Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study

EDENT1FI Master Protocol for screening of presymptomatic early-stage type 1 diabetes in children and adolescents

INTRODUCTION

The identification of type 1 diabetes at an early presymptomatic stage has clinical benefits. These include a reduced risk of diabetic ketoacidosis (DKA) at the clinical manifestation of the disease and a significant reduction in clinical symptoms. The European action for the Diagnosis of Early Non-clinical Type 1 diabetes For disease Interception (EDENT1FI) represents a pioneering effort to advance early detection of type 1 diabetes through public health screening. With the EDENT1FI Master Protocol, the project aims to harmonise and standardise screening for early-stage type 1 diabetes and care.

METHODS AND ANALYSIS

Public health islet autoantibody screening is conducted in the Czech Republic, Denmark, Germany, Italy, Poland, Portugal, Sweden and the UK. Between November 2023 (start date) and October 2028 (planned end date), an estimated number of 200 000 children and adolescents aged 1-17 years are expected to be screened. Screening is performed in capillary blood, examining different islet autoantibodies (autoantibodies against insulin, glutamic acid decarboxylase-65, insulinoma-associated antigen-2 and/or zinc transporter-8). Positive screening results undergo confirmation through a second antibody method. A second (venous) blood sample is requested if at least two autoantibodies are detected, to confirm the autoantibody status. Children and adolescents with confirmed two or more autoantibodies are invited to metabolic staging (oral glucose tolerance test, haemoglobin A1c (HbA1c), random glucose, optionally continuous glucose monitoring); an educational programme and recommendations for monitoring are provided. The feasibility and acceptability of screening are evaluated by feedback questionnaires. Pseudonymised data is collated in the EDENT1FI Registry. Study outcomes include country-specific screening rates, prevalences of stage 1 and stage 2 type 1 diabetes, number in EDENT1FI Registry, proportion with DKA and symptoms at clinical diagnosis and median HbA1c.

ETHICS AND DISSEMINATION

Following the EDENT1FI Master Protocol, site-specific protocols are developed and approved by local ethics committees (Technical University of Munich, Medical Faculty, Nr. 70/14; Medizinische Hochschule Hannover, Nr. 9588_BO_S_2021; Technische Universität Dresden, Nr. BO-EK-356082020; Center for Sundhed Region Hovedstaden, Nr. H-22053116; Swedish Ethical Review Authority, Nr. 2023-00312-01; National Health Service Health Research Authority and Health Care Research Wales, IRAS (Integrated Research Application System) project ID 309252; Italian National Institute of Health, National ethics committee for clinical trials of public research bodies (EPR) and other national public institutions, Prot. PRE BIO CE Nr. 0059835; Charles University in Prague, Ethics Committee for Multi-Centric Clinical Trials of the University Hopital Motol and 2nd Faculty of Medicine, Nr. 1271/23; Bioethics Committee at the Medical University of Warsaw, Nr. 21/2024 and KB/6/R/2024; Associação Protectora dos Diabéticos de Portugal, Nr. 211/2024). Results are disseminated through peer-reviewed journals and conference presentations and will be shared openly.

The Use of MiniMed780G System Is Associated With Stable Glycemic Control in People With Type 1 Diabetes Before, During, and After Ramadan: An Observational Study

Aims: The study was aimed at assessing the role of the MiniMed780G system of glycemic control before, during, and after Ramadan among people with Type 1 diabetes (PwT1D). Methods: This is a single-center retrospective analysis of MiniMed780G system users aged 14 years and above whose glycemic profiles were collected from February 21 to May 20, 2023, which corresponds to the Hijri months of Sha'ban, Ramadan, and Shawwal 1444/1445. Data was collected, processed, and analyzed in the framework of the Medtronic Galaxy service of the One Hospital Clinical Service (OHCS) program in Dallah Hospital, Riyadh, Saudi Arabia. Data from 43 PwT1D (24 females, mean age 30 ± 11 years with 14 ± 8 years from diabetes onset) using the MiniMed780G system were collected. Results: Overall, the 3-month (Sha'ban, Ramadan, and Shawwal) mean sensor glucose (SG), time in range (TIR) (70-180 mg/dL), time below range (TBR) (54-69 mg/dL and < 54 mg/dL), time above range (TAR) (180-250 mg/dL and > 250 mg/dL), and glucose management indicator (GMI) showed no statistical differences within the three periods. No differences in insulin total daily dose have been detected, and no diabetic ketoacidosis (DKA) or severe hypoglycemia events occurred. Conclusion: The use of the MiniMed780G system is safe with favorable glycemic outcomes across nonfasting and fasting months.

Nationwide trends and incidence of blindness in patients with diabetic retinopathy identified using an age-period-cohort analysis

OBJECTIVES

To estimate the epidemiologic trends of blindness in patients with diabetic retinopathy (DR) and investigate the age-, period-, and cohort-specific effects on blindness.

METHODS

A total of 2.5 million patients with DR aged 20 years or older were included from the Korean National Health Claims database from 2005 to 2019. Non-proliferative DR/ proliferative DR (NPDR/PDR) cohorts were constructed separately. Participants were identified as having a blindness in at least one eye. The incidence of blindness were calculated using a log-linear Poisson age-period-cohort (APC) analysis model, each effect on blindness were estimated for each study group.

RESULTS

The incidence of blindness was 1326.62 per 100,000 in the NPDR group and 3397.57 in the PDR group. The blindness rate sharply decreased after 2011, with annual decreases of 5.6% and 4.4% in the NPDR and the PDR groups, respectively. People born between 1920 and 1930 had the highest overall risk of blindness, with the risk decreasing rapidly after that. For those born after 1980, the risk started to increase in both sexes. Among the APC models, the combination model of age, period, and cohort effects showed the highest explanatory power (0.96).

CONCLUSIONS

In this nationwide long-term study, blindness in DR was not due to a single epidemiologic cause but rather a combination of biological age, social determinants, and healthcare policies. The increased risk of blindness in individuals in their 20 s and 30 s may even increase in the future and should not be ignored. Therefore, vigilance of younger patients is recommended.

The Teachers' Knowledge of Type 1 Diabetes in Schools: An Interventional Study

BACKGROUND

Managing type 1 diabetes in school is a real challenge for teachers, parents, and students themselves. Involving school educators in providing care and support is becoming more of a necessity than a luxury to facilitate access to healthcare services in schools for children with type 1 diabetes.

OBJECTIVES

Our work aimed to assess the background knowledge of teachers on type 1 diabetes and evaluate the impact of an educational intervention in improving this knowledge.

METHODS

We included 346 participants working in elementary schools in Oujda City, Morocco. We collected data on anonymous data sheets. Then, a first pre-coded questionnaire was distributed to the participants to assess their background knowledge of type 1 diabetes. Afterward, a simplified educational session was delivered to them. Subsequently, the same pre-coded questionnaire was distributed for evaluation after education.

RESULTS

Around 84% of the participants recognized polyuria and polydipsia as major signs of diabetes. Only 35.3% of them knew the definition of hypoglycemia. Hyperglycemia was identified by 65% of the participants. About 40% believed children cannot exercise, while 55.5% thought taking free sugar before exercise was mandatory. We found a significant correlation between a good level of knowledge and knowing a person with diabetes (aOR=2.66, CI95%: 1.51- 4.70, p=0.001). There was a significant improvement in knowledge after the educational intervention (p=0.0001).

CONCLUSION

Our study showed a lack of information about type 1 diabetes among teachers. We also proved the effectiveness of targeted education in correcting misconceptions and encouraging awareness of type 1 diabetes.

Balancing life with type 1 diabetes mellitus: A qualitative study of jordanian adolescents

OBJECTIVES

To explore the lived experiences of Jordanian adolescents with type 1 diabetes mellitus (T1DM) and identify their specific needs.

METHODS

Qualitative interviews were conducted with 10 Jordanian adolescents. Thematic analysis was used to identify key themes.

RESULTS

Three main themes emerged: (1) Living with diabetes as a constant struggle, including emotional turbulence, social withdrawal, and difficulty with treatment regimens; (2) Restoring balance in life through social support, following treatment protocols, and accepting the disease; and (3) Adolescents' needs for a better environment, including improved knowledge, resources, and social integration.

CONCLUSIONS

Adolescents with T1DM face significant challenges, including emotional distress, social isolation, and difficulties managing their disease. This study provides valuable insights into their experiences and highlights the importance of comprehensive support.

PRACTICE IMPLICATIONS

To effectively support adolescents with T1DM, healthcare providers and educators should focus on providing emotional support, social support, and practical assistance. Additionally, improving knowledge and awareness about T1DM among adolescents and their families is crucial, as well as increasing access to resources that can help them manage their disease and live fulfilling lives.

