Type 1 Diabetes

There is strong evidence that oxidative stress is involved in the aetiology and pathogenesis of diabetes and its complications. Increased production of reactive oxygen species in vivo can lead to cellular biomolecule damage, such as lipid peroxidation and DNA damage. The aim of this study was to determine the extent of this damage by measuring in vivo antioxidant status, levels of lipid peroxidation, and levels of neutrophil DNA damage in 50 participants with type 1 diabetes and 50 age-and sex-matched, healthy controls. Gylcaemic control (%HbA1c) was relatively good with a group mean of 7.71% which increased to 8.12 % in those with complications. Compared to the control group there were significantly elevated levels of neutrophil DNA damage (% tail DNA, p<0.0001) and plasma MDA levels (p<0.05) in the Type 1 group as a whole, this significance rose to p<0.01 in those with complications. There were significant alterations in markers of antioxidant status including, reduced levels of superoxide dismutase (p<0.0001), uric acid (p<0.05) and Vitamin C (p<0.05) and elevated levels of catalase (p<0.001). These results indicate that even with acceptable glycaemic control significant oxidative damage still occurs and this damage increases, in some indices, with the onset of complications.

Parents whose children suffer from diabetes face various issues and challenges, including reduced Quality of Life (QoL). On the other hand, they have an essential role in taking care of their diabetic children. Materials and Methods: This descriptive correlational study was conducted in 2020 in Jiroft, Iran, to evaluate the QoL in 96 parents of children with type 1 diabetes. The sampling method in this study was census and the study population was parents with a child suffering from type 1 diabetes. Research tools included Demographic Information Checklist and Health-related QoL Questionnaire (SF36). SPSS software v. 19 was used for data analysis. Descriptive statistics was used as frequency tables, and indicators such as mean and standard deviation described the demographic characteristics and the QoL. Pearson correlation coefficient test was deployed to assess the QoL. Independent chi-square and t-test were used to relate this variable to demographic characteristics. Results: There is a significant difference between life satisfaction, parental boredom, feeling of well-being, sufficient income, general health status, and being covered by supportive institutions of parents of type 1 diabetic children with the QoL (P<0.05). Conclusion: By knowing this group of parents' living conditions and implementing programs to support these families, the QoL of parents with a diabetic child can be improved.

Aims
Continuous subcutaneous insulin infusion delivered via a pump is increasingly recommended for younger children with type 1 diabetes. We aimed to better understand the impacts on parents who care for young children using insulin pumps. Our objectives were to help interpret psychological outcomes reported in quantitative research and inform provision of support to future parents.

Methods
In-depth interviews with 19 parents of children (aged ≤12 years) with type 1 diabetes who used an insulin pump. Data were analysed thematically.

Results
Parents reported multiple benefits from using insulin pumps, including: no longer having to administer painful injections, less restriction on the frequency, timing and carbohydrate contents of snacks and meals, improvements in family life and their child’s glycaemic control. Parent liked and felt less anxious about using bolus calculators to determine insulin doses. Parents, however, also described undertaking additional and unanticipated work to manage their child’s diabetes using a pump. This included: performing more blood glucose tests in order to calculate insulin doses for snacks and to address their concerns that the pump increased their child’s risk of hypoglycaemia. Some parents reported doing additional blood glucose checks because they could adjust pump settings to better manage hypo- and hyperglycaemia.

Conclusions
Parents liked and perceived benefits for their child and themselves from using an insulin pump. However, parents would benefit from being made aware of the additional work involved in using a pump and education and support to address concerns about hypoglycaemia. Better measures to evaluate parents’ experiences are also recommended.

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The rising burden of diabetes is mainly ascribed to environmental and emotional changes. The main contributors are sedentary lifestyle including internet and TV usage, caloric rich diets leading to increasing obesity. The National Diabetes Survey of Pakistan (NDSP 2016– 2017) has reported the prevalence of diabetes as 26.3% in Pakistan. Pakistan with very high numbers of prevalent diabetes needs a cost-effective population based approach for screening. Proper governance system has to be adopted to facilitate multi sectoral collaboration, including transparency and evaluation for achieving Non-Communicable Disease (NCD) associated targets. According to health economists, if a country invests 1$ per person in interventions for NCDs now, it shall expect a return of 7$ per person in NCDs by 2030. Increase NCDs with increasing age is not unexpected but premature morbidity and mortality with NCDs must be efficiently and diligently tackled. Finally, though the numbers to treat are really high, but human resources and evidence based solutions are enough to call multi stake holders to ACT NOW.

