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Carlsson, A., Shepherd, M., Ellard, S., Weedon, M., Lernmark, A., Forsander, G., . . . Hattersley, A. T. (2020). Absence of Islet Autoantibodies and Modestly Raised Glucose Values at Diabetes Diagnosis Should Lead to Testing for MODY: Lessons From a 5-Year Pediatric Swedish National Cohort Study. Diabetes Care, 43(1), 82-89
Öppna denna publikation i ny flik eller fönster >>Absence of Islet Autoantibodies and Modestly Raised Glucose Values at Diabetes Diagnosis Should Lead to Testing for MODY: Lessons From a 5-Year Pediatric Swedish National Cohort Study
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2020 (Engelska)Ingår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 43, nr 1, s. 82-89Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE Identifying maturity-onset diabetes of the young (MODY) in pediatric populations close to diabetes diagnosis is difficult. Misdiagnosis and unnecessary insulin treatment are common. We aimed to identify the discriminatory clinical features at diabetes diagnosis of patients with glucokinase (GCK), hepatocyte nuclear factor-1A (HNF1A), and HNF4A MODY in the pediatric population.

RESEARCH DESIGN AND METHODS Swedish patients (n = 3,933) aged 1–18 years, diagnosed with diabetes May 2005 to December 2010, were recruited from the national consecutive prospective cohort Better Diabetes Diagnosis. Clinical data, islet autoantibodies (GAD insulinoma antigen-2, zinc transporter 8, and insulin autoantibodies), HLA type, and C-peptide were collected at diagnosis. MODY was identified by sequencing GCKHNF1A, and HNF4A, through either routine clinical or research testing.

RESULTS The minimal prevalence of MODY was 1.2%. Discriminatory factors for MODY at diagnosis included four islet autoantibody negativity (100% vs. 11% not-known MODY; P = 2 × 10−44), HbA1c (7.0% vs. 10.7% [53 vs. 93 mmol/mol]; P = 1 × 10−20), plasma glucose (11.7 vs. 26.7 mmol/L; P = 3 × 10−19), parental diabetes (63% vs. 12%; P = 1 × 10−15), and diabetic ketoacidosis (0% vs. 15%; P = 0.001). Testing 303 autoantibody-negative patients identified 46 patients with MODY (detection rate 15%). Limiting testing to the 73 islet autoantibody-negative patients with HbA1c <7.5% (58 mmol/mol) at diagnosis identified 36 out of 46 (78%) patients with MODY (detection rate 49%). On follow-up, the 46 patients with MODY had excellent glycemic control, with an HbA1c of 6.4% (47 mmol/mol), with 42 out of 46 (91%) patients not on insulin treatment.

CONCLUSIONS At diagnosis of pediatric diabetes, absence of all islet autoantibodies and modest hyperglycemia (HbA1c <7.5% [58 mmol/mol]) should result in testing for GCK, HNF1A, and HNF4A MODY. Testing all 12% patients negative for four islet autoantibodies is an effective strategy for not missing MODY but will result in a lower detection rate. Identifying MODY results in excellent long-term glycemic control without insulin.

Ort, förlag, år, upplaga, sidor
Arlington, VA, United States: American Diabetes Association, 2020
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:liu:diva-163462 (URN)10.2337/dc19-0747 (DOI)000508573600023 ()31704690 (PubMedID)2-s2.0-85077016348 (Scopus ID)
Anmärkning

Funding Agencies|Swedish Child Diabetes Foundation; National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [DK-063861]; National Institute for Health Research (U.K.)National Institute for Health Research (NIHR); Wellcome TrustWellcome Trust; Wellcome TrustWellcome Trust [098395/Z/12/Z]

