OBJECTIVETo test the feasibility of using 1,5-anhydroglucose alcohol (1,5-AG) as a diagnostic indicator of fulminant type 1 diabetes (FT1DM).

METHODSFifteen patients with newly diagnosed FT1DM and 52 with type 2 diabetes (T2DM) were examined for serum biochemistry, glycosylated hemoglobin (HbAlc), and serum 1, 5-AG level.

RESULTSThe patients with FT1DM and T2DM showed significantly different fasting levels of blood glucose (FBG), fructosamine (FMN), creatinine (Cr), urea, HbAlc and serum 1,5-AG (P<0.05). In FT1DM patients, serum 1,5-AG was found to inversely correlate with FBG (r=-0.646, P=0.032) and FMN (r=-0.680, P=0.021), and in T2DM patients, serum 1,5-AG was inversely correlated with FBG (r=-0.407, P=0.001), FMN (r=-0.314, P=0.01) and HbAlc (r=-0.576, P<0.01). Receiver-operating characteristic (ROC) curve analysis showed an area under the curve of serum 1,5-AG of 0.804 with a cutoff value of 67.95, a sensitivity of 82.9% and a specificity of 60% for FT1DM diagnosis.

CONCLUSIONSerum 1, 5-AG can reflect acute blood glucose fluctuation in FT1DM patients and is useful for differential diagnosis of FT1DM when combined with evaluations of the clinical characteristics of the patients and other related indicators.

Blood Glucose ; Diabetes Mellitus, Type 1 ; blood ; diagnosis ; Diabetes Mellitus, Type 2 ; blood ; diagnosis ; Diagnosis, Differential ; Ethanol ; Glycated Hemoglobin A ; chemistry ; Humans ; ROC Curve ; Sensitivity and Specificity

PURPOSE: Type I diabetes mellitus(DM) is an autoimmune disease which decreases insulin secretion of pancreatic beta-cell. The honeymoon period in type I DM is known to be related to the partial recovery of C-peptide and preservation of pancreatic beta-cell function. The aim of this study was to determine factors influencing the onset of honeyrnoon period in children with type I DM. METHODS: The study group was composed of 50 patients with type I DM. The honeymoon period was defined as a period requiring less than 0.5U/kg/day to maintain near-normal blood glucose control without urine glucose for consecutive days. The factors for three study were age at diagnosis, sex, initial 24-hr urine C-peptide, initial HbA C, diabetic ketoacidosis and maximum insulin dose for near-normal blood glucose control before honeymoon. RESULTS: The group with honeymoon period received significantly smaller doses of insulin near-normal blood glucose control, compared to the group without honeymoon period, before honeymoon(P<0.01). Other factors had no significant connection with the development of honeymoon period. CONCLUSION: The developrnent of honeymoon period in type I DM had a significant relationship with maximum insulin dose before the onset of honeymoon period for near-normal blood glucose control. This needs remains to be further study.
Autoimmune Diseases ; Blood Glucose ; C-Peptide ; Child* ; Diabetes Mellitus* ; Diabetes Mellitus, Type 1 ; Diabetic Ketoacidosis ; Diagnosis ; Glucose ; Humans ; Insulin

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the 6th Clinical Practice Guidelines in 2019. Targets of glycemic, blood pressure, and lipid control in type 2 diabetes mellitus (T2DM) were updated. The obese and overweight population is increasing steadily in Korea, and half of the Koreans with diabetes are obese. Evidence-based recommendations for weight-loss therapy for obesity management as treatment for hyperglycemia in T2DM were provided. In addition, evidence from large clinical studies assessing cardiovascular outcomes following the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with T2DM were incorporated into the recommendations.
Blood Pressure ; Diabetes Mellitus, Type 2 ; Diagnosis ; Glucagon-Like Peptide 1 ; Humans ; Hyperglycemia ; Korea ; Obesity ; Overweight

