Intellectual development and academic performance of children with insulin-dependent diabetes mellitus: A longitudinal study.

87 school-age children with insulin-dependent diabetes mellitus (IDDM) were assessed repeatedly over the 1st 6 yrs of their IDDM to determine the effects of the medical disorder on intellectual development and academic performance. At the initial diagnosis, verbal and nonverbal intellectual performance and school grades were in the average ranges. Over time, verbal performance and school grades declined, whereas nonverbal intellectual performance improved slightly. Duration of IDDM was found to be related to the outcome variables, but the degree of metabolic control was not. Analyses of longitudinal data for a 6-yr interval on a demographically closely matched post hoc comparison group revealed parallel but less pronounced trends in verbal and nonverbal intellectual performance but not in school grades. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study of life events and metabolic control among youths with insulin-dependent diabetes mellitus.

In a study of school-age children with new-onset insulin-dependent diabetes mellitus (IDDM), life stress, metabolic control (glycosylated hemoglobin), and psychiatric and psychosocial variables were assessed repeatedly for up to 6 years. Life stress was defined as the number of undesirable life events and extent of life change necessitated by all life events. In univariate longitudinal analyses, total life change units were related to metabolic control, with a trend for number of undesirable events to be associated with metabolic control. In multivariate analyses, metabolic control was related to life change units, whether the glycosylated hemoglobin was in the 1st year of IDDM, IDDM duration, and the diagnosis of pervasive noncompliance with medical regimen. The relationship of life stress to metabolic control among youths with diabetes is significant but clinically modest and may be partially mediated by serious noncompliance with the medical regimen. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive functioning and academic achievement in children with insulin-dependent diabetes mellitus (IDDM).

Discusses the effects of insulin-dependent diabetes mellitus (IDDM) on cognitive and academic functioning in children. IDDM children may have lower intellectual functioning, but their performance is usually average. Early age of disease onset, severe hypoglycemia, and diabetic ketoacidosis are the disease risk factors for lower IQ scores. Boys with IDDM are at greater risk for learning problems than girls, and both acute and chronic metabolic abnormalities may relate to poorer cognitive functioning. The high-risk children need periodic monitoring of their academic achievement, and may require special intervention. Intensive preschool or early intervention programs may be especially beneficial for those under the age of 5. An abbreviated Wechsler Intelligence Scale for Children—Revised (WISC—R) or WISC-III may be used for evaluating children with IDDM, as prorated performance or full scale IQ scores may not act as traditional measures of nonverbal intelligence in such children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increase in incidence of insulin-dependent diabetes mellitus among children in Finland

It has been proposed that NO may function as an endogenous cardioprotectant. We have investigated whether modulation of NO levels (detected in coronary effluent by chemiluminescence) by a blocker of its synthesis, by supplementation of its precursor, and by administration of an NO donor can influence reperfusion arrhythmias in the isolated rat heart. Rat hearts were perfused with modified Krebs' solution and subjected to 5, 35, or 60 minutes of left regional ischemia followed by 10 minutes of reperfusion. NG-Nitro-L-arginine methyl ester (L-NAME), which blocks NO synthase, increased the incidence of reperfusion-induced ventricular fibrillation (VF) from 5% in the control condition to 35% after 60 minutes of ischemia (n = 20, P < .05). The profibrillatory effect of L-NAME was prevented in hearts coperfused with 1 or 10 mmol/L L-arginine (an NO precursor) but persisted in hearts coperfused with D-arginine (1 mmol/L). L-NAME did not increase VF susceptibility in hearts reperfused after 5 or 35 minutes of ischemia. L-NAME caused sinus bradycardia (264 +/- 10 versus 309 +/- 5 bpm in control groups, P < .05) and reduced coronary flow before ischemia (6.2 +/- 0.6 versus 9.2 +/- 0.6 mL.min-1.g-1 tissue in controls, P < .05). L-NAME reduced coronary effluent NO levels after 60 minutes of ischemia; during the first minute of reperfusion, values were reduced from 1457 +/- 422 to 812 +/- 228 pmol.min-1.g-1 (P < .05). This effect was prevented by coperfusion with L-arginine (10,344 +/- 1730 pmol.min-1.g-1, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)     

New developments in treating children with insulin-dependent diabetes mellitus

A number of new developments in the management of insulin-dependent diabetes mellitus have occurred in the past several years. Primary care providers including pediatric nurse practitioners need to be aware of these developments so that they can work effectively with specialty providers in caring for children with insulin-dependent diabetes mellitus. This article discusses the implications of the Diabetes Control and Complications Trial for children and adolescents, the Diabetes Prevention Trial-Type I, and several other recent developments in caring for children with insulin-dependent diabetes mellitus.     

