Role of parenting style in achieving metabolic control in adolescents with type 1 diabetes.

Objective: To examine the role of parenting style in achieving metabolic control and treatment adherence in adolescents with type 1 diabetes.

Research Design And Methods: Parents of 100 adolescents with type 1 diabetes completed assessments of their parenting style and sense of helplessness. Parents and patients rated patient adherence to the treatment regimen.

Automatic learning algorithm for the MD-logic artificial pancreas system.

Background: Applying real-time learning into an artificial pancreas system could effectively track the unpredictable behavior of glucose-insulin dynamics and adjust insulin treatment accordingly. We describe a novel learning algorithm and its performance when integrated into the MD-Logic Artificial Pancreas (MDLAP) system developed by the Diabetes Technology Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.

Methods: The algorithm was designed to establish an initial patient profile using open-loop data (Initial Learning Algorithm component) and then make periodic adjustments during closed-loop operation (Runtime Learning Algorithm component).

Endocrine outcome in long-term survivors of childhood brain tumors.

Aim: To evaluate the rates of endocrine abnormalities in survivors of childhood brain tumors and identify risk factors.

Methods: The medical charts of patients were reviewed for background, disease-related and treatment-related data. Endocrine dysfunction was determined by clinical and laboratory evaluation.

Pelvic ultrasound examination in girls with precocious puberty is a useful adjunct in gonadotrophin-releasing hormone analogue therapy monitoring.

Objective: As there are no standard criteria for monitoring suppression during treatment of central precocious puberty (CPP) with gonadotrophin-releasing hormone analogues (GnRHa), we assessed the use of pelvic ultrasound examination for this purpose.

Design/patients/measurements: In 31 girls with CPP, transabdominal pelvic ultrasound examination was performed before initiation of therapy with GnRHa, after approximately 3 and 6 months, at last treatment visit and after its discontinuation.

Results: Three months after treatment initiation, there was a significant decrease in most uterine and ovarian parameters, with at least three parameters decreased in each patient.

Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes.

Objective: To assess the impact of continuous glucose monitoring on hypoglycemia in people with type 1 diabetes.

Research Design And Methods: In this randomized, controlled, multicenter study, 120 children and adults on intensive therapy for type 1 diabetes and a screening level of glycated hemoglobin A(1c) (HbA(1c)) <7.5% were randomly assigned to a control group performing conventional home monitoring with a blood glucose meter and wearing a masked continuous glucose monitor every second week for five days or to a group with real-time continuous glucose monitoring.

Differentiation of Crohn's disease from intestinal tuberculosis in India in 2010.

Differentiating intestinal tuberculosis from Crohn's disease (CD) is an important clinical challenge of considerable therapeutic significance. The problem is of greatest magnitude in countries where tuberculosis continues to be highly prevalent, and where the incidence of CD is increasing. The final clinical diagnosis is based on a combination of the clinical history with endoscopic studies, culture and polymerase chain reaction for Mycobacterium tuberculosis, biopsy pathology, radiological investigations and response to therapy.

Coexistent autoimmunity in familial type 1 diabetes: increased susceptibility in sib-pairs?

Background: Type 1 diabetes (T1D) patients are at risk for additional autoimmune diseases (AID).

Objective: To compare the characteristics of associated autoimmunity among familial (parent-offspring and sib-pair) subgroups and sporadic T1D patients.

Patients And Methods: Data regarding AID in T1D patients and their nuclear family members were extracted from medical files of 121 multiplex T1D families (58 parent-offspring, 63 sib-pairs) and 226 sporadic controls followed between 1979 and 2008.

Role of pelvic ultrasound in girls with precocious puberty.

Pelvic ultrasound evaluation of girls presenting with secondary sex characteristics before the age of 8 years may help to differentiate precocious puberty from premature thelarche, functioning ovarian cyst, and obesity. However, although uterine and ovarian measurements are significantly higher in girls with true precocious puberty than controls, there is a significant overlap of normal prepubertal and early pubertal values. In girls with precocious puberty treated with gonadotropin-releasing hormone analogue, ultrasound is a valid tool for monitoring ovarian suppression.

A novel loss-of-function mutation in GPR54/KISS1R leads to hypogonadotropic hypogonadism in a highly consanguineous family.

Context: The G protein-coupled receptor 54 (GPR54), the kisspeptin receptor, is essential for stimulation of GnRH secretion and induction of puberty. Recently loss-of-function mutations of the GPR54 have been implicated as a cause of isolated idiopathic hypogonadotropic hypogonadism (IHH).

Objective: The objective of the study was to identify the genetic cause of IHH in a consanguineous pedigree and to characterize the phenotypic features from infancy through early adulthood.

Real-time continuous glucose monitoring in randomized control trials.

Several recent randomized controlled trials offer firm evidence supporting the efficacy and safety of real-time continuous glucose monitoring (RT-CGM) in type 1 diabetes mellitus (T1DM). Improved metabolic control with significant lowering of glycated hemoglobin (A1C) along with other parameters of glycemia, and without a concomitant increase in hypoglycemia, has been demonstrated. However, poor compliance in adolescents has been a limiting factor in that age group.

Natural history of idiopathic advanced bone age diagnosed in childhood: pattern of growth and puberty.