This work compares several well-known models and simulators which may be used as a means to analyze glucose level controllers for Insulin Dependent Diabetes Mellitus (IDDM) patients. The objective is to compare them in terms of their use in practical situations which should include important issues: model uncertainty, time variations, nonlinearities, glucose and insulin measurement noise, delays between subcutaneous and plasma levels, pump saturation, and real-time controller implementation. The prospective use as a means of controller design is also taken into consideration.

This dissertation aims to critically analyse the children’s nurse’s role in improving compliance in adolescents with type 1 diabetes, to enhance their quality of life. Non-adherence to a type 1 diabetes treatment regime is a growing problem within the adolescent population for many different reasons. The biopsychosocial approach will be utilised to explore themes such as puberty, stigma, depression, peers and parenting. The children’s nurse’s role within the wider multidisciplinary team will be highlighted and how all roles and responsibilities are significant in ensuring the child can receive best quality care. Additionally, the children’s nurse’s role in leadership and management will be analysed and the implementation of improvement strategies to encourage adherence will be discussed.
Health promotion, medical conferences, sporting innovations and medical technology are highlighted as four effective strategies to improve adherence. Furthermore, leadership and management theories will be analysed and applied by the children’s nurse to underpin how suitable strategies can be implemented. The children’s nurse’s role in ensuring the family centred care approach is continuously applied will be explained, ensuring the child and family have a voice within their care. The children’s nurse must enhance the young person’s understanding of why adherence to treatment is fundamental and aid them in achieving this, resulting in positive health outcomes and a good quality of life throughout adolescence, into adulthood.

Nutritional ketosis is effective to contrast seizure disorders and various acute and chronic neurological disorders. From a physiological perspective, glucose is the primary metabolic fuel for cells. However, many neurodegenerative disorders have been recently associated with impaired glucose transport and metabolism and with mitochondrial dysfunction causing energy deficits, such as in Alzheimer’s disease, Parkinson’s disease, general seizure disorders, and traumatic brain injury. Therapeutic ketosis can be considered as a metabolic therapy by providing alternative energy substrates, which may have potent cellular protective properties independent of their bioenergetic function. Therapeutic ketosis leads to metabolic adaptations that may improve brain metabolism, restore mitochondrial ATP production, decrease reactive oxygen species production, reduce inflammation, and increase neurotrophic factors’ function. Prior to the advent of exogenous insulin for the treatment of diabetes mellitus (type II) in the 1920's, the general guidelines for therapy were represented only by dietary modifications. At the time, diet recommendations aimed to control blood glucose (which in most cases was only glycosuria) and were dramatically different from current low-fat, high-carbohydrate dietary recommendations for patients with diabetes. The aim of this review article is to analyze the current literature in matter of therapeutic ketosis and its successful clinical applications in diabetes type I and II, thus paving the road towards a wider and safer use of this metabolic approach in these patients.

This work compares three well-known models and simulators in terms of their use in the analysis and design of glucose controllers for patients with Type 1 Diabetes Mellitus (T1DM). The objective is to compare them in practical scenarios which include: model uncertainty, time variance, nonlinearities, glucose measurement noise, delays between subcutaneous and plasma levels, pump saturation, and real-time controller implementation. The pros and cons of all models/simulators are presented. Finally, the simulators are tested with different robust controllers in order to identify the difficulties in the design and implementation phases. To this end, three sources of uncertainty are considered: nonlinearities, time-varying behavior (intra-patient) and inter-patient differences.

Diabetes mellitus is a major global metabolic disorder of 21 st century. This is due to its broad spectrum of associated complications with risks, like cardiac and renal disorders. The rapid growth of diabetes is becoming a major burden upon healthcare facilities in all affected countries. Due to lack of definitive preventative measures of diabetes, we must be aware of this pandemic and follow a disciplined lifestyle to limit it. In this communication, recent advances in diabetes management and current preventative measures have been concluded.

