Seroprevalence of Helicobacter pylori in children with type 1 diabetes mellitus in Sardinia.

A few studies have reported an increased prevalence of Helicobacterpylori (HP) infection in diabetic subjects, which may be one of the causes of gastrointestinal symptoms and chronic atrophic gastritis frequently seen in diabetes of long duration. We determined the prevalence of HP infection in children and adolescents with Type 1 diabetes mellitus (T1DM) in the area of Sassari (northern Sardinia, Italy), which is characterized by an ethnically homogenous population at high risk of T1DM. HP IgG and IgA titres were measured in 138 patients with T1DM and 138 age-matched healthy controls. The percentage of infected subjects did not differ between T1DM patients (29.7%) and controls (32.6%). Globally, infected subjects were more than 1 yr older (13.0 +/- 2.7 yr) than non-infected ones (11.8 +/- 2.9 yr), independently of the presence of T1DM; in most HP-positive subjects infection was asymptomatic, and only 2 subjects in each group reported clinically relevant symptoms. HP-positive and HP-negative diabetic patients had the same duration of the disease (5.6 +/- 3.5 vs 5.5 +/- 3.6 yr) and received very similar doses of insulin (0.94 +/- 0.27 vs 0.96 +/- 0.4 IU/kg/d), whereas mean HbA1c was significantly lower in HP-positive patients (7.8 +/- 1.6% vs 8.6 +/- 1.7%,p=0.02). We conclude that the prevalence of HP infection is not higher in Sardinian children with T1DM as compared to controls of similar age, and the overall clinical impact of HP infection in terms of gastrointestinal symptoms and diabetic control seems to be low.

High prevalence of lactose absorbers in Northern Sardinian patients with type 1 and type 2 diabetes mellitus.

BACKGROUND: Increased intestinal lactase activity has been shown to occur in alloxan and streptozotocin diabetic rats. OBJECTIVE: The objective of this study was to determine whether increased intestinal lactase activity is present in humans with diabetes mellitus. DESIGN: We assessed the capacity to digest lactose by measuring breath-hydrogen production after oral administration of lactose in 50 patients with type 1 diabetes, 50 patients with type 2 diabetes, and 50 healthy control subjects from Sassari, Sardinia, Italy, a population characterized by a low prevalence of lactase persistence (lactose absorbers). RESULTS: Fourteen percent of control subjects were lactose absorbers, compared with 48% of patients with type 1 diabetes and 52% of patients with type 2 diabetes (P < 0.005). The odds ratio of lactase persistence in patients with type 1 diabetes was 5.3 (95% CI: 2.0, 14.0) and in patients with type 2 diabetes was 5.5 (95% CI: 2.1, 14.5). CONCLUSIONS: Diabetes is associated with increased intestinal lactase activity in humans. Consequently, there is a greater exposure to glucose and galactose in diabetic patients with high lactose consumption. This may explain the association between diabetes and the risk of cataract.

RH blood groups and diabetic disorders: is there an effect on glycosylated hemoglobin level?

Recent cloning of RH genes has elucidated their structure, suggesting that RH proteins are part of an oligomeric complex with transport function in the erythrocyte. This observation prompted us to investigate a possible relationship between the RH system and the glycosylated hemoglobin level (Hb A(1c)) in diabetes. This compound is considered an important indicator- of glycemic control in diabetic disorders. We studied 278 subjects with non-insulin-dependent diabetes mellitus (NIDDM) from the population of Penne, Italy. Glycemic and glycosylated hemoglobin (Hb A(1c)) levels are associated with RH phenotype. Glucose and Hb A(1c) levels are increased in DCcEe subjects and decreased in ddccee subjects as compared to the mean values for other genotypes. Sex, age at onset of disease, duration of disease, and age of patients were also considered. Correlation analysis suggests that these variables influence glycemia directly and Hb A(1c) indirectly. The RH system, on the other hand, seems to influence the Hb A(1c) level directly. Preliminary data on 53 children with insulin-dependent diabetes mellitus (IDDM) from Sardinia seem to confirm the relationship between RH and Hb A(1c) observed in NIDDM. Since glycosylated hemoglobin is found inside red blood cells, the relationship between RH genetic variability and Hb A(1c) level suggests that RH proteins may influence glucose transport through red cell membrane and/or hemoglobin glycation.