Relative nocturnal hypertension in children with insulin-dependent diabetes mellitus

Twenty-four-hour blood pressure and heart rate measurements were carried out in 14 newly diagnosed diabetics and in 28 diabetics with 5-13 years' duration of the disease; 8 healthy children were used as controls. Mean arterial blood pressure increased at night in 5, decreased slightly (less than 10%) in 5 and decreased markedly (more than 10%) in 18 diabetics with longer duration of the disease. The diurnal-nocturnal differences in heart rates were significantly lower in diabetics with relative "nocturnal hypertension" compared to the control group (p < 0.05). A significant negative correlation was found between maximal arterial blood pressure during physical exercise and the diurnal-nocturnal differences in mean arterial blood pressure in diabetics (r = -0.58; p < 0.02). In conclusion, we found elevated nocturnal blood pressure in a subgroup of children with longer duration of diabetes and without increased albumin excretion. However, longitudinal studies of blood pressure profiles are needed to identify the candidates for diabetic vasculopathy among diabetic children.     

Short-term memory and strategy use in children with insulin-dependent diabetes mellitus.

The present study was designed to examine recall and rehearsal in short-term memory among children with insulin-dependent diabetes mellitus (IDDM). Children with onset of IDDM before age 5 years, children with onset after 5 years, and children without IDDM were administered a measure of short-term memory that provides information about rehearsal as well as level of recall. Children with later onset of diabetes and children without IDDM were expected to recall more words and use more effective rehearsal strategies than children with early onset of diabetes. Results indicate that children diagnosed with IDDM early in life used similar rehearsal strategies but recalled fewer words than children with later onset of diabetes and children without IDDM. In addition, results provide evidence that children who are in poor control of their diabetes did not use strategies designed to increase recall as often, or as well as, children in better control of their diabetes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of insulin-dependent diabetes mellitus in siblings of children with diabetes. A population-based study. The Childhood Diabetes in Finland Study Group

The relationship between parental divorce occurring during adolescence and young adult psychosocial adjustment was examined, as was the role of family process variables in clarifying this relationship. Participants were young Caucasian adults from divorced (n = 119) and married (n = 123) families. Assessments were conducted during adolescence and 6 years later during early adulthood. Young adults from married families reported more secure romantic attachments than those from divorced families; however, differences were not evident in other domains of psychosocial adjustment after demographic variables were controlled. Three family process variables (parent-adolescent relationship, interparental conflict, and maternal depressive symptoms) were examined as potential mediators and moderators of the association between parental divorce and young adult adjustment. No evidence supporting mediation or moderation was found; however, the parent-adolescent and parent-young adult relationships, particularly when the identified parent was the father, emerged as significant predictors of young adult psychosocial adjustment.     

Social functioning and adjustment in Chinese children: A longitudinal study.

A sample of Chinese children in Shanghai, People's Republic of China, initially 8 and 10 years of age, participated in a 2-year longitudinal project. Information on social behavior and indexes of social and school adjustment was collected from multiple sources. Consistent with Western literature, sociability-leadership was associated with and predictive of indexes of adjustment. Aggression was associated with and predictive of indexes of maladjustment. Finally, inconsistent with the Western literature (e.g., K. H. Rubin & J. Asendorpf, 1993), shyness-sensitivity was positively and concurrently associated with peer acceptance, teacher-assessed competence, leadership, and academic achievement at ages 8 and 10 years in the Chinese children. However, as in the Western literature, shyness-sensitivity was positively correlated with peer rejection at age 12 years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Growth and sexual maturation in children with insulin-dependent diabetes mellitus

