[Individualization of diabetes treatment by automated insulin delivery]. / Individualisierung der Diabetestherapie durch Automatisierung der Insulingabe.

Insulin pumps and glucose sensors have been shown to be effective in improving diabetes treatment and reducing acute complications according to data from registries. Therefore, in pediatric diabetology the use of at least one technical device is standard. Both devices can also be combined to form automated insulin delivery (AID) systems.Many AID systems have been tested in clinical trials and have proven to be safe and effective. The supply situation in Germany currently only allows one system to be prescribed for people insured by the statutory health insurances. Currently, children younger than 7 years of age cannot be treated with this system. The reasons for this are legal hurdles and lack of certification by the manufacturers. The CE certification can also lead to problems with insulin prescriptions. Open-source systems are non-regulated variants to circumvent existing regulatory conditions. There are risks here for both users and prescribers.For permanent use a thorough knowledge of the features of each AID system is necessary for both the user and the practitioner. Complete automation does not yet work. For the evaluation of the AID treatment, the metric data of the glucose sensors, the time in range and the glucose management index are the recognized and suitable parameters, because they allow a consultation based on real data from the daily life of people with diabetes.As all glucose sensors are read out via cloud-based software or the data are obtained directly and automatically from a telephone-linked receiver device, this provides the ideal technical basis for telemedical care, which still needs to be configured.

Updated 24-year trend of Type 1 diabetes incidence in children in Poland reveals a sinusoidal pattern and sustained increase.

AIMS: To present the incidence trend for Type 1 diabetes in Polish children aged 0-14 years, updated using data collected during 2005-2012, and assess the reliability of the predictive model constructed previously using the 1989-2004 database. METHODS: Children aged < 15 years with newly diagnosed Type 1 diabetes are recorded prospectively (EURODIAB criteria) in several regional registers in Poland. Age- and gender-standardized incidence rates for Type 1 diabetes were calculated per 100 000 persons/year. Incidence rates were analysed in terms of the dependency on age, gender, geographical region and population density. Incidence rate trends over time were modelled using generalized linear models. RESULTS: The mean standardized incidence for 1989-2012 was 12.72 per 100 000 persons/year [95% confidence interval (CI), 11.35 to 14.21]. Over the 24-year observation period, the incidence increased from 5.36 to 22.74 per 100 000 persons/year. The lowest incidence rate was in children aged 0-4 years (8.35, 95% CI 7.27 to 9.57 per 100 000 persons/year). There was no difference between genders, or urban and rural regions. Incidence rates were higher in northern compared with southern Poland [14.04 (95% CI 12.59 to 15.63) vs. 11.94 (95% CI 10.62 to 13.39) per 100 000 persons/year]. The new data corrected the earlier predictive model by changing the estimates of some factors related to patient age, gender and their interactions with the remaining factors. The incidence rate shows periodic 5.33-year fluctuations. The periodicity component allows for a more accurate prediction of the incidence rate over time. CONCLUSIONS: This cohort study reveals a sustained increase in Type 1 diabetes incidence in Polish children aged 0-14 years with regular, sinusoidal fluctuations and a slight levelling off in past few years. It is of concern that are the highest increases in incidence are found in children aged 0-4 years.

ATP4A autoimmunity and Helicobacter pylori infection in children with type 1 diabetes.

Persistent presence of ATP4A autoantibodies (ATP4AA) directed towards parietal cells is typical for atrophic body gastritis (ABG), an autoimmune disease associated with type 1 diabetes. We assessed whether Helicobacter pylori (Hp) infection might be associated with positivity for ATP4AA in children with type 1 diabetes. Sera were collected from 70 (38♀) type 1 diabetes children [aged 13·2 ± 4·5 years, age at diagnosis 8·8 ± 4·3 years, diabetes duration 4·5 ± 3·8 years, mean HbA1c 7·8 ± 1·6% (62 ± 17·5 mmol/mol)] seen at the regional diabetes clinic in Katowice, Poland. Patients were tested concurrently for Hp infection by means of a 13C urea breath test. ATP4AA were measured using a novel radioimmunoprecipitation assay developed at the Barbara Davies Center for Childhood Diabetes, University of Colorado. ATP4AA were present in 21 [30%, 95% confidence interval (CI) = 19-41%] and Hp infection was detected in 23 (33%, 95% CI = 22-44%) children. There was no statistically significant association between ATP4AA presence and Hp status. ATP4AA presence was not associated with current age, age at type 1 diabetes diagnosis, diabetes duration or current HbA1c. ATP4AA were more prevalent in females [42% (26-58%)] than males [16% (3-28%)], P = 0·016. ATP4A are found in nearly one-third of children with type 1 diabetes and more common among females. In this cross-sectional analysis, Hp infection was not associated with autoimmunity against parietal cells.

