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J Ludvigsson

Publications and source records attributed to J Ludvigsson.

At least 127 records · Page 7Linked to original sources
PubMed1989

Insulin, love and care.

Beside a physiological substitution of insulin, psychosocial care is probably the most important part of the management of diabetes in children and adolescents. This is well known by every experienced clinician but very difficult to document scientifically. Traditional methods useful and necessary in clinical or experimental research are often rough and irrelevant in the description of complicated and 'soft' psychological phenomena, and statistical methods are of little help to prove whether the feelings of a child are acceptable or not. Based on one single case history, the psychological crisis of the child who gets diabetes as well as the attitudes of the medical staff are discussed.

Child↗
PubMed1988

Insulin autoantibodies are associated with islet cell antibodies; their relation to insulin antibodies and B-cell function in diabetic children.

Blood was drawn from 74 children, 3-16 years old, at diagnosis of Type 1 (insulin-dependent) diabetes and before the first insulin injection. Insulin autoantibodies were detected with a polyethylen-glycol-method in 27/74 (36.4%) and with an immuno-electrophoretic method in 6/74 (8.1%). Islet cell cytoplasmic antibodies detected by indirect immuno-fluorescence were found in 49/74 patients (66.2%), who included as many as 23 of the 27 patients with insulin autoantibodies determined with the polyethylen-glycol-method (p less than 0.01). The proportion of insulin autoantibody-positive patients who developed insulin antibodies during the first 9 months of insulin treatment was not significantly greater (51.8%) than that of insulin autoantibody-negative patients (44.6%), but patients with both islet cell antibodies and insulin autoantibodies at diagnosis produced more insulin antibodies during the first 9 months (p less than 0.05). There was no difference in fasting or meal stimulated serum C-peptide after 3, 9 or 18 months as related to occurrence of insulin autoantibodies and/or islet cell antibodies. The correlation between insulin autoantibodies and islet cell antibodies indicates that both types of autoantibodies reflect the same immunological process, although the lack of correlation to C-peptide may indicate that they play a minor causal role. In addition, the results show that patients with an active autoimmune process evidently tend to produce more insulin antibodies during the first months of insulin treatment, but the islet cell antibodies and insulin autoantibodies-positive patients had at least as good residual B-cell function as patients without autoantibodies at diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Autoantibodies↗
PubMed1988

IgM against Coxsackie B viruses in children developing type I diabetes mellitus--a seven-year retrospective study.

IgM antibodies to coxsackievirus type B 1-5 (CB 1-5) have recently been observed in sera from children with newly diagnosed insulin-dependent diabetes mellitus (IDDM). In the present study IDDM patients below 15 years of age diagnosed between 1978 and 1984 inclusive in two different areas (counties) of Sweden, Uppsala and Linköping, were studied at the onset of their disease. The incidence of IDDM per 100,000 children below the age of 15 years varied between 11.1 and 40.8, with a mean of 26.3 in Uppsala and 23.0 in Linköping. CB-IgM was determined by a mu-antibody capture radioimmunoassay (RIA) and was found in the sera of 40% (range 15-76%) of the Uppsala patients and 30% (0-57%) of the Linköping patients. The IDDM onset peaked in January, August and October, and these months also displayed the largest numbers of CB-IgM-positive cases. There seemed to be a relation between IDDM incidence and CB-IgM positivity, but not during the whole period. IgM antibodies against CB2 and CB3 predominated during the first part of the study period, whereas during the last two years IgM antibodies against all five serotypes were demonstrated. It is concluded that if CB virus infection is involved in the pathogenesis of IDDM in children, this may be the case in less than half of the patients, though with seasonal and annual peaks and nadirs and also changes of serotypes that may reflect the natural epidemiology of these viruses.

Adolescent↗
PubMed1988

Development of insulin antibodies, metabolic control and B-cell function in newly diagnosed insulin dependent diabetic children treated with monocomponent human insulin or monocomponent porcine insulin.

One hundred and thirty eight patients participated in a two-year randomized, double-blind multicentre trial to compare monocomponent human insulin and porcine insulin in the treatment of newly diagnosed insulin dependent diabetic children with respect to development of insulin antibodies, metabolic control and B-cell function. There was no difference between the two patient groups throughout treatment either in the level of IgG insulin binding or the percentage of patients with insulin antibodies (IgG-insulin greater than 0.012 U/l). However, the estimated mean of log insulin binding values in the antibody positive patients alone was significantly lower (p less than 0.05) in the human insulin treated group at all times apart from 1 and 18 months (e.g., human insulin group at one and two years: 0.104 and 0.152 U/l, porcine insulin group at one and two years: 0.162 and 0.212 U/l). The insulin antibodies in both patient groups bound equivalent amounts of human and porcine insulin tracer. Metabolic control, insulin dosage and B-cell function in the two treatment groups were similar throughout the treatment period. It is concluded that in newly diagnosed insulin dependent diabetic children monocomponent human insulin is slightly less immunogenic than monocomponent porcine insulin, and equally effective in overall metabolic control.

