Andrea Lukács

Reduced physical fitness in children and adolescents with type 1 diabetes

To evaluate motor performance and cardiorespiratory function in youths with type 1 diabetes in comparison with age‐matched control groups and to analyze the influence of physical activity level, anthropometric and physical fitness parameters on long‐term metabolic control.

Factors influencing the diabetes-specific health-related quality of life in children and adolescents with type 1 diabetes mellitus

This study aimed to investigate the association of the anthropometric, clinical variables and maximal oxygen uptake (Vo 2max) with diabetes-specific health-related quality of life (HRQoL) in youths with type 1 diabetes mellitus (T1DM) and to find the predictors of HRQoL and blood glucose control. A total of 239 youths with diabetes (124 boys and 115 girls) were recruited from diabetes-based summer camps. HRQoL assessment was carried out with the Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (Information Resources Centre, Mapi Research Trust, France); Vo 2max was evaluated by conducting the 20-m shuttle run test. Higher Vo 2max and the insulin pump therapy were significant predictors of the HRQoL in the multiple regression analysis; other clinical and anthropometric variables had no effect. The better blood glucose control was explained only by the higher Vo 2max. The good cardiorespiratory fitness (expressed by Vo 2max) has clinical and QoL benefits for paediatric patients with T1DM.

BENEFITS OF CONTINUOUS SUBCUTANEOUS INSULIN INFUSION ON QUALITY OF LIFE

PURPOSE The aim of this study was to compare the general health-related quality of life (HRQoL), the metabolic control (HbA1c), the anthropometric measurement, and the cardiorespiratory fitness (expressed by VO2max) in youths with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) to those receiving multiple daily injections (MDI). We looked for factors influencing the HRQoL and metabolic control. METHODS A total of 239 patients treated with CSII (51 girls and 53 boys) or MDI (64 girls and 71 boys) between ages 8 and 18 years were assessed with the Pediatric Quality of Life Inventory, Generic Core Scales, and Diabetes Module. VO2max was evaluated using the 20-meter shuttle run test. RESULTS CSII group had significantly better HRQoL according to both child self-report and parent proxy-report. Youths with CSII reported better physical, emotional, and school-related functioning, and had less diabetes-related fear and symptoms than the MDI group. There were no significant differences in body mass index z-scores, insulin doses, HbA1c, and VO2max between the groups. HRQoL was predicted by the CSII therapy (β = -0.220; p = .000) and the VO2max (β = 0.386; p = .000), other clinical and anthropometric parameters had no effect; the HbA1c was predicted only by VO2max (β = -0.353; p = .000). CONCLUSIONS Diabetic youths treated with CSII therapy have better HRQoL than those treated with MDI. There are no differences between the investigated groups in anthropometric data, glycated hemoglobin, and physical fitness. Moreover, good physical fitness has an important role in achieving better metabolic control and HRQoL, which underlines the importance of regular aerobic exercise in the treatment and care of type 1 diabetes in childhood.

Effect of aerobic and anaerobic exercises on glycemic control in type 1 diabetic youths

AIM To evaluate the long-term effect of aerobic and/or anaerobic exercise on glycemic control in youths with type 1 diabetes. METHODS Literature review was performed in spring and summer 2014 using PubMed/MEDLINE, Google Scholar, Scopus, and ScienceDirect with the following terms: aerobic, anaerobic, high-intensity, resistance, exercise/training, combined with glycemic/metabolic control, glycated haemoglobin A1c (HbA1c) and type 1 diabetes. Only peer-reviewed articles in English were included published in the last 15 years. It was selected from 1999 to 2014. Glycemic control was measured with HbA1c. Studies with an intervention lasting at least 12 wk were included if the HbA1c was measured before and after the intervention. RESULTS A total of nine articles were found, and they were published between the years of 2002-2011. The sample size was 401 diabetic youths (166 males and 235 females) with an age range of 10-19 years except one study, in which the age range was 13-30 years. Study participants were from Australia, Tunisia, Lithuania, Taiwan, Turkey, Brazilia, Belgium, Egypt and France. Four studies were aerobic-based, four were combined aerobic and anaerobic programs, and one compared aerobic exercise to anaerobic one. Available studies had insufficient evidence that any type of exercise or combined training would clearly improve the glycemic control in type 1 diabetic youth. Only three (two aerobic-based and one combined) studies could provide a significant positive change in glycemic control. CONCLUSION The regular physical exercise has several other valuable physiological and health benefits that justify the inclusion of exercise in pediatric diabetes treatment and care.

