Toll-like Receptor 3 Deficiency in a Child with Recurrent Infections and Diabetes Mellitus

There are more than 400 different primary immune deficiencies worldwide. Amongst them, patients with humoral immunodeficiency are more common. Most of the innate immune defects, affect the phagocytic system. There are a few cases of toll-like receptor deficiency with innate immune defects, like TLR3 mutations, which usually present with Herpes simplex encephalitis. Herein, we report a two-year old boy with TLR3 deficiency, who was presented with recurrent infections and type one diabetes mellitus.

Subcutaneous regular insulin use for the management of diabetic ketoacidosis in resource limited setting

Objectives The standard recommendation of insulin therapy for patients with DKA is the administration of slow continuous intravenous (IV) regular insulin. Currently subcutaneous insulin is being recommended as an alternative treatment of DKA in mild and moderate cases in resource-limited settings. The purpose of this study was to assess the effectiveness and safety of six-hourly subcutaneous regular insulin use for the treatment of DKA among children with type one diabetes mellitus. Methods A retrospective cohort study was conducted among 224 DKA episodes which occurred in 161 children who were treated at St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia, from November 2015 to November 2020. Results Majority (68.8%) of the episodes occurred in newly diagnosed cases. The median time for urinary ketones clearance was 24 h. DKA severity was found to be the only significant predictor of time to DKA resolution. Only 13 (5.8%) were treated at the pediatric intensive care unit (PICU), and 27 (12.1%) developed complications during management. No death or neurological complications observed. Conclusions The six-hourly subcutaneous regular insulin use was found to be safe and effective alternative to slow IV insulin infusion for the treatment of DKA in a non PICU setting. As it resulted in minimum morbidity and no mortality, we recommend its use in the treatment of DKA irrespective of its severity. It can also decrease the health care cost and patients’ inconvenience.

Effects of Academic Stress on Teenagers with Type 1 Diabetes

Type one diabetes is a a condition that is exponentially growing in the US and all over the world. As the majoirty of these patients are diagnosed at a young age, much research is being completed in order to find ways to help these adolescents live a more normal life by minimizing its effects. The goal of this research is to find a possible correlation between diabetic teenagers’ academic stress levels and their average glucose levels. By means of an extensive 3 week survey in which each participant was asked to share their stress levels, lifestyle habits, and glucose reports on a daily basis, it was found that there is a strong positive correlation between he two variables. They produced an r-value of about 0.9939, suggesting statistical significance. Knowing this information will help patients within this age group manage their glucose readings better and keep them at better control throughout the day.

A qualitative exploration of attitudes towards physical activity, exercise and sport participation in people living with type one diabetes (T1D).

Regular exercise has many benefits such as increasing energy levels, reducing depressive symptoms, improving sleep quality and reducing the risk of chronic diseases. For people living with Type 1 diabetes (T1D) there are additional benefits such as increased insulin sensitivity, improved glycaemic control and a reduced risk of diabetes complications. Little research has been published which investigates attitudes towards exercise and sport in those with T1D and who are already active. Seven interviews were undertaken with already active people living with T1D, aged 24-81 years. The aim of the interviews were to explore the attitudes and beliefs that influenced already active people living with T1D towards physical activity, exercise and sport participation. Thematic analysis identified four themes: Motivations, Influences, Deterrents and Normalising participation. Latent analysis of the themes suggests that the factors that influence the attitudes of already active people living with T1D towards physical activity and sport participation are focused around the influence of peers, parents and the media, as stated in the Tripartite Model, motivation and level of diabetes management knowledge

Safety and Efficacy of Teplizumab for Treatment of Type One Diabetes Mellitus: A Systematic Review and Meta-analysis

Background:: Type one diabetes mellitus (T1DM) is an autoimmune disease characterized by gradual destruction of beta cells in islets of Langerhans. Teplizumab is a humanized anti-CD3 monoclonal antibody, which may have beneficial effects for T1DM patients. Objective:: To assess the safety and efficacy of teplizumab in T1DM patients. Methods:: We searched electronic databases using related keywords for randomized clinical trials that assessing the safety and efficacy of teplizumab. We evaluated the retrieved citations for eligibility, and we extracted the data then analyzed it using Review Manager Software. Results:: We included eight randomized clinical trials with 866 patients. Teplizumab was associated with lower insulin use than placebo at 6 months (MD = -0.17, 95% CI [-0.24, -0.09], P < 0.001), 12 months (MD = -0.12, 95% CI [-0.18, -0.06], P < 0.001), 18 months (MD = -0.22, 95% CI [-0.32, -0.11], P < 0.001) and 24 months (MD = -0.17, 95% CI [-0.28, -0.06], P = 0.003). The area under the curve of C-peptide was significantly increased in teplizumab group at 12 months (MD = 0.08, 95% CI [0.01, 0.15], P = 0.03), 18 months (MD = 0.13, 95% CI [0.01, 0.25], P = 0.03) and 24 months (MD = 0.13, 95% CI [0.01, 0.24], P = 0.03). No significant effect of teplizumab on HbA1c levels at any time point. Teplizumab was associated with some side effects such as lymphopenia, skin and subcutaneous tissue disorders. Conclusions:: Teplizumab is associated with lower insulin use and higher AUC of C-peptide in type 1 diabetic patients with no significant effect on Hb1c levels. Besides, teplizumab showed some adverse effects.