Regulatory T-cells (Tregs) play important role in regulation of immune responses to self-antigens. Alterations in frequency and function of Tregs have been reported in Type 1 Diabetes (T1D) subjects. Tregs have the potential to prevent destruction of pancreatic beta cells by targeting effector T-cells (Teff) and other immune cells causing inflammation. Therefore, strategies to increase Treg cell numbers and function are being explored as potential immunotherapeutic approaches in treating T1D. Today, several groups are involved in exploring different Treg cell types, sources, induction procedures and experimental systems in pursuit of generation of highly efficacious and stable Tregs for their clinical applications. Various protocols have been developed for the induction and expansion of islet antigen specific Tregs and polyclonal Tregs. Studies have shown that antigen specific Tregs are required at less number and are more efficient than polyclonal Tregs in suppressing autoimmune diabetes and they do not cause generalized immune suppression. Alternatively, generation of colonic Tregs (cTregs) has also gathered attention in recent years as an approach to limit pancreatic inflammation via gut induced tolerance. With a definitive treatment for T1D still elusive, application of Tregs as a part of combination therapy seems promising in treatment of T1D.

Diabetes Melitus adalah gangguan metabolisme lemak, karbohidrat, dan protein. Gangguan ini disebabkan karena kekurangan sekresi insulin, penurunan sensitivitas aksi insulin atau keduanya. Diabetes Melitus terbagi menjadi dua, yaitu Diabetes tipe 1 dan Diabetes tipe 2. Membahas tentang Riwayat alamiah penyakit (RAP) dan pencegahannya.

Background: Diabetes mellitus has reached epidemic proportions in many countries. Current challenges in diabetes
mellitus management include: optimizing the use of currently available therapies to ensure adequate glycemic, blood
pressure, and lipid control and to reduce complications. Aim of the review is to provide a brief overview of recent
advancement in diabetes mellitus management. Method Different published articles were reviewed systematically.
Result Current standard of care for Type 2 Diabetes mellitus consists of screening for elevated HbA1c levels or, in some
cases, fasting plasma glucose, with diagnosis followed by management with lifestyle modifications and metformin. While
Insulin, along with diet, is crucial to the survival of individuals with Type 1Diabetes Mellitus. Despite the known benefits
of lifestyle modification, and insulin therapy many individuals still find it harder to maintain a healthier life because
of the higher possibilities of sedentary behavior and overeating in the modern world. The success of antidiabetes
medication has also been limited by their mechanisms of action, and undesirable side effects. The past 10 years have
seen an explosion in the number of new treatments available for diabetes and there are a number of exciting new drugs
in development to achieve these goals including oral insulin, islet and pancreatic cell transplant, gene therapy, the
incretins, dipeptidyl peptidase-4 inhibitors, peroxisome proliferator-activated receptor inhibitors, and sodium–glucose
cotransporter inhibitors to treat Type 2 diabetes Mellitus. Conclusion Current standard of care for diabetes management
is not sufficient to provide long run benefits to diabetes patients. Therefore, future remedies with the modifications in
insulin delivery system and pharmacogenetic therapeutic approaches could possibly provide the much nodded effect
and changes the outcome of diabetes management with new outlook.

Parent-child relationships play a crucial role in shaping our developing nervous
systems, exerting a particularly strong influence in early life during pregnancy, labor, and
delivery. Their vital role continues through infancy, into adolescence and beyond. Indeed,
these relationships affect us across multiple generations, influencing not only our genes
and behaviors, but impacting our nervous systems and physiologies as well. Because the
nervous system regulates and interacts with all other organ systems, factors that influence
its regulatory relationships and patterns may also have an impact on health and risk for
disease.
Early relationships and traumatic life events represent environmental factors that
interact with genes to shape our capacities for self-regulation. These factors also
influence how we respond to life in general, and to stress in particular. A model for
understanding the role of environmental factors in the origins of chronic illness is
proposed, applying growing scientific research from the psychophysiology, neurology,
and biology of bonding and traumatic stress as a means for elucidating findings from
clinical, pathophysiological, and epidemiological studies of chronic illness. The
integration of this multidisciplinary information suggests a link between early life events
and relationships, long-term health, and risk for disease. These perspectives also have
meaningful implications for individual, societal, and global health, and offer insights
regarding the development of effective strategies for prevention and treatment.