PURPOSE:Urine examination for microalbuminuria during the clinical silent years can help to identify those patients most likely to progress to overt nephropathy. The normalization of the AER(Albumin Excretion Rate) by alteration of glomerular hemodynamics may be the key to preventing or delaying overt nephropathy. The prognostic and therapeutic implications have led to attempts to identify patients with microalbuminuria as early as possible.Because diagnosis of microalbuminuria has required a 12 or 24 hour urine collection,there has been interested in developing tests that might serve as a first-stage screen for microalbuminuria. Most reports have dealt with the usefulness of either the albumin concentration or the albumin/creatinine ratio in a timed or randomly collected urine specimen. Exercise induced albumin excretion is increased compared to resting and could unmask latent glomerular damage. The purpose of this study is to evaluate diagostic significance of urinary albumin measurement after exercise in children with insulin dependent diabetes. METHODS:Fifty-seven patients with IDDM collected their overnight urine from 22:00 to 6:00 in following morning. Exercised method for urine examination was 100M running and collected 2 hour urine after exercise. The AER and Albumin/ creatinine ratio(ACR) were measured in the urine and compared with before and after exercise. RESULTS:Mean ages of diabetic children was 13.7 yrs old and duration of diabetes was 4.1+/-2.7yrs, HbA1c 8.6+/-1.9%,Systolic BP 107+/-10mmHg and Diastolic BP 67+/-8mmHg. The exercise induced AER was increased compared to before exercise(10.3+/-10.5 vs 18.1+/-16.0 mg/24hr). The exercise induced ACR also increased too(1.4+/-1.5 mg/g.Cr vs 4.1+/-3.6mg/g.Cr)(P<0.01). Two(3.5%) children with IDDM was positive for microalbuminuria in terms of AER before exercise and 8 children(14%) after exercise. No one positive for microalbuminuria in terms of Alb/cr before and after exercise. The charateristics of 8 children with microalbuminuria after exercise was no specific difference between positive and negative microalbuminuria. There was specific correlation between microalbuminuria and HbA1c(P<0.05) but sex, ages, duration of diabetes & blood pressure were not correlated with incidence of microalbuminuria. CONCLUSION: The mean timed urinary albumin excretion after exercise was significantly higher than before exercise. Measurement of timed urinary albumin excretion after exercise will be helpful for detecting microalbuminuria earlier.
Blood Pressure ; Child* ; Creatinine ; Diabetes Complications ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies ; Diagnosis ; Hemodynamics ; Humans ; Incidence ; Insulin ; Running

Latent autoimmune diabetes in adults (LADA), presenting with a similar phenotype of type 2 diabetes at early stage, belongs to the slowly progressive subtype of autoimmune type 1 diabetes. LADA differs from classic juvenile-onset type 1 diabetes in which its autoimmune destructive process of islet beta-cells is much slower, so LADA may serve as a human model of autoimmune type 1 diabetes. Although no international standardized criteria for the diagnosis of LADA has been established, it should be noted that LADA has some specific features in clinical characteristics, susceptible genotypes, cellular and humoral immune markers, as well as islet pathology. Presence of islet autoantibodies is necessary for the diagnosis of LADA. Early insulin intervention may preserve residual islet beta-cell function in LADA. The different pathological manifestations of LADA with different autoantibody titers can help throw light on the autoimmune process, laying foundation of prevention or even cure of type 1 diabetes.
Adult ; Autoantibodies ; blood ; Diabetes Mellitus, Type 1 ; classification ; diagnosis ; drug therapy ; Humans ; Insulin ; therapeutic use ; Islets of Langerhans ; immunology

OBJECTIVETo investigate the diagnostic value of serum islet autoantibody-glutamic acid decarboxylase antibody (GADA) and islet cell antibody (ICA) in patients with hepatogenic diabetes.

METHODSSerum GADA and ICA were measured with enzyme-linked immunosorbent assay (ELISA) in 217 patients with chronic hepatitis B (CH) or liver cirrhosis (LC). The positivity rate of GADA and ICA in different phases of CH and LC and their relations with diabetes mellitus were analyzed.

