J Aman

Increased Prevalence of Upper Gastrointestinal Symptoms in Long‐term Type 1 Diabetes Mellitus

Using a validated postal questionnaire, we investigated the frequency of 24 gastrointestinal symptoms during the previous 3 months in a cohort of 110 young adult patients (54 males and 56 females, mean age 37.2u2009±u20094.7 years) with onset of Type 1 diabetes mellitus at <16 years of age. They were compared with 210 age‐ and sex‐matched controls (104 males and 106 females). The main difference in the frequency of various symptoms between the two groups was a significant increase among the diabetic patients in upper gastrointestinal symptoms, such as loss of appetite (17.8%u2009vsu20093.6%, pu2009<u20090.001), early satiety (26.8%u2009vsu20096.1%, pu2009<u20090.001), nausea (22.7%u2009vsu20099.1%, pu2009<u20090.01) and vomiting (12.2%u2009vsu20093.0%, pu2009<u20090.01). No difference was noted in the frequency of symptoms from the lower gastrointestinal tract, apart from a significant increase in the feeling of incomplete defaecation (28.6%u2009vsu200917.0%, pu2009<u20090.04) in the diabetic patients. Patients with levels of haemoglobin A1c in the highest quartile had significantly more gastrointestinal symptoms than other diabetic patients. Further, the prevalence of symptoms was higher in females than in males. In conclusion, long‐term Type 1 diabetes is accompanied by a markedly increased frequency of upper gastrointestinal symptoms, mainly in females and patients with poor metabolic control.

Hypoglycaemia Increases the Gastric Emptying Rate in Patients with Type 1 Diabetes Mellitus

The effect of insulin‐induced hypoglycaemia on the gastric emptying rate was studied in eight patients with Type 1 diabetes mellitus of short duration (1–5 years). Gastric emptying was studied using a scintigraphic technique. All patients were studied twice, both during euglycaemia and insulin‐induced hypoglycaemia. The blood glucose concentration was adjusted with an insulin‐glucose clamp technique. All patients were examined in a standardized way, undergoing the first examination during euglycaemia, with a blood glucose concentration of 4–7 mmol ***I−1, and the second during hypoglycaemia, with a mean blood glucose concentration of 1.9 ± 0.3 mmol ***I−1 at the time of starting the gastric emptying study. During hypoglycaemia both the liquid and the solid gastric emptying rates were significantly increased compared to the rate during euglycaemia. The time to empty 50% of the radioactivity from the stomach for liquid was 48.5 ± 9.8 min during euglycaemia, compared to 27.6 ± 20.2 min during hypoglycaemia, p < 0.001. The time to empty 50% of the radioactivity from the stomach for solid food was 48.7 ± 10.3 min and 23.2 ± 15.9 min, respectively, p < 0.001. In conclusion, it appears that insulin‐induced hypoglycaemia increases the gastric emptying rate in patients with Type 1 diabetes mellitus.

Prevalence of coeliac disease in Turner syndrome.

This study was undertaken to investigate the prevalence of coeliac disease in children and adolescents with Turner syndrome. Eighty‐seven children and adolescents with Turner syndrome were screened for IgA‐antiendomysium antibodies (EMA) and IgA‐antigliadin antibodies (AGA), 5% (4/87) being found to be EMA‐positive, and 15% (13/87) to have AGA levels above normal. Of the 10 patients who were either AGA‐ or EMA‐positive and further investigated with intestinal biopsy, four manifested villous atrophy (i.e. all three of the EMA‐positive patients, but only one of the seven AGA‐positive patients). The results suggest EMA‐positivity to be a good immunological marker for use in screening for coeliac disease, and such screening to be justified in patients with Turner syndrome. □Coeliac disease, IgA‐antiendomysium antibodies, IgA‐antigliadin antibodies, Turner syndrome

Physical activity and energy intake in adolescent girls with Type 1 diabetes

Aimsu2003 Girls with Type 1 diabetes often gain excessive weight during puberty. The aims of this study were to compare objectively assessed physical activity and energy intake in girls with Type 1 diabetes with those in healthy age‐matched controls.

Body composition in adolescent girls with type 1 diabetes.

Aimsu2003 To compare body composition in adolescent girls with Type 1 diabetes with healthy controls.