Animals↗
PubMed1988

Mumps with laboratory signs of subclinical pancreatitis may cause a disturbed beta-cell function.

Mumps epidemics are followed by sporadic cases of insulin dependent diabetes mellitus (IDDM). We have studied beta-cell function in 11 subjects who had had a mumps infection. They had no clinical pancreatitis but were selected as they had abnormal pancreas iso-amylase values and/or glucosuria during the mumps virus infection. At the follow-up some years later the subjects were healthy. A few HbA1-values were noted in the upper part of the normal range. Total serum insulin values were normal, but the C-peptide values were low at first follow-up 1-3 years after infection in all but two patients. These values increased in 4/7 patients during the follow-up period but were subnormal in five subjects still 3-6 years after the infection. All five patients had HLA-DR 3 and/or 4. In 7 out of 11 patients islet cell surface antibodies could be demonstrated. Our results indicate that subclinical mumps pancreatitis may initiate a reaction towards the beta-cells recognized as subnormal C-peptide levels several years later in certain patients. This might contribute to manifest IDDM many years after infection.

Acute Disease↗
PubMed1987

Family interaction and metabolic balance in juvenile diabetes mellitus. A prospective study.

Family interaction was assessed in 30 children with insulin-dependent diabetes mellitus (IDDM) of at least 2 years' duration using video-tapes of standardised family tasks. The relationship between measures of family interaction and metabolic balance (HbA1) was investigated 1 and 5 years after the task performance. No significant relationship between family interaction and HbA1 was found after 1 year, but HbA1 values 5 years after the family assessments were significantly higher in the children who belonged to families in which family interaction was considered disturbed (P less than 0.05). If family interaction was used as a predictor of metabolic control, 67% of the cases were correctly classified. In the group with disturbed family interaction HbA1 increased during the observation period in 44% of cases while in the group with functional interaction this occurred in only 11% of the cases. When the children were divided according to age, significantly higher HbA1 values were found only in the younger group (less than 18 years at the 5-year evaluation) of the children of families with disturbed family interaction (P = 0.025). Here a correlation between disturbed family interaction and HbA1 was found (rs = 0.46, p = 0.03). In conclusion, certain family interaction patterns seem to influence metabolic balance in IDDM in children during adolescence, but not during pre-adolescence and early adulthood.

Adaptation, Psychological↗
PubMed1987

Asthma and family interaction.

Patterns of family interaction were compared in the families of 22 children with chronic asthma, 30 children with diabetes mellitus, and six healthy children. The groups were similar in terms of age (range 4-14 years and mean 10.2 years). Peak expiratory flow and signs of allergy were correlated with family interaction in the subjects with asthma. The following significant findings were made. Family interaction was more disturbed in asthma compared with both the diabetic and the healthy groups. In most of the disturbed families interaction patterns were rigid and enmeshed, but a few showed chaotic and disengaged patterns. There was a negative correlation between peak expiratory flow and disturbed cohesion in non-steroid dependent cases. The severely ill children with asthma living in families with a normal cohesion score had higher IgE concentrations than children living in disturbed families. It is concluded that family interaction should be considered to be an important dimension in the investigation of severe childhood asthma.

Asthma↗
PubMed1987

Radiation in dwellings and cancer in children.

Indoor radiation, especially radon exposure, has been in focus in the public domain during the past several years. The growing concern among parents of children with cancer possibly having high radiation levels in their homes led us to study the levels of gamma- and alpha-radiation levels in the homes of a group of children in the county of Ostergötland. The indoor concentration of alpha-emitting radon daughters was measured by a high-voltage method. The gamma activity was measured with a standard detector scintillation meter. The yearly average for radon-daughter concentration in both cases (57 Bq/m3) and controls (61 Bq/m3) corresponds fairly well with the national average of 53 Bq/m3. The yearly average for gamma radiation (cases 0.37 mGy, controls 0.36 mGy) is much lower than the permissible upper level in dwellings (2.5 mGy/year). The values seem to be of the same order as the subtracted cosmic radiation, which is 0.24-0.26 mGy. No appreciable difference could thus be found between cases and controls either from gamma radiation or radon-daughter exposure. We cannot from our study rule out the possibility of an effect of low-level radiation in susceptible individuals, but it seems clear that children who get cancer do not live in more radioactive homes than other children.

