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- Ludvigsson, Johnny, et al.
(author)
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Combined Etanercept, GAD-alum and vitamin D treatment: an open pilot trial to preserve beta cell function in recent onset type 1 diabetes
- 2021
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In: Diabetes-Metabolism Research and Reviews. - : Wiley. - 1520-7552 .- 1520-7560.
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Journal article (peer-reviewed)abstract
- Aim We aimed to study the feasibility and tolerability of a combination therapy consisting of glutamic acid decarboxylase (GAD-alum), Etanercept and vitamin D in children and adolescents with newly diagnosed with type 1 diabetes (T1D), and evaluate preservation of beta cell function. Material and Methods Etanercept Diamyd Combination Regimen is an open-labelled multi-centre study pilot trial which enrolled 20 GAD antibodies positive T1D patients (7 girls and 13 boys), aged (mean +/- SD): 12.4 +/- 2.3 (8.3-16.1) years, with a diabetes duration of 81.4 +/- 22.1 days. Baseline fasting C-peptide was 0.24 +/- 0.1 (0.10-0.35) nmol/l. The patients received Day 1-450 Vitamin D (Calciferol) 2000 U/d per os, Etanercept sc Day 1-90 0.8 mg/kg once a week and GAD-alum sc injections (20 mu g, Diamyd (TM)) Day 30 and 60. They were followed for 30 months. Results No treatment related serious adverse events were observed. After 6 months 90-min stimulated C-peptide had improved in 8/20 patients and C-peptide area under the curve (AUC) after Mixed Meal Tolerance Test in 5 patients, but declined thereafter, while HbA1c and insulin requirement remained close to baseline. Administration of Etanercept did not reduce tumour necrosis factor (TNF) spontaneous secretion from peripheral blood mononuclear cells, but rather GAD65-induced TNF-alpha increased. Spontaneous interleukin-17a secretion increased after the administration of Etanercept, and GAD65-induced cytokines and chemokines were also enhanced following 1 month of Etanercept administration. Conclusions Combination therapy with parallel treatment with GAD-alum, Etanercept and vitamin D in children and adolescents with type 1 diabetes was feasible and tolerable but had no beneficial effects on the autoimmune process or beta cell function.
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- Lundgren, Markus, et al.
(author)
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Reduced morbidity at diagnosis and improved glycemic control in children previously enrolled in DiPiS follow-up
- 2014
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In: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X. ; 15:7, s. 494-501
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Journal article (peer-reviewed)abstract
- Aims/hypothesis: Children participating in longitudinal type 1 diabetes prediction studies were reported to have less severe disease at diabetes diagnosis. Our aim was to investigate children who from birth participated in the Diabetes Prediction in Skane (DiPiS) study for metabolic status at diagnosis and then continued to be followed for 2 yr of regular clinical care. Methods: Children, followed in DiPiS before diagnosis, were compared to children in the same birth cohort, who did not participate in follow-up. Metabolic status, symptoms at diagnosis as well as hemoglobin A1c (HbA1c) and doses of insulin at 3, 6, 12, and 24 months after diagnosis were compared. Results: Children, followed in DiPiS and diagnosed at 2-12 yr of age, had 0.8% (9 mmol/mol) lower HbA1c at diagnosis than those who were not followed (p=0.006). At diagnosis, fewer DiPiS children had symptoms (p=0.014) and ketoacidosis at diagnosis were reduced (2% compared to 18%, p=0.005). During regular clinical care, HbA1c levels for the DiPiS children remained lower both at 12 (0.4% (4 mmol/mol); p=0.009) and 24 months (0.8% (9 mmol/mol) p < 0.001) after diagnosis, despite no difference in total daily insulin between the two groups. Conclusions: Participation in prospective follow-up before diagnosis of type 1 diabetes leads to earlier diagnosis with fewer symptoms, decreased incidence of ketoacidosis as well as better metabolic control up to 2 yr after diagnosis. Our data indicate that metabolic control at the time of diabetes diagnosis is important for early metabolic control possibly affecting the risk of long-term complications.
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- Vigård, Tore, et al.
(author)
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Low glycaemic index (GI) foods improve glucose control in children with type I diabetes.
- 2003
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In: ESPGHAN (European Society for Pediatric Gastroenterology, Hepatology and Nutrition) 36th annual meeting, Prag 4-7 June 2003, Abstract: Journal of Pediatric, Gastroenterology and Nutriton 36,4. - 0277-2116 .- 1536-4801. ; 36:4, s. 576-576
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Conference paper (peer-reviewed)abstract
- Aim: Does metabolic control improve in children with insulin dependent diabetes mellitus (IDDM), when modifying the quality of carbohydrates by introducing low glycaemic index (GI) foods? Methods: The inclusion criteria for the study was children with diabetes mellitus type 1, age from 7 to 11 years old, they should have a moderate glucose control with HbA1c between 7,5 to 8,5 and no allergy to cereals nor coeliac disease. Seventeen children were enrolled in the study. The design of the study was a blind cross-over study, each study period was 6 weeks with a wash-out period forthree weeks in between. One study period they got regular diabetic foods, during the other period they got foods with a lower glycaemic index (GI). A diet record was done prior to the start of the study, and one diet record in each period to see that the macro nutrient composition was the same. HbA1c, total cholesterol and triglyceridewere checked at the beginning and at the end of each period. Results: For each study person we calculated a delta value for HbA1c by subtracting the HbA1c at the start of the period from the HbA1c at the end of the same period. During the period with regular diabetic foods, the change of HbA1c was (mean±SD) −0,06±0,4, while the change of HbA1c was (mean±SD) -0,34±0,4 during the low GI period. By using Wilcoxon Signed Rank test we found out that there was a significant improvement, ie lowering of HbA1c during the period with low GI foods (p0,039). Regarding serum lipids, there were no significant changes. Conclusion: The concept of low GI foods is relevant for children with insulin dependent diabetes mellitus, it may be one way of optimizing the glucose control for those who have a slightly elevated HbA1c.
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