Validation of the type 1 diabetes distress scale (T1-DDS) in a large Danish cohort: Content validation and psychometric properties.

Aim: To validate the Type 1 Diabetes Distress Scale (T1-DDS) in a large sample of adults with Type 1 diabetes (T1D) from diabetes clinics in Denmark. Methods: Altogether 40 adults with T1D were interviewed to explore the content of T1-DDS in a Danish setting and to validate the translation of the T1-DDS into Danish. Subsequently, a survey including T1-DDS, the Problem Areas In Diabetes scale (PAID-20), fear of hypoglycemia, social support, and diabetes duration was answered by 2201 people with T1D. Other person characteristics were collected from the National Patient Register. HbA1c was obtained from the Clinical Laboratory Information System. Data distribution, internal consistency, convergent and construct validity, factor structure, three weeks retest, and cut-points were explored. Results: Interview data supported the relevance of all T1-DDS items for the assessment of diabetes distress among adults with T1D. The T1-DDS showed good content and acceptable construct validity, and the ability to detect high diabetes distress levels. A high correlation between T1-DDS and PAID-20 (rho = 0.91) was found. The retest scores showed a good reliability (all rho ≥0.68) with the highest variability in the Friends/Family Distress and Physician Distress subscales and the lowest variability in the Powerlessness and Eating Distress subscales of the T1-DDS. Qualitative findings pointed out relevant concerns of people with T1D, which were not included in the T1-DDS. Conclusion: The study supports the use of the Danish T1-DDS, but also highlights that existing diabetes distress questionnaires including T1-DDS do not cover all potential diabetes stressors and worries.

Vitamin D, parathyroid hormone, and bone mineral content of lumbar spine and femur in primary biliary cirrhosis.

In order to elucidate the pathogenesis and degree of osteopoenia in primary biliary cirrhosis (PBC) we conducted a cross-sectional study of 47 non-selected female patients with biopsy-proven PBC. Bone mineral content (BMC) of the lumbar spine, femoral neck and femoral shaft was determined using dual photon absorptiometry. Compared to healthy females of corresponding decades the PBC patients exhibited significantly decreased mean BMC-values in lumbar spine (88%, P less than 0.05) and femoral neck (92%, P less than 0.05) but not in femoral shaft (96%, NS). Bone mineral content was not significantly associated with duration of liver disease, impairment of liver function (serum concentrations of albumin, clotting factors II + VII + X, bilirubin, alkaline phosphatase galactose elimination capacity or histology), variables reflecting calcium homeostasis (serum concentrations of ionized calcium, parathyroid hormone, vitamin D binding protein, 25-hydroxy vitamin D3 and 1,25-dihydroxy vitamin D3) or previous treatment with glucocorticosteroids. In view of our negative findings we suggest that future studies in this field should focus on physical activity and female sex hormones as determinants for the prevention of osteopoenia in females with primary biliary cirrhosis.

Low serum free T3 concentrations in postobese patients previously treated with very-low-calorie diet.

Thirteen postobese patients with stable body weights were studied and compared with obese patients and normal subjects. Six had previously been treated with a very-low-calorie diet (VLCD) whereas seven had been treated with gastroplasty (GP). The median observation time of post-obesity was 20 months for GP patients, but significantly (P less than 0.001) shorter by 2 months in VLCD patients. The median serum concentration of free triiodothyronine (T3) was significantly (P less than 0.005) reduced in the postobese VLCD patients (3.4 pmol/l) but normal in postobese GP patients (4.2 pmol/l) and obese patients (4.5 pmol/l). The serum level of total T3 was correspondingly lowered in the postobese VLCD patients. Also the postobese GP patients had a small, but significant (P less than 0.01) reduction in the median serum concentration of total T3 suggesting a slight decrease in the binding capacity. The serum levels of thyroxine-binding globulin and thyroxine-binding prealbumin were normal in both postobese and obese patients. Furthermore, the serum levels of thyroxine were normal showing that the postobese patients were euthyroid. The study shows that serum concentrations of T3 are not associated with body weights and low serum concentration may be seen in postobese patients after VLCD.

Serum free triiodothyronine in obesity.

Serum concentrations of free triiodothyronine (T3) and total T3 were measured in 25 grossly obese patients with constant body weight and no dietary restrictions. The results were compared with serum free T3 and total T3 in 55 non-obese volunteers matched in sex and age. Median serum concentration of free T3 (4.5 pmol/l) and total T3 (1.80 nmol/l) in the obese patients were not significantly (P greater than 0.10) different from free T3 (4.6 pmol/l) and total T3 (1.84 nmol/l) in the normal persons. The risk of type II error (P beta) for overlooking a possible, true difference between obese and normal persons were estimated. If there is a difference in the mean value of free T3 then it is less than 0.5 pmol/l (P beta less than 0.05), corresponding to 12 per cent of the mean value of free T3 in the normal persons. If there is a difference in the mean value of total T3 then it is less than 0.21 nmol/l (P beta less than 0.01) corresponding to 11 per cent of the mean value of total T3 in the normal persons. The caloric and carbohydrate intakes were estimated in 17 of the obese patients and showed no significant correlations with serum free or total T3. The study indicates that the thyroid function per se is normal in obesity and adapts to increasing body weight by enhanced production of thyroid hormones and thereby sustaining a normal serum concentration of free T3.

Endocrine effects of lithium: II. 'Primary' hyperparathyroidism.

Ninety-six manic-depressive patients were studied during long-term lithium treatment. Highly significant elevations were observed respecting the levels of serum immunoreactive parathyroid hormone (P less than 0.001) as well as the protein-corrected levels of serum calcium (P less than 0.001) and serum magnesium (P less than 0.001), thus indicating a state of 'primary' hyperparathyroidism. The patients as a group had normophosphataemia and normophosphatasia supporting the impression of a rather mild state of biochemical hyperparathyroidism.

Parathyroid hormone and calcitonin in serum of patients with mammary carcinoma.

Immunoreactive parathyroid hormone and calcitonin in serum were measured in 34 normocalcemic patients with mammary carcinoma. The mean value of parathyroid hormone was significantly higher in 26 patients with bone metastases than in 8 patients without (p less than 0.025). One patient with bone metastases had slightly raised calcitonin in serum. No difference as to parathyroid hormone values between the groups of previously irradiated and non-irradiated patients was found. A possible explanation of the normocalcemic hyperparathyroidism is presented.