Screening for diabetic retinopathy with fluorescein angiography in patients with type 1 diabetes from adolescence to adult life. A retrospective study of the past 30 years of clinical practice in a tertiary Belgian centre.

Background: The aim of the present study was to describe the prevalence and progression of DR diagnosed by fluorescein angiography (FA) in patients with type 1 diabetes (T1D) during a 30-year follow-up, and the relationship with glycated haemoglobin (HbA1c).

Materials And Methods: We included 4325 FA reports representing 851 patients with T1D with a mean age at diagnosis of 10.4 years (range: 0.

Diabetic ketoacidosis in children newly diagnosed with type 1 diabetes mellitus: Role of demographic, clinical, and biochemical features along with genetic and immunological markers as risk factors. A 20-year experience in a tertiary Belgian center.

Background: Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes (T1D). Little is known about the association between genetic and immunological markers and the risk for DKA at onset of T1D. The aim of this study was to create a model foreseeing the onset of DKA in newly diagnosed patients.

Targets and teamwork: Understanding differences in pediatric diabetes centers treatment outcomes.

Objective: The reason for center differences in metabolic control of childhood diabetes is still unknown. We sought to determine to what extent the targets, expectations, and goals that diabetes care professionals have for their patients is a determinant of center differences in metabolic outcomes.

Research Design And Methods: Children, under the age of 11 with type 1 diabetes and their parents treated at the study centers participated.

Twenty-Year Progression Rate to Clinical Onset According to Autoantibody Profile, Age, and Genotype in a Registry-Based Group of Children and Adults With a First-Degree Relative With Type 1 Diabetes.

Objective: We investigated whether islet autoantibody profile, genotype, and age influenced a 20-year progression to diabetes from first autoantibody positivity (autoAb) in first-degree relatives of patients with type 1 diabetes.

Research Design And Methods: Persistently islet autoAb siblings and offspring ( = 462) under 40 years of age were followed by the Belgian Diabetes Registry. AutoAbs against insulin (IAA), GAD (GADA), IA-2 antigen (IA-2A), and zinc transporter 8 (ZnT8A) were determined by radiobinding assay.

HLA-DQ genotypes - but not immune markers - differ by ethnicity in patients with childhood onset type 1 diabetes residing in Belgium.

Aim: The aim of this study was to compare genetic (HLA-DQ) and immune markers in a large population of type 1 diabetic (T1D) children and adolescents residing in the same environment, but of different ethnic origin: European Caucasians (EC), Moghrabin Caucasians (MC), Black Africans (BA) and of Mixed Origin (MO).

Methods: Retrospective study, including 452 patients with T1D aged 0.1-17.

One center in Brussels has consistently had the lowest HbA1c values in the 4 studies (1994-2009) by the Hvidoere International Study Group on Childhood Diabetes: What are the "recipes"?

The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications (retinopathy, neuropathy, nephropathy, cardiovascular disease, etc.) by maintaining blood glucose concentrations close to normal level. Glycated hemoglobin levels (HbA1c) provide a good criterion of overall glycemic control.

HLA-A*24 is an independent predictor of 5-year progression to diabetes in autoantibody-positive first-degree relatives of type 1 diabetic patients.

We investigated whether HLA-A*24 typing complements screening for HLA-DQ and for antibodies (Abs) against insulin, GAD, IA-2 (IA-2A), and zinc transporter-8 (ZnT8A) for prediction of rapid progression to type 1 diabetes (T1D). Persistently Ab(+) siblings/offspring (n = 288; aged 0-39 years) of T1D patients were genotyped for HLA-DQA1-DQB1 and HLA-A*24 and monitored for development of diabetes within 5 years of first Ab(+). HLA-A*24 (P = 0.

Metabolic outcomes in young children with type 1 diabetes differ between treatment centers: the Hvidoere Study in Young Children 2009.

Objective: To investigate whether center differences in glycemic control are present in prepubertal children <11 yr with type 1 diabetes mellitus.

