Stuart J Brink | Tufts University School of Medicine (original) (raw)
Papers by Stuart J Brink
Sick day management in children and adolescents with diabetes
Diabetology, 2022
Before the discovery of insulin and the critical role of the pancreas vis-à-vis diabetes mellitus... more Before the discovery of insulin and the critical role of the pancreas vis-à-vis diabetes mellitus pathophysiology, childhood diabetes or what we now call type 1 or autoimmune diabetes mellitus was almost universally fatal. In limited-resource countries (LRC) around the world, this remains sadly true because of the expense and unavailability of medical care, medical information, and/or medications. In 1889, Minkowski and Mering identified the pancreas as the likely source of the problem in pancreatectomized dog experiments, and Langerhans, working with Virchow, identified the islands of pancreatic tissue now named after Langerhans as the likely source of the problem. Prior to that, Cawley, Boucherdat, Zuelzer, Gley, de Meyer, Schafer, Scott, Kleiner, and Paulescu all worked on this problem with varying results until Banting, Best, MacLeod, and Collip in Toronto in 1921 successfully treated pancreatectomized dogs with an alcohol-based pancreatic extract and then were the first to do t...
The Journal of pediatrics, Jan 4, 2016
Acta paediatrica (Oslo, Norway: 1992). Supplement
ABSTRACT
Canadian Journal of Diabetes, 2013
Acta Paediatrica, 2004
This article is a chapter in the ISPAD Clinical Practice Consensus Guidelines 2014 Compendium. Th... more This article is a chapter in the ISPAD Clinical Practice Consensus Guidelines 2014 Compendium. The complete set of guidelines can be found for free download at www.ispad.org. The evidence grading system used in the ISPAD Guidelines is the same as that used by the American Diabetes Association. See page 3 (the Introduction in Pediatric Diabetes 2014; 15 (Suppl. 20): 1-3). • Health care professionals have the responsibility to advise parents, other care providers, and young people on adjusting insulin therapy safely and effectively. This training requires regular review, reassessment, and reinforcement (E).
Practical Paediatric Endocrinology, 2013
Abstract Type 1 diabetes mellitus is the most common of all the pediatric and adolescent endocrin... more Abstract Type 1 diabetes mellitus is the most common of all the pediatric and adolescent endocrine disorders despite its overall relative rarity in the developing world where infectious diseases and malnutrition are rampant. Diabetes is often not even considered so death at diagnosis occurs in more than 90% of youngsters all too often. Diabetes symptoms can be subtle, masquerade or co-exist with HIV/AIDS and many other overwhelming infections such as (cerebral) malaria, gastroenteritis, parasitic infestation and sepsis. When health care professionals and even parents are aware of symptoms such as dehydration with concomitant enuresis or excess urination, or even simpler questions such as ants at the site of urination, then training to question the possibility of diabetes allows appropriate confirmation, insulin and fluid management and recognition of diabetic ketoacidosis. Once diagnosed, costs of insulin as well as blood glucose testing can be overwhelming but new initiatives by ISPAD working with pharmaceutical and medical industry initiatives as well as health ministries and private donations can raise awareness, offer education for health care workers, general physicians and pediatricians and drastically cut DKA rates. Earlier diagnosis means less morbidity and mortality and lower health care costs. Ongoing treatment strategies, group education and support for health profesionals as well as patients and their families all work together successfully to improve diabetes diagnosis and ongoing care incrementally as outlined in this chapter.
The DCCT established the basis for treatment of type 1 diabetes around the world. While there wer... more The DCCT established the basis for treatment of type 1 diabetes around the world. While there were many previous proponents of “strict ” or “tight ” control, there was no scientifically validated research studies to support these concepts and many scientific battles oc-curred between the two groups for many decades. The results of the DCCT were announced and published in 1993 (1) and 1994 (2) setting a standard for near-normalization of blood glucose as well as hemoglobin A1c and utilizing a multidisciplinary team approach (3), frequent blood glucose monitoring and patient-centered adjustments of food and insulin based upon blood glucose data generated by the patient (4). While there were no pre-teenagers recruited in the DCCT, the standard for youngsters with type 1 diabetes was also established with some modifications (5-7) to take into account the risks of hypoglycemia as well as the difficulties of dealing with growing chil-dren. DCCT follow-up studies (8) as well as Belgian (9)...
