Family-based association study of HLA class II with type 1 diabetes in Moroccans.

BACKGROUND: The T1D is a multifactorial disease; with a strong genetic control. The human leukocyte antigen (HLA) system plays a crucial role in the autoimmune process leading to childhood diabetes. About 440,000 of the childhood population of the world (1.8 billion children under 14 years of age), have type 1 diabetes, and each year an additional 70,000 develop this disorder. The objective of this study was to investigate the distribution of HLA class II in Moroccan families of diabetic children to identify susceptibility alleles of the Moroccan population. SUBJECTS AND METHODS: We included in this study, Moroccan families who have at least one child with T1D. The age of onset of diabetes was less than 15 years. HLA class II (DRB1* and DQB1*) was carried out by molecular biology techniques (PCR-SSP and PCR-SSO). The FBAT test (family-based association test) was used to highlight the association between T1D and the HLA-DRB1* and -DQB1* polymorphism. RESULTS: The association of HLA class II (DRB1*, DQB1*) in type 1 diabetes was analyzed in fifty-one Moroccan families, including 90 diabetics. The results revealed that the most susceptible haplotypes are the DRB1*03:01-DQB1*02:01, DRB1*04:05-DQB1*03:02 (Z=3.674, P=0.000239; Z=2.828, P=0.004678, respectively). And the most protective haplotype is the DRB1*15-DQB1*06. CONCLUSION: This is the first family-based association study searching for an association between HLA class II and T1D in a Moroccan population. Despite the different ethnic groups forming Morocco, Moroccan diabetics share the most susceptible and protective HLA haplotypes with other Caucasians populations, specifically the European and Mediterranean populations.

Cross talk between the extracellular matrix and the immune system in the context of endocrine pancreatic islet transplantation. A review article.

This review aims to highlight the importance of the bidirectional influence of the extracellular matrix (ECM) and immune cells in the context of type 1 diabetes mellitus (T1DM) and endocrine pancreatic islet transplantation. We introduced the main classes of molecules and proteins constituting the ECM as well as cells and cytokines of the immune system with the aim to further examine their roles in T1DM and islet transplantation. Integrins expressed by immune cells and their functions are detailed. Finally, this article reviews the roles of the ECM and the immune system in islet transplantation as well as ECM-related cytokines and their influence on the ECM and immune cells.

Murphy's Law and Ophthalmic Complications in a Patient With Type 1 Diabetes Mellitus.

Diabetes can lead to various acute clinical complications, although the occurrence of ophthalmic signs and symptoms is uncommon. Neovascular glaucoma (NG), a rare complication associated with diabetes mellitus, is one such condition. Additionally, anti-vascular endothelial growth factor (VEGF)-induced toxic anterior segment syndrome (TASS) is a rare complication of intravitreal bevacizumab. In this case report, we present a unique case of a patient with juvenile diabetes (type 1 diabetes mellitus) who presented to the emergency room (ER) with typical features of diabetic ketoacidosis (DKA) accompanied by bilateral ocular pain. Subsequent investigation revealed secondary angle-closure neovascular glaucoma as the underlying cause. The patient received management for DKA in the ER and subsequent medicine ward. Various interventions were performed for glaucoma in the right eye, including addressing cataracts, which ultimately resulted in TASS. The patient was successfully treated with cryo-diode laser therapy.

Metabolic Syndrome in Patients With Diabetes Mellitus.

Aim Our study aims to assess the prevalence of metabolic syndrome (MS) in patients with diabetes mellitus, identify its determinants, and determine the correlation between MS and degenerative complications. Method A retrospective, descriptive and analytic study was conducted at the Endocrinology, Diabetology, and Nutrition department of the Hassan II University Hospital in Fez, over the period between January 2009 and January 2019. We included in our study all type 1 and type 2 diabetic patients. The presence of metabolic syndrome was defined according to the criteria of the International Diabetes Federation (IDF) and American Heart Association/National Heart, Lung and Blood Institute (AHA / NHLBI) Joint Scientific Statement (2009). The data were entered in Microsoft Excel (Microsoft Corporation. 2018). and analyzed using SPSS software (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp). Result A total of 1034 patients were included in this study; 78.7% were type 2 diabetics (T2D) and 21.3% were type 1 diabetics (T1D). The average age was 52,06 ± 17,33 years in T2D and 27,04 ± 9,66 years in T1D. 65,5% were females. The prevalence of metabolic syndrome was 78.4% for T2D, and 27.3% for T1D. The most common abnormality was high blood pressure in T2D (87.7%), and visceral obesity in T1D (68.3%). The most common triad was the association of increased waist circumference, hypertension, and diabetes (in 25,5% of T2D and 20% of T1D). By comparing the population of diabetics with metabolic syndrome (MS) and those without, we noticed a significant difference (p<0.05) concerning age, gender, all components of MS (high blood pressure, abdominal obesity, hyper triglyceridemia (TG), and hypo high-density lipoprotein cholesterol (HDL-C). Diabetic retinopathy and ischemic heart disease were the only chronic complications correlated with MS (p <0.05). Conclusion High prevalence of metabolic syndrome in diabetic patients. Its screening and the specific treatment of its various components are essential in order to reduce the complications which jeopardize the functional as well as the vital prognosis of these patients.

