Alessandra Cocca

Chat Line for Adolescents with Type 1 Diabetes: A Useful Tool to Improve Coping with Diabetes: A 2-Year Follow-Up Study

BACKGROUND We evaluated the impact of a 2-year chat line involving adolescents with type 1 diabetes regarding quality of life and metabolic control. METHODS We enrolled 193 children, 10-18 years of age (mean ± SD, 13.6 ± 2.7 years), with type 1 diabetes for 1.2-6 years (3.6 ± 2.4 years), body mass index of 23.2 ± 4.1 kg/m(2), insulin requirement of 0.7 ± 0.3 U/kg/day, and glycated hemoglobin (HbA1c) of 7.8 ± 1.1%, who participated in a weekly physician-moderated chat line for a 2-year follow-up period. Each patient completed the Diabetes Quality of Life for Youth Inventory (DQOLY) at baseline and after 1 and 2 years. A measure of glycemic control (HbA1c) was also collected. Data from 17 patients who discontinued using the chat line were not included in the analysis. As controls, 203 patients with type 1 diabetes, age- and sex-matched, with similar HbA1c at baseline and socioeconomic status, were randomly selected among 834 patients who refused to participate in the chat sessions. RESULTS DQOLY responses from youth with type 1 diabetes showed a significant improvement (P = 0.0001) only in patients who participated in chat sessions. We observed a decrease of 0.4% in HbA1c in patients who participated in chat session (7.8 ± 1.1% vs. 7.4 ± 0.5%, P < 0.0001) compared with the 0.1% of the controls (7.9 ± 1.9% vs. 7.8 ± 1.8%, P = 0.668). No difference was observed in HbA1c between the two groups (P = 0.056). CONCLUSIONS A chat line is also a cheap and effective tool that helps improve diabetes compliance. The chat line could help the diabetes team understand and treat their patients more comprehensively; moreover, it could help patients cope better with their daily life.

All classifications not built on pathogenesis become inadequate sooner or later

Keywords Gestational diabetes.Glucokinase.MODY-2AbbreviationsHAPO Hyperglycemia Adverse Pregnancy OutcomeLGA Large for gestational ageSGA Small for gestational ageTo the Editor: We read with interest the paper by E. A. Ryan[1] concerning the new criteria suggested by the Hypergly-cemia Adverse Pregnancy Outcome (HAPO) study for thediagnosis of gestational diabetes [2]. Ryan showed thatapplying these criteria would result in a doubling of thenumber of pregnant women diagnosed with gestationaldiabetes without a clear demonstration of the benefitsderived from this new classification. As he observes,maternal obesity represents a stronger predictor of large-for-gestational-age (LGA) babies than glucose levels in allexcept the highest glucose category [1, 3]. This suggeststhat not all gestational hyperglycaemia has the sameaetiology. As was the case in paediatrics, where for manydecades we wrongly diagnosed all children with hyper-glycaemia as having type 1 diabetes [4], we risk includingin this generic categorisation of gestational diabetes theundetected monogenic forms that are often underdiagnosed[5, 6]. For example, in those patients belonging to thelowest glucose categories of HAPO those with MODY-2obtain no benefit from the treatment of their hyperglycae-mia. In the 11 patients with MODY-2 that we followed up

Not every child with diabetes needs insulin.

Insulin is miraculous,1 and, as happens with most good and effective drugs, it has tended to be used whenever doctors meet a child with high blood sugar values. This presupposes that hyperglycaemia in children always means type 1 diabetes, overlooking the existence of many …

Lower limbs edema by insulin glargine treatment: two other cases in pediatrics

Marta, 13 years aged, suffered from type 1 diabetes from the age of 9 years. She was admitted in our clinic for a progressive appearance of edema in both legs (Fig. 1). The edema was located in the pretibial and ankle region, bilaterally, mainly on the left; the skin was normal, not hot and not erythematous. Femoral and popliteal pulses were normal. Left and right ankle diameters were, respectively, 29.5 and 28 cm. The family history was negative for diseases associated with edema. The metabolic control has always been good (yearly mean HbA1c 7.5 % 58 mmol/mol). She was on multi-daily injections (MDI) therapy, and the need of insulin was 0.7 U/kg/day. Up to 3 months before the occurrence of edema, she had been treated with human insulin (Humulin R and Humulin I ). During the adolescence, as the lifestyle was changing, we decided to start basal bolus therapy. Boluses of fast analogues were administered on the arms and in abdomen, while insulin glargine was administered exclusively on both thighs, alternating the right and the left thigh every day. All the most common causes of edema have been ruled out with specific investigations: Color Doppler ultrasound of the arteries and veins of the limbs excluded vascular diseases; ECG and transthoracic echocardiography excluded cardiac failure. Blood count, C-reactive protein (CRP) and VES, serum electrolytes, protein electrophoresis and the liver, thyroid and kidney function tests were within the normal range. Moreover, we rejected other causes of edema due to infection diseases. To exclude obstruction of the inferior vena cava or the thoracic duct, the patient underwent, respectively, abdominal ultrasound and chest X-rays, which did not show pathognomonic features. In addition, we also ruled out the Turner syndrome with the high-definition karyotype study. Medical history, clinical examination and laboratory findings excluded the involvement of systemic diseases. No other medicaments except for insulin had been assumed so, suspecting that the cause of the edema could have been the local mechanism of absorption of basal insulin, we replaced insulin glargine with rapid and intermediate human insulin. After 1-month edema was still present, but significantly reduced (diameter 25 cm in both legs). The complete resolution occurred after 3 months from the suspension of glargine even if a slight worsening of metabolic control (HbA1c 8.5 % 69 mmol/mol) was observed. Managed by Antonio Secchi.

Not Autoimmune Diabetes Mellitus in Paediatrics

The rooted conviction according to which the childhood diabetes should only be an autoimmune diabetes is gradually disappearing, thanks to the discovery of not autoimmune paediatric diabetes.

Association between congenital hypopituitarism and agenesis of the internal carotid artery

5 ES P E Poster presented at: To describe a very rare case charactherised by the association between the congenytal hypopithuitarism and the abnormalities of the ICA. The abnormalities of the Internal Carotid Artery (ICA) are very rare phenomena and the agenesis, in particular , has an estimated incidence of 0.01% among the general population. It could be also associated with another rare condition: the congenital hypopituitarism.