The Diabetes …, 2000
The Diabetes Educator Volume 26, Number 4 July/August 2000 Self-Reported Factors That Affect Gl... more The Diabetes Educator Volume 26, Number 4 July/August 2000 Self-Reported Factors That Affect Glycémie Control in College Students With Type 1 Diabetes Neesha Ramchandani, MA Jean M. Cantey-Kiser, PhD Craig A. Alter, MD Stuart J. Brink, MD Shelley D. Veager ...
Diabetic ketoacidosis (DKA) is one of the two acute emergency situations in those who have diabet... more Diabetic ketoacidosis (DKA) is one of the two acute emergency situations in those who have diabetes mellitus. DKA should be identifiable and is often preventable. Any associated complications of DKA should also be preventable with proper education and treatment. Awareness of presenting signs and symptoms, on the part of the general public, primary care providers and emergency department personnel, should help minimise the severity of DKA through earlier diagnosis and focusing on appropriate physiologic treatment as well as close, ongoing monitoring to minimise potential lethal DKA complications such as cerebral oedema. Missed diagnosis, late diagnosis, inappropriate treatment, delayed treatment and lack of appropriate monitoring are usually associated with more morbidity and mortality as well as increased hospital costs. Insulin treatment is only one part of DKA management. Fluid and electrolyte monitoring and treatment are often a critical aspect of such management. All aspects of ...
Acta bio-medica : Atenei Parmensis, 2004
Type 1 diabetes is one of the most frequent chronic diseases in childhood. As in other chronic di... more Type 1 diabetes is one of the most frequent chronic diseases in childhood. As in other chronic diseases (asthma, cystic fibrosis, rheumatoid arthritis, epilepsy) children and their families become the focus of self-treatment and the directors of their own care; thus, the health care team should be the guides who set the stage, provided advice and oversight and helped to re-focus efforts when goals were not being met all centered around the patient and family. Rather than the diabetes health care team being the only ones to initiate treatment, patient and parents have to be empowered to analyze their own data, identify patterns, problem solve with food and activity and do so based upon actual blood glucose results. Home record keeping and memory meters facilitate such analysis just as the algorithms currently in use attempt to mimic the basalbolus pattern of endogenous insulin secretion previously provided by a working pancreas. In the past, often disaster control was the modus opera...
Revue medicale de Bruxelles, 2010
"Monsieur Le Professor Harry Dorchy is r... more "Monsieur Le Professor Harry Dorchy is retiring". He has had a brilliant 40 year career since receiving his medical degree from the Free University of Brussels in 1969 and his PhD--entitled " Contribution a l'etude du diabète de l'enfant et de l'adolescent "--in 1981 from the same illustrious university. He had the great fortune to connect with his mentor, Professor Helmut Jean Loeb, and for many years, the two of them cared for young people with diabetes in Brussels and worked closely to establish a remarkable legacy of clinical care, research and innovative thinking about how young children in Belgium--in fact, around the world--, ought to be considered and treated. At the moment of his official retirement, he has an active patient census of 792 patients, 442 under the age of 18 years, at the Queen Fabiola University Children's Hospital in Brussels. As a member of the Hvidoere International Study Group on Childhood Diabetes, Dr Dorchy's patients have the great honor of being the most successful study cohort: those with the lowest (ie. best) levels of hemoglobin A1c. And they do so without excessive hypoglycemia! Dr Dorchy has had 490 publications as an author in his scientific career, 335 as first author. Dr Dorchy's research has complemented his superb work as a clinician : screening for subclinical complications, normal and flexible diet, physical activity, glycemic control and insulin treatment, quality of life, genetics and immunology, specific types of diabetes, etc. Since 1996, with his pediatric diabetologist comrade, Professor Stuart Brink from Boston, he has traveled annually to Romania to help organize, administer and teach at an annual ISPAD-Timisoara Pediatric and Adolescent Diabetes Post-Graduate Course with Professor Viorel Serban.