Health-Related Quality of Life of Youths with Type 1 Diabetes: Reliability and Validity of the Hungarian Version of the PedsQL 3.0 Diabetes Module

Type 1 diabetes mellitus (T1DM) is one of the chronic diseases that are life threatening without proper clinical care and self-management. The incidence of T1DM is on the rise worldwide approximately by 3% per year, and this draws the attention to the seriousness and public health impact of the disease [1]. It is predicted that the number of cases will double within ten years in young children [2]. The health-related quality of life (HRQoL) measurements that focus on the patients’ own perception of disease provide additional information for the physicians and health care experts [3]. In the routine visits mostly the clinical parameters are measured, such as the body composition, metabolic control, complications, and hardly any attention is paid to the quality of life assessment. The children’s positive attitude towards life can help to maintain the good metabolic control which contributes to the prevention of long-term complications, such as retinopathy, nephropathy and neuropathy. In order to evaluate the HRQoL of paediatric patients with T1DM in a specific country a culturally adapted questionnaire must be used.

Condom use in the context of romantic relationships: A study among university students from 12 universities in four Central and Eastern European countries.

Abstract Objective To investigate the extent to which romantic relationship status influences condom use during vaginal, oral and anal sex among students from 12 universities in the Czech Republic, Hungary, Lithuania and Slovakia. Methods A pilot study of 880 students from the ongoing Student Life Cohort in Europe (SLiCE) study. Multiple logistic regression was conducted to establish the effect of romantic relationship status on condom use during vaginal, anal and oral sex in the previous 30 days, while adjusting for participants’ age, gender, use of alcohol and other drugs prior to sex, condom-carrying practices and number of sexual partners. Results Of the total sample, 73.7% were currently engaged in a romantic relationship and their condom use during vaginal sex (p < 0.001), oral sex (p < 0.001) and anal sex (p = 0.003) was significantly associated with their romantic relationship status. Students who were not in a romantic relationship had the lowest odds of condom use. Use of alcohol or other drugs before sex was detrimental to condom use (odds ratio 0.5; p = 0.045) during vaginal sex. Condom use during vaginal and oral sex was lower among older students. Conclusion The need to target university students with more pragmatic sexual health risk reduction interventions that accommodate the role of romantic relationships on behavioural choices is justified. Chinese Abstract 摘要 目的：在捷克、匈牙利、立陶宛和斯洛伐克12个大学的大学生中调查恋爱关系状态如何影响阴道性交、口交和肛交时避孕套的使用。 方法：来自正在进行的欧洲学生生活队列研究(SLiCE)中的880名学生进行初步研究。使用多元回归分析对近30天前恋爱关系状态对阴道性交、口交和肛交使用避孕套的影响进行研究，同时根据受试者年龄、性别、性交前饮酒或用其它药物、避孕套佩戴和性伙伴数目做校正。 结果：在所有的样本中，73.7%已处于恋爱关系中，且他们在阴道性交(p < 0.001)、口交(p = 0.001)和肛交( p =0.003)时避孕套的使用与恋爱关系状态显著相关。未处于恋爱状态的大学生使用避孕套的几率最低。在性行为之前饮酒或其它药物后对阴道性交时避孕套的使用(OR=0.5；p = 0.045)产生不利影响。年龄稍长的学生阴道性交和口交时较少使用避孕套。 结论：应当针对大学生进行更实际的性健康风险教育，以调节恋爱关系在行为选择中的作用。 关键词 避孕套使用，恋爱关系，性，大学生

Cognitive functions in type 1 and type 2 diabetes. Metaanalysis

INTRODUCTION Diabetes has been repeatedly associated with a wide variety of cognitive impairments. AIM To clarify the differences in cognitive dysfunctions between the two types of diabetes. METHOD Metaanalysis was performed using databases of Medline, PubMed and ScienceDirect (3 studies with type 1 and 6 with type 2 diabetes). RESULTS Adults with type 1 diabetes showed lower performance than control subjects in all fields. The effect size had the highest value in psychomotor activity (D = -0.69). The effect size was small for delayed verbal memory (D = -0.48), attention (D = -0.47), language (D = -0.44), visual processing (D = -0.35), immediate verbal memory (D = -0.30), working memory (D = -0.27) and executive functions (D = -0.26). Adults with type 2 diabetes showed lower performance than control subjects in all cognitive domains, except for working memory (D = +0.03). The effect size had the highest value in immediate verbal memory (D = -1.12), psychomotor activity (D = -0.82) and delayed verbal memory (D = -0.81). The effect size was moderate for general intellectual abilities (D = -0.68) and small for general memory (D = -0.37), attention (D = -0.35), language (D = -0.35), visual processing (D = -0.33) and executive functions (D = -0.33). CONCLUSION Both types of diabetes are associated with reduced performance in numerous cognitive domains.

