Dissertations / Theses: 'Diabetes in childhood'

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Tah, Priya. "Fear of hypoglycaemia in childhood diabetes." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/95239/.

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Hypoglycaemia is an unavoidable consequence of treatment of Type 1 Diabetes Mellitus (T1DM). Symptoms are often embarrassing and distressing and can lead to the development of fear of hypoglycaemia (FoH). This fear can have a negative impact on diabetes management and can lead to further medical complications. 210 children and young people (CYP), aged 3-17 years and 190 parents from diabetes paediatric clinics across the West Midlands, UK, completed questionnaires exploring the prevalence of hypoglycaemia, FoH and links to hypoglycaemia awareness, self-care, quality of life and anxiety. Demographic information and HbA1c data were also collected. Results indicated that hypoglycaemia and severe hypoglycaemia (SH) are a problem for CYP in the UK. Hypoglycaemia Fear Survey (HFS) scores were higher in parents than in CYP (Total HFS 37.1±14.9 vs. 50.2±17.8 vs. 45.2±18.0, CYP vs. mother vs. father, respectively, p < 0.01). Adolescents with prior experience of severe hypoglycaemia (SH) had higher HFS scores compared to those without (t=-3.61, p < 0.001). Trait anxiety and SH explained 23% of the variance in HFS scores in adolescents. Trait anxiety explained 37% of the variance in HFS scores in under 11 year olds, 18% in mothers of under 11 year olds, 6% in mothers of adolescent and 10% in fathers of adolescents. There was no correlation between HFS and HbA1c. Qualitative analyses identified ‘Burden’ as an overarching theme from CYP and parent interviews. ‘Negative emotions’ and ‘Living with diabetes’ emerged as the key themes of analysis. This research study adds to existing findings on the prevalence of hypoglycaemia, severe hypoglycaemia, FoH and possible related factors, by focusing on the paediatric population and their parents, in the UK, for which there is limited research. Qualitative analyses also provided novel reports of the experience of T1DM for CYP and their mothers. Implications of this research could lead to the development of an FoH and anxiety managementprogramme for CYP and their parents. The findings of this study also help to raise awareness of this very real and current issue in diabetes management.

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2

Staines, Anthony. "The geographical epidemiology of childhood insulin dependent diabetes and childhood acute lymphoblastic leukaemia in Yorkshire." Thesis, University of Leeds, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422397.

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3

Hamilton-Shield, J. P. "Sub-clinical manifestations of microvascular disease in childhood onset insulin dependent diabetes mellitus (IDDM) : a follow up study on the 'Avon Childhood Diabetes Cohort'." Thesis, University of Bristol, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387992.

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4

Mentzel, Tammy K. "Effects of Adverse Childhood Experiences (ACEs) on Control of Diabetes." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1447690892.

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Martinez, Kelly Marie. "Psychological aspects of living with diabetes, in adolescence and childhood." Thesis, Queen's University Belfast, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.695664.

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Research thesis encompassing two papers: Psychological factors associated with diabetes self-management among adolescents with Type 1 diabetes: a systematic review The purpose of the review was to determine what psychological factors are associated with diabetes self-management. Twenty-one articles were determined to be eligible for this review. Numerous psychological factors were found to be associated with self management; however, correlations were typically small to moderate. Study validity was variable and there was little overlap between psychological factors examined. Variables are presented in a narrative synthesis. The strongest associations were found between social anxiety and diet (among boys); greater intrinsic motivation, conscientiousness and diet; and extraversion and exercise. Evidence exists for relationships between psychological factors and diabetes self-management but due to the individual nature of the studies, firm conclusions cannot be drawn. Future research needs to attempt replication and utilise validated measures to provide a stronger evidence base from which to develop theory for this population. The relationships between diabetes distress, illness perceptions and glycaemic control in adults with Type 2 diabetes This study aimed to investigate whether illness perceptions moderate the relationship between diabetes distress and glycaemic control. Participants with Type 2 DM attending diabetes outpatient clinics (n = 82) completed the Diabetes Distress Scale 17, Brief Illness Perceptions Questionnaire and the Patient Health Questionnaire 9 as well as providing demographic and clinical information. Most recent HbA 1 c and BMI were collected from medical records. Personal Control was the only significant contributor in the final regression model predicting HbA 1 c. The relationship between regimen-related distress and HbA 1 c was mediated by personal control. Moderating effects were non-significant. Personal control has an important role in explaining the link between diabetes distress and HbA 1 c. Psychological interventions seeking to improve HbA 1 c need to address individuals' perceptions of personal control.

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6

Nygren, Maria. "Stress in childhood and the risk of type 1 diabetes." Doctoral thesis, Linköpings universitet, Avdelningen för kliniska vetenskaper, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-121066.

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Background: It is still unknown why children develop type 1 diabetes (T1D), although both genetic predisposition and environmental factors seems to be involved. Stress has been suggested as one environmental factor contributing to the development of T1D since the stress hormones may increase the need for insulin or increase insulin resistance. The family is important for the child’s emotional security, development, and regulation of emotions, hence stress among the parent’s may influence the child’s experiences of stress and coping with stressors. Aim: The aim of the current thesis was to evaluate self--‐assessment measurements of psychological stress in the family and to investigate if psychological stress in the family is involved in the development of childhood T1D. Methods: The All Babies in Southeast Sweden (ABIS) study is a prospective cohort study following children born in southeast Sweden between 1997 and 1999. All parents of children born in the region, approximately 21600 were asked to participate. In total, questionnaire data has been obtained from n=16142 (response rate approximately 75%) in some of the six data--‐collections and between 15845 (73%) and 4022 (19%) at each data collection. Psychological stress in the family was measured by questionnaires assessing: Serious life events experienced by the child and the parent, parenting stress, parental dissatisfaction, parental worries, the parent’s adult attachment, and the parents’ social support. Identification of cases with T1D was done through the national register SweDiabKids. At Dec the 31st 2012 had in total 104 (0,64%) children been diagnosed with T1D. Diabetes--‐cases included in the study samples was n=42 and n=58. Results: Parenting stress, parental worries, and size of social support were judged as reliable measurements assessing different aspects of psychological stress in the family, as well as they were all associated to children’s mental health in early adolescence. A serious life event experienced in childhood (measured by checklist at age 5--‐6, 8 and 10--‐ 14 years) was associated with an increase in risk for manifest T1D up to 13--‐15 years of age. None of the variables measuring psychological stress among parents were found to associate with risk of T1D. Conclusions: In addition to a checklist assessing serious life events experienced by the child is self--‐assessment measurements of parenting stress, parental worries and the parent’s social support be useful in large--‐scale studies as proxies for psychological stress of the child. The current study is the first unbiased prospective study that can confirm an association between the experience of a serious life event and increased risk of T1D. The result was independent of the child’s BMI and the parents’ educational level. Our results gives us strong reason to believe that psychological stress caused by serious life events can play a part in the immunological process leading to the onset of T1D.

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Galler, Angela, Thoralf Stange, Gabriele Müller, Andrea Näke, Christian Vogel, Thomas Kapellen, Heike Bartelt, et al. "Incidence of Childhood Diabetes in Children Aged Less than 15 Years and Its Clinical and Metabolic Characteristics at the Time of Diagnosis: Data from the Childhood Diabetes Registry of Saxony, Germany." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-137438.

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Aims: The Childhood Diabetes Registry in Saxony, Germany, examined the incidence and metabolic characteristics of childhood diabetes. Methods: In the federal state of Saxony, newly diagnosed cases of diabetes in children and adolescents aged less than 15 years were registered continuously from 1999 until 2008. Family history, date of diagnosis, clinical and laboratory parameters were obtained. Reported cases were ascertained by public health departments as an independent data source and verified using the capture- recapture method. Results: A total of 865 children and adolescents with newly diagnosed diabetes were registered in Saxony. About 96% of them were classified as having type 1 diabetes, 0.6% had type 2 diabetes, 2.4% had maturity-onset diabetes of the young (MODY), and 1.4% had other types of diabetes. The age-standardized incidence rate of type 1 diabetes was estimated at 17.5 per 100,000 children per year. Completeness of ascertainment as calculated by the capture-recapture method amounted to 93.6%. At the time of diagnosis, 27.1% of children with type 1 diabetes had ketoacidosis, 1.5% had a blood pH <7.0, and 1.1% were unconscious. Conclusion: The registry provided data about the incidence rates and clinical presentation of childhood diabetes in a defined German population. We observed higher incidence rates compared to previous surveys
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

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8

Marteau, Theresa Mary. "Perceptions of diabetes in childhood : a study of parents and physicians." Thesis, University of London, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.338283.

