Urbonaitė, Bronislava

BACKGROUND: Initial classification of diabetes of young may require revision to improve diagnostic accuracy of different forms of diabetes. The aim of our study was to examine markers of beta-cell autoimmunity in a cohort of young (0-25 years) patients with type 1 diabetes and compare the presentation and course of the disease according to the presence of pancreatic antibodies. METHODS: Cross-sectional population-based study was performed covering 100% of pediatric (n = 860) and 70% of 18-25 years old adult patients (n = 349) with type 1 diabetes in Lithuania. RESULTS: No antibodies (GAD65, IA-2, IAA and ICA) were found in 87 (7.5%) cases. Familial history of diabetes was more frequent in those with antibodies-negative diabetes (24.1 vs. 9.4%, p < 0.001). Gestational age, birth weight and age at diagnosis was similar in both groups. Ketosis at presentation was more frequent in patients with autoimmune diabetes (88.1 vs. 73.5%, p < 0.05). HbA1c at the moment of investigation was 8.6 (3) vs. 8.7 (2.2)% in antibodies-negative and antibodies-positive diabetes groups, respectively, p > 0.05. In the whole cohort, neuropathy was found in 8.8% and nephropathy - in 8.1% of cases, not depending on autoimmunity status. Adjusted for age at onset, disease duration and HbA1c, retinopathy was more frequent in antibodies-negative subjects (13.8 vs. 7.8%, p < 0.05). CONCLUSION: Antibodies-negative pediatric and young adult patients with type 1 diabetes in this study had higher incidence of family history of diabetes, higher frequency of retinopathy, less frequent ketosis at presentation, but similar age at onset, HbA1c, incidence of nephropathy and neuropathy compared to antibodies-positive patients.

Background: Patients with type 1 diabetes (T1D) are at higher risk for developing coexisting autoimmune diseases. Objective and hypotheses: To evaluate thyroid and celiac disease prevalence in children with T1D in Lithuanian paediatric population. Method: 777 patients (49.7% males) <18yrs with T1D, covering all T1D pediatric Lithuanian population, were examined. Serum free thyroxine (FT4), thyrotropin (TSH), antithyroid peroxidase (ATPO) and tissue transglutaminase antibodies (tTG-A) were measured. Results: Mean age of patients was 12.1±4.4 years (0–4 years 7.9%, 5–9 years 23.4%, 10–14 years 36.9%, 15–18 years 31.8%). Mean duration of T1D was 3.9±3.9 years, in 68.1% duration of disease was <5 years. The average level of HbA1c was 8.75±2.22%. 33.7% of children had HbA1c <7.5%. Thyroid dysfunction was detected in 17.6% of cases. Hypothyroidism was evident in 0.4%, subclinical hypothyroidism – in 16.6%, hyperthyroidism – in 0.6% of cases. Thyroid dysfunction was significantly more prevalent in females (P=0.053). ATPO were positive in 12% of cases. There was a significant association between positive ATPO and thyroid dysfunction (r=-0.165, P<0.001). No significant associations between thyroid dysfunction and metabolic control were found. Positive tTG-A were found in 4%. No significant correlations between positive tTG-A and HbA1c or duration of T1D were found (P=0.947 and P=0.062, respectively). Conclusion: Thyroid dysfunction was more common in females and in patients with positive ATPO antibodies. The prevalence of positive tTG-A in Lithuanian children with T1D is similar to data from most other countries.

BACKGROUND: The month of diagnosis in childhood type 1 diabetes shows seasonal variation. OBJECTIVE: We describe the pattern and investigate if year-to-year irregularities are associated with meteorological factors using data from 50 000 children diagnosed under the age of 15 yr in 23 population-based European registries during 1989-2008. METHODS: Tests for seasonal variation in monthly counts aggregated over the 20 yr period were performed. Time series regression was used to investigate if sunshine hour and average temperature data were predictive of the 240 monthly diagnosis counts after taking account of seasonality and long term trends. RESULTS: Significant sinusoidal pattern was evident in all but two small centers with peaks in November to February and relative amplitudes ranging from ±11 to ±38% (median ±17%). However, most centers showed significant departures from a sinusoidal pattern. Pooling results over centers, there was significant seasonal variation in each age-group at diagnosis, with least seasonal variation in those under 5 yr. Boys showed greater seasonal variation than girls, particularly those aged 10-14 yr. There were no differences in seasonal pattern between four 5-yr sub-periods. Departures from the sinusoidal trend in monthly diagnoses in the period were significantly associated with deviations from the norm in average temperature (0.8% reduction in diagnoses per 1 °C excess) but not with sunshine hours. CONCLUSIONS: Seasonality was consistently apparent throughout the period in all age-groups and both sexes, but girls and the under 5 s showed less marked variation. Neither sunshine hour nor average temperature data contributed in any substantial way to explaining departures from the sinusoidal pattern.