Prediabetes, the interval preceding the clinical recognition of diabetes mellitus, is believed to consist of several months or years of beta-cell destruction associated with no clinically recognized signs other than possible increased growth velocity. This increased growth rate may be the result of increased insulin, increased growth hormone, or both. As insulin-dependent diabetes approaches clinical recognition, insulin deficiency becomes manifest as slowing of growth velocity and more obvious weight loss. If a prepubertal child has insulin-dependent diabetes mellitus, sexual maturation is frequently delayed and physical growth is adversely affected. Insulin is an anabolic hormone that regulates metabolic pathways involved in the production of protein, glycogen, and fat. The normal release of growth hormone and the hepatic production of insulin-like growth factor I is modulated by the action of insulin. The absence of physiologic insulin response leads to dysfunctional quantities of growth hormone, insulin-like growth factor I, and sex hormones, resulting in growth impairment and delayed sexual maturation. Delayed sexual maturation may cause concern because it has a major impact on growth and maturation of children. However, there is evidence that sex hormones have a stimulating effect on the tissue damage associated with chronic hyperglycemia. The loss of physiologic insulin release significantly affects physical growth, sexual maturation, and the chronic complications associated with insulin-dependent diabetes mellitus.     

Altered adrenal and thyroid function in children with insulin-dependent diabetes mellitus

In 129 children, aged 12.6 +/- 3.8 years, affected by type 1 diabetes mellitus, the levels of dehydroepiandrosterone sulfate (DHEAS), cortisol, T3, fT3, T4, fT4, rT3, TSH, cholesterol, and triglycerides were evaluated and compared with those of a control group of 458 healthy age-matched children. The results were also correlated with hemoglobin HbA1C. The DHEAS-standard deviation score (DHEAS-SDS; -0.36 +/- 0.77) was significantly different from zero in diabetic children, while the cortisol serum level was higher than in control subjects (485 +/- 94 vs 359 +/- 132 nmol/l). Moreover, the DHEAS-SDS and DHEAS-SDS/cortisol ratio correlated negatively with HbA1c. Diabetic patients also showed lower T3 values (2.22 +/- 0.4 vs 2.32 +/- 0.3 nmol/l) and a higher rT3/T3 ratio (0.17 +/- 0.09 vs 0.15 +/- 0.05) than controls. There was a negative correlation between T3 and HbA1C. Cholesterol (4.77 +/- 1.08 vs 4.51 +/- 0.76 mmol/l) and triglycerides (0.82 +/- 0.53 vs 0.63 +/- 0.37 g/L) levels were higher in diabetic children and positively correlated with HbA1c, but not with DHEAS-SDS. We can therefore conclude that diabetes, particularly if poorly controlled, tends to induce a dissociation of cortisol and DHEAS secretion and a low T3 syndrome, similar to that seen in other illnesses.     

Coping styles in youths with insulin-dependent diabetes mellitus.

The relationships between two coping styles (i.e., use of personal and interpersonal resources; ventilation and avoidance) and two health outcomes (i.e., adherence and metabolic control) were evaluated in 135 youths with insulin-dependent diabetes mellitus (IDDM). Individual characteristics (i.e., age, duration of illness) and contextual variables (i.e., stress, family relations) were used to predict coping styles. Poor adherence to treatment, older adolescent age, and long duration of IDDM were correlated with ventilation and avoidance coping. Youths with short duration of IDDM were more likely to cope through the use of personal and interpersonal resources, although this strategy was not associated with health outcomes. A multiple regression analysis indicated that high ventilation and avoidance coping was predicted by high stress, low family cohesion, and older adolescent age. In addition, the interaction between family adaptability and duration of IDDM significantly predicted ventilation and avoidance coping. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological reactions at the onset of insulin-dependent diabetes mellitus in children and later adjustment and metabolic control

The initial psychological reactions at the onset of insulin-dependent diabetes mellitus (IDDM) in a population-based sample of 76 children were studied with staff observations and a self-report questionnaire for children 12 years of age and more. Younger children reacted with more anger and less distress than the older children. High initial self-reported distress was associated with poorer subjective psychological IDDM adjustment at a follow-up 10 months later for the older children. The children's initial reactions as well as later adjustment were intimately associated with maternal initial reactions in the total group. The metabolic control, estimated as the mean level of the major fraction of glycosylated haemoglobin (Hb AIc) during the first 2 years, was poorer in the adolescent group. Initial anxiety over injections and protest but low general distress in mothers and children were associated with better metabolic control.     