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9

Rytkönen, M. (Mika). "Geographical study on childhood type 1 diabetes mellitus (T1DM) in Finland." Doctoral thesis, University of Oulu, 2004. http://urn.fi/urn:isbn:9514272862.

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Abstract Type 1 diabetes mellitus (T1DM) among children is of a particular importance in Finland, where its incidence is the highest in the world and still increasing. However, the aetiology of T1DM is not fully known. According to current knowledge, both genetic and environmental factors operate together, leading to an attack by the immune system on the insulin-producing beta cells. The purpose of this study was to investigate the geographical variation in the incidence of T1DM among children aged up to 14 years in Finland. Geographical Information Systems (GIS) and Bayesian spatial statistics were applied in a search for unusual spatial patterns and risk factor associations. The incidence of T1DM among children aged up to 14 years showed clear geographical variations in Finland. Living in a rural environment increased the risk for T1DM, and the risk was particularly high among children living in rural heartland areas. There was no association between the variation in T1DM incidence and the zinc and nitrate concentrations of drinking water. A male excess in the incidence of T1DM was seen in the low-incidence areas. The geographical variation in the risk of T1DM was marked only among children aged up to 9 years. Because genetics is a necessary but not a sufficient cause of T1DM, it could be hypothesized that there are some thus far unknown environmental risk factors affecting particularly younger children in Finland. Some of those factors may be related to a rural environment. The geographical variation in the M/F ratio of T1DM was a challenging observation and warrants more analytical study.

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10

Galler, Angela, Thoralf Stange, Gabriele Müller, Andrea Näke, Christian Vogel, Thomas Kapellen, Heike Bartelt, et al. "Incidence of Childhood Diabetes in Children Aged Less than 15 Years and Its Clinical and Metabolic Characteristics at the Time of Diagnosis: Data from the Childhood Diabetes Registry of Saxony, Germany." Karger, 2010. https://tud.qucosa.de/id/qucosa%3A27733.

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Aims: The Childhood Diabetes Registry in Saxony, Germany, examined the incidence and metabolic characteristics of childhood diabetes. Methods: In the federal state of Saxony, newly diagnosed cases of diabetes in children and adolescents aged less than 15 years were registered continuously from 1999 until 2008. Family history, date of diagnosis, clinical and laboratory parameters were obtained. Reported cases were ascertained by public health departments as an independent data source and verified using the capture- recapture method. Results: A total of 865 children and adolescents with newly diagnosed diabetes were registered in Saxony. About 96% of them were classified as having type 1 diabetes, 0.6% had type 2 diabetes, 2.4% had maturity-onset diabetes of the young (MODY), and 1.4% had other types of diabetes. The age-standardized incidence rate of type 1 diabetes was estimated at 17.5 per 100,000 children per year. Completeness of ascertainment as calculated by the capture-recapture method amounted to 93.6%. At the time of diagnosis, 27.1% of children with type 1 diabetes had ketoacidosis, 1.5% had a blood pH <7.0, and 1.1% were unconscious. Conclusion: The registry provided data about the incidence rates and clinical presentation of childhood diabetes in a defined German population. We observed higher incidence rates compared to previous surveys.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

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11

Berhan, Yonas. "Epidemiological studies of childhood diabetes and important health complications to the disease." Doctoral thesis, Umeå universitet, Pediatrik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-85248.

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Background and aims: The overall aim of this thesis was to increase knowledge regarding the occurrence of childhood onset T1D and T2D in Sweden and in relation to that describe and elucidate important aspects on two grave complications to diabetes; end-stage renal disease (ESRD) and mortality. The two first studies included in this thesis aimed to describe and analyze the cumulative incidence of childhood onset T1D in Sweden and to assess the occurrence of undetected T2D in Swedish children. The aim with the third study was to describe the cumulative incidence of ESRD, and to analyze how ESRD risk differs with age at-onset and sex. The aim of the fourth study was to show how parental socioeconomic status (SES) affects all cause mortality in Swedish patients with childhood onset T1D. Study populations: The foundation for the studies on T1D was data from the Swedish Childhood Diabetes Registry (SCDR). When studying ESRD we also included adult onset T1D cases from the Diabetes Incidence Study in Sweden (DISS). The study on T2D was a population-based screening study where BMI was measured in 5528 school-children and hemoglobin A1c was measured in children with overweight according to international age and sex specific BMI cut-offs. To study ESRD and mortality, we linked the SCDR to various nationwide registers containing individual information on SES, mortality and ESRD. Results: The incidence rates of childhood onset T1D has continued to increase in Sweden 1977–2007. Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4–23.9) during 1978–1980 to 43.9 (95% CI 40.7– 47.3) during 2005–2007. Cumulative incidence by birth-cohorts has shifted to a younger age at-onset over the first 22 years of incidence registration. From the year 2000 there was a significant reverse in this trend (p<0.01). In contrast to the increase of T1D, we found no evidence of undetected T2D among Swedish school children. Despite a relatively high incidence in T1D in Sweden there is low cumulative incidence of ESRD, 3.3% at maximum 30 years of duration. We found difference between the sexes regarding long-term risk of developing ESRD that was dependent on the age at onset of T1D. When analyzing how socioeconomic status affects mortality in different age at death groups, we found that having parents that received income support increased mortality up to three times in those who died after 18 years of age. Conclusion: The incidence of childhood onset T1D continued to increase in Sweden 1978-2007. Between the years 1978-1999 there was a shift to a younger age at-onset, but from the year 2000 there is a change in this shift indicating a possible trend break. The prevalence of T2D among Swedish children up to 12 years of age is probably very low. There is still a low cumulative incidence of T1D associated ESRD in Sweden. The risk of developing ESRD depends on age at-onset of T1D, and there is a clear difference in risk between men and woman. Excess mortality among subjects with childhood onset T1D still exists, and low parental socioeconomic status additionally increased mortality in this group.

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Persson, Emma. "Causal inference and case-control studies with applications related to childhood diabetes." Doctoral thesis, Umeå universitet, Statistik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-94993.

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This thesis contributes to the research area of causal inference, where estimation of the effect of a treatment on an outcome of interest is the main objective. Some aspects of the estimation of average causal effects in observational studies in general, and case-control studies in particular, are explored. An important part of estimating causal effects in an observational study is to control for covariates. The first paper of this thesis concerns the selection of minimal covariate sets sufficient for unconfoundedness of the treatment assignment. A data-driven implementation of two covariate selection algorithms is proposed and evaluated. A common sampling scheme in epidemiology, and when investigating rare events, is the case-control design. In the second paper we study estimators of the marginal causal odds ratio in matched and independent case-control designs. Estimators that, under a logistic regression model, utilize information about the known prevalence of being a case is examined and compared through simulations. The third paper investigates the particular situation where case-control sampled data is reused to estimate the effect of the case-defining event on an outcome of interest. The consequence of ignoring the design when estimating the average causal effect is discussed and a design-weighted matching estimator is proposed. The performance of the estimator is evaluated with simulation experiments, when matching on the covariates directly and when matching on the propensity score. The last paper studies the effect of type 1 diabetes mellitus (T1DM) on school achievements using data from the Swedish Childhood Diabetes Register, a population-based incidence register. We apply theoretical results from the second and third papers in the estimation of the average causal effect within the T1DM population. A matching estimator that accounts for the matched case-control design is used.

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Zhao, Hongxin. "Epidemiological studies of childhood onset type 1 diabetes in Devon and Cornwall." Thesis, University of Plymouth, 2000. http://hdl.handle.net/10026.1/2398.

