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1.
Med Sci (Paris) ; 36(10): 879-885, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33026330

RESUMO

Pancreatic islet transplantation is a valid cure for selected type-1 diabetic patients. It offers a minimally invasive ß-cell replacement approach and has proven its capacity to significantly enhance patients quality of life. However, these insulin-secreting mini-organs suffer from the loss of intrinsic vascularization and extra-cellular matrix occurring during isolation, resulting in hypoxic stress and necrosis. In addition, they have to face inflammatory and immune destruction once transplanted in the liver. Organoid generation represents a strategy to overcome these obstacles by allowing size and shape control as well as composition. It does offer the possibility to add supporting cells such as endothelial cells, in order to facilitate revascularization or cells releasing anti-inflammatory and/or immunomodulatory factors. This review describes the limitations of pancreatic islet transplantation and details the benefits offered by organoids as a cornerstone toward the generation of a bioartificial pancreas.


Assuntos
Células Secretoras de Insulina/metabolismo , Insulina/metabolismo , Organoides/metabolismo , Pâncreas Artificial , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/terapia , Humanos , Secreção de Insulina/fisiologia , Células Secretoras de Insulina/citologia , Ilhotas Pancreáticas/citologia , Ilhotas Pancreáticas/metabolismo , Transplante das Ilhotas Pancreáticas/métodos , Organoides/citologia , Pâncreas Artificial/provisão & distribução , Técnicas de Cultura de Tecidos/métodos
2.
Nutrients ; 12(10)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33008059

RESUMO

COVID-19 related restrictions aimed at curbing the spread of the coronavirus result in changes in daily routines and physical activity which can have a negative effect on eating and health habits. The aim of the study was to assess the impact of the COVID-19 pandemic on patients with diabetes and their nutrition and health behaviours. A survey conducted in July 2020 included 124 individuals with type 1 (n = 90) and 2 (n = 34) diabetes mellitus from Poland. To assess nutritional and health behaviours, an online questionnaire covering basic information, anthropometric data, and details regarding physical activity, eating, and hygiene habits was used. Almost 40% of all respondents with type 1 and 2 diabetes mellitus (DM) stated that their disease self-management had significantly improved. Over 60% of all participants declared that they had started eating more nutritious and regular meals during the COVID-19 pandemic. Enhanced hygiene, in particular, during the period, a statistically significant increase in hand sanitiser use was reported by respondents (18% vs. 82%, p < 0.001). The study demonstrated that the pandemic had a significant impact on the behaviour of patients with DM. Improved disease self-management and making healthy, informed food and hygiene choices were observed.


Assuntos
Infecções por Coronavirus , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Dieta , Comportamentos Relacionados com a Saúde , Pandemias , Pneumonia Viral , Autogestão , Adolescente , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Exercício Físico , Comportamento Alimentar , Feminino , Desinfecção das Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Inquéritos e Questionários , Adulto Jovem
3.
Rev Med Liege ; 75(10): 653-659, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33030841

RESUMO

Physical activity is a key step in the management of diabetes, both in type 1 and type 2 diabetes. In diabetic subjects, it is recommended to practice 150 minutes of weekly physical activity spread over at least three days, with a maximum of two consecutive days without exercise. However, more than 60 % of type 1 diabetic patients fail to meet this goal. This is largely explained by the fear of potential adverse effects, in particular the occurrence of hypoglycaemia during exercise, which represents a major obstacle to its safe practice. Therefore, specific therapeutic education should be considered in these subjects in order to promote regular physical activity.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Hipoglicemia , Esportes , Diabetes Mellitus Tipo 1/terapia , Exercício Físico , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/prevenção & controle
5.
Ther Umsch ; 77(7): 297-301, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32996427

RESUMO

Laboratory investigations in clinical diabetic practice Abstract. Laboratory analysis are useful to diagnose the proper form of diabetes mellitus, for follow-up of the metabolic control, and to identify secondary complications or associated diseases. The proof of auto-antibodies confirms Type 1 diabetes and a broad range of endocrine entities of the polyglandular autoimmune syndrome, and genetic testing classifies monogenetic diabetes like MODY or MIDDM. In secondary diabetes forms underlying disease can be detected by clinical and laboratory investigation, and thus, causal treatment of the diabetes may be possible.