Pregnancy in Patients with Type One Diabetes Mellitus Treated with Continuous Subcutaneous Insulin Infusion—Preconception Basal Insulin Dose as a Potential Risk Factor for Fetal Overgrowth?

Despite widespread use of technology, type one diabetes mellitus (T1DM) is still a great clinical challenge during pregnancy. This study aims to assess how prenatal variables of T1DM patients using continuous subcutaneous insulin infusion (CSII) influence pregnancy outcomes. We performed a retrospective study of 35 patients with T1DM treated with CSII during pregnancy. Alterable preconception variables (A1C, body mass index, basal and bolus insulin dose) were analysed as possible contributors to birth weight and large-for-gestational-age (LGA) prevalence. Inclusion criteria were presence of T1DM for more than two years, A1C < 7.4% and treatment with CSII for at least three months prior to conception. The preconception basal insulin dose and A1C had a significant correlation to the neonatal birth weight (p = 0.01, r = 0.4 and p = 0.04, r = 0.3, respectively) and were significant in regression analysis together contributing 22% of the variance in birth weight percentiles (sig = 0.17, R square = 0.22). Prevalence of LGA was 46%. Women who had LGA neonates also had a higher preconception basal insulin dose compared to women with non-LGA neonates (26 ± 9 vs. 18 ± 7 IU (international units), p = 0.01). The LGA group had a higher preconception A1C, but it did not reach statistical significance (6.5 ± 0.5% vs. 6.2 ± 0.9%, respectively, p = 0.2). Women with T1DM treated with CSII who had unregulated glycaemia and more basal insulin were at greater risk for development of LGA neonates.

SAT-660 Rare Case of Portal Vein Thrombosis Secondary to Acute Pyelonephritis in Type 1 Diabetic Patient

Background: Portal vein thrombosis (PVT) refers to venous thrombosis that develops within the extrahepatic portal venous system and can extend to the branches of the intrahepatic portal vein or up to splenic veins and superior mesenteric. A few cases have been reported about portal vein thrombosis in non-cirrhotic patient. Asymptomatic or non-specific symptom of portal vein thrombosis may lead to misdiagnosed or delay the diagnosis until the complications develop. We report a case of Portal vein thrombosis in type one diabetes associated with acute pyelonephritis. Case report: 18 years old female with type one diabetes on insulin pump present with epigastric abdominal pain for three days associated with nausea and vomiting of three days duration. On examination; conscious alert oriented young female looks in pain, vital sign were stable temperature 37oC, heart rate 89 beat per minute, blood pressure 103/72 mmHg, respiratory rate 20 per minute, oxygen saturation 100% and random blood sugar (RBS) 179 mg/dl. Abdominal examination revealed soft and lax abdomen with tenderness in the epigastric area and right renal angle. No sign of rigidity or rebound tenderness. Bowel sound was present. No sign of ascites, splenomegaly or hepatomegaly. Investigations showed; WBC: 10.2, neutrophil 65%, urine analysis WBCs 30-50 per high field microscopy, RBC 5-10, PH 7, negative nitrate and culture did not show any growth. ESR was 48 and CRP was 4.2. Thrombophilic screen was done and all within normal. Computed tomography (CT) reveled reduced enhancement of right kidney likely indicating acute pyelonephritis and portal vein edema with complete occlusion of left branch of portal vein. Local factors and prothrombotic disorders were ruled out. The patient was managed with ciprofloxacin, enoxaparin and warfarin. The patient was symptomatic free and discharge home with a therapeutic range INR. Conclusion: Portal vein thrombosis is uncommon condition in absence of liver diseases. Few case report liking between sepsis and portal vein thrombosis. Sepsis can create a predisposed environment for hypercoagulability.