Tillgänglig från: 2020-02-17 Skapad: 2020-02-17 Senast uppdaterad: 2020-02-25Bibliografiskt granskad
Ludvigsson, J. (2019). Bättre diabetesdiagnos behövs självklart även vid vuxendiabetes [LADA - a common serious disease that needs to be adressed]. Läkartidningen, 116
Öppna denna publikation i ny flik eller fönster >>Bättre diabetesdiagnos behövs självklart även vid vuxendiabetes [LADA - a common serious disease that needs to be adressed]
2019 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116Artikel i tidskrift, Editorial material (Övrigt vetenskapligt) Published
Abstract [en]

Latent Autoimmune Diabetes in Adults (LADA) is a common serious disease. To differ LADA from type 2 diabetes is clinically important. Adults with diabetes should get as correct diagnosis as possible, with determination of autoantibodies, HLA and C-peptide.

Ort, förlag, år, upplaga, sidor
Stockholm, Sweden: Sveriges Läkarförbund, 2019
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:liu:diva-164809 (URN)31237664 (PubMedID)
Tillgänglig från: 2020-04-01 Skapad: 2020-04-01 Senast uppdaterad: 2020-05-01Bibliografiskt granskad
Faresjö, T., Ludvigsson, J., Wennerholm, C., Olsen Faresjö, Å. & Nilsson, H. (2019). Folkhälsoskillnaderna består mellan Norrköping och Linköping [Public health differences between »the twin cities« persist].. Läkartidningen, 116, Article ID FI6H.
Öppna denna publikation i ny flik eller fönster >>Folkhälsoskillnaderna består mellan Norrköping och Linköping [Public health differences between »the twin cities« persist].
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2019 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, artikel-id FI6HArtikel i tidskrift (Refereegranskat) Published
Abstract [sv]

A decade ago, major public health differences between two neighboring, equal sized large Swedish cities, Norrköping and Linköping (»the Twin cities«) were revealed. These differences were considerable for cardiovascular mortality and life expectancy. An important finding was that cardiovascular mortality rates for men and women in the city of Norrköping were highest compared to other major Swedish cities. In this follow-up, a decade later, cardiovascular mortality rates are still highest for the Norrköping population in comparison to the largest Swedish cities. There are also still profound and major public health differences between these twin cities. The differences seem to persist over time. These differences could not be explained by differences in health care, but are rather reflecting different social history and socioeconomic and life style differences in these two cities.

Abstract [sv]

Hjärt–kärldödligheten minskar totalt sett i landet, men betydande skillnader i hjärt–kärldödlighet framkommer mellan de största svenska städerna.

Norrköping har den högsta hjärt–kärldödligheten både hos kvinnor och män, av de största svenska städerna, liksom för 10 år sedan.

Skillnaderna i hjärt–kärlmortalitet och förväntad medellivslängd mellan »tvillingstäderna« Norrköping och Linköping verkar inte minska i ett 10-årsperspektiv.

Folkhälsoskillnaderna mellan tvillingstäderna kan inte förklaras av skillnader i hälso- och sjukvård utan snarare av socioekonomiska och livsstilsrelaterade skillnader liksom städernas olika socialhistoria.