Sick day management in children and adolescents with diabetes
Diabetology, 2022
Before the discovery of insulin and the critical role of the pancreas vis-à-vis diabetes mellitus... more Before the discovery of insulin and the critical role of the pancreas vis-à-vis diabetes mellitus pathophysiology, childhood diabetes or what we now call type 1 or autoimmune diabetes mellitus was almost universally fatal. In limited-resource countries (LRC) around the world, this remains sadly true because of the expense and unavailability of medical care, medical information, and/or medications. In 1889, Minkowski and Mering identified the pancreas as the likely source of the problem in pancreatectomized dog experiments, and Langerhans, working with Virchow, identified the islands of pancreatic tissue now named after Langerhans as the likely source of the problem. Prior to that, Cawley, Boucherdat, Zuelzer, Gley, de Meyer, Schafer, Scott, Kleiner, and Paulescu all worked on this problem with varying results until Banting, Best, MacLeod, and Collip in Toronto in 1921 successfully treated pancreatectomized dogs with an alcohol-based pancreatic extract and then were the first to do t...
The Journal of pediatrics, Jan 4, 2016
Acta paediatrica (Oslo, Norway: 1992). Supplement
ABSTRACT
Canadian Journal of Diabetes, 2013
Acta Paediatrica, 2004
This article is a chapter in the ISPAD Clinical Practice Consensus Guidelines 2014 Compendium. Th... more This article is a chapter in the ISPAD Clinical Practice Consensus Guidelines 2014 Compendium. The complete set of guidelines can be found for free download at www.ispad.org. The evidence grading system used in the ISPAD Guidelines is the same as that used by the American Diabetes Association. See page 3 (the Introduction in Pediatric Diabetes 2014; 15 (Suppl. 20): 1-3). • Health care professionals have the responsibility to advise parents, other care providers, and young people on adjusting insulin therapy safely and effectively. This training requires regular review, reassessment, and reinforcement (E).
Practical Paediatric Endocrinology, 2013
Abstract Type 1 diabetes mellitus is the most common of all the pediatric and adolescent endocrin... more Abstract Type 1 diabetes mellitus is the most common of all the pediatric and adolescent endocrine disorders despite its overall relative rarity in the developing world where infectious diseases and malnutrition are rampant. Diabetes is often not even considered so death at diagnosis occurs in more than 90% of youngsters all too often. Diabetes symptoms can be subtle, masquerade or co-exist with HIV/AIDS and many other overwhelming infections such as (cerebral) malaria, gastroenteritis, parasitic infestation and sepsis. When health care professionals and even parents are aware of symptoms such as dehydration with concomitant enuresis or excess urination, or even simpler questions such as ants at the site of urination, then training to question the possibility of diabetes allows appropriate confirmation, insulin and fluid management and recognition of diabetic ketoacidosis. Once diagnosed, costs of insulin as well as blood glucose testing can be overwhelming but new initiatives by ISPAD working with pharmaceutical and medical industry initiatives as well as health ministries and private donations can raise awareness, offer education for health care workers, general physicians and pediatricians and drastically cut DKA rates. Earlier diagnosis means less morbidity and mortality and lower health care costs. Ongoing treatment strategies, group education and support for health profesionals as well as patients and their families all work together successfully to improve diabetes diagnosis and ongoing care incrementally as outlined in this chapter.
The DCCT established the basis for treatment of type 1 diabetes around the world. While there wer... more The DCCT established the basis for treatment of type 1 diabetes around the world. While there were many previous proponents of “strict ” or “tight ” control, there was no scientifically validated research studies to support these concepts and many scientific battles oc-curred between the two groups for many decades. The results of the DCCT were announced and published in 1993 (1) and 1994 (2) setting a standard for near-normalization of blood glucose as well as hemoglobin A1c and utilizing a multidisciplinary team approach (3), frequent blood glucose monitoring and patient-centered adjustments of food and insulin based upon blood glucose data generated by the patient (4). While there were no pre-teenagers recruited in the DCCT, the standard for youngsters with type 1 diabetes was also established with some modifications (5-7) to take into account the risks of hypoglycemia as well as the difficulties of dealing with growing chil-dren. DCCT follow-up studies (8) as well as Belgian (9)...