Assuntos
Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/terapia , Testes Genéticos , Humanos
6.
Rev. Hosp. Ital. B. Aires (2004) ; 40(3): 95-104, sept. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1128985

RESUMO

La relación entre inmunidad y cáncer es compleja. Las células tumorales desarrollan mecanismos de evasión a las respuestas del sistema inmunitario. Esta capacidad permite su supervivencia y crecimiento. La inmunoterapia ha transformado el tratamiento oncológico mejorando la respuesta inmunitaria contra la célula tumoral. Esta se basa en el bloqueo de los puntos de control inmunitario mediante anticuerpos monoclonales contra la molécula inhibidora CTLA-4 (antígeno 4 del linfocito T citotóxico [CTLA-4]) y la proteína 1 de muerte celular programada y su ligando (PD-1/PD-L1). Aunque los inhibidores de los puntos de control inmunitario (ICIs) son fármacos bien tolerados, tienen un perfil de efectos adversos conocido como eventos adversos inmunorrelacionados (EAI). Estos afectan varios sistemas, incluyendo las glándulas endocrinas. Los eventos adversos endocrinos más frecuentes son la disfunción tiroidea, la insuficiencia hipofisaria, la diabetes mellitus autoinmune y la insuficiencia suprarrenal primaria. El creciente conocimiento de estos efectos adversos endocrinos ha llevado a estrategias de tratamiento efectivo con el reemplazo hormonal correspondiente. El objetivo de esta revisión es reconocer la incidencia de estas nuevas endocrinopatías, la fisiopatología, su valoración clínica y el manejo terapéutico. (AU)


The relationship between immunity and cancer is complex. Tumor cells develop evasion mechanisms to the immune system responses. This ability allows their survival and progression. Immunotherapy has transformed cancer treatment by improving the immune response against tumor cells. This is achieved by blocking immune checkpoints with monoclonal antibodies against cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 and its ligand (PD-1 / PD-L1). Although the immune checkpoint inhibitors (ICIs) are well tolerated drugs, they have a profile of adverse effects known as immune-related adverse events (irAES). These involve diverse systems, including the endocrine glands. The most frequent endocrine immune-related adverse events are thyroid and pituitary dysfunction, autoimmune diabetes mellitus and primary adrenal insufficiency. The increasing knowledge of these irAES has led to effective treatment strategies with the corresponding hormonal replacement. The objective of this review is to recognize the incidence of these new endocrinopathies, the physiopathology, their clinical evaluation, and therapeutic management. (AU)


Assuntos
Humanos , Doenças do Sistema Endócrino/induzido quimicamente , Imunoterapia/efeitos adversos , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/induzido quimicamente , Doenças da Glândula Tireoide/patologia , Doenças da Glândula Tireoide/terapia , Tiroxina/administração & dosagem , Tri-Iodotironina/uso terapêutico , Corticosteroides/administração & dosagem , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/induzido quimicamente , Insuficiência Adrenal/patologia , Insuficiência Adrenal/terapia , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/induzido quimicamente , Diabetes Mellitus Tipo 1/patologia , Diabetes Mellitus Tipo 1/terapia , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/fisiopatologia , Doenças do Sistema Endócrino/terapia , Hipofisite/diagnóstico , Hipofisite/induzido quimicamente , Hipofisite/patologia , Hipofisite/terapia , Glucocorticoides/administração & dosagem , Insulina/uso terapêutico , Metimazol/uso terapêutico , Mineralocorticoides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Neoplasias/imunologia
7.
Rev Med Suisse ; 16(703): 1494-1497, 2020 Aug 26.
Artigo em Francês | MEDLINE | ID: mdl-32852170

RESUMO

The artificial pancreas is a system coupling an automatic insulin infusion according to a continuous glucose monitoring. It is mainly intended for type 1 diabetic patients. Many advances in this area have led to the commercialization of so-called hybrid artificial pancreas devices. These devices always require human intervention to announce the amount of carbohydrates ingested at each meal. The complete fully automated system, called closed loop, is being evaluated thanks to the improvement of prediction algorithms. This paper aims to describe the progress of the artificial pancreas in 2020.