Effect of fenofibrate on residual beta cell function in adults and adolescents with newly diagnosed type 1 diabetes: a randomised clinical trial

AIMS/HYPOTHESIS

Fenofibrate, a peroxisome proliferator-activated receptor alpha agonist, shows some promise in alleviating beta cell stress and preserving beta cell function in preclinical studies of type 1 diabetes. The aim of this phase 2, placebo-controlled, double-blinded, randomised clinical trial was to investigate the efficacy and safety of fenofibrate in adults and adolescents with newly diagnosed type 1 diabetes.

METHODS

We enrolled 58 individuals (aged 16 to 40 years old) with newly diagnosed type 1 diabetes and randomised them to daily oral treatment with fenofibrate 160 mg or placebo for 52 weeks (in a block design with a block size of 4, assigned in a 1:1 ratio). Our primary outcome was change in beta cell function after 52 weeks of treatment, assessed by AUC for C-peptide levels following a 2 h mixed-meal tolerance test. Secondary outcomes included glycaemic control (assessed by HbA1c and continuous glucose monitoring), daily insulin use, and proinsulin/C-peptide (PI/C) ratio as a marker of beta cell stress. We assessed outcome measures before and after 4, 12, 26 and 52 weeks of treatment. Blinding was maintained for participants, their healthcare providers and all staff involved in handling outcome samples and assessment.

RESULTS

The statistical analyses for the primary outcome included 56 participants (n=27 in the fenofibrate group, after two withdrawals, and n=29 in the placebo group). We found no significant differences between the groups in either 2 h C-peptide levels (mean difference of 0.08 nmol/l [95% CI -0.05, 0.23]), insulin use or glycaemic control after 52 weeks of treatment. On the contrary, the fenofibrate group showed a higher PI/C ratio at week 52 compared with placebo (mean difference of 0.024 [95% CI 0.000, 0.048], p<0.05). Blood lipidome analysis revealed that fenofibrate repressed pathways involved in sphingolipid metabolism and signalling at week 52 compared with placebo. The 52 week intervention evoked few adverse events and no serious adverse events. Follow-up in vitro experiments in human pancreatic islets demonstrated a stress-inducing effect of fenofibrate.

CONCLUSIONS/INTERPRETATION

Contrary to the beneficial effects of fenofibrate found in preclinical studies, this longitudinal, randomised, placebo-controlled trial does not support the use of fenofibrate for preserving beta cell function in individuals with newly diagnosed type 1 diabetes.

TRIAL REGISTRATION

EudraCT number: 2019-004434-41 FUNDING: This study was funded by the Sehested Hansens Foundation.

Unraveling the Therapeutic Potential of Muscle Strengthening Exercises for Reversing Diabetes Mellitus

BACKGROUND

Millions of people worldwide are affected by the serious consequences of diabetes mellitus, which is a major global health concern. We analyze the possibility of muscle- strengthening activities as an appropriate therapeutic strategy for controlling the progression of diabetes mellitus in this comprehensive review. In this review, we explore the molecular processes underlying the glucose uptake in skeletal muscle, revealing how exercise can improve insulin sensitivity and glucose homeostasis.

METHODOLOGY

Articles published between 2010 and 2023 were analyzed in detail by using bibliographic databases like PubMed, Medline, and Scopus. The most commonly searched terms were "muscle strengthening exercises," "diabetes mellitus," "insulin resistance," "glucose uptake," "skeletal muscle," and even "exercise therapy." The inclusion criteria were randomized controlled trials, observational studies, and systematic reviews. This allowed for the selection of sources that were related to the topic at hand and were reliable.

RESULTS

This review highlights the benefits of exercise for diabetes mellitus, elucidating the positive effects of acute and regular exercise on glucose uptake in skeletal muscle. It also analyzes the impact of various exercise modalities, including aerobic and resistance exercises, on glucose metabolism in individuals with and without type 2 diabetes. Furthermore, this review examines the effectiveness of combining aerobic and resistance training for optimal diabetes management.

CONCLUSION

Our analysis reveals promising evidence supporting the role of resistance training in diabetes mellitus reversal. Regular resistance exercise has been shown to improve glycemic control, insulin sensitivity, and muscle function in individuals with type 2 diabetes. Combining aerobic and resistance exercises appears to be more effective than single-mode training in managing blood glucose levels and enhancing overall metabolic health. However, potential contraindications for exercise in diabetes patients, along with barriers to implementing resistance training, warrant careful consideration.

Prevalence of cardiovascular risk factors according to Life's Essential 8 in children and adolescents during the COVID-19 pandemic: A systematic review and meta-analysis including 1 526 173 participants from 42 countries

INTRODUCTION

Cardiovascular health is a crucial aspect of overall health. The aim of this study was to estimate the prevalence of cardiovascular risk factors among children and adolescents during the COVID-19 pandemic based on the Life's Essential 8 domains.

METHODS

PubMed, Scopus and Web of Science were systematically searched until 24 February 2023. Studies had to meet the following criteria: (1) observational studies, (2) studies reporting proportion of selected risk factors, (3) studies involving children or adolescents, (4) studies that collected data during the COVID-19 pandemic and (5) studies with representative samples. The outcomes included were diet, physical activity, nicotine exposure, sleep health, obesity, dyslipidaemia, diabetes and elevated blood pressure.

RESULTS

Sixty-two studies with 1 526 173 participants from 42 countries were included. Of these, 41 studies were used in the meta-analyses. The overall pooled prevalence of risk factors in the behavioural domain was as follows: poor quality diet 26.69% (95% CI 0.00%-85.64%), inadequate physical activity 70.81% (95% CI 64.41%-76.83%), nicotine exposure 9.24% (95% CI 5.53%-13.77%) and sleep disorders 33.49% (95% CI 25.24%-42.28%). The overall pooled prevalence of risk factors in the health domain was as follows: obesity 16.21% (95% CI 12.71%-20.04%), dyslipidaemia 1.87% (95% CI 1.73%-2.01%), diabetes 1.17% (95% CI 0.83%-1.58%) and elevated blood pressure 11.87% (95% CI 0.26%-36.50%).

CONCLUSIONS

These results highlight the need for prevention strategies to maintain better cardiovascular health from an early age, particularly by increasing physical activity levels, sleep time and promoting the consumption of more fruits and vegetables.

Screening and care for preclinical stage 1-2 type 1 diabetes in first-degree relatives: French expert position statement

The natural history of type 1 diabetes (T1D) evolves from stage 1 (islet autoimmunity with normoglycemia; ICD-10 diagnostic code E10.A1) to stage 2 (autoimmunity with dysglycemia; E10.A2) and subsequent clinical stage 3 (overt hyperglycemia), which is commonly the first time of referral. Autoantibody testing can diagnose T1D at its preclinical stages 1-2 and lead to earlier initiation of care, particularly for first-degree relatives of people living with T1D, who are at higher genetic risk. Preclinical T1D screening and monitoring aims to avoid inaugural ketoacidosis and prolong preservation of endogenous insulin secretion, thereby improving glycemic control and reducing long-term morbidity. Moreover, early management can help coping with T1D and correct modifiable risk factors (obesity, sedentary lifestyle). New treatments currently under clinical deployment or trials also offer the possibility of delaying clinical progression. All these arguments lead to the proposition of a national screening and care pathway open to interested first-degree relatives. This pathway represents a new expertise to acquire for healthcare professionals. By adapting international consensus guidance to the French specificities, the proposed screening strategy involves testing for ≥ 2 autoantibodies (among IAA, anti-GAD, anti-IA-2) in relatives aged 2-45 years. Negative screening (∼95 % of cases) should be repeated every 4 years until the age of 12. A management workflow is proposed for relatives screening positive (∼5 % of cases), with immuno-metabolic monitoring by autoantibody testing, OGTT, glycemia and/or HbA1c of variable frequency, depending on T1D stage, age, patient preference and available resources, as well as the definition of expert centers for preclinical T1D.

Association between osteocalcin and residual β-cell function in children and adolescents newly diagnosed with type 1 diabetes: a pivotal study

PURPOSE

This pivotal study aimed to evaluate circulating levels of bone remodeling markers in children and adolescents at the onset of type 1 diabetes (T1D). Additionally, we assessed their correlation with glucose control, residual β-cell function, and the severity of presentation.

METHODS

In this single-center cross-sectional study, we recruited children and adolescents newly diagnosed with T1D at our tertiary-care Diabetes Centre. Anamnestic, anthropometric, clinical, and biochemical data at T1D diagnosis were collected. Basal and stimulated C-peptide levels were assessed, along with the following bone remodeling biomarkers: osteocalcin (OC), alkaline phosphatase (ALP), parathormone (PTH), 25-OH Vitamin D (25OH-D), and the C-terminal cross-linked telopeptide of type 1 collagen (CTX).

RESULTS

We enrolled 29 individuals newly diagnosed with T1D, with a slight male prevalence (51.7%). The mean age was 8.4 ± 3.7 years. A positive correlation between OC and stimulated C-peptide (R = 0.538; p = 0.026) and between PTH and serum HCO3- (R = 0.544; p = 0.025) was found. No other correlations between bone remodeling biomarkers and clinical variables were detected.