IDDM and early infant feeding. Sardinian case-control study.

OBJECTIVE: To further investigate the association between the type of feeding in infancy and the development of IDDM. RESEARCH DESIGN AND METHODS: We have carried out a case-control study in the area of Sassari (northern Sardinia, Italy), which is characterized by an ethnically homogenous population at high risk of IDDM. The study subjects comprised 100 IDDM patients and 100 control subjects, matched for sex and age and selected from children admitted at the Department of Pediatrics of the University of Sassari. Diabetic children (53 boys, 47 girls) had been diagnosed between 1983 and 1994, and their age at diagnosis ranged between 1 and 15 years. Information on feeding patterns during the 1st year of life was collected through questionnaires administered to the mothers. The questionnaire was designed to evaluate the duration of complete or partial breast-feeding and the age at which dietary products containing cow's milk were introduced into the diet. RESULTS: A larger proportion of the diabetic children rather than the control children had been breast-fed, and the risk of IDDM among children who had not been breast-fed was below unity (odds ratio [OR] 0.41; 95% CI 0.19-0.91). No clear difference was observed between diabetic and control subjects in the duration of breast-feeding (medians: 3 and 2 months, respectively), even if, overall, the data suggested a slight increase in the risk of IDDM with longer duration of breast-feeding (OR 1.10; 95% CI 0.99-1.22 per month). Although a larger proportion of control children rather than diabetic children had been given cow's milk-derived formula and solid food before the age of 3 months, there was no time-risk relationship. CONCLUSIONS: Our data do not support the existence of a protective effect of breast-feeding on the risk of IDDM, nor do the data indicate that early exposure to cow's milk and dairy products has any influence on the development of IDDM in a high-risk population.

Lactose absorption in patients with glucose 6-phosphate dehydrogenase deficiency with and without favism.

BACKGROUND: It has recently been suggested that primary lactase deficiency might have been selected for by malaria, as has been previously shown to occur for thalasaemia and glucose 6-phosphate dehydrogenase (G6PD) deficiency. AIMS: To test this hypothesis, the prevalence of primary lactase deficiency in G6PD deficient subjects and in controls from the area of Sassari (Northern Sardinia) was determined, which in the past was characterised by an intermediate malarial endemicity. SUBJECTS: 70 adult subjects with G6PD deficiency, 34 of whom had a past history of favism, and 50 age matched control subjects. METHODS: The capacity to absorb lactose was assessed by measuring breath hydrogen production after oral administration of lactose (50 g) by a gas chromatographic method. RESULTS: Twenty per cent of G6PD deficient subjects with a positive history of favism and 22% of G6PD deficient subjects without a positive history of favism were lactose absorbers compared with 14% lactose absorbers in the control group. The differences were not statistically significant. CONCLUSIONS: These data show that the prevalence of primary lactase deficiency in the area of Sassari is relatively high, but comparable to that seen in the adult population from another area of southern Italy (Naples) where malaria was less endemic.

Aspirin-induced acute haemolytic anaemia in glucose-6-phosphate dehydrogenase-deficient children with systemic arthritis.

In a 4-year 7-month-old boy with glucose-6-phosphate dehydrogenase deficiency and systemic arthritis a severe haemolytic anaemia occurred after the administration of acetylsalicylic acid. Erythrocyte fragmentation, with haemoglobin condensation zones next to clear zones, was observed on peripheral blood smears. Since viral or bacterial infections were excluded on the basis of the laboratory data, the anaemia was ascribed to aspirin.