Research Design And Methods: This cross-sectional study involved 18 pediatric centers worldwide. All children, <11 y with a diabetes duration ≥12 months were invited to participate.

[Félicien Rops and phosphatous diabetes in the 19th century].

Félicien Rops was among the 19th century's finest draughtsmen and Belgium's most sulphurous artist. Rops was also a prolific letter-writer. In his correspondence, he complained of real or imaginary diseases among which phosphatous diabetes.

[(Pre)type 2 diabetes and MODY: pediatric diabetology future].

Type 2 diabetes mellitus (T2D) is no longer a disease only of adults. In some American locations and populations, incidence and prevalence of T2D are much higher than those of type 1 diabetes, because of increased calorie and fat intake, and decreased exercise. The increasing prevalence of T2D in the United States has closely paralleled the increase in childhood obesity noted there, but now across the Western world.

[Neonatal diabetes: a case of pancreatic beta cell agenesis and a 38-year follow-up of a permanent neonatal diabetes mellitus].

Neonatal diabetes, transient (TND) or permanent (PND) is a rare disease, with a reported frequency of 1/300,000. If establishing a diagnosis is quite easy, treatment remains challenging during childhood. Understanding of physiopathology increased this last decade, as many mutations in genes playing critical roles in the development of pancreas, have been described: the most common are chromosome 6q anomalies in the case of TND, and mutations in KCNJ11 and ABCC8 genes encoding the subunit of the insulin cell potassium channel in the case of PND.

[Screening for subclinical complications in children and adolescents with type 1 diabetes: experience acquired in Brussels].

Clinical studies conducted since the 1970s by the pediatric diabetology group of the Free University of Brussels have demonstrated that screening for subclinical retinopathy, neuropathy, and nephropathy should be started at puberty and at least 3 years after the diabetes diagnosis with the goal of detecting early abnormalities responsible for subclinical disorders that can be reversed by improved metabolic control, thus preventing the occurrence of irreversible potentially incapacitating lesions. A 1974 retinal fluorescein angiography study showed that the development of microaneurysms, which are irreversible lesions, could be preceded by fluorescein leakage due to disruption of the blood-retinal barrier. Risk factors for early retinopathy include: duration of diabetes, age at diagnosis (with younger children having longer times to retinopathy), puberty and sex (with onset one year earlier in girls than in boys), long-term bad metabolic control over several years, high cholesterol levels and excessive body mass index (2002).

[Growth in type 1 diabetic children].

Despite the fact that height in diabetic children has extensively been studied, many controversies remain. The aim of this study is to review growth in type 1 diabetes. Height at diagnosis is probably not increased compared with appropriate reference data.

[Diabetic ketoacidosis: diagnosis, management, prevention].

Diabetic ketoacidosis results from relative or absolute deficiency of insulin and is a frequent metabolic emergency. It occurs in previously undiagnosed diabetes, in half of the cases in Europe, or is the consequence of a severe unbalance in a well-known diabetic patient, who, deliberately or not, does not take enough or not at all insulin. In population studies, the mortality rate in children ranges from 0,15% to 0,30%, cerebral edema accounts for 60% to 90%.

[Severe hypoglycemia in children and adolescents with type 1 diabetes: risks factors and management].

Hypoglycemia is one of the most common acute complications in the treatment of type 1 diabetes. It is the result of a mismatch between insulin dose, food consumed, and recent exercise. Hypoglycemia occurs more frequently in younger children and with lower HbA1c levels.

[Biological variation of glycation and mean blood glucose have greater influence on Hba1c levels in type 1 young diabetic patients than glucose instability].

The aim of the study was to assess the relative influence of mean blood glucose (MBG), glucose instability (GI) and biological variation of glycohemoglobin (BVG) on HbA1c. The study included 378 unselected young type 1 diabetic patients with a diabetes duration > 1 year. There were 1,409 visits with simultaneous HbA1c determinations and self-monitoring of BG meter downloads.

