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Unlabelled: AIM : Current studies show that diabetic patients are at greater risk of developing psychiatric disorders than general population. The aim of this study was to evaluate the frequency of depressive symptoms in school-aged children with type 1 diabetes (T1D)., Methods: The study involved 477 children with T1D, with mean age of 13.1 ± 2.7 years and mean diabetes duration of 5.0 ± 3.5 years, treated for at least one year. Patients were asked to fill out the Polish version of the Children's Depression Inventory (CDI) and Quality of Life Questionnaire. Demographic data such as height, weight, diabetes duration, daily insulin dose (TDD) was also collected., Results: 17% (81/477) of all participants presented depressive symptoms (CDI . 13 scores), 20.9% of them were children . 12 years of age, and 8.1% of them were children at the age of . 12 years, p = 0.0005. Participants with CDI scores of 13 or higher were older (p = 0.002), had higher BMI (p = 0.029), TDD (p = 0.026) and lower quality of life (p < 0.0001) in comparison with children who scored < 13. There was no difference in glycated hemoglobin (HbA1c) values between groups with and without depressive symptoms (p = 0.249). However, there is a correlation between HbA1c value and CDI score (r = 0.16; p = 0.0002)., Conclusions: Depressive symptoms were observed in 1 out of 12 T1D children in a primary school and in 1 out of 5 teenagers. Depressive symptoms may affect metabolic control and quality of life. Therefore, early detection and treatment of depressive symptoms in T1D school children is needed.

Unlabelled: Diabetes is a common and severe complication of cystic fibrosis. If unrecognized, the condition not only causes deterioration of pulmonary function and failure to gain weight, but also a six-fold increase in mortality., Aim: 1. To evaluate the course of abnormal glucose tolerance and cystic fibrosis-related diabetes (CFRD), as well as the effects of treating these conditions in children with cystic fibrosis. 2. To analyze the association between the classes of mutations in both alleles of the CFTR gene and glucose intolerance., Materials and Methods: analysis was undertaken of the clinical records of 12 children (from the years 2002 to 2014), who were under the care of the Diabetes Outpatient Clinic at the Medical University of Warsaw and the Cystic Fibrosis Centre of the Institute of Mother and Child in Warsaw. The patients were divided into groups based on glucose tolerance categories in the Oral Glucose Tolerance Test (impaired glucose tolerance - IGT, cystic fibrosis related diabetes without fasting hyperglycemia - CFRD FH⁻ or with fasting hyperglycemia - CFRD FH⁺). The mean age of the children who were referred to the Diabetes Outpatient Clinic was 12.09 ± 3.57 years and the mean HbA1c at the baseline versus the end of the follow up was 6.16 ± 1,77% versus 6.03 ± 1.05%, respectively. We used the continuous glucose monitoring system (CGMS) for the diagnostics of 4 patients. The mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene were investigated in all the patients. All the children had mutations in at least one allele of the CFTR gene belonging to class I or II. Six (6/12) patients were homozygous, and 3 (3/12) patients heterozygous for the Phe508del (former F508del) mutation. Three children had other mutations (1717-1G>A/2183AA-G, R553X/3380delGAAG, G542X/2143delT)., Results: In our study group we recognized impaired glucose tolerance (IGT) in 7 (7/12) patients and cystic fibrosis-related diabetes (CFRD) in 5 (5/12) patients; there were 4 patients with CFRD FH⁺ and 1 patient with CFRD FH⁻. During follow up we observed IGT deterioration of glucose tolerance towards CFRD FH⁻ in 4(4/7) patients. Eight (8/12) patients were on functional insulin therapy, five of them (5/8) used insulin pumps. The remaining patients (4 individuals - 4/12), who were in good condition and on a high-glycemic index product restricted diet, did not require insulin. In the group treated with insulin we observed improvement in BMI z-scores (from-1.14 to -0.70)., Conclusions: Glucose tolerance in children with cystic fibrosis deteriorates with age. Patients in a good condition and with good compliance to a low-glycemic index product diet, start insulin therapy later. Patients with a severe course of cystic fibrosis and diabetes require immediate insulin implementation. Insulin treatment improves their nutritional status. A continuous glucose monitoring system is a useful diagnostic tool which can be taken into account in therapeutic decisions. Prospective studies on the pediatric population with cystic fibrosis are needed in Poland for a better analysis of the associations between abnormal glucose tolerance, the class of mutation in the CFTR gene and the impact of glucose intolerance treatment on the clinical status of the patients.

Background: Hypoglycemia is an acute disturbance of energy, especially impacting the central nervous system, but direct influence on peripheral nervous function is not detected. The aim of the study was to establish the influence of hypoglycemic moderate and severe episodes on the function of peripheral nerves, hearing and visual pathway., Material and Methods: 97 children with type 1 diabetes (mean age 15.4+/-2.16 years, mean duration of diabetes 8.11+/-2.9 years, mean HbA1c 8,58+/-1.06%), at least 10 years old and with at least 3 years duration of diabetes, were included to study. Nerve conduction studies, visual (VEP) and auditory (ABR) evoked potentials were performed with standard surface stimulating and recording techniques. Moderate hypoglycemic episodes were defined as events of low glycemia requiring help of another person but without loss of consciousness and/or convulsions but recurrent frequently in at least one year. Severe hypoglycemia was defined as events with loss of consciousness and/or convulsions. Univariate ANOVA tests of significance or H Kruskal-Wallis test were used, depending on normality of distribution., Results: The subgroups with a history of hypoglycemic episodes had significant delay in all conduction parameters in the sural nerve (amplitude p<0.05, sensory latency p<0.05, and velocity p<0.005) and in motor potential amplitude of tibial nerve (p<0.005). In ABR wave III latency and interval I-III in subgroups with episodes of hypoglycemia (p<0,05) were significantly prolonged. In analyses of VEP parameters no differences were detected., Conclusions: The study showed influence of hypoglycemic episodes on function of all sural nerve parameters and tibial motor amplitude, and in ABR on wave III and interval I-III. Frequent moderate hypoglycemic episodes were strong risk factors for damage of the peripheral and central nervous systems, comparable with impact of several severe hypoglycemias.