Ort, förlag, år, upplaga, sidor
Sveriges Läkarförbund, 2019
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-163818 (URN)31192409 (PubMedID)
Tillgänglig från: 2020-02-20 Skapad: 2020-02-20 Senast uppdaterad: 2020-04-01
Ludvigsson, J., Andersson-White, P. & Guerrero-Bosagna, C. (2019). Toxic metals in cord blood and later development of Type 1 diabetes.. Pediatric dimensions, 4(2)
Öppna denna publikation i ny flik eller fönster >>Toxic metals in cord blood and later development of Type 1 diabetes.
2019 (Engelska)Ingår i: Pediatric dimensions, ISSN 2397-950X, Vol. 4, nr 2Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The incidence of type 1 diabetes (T1D) has increased explained by changes in environment or lifestyle. In modern society dissemination of heavy metals has increased. As the autoimmune process usually starts already, we hypothesized that exposure to toxic metals during fetal life might contribute to development of T1D in children. We analysed arsenic (AS), aluminium (Al), cadmium (Cd), lithium (Li), mercury (Hg), lead (Pb), in cord blood of 20 children who later developed T1D (probands), and in 40 age-and sex-matched controls. Analysis of heavy metals in cord blood was performed by ALS Scandinavia AB (Luleå, Sweden) using the 'ultrasensitive inductively coupled plasma sector field mass spectrometry method' (ICP-SFMS) after acid digestion with HNO3. Most children had no increased concentrations of the metals in cord blood. However, children who later developed T1D had more often increased concentrations (above limit of detection; LOD) of aluminium (p = 0.006) in cord blood than the non-diabetic controls, and also more often mercury and arsenic (n.s). Our conclusion is that exposure to toxic metals during pregnancy might be one among several contributing environmental factors to the disease process if confirmed in other birth cohort trials.

Nyckelord
ABIS, aetiology, children, toxic metals, type 1 diabetes
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-163814 (URN)10.15761/PD.1000186 (DOI)31396560 (PubMedID)
Tillgänglig från: 2020-02-20 Skapad: 2020-02-20 Senast uppdaterad: 2020-04-27
Long, A. E., Wilson, I. V., Becker, D. J., Libman, I. M., Arena, V. C., Wong, F. S., . . . Gillespie, K. M. (2018). Characteristics of slow progression to diabetes in multiple islet autoantibody-positive individuals from five longitudinal cohorts: the SNAIL study. Diabetologia, 61(6), 1484-1490
Öppna denna publikation i ny flik eller fönster >>Characteristics of slow progression to diabetes in multiple islet autoantibody-positive individuals from five longitudinal cohorts: the SNAIL study
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2018 (Engelska)Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, nr 6, s. 1484-1490Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aims/hypothesis Multiple islet autoimmunity increases risk of diabetes, but not all individuals positive for two or more islet autoantibodies progress to disease within a decade. Major islet autoantibodies recognise insulin (IAA), GAD (GADA), islet antigen-2 (IA-2A) and zinc transporter 8 (ZnT8A). Here we describe the baseline characteristics of a unique cohort of slow progressors (n = 132) who were positive for multiple islet autoantibodies (IAA, GADA, IA-2A or ZnT8A) but did not progress to diabetes within 10 years. Methods Individuals were identified from five studies (BABYDIAB, Germany; Diabetes Autoimmunity Study in the Young [DAISY], USA; All Babies in Southeast Sweden [ABIS], Sweden; Barts Oxford Family Study [BOX], UK and the Pittsburgh Family Study, USA). Multiple islet autoantibody characteristics were determined using harmonised assays where possible. HLA class II risk was compared between slow progressors and rapid progressors (n = 348 diagnosed amp;lt; 5 years old from BOX) using the chi(2) test. Results In the first available samples with detectable multiple antibodies, the most frequent autoantibodies were GADA (92%), followed by ZnT8A (62%), IAA (59%) and IA-2A (41%). High risk HLA class II genotypes were less frequent in slow (28%) than rapid progressors (42%, p = 0.011), but only two slow progressors carried the protective HLA DQ6 allele. Conclusion No distinguishing characteristics of slow progressors at first detection of multiple antibodies have yet been identified. Continued investigation of these individuals may provide insights into slow progression that will inform future efforts to slow or prevent progression to clinical diabetes.