Assuntos
Diabetes Mellitus Tipo 1 , Pâncreas Artificial , Algoritmos , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/terapia , Humanos , Hipoglicemiantes , Insulina , Sistemas de Infusão de Insulina , Pâncreas Artificial/tendências
9.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32789003

RESUMO

Despite the clear evidence that type 1 diabetes (T1D) begins well before hyperglycemia is evident, there are no clinically available disease-modifying therapies for early-stage disease. However, following the exciting results of the Teplizumab Prevention Study, the first study to demonstrate that overt T1D can be delayed with immunotherapy, there is renewed optimism that in the future, T1D will be treated before hyperglycemia develops. A different treatment paradigm is needed, as a majority of people with T1D do not meet the glycemic targets that are associated with a lower risk of T1D complications and therefore remain vulnerable to complications and shortened life expectancy. The following review will outline the history and current status of immunotherapy for T1D and highlight some challenges and ideas for the future. Although such efforts have been worldwide, we will focus particularly on the activities of Diabetes TrialNet, a National Institutes of Health consortium launched in 2004.


Assuntos
Diabetes Mellitus Tipo 1 , Hiperglicemia , Insulina/uso terapêutico , Diabetes Mellitus Tipo 1/terapia , Humanos , Imunoterapia , Estados Unidos
10.
J Adolesc Health ; 67(4): 615-617, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32798101

RESUMO

Amidst the unprecedented global pandemic of COVID-19, attending to the needs of adolescents with diabetes mellitus became more challenging. They faced the uncertainty of access to care and the attendant problems of a lockdown. We present the nurse-led telehealth initiative for adolescents with diabetes mellitus, leveraging on existing infrastructure and resources with the aim of addressing the anticipated challenges that many of the adolescents might face. The initiative was well received among those who participated, and there were no significant adverse effects noted.


Assuntos
Diabetes Mellitus Tipo 1/enfermagem , Telemedicina , Adolescente , Betacoronavirus , Infecções por Coronavirus , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/terapia , Hemoglobina A Glicada/análise , Humanos , Pandemias , Satisfação do Paciente , Pneumonia Viral , Singapura , Inquéritos e Questionários
11.
Scand J Immunol ; 92(5): e12961, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32853446

RESUMO

The new era of immune and reconstitution therapy of autoimmune disorders is ongoing. However, endocrine autoimmune diseases comprise a group of elaborating pathologies where the development of new treatment strategies remains slow. Substitution of the missing hormones is still standard practice, taking care of the devastating symptoms but not the cause of disease. As our knowledge of the genetic contribution to the aetiology of endocrine disorders increases and early diagnostic tools are available, it is now possible to identify persons at risk before they acquire full-blown disease. This review summarizes current knowledge and treatment of endocrine autoimmune disorders, focusing on type 1 diabetes, Addison's disease, autoimmune thyroid diseases and primary ovarian insufficiency. We explore which new therapies might be used in the different stages of the disease, focus on legalized therapy and elaborate on the ongoing clinical studies for these diseases and the research front, before hypothesizing on the way ahead.


Assuntos
Doença de Addison/imunologia , Doenças Autoimunes/imunologia , Diabetes Mellitus Tipo 1/imunologia , Doenças do Sistema Endócrino/imunologia , Insuficiência Ovariana Primária/imunologia , Doenças da Glândula Tireoide/imunologia , Doença de Addison/genética , Doença de Addison/terapia , Doenças Autoimunes/genética , Doenças Autoimunes/terapia , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/terapia , Doenças do Sistema Endócrino/genética , Doenças do Sistema Endócrino/terapia , Feminino , Humanos , Imunoterapia/métodos , Modelos Imunológicos , Insuficiência Ovariana Primária/genética , Insuficiência Ovariana Primária/terapia , Doenças da Glândula Tireoide/genética , Doenças da Glândula Tireoide/terapia
12.
Curr Diab Rep ; 20(8): 37, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32638126