Genetics of insulin-dependent diabetes mellitus

IDDM is caused by autoimmune destruction of insulin-producing beta cells of the pancreas in genetically susceptible individuals. Although the incidence and prevalence if IDDM in Japan are much lower than those in Caucasian countries, the recurrence risk in siblings of IDDM probands is much higher than the population prevalence, indicating that IDDM is clustered in families even in Japan, where the incidence of the disease is the lowest in the world. The higher concordance rate in monozygotic twins than in dizygotic twins indicates that genetic factors contribute to the familial clustering of IDDM in Japan. Analysis of the HLA region revealed that susceptibility genes (IDDM1) consist of multiple components, those in class II DR and DQ regions and another in the class I region. Analysis in NOD mice, an animal model of IDDM, supports this observation: susceptibility genes (Idd1) are mapped to class II A and E regions, but the incidence of the disease is strongly affected by a gene or genes outside of this segment (Idd16). Studies in both humans and an animal model will clarify the genetic components of IDDM, facilitating prediction of the disease and the development of effective strategies for its prevention.     

Blood glutathione in various phases of insulin-dependent diabetes mellitus in children

Reduced glutathione (GSH) in whole blood was studied in 15 insulin-dependent juvenile diabetic patients at onset of diabetes (group A). In 5 of these patients the blood GSH concentration was followed during the first month after onset. The blood GSH content was also analyzed in 16 children with insulin-dependent diabetes mellitus (IDDM) with a duration of diabetes of more than 2 years (group B), and in a control group of 76 healthy children (group C). The GSH levels in groups A, B and C were 48.3 +/- 5.7, 47.1 +/- 4.6 and 47.6 +/- 4.3 mg/100 ml erythrocytes, respectively. Thus, there were no significant differences between the patients and the control group. In group A, there were no significant differences in blood GSH values at onset and 1 month later.     

Social relationships among young adults with insulin-dependent diabetes mellitus: ten-year follow-up of an onset cohort

In many polygynous bird species, males allocate most of their parental effort to their primary females' broods. There are several hypotheses that may explain this: the relative reproductive value of the brood, the energetic demand of the brood, the genetic quality of the female and the certainty of fatherhood may all be higher for the primary females' broods. Since these parameters may covary in nature, experiments are necessary to determine their importance. Bigynous male European starlings, Sturnus vulgarispredominantly incubated the eggs and fed the nestlings of their primary females. In an experiment we altered the order in which the clutches hatched by exchanging the primary and secondary females' eggs before hatching. Even though experimental males mostly incubated their primary females' clutches, they predominantly fed the nestlings of the secondary female. Experimental males fed secondary females' nestlings significantly more than control males did. In fact, experimental males invested in their secondary females' broods to the same extent as control males invested in their primary females' broods. This result demonstrates that males use relative brood age to decide how to allocate their parental effort between their broods which has important implications for the evolution of the starling mating system.     

The health belief model and adolescents with insulin-dependent diabetes mellitus.

Tested the predictive utility of the health belief model for adherence with a complex, ongoing medical regimen in 56 adolescent outpatients (aged 10–19 yrs) with insulin-dependent diabetes mellitus. A 3-construct model of health beliefs was tested: Threat (perceived susceptibility combined with severity), Benefits–Costs, and Cues to seek treatment. The Benefits–Costs and Cues constructs were related to compliance in the positive direction. Threat interacted with Benefits–Costs in the prediction of compliance and with Cues in the prediction of metabolic control. The greatest compliance was achieved with low perceived Threat and high perceived Benefits–Costs. Poor metabolic control was associated with high Threat and Cues. As age increased, adherence to the exercise, injection, and frequency components of the regimen decreased. (PsycINFO Database Record (c) 2010 APA, all rights reserved)