CONCLUSION

Our data showed a positive correlation between OC levels and residual β-cell function in children and adolescents at T1D presentation. Further longitudinal studies evaluating OC levels in pediatric subjects with T1D are needed to better understand the complex interaction between bone and glucose metabolisms.

2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Impaired Fibroblast Growth Factor 21 (FGF21) Associated with Visceral Adiposity Leads to Insulin Resistance: The Core Defect in Diabetes Mellitus

The Central nervous system (CNS) is the prime regulator of signaling pathways whose function includes regulation of food intake (consumption), energy expenditure, and other metabolic responses like glycolysis, gluconeogenesis, fatty acid oxidation, and thermogenesis that have been implicated in chronic inflammatory disorders. Type 2 diabetes mellitus (T2DM) and obesity are two metabolic disorders that are linked together and have become an epidemic worldwide, thus raising significant public health concerns. Fibroblast growth factor 21 (FGF21) is an endocrine hormone with pleiotropic metabolic effects that increase insulin sensitivity and energy expenditure by elevating thermogenesis in brown or beige adipocytes, thus reducing body weight and sugar intake. In contrast, during starvation conditions, FGF21 induces its expression in the liver to initiate glucose homeostasis. Insulin resistance is one of the main anomalies caused by impaired FGF21 signaling, which also causes abnormal regulation of other signaling pathways. Tumor necrosis factor alpha (TNF-α), the cytokine released by adipocytes and inflammatory cells in response to chronic inflammation, is regarded major factor that reduces the expression of FGF21 and modulates underlying insulin resistance that causes imbalanced glucose homeostasis. This review aims to shed light on the mechanisms underlying the development of insulin resistance in obese individuals as well as the fundamental flaw in type 2 diabetes, which is malfunctioning obese adipose tissue.

Relationships Among Stress, Diabetes Distress, and Biomarkers in Children with Type 1 Diabetes Mellitus from Diverse Income and Racial Backgrounds

INTRODUCTION

The purpose of this quantitative study was to consider factors that may negatively impact glycemic levels in Black and White children 8-12 years old with a diagnosis of type 1 diabetes mellitus.

METHOD

Perceived stress, diabetes distress, morning and afternoon salivary cortisol, inflammatory biomarkers, and hemoglobin A1c (HbA1c) were measured in this quantitative, cross-sectional phase of a larger, mixed methods study. Thirty-four children and their parents completed self-report surveys, and children provided blood and salivary samples, to examine effect sizes of relationships among variables of interest.

RESULTS

Most children did not meet ADA recommendations for HbA1c. HbA1c was higher in Black children. Medium-to-large effects were noted between perceived stress and HbA1c. Cortisol and IL-8 may mediate the relationship between perceived stress and HbA1c in children.

DISCUSSION

Understanding causes of elevated glycemic levels in children, especially from low-income and underrepresented populations, may help tailor diabetes management interventions to improve health outcomes.

Oxygenation and function of endocrine bioartificial pancreatic tissue constructs under flow for preclinical optimization

Islet transplantation and more recently stem cell-derived islets were shown to successfully re-establish glycemic control in people with type 1 diabetes under immunosuppression. These results were achieved through intraportal infusion which leads to early graft losses and limits the capacity to contain and retrieve implanted cells in case of adverse events. Extra-hepatic sites and encapsulation devices have been developed to address these challenges and potentially create an immunoprotective or immune-privileged environment. Many strategies have achieved reversal of hyperglycemia in diabetic rodents. So far, the results have been less promising when transitioning to humans and larger animal models due to challenges in oxygenation and insulin delivery. We propose a versatile in vitro perfusion system to culture and experimentally study the function of centimeter-scale tissues and devices for insulin-secreting cell delivery. The system accommodates various tissue geometries, experimental readouts, and oxygenation tensions reflective of potential transplantation sites. We highlight the system's applications by using case studies to explore three prominent bioartificial endocrine pancreas (BAP) configurations: (I) with internal flow, (II) with internal flow and microvascularized, and (III) without internal flow. Oxygen concentration profiles modeled computationally were analogous to viability gradients observed experimentally through live/dead endpoint measurements and in case I, time-lapse fluorescence imaging was used to monitor the viability of GFP-expressing cells in real time. Intervascular BAPs were cultured under flow for up to 3 days and BAPs without internal flow for up to 7 days, showing glucose-responsive insulin secretion quantified through at-line non-disruptive sampling. This system can complement other preclinical platforms to de-risk and optimize BAPs and other artificial tissue designs prior to clinical studies.

A qualitative exploration of the early adoption of an electronic medical record system for type 1 diabetes management in Rwanda

Background

Delivering adequate quality care remains a challenge in many low-and middle-income countries (LMICs), especially for people living with type 1 diabetes (T1D), requiring a complex treatment regimen. Digital health solutions, including electronic medical record (EMR) systems, have shown potential to improve delivery and quality of care but still require a successful implementation.

Objective

To analyze the adoption of a newly implemented EMR system in Rwanda from the perspectives of individuals with T1D, health care providers, and experts.

Study design

A qualitative study was conducted using the Diffusion of Innovation (DoI) theory to guide the focus of the analysis. A data triangulation strategy was used to gain multi-dimensional insights, involving in-depth interviews and participant observations with T1D individuals, EMR system users, and experts (with varying levels of acquaintance with the EMR system). Experiences of early adoption of the EMR system were explored through thematic analysis guided by the DoI theory.

Results

In general, all the participant groups had a positive attitude towards the EMR system, believed to increase the likelihood of a successful implementation. The system was described as user-friendly and improved workflows, data quality, and patient care. The main concerns to successful adoption were related to the maintenance and long-term sustainability of the system.

Conclusion

The EMR system showed great potential, was valued by users, and was positively believed to have potential to improve care and outcomes for patients. However, sustainability aspects must not be overlooked when assessing the adoption and use of an EMR system.

Treatment regimens and glycaemic outcomes in more than 100 000 children with type 1 diabetes (2013-22): a longitudinal analysis of data from paediatric diabetes registries

BACKGROUND

Advances in paediatric type 1 diabetes management and increased use of diabetes technology have led to improvements in glycaemia, reduced risk of severe hypoglycaemia, and improved quality of life. Since 1993, progressively lower HbA1c targets have been set. The aim of this study was to perform a longitudinal analysis of HbA1c, treatment regimens, and acute complications between 2013 and 2022 using data from eight national and one international paediatric diabetes registries.

METHODS

In this longitudinal analysis, we obtained data from the Australasian Diabetes Data Network, Czech National Childhood Diabetes Register, Danish Registry of Childhood and Adolescent Diabetes, Diabetes Prospective Follow-up Registry, Norwegian Childhood Diabetes Registry, England and Wales' National Paediatric Diabetes Audit, Swedish Childhood Diabetes Registry, T1D Exchange Quality Improvement Collaborative, and the SWEET initiative. All children (aged ≤18 years) with type 1 diabetes with a duration of longer than 3 months were included. Investigators compared data from 2013 to 2022; analyses performed on data were pre-defined and conducted separately by each respective registry. Data on demographics, HbA1c, treatment regimen, and event rates of diabetic ketoacidosis and severe hypoglycaemia were collected. ANOVA was performed to compare means between registries and years. Joinpoint regression analysis was used to study significant breakpoints in temporal trends.

FINDINGS

In 2022, data were available for 109 494 children from the national registries and 35 590 from SWEET. Between 2013 and 2022, the aggregated mean HbA1c decreased from 8·2% (95% CI 8·1-8·3%; 66·5 mmol/mol [65·2-67·7]) to 7·6% (7·5-7·7; 59·4mmol/mol [58·2-60·5]), and the proportion of participants who had achieved HbA1c targets of less than 7% (<53 mmol/mol) increased from 19·0% to 38·8% (p<0·0001). In 2013, the aggregate event rate of severe hypoglycaemia rate was 3·0 events per 100 person-years (95% CI 2·0-4·9) compared with 1·7 events per 100 person-years (1·0-2·7) in 2022. In 2013, the aggregate event rate of diabetic ketoacidosis was 3·1 events per 100 person-years (95% CI 2·0-4·8) compared with 2·2 events per 100 person-years (1·4-3·4) in 2022. The proportion of participants with insulin pump use increased from 42·9% (95% CI 40·4-45·5) in 2013 to 60·2% (95% CI 57·9-62·6) in 2022 (mean difference 17·3% [13·8-20·7]; p<0·0001), and the proportion of participants using continuous glucose monitoring (CGM) increased from 18·7% (95% CI 9·5-28·0) in 2016 to 81·7% (73·0-90·4) in 2022 (mean difference 63·0% [50·3-75·7]; p<0·0001).