Objectives Type 1 diabetes mellitus (T1DM) is an auto-immune disease that requires an important effort in self-management. The onset of T1DM in a child places a significant burden on parents, requiring careful management of blood glucose levels through insulin injections, diet and exercise. The main aim of our study is to synthesise what is known about the consequences of T1DM onset for families and, in particular, how parents share the emotional, practical and educational burden of care connected with diabetes management. Methods To accomplish this goal, we conducted an integrative review of 29 studies concerned with the ways in which disease management permeates the daily lives of families. Based on our findings, we offer suggestions for future research. For this study, PubMed, SAGE Journals, Google Scholar, ERIC, Web of Science, Embase and Scopus databases from 2000 to 2017 were searched using keywords related to T1DM management in families, parental roles and learning processes. Our sample included qualitative, quantitative and mixed-method studies which assessed the consequences of T1DM onset for the family and, in particular, the ways through which disease management permeates the daily lives of mothers and fathers of children with T1DM (3-18 years of age). Results The initial literature search returned 113 papers and 29 studies that met all the inclusion criteria. Through a content analysis, we identified three conceptual categories: (i) 'managing emotions after diagnosis', (ii) 'reconstructing routines around new needs' and (iii) 'educating young patients to enhance autonomy'. Conclusions The review results strongly support that diabetes is a family illness in which patients and parents are at the centre of emotions, routines and knowledge strictly connected to diabetes. Strong emotions, new routines and educational processes arise after T1DM onset, changing family life definitively.

Diabetes is one of the most commonly found health ailment globally. Early detection of Diabetes aids in better diagnosis & treatment. With this consideration, Real-time Continuous monitoring of the blood glucose level is highly desirable. A number of invasive and non- invasive techniques have been proposed in past. In this paper, we propose a unique Real time Invasive Blood Glucose Monitoring system. Our work is based on PIC16 microcontroller. We have also included a GSM SIM 900a for transmitting the Blood Glucose Level data to a Personal Computer used to record the readings and also to the doctor’s mobile. We have used MPLAB IDE 8.92 for generating the binary files and Ki-Cad for PCB design.

The theory of resilience and relational load was tested with 60 couples and their adolescent children (ages 11–18) with type I diabetes (T1D). The couples participated in a stress-inducing conversation task in their home, followed by a random assignment to a two-week intervention designed to increase their relationship maintenance. Before the intervention, stronger communal orientation predicted greater
maintenance for husbands and wives, but maintenance only reduced T1D stress for wives. The wives’ and adolescents’ T1D stress were also correlated, but the husbands’ T1D stress was not significantly associated with either of them. Better maintenance was associated with less conflict during couples’ conversations. Maintenance was also directly associated with less perceived and physiological stress (cortisol) from the conversation. Finally, wives in the intervention reported the most thriving, communal orientation and the least loneliness. The intervention also reduced adolescents’ general life stress, but it did not influence their T1D stress or thriving.