Vaikų 1 tipo cukrinio diabeto pirminis sergamumas nuolatos auga. Tikslas – nustatyti 0-14 metų amžiaus vaikų 1 tipo cukrinio diabeto pirminio sergamumo kitimo tendencijas skirtingos lyties ir amžiaus vaikų grupėse 1983-2014 metais. Šis tyrimas atliktas retrospektyviai analizuojant Lietuvos nacionalinio vaikų 1 tipo cukrinio diabeto registro duomenis. Populiaciniai duomenys pagal lytį ir amžių gauti iš Lietuvos statistikos departamento. Vaikų 1 tipo cukrinio diabeto standartinis pirminio sergamumo rodiklis – 10,42 (95 proc. PI 10,01-10,85)/100.000 vaikų poopuliacijos. 1 tipo cukrinio diabeto bendras pirminis sergamumas tarp 0-14 metų amžiaus skirtingos lyties vaikų nesiskyrė: berniukų buvo 10,37 (95 proc. PI 9,78-10,98), mergaičių – 10,79 (95 proc. PI 10,18-11,43). 1 tipo cukrinio diabeto pirminis sergamumas 0-4 metų vaikų amžiaus grupėje yra 6,36 (95 proc. PI 5,77-6,98), 5-9 metų vaikų amžiaus grupėje – 10,85 (95 proc. PI 10,11-11,63), 10-14 metų vaikų amžiaus grupėje – 14,04 (95 proc. PI 13,22-14,90)/100.000 vaikų populiacijos. Standartizuotas berniukų mergaičių santykis: B/M=0,96, p=0,35. Tyrimo išvados. Standartizuotas vaikų 1 tipo cukrinio diabeto pirminio sergamumo rodiklio vidurkis yra 10,42 (95 proc. PI 10,01-10,85)/100.000 vaikų populiacijos. Didžiausias 1 tipo cukrinio diabeto pirminis sergamumas yra 10-14 metų amžiaus vaikų grupėje – 14,04/100.000 vaikų populiacijos (95 proc. PI 13,22-14,90). Vaikų 1 tipo cukrinio diabeto metinis pirminis sergamumo augimas yra 4,75 procentų per metus.

Objectives: To evaluate significance of gender, age, duration of T1D, degree of glycemic control and autoimmunity status for development of microvascular complications in Lithuanian pediatric population. Methods: Data of 289 T1D patients <18 years were analyzed. The degree of retinopathy was evaluated by digital fundus photography. 24 h urinary albumin concentration was measured for the screening of nephropathy. Michigan Neuropathy Screening Questionnaire and tests for vibration, pressure and temperature sensation were used for neuropathy screening. The autoimmunity status was evaluated by measuring GAD65, IA2, and IAA (RIA); ICA antibodies were measured by ELISA method. Results: Mean age of patients was 12.1 4 years. Distribution by age: 0–4 years 4.5%, 5–8 years 18%, 9–12 years 23.2%, 13–17 years 54.3%. 48.4% were males. Mean duration of T1D was 4.2 3.4 years, in 61.9% duration of disease was <5 years. Neuropathy, nephropathy and retinopathy were present in 9.3%, 4.7% and 1.8% of our patients, respectively. 2 patients had diabetic cataract. The average level of HbA1c was 8.1 1.78%. 43.6% of patients had HbA1c <7.5%. Adolescents (both genders, 13–17 years) and girls had the worst glycemic control (mean HbA1c 8.49 1.9 and 8.35 1.8%, respectively). Duration of T1D and glycemic control were significantly related to the presence of nephropathy and retinopathy (p = 0.03 and p < 0.001, respectively), but not to that of neuropathy. Anti-IA2 alone were found 56.4%, GAD65 - in 46.7%, both types of antibodies - in 31.1% of cases. IAAwere found in 91.8%, ICA - in 6.1% of cases. No significant associations between presence of any type of antibodies and microvascular complications were found. Conclusions: Adolescents, especially girls, have the worst glycemic control compared with other age groups. T1D duration ≥5 years and poor glycemic control have a major impact on the development of nephropathy and retinopathy. [...].