INTERPRETATION

Between 2013 and 2022, glycaemic outcomes have improved, parallel to increased use of diabetes technology. Many children had HbA1c higher than the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2022 target. Reassuringly, despite targeting lower HbA1c, severe hypoglycaemia event rates are decreasing. Even for children with type 1 diabetes who have access to specialised diabetes care and diabetes technology, further advances in diabetes management are required to assist with achieving ISPAD glycaemic targets.

FUNDING

None.

TRANSLATIONS

For the Norwegian, German, Czech, Danish and Swedish translations of the abstract see Supplementary Materials section.

3D evaluation of the extracellular matrix of hypoxic pancreatic islets using light sheet fluorescence microscopy

Pancreatic islet transplantation is a promising treatment for type 1 diabetes, but the survival and function of transplanted islets are hindered by the loss of extracellular matrix (ECM) during islet isolation and by low oxygenation upon implantation. This study aimed to evaluate the impact of hypoxia on ECM using a cutting-edge imaging approach based on tissue clearing and 3D microscopy. Human and rat islets were cultured under normoxic (O2 21%) or hypoxic (O2 1%) conditions. Immunofluorescence staining targeting insulin, glucagon, CA9 (a hypoxia marker), ECM proteins (collagen 4, fibronectin, laminin), and E-cadherin (intercellular adhesion protein) was performed on fixed whole islets. The cleared islets were imaged using Light Sheet Fluorescence Microscopy (LSFM) and digitally analyzed. The volumetric analysis of target proteins did not show significant differences in abundance between the experimental groups. However, 3D projections revealed distinct morphological features that differentiated normoxic and hypoxic islets. Under normoxic conditions, ECM could be found throughout the islets. Hypoxic islets exhibited areas of scattered nuclei and central clusters of ECM proteins, indicating central necrosis. E-cadherin was absent in these areas. Our results, demonstrating a diminution of islets' functional mass in hypoxia, align with the functional decline observed in transplanted islets experiencing low oxygenation after grafting. This study provides a methodology combining tissue clearing, multiplex immunofluorescence, Light Sheet Fluorescence Microscopy, and digital image analysis to investigate pancreatic islet morphology. This 3D approach allowed us to highlight ECM organizational changes during hypoxia from a morphological perspective.

Macroencapsulation Device with Anti-inflammatory Membrane Modification Enhances Long-Term Viability and Function of Transplanted β Cells

Treating type 1 diabetes (T1D) through β-cell macroencapsulation is a promising long-term solution, but it faces challenges such as immune-mediated fibrosis on the capsule surface, which impairs cell functionality and compromises longevity and effectiveness. This study presents an approach for including an anti-inflammatory molecule on the macroencapsulation device (MED) using initiated chemical vapor deposition for the surface modification of poly(tetrafluoroethylene) (PTFE) membranes. The surface-modified MEDs significantly reduced fibrosis, improved β-cell viability and functionality, and promoted M2 macrophage polarization, which is associated with anti-inflammatory effects. This MED displayed improved glycemic control in a streptozotocin-induced diabetic mouse model for 45 days. The findings underscore the potential of surface-modified MEDs for improving T1D management by mitigating inflammation and enhancing the therapeutic efficacy of β-cell encapsulation.

"When I gave him the insulin injection, I felt the pain in my heart": Experiences of parents of young children with type 1 diabetes in an Arab country

Type 1 diabetes mellitus in children is one of the most common chronic health conditions, requiring constant monitoring and care. Living with children who are diagnosed with chronic illness affects multiple aspects of parents' daily lives, including the physical, mental, and social aspects. Due to their child's diabetes, parents may experience many special difficulties with their daily responsibilities. This study describes parental experiences caring for a child with type 1 diabetes. The study was based on semi-structured interviews with 10 parents caring for a child with type 1 diabetes. We analyzed the interviews using Colaizzi's strategy of descriptive phenomenological data analysis in nursing research. Participants were described a profoundly challenging situation, and they were in need of support to help them handle a challenging life situation, especially during the first years of a child's diagnosis. The following themes emerged from the data: adapting to the new reality after diagnosis, keeping up with the child's treatment regimen, psychological, social, and financial burdens, and staying tuned for complications.

Online diabetes self-management education application for reducing glycated hemoglobin level among patients with type 1 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

This meta-analysis study aims to evaluate the Diabetes Self-Management Education and Support (DSMES) online application for reducing glycated hemoglobin levels among patients with type 1 diabetes mellitus (T1DM) patients.

MAIN TEXT

The Web of Science (WoS), Cochrane Library, PubMed, Scopus, PROSPERO, and EMBASE databases were searched with Medical Subject Headings (MeSH) terms without minimum time limitation until February 2024. To be eligible, all the following predefined inclusion criteria must have been met in the original randomized controlled trial (RCT) studies without language limitation including T1DM, patients, online digital interventions such as web-based, mobile health applications, or e-health, 3 or more months follow-up, and measuring HbA1c. Finally, 10 studies were conducted, 1195 T1DM patients were included in this study of which 421 (35.2%) were adults and 774 (64.8%) were adolescents. Overall, the mean differences for HbA1c at 6 months between baseline and follow-up groups was 0.27% (-0.76, 1.31) (P < 0.001) in adultescents and 0.92% (0.34, 1.5) (P < 0.001) in adults. Moreover, the mean differences for HbA1c at 12 months between baseline and follow-up groups was - 0.02% (-0.31, 0.26) (P = 0.85) in adults.

CONCLUSIONS

Online DSME is effective in improving the glycemic control of adults and adultescents individuals with T1DM for reducing HbA1c while maintaining this important factor at an appropriate dose.

Young-Onset Diabetes in Sri Lanka: Experience From the Developing World

Background: Young-onset diabetes (YOD) is characterised by unique diagnostic and management challenges more pronounced in resource-limited settings like Sri Lanka. Aims: We aimed to ascertain the prevalence, patterns and characteristics of YOD in Sri Lanka and describe the state of care. Methods: Retrospective review of baseline data of all patients enrolled in the prospective multicentre Database for Young-Onset Diabetes, Sri Lanka (DYOD-SL), was performed, from April 2021 to April 2023. Results: A total of 2531 patient data were included from 28 centres island-wide. Females were 57.6%. The median age was 20 years (interquartile range (IQR) 17, 23), and the age at diagnosis was 15 years (IQR 12, 18). Type 1 diabetes (T1D) was the commonest (57.6%), followed by Type 2 diabetes (T2D) at 34.3%. Younger age at disease onset (p < 0.001), lower BMI (p < 0.001), and diabetic ketoacidosis (DKA) at presentation (p < 0.001) favoured T1D. In the total cohort, the median HbA1c was 9.8% (IQR 7.8, 12.1) with younger patients having poorer control (p = 0.001). Prevalence of nephropathy was 8.1%, retinopathy was 6.6%, neuropathy was 4.1%, moderate-high-risk diabetic foot disease was 1.9%, and macrovascular complications were 0.5%. Hypertension and dyslipidaemia occurred in 2.7% and 14%, respectively. Among patients > 18 years, overweight and obese were 22.2% and 10.4%. Corresponding prevalence in the 5-18-year age group was 20% and 14.7%. Among the insulin users (76%) in the total cohort, the majority (64.7%) were on premixed-based insulin regimens delivered by syringes. Self-monitoring of blood glucose (BG) was reported in 71.3% of the total population. None were on continuous/flash glucose monitoring or insulin pumps. Conclusion: T1D was the commonest subtype of YOD in this hospital-based population. However, T2D was notably higher and is of significant concern. Overall, suboptimal glycaemic control and high rate of complications were noted along with substandard insulin regimens and BG monitoring.

Intestinal glucagon-like peptide-1 in hypoglycemic counterregulation for type 1 diabetes management

Type 1 diabetes (T1D) is characterized by the autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency and the need for exogenous insulin. A significant concern in T1D management is hypoglycemia, which is worsened by impaired counterregulatory mechanisms. Effective counterregulation involves hormones such as glucagon and adrenaline, which work to restore normal blood glucose levels. However, in T1D, these mechanisms often fail, particularly after recurrent hypoglycemia, resulting in hypoglycemia-associated autonomic failure. Recent research indicates that elevated levels of intestinal glucagon-like peptide-1 (GLP-1) impair counterregulatory responses by reducing the secretion of glucagon and adrenaline. This editorial underscores GLP-1's role beyond its incretin effects, contributing to impaired hypoglycemic counterregulation. This understanding necessitates a nuanced approach to GLP-1-based therapies in T1D, balancing the benefits of glycemic control with potential risks. Future research should delve into the mechanisms behind GLP-1's effects and explore potential interventions to improve hypoglycemic counterregulation. The goal is to enhance the safety and quality of life for T1D patients.

Enhanced Metabolic Control in a Pediatric Population with Type 1 Diabetes Mellitus Using Hybrid Closed-Loop and Predictive Low-Glucose Suspend Insulin Pump Treatments

BACKGROUND

Insulin pumps coupled with continuous glucose monitoring sensors use algorithms to analyze real-time blood glucose levels. This allows for the suspension of insulin administration before hypoglycemic thresholds are reached or for adaptive tuning in hybrid closed-loop systems. This longitudinal retrospective study aims to analyze real-world glycemic outcomes in a pediatric population transitioning to such devices.