Background: Many adults with type 1 diabetes cannot self-manage their diabetes effectively and die prematurely with diabetic complications as a result of poor glucose control. Following the positive results obtained from a randomised controlled trial (RCT) by the Dose Adjustment For Normal Eating (DAFNE) group, published in 2002, structured training is recommended for all adults with type 1 diabetes in the UK.
Aim: With evidence that blood glucose control is not always improved or sustained, we sought to determine factors explaining why some patients benefit from training more than other patients, identifying barriers to successful self-management, while developing other models to make skills training more accessible and effective.
Findings: We confirmed that glycaemic outcomes are not always improved or sustained when the DAFNE programme is delivered routinely, although improvements in psychosocial outcomes are maintained. DAFNE courses and follow-up support is needed to help participants instil and habituate key self-management practices such as regular diary/record keeping. DAFNE graduates need structured professional support following training. This is currently either unavailable or provided ad hoc without a supporting evidence base. Demographic and psychosocial characteristics had minimal explanatory power in predicting glycaemic control but good explanatory power in predicting diabetes-specific quality of life over the following year. We developed a DAFNE course delivered for 1 day per week over 5 weeks. There were no major differences in outcomes between this and a standard 1-week DAFNE course; in both arms of a RCT, glycaemic control improved by less than in the original DAFNE trial. We piloted a course delivering both the DAFNE programme and pump training. The pilot demonstrated the feasibility of a full multicentre RCT and resulted in us obtaining subsequent Health Technology Assessment programme funding. In collaboration with the National Institute for Health Research (NIHR) Diabetes Research Programme at King’s College Hospital (RG-PG-0606-1142), London, an intervention for patients with hypoglycaemic problems, DAFNE HART (Dose Adjustment for Normal Eating Hypoglycaemia Awareness Restoration Training), improved impaired hypoglycaemia awareness and is worthy of a formal trial. The health economic work developed a new type 1 diabetes model and confirmed that the DAFNE programme is cost-effective compared with no structured education; indeed, it is cost-saving in the majority of our analyses despite limited glycated haemoglobin benefit. Users made important contributions but this could have been maximised by involving them with grant writing, delaying training until the group was established and funding users’ time off work to maximise attendance. Collecting routine clinical data to conduct continuing evaluated roll-out is possible but to do this effectively requires additional administrator support and/or routine electronic data capture.
Conclusions: We propose that, in future work, we should modify the current DAFNE curricula to incorporate emerging understanding of behaviour change principles to instil and habituate key self-management behaviours that include key DAFNE competencies. An assessment of numeracy, critical for insulin dose adjustment, may help to determine whether or not additional input/support is required both before and after training. Models of structured support involving professionals should be developed and evaluated, incorporating technological interventions to help overcome the barriers identified above and enable participants to build effective self-management behaviours into their everyday lives.
Trial registration: ClinicalTrials.gov NCT01069393.
Funding: The NIHR Programme Grants for Applied Research programme.

Aim: To describe the presence and type of disturbed eating behaviours and thoughts in a combined male/female Australian sample of adolescents with type 1 diabetes, and examine the association of eating behaviours and thoughts with glycaemic control as evidenced by high glycosylated haemoglobin levels (HbA1c). Methods: In this cross-sectional descriptive study, 124 adolescents aged 13-18 years were invited to complete three self-administered questionnaires. The Youth Eating Disorder Examination Questionnaire (YEDE-Q) and the Eating Disorder Inventory-3 Risk Composite (EDI-3RC) assessed risk for an eating disorder. The third questionnaire, the Strengths and Difficulties Questionnaire (SDQ) assessed emotional and behavioural concerns. Clinical data were collected from the medical records, routine clinic appointments and the adolescent. Results: Any disturbed eating behaviour was reported by approximately one-third of participants (32.3%) and was common in females and males (37.9% vs. 25.9%). Binge eating (17.7%), driven exercise (13.0%) and dietary restraint (8.9%) were the most common disturbed eating behaviours, although restraint was not evident in males. Insulin manipulation/omission (5.6%), vomiting (3.3%), laxative (0.8%) or diuretic use (0.8%) were less common. Regression analysis showed a significant association between HbA1c and more disturbed eating behaviours and thoughts which remained significant when adjusted for confounders. Conclusions: High rates of disturbed eating behaviours and thoughts were seen in this Australian sample of adolescents with type 1 diabetes. High scores on both eating disorder measures were associated with poorer glycaemic control. These results highlight the need to screen for disordered eating in adolescents with type 1 diabetes.

Objective: Spinal misalignment increases spinal cord tension and is linked to various health conditions. There has never been a study on the impact of spinal alignment on blood glucose metabolism. This prospective case with long-term follow-up explores spinal alignment and its impact on type 1 diabetes mellitus.
Case and methods: A 26-year-old male presented with chronic mid-back pain for 9 years and type 1 diabetes mellitus. Radiography and MRI revealed hypokyphosis of the thoracic spine with spinal misalignment from thoracic vertebrae 6 through 9 consistent with vertebral subluxation. Glycosylated hemoglobin and blood-glucose averages were obtained by continuous glucose monitoring. Back pain, paraspinal muscle tension, and quality of life were also measured. The patient received Chiropractic BioPhysics® care including Mirror Image® corrective spinal exercises, adjustments, and traction.
Results: After 36 visits, the patient reported improvement in his mid-back pain and quality of life. Thoracic x-rays showed correction of thoracic hypokyphosis. Surface EMG measuring paraspinal muscle tension improved and continuous glucose monitoring showed dramatic drop in blood glucose immediately following the onset of each visit and improvement in blood glucose averages, percentage of time of blood glucose in a healthy target range, and glycosylated hemoglobin. The patient reported he reduced his basal insulin by approximately half during chiropractic care.
Conclusions: This case suggests that correction of thoracic hypokyphosis using Chiropractic BioPhysics® care protocols may result in improved glycosylated hemoglobin and blood glucose metabolism for a person with type 1 diabetes mellitus, as well as back pain, paraspinal muscle tension, and quality of life.