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A high quality register of children with type 1 diabetes, The Cornwall and Plymouth Children's Diabetes Register (CPCDR), has been successfully established in the far South West of England for this thesis. Children aged 0-15 years of age who were diagnosed with type I diabetes in the study area have been systematically registered on the database since 01 /01/1975 until the present day. Children are now registered prospectively, to provide a database of the disease in this region and to allow epidemiological studies. Basic descriptive studies on the occurrence of the disease based on the CPCDR between 1975-1996 have been carried out for this thesis. In addition, space-time clustering analysis of the disease has been conducted, as well as an exploration of the association of some chemical contents in domestic drinking water, serum minerals and birth weight to the risk of developing the disease. The incidence study demonstrated that the overall incidence rate of childhood onset type 1 diabetes was 14.9 cases/100 000/year in this area during the 22-year study period (1975-1996). The case ascertainment was 94.4% for the whole register. A significant increase (2.49% per year) of overall incidence has been observed, mainly due to a significant increase in the 0-4-year age group (6.32% per year). The incidence significantly differed among the 22 years with peak incidences seen in the years 1977, 1983, 1988, 1990 and 1993-94. Incidence increased with age, with a peak age of 12 years for girls and 14 years for boys. Girls had a significantly higher incidence than boys. The significant seasonal variations at diagnosis were detected with the peak incidence appearing in autumn and winter. Significant space-time clustering was found by the Knox test in the study region in the following combinations of critical cutoff values, 25, 35 and 50 km and 270 or 360 days (P values < 0.05), and 50 km and 90 days (P < 0.05) with the highest level of significance found at 35 km and 360 days (P < 0.01). Stronger clustering was found in the younger children (0-4 years). Therefore, there is evidence of space-time clustering in the onset of childhood diabetes in the far South West of England. These results lend some support to the hypothesis that viral infections in early life or other unknown environmental factor(s) may have a role to play in the development of childhood diabetes. The relationship between childhood diabetes and drinking water quality has been explored in the study area. The initial analysis with the Spearman's rank test and χ² test for trend on the tertiles of the dataset suggest that copper, magnesium and nitrate have some protective effect on children for developing type 1 diabetes. However, Poisson regression analyses revealed that zinc and magnesium were the main possible protective chemicals. The concentration ranges of zinc (22.27-27.00 µg/L) and magnesium (>= 2.61 mg/L) in domestic drinking water would significantly decrease the risk of childhood diabetes. The results indicated that zinc and magnesium in drinking water are protective factors against the development of childhood diabetes. No significant associations were detected between birth weight or serum minerals and the risk of developing the disease.

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14

Cardwell, C. R. "Childhood type 1 diabetes in Northern Ireland : aetiology and provision of care." Thesis, Queen's University Belfast, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.431480.

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15

Campbell, Fiona M. "The investigation of early physiological changes in renal function in childhood diabetes." Thesis, University of Dundee, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322219.

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Horton, Sara Jane. "Refining the prediction of childhood diabetes using insulin autoantibodies : disease predictive idiotypes." Thesis, University of Exeter, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.418545.

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17

Karachaliou, Fotini-Heleni. "The Avon Childhood Diabetes Project : evolution of microvascular disease and autonomic neuropathy." Thesis, University of Bristol, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.389377.

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Jefferson, I. G. "Insulin-dependent diabetes in childhood : Its epidemiology, and the detection and prevention of associated microvascular disease." Thesis, University of Oxford, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.383459.

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19

Örtqvist, Eva. "The importance of immunological, genetic and clinical factors for beta cell function in childhood diabetes /." Stockholm, 2001. http://diss.kib.ki.se/2001/91-628-4632-9/.

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20

Lilly, Mary Kristine M. S. "An Analysis of Adherence in Childhood Diabetes: Social Learning and Family Systems Variables." Diss., Virginia Tech, 1998. http://hdl.handle.net/10919/30416.

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The purpose of the current study was threefold: 1) to assess youths' and parents' perceptions of their competency in managing diabetes, 2) to assess family flexibility and cohesiveness, and 3) to assess the utility of self-efficacy and family factors as predictors of adherence and metabolic control. Participants included 62 youths with insulin-dependent diabetes mellitus (IDDM) and their parents. Parents' and youths' perceptions of their abilities in diabetes and related situations, family cohesion and adaptability, and perceptions of the family's ability to integrate the demands of the diabetes regimen into general family routines were assessed. Results suggested that both social learning factors and general family relations were important in the prediction of youths' adherence to the treatment regimen for diabetes and metabolic control. Moreover, family efficacy and family cohesion were related, suggesting the need for models of assessment and intervention that include both social learning and general family functioning variables.
Ph. D.

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21

Schultz, C. J. "The early natural history of determinants of microalbuminuria in childhood type-1 diabetes." Thesis, University of Oxford, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365713.

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Robertson, Lynn M. "Maternal and neonatal risk factors for childhood type 1 diabetes a pilot matched case-control study /." Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2009. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=26211.

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Carrillo, Larco Rodrigo M., J. Jaime Miranda, and Antonio Bernabe-Ortiz. "Delivery by caesarean section and risk of childhood obesity: analysis of a Peruvian prospective cohort." PeerJ, Inc, 2015. http://hdl.handle.net/10757/558501.

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Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates. Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity), and central obesity (waist circumference) at the age 5 (first follow-up) and 7 (second follow-up) years. The exposure of interests was delivery by Caesarean section. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated using multivariable models adjusted for child-related (e.g., birth weight) and familyrelated (e.g., maternal nutritional status) variables. Results. At baseline, mean age was 11.7 (± 3.5) months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome, data from 6,038 and 9,625 children-years was included from baseline to the first and second follow-up, respectively. Compared to those who did not experience Caesarean delivery, the risk of having obesity was higher in the group born by Caesarean: RRs were higher at early-childhood (first follow-up: 2.25; 95% CI [1.36–3.74]) than later in life (second follow-up: 1.57; 95% CI [1.02–2.41]). Family-related variables had a greater effect in attenuating the risk estimates for obesity at the first, than at the second follow-up. Conclusion. Our results suggest a higher probability of developing obesity, but not overweight, among children born by Caesarean section delivery. The magnitude of risk estimates decreased over time, and family-related variables had a stronger effect on the risk estimates at early-childhood.
RMC-L, JJM, AB-O, and the CRONICAS Center of Excellence in Chronic Diseases were supported by the National Heart, Lung, and Blood Institute Global Health Initiative under the contract Global Health Activities in Developing Countries to Combat Non-Communicable Chronic Diseases (Project Number 268200900033C-1-0-1). AB-O is currently supported by a Wellcome Trust Research Training Fellowship in Public Health and Tropical Medicine (Grant 103994/Z/14/Z). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Marshall, Anna Louise. "A matched case-control study of the epidemiology of insulin-dependent diabetes mellitus in childhood." Thesis, Lancaster University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249800.

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Innes, Joanne. "The role of social networks in developing and maintaining effective outcomes in early childhood diabetes." Thesis, University of Ulster, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428818.

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Abdalrahaman, Naiemh. "The assessment of bone health in young women with childhood-onset type one diabetes mellitus." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8413/.

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The risk of hip fracture in people with type one diabetes mellitus (T1DM) is reported to be 7 to 12 times greater than in those without T1DM, and this increased risk is evident in both children and young adults. This fracture risk is higher than expected bone mineral density (BMD) measurements, which indicates the likelihood that other skeletal factors, not captured by DXA, may contribute toward increased fracture risk. There is increasing evidence that alteration in trabecular bone microarchitecture and increased bone marrow adiposity (BMA) are causes for excess skeletal fragility, yet these data are lacking in people with T1DM. Recent technological advances in magnetic resonance imaging (MRI) have allowed the quantification of trabecular bone architecture. In addition, MRI can quantify the amount of intra-abdominal fat, and magnetic resonance spectroscopy (MRS) can also be used to assess BMA. These advances may enhance our understanding of the underlying causes of diabetic osteopathy which may lead to improved fracture risk predictors and preventive measures in patients with T1DM beyond that provided by dual energy x-ray absorptiometry (DXA). The overall objective of this thesis was to improve the understanding of the bone pathology of young adult women with childhood-onset T1DM by using high resolution MRI. A cross-sectional study was first carried out to assess trabecular bone microarchitecture of the tibia, vertebral BMA and abdominal adiposity in patients with childhood onset T1DM (n=30) compared with healthy controls (n=28). Additionally, the biochemical markers of bone turnover, adiposity and GH/IGF-1 axis (IGF-1, IGFBP3, and ALS) were examined to evaluate the underlying mechanism that might result in bone deficit in this group of people. We found that young women with childhood onset T1DM had reduced apparent trabecular bone volume (appBV/TV) and apparent trabecular number (appTbN) and greater apparent trabecular separation (appTbSp) than women without T1DM. Interestingly, these differences remained significant after adjustment for multiple confounders. Furthermore, these abnormalities were markedly obvious in those with microvascular complication compared with those without microvascular complication. Although women with T1DM had greater abdominal adiposity compared with healthy controls, there was no significant difference in BMA between the groups. However, BMA showed positive significant association with current glycaemic control (r= 0.45, p=0.02). Women with T1DM had lower bone turnover and decreased GH/IGF axis compared with healthy controls. Osteocalcin and ALS were negatively correlated with trabecular separation in women with T1DM. III Next, a one-year prospective study was conducted in a subset (n=28) of the participants involved in the cross-sectional study. The aim of this study was to compare one year changes in trabecular bone microarchitecture and BMA in women with and without T1DM. Additionally, the study aimed to evaluate the effect of glycaemic control on these changes over this period. After adjustment for relevant confounders, the cases (n=17) had a lower median appTbN and a higher median appTbSp at baseline and 12 months compared with healthy controls (n=11). Although the sample size was small at follow-up, the trabecular bone deficits were clearly noticeable in those with retinopathy compared with those without retinopathy. Similarly, there was no difference in median BMA which was 26.2% (12.1, 62.1) and 22.4% (9.6, 41.9) in cases and controls, respectively (p=0.57). Additionally, over the 12 month period, there was no significant change in MRI-measured parameters in cases or in controls, and no differences in the change of these variables between the two groups. Mixed model effect analysis showed that age was a negative predictor of percent changes of appBV/TV, appTbN and appTbSp in both cases and controls (p=0.02, p=0.02, p=0.002, respectively). Interestingly, there was a strong correlation between change in HbA1c and change in BMA (r=0.8; p=0.002). In the third study, we aimed to assess adiposity-based determinants of bone mineral density and bone microarchitecture in healthy young women and women with T1DM. Additionally, we aimed to compare the feasibility of using DXA and MRI-measured bone parameters to differentiate women with and without T1DM. In addition to high resolution MRI we used DXA scans to measure BMD and body composition from the same participants (n=26) involved in the longitudinal study. Vertebral BMA was positively correlated with VAT. Additionally, we demonstrated evidence of an inverse association of vertebral BMA and DXA-measured bone parameters of femoral neck, lumbar spine and total body independent of demographics and body composition in healthy young women and women with T1DM. These finding support the hypothesis that BMA is linked with low bone density, and may contribute to excess bone fragility. Moreover, this study suggested that MRI-measured trabecular bone measurements were able to differentiate between T1DM with and without microvascular complication compared with DXA-measured BMD. In summary, differences in MRI-measured trabecular microarchitecture parameters identified in this body of work provide preliminary explanations for elevated fracture risk in young women with childhood onset T1DM. Additionally, these findings provide potential insight into a number of possible underlying mechanisms of diabetic osteopathy.