Objectives. To evaluate significance of gender, age, duration of type 1 diabetes (TID), degree of glycemic control and autoimmunity status for development of microvascular complications in Lithuanian pediatric population. Methods. Data of 289 TID patients < 18 yrs analyzed. The degree of retinopathy was evaluated by digital fundus photography. 24 h urinary albumin concentration was measured for the screening of nephropathy. Michigan Neuropathy Screening Questionnaire and tests for vibration, pressure sensation and temperature sensation were used for neuropathy screening. The autoimmunity status was evaluated by measuring GAD65, IA2, and insulin autoantibodies (RIA); ICA antibodies were measured by ELISA method. Results. Mean age of patients was 12.1±4 yrs. Distribution by age: 0-4 yrs 4.5%, 5-8 yrs 18%, 9-12 yrs 23.2%, 13-17 yrs 54.3%. 48.4% were males. Mean duration of TID was 4.2±3.4 years, in 61.9% duration of disease was < 5 yrs. [...].

Aim. To establish sexuality of 26-36-year-aged type 1 diabetics of different diabetes duration groups and control men. Methods. 149 26-36 year-old men completed the self-administered European Male Ageing Study-Sexual Function Questionnaire (EMAS-SFQ). 88 26-36-year-old type 1 diabetics were randomly selected from Lithuanian Diabetes Register. 61 controls were participants from a 2003/2004 project 'The reproductive function of Estonian, Latvian and Lithuanian young men'. Diabetics were separated into different disease duration groups: 0-9 years (N=29), 10-19 years (N=26), 20-29 years (N=29). Each group of different diabetes duration was compared with control group. Statistical analysis was performed using IBM SPSS Statistics 20.0. Mann-Whitney U Test and chi square test were used with significance level of 0.05. Results. 1. Sexual function distress was higher in type 1 diabetics with disease duration of 0-9 years than in healthy controls (3.28±3.84 (Mean±Standard Deviation) vs. 1.64±2.07, p=0.04), but not later. 2. Capacity to have and maintain erection was lower in type 1 diabetics with disease duration of 10-19 years than in control group (2.08±0.89 vs. 2.67±0.51, p<0.01) and in 20-29-year-duration diabetics (2,32±0,67 vs 2,67±0,56). 3. Overall sexual function and masturbation score were higher in the age-matched healthy controls than in type 1 diabetics with disease duration of 20-29 years (21.38±5.85 vs. 17.72±7.30, p=0.02 and 2.46±1.95 vs. 0.97±1.54, p=0.01 respectively). Conclusions. 1. Diabetics of short (0-9 years) disease duration are most concerned about their sexual function. 2. Overall sexual function disturbance and decrease of masturbation score manifest as the duration of diabetes gets 20-29 years. 3. Erectile dysfunction is the first sign of sexual dysfunction and appears when diabetes duration is 10-19 years.