Ort, förlag, år, upplaga, sidor
SPRINGER, 2018
Nyckelord
HLA class II; Islet autoantibodies; Slow progression; Type 1 diabetes
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:liu:diva-147895 (URN)10.1007/s00125-018-4591-5 (DOI)000431650800024 ()29532109 (PubMedID)
Anmärkning

Funding Agencies|Diabetes UK-Fulbright Award; Diabetes UK Moffat Travelling Fellowship [13/0004636]; Diabetes UK [14/0004869]; JDRF [17-2013-529, 17-2013-535]; Deutsche Forschungsgemeinschaft (DFG) [ZI-310/14-1]; National Institutes of Health (NIH) [R01 DK32083, DK32493]; Vetenskapsradet; Novo Nordisk; Barndiabetesfonden; ALF grants; Region Ostergotland and Medical Research Council of southeast Sweden (Forskningsradet i sydostrasverige, FORSS) [12594]; NIH [R01 DK53456, DK56200, R01 DK24021]; NIDDK [PA-04-081]; Brehm Coalition by the University of Michigan Center for Computational Medicine and Biology Pilot Research Program NIH Grant [R01 DK46864]; General Clinical Research Center of the Childrens Hospital of Pittsburgh Grant [MO1 RR 00084]; Renziehausen fund

Tillgänglig från: 2018-05-23 Skapad: 2018-05-23 Senast uppdaterad: 2019-05-01
Knip, M., Akerblom, H. K., Al Taji, E., Becker, D., Bruining, J., Castano, L., . . . Wasikowa, R. (2018). Effect of Hydrolyzed Infant Formula vs Conventional Formula on Risk of Type 1 Diabetes The TRIGR Randomized Clinical Trial. Journal of the American Medical Association (JAMA), 319(1), 38-48
Öppna denna publikation i ny flik eller fönster >>Effect of Hydrolyzed Infant Formula vs Conventional Formula on Risk of Type 1 Diabetes The TRIGR Randomized Clinical Trial
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2018 (Engelska)Ingår i: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 319, nr 1, s. 38-48Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

IMPORTANCE Early exposure to complex dietary proteins may increase the risk of type 1 diabetes in children with genetic disease susceptibility. There are no intact proteins in extensively hydrolyzed formulas. OBJECTIVE To test the hypothesis that weaning to an extensively hydrolyzed formula decreases the cumulative incidence of type 1 diabetes in young children. DESIGN, SETTING, AND PARTICIPANTS An international double-blind randomized clinical trial of 2159 infants with human leukocyte antigen-conferred disease susceptibility and a first-degree relative with type 1 diabetes recruited from May 2002 to January 2007 in 78 study centers in 15 countries; 1081 were randomized to be weaned to the extensively hydrolyzed casein formula and 1078 to a conventional formula. The follow-up of the participants ended on February 28, 2017. INTERVENTIONS The participants received either a casein hydrolysate or a conventional adapted cows milk formula supplemented with 20% of the casein hydrolysate. The minimum duration of study formula exposure was 60 days by 6 to 8 months of age. MAIN OUTCOMES AND MEASURES Primary outcome was type 1 diabetes diagnosed according to World Health Organization criteria. Secondary outcomes included age at diabetes diagnosis and safety (adverse events). RESULTS Among 2159 newborn infants (1021 female [47.3%]) who were randomized, 1744 (80.8%) completed the trial. The participants were observed for a median of 11.5 years (quartile [Q] 1-Q3, 10.2-12.8). The absolute risk of type 1 diabetes was 8.4% among those randomized to the casein hydrolysate (n = 91) vs 7.6% among those randomized to the conventional formula (n = 82) (difference, 0.8%[95% CI, -1.6% to 3.2%]). The hazard ratio for type 1 diabetes adjusted for human leukocyte antigen risk group, duration of breastfeeding, duration of study formula consumption, sex, and region while treating study center as a random effect was 1.1 (95% CI, 0.8 to 1.5; P = .46). The median age at diagnosis of type 1 diabetes was similar in the 2 groups (6.0 years [Q1-Q3, 3.1-8.9] vs 5.8 years [Q1-Q3, 2.6-9.1]; difference, 0.2 years [95% CI, -0.9 to 1.2]). Upper respiratory infections were the most common adverse event reported (frequency, 0.48 events/year in the hydrolysate group and 0.50 events/year in the control group). CONCLUSIONS AND RELEVANCE Among infants at risk for type 1 diabetes, weaning to a hydrolyzed formula compared with a conventional formula did not reduce the cumulative incidence of type 1 diabetes after median follow-up for 11.5 years. These findings do not support a need to revise the dietary recommendations for infants at risk for type 1 diabetes.