RESULTSThe positivity rate of the islet autoantibody in the circulation was 72% in CH and LC patients with diabetes mellitus and 30% in patients with normal glucose level, showing significant difference between the two patient groups (Chi2=36.620, P=0.000). CH patients with diabetes had much higher positivity rate for the antibody [52% than type 2 diabetic patients with liver dysfunction [8%, P<0.05]. The positivity rate was also much higher in CH and LC patients with lowered C peptide level [70%] than in those with normal C peptide level [40%, P<0.005].

CONCLUSIONBoth GADA and ICA have important value in the diagnosis of hepatogenic diabetes and may serve as indexed in laboratory test for distinguishing hepatogenic diabetes from type 2 diabetes.

Adult ; Autoantibodies ; blood ; Diabetes Mellitus, Type 1 ; complications ; diagnosis ; immunology ; Diabetes Mellitus, Type 2 ; complications ; diagnosis ; immunology ; Diagnosis, Differential ; Female ; Glutamate Decarboxylase ; immunology ; Hepatitis B, Chronic ; complications ; Humans ; Islets of Langerhans ; immunology ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Predictive Value of Tests

Spot urinary albumin to creatinine ratio (ACR) measurement has been suggested as a surrogate to 24-hr urine collection for the assessment of microalbuminuria, and cystatin C (cysC) is known as an advantageous marker for renal function. The aim of this study was to evaluate the clinical values of spot urinary ACR and serum cysC for the assessment of diabetic nephropathy instead of 24-hr urine microalbumin in children and adolescents with diabetes. A total of 113 children and adolescents (age 12-19 yr, M:F = 47:66) with type 1 or 2 diabetes were enrolled. We evaluated the validity of spot urine ACR and serum cysC, and then compared them to 24-hr urine microalbumin and creatinine clearance. Spot urine ACR was correlated with 24-hr urine albumin excretion (R2 = 0.828, P = 0.001) and creatinine clearance (R2 = 0.249, P = 0.017). The ROC curve analysis of serum cysC demonstrated higher diagnostic accuracy than that of serum creatinine (AUC 0.732 vs 0.615). Both the measurements of spot urine ACR and serum cysC might better predict the presence of diabetic nephropathy than 24-hr urine microalbumin in childhood diabetic patients.
Adolescent ; Albuminuria/*urine ; Child ; Creatinine/*urine ; Cystatin C/*blood ; Diabetes Mellitus, Type 1/*diagnosis ; Diabetes Mellitus, Type 2/*diagnosis ; Diabetic Nephropathies/*diagnosis ; Female ; Glomerular Filtration Rate ; Hemoglobin A, Glycosylated/analysis ; Humans ; Kidney Function Tests ; Male ; Predictive Value of Tests ; ROC Curve

OBJECTIVETo review the incident status of childhood type 1 diabetes mellitus hospitalized in the Children's Hospital of Zhejiang University School of Medicine from 1999 to 2009 and to explore the clinical value of IL-10 in diabetic ketoacidosis.

METHODSThe clinical data of 263 children with type 1 diabetes mellitus hospitalized in the Children's Hospital of Zhejiang University School of Medicine from January 1999 to February 2009 were retrospectively reviewed. Serum lipid levels were measured in 48 children with type 1 diabetes mellitus and in 24 healthy children. The diabetic children were classified into two subgroups, with or without ketoacidosis. Serum lipid and cytokines levels were compared.

RESULTSChildhood type 1 diabetes mellitus was common in females (56.3%). The peak incident age of the disease was between 6 and 11.9 years. Diabetic ketoacidosis was as the presenting symptom for the first visit in 86 cases (32.7%). The levels of serum lipid, blood glucose and HbA1c in diabetic children with ketoacidosis were significantly higher than those without ketoacidosis (P<0.05). Logistic analysis demonstrated that the increased levels of blood glucose, serum lipid and HbA1c were risk factors for diabetic ketoacidosis. The level of serum IL-10 in diabetic children with ketoacidosis was significantly higher than that in patients without ketoacidosis (P<0.01), while there were no differences in serum levels IL-2, IL4, IL-6, TNF-α and IFN-γ between them. Serum levels IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ in diabetic children were significantly higher than those in healthy children (P<0.01).