Background: Diabetic ketoacidosis remains a serious condition in newly diagnosed type 1 diabetes (T1D) in children with a frequency varying from 25 to 70% in different countries. Objectives: To test if there is an association of diabetic ketosis at presentation with age, autoimmunity status and family history of diabetes in the Lithuanian pediatric population. Methods: Study sample consisted of 256 newly diagnosed T1D in children less than 18 yrs in Lithuania since 2007 in whom pancreatic antibodies tests were available. Results: At presentation, 22.8% of children were 0–4 years old, 28.3% - 5–9 years old, 42.9% - 10–14 years old and 5.9% older than 14 years. Frequency of ketosis at presentation was 67.2%. 24.2% of children had positive family history of diabetes among first, second or thirddegree relatives. Tyrosine phosphatase antibodies (IA2) alone were found in 20.7%, glutamic acid decarboxylase antibodies (GAD65) alone - in 19.3%; both types of antibodies - in 53.1% of cases; 6.9% of children were antibody-negative.No significant association between ketosis at the onset of disease and age groups was found (p=0.95). Ketosis at the diagnosis was present in 55% of patients without family history of diabetes and only in 12% in those with positive family history (p=0.02). Diabetic ketosis was found in 76.7% of children with positive IA2 antibodies, in 60.7% - with positive GAD65 antibodies, in 71,4% - with both types of antibodies, and in 30% in antibody-negative children (Fisher exact p=0.074). Conclusions: Ketosis in newly diagnosed diabetes cases in childhood in Lithuania was more frequent among children without family history of diabetes, but not related to age at presentation. A trend towards more frequent ketosis was found in children with positive pancreatic antibodies, especially IA2 and a combination of IA2 and GAD65.

AIMS: The aim was to assess the frequency and correlates of selected cardiovascular disease risk factors among Lithuanian children and adolescents with type 1 diabetes mellitus (T1DM). METHODS: A cohort of 539 T1DM children was investigated. Total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), glycated haemoglobin (HbA1c) was determined. RESULTS: The mean of HbA1c was 8.5±1.8%. Overweight was present in 72 (13.4%, 95% CI 10.6-16.9) and 113 (21.0%, 95% CI 17.5-25.3) had arterial hypertension. Hypercholesterolemia was diagnosed in 120 (22.3%; 95% CI 18.6-26.7), decreased HDL in 22 (4.1%; 95% CI 2.7-6.2), high LDL in 79 (14.7%; 95% CI 11.8-18.3), and high TG in 96 (17.8%, 95% CI 14.7-21.9) subjects. There were positive linear correlations between TG and high HbA1c levels (r=0.192; p<0.001), and between LDL and high HbA1c levels (r=0.238; p<0.001). Two cardiovascular risk factors were present 14.3%, three risk factors in 6.9%, four in 2.4% and five in 0.9%. The frequency of two cardiovascular risk factors was higher among 10-17-year-old T1DM patients than among 1-9-year-old children (27.0% vs. 13.3% respectively, p<0.01). CONCLUSION: The frequency of cardiovascular risk factors is common in young people with T1DM and was associated with poor glycaemic control.

Endokrininių liaukų sistema yra labai sudėtinga, ir bent vienos liaukos veiklos sutrikimas sutrikdo ir kitų liaukų funkciją. Endokrininių liaukų patologiją nustatyti dažnai nėra lengva ne tik bendrojo profilio gydytojams, bet ir specialistams, nes tokiais atvejais trikdoma ne tik endokrininė, bet ir kitų organų bei sistemų veikla. Šis leidinys – tai antra patikslinta ir papildyta naujausiais mokslo pasiekimais bei praktine patirtimi knyga. Leidinio tikslas – atkreipti praktikos gydytojų dėmesį į dažniausiai pasitaikančių endokrininių liaukų ligų kliniką, diagnostiką ir gydymą. Šis leidinys parengtas Lietuvos sveikatos mokslų universiteto specialistų – endokrinologų, kartu su kitų sričių specialistais – akušeriais-ginekologais, chirurgais, nefrologais, oftalmologais, fiziologais, biologais, psichologais ir kt. Jame pateikiama endokrininių laiukų fiziologija, dažniausiai pasitaikančių endokrininių liaukų ligų priežastys, klinika, diagnostika, galimos komplikacijos, ryšys su įtaka kitoms ne endokrininės kilmės ligomis bei gydymas. Daugiausia dėmesio leidinyje skiriama cukriniam diabetui, skydliaukės ligoms, hipofizės ir antinksčių patologijai, lytinių liaukų veiklos sutrikimams, neuroendokrininiams tumorams, osteoporozei, nutukimui, vaikų endokrininių ligų ypatumams ir kt. Leidinys skiriams šeimos gydytojams, internistams, endokrinologams ir kitų sričių medikams. Manome, kad jis bus naudingas ir gydytojams rezidentams bei studentams medikams.