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Staaf, Johan. "Childhood Obesity and Islet Function." Doctoral thesis, Uppsala universitet, Institutionen för medicinsk cellbiologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-313310.

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The prevalence of childhood obesity and Type 2 Diabetes Mellitus (T2DM) has increased during recent decades. T2DM is accompanied with functional changes in the islets of Langerhans, which can be identified early in the pathogenesis. The aim of this thesis was to explore how metabolic changes caused by obesity early in life relate to islet function prior to overt T2DM. To address this, Uppsala Longitudinal Study of Childhood Obesity (ULSCO) was established (paper I). Initially, the association between palmitate and insulin secretion was investigated using a translational approach with obese and lean normoglycemic juveniles and isolated human islets (paper II). Secondly, dynamics of islet-hormones insulin and glucagon, and gut-hormones glucagon like-peptide 1 (GLP-1) and glicentin (paper III) and magnetic resonance imaging of pancreatic fat fraction (PFF) (paper IV) were studied in association to glucose tolerance and beta-cell function. Finally, a novel method of analysing shape features of oral glucose tolerance test (OGTT) curves was introduced and evaluated (paper V). Obese subjects had high prevalence of prediabetes and metabolic syndrome (MetS) (paper I). In obese pre-pubertal children with elevated palmitate levels, hyperinsulinemia was observed (paper II). In contrast, obese pubertal adolescents with similar palmitate levels showed moderate insulin levels during OGTT with delayed first phase insulin response. To explore mechanisms for these variations, isolated human islets were exposed to palmitate for different time periods in vitro. After 2 days accentuated insulin response was observed. Impaired beta-cell function and apoptosis were evident after 7 days, however. Hyperglucagonemia and disturbed GLP-1 and glicentin levels were associated with obesity and glycaemic status, with fasting glicentin being predictive of prediabetes (paper III). Furthermore, PFF was increased in obese subjects and associated to MetS and visceral adipose tissue, but not to beta-cell function (paper IV). OGTT curves were converted into geometric centres, centroids, which correlated with differences in glucose tolerance (paper V). In conclusion, the islet function in obese children was associated with elevated levels of palmitate, but not pancreatic fat. Fasting palmitate and glicentin levels, as well as centroid analyses of OGTT curves, could potentially identify obese children at risk of prediabetes and subsequent T2DM.

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Miller, Laura Jean. "Population mixing and the geographical epidemiology of childhood leukaemia and type 1 diabetes in New Zealand." Thesis, University of Canterbury. Geography, 2008. http://hdl.handle.net/10092/1530.

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Over the past twenty years the incidence of both childhood acute lymphoblastic leukaemia (ALL) and type 1 diabetes have risen in many developed countries, including New Zealand. Although the explanations for this increase and the precise aetiology of both diseases remain unclear, environmental factors are thought to be important. One factor receiving increasing attention is the role of infections introduced through population mixing. However, previous studies on this topic show mixed results and population mixing itself tends to be under-theorised. Furthermore, this issue has not been adequately assessed in New Zealand, a country characterised by high levels of population mobility. In this research, a variety of population mixing measures for small areas in New Zealand were developed. National data on ALL registrations were obtained from the New Zealand Cancer Registry, and regional type 1 diabetes data were obtained from the Canterbury Diabetes Register for the Canterbury Region of the South Island. The analyses were undertaken in three stages. First, standardised incidence ratios of each disease were examined at different geographical and temporal scales, between areas of differing socioeconomic status, and in urban and rural New Zealand. Second, cluster analysis was employed to test for spatial-temporal clustering of the two diseases. Finally, multivariate regression analyses were utilised to investigate the association between each disease and the various measures of population mixing at the area-level. The results reveal similarities in the geographical epidemiology of childhood ALL and type 1 diabetes in New Zealand. The majority of the findings were suggestive of an infectious aetiology for both diseases. In addition, higher incidence of both diseases was observed in areas which increased the most in population mixing over short time periods (6/7 years). Furthermore, raised type 1 diabetes incidence was also associated with high population mixing in early life.

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Hippich, Markus [Verfasser], Anette-Gabriele [Akademischer Betreuer] Ziegler, Fabian [Gutachter] Theis, and Anette-Gabriele [Gutachter] Ziegler. "Heterogeneity of Childhood Diabetes / Markus Hippich ; Gutachter: Fabian Theis, Anette-Gabriele Ziegler ; Betreuer: Anette-Gabriele Ziegler." München : Universitätsbibliothek der TU München, 2019. http://d-nb.info/120419999X/34.

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Slinger, Richard. "An investigation into child and parental adjustment to childhood insulin dependent diabetes : the relationship between adjustment, metabolic control and perceived severity." Thesis, Bangor University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263189.

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Caleyachetty, Rishiraj. "Cumulative social risk during childhood and type 2 diabetes in adult life : findings from the EPIC-Norfolk cohort study." Thesis, University of Cambridge, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708702.

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Sadauskaitė-, Kühne Vaiva. "Genetic and environmental factors in relation to childhood type 1 diabetes mellitus aetiology and clinical presentation in Sweden and Lithuania /." Linköping, 2004. http://www.bibl.liu.se/liupubl/disp/disp2004/med835s.pdf.

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Geiger, Debra Farrell. "How do adverse childhood experiences (ACE) influence self-management and control of type-2 diabetes in later life?" Thesis, Teachers College, Columbia University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3706515.

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Research indicates that ACEs are common and adults who have experienced abuse, neglect, or household dysfunction are at higher risk for emotional, mental, and physical health problems, such as type-2 diabetes. However, little is known about how adults with type-2 diabetes and ACEs self-manage their diabetes. The delayed time between exposure to ACEs and the diagnosis of diabetes can inhibit recognition of the relationship between the two. Identifying ACEs in adults and treatment of diabetes share similar goals: to improve health outcomes and quality of life. Self-management of type-2 diabetes can be stringent and challenging, requiring collaborative work between patients and healthcare providers.

The purpose of this study was to explore the adults’ perception of how ACEs influence how they self-manage and control their type-2 diabetes. This qualitative multiple case study took place at two healthcare practices at the Institute for Family Health, which serves Hispanic/Latino and Black, low socioeconomic communities. One-on-one semi-structured interviews were the primary means of data collection. A diabetes self-management survey (SDSCA) and collection of hemoglobin A1C levels were utilized to provide triangulation.

The findings revealed that all participants described multiple ACEs and spoke of emotional neglect. Physical neglect and abuse, and separation from family member(s) were also prevalent. Most often these experiences evoked feeling helpless, unloved, and depressed. Overall, this group of adults self-managed their diabetes poorly, as evidenced by their responses to the interview, SDSCA, and A1C levels. Finally, they denied the influence of ACEs on how they self-managed their diabetes.