Adolescent↗
PubMed1986

Maternal smoking during pregnancy and risk of childhood cancer.

In a case-control study of childhood cancer a dose-response relationship was found between the number of cigarettes smoked per day by the mother during pregnancy and cancer risk in the offspring. When all tumour sites were considered the cancer risk was 50% higher for the most exposed group than for the controls. The risk was doubled for non-Hodgkin lymphoma, acute lymphoblastic leukaemia, and Wilms' tumour. These findings provide further evidence for the harmful effects of cigarette smoke on the growing fetus.

Adolescent↗
PubMed1986

HLA-DR 3 is associated with a more slowly progressive form of type 1 (insulin-dependent) diabetes.

The presence of HLA-DR 3 was analysed in 745 patients with Type 1 (insulin-dependent) diabetes with age at diagnosis between 1-19 years. HLA-DR 3 and/or 4 was found in 678/745 (91%) of the patients. Presence of DR2 with neither DR 3 nor 4 was demonstrated in 15 patients. Patients with HLA-DR 3 without DR 4 presented with Type 1 diabetes more evenly over the year; they also presented without incidence peaks at 7 years or 10-11 years, as seen especially in DR 3/4 patients. The DR 3 patients more often had mild disease with less ketonuria at diagnosis, less often ketoacidotic symptoms and more often a subsequent partial remission. The apparently more severe disease among diabetic girls may, at least to some extent, be explained by their higher prevalence of HLA-DR 4. The differences found were similar in North America and Europe. The results suggest that Type 1 diabetes is a genetically heterogeneous disease and that HLA-typing may be a useful marker of this heterogeneity.

Adolescent↗
PubMed1986

A two-colour immunofluorescence test with a monoclonal human proinsulin antibody improves the assay for islet cell antibodies.

The conventional indirect immunofluorescence assay for islet cell antibodies was compared with a two-colour immunofluorescent assay to detect both islet cell antibodies with fluorescein isothiocyanate-labeled rabbit anti-human IgG and pancreatic B cells with a monoclonal human proinsulin antibody and Texas red-labeled sheep anti-mouse IgG. Determinations of end-point titres showed a correlation between the new two-colour immunofluorescent assay and the conventional indirect immunofluorescent assay in 1) selected sera positive for islet cell antibodies and insulin autoantibodies rs = 0.93 (p less than 0.01) or for islet cell antibodies alone rs = 0.99 (p less than 0.005) and 2) sera from children or young adults with newly diagnosed Type 1 (insulin-dependent) diabetes rs = 0.95 (p less than 0.0001). No interference between the monoclonal human proinsulin antibodies and islet cell antibodies with or without insulin autoantibodies or between the two second fluorescent antibodies was detected. It is concluded that the two-colour immunofluorescence assay is advantageous since it is possible to mix the reagents to avoid a more time-consuming and technically complicated assay, the presence of B cells can be confirmed in each section to permit detection of B cell cytoplasmic antibodies and microscopic evaluation is easier and more accurate, particularly in islet cell antibody negative samples.

Aged↗
PubMed1986

Home blood glucose monitoring in diabetic children and adolescents. A 3-year feasibility study.

In order to elucidate the question whether blood glucose monitoring should replace glucosuria testing in childhood diabetes 160 diabetic children and adolescents were invited to participate in a feasibility study on home blood glucose testing. Seventeen girls and 15 boys with an age of 4-21 years and duration of diabetes for 0.3-18.7 years accepted, thus a selection of motivated patients. They performed 20-22 diurnal blood glucose profiles, each consisting of 7 blood samples, during a 3 month period. Thereafter, all patients were encouraged to continue blood glucose self-control and the actual performance of the 32 patients was evaluated 3 years later. Daily glucosuria tests were also made and HbA1 was analysed. Patients' attitudes were evaluated through 2 questionnaires. The study shows that blood glucose monitoring is feasible in the actual age groups. Most patients were positive towards blood tests, particularly because it gave an immediate answer to an actual problem, but its introduction did not change the metabolic control. However, pain restricted its daily use and only 6.4% of the patients preferred blood testing to urinalysis for long term use. Furthermore, the correlation between home glucosuria and HbA1 was as good as between home blood glucose and HbA1. It is concluded, that blood glucose self-monitoring is a valuable tool in the management of childhood diabetes, but that it should be regarded as a complement to and not a substitute for daily home urinalysis.

Adolescent↗