Diabetes is generally divided into the categories ‘type 1 diabetes’ and ‘type 2 diabetes’. They have much in common with each other, but differ in the cause and urgency of treatment necessary (see Table 1.1). As a broad generalization, type 1 diabetes occurs in those who are generally younger, so children and teenagers are more likely to have type 1 diabetes, and those in middle age type 2. It is also true that those with type 1 diabetes are generally of normal weight, while overweight is common in those with type 2. It is certain that overweight is a risk for type 2 diabetes, and not for type 1.

Diabetes Mellitus is the seventh leading cause of death in the United States. Three types of diabetes are Type One – commonly referred to as Juvenile Diabetes, Type Two – commonly referred to as adult onset, and Gestational Diabetes. Type One Diabetes is an auto-immune disorder in which the beta cells located in the pancreatic islets are destroyed by T cells; this causes insulin dependence. Type 2 Diabetes is primarily a Western Culture lifestyle disease that is developed from the breakdown of communication between the liver and pancreas, causing insulin resistance. Gestational diabetes presents in women who are childbearing age, particularly overweight women. The risks of complications for mother and fetus are high in both prenatal and neonatal stages of gestation and childbirth.  Other forms of Diabetes Mellitus will be examined and classified. Diagnosis and treatment of the most common forms of Diabetes Mellitus is explored in this research paper.

Background: Mixed outcomes and national geographical variations in short and long-term psychological and biomedical benefits of continuous subcutaneous insulin infusion (CSII) have led The University Hospital Southampton (UHS) CSII service (conceived in 2014) to develop a new approach to care; The SPANGLE Model. SPANGLE: Southampton’s patient-orientated approach emphasizes Pump education which is All-inclusive and Non-judgmental. The focus is on Group work which is tailored according to the Life-events and needs patients using this service. Using E-health is also key, running virtual clinics (via email, telephone and texts) to provide a flexible and accessible service. Aim: To assess the impact of insulin pumps on patient outcomes in the context of a relatively new and forward-thinking clinic. Methods: Data were collected from n=90 patients who began CSII therapy at UHS. >6 months ago. Baseline HbA1c, Problem Areas In Diabetes (PAID) and CLARKE hypoglycaemia awareness survey results were compared to 6 months, 1, 2, 3, and 4 years post-pump therapy. Results: Participants had a Mean age of 42.28 ±14 (range 21-77) diagnosis of 21.2 years ±12.40 (1-49 years) and n=55 (61.1%) were Female. A baseline Mean HbA1c of 69mmol/mol±13 (8.5%) reduced significantly to 60mmol/mol±11 (7.6%) at 6 months, (p <0.001), 60mmol/mol±11 (7.6%) at 1 year (p <0.001), 61mmol/mol±13 (7.7%) at 2 years, (p < 0.001), and to 62mmol/mol±11 (7.8%) at 3 years (p < 0.001). HbA1c was still reduced up to 4 years on but results were not statistically significant (lack of statistical power due to low numbers of patients). Baseline PAID scores (32.75± 21) decreased significantly at 6 months (20 ± 17) (p < 0.001) and 1 year (19 ± 16) (p < 0.05). PAID scores continued to be lower at 2 and 3 years than baseline but not significantly (due to low questionnaire response rates). Hypoglycaemia awareness improved from 65% of patients at baseline to 82% (6 months), 88% (1 year) and 92% (2 years) (low survey response rates >2 years). Conclusion: Early evaluations of this patient-orientated clinic are promising due to sustained improvements in glycaemic control, hypoglycaemia awareness and diabetes-related distress. . Future work will focus on whether these results continue to sustain over a longer period and the particular factors that lead to improvements. Uptake of new technologies have increased especially in relation to Flash Glucose Monitoring (available on prescription locally) and Continuous Glucose Monitoring. The service needs to examine how this might impact on patient needs and outcomes.