Magnetic and structural phase transitions in La0.5Sr0.5CoO(3-δ) (0 ≤ δ < 0.3) cobaltites.

The evolution of the crystal structure and the magnetic properties was investigated in the La0.5Sr0.5CoO(3-δ) (0 < δ < 0.3) system as a function of the oxygen deficit δ. Compounds with a low oxygen deficit (δ < 0.1) are shown to be predominantly ferromagnetic, while further increase (δ > 0.1) gradually changes the magnetic structure from ferromagnetic to G-type antiferromagnetic and causes a structural transition from rhombohedral to cubic symmetry. Resistivity and magnetoresistance at low temperature increase with increasing of oxygen vacancies. It is argued that oxygen reduction facilitates stabilization of the high spin state of Co(3+) ions. Antiferromagnetic interactions between cobalt ions in the high spin state are found to dominate in compounds with the oxygen deficit δ > 0.18.

Rapid increase in the incidence of type 1 diabetes in Polish children from 1989 to 2004, and predictions for 2010 to 2025.

AIMS/HYPOTHESIS: We analysed the temporal changes in the incidence of childhood type 1 diabetes and its demographic determinants in Poland from 1989 to 2004, validating the model with data from 1970 to 1989. We also estimated a predictive model of the trends in childhood diabetes incidence for the near future. METHODS: Children under 15 years with newly diagnosed type 1 diabetes mellitus and drawn from seven regional registries in Poland were ascertained prospectively using the Epidemiology and Prevention of Diabetes study (EURODIAB) criteria. The type 1 diabetes incidence rates (IRs) were analysed in dependency of age, sex, seasonality, geographical region and population density. Time trends in IR were modelled using several approaches. RESULTS: The average incidence, standardised by age and sex, for 1989 to 2004 was 10.2 per 100,000 persons per year and increased from 5.4 to 17.7. No difference was found between boys and girls, or between urban and rural regions. In children above 4 years, IR was significantly higher in the population of northern Poland than in that of the country's southern part, as well as in the autumn-winter season, this finding being independent of child sex. Based on the trend model obtained, almost 1,600 Polish children aged 0 to 14 years are expected to develop type 1 diabetes in 2010, rising to more than 4,800 in 2025. The estimates suggest at least a fourfold increase of IR between 2005 and 2025, with the highest dynamics of this increment in younger children. CONCLUSIONS/INTERPRETATION: These estimates show that Poland will have to face a twofold higher increase in childhood type 1 diabetes than predicted for the whole European population. The dramatic increase could have real downstream effects on Poland's healthcare system.

Bone status in adolescents with type 1 diabetes.

AIMS: The aim of the study was to investigate the potential negative impact of type 1 diabetes on bone status of adolescents. Bone status in adolescents with type 1 diabetes was assessed by means of quantitative ultrasound (QUS) and the influence of metabolic control and other disease-related and growth variables was analysed. METHODS: Group I consisted of 99 pubertal (Tanner > or = 2) adolescents (49 female), aged 14.3 +/- 2.5 years, diabetes duration 4.6 +/- 2.3 years. Controls (group II) were 297 children, matched by sex and age, from a healthy population. The influence of glycated haemoglobin (current: HbA(1c)D; last year's mean: HbA(1c)Y; whole duration mean: HbA(1c)T), diabetes duration, percentage of life with disease and daily insulin requirement (DIR) on amplitude dependent speed of sound (Ad-SoS) at distal phalanges was studied. RESULTS: In comparison to the control group, adolescents with type 1 diabetes presented significantly higher BMI SDS (0.82 [95% CI 0.54, 1.10] vs -0.06 [95% CI -0.16, 0.04] p < 0.001) and lower Ad-SoS SDS (-0.34 [95% CI -0.57, -0.11] vs -0.03 [95% CI -0.15, 0.08], p < 0.05). No correlation between Ad-SoS SDS and sex, DIR or diabetes duration was observed. The lower Ad-SoS SDS reflects reduced bone status, and the reduction was significantly more marked in those patients whose HbA(1c)T was higher than 7.0% when compared with those whose HbA(1c)T was lower. CONCLUSIONS: Bone status of adolescents with type 1 diabetes mellitus assessed with QUS differs from that of healthy peers and is dependent on long-term metabolic control.