Background: Significant idiopathic bone age (BA) advancement is defined as BA >2 SD above the mean chronological age (CA) with no underlying etiology. BA advancement due to endocrinopathies is associated with early puberty and compromised adult height (AHt), necessitating treatment. The natural history of idiopathic BA advancement is not well-established.

Factors associated with increased risk of insulin pump discontinuation in pediatric patients with type 1 diabetes.

Background: There are few reports on rates and predictors for pump discontinuation in the pediatric population.

Objective: To study the rate of and predictors for insulin pump discontinuation among pediatric patients with type 1 diabetes.

Methods: Medical chart review of 530 patients with type 1 diabetes who had started pump therapy between 2000 and 2008 in our center revealed that 11.

Closing the loop.

The dream of closing the loop is actually the dream of creating an artificial pancreas and freeing the patients from being involved with the care of their own diabetes. Insulin-dependent diabetes (type 1) is a chronic incurable disease which requires constant therapy without the possibility of any 'holidays' or insulin-free days. It means that patients have to inject insulin every day of their life, several times per day, and in order to do it safely they also have to measure their blood glucose levels several times per day.

Predictors of glycaemic control in patients with Type 1 diabetes commencing continuous subcutaneous insulin infusion therapy.

Aims: To identify variables that predict glycaemic control in Type 1 diabetic patients switched to a continuous subcutaneous insulin infusion (CSII) regimen, in order to improve patient selection for this treatment.

Methods: The notes of 421 Type 1 diabetic patients aged 2.6-39.

A novel loss-of-function mutation in OTX2 in a patient with anophthalmia and isolated growth hormone deficiency.

Heterozygous mutations of the gene encoding transcription factor OTX2 were recently shown to be responsible for ocular as well as pituitary abnormalities. Here, we describe a patient with unilateral anophthalmia and short stature. Endocrine evaluation of the hypothalamic-pituitary axis revealed isolated growth hormone deficiency (IGHD) with small anterior pituitary gland, invisible stalk, ectopic posterior lobe, and right anophthalmia on brain magnetic resonance imaging.

Is sex hormone priming in peripubertal children prior to growth hormone stimulation tests still appropriate?

Low growth hormone (GH) secretion during puberty may stem from either a permanent GH axis abnormality or from transient GH deficiency secondary to lack of sex hormones. Although well known to enhance stimulated GH secretion in pre- or early puberty, sex hormone priming for the evaluation of the function of the GH-IGF-I axis remains controversial. Many pediatric endocrinologists consider that omission of such priming during the preadolescent period decreases the specificity of GH stimulation tests and increases the percentage of false-positive diagnosis results.

MD-logic artificial pancreas system: a pilot study in adults with type 1 diabetes.

Objective: Current state-of-the-art artificial pancreas systems are either based on traditional linear control theory or rely on mathematical models of glucose-insulin dynamics. Blood glucose control using these methods is limited due to the complexity of the biological system. The aim of this study was to describe the principles and clinical performance of the novel MD-Logic Artificial Pancreas (MDLAP) System.

Familial type 1 diabetes mellitus - gender distribution and age at onset of diabetes distinguish between parent-offspring and sib-pair subgroups.

Background: Familial type 1 diabetes mellitus (T1D) comprises parent-offspring and sib-pair subgroups.

Objective: To compare the demographic and clinical characteristics in the two subgroups at diagnosis and evaluate the differences between index cases and second affected family members.

Methods: Retrieved from our institutional registry of new T1D cases for the years 1979-2008 were a cohort of 194 familial cases (87 parent-offspring, 107 sib-pairs); 133 sporadic cases matched by age, gender, and year of diagnosis were selected as controls.

Premature thelarche: age at presentation affects clinical course but not clinical characteristics or risk to progress to precocious puberty.

Objectives: To determine whether age at premature thelarche (PT) onset affects the clinical characteristics, course, and risk of progression to precocious puberty (PP).

Study Design: Data regarding course of growth and puberty were retrieved from the medical files of 139 girls with PT followed up from 1995 to 2005. Analysis was based on age at PT appearance (birth, 1-24 months, and 2-8 years); course was categorized as regressive, persistent, progressive, or cyclic.

Target setting in intensive insulin management is associated with metabolic control: the Hvidoere childhood diabetes study group centre differences study 2005.

Objective: To evaluate glycaemic targets set by diabetes teams, their perception by adolescents and parents, and their influence on metabolic control.

Methods: Clinical data and questionnaires were completed by adolescents, parents/carers and diabetes teams in 21 international centres. HbA1c was measured centrally.

Growth without growth hormone and similar dysmorphic features in three patients with sporadic combined pituitary hormone deficiencies.

Background/aims: Mutations in the HESX1 gene are associated with a broad spectrum of phenotypes: septo-optic dysplasia, midline defects, pituitary abnormalities with consequent hypopituitarism, isolated growth hormone (GH) deficiency or combined pituitary hormone deficiencies (CPHD). This study examined the prevalence of mutations in the HESX1 gene in patients with CPHD.

Patients/methods: Sixty patients with sporadic CPHD without septo-optic dysplasia were screened for mutations in HESX1.