Generic and disease-specific quality of life in adolescents with type 1 diabetes: comparison to age-matched healthy peers.

Abstract Background: This study aimed to evaluate the health-related quality of life (HRQoL) of adolescents with type 1 diabetes (T1DM) on the basis of the pediatric quality of life inventory™ (PedsQL™) generic and diabetes-specific modules, and to compare it to that of healthy peers. Methods: This retrospective case-control study involved 650 participants between ages of 13 and 19 years including 296 adolescents with T1DM from four diabetes centers and 354 healthy peers matched for age and gender from three different cities of the country. Participants completed the validated PedsQL™ for assessing the HRQoL. The analysis included an independent t-test to compare the means of the total and subscales of the PedsQL™ between boys and girls as well as between a healthy group and a group with T1DM. Gender differences in exercise, insulin therapy modalities were evaluated with the Pearson χ2-test. Results: Adolescents with T1DM have similar HRQoL in all domains when compared to their healthy counterparts. Females report worse HRQoL regardless of the presence of the disease. Insulin pump therapy facilitates better glycemic control and HRQoL. Regular exercise positively correlates with the generic HRQoL in both groups; however, it has no relationship with glycemic control. Conclusions: Optimal metabolic control and improved HRQoL are the eventual goals of diabetes management. Despite the difficulties, adolescents with diabetes can manage their disease well and live normal lives, similar to their healthy peers. Although diabetes-related problems exist, it seems that regular exercise and staying physically active, as well as promoting insulin pump therapy where it is applicable are related to favorable HRQoL.

A cross-cultural study on perceived health-related quality of life in children and adolescents with type 1 diabetes mellitus

OBJECTIVE This study investigated whether culture can affect self- and proxy-reports of perceived diabetes-specific health-related quality of life of children and adolescents with type 1 diabetes when taking into account glycemic control, gender and age. METHODS A total of 416 patients aged between 8 and 18 years--84 (Greece), 135 (Hungary) and 197 (Kuwait)--and their parents completed the Pediatric Quality of Life Inventory 3.0. Diabetes Module. RESULTS Gender and age did not have any effect on perceived diabetes-specific health-related quality of life. Significant differences were detected among countries in self- and proxy-reports of diabetes-specific health-related quality of life when controlling for glycemic control. More specifically, Greek patients with type 1 diabetes and their parents reported significantly worse disease-specific health-related quality of life than their peers from Kuwait and Hungary. Moreover, culture affected the level of agreement between self- and proxy-reports with parents from Kuwait underestimating their childrens diabetes-specific health-related quality of life. CONCLUSION The impact of culture on self- and proxy-reports of diabetes-specific health-related quality of life warrants further investigation, since it might suggest the need for differential psychosocial treatment.

Perception of High Alcohol Use of Peers Is Associated With High Personal Alcohol Use in First-Year University Students in Three Central and Eastern European Countries

ABSTRACT Objectives: The objectives of this study were to assess discrepancies between estimated peer and personal drinking behavior and to determine associations between perceptions of peer and personal drinking behavior among university students from Hungary (HU), Lithuania (LT), and the Slovak Republic (SK). Methods: 2,554 freshman university students completed an online questionnaire on the frequency of their personal alcohol use, the number of heavy drinking occasions and on their perception concerning the corresponding drinking behavior of a typical student. Associations between perceived peer and personal use were analyzed by means of logistic regression, adjusting for sex. Results: The majority of students across all countries thought their peers drink more frequently and are more often involved in heavy drinking occasions than themselves. Students who perceived the frequency of peer alcohol use to be higher were more likely to drink alcohol twice a week or more often (SR: OR = 3.81, 95% CI = 2.51–5.79; LT: OR = 3.16, 95% CI = 2.11–4.75; HU: OR = 2.10, 95% CI = 1.53–2.87) compared with students who drink alcohol monthly or less. Those who perceived the number of peer heavy drinking occasions as high were more likely to report heavy drinking weekly or more often (SR: OR = 3.16, 95% CI = 1.92–5.20; LT:OR = 3.56, 95% CI = 2.14–5.94; HU:OR = 1.41, 95% CI = 0.79–2.51) compared with students who report heavy drinking less than monthly. Conclusions/Importance: University students perceived peer alcohol use to be higher than their personal use. Given the association between perceptions and personal alcohol use, future research should investigate if targeting perceptions in the surveyed countries may have an impact on alcohol use.