This study found that ACEs elicit physical and emotional effects that may influence how adults with type-2 diabetes self-manage their diabetes. Denial of a connection between the two may contribute to poor self-management. Further analysis determined that participants fell into one of three groups: (1) the Proactives, a small group, who despite their ACEs were actively involved in self-management; (2) the Deniers, who denied the severity of their ACEs and diabetes and didn’t adequately participate in their care; and (3) the Debilitated, who appeared depressed and incapable of participating in self-management. The influence of racial/ethnic, low education, and low SES cannot be underestimated.

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Haynes, Magret C. "Prevalence of overweight and obesity in children aged 5 to 6 years exposed to Gestational Diabetes Mellitus complicated pregnancies in the Western Cape, South Africa." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/29982.

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Background: Gestational Diabetes Mellitus (GDM) has been linked with later metabolic abnormalities in offspring due to subsequent overweight and obesity. In Sub-Saharan Africa, there is a paucity of data on the outcomes of children exposed to GDM in utero. Aims: The primary aim of this sub-study was to investigate the prevalence of overweight and obesity in 5 and 6-year-old children from GDM complicated pregnancies and macrosomia at birth in the same cohort. The secondary aim was to identify risk factors associated with overweight and obesity in these 5 and 6-year-old children. Outcome measures: The main outcome was the prevalence of overweight and obesity in these children as measured by their age-specific body mass index (BMI) and Z-scores. Additionally, the association between other risk factors, overweight and obesity was investigated. Methods: A cross-sectional sub-study design was employed nested within a larger study that is investigating the progression to type 2 diabetes in women managed for GDM during 2010 and 2011. Mothers who participated in the larger study were informed about the sub-study and invited to allow their children to participate in the sub-study. Written informed consent was obtained from the mothers for the sub-study. The following data were collected: anthropometric data at birth and pregnancy related information from the mothers’ hospital record, additional demographic, social and medical information by questionnaire from the mother and at the research center. In addition, the children were weighed and had their height measured using standardized methods. Anthropometry was standardized using WHO standards. Risk factors for overweight and obesity were tested using a BMI>1 Z-score cut-off, (as a binary variable) in a manual multivariate logistic regression model. Results: The sub-study recruited 176 participants; 78 boys (44.3%) and 98 girls (55.7%). The mean (SD) Z-scores for the children’s anthropometry at ages 5 to 6 years were 0.28 (1.40) for weight, 0.01 (1.07) for height and 0.37 (1.63) for BMI. The overall prevalence of macrosomia at birth (birth weight>4000 gm) was 12.3 % (95% CI 8.2-9.1). The overall prevalence of overweight in the 5 and 6-year-old children was 13.4% (95% CI 8.6-20.4), while the prevalence of obesity was 14.2% (95% CI 9.2-21.2). The combined prevalence of overweight and obesity was 27.6% (95% CI 20.6-35.9). The prevalence of macrosomia (P=0.53) or overweight/obesity proportions (P=0.37) at ages 5 to 6 years did not differ by gender. In multivariate logistic regression analysis, factors independently associated with the risk of overweight and obesity were: mothers’ oral glucose tolerance test 2-hour blood glucose level during pregnancy (AOR=2.06, 95% CI 1.14-3.74, P=0.02), birth weight (AOR=1.00, 95% CI 1.00-1.00, P=0.01), child’s age in years (AOR=0.03, 95% CI 0.002-0.29, P=0.004) and number of adults in the house (AOR=0.38, 95% CI 0.17-0.86, P=0.02). Conclusion: This is the first study to report the prevalence of overweight and obesity in children born from GDM complicated pregnancies, in the Western Cape, South Africa. The combined prevalence of overweight and obesity found in 5 and 6-year-old children exposed to GDM in the Western Cape is higher than overweight and obesity in children reported in other South African studies. This can imply a higher tendency towards overweight and obesity in children exposed to GDM which needs further exploration.

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Hekkala, A. (Anne). "Ketoacidosis at diagnosis of type 1 diabetes in children under 15 years of age." Doctoral thesis, Oulun yliopisto, 2016. http://urn.fi/urn:isbn:9789526212579.

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Abstract The aim of this work was to evaluate the frequency of diabetic ketoacidosis (DKA) in children <15 years of age at the time of diagnosis of type 1 diabetes (T1D) at Oulu University Hospital over a period of 33 years (1982−2014) and throughout Finland in 2002−2005. The aim was to assess the effect of certain host characteristics (age at diagnosis, family history of T1D, T1D-associated HLA risk genotypes and participation in T1D prediction and prevention trials) on the frequency on DKA. A further aim was to assess temporal changes in the frequency of DKA. The overall frequency of diabetic ketoacidosis at the diagnosis of T1D in children <15 years was low both at Oulu University Hospital and over the whole country. A decrease in the frequency of DKA was observed at the university hospital during the years 1982−2001, but it then seemed to stabilize at just under 20.0%. The frequency in the whole of Finland during the period 2002−2005 was similar, i.e. 19.4%. The frequency of DKA at diagnosis in very young children (<2 years of age) at Oulu University Hospital decreased markedly during the period in question, being 50.0% in 1982−1991, 39.1% in 1992−2001 and 17.1% in 2002−2014 (p=0.021), and a similar decrease was seen in children <5 years (32.1% in 1982−1991, 17.7% in 1992−2001 and 13.0% in 2002−2014, p=0.007). The children aged 10−14.9 years at diagnosis, however, had an increased risk of DKA over the whole period studied here, and more attention should definitely be paid to this group in the future to reduce its DKA frequency. In the analysis of the data based on all children in Finland diagnosed with T1D in 2002−2005 the risk of DKA at diagnosis was lower in those with a first-degree relative affected by T1D. The children carrying a higher HLA-conferred risk of T1D had DKA less frequently at the manifestation of the disease. Prospective studies based on screening for HLA-DQB1-associated genetic susceptibility to T1D from cord blood and subsequent regular clinical, immunological and metabolic follow-up have been going on in Oulu University Hospital since 1995, and the children taking part have been found to have a reduced frequency of DKA (5%) at diagnosis. Genetic screening without follow-up did not prevent DKA at disease presentation
Tiivistelmä Väitöstyön tarkoituksena oli tutkia diabeettisen ketoasidoosin (DKA) esiintymistä alle 15–vuotiailla lapsilla tyypin 1 diabeteksen toteamisvaiheessa Oulun yliopistollisessa sairaalassa vuosina 1982–2014 ja koko Suomessa vuosina 2002–2005. Tavoitteena oli selvittää tiettyjen lapsen erityispiirteiden (ikä diagnoosihetkellä, perheen diabeteshistoria, diabetekseen liittyvien HLA riskigenotyyppien esiintyminen ja osallistuminen prospektiivisiin tyypin 1 diabeteksen seurantatutkimuksiin) vaikutusta ketoasidoosin esiintymiseen. Lisäksi tärkeänä tavoitteena oli tutkia mahdollisia ajallisia muutoksia ketoasidoosin esiintymisessä. Kaikkiaan ketoasidoosin esiintyminen oli matala alle 15–vuotiailla lapsilla tyypin 1 diabeteksen diagnoosihetkellä Oulun yliopistollisessa sairaalassa tutkimusjakson aikana. Ketoasidoosin esiintymisessä nähtiin vähenemistä kahden ensimmäisen 10–vuotisjakson aikana (1982–1991 ja 1992–2001), minkä jälkeen sen esiintyminen vakiintui alle 20 %:n tasolle. Koko Suomessa ketoasidoosin kokonaisesiintyvyys vuosina 2002–2005 oli 19,4 % mikä vastasi Oulun yliopistollisessa sairaalassa havaittua esiintyvyyttä. Pienillä, alle 2–vuotiailla lapsilla ketoasidoosin esiintyminen diabeteksen toteamisvaiheessa väheni huomattavasti tutkimusjakson aikana Oulun yliopistollisessa sairaalassa ollen 50,0 % 1982–2001, 39,1 % 1992–2001 ja 17,1 % 2002–2014 (p=0,021). Samanlainen laskeva suunta havaittiin tuona ajanjaksona myös alle 5–vuotiailla lapsilla (32,1 % 1982–1991, 17,7 % 1992–2001 ja 13,0 % 2002–2014, p=0,007). Sen sijaan ketoasidoosiriski pysyi huomattavan korkeana yli 10–vuotiailla lapsilla koko tutkimusjakson ajan. Tulevaisuudessa on tärkeä kiinnittää erityishuomio tähän ikäluokkaan ketoasidoosin vähentämiseksi. Analysoitaessa kaikkia Suomessa 2002–2005 tyypin 1 diabetekseen sairastuneita lapsia, havaittiin lapsilla, joilla oli ensimmäisen asteen tyypin 1 diabetesta sairastava sukulainen (vanhemmat, sisarukset), ketoasidoosiriski matalammaksi. Lisäksi niillä lapsilla, joilla oli korkeaan sairastumisriskiin liittyvä HLA–genotyyppi, oli ketoasidoosin esiintyminen vähäisempää tyypin 1 diabeteksen diagnoosihetkellä. Prospektiivinen tyypin 1 diabeteksen kehittymistä selvittävä seurantatutkimus aloitettiin Oulussa 1995. Tutkimuksessa lapsen napaverinäytteestä analysoidaan perinnöllinen diabetesalttius ja riskiryhmiä seurataan säännöllisesti. Seurantatutkimukseen osallistuneiden lasten ketoasidoosiriski diabeteksen diagnoosihetkellä oli vähentynyt taudin toteamishetkellä (5,0 %). Pelkkä geneettiseen seulontatutkimukseen osallistuminen ei kuitenkaan suojannut lasta ketoasidoosilta

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Rothe, Ulrike, Alexander Bendas, Wieland Kiess, Thomas Michael Kapellen, Thoralf Stange, Ulf Manuwald, Eckhard Salzsieder, et al. "Trends in Incidence Rates during 1999-2008 and Prevalence in 2008 of Childhood Type 1 Diabetes Mellitus in GERMANY – Model-Based National Estimates." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-191895.