Final height after combined growth hormone and GnRH analogue treatment in adopted girls with early puberty

Background: Girls adopted from developing countries often have early or precocious puberty, requiring treatment with gonadotrophin‐releasing hormone (GnRH) analogues. During such treatment, decreased growth velocity is frequent. Aim: To study whether the addition of growth hormone (GH) to GnRH analogue treatment improves final height in girls with early or precocious puberty. Methods: Forty‐six girls with early or precocious puberty (age ± 9.5y) adopted from developing countries were randomized for treatment for 2–4 y with GnRH analogue, or with a combination of GH and GnRH analogue. Results: During treatment, the mean growth velocity in the GH/GnRH analogue group was significantly higher compared to the control group. Combined GH/GnRH analogue treatment resulted in a higher final height: 158.9 cm compared to 155.8 cm in the GnRH analogue‐treated group. Three out of 24 girls (13%) in the combined group and nine of the 22 girls (41%) treated with GnRH analogue alone attained a final height below –2 standard deviation scores (SDS).

Effect of growth hormone (GH) during puberty in GH-deficient children : preliminary results from an ongoing randomized trial with different dose regimens

Albertsson Wikland K, Alm F, Aronsson S, Gustafsson J, Hagenas L, Hager A, Ivarsson S, Kristrom B, Marcus C, Moe11 C, Nilsson KO, RitzCn M, Tuvemo T, Westgren U, Westphal 0, Aman J. Effect of growth hormone (GH) during puberty in GH‐deficient children: preliminary results from an ongoing randomized trial with different dose regimens. Acta Pxdiatr 1999; Suppl 428:80‐4. Stockholm. ISSN 0803‐5326

Social Consequences of Insulin-dependent Diabetes Mellitus are Limited: A Population-based Comparison of Young Adult Patients vs Healthy Controls

In a population‐based study, the social situation of 91 young adult patients with Type 1 diabetes mellitus (IDDM) since childhood was compared to that of an age‐ and sex‐matched group of 189 healthy persons. Their mean age was 37.2 years, duration of diabetes 28.7 years and severe complications were present in 13 of the 91 patients. A nearly 10‐fold increased mortality rate was found in diabetic patients, mainly due to diabetic nephropathy and trauma, including suicide. The employment rate was lower in diabetic patients (71u2009% vs 85u2009%, pu2009<u20090.05); the need for welfare benefits was greater (15u2009% vs 3u2009%, pu2009<u20090.01). These differences were mainly the consequence of diabetic late complications. Education, housing conditions, life style, civil state, alcohol and smoking habits were similar in both groups. Confidence in the future was slightly less in diabetic patients (pu2009<u20090.05). In conclusion, besides an increased mortality rate, the present study has shown no serious social consequences in adult Type 1 diabetic patients without severe late complications, as compared to matched controls. Our results indicate that IDDM affects social life only to a limited extent, in the absence of severe vascular complications.

SUMO4 M55V polymorphism affects susceptibility to type I diabetes in HLA DR3- and DR4-positive Swedish patients

SUMO4 M55V, located in IDDM5, has been a focus for debate because of its association to type I diabetes (TIDM) in Asians but not in Caucasians. The current study aims to test the significance of M55V association to TIDM in a large cohort of Swedish Caucasians, and to test whether M55V is associated in those carrying human leukocyte antigen (HLA) class II molecules. A total of 673 TIDM patients and 535 age- and sex-matched healthy controls were included in the study. PCR–RFLP was performed to identify the genotype and allele variations. Our data suggest that SUMO4 M55V is not associated with susceptibility to TIDM by itself. When we stratified our patients and controls based on heterozygosity for HLA-DR3/DR4 and SUMO4 genotypes, we found that presence of SUMO4 GG increased further the relative risk conferred by HLA-DR3/DR4 to TIDM, whereas SUMO4 AA decreased the risk. From the current study, we conclude that SUMO4 M55V is associated with TIDM in association with high-risk HLA-DR3 and DR4, but not by itself.

Body composition in young female adults with type 1 diabetes mellitus. A prospective case-control study

Aimsu2003 Overweight is common during late puberty in female patients with Type 1 diabetes. The aim of this study was to examine the change in body composition from late puberty to early adulthood in such female patients in comparison with age‐matched control subjects.