The aim of the nongovernmental organization Type 1 diabetes mellitus support (T1Diams) is to empower
children, adolescents, and young adults with Type 1 diabetes to optimally manage their medical condition.
In the Republic of Mauritius (an Island in the South-West of the Indian Ocean), since 2007, T1Diams has
been organizing a yearly diabetic camp of 7-day duration during the winter season for its members and
their families. Two age groups are present (0–11 years and 12–25 years). For the first group, the children are
accompanied by their parents while the second group comes on their own. During the camp, therapeutic
education is carried out. The acquisition of knowledge and self-care skills are ensured through pedagogical
diabetes-related games and presentations. Physical activities as well as workshop on carbohydrate
counting are also organized. Those activities help the participants acquire and maintain the skills that
are sine qua non to live optimally with their disease. During the camp, there are also interventions from
professionals (nutritionist, psychologist, social worker, endocrinologist, ophthalmologist, podiatrist, and
dentist) so that they get a complete medicosocial follow-up. Self-monitoring of blood glucose and education
on insulin injections are done on a regular basis (at least 4 times/day). Tests for glycated hemoglobin and
microalbuminuria are performed with all the patients.
Keywords: Diabetic camp, Mauritius, nongovernment organization, self-care, therapeutic education, Type 1
diabetes, Type 1 diabetes mellitus support

Daniel Ullman, Elizabeth Phillips, Salomi Aladia, Peter Haas, Halle S. Fowler, Iman S. Iqbal, Kaitlyn L. Mi, Isabel W. Riches, Maya Omori, Bertram F. Malle
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Type 1 diabetes (T1D), previously known as juvenile diabetes, has a large impact on everyday life and can pose a number of challenges for both children and their parents. A patient-centered design company, Sproutel, has designed and developed Jerry the Bear®-an interactive augmented reality (AR) stuffed animal toy bear designed to provide children with T1D both comfort and education about their diabetes management through play. We evaluated the AR device in a research study that involved participation over the course of approximately two weeks; the overall research project spanned three years and involved a variety of partners. We investigated whether Jerry the Bear offered psychosocial support to children with T1D and their parents and whether a new prototype version (equipped with audio responses) offered any additional benefits. We conducted two versions of the study-a lab study (n =11) and a remote study without any in-person component (n = 14). We found two major takeaways: (1) The results from the remote study seamlessly paralleled the more time-and effort-intensive lab study, pointing to a promising avenue of research for hard-to-reach populations. (2) Jerry the Bear had a positive impact on children with T1D and their parents in almost all cases-in some the impact was more neutral, but never markedly negative. We did not find evidence for a consistent preference between the current Jerry the Bear and the new prototype. We also discuss the challenges of conducting rigorous research in highly specific target populations.

Background: Psychological complications are frequent in type 1 diabetes (T1D) but they might be difficult to distinguish one from the other in clinical practice. Our objective was to study the distinguishing characteristics, overlaps and their use in the literature between three concepts of T1D: depression, diabetes distress (DD) and diabetes burnout (DB). Methods: A scoping review (PRISMA guidelines) performed in three databases (PubMed/MEDLINE, PsycInfo, Web of Science) with the keywords: T1D, depression, diabetes and burnout, from January 1990 to June 2021. We selected original studies with participants with T1D, which reported depression, DD, or DB. We extracted information about the concepts, their sub-concepts and screening tools. Findings: Of the 4763 studies identified, 201 studies were included in the study. Seventy-three percent, 57% and 45% of sub-concepts do not overlap in depression, DD, and DB, respectively. We observed overlap between depression (27%)/DD (27%) and between DD (20%)/DB (50%). Interpretation: A number of sub-concepts distinguish depression and DD. Overlaps between concepts suggest that a more precise definition is still lacking. DB is still a relatively new concept and more research is needed to better understand how it can present itself differently, in order to personalize care in comparison to those having DD.