METHODS

We evaluated children with type 1 diabetes mellitus (T1D) admitted to the Pediatric Diabetes Department from a major University Hospital in Bucharest, Romania, who transitioned to hybrid closed-loop or predictive low-glucose suspend system from either non-automated insulin pumps or multiple daily injections. The primary outcome was assessing the change in glycated hemoglobin (HbA1c) after initiating these devices. Secondary outcomes analyzed changes in glucose metrics from the 90 days prior to the baseline and follow-up visit.

RESULTS

51 children were included (58.8% girls), the mean age was 10.3 ± 3.7 years, and the mean follow-up duration was 13.2 ± 4.5 months. The analyzed parameters, such as HbA1c (6.9 ± 0.7% vs. 6.7 ± 0.6%, p = 0.023), time in range (69.3 ± 11.2% vs. 76 ± 9.9%, p < 0.001), time in tight range (47.4 ± 10.9% vs. 53.7 ± 10.7%, p < 0.001), time below range (5.6 ± 2.9% vs. 3.5 ± 1.9%, p < 0.001), time above range (25 ± 11.2% vs. 20.4 ± 9.4%, p = 0.001), and coefficient of variation (37.9 ± 4.8% vs. 35.6 ± 4.6%, p = 0.001), showed significant improvements.

CONCLUSIONS

The application of these sensor-integrated insulin pumps can significantly enhance metabolic control in pediatric populations, minimizing glycemic variations to mitigate complications and enrich the quality of life.

The Extra-Islet Pancreas Supports Autoimmunity in Human Type 1 Diabetes

In autoimmune Type 1 diabetes (T1D), immune cells infiltrate and destroy the islets of Langerhans - islands of endocrine tissue dispersed throughout the pancreas. However, the contribution of cellular programs outside islets to insulitis is unclear. Here, using CO-Detection by indEXing (CODEX) tissue imaging and cadaveric pancreas samples, we simultaneously examine islet and extra-islet inflammation in human T1D. We identify four sub-states of inflamed islets characterized by the activation profiles of CD8 + T cells enriched in islets relative to the surrounding tissue. We further find that the extra-islet space of lobules with extensive islet-infiltration differs from the extra-islet space of less infiltrated areas within the same tissue section. Finally, we identify lymphoid structures away from islets enriched in CD45RA + T cells - a population also enriched in one of the inflamed islet sub-states. Together, these data help define the coordination between islets and the extra-islet pancreas in the pathogenesis of human T1D.

Incidence of type 1 diabetes in Gansu Province, Northwest China from 2018 to 2022: a multicenter, hospitalization-based study

OBJECTIVE

To survey the epidemiology of type 1 diabetes in all age groups living in the Gansu Province, China during 2018-2022.

METHODS

Using the data from the Gansu Province Health Commission Information Center and medical records, the crude incidence and 95%CI were calculated by region, age group, and sex assuming a Poisson distribution. The incidence differences were evaluated using the χ2 test. Spearman correlation was used to analyze the relation between latitude and incidence. The seasonality was analyzed using concentration, seasonal index and circular distribution method.

RESULTS

1393 cases of newly diagnosed type 1 diabetes were ascertained. The crude incidence of type 1 diabetes per 100,000 person-years in all individuals in Gansu Province was 1.09(95% confidence interval 1.03 to 1.15). The estimated incidence per 100,000 person-years by age group was 1.39 (95%CI:1.24-1.54) for 0-14 years, 3.58 (95%CI:3.33-3.83) for 15-29 years, 0.33(95%CI:0.29-0.37) for ≥ 30 years, with a peak in age group 15-19 years. There was a difference between males and females. Incidence of type 1 diabetes in Gansu Province was strongly correlated with latitude among children aged 0-29 years, and all age groups, but such correlation was not observed in adults aged ≥ 30 years. The seasonality of the type 1 diabetes is not obvious.

CONCLUSION

The incidence of type 1 diabetes was relatively lower from 2018 to 2022 in Gansu Province, with variations across different regions and a positive correlation with latitude observed in all age groups. The incidence peak was noted in the 15-19 years group, and the incidence among males was higher than in females in all age groups. There was no significant seasonal variation in the incidence of type 1 diabetes.

Characteristics of Children, Youth, and Young Adults With Diabetes: A Cross-Sectional Study in New Zealand Aotearoa

Background: The prevalence of diabetes mellitus among children, youth, and young adults is increasing, yet limited information is known about the characteristics and management of these groups with Type 1 (T1D) and Type 2 (T2D) diabetes in primary care. The aim of the study is to explore the characteristics of people with T1D and T2D aged < 25 years across the Auckland and Waikato regions of New Zealand. Methods: Sociodemographic and clinical data were collected from electronic primary care records (February 2021-July 2022) of four primary healthcare organisations, with medication data sourced from the National Pharmaceutical dataset. Associations between sociodemographic and clinical data were conducted using chi-square and nonparametric ANOVA. Results: Of 1198 patients, 72% had T1D and 28% had T2D. People with T1D were evenly distributed by gender but more commonly of European descent (66.7%) compared to other ethnic groups. A higher proportion of T2D was observed in females (58.2%) compared to males (41.6%) and among Māori (38.2% vs. 20.3% European; p < 0.001). Over 95% of individuals with T2D were overweight/obese. Overall, 9.5% and 23.9% of individuals with T1D and T2D, respectively, were at target for HbA1c, though median HbA1c was higher for Māori and Pasifika compared to other ethnicities (p < 0.001). In T1D, 94.7% of individuals were dispensed insulin and 7.5% and 4.4% were dispensed angiotensin-converting enzyme (ACE) inhibitors and statins, respectively. In T2D, medication use included metformin (84.9%), insulin (76.1%), and SGLT2i/GLP1RA (59.5%). Conclusions: The increasing burden of diabetes among young individuals in New Zealand underscores the urgent need for comprehensive strategies to address obesity and socioeconomic disparities, especially among marginalised communities. Addressing socioeconomic factors such as affordable housing, living wages, and healthcare access may be important for improving diabetes outcomes, as these factors significantly influence overall childhood health and well-being.

Painful Diabetic Neuropathy: Sex-Specific Mechanisms and Differences from Animal Models to Clinical Outcomes

Diabetes is a chronic and progressive disease associated with high blood glucose levels. Several co-morbidities arise from diabetes, the most common and severe one is diabetic neuropathy whose symptoms also include pain hypersensitivity. Currently, there are no effective therapies to counteract painful diabetic neuropathy or slow down the progression of the disease, and the underlying mechanisms are yet to be fully understood. Emerging data in recent decades have provided compelling evidence that the molecular and cellular mechanisms underlying chronic pain are different across the sexes. Interestingly, relevant differences have also been observed in the course and clinical presentation of painful diabetic neuropathy in humans. Here, we reviewed the current state of the art on sex differences in diabetic neuropathy, from animal models to clinical data. Comparing the output of both preclinical and clinical studies is necessary for properly orienting future choices in pain research, refining animal models, and interpreting clinical data. The identification of sex-specific mechanisms may help to develop more targeted therapies to counteract pain symptoms in diabetes.

Functional Modulation of Gut Microbiota and Blood Parameters in Diabetic Rats Following Dietary Intervention with Free or Immobilized Pediococcus acidilactici SK Cells on Pistachio Nuts

BACKGROUND/OBJECTIVES

The gut microbiota is linked to the pathogenesis of type 1 diabetes mellitus (T1DM), while supplementation with probiotics may result in positive alterations in the composition of the gut microbiome. This research aimed to map the changes in the gut microbiome and blood markers of streptozotocin-induced diabetic rats after a dietary intervention with free or immobilized cells of the presumptive probiotic Pediococcus acidilactici SK on pistachio nuts.

METHODS

Twenty-four male Wistar rats were studied and divided into four groups (healthy or diabetic) which received the free or the immobilized P. acidilactici SK cells on pistachio nuts for 4 weeks. Blood, fecal, and intestinal tissue samples were examined.

RESULTS

The diabetic rats exhibited an elevated concentration of HDL-c, while the inflammatory IL-1β levels were significantly lower in the diabetic animals that received the immobilized cells compared to the group that received the free cells. The dietary intervention with immobilized cells led to decreased counts of fecal staphylococci and enterococci in the diabetic animals, while the diet with both free and immobilized P. acidilactici SK cells rendered levels of these populations in normal values in the feces and intestinal tissue of the diabetic animals. Noticeably, the Lactobacillus and Bifidobacterium genera were elevated after the supplementation with immobilized P. acidilactici SK cells on pistachio nuts.