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Aims To estimate the national incidence rate and trend of type 1 diabetes (T1DM) in Germany from 1999 to 2008 and the national prevalence in 2008 in the age group 0–14 years. Methods Data were taken from a nationwide registry for incident cases of T1DM in the ages 0–4 years and 3 regional registries (North-Rhine-Westphalia, Baden-Wuerttemberg and Saxony) for incident cases of T1DM in the ages 0–14 years covering 41% of the child population in Germany. The degree of ascertainment was ≥ 97% in all registries. Incident and prevalent cases were grouped by region, sex, age (0–4, 5–9, 10–14 years), and, for incident data, additionally by two 5-year periods (1999–2003, 2004–2008). Poisson regression models were fitted to the data to derive national estimates of incidence rate trends and prevalence in the age groups 5–9, 10–14 and 0–14 years. We used direct age-standardization. Results The estimated national incidence rate in 0-14-year-olds increased significantly by 18.1% (95%CI: 11.6–25.0%, p<0.001) from 1999–2003 to 2004–2008, independent of sex, corresponding to an average annual increase of 3.4% (95%-CI: 2.2–4.6%). The overall incidence rate was estimated at 22.9 per 100,000 person-years and we identified a within-country west-east-gradient previously unknown. The national prevalence in the ages 0–14 years on 31/12/2008 was estimated to be 148.1 per 100,000 persons. Conclusions The national incidence rate of childhood T1DM in Germany is higher than in many other countries around the world. Importantly, the estimated trend of the incidence rate confirms the international data of a global increase of T1DM incidences.

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Forsén, Tom. "Early growth and adult disease : programming of coronary heart disease, type 2 diabetes and hypertension by fetal and childhood growth." Helsinki : University of Helsinki, 2000. http://ethesis.helsinki.fi/julkaisut/laa/kansa/vk/forsen/.

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Jones, Elizabeth Murphy. "The Efficacy of Intensive Individual Play Therapy for Children Diagnosed with Insulin-Dependent Diabetes Mellitus." Thesis, University of North Texas, 2000. https://digital.library.unt.edu/ark:/67531/metadc2636/.

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This study was design to determine the efficacy of intensive individual play therapy as a method of intervention for children diagnosed with insulin-dependent diabetes mellitus. The purpose of this study was designed to study the effectiveness of an intensive play therapy intervention in: a) reducing symptoms of childhood depression in children with IDDM; b) reducing symptoms of anxiety in children with IDDM; c) reducing the overall behavior difficulties in children with IDDM; d) increasing healthy adjustment in children with IDDM; e) increasing diabetic's children's adherence to their diabetic regime; and f) impacting these emotional and behavioral symptoms over time. The 15 children in the experimental group received 12, daily play therapy sessions while attending a summer camp for children with diabetes. The control group, consisting of 15 children who attended the diabetic summer camp, received no play therapy. Children and parents in both groups completed pretest, post-test and three-month follow-up data, consisting of: the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Filial Problems Checklist and the Diabetes Adaptation Scale. Analysis of covariance revealed that the children in the experimental group significantly improved their adaptation to their diabetes following intensive play therapy as reflected by the Diabetes Adaptation Scale. No other hypothesis were retained, although statistical trends noted increased improvement in the experimental group in the areas of behavior difficulties and adherence behavior. Possible explanations for these results include a lack of symptoms reported at the time of pretesting and the validity of these instruments for a chronically ill population. The results of this study indicate that intensive play therapy may be an effective intervention for children diagnosed with IDDM. Qualitative observations and progress noted in therapy reveal that young children with IDDM have the capability to address and resolve issues of anxiety, depression and other emotional issues related to their diabetes in play therapy. Preventative approaches such as play therapy for children with IDDM are particularly important for this population as current behavior patterns and treatment adherence are highly correlated with long-term medical and psychological health.

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Rothe, Ulrike, Alexander Bendas, Wieland Kiess, Thomas Michael Kapellen, Thoralf Stange, Ulf Manuwald, Eckhard Salzsieder, et al. "Trends in Incidence Rates during 1999-2008 and Prevalence in 2008 of Childhood Type 1 Diabetes Mellitus in GERMANY – Model-Based National Estimates." Public Library of Science, 2015. https://tud.qucosa.de/id/qucosa%3A29141.

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Aims To estimate the national incidence rate and trend of type 1 diabetes (T1DM) in Germany from 1999 to 2008 and the national prevalence in 2008 in the age group 0–14 years. Methods Data were taken from a nationwide registry for incident cases of T1DM in the ages 0–4 years and 3 regional registries (North-Rhine-Westphalia, Baden-Wuerttemberg and Saxony) for incident cases of T1DM in the ages 0–14 years covering 41% of the child population in Germany. The degree of ascertainment was ≥ 97% in all registries. Incident and prevalent cases were grouped by region, sex, age (0–4, 5–9, 10–14 years), and, for incident data, additionally by two 5-year periods (1999–2003, 2004–2008). Poisson regression models were fitted to the data to derive national estimates of incidence rate trends and prevalence in the age groups 5–9, 10–14 and 0–14 years. We used direct age-standardization. Results The estimated national incidence rate in 0-14-year-olds increased significantly by 18.1% (95%CI: 11.6–25.0%, p<0.001) from 1999–2003 to 2004–2008, independent of sex, corresponding to an average annual increase of 3.4% (95%-CI: 2.2–4.6%). The overall incidence rate was estimated at 22.9 per 100,000 person-years and we identified a within-country west-east-gradient previously unknown. The national prevalence in the ages 0–14 years on 31/12/2008 was estimated to be 148.1 per 100,000 persons. Conclusions The national incidence rate of childhood T1DM in Germany is higher than in many other countries around the world. Importantly, the estimated trend of the incidence rate confirms the international data of a global increase of T1DM incidences.

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Moffett, Carol D. "The Impact of Childhood Measures of Glycemia and Insulin Resistance Factors on Follow-Up Glycemic Measures." Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/194096.

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The purpose of this research was to evaluate the impact of glycemic measures, and changes in identified risk factors (BMI, waist circumference, lipids, blood pressure) on follow-up glycemia, in Pima children at high risk for type two diabetes (type 2 DM).I computed incidence and cumulative incidence of type 2 DM in Pima children 5-19 years of age between 1983 and 2004. Cox proportional hazards rates for development of type 2 DM were calculated by glycemic measure (HbA1C, 20PG, FPG) controlling for confounding factors (age, sex, BMI, blood pressure, and cholesterol). Diabetes was defined by the presence of at least one of four criteria: 1) 20PG of >200 mg/dl, 2) FPG of >126 mg/dl, 3) HbA1C > 8.0%, or 4) hypoglycemic treatment. Linear regression models were computed to identify the impact of changes in risk factors on changes in HbA1C. Only exams performed in non-diabetic children during childhood were included in the regression models.Among 2658 non-diabetic children, 258 cases of diabetes occurred during mean 9.1 years of follow-up (1.5 - 21.7). The age-sex adjusted incident rate of diabetes was 19.0 cases per 1000 person-years, and cumulative incidence was 54% by age 40. Incidence rates increased with increasing baseline values of 20PG, and FPG, but not for HbA1C. For HbA1C the relationship was u-shaped with the lowest and highest quartiles having the highest DM rates. After adjustment for confounding risk factors using Cox proportional hazards analysis, the risk for diabetes increased 2-fold for every 10 mg/dl increase in FPG. Changes in waist circumference best predicted changes in HbA1C (R2 = 0.48, Ï <0.001). However, the ability of waist circumference to predict change is limited due to the powerful effect of regression to the mean, suggesting that these risk factors contribute very little to changes in HbA1C, at least in childhood.Childhood levels of glycemia predict development of type 2 DM later in life. While changes in waist circumference are associated with only moderate changes in HbA1C, this does not refute the significant contribution of adiposity in childhood to the development of type 2 DM.

