摘要:

AbstractJapn, Norway, Israel and the United States have studied have studied the epidemiology of IDDM in children by a similar method of data collection. Afterwards, the data were compared. Available data demonstrated that children in Norway, the United States and Israel were almost 20,15 and 5 times more likely respectively to develop IDDM than children in Japan. Although there was a samll difference in sex ratio, incidence in the smaller age group, and incidence of slowly progressing type IDDM between Japan and the other three countries, the other descriptive epidemiology of IDDM was quite similar, despite the large difference in the incidence and prevalence of IDDM.Therefore, it seems that the difference in the incidence would not be primarily environmental and could be related to the number of individuals susceptible to diabetes. It was hypothesized that the difference in incidence may be linked to the difference in prevalence of HLA type among the children in those four countries. However, it cannot be fully explained nby HLA difference. Other genetic markers associated with the developing IDDM musrt be evaluated.

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01825.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

AbstractThe prevalence of diabetes mellitus in the age group5–16 years, determined from 13,152 subjects residing in Kwangju, Chonnam Provice was 0.099 per cent or 98.9/100,000 in a study performed from December, 1976 to June 1977. On the other hand an epidemiologic study carried out on 254,835 subjects in the age groups14–15 and17–18 years from March 1981 to March 1982 in Seoul City revealed on overall prevalence of 7.85/100,000. In a retrospective study, 88.0/100,000 or out of a total of 10,228 pediatric inpatients were confirmed casesw of insulin‐dependent diabetes mellitus, during 7 years and 2 months (from january 1974 to March 1981) at a general hospital located in Jeonju City. The wide range in the prevalence and incidence figures of diabetes mellitus in Korean children probably resulted from lack of uniformity in epidemiological methodology and the degree of ascertainment.The adge distribution at onset of diabetes mellitus showed a gradual incdrease and peak incidences at 3,8 and 12 years of age. The4 sex difference in incidence was not obvious, though girls slightly outnumbered boys. Seasonal variation at onset of diabetes mellitus showed the highest frequency of new cases in winter and spring

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01826.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

AbstractNinety‐four Japanese patients with insulin‐dependent diabetes mellitus (IDDM) and 388 healthy randomly selected Japanese were HLA typed. Significantly increased frequencies of Bw54, Cwl, DR4, B17 (Bw58), DR3 and DRw9 were observed. Simultaneously, the frequencies of Bw52 and DR2 in the patients were found to be significantly low as compared with those in helathy Japanese controls. It was suggested that one of the susceptibility genes to IDDM, which is associated with B8, DR3 haplotypes in Caucasoids, might be associated with B17 (Bw58), DR3 haplotypes in Japanese and in Chinese. Another susceptibility gene to IDDM associated with DR4 in Caucasoids might be associated with both DR4 and DRw9 in Japanese. A very rare variant of properdin factor B allotypes (BF*FT or BF*F075) was shown to be associated significantly with Japanese IDDM and with Bw52, DRw9 haploty

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01827.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

AbstractDifferent environmental factors such as virus infections or toxic agents may play a role in the etiology of insulin‐dependent diabetes mellitus, but it is evident that hereditary factors also are important. These two basic components can be unified into one common etiological mechanism, the immunological. Several facts support this hypothesis, which is reviewed in this paper. The theory now seems strong enough to justify trials to interfere with the immune response at the onset of diabetes in an effort to change the gradual loss of beta cell functio

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01828.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

AbstractIn this paper some findings concerning autoimmunity have been studied in young Japanese patients with diabetes. Patients diagnosed before 30 years old were classified carefully into new categories recommended by WHO in 1980: insulin‐dependent (IDDM), non‐insulin‐dependent (NIDDM) and other types of diabetes. HLA antigen types, islet cell antibodies (ICA) and islet cell surface antibodies (ICSA) were checked in the sera. HLA‐Bw54 and ‐DR4 were found in a significantly high percentage of IDDM patients, especially in those with Insulin‐Dependent Diabetes Mellitus with Special Reference to acute onset of the disease. Positivity of ICA was remarkably high in IDDM Viral Infections patients within one year after the onset, and then decreased very rapidly. ICSA had the same tendency, but the rate of decrease of positivity seemed slower than that of ICAApparent autoimmune diseases were rare among our patients, and persistent positivity of ICA was found only in a few cases. At this time we have notenough evidence concerning autoimmunity as a major ca

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01829.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

AbstractThe etiology of IDDM remains incompletely understood, with genetic predisposition, autoimmune destruction of the beta cells and viral infections interacting to produce disease. It appear that the underlying genetic defect is an alteration in cellular and/or humorally‐mediated immunological responsiveness. There are at least two (and probably more) genetically determined defects identified by HLA B‐8 (DR3) and B‐ 15 (DR4). A number of viruses have been implicated in IDDM causation, including Coxsackie, mumps, rubella, Epstein‐Barr, hepatitis and influenza viruses, but in only a few cases is viral etiology fully documented. Viral infections may trigger autoimmunity. Alterations in immunoglobulin concentration, particularly IgA deficiency, have been reported by several investigators. Collaborative prospective studies of individuals at high risk for the development of IDDM (siblings with HLA identical to the index case) are essential in the future study of IDDM e