CONCLUSIONS

Dietary supplementation with P. acidilactici SK cells (in free or in immobilized form) beneficially affected the gut microbiota/microbiome of streptozotocin-induced diabetic rats, leading to the alleviation of dysbiosis and inflammation and control over their lipid levels.

Beta-Cell-Derived Extracellular Vesicles: Mediators of Intercellular Communication in the Islet Microenvironment in Type 1 Diabetes

Type 1 diabetes (T1D) is a chronic autoimmune disorder characterised by an autoimmune response specifically mounted against the insulin-producing beta cells. Within the islet, high cellular connectivity and extensive vascularisation facilitate intra-islet communication and direct crosstalk with the surrounding tissues and the immune system. During the development of T1D, cytokines and extracellular vesicles released by beta cells can contribute to the recruitment of immune cells, further amplifying autoimmunity and aggravating beta cell damage and dysfunction. In this review, we will evaluate the role of beta-cell-derived extracellular vesicles as mediators of the autoimmune response and discuss their potential for early diagnosis and new therapeutic strategies in T1D.

Green space quantity and exposure in relation to the risk of immune-mediated diseases: a scoping review

The growing global incidence of immune-mediated and inflammatory diseases (IMIDs) is worrisome, with evidence suggesting that environmental factors, notably urbanization and the reduction of green spaces, may act as potential instigators. However, conflicting findings in studies necessitate a closer examination of recent research (January 2020 - February 2024) to elucidate the factors contributing to these inconsistencies. This review explores study protocols to avoid erroneously endorsing the null hypothesis of no association between green space coverage and IMID risks. A literature search adhering to PRISMA-ScR guidelines yielded 46 relevant papers from Google Scolar and Pub Meb. The studies varied in design, with 17 being longitudinal, 24 cross-sectional, and five focusing on longitudinal parent-offspring connections. Geographic scope differed, with 21 multi-location and 25 single-location studies. Participant numbers ranged from 144 to 982,131 across diverse demographics. Additionally, some studies examined disease frequencies in large groups (several million people) residing in specific regions. Green space metrics encompassed NDVI, land cover data, plant biodiversity, and novel indexes, measured within 7.5-5000 m diameter buffers around residences or schools. The review advises against making definitive statements regarding the relationship between urban green spaces and the prevalence of IMIDs. It suggests that inconsistencies in study results may stem from variations in study designs and methodologies, as well as the complex, interacting mechanisms through which green spaces affect immune health. Future research recommendations include larger cohorts, early-life exposure data, and testing specific hypotheses related to vegetation types and participants' genetic predispositions.

Literature trends and hidden patterns in health literacy studies among individuals with type 1 diabetes: A scoping review protocol

The rising prevalence and incidence of Type 1 Diabetes (T1D) highlights its impact on quality of life, long-term health complications, and the economic burden it poses across socio-economic strata. Effective management of T1D demands robust self-care skills, which are significantly influenced by health literacy (HL) levels; studies have shown that lower HL is associated with poorer health outcomes. This scoping review protocol is designed to identify literature trends and hidden patterns in research assessing HL among individuals with T1D. The review will consider studies that address HL in individuals with T1D across all age groups and settings. Studies published in English or those with an available HTML version will be included to allow automatic translation of the contents for non-English records. Guided by the Joanna Briggs Institute (JBI) guidelines and the PRISMA-ScR 2020 framework, this scoping review will systematically search electronic databases, including PubMed, Scopus, CINAHL, EMBASE, Google Scholar, and Web of Science (WoS) without time restrictions. Two independent reviewers will assess each study for eligibility and perform data extraction using a standardized form.•The review aims to map out the existing research landscape on HL in T1D and highlight areas requiring further investigation.•It seeks to establish connections between HL and self-care efficacy in T1D, contributing to improved patient education and management strategies.•Findings will inform future research directions and potentially influence policy and clinical practices surrounding diabetes care management.

Evaluation of miRNA-146a, miRNA-34a, and pro-inflammatory cytokines as a potential early indicators for type 1 diabetes mellitus

Background

Type I diabetes mellitus (T1DM) is one of the most common chronic autoimmune diseases worldwide. miRNAs are a class of small non-coding RNA molecules that have been linked to immune system functions, β-cell metabolism, proliferation, and death, all of which contribute to pathogenesis of TIDM. Dysregulated miRNAs have been identified in Egyptian TIDM patients.

Aim

Several miRNAs were profiled in Egyptian TIDM patients to determine whether they can be used as molecular biomarkers for T1DM. The relationship between the investigated miRNAs and pro-inflammatory cytokines (TNF-α and IL-6) has also been evaluated in the development of TIDM, in addition to the creation of a proposed model for TIDM prediction.

Patients & methods

Case-control study included 177 Egyptian patients with confirmed type I diabetes mellitus and 177 healthy individuals. MiRNA-34 and miRNA-146 were detected in serum samples using real-time PCR, whereas TNF-α and IL-6 levels were assessed using ELIZA.

Results

Patients with TIDM showed a significant decrease in the expression of miRNA-146, with a cut-off value ≤ 3.3, 48 % specificity, and 92.1 % sensitivity, whereas miRNA-34 had the highest sensitivity (95.5 %) and specificity (97.2 %) for differentiating diabetic patients from controls. Furthermore, other diagnostic proinflammatory markers showed lower sensitivity and specificity.

Conclusion

Serum levels of miRNA-34a, miRNA-146, IL-6, and TNF-α provide new insights into T1DM pathogenesis and could be used for screening and diagnosis purposes. They can be also a potential therapeutic target, as well as allowing for more strategies to improve T1DM disease outcomes.

Efficacy and Safety of a Tubeless AID System Compared With Pump Therapy With CGM in the Treatment of Type 1 Diabetes in Adults With Suboptimal Glycemia: A Randomized, Parallel-Group Clinical Trial

OBJECTIVE

To examine the efficacy and safety of the tubeless Omnipod 5 automated insulin delivery (AID) system compared with pump therapy with a continuous glucose monitor (CGM) in adults with type 1 diabetes with suboptimal glycemic outcomes.

RESEARCH DESIGN AND METHODS

In this 13-week multicenter, parallel-group, randomized controlled trial performed in the U.S. and France, adults aged 18-70 years with type 1 diabetes and HbA1c 7-11% (53-97 mmol/mol) were randomly assigned (2:1) to intervention (tubeless AID) or control (pump therapy with CGM) following a 2-week standard therapy period. The primary outcome was a treatment group comparison of time in range (TIR) (70-180 mg/dL) during the trial period.

RESULTS

A total of 194 participants were randomized, with 132 assigned to the intervention and 62 to the control. TIR during the trial was 4.2h/day higher in the intervention compared with the control group (mean difference 17.5% [95% CI 14.0%, 21.1%]; P < 0.0001). The intervention group had a greater reduction in HbA1c from baseline compared with the control group (mean ± SD -1.24 ± 0.75% [-13.6 ± 8.2 mmol/mol] vs. -0.68 ± 0.93% [-7.4 ± 10.2 mmol/mol], respectively; P < 0.0001), accompanied by a significantly lower time <70 mg/dL (1.18 ± 0.86% vs. 1.75 ± 1.68%; P = 0.005) and >180 mg/dL (37.6 ± 11.4% vs. 54.5 ± 15.4%; P < 0.0001). All primary and secondary outcomes were met. No instances of diabetes-related ketoacidosis or severe hypoglycemia occurred in the intervention group.

CONCLUSIONS

Use of the tubeless AID system led to improved glycemic outcomes compared with pump therapy with CGM among adults with type 1 diabetes, underscoring the clinical benefit of AID and bolstering recommendations to establish AID systems as preferred therapy for this population.

An Evidence-Based Measure to Assess Self-Efficacy Among Adolescents With Type 1 Diabetes Mellitus in Jordan

PURPOSE

The purpose of the study was to assess self-efficacy among adolescents with type 1 diabetes mellitus and to identify its contributing factors using a new measure based on the International Society for Pediatric and Adolescent Diabetes Guidelines: the Type 1 Diabetes Mellitus Self-Efficacy Scale (T1DM-SES).

METHOD

A descriptive, cross-sectional design was used to collect data from 161 adolescents ages between 12 and 18 via an online questionnaire survey, including demographic and management-related variables and the 21 items of T1DM-SES.

RESULTS

Results demonstrated that adolescents had high self-efficacy levels regarding the basic needs to manage their diabetes and relatively moderate and low levels regarding more sophisticated needs, such as adjusting insulin dose to correct fluctuated glucose levels, covering carbohydrates, and managing ketoacidosis at home. Adolescent females and adolescents who have working mothers or caregivers demonstrated higher levels of self-efficacy, whereas adolescents who have another family member with T1DM reported lower levels.

CONCLUSION

Assessing adolescents' self-efficacy using evidence-based measures is crucial for informing health education plans. There should be a greater focus on acquiring the advanced knowledge and skills necessary for adolescents to manage the constantly evolving challenges of diabetes management. Access to health care and sufficient health insurance coverage that encompasses modern technology are fundamental for the effective management of T1DM.