[Management of type 1 diabetes (insulin, diet, sport): "Dorchy's recipes"].

The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications by maintaining blood glucose concentrations close to the normal range and an HbA1c level under 7%. The number of daily insulin injections, 2 or > or = 4, by itself does not necessarily give better results, but the 4-injection regimen allows greater freedom, taking into account that the proper insulin adjustment is difficult before adolescence. Successful glycemic control in young patients depends mainly on the quality and intensity of diabetes education.

[(R)evolution in pediatric diabetology].

Before the discovery of insulin 87 years ago, all diabetic children died within a few weeks or months following diagnosis. Since then, improvements in the treatment and live of young diabetics have sometimes occurred in (r)evolutions that have caused debate among physicians. They are briefly reviewed in this paper.

[Pediatric diabetology at the University Children's Hospital Queen Fabiola in Brussels is 40 years old].

By the end of medical school at the Free University of Brussels (ULB) in 1969, I began my specialization in pediatrics. Immediately, my mentor, Professor Helmut Loeb led me into pediatric diabetes which was non-existent in Belgium. Forty years later, the diabetes clinic for children and adolescents at the University Children's Hospital Queen Fabiola in Brussels has the largest number of young patients in Belgium, social medical activities and clinical research, with the best protective glycated hemoglobin levels (proven in international comparisons from Hvidøre Study Group on Childhood Diabetes) in relation to potentially invalidating complications in the short and long term.

Bone age corresponds with chronological age at type 1 diabetes onset in youth.

Objective: To our knowledge, only two controversial articles have reported the study of bone age at diagnosis in diabetic children. The aim of this study was to compare chronological age with bone age and to evaluate the impact of A1C on bone age in children at diagnosis of type 1 diabetes.

Research Design And Methods: In 496 diabetic children, height was measured at diagnosis and height SD score was calculated using the British 1990 growth reference.

Continuing stability of center differences in pediatric diabetes care: do advances in diabetes treatment improve outcome? The Hvidoere Study Group on Childhood Diabetes.

Objective: To reevaluate the persistence and stability of previously observed differences between pediatric diabetes centers and to investigate the influence of demography, language communication problems, and changes in insulin regimens on metabolic outcome, hypoglycemia, and ketoacidosis.

Research Design And Methods: This was an observational cross-sectional international study in 21 centers, with clinical data obtained from all participants and A1C levels assayed in one central laboratory. All individuals with diabetes aged 11-18 years (49.

[Helicobacter pylori infection and eradication are not related to glycosylated hemoglobin levels (HbA1c) in young patients with type 1 diabetes].

Objective: Helicobacter pylori (Hp) is a chronic stomach infection common throughout the world. The pediatric diabetes literature on the relation between Hp and HbA1c is sparse and controversial. This study aimed to investigate this relation.

Parent and health professional perspectives in the management of adolescents with diabetes: development of assessment instruments for international studies.

Objective: Assessment of quality of life (QOL) in adolescents with diabetes requires patient, parent and health professional input. Psychometrically robust instruments to assess parent and professional perspectives are required.

Research Design And Methods: Questionnaires concerning adolescent QOL were developed for completion by parents and health professionals.

Screening for subclinical complications in young type 1 diabetic patients: experience acquired in Brussels.

Clinical studies conducted since the 1970s by the pediatric diabetology group of the Free University of Brussels have demonstrated that screening for subclinical retinopathy, neuropathy and nephropathy should be started at puberty and at least 3 years after the diabetes diagnosis. The goal is to detect early abnormalities responsible for subclinical disorders that can be reversed by improved metabolic control, thus preventing the occurrence of irreversible potentially incapacitating lesions. A 1974 retinal fluorescein angiography study showed that the development of microaneurysms, which are irreversible lesions, could be preceded by fluorescein leakage due to disruption of the blood-retinal barrier.