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Mockevičienė, Giedrė. "Vaikystėje susirgusiųjų pirmo tipo cukriniu diabetu mirtingumo ir ligos komplikacijų ypatumai." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2010. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2009~D_20100422_105245-48375.

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Darbo tikslas Įvertinti pacientų, vaikystėje susirgusių pirmo tipo cukriniu diabetu (iki 15 m.), mirtingumo ir komplikacijų išsivystymo ypatumus. Darbo uždaviniai 1. Įvertinti standartizuotus mirtingumo rodiklius 1983–2005 metais. 2. Įvertinti ir palyginti standartizuotus mirtingumo rodiklius 1983–1995 m. ir 1996–2005 m. laikotarpiais. 3. Įvertinti mirties priežastis. 4. Įvertinti cukrinio diabeto komplikacijų išsivystymo ypatumus.
The aim of the study was to evaluate the characteristics of mortality and development of diabetes complications in patients with childhood-onset (under the age of 15 years) type 1 diabetes mellitus. The objectives of the study: 1. To evaluate the standardized mortality ratios in 1983–2005. 2. To evaluate and compare the standardized mortality ratios between the periods of 1983–1995 and 1996–2005. 3. To determine the causes of death. 4. To evaluate the characteristics of development of diabetes compli-cations.

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Sabin, Matthew Allen. "The role of non esterified fatty acids and adiponectin in the development of insulin resistance and type II diabetes in childhood obesity." Thesis, University of Bristol, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.435846.

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Ranta, Jukka O. "On probabilistic models for surveillance and prediction of disease incidence with latent processes : case studies on meningococcal outbreaks, childhood diabetes and poliomyelitis." Helsinki : University of Helsinki, 2001. http://ethesis.helsinki.fi/julkaisut/mat/rolfn/vk/ranta/.

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Pundziute-Lyckå, Auste. "Incidence trends and environmental determinants of type 1 diabetes in Lithuania and Sweden." Doctoral thesis, Umeå University, Clinical Sciences, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-114.

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Variation of diabetes incidence over time in countries with different incidence levels and socio-economic conditions, and in an age span beyond the childhood years, may give clues for diabetes causes.

Materials: Data from prospective type 1 diabetes registers in Sweden and Lithuania in children (0-14 years) and young adults (15-34 and 15-39 years, respectively). Number of infections recorded in health care booklets (117 cases; 270 controls); interview about the dietary intake one-year before the diagnosis and routinely recorded growth data (99 cases; 180 controls).

Results: The incidence of type 1 diabetes in Sweden and Lithuania differed most in the younger age groups, 28.9 and 7.5/100,000/year in 0-14-year group, respectively. During 1983-2000 incidence increased in 0-14-year old children in both countries, but the pattern of change differed. During 1983-1998 the incidence increased in Swedish children, but tended to decrease in young adults, with no increase in the age group below 35 years, indicating that the increase of childhood diabetes may be due to a shift towards a younger age at diagnosis. Within a low-incidence country Lithuania there was an urban-rural gradient of incidence, especially in the younger age groups, that seemed to follow poverty distribution: incidence in the 0-39-year group was 7.1, 9.0 and 8.8/100,000/year in rural areas, towns and cities, respectively, p<0.001.

Exposure to one or more non-specific infection during the first half-year of life reduced diabetes risk: odds ratios (95%-CI) in 0-14 and 5-14-year groups were (0.60; 0.37-0.98) and (0.47; 0.26-0.87), respectively. Higher energy intake and weight-for-age were independent diabetes risk factors: odds ratios for medium and high levels of energy were 1.33 (0.52-3.42) and 5.23 (1.67-16.38), and for weight-for-age 3.20 (1.30-7.88) and 3.09 (1.16-8.22), respectively. High intake of carbohydrates, disaccharides and sucrose in particular, increased diabetes risk independently of the high intake of energy.

Conclusion: Environmental factors associated with socio-economic conditions in childhood may be important for the occurrence of type 1 diabetes. Lack of exposure to microbial antigens early in life, higher intake of energy and more rapid growth may contribute to the increase of childhood-onset diabetes observed in many countries.

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Ehtisham, Sarah. "A study of the clinical characteristics of childhood type 2 diabetes with particular reference to ethnic differences in body composition and insulin sensitivity." Thesis, University of Birmingham, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.433425.

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Type 2 diabetes is increasingly recognised in childhood, and is more common in South Asians and in girls in the UK. It is not clear how this increased risk relates to sex and ethnic differences in insulin sensitivity and body composition. The aims of this study were to describe the emergence of type 2 diabetes in UK children, and evaluate sex and ethnic differences in healthy adolescents to understand why certain children were more at risk of developing type 2 diabetes. I undertook a cross-sectional cohort study of adiposity and insulin sensitivity in healthy White UK and South Asian adolescents. I confirmed that South Asian adolescents were less insulin sensitive with a trend towards lower insulin sensitivity in girls. South Asian adolescents had significantly more body fat which was more centrally distributed. The sex-ethnic differences in insulin sensitivity were no longer seen on covariate analysis with body fat. South Asian children had higher leptin and lower adiponectin concentrations consistent with their increased adiposity. Ethnic differences in insulin sensitivity are associated with ethnic differences in body composition. South Asian adolescents are more insulin resistant, with more body fat, which may contribute to their increased risk of developing type 2 diabetes.

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Teneralli, Rachel Ellen. "EXAMINING THE RELATIONSHIP BETWEEN EARLY LIFE ANTIBIOTIC EXPOSURE AND RISK OF AN IMMUNE MEDIATED DISEASE DURING CHILDHOOD THROUGH ADOLESCENCE." Diss., Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/527904.

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Public Health
Ph.D.
Rates of immune-mediated diseases (IMDs) have rapidly increased. Although the exact etiology has not yet been fully elucidated, disruptions to the microbiome has been proposed as a potential mechanism. We conducted a retrospective, longitudinal, birth cohort study utilizing electronic health records (EHR) to investigate the association between early life antibiotic exposure and the risk of developing juvenile idiopathic arthritis (JIA), pediatric psoriasis, or type 1 diabetes. Incident rate ratios (IRR) were estimated using modified Poisson regression models and adjusted for significant confounders. Children exposed to two or more antibiotics prior to 12 months of age had a 69% increased risk of developing JIA (1.69 IRR, 95% CI [1.04-2.73]), which rose to 97% when exposed prior to 6 months (1.97 IRR, 95% CI [1.11-3.49]). Children exposed to a penicillin antibiotic had a 62% increase in risk for psoriasis (1.62 IRR, 95% CI [1.06-2.49]), which rose slightly to 64% when exposure occurred between 6 and 12 months of age [(1.64 IRR, 95% CI [1.04-2.59]). We found a moderate to strong association between early antibiotic exposure and risk for JIA and psoriasis when exposure was examined by age, frequency, and type of antibiotic, but not for type 1 diabetes. Potential interactions effects between infection and antibiotics with an increased susceptibility to early life infections among children with an IMD was also observed. Overall, children exposed to antibiotics at an early age have an increased probability of developing an IMD after 12 months of age. However, alternative explanations for this association should be considered.
Temple University--Theses

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Gilmour, Vairi A. W. "Parents' experiences during the transition from childhood to adolescence with Type 1 Diabetes : parent-child relationships and support received during this time and clinical research portfolio." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7598/.

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Background: Type 1 Diabetes (T1D) management often worsens as children become adolescents. This can be a difficult time for parents as they hand over responsibility of diabetes management to their adolescent. Objectives: To look at the experiences of parents with a child with T1D as they move to adolescence and take more responsibility for their diabetes management. To find out about parents’ experience of support during this transition. Subjects: Three parents of adolescents with T1D. Participants were recruited from the NHS Highland Paediatric Diabetes Service. Methods: Participants took part in a one-to-one semi-structured interview with a researcher. Interpretative Phenomenological Analysis was used to analyse the interviews and find common themes across the interviews. Results: Participants experienced worry throughout their child’s transition to adolescence. They found it difficult to let their child take responsibility for their diabetes but acknowledged that their involvement caused tensions with their adolescent. Participants’ experience was that there were a number of practical adjustments to be made with a diagnosis of T1D and educating the network around their child was important. The participants reported that the diagnosis of T1D had an impact on the whole family and not just the child with the diagnosis. The parents felt well supported medically but said that the amount of time before their first clinic appointment felt too long. All participants had concerns about their adolescent moving to the adult diabetic service. Conclusions: Participants experienced worry relating to aspects of their adolescents T1D that they could not control, but were aware of the tensions caused by trying to keep elements of control. Areas of future research were identified.