RESUMO

PURPOSE OF REVIEW: Youth with strong self-regulation (SR), or the ability to manage thoughts, emotions, and behaviors, engage in more effective type 1 diabetes (T1D) management. However, while parent support and engagement are critical to ensuring positive youth T1D outcomes, it is rarely considered that parents' SR may also influence youth T1D management. If this is the case, novel interventions to improve parents' SR or ensure adequate support for parents with SR challenges offer great potential to improve family functioning and youth T1D management. RECENT FINDINGS: Theoretical and preliminary empirical evidence suggests that parental SR impacts family processes that support youth T1D treatment regimen adherence. Furthermore, parent and youth SR likely interact, with high parent SR enhancing the positive effects of high youth SR or compensating for low youth SR. Continued research is needed to better understand the ways in which parent SR matters to youth T1D management and identify how to support improvements in T1D management among families of parents with low SR.


Assuntos
Diabetes Mellitus Tipo 1 , Autocontrole , Adolescente , Diabetes Mellitus Tipo 1/terapia , Humanos , Pais
13.
Pediatr Clin North Am ; 67(4): 661-664, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650864

RESUMO

Management of type 1 diabetes mellitus for pediatric and young adult patients is well suited for telehealth. Diabetes management requires frequent communication with health care providers as well as the interpretation of many types of data that can be measured in the home and shared virtually to the provider by the patient. Telehealth technologies allow for a safe alternative and/or addition to in-person care for youth with diabetes. Telehealth increases access to health care, saves time and money, and results in improvements in rates of appointment adherence, patient satisfaction, and quality of life.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Gerenciamento Clínico , Telemedicina/métodos , Criança , Humanos , Satisfação do Paciente , Qualidade de Vida
14.
Pediatr Clin North Am ; 67(4): 759-772, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650871

RESUMO

Lack of access to subspecialty care and persistent suboptimal outcomes for insulin-requiring patients with diabetes mandates development of innovative health care delivery models. The workforce shortage of endocrinologists in the United States results in primary care providers taking on the role of diabetes specialists despite lack of confidence and knowledge in complex diabetes management. The telementoring model Project ECHO amplifies and democratizes specialty knowledge to reduce disparities in care and improve health outcomes. Project ECHO can be applied to type 1 diabetes and other complex medical conditions to address health disparities and urgent needs of complex patients throughout the lifespan.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Educação Continuada/métodos , Educação a Distância/métodos , Endocrinologia/educação , Visitas com Preceptor , Telemedicina/métodos , Humanos , Modelos Educacionais , Populações Vulneráveis
16.
Cardiovasc Diabetol ; 19(1): 102, 2020 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-32622354

RESUMO

Glycemic variability (GV), defined as an integral component of glucose homoeostasis, is emerging as an important metric to consider when assessing glycemic control in clinical practice. Although it remains yet no consensus, accumulating evidence has suggested that GV, representing either short-term (with-day and between-day variability) or long-term GV, was associated with an increased risk of diabetic macrovascular and microvascular complications, hypoglycemia, mortality rates and other adverse clinical outcomes. In this review, we summarize the adverse clinical outcomes of GV and discuss the beneficial measures, including continuous glucose monitoring, drugs, dietary interventions and exercise training, to improve it, aiming at better addressing the challenging aspect of blood glucose management.


Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Estilo de Vida Saudável , Hipoglicemiantes/uso terapêutico , Comportamento de Redução do Risco , Animais , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Dieta Saudável , Exercício Físico , Homeostase , Humanos , Hipoglicemiantes/efeitos adversos , Valor Nutritivo , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Diabetes Res Clin Pract ; 166: 108297, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32623042