Ort, förlag, år, upplaga, sidor
AMER MEDICAL ASSOC, 2018
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:liu:diva-144246 (URN)10.1001/jama.2017.19826 (DOI)000419116000014 ()29297078 (PubMedID)
Anmärkning

Funding Agencies|Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health [HD040364, HD042444, HD051997]; Canadian Institutes of Health Research; Commission of the European Communities [QLK1-2002-00372]; European Foundation for the Study of Diabates/JDRF/Novo Nordisk; Academy of Finland (Centre of Excellence in Molecular Systems Immunology and Physiology Research) [250114]; Dutch Diabetes Research Foundation; Finnish Diabetes Research Foundation; JDRF

Tillgänglig från: 2018-01-22 Skapad: 2018-01-22 Senast uppdaterad: 2019-05-01
Simona Chisalita, I. & Ludvigsson, J. (2018). Insulin-Like Growth Factor-1 at Diagnosis and during Subsequent Years in Adolescents with Type 1 Diabetes. Journal of Diabetes Research, Article ID 8623560.
Öppna denna publikation i ny flik eller fönster >>Insulin-Like Growth Factor-1 at Diagnosis and during Subsequent Years in Adolescents with Type 1 Diabetes
2018 (Engelska)Ingår i: Journal of Diabetes Research, ISSN 2314-6745, E-ISSN 2314-6753, artikel-id 8623560Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background. Type 1 diabetes (T1D) in adolescents is associated with alterations in the insulin-like factor system probably caused both by a deranged metabolism and insulinopenia in the portal vein.

Objective. To study how the circulating IGF-1 is affected at diagnosis and during subsequent years in adolescents with T1D.

Methods. Ten girls and ten boys with type 1 diabetes (T1D), aged 13.0 +/- 1.4 (mean +/- SD) years at diagnosis, took part in the study. Blood samples were drawn at diagnosis and after 3, 9, 18, and 48 months. HbA1c, total IGF-1, and C-peptide were measured.

Results. At diagnosis, the patients had high HbA1c, low IGF-1, and measurable C-peptide. After the start of insulin treatment, maximal improvement in glycemic control and IGF-1 occurred within 3 months and then both tended to deteriorate, that is, HbA1c to increase and IGF-1 to decrease. C-peptide decreased with time, and after 4 years, half of the patients were C-peptide negative. At diagnosis, C-peptide correlated positively to IGF-1 (r = 0 50; p amp;lt; 0 03). C-peptide correlated negatively with insulin dose (U/kg) after 18 and 48 months from diagnosis (r = -0 48; p amp;lt; 0 03 and r = -0 72; p amp;lt; 0 001, resp.).

Conclusions. In conclusion, our results show that in newly diagnosed adolescents with type 1 diabetes and deranged metabolism, the IGF-1 level is low and rapidly improves with insulin treatment but later tends to decrease concomitantly with declining endogenous insulin secretion.

Ort, förlag, år, upplaga, sidor
Hindawi Publishing Corporation, 2018
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:liu:diva-147455 (URN)10.1155/2018/8623560 (DOI)000428896300001 ()29744370 (PubMedID)
Anmärkning

Funding Agencies|Landstinget Ostergotland; Swedish Medical Research Council [04952]

