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Articles by K. Kanc
Total Records ( 2 ) for K. Kanc
  H. Holmberg , H. Mersebach , K. Kanc and J. Ludvigsson
  Aims  To compare levels of insulin antibodies in children and adolescents after initiation of insulin therapy using either insulin aspart (IAsp) or human insulin (HI) in combination with Neutral Protamine Hagedorn (NPH) insulin, and to investigate the relationships between insulin antibodies and HbA1c and insulin dose.

Methods  IAsp-specific antibodies (IAsp-Ab) and antibodies cross-reacting with HI and IAsp (HI-cross-Ab) were analysed by radioimmunoassay at diagnosis of diabetes and every 3-6 months for 30 months. Seventy-two patients (HI = 30, IAsp = 42) with Type 1 diabetes, aged 2-17 years were included. Data on HbA1c, insulin dose and serious adverse events (SAEs) were collected retrospectively.

Results  IAsp-Ab levels remained low throughout the study. After 9 months, the level of HI-cross-Ab increased [mean (sd) HI, 48.8% (21.53); IAsp, 40.2% (17.92)] and remained elevated. Repeated measurement analysis of HI-cross-Ab levels showed no significant difference between treatments (P = 0.16). HI-cross-Ab were significantly associated with total insulin dose (U/kg) (P = 0.001) and time (P < 0.0001), but not with HbA1c (P = 0.24). Mean (± sd) HbA1c was similar at diagnosis (HI 9.5 ± 1.97%; IAsp 9.6 ± 1.62%); HbA1c then decreased and stabilized to about 6.0% in both groups. Few SAEs were reported, the majority being hypoglycaemic episodes.

Conclusions  Treatment with IAsp and with HI was associated with an increase in HI-cross-Ab in insulin-naive children, but this did not influence treatment efficacy or safety. These results support the safe use of IAsp in children and adolescents with Type 1 diabetes.

  L. A. Gonder-Frederick , K. A. Vajda , K. M. Schmidt , D. J. Cox , J. H. DeVries , O. Erol , K. Kanc , H. Schachinger and F. J. Snoek


The Hypoglycemia Fear Survey (HFS)-II Behaviour and Worry subscales were developed to measure behaviours and anxiety related to hypoglycaemia in diabetes. However, previous studies found lower reliability in the HFS Behaviour subscale and inconsistent relationships with glucose control. The purpose of this study was to conduct extensive analyses of the internal structure of the HFS Behaviour subscale's internal structure and its relationships with diabetes outcomes, including HbA1c and episodes of severe hypoglycaemia.


HFS-II survey data from 1460 adults with Type 1 diabetes were collected from five countries. This aggregated sample underwent exploratory factor analysis and item analysis to determine the internal structure of the survey and subscales.


A three-factor solution showed the best fit for the HFS, with two subscales emerging from the HFS Behaviour representing tendencies towards (1) maintenance of high blood glucose and (2) avoidance of hypoglycaemic risks by other behaviours, and a third single HFS Worry subscale. Subscale item analysis showed excellent fit, separation and good point-measure correlations. All subscales demonstrated acceptable (0.75) to excellent (0.94) internal reliability. HbA1c correlated with Maintain High Blood Glucose subscale scores, r = 0.14, P < 0.001, and severe hypoglycaemia frequency correlated with all subscales.


The HFS Worry subscale measures one construct of anxiety about various aspects of hypoglycaemia. In contrast, the HFS Behaviour subscale appears to measure two distinct aspects of behavioural avoidance to prevent hypoglycaemia, actions which maintain high blood glucose and other behaviours to avoid hypoglycaemic risk. These results demonstrate the clinical importance of the HFS Behaviour subscales and their differential relationships with measures of diabetes outcome such as HbA1c.

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