Child ; Diabetes Mellitus, Type 1 ; diagnosis ; etiology ; Humans ; Male

Ketosis-prone diabetes mellitus (KPD), which is an atypical type of diabetic mellitus with severe β cell dysfunction, is accompanied by ketosis or ketoacidosis without specific preceding factors at diagnosis. KPD shows mixed features of type 1 and type 2 diabetes. In some cases, the recovery of the function of β cells during intensified diabetic management enabled the termination of insulin therapy. The Aβ classification system classifies KPD patients into four distinct subgroups depending upon the presence or absence of β cell autoimmunity and β cell functional reserve and has been recognized as an important tool to predict clinical outcomes. In Korea, several cases of KPD with absence of β cell autoimmunity have been reported. A 60-year-old man presenting with DKA (diabetic ketoacidosis) as the first manifestation of diabetes, was shown to have β cell autoimmunity. A significant improvement in glycemic control was shown as a result of aggressive diabetic management; shortly after an acute episode of DKA, the recovery of β cell functional reserve was confirmed. This result allowed discontinuation of insulin therapy and maintenance of euglycemic status without antidiabetic medication.
Autoimmunity ; Classification ; Diabetes Mellitus, Type 1* ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Diagnosis ; Humans ; Insulin ; Ketosis ; Korea ; Middle Aged

Diabetes Mellitus, Type 1 ; diagnosis ; etiology ; Humans ; Klinefelter Syndrome ; complications ; diagnosis ; Male

Klinefelter’s syndrome (KS) is the most common sex chromosome disease in men. Classical features of the syndrome include a eunuchoidal body habitus, small testes and hypergonadotrophic hypogonadism. There has been an increased risk of diabetes mellitus and autoimmune disease for KS patients. This paper reports a case of KS in association with type 1 diabetes mellitus. The patient was a 21-year-old man, who has been confirmed by absolute insulin deficiency and positive IA-2 autoantibody. The hyperinsulinemic euglycemic clamp test indicated his insulin sensitivity in normal range, and his blood glucose was controlled well by the insulin therapy.
Adult ; Diabetes Mellitus, Type 1 ; diagnosis ; etiology ; Humans ; Klinefelter Syndrome ; complications ; diagnosis ; Male ; Young Adult

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

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

Adult ; Diabetes Mellitus, Type 1/therapy* ; Diabetes Mellitus, Type 2/diagnosis* ; Genetic Predisposition to Disease ; Glucose Intolerance ; Humans ; Islets of Langerhans ; Latent Autoimmune Diabetes in Adults/therapy*

PURPOSE: Study purposes were to exam effects of self-care education for children with type 1 diabetes on their diabetes management behaviors and to explore the relationship among diabetes management behaviors, knowledge, self-efficacy and clinical variables. METHODS: This study was a one group quasi-experimental study. Study participants were children with type 1 diabetes and attended a four hour self-care education of a diabetes camp. Data were collected using structured questionnaires including Diabetes Management Behavior Scale (DMBS), Michigan Diabetes Research and Training Center's Brief Diabetes Knowledge Test and Self-Efficacy for Diabetes Self-Management. RESULTS: The mean age of the participants was 12 (+/-2.3) years. After the education, their DMBS and knowledge improved, but the improvement was not statistically significant (t=1.758, p=.101; t=0.528, p=.606). Two areas of DMBS, daily prevention behaviors and modification of care plan, were associated with study variables. Daily prevention behaviors were associated with duration of diabetes (r=.653, p=.008), HbA1c (r=.563, p=.038) and having a complication (r=-2.788, p=.015). Modification of care plan was associated with age at diagnosis (r=-.552, p=.033). CONCLUSION: Children with type 1 diabetes could improve some parts of their diabetes management behaviors even after a short diabetes camp.
Child* ; Diabetes Mellitus, Type 1 ; Diagnosis ; Disease Management ; Education* ; Humans ; Michigan ; Self Care* ; Self Efficacy

PURPOSE: We observed the prevalence rate of microalbuminuria(MA) and its relationship with the various clinical factors in children and adolescents with type 1 diabetes mellitus(DM). METHODS: Seventy two children and adolescents(26 males and 46 females, 17.1+/-3.0 years) were included. MA was defined as 24 hour urine microalbumin >30mg/day(20microgram/min). Subjects were classified into three groups(normoalbuminuria, transient MA, or persistent MA). Additionally, sub jects were classified into another three groups according to age at diagnosis(<5, 5-11, or >11 years), arbitrarily. Clinical characteristics were analyzed between these groups and prevalence rates of MA by age and by duration of diabetes were analyzed. RESULTS: Of the 72 patients, 42(58.3%), 11(15.3%), and 19(26.4%) patients were included in nor moalbuminuric, transient MA, and persistent MA group, respectively. The mean level of HbA1c in persistent MA group was greater than those of other groups(P<0.01). The prevalence rates of diabetic retinopathy(27.8%) and neuropathy(16.7%) in the persistent MA group were higher than those in other groups(P<0.05). The cumulative incidence for developing persistent MA was 1.4% at 13 years, 4.7% at 15 years, and 20.7% at 18 years of age. The cumulative incidence for developing persistent MA was 3.4% after 6 years, 15.6% after 7 years, and 17.8% after 8 years. In patients who were diagnosed before 11 years of age, the appearance of persistent MA was delayed until pubertal age, whereas those who were diagnosed after 11 years of age developed persistent MA earlier after diagnosis. CONCLUSION: These data suggest that screening for MA should be performed in children and adolescents who have had diabetes for more than 5 years, or have entered into puberty, especially those with poor metabolic control.
Adolescent* ; Child* ; Diabetes Mellitus, Type 1* ; Diagnosis ; Female ; Humans ; Incidence ; Male ; Mass Screening ; Prevalence ; Puberty

PURPOSE: Reduced growth and microvascular complications have been recognized as consequences of type 1 diabetes mellitus (T1DM). We assessed the effect of T1DM on growth and factors associated with the development of microvascular complications. METHODS: We conducted a retrospective longitudinal evaluation of 154 patients above 16 years of age. We analyzed factors which affect final height standard deviation scores (SDS) and development of microvascular complications. RESULTS: Final height SDS was -0.11+/-1.15 (-0.26+/-1.33 in females, 0.04+/-0.91 in males). Final height SDS was significantly lower than midparental height SDS and height SDS at diagnosis. There was no difference in final height SDS according to age at onset, existence or nonexistence of complications, or average HbA1C. Height SDS at onset of puberty, midparental height SDS and pubertal growth gain affected final height SDS. The number of patients with complications was 37 (24 percent). Microvascular complications developed at a younger age and after longer duration of diabetes in patients with a prepubertal onset of T1DM compared to patients with pubertal onset. Patients with complications had a higher level of average HbA1C than patients without complications. Patients whose microalbuminuria regressed had lower levels of average HbA1C, systolic BP, second 24h urine microalbumin than patients with persistant or progressed microalbuminuria. CONCLUSION: The results suggest that degrees of glycemic control don't affect final height, but various factors associated with T1DM can impair growth potential. Additionally, the degrees of glycemic control and puberty affect the development of microvascular complications.
Adolescent ; Diabetes Mellitus, Type 1* ; Diagnosis ; Female ; Humans ; Puberty ; Retrospective Studies