Mortality attributable to diabetes in Cuba: Estimates for 2019

Objective

To estimate the national and provincial number of excess deaths due to diabetes across Cuba in 2019.

Study design

Cross-sectional design with secondary data.

Methods

We used DISMODII, a computerized generic disease model, to assess disease burden by modelling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, total mortality, and age- and sex-specific estimates for diabetes prevalence from the Cuban National Health Survey 2019, and available published estimates of the relative risk of death for people with diabetes compared to people without diabetes. The results were internally validated with DISMODII output for duration of diabetes (years).

Results

In 2019, we estimated an excess of mortality attributable to diabetes of 7.5 times the diabetes mortality reported by the National Death Registry, which is equivalent to 16.4 % of all deaths in Cuba. The percentages of all-cause mortality among provinces varied between 10.7 % in Villa Clara and 24.5 % in Ciego de Avila.

Conclusions

These are the first estimates of mortality attributable to diabetes in Cuba and its provinces. Diabetes is likely to be a much more prominent leading cause of death than the 9th ranking reported by the Cuban National Death Registry 2019. Disease models similar to DISMODII are important tools to validate the epidemiologic indicators used in the burden of disease calculations.

Increasing trend of childhood type 1 diabetes incidence: 20-year observation from Greater Poland Province, Poland

AIM

Type 1 diabetes is one of the fastest-growing chronic health conditions. Estimating the incidence rate of childhood type 1 diabetes will allow to aid in adequate planning of health care resources. The study's aim was to assess the incidence rate of type 1 diabetes in children below 15 years of age from Greater Poland (Poland) between 2006 and 2018, and then to compare obtained data to records collected between 1998 and 2003 in pediatric population aged 0-14 years from the same area.

METHODS

In this cohort study covering the period from January 1998 to December 2018, data were collected for children and adolescents below 14 years of age with newly diagnosed type 1 diabetes living in Greater Poland. The overall population size was taken from the Statistical Office of Poland. Total, sex-, and age-specific incidence rates per 100,000 person-years were calculated for each calendar year.

RESULTS

Over a 20-year period, the incidence rate of type 1 diabetes in children aged 0-14 years rose around 3.6-fold, from 8.4/100,000 in 1998 to 30.8/100,000 in 2018, with the peak incidence recorded in last year of the study. A clear male predominance of type 1 diabetes was seen in all ages. The rate of type 1 diabetes incidence growth was comparable between all age groups, while the highest incidence rate was mostly observed in children aged 5-9 and 10-14 years.

CONCLUSIONS

The incidence of type 1 diabetes in children aged 0-14 years is rapidly increasing in Greater Poland.

Using GeoMx DSP Spatial Proteomics to Investigate Immune Infiltration of NOD Mouse Islet and Exocrine Compartments

PURPOSE

Type 1 Diabetes (T1D) pathogenesis involves immune cells infiltrating pancreatic Islets of Langerhans, leading to T cell activation, beta cell destruction, and impaired insulin production. However, infiltration has a heterogenic nature that isn't described in detail, as not all islets are infiltrated. The aim of this study was to investigate if the observed heterogeneity is coupled to differences in immune and/or dysfunctional status of islets or exocrine cells, and if specific markers could elucidate mechanistic details of T1D pathogenesis.

PROCEDURES

The GeoMx platform was used to spatially quantify protein levels in pancreatic islets and exocrine tissue in Non-Obese Diabetic (NOD) mice. The protein panel included 17 immune activity markers and nine dysfunction markers. Immunohistochemical (IHC) staining and digital image analysis was used to analyze select marker proteins.

RESULTS

Use of the GeoMx platform to investigate T1D was shown to be possible, as Granzyme B protein levels were found to be lower in distal islet areas when compared to proximal areas. Smooth Muscle Actin protein levels were higher in exocrine areas proximal to immune-infiltrated islets, when compared to distally located exocrine areas. Findings from GeoMx were however not observed in IHC-stained sections.

CONCLUSIONS

This study demonstrates that investigating T1D is possible with spatial proteomics, as the assays revealed presence of heterogenic islet areas in NOD mice, which may play a role in T1D progression and escape from immune recognition. This study highlights the potential of spatial technologies for elucidating T1D pathogenesis and future treatment strategies.

Global and regional estimates of hip fracture burden associated with type 1 diabetes from 1990 to 2021

AIM

To assess the global and regional burden of hip fractures associated with type 1 diabetes (T1D) from 1990 to 2021.

MATERIALS AND METHODS

The population attributable fraction was calculated by combining the published risk ratio with T1D prevalence (age ≥ 20 years) from the Global Burden of Disease study to estimate the T1D-associated hip-fracture burden. Trends were assessed using the age-standardized incidence rate (ASIR) and estimated annual percentage change (EAPC).

RESULTS

The global incidence of T1D-related hip fractures was 290 180 in 2021 with an ASIR of 3.96 (95% confidence interval: 1.92-5.87) per 100 000 population and a male-to-female ratio of 0.54. At the super-regional level, the highest incidence (204 610) and ASIR (13.09 per 100 000 population; 6.40-25.53) were observed in high-income regions, in particular in Australasia and Western Europe. Notably, Australasia exhibited the highest EAPC, 2.90% in T1D-associated ASIR, followed by East Asia (2.73%). The incidence among those aged 45-64 years grew significantly in 14 regions over the past decade. Nationally, the ASIR increased in 166 countries from 1990 to 2021.

CONCLUSIONS

High-income regions experienced the greatest burden of T1D-associated hip fracture, while Australasia and East Asia witnessed the largest increase over the last 32 years. Prioritizing the promotion of T1D treatment and hip-fracture screening for middle-aged females living with T1D is crucial in these regions.

Utilisation of blood glucose test strips in insulin-requiring people with diabetes mellitus using continuous glucose monitoring in Saxony-Anhalt - Analysis of health insurance data

AIMS

Continuous glucose measurement (CGM) systems are increasingly utilised by people with diabetes mellitus (DM) and less is known about usage behaviour. Therefore, this study aims to analyse additionally utilisation of blood glucose measurement (BGM) for insurants who are using CGM.

METHODS

The study used secondary data, health claims data from the AOK Saxony-Anhalt (Germany), from 2016 to 2021, analysing a sample of 52,296 individuals with insulin-requiring DM.

RESULTS

Nearly all CGM users reduced their utilisation of BGM test strips. 2,306 persons with CGM long-time utilisation, about half showed a mean usage behaviour, nearly one third did not use test strips anymore, about 8 % stopped using CGM, 9 % were intense users. A high test strip utilisation beside CGM was associated with younger age, T1DM, a high number of test strip before starting CGM, no contact with a general practitioner, and no enrolment in a disease management program.

CONCLUSIONS

Great differences in reductions and usage behaviour was revealed between insurants. The results can be used to better identify and offer more tailored CGM to people with DM, and to better tailor CGM trainings.

Evidence of traditional Chinese medicine for treating type 2 diabetes mellitus: from molecular mechanisms to clinical efficacy

CONTEXT

The global prevalence of type 2 diabetes mellitus (T2DM) has increased significantly in recent decades. Despite numerous studies and systematic reviews, there is a gap in comprehensive and up-to-date evaluations in this rapidly evolving field.

OBJECTIVE

This review provides a comprehensive and current overview of the efficacy of Traditional Chinese Medicine (TCM) in treating T2DM.

METHODS

A systematic review was conducted using PubMed, Web of Science, Wanfang Data, CNKI, and Medline databases, with a search timeframe extending up to November 2023. The search strategy involved a combination of subject terms and free words in English, including 'Diabetes,' 'Traditional Chinese Medicine,' 'TCM,' 'Hypoglycemic Effect,' 'Clinical Trial,' and 'Randomized Controlled Trial.' The studies were rigorously screened by two investigators, with a third investigator reviewing and approving the final selection based on inclusion and exclusion criteria.

RESULTS

A total of 108 relevant papers were systematically reviewed. The findings suggest that TCMs not only demonstrate clinical efficacy comparable to existing Western medications in managing hypoglycemia but also offer fewer adverse effects and a multitarget therapeutic approach. Five main biological mechanisms through which TCM treats diabetes were identified: improving glucose transport and utilization, improving glycogen metabolism, promoting GLP-1 release, protecting pancreatic islets from damage, and improving intestinal flora.

CONCLUSIONS

TCM has demonstrated significant protective effects against diabetes and presents a viable option for the prevention and treatment of T2DM. These findings support the further exploration and integration of TCM into broader diabetes management strategies.