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01830.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

AbstractThe most important aspects of the diet for diabetic children are:1. The timing of the meals. For the main meals, the time of the school meal and of the family dinner should be followed. Smaller meals will be necessary in between, with a total of about 6 meals daily.2. The size of the meals and total amount of energy must be adjusted to the need of the children, and to the insulin type, dose and time of injection. A reasonable variation in energy intake is supported. Extra intake related to exercise will not only be taken on the days of exercise but also on the day after. This is supported by our own investigation. The appetite of the children should also be used in this regulation.Newer studies are summarized about the change in absorbability of starch by heating and cooking, and the effect on blood glucose of potatoes, rice and bread, different fruits and sorbitol. A long‐term study of different fibres in bread is presented. A decrease both in mean bloodglucose and HbAl was found to be induced both by bran and by guar. The practical accomplishment of the diet is a larger problem than the theoretical one

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01831.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

AbstractExercise has a beneficial metabolic effect in diabetic children and adolescents only when they are in good metabolic control with optimal insulin administration. In insulin‐deficient patients exercise may seriously aggravate the diabetic state. The physical working capacity of young diabetics is often lower than that of non‐diabetic children. Their physical fitness can be improved by regular training programs.Exercise‐induced hypoglycemia is due to suppression of hepatic glucose output in response to an abnormal insulinemia. It can as a rule be prevented by a liberal carbohydrate intake before and during the exercise period. On a long‐term basis regular physical activity improves diabetic control in young diabetics, increases glucose tolerance and normalizes blood lipids. Regular physical activity increases diabetics' sense of well‐being, gives self‐confidence and makes feelings of being handicapped disappear. Exercise may contribute topreventing the development of long‐term diabetic microangiopathy andneuropathy. However, when such complications once have become manifest, the value of exercise is less obvious. It may even be harmful and should therefore, in such situations, be undertaken with great caution and after careful medic

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01832.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

AbstractHome blood glucose monitoring (HBGM) is now widely accepted as an important component of care of the diabetic child. It is helpful in maintaining satisfactory control, in preventing hypoglycaemia and in managing diabetes during intercurrent illness.There are problems which may lead to confusing monitoring results. These include technical problems as a result of incorrect performance of the test or reflectance meter faults. HBGM is only effective in assisting in the control when it is used in conjunction with an adequate and on‐going education programme. When this is not provided HBGM may be of little value.Problems of patient acceptance arise during adolescence. A survey conducted on 202 teenaged diabetics indicated that half found HBGM painful at least at times, and half occasionally falsified their results.HBGM may not be a reliable means of assessing overall control. Correlation with other parameters of control is often poo

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01833.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

AbstractSubcutaneous insulin infusion (SCII) has been shown in adults, but not yet in childhood IDDM, to successfully induce long‐term improvement of glycemic control&substrate&counterregulatory hormonal abnormalities. We studied 17 adolescents aged 15‐ 19 yrs during conventional therapy (A), after 6 wks of intensive monitoring with1–2 insulin injections (B), after1–2 wks (C),1–2 (D),4–5, (E),&6–8 (F) mos,&1–2 yrs of SCII. One girl was unable to tolerate the pump for more than 1 wk. Three boys discontinued SCII after 2&3 mos because of interference with sports&inability to adapt,&two girls because of excessive weight gain&return to poor control. A poorly compliant boy died in his sleep after 10 mos of SCII. Four others continued SCII for at least 1 yr, at which time two changed to multiple dose injection regimens.The major decrease in whole blood glycosylated hemoglobin (GHb) occurred from A (12.3 ± 1.7%, SD)to B (10.8 ± O.8%, P<01). A further, decrease at C (10.1 ± 1.2%) was less significant (P<0.05). Thereafter, there was a gradual increase to 11.2 ± 1.2% (P=0.02) at D, 11.9 ± 1.6% at E, 11.9 ± 1.7% at F,&11.5 ± 0.9% at G. The stable GHb followed a similar pattern with a significant decrease from A to B of 11.8 ± 1.6% to 10.2 ± 0.7% (P<0.05), a non‐significant decrease at C to 9.5 ± 0.9% at G. The stable GHb followed a similar pattern with a significant decrease from A to B of 11.8± 1.6% to 10.2 ± 0.7% (P<0.05), a non‐significant decrease at C to 9.5 ± 1.1%&9.6% 1.0% at D. At E, F,&G, this rose to 11.9%, 10.3%&10.7%, respectively,&the means were not different from our clinic population. Mean blood sugars during 24 hr sampling showed similar patterns. 24 hr measurement of glucagon, growth hormone, cortisol, FFA,&ketones significantly decreased during C.&D. These were occasionally below age‐matched normals. During SCII, there was increased incidence of ketoacidosis&some initial problems with infection. Many patients were unable to comply with the rigorous monitoring demands to make SCII safe&effective. Our data do not support the widespread use of SCII in adolescents, unles

ISSN:1328-8067    

DOI:10.1111/j.1442-200X.1984.tb01834.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY