initiate an intensive treatment of diabetic children from the onset of the disease.

Adolescent↗
PubMed1984

[Assay of C-peptide in diabetes in children and adolescents].

Thirty eight children and adolescents aged 3 to 19 years with insulin-dependent diabetes had basal plasma C-peptide levels 50 to 70 p. 100 lower than comparable non-diabetic subjects. An appreciable residual fasting endogenic secretion greater than 1 ng/ml was found in half the patients during the first two years after the onset of diabetes. After this period, the concentrations were almost always lower than 1 ng/ml and in half the cases, at the lower limit of detection. In addition, it was difficult to stimulate C-peptide secretion by food or drugs. The effects of variations in blood glucose were made allowance for by using molar C-peptide/glucose ratio. This gives a better evaluation of the inverse relationship between residual pancreatic function and the duration of the diabetes and of the degree of residual beta-langerhans secretion to help obtain stable metabolic equilibrium.

Adolescent↗