RESUMO

AIMS: Coronavirus disease (Covid-19) could lead persons with pre-existing medical conditions to severe respiratory infections. The Italian Government introduced quarantine to limit viral transmission. This measure could lead people with type 1 diabetes (PWT1D) to disrupt daily care routine including PA practice with difficulties in glycemia management. This study aims to explore PA level in PWT1D before and during quarantine and to describe variation in glycemia values. METHODS: An online survey investigating medical factors and the perceived and PA level in pre-established period before and after the introduction of quarantine was developed. Comparison between pre and post quarantine was assessed by Wilcoxon Signed Ranks test for continuous variables. RESULTS: A total of 154 subjects satisfied the eligibility criteria (54.5% males, 44.8 ± 12.5 years). We found a decrease of PA level (Godin Scale Score 25 ± 1.7vs38.6 ± 1.7 points), steps number and minutes of exercise (respectively 12.606 ± 5026vs4.760 ± 3.145 and 66±4 vs 38±3) and an increase of glycemia values (142.1 ± 25.4 mg/dLvs150.8 ± 29.4 mg/dL). CONCLUSIONS: PWT1D reported a decrease in exercise and worst glycemia. Although PWT1D tried to remain active, their PA level was inadequate to prevent glycemia rising. The difficult to maintain a glycemic control could expose patients to diabetes complications and to an higher risk to counteract infections.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Diabetes Mellitus Tipo 1/terapia , Exercício Físico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Glicemia/análise , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/virologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Quarentena , Inquéritos e Questionários
18.
Diabetes Res Clin Pract ; 166: 108281, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628980

RESUMO

AIMS: To evaluate the effect of continuous subcutaneous insulin infusion (CSII) on glycaemic control, hypoglycaemia and emotional distress in adults with type 1 diabetes (T1D) during the first 12 months. METHODS: 47 patients were started on CSII as per NICE guidelines. Anthropometric, clinical and biochemical parameters, hypoglycaemia rates and emotional distress measured by Problem Areas in Diabetes questionnaires (PAID) were recorded at baseline and during follow up at 3-6 months and 6-12 months. RESULTS: Mean HbA1c dropped by 1.1% (11.8 mmol/mol; p < 0.0001) at 3-6 months and by 0.8% (8.6 mmol/mol; p = 0.008) at 6-12 months. Most patients had improved HbA1c between 6.5 and 8.5% (48-69 mmol/mol) during these follow ups (68.3% and 71.5% respectively). Frequency of hypoglycaemia reduced from 338.2 to 187.2 and 155.3 per 100 patient years during follow ups. Severe hypoglycaemia also decreased from 48.9 to 8.5 and 6.3 per 100 patient years respectively. PAID scores improved from 29.8 ± 18.5 to 17.2 ± 14.0 (p = 0.0002) at 3-6 months and to 12.8 ± 11.7 (p < 0.00001) at 6-12 months. Reduction in HbA1c, insulin dose and PAID scores was more significant in group with HbA1c > 8.5% (69 mmol/mol) at baseline whereas improvement in episodes of hypoglycaemia and severe hypoglycaemic was more in patients who had HbA1c ≤ 8.5% before commencement of CSII therapy. CONCLUSIONS: CSII therapy led to early improvement in glycaemic control, rates of hypoglycaemia and diabetes specific emotional distress. As beneficial effects are recorded within the first few months, CSII therapy should be started more proactively in T1D.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 1/terapia , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Angústia Psicológica , Estresse Psicológico/etiologia , Adulto , Glicemia/análise , Glicemia/metabolismo , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Seguimentos , Humanos , Hipoglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-32708617

RESUMO

Many adolescents with type 1 diabetes experience challenges in achieving good glycemic control and have insufficient understanding in executing interventions for glycemic control. This study aimed to understand self-management experiences of adolescents with type 1 diabetes in Taiwan. In this descriptive phenomenological study, we conducted in-depth interviews with 18 adolescents with type 1 diabetes from the pediatric outpatient clinic of a medical center. Data were analyzed using the Colaizzi's method. Four themes were identified: (1) misconception regarding self-management of blood glucose; (2) conflict between depending on and breaking away from parental assistance for glycemic control; (3) encounter with disruptions in glycemic control regimen due to the presence of schedule changes; and (4) lack of motivation to achieve good glycemic control. The findings indicated that the misconceptions of adolescents with type 1 diabetes about managing glycemic levels resulted from an insufficient understanding of self-management of diabetes. In Taiwan, the heavy emphasis of academic achievement and changes of schedules during breaks tended to disrupt the regimen for glycemic control. Healthcare professionals are encouraged to provide individualized education focusing on the adolescents' misconceptions regarding self-management of diabetes.


Assuntos
Diabetes Mellitus Tipo 1 , Autogestão , Adolescente , Glicemia , Diabetes Mellitus Tipo 1/terapia , Humanos , Motivação , Taiwan
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