**6. Conclusions**

We have shown, that the prevalence of T1D in the Ukrainian regions differs substantially. The daily insulin dose was found to increase regularly with the duration of the disease. This study also revealed a positive relation between T1D prevalence and the daily insulin doses, and observed a difference in the blood GADA levels among the T1D adults residing in territories with different T1D prevalence.

A unique feature of this study is that instead of examining the incidence, the prevalence of T1D was examined. This can be attributed to the relatively recent development of the Ukrainian diabetes-mellitus register (Khalangot & Tronko, 2007). Nevertheless, we believe that such an approach enabled us to study virtually the entire Ukrainian T1D population, and reveal a positive correlation between T1D prevalence, intensity of insulin treatment, hyperglycemia (HbA1c), and GADA levels, and its prevalence in adults. However, an earlier study of GADA in children recently diagnosed with T1D did not find any relation between GADA positivity and the clinical parameters of the disease (Holmberg, 2006).

#### **7. Acknowledgements**

The authors of this work acknowledge the efforts of all Ukrainian endocrinologists, who have contributed data about their patients to the diabetes mellitus register. Special thanks to Novo Nordisk A/C, Ukraine, for helping to promote the manuscript.

#### **8. References**


comparison to the levels of zinc in the environment and human body will provide new

We have shown, that the prevalence of T1D in the Ukrainian regions differs substantially. The daily insulin dose was found to increase regularly with the duration of the disease. This study also revealed a positive relation between T1D prevalence and the daily insulin doses, and observed a difference in the blood GADA levels among the T1D adults residing in

A unique feature of this study is that instead of examining the incidence, the prevalence of T1D was examined. This can be attributed to the relatively recent development of the Ukrainian diabetes-mellitus register (Khalangot & Tronko, 2007). Nevertheless, we believe that such an approach enabled us to study virtually the entire Ukrainian T1D population, and reveal a positive correlation between T1D prevalence, intensity of insulin treatment, hyperglycemia (HbA1c), and GADA levels, and its prevalence in adults. However, an earlier study of GADA in children recently diagnosed with T1D did not find any relation between

The authors of this work acknowledge the efforts of all Ukrainian endocrinologists, who have contributed data about their patients to the diabetes mellitus register. Special thanks to

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**6. Conclusions** 

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**Part 2** 

**Psychological Aspects of Diabetes** 


**Part 2** 

**Psychological Aspects of Diabetes** 

82 Type 1 Diabetes – Complications, Pathogenesis, and Alternative Treatments

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**5** 

*Cincinnati, Ohio* 

*USA* 

**Type I Diabetes in Children and Adolescents** 

*2Department of Sociology, College of Arts and Sciences, University of Cincinnati, 3Department of Psychology, College of Arts and Sciences, University of Cincinnati,* 

Type I Diabetes is characterized by pancreatic failure. Daily exogenous insulin replacement is necessary for the child's survival. Insulin typically is administered by injections before lunch and dinner. Type I diabetes affects approximately 1 in every 400 to 600 children (Centers for Disease Control and Prevention, 2003). Rates of Type I diabetes are increasing (Chisholm et al., 2007). This is concerning as this disease has long-term health care consequences including problems with circulation, vision, and cardiovascular issues (Frey et al., 2006). The care of children with Type I diabetes involves complex procedures including daily blood glucose testing, dietary monitoring, intensive insulin therapy, and increased physical activity to maintain metabolic control (Anderson et al., 2007). Several studies have shown that children as well as adolescents have difficulty adhering to diet, exercise, blood glucose testing, and insulin regimens (e.g., Chang et al., 2007; Frey et al., 2006). Patterns of diabetes care are established early in the disease course, and therefore understanding factors related to child adherence is a mechanism for generating strategies to improve diabetes management for children. This, in turn, may positively influence health outcomes in

Children's management of their diabetes is often measured by assessment of blood glucose or HbA1c levels (i.e., measure of diabetic control). Monitoring blood glucose levels has become an increasingly important self-management task for children who have diabetes (Bui et al., 2005). Psychosocial factors, such as attitudes about one's diabetes, support from others, and stress, have been related to HbA1c levels or other factors serving as proxy variables for diabetes management (Chisholm et al., 2007; Nabors et al., 2010). This chapter reviews the relationship between psychosocial factors, chiefly children's attitudes, support from others, stress, and diabetes management. This chapter will provide suggestions for improving children's attitudes and reducing their stress to improve their diabetes management. The next section of this chapter reviews ways in which children's attitudes, namely health locus of control and stress, influence children's

**1. Introduction** 

adolescence and adulthood (Bui et al., 2005).

diabetes management.

*1School of Human Services, College of Education, Criminal Justice, and* 

Laura Nabors1, Phillip Neal Ritchey2,

*Human Services, University of Cincinnati,* 

Bevin Van Wassenhove3 and Jennifer Bartz3