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Uebel, Kirsten [Verfasser], Johann Josef [Akademischer Betreuer] Hauner, and Martin [Akademischer Betreuer] Klingenspor. "Effect of maternal obesity with and without gestational diabetes on placental gene expression and early childhood obesity / Kirsten Uebel. Betreuer: Johann Josef Hauner. Gutachter: Martin Klingenspor ; Johann Josef Hauner." München : Universitätsbibliothek der TU München, 2015. http://d-nb.info/1081216638/34.

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Soomro, Munawar Hussain. "Health effects of endocrine disruptors during pregnancy and childhood Exposure to heavy metals during pregnancy related to gestational diabetes mellitus in diabetes-free mothers Prenatal exposure to phthalates and the development of eczema phenotypes in male children: Results from the EDEN mother-child Cohort study." Thesis, Sorbonne université, 2019. https://accesdistant.sorbonne-universite.fr/login?url=http://theses-intra.upmc.fr/modules/resources/download/theses/2019SORUS243.pdf.

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Les perturbateurs endocriniens (PE) sont des composés synthétiques capables de se lier aux récepteurs cellulaires et d'imiter ou de bloquer le fonctionnement des hormones naturelles, pouvant ainsi entraîner des effets néfastes sur la santé. Ces dernières années, des hypothèses ont été émises selon lesquelles les PE pourraient également contribuer au développement de maladies allergiques et respiratoires. En outre, il est probable que les PE pourraient déjà agir pendant la grossesse en provoquant un diabète gestationnel (DG) et une hypertension induite par la grossesse, pouvant également provoquer une hypertension et un diabète plus tard dans la vie. Ce travail de thèse a permis de mettre en évidence que l'exposition maternelle aux phtalates et aux métaux lourds (plomb, cadmium et manganèse) pendant la grossesse pourrait être associée au diabète gestationnel, à l'hypertension induite par la grossesse et à l'eczéma/dermatite atopique chez l'enfant. Nous avons utilisé les données de la cohorte Française de naissance mère-enfant, EDEN (Étude des déterminants pré et post-natals du développement de la santé de l’enfant) pour examiner les hypothèses de ce travail de thèse. Nos résultats apportent de nouvelles preuves potentielles sur la relation entre les perturbateurs endocriniens (phtalates et métaux lourds étudiés) et la santé de la mère et de l’enfant, selon lesquelles l’exposition prénatale à certains phtalates et métaux toxiques lourds pourrait jouer un rôle dans le développement du diabète gestationnel et de l’hypertension induite par la grossesse pendant la grossesse et, ultérieurement, un eczéma pendant la petite enfance
All humans are exposed to chemicals in everyday life, from food, indoor environment, cosmetics and other products that surround us at home and at work. Endocrine disruptors (EDCs) are man-made compounds that can bind to cell receptors and mimic or block the functions of natural hormones potentially resulting in adverse health effects. In recent years, hypotheses have been put forward that EDCs may contribute also to the development of allergic and respiratory diseases. In addition, it is likely that EDCs could act already during pregnancy by causing gestational diabetes mellitus and pregnancy induced hypertension, which may also trigger to develop hypertension and diabetes mellitus later in life. This dissertation provides evidence that maternal exposure to phthalates and heavy metals (Lead, Cadmium and Manganese) during pregnancy may be associated with gestational diabetes mellitus, pregnancy induced hypertension and later eczema/atopic dermatitis in children. We used ongoing French EDEN-mother child cohort data for our three studies. Our results add new suggestive evidence on the relationship between EDCs (phthalates and heavy metals we studied) and maternal and children health, that prenatal exposure to certain phthalates and heavy toxic metals may play a role in the development of gestational diabetes mellitus and pregnancy induced hypertension during pregnancy and later eczema in early childhood. Future research focusing on larger populations and addressing multiple exposures assessed prenatally and postnatally are required to provide more evidence on possible contributions of emerging pollutants to study the role of phthalates and heavy metals

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Adom, Theodosia. "Individual and environmental factors associated with overweight among children in primary schools in Ghana." University of the Western Cape, 2019. http://hdl.handle.net/11394/7219.

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Philosophiae Doctor - PhD
Background Overweight/obesity is a risk factor for non-communicable diseases such as cardiovascular diseases, diabetes, and some cancers. Obesity in childhood is known to predict later obesity in adolescence and adulthood. Understanding the factors associated with overweight/obesity among children may present an opportunity for timely and appropriate interventions in the African setting. Aims 1. To describe the prevalence of overweight and obesity and associated factors among school children aged 8 - 11 years in primary schools in Adentan Municipality, Ghana. 2. To review the available literature on childhood obesity in the African context to provide evidence to support the design and improvement of appropriate school-based interventions for the prevention and control of overweight/obesity among African learners. Methodology This was a cross-sectional study design which was conducted in two phases. In Phase I, the available literature on the prevalence of overweight and obesity among learners, school-based interventions to promote healthy nutrition and physical activity (PA), and weight status, and key policy interventions at the national levels to provide supportive environments in the African context was reviewed and synthesised. In Phase II, interviews were conducted to collect individual and family data from 543 learners in 14 schools to assess family socio-demographics characteristics, dietary, PA, and sedentary behaviours, and sleep duration. Body weight, height, and waist circumference were measured. Data on perceived school neighbourhood/ community, school food, and PA environments were collected from school heads/administrators. A sub-sample of 183 children participated in the assessment of body fat using the deuterium dilution method. Multivariable and logistic regressions, multilevel logistic regressions, and multilevel linear regression models were used to examine the associations among child, family, and school level explanatory variables, and overweight/obesity, abdominal obesity and body mass index (BMI). Results The reviews revealed the following: (i) The pooled overweight and obesity estimates across Africa were: (10.5% 95% CI: 7.1-14.3) and 6.1% (3.4-9.7) by World Health Organization; 9.5% (6.5-13.0) and 4.0% (2.5-5.9) by International Obesity Task Force; and 11.5% (9.6-13.4) and 6.9% (5.0-9.0) by Centers for Disease Control and Prevention, respectively and differed for overweight (p=0.0027) and obesity (p<0.0001) by the criteria. The estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year, and sample size; (ii) Although inconsistent, school-based interventions broadly improved weight status and some energy-balance related health behaviours of African learners; (iii) On applying the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, key interventions on unhealthy diets and physical inactivity targeted the school, family and community settings, and macro environments, and broadly aligned with global recommendations. In the school-based study, 16.4% of Ghanaian learners were overweight (9.2%) or obese (7.2%), with the prevalence being significantly higher in children from middle- to high socio-economic status (SES) households, and private schools. In multivariable regression models, attending private school (AOR = 2.44, 1.39–4.29) and excessive television viewing (AOR = 1.72, 1.05–2.82) significantly increased the likelihood of overweight/obesity, whereas adequate sleep (AOR = 0.53, 0.31–0.88), and active transport to and from school (AOR = 0.51, 0.31 – 0.82) decreased the odds. Using deuterium-derived percent body fat as criterion method, the published BMI criteria was found to be highly specific but with moderate sensitivity for diagnosing obesity among Ghanaian children. Moreover, the BMI-for-age z-scores that optimise sensitivity, specificity, and predictive values for obesity were lower than the published cut-off points. Multilevel logistic and linear regression analyses revealed that the school contextual level contributed 30.0%, 20.6% and 19.7% of the total variance observed in overweight (including obesity), abdominal obesity, and BMI respectively. Availability of school cafeteria (β = 1.83, p = 0.017) and shops (β = 2.34, p = 0.001), healthy foods (β = 0.77, p = 0.046), less healthy foods (β = 0.38, p = 0.048), child age (β = 0.40, p = 0.008), school-level SES (β = 1.02, p < 0.0001), private school attendance (β = -1.80, p = 0.006), and after-school recreational facilities (β = 0.89, p < 0.0001) were all associated with BMI. In the mutually adjusted models for all significant predictors, school-level SES, healthy foods, after-school recreational facilities, and PA facility index remained significant predictors of overweight and or abdominal obesity. Conclusions The prevalence of overweight/obesity is significantly higher in urban children attending private or high SES schools, regardless of criteria used to define obesity. A number of individual, family, and school-level factors significantly predicted weight status of school children in Ghana. Given that many African governments have initiated policy interventions aiming to provide supportive environments for healthy choices, it is recommended that resources are made readily available for the implementation of these interventions across the home, school and community.

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Dissertations / Theses on the topic 'Diabetes in childhood'

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