CONCLUSIONSKetoacidosis is a common acute complication of type 1 diabetes mellitus. The disorders of glucose and lipid metabolism are the risk factors for ketoacidosis in diabetic children. IL-10 may be a sensitive index of diabetic ketoacidosis in children with type 1 diabetes mellitus.

Adolescent ; Child ; Child, Preschool ; Diabetes Mellitus, Type 1 ; blood ; complications ; Diabetic Ketoacidosis ; blood ; diagnosis ; Female ; Humans ; Infant ; Interleukin-10 ; blood ; physiology ; Logistic Models ; Male ; Retrospective Studies

Insulin is readily concentrated from 10 to 50 ml of urine with better than 75% recovery using octadecylsilyl (ODS) silica columns (C18Sep-Pak cartridge) and can then be measured by radioimmunoassay. Fractionation on Sephadex G50 gel filtration reveals that the apparent immunoreactivity corresponds for the most part to 6000 dalton insulin. Renal clearance of insulin in 5 normal subjects does not appear to differ in the fasted or fed state and ranged from 0.34 to 0.58 ml/min with an average of 0.44 +/- 0.10 (S.D.) ml/min. Increased urinary insulin output was observed following feeding and fell during prolonged fasting. Insulin output in urine from 7 non-diabetic subjects ranged from 11 to 39 mU/24 hr, averaging 25 +/- 10 mU/24 hr. In normal subjects without renal disease a single determination of renal insulin clearance and a timed urinary insulin output appear to be sufficient for determination of mean plasma insulin during that time period. Concentration of urine using this methodology could provide the material for HPLC screening for abnormal insulins and for their subsequent purification to determine the site of change in amino acid sequence.
Adult ; Chromatography, Gel ; Diabetes Mellitus, Type 1/diagnosis ; Female ; Humans ; Insulin/blood/*urine ; Male ; Metabolic Clearance Rate ; Middle Aged ; Radioimmunoassay/*methods

BACKGROUND: Diabetic nephropathy is the main cause of the end-stage renal disease in Korea. This study was performed to evaluate the progression pattern and risk factors of diabetic nephropathy in type 1 diabetes patients. METHODS: Total 64 patients who were registered in Ajou University Hospital since April 1994 till April 2004 were enrolled. We retrospectively analyzed the influence of systolic and diastolic blood pressure, serum creatinine, total cholesterol, albumin, HbA1c and urine albumin excretion on the rate of decline in creatinine clearance (CCr) by Cockcroft- Gault equation. RESULTS: The patients (27 males/37 females), aged 32.8+/-9.1 (mean+/-SD) years, with a mean duration of diabetes of 9.5+/-4.9 years, were followed more than 6 months. CCr were 113.0+/-20 mL/min/1.73m2 at diagnosis and a mean decrease rate was 3.8+/-3.6 mL/ min/1.73m2/year. Doubling time of serum creatinine was 13.1+/-3.2 year in patients who developed doubling of their creatinine (26.6%). Microalbuminuria and overt proteinuria developed at 8.1+/-2.5 year and at 11.4+/-1.5 year after the diagnosis of type 1 diabetes respectively. A mean decrease rate of CCr was 6.1+/-2.9 mL/min/1.73m2/year in patients who develop ESRD after 14.2+/-2.8 years. During the follow up, systolic and diastolic blood pressure, serum total cholesterol were significantly higher and the mean serum albumin and creatinine clearance were significantly lower in chronic renal failure (CRF) group compared to non-renal failure (non-CRF) group (p< 0.05). There was no significant difference in HbA1c between CRF and non-CRF groups. CONCLUSION: The results may suggest that Korean type 1 diabetes patients with diabetic nephropathy in Ajou hospital have a rather faster decline in kidney function compared with other reports. But we need further prospective study to confirm this findings.
Blood Pressure ; Cholesterol ; Creatinine ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies* ; Diagnosis ; Follow-Up Studies ; Humans ; Kidney ; Kidney Failure, Chronic ; Korea* ; Proteinuria ; Retrospective Studies ; Risk Factors ; Serum Albumin