[Maternal diabetic ketosic decompensation which occurred during corticotherapy for fetal lung maturation. A report of three cases]. / Décompensation cétosique d'un diabète maternel au décours d'une corticothérapie de maturation pulmonaire fœtale. À propos de trois cas.

Three cases of ketosis decompensation occurring immediately in type I diabetic after corticotherapy for lung foetal maturation (LFM) are reported. Few of observations have been published. Increasing doses of insulin is mandatory under close monitoring of blood glucose levels, in particular according to the protocol proposed by Kaushal et al.: infusion of insulin adapted to the results of glucose levels, as a supplementation to the usual doses in each patient. Diabetes does not lead to hesitate prescribing a corticotherapy for LFM, but requires a strict control of needs in insulin to avoid a ketosis decompensation.

Influence of age at diagnosis on glycaemic control evolution in patients with type 1 diabetes.

AIM: The objective of this study was to describe the relationship between age at onset, with no age limits, and glycaemic control evolution from the time of onset in patients with type 1 diabetes (T1D). METHODS: This observational retrospective follow-up study included 716 patients with T1D onset between 1990 and 2008 treated at the Navarre Hospital Complex. The mean (SD) follow-up lasted 10.1 (5.3) years. Information on their HbA(1c) levels was collected at onset and every year thereafter. Generalized additive mixed models and linear models were used, with patients' annual HbA1c levels as the response variable and the number of years since onset together with age at onset as covariates. RESULTS: The evolution of glycaemic control is not linear and differs across all age groups. Children reach their highest values in adolescence, while patients with onset at ages 10-15 years stabilize their HbA(1c) values after 7 or 8 years. In adults, it is notable that an age of onset ≥ 45 years is associated with the worst control. CONCLUSION: A non-linear increase in HbA(1c) levels can be observed from the time of T1D diagnosis, with significant differences across all age groups.

Skin autofluorescence is associated with past glycaemic control and complications in type 1 diabetes mellitus.

As skin autofluorescence (AF) can assess subcutaneous accumulation of fluorescent advanced glycation end-products (AGEs), this study aimed to investigate whether it was linked to glycaemic control and complications in patients with type 1 diabetes mellitus (T1DM). Using the AGE Reader™, AF was measured in T1DM patients referred to Haut-Levêque Hospital (Bordeaux, France); data on their HbA1c levels measured every 6months as far back as the last 5years were also collected. The association of AF with the patients' past glucose control, based on their latest HbA1c values, and the means of the last five and 10 HbA1c values, and with diabetic complications was also examined by linear regression analysis. The sample included 300 patients: 58% were male; the mean age was 49 (SD 17) years and the mean diabetes duration was 21 (SD 13) years. The median skin AF measurement was 2.0 [25th-75th percentiles: 1.7-2.4] arbitrary units (AU), and this was associated with age (ß=0.15 per 10years, P<0.001) and diabetes duration (ß=0.17 per 10years, P<0.001). After adjusting for age and estimated glomerular filtration rate (eGFR), the skin AF measurement was also related to the means of the last five and 10 HbA1c values (ß=0.10 per 1% of HbA1c, P=0.005, and ß=0.13 per 1% of HbA1c, P=0.001, respectively). In addition, the skin AF was associated with retinopathy (P<0.001), albuminuria (P<0.001) and decreased eGFR (P<0.001). In conclusion, the skin AF is related to the long-term glucose control and diabetic complications.