The Diabetes …, 2000
The Diabetes Educator Volume 26, Number 4 July/August 2000 Self-Reported Factors That Affect Gl... more The Diabetes Educator Volume 26, Number 4 July/August 2000 Self-Reported Factors That Affect Glycémie Control in College Students With Type 1 Diabetes Neesha Ramchandani, MA Jean M. Cantey-Kiser, PhD Craig A. Alter, MD Stuart J. Brink, MD Shelley D. Veager ...
Diabetic ketoacidosis (DKA) is one of the two acute emergency situations in those who have diabet... more Diabetic ketoacidosis (DKA) is one of the two acute emergency situations in those who have diabetes mellitus. DKA should be identifiable and is often preventable. Any associated complications of DKA should also be preventable with proper education and treatment. Awareness of presenting signs and symptoms, on the part of the general public, primary care providers and emergency department personnel, should help minimise the severity of DKA through earlier diagnosis and focusing on appropriate physiologic treatment as well as close, ongoing monitoring to minimise potential lethal DKA complications such as cerebral oedema. Missed diagnosis, late diagnosis, inappropriate treatment, delayed treatment and lack of appropriate monitoring are usually associated with more morbidity and mortality as well as increased hospital costs. Insulin treatment is only one part of DKA management. Fluid and electrolyte monitoring and treatment are often a critical aspect of such management. All aspects of ...
Acta bio-medica : Atenei Parmensis, 2004
Type 1 diabetes is one of the most frequent chronic diseases in childhood. As in other chronic di... more Type 1 diabetes is one of the most frequent chronic diseases in childhood. As in other chronic diseases (asthma, cystic fibrosis, rheumatoid arthritis, epilepsy) children and their families become the focus of self-treatment and the directors of their own care; thus, the health care team should be the guides who set the stage, provided advice and oversight and helped to re-focus efforts when goals were not being met all centered around the patient and family. Rather than the diabetes health care team being the only ones to initiate treatment, patient and parents have to be empowered to analyze their own data, identify patterns, problem solve with food and activity and do so based upon actual blood glucose results. Home record keeping and memory meters facilitate such analysis just as the algorithms currently in use attempt to mimic the basalbolus pattern of endogenous insulin secretion previously provided by a working pancreas. In the past, often disaster control was the modus opera...
Revue medicale de Bruxelles, 2010
"Monsieur Le Professor Harry Dorchy is r... more "Monsieur Le Professor Harry Dorchy is retiring". He has had a brilliant 40 year career since receiving his medical degree from the Free University of Brussels in 1969 and his PhD--entitled " Contribution a l'etude du diabète de l'enfant et de l'adolescent "--in 1981 from the same illustrious university. He had the great fortune to connect with his mentor, Professor Helmut Jean Loeb, and for many years, the two of them cared for young people with diabetes in Brussels and worked closely to establish a remarkable legacy of clinical care, research and innovative thinking about how young children in Belgium--in fact, around the world--, ought to be considered and treated. At the moment of his official retirement, he has an active patient census of 792 patients, 442 under the age of 18 years, at the Queen Fabiola University Children's Hospital in Brussels. As a member of the Hvidoere International Study Group on Childhood Diabetes, Dr Dorchy's patients have the great honor of being the most successful study cohort: those with the lowest (ie. best) levels of hemoglobin A1c. And they do so without excessive hypoglycemia! Dr Dorchy has had 490 publications as an author in his scientific career, 335 as first author. Dr Dorchy's research has complemented his superb work as a clinician : screening for subclinical complications, normal and flexible diet, physical activity, glycemic control and insulin treatment, quality of life, genetics and immunology, specific types of diabetes, etc. Since 1996, with his pediatric diabetologist comrade, Professor Stuart Brink from Boston, he has traveled annually to Romania to help organize, administer and teach at an annual ISPAD-Timisoara Pediatric and Adolescent Diabetes Post-Graduate Course with Professor Viorel Serban.