Controlling human stem cell-derived islet composition using magnetic sorting

Stem cell-derived islets (SC-islets) consists of multiple hormone-producing cell types and offer a promising therapeutic avenue for treating type 1 diabetes (T1D). Currently, the composition of cell types generated within these SC-islets currently cannot be controlled via soluble factors during this differentiation process and consist of off-target cell types. In this study, we devised a magnetic-activated cell sorting (MACS) protocol to enrich SC-islets for CD49a, a marker associated with functional insulin-producing β cells. SC-islets were generated from human pluripotent stem cells (hPSCs) using an adherent differentiation protocol and then sorted and aggregated into islet-like clusters to produce CD49a-enriched, CD49a-depleted, and unsorted SC-islets. Single-cell RNA sequencing (scRNA-seq) and immunostaining revealed that CD49a-enriched SC-islets had higher proportions of β cells and improved transcriptional identity compared to other cell types. Functional assays demonstrated that CD49a-enriched SC-islets exhibited enhanced glucose-stimulated insulin secretion both in vitro and in vivo following transplantation into diabetic mice. These findings suggest that CD49a-based sorting significantly improves β cell identity and the overall function of SC-islets, improving their effectiveness for T1D cell replacement therapies.

Automated insulin delivery systems in the treatment of diabetes: Benefits, challenges, and practical considerations in pediatric patients

At present, the majority of patients with type 1 diabetes mellitus do not achieve the recommended glycemic control goals to reduce the risk of acute and chronic complications. Hybrid closed-loop systems or automated insulin infusion systems emerged as an opportunity to improve metabolic control, quality of life and reduce the psychosocial impact of type 1 diabetes. This article analyzes the evidence regarding their effectiveness and safety, the challenges they pose and best practices to optimize results when implemented in clinical practice.

GHRH in diabetes and metabolism

Despite over a century of insulin therapy and recent advances in glucose monitoring, diabetes and its complications remain a significant burden. Current medications are not durable, with symptoms often returning after treatment ends, and responses vary between patients. Additionally, the effectiveness of many medications diminishes over time, highlighting the need for alternative approaches. Maintaining β-cell mass and promoting β-cell regeneration offer more curable treatments, while cell replacement therapies could be an option if regeneration is not feasible. For both strategies, enhancing β-cell survival is crucial. Growth hormone-releasing hormone (GHRH) was originally discovered for its ability to stimulate the production and release of growth hormone (GH) from the pituitary. Beyond the hypothalamus, GHRH is produced in peripheral tissues, with its receptor, GHRHR, expressed in tissues such as the pituitary, pancreas, adipose tissue, intestine, and liver. Several studies have shown that GHRH and its analogs enhance the survival of insulin-producing pancreatic β-cells both in vitro and in animal models. These beneficial effects strongly support the potential of GHRH agonists and antagonists for the clinical treatment of human metabolic diseases or for enhancing β-cell survival in cells used for transplantation. In the current review, we will discuss the roles of hypothalamic and extrahypothalamic GHRH in metabolism in physiological and pathological contexts, along with the underlying mechanisms. Furthermore, we will discuss the potential beneficial effects of GHRH analogs for the treatment of metabolic diseases.

Exploring homeostasis in children, the body's dynamic balancing act

Homeostasis can be described as the dynamic process within an organism designed to maintain a relatively constant internal environment that is conducive to the optimal functioning of cells, enzymes and organs. To regulate physiological variables, homeostasis relies on mechanisms called negative and positive feedback loops. However, certain factors can disrupt homeostatic processes, leading to dysregulation and disease. This article provides an overview of homeostasis, including negative and positive feedback loops and dysregulation. The authors use a fictional case study - an adolescent girl with type 1 diabetes who develops diabetic ketoacidosis - to illustrate the adverse effects of homeostatic dysregulation and demonstrate the relevance of understanding homeostasis in children's nursing.

Organic vs. inorganic nitrates: Metabolic and vascular outcomes in STZ-induced diabetes in mice

BACKGROUND

Diabetic animals often display dysregulated nitric oxide (NO) metabolism, contributing to vascular dysfunction. This study evaluates the metabolic and vascular effects of organic nitrate isosorbide mononitrate (ISMN) versus inorganic sodium nitrate (NaNO3) in mice with type 1 diabetes mellitus (T1DM) induced by streptozotocin (STZ).

EXPERIMENTAL APPROACH

T1DM was induced in male C57Bl6 mice with STZ ip and confirmed by fasting glucose. Mice were treated with ISMN (10 mg·kg-1) or NaNO3 (85 mg·L-1) for 14 days. A combination of in vivo, in vitro, and ex vivo studies assessed cardiometabolic benefits.

RESULTS

Both nitrates reduced blood and urinary hyperglycemia in T1DM mice, with ISMN exhibiting more significant reductions in blood glucose. ISMN and NaNO3 similarly reduced water and food intake, urinary volume, glucose intolerance, and insulin resistance while increasing insulin and nitrite levels in serum and urine. Both nitrates improved endothelium-independent vascular function and attenuated reactive oxygen species (ROS) while increasing NO levels in the aortic rings of T1DM mice. Furthermore, both nitrates similarly reduced mean arterial pressure in T1DM mice.

CONCLUSION AND IMPLICATIONS

ISMN and NaNO₃ have demonstrated comparable hypotensive and antioxidant effects, offering metabolic and vascular benefits in STZ-TDM1 mice. The more pronounced reduction in blood glucose with ISMN treatment compared to NaNO₃ is particularly promising. The antihyperglycemic effects of both nitrates were linked to increased serum insulin levels and enhanced insulin sensitivity. These results provide a foundation for future clinical studies to evaluate the potential of ISMN or NaNO3 as antidiabetogenic and antihypertensive adjuvant therapies in diabetic patients.

Adaptation of the Problem Areas in Diabetes-Teen Scale into Turkish and examination of its psychometric properties: a validity and reliability study

OBJECTIVE

Management of type 1 diabetes (T1DM) is quite challenging for both adolescents and their families. In this study, we aimed to translate the 14-item Problem Areas in Diabetes-Teen (PAID-T) scale, which measures variables that influence diabetes distress, to Turkish and investigate the Turkish version's reliability and validity.

METHODS

One hundred and ninety-four adolescents with T1DM participated in the study. PAID-T and forms for sociodemographic and diabetes characteristics were used for data collection. The scale's content validity was checked using the Davis technique. Cronbach's α was used to analyze the scale's internal reliability and the test-retest for the scale's reliability. Exploratory factor analysis (EFA) was utilized to examine the factor structure. The fit of the scale was assessed using confirmatory factor analysis (CFA).

RESULTS

Of the participants, 54.6% (n=106) were girls. The content validity index values of the scale items ranged between 0.86 and 1.0. The PAID-T scores of girls and boys were similar. No significant difference was found between PAID-T scores with sociodemographic data and diabetes characteristics (p>0.05). The test-retest correlation coefficient of the scale was found to be 0.952. The three-factor (emotional burden, family and friend distress, and regimen-specific distress) model identified in EFA explained 61.8% of the common variance. Fit analysis was performed using CFA for the three-factor model, which did not show adequate fit (x2/df = 2.402, GFI = 0.822, CFI = 0.815, NFI = 0.727, NNFI = 0.772, RMSEA = 0.118). The Cronbach α value of the scale was 0.864.

CONCLUSION

The Turkish version of the 14-item PAID-T showed moderate validity and strong reliability. Accordingly, it can be used as a reliable measurement tool to assess diabetes stress in adolescents with T1DM.

Small-molecule inhibitors of the CD40-CD40L costimulatory interaction are effective in pancreatic islet transplantation and prevention of type 1 diabetes models

As part of our work to develop small-molecule inhibitors (SMIs) of the CD40-CD40L(CD154) costimulatory protein-protein interaction, here, we describe the ability of two of our most promising SMIs, DRI-C21041 and DRI-C21095, to prolong the survival and function of islet allografts in two murine models of islet transplantation (under the kidney capsule and in the anterior chamber of the eye) and to prevent autoimmune type 1 diabetes (T1D) onset in NOD mice. In both transplant models, a significant portion of islet allografts (50%-80%) remained intact and functional long after terminating treatment, suggesting the possibility of inducing operational immune tolerance via inhibition of the CD40-CD40L axis. SMI-treated mice maintained the structural integrity and function of their islet allografts with concomitant reduction in immune cell infiltration as evidenced by direct longitudinal imaging in situ. Furthermore, in female NODs, three-month SMI treatment reduced the incidence of diabetes from 80% to 60% (DRI-C21041) and 25% (DRI-C21095). These results (i) demonstrate the susceptibility of this TNF superfamily protein-protein interaction to small-molecule inhibition, (ii) confirm the in vivo therapeutic potential of these SMIs of a critical immune checkpoint, and (iii) reaffirm the therapeutic promise of CD40-CD40L blockade in islet transplantation and T1D prevention. Thus, CD40L-targeting SMIs could ultimately lead to alternative immunomodulatory therapeutics for transplant recipients and prevention of autoimmune diseases that are safer, less immunogenic, more controllable (shorter half-lives), and more patient-friendly (i.e., suitable for oral administration, which makes them easier to administer) than corresponding antibody-based interventions.