Parents of children with diabetes type 1 (DT1) usually mention high stress levels as they have to cope with multiple demands in everyday life. Simple stress management techniques can be administered in everyday life and thus may hold some benefit for parents with diabetic children. The purpose of this study was to assess to evaluate the effectiveness of a stress management program (relaxation breathing and progressive muscle relaxation/RB-PMR) in reducing symptoms of stress. Self-reported validated measures were used to evaluate perceived stress, health locus of control, daily routine, anxiety and depression. This is a pilot, randomized controlled trial. A total of 54 parents were randomly assigned to the intervention group (n = 28) and control group (n = 26). In parents in the intervention group perceived stress, symptoms of depression and anxiety were significantly decreased after 8 weeks of the relaxation program (0.017, 0.044 and 0.006). RB-PMR practice was associated with changes in physical and psychological symptoms of parents with children with DT1. Future studies should extend by incorporating more objective clinical and laboratory outcomes.

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Background: Diabetes is a major problem of public health through its personal and social dimensions. The treatment of diabetes associated with lifestyle modification and monitoring of laboratory parameters will lead to decrease diabetes complications and associated costs.

Aim & Objectives: The purpose of the present study is to describe the profile of the diabetic patient in Romania, studying the adherence of treatment and self-monitoring of diabetics.

Methods/Study Design: This research is a cross-sectional  study, carried out in 2011, February- April.We included in the study a number 477 patients from 10 GPs (Bucharest and Ilfov County) who agreed to cooperate. We colected data from two questionnaires (demographic, diabetes status, self-management activities) and from  GPs evidence (treatment, co-morbidities, BMI, blood pressure, lipid profile,  HbA1c level).

Results/Findings: More type 2 diabetics had other diseases than type 1 diabetcs (p<0,001) because they are older persons. Over 2/3 of the patients declare to have a good adherence to the medication but the majority had a poor control of the glycaemia (HbA1c level). The HbA1c value differences were non-significant between type 1 and type 2 diabetics. Complications score was highly correlated with HbA1c value and with adherence to the treatment. The strongest factor related with a better HbA1c value is, as expected, the special diet for diabetics (p=0,021).

Conclusion: The average HbA1c is over what is considered as adequate and, obviously, the number and the extent of complications, high, in spite of the declared good coping with the medication program. A better and closer follow up and monitoring of diabetic patients, a tighter schedule of consultations with the GP and specialist, the onset of a program of support carried out by trained nurses could be answers to serious inadequate behaviors.

Artificial pancreas (AP) device consists of continuous subcutaneous insulin infusion (CSII) pump, continuous glucose monitoring (CGM) sensor, CGM receiver and control algorithm which measure and regulate current blood glucose level (BGL) of Type 1 Diabetes (T1D) patients in an automated manner. All components of the AP device are now well-established and readily available in the world market, however, its control algorithm is still at infant stage. This sometimes leads to insufficient or excessive amounts of insulin injected into their body causing hyperglycaemia or hypoglycaemia episodes, respectively.  Mathematical equations of Hovorka model were widely used in the control algorithm; however, the model had shown somewhat lacking in terms of interaction and interrelation of selected parameters in its glucose-insulin dynamics. An attempt was made by previous researchers to modify certain subsystem equations in the Hovorka model involving glucose, plasma insulin, and insulin action subsystems by introducing additional parameters which, in turn, resulted in producing so-called improved Hovorka equations. This study aims to develop a computer algorithm in order to simulate the BGL of T1D patients during their meal intakes using the improved Hovorka equations via MATLAB and model predictive control (MPC). Results showed that different amounts of administered insulins(Ut) namely; 0.0003 U/min and 0.009 U/min were required to maintain the BGL within normal range (4.5 to 6 mmol/L) when the amounts of meals (DG) taken by the patients were at 57g CHO and 86.5g CHO during lunch and dinner times, respectively. However, the BGL was above the normal range, i.e. hyperglycaemia when DG and Ut were at 32g CHO and 0.035 U/min, respectively during breakfast time. In conclusion, this study has proven that the improved Hovorka equations can be used to simulate the meal disturbance effect on BGL for T1D patients.