Tillgänglig från: 2018-05-16 Skapad: 2018-05-16 Senast uppdaterad: 2019-02-28Bibliografiskt granskad
Ludvigsson, J., Lefebvre, P. & Nerup, J. (2018). It is time to restore Rules for Authorship of scientific publications [Letter to the editor]. Pediatric Diabetes, 19(3), 586-586
Öppna denna publikation i ny flik eller fönster >>It is time to restore Rules for Authorship of scientific publications
2018 (Engelska)Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 19, nr 3, s. 586-586Artikel i tidskrift, Letter (Övrigt vetenskapligt) Published
Abstract [en]

n/a

Ort, förlag, år, upplaga, sidor
WILEY, 2018
Nyckelord
authorship; fraud in research; research ethics
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:liu:diva-147920 (URN)10.1111/pedi.12572 (DOI)000430921600036 ()28994232 (PubMedID)2-s2.0-85045886791 (Scopus ID)
Tillgänglig från: 2018-05-23 Skapad: 2018-05-23 Senast uppdaterad: 2019-05-01Bibliografiskt granskad
Ludvigsson, J. (2018). Nej – barn med typ 1-diabetes lever inte i ständig livsfara. Läkartidningen, 115
Öppna denna publikation i ny flik eller fönster >>Nej – barn med typ 1-diabetes lever inte i ständig livsfara
2018 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115Artikel i tidskrift, Editorial material (Övrigt vetenskapligt) Published
Ort, förlag, år, upplaga, sidor
Stockholm, Sweden: Läkartidningen Förlag AB, 2018
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:liu:diva-156937 (URN)30536231 (PubMedID)
Tillgänglig från: 2019-05-15 Skapad: 2019-05-15 Senast uppdaterad: 2019-06-14Bibliografiskt granskad
Åkerman, L., Casas, R., Ludvigsson, J., Tavira Iglesias, B. & Skoglund, C. (2018). Serum miRNA levels are related to glucose homeostasis and islet autoantibodies in children with high risk for type 1 diabetes. PLoS ONE, 13(1), Article ID e0191067.
Öppna denna publikation i ny flik eller fönster >>Serum miRNA levels are related to glucose homeostasis and islet autoantibodies in children with high risk for type 1 diabetes
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2018 (Engelska)Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 1, artikel-id e0191067Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Micro RNAs (miRNAs) are promising disease biomarkers due to their high stability. Their expression in serum is altered in type 1 diabetes, but whether deviations exist in individuals with high risk for type 1 diabetes remains unexplored. We therefore assessed serum miRNAs in high-risk individuals (n = 21) positive for multiple islet autoantibodies, age-matched healthy children (n = 17) and recent-onset type 1 diabetes patients (n = 8), using Serum/Plasma Focus microRNA PCR Panels from Exiqon. The miRNA levels in the high-risk group were similar to healthy controls, and no specific miRNA profile was identified for the high-risk group. However, serum miRNAs appeared to reflect glycemic status and ongoing islet auto-immunity in high-risk individuals, since several miRNAs were associated to glucose homeostasis and autoantibody titers. High-risk individuals progressing to clinical disease after the sampling could not be clearly distinguished from non-progressors, while miRNA expression in the type 1 diabetes group deviated significantly from high-risk individuals and healthy controls, perhaps explained by major metabolic disturbances around the time of diagnosis.

Ort, förlag, år, upplaga, sidor
PUBLIC LIBRARY SCIENCE, 2018
Nationell ämneskategori
Endokrinologi och diabetes
Identifikatorer
urn:nbn:se:liu:diva-145142 (URN)10.1371/journal.pone.0191067 (DOI)000422749500025 ()29346396 (PubMedID)
Anmärkning

Funding Agencies|Swedish Child Diabetes Foundation (Barndiabetesfonden); Swedish Research Council (Vetenskapsradet); Medical Research Council of Southeast Sweden (Forskningsradet i sydostra sverige, FORSS); Novo Nordisk Foundation; ALF/County Council of Ostergotland

Tillgänglig från: 2018-02-13 Skapad: 2018-02-13 Senast uppdaterad: 2019-05-21
Organisationer
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0003-1695-5234

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