The HLA complex, located on the short arm of chromosome 6, is the strongest genetic marker for type 1 diabetes (T1DM). In previous study we demonstrated association between genes HLA-DRB1 and HLA-DQB1 and T1DM in the Polish population. There is a strong-independent association of alleles HLA-DRB1*0401 and DQB1*302, despite population linkage disequilibrium among alleles of these genes. The aim of the current study was to verify a hypothesis that some alleles or haplotypes of HLA-DRB1, DQA1 and DQB1 genes increase the risk for familiar aggregation of T1DM. We analysed 507 patients with IDDM derived from 80 multiplex and 325 patients from simplex families. PCR and hybridisation with SSO probes performed HLA typing for DRB1, DQA1 and DQB1 alleles. Genetic analysis demonstrated strong association of allele HLA-DQB1*0302 with T1DM in the Polish population in families with single (DM1) and more numerous cases (DM2) cases, compared with healthy cases (n=103). The HLA-DQB1*302 allele frequencies were 27.8% vs 8.7%; Pc<10(-5); OR(95%CI)=4,03(3.80-4.25) and 16.3% vs 8.7%; Pc<0.04; OR(95%CI)=2.04(1.79-2.89), respectively. The presence of allele HLA-DQB1*0602 has a strong protective effect from T1DM in both studied groups (1.46% vs. 13.6%; Pc<10(-5); OR(95%CI)=0.09(-0.25-0.44) and 0.98% vs. 13.6%; Pc<10(-5); OR(95%CI)=0.06(-0.46-0.58), respectively. Interestingly, HLA-DRB1*04 allele more often co-segregated with DM2 families as comparing the DM1 group (31.0% vs. 15.8%, respectively; Pc<10(-5)). However in both cases differences remain significant as compared to controls: Pc<10(-5), OR (95%CI)=3.52(3.33-3.70) and Pc<10(-5) OR(95%CI)=6.17(5.97-6.37), for DM1 and DM2 respectively. Subtyping of HLA-DRB1*04 alleles demonstrated that the strongest predisposing effect has been identified with DRB1*0401. Moreover, difference in frequencies of the protective allele HLA-DQB1*0301 among DM1 and DM2 group was revealed (8.8% vs. 13.7%, respectively; Pc<10(-5)) and the protective effect of this allele remained only significant in DM1 group: 8.8% vs. 19.9%; Pc<10(-5); OR(95%CI)=0.39(0.19-0.58). The results suggest that it is likely that familial aggregation of T1DM is associated with lower frequency of protective alleles of HLA-DQB1 gene.

Unlabelled: Intensive insulin therapy is a method of choice in the management of patients with type 1 diabetes. Its administration in the youngest children is limited by little or no acceptance of multiple injections and a typical fear of needles and syringes. In recent years more and more frequently the method of multiple daily injections (MDI) of insulin is being replaced by the method of continuous subcutaneous insulin infusion (CSII) even in the youngest children., Objective: Evaluation of the safety and efficacy of CSII method in children at prepubertal age., Material and Methods: There were 61 children under 10 years of age with type 1 diabetes recruited for the study (33 boys, 28 girls). CSII method was implemented for the period of minimum 6 months. In the group of 21 children CSII method was the first method of their therapy (it was administered at the time of diagnosis). Mean duration of diabetes was 3.0 years +/-1.87 year, mean age at diagnosis was 3.82+/-2.19 years and mean duration of CSII treatment was 1.4 +/-0.75 year. The average HbA1c at the baseline for all children was 8.7+/-1.4%., Results: In the group where CSII therapy was implemented as the first method of management, mean duration of treatment was 1.5 years, mean HbA1c decreased after first 3 months from 9.6+/-1.68% to 7.22+/-0.99% (p<0.05). After 12 and 24 months the value further decreased to 7.01+/-0.57%. In the group that was earlier treated with MDI method (n=40), mean value of HbA1c decreased after 3 months from 8.27+/-1.4% to 7.6 +/-0.86% (p<0.05), after 12 months it further decreased to 7.37+/-0.86%, after 24 months its mean value was 7.53%. The number of patients with HbA1c >8% decreased from 58.4% to 10%. Adverse events were observed only in the group that was earlier treated with the MDI method. There were 3 incidences of severe hypoglycaemia, 2 incidences of diabetic ketoacidosis, 2 incidences of infection at the needle site (in one case the surgical attention was necessary). After two years of the trial there was a statistically significant difference in the mean value of HbA1c between children that used CSII method from the moment of their diagnosis (HbA1c=7.01%) and those who were earlier treated with MDI method (HbA1c=7.53 +/-0.73%). In both groups the daily insulin requirement was similar (CSII method 0.69+/-0.2 unit/kg/day, MDI method 0.75+/-0.19 unit/kg/day)., Conclusions: The method of continuous subcutaneous insulin infusion (CSII) provides good and sustained metabolic control in the youngest children with type 1 diabetes. Administering of that method from the very beginning of the diabetes treatment may decrease the risk of acute complications.