Insulin pump therapy started at the time of diagnosis: effects on glycemic control and pancreatic β-cell function in type 1 diabetes.

Background: In the interest of preserving residual insulin secretory capacity present at the time of diagnosis with type 1 diabetes (T1D), we compared the efficacy of starting insulin pump therapy at diagnosis with standard multiple daily insulin injections (MDIs).

Methods: We conducted a prospective, randomized, pilot trial comparing MDI therapy with continuous subcutaneous insulin therapy (pump therapy) in 24 patients, 8-18 years old, with newly diagnosed T1D. Subjects were evaluated at enrollment and 1, 3, 6, 9, and 12 months after initial diagnosis of T1D.

GAD-alum immunotherapy in Type 1 diabetes mellitus.

Glutamic acid decarboxylase (GAD)-alum (Diamyd(®), Diamyd Medical, Stockholm, Sweden) is an adjuvant-formulated vaccine incorporating recombinant human GAD65, the specific isoform of GAD expressed in human pancreatic β-cells and a major antigen targeted by autoreactive T lymphocytes in Type 1 diabetes mellitus. Intermittent vaccination with this protein is theorized to induce immune tolerance to GAD65, thereby potentially interrupting further β-cell destruction. Hence, clinical trials are ongoing to examine the efficacy and safety of GAD-alum immunotherapy in patients with autoimmune-mediated forms of diabetes, including Type 1 diabetes and latent autoimmune diabetes in adults.

Cerebral edema before onset of therapy in newly diagnosed type 2 diabetes.

To discuss the management of a rare case of cerebral edema before initiation of therapy in an adolescent with new-onset type 2 diabetes. The University of Arkansas for Medical Sciences Institutional Review Board approved the review of medical records. A previously healthy obese adolescent female suffered diabetic ketoacidosis (DKA)-related cerebral edema before initiation of therapy.

Novel TSHbeta subunit gene mutation causing congenital central hypothyroidism in a newborn male.

Newborn screening programs that use only high TSH levels as a marker for hypothyroidism may overlook neonates with congenital hypothyroidism (CH) due to TSH deficiency. We sought the cause of TSH deficiency in a neonate with low levels of thyroxine and TSH. The coding region of the TSHbeta gene was amplified and its sequence examined for mutations.

Death caused by hyperglycemic hyperosmolar state at the onset of type 2 diabetes.

Seven obese African American youth were considered to have died from diabetic ketoacidosis (DKA) due to type 1 diabetes, despite meeting the criteria for hyperglycemic hyperosmolar state and not for DKA. All had previously unrecognized type 2 diabetes, and death